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Biomedical subjects

E Voth

Publications and source records attributed to E Voth.

89 records · Page 5Linked to original sources
PubMed1989

[Excimer laser coronary angioplasty in high-grade stenoses and chronic occlusion].

Excimer-laser-angioplasty offers the advantage of minimal thermal injury to adjacent tissue compared to other laser ablation techniques. Highly flexible glass-fiber-catheter systems are now available, and are capable of transmitting sufficient energy densities to ablate even calcified atherosclerotic coronary plaques. We report initial results of excimer-laser-ablation of severe coronary stenoses and occlusions in 17 patients. An excimer-laser (308 nm) with a pulse duration of 50 ns and a repetition rate of 10 to 40 Hz served as laser source. Eight patients had a chronic total occlusion (RCA, n = 4, RCx, n = 3, LAD, n = 1), nine patients had 90% to 95% stenoses (LAD, n = 7, RCA, n = 2). In all cases a laser-catheter consisting of 17 circumferentially orientated 100 microns glass-fibers and a central 15/1000-inch lumen could be advanced to the stenoses/occlusion over a guidewire that had been passed across the stenoses/occlusion. Stenoses diameter could be reduced by 41.5 +/- 10.1% in all patients and vessel lumen was further increased by subsequent balloon dilatation in 10 cases. After 24 h, 16 vessels were patent and showed no restenoses; one recanalized RCA was found reoccluded. We observed no complications, such as perforation, spasm, or thrombi.

Aged↗
PubMed1989

[Does the stomach balloon modify the function of the esophagus and lower esophageal sphincter, stomach emptying and release of gastrointestinal peptides?].

The Willmen gastric bubble has been used as an adjunct to weight loss in morbidly obese patients. 35 patients with morbid obesity were studied with routine manometry, esophageal 24-h-pH-measurement, and gastric emptying studies before and 4 weeks after bubble placement. During emptying studies blood samples were taken to measure gastrin, PP, CCK, VIP, neurotensin and insulin. No patient developed heartburn or regurgitation after bubble placement. Esophageal motility and LES function remained unchanged. There was no important pathological gastroesophageal reflux before and after gastric bubble. The gastric emptying time of solid food was unchanged by gastric bubble placement and the emptying time of liquids was accelerated up to normal. In patients with fasting gastrin levels less than 20 pg/ml at the beginning of the first test we found no differences in gastrin release before and after bubble insertion. In patients with primary high fasting values gastrin release was significantly increased. CCK, VIP, neurotensin and insulin levels were unchanged. With PP we measured significantly raised fasting levels after gastric bubble. We conclude that esophageal and LES functions are not altered by Willmen gastric bubble placement and that primary retardation of fluids is changed to normal. Bubble induced gastric tension increases fasting PP. In case of high fasting gastrin the bubble leads to an extremely high food response without any clinical signs.

Adult↗
PubMed1989

[Long-term results following conservative and surgical treatment of infantile hypertrophic pyloric stenosis].

UNLABELLED: From 1960 to 1970, 314 children (male:female = 3.9:1) were treated in our hospital for infantile hypertrophic pyloric stenosis (IHPS) (group 1 operatively: n = 216; group 2 conservatively: n = 98). The aim of the present study was to evaluate whether patients with IHPS do frequently have complaints in the upper gastrointestinal tract at long term. RESULTS: 1. Using the patients' files, a retrospective analysis of the familiar predisposition, symptoms, course of treatment and duration of ward treatment was made. Mortality due to operation was 0%, the postoperative rate of complications was low. 2. 17-27 years after treatment, the patients were questioned as to their subsequent health. 175 returned questionnaires able to be evaluated. According to these, only few of these patients had the symptoms of delayed gastric emptying (frequent vomiting, nausea). The velocity of gastric emptying has been measured for 53 patients for both solids and fluids (2.2 MBq 99mTc Sn colloid in a standard solid meal or in 300 ml of apple juice). There was no significant difference between the two groups, and the results were comparable to normal controls. CONCLUSION: Surgical therapy is superior to the conservative one, since the patient feels better sooner, complications are seldom and correspond with the long-term results of conservative therapy.

Adolescent↗
PubMed1988

Heparin therapy, deep-vein thrombosis and pulmonary embolism after intracerebral hemorrhage.

A prospective randomized pilot study of subcutaneous low-dose heparin in the prevention of deep-vein thrombosis and pulmonary embolism was carried out in patients admitted to hospital after intracerebral hemorrhage. A high incidence of deep-vein thrombosis and lung embolism was detected by phleboscintigraphy and lung perfusion scintigraphy, respectively. There was no significant reduction of deep-vein thrombosis and pulmonary embolism in the therapy group. Heparin did not increase the risk of rebleeding.

Cerebral Hemorrhage↗
PubMed1988

Significance of gated equilibrium radionuclide ventriculography in quantification and follow up of valvular regurgitation.

In order to evaluate the significance of gated equilibrium radionuclide ventriculography (RNV) for non invasive quantification of valvular regurgitation and follow up, various approaches were tested concerning accuracy and reproducibility. By using in vitro labeling of red blood cells and extending the acquisition time, a clear reduction of dispersion was obtained in patients without valvular insufficiency. Quantification of regurgitation directly from functional images (ventricular amplitude or stroke volume image) was clearly superior compared to the variable region of interest method. Employing functional images, reproducibility between two observers and between two independent measurements was excellent. Correlation to regurgitation values determined by cardiac catheterization was only moderate with all RNV approaches tested. RNV is limited in the absolute quantification of valvular regurgitation due to the variable overlap of right atrium and right ventricle. However, because of its high reproducibility, RNV is a non invasive technique suitable for intraindividual follow up of patients with valvular insufficiency.

Adult↗
PubMed1988

Asymptomatic myocardial abscess.

This report describes a rare case of an asymptomatic myocardial abscess which was not associated with infective endocarditis but was diagnosed to be a tumor and treated by open-heart surgery. A 69-year-old patient without a history of endocarditis or myocardial infarction was submitted to invasive cardiac diagnostics after an embolic event in the brachial artery. Investigation revealed an "intracardiac tumor" and the patient subsequently underwent open-heart surgery. After cardiotomy the suggested tumor was found in the posterior wall of the left atrium adjacent to the mitral ring, appearing as a circumscribed, indurated, and plane area. After incision for biopsy, a cheesy pus emptied from a cavity. The tissue sections showed an intramural myocardial abscess. Because of the extent, location and the character of the abscess, the cavity was closed after rinsing using mattress sutures. The postoperative course was uncomplicated. This report demonstrates that in suspected cardiac tumors a myocardial abscess should be considered in any differential diagnosis despite the rarity of the event, since the diagnosis of the myocardial abscess is not an absolute indication for surgical intervention.

Abscess↗
PubMed1988

[Is the plasma ANP level an index of volume expansion in dialysis patients?].

Fluid overload is a frequent complication in anuric patients undergoing hemodialysis (HD) or hemofiltration (HF). Elevated ANP plasma concentrations are associated with overhydration or congestive heart failure (CHF). After intensive ultrafiltration in 18 HD patients with high ANP levels at the end of HD, ANP values normalized (28 +/- 4 fmol/ml) in 11 patients (group A), suggesting previous volume overload, whereas ANP remained elevated (126 +/- 31 fmol/ml) in seven patients (group B). Left ventricular ejection fraction by radionuclide ventriculography (LVEF) was significantly (p less than 0.01) lower in group B (41 +/- 7%) as compared to normal values in group A (67 +/- 8%). M-mode echocardiography demonstrated left atrial enlargement (53 +/- 3 mm) and pathologic enddiastolic left ventricular diameters (58 +/- 4 mm) in group B, compared to normal dimensions of left atrial (43 +/- 1 mm) and left ventricular enddiastolic diameters (47 +/- 4 mm) in group A. Persisting high ANP concentrations after intensive ultrafiltration in HD patients indicate CHF and require further diagnostic evaluation.

Atrial Natriuretic Factor↗
PubMed1988

[An iterative strategy for determining the source distribution in single photon tomography using a rotating gamma camera (SPECT)].

A new iterative strategy for determination of the source distribution in single-photon emission tomography (SPECT) simulates mathematically the scintigraphic imaging process during direction sum computation. Limited spatial resolution and gamma-ray attenuation are taken into account using simplifying approximations. Highly resolved low-noise tomograms without obvious artifacts are obtained. Results of phantom measurements as well as cases of thyroid and brain perfusion imaging are presented to demonstrate the capabilities of the method.

Cerebrovascular Disorders↗
PubMed1987

Evaluation of three methods for quantifying valvular regurgitation using gated equilibrium radionuclide ventriculography.

The non-invasive quantification of mitral and aortic regurgitation using the left-to-right stroke count ratio (SCR) calculated with gated equilibrium radionuclide ventriculography (RNV), is affected by the overlap of atria and ventricles and the consequent difficult definition of the ventricular regions of interest (ROI). Various solutions of the problem have been proposed. In this study we evaluated the results obtained with a technique based on visual inspection of the RNV images (variable ROI method--VRI) and those of two approaches which utilize functional images (stroke volume image method--SVI--and Fourier amplitude ratio--FAR), by comparing them with the invasive quantification of valvular regurgitation according to Sandler et al. (stroke volume ratio--SVR). Forty patients (15 controls and 25 valvular patients) were studied. In the control group the range of the SVR was 0.81 +/- 1.11 (mean +/- 1 SD = 1.01 +/- 0.08). The SCR was 0.83-L28 (1.03 +/- 0.15) with VRI, 1.10-1.15 (1.30 +/- 0.14) with SVI and 1.11-1.58 (1.35 +/- 0.17) with FAR. The correlations between SVR and SCR were r = 0.47 (P less than 0.05), r = 0.62 (P less than 0.001) and r = 0.55 (P less than 0.01) respectively with VRI, SVI and FAR. The SCR of valvular patients fell in the range of controls in 11/25 using VRI, 6/25 using SVI and in 4/25 using FAR. This overlap was present in 2/25 with the invasive quantification. Irrespective of the method used, a reliable assessment of the valvular regurgitation was not possible in two patients with severely depressed left ventricular function. We conclude that the use of techniques based on functional images clearly improves the effectiveness of the non-invasive quantification of valvular regurgitation with the SCR even if this cannot be regarded as a substitute for invasive quantification and has a limited reliability in particular groups of patients.

Adult↗
PubMed1987

[Right ventricular stroke volume--comparison of various methods of angiography and equilibrium radionuclide ventriculography].

In 21 patients with various heart diseases RVEF was measured angiographically and by radionuclide ventriculography. Using biplane angiocardiography evaluation was performed by 7 different methods (Simpson's rule, Dogde, Arcilla, Ferlinz, Duebel). Using equilibrium RNV, evaluation was performed by 9 modifications of analysis. Problems were evident to separate the right atrium from the ventricle and to define the site of the pulmonary valve. The results show that when using the various methods of angiography considerable variations of the absolute volumes occur, but least so with RVEF. When using RNV with one single enddiastolic ROI, the RVEF was much too low. By means of the enddiastolic/endsystolic Double-ROI-method a good agreement with angiography was found, with correlation coefficients up to r = 0.85. There was only a minor effect of background correction.

Adult↗
PubMed1987

Fatty acid metabolism in symptomatic patients with mitral valve prolapse but without coronary artery disease--comparison with 201Tl myocardial perfusion scintigraphy.

Using 123I-omega-heptadecanoic acid (HDA) and 201Tl, respectively, myocardial fatty acid metabolism and perfusion were studied in 51 symptomatic patients with mitral valve prolapse (MVP) as diagnosed by ventriculography, and no evidence of coronary artery disease. Twelve subjects with normal coronary arteries and normal ventriculogram served as a control group for the evaluation of elimination kinetics of HDA. In the control group, the mean elimination half-life was 26.1 +/- 3.6 min, whereas the patients with MVP had a mean value of 25.0 +/- 6.4 min. In patients with MVP, a high incidence concerning abnormalities of accumulation and/or elimination of HDA occurred, namely accumulation defects in 31% and both prolonged and shortened elimination half-lives in 16% and 29%, respectively. Myocardial perfusion scintigraphy using 201Tl showed abnormalities in 76%. Correlations were found between decreased uptake of HDA and prolonged elimination half-life as well as defects by 201Tl, presumably due to ischemia based on small-vessel disease or abnormalities of cellular metabolism.

Adult↗
PubMed1986

[Cementless implantation of Zweymueller-Endler total endoprosthesis of the hip. Clinical, radiologic and scintigraphic follow-up of 2 years].

Sixty-four patients with cementless Zweymueller-Endler total endoprostheses of the hip underwent follow-up postoperatively for 2 years. In 3 patients loosening or infection occurred. In 61 patients no complications were observed. However, in 74% of these patients increasing activity uptake at the tip of the shaft was found by scintigraphy. This was associated with hypertrophy of the corticalis and/or with a marrow cavity reaction, observed radiologically. The results show that scintigraphic evaluation of cementlessly implanted Zweymueller-Endler endoprostheses of the hip must be interpreted differently compared to isoelastic or to cemented prostheses.

Adult↗
PubMed1985

Mitral valve prolapse in the ventriculogram: scintigraphic, electrocardiographic, and hemodynamic abnormalities.

Patients with mitral valve prolapse (MVP) frequently have chest pain, which may be difficult to differentiate from angina pectoris in coronary artery disease (CAD). We performed resting and exercise ECGs, pulmonary arterial pressure measurements, radionuclide ventriculography (99mtechnetium), and perfusion scintigrams (201thallium) in 56 patients with angiographically proven MVP and no CAD. Pathological results were obtained in 31% of exercise ECGs, 33% of pulmonary arterial pressure measurements during exercise, 22% of radionuclide ventriculographies, and in 75% of thallium perfusion scintigrams. A significant correlation in pathological results was found only between exercise ECG and both radionuclide ventriculography and pulmonary arterial pressure measurements. Because of the high prevalence of false-positive perfusion scintigrams in patients with typical or atypical chest pain, the use of exercise 201Tl imaging as a screening method to separate patients with MVP from those with CAD will not be appropriate. The variability of cardiac abnormalities in our patients with MVP and angiographically normal coronary arteries suggests that the MVP syndrome may represent a variable combination of metabolic, ischemic, or myopathic disorders.

Coronary Disease↗
PubMed1985

Detection of occult and intermittent rhinorrhea using 111In-DTPA.

In an attempt to detect occult or intermittent rhinorrhea, 10 patients without and 9 cases with rhinorrhea were investigated after a lumbal injection of 1.3 mCi 111In-DTPA. Significant count rates were detectable in the nasal pledgets of all individuals, so that it was not possible to distinguish those with and those without rhinorrhea. Therefore, the ratio of activity in nasal pledgets and blood normalized for weight recommended by McKusick et al. was used. In the patients without evidence of rhinorrhea, the ratio did not exceed 2.0, whereas in 8 of the 9 cases with rhinorrhea, it was considerably increased. The detectability of rhinorrhea was increased by using more than one measurement and by provocation manoeuvres.

Adult↗
PubMed1983

Profuse diarrhea induced by Campylobacter.

A 31-year-old woman with a five-day prodrome of fever, chills, and diarrhea was hospitalized with severe dehydration and profuse diarrhea due to infection with Campylobacter jejuni. Stool volumes were as high as 8,800 ml per 24 hours. Treatment with intravenous fluids, trimethoprim-sulfamethoxazole, and an oral isotonic glucose-sodium solution produced rapid improvement, suggesting a possible role for oral fluid and electrolyte replacement in Campylobacter enteritis.

Adult↗
PubMedDate not supplied

MRI assessment of myocardial viability: comparison with other imaging techniques.

The identification of dysfunctional but viable myocardium in patients with coronary artery disease with or without a history of myocardial infarction is of paramount clinical importance since viable myocardial areas are most likely to benefit from revascularization, whereas revascularization of scar tissue will not lead to improvement of left ventricular function. In some patients cardiac catheterization itself already provides important clues to the presence of viable myocardium based on the degree of wall motion abnormalities, post-extrasystolic improvement of wall motion, the presence of collateral vessels or persisting angina in a patient with single vessel disease. However, due to the complexity of viability assessment especially in patients with severely depressed left ventricular function and multi-vessel disease, viability tests are usually requested after the results of coronary angiography are known. Among the diagnostic armamentarium to identify viable myocardium the most established techniques are single photon emission computed tomography (SPECT), positron emission tomography (PET) if available and dobutamine stress-echocardiography. With the application of magnetic resonance imaging (MRI) in clinical cardiology an important and exciting diagnostic tool has been added for the prospective identification of viable myocardium for purposes of guiding therapeutic interventions in individual patients. This article reviews comparative studies between MRI and established imaging techniques like PET, SPECT and dobutamine-echocardiography with respect to the assessment of viable myocardium in patients with acute myocardial infarction and chronic coronary artery disease.

Angina Pectoris↗