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Biomedical subjects

F Dienstl

Publications and source records attributed to F Dienstl.

At least 19 recordsLinked to original sources
PubMed1992

Endothelin-1 in patients with complicated and uncomplicated myocardial infarction.

Endothelin-1 concentrations were measured in peripheral venous blood samples from 42 patients with acute myocardial infarction. In patients with ischemic or hemodynamic complications (n = 11), endothelin-1 concentrations were significantly higher already on admission (P = 0.008) and remained significantly higher until day 6 after admission compared to patients with uncomplicated infarctions (n = 31; P = 0.035). There were no close correlations between peak concentrations of endothelin-1 and creatine kinase or creatine kinase isoenzyme MB mass in either group. Only in complicated patients did left ventricular ejection fraction correlate closely and inversely with peak endothelin-1 concentrations (r = -0.71; P = 0.03). Therefore, plasma endothelin-1 concentrations in patients with acute myocardial infarction patients may reflect states of markedly depressed cardiac performance and recurrent myocardial ischemia.

Adult↗
PubMed1992

Calcitonin gene-related peptide in patients with and without early reperfusion after acute myocardial infarction.

Plasma concentrations of calcitonin gene-related peptide (CGRP), a potent regulator of vascular tone, creatine kinase, myoglobin, and cardiac troponin T were assessed in 31 patients with acute myocardial infarction. In patients who had sustained acute myocardial infarctions, maximum CGRP concentrations (median, 3.2 pmol/L; interquartile range, 1.5 to 4.8 pmol/L) were markedly elevated as compared with healthy control subjects (n = 23; median, 1.02 pmol/L; p = 0.02). However, no marked differences in CGRP levels were observed between patients with early reperfusion (n = 19; median, 3.5 pmol/L) and patients without early reperfusion (n = 12; median, 2.6 pmol/L; p = 0.96), as well as between those with congestive heart failure (n = 8; median, 3.9 pmol/L) and those without congestive heart failure (n = 23; median, 3.2 pmol/L; p = 0.62). CGRP did not correlate closely with myocardial protein release or hemodynamic parameters (heart rate and blood pressure) or the occurrence of arrhythmias. Therefore we conclude that elevated peripheral venous CGRP concentrations in patients who have sustained an acute myocardial infarction are independent of successful reperfusion and hemodynamic state. Although the cause of CGRP increase is not yet identified, CGRP may play a role in the regulation of coronary vascular tone in patients after acute myocardial infarction.

Adolescent↗
PubMed1992

Early diagnosis of acute myocardial infarction by a newly developed rapid immunoturbidimetric assay for myoglobin.

OBJECTIVE: To evaluate a rapid immunoturbidimetric assay for myoglobin and to investigate its clinical usefulness in the early detection of acute myocardial infarction. DESIGN: Prospective study. Immunoturbidimetrically determined myoglobin concentrations were compared with radioimmunoassay results obtained with the same blood samples. The diagnostic performance of myoglobin determination was compared with creatine kinase and creatine kinase MB activity (current standard of routine diagnosis). SETTINGS: Part 1: coronary care unit. Part 2: emergency room in a university hospital. PATIENTS: Part 1:30 patients with acute myocardial infarction admitted not later than four hours (median two hours) after the onset of symptoms. Part 2: 126 patients admitted to the emergency room with chest pain not caused by trauma (51 cases of acute myocardial infarction, 51 cases of angina pectoris, and 24 cases of chest pain not related to coronary artery disease). INTERVENTIONS: Part 1: routine treatment including intravenous thrombolytic treatment (28 patients). Part 2: routine emergency treatment without thrombolytic treatment. MAIN OUTCOME MEASURES: The analytical quality of the immunoturbidimetric myoglobin assay and a comparison between the myoglobin assay and creatine kinase and creatine kinase MB for diagnostic sensitivity and performance. RESULTS: The immunoturbidimetric myoglobin assay was fast and convenient and gave myoglobin determinations of high analytical quality. The concentration of myoglobin increased, peaked, and returned to the reference range significantly earlier than creatine kinase (p < or = 0.0001) and creatine kinase MB (p < or = 0.0002). Before thrombolytic therapy was started the diagnostic sensitivity of myoglobin was significantly higher than that of creatine kinase MB activity 0-6 h after the onset of chest pain and significantly higher (0.82 v 0.29) than creatine kinase 2-4 h after the onset of chest pain. In almost all patients (92%) plasma myoglobin concentrations were increased 4-6 h after the onset of chest pain. CONCLUSION: Myoglobin was more sensitive in detecting early myocardial infarction than creatine kinase and creatine kinase MB activity. Immunoturbidimetric myoglobin measurements could be useful in the early evaluation of patients with suspected myocardial infarction because this assay takes less than two minutes.

Clinical Enzyme Tests↗
PubMed1992

Cardiac troponin T in the diagnosis of myocardial injury.

In the last several decades serum levels of cardiac enzymes and isoenzymes have become the final arbiters by which myocardial damage is diagnosed or excluded. Because conventionally used enzymes are neither perfectly sensitive nor specific, there is need for a new sensitive and cardiospecific marker of myocardial damage. Cardiac troponin T (TnT) is a contractile protein unique to cardiac muscle and can be differentiated by immunologic methods from its skeletal-muscle isoform. An enzyme immunoassay specific for cardiac TnT is now available in a commercial kit for routine use. The biggest advantage of this assay is its cardiospecificity. TnT measurements, however, are also highly sensitive in diagnosis of myocardial injury and accurately discern even small amounts of myocardial necrosis. TnT measurements are, therefore, particularly useful in patients with borderline CK-MB and in clinical settings in which traditional enzymes fail to diagnose myocardial damage efficiently because of lack of specificity--for example, perioperative myocardial infarction or blunt heart trauma. TnT release kinetics reveal characteristics of both soluble, cytoplasmic, and structurally bound molecules. It starts to increase a few hours after the onset of myocardial damage and remains increased for several days. TnT allows late diagnosis of myocardial infarction. The diagnostic efficiency remains at 98% until 6 d after the onset of infarct-related symptoms. TnT is also useful in monitoring the effectiveness of thrombolytic therapy in myocardial infarction patients. The ratio of peak TnT concentration on day 1 to TnT concentration at day 4 discriminates between patients with successful (greater than 1) and failed (less than or equal to 1) reperfusion. TnT measurements are very sensitive and specific for the early and late diagnosis of myocardial damage and could, therefore, provide a new criterion in laboratory diagnosis of the occurrence of myocardial damage.

Biomarkers↗
PubMed1991

[Values of atrial natriuretic peptide (ANP) and cyclic guanosine monophosphate (cGMP) in cardioversion].

We investigated atrial natriuretic peptide (ANP) and cyclic guanosine monophosphate (cGMP) in patients undergoing elective direct current cardioversion (CV group) due to atrial fibrillation (n = 9) or atrial flutter (n = 3). Anesthesia for cardioversion (CV) was induced with propofol 1.5 mg/kg. Conversion was achieved in all patients. Before CV all patients had elevated ANP and cGMP plasma levels. After CV the concentrations of ANP and cGMP decreased significantly within 15 and 30 minutes (p less than 0.01), respectively. Only one patient in the CV group showed increasing ANP and cGMP levels although his heart rate had decreased after CV and his blood pressure remained stable. High concentrations of ANP and cGMP might possibly be a compensatory mechanism of cardiac dysfunction. To study the influence the anesthetic agent on plasma levels of ANP and cGMP, we investigated six patients anesthetized with propofol for high-density radiation (HDR group). The data from this control group showed that propofol did not influence the plasma levels of ANP and cGMP. ANP correlated statistically significantly (p less than 0.05) with cGMP in both groups (r = 0.88 and 0.76 in the HDR and CV groups, respectively). In addition, we found a cGMP release of 149.6 +/- 17.6 per mol ANP in the HDR group, in the CV group the release was 109 +/- 54.2 cGMP per mol ANP. This phenomenon could be due to minor response of target cells to ANP stimulation (receptor down-regulation) in patients with heart disease. In conclusion, ANP and cGMP levels decreased after successful cardioversion.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Propofol for direct current cardioversion in cardiac risk patients.

We investigated 69 patients (most belonging to NYHA classes II and III) undergoing elective direct current cardioversion of atrial fibrillation (46 patients) and atrial flutter (23 patients), respectively. Without premedication anaesthesia was induced with the new soya bean emulsion of propofol ('Diprivan') 1.2 mg.kg-1 over 45 s. Recovery time was measured from the start of the anaesthetic injection to the moment at which the patients regained consciousness. Completeness of recovery was assessed with two methods: opening eyes on command and time orientation. Good amnesia was observed in all patients. Conversion was achieved in all but seven patients (90%). After injection of propofol, the mean arterial pressure decreased slightly (2% below baseline). Induction of anaesthesia and successful DCC effected a statistically significant decrease in both the heart rate and the rate pressure product. Eleven patients required assisted ventilation for 2 min due to respiratory depression. Fifteen patients developed arrhythmias. Side-effects, such as myocloni, recall or vomiting, were not observed. In conclusion, propofol may well prove to be the anaesthetic of choice for DCC in cardiac patients because of good amnesia, low incidence of side-effects and short recovery time (mean 5.3 min).

Adult↗
PubMed1979

[Does myocardial damage arise as a result of administration of tocolytic drugs? (author's transl)].

Fifty pregnant women admitted consecutively on account of threatened abortion or premature labour and treated with Ritodrine and Verapamil intravenously in the usual dosage were investigated with respect to creatine kinase activity and, in the event of a raised level, its isoenzyme creatine kinase--MB. Determinations were carried out before treatment and, in accordance with expected peak values in case of myocardial necrosis, after 6 and 12 hours. Three pathological values were recorded and these are discussed individually. Furthermore, statistical evaluation of the recorded values showed no significant differences.

Abortion, Threatened↗
PubMed1979

[Estimation of myocardial damage after open-heart surgery by CK isoencymes (author's transl)].

After 12 cases of open-heart surgery serum activities of CK and CKMB have been registrated. To make a more exact statement about myocardial damage the portion of CKMB out of the CK-activity has been evaluated by the way of a mathematic programm. The results verify the statement that after aortic valve replacement the CKMB portion is higher than the average, and that after intraoperative complications the highest CKMB portions have been reached. No myocardial infarction occurred.

Aortic Valve↗
PubMed1979

[Does myocardial damage arise as a result of administration of tocolytic drugs? (author's transl)].

Fifty pregnant women admitted consecutively on account of threatened abortion or premature labour and treated with Ritodrine and Verapamil intravenously in the usual dosage were investigated with respect to creatine kinase activity and, in the event of a raised level, its isoenzyme creatine kinase--MB. Determinations were carried out before treatment and, in accordance with expected peak values in case of myocardial necrosis, after 6 and 12 hours. Three pathological values were recorded and these are discussed individually. Furthermore, statistical evaluation of the recorded values showed no significant differences.

Adolescent↗
PubMed1978

[Differential diagnosis between skeletal muscle lesions and myocardial damage in multiple injury by determination of myocardial-specific creatine phosphokinase (CK-MB) (author's transl)].

The serum level of the myocardial-specific isoenzyme of creatine phosphokinase, CK-MB was determined in 50 patients with severe multiple injuries or following extensive surgery. It is concluded that whenever the proportion of CK-MB exceeds 10% of the total creatine phosphokinase activity myocardial damage has occurred, especially since equivalent ECG changes were registered in this group of patients.

Contusions↗
PubMed1978

[Delivery of a normal child after chemotherapy of acute promyelocytic leukaemia during pregnancy (author's transl)].

Upon chemotherapy with daunorubidomycin and cytosinarabinoside, a patient suffering from acute promyelocytic leukaemia during the 28. week of pregnancy achieved complete haematological remission. In spite of complicating disseminated intravascular coagulopathy and aggressive chemotherapy a normal child was delivered by cesarian section during the 34. week of pregnancy. Specific problems in the treatment of acute leukaemia during pregnancy are discussed.

Cesarean Section↗
PubMed1978

[The value of CKMB in multiple trauma and high voltage injuries].

The paper deals with a new aspect in patients with polytrauma using a method to distinguish between myocardial or skeletal muscle damage. The isoenzyme CKMB of kreatine kinase is found to be characteristic for myocardial damage when increasing to more than 10% of the whole enzyme activity. It should be mentioned that this elevation is also seen in other disorders. Therefore the correlation to ECG changes is important in considering the diagnosis.

Adolescent↗