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Biomedical subjects

F X Roithinger

Publications and source records attributed to F X Roithinger.

32 records · Page 2Linked to original sources
PubMed1996

[Ventricular septal rupture after blunt chest trauma].

HISTORY AND CLINICAL FINDINGS: Case 1: a 20-year-old previously healthy man sustained multiple nonvascular injuries without visible chest trauma in a car accident. Four days later a loud systolic murmur was heard over the heart. Case 2: a 21-year-old man similarly sustained in a car accident multiple injuries without visible chest involvement but causing haemorrhagic shock. A loud systolic heart murmur was heard and after shock treatment he developed left heart failure requiring catecholamine infusions. INVESTIGATIONS: Echocardiography demonstrated posttraumatic ventricular septal rupture in both patients. Cardiac catheterisation revealed a small left to right (1 : 1.6) shunt in case 1, and a large one, 1 : 3, with markedly elevated pulmonary artery pressure in case 2. COURSE: In case 1, no treatment was needed as the intracardiac shunt was small and there were no symptoms. But in case 2 the large shunt with pulmonary hypertension required operative closure with a Dacron patch 2 days after the diagnosis had been established. CONCLUSION: Ventricular septal rupture after blunt trauma to the chest is a rare occurrence. Even though in general the prognosis is good, a large intracardiac shunt may require early surgical repair.

Accidents, Traffic↗
PubMed1996

[Dentogenic sources of infection in patients with awaiting heart valve replacement].

The detection of all teeth with periapical pathological conditions and optimal treatment of the affected teeth are a part of the evaluation program for patients who are scheduled to undergo cardiac value replacement. 48 patients (50 value replacement operations) were evaluated for the incidence of periapical pathological conditions, as well as for the different kinds of oral surgical interventions. A periapical pathological condition was present in 28 of 48 patients (58.3%). In general, the incidence of a dental focus was significantly higher in patients awaiting aortic valve replacement than in patients undergoing mitral valve replacement (69.7% vs. 23.1%; p < 0.01). Patients for aortic valve replacement presented significantly more periapical pathological conditions than patients for mitral valve replacement (1.7 vs. 0.8). Optimal timing of dental consultations is helpful in the oral rehabilitation of patients about to undergo a valve replacement procedure. Furthermore, close interdisciplinary cooperation is necessary to minimize the social and psychological problems following unexpected tooth extractions. Cardiologists and heart surgeons have an important role in the organisation of the oral rehabilitation of patients undergoing valve replacement procedures.

Adult↗
PubMed1996

[Comparison between ambulatory 24-hour blood pressure measurement and occasional blood pressure measurement in hemodialysis patients with left heart hypertrophy].

Since 24-hour blood pressure monitoring seems to be superior to occasional blood pressure measurement as far as risk stratification is concerned, we compared the two methods in patients with secondary hypertension and left ventricular hypertrophy. In 26 haemodialysis patients (12 male, mean age 54 +/- 13 years), the mean occasional blood pressure values during haemodialysis were 147 +/- 18/82 +/- 9 mmHg, the mean 24-hour blood pressure values were 145 +/- 21/ 85 +/- 13 mmHg, during the day 145 +/- 23/86 +/- 13, during the night 143 +/- 25/81 +/- 13 mmHg. The nocturnal reduction of mean blood pressure was -3.6 +/- 7%. Both methods of blood pressure monitoring showed a significant correlation with the relevant echocardiographic parameters of left ventricular hypertrophy, cardiac mass and interventricular septum diameter. Patients with and without a nocturnal reduction in blood pressure could not be differentiated by the mean occasional blood pressure values. Therefore, 24 h ambulatory blood pressure monitoring seems warranted in this high risk group, especially to monitor antihypertensive drug therapy.

Adult↗
PubMed1996

Short-term frequency and time domain analysis of heart rate variability in type I diabetic subjects.

Assessment of heart rate variability as a measure of sympathovagal balance has proven useful in the risk stratification of patients with coronary artery disease. Since diabetic subjects with autonomic neuropathy, carrying a high risk of cardiovascular events, have been shown to have reduced heart rate variability, we performed a short-term (600 RR-intervals) frequency and time domain analysis in type I diabetic subjects. 19 patients without clinical signs of autonomic neuropathy were compared with 11 age- and sex-matched control persons. At a comparable cycle length, diabetic subjects differed significantly from healthy controls in all calculated time domain parameters (standard deviation: 41 +/- 23 vs. 66 +/- 17 ms, p = 0.005; root mean square successive difference of normal RR-intervals: 25 +/- 17 vs. 41 +/- 17 ms, p = 0.02) and frequency domain parameters (low frequency: 58 +/- 67 vs. 158 +/- 97 ms2, p = 0.002; high frequency: 29 +/- 42 vs. 85 +/- 96 ms2, p = 0.03). Thus, short-term frequency and time domain analysis of heart rate variability can be used easily and quickly in an outpatient setting for estimation of changes in the sympathovagal balance in diabetic subjects. However, the prognostic significance and the influence of drugs on impaired heart rate variability in diabetic subjects have yet to be determined.

Adolescent↗
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↗
PubMed1995

Parameters of prognostic relevance to the patency of vascular access in hemodialysis patients.

The objectives of this study were to evaluate whether age, sex, underlying renal disease, or the performing surgeon is of prognostic relevance to the patency of the vascular access. In a routine clinical setting, 139 first and 144 further fistula operations were done in 139 patients during 5 yr and were analyzed in retrospect. Within a group of 108 patients with first Cimino-Brescia fistulae, Cox multivariate regression analysis revealed the surgeon to be the only determinant with a continuous, significant effect on fistula patency throughout the observation period (P(out) < 0.1). The patency rates of the seven surgeons at 1, 2, and 3 yr differed from 34 to 69, 13 to 62, and 13 to 62%, respectively. Hazard ratios among the surgeons varied from 0.65 to 2.21. Additionally, age (P < 0.004) and diabetes mellitus (P < 0.02) were disclosed to be significant risk factors for impaired patency, but later in the course of disease (time dependent). Sex had no influence. After the failure of the first fistula, revisions of or new Cimino-Brescia fistulae (N = 56) were superior to polytetrafluoroethylene grafts (N = 61). The mean patency of the former amounted to 320 +/- 377 versus 156 +/- 281 days in polytetrafluoroethylene grafts (P < 0.05). It was concluded that increasing age and diabetes mellitus are time-dependent risk factors for the shortened patency of arteriovenous fistulae. The operating surgeon, however, seems to be the major determinant for the continuous patency of Cimino-Brescia fistulae.

Adolescent↗
PubMed1995

A lethal course of chronic hepatitis C, glomerulonephritis, and pulmonary vasculitis unresponsive to interferon treatment.

Several extrahepatic syndromes have been associated with chronic hepatitis C virus infection. In our patient (a 57-yr-old woman without risk factors for hepatitis), chronic active hepatitis C was diagnosed serologically and histologically. Three months later, membranoproliferative glomerulonephritis with compromised renal function and peripheral edema, cryoglobulinemia, and a vasculitis of the finger tips developed. During interferon treatment for 3 months, neither the clinical condition nor serological parameters improved significantly. Progressive dyspnea was due to bilobar pulmonary infiltration. Despite antibiotic, virostatic, and corticosteroid therapy, the patient died from respiratory failure. Autopsy revealed diffuse pulmonary vasculitis. Thus, this is the first description of chronic hepatitis C virus infection, glomerulonephritis, and cryoglobulinemia complicated by immunologically mediated pulmonary vasculitis. Because interferon therapy may be ineffective, immunosuppressive therapy should be considered.

Cryoglobulinemia↗
PubMed1995

[Spontaneous regression of a small cell bronchial carcinoma].

A circular focus of 1 cm diameter was discovered by chance on a thoracic x-ray of a female patient of 66 years of age suffering from chronic interstitial nephritis due to analgesics. Bronchoscopic suction revealed histologically a small-cell carcinoma of the lung but there was no indication of formation of metastases. The patient refused any tumor-specific treatment. In the further course of the disease the focus showed up radiologically for seven months and was then no longer visible throughout the following 14 months. The patient finally died subsequent to an extensive posterior myocardial infarction. Postmortem examination excluded the presence of a primary tumor of the lung or metastases. Our case suggests the rare occurrence of a spontaneous regression of a small-cell bronchial carcinoma. Although spontaneous regression of malignant diseases is ascribed to immunological factors, such regression can also occur if the immunological system is impaired, as had been the case in this particular patient with chronic renal insufficiency.

Aged↗
PubMed1994

The influence of ACE-inhibition on myocardial mass and diastolic function in chronic hemodialysis patients with adequate control of blood pressure.

The objectives of this study were to evaluate the specific effect of the ACE-inhibitor lisinopril on myocardial mass and diastolic function in uremic patients using a protocol designed to leave blood pressure unchanged. Nineteen hemodialysis patients (7 males; mean age: 55 +/- 13 years; mean time on dialysis: 44 +/- 35 months) received lisinopril for 6 months in addition to their preexistent antihypertensive treatment regimens (mean: 1.4 +/- 0.8 drugs). Doses of antihypertensive drugs were adjusted to keep both systolic and diastolic blood pressure stable. Nine patients were withdrawn from lisinopril treatment after 43 +/- 33 days because of hypotension (n = 4), withdrawn consent (n = 3), stroke (n = 1) and cough (n = 1). Seven of them were further studied as controls. Ten patients received 6.4 +/- 4 mg lisinopril as a mean for 6 months. Mean myocardial mass, calculated by M-mode echocardiography, was 324 +/- 103 g before, and 313 +/- 79 g after 6 months of lisinopril treatment. In the control patients, myocardial mass was 318 +/- 110 g initially, and after 6 months, it was 334 +/- 159 g. Early and late transmitral diastolic flow velocities were not significantly influenced by lisinopril. Throughout the study, both the systolic and diastolic 24-h mean blood pressure levels remained stable (systolic: before: 145 +/- 19 mmHg, at 6 months: 147 +/- 17 mmHg; diastolic: before: 87 +/- 12 mmHg, at 6 months 87 +/- 10 mmHg). Thus, no specific effect of lisinopril on regression of myocardial hypertrophy or improvement of diastolic function could be observed within a 6-month period in this small group of hemodialysis patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Antihypertensive Agents↗
PubMed1994

[Low dosage methotrexate treatment in chronic polyarthritis].

30 patients with rheumatoid arthritis were treated with a weekly low dose of Methotrexate for a period of 12 months. In the course of treatment there was significant improvement in pain and mobility, in the number of inflamed joints and use of steroids. There was a fall in erythrocyte sedimentation rate and hemoglobin content rose significantly. 81% of the patients improved. Of these 14% had a complete clinical remission. There were 19% non-responders. Adverse reactions developed in 13 patients (43.3%, gastrointestinal symptoms, elevated liver enzymes, loss of hair, stomatitis). After decreasing or temporary discontinuing in 10 of them the drug was taken again later on. It had to be withdrawn in 3 patients (10%). All recovered when Methotrexate was discontinued. It is concluded that low dose Methotrexate is effective in the long term treatment of chronic rheumatoid arthritis.

Aged↗
PubMed1994

The influence of aortic valve prosthesis diameter on the reversibility of pulmonary hypertension in isolated aortic stenosis.

Patients with pulmonary artery hypertension in the late course of isolated aortic stenosis are considered to have a poor prognosis. The aim of the following study was to determine the incidence of pulmonary artery hypertension, the postoperative course after valve replacement and the reversibility of pulmonary hypertension dependent on the valve prosthesis diameter. Seventy-six consecutive patients with symptomatic aortic stenosis undergoing isolated aortic valve replacement were studied. Preoperative right and retrograde left heart catheterization was performed in the cardiac catheterization laboratory. Three days after valve replacement, hemodynamic evaluation was repeated by a Swan-Gantz catheter. Patients with preoperative pulmonary hypertension (systolic pulmonary artery pressure > 30 mmHg, n = 53) differed significantly from patients without pulmonary hypertension (n = 23) with respect to systolic pulmonary pressure (52.4 +/- 17 vs. 24.3 +/- 4 mmHg), pulmonary capillary wedge pressure (22.3 +/- 10 vs. 8.8 +/- 2, p < 0.001), left ventricular end diastolic pressure (29.6 +/- 13 vs. 21.4 +/- 11) and valve area (0.64 +/- 0.10 vs. 0.79 +/- 0.11 cm2, p < 0.05). No difference was found with respect to age, maximum systolic transvalvular aortic gradient or cardiac output. Following valve replacement, the two groups did not differ significantly in fatal (2/53 vs. 1/23 or non-fatal (14/53 vs. 5/23) complications. In patients with pulmonary hypertension, systolic pulmonary pressure decreased from 52.4 +/- 17 to 38.9 +/- 6, diastolic pressure from 24.7 +/- 9 to 12.6 +/- 3, pulmonary capillary wedge pressure from 22.3 +/- 10 to 12.1 +/- 3, pulmonary capillary wedge pressure from 22.3 +/- 10 to 12.1 +/- 3 mmHg.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1993

Myocardial infarction after chronic ergotamine abuse.

As a result of chronic ergotamine abuse, reversible arterial narrowing has been documented angiographically in peripheral, but not in coronary arteries. We report on a patient with no cardiovascular risk factors, but because of chronic ergotamine abuse suffered on acute myocardial infarction, complicated by ventricular fibrillation. Coronary angiography performed 3 days after resuscitation revealed a distal occlusion of the left anterior descending artery. Three months later, spontaneous recanalization had occurred, and no residual narrowing was seen angiographically. Thus, surveillance of patients with migraine headache to avoid chronic ergotamine abuse is recommended to prevent cardiovascular complications.

Coronary Disease↗
PubMed1992

Ventricular late potentials in haemodialysis patients and the risk of sudden death.

Cardiovascular diseases account for approximately 50% of deaths in patients on chronic haemodialysis. Therefore we prospectively studied 54 consecutive patients on dialysis for the presence or absence of ventricular late potentials (LP). LP, i.e. low-amplitude potentials in the terminal part of the QRS complex, have been shown to be highly indicative of life-threatening arrhythmias and sudden death. The results were correlated with echocardiographic studies and the clinical outcome during a follow-up period of 18 months. Fifty patients were suitable for evaluation (29 males, 21 females; mean age 55 years; mean time on dialysis 32 months; coronary artery disease present in 5) Our analysis revealed LP in seven of 50 patients only. Left ventricular hypertrophy, i.e. mean wall diameter > 12 mm, was present in 78%, a compromised left ventricular function, i.e. shortening fraction < 28%, was found in 28% of the patients. With respect to echocardiographic parameters, patients with and without LP were similar. During follow-up, sudden cardiac death was observed in three of 11 patients deceased. LP were detectable in one of the three only. From the remaining six patients with LP, four are still alive, and two patients died due to atherosclerosis and pulmonary embolism. Our data underline the crucial role of sudden cardiac death in dialysis patients. Ventricular late potentials, however, are of no prognostic relevance with respect to identification of dialysis patients at risk of sudden death.

Adolescent↗