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G Cieslinski

Publications and source records attributed to G Cieslinski.

At least 19 recordsLinked to original sources
PubMed1999

[Magnesium excretion in urine is not a marker of magnesium deficiency. Reliability of an oral magnesium administration test].

BACKGROUND: Serum magnesium analysis does not reflect body content of magnesium. So substitution is based on empirical maneuvers. PATIENTS AND METHOD: In a study on 44 patients urinary magnesium excretion was analyzed before and after oral magnesium substitution (40 mval). The provable hypothesis was the estimation that patients in magnesium deficiency under chronical diuretic treatment (n = 11) would have a lower magnesium excretion than patients of the control group (n = 10). Further analysis was done with patients after orthotopic cardiac transplantation (n = 12) and those suffering from coronary heart disease (n = 11). RESULT: After oral administration of magnesium in all 4 groups there was a rise in blood levels, only significant in the patient group under chronic diuretic treatment. Urinary magnesium excretion, however, showed no significant differences. Patients after cardiac transplantation had the lowest rise in urinary magnesium excretion. CONCLUSION: There was no clear differentiation by means of this oral magnesium substitution test. Magnesium excretion even after oral substitution is of no value to analyze magnesium deficiency.

Administration, Oral↗
PubMed1998

Improved systolic function after PTCA can be estimated by femoral arterial Doppler.

The effect of coronary angioplasty to the post exertional femoral arterial pulse was analyzed in a prospective trial. In 26 patients 30 coronary stenoses could be treated. Narrowed lumen diameter dropped from 85.5% +/-8.2 to 34.6% +/-10.7 (P<0.0001). Patients with a residual coronary artery stenosis of <60% (group A, n=15) were compared to those with incomplete revascularisation (stenoses >60%, group B, n=11). Post exertional Doppler criteria differed between both groups: Peak velocity in group A was 86.08 cm/s +/- 17.8, in group B 72.9 cm/s +/-17, mean velocity 32.06 cm/s +/-12.5 versus 23.6 cm/s +/-10.3 acceleration or dV/dt 813.5 cm/s2 versus 722 cm/s2 +/-164. Statistical significant pre to post postexertional findings improved only in group A (P<0.01, peak velocity, P<0.05 mean velocity and dV/dt). It is concluded that patients with still-existing exertional myocardial ischemia can be distinguished from those without hemodynamic relevant stenoses by means of a simple noninvasive Doppler analysis of femoral arterial pulse.

Angioplasty, Balloon, Coronary↗
PubMed1995

[Implantable defibrillator in the long QT syndrome].

A 29-year-old otherwise symptom-free patient had undergone a partial thyroidectomy 5 years ago followed by an episode of ventricular tachycardia and (after lidocaine injection) ventricular fibrillation requiring external defibrillation. No cause for the arrhythmias had been found at that time. Two subsequent syncopes led to her hospitalization. An asystole occurred while she was being monitored, and during the resuscitation there were several periods of ventricular fibrillation, which responded to external defibrillation. Subsequently several episodes of self-limiting ventricular tachycardia were recorded. A long QT syndrome with torsade-de-pointes tachycardia was diagnosed on the basis of typical ECG changes (QT interval 545 ms). Extensive diagnostic tests failed to find a cause. To prevent further tachycardias she was given propranolol, 40 mg three times daily, and an automatic defibrillator was implanted as a precaution. But no defibrillator discharge has so far been required (more than 10 months).

Adult↗
PubMed1995

Comparison of calculated and measured mixed venous oxygen saturation in critically ill patients.

OBJECTIVE: According to the Fick principle the calculation of cardiac output and shunts is based on the exact determination of oxygen saturation. In this study an intraindividual comparison of two frequently applied methods was done. DESIGN AND SETTING: The calculated saturation by measuring partial oxygen pressure was compared with a gold standard, the reflectometrically measured saturation. PATIENTS: 75 patients of an intensive care unit in whom a Swan-Ganz catheter was introduced to answer clinical questions. RESULTS: Overall, most calculated values were higher than the measured ones, the mean difference was 5.9% (+/- 8.03%), ranging from -10.4 to +37%. In lower saturations (< 65%) the difference between both estimated values was larger than in the range above 65%. CONCLUSIONS: Especially when handling with lower oxygen saturations, calculation of saturation with an automatic gas analyzer leads to overestimated values. The Fick principle can only be applied for hemodynamic calculations when oxygen saturation can be determined by an easy and correct method.

Blood Gas Analysis↗
PubMed1994

Risk of endomyocardial biopsy in immunosuppressed patients after cardiac transplantation.

OBJECTIVES: Central venous puncture is required for endomyocardial biopsy to identify rejection after cardiac transplantation. We evaluated our use of the Seldinger technique to determine the safety of this invasive method. METHODS: In 42 immunosuppressed patients central venous puncture was performed after cardiac transplantation using the Seldinger technique for right heart biopsy. Together with physical examinations, chest X-ray and cardiac ultrasonography were performed during the inhospital follow-up. Outpatient follow-up continues and all reported adverse effects were evaluated by the attending cardiologist. RESULTS: There were a total of 620 central venous punctures, most via the right internal jugular vein (77.9%). The planned puncture could not be performed in 3.2% of the cases and an alternative site was used. The femoral approach was associated with the longest radiation time. No severe adverse effects were observed and no complications (infection, large haematoma, pneumothorax, severe rhythm disorders) were recorded. CONCLUSION: Even in immunosuppressed patients frequently requiring central venous puncture, right heart endomyocardial biopsy can be safely performed to evaluate rejection.

Adult↗
PubMed1994

Correlation between long-chain acylcarnitine in serum and myocardium after heart transplantation in humans.

The concentrations of free, short-chain, and long-chain acylcarnitine were determined in 19 right ventricular endomyocardial biopsies and in serum from 14 patients after orthotopic heart transplantation and 3 nontransplanted control patients with normal cardiac function. Coronary angiography was normal in all patients. Left ventricular ejection fraction as measured by radionuclide ventriculography was not different between heart-transplanted and control patients (60.3 +/- 6.7% and 61.7 +/- 10.7%, respectively). Myocardial and serum carnitine concentrations in heart-transplanted patients were not different from control patients (myocardium: free carnitine 11.8 +/- 4.8 vs 7.1 +/- 7.1, short-chain acylcarnitine 4.5 +/- 2.1 vs 5.8 +/- 2.0, long-chain acylcarnitine 4.9 +/- 3.8 vs 3.9 +/- 3.2 mumol/g noncollagen protein; serum: free carnitine 32.6 +/- 11.2 vs 32.0 +/- 9.9, short-chain acylcarnitine 7.3 +/- 5.2 vs 5.1 +/- 1.3, long-chain acylcarnitine 4.1 +/- 2.7 vs 4.8 +/- 4.0 mumol/L). There was a highly significant correlation between myocardial and serum long-chain acylcarnitine (r = 0.76, P < 0.001). The data suggest that carnitine metabolism is not altered after heart transplantation.

Adult↗
PubMed1994

Endothelium-dependent and endothelium-independent vasomotion in large coronary arteries and in the microcirculation after cardiac transplantation.

Endothelium-dependent and endothelium-independent vasodilation of the epicardial conduit vessels and the microcirculatory coronary vessels was investigated with cumulative doses of acetylcholine (ACh 50 micrograms and 100 micrograms i.c.), nitroglycerin (0.3 mg i.c.) and dipyridamole (0.56 mg.kg-1 i.v.) in 17 patients (3 female/14 male; age: 47 +/- 3.6 years) with angiographically normal coronary arteries 40 +/- 5.1 months after cardiac transplantation. The effect of ACh on large conduit arteries was evaluated angiographically. Coronary blood flow velocity changes were measured utilizing an 8F Judkins style 20 MHz Doppler catheter positioned in the left main coronary artery. A coronary flow index was calculated from the mean Doppler flow velocity and the computed cross-sectional vascular area. After 50 micrograms of ACh the diameter of proximal, middle and distal segments of the left anterior descending coronary artery decreased significantly by 7.6 +/- 2.06% (P < 0.05), 10.6 +/- 3.5% (P < 0.01) and 12.6 +/- 3.29% (P < 0.01) and after 100 micrograms ACh by 10.5 +/- 2.4% (P < 0.05), 13.0 +/- 3.7% (P < 0.01) and 15.3 +/- 3.9% (P < 0.01). The endothelium-independent vasodilator nitroglycerin (0.3 mg i.c.) induced an increase in vascular diameter of 14.4 +/- 3.1% (P < 0.01), 18.6 +/- 4.1% (P < 0.01) and 20.8 +/- 2.9% (P < 0.01) in proximal, mid and distal segments of the left anterior descending coronary artery.(ABSTRACT TRUNCATED AT 250 WORDS)

Acetylcholine↗
PubMed1993

Coronary anomalies: incidence and importance.

Most patients with coronary anomalies are asymptomatic. The knowledge of those variations could be important in regard to invasive catheter treatment or bypass surgery. In a retrospective study, the angiographic findings based on 4,016 patients (1985-1989) were analyzed concerning coronary anomalies and malformations. Of the patients studied, 39 (0.97%) had coronary anomalies, and in 26 of these patients it was an anomalous circumflex branch. In 14 cases, the circumflex branch arose from a separate origin in the left aortic sinus. In 11 patients the origin was from the proximal segment of the right coronary artery. A singular coronary artery was found in five patients, originating from the right aortic sinus in two patients and from the left aortic sinus in three patients. An origin of the left coronary artery from the pulmonary artery, a coronary fistula, or an origin of the left anterior descending coronary artery from the RCA could be found in only one patient. Unexpected findings during invasive procedures would suggest a possibly existing coronary anomaly, especially when main branches cannot be opacified by selective contrast medium injection.

Cardiac Catheterization↗
PubMed1993

Accuracy of blood sampling through central venous lines in intensive-care unit patients.

OBJECTIVE: In intensive-care unit (ICU) patients it is common practice to sample blood from central venous lines (CVL). This study was designed to answer the question on how much blood has to be aspirated through the CVL before the actual blood sample is taken to get accurate laboratory findings. DESIGN AND SETTING: Simultaneous blood samples from a peripheral vein (intraindividual control) and 5-ml portions from a CVL up to 25 ml were analyzed. PATIENTS: 5 patients of an internal ICU participated in the study. RESULTS: For the analyzed 24 different parameters it could be shown that after aspirating 10 ml of blood, the results are comparable to analyses from peripheral vein samples. CONCLUSIONS: Although blood sampling from a CVL--after aspiration of 10 ml blood--results in correct laboratory analyses, this procedure leads to a greater amount of blood loss and, hence, cannot be recommended in long-term ICU treatment.

Aged↗
PubMed1993

[Heart volume determination as an indication of rejection after orthotopic heart transplantation].

Endomyocardial biopsy in cardiac transplantation is still the most exact test (gold standard) to confirm or exclude a suspected rejection. Up to now, all available noninvasive tests suffer from a low sensitivity and specificity. For a further reduction of biopsies early available noninvasive methods are desirable. In the data presented a comparison between histological findings and heart volume measurements is shown in 40 patients (112 histological findings) after orthotopic cardiac transplantation. In 46 cases with no evidence of histological rejection the echocardiographically or radiologically determined heart volume was 869 +/- 142 ml/1.73 m2 body surface area, compared to 1026 +/- 178 ml/1.73 m2 in 29 cases with mild cardiac rejection. In 37 cases with a moderate or severe rejection heart volume as 1094 +/- 181 ml/1.73 m2. The diagnosis of a moderate or severe rejection by biopsy is combined with a heart volume above 950 ml/1.73 m2 with a sensitivity of 78% and a specificity of 73%. Intramyocardial edema as well as an increase in right and left ventricular volumes due to heart failure may be the causes for heart volume increase in rejection. Thus, heart volume measurement which can be performed easily during routine echocardiography gives additional information about whether a rejection has to be assumed or can be excluded. Today, sensitivity and specificity of the test does not allow a reduction of biopsy frequency. Further investigations are necessary to analyze the course of heart volume changes during an episode of rejection.

Biopsy↗
PubMed1992

[Iatrogenic origin of pleural effusion. A rare complication of the central venous catheter].

CASE REPORT: A 47-year-old woman with unremarkable plain chest X-rays in whom the Seldinger technique was employed to place a central venous line via the jugular vein, a catheter-related pleural effusion developed. CONCLUSIONS: This case points up the need to exercise care when placing a central venous line, and suggests the need to use contrast medium for the radiological follow-up examination.

Acute Disease↗
PubMed1992

Right ventricular volumes and hemodynamics after successful orthotopic heart transplantation. A comparison to coronary artery disease using thermodilution.

Only few data exist concerning right ventricular function in the chronic stage after cardiac transplantation. Therefore, we investigated hemodynamic and right ventricular volumetric data by a computerized thermodilution Swan-Ganz catheter in 17 patients (median age: 53, range: 18-63 yr) at a median of 24 (4 to 44) months after cardiac transplantation during rest and supine bicycle exercise. Myocardial biopsy showed grade one or less according to the classifications of Billingham. Sixteen patients with coronary artery disease, but without prior myocardial infarction, served for comparison. While angiographic left ventricular ejection fraction was nearly identical in transplant recipients [77 (60-92)%, median (range)] and in patients with coronary artery disease [78 (64-94)%], right ventricular ejection fraction was lower (p < 0.001) in patients after cardiac transplantation [37 (16-58)%] as compared to patients with coronary artery disease [56 (46-62)%]. In transplant recipients right atrial pressure was significantly higher both at rest [10 (2-18) mmHg] and exercise [18 (8-30) mmHg] than in patients with coronary artery disease [5 (1-11) and 8 (3-18) mmHg]. Pulmonary capillary wedge pressure behaved similar in both groups. To further evaluate reasons for right ventricular impairment, a correlation analysis was performed. This showed a negative correlation between right ventricular ejection fraction and the time interval after transplantation (p < 0.0002). However, there was no correlation between right ventricular ejection fraction and acute rejection or a rejection score. In conclusion, right ventricular function may be severely altered in transplant recipients, in contrast to an only slight impairment of left ventricular function.

Adolescent↗
PubMed1992

Can the coronary atherosclerotic process be influenced by calcium antagonists?

Cell culture experiments and various animal models have shown that calcium antagonists can inhibit atheroma development. A number of antiatherosclerotic mechanisms have been proposed and the promising results of these in vitro and animal experiments prompted clinical trials. Retrospective analyses indicated that verapamil might retard disease progression and the development of new stenoses. Prospective clinical studies, however, have revealed no effect by calcium antagonists on pre-existing coronary stenoses (> or = 20%) and it is suggested that the study duration (2 to 3 years) may have been too short and that advanced stages of atheromatous disease are not influenced by calcium antagonists. Current data suggest that only early stages of coronary atheromatosis may be affected by treatment with calcium antagonists; however, optimum drug, dosage and suitable patients are yet to be defined.

Animals↗
PubMed1991

[Modification of coronary arteriosclerosis in man by calcium antagonists?].

Calcium channel blockers may retard development and progression of coronary arteriosclerosis in man because of protective effects on membranes, (especially the endothelium), relaxation of vessel walls, inhibition of various platelet functions, impairment of proliferation and migration of smooth muscle cells in the vessel wall, and an improvement of vascular cholesterol metabolism. In animal trials development of atheromas in large arteries induced by cholesterol-rich food and other stimuli of atherogenesis could be successfully retarded by a broad variety of calcium channel blockers. Some clinical observations in patients with coronary artery disease pointed at positive effects of calcium antagonists in coronary arteriosclerosis. To date, the results of three prospective placebo-controlled trials with calcium antagonists in coronary arteriosclerosis are available. In all trials progression of atherosclerosis was assessed by serial angiograms: 1) INTACT (nifedipine: 20 mg four times daily; observation period: 3 years, two coronary angiograms); 2) Study of the Montreal Heart Institute (nicardipine: 30 mg three times daily; observation period: 2 years, two coronary angiograms); 3) FIPS (Frankfurt Isoptin Progression Study) (verapamil: 120 mg three times daily; observation period: 3 years, three coronary angiograms). Target variables in these studies were progression or regression of preexisting lesions, development of new lesions and the incidence of vessel occlusions. The INTACT and the Nicardipine studies preferably included patients in early stages of coronary artery disease. The patients of FIPS who were entered into the study immediately after coronary bypass surgery suffered from severe, advanced coronary artery disease. In the latter study progression of coronary artery disease was assessed separately in different vascular regions (bypassed and non-bypassed segments) and in the bypass grafts.(ABSTRACT TRUNCATED AT 250 WORDS)

Calcium Channel Blockers↗
PubMed1991

[Experiences with the application of monoclonal Indium-111 antimyosin scintigraphy in the diagnosis of rejection episodes following orthotopic heart transplantation].

Indium-111-labeled Fab fragment imaging using a murine antimyosin monoclonal antibody (Myoscint, Centocor, Leiden) was evaluated for efficacy in detecting cardiac allograft rejection. Diagnosis of rejection was made by endomyocardial biopsy with four to five samples taken for each procedure. Eighty-one studies were performed in 25 patients (21 men, four women, mean age 50 +/- 9 years) from 2 weeks to 45 months after cardiac transplantation. 0.5 mg of the monoclonal antibody labeled with 60 MBq Indium-111 (Antimyosin-Fab-DTPA) was administered i.v. Planar scintigraphic images were obtained in LAO 45 and anterior projections as well as "half-body-scintigrams" 48 h after injection. Using the regions-of-interest-(ROI)technique the relative uptake over the lung and the heart was determined and an index of In-111 uptake was calculated. A heart-to-lung ratio of 1.5 or higher was considered indicative for moderate to severe rejection. Specificity was 86% (nine false-positive In-111 studies in 68 negative biopsy studies), sensitivity was 85% (two false-negative In-111 studies in 13 pathological biopsy studies). It is concluded that the In-111 method has a high sensitivity and specificity in detecting heart transplant rejection and may be useful in the monitoring of patients in the chronic phase after heart transplantation. The 48-h delay in establishing the diagnosis limits the applicability in acute severe rejection.

Adult↗