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Biomedical subjects

G Kessler

Publications and source records attributed to G Kessler.

At least 37 records · Page 2Linked to original sources
PubMed1990

[Ophthalmological significance of stenosing carotid processes].

In a retrospective study we looked at the incidence of carotid artery stenosis in 191 ophthalmological patients, which underwent duplex sonography. In all these patients the oculist had considered carotid artery stenosis to be a possible reason for the present eye disease or visual disturbance. The incidence of stenosis found in these patients was compared to a group of 186 persons of the same mean age, which underwent routine-sonography without suffering from any symptoms related to carotid artery disease. Patients with amaurosis fugax, with occluded retinal veins and patients with glaucoma associated changes of the retina (in spite of normal eye pressure) suffered more often from carotis stenosis than asymptomatic persons (statistically significant), patients with occluded retinal arteries showed also more often carotid artery stenosis than the asymptomatic collective but without statistical significance. We conclude, that patients presenting with the mentioned symptoms should undergo carotid artery sonography. Furthermore these results could be of importance in evaluation the indication for carotid thrombendarterectomy (stadium II of cerebrovascular insufficiency).

Adult↗
PubMed1990

Altered left ventricular volume and ejection fraction responses to supine dynamic exercise in athletes.

Two-dimensional echocardiography was used to determine the responses of left ventricular volumes, ejection fraction and segmental left ventricular motion to supine dynamic exercise in 22 professional athletes, comparing these responses with those in 22 age- and gender-matched healthy untrained individuals. End-systolic volume was significantly greater at rest and during exercise in the athletes (50 +/- 6 versus 29 +/- 4 ml and 40 +/- 5 versus 17 +/- 4 ml, respectively, p less than 0.001 for both). It decreased during exercise in all the untrained subjects, but did not change or increased in nine athletes (41%). End-diastolic volume was greater in the athletes at rest (143 +/- 12 versus 98 +/- 9 ml) and during exercise (157 +/- 14 versus 121 +/- 13 ml, p less than 0.01 for both). It increased in all the untrained subjects, but decreased or did not change in six athletes (27%). Ejection fraction was significantly lower in the athletes at rest and during exercise (65 +/- 4% versus 70 +/- 5% and 73 +/- 5% versus 86 +/- 5%, p less than 0.01 and 0.001, respectively); the values augmented normally in all the untrained subjects, but increased only by less than 5% units, did not change or decreased in nine athletes (41%). Eight athletes (36.5%) failed to demonstrate the expected symmetric hyperkinetic wall motion changes during exercise, which were seen in all the untrained subjects. No correlation was found between atypical responses to exercise and electrocardiographic patterns.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

[Changes in blood flow velocity in the basal cerebral arteries following neck dissection].

Cerebral blood-flow velocities (cm/s) and pulse index (PI) were studied pre- and postoperatively in a total of 15 male patients following bilateral radical/functional (group A; n = 10) or unilateral radical neck dissection (group B; n = 5) using a 2 MHz-pulsed transcranial Doppler ultrasonographical system (TCD), with a transtemporal approach to the middle cerebral artery. Systolic and mean flow velocities were significant reduced with subsequent increases in PI during the first postoperative sonography in group A-patients while no significant differences in TCD date developed in group B. Blood-flow velocities and PI reached control values within three days. General hemodynamic and respiratory parameters did not influence the changes in TCD flow profiles with the exception of moderate increases in arterial CO2 during the early postoperative period. It is concluded that the reductions in blood-flow velocities and concomitant increases in PI reflect a heightened resistance to flow in the arterial cerebral vasculature. The decrease in cerebral vascular compliance suggests increases in the cerebral venous outflow following the resection of essential drainage pathways. However, TCD does not provide any information about the adequacy of cerebral blood flow.

Adult↗
PubMed1990

Radial partition fluorescent immunoassay of thyrotropin. Analytic evaluation and clinical correlation.

The authors evaluated the analytic and clinical performance of a sensitive radial partition fluorescent enzyme immunoassay for thyrotropin (TSH) performed on Stratus and compared it with a nonsensitive radioimmunoassay (RIA) method. Sensitivity of 0.15 mIU/L was obtained, and precision, specificity, and linearity were acceptable. A good correlation was observed between the two assays in samples from 311 hospitalized patients (r = 0.976). Stratus TSH results were outside the reference range for 20% of clinically euthyroid patients (n = 126), and 2.4% had undetectable levels. The clinically hyperthyroid group (n = 11) with the exception of one patient had TSH values below 0.2 mIU/L. Only 39% of hypothyroid patients on thyroid hormone replacement (n = 74) had TSH values in the reference range, with 38% and 23% exhibiting low and high values, respectively. All untreated primary hypothyroid patients (n = 8) had elevated TSH concentrations. The authors conclude that this sensitive TSH assay is useful for diagnosing hyperthyroidism when there is a clinical suspicion but cannot be recommended for thyroid screening in hospitalized patients.

Adult↗
PubMed1990

Interference in an automated radial partition fluorescent immunoassay of thyrotropin associated with liver-function abnormalities.

In a previous evaluation of a "sensitive" radial partition fluorescent immunoassay on the Stratus system, thyrotropin (TSH) values exhibited a positive bias in icteric samples when compared with results of a nonsensitive radioimmunoassay. In the present study, we evaluated 366 patients samples to assess whether any biochemical markers of liver function could identify samples for which TSH values would be falsely increased. gamma-Glutamyltransferase and total bilirubin concentrations were unrelated to discrepant TSH values. In contrast, alkaline phosphatase (ALP) was significantly positively correlated with differences in Stratus and RIA TSH concentrations (P less than 0.001). However, this correlation explained only 34% of the observed residual variability around the estimated regression line. On average, the higher ALP values were associated with larger discrepancies between Stratus and RIA TSH values, although several samples with increased ALP did not have falsely increased Stratus TSH values. TSH measurements performed with a Stratus should be interpreted with caution in patients with abnormal biochemical markers of liver function.

Autoanalysis↗
PubMed1990

Preoperative magnetic resonance imaging in Marfan syndrome.

We report one of the first cases in Israel of composite-graft repair of an aortic aneurysm in Marfan syndrome, in which preoperative evaluation was done noninvasively using magnetic resonance imaging (MRI). Because of the relatively favorable outcome of surgical compared with medical treatment of aortic aneurysm in patients with Marfan syndrome, surgery is now more frequently considered, even in asymptomatic patients. MRI is an excellent diagnostic tool for evaluating the thoracic aorta and has been suggested as a replacement for preoperative cardiac catheterization. In the case presented here, MRI preoperative confirmation of a 6.0-cm aortic aneurysm in an asymptomatic 38-year-old man with Marfan syndrome, was followed by composite ascending aorta and aortic valve replacement. The postoperative course was good. This case supports the view that aortic aneurysm replacement can be performed based on a noninvasive preoperative evaluation using MRI.

Adult↗
PubMed1990

[Thoracic impedance in the determination of hydration following heart surgery under extracorporeal circulation].

Changes in thoracic water content are measurable by determining basic impedance (Zo). In 57 cardiac surgical patients Zo decreased postoperatively by an average 24% corresponding to water retention of about 1.51. On the second postoperative day the difference to the initial preoperative value was still 8.5% corresponding to a water amount of over 500 ml. A close mathematic correlation exists between changes in the basic impedance (delta Zo) and fluid balance with a correlation coefficient of 0.94. The simple, non-invasive method is suitable for therapeutic control of fluid balance and quantitative diagnosis of pulmonary hyperhydration forms of various causes.

Adult↗
PubMed1989

[High-frequency jet ventilation in emergency tracheal puncture].

A case of obstruction of the upper respiratory tract is reported, in which an intubation or insufflation by rigid tracheobronchoscopes was not possible. Due to the anatomical situation after multiple operations and irradiation, coniotomy could not be performed. Blind puncture of the trachea with subsequent High Frequency Jet Ventilation has proved successful as an emergency approach to maintain respiratory function.

Airway Obstruction↗
PubMed1989

Usefulness of immediate postexercise two-dimensional echocardiography in post-myocardial infarction patients without ischemic ECG changes in stress testing: comparison with radionuclide angiography.

Of 38 post-myocardial infarction (MI) applicants for a cardiac rehabilitation program, 17 (45%) did not have ischemic ECG changes in exercise testing. Ten (59%) of these 17 patients had echocardiographic wall motion abnormalities at rest. Immediate postexercise two-dimensional echocardiography demonstrated exercise-induced changes in 8 (47%) patients (2 with normal and 6 with abnormal results from rest studies). The comparative radionuclide (RNA) examinations showed that there were 6 patients with abnormal findings from rest RNA; exercise-induced changes were detected in 7 (44%) of 16 patients (3 with normal and 4 with abnormal results from rest RNA tests). Statistical analyses, using RNA as reference point, revealed that the total correctly diagnosed cases for the echocardiographic rest studies was 13/17 (77%) and for the exercise studies, 13/16 (81%). The negative predictive values were 7/7 (100%) and 7/8 (88%), respectively. The corresponding positive predictive values were 6/10 (60%) and 6/8 (75%). The same pattern was observed when each segment (septal, apical, and posterolateral) was evaluated separately. The authors conclude that in post-MI patients with a negative stress test, the efficacy of postexercise echocardiography equals that of RNA in the identification of additional patients with ischemia.

Adult↗
PubMed1989

[The spectrum of bacterial strains and problems of antibiotic prophylaxis in an intensive care unit].

Out of a total number of 1,935 patients of a mainly cardiac surgically orientated intensive care unit, 103 material extractions and 111 germ diagnoses with resistance examinations were carried out in 60 patients. The infection rate was 3.1%. Thirty-two of the 60 patients died (53.3%). Fifty-seven patients (95%) underwent open-heart surgery. With respect to the total number of open-heart operations (n = 1,345), the rate of severe infections was 4.23%. The germ spectrum reveals a predominance of "problem germs", especially pseudomonas and enterobacteria. The results of the resistance examinations show that no antibiotic combination is suitable for complete germ elimination. Cefotiam (halospor) is effective against 50% of the germs. Problems of an antibiotic prophylaxis are shown. Recommendations are given to restrict antibiotic prophylaxis to 24 hours perioperatively, preferably using a cephalosporin preparation.

Anti-Bacterial Agents↗
PubMed1989

Stratus automated creatine kinase-MB assay evaluated: identification and elimination of falsely increased results associated with a high-molecular-mass form of alkaline phosphatase.

We compared the performance of an automated assay of creatine kinase MB isoenzyme (CK-MB) mass (Stratus) with that of a CK-MB enzymatic assay routinely used at our institutions. Both of these assays use the same CK-MB-specific monoclonal antibody to immunocapture CK-MB, thus providing a direct means of comparing a mass assay with an activity assay. Routine CK-MB measurements for 206 samples within the analytical range of both assays revealed the following relationship: Stratus (micrograms/L) = 0.67 (activity U/L) + 0.18 (r = 0.95, Sx.y = 4.45). The linearity, sensitivity, and precision of the Stratus assay were acceptable for routine clinical use. Icteric, lipemic, and hemolyzed samples do not interfere with the assay. During our evaluation we identified a single, clinically significant false-positive sample. Because this patient had alkaline phosphatase values greater than 1100 U/L, we investigated additional samples with increased activities of alkaline phosphatase and found that samples from 12 of 23 patients selected for alkaline phosphatase values greater than 460 U/L produced falsely increased CK-MB values. We determined that a membrane-associated, high-molecular-mass form of alkaline phosphatase was a cause of these falsely increased values and instituted an approach to identify falsely increased Stratus CK-MB values. Samples from 23 of 1933 patients were falsely increased, the increase being clinically significant in samples from 14 of these patients. Consultation with the manufacturer resulted in the successful reformulation of the substrate/wash solution to minimize interferences from high-molecular-mass forms of alkaline phosphatase.

Alkaline Phosphatase↗
PubMed1989

[Pulse oximetry in surgery of the bronchial system].

Oxygen saturation was determined by pulse oximetry in 35 children and adults during general anaesthesia using jet- or manually assisted ventilation for minor elective laryngeal and tracheo-bronchial surgery. The method is non-invasive and provides continuous information about the arterial oxygen saturation (saO2) and heart rate. Compromised arterial oxygenation during anaesthesia and the effects and brief ventilatory arrest are accurately detectable. Data such as pO2, pCO2 or pH cannot be assessed by pulse oximetry; carbon monoxide and methemoglobinaemia may lead to less accurate results. Pulse oximetry provides on-line information about sudden hypoxic events and allows early therapeutic intervention because arterial desaturation precedes the clinical signs and symptoms of hypoxia.

Anesthesia, General↗
PubMed1989

[Impedance cardiography following cardiac surgery].

For checking the possibility of using impedance cardiography in intensive care, 10 patients were examined before and up to 2 days after cardiac surgery with extracorporeal circulation. The comparison of stroke volumes examined by thermodilution with those calculated from impedance cardiography showed a good correlation (r = 0.933). The cardiac output measured by impedance cardiography was reduced to 77% of the initial preoperative value. It increased again to 94% on the second postoperative day. HEATHER-index and dZ/dt are well suited for supervision and quantitative treatment control in the postoperative period. The thoracic impedance was diminished more than 20% after extracorporeal circulation and did not yet reach the preoperative value on the second day. The continuous measurement of the thoracic impedance proved to be particularly helpful for assessing the pulmonary hydration and for controlling the fluid balance.

Cardiac Surgical Procedures↗
PubMed1989

[Tuberculin sensitivity and tolerance of "direct" BCG vaccination of youths leaving school].

In 3,296 school-leavers (girls and boys aged 16 years with preceding BCG-vaccination as newborns and without boosting by tuberculin-testing or revaccination during the meantime) simultaneously with compulsory BCG-revaccination tuberculin testing with 2 TU PPD Dessau + Tween 80 was performed in 3 regions of the GDR (Cottbus, Erfurt, Neubrandenburg) in the 2nd half of 1985 and in the 1st quarter of 1986. Sensitivity to tuberculin was found in 7.3% considering reactions with greater than or equal to 6 mm induration as positive, and in 2.9% considering reactions with greater than or equal to 10 mm only. Positive reactions greater than or equal to 6 mm include remaining allergy caused by BCG and non-specific tuberculin sensitivity while a reaction limit greater than or equal to 10 mm is suitable to define tuberculosis infection prevalence. In contrast to studies performed 1973 and 1979 in the same territories a significant decrease in tuberculin sensitivity was evident (43.8% positive reactions (greater than or equal to 6 mm) in 1973 and 11.7% in 1979). The acceptability of "direct" BCG-revaccination has been estimated by evaluation of local reactions 4 weeks after vaccination in 2,123 school-leavers. The ulceration rate in tuberculin positive adolescents was significantly higher than in tuberculin negative. It showed highly significant decrease in comparison with 1979.

Adolescent↗