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Biomedical subjects

G Lehmann

Publications and source records attributed to G Lehmann.

At least 19 recordsLinked to original sources
PubMed2006

Multi-site quantitative ultrasound compared to dual energy X-ray absorptiometry in rheumatoid arthritis: effects of body mass index and inflamed soft tissue on reproducibility.

The objective of the study is to evaluate multi-site quantitative ultrasound (QUS) in comparison to dual energy X-ray absorptiometry (DXA) considering the effects of body mass index (BMI) and disease activity on measurements in patients suffering from rheumatoid arthritis (RA). Sixty-eight patients underwent a cross-sectional analysis of bone mineral density measured by DXA (lumbar spine, total femur) and speed of sound estimated by QUS (phalanx III, distal radius). The short-term precision of QUS was investigated with regard to BMI of healthy individuals and with regard to the level of disease activity in patients suffering from RA. The patients with RA were divided into two BMI groups as well as into low and advanced disease activity groups. The short-term precision of QUS-SOS ranged from 0.90 to 2.55% (healthy controls) and from 0.64 to 1.89% (patients with RA). The association between DXA and QUS parameters were limited in the case of advanced disease activity and pronounced BMI. Low QUS-SOS was observed for advanced disease activity group (QUS-SOS phalanx: -2.5%; QUS-SOS distal radius: -2.1%) in comparison to low disease activity group, whereas only a slight change of DXA parameters was observed. DXA-BMD and QUS parameters revealed higher values with pronounced BMI. The system shows only a short-term precision with limitations in healthy controls with accentuated BMI, as well as in patients with active RA. The application of multi-site QUS seems to be restricted for patients with active inflammation based on soft tissue alteration in RA and for healthy individuals with pronounced body mass.

Absorptiometry, Photon↗
PubMed2006

Peripheral bone status in rheumatoid arthritis evaluated by digital X-ray radiogrammetry and compared with multisite quantitative ultrasound.

The development of secondary osteoporosis in rheumatoid arthritis (RA) has recently become well recognized, characterized by demineralization at axial and in particular periarticular peripheral bone sites. Our aim was to evaluate multisite quantitative ultrasound (QUS) compared to digital X-ray radiogrammetry (DXR) by the quantification of cortical bone loss dependent on the severity of RA. Fifty-three patients with verified RA underwent QUS measurements (Sunlight Omnisense 7000) with estimation of the speed of sound (QUS-SOS) at the distal radius and at the phalanx of the third digit. Also, bone mineral density (DXR-BMD) and metacarpal index (DXR-MCI) were estimated on metacarpals II-IV using DXR technology. Additionally, Larsen score and Steinbroker stage were assessed. Disease activity of RA was estimated by disease activity score 28 (DAS 28). For the group with minor disease activity (3.2 5.1), QUS-SOS of the radius revealed a significant correlation to DXR-BMD (R = 0.71) and DXR-MCI (R = 0.84), whereas for QUS-SOS (phalanx) no significant association to the DXR parameters was shown. The DXR parameters and, to a lesser extent, the QUS data also demonstrated pronounced declines in the case of accentuated disease activity (DAS > 5.1). Both DXR-BMD (-25.9 %, P < 0.01) and DXR-MCI (-38.6 %, P < 0.01) revealed a notable reduction dependent on the severity of RA. Otherwise, QUS-SOS marginally decreased, with -2.6% (radius) and -3.9% (phalanx). DXR revealed a significant reduction of DXR-BMD as well as DXR-MCI dependent on the severity of RA and surpassed multisite QUS as a promising diagnostic tool.

Absorptiometry, Photon↗
PubMed2006

[The osteoporosis patient with renal insufficiency: what has to be taken into account in the selection and administration of antiosteoporosis medication?].

The incidence of osteoporosis and renal insufficiency increases with age, the use of antiosteoporotic drugs approved for long-term administration in patients with inadequate renal function is therefore a cause for concern. In the dose approved for the treatment of osteoporosis oral bisphosphonates and i.v. ibandronate (3 mg every 12 weeks) have a secure antifracture efficacy, and their use is considered safe in patients with glomerular filtration rate (GFR) > 30 mI/min. Treatment with strontium ranelate and the osteoanabolic substance teriparatide is not altered by impaired renal function until GFR falls below 30 ml/min. Efficiancy of the selective estrogen receptor modulator (SERM) raloxifene is not altered by renal function.

Administration, Oral↗
PubMed2006

Advanced glycation end product modification of bone proteins and bone remodelling: hypothesis and preliminary immunohistochemical findings.

BACKGROUND: The process of bone remodelling is disturbed in the development of osteoporosis. OBJECTIVE: To investigate if proteins in osteoporotic bone are modified by advanced glycation end products (AGEs), and whether these alterations are related to measures of bone remodelling based on histomorphometric findings. METHODS: Bone specimens taken from the iliac crest by bone biopsy of eight osteoporotic patients were investigated by histomorphometry and by immunohistochemical staining with the AGEs imidazolone and N(epsilon)-carboxymethyllysine. RESULTS: Both AGEs were found in all bone specimens. The intensity of staining correlated with patient age. The percentage of bone surface covered with osteoblasts showed a significantly negative correlation with the staining intensity of both AGEs. CONCLUSIONS: It is known that AGEs can regulate proliferation and differentiation of osteoblastic cells and that AGE-specific binding sites are present in cultured osteoblast-like cells. Moreover, AGE induced biological effects in these cells might be mediated by RAGE (receptor of AGE) or by other AGE receptors in different stages of osteoblast development. The inverse relation between AGE staining intensity and the percentage of bone surface covered with osteoblasts in the trabecular bone may provide evidence that AGE modification of bone proteins disturbs bone remodelling.

Adult↗
PubMed2005

Digital radiogrammetry as a new diagnostic tool for estimation of disease-related osteoporosis in rheumatoid arthritis compared with pQCT.

OBJECTIVES: To investigate the potential of a new osteogeometric technology based on digital X-ray radiogrammetry (DXR) as a diagnostic tool for quantification of severity-dependent osteoporosis, and to distinguish between inflammation-mediated and corticoid-induced variations of bone mineralisation in patients suffering from rheumatoid arthritis. METHODS: Ninety-six patients (duration of disease: <18 months) underwent retrospective calculations of bone mineral density (DXR-BMD) and metacarpal index (MCI) by DXR, which were calculated from plain radiographs of the non-dominant hand. For comparison, pQCT-calculated BMD (total, cortical-subcortical and trabecular partition of bone tissue) was done on the distal radius. Severity was classified using Ratingen Score by two independent radiologists, and divided into three main groups. In addition, the patients were separated into those with corticoid medication (n=44; 5 mg/day over a half year period) and a control group (n=52) without any corticoid therapy. RESULTS: Correlations between DXR-BMD and MCI versus pQCT parameters were all significant (0.36<R<0.71; p<0.01), independent of corticoid therapy. Only in the group without corticoid application, the correlation between DXR-BMD and pQCT-BMD (cortical) showed no significant association. For patients with corticoid therapy, our data revealed the lowest correlation coefficient between DXR parameters and pQCT-BMD (trabecular). Without a difference in comparison to corticoid therapy, the significant relative decrease of BMD estimated by DXR between the highest and lowest score was between 11.1% and 14.3% and for MCI between 15.8% and 17.8%. The also significant relative decrease of trabecular BMD using pQCT varied from 10.3% to 16.9%, whereas no significant results could be verified for pQCT-BMD (cortical and total). CONCLUSIONS: Digital radiogrammetry can precisely estimate severity-dependent cortical reduction of bone mineral density in patients suffering from rheumatoid arthritis both with and without corticoid therapy, and seems to be able to distinguish the side effects of antirheumatic treatment from the disease-related periarticular bone loss. The detection and quantification of periarticular osteoporosis by DXR could be an important diagnostic tool in early rheumatoid arthritis.

Absorptiometry, Photon↗
PubMed2005

Digital X-ray radiogrammetry combined with semiautomated analysis of joint space widths as a new diagnostic approach in rheumatoid arthritis: a cross-sectional and longitudinal study.

OBJECTIVE: To evaluate digital x-ray radiogrammetry (DXR) and the Radiogrammetry Kit program as new diagnostic tools for quantifying disease-related periarticular osteoporosis and for measuring joint space narrowing according to the severity and duration of rheumatoid arthritis (RA). METHODS: Using DXR, we performed computerized calculations of bone mineral density (BMD) and the metacarpal index (MCI) in 258 patients with active RA. Using the Radiogrammetry Kit program, we also performed semiautomated measurements of joint space width (JSW) at the second through the fifth metacarpophalangeal (MCP) joints in these patients. RESULTS: All correlations between the different parameters of both techniques (BMD and the MCI as measured by DXR and MCP JSW as measured by the Radiogrammetry Kit) were significant (0.36 < or = R < or = 0.63; P < 0.01). As expected, a significant negative association was shown between the different MCP JSW results and the results of all scoring methods (-0.67 < or = R < or = -0.29). The BMD and the MCI measured by DXR both decreased significantly between Steinbrocker stage I and stage IV (by 32.7% and 36.6%, respectively; both P < 0.01). Reductions in the overall (mean) MCP JSW varied from 35.3% (Larsen score) to 52.9% (Steinbrocker stage). Over a period of 6 years, we observed relative decreases in BMD and the MCI as measured by DXR (32.1% and 33.3%, respectively), as well as in the overall (mean) MCP JSW (23.5%), and these were pronounced in early RA (duration <1 year). In addition, excellent reproducibility of DXR and Radiogrammetry Kit parameters was verified (coefficients of variation <1%). CONCLUSION: DXR with the integrated Radiogrammetry Kit program could be a promising, widely available diagnostic tool for supplementing the different RA scoring methods with quantitative data, thus allowing an earlier and improved diagnosis of RA and more precision in determining disease progression.

Absorptiometry, Photon↗
PubMed2005

[Influence of body constitution on bone mineral density measured by digital radiogrammetry].

PURPOSE: In addition to many established osteodensitometric techniques, digital radiogrammetry (DXR) is considered to be a reliable method for measuring the cortical bone mineral density (DXR-BMD). This study investigates the influence of body constitution on BMD of healthy adults as calculated by DXR. MATERIALS AND METHODS: In a prospective study, 246 adults without bone affecting diseases in their clinical history underwent DXR for analysis and calculations of bone mineral density and determination of metacarpal index (MCI) and porosity index (PI). Height, weight and body mass index (BMI) were recorded for each patient. RESULTS: For all individuals and for all BMI subgroups, both height (0.55 < R < 0.70, p < 0.01) and body weight (0.56 < R < 0.78, p < 0.01) correlated closely with DXR-BMD. Only in the over-weight group, no significant correlation was found between body weight and DXR-BMD. In addition, a significant reduction of the relative DXR-BMD and MCI values was observed between the over-weight and the under-weight group as well as between normal-weight and under-weight individuals (p < 0.01). Otherwise, cortical porosity decreased with increasing body weight. CONCLUSION: Similar to Dual Energy X-ray Absorptiometry-based studies (DXA), digital radiogrammetry measures an increase in BMD with increasing body weight. Therefore DXR, which provides a precise technique without influence of soft tissue, seems to be a promising technique for quantifying marginal alterations in cortical BMD as well for following the course of osteoporosis.

Absorptiometry, Photon↗
PubMed2004

[Clinical trial for differentiation between corticoid-induced osteoporosis and periarticular demineralization via digital radiogrammetry in patients suffering from rheumatoid arthritis].

PURPOSE: To investigate a new bone densitometric technology based on digital radiogrammetry (DXR) with respect to its ability to measure severity-dependent variations of bone mineral density (BMD) in patients with rheumatoid arthritis and to differentiate between corticoid-induced and periarticular bone mineral density loss. PATIENTS AND METHODS: A total of 153 randomly selected patients suffering from verified rheumatoid arthritis underwent digitally performed plain radiographs of the non-dominant hand and also measurements of dual-energy X-ray absorptiometry (DXA) regarding total femur and lumbar spine in 102 patients and peripheral quantitative computed tomography (pQCT) regarding the distal radius in 51 patients. Using DXR the radiographs of the non-dominant hand were analyzed for cortical bone mineral density calculation. The severity was classified in the DXA group using the Ratingen score. Furthermore, both study populations were divided into patients with and without corticoid therapy. RESULTS: Correlations between BMD determined by DXR and by DXA (R=0.44 for lumbar spine and R=0.61 for total femur) versus pQCT (0.46<R<0.59) were all significant. An appropriate association was confirmed between pQCT and DXA (R=0.61 for total femur and 0.73 for LWS). In the subgroup of patients with corticoid therapy (mean dose: 5 mg/d for a period of more than 6 month), our data showed-similar to the collective of all patients-significant correlations (0.34<R<0.59) between DXR and the other methods. In contrast to pQCT (0.37<R<0.59) the study revealed a poor association between DXR- and DXA-parameters in the subgroup of patients without corticoid therapy; only the correlation between DXA-BMD of total femur and DXR-BMD achieved a significant level (R=0.38, p<0.05). The mean value of BMD measured by DXR decreased severity dependently from 0.59 g/cm(2) (Stage 1) to 0.46 g/cm(2) (Stage 5). Similar results were verified for the metacarpal index (DXR). The relative decrease of BMD between the highest and lowest score was 21% (p<0.05). Otherwise the reduction of bone mineral density using DXA revealed no significant results. CONCLUSION: The DXR-based BMD calculation can distinguish severity and progress of disease-related periarticular demineralization in contrast to those of DXA. In this context, DXA primarily measures the systemic (corticoid-induced) osteoporosis and pQCT partially estimates disease-related bone mineral density loss, whereas DXR can predominantly analyze and quantify the periarticular demineralization, which often shows a manifestation at an early stage of rheumatoid arthritis. Therefore DXR seems to be a diagnostic tool in the course of rheumatoid arthritis.

Absorptiometry, Photon↗
PubMed2003

Potential clinical relevance of digital radiogrammetry for quantification of periarticular bone demineralization in patients suffering from rheumatoid arthritis depending on severity and compared with DXA.

The aim of this study was to investigate a new bone densitometric technology based on digital radiogrammetry (DXR) with respect to its ability to measure severity-dependent variations of bone mineralization in patients with rheumatoid arthritis. One hundred six randomly selected patients suffering from verified rheumatoid arthritis underwent digitally performed plain radiographs of the non-dominant hand and measurements of dual-energy X-ray absorptiometry (DXA) regarding total femur and lumbar spine. Using DXR the radiographs were analyzed retrospectively for bone mineral density (BMD) calculation. The severity was classified using Larsen score and Steinbroker stage blinded by two radiologists. A third radiologist reviewed the incongruently scored cases. Mean values of calculated parameters changed as follows from Larsen 1 to Larsen 5: Bone mineral density (DXR-BMD) decreased from 0.55 to 0.44 g/cm2 (p=0.000), DXR-MCI decreased from 0.44 to 0.33 (p=0.001), DXA-BMD (total femur) decreased from 0.92 to 0.78 g/cm2 (p=0.090) and DXA-BMD (lumbar spine) decreased from 0.91 to 0.84 g/cm2 (p=0.595). Similar results were verified for the Steinbroker stage. The relative decrease of BMD measured by DXR between the highest and lowest score was 20% for Steinbroker stage and Larsen score (p<0.05). The relative decrease of BMD using DXA revealed not such a significant result. Similar results were verified for metacarpal index (estimated by DXR). Correlations between BMD determined by DXR and by DXA were all significant (R=0.45 for lumbar spine and R=0.59 for total femur). Consequently, less than 35% of the DXR-BMD value is explainable by corresponding DXA values. The DXR-based BMD calculation seems to be able to distinguish severity and progress of the disease in contrast to those of DXA at lumbar spine and total femur.

Absorptiometry, Photon↗
PubMed2003

Advanced glycation end-products pentosidine and N epsilon-carboxymethyllysine are elevated in serum of patients with osteoporosis.

OBJECTIVE: To investigate serum levels of the advanced glycation end-products (AGEs) pentosidine and N epsilon-carboxymethyllysine (CML) in patients classified into different osteoporosis subgroups according to histomorphometric data. METHOD: Serum samples were obtained from 116 osteoporotic patients (34 men, 82 women) classified by bone histomorphometry into subgroups with high turnover (HTO, n = 32), low turnover (LTO, n = 39), normal turnover (NTO, n = 9) and cellular uncoupled osteoporosis (CUO, n = 36). Pentosidine was measured by high-performance liquid chromatography, and CML by a competitive enzyme-linked immunoassay. RESULTS: The entire osteoporosis group had significantly higher pentosidine and CML serum concentrations than healthy subjects. In contrast to healthy subjects, no correlation between levels of AGEs and age could be found. In subgroups characterized by increased bone resorption (HTO, CUO), serum pentosidine correlated significantly with the histomorphometric marker reflecting osteoclast activity/bone resorption (eroded surface as a percentage of trabecular surface). Moreover, in CUO a strong correlation between pentosidine and the mineral apposition rate was found. Surprisingly, in HTO the levels of CML and percentage of eroded surface were significantly negatively correlated. CONCLUSION: AGE-modified proteins may be a cause of disturbed bone remodelling in osteoporosis. Our findings do not support the alternative hypothesis that increased AGEs in serum indicate only a more intensive releasing of AGEs in circumstances of increased bone resorption.

Adult↗
PubMed2002

[Severe adverse event following iv administration of 10 ml 6% Dextran60 (0.6 g) in a healthy volunteer].

We describe the case of a 24-year-old healthy volunteer who underwent a dextran-induced anaphylactic/anaphylactoid reaction (DIAR) type III after administration of 10 ml 6% Dextran60 (0.6 g) during a preliminary examination. There were no specific incidents in the medical history or any infusions of any colloids. In contrary to other DIAR case reports of anaphylactic reactions, in this case we observed a latency period after intravenous application of Dextran60 to the first clinical symptoms of anaphylactic shock of about 5 min. The initial decrease of systolic blood pressure to less than 90 mmHg and consecutive increase in heart rate to higher than 90 bpm returned to normal after therapy with head-down position, iv injection of 2 mg Clemastin, 100 mg hydrocortisone and infusion of 500 ml hydroxyethyl starch after approximately 8 min. During this period responsiveness was unsatisfactorily although the volunteer complained about warming of the skin, paresthesia and nausea. Immediate shock symptoms that normally belong to antigen-antibody reactions were not observed. It is therefore still unclear whether this case was caused by antibody reactions. Nevertheless, to provide DIAR it is still absolute necessary to give 20 ml Promit((R)) 15% in advance. It is not an acceptable alternative to infuse the first 100 ml of dextran as a bolus and it must remain a point of discussion as to whether the reactions described could have been due to a bolus administration of the first 100 ml Dextran. It is absolutely necessary to accurately monitor the first 10 min after an infusion even if only small volumes of dextran (i.e. 0.6 g) are infused. This is becoming more and more important due to the increasing use of "small volume resuscitation", solutions containing dextran (RescueFlow((R)), Biophausia AB, Uppsala, Schweden) or cryoconservation with dextran.

Adult↗
PubMed2002

[Thrombelastographic coagulation analysis following in vitro and in vivo haemodilution with hydroxyethyl starch (HES)].

In the study presented the effects of in vitro hemodilution with HES on coagulation are compared with the effects of in vivo hemodilution using thrombelastography (TEG). The in vivo hemodilution was performed by the i. v. infusion of 1000 ml 6 % solution of hydroxyethyl starch HES (2 formulations with HES 130/0.4 and one formulation with HES 200/0.5) in healthy volunteers during 30 min. The in vitro hemodilution was performed with blood samples taken from the volunteers before the infusion was started. These samples were diluted with HES-solution until the same hemoglobin concentration measured at the end of the infusion was attained. The in vivo TEG-parameters remained in the reference range of the method, however all in vitro TEG-parameters are out of the range of normal values. The isolated interpretation of the in vitro data shows an impairment of blood coagulation. The shortening of the reaction time as an indicator for the initiation of blood clotting points to activated coagulation by in vivo hemodilution with HES, whereas in vitro the prolongation of the reaction time is indicative for retardation of clotting. The evaluation of the TEG-parameters and of other clotting parameters determined prior to the beginning of the infusion, at the end of the infusion and four hours after termination of the infusion of HES 130/0.4 and of HES 200/0.5 to healthy volunteers show alterations of blood coagulation parameters caused mainly by dilutional effects. The more pronounced alterations found in vitro cannot be interpreted as impairment of haemostasis in vivo. On the other hand, the likewise haemodilution in vitro causes an impairment of coagulation. Therefore, the effects of in vitro hemodilution with HES on coagulation differ qualitatively and quantitatively from the effects of in vivo hemodilution.

Adult↗
PubMed2002

Aluminum deposition in the bone of patients with chronic renal failure--detection of aluminum accumulation without signs of aluminum toxicity in bone using acid solochrome azurine.

In this study, the sensitivity of the aurine tricarboxylic acid (ATA) and acid solochrome azurine (ASA) stain for aluminum were compared under special consideration of the relationship to bone histology in renal osteodystrophy. Al deposition in iliac crest bone biopsies taken from 78 patients with chronic renal failure (CRF) was assessed histochemically using the ATA and ASA stain; the Al accumulation was correlated with bone histology and histomorphometry. Significantly more Al was detectable with the ASA method on trabecular bone surfaces and cement lines (18 +/- 20% vs 4 +/- 12% on surfaces; 13 +/- 18% vs 0.4 +/- 1.3% on cement lines). In 31 cases in which ATA yielded negative results, ASA in contrast indicated Al deposits on up to 20% of the trabecular bone surface. The specimens with more Al on the trabecular bone surface had a significantly higher osteoid volume and osteoid surface. With ATA, these differences were observed at a staining of > or = 10% of the trabecular surface, with ASA at a staining of > or = 40% of the trabecular surface. Therefore, it seems to be possible to detect a very low Al deposition, without any Al-induced changes in bone morphology or signs of Al toxicity in the bone using the ASA method. By contrast, a positive ATA stain is mainly found in biopsies with typical signs of Al-induced changes of histomorphometric bone parameters. We, therefore, recommend the routine use of the ASA stain to detect Al deposition in bone.

Adult↗
PubMed2001

[Problems of electrocardiographic diagnosis of occlusion of the left circumflex coronary artery].

BACKGROUND AND OBJECTIVE: The electrocardiographic diagnosis of posterior myocardial infarction is difficult. It was the objective of the present study to evaluate ST-segment changes in angiographically documented occlusion of the left RCX in the setting of an acute myocardial infarction and to analyse the value of the posterior chest leads V(7)-V(9). PATIENTS AND METHODS: Data of 120 patients (88 males, on average 61+/-13 years old) with an acute myocardial infarction and angiographically proven occlusion of the left circumflex artery were included in the study. Mean time of pain onset to ECG recording was 5.5 +/- 2.8 hours. The ECGs were analysed for ST-segment changes of > or = 1 mm in two contiguous leads in surface leads I-aVF, > or = 2 mm in the precordial leads V(1)-V(6), and > or = 1 mm in right precordial (V(3)R-V(6)R) and posterior (V(7)-V(9)) leads. These additional leads were recorded only in a subgroup of 36 patients. Maximal creatine kinase activity was determined as a measure of infarct size. RESULTS: Standard leads I-V(6) showed ST-segment elevation in 55 of 120 patients (46 %). In the subgroup of patients with extended chest leads 61 % (11/36) had significant ST-segment elevation, whereas isolated ST-segment elevation in the posterior leads occurred in 8 % (3/36). ST-segment depression in the standard leads was observed in 73 of the 120 patients (54 %), and isolated ST-segment depression was seen in 31 patients (26 %). No significant ST-segment changes in the standard leads were found in 34 patients (28 %). Maximum CK values were not significantly different among the three groups (1107 +/- 815 IU/l vs 953 +/- 651 IU/l vs 816 +/- 553 IU/l; (P = 0.447). CONCLUSION: These findings confirm that the sensitivity of the standard ECG leads is less than 50 % in angiographically documented occlusion of the left RCX. The extended posterior chest leads (V(7)-V(9)) improve sensitivity only marginally (by 8 %). Isolated ST-segment depression or no significant ST-segment depression in the standard leads was observed in 26 % and 28 % respectively. The infarct size - as measured by maximum CK-values - did not differ among the respective groups.

Aged↗
PubMed2001

Maintenance of sinus rhythm after electrical cardioversion of persistent atrial fibrillation; sotalol vs bisoprolol.

AIMS: The purpose of the study was to compare the efficacy and safety of sotalol and bisoprolol in the maintenance of sinus rhythm after electrical cardioversion of atrial fibrillation. METHODS: Patients (n=128) were randomized to sotalol (80 mg b.i.d.) or bisoprolol (5 mg x day(-1)). Patients with contraindications to beta-blockers, class III antiarrhythmic drugs or prior treatment with use of study medication for prevention of atrial fibrillation were excluded. Follow-up clinical evaluation was performed 1 day and 1 month after cardioversion and thereafter at 3-month intervals. RESULTS: There were no group differences in baseline clinical characteristics. After a follow-up of 12 months, 59% of all patients were still in sinus rhythm. The fraction remaining in sinus rhythm was calculated for the two groups by Kaplan--Meier analysis. During follow-up, 41% of patients on sotalol and 42% on bisoprolol developed atrial fibrillation (ns). In two patients (3.1%) on sotalol, life-threatening proarrhythmias (torsade de pointes tachycardias) occurred, whereas none were found in the bisoprolol group. Symptomatic bradycardias occurred in two patients on sotalol and three on bisoprolol. CONCLUSION: This study demonstrates that sotalol (160 mg x day(-1)) and bisoprolol (5 mg x day(-1)) are equally effective in maintaining sinus rhythm. Because of the side effects of sotalol, bisoprolol seems to be advantageous for maintenance of sinus rhythm after cardioversion of atrial fibrillation.

Adrenergic beta-Antagonists↗
PubMed2001

[The in vivo molecular weight and renal threshold of hydroxyethyl starch in the example of molar substituted HES70/0/5].

The intravascular changes of the in vivo molecular weight of HES 70/0.5 were investigated on healthy volunteers. A repeated daily infusion of 835 ml of 6% HES solution (50 g HES 70/0.5; Rheohes) during four hours on five consecutive days was performed. The analysis of the distribution of the molecular masses in serum and urine was performed by SEC-HPLC with MALLS/RI detection. The in vivo average molecular weight (Mw) of HES was found to be 58,000 Da at the end of the infusion. This was lower than the Mw of 66,000 Da as measured initially in the HES solution. In the time following the infusion Mw increased steadily up to 64,000 Da because of renal elimination of low molecular HES. However, in the morning before the start of the next infusion of HES, the average molecular weight Mw of HES was even higher up to 71,000 Da. In the first collected portion of urine (i.e. up to 8 h after beginning the infusion) the average molecular weight of HES was as low as 17,000 Da. During the next hours (i.e. in the second collection period lasting from 8 up to 24 h after start of the HES infusion) Mw of HES increased up to 28,000 Da. The top fraction of the first period showed molecular masses of 27,000 Da, in the second collection period top fraction of molecular masses measured 40,000 Da. According to the presented data it is concluded that the renal threshold for medium substituted HES is independent of the initial Mw and related primarily to the molar substitution of the HES used. This renal threshold for medium substituted HES is determined to be at 40,000 Da. The in vivo Mw of HES is variable and related to the sampling time and predicted predominantly by the molar substitution of the HES used. The in vivo Mw, therefore, is not suited for characterisation of HES.

Adult↗