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Biomedical subjects

H H Hilger

Publications and source records attributed to H H Hilger.

At least 55 records · Page 3Linked to original sources
PubMed1992

[Determination of normal values of the aortic blood flow profile using continuous Doppler echocardiography from apical and suprasternal echo position].

The present study was undertaken to measure normal aortic blood velocity profiles by means of continuous wave Doppler echocardiography from apical and suprasternal positions in 40 healthy adults. The profiles in the ascending aorta were measured from both positions, whereas the profiles in the descending aorta were measured only from the suprasternal position. The highest values for the maximal flow velocities were found in the ascending aorta from the suprasternal position (1.28 +/- 0.18 m/s), the lowest values for the maximal flow velocities were found in the descending aorta (1.17 +/- 0.22 m/s). This trend was also found for the mean velocity values. As to the time parameters, a longer acceleration time for the descending aorta was remarkable (106 +/- 24 ms), whereby the mean values for the ejection time for the descending aorta (308 +/- 25 ms, suprasternal: 320 +/- 30 ms). The highest values for the acceleration were found in the ascending aorta (suprasternal: 1526 +/- 531 cm/s2, apical: 1422 +/- 330 cm/s2) and the lowest values in the descending aorta (1208 +/- 378 cm/s2). Regarding the maximal velocity index there was no significant difference for the maximal values between the different transducer positions. The results of the regression analysis showed only a weak correlation of the maximal velocity values in the different transducer positions. This means that for follow-up examinations only those values should be used that were obtained from the same transducer position.

Adult↗
PubMed1992

[Assessment with magnetic resonance tomography of anatomy and ventricular function after Mustard correction of transposition of the great arteries].

In order to evaluate postoperative sequelae and ventricular function after Mustard-operation in patients with transposition of the great arteries (TGA), 30 patients were assessed by magnetic resonance imaging in EKG-triggered spin-echo (SE) and gradient-echo (GE) technique. Twenty-three patients, aged 4.7 to 15.8 years, had transposition of the great arteries with intact ventricular septum with or without left-ventricular outflow tract obstruction (TGA+IVS +/- SPS). Seven patients aged 9.5 to 21.7 years had transposition of the great arteries with ventricular septal defect (TGA+VSD). Five patients showed a residual baffle leak, one had a pulmonary venous obstruction, five an obstruction at the caval veins, 13 a left-ventricular outflow tract obstruction, and 14 a tricuspid regurgitation. Right-ventricular enddiastolic volume in patients with TGA+VSD (77.0 +/- 25.5 ml/m2) was significantly higher than in patients with TGA+IVS +/- SPS (61.2 +/- 12.0 ml/m2). In TGA+VSD right-ventricular ejection fraction (47.6 +/- 13.0%) was significantly lower than in patients with TGA+IVS +/- SPS (56.7 +/- 10.7%). The ratio of muscle masses of right to left ventricle was 1.8:1 in patients with TGA+IVS +/- SPS and 2.5:1 in patients with TGA+VSD. In conclusion, after Mustard-operation in patients with transposition of the great arteries (TGA) magnetic resonance imaging provides a comprehensive and noninvasive assessment of postoperative sequelae, residuae, and ventricular function and will, therefore, become the method of choice for postoperative evaluation.

Child, Preschool↗
PubMed1991

[Perimyocarditis in influenza A virus infection].

A 48-year old man was admitted with suspected acute myocardial infarction because of severe precordial pain and monophasic ST-elevations in the ECG. The patient's history of an ongoing infection, the localization, extent, and course of the ECG changes as well as the development of a pericardial effusion suggested viral perimyocarditis. The diagnosis was supported by a significant rise of antibodies (seroconversion) against influenza A virus.

Adult↗
PubMed1991

New option for balloon recanalization of total coronary occlusions.

In 9 out of 12 patients with a total coronary occlusion but definite signs of viable myocardium a new approach for the recanalization procedure was successfully employed: Following recanalization using an on-the-wire 2.0 or 2.5 mm angioplasty catheter, a standard coronary guidewire was placed along the angioplasty catheter. After withdrawal of the catheter, over-the-wire angioplasty with an appropriately sized balloon was performed for final dilatation. Pending further studies in a larger patient population, this new method may offer an alternative approach for revascularization of total coronary occlusions.

Aged↗
PubMed1991

Effects of a twenty-four-hour milrinone infusion in patients with severe heart failure and cardiogenic shock as a function of the hemodynamic initial condition.

The systemic and pulmonary arterial hemodynamics of 40 patients with severe congestive heart failure were determined during a 24-hour infusion of milrinone (0.5 micrograms/kg/min) after a loading dose of 50 micrograms/kg. A subgroup (n = 18) with severe cardiac pump dysfunction and three patients in cardiogenic shock were analyzed separately; their hemodynamic response was compared with that of the total group (n = 40). After 15 minutes of intravenous therapy with milrinone, the total group (n = 40) showed an increase of 65% in cardiac index; in the subgroup (n = 18) cardiac index increased by 94% after 15 minutes and by 106% after 30 minutes. Likewise, pulmonary capillary wedge pressure decreased after 30 minutes in both the total group (n = 40) and the subgroup (n = 18). The heart rate showed an overall tendency to decrease. The systolic blood pressure tended upward and remained statistically unchanged in the total group, whereas in the subgroup in which pressure was initially low, there was an increase in the systolic pressure after 1 hour and a further increase after 24 hours. Mean arterial pressure also rose in this subgroup. The early improvement in all measured hemodynamic parameters was sustained throughout the 24-hour infusion period. Development of tolerance was not observed, nor were any clinically symptomatic side effects or symptomatic arrhythmias. Thus intravenous milrinone is a safe medication for the rapid and prolonged improvement in hemodynamics, specifically in patients with severely restricted cardiac pumping function.

Adult↗
PubMed1991

Phosphodiesterase III inhibition or adrenoreceptor stimulation: milrinone as an alternative to dobutamine in the treatment of severe heart failure.

High levels of endogenous plasma catecholamines in patients with severe congestive heart failure induce a down-regulation of the myocardial beta-adrenoreceptors and thus cause adrenoreceptor agonists, such as dobutamine, to be less effective in the treatment of these patients. Phosphodiesterase III inhibitors work independent of adrenoreceptor activity and plasma catecholamine levels; thus these agents are likely to be more effective in the treatment of severe heart failure. The present study compares both the initial and late hemodynamic effects of dobutamine and milrinone during sequentially administered 24-hour infusions. Twenty patients with severe heart failure (New York Heart Association class III, n = 4; New York Heart Association class IV, n = 16) were investigated. Dobutamine could be administered at the prescribed maximum dose of 15 micrograms/kg/min for 24 hours in only 15 of 20 patients. In three patients the dose was reduced or dobutamine infusion completely stopped because of a drug-related increase in heart rate greater than 140 beats/min. Another 2 of 20 patients showed no hemodynamic improvement over 3 hours at the maximum dose of 15 micrograms/kg/min. Dobutamine administration was also discontinued in these patients on account of the existing unfavorable hemodynamic condition, and therapy with intravenous milrinone was started. All 20 patients responded to milrinone without side effects, although comparison of the hemodynamic effects during a 24-hour infusion was possible in only 15 patients. The 15 patients studied over both observation periods experienced an increase in heart rate from 88.8 to 105.6 beats/min (+ 1 hour; p less than or equal to 0.001) when receiving dobutamine but had no increase with milrinone. Stroke volume increased during dobutamine infusion from 19.3 to 28.9 ml/m2 (+49.6%) after 1 hour and then fell continuously to 25.2 ml/m2 after 12 hours; during milrinone therapy, stroke volume increased from 18.8 to 31.2 ml/m2 (+66%; p less than or equal to 0.001) and remained at this level until the end of the infusion (30.2 ml/m2). Pulmonary capillary wedge pressure (PCWP) decreased (p less than or equal to 0.001) immediately during milrinone therapy from 26.5 to 16.2 mm Hg after 30 minutes and stabilized at 20.1 mm Hg after 24 hours. During dobutamine infusion PCWP showed a delayed decrease from 27.8 to 19.0 mm Hg after 6 hours and subsequently rose to 22.7 mm Hg after 24 hours.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1991

Diagnostic value of transesophageal echocardiography in cardiac surgery.

The aim of this study was to assess the diagnostic value of intraoperative 2-D color Doppler transesophageal echocardiography (ITEE) for the surgeon and anesthesiologist in patients undergoing coronary bypass surgery or heart valve replacement. Information given by ITEE in 100 cardiac operations was documented. We judged the ITEE information, considering to what extent it was not to be obtained by other methods and to what extent it influenced the operation itself. The value was classified as dispensable (0), informative (1), valuable (2), or essential (3). In 50 consecutive patients with heart-valve replacement (25 aortic valve prostheses, 25 mitral valve prostheses) ITEE was 38 x (0), 8 x (1), 4 x (2). In 50 consecutive patients undergoing coronary artery bypass graft surgery it was 33 x (0), 11 x (1), 4 x (2), 2 x (3). The two essential diagnoses referred to undetected vein graft occlusions. Information classified as valuable mainly referred to left and right ventricular function or valvular and prosthetic valve function when difficulties occurred during and after extracorporeal circulation. In conclusion, information given by ITEE, although generally regarded as dispensable in the procedures considered, was valuable in 10% of cases and in 2% even essential.

Cardiac Surgical Procedures↗
PubMed1991

[Magnetic resonance tomography in patients with a heart valve prosthesis].

Artificial valve prostheses are often regarded as a contraindication for magnetic resonance imaging (MRI), although preliminary in vitro studies suggested, that patients with these metallic implants might safely undergo MR examination. This study reports on the experience with a group of 89 patients with 100 heart valve prostheses who were examined by spin-echo MR and gradient-echo MR. MR examination was performed in all patients without complications. The spin-echo sequence showed advantages in the depiction of anatomical structures like paravalvular abscesses. Anatomical structures adjacent to the artificial valve were clearly visible and the metal components of the valves showed no or only small artifacts. Artifacts were accentuated when using gradient-echo sequences. Gradient-echo sequences provided valuable information regarding the presence of valvular insufficiency. Physiological valvular regurgitation was easy to differentiate from pathological paravalvular or transvalvular regurgitation. These results demonstrate that patients with artificial valve prostheses can be imaged by MR without risk and that prosthesis-induced artifacts do no interfere with image interpretation.

Abscess↗
PubMed1991

Pentamidine aerosol increases the number of alveolar macrophages in HIV-infected patients.

In order to determine the possible effect of aerosolized pentamidine on the cellular composition of the bronchoalveolar lavage fluid in HIV-infected patients, differential counts of 22 consecutive patients who had been rebronchoscopied after 3-19 months were reviewed. Eleven patients were started on pentamidine prophylaxis subsequent to their first presentation. Eleven patients had never taken pentamidine or had discontinued the prophylactic regimen. Compared to first bronchoscopy, the bronchoalveolar lavage (BAL) from patients on regular prophylaxis revealed a significant increase in absolute alveolar macrophage (AM) counts at second presentation (20.8 +/- 11.2 to 50.3 +/- 39.4 x 10(5) cells/100 ml BAL; P less than 0.01). The AM counts of those without pentamidine remained essentially unchanged. Lymphocytes, including CD4 and CD8 subtypes, and neutrophils did not change over time in either group. The results of this retrospective analysis suggest that, in addition to its antimicrobial action, pentamidine may modulate local lung defence mechanisms, particularly by increasing the absolute number of AM.

Administration, Inhalation↗
PubMed1991

[Diagnosis and classification of tricuspid valve insufficiency with dynamic magnetic resonance tomography: comparison with right ventricular angiography].

To evaluate the diagnostic potential of magnetic resonance imaging (MRI) to diagnose and evaluate tricuspid incompetence (TI), right ventricular angiography (RVA) and MRI were compared in 51 patients. For angiographic semi-quantification a 4-grade modified Sellers classification was used. Several MRI-parameters (jet volume, jet area, number of slices with visible jet, duration of the regurgitation and volume of the right atrium) were examined concerning their validity to evaluate TI and compared to the angiographic data. Limits for MRI jet areas and volumes for each angiographic group were defined to obtain the best agreement with angiographic results. Thirty of 34 patients with angiographically visible TI (sensitivity = 88%) were diagnosed correctly with MRI. The 4 remaining patients also showed a small regurgitant jet which was, however, interpreted as physiologic. One of the 17 patients without angiographic TI was diagnosed as mild TI by MRI (specificity = 94%). MRI classification using jet volume (46/51 = 90% correct classifications) was not significantly better than the easier and faster MRI classification using jet area (43/51 = 84%). The other parameters (number of slices, duration of regurgitation and volume of the right atrium) showed considerable overlap between angiographic groups and did therefore not allow a classification into 4 grades. However, simple classification into hemodynamic relevant and irrelevant TI was possible. Thus MRI is able to diagnose TI with good sensitivity and specificity. Classifications based on jet volume and jet area showed good agreement with angiographic results. However, both parameters depend on the magnet and the pulse sequence used and must therefore be specifically determined for each imaging routine.

Adult↗
PubMed1991

Cardiopulmonary exercise testing (CPX) and transthoracic bioimpedance measurements: new tools for an "old disease" (congestive heart failure).

The purpose of the study was to examine the cardiovascular and cardiopulmonary exercise capacity in patients with symptomatic congestive heart failure more exactly than with conventional investigations, using the simultaneous non-invasive determination of the gas exchange parameters (ergospirometry, CPX) and of the hemodynamic (transthoracic bioimpedance). The reproducibility of the data were measured with each method with repeated tests under the same conditions in healthy subjects and patients with myocardial failure. Therefore we tested 15 patients with documented congestive heart failure repeatedly on a bicycle (semi-supine, +15 watts/min, symptom-limited). The ergospirometric (VO2, VCO2, RER = VCO2/VO2, max. VO2, VO2AT, VE, RR) and the bioimpedance-parameters (CI, SVI, HR) were measured simultaneously during rest and exercise. According to Wasserman et al. we used the VO2AT and the max. VO2 to assign the patients to the different Weber classes: Weber A: greater than 20 ml/min/kg max. VO2, greater than 14 ml/min/kg VO2AT; Weber B: 16 to 20 ml/min/kg max. VO2, 11 to 14 8 to 11 ml/min/kg VO2AT; Weber D: 6 to 10 ml/min/kg max. ml/min/kg VO2AT; Weber C: 10 to 16 ml/min/kg max. VO2, 8 to 11 ml/min/kg VO2AT; Weber D: 6 to 10 ml/min/kg max. VO2, 4 to 8 ml/min/kg VO2AT: Weber E: less than 6 ml/min/kg max. VO2, less than 4 ml/min/kg VO2AT. The V-slope-method according to Beaver et al. allowed for the determination of the anaerobic threshold in 13/15 patients. 2/15 patients didn't reach the anaerobic threshold. Oscillations of the gas exchange parameters due to Cheyne-Stokes-breathing were found in 9/15 patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

[The effect of hemodynamic changes in 24-hour milrinone infusion on sympathetic activity and the renin-angiotensin-aldosterone system in patients with severe heart failure].

The hemodynamics of 18 patients (subgroup A) with severe heart failure (baseline Cl less than or equal to 1.55 l.min-1.m-2), including three patients with cardiogenic shock, and another 22 patients (subgroup B) with moderate heart failure (baseline Cl from 1.55 to 2.5 l.min-1.m-2) were investigated during a 24 h milrinone infusion, combined with investigation of the response of the sympathetic tone (plasma catecholamine levels) and the renin-angiotensin-aldosterone system to the hemodynamic improvement in both subgroups. Cl increased (p less than or equal to 0.001) to 162.7% after 5 min and further to 206.4% of baseline after 30 min of milrinone therapy in subgroup A, and in B to 139.3% and further to 146.4% after 15 min. PCWP decreased (p less than or equal to 0.001) to 83.8% and further to 65.5% of baseline after 30 min in subgroup A, and to 58.4% in subgroup B. Heart rate decreased (p less than or equal to 0.05) from 99.4 to 94.7 bpm in A and showed a decreasing tendency in B. MAP rose in A from 75.5 to 79.4 after 1 h and further to 83.3 mm Hg (p less than or equal to 0.01) after 24 h; in subgroup B, MAP did not change. Plasma noradrenaline level decreased (p less than or equal to 0.001) in A from 1419.5 (B: 782.9) to 838.2 (B: 529.6) after 1 h and further to 655.1 (B: 467.9) pg/ml after 24 h. Plasma renin decreased (p less than or equal to 0.01) in A from 1047.6 (B: 460.2) to 597.4 (B: 222.5) and further to 392.6 (B: 191.7) microU/ml.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

[Hemodynamics with dobutamine and milrinone in patients with severe heart failure in an intra-individual comparison].

Hemodynamics during 24-h dobutamine (dob) and subsequent 24-h milrinone (mil) infusion were studied in 20 patients (pts) with severe heart failure (NYHA III: 4 pts, NYHA IV: 16 pts). Three of 20 patients showed a heart-rate increase to 140 bpm and more during dob; five patients were non-responders to dob. Heart rate rose (p less than or equal to 0.001) during dob from 88.8 to 105.6 bpm (+1 hr) and then decreased to 93.0 bpm after 24 h; stroke volume index increased (p less than or equal to 0.001) from 19.3 to 28.9 ml.m-2 (+49.6%) after 1 h and then decreased to 25.2 ml.m-2 after 12 h as did heart rate. During mil heart rate did not change; stroke volume index increased from 18.8 to 31.2 (+66.0%, p less than or equal to 0.001) after 1 h and showed no development of tolerance during the rest of the infusion period. PCWP decreased (p less than or equal to 0.001) during mil from 26.5 to 16.2 mm Hg after 30 min, tending upward again to 20.1 mm Hg after 24 h; during dob the decrease (p less than or equal to 0.01) of PCWP from 27.8 to 19.0 mm Hg after 6 h was delayed, also tending upward during the rest of the infusion period to 22.7 mm Hg after 24 h. There was no sustained decrease of PVR during dob, but after the start of mil infusion PVR decreased (p less than or equal to 0.001) from 312.7 to 172.1 dynes/s/cm-5 (+15 min), remaining on this level during the rest of mil infusion.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

[Acute pneumocystosis during polychemotherapy following the MACOP-B protocol].

Four out of eleven patients--none of them HIV positive--who received treatment for non-Hodgkin lymphoma by the MACOP-B protocol between June 1989 and February 1990 were taken ill during or shortly after the conclusion of the course with fulminant pneumonia necessitating artificial ventilation. In three cases Pneumocystis carinii was identified as the pathogen, and in one patient the diagnosis of pneumocystosis seemed probable. The mean cumulative doses given before the outbreak of pneumonia were as follows: cyclophosphamide 2753 +/- 1161 mg, methotrexate 1590 +/- 667 mg, bleomycin 36 +/- 16.8 mg and prednisone 4378 +/- 1734 mg. The mean haemoglobin concentration was 10.7 +/- 0.5 g/dl, leucocyte count 5250 +/- 2100/microliters, lymphocyte count 1300 +/- 300/microliters and lactate dehydrogenase 227 +/- 34 U/l. The cumulative doses and laboratory findings in the seven patients not affected by pneumocytosis were not significantly different. The patients with pneumonia were supported by mechanical ventilation for 6-26 days and treated with large doses of corticosteroids and co-trimoxazole. One patient died after 17 days' ventilation. Three patients were successfully weaned from the ventilator. Chemotherapy protocols such as MACOP-B predispose to acute Pneumocystis pneumonia. The risk of infection is independent of the cumulative doses of the drugs employed. For this reason, prophylaxis with co-trimoxazole is normally mandatory.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1990

[Hemodynamics and differentiated CO transfer following fulminant lung embolism and pulmonary artery embolectomy and following recurrent lung embolism].

Pulmonary embolectomy as an emergent surgical treatment after massive pulmonary embolism often is necessary in cardiogenic shock (CS) and even without previous diagnostic. If complete dissolution of the thromboembolus is possible or spreading of microemboli may occur is unknown. Therefore we studied 21 patients surgically treated by embolectomy, ten of these with consecutive cardiogenic shock (CS) and twelve patients after repetitive microembolism and cava-blocking. Besides lung-functional parameters for special CO-diffusion capacity (DLCO), differentiated in membrane (DM) and vascular (VC) component (Roughton and Forster), we measured mean pulmonary artery pressure (PAP) at rest and at exercise. Patients after repetitive embolism showed considerably more diminution of DLCO (-31%) than those after single massive embolic event (-15%) even concomitant by CS (-10%). Repetitive microembolism lowered VC by 21%. Slight decrease of DM was found after CS. Mean pulmonary artery pressure was elevated at rest (26 mm Hg) and exercise (33 mm Hg) after repetitive microembolism and normal after massive embolism or CS. Pulmonary embolectomy may prevent disturbances of DLCO or PAP even after CS. Damage of vascular integrity (VC) was found after microembolism. Pulmonary embolectomy seems to remove total embolic material and therefore seems to be optimal.

Adult↗
PubMed1990

[Advantages of biplane transesophageal echocardiography].

Biplane transesophageal echocardiography (BTEE) was intraoperatively performed on 27 patients; ten patients with coronary artery bypass graft surgery, ten with aortic valve replacement, five with mitral valve replacement, one with reconstruction of complete AV-canal, and one with surgical repair of dissecting aortic aneurysm. Compared with the transverse views of the monoplane TEE, BTEE permits the following additional images of the heart: 1) Longitudinal "two-chamber-view" for assessment of left ventricular (LV) anterior, apical, and posterior wall motion, and for assessment of mitral valve anatomy and function (e.g., grading of color flow regurgitation). 2) Imaging of the right-ventricular outflow tract (RVOT) for evaluation of RVOT obstruction, including a crosswise imaging of aortic valve. 3) Proximal two-thirds of the aorta ascendens for the diagnosis of dissecting aortic aneurysm (de Bakey Types I and II). 4) Imaging of the superior vena cava, helpful for detecting transposition of pulmonary veins. 5) Apex of left ventricle, advantageous for detecting thrombus. 6) Longitudinal view of the descending aorta: from the origin of the left subclavian artery down to the origin of the coeliac artery (origins of both vessels, inclusively). We prepared post mortem sections of the heart corresponding to the longitudinal echocardiographic views and documented them by photography. In conclusion, the second plane provides an important improvement in semi-invasive imaging of the heart.

Adult↗