[Naftidrofuryl in patients with prosthetic femoral-popliteal bypass].
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Adult↗
Biomedical subjects
H Hirche
Publications and source records attributed to H Hirche.
[Can the progression of arteriosclerosis be influenced pharmaco- logically?].
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Adult↗
[Variability of transcutaneous p02 in repeated measurements in patients with peripheral arterial occlusive disease].
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Arterial Occlusive Diseases↗
Inotropic changes in ischaemic and non-ischaemic myocardium and arrhythmias within the first 120 minutes of coronary occlusion in pigs.
In 16 anaesthetized open-chest pigs occlusion of the distal third of the LAD was performed. Local myocardial contractility within and outside the ischaemic area, measured using electromagnetic and ultrasonic probes, arrhythmias and plasma catecholamine concentrations were monitored during 180 min before and 120 min after occlusion of the distal LAD. 5 pigs developed ventricular fibrillation (VF) during phase 1 a of arrhythmias (1-6 min post occlusion) and a further 5 pigs during phase 1 b (10-30 min post occlusion). Segment lengthening within the ischaemic area, measured at the beginning of ventricular ejection, started within a few seconds of ischaemia and reached 11-13.5% of end-diastolic length prior to occlusion after 2 min of ischaemia. Between 2 min and 120 min after the onset of occlusion, no further segment lengthening was observed. There were no significant differences in segment lengthening between VF and non-VF pigs. However, within the VF group, mechanical alterations 2 min after the onset of ischaemia were more marked in pigs developing VF within phase 1 a than those with VF in phase 1 b. VES increased markedly after 50 min of occlusion and seemed to occur independently of further mechanical alterations, VF within the first 30 min of ischaemia often occurred without preceding VES.
Animals↗
Sequential or single pulse defibrillation? Investigations towards energy reduction in experimental animals.
With introduction of the automatic implantable cardioverter-defibrillator for treatment of medically refractory ventricular arrhythmias, many investigations are focussing on possibilities of reducing the energy necessary for defibrillating the heart to obtain a more adequate size and a longer durability of the generator. Several studies favour the sequential pulse delivery, using three electrodes, either endocardial, epicardial or subcutaneous plates, to improve defibrillation performance of low energy shocks. However, the validity of this conclusion remains equivocal since two different electrode configurations were used for single and sequential defibrillation. In the present study the influence of sequential pulse delivery, pulse sequence and resultant current pathways on defibrillation energy requirements were examined in comparison with single-shocks between the same epicardial electrode configuration as well as four orthogonally positioned patches. The energy requirement for 100% efficiency could be reduced by sequential pulsing with a time interval of 1 msec thus yielding significant superiority compared to single pulse defibrillation using three electrodes. The same reliable defibrillation and reduced threshold has been obtained by using four electrodes and one single shock. The addition of a third electrode alone had no influence on the energy requirements. Therefore, we have to discuss a different electrophysiological mechanism for sequential defibrillation than for single shocks with an extended current distribution over the heart using four electrodes. Possibly the action potential of the single cell of the fibrillating heart is of interest in reflecting the efficiency of sequential pulse defibrillation. By influencing the action potential pharmacologically in some animals, the optimal time interval for double shocks could be extended up to 7 msec.(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗
Effects of morphine on catecholamine release and arrhythmias evoked by myocardial ischaemia in rats.
The effects of morphine (10 mg kg-1 i.p.) on haemodynamics, arrhythmias and plasma and myocardial catecholamines (CA) were studied after coronary artery occlusion in anaesthetized rats. Myocardial intraneuronal CA were assessed histofluorimetrically and CA concentrations measured by high performance liquid chromatography. Morphine increased blood pressure, presumably due to higher plasma noradrenaline (NA) concentrations found in morphine-treated rats. Morphine increased the area of catecholamine-containing fluorescing neurones in the myocardium (as a percentage of total field area) 60 min after sham-operation (0.87 +/- 0.07%) or occlusion (0.57 +/- 0.05%) compared to untreated animals (0.67 +/- 0.06 and 0.38 +/- 0.03% respectively). Tissue NA content was not significantly affected by coronary occlusion and/or morphine within the first 60 min. Morphine had no effect on ischaemia-induced arrhythmias. Whether the higher intraneuronal NA content following morphine resulted from reduced central sympathetic outflow to the heart, presynaptic inhibition of NA release, or increased uptake due to higher plasma concentrations is unclear. Ischaemia-induced local NA release appears independent of these mechanisms, as it was unaffected by morphine.
Animals↗
Effects of high and low doses of methimazole in patients with Graves' thyrotoxicosis.
In spite of the long-established use of antithyroid drugs, there are many unsettled questions connected with this treatment of Graves' disease. There is a lack of controlled prospective trials studying the results of antithyroid drug therapy while considering the many variables such as disease heterogeneity, regional differences, drug dosage and duration of treatment. Therefore, a multicenter study has been set up in order to compare the effects of two fixed doses of methimazole (10 vs 40 mg) with thyroid hormone supplementation on the clinical, biochemical and immunological course of Graves' disease and on remission rates. Experience accumulated so far suggests that treatment is safe using either 10 or 40 mg of methimazole. While there is a tendency for an advantage of the higher dose within the first weeks (higher effectiveness in controlling hyperthyroidism), this difference is not significant. The impact of dosage on remission rates remains to be shown.
Adult↗
Effects of lidocaine on catecholamine release in the ischemic rat heart.
The effects of lidocaine (5 or 10 mg/kg bolus + 2.5 mg/kg/h) on arrhythmias and changes in myocardial and plasma catecholamines (CAs) after left coronary artery occlusion were investigated in anesthetized rats. Myocardial intraneuronal CAs were assessed histofluorimetrically and CA concentrations were measured using high-pressure liquid chromatography (HPLC). Both doses of lidocaine caused reductions in heart rate and blood pressure. The higher dose significantly reduced the number of ischemia-induced ventricular extrasystoles from 425 +/- 123 to 25 +/- 12 in the first 60 min of ischemia and abolished ventricular tachycardia and fibrillation. In the myocardium of untreated animals, the area of fluorescing adrenergic neurons (as percentage of total field area) was 0.42 +/- 0.02% after 60 min of ischemia as compared with 1.38 +/- 0.17% in sham-operated animals. Lidocaine pretreatment resulted in a dose-dependent inhibition of this ischemia-induced CA release from adrenergic neurons (0.96 +/- 0.06 and 1.30 +/- 0.05% for the lower and higher dose, respectively). Tissue and plasma CA concentrations were not significantly affected by lidocaine pretreatment and by coronary occlusion. It is concluded that lidocaine inhibits CA release from sympathetic nerve endings in the ischemic myocardium by its endoanesthetic and membrane-stabilizing properties. The reduction in CA release may also contribute to its antiarrhythmic effects.
Animals↗
[Detection and follow-up of early arteriosclerotic vascular lesions].
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Arteries↗
[Blood pressure in children and adolescents aged 4 to 18. Correlation of blood pressure values with age, sex, body height, body weight and skinfold thickness (Essen Blood Pressure Study)].
1,165 randomly selected school children/adolescents and 306 preschool children living in Essen, West Germany, were examined for their systolic and diastolic (phase IV and V) blood pressure (BP), height, weight, and skinfold thickness. These are 97% of the original random sample school children/adolescents and 70.7% of the preschool children (under seven years old). Ages ranged from 4 to 18 years with 51% male and 49% female. Examination of the school children was performed in 20 different schools representative for the various types of school found in this city. BP was found to increase with age. In boys, the increase was significantly steeper during adolescence than in the preadolescence period (p less than 0.001). Adolescent boys had higher BP values than adolescent girls. In children younger than 10 years BP was similar to that reported in the Bogalusa study. The evaluation of partial correlation coefficients (rpart) identified body weight as the most important determinant of systolic BP (rpart = 0.25) and diastolic BP (rpart = 0.17) (p less than 0.0001).
Adolescent↗
[First clinical experience with coronary endoscopy].
In four different groups coronary endoscopy and endoscopy of peripheral vessels was carried out, using two ultrathin fibre endoscopes with a working length of 120 cm and a diameter of 1.4 or 1.8 mm. In a first series of seven cadaver hearts, normal vessels were found in three, one had high-grade stenosis and in the remaining three there were flat whitish atheromatous changes, rather scar-like in appearance. In a second series of 16 patients, the vascular wall in the iliac region was easily visualised in ten, while six showed diffuse atherosclerotic changes of the wall. In a third group of eight patients, coronary endoscopy was carried out at the time of balloon-catheter dilatation; endoscopy was successful in five patients. In two of them, the stenosis or occlusion to be dilated by balloon was visualised. In a fourth series, good visualisation of the vessels was obtained intraoperatively in seven out of nine patients, and in addition the course of the vessel distal to the stenosis as well as the site of anastomosis with the venous bypass graft could be seen. No serious side-effects of the procedure have yet been observed. Coronary endoscopy opens up a new dimension in the morphological assessment of coronary vascular changes. The method must, however, still be regarded as experimental.
Angioplasty, Balloon↗
Recovery of ventricular late potentials from body surface using the signal averaging and high resolution ECG techniques.
In 70 patients (3 females and 67 males), aged 16-72 years (mean: 51 +/- 9 years), the low noise ECG was recorded from body surface by the signal averaging and the high resolution beat-to-beat techniques. We found 61 patients were suffering from coronary heart disease, 4 had atypical coronary heart disease (syndrome X), 4 had dilatative cardiomyopathy, and one had the long QT syndrome (Romano-Ward syndrome). We found the following recovery rates for ventricular late potentials within the ST segment with the averaging technique: clearcut in 13/53 patients, doubtful in 16/53 patients, and late potentials absent in 26/53 patients. With the beat-to-beat technique the following recovery rates were found: clearcut late potentials in 27/70 patients, doubtful in 23/70 patients, none in 20/70 patients, and intermittently occurring late potentials in 18/70 patients (categorized as doubtful late potentials). When comparing the detection of late potentials with both methods in individual patients, we found concordant results in 39/53 patients studied (positive with both methods in 24/53 patients, negative with both methods in 15/53 patients), and discordant results in 14/53 patients (positive with the beat-to-beat technique and negative with the averaging technique in 12 individuals, negative with the beat-to-beat technique and positive with the averaging technique in the remaining 2 patients). The correlation between the incidence of late potentials and the presence of exercise-induced myocardial ischemia (submaximal bicycle exercise) was higher when using the high resolution beat-to-beat technique, as holds also true for the correlation to complex ventricular arrhythmias.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
[Hemodynamics of coronary surgery patients under isoflurane and neuroleptanalgesia].
The haemodynamic effects of isoflurane- and modified neurolept-anaesthesia were evaluated in 24 patients undergoing coronary artery bypass grafting. 12 patients (isoflurane group) were anaesthetized after an induction with 1.5 mg/kg methohexital and a unique dose of 0.005 mg/kg fentanyl with isoflurane (0.5-1.5 Vol%), N2O/O2 and pancuronium. 12 patients (neurolept group) received fentanyl (0.04 mg/kg), flunitrazepam, pancuronium and N2O/O2. Haemodynamic measurements were made before anaesthesia, in steady state anaesthesia, after sternotomy, after extracorporal circulation, after thoracic closure and one, two and four hours after the end of the operation. Between both groups we could not find significant differences in the haemodynamic parameters RAP, PAP, PCWP, PVR, CI, SVI, AP and CPP. However in the isoflurane group the peripheral vascular resistance (TPR) was significantly lower in steady state anaesthesia and after sternotomy. In the neurolept group the heart rate (HR) was significantly higher after bypass than in the isoflurane group. We believe, that at this time fentanyl analgesia was reduced. Before extracorporal bypass, patients with isoflurane anaesthesia had a lower arterio-mixed venous oxygen content difference (AVDO2) than patients with neurolept anaesthesia. Therefore it can be supposed that isoflurane lowers the oxygen demand more than neurolept anaesthesia. After surgery neurolept anaesthetized patients showed postanaesthetic shivering more frequently than those in the isoflurane group. We suggest that the vasodilating effect of isoflurane induces a homogeneous heat gain during warming the patients up, and that, therefore, in patients of the isoflurane-group AVDO2 and TPR were lower than in the patients of the neurolept-group during the first postoperative hours.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
[Naftidrofuryl in the treatment of simple diabetic retinopathy. A double-blind study].
During a randomized double-blind study 23 patients with nonproliferative diabetic retinopathy were treated orally with 600 mg Naftidrofuryl daily for six months, while 25 patients served as control group. Measurements of visual acuity and fundus photography were performed before and after 3 and 6 months of observation. Measurement of visual acuity showed a significant deterioration in the functional state of eyes in the control group. This deterioration was clearly less pronounced in the treated group, though not statistically significant. There was no significant change in the amount of exudation in either group. In contrast, retinal bleeding and the number of microaneurysms increased significantly both within the control group as well as compared with the treated group (p less than 0.05). This progression was checked to a significant extent in the treated group. Thus, the overall assessment of therapy indicated that Naftidrofuryl treatment brought significant advantages (p less than 0.05).
Aged↗
Haemodynamic and antiarrhythmic protective effects of intracoronary perfusion during percutaneous transluminal coronary angioplasty.
In 17 anaesthetized open-chest pigs, experiments were performed to determine if a myocardial protective effect can be obtained by intracoronary perfusion through the dilatation catheter during balloon inflation for percutaneous transluminal coronary angioplasty. Placement of the catheter such that the balloon lay in the middle third of the left anterior descending coronary artery caused a significant deterioration in haemodynamic status prior to balloon inflation, and on 5 occasions led to the development of ventricular fibrillation (VF). Balloon inflation without perfusion for periods of up to 5 min produced further haemodynamic deterioration, and culminated in VF in 4/14 cases. Simultaneous perfusion during balloon inflation (proximal perfusion pressure 900-1200 mmHg), with flow rates of 14.5 ml min-1 for arterial whole blood and 21 +/- 7 ml min-1 for blood diluted with 0.90% NaCl (haematocrit approx. 25%), not only prevented the haemodynamic deterioration but resulted in an improvement compared with values obtained with the catheter in position prior to balloon inflation. In no case did VF occur during 5 min of balloon inflation plus perfusion. The use of diluted blood as the perfusate was not associated with intracatheter thrombus formation, which was sometimes seen as a complication of whole blood perfusion.
Angioplasty, Balloon↗
Vicious cycle of catecholamines and K+ in cardiac ischemia.
The distribution of catecholamine (CA)-containing neurones and tissue noradrenaline (NA) concentration was investigated in pig hearts with and without myocardial ischemia. All hearts were shock-frozen using a Wollenberger clamp, and tissue samples were obtained from the mid- and apical left ventricular wall (nonischemic and ischemic areas, respectively, in hearts with coronary artery occlusion). The distribution of CA-containing neurones was assessed morphometrically from histofluorescence sections, and the NA content measured using high pressure liquid chromatography (HPLC). In hearts without myocardial ischemia, both the density of CA-containing neurones (0.96 +/- 0.07 compared with 1.09 +/- 0.07% of total field area) and the NA content (738 +/- 63 compared with 884 +/- 84 ng/g wet weight, p less than 0.025) were less in apical samples compared with those obtained at the midventricular level. These differences were more pronounced in samples from hearts obtained following 5 min (fluorescence, 0.96 +/- 0.19 compared with 1.38 +/- 0.18%, p less than 0.01; NA content, 543 +/- 109 compared with 816 +/- 82 ng/g wet weight, p less than 0.01) or 15 min (fluorescence, 0.77 +/- 0.07 compared with 1.12 +/- 0.09%; NA content, 521 +/- 43 compared with 753 +/- 79 ng/g wet weight, p less than 0.01) of coronary artery occlusion, indicating a release of CA in the ischemic myocardium.
Animals↗
An electromagnetic distance measuring system.
A new accurate method to determine the myocardial deformation during the cardiac cycle in vivo is described. The system is based upon the mutual inductance principle, yet with transducers which consist of three perpendicular coils, yielding a spherical radiation and sensing characteristic. Thus the system is invariant with regard to rotational movements of the transducers. Residual angle dependences of the transducers can cause deviations of the recorded distance up to 4%. The output voltage is linear with the distance, with an accuracy better than 1%. The frequency response is set to 100 Hz (-3 dB). Zero drift doesn't exceed 0.5% after 24 hours. Measurements are not restricted to radiation propagating media, thus they can be performed in air, inside or outside of any biological object. For studies of regional myocardial performance in the left ventricle spherical transducers were designed with a diameter of 1.5 mm and a measuring range between 5 and 25 mm and flat surface transducers (5 mm diameter, 1.5 mm height) with a measuring range between 15 and 200 mm.
Animals↗
[Comparison of the measurement accuracy of electronic blood pressure self measurement devices 1980-1983].
The accuracy of 21 new electronic devices designed for self-measurement of blood pressure has been tested on an average of 22-24 subjects each by simultaneous measurements on the same arm. Compared with electronic devices made in 1980 the accuracy has improved, especially with regard to the estimation of diastolic blood pressure. Nevertheless, most devices still give too low a value for diastolic blood pressure. In agreement with former results the systolic differences are greater in women and in normotensive subjects, whereas the diastolic differences are more pronounced in younger subjects, in males and in hypertensive patients. Despite the differences due to different sites of auscultation, the results of the best devices tested show that electronic devices may estimate the same blood pressure values over the brachial artery as measured by auscultation in the antecubital fossa. We therefore suggest stronger regulations for the licensing of new electronic devices.
Blood Pressure↗