PubMed Health⌕ Search

Biomedical subjects

H J Engel

Publications and source records attributed to H J Engel.

At least 19 recordsLinked to original sources
PubMed1992

[Massive proteinuria and HELLP syndrome].

HELLP syndrome continues to be a clinical entity of difficult diagnosis. Weinstein first defined it in 1982 giving the practicing obstetrician a sequence of useful initials (H = hemolysis; EL = elevated liver enzymes; LP = low platelets). Since then a lot has been written and it has become clear that the syndrome is a form of severe preeclampsia. The American College of Obstetrics and Gynecology does not include HELLP in the description of severe pre-eclampsia as such but does accept each of its components as being part of severe pre-eclampsia. The case presented deals with a 33 year old white female, admitted at 27 weeks gestation with nausea, epigastric pain resembling acute abdomen, nose bleeding and mild hypertension. The analysis revealed an abnormal liver profile with elevated GOT, GPT and LDH, heavy proteinuria (14.4 g/day), decreased platelet count (92000/mm3) and elevated total bilirubin. Pregnancy was terminated by cesarean section 24 hours after admission because the patient's condition was deteriorating. Obviously in pre-eclampsia/eclampsia there is a systematic injury to all tissues. Proof of this is the hypertension as a consequence of vascular spasm and proteinuria due to glomerular injury. In HELLP the sequence of events is probably altered; hepatic injury precedes vascular and renal injury of conventional preeclampsia. The syndrome results from many clinical and pathological symptoms derived from endothelial microvascular injury which determine a rapid platelet activation causing vascular spasm, platelet aggregation and further endothelial injury through a feedback mechanism.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

[Immediate bypass operation prevents heart infarct in PTCA emergencies].

UNLABELLED: Between December 1984 and June 30, 1989, we performed PTCAs on 1438 patients. The procedures were performed with strict cardiosurgical standby. In 24 patients (22 X LAD, 2 X RCA), abrupt coronary occlusion necessitated immediate bypass surgery. In 19 cases, abrupt coronary closure occurred during PTCA in the cath lab; in five patients, during the following 24 h on the intermediate care ward. No patient died. Immediate bypass surgery prevented myocardial infarction (MI) in 79.2% of the cases. None of the 19 patients with abrupt coronary closure in the cath lab had a Q-wave myocardial infarction postoperatively. One of these 19 patients had an R-wave reduction (non-Q-MI) and one patient had a new terminally negative T-wave in the postoperative ECG. Two of the five patients with evidence of acute coronary occlusion on the intermediate care ward had small Q-wave MIs and one had a non-Q-wave MI postoperatively. Time of ischemia (defined als time interval between the end of PTCA and the beginning of extracorporal circulation) was 65 +/- 28 min in the former group and 122 +/- 30 min in the latter. CONCLUSION: Because immediate bypass surgery prevents Q-wave MI after abrupt closure during PTCA, strict temporal and spatial cooperation with the cardiac surgeon is mandatory.

Angioplasty, Balloon, Coronary↗
PubMed1990

[Hemodynamic and clinical results following percutaneous aortic valve valvuloplasty in adults].

We analyzed the results and the follow-up in our first 80 patients after percutaneous balloon aortic valvuloplasty (BAV) since November 1986. Mean age was 74 +/- 10 years, 78 patients were in the NYHA functional classes III or IV. Initially we used relatively small balloons (15-18 mm), later balloons of 20 mm and, with increasing frequency, of 23 mm diameter were utilized, providing very strong inflations at the end of the procedure. The average valve area after BAV increased from initially 0.75 +/- 0.18 to 0.87 +/- 0.28 cm2 after July 1987. Using the 23-mm balloon a mean valve area of 1.05 +/- 0.19 cm2 was obtained. The procedure-related mortality was 2.5%, the total early mortality (30 days) was 6.25%. Other non-fatal complications included two cases of severe valve incompetence requiring valve replacement, one dissection in the aortic root, one cerebrovascular accident, and eight cases of arterial damage (surgical repair). Twenty-six patients with initially successful dilation were restudied hemodynamically, 12 of whom had a restenosis (46%) after 5 months; 13 patients had a second dilatation. The clinical improvement was remarkable (at least 1 NYHA functional class) in 79% of the patients. 33% were improved 1 year and 20% 18 months after the first or eventually the second BAV. Eighteen of the discharged patients died in the follow-up period (two after valve replacement); 20 patients had aortic valve replacement due to restenosis. Our results show a correlation of the maximal balloon size to the valve area after BAV. However, even a perfect technique cannot prevent the restenosis that occurs mostly during the first year. Therefore, BAV may be useful and appropriate for selected patients with inoperable aortic stenosis, but it is no alternative to valve replacement.

Aged↗
PubMed1989

[Endocardial dual-chamber stimulation in an anomalous persistent left superior vena cava].

A persistent left superior vena cava was noted in a 63-year-old woman during pacemaker implantation because of sinus bradycardia and AV dissociation. During atrial test stimulation a 2 degree AV block occurred at a rate of only 110/min and dual-chamber provision was thus necessary. Both catheters were introduced into the right heart via the coronary sinus, but placement of the right-ventricular lead was made more difficult than usual because of looping. One year later pacemaker function (DDI mode) was unchanged and the patient symptom-free.

Cardiac Catheterization↗
PubMed1988

[Coronary spasm immediately following coronary revascularization].

Of 2,600 coronary operations performed from August 1983, to December 1988, two ischemic reactions of the inferior wall immediately after operation were observed. In both patients the right coronary artery was either dissected or revascularized intraoperatively. Under the diagnosis of postoperative spasm both patients had reangiography three hours after surgery. Right coronary artery spasm was demonstrated in both patients. After intracoronary injection of calcium channelblockers the spasm resolved completely. Patient 1 demonstrated a small inferior infarction during control angiography, patient 2 remained free of a myocardial infarction. The possible causes of coronary spasm during or after surgery are discussed. The diagnosis and an approach to therapy are outlined.

Coronary Artery Bypass↗
PubMed1987

[Balloon dilatation of calcified aortic stenosis].

Between November 1986 and March 1987, 14 patients (11 men and three women, aged 48-84 years, mean 71.3 years) had percutaneous transluminal balloon dilatation of calcific aortic valve stenosis. Peak transvalvar pressure gradients were reduced from a mean of 81.4 mm Hg (25-122 mm Hg) to a mean of 44.8 mm Hg (range 19-63 mm Hg). Calculated valve opening area was increased from a mean of 0.48 (0.3-0.86) cm2 to 0.75 (0.6-1.16) cm2. All but one patient were in stage III or IV (New York Heart Association) and most improved by about one stage. There were no complications that could be ascribed to the procedure. Blood transfusion was not required.

Aged↗
PubMed1987

Evaluation of prognostic indices based on hemodynamic and oxygen transport variables in shock patients with adult respiratory distress syndrome.

We tested prospectively 30 hypotensive shock patients using a continuous, on-line, real-time hemodynamic and oxygen transport monitoring system with a previously described predictive index, modified for the clinical conditions in our ICU. Continuous monitoring and display of cardiac output and 20 or more derived variables, together with the predictive index, were a feasible and useful approach. Unlike previously documented series of elective postoperative general surgical patients, our series consisted of patients with multiple trauma, myocardial infarction, sepsis, and other medical emergencies as well as postoperative cardiac and general surgical patients, all of whom had respiratory failure (acute respiratory distress syndrome). In addition to these differences, our patients were invariably admitted to the ICU after the nadir of their hypotensive crisis. To compare the continuous recorded values with previous studies that used intermittent measurements, three comparable time intervals were selected; data at these time intervals and the predictions derived from them were in satisfactory agreement with prior studies. Moreover, therapeutic goals based on the median values of survivors of the present series were similar, but not identical, to prior series despite differences in the clinical mix and the later postresuscitation ICU admissions of our series.

Adult↗
PubMed1987

[Angiography findings following myocardial infarct in young females: the role of oral contraceptives].

In 173 women less than 50 years of age with myocardial infarction, angiographic evidence of coronary sclerosis was observed in only 108 (62%). Completely normal coronary arteries were found in 15 patients (9%) and in 50 patients (29%) an isolated poorly delineated stenosis was found in the presence of otherwise completely normal coronary arteries. Of the 65 patients with myocardial infarction but without typical coronary sclerosis, 47 (72%) were taking oral contraceptives at the time of infarction. In 60% of the oral contraceptive users with infarction, angiographically, there was no evidence of typical coronary sclerosis. With the exception of cigarette smoking, the number of atherogenic risk factors in these patients was low such that myocardial infarction during treatment with oral contraceptives may possibly represent a separate disease entity distinguishable from coronary sclerosis. In support of this, in some cases, repeat angiography demonstrated spontaneous regression of the isolated stenosis. Etiologically, possible thromboembolic vascular occlusion has been assumed. In women in the premenopausal years, coronary sclerosis is uncommon and usually associated with a substantial number of atherogenic risk factors. In this case, 29% of the women had used oral contraceptives, the causal role of which remains uncertain. Even though oral contraceptive use is associated with a higher risk of myocardial infarction, apparently, it cannot be regarded as a typical atherogenic risk factor.

Adult↗
PubMed1985

Microcomputer-assisted monitoring system for measuring and processing cardiorespiratory variables: preliminary results of clinical trials.

A microcomputer-assisted monitoring system was developed for the continuous measuring and processing of cardiorespiratory variables, including: systemic and pulmonary arterial pressures, CVP, minute ventilation, inspired and expired O2 and CO2 concentrations, temperature, and heart rate. The primary data were converted to digital form, processed, displayed on a CRT monitor, and also stored for later evaluation. This system automatically calculated and displayed on-line and in real-time both primary measurements and derived cardiorespiratory variables, including: oxygen consumption, CO2 production, left and right ventricular stroke work, pulmonary venous admixture, and systemic and pulmonary vascular resistances. Printouts of the variables and trend graphs could be obtained for any desired time period. During its development, we tested this monitoring system in 30 critically ill patients, finding that the real-time calculation of cardiorespiratory variables was a great advantage during monitoring and treatment.

Adult↗
PubMed1982

An interaction study between benoxaprofen and digoxin.

The influence of maintenance therapy with benoxaprofen, 600 mg daily, on digoxin steady-state plasma levels was studied in 12 patients with rheumatic disease. No difference could be shown during concomitant therapy or after withdrawal of benoxaprofen (p greater than 0.10 and p greater than 0.90, respectively). Toxic concentrations were not observed. There were no changes in renal function values.

Anti-Inflammatory Agents↗
PubMed1982

[Relation between coronary obstructions, left ventricular wall motion and regional myocardial blood flow in single-vessel coronary artery disease (author's transl)].

UNLABELLED: Regional myocardial blood flow was studied at rest in 72 patients with a typical history of angina pectoris and/or myocardial infarction using the 133Xenon clearance technique. 62 patients had isolated greater than 50% obstructions of the left anterior descending or of the left circumflex branch, 10 patients had segmental asynergy yet no or only minimal (less than 35%) coronary obstructions. In each patient, flow of the poststenotic (asynergic) LV wall area was related to flow of the normal area (= 100%). Coronary obstructions were measured in multiple projections using a vernier, and segmental wall motion was quantitated by systolic halfaxial shortening. RESULTS: A progressive decrease of poststenotic flow was found with increasing severity of coronary obstructions: in relation to the respective normal areas, poststenotic flow was reduced to 84% distal to 50-75% obstructions (p less than 0.01), to 75% distal to 76-90% obstructions (p less than 0.0005), and to 67% distal to less than 90% obstructions (p less than 0.0005). However, analysis of poststenotic LV wall motion suggested that flow was correlated more closely to poststenotic wall motion: in hypokinetic areas, flow was reduced to 75% (p less than 0.0005), and in akinetic areas to 55% (p less than 0.0005) whereas in poststenotic areas with normal wall motion resting flow was normal regardless of the severity of coronary obstructions. Furthermore, the reduction of flow in asynergic areas of patients without coronary obstructions was comparable to flow in asynergic areas supplied by severely stenosed vessels. Thus in chronic coronary heart disease, regional myocardial blood flow correlates not only to the severity of coronary obstructions but also to segmental left ventricular wall motion.

Adult↗
PubMed1981

Magnesium concentration in saliva -- an indicator of digitalis toxicity. ?

In a prospective study salivary magnesium was measured by atomic absorption spectrophotometry in 168 patients on chronic digoxin therapy. Magnesium concentration in saliva was correlated with clinical data and plasma digoxin levels. A significant elevation in salivary magnesium concentration was caused by digoxin therapy (0.58 +/- 0.39 mmol/l, n = 93) in comparison to patients with no digitalis treatment (0.17 +/- 0.07 mmol/l, n = 35). Magnesium concentrations in saliva were significantly higher in toxic patients (1.1 +/- 0.68 mmol/l, n = 32) than in nontoxic patients. Possibly toxic patients showed a magnesium level of saliva of 0.63 +/- 0.39 mmol/l (n = 40). In 89% of the intoxicated patients salivary magnesium concentrations were higher than 1.0 mmol/l. The overlap of magnesium between toxic and nontoxic patients was less as compared to calcium and potassium concentrations in saliva. No changes were noted in serum magnesium levels. Magnesium concentration in saliva was influenced by chronic digoxin therapy only. No significant increase of magnesium in saliva was observed within 24 h after i.v. injection of 1.0 mg digoxin in four healthy volunteers. It is concluded that salivary magnesium concentration is a valid method for monitoring digoxin therapy in addition to plasma digoxin levels.

Digoxin↗
PubMed1981

[Transluminal angioplasty of the coronary arteries--An analysis of the most important complications by a postmortal study in the human heart (author's transl)].

The technique of dilatation of coronary obstructions with balloon-catheters according to Grüntzig was performed in 12 hearts with 17 proximal, predominantly excentric coronary stenoses. In all stenoses we saw a significant effect of dilatation with a mean increase of the diameter from 1.2 to 1.7 mm (p less than 0.001). Histological examinations revealed the following alterations: stretching (and compression) of the normal wall segment in most of the obstructions, injury of the plaque (11 times), perforation of the free wall (twice) and dissection of the wall (five times). The possible significance of these postmortal findings for the intravital application of the technique is discussed.

Catheterization↗
PubMed1981

[201-thallium stress scintigram in patients with coronary artery disease after administration of the cardioselective betablocker atenolol (author's transl)].

UNLABELLED: Changes of regional myocardial perfusion before and after administration of Atenolol (AT) (5 mg i.v.) were investigated by 201-Tl stress-imaging in 14 patients (PAT) with greater than or equal to 70% coronary obstructions. Scintigrams were performed in 4 projections (AP, 30 degree LAO, 60 degrees LAO, left lateral); scintigraphic defects (SD) in one of the 6 LV segments (anterior, apical, inferior, septal, lateral, posterior) had to be identified in at least 2 projections and to show a decrease of activity greater than or equal to 25%. All PAT had at least one reversible SD. RESULTS: After AT, stress, induced SDs were unchanged in 11 of the 14 PAT at identical work loads (131 Watt). The total number of reversible defects was 33 before and 28 after AT (n.s.). However, not only the 3 PAT with improved stress scintigrams, but also 6 of the 11 PAT with unchanged abnormal stress scintigrams were clinically improved (ECG normalized, no angina). Thus in almost half of the patients (6/14), the stress ECG was normalized without normalization of perfusion pattern of thallium scintigrams. We conclude that in these patients subendocardial perfusion was enough improved to meet the reduced metabolic needs, but not enough to normalize stress images.

Adult↗