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Biomedical subjects

H O Klein

Publications and source records attributed to H O Klein.

At least 19 recordsLinked to original sources
PubMed1979

Inefficacy of digitalis in the control of heart rate in patients with chronic atrial fibrillation: beneficial effect of an added beta adrenergic blocking agent.

The role of digoxin and the new beta adrenergic blocking agent, timolol, in controlling heart rate at rest and during exercise was investigated in 28 patients with chronic atrial fibrillation. Digoxin failed to prevent excessively rapid heart rates during mild to moderate exercise. Increasing digoxin blood levels from a mean of 0.6 to 1.8 ng/ml had no effect on heart rate either at rest or during exercise. The addition of timolol, 20 to 30 mg/day, resulted in a satisfactory and significant attenuation of the rapid heart rates both at rest and during exercise. Heart rates at rest were 91 and 98 beats/min in the patients with low and high digoxin dosage and rose to 135 and 139 beats/min, respectively, during exercise. Timolol reduced the heart rate to 67 at rest and to 92 beats/min during exercise. The effect of beta adrenergic blockade at rest was less pronounced in patients whose initial heart rates were below 90 beats/min. Digoxin alone may not suffice to control excessive heart rate in patients with chronic atrial fibrillation. The additional beta adrenergic blockade actually normalizes the heart rate response in these patients.

Adrenergic beta-Antagonists↗
PubMed1979

Controlled clinical studies with an antidote against the urotoxicity of oxazaphosphorines: preliminary results.

A randomized study in 20 patients with cancer was carried out to test the clinical efficacy of sodium-2-mercaptoethane sulfonate (ASTA D-7093; mesnum) as an agent to prevent urotoxic side effects (in particular, hemorrhagic cystitis) during cytostatic therapy with the oxazaphosphorines cyclophosphamide and ifosfamide. Eleven patients received mesnum iv and nine patients received a standard prophylaxis. The frequency of microhematuria was significantly lower in the patients receiving mesnum. A slight microhematuria was observed in one patient. With the standard prophylaxis, all nine patients receiving single-agent therapy with ifosfamide or cyclophosphamide had hematuria and three of these had macrohematuria. According to the available results, a daily mesnum dose of 60% (wt/wt) of the ifosfamide or cyclophosphamide dose is recommended. This dose should be divided into three equal fractions. The first administration should be given concurrently with the cytostatic agent and the subsequent two administrations at 4 and 8 hours after administration of the cytostatic agent. Significantly higher doses of mesnum (eg, 133% of the cyclophosphamide or ifosfamide doses) lead to gastrointestinal disorders, which are easily reversible.

Clinical Trials as Topic↗
PubMed1979

The beneficial effects of verapamil in chronic atrial fibrillation.

Digitalis preparations frequently fail to control heart rate in many patients who have chronic atrial fibrillation, particularly during physical exertion. The effects of orally administered verapamil, 160 to 240 mg/day, on the heart rate at rest and during mild exercise were studied in 23 digitalized patients with chronic atrial fibrillation of various causes. Verapamil substantially reduced the excessive heart rate response to exercise in well-digitalized patients who had chronic atrial fibrillation.

Aged↗
PubMed1978

Procainamide-induced left anterior hemiblock of the 2:1 type (pseudoelectrical alternans).

A selective defect in cardiac conduction in the anterior division of the left bundle branch was induced in a patient by therapy with procainamide hydrochloride. The defect in conduction, when intermittent, resulted in 2:1 Wencklebach sequences and produced a pattern similar to classic electrical alternans. The prognosis in drug-induced alternans is good, and it is important to differentiate it from true electrical alternans.

Aged↗
PubMed1978

Treatment of ruptured interventricular septum with afterload reduction.

Two patients with a ruptured interventricular septum complicating acute myocardial infarction were treated with isosorbide dinitrate. The first patient recovered from cardiogenic shock after sublingual administration of 5 mg of isosorbide dinitrate every two hours and was successfully operated on. The second patient recovered from severe pulmonary edema during the acute stage of the infarction with sublingual isosorbide dinitrate. Moreover, she experienced a considerable symptomatic improvement when a 5 mg sublingual dose of isosorbide dinitrate every three hours was added to her long-term treatment. Analysis of hemodynamic data showed that the most striking change following administration of the drug was the substantial reduction of pulmonary wedge pressure. The striking symptomatic and hemodynamic improvement was achieved by the favorable effect of afterload reduction on left ventricular performance and not by reduction in left to right shunt.

Aged↗
PubMed1977

Bradycardia-related (phase 4) left anterior hemiblock.

A case is presented in which left anterior hemiblock (LAH) appeared transiently after the pause terminating atrial pacing, after atrial premature beats and during the slowing of sinus rhythm induced by carotid sinus massage. The transient LAH is attributed to phase-4 block, and is reported in order to add weight to the hypothesis that phase-4 block is a significant factor in the genesis of discrete conduction blocks in the human heart.

Aged↗
PubMed1977

Beta-adrenergic blockade as adjunctive oral therapy in patients with chronic atrial fibrillation.

In many patients with chronic atrial fibrillation, it is difficult to prevent an excessive ventricular rate under stress, even with high levels of digoxin in the blood. The effect of adding beta-adrenergic blockade with practolol to digoxin on the heart rate at rest and during low-grade controlled exercise was investigated in 28 patients with chronic atrial fibrillation and in ten normal control subjects who were receiving maintenance dosages (0.25 to 0.75 mg) of digoxin. In atrial fibrillation, therapy with practolol decreased the mean heart rate at rest from 99.8 beats per minute to 77.5 beats per minute (23 percent reduction; P less than 0.01) and during mild exercise from 148.9 beats per minute to 105.4 beats per minute (29 percent) reduction (P less than 0.001). Fifteen patients had clinically significant heart failure; therapy with practolol did not worsen it. Reversible side effects were detected in two patients. When therapy with digoxin is not sufficient to control atrial fibrillation, the addition of a beta-adrenergic blocking agent is recommended as adjunctive treatment in selected patients.

Administration, Oral↗
PubMed1977

Thoracoscintigraphy in the differential diagnosis of cardiomegaly.

"Thoracoscintigraphy" is a radioisotopic scanning technique for demonstrating the nature of an enlarged cardiac shadow found on chest X-ray. The technique consists of superimposing scintiscans of the cardiac blood pool, the liver and the lungs and comparing the outline of the cardiac blood pool image with the cardiac shadow seen on X-ray. With this procedure the correct diagnosis of pericardial effusion was made in 11 of 15 patients and of pure cardiac dilatation and/or myocardial hypertrophy in three patients. In one of the patients the thoracoscintigraphic diagnosis was equivocal. Thoracoscintigraphy clearly demarcates the cardiac shadow from the surrounding organs, delineates the intracardiac blood pool within the cardiac shadow and indicates the best approach for pericardiocentesis. The procedure is harmless and noninvasive, and the radiation exposure is low and safe.

Adult↗
PubMed1976

[Frequency, diagnosis, and course of hepatotoxic side effects of Rifampicin (author's transl)].

In a retrospective study the following was found: Out of 111 patients suffering from tuberculosis and receiving a combined INH-therapy without Rifampicin 23% showed an increase of serum-transmainase activities, on the other hand out of 105 patients, treated with a combination including Rifampicin 74% did so. A pathological De Ritis ratio GOT/GPT was found in 31 among 59 comparable cases of Rifampicin-treated patients, and a pathological ratio GOT + GPT/AP in 22 among 37 cases before the transaminase-activities rose above normal. Development of a distinct toxic hepatic damage has to be anticipated in those cases, which show a De Ritis ratio below 0,5 or a GOT + GPT/AP ratio above 1,0 while transaminase-activity still is only slightly elevated. Liver biopsies taken from 10 patients showed no regular relation to the biochemical data.

Alanine Transaminase↗
PubMed1976

The Wenckebach phenomenon between electric pacemaker and ventricle.

Two cases which exhibited a Wenckebach form of exit conduction between an electrical pacemaker and the ventricular myocardium are presented. This manifests with increasing latency (stimulus to QRS intervals) and ultimate stimulus failure (block). The cycle then repeats itself. The QRS duration also increases progressively within each cycle. The phenomenon connotes an adverse prognosis. Several postulates regarding the mechanism are discussed.

Female↗
PubMed1976

Rate-dependent premature beats in man.

Ventricular premature beats (VPBs) appeared in a patient after pacemaker insertion for complete heart block secondary to acute myocardial infarction. Contrary to expectations, the frequency of VPBs was directly related to the basic pacemaker rate. The VPBs are either reentrant beats or represent VPBs arising from pacemaker cells with "slow-response" characteristics, which have been shown to become more automatic with increasing rates of electrical stimulation. This case documents the phenomenon of rate dependency of VPBs in man and discusses its practical importance.

Arrhythmias, Cardiac↗