PubMed Health⌕ Search

Biomedical subjects

H R Arntz

Publications and source records attributed to H R Arntz.

At least 19 recordsLinked to original sources
PubMed1992

Efficiency of a physician-operated mobile intensive care unit for prehospital thrombolysis in acute myocardial infarction.

The efficiency of an emergency medical system for routinely performed prehospital thrombolysis is evaluated for 1 of the 7 physician-staffed mobile intensive care units (MICU) in former West Berlin. During 19 consecutive months the MICU had 4,920 missions, and 1,226 patients had chest pain of presumed cardiac origin. The diagnosis at hospital discharge was acute myocardial infarction (AMI) in 406 patients and "interrupted" infarction in 11 patients (total 417). Correct on-scene electrocardiographic diagnosis of acute injury was made in 268 patients (64%) and was false-positive in 4 patients (1%). In 8%, present ST elevations were not recognized. In 27%, the electrocardiogram on scene was nondiagnostic (16% with no ST elevation, 11% with bundle branch block). Of all 417 patients with later hospital evidence of AMI, 317 (76%) were seen by the MICU physician within 4 hours, and 173 (41%) within the first hour from symptom onset. Two hundred three patients seen within 4 hours had diagnostic ST elevation on the scene, of whom 124 (61%) received prehospital thrombolysis (74 patients [36%] within the first hour). There was no prehospital death; hospital mortality was 6.3%. Because greater than 50% of all patients in the community, hospitalized because of AMI, made use of the MICU and 3/4 of them had called within 4 hours from symptom onset, a large proportion of all patients with AMI were candidates for the actually received prehospital thrombolysis.

Ambulances↗
PubMed1992

Blood rheology in acute myocardial infarction: effects of high-dose i.v. streptokinase compared to placebo.

To compare the haemorheological effects of an i.v. infusion of 1.5 MU of streptokinase with placebo, we investigated the time course of plasma fibrinogen concentration and the haemorheologic parameters plasma viscosity, erythrocyte aggregation and whole blood viscosity at different shear rates during the early phase of acute myocardial infarction until week 3 in 38 unselected patients from the ISAM and ISIS-2 study. Within 3 h, streptokinase led to a near afibrinogenaemia lasting for more than 24 h. Concomitantly, with streptokinase we found a reduction of plasma viscosity, erythrocyte aggregation and whole blood viscosity, whereas with placebo, values showed a slight increase, resulting in significant differences between the groups within the first 2 days. Thereafter, both groups showed an increase in all parameters, values reaching a maximum after 1 week. The streptokinase-induced reduction in blood viscosity may lead to an improvement in microcirculation in the infarction area during the early phase, whereas the hyperviscosity observed independently of therapy after 1 week may lead to an impairment of microcirculation.

Adult↗
PubMed1992

[Wake up time, thrombocyte aggregation and the risk of acute coronary heart disease. The TRIMM (Trigger and Mechanisms of Myocardial Infarct) Study Group].

A circadian variation in the incidence of acute coronary artery disease (CAD) was observed, but the correlation to possible triggering external factors and pathophysiologic mechanisms is unclear. In the "Trigger and Mechanisms of Myocardial Infarction" (TRIMM) Study, 573 patients (61 +/- 10 years; 74% male) underwent a systematic interview within 2 weeks after myocardial infarction. From 8.00 to 11.00 a.m. (peak) the relative risk of myocardial infarction was 1.9 (1.6-2.3). After statistical adjustment for individual wake-time the relative risk during the initial 3 hours after awakening was 2.7 (2.2-3.3). In 24 hour studies at platelet aggregability in 10 patients with CAD the threshold concentration of ADP (from 4.8 +/- 0.8 to 2.6 +/- 0.4 mumol, p less than 0.02) and epinephrine (from 7.3 +/- 2.3 to 1.8 +/- 0.9 mumol, p less than 0.02) decreased significantly between 6.00 and 9.00 a.m. indicating an increase of aggregability. The temporal coincidence of clinical events and physiological changes suggests a causal relationship. Further possible important factors in increasing the risk of CAD during the morning include the increase of blood pressure enhancing the risk of plaque rupture and of coronary tone at the same time of day. These results are important in determining the acute mechanisms of CAD and in improving its prevention.

Aged↗
PubMed1992

[Is pre-hospital thrombolysis in acute myocardial infarct valuable as a routine measure?].

UNLABELLED: In 4920 consecutive missions of the mobile intensive care unit Klinikum Steglitz, 1226 patients (25%) had chest pain of presumed cardiac origin. In 272 patients (22%) an acute myocardial infarction (AMI) was diagnosed in the field. In four patients the diagnosis was wrong; 11 patients with proven coronary artery disease had significant ST-segment elevation, but did not develop AMI. In hospital, a total of 406 patients had evidence of AMI; 173 of these (41%) were seen by an emergency physician in the field already within the first hour after onset of symptoms. In 6%, diagnostic ST-elevation was not recognized by the emergency physician; 27% had non-diagnostic ECG changes (11% bundle-branch block). Prehospital thrombolysis within 4 h after symptom onset was performed in 126 of 205 patients (61%); 74 of these patients were seen by the emergency physician within the first hour. The main reason for exclusion was advanced age. Inclusion of older patients and also those with bundle-branch block could further increase the prehospital thrombolysis rate. CONCLUSION: With an effective emergency medical system a large proportion of all patients with AMI can correctly be identified and properly treated with a thrombolytic drug in the field. The time gain is considerable.

Aged↗
PubMed1991

[Effectiveness of pravastatin and bezafibrate in primary hypercholesterolemia].

The efficacy and safety of pravastatin and bezafibrate (in retard form) were compared in a randomised double-blind trial comprising 96 patients (48 men, 48 women; mean age 52.5 [20-68] years) with primary hypercholesterolaemia types IIa and IIb. After four weeks' treatment 6 out of 38 patients (400 mg/d bezafibrate) and 27 out of 58 patients (20 mg/d pravastatin) reached a LDL cholesterol level of 190 mg/dl or less. In the other 31 patients of the pravastatin group the dose was raised to 40 mg/d. During the twelve-week course of pravastatin total cholesterol concentration fell from a mean of 364 +/- 75 mg/dl (initial value) to 281 +/- 61 mg/dl (P less than 0.01), while LDL-cholesterol fell from 288 +/- 81 mg/dl to 206 +/- 64 mg/dl (P less than 0.01) and triglyceride concentration from 168 +/- 83 mg/dl to 148 +/- 80 mg/dl (P less than 0.05). During the twelve-week course of treatment with 400 mg bezafibrate total cholesterol concentration fell from a mean of 363 +/- 91 mg/dl to 325 +/- 73 mg/dl (P less than 0.01), LDL-cholesterol level fell from 284 +/- 88 mg/dl to 242 +/- 70 mg/dl (P less than 0.01) and the triglyceride concentration from 173 +/- 91 mg/dl to 121 +/- 83 mg/dl (P less than 0.01). HDL cholesterol concentration rose by 9% in the bezafibrate group and by 8.4% in the pravastatin group (P less than 0.05). Except in the case of HDL-cholesterol, the falls were significantly different in the two treatment groups: pravastatin was superior to bezafibrate in terms of the reductions in both total and LDL-cholesterol (P less than 0.01 for each). However, bezafibrate produced a greater fall in serum triglycerides (P less than 0.05). No serious side effects were associated with either drug.

Adult↗
PubMed1990

Dietary sodium restriction: adverse effect on plasma lipids.

In order to examine the effect of dietary sodium intake on plasma lipids, 15 healthy male volunteers were given a low-salt diet (20 mmol/day) for 3 weeks, adding either placebo, sodium chloride (200 mmol/day), or a non-chloride sodium salt (sodium citrate, 200 mmol Na/day) for one week each, in a single-blind randomized crossover study. Plasma levels of total cholesterol and LDL cholesterol were significantly higher at the end of the placebo period than with either sodium chloride (by 8.7 and 11.9%, respectively) (P less than 0.005) or sodium citrate (by 11.3% and 16.8%, respectively) (P less than 0.005). Thus this effect was dependent on sodium but not on chloride intake. Triglyceride and HDL-cholesterol levels were not affected by the dietary regimens. We conclude that short-term dietary sodium restriction may lead to a rise in plasma total and LDL cholesterol, thereby possibly increasing the risk of atherosclerotic vascular disease. Our findings render it possible that diuretic-induced lipid disturbances may also be caused by sodium depletion.

Adult↗
PubMed1990

Outcome prediction models on admission in a medical intensive care unit: do they predict individual outcome?

Prospectively acquired data from 941 patients staying greater than 24 h in a medical ICU were analyzed to determine the relevance of scoring on ICU admission by the following methods of outcome prediction: Acute Physiology and Chronic Health Evaluation (APACHE II), Simplified Acute Physiology Score (SAPS), and Mortality Prediction Model (MPM). Analysis was performed separately for all patients (group A) and for a subsample (group B), obtained by excluding coronary care patients. Calculation of risk and classification of patients were carried out as recommended in the literature for MPM, APACHE II, and SAPS. In group A, sensitivities (correct prediction of hospital mortality) were 44.7%, 51.1%, and 21.2% and specificities (correct prediction of survival) were 84.5%, 85.4%, and 96.8%, respectively; overall correct classification rates were 73.3%, 75.8%, and 75.6%. In group B, sensitivities were slightly higher, but total correct classification rates did not reach group A levels. Goodness-of-fit testing showed low levels of fit for all methods in both groups. Application of APACHE II to diagnostic subgroups, using disease-adapted risk calculations, revealed marked inconsistencies between the estimated risk and the observed mortality. We conclude that the estimation of risk on admission by the three methods investigated might be helpful for global comparisons of ICU populations, although the lack of disease specificity reduces their applicability for severity grading of a given illness. The inaccuracy of these methods makes them ineffective for predicting individual outcome; thus, they provide little advantage in clinical decision-making.

Female↗
PubMed1990

Haemorheological changes in patients with retinal vein occlusion after isovolaemic haemodilution.

In 83 patients with central retinal vein occlusion and branch vein occlusion we measured the haematocrit (HCT), plasma viscosity (PV), red cell aggregation (RCA), red cell filterability (RCF) and apparent whole blood viscosity (WBV). A control group (n = 41) was matched for sex, age, and cardiovascular risk factors. Measurements were performed before and after treatment with isovolaemic haemodilution (IHD). We found no significant differences between patients with retinal vein occlusion (RVO) and control subjects in haematocrit, plasma viscosity, red cell aggregation, and red cell filterability and no increased whole blood viscosity in the patient group. Patients with ischaemic retinal vein occlusion and non-ischaemic retinal vein occlusion did not show different haemorheological parameters either. After treatment with haemodilution, only the haematocrit and whole blood viscosity were significantly decreased, and there were no changes in plasma viscosity, red cell aggregation or red cell filterability.

Adult↗
PubMed1990

Long-term plasma exchange via Cimino fistula in patients with hypercholesterolemia.

Two patients with familial hypercholesterolemia were treated by long-term plasma exchange via an arteriovenous Cimino shunt using unselective membrane separation. Cholesterol was lowered to 40 percent (+/-3) of peak levels by each procedure. Sieving coefficient was 0.76 (+/-0.12). With a mean exchange interval of 11 days (+/-2), the peak cholesterol levels decreased from 406 mg per dl (+/-28) to 322 mg per dl (+/-27), the LDL fraction from 338 mg per dl (+/-9) to 265 mg per dl (+/-25) whereas the HDL fraction remained unchanged at 28 mg per dl (+/-4). Electrocardiographic stress testing improved in the first patient after treatment for 12 months.

Adult↗
PubMed1989

[Acute myocardial infarct: aspects of changed mortality at the intensive care unit. Results of a prospective study from 1985 to 1987].

Between 1975 and 1987 the mortality rate among 3143 patients with acute myocardial infarction admitted to an intensive care unit fell from 25% to below 10%. Among 829 patients examined prospectively during three consecutive years, the rate was 12.5% in 1985, 13.1% in 1986, and 9.3% in 1987 (mean of 11.6%). In addition to higher age, other risk factors were identified (mortality in brackets): female sex (14.6%), heart failure (20.6%), and diabetes (19.7%). Hypertension (11.2%) and previous infarct (12.8%) had no influence on mortality rate. The mortality rate was significantly reduced (P less than 0.0003) among 290 patients who had received intravenous fibrinolytic treatment, but this effect was marked only among women, elderly patients and those without risk factors. It is concluded that many measures had led to the observed reduction in acute death rate to about 10%. It is not yet possible to determine which of the different interventions played a part.

Age Factors↗
PubMed1979

[Effect of uric acid lowering drugs in low dosage in patients with hyperuricemia and hypertriglyceridemia in a randomized group study].

The serum uric acid lowering effects of 100 mg Allopurinol (A), 20 mg Benzbromarone (B) and the combination of both were tested in a randomized block-trial in 12 male patients suffering from hyperuricemia and hyperlipoproteinemia type IIb/IV. Therapy periods lasted 4 weeks each. Allopurinol lowered the uric acid concentrations from 7,54 mg/100 ml to 5,95 mg/100 ml, Benzbromarone from 7,54 mg/100 ml to 6,11 mg/100 ml and the combination from 7,54 mg/100 ml to 4,90 mg/100 ml, all three significantly. The difference between the effect of the combination drug and Allopurinol and Benzbromarone respectively was also significant. An additive effect of both components is evident. Serum creatinin concentration remained constant. Uric acid and creatinin excretion could not be evaluated because of failure of patient compliance in the collecting of urine.

Adult↗
PubMed1979

Influence of clofibrate on blood viscosity in primary hyperlipoproteinemia.

In patients with primary hyperlipoproteinemia (23 patients type II a and II b, 13 patients type IV), changes in lipoprotein concentrations (lipid fraction), fibrinogen concentrations, in kinematic serum and plasma viscosity (determined by means of a capillary viscosimeter) and changes in relative apparent viscosity at shear rate 46 s-1 and 115 s-1 (determined by means of a plate-cone-viscosimeter) were measured before and after a clofibrate therapy (2 X 1 g/day) lasting for 7 to 9 weeks. Serum and plasma viscosity was lowered significantly in both types II and IV. The apparent viscosity decreased at shear rate 46 s-1 in type IV, whereas it remained unchanged in type II. Moreover, there exists a qualitative correlation between changes in serum viscosity and changes in lipoprotein concentration. Fibrinogen concentration remained unaltered.

Blood Viscosity↗
PubMed1978

[Comparison of clofibrate and bezafibrate in type IIa and type IIb hyperlipoproteinemia].

In a randomized block-trial the comparative efficacy and side-effects of clofibrate (2 X 1 g), placebo and bezafibrate (3 X 150 mg) were tested in groups of 24 patients each with hyperlipoproteinemia type IIa and IIb. Each period of treatment was 2 months. Both bezafibrate and clofibrate as compared to placebo were associated with a significant lowering of triglycerides and cholesterol: triglycerides by 30% in type IIa and a 41% reduction in type IIb, whereas clofibrate lowered triglycerides by 23% in type IIa and 28% in type IIb. Bezafibrate reduced total cholesterol by 18% in type IIa and 12% in type IIb as opposed to clofibrate reducing cholesterol by 16% in type IIa and 8% in type IIb. Bezafibrate compared to clofibrate was shown to be significantly more effective in lowering triglycerides in type IIa correlating to a significant reduction of VLDL- and LDL-triglycerides in this type. Both substances significantly lowered LDL-cholesterol in type IIa; in type IIb only bezafibrate was effective. HDL-cholesterol increased significantly with bezafibrate. The effect of clofibrate raising LDL-cholesterol in dependence on the initial concentration of the VLDL-triglycerides was seen less frequently after bezafibrate and only with higher initial VLDL-concentrations as compared to clofibrate. Patients tolerated both bezafibrate and clofibrate equally well. It should be considered that bezafibrate was not given in the optimal dose of 3 X 200 mg.

Adult↗
PubMed1978

[Blood viscosity and red cell deformability in primary hyperlipoproteinemia (author's transl)].

In patients with primary hyperlipoproteinemia (types IIa, IV, IIb) we determined by means of a Wells-Brookfield plateconeviscometer and an Ubbelohde capillary-viscometer the serum-, plasma-, apparent and relative apparent blood viscosity as well as the red cell deformability with a filtration technique. All parameters were found to be significantly changed in comparison to those of a normolipidemic control-group: The viscosity values of type IIb showed the greatest increase and of type IIa the smallest, while the red cell deformability was reduced in all types to the same degree.

Blood Viscosity↗
PubMed1977

Studies of plasma viscosity in primary hyperlipoproteinaemia.

Using an Ubbelohde capillary viscometer, viscosity was determined in the plasma of 39 patients with a primary hyperlipoproteinaemia (type IIa, n=13; type IV, n=12; type IIb, n=14), in isolated lipoprotein fractions as well as in sera which differed only in their lipoprotein concentration. Plasma viscosity of the patients with hyperlipoproteinaemia was compared to that of a normolipidaemic control group and correlated with the lipid fractions characteristic of the different hyperlipoproteinaemia types. Plasma viscosity in types IIa, IV and IIb was found to be significantly higher than in the control group. Of the different hyperlipoproteinaemia types, IIa exhibited the lowest and IIb the highest plasma viscosity levels. The elevation of plasma viscosity was correlated with the concentration of lipoproteins (lipid fractions). In viscosity measurements of sera which varied only in lipoprotein concentrations, a correlation between the increase of viscosity and lipoprotein concentration as well as a greater efficiency of VLDL fractions was observed, similar to the viscosity results from isolated lipoproteins.

Adult↗