Successful thrombolysis of an aortic-arch thrombus in a patient after mesenteric embolism.
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Aorta, Thoracic↗
Biomedical subjects
J Niedermeyer
Publications and source records attributed to J Niedermeyer.
[Anti-basement membrane antibody disease of the lungs without clinical kidney involvement].
Anaemia (haemoglobin 10.7 g/dl) and small spotty infiltrates in both lungs were found in an 18-year-old man who had increasing haemoptysis over the preceding 3 weeks. Bronchoscopy revealed diffuse bilateral pulmonary haemorrhage. Further diagnostic measures provided no evidence of involvement of other organs, in particular the kidneys. The demonstration of anti-basement membrane antibodies confirmed the diagnosis of a disease within the group of immune-induced alveolar haemorrhage. The radiological signs in the lungs regressed over 3 weeks of administering prednisone, initially 100 mg daily, then 60 mg daily, and the patient was discharged. While being treated as an out-patient, with reduction of prednisone to 10 mg daily, the haemoptysis recurred so that a single dose of cyclophosphamide, 1.5 g, was added to the immunosuppressive treatment. There was no further haemoptysis and the prednisone was discontinued after having been given for 15 months. The patient has now been in complete clinical remission for 3 years and anti-basement membrane antibodies are no longer demonstrable. At no time was there any evidence of renal involvement in the sense of the classical Goodpasture's syndrome.
Adolescent↗
[Acoustic quantification--a new online procedure for automatic recording of left ventricular areas and area changes in the echocardiogram].
Initial experiences were obtained with a new technique for automatic quantification of left ventricular areas and area changes in two-dimensional (2D) echocardiograms (acoustic quantification, AQ). AQ is based on integrated back-scatter-analysis in real-time. Practicality and reliability of AQ were studied in 50 non-selected patients. AQ measurements of left-ventricular (LV) cavities were compared with off-line measurements which were obtained by analysis of videotaped images. Thirty-two (64%) and 39 (78%) patients could be studied by AQ from parasternal and apical views, respectively. LV areas measured from parasternal views or apical views showed a good correlation with corresponding values obtained by off-line analysis (r = 0.78 to 0.91). In addition, LV fractional area changes measured by AQ showed an excellent correlation with off-line measurements (parasternal: r = 0.86; apical: r = 0.84). During infusion of dobutamine (n = 3; 5, 10, 20 micrograms/kg/min, 10 min each dose), reduction of LV cavity areas could be continuously monitored and quantified by AQ for each cardiac cycle. In five of six patients who underwent transesophageal echocardiography, AQ could easily detect LV contours in the transgastric short axis view. Although AQ is not practicable in all patients, this new technique appears to be a promising and reliable approach for real-time, automatic boundary detection in 2D echocardiograms.
Adolescent↗
Early biochemical indicators of the obliterative bronchiolitis syndrome in lung transplantation.
The diagnosis of the obliterative bronchiolitis syndrome in lung transplantation is presently best established by evaluation of postoperative lung function tests. Unfortunately the decline in lung function occurs only when obliteration has progressed significantly and is therefore not an early predictive indicator. To distinguish patients at increased risk for the development of obliterative bronchiolitis, we regularly assessed the chemiluminescence response of polymorphonuclear leukocytes, opsonic capacity, and plasma elastase/beta-N-acetylglucosaminidase in 52 outpatients (25 women and 27 men; mean age 45 +/- 12 years) who underwent transplantation between January 1991 and January 1992. Recent onset bronchiolitis within the described observation period occurred in 16 patients (group obliterative bronchiolitis). A matched cohort of 16 patients was formed according to type of procedure, age and follow-up (control) from the remaining 36 patients. Data obtained from a period 6 months before clinical onset of the syndrome showed a significant drop of the opsonic capacity (group obliterative bronchiolitis = 87% +/- 7%; control = 100% +/- 9%; p < 0.023) and rise of the N-acetyl-D-glucosaminidase (group obliterative bronchiolitis = 7.5 +/- 2 U/L; control = 5.8 +/- 1.8 U/L; p < 0.04). No correlation was found between the number of infectious events or rejection episodes and the incidence of obliterative bronchiolitis. According to these results, it can be concluded that a decrease in the plasma opsonic capacity and a rise in beta-N-acetylglucosaminidase may be early markers before clinical onset of obliterative bronchiolitis. The nonspecific immune system may therefore play an important role in the development of obliterative bronchiolitis.
Acetylglucosaminidase↗
[Thrombolytic therapy in pulmonary embolism. Indications and therapeutic strategies].
The absence of significant symptoms and signs makes the diagnosis of pulmonary embolism difficult. Sensitivity and specificity of laboratory tests, chest X-ray, ECG, echocardiography and venous studies is low. Ventilation-perfusion scanning is also often not diagnostic. The combination of several diagnostic techniques, however, and pulmonary angiography confirm the diagnosis. Heparin remains the standard therapy for patients with stable haemodynamics. Thrombolytic therapy is recommended in haemodynamically compromised patients, since it yields accelerated clot lysis and pulmonary reperfusion. In standard dose regimes streptokinase, urokinase and t-PA are equally efficient. t-PA, however, acts more rapidly than the other agents. So far there is no study to prove that thrombolytic therapy significantly reduces mortality in pulmonary embolism.
Blood Coagulation Tests↗