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Biomedical subjects

J Stoermer

Publications and source records attributed to J Stoermer.

At least 19 recordsLinked to original sources

Nordic teleradiology development.

In the Nordic countries there are several reasons why teleradiology has been an interesting topic of research during the last years. The distances in rural areas are long, and radiology expert service is not available in every health centre which is able to provide X-rays. Also, the telecommunication network is on a very advanced level in the Nordic countries. The staff is well educated and they are used to operating with computers. This all means that the infrastructure to develop and use systems like teleradiology exists. This paper describes two separate systems developed in Norway and Finland. Their development has been in many respects the same. The common hardware and software features, as well as the differences and the clinical experiences, are discussed in this paper.

Computer Systems

Alpha- and beta-adrenoceptors in hypertension. II. Platelet alpha 2- and lymphocyte beta 2-adrenoceptors in children of parents with essential hypertension. A model for the pathogenesis of the genetically determined hypertension.

To study whether changes in alpha- and beta-adrenoceptors in human essential hypertension (EHT) might be genetically determined, we assessed platelet alpha 2- and lymphocyte beta 2-adrenoceptor density in 48 normotensive children of normotensive parents (NT) and in 41 normotensive children with one EHT-parent. Both groups did not differ in age, body weight and height, blood pressure, heart rate, plasma catecholamine levels, plasma renin activity (PRA), and lymphocyte beta 2-adrenoceptor density. Platelet alpha 2-adrenoceptor density, however, was in EHT-children significantly higher than in NT-children. In NT-children, platelet alpha 2-adrenoceptors were significantly, inversely correlated with PRA, indicating that they might mirror renal alpha 2-adrenoceptors which inhibitorily regulate renin release. In contrast, in EHT-children PRA was not at all related to platelet alpha 2-adrenoceptors, suggesting an early (even in the normotensive stage) disturbance of the alpha 2-adrenoceptor-mediated regulation in renin release. From these results and those obtained in the experimental rat models of acquired hypertension, a model for the pathogenesis of the genetically determined hypertension is proposed in which a very early step in the development of hypertension is a genetically determined increase in renal alpha-adrenoceptors that causes enhanced sodium retention. This initiates a chain of events that finally results in increased peripheral vascular resistance and, hence, blood pressure. On the other hand, beta-adrenoceptor changes seem to be secondary phenomena due to the elevation in blood pressure.

Adolescent

[Psycho- and neurovegetative effects on the ECG of children and adolescents].

In six patients between 10 and 21 years of age vegetative function disorders were diagnosed. All of them showed an inversion of T in lead II and/or III and in V4 to V6. After exercise-testing the ECG signs normalized. Other clinical investigations, echocardiography, and in one case heart-catheterization revealed no pathological findings. It is necessary to distinguish these rare ECG findings from pathological ECG changes.

Adolescent

[Changes in blood pressure in children with valvular aortic stenosis in bicycle ergometer stress].

Children with aortic stenosis (n = 25) show a lower systolic blood pressure elevation during exercise than normal subjects (n = 47). The post-exercise systolic blood pressure minus the pre-exercise systolic pressure was calculated in both groups (23.60 +/- 10.8 mm Hg versus 47.23 +/- 14.9 mm Hg). There is no significant correlation between pressure response during exercise and the pull back gradient during heart catheterization. But if the difference between post-exercise systolic pressure and pre-exercise pressure is greater than 25 mm Hg there is a very low probability of a pull back gradient greater than 50 mm Hg. We conclude that exercise testing may be helpful in selecting those patients with aortic stenosis for catheterization who are likely to require surgery.

Adolescent

[Noninvasive diagnosis in the evaluation of shunt size in children with atrial septal defect--an evaluation scheme].

A cumulative score of five non-invasive diagnostic procedures is used to predict the size of the shunt in atrial septal defect (type II) in children. Each of those diagnostic managements being represented by zero, plus one, or two points: a higher score value refers to a more significant shunt volume. Summing up the points you will find 10 to 7 in an atrial septal defect that is worth being operated. In 6 and 5 points the prediction is unsure by scoring. Values of 4 or less points indicate a septal defect with no significant shunting. The validity of this scoring system has been tested in 35 children each examined by heart catheterization.

Adolescent

[Dilated cardiomyopathy in childhood: intravital differentiation of endocardial fibroelastosis using transvascular endomyocardial biopsy].

Possibly due to the lack of clinical reports concerned with dilated cardiomyopathy in childhood, pediatric cardiologists may inadvertently designate the angiographic finding of a dilated left ventricle as endocardial fibroelastosis. We report historical and noninvasively-obtained data from twelve children, aged seven months to 17 years, with poorly-functioning dilated left ventricles, in whom no differentiation between the two diseases was enabled. Only by means of transvascular endomyocardial biopsies, performed during cardiac catheterization with a 6-F guide-catheter and a Machida bioptome for light and electron microscopal examination, was differentiation achieved among six patients with endocardial fibroelastosis and six with the nonspecific histological findings of muscular hypertrophy, interstitial fibrosis and marked degenerative changes. After exclusion of noxious and inflammatory etiologies, even in childhood, the diagnosis of primary dilated cardiomyopathy must be regarded as established. Since experience previously reported with endocardial fibroelastosis has not been based on histologic documentation of the diagnosis, questions with respect to natural history and prognosis remain unanswered.

Adolescent

[Ambulatory care of children with heart diseases].

The out-patient unit for pediatric cardiology is important in establishing diagnoses and caring for children with congenital heart disease. In addition it provides postoperative care and helps the local physician to decide whether a heart-catheter or a heart operation is necessary. Innocent murmurs in children can be recognized, cardiac arrhythmias analyzed and treated. In this sense the pediatric cardiology out-patient unit is expected to maintain the work of a locally practising pediatric cardiologist, as well as providing student and postgraduate training facilities in pediatric cardiology.

Ambulatory Care

[Protein-losing enteropathy following Fontan operation for a complex heart defect].

A 12 year old boy developed protein losing enteropathy 6 months after surgery for a severe cardiac malformation complex by a modified Fontan procedure. Gastrointestinal protein loss was due to sustained venous pressure elevation. Conservative therapy with diet, diuretics and albumininfusions remained ineffective. The patient died from right atrial and pulmonary thrombembolism 10 months after surgery.

Adolescent

[Complete heart block and pacemaker therapy in children (author's transl)].

The etiology of congenital and acquired complete heart block is discussed. The prognosis is much better in mostly congenital suprabifurcational blocks, than in the infrabifurcational blocks, which are acquired in most instances. Suprabifurcational blocks are characterized by normal QRS complexes, higher heart rates, and adequate frequency adaptation to exercise. Widened and deformed QRS complexes and fixed heart rates as low as 40--50 beats per minute are typical in infrabifurcational blocks. Whereas children with congenital heart blocks only eventually need pacemakers, the immediate implantation of a pacemaker is mandatory in children with acquired heart blocks after a decrease of the heart rate below 30--40 beats per minute and/or after an Adams-Stokes attack. With demand pacemakers being available, fixed rate systems are obsolete for children. Lithium batteries should be preferred for their smallness and their larger life span. A considerable body of surgical and technical problems due to infection, wire damage, and other complications still awaits solution.

Adolescent

Vacuolated lymphocytes in type II glycogenosis--a diagnostic approach?

Using electron microscopy, glycogen-filled lysosomes were found in peripheral lymphocytes in 5 cases of the infantile form of glycogenosis type II. In two infants whose blood smears were available, the ultrastructural demonstration of this pathognomonic storage corresponded to well-delineated vacuoles detected by routine light microscopy. Detection of such vacuoles in peripheral lymphocytes by light microscopy and demonstration of glycogen-filled lysosomes by electron microscopy could be a simple and harmless tool for diagnosing the classical form of type II glycogenosis.

Female

[Persistent truncus arteriosus communis (type I) and interruption of the aortic arch (type B) (author's transl)].

Description of the history, the clinical findings, and the autoptic results in a 5-days-old newborn child with a truncus arteriosus (Type I) and an interrupted aortic arch (Type B). Perfusion of the distal aortic arch by a wide open Ductus arteriosus. Additional anomalies: Atrial septal defect with partial anomalous pulmonary venous drainage of the right lung into the right atrium. Persistant left superior vena cava which leads to the left atrium. Hypoplasia and dysplasia of the left kidney. A tear caused by friction in the left sensorium with intra-and subdural bleeding. Discussion of the clinical, electrocardiographic, radiologic, angiocardiographic and pathologic-anatomical peculiarities of the persistent Truncus arteriosus and of the interrupted aortic arch connected with both defects.

Abnormalities, Multiple

[The acid-base status in infants with complete transposition of the great arteries (author's transl)].

In 36 infants with complete transposition of the great arteries aged one day to ten weeks, the acid-base balance was studied before, during, and after heart catheterization. The results indicate the dependency of the acid-base equilibrium on pulmonary function. Infants with only small shunts or with decreased pulmonary blood flow had a metabolic acidosis. Impairment of lung function either by high pulmonary blood flow, pulmonary congestion, or pneumonia caused mixed acidosis. Regulary found after heart catheterization and angiocardiography we found a more severe and mixeden acidosis. The therapeutic implications are briefly discussed.

Acid-Base Equilibrium