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Biomedical subjects

M Kindler

Publications and source records attributed to M Kindler.

14 recordsLinked to original sources
PubMed1989

Follow-up of breast cancer patients.

The existing follow-up standard for breast cancer patients has been reviewed by a representative trial involving 1,004 curatively treated patients, who underwent surgery between 1977 and 1987. The objective of the study has been to establish whether intensive diagnostics of recurrences and metastases will lead, as a result of the follow-up, to life prolongation or improvement of life quality, and which methods will be adequate to achieve this goal. The analysis has shown that metastases are recognized only insignificantly earlier, and that improvement of survival is not achieved. The results of the trial have led to a recommendation for an effective follow-up programme for breast cancer patients, with emphasis on subtle case history data and exact clinical investigations.

Breast Neoplasms↗
PubMed1989

[A retrospective determination of the validity of various methods of early detection of recurrence and metastasis of breast cancer].

The valid follow-up standard for mammary carcinoma was checked by means of a retrospective study with 1,004 curatively treated patients operated between 1977 and 1987. The aim of this study was to find out whether intensive diagnostics of recurrences and metastases resulted in early detection and prolongation of life and/or improvement of life quality. Evaluation of two groups (early detection and treatment as compared to late detection and treatment) showed that diagnosis was only slightly earlier (1,2 months) which did not lead to longer life. These results gave rise to recommendations for an efficient follow-up regime for patients with mammary carcinoma. Exact case history and clinical examinations are more important for asymptomatic patients than intensive diagnostics:

Breast Neoplasms↗
PubMed1988

[New aspects of adequate postoperative prosthetic management following mastectomy].

The availability of one unitised organ replacement model is no longer sufficient for adequate prosthetic care at any time. The first phase of a complex system of prosthetic care was completed by the development of "femi-Form", an epithesis master model, in 1982. Two more variants were introduced in 1986, "femi-Form S" and an interim prosthesis. The complex system of prosthetic care in its totality is considered to be an important step in public health. Great attention is given to it in the GDR for follow-up treatment in the context of tumour diseases. Manufacturers are expected to go to great lengths in developing adequate prosthetic devices for postoperative care. However, it is a challenge to the medical profession to speed up and generally support the introduction of this complex post-mastectomy system.

Breast Neoplasms↗
PubMed1987

[Determination of active components of amrinone by analysis of pressure-volume results; use of the conductance (volume) catheter technic and rapid load change by balloon occlusion of the inferior vena cava].

Endsystolic pressure-volume relationships (ESPVR) were determined using the conductance (volume) catheter-technique and the required rapid load changes by applying vasoactive drugs (nitroprusside = NP; phenylephrine = PE) or brief preload reduction by balloon occlusion of the vena cava inferior (BOVCI). With this load-independent index of contractility, we analyzed the hemodynamically active components of amrinone (AM) over a range of different LV-loading conditions. In 19 patients (study I) with still normal LV-function (LVF) in group A (dP/dtmax 1585 +/- 386 mmHg/s; n = 10) and impaired LVF in group B (dP/dtmax 1044 +/- 164 mmHg/s; n = 9) an infusion of AM, 1.5 mg/kg over 2 min, failed to induce changes in ESPVR (p greater than 0.05), but rather caused load changes, resembling like those seen with NP. During continuously paced heart rates (90/min) brief infusion phases with NP and PE provided the necessary load changes. In 11 patients (study II) with impaired LVF (dP/dtmax = 1177 +/- 163 mmHg/s) 2.5 mg/kg AM i.v. induced an increase in contractility, which was more pronounced after the additional application of dobutamine (DOB) at 10 micrograms/kg/min.; (1) Slope k rose from 0.52 to 0.80 mmHg/ml; (2) dP/dtmax increased by an average of 39% and 57% (p less than 0.01), respectively. The BOVCI provided the necessary load changes. Thus AM demonstrates its contractility-increasing effects in a dose-related fashion, probably (at least in part) via an increase in heart rate; inotropic effects further increased with the combination of AM and DOB. The use of the conductance technique for the assessment of ESPVR during acute decrease of preload by temporary BOVCI is innocuous to the patient, reproducible and can be carried out under the conditions of a routine cardiac catheter procedure. This technique seems to be useful in the assessment of relative inotropic effects of the newer cardiotonic drugs.

Amrinone↗
PubMed1987

Effects of forskolin on left ventricular function in dilated cardiomyopathy.

The adenylate cyclase activator 17 beta-acetoxy-8, 13-epoxy-1 alpha,6 beta,9 alpha-trihydroxylabd-14-en-11-one (forskolin) was studied for its beneficial effect as therapeutic agent for the treatment of dilated cardiomyopathy (DCM). In 7 DCM-patients with normal (group A) and 8 DCM-patients with pathological dP/dtmax-values (group B), we analyzed serially (computer-assisted) the pressure/volume (P/V) effects as P/V-loops (microtip catheter/Tc-99m scintigraphy) and on-line MV02 (indirectly: Bretschneider equation) under dobutamine, 10 micrograms/kg/min i.v., and forskolin, 3 micrograms/kg/min i.v. For the total group (A + B) there was no change of contractility during forskolin (p greater than 0.05); with dobutamine, however, it rose by an average of +25%. The preload decline was more pronounced with forskolin (LVEDP by -27%) as compared to dobutamine (by-19%); while left ventricular (LV-)function improved moderately only with forskolin (by +9%) and significantly (by +34%) with dobutamine. Thus, forskolin improved LV-function primarily via reduction of preload in DCM-hearts and without rising metabolic costs. Beneficial hemodynamic effects with forskolin are quantitatively less as compared to those with dobutamine (accompanied by higher MVO2-costs). It is concluded that residual myocardial reserves in DCM are mobilized by dobutamine rather than forskolin. Serial P/V-loop and on-line MVO2 registration aided in the demonstration of forskolin efficacy as compared to dobutamine.

Angiography↗
PubMed1985

Analysis of the efficacy of the new cardiotonic agent TA-064.

TA-064 is a new cardiotonic agent which is also effective orally, according to investigations conducted in Japan. We analyzed computer-assisted alterations of pressure-volume relationships serially and of indirect myocardial oxygen consumption (MVO2) estimations on line during TA-064 influence in 16 patients with congestive cardiomyopathy: left ventricular function was moderately decreased in seven patients (group A) and drastically decreased in nine (group B). Results showed that TA-064, 8 micrograms/kg/min intravenously, exerted positive inotropic effects in both groups and induced mean maximal delta percentage changes at about 5 minutes of infusion as follows: left ventricular stroke work index +65% and +47%; dP/dtmax +61% and 59%; left ventricular efficiency +62% and 53%; MVO2 +31% and +11% (p less than 0.05). TA-064, 20 mg by mouth induced serum levels (group A = 23.8 +/- 12ng/ml and group B = 26.4 +/- 20 ng/ml) corresponding to the effects with dosages of 1 to 2 ng/kg/min intravenously (p greater than 0.05), thus implying that significant changes in left ventricular function require higher oral dosages. We conclude that TA-064 improves left ventricular function, primarily via a contractility increase, also in group B patients without toxic side effects. On-line indirect MVO2 assessment and analysis of serial pressure-volume relationships helped to provide a more complex definition of the mechanism and efficiency of the cardiotonic agent under study.

Administration, Oral↗
PubMed1985

[Double nuclide myocardial scintigraphy with thallium 201 and iodine 123-heptadecanoic acid--the possibilities in cardiological diagnosis].

UNLABELLED: We studied in 11 patients the individual variable pattern of coronary blood supply after the end of diagnostic coronary catheterisation by intracoronary injection of T1201 into the left and J 123-heptadeconic acid into the right coronary artery. In 4 static views computer aided quantitative analysis of circumferential profiles was performed. Based on Schlesinger's criteria three types of coronary arterial patterns were defined (right, left preponderant, balanced) after the presentation in the angiographic projections. CONCLUSIONS: Sharp boders between different perfusion areas could be detected by the gamma camera. If patients with right preponderant circulation are compared with balanced circulation, the perfusion areas of the left coronary artery are greater in all cases with balanced circulation than expected. More important for the indication of coronary artery surgery is that a considerable area of the left ventricular myocardium is perfused by the right coronary artery independent of the anatomical perfusion pattern with the exception of the left preponderant type.

Coronary Disease↗
PubMed1985

[Comparative echocardiographic volume determinations using a dynamic heart model].

Using a dynamic and symmetrical cardiac phantom different echocardiographic mathematical models (Simpson 7 slices, area-length method, Simpson 2 slices and method according to Teichholz) were compared. 9 different end-diastolic (EDV) and end-systolic (ESV) volumes, 9 different stroke volumes (SV) and ejection fractions (EF) were used. EDV and ESV varied between 39-298 ml; SV between 29-100 ml and EF between 14-46%. In addition 10 fixed volumes of the same shape were evaluated using the same echocardiographic mathematical models. While symmetrical fixed volumes can be assessed correctly (r = 0.97-0.98), apart from the formula according to Teichholz (r = 0.89, significant underestimation of volumes), the correlation coefficients decrease using a dynamic cardiac phantom. In the modification of Simpson with 7 slices the best correlation was found for all parameters (EDV: r = 0.93; ESV: r = 0.94; EF: r = 0.87; SV: r = 0.81). The biplane area-length method has no advantages over Simpson's rule with 2 slices in the short axis; for symmetrical models both methods are comparable, both having high correlation coefficients (for volumes r = 0.85 and r = 0.88; for EF 0.78 and 0.84). Using the method according to Teichholz symmetrical volumes can be well assessed (r = 0.90), for the determination of EF the correlation coefficient decreases to r = 0.65 and for stroke volume to 0.33, reflecting no significant correlation to the actual SV. Possible causes for a poorer correlation are discussed for moving objects as opposed to the fixed volumes.

Cardiac Output↗
PubMedDate not supplied

Comparative efficacy of the new cardiotonic agent DPI 201-106 versus dobutamine in dilated cardiomyopathy: analysis by serial pressure/volume relations and "on-line" MVO2 assessment.

DPI 201-106 (DPI) as a positive inotropic drug might be useful in treating dilated cardiomyopathy (DCM). In seven DCM patients with normal (group A) and eight DCM patients with abnormal (group B) left ventricular (LV) function, we analyzed serially (computer-assisted) pressure/volume (P/V) effects as P/V loops (microtip catheter/99mTc scintigraphy) using DPI (30 micrograms/kg X min i.v.) and dobutamine (DOB) (10 micrograms/kg X min i.v.) for quantitative comparison of hemodynamic effects. Contractility (dP/dtmax) improvement was greater with DPI (group A, +23%; group B, +47%) than with DOB (group A, +21%; group B, +32%), as was the simultaneous LV end-diastolic pressure decrease--DPI (group A, -39%; group B, -42%) versus DOB (group A, -21%; group B, -18%). LV efficiency increased with DPI (group A, +22%; group B, +55%), but myocardial oxygen consumption (MVO2) did not change significantly. Five of 15 patients showed an increase in dP/dtmax with DPI only; with DPI there were fewer "nonresponders" than with DOB. Thus, DPI increases contractility in DCM hearts while reducing preload rather than causing higher metabolic costs. Such beneficial hemodynamic effects appear to be stronger in the more impaired myocardium (group B patients) and quantitatively superior to those induced by DOB. This might indicate that residual myocardial reserves are more readily accessible to the influences of DPI than to those of DOB. Serial P/V loops and MVO2 assessment aided the demonstration of DPI's efficacy in a more complex way.

Adult↗