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Biomedical subjects

M Pichler

Publications and source records attributed to M Pichler.

At least 37 records · Page 2Linked to original sources
PubMed1995

Ergometric exercise testing and sensitivity of cyclic guanosine 3',5'-monophosphate (cGMP) in diagnosing asymptomatic left ventricular dysfunction.

OBJECTIVE: Increased plasma concentrations of cyclic guanosine monophosphate (cGMP) have been reported in patients with manifest heart failure. At rest, however, cGMP concentrations in patients with asymptomatic left ventricular dysfunction or heart failure in New York Heart Association (NYHA) functional class I do not differ significantly from those of healthy subjects. The purpose of this study was to investigate whether graded exercise on an ergometer improves the sensitivity of cGMP in diagnosing asymptomatic left ventricular dysfunction. PATIENTS: Plasma cGMP concentrations were compared in 17 healthy controls and 98 patients with asymptomatic left ventricular dysfunction or congestive heart failure of different stages (asymptomatic left ventricular dysfunction or NYHA functional class I, 56 patients; NYHA class II, 31 patients; NYHA class III, 11 patients). RESULTS: Before exercise plasma cGMP concentrations in patients with clinical heart failure (NYHA functional classes II and III) were significantly higher than those in healthy controls. In patients with asymptomatic left ventricular dysfunction or heart failure of functional class I plasma cGMP concentrations were not significantly different from those in healthy subjects. Thirty minutes after exercise, however, cGMP concentrations in patients with asymptomatic left ventricular dysfunction or class I heart failure were significantly higher than those in healthy controls. CONCLUSION: Measurement of plasma cGMP concentrations 30 minutes after ergometric exercise testing allows better discrimination between healthy subjects and patients with symptomless left ventricular dysfunction or mild heart failure (NYHA class I) than measurement of such concentrations before exercise.

Adult↗
PubMed1995

[Isosorbide-5-mononitrate in silent ischemia].

Thirty six patients with documented coronary artery disease and exercise-induced silent ischemia were evaluated in a double-blind randomised placebo-controlled crossover study. The effect of once daily 60 mg sustained-release isosorbide-5-mononitrate (IS-5-MN) was tested on exercise-induced and ambulatory silent ischemia. After a wash-out period in which no cardioactive drugs were administered, each patient received IS-5-MN for the first week, followed by placebo for the second week, or vice versa. A symptom-limited bicycle exercise test and Holter monitoring over a 24-hour period were performed after wash-out and at the end of each one-week treatment period. In comparison with wash-out IS-5-MN significantly (p < 0.05) prolonged time on onset of 1 mm ST-segment depression during exercise testing. On the other hand, the number and circadian variation of ischemic episodes during Holter monitoring were not influenced by IS-5-MN. Thus, 60 mg IS-5-MN once daily significantly improved silent ischemia during exercise testing but not during Holter monitoring. This discrepancy may be due to different pathogenetic mechanisms of ischemia during ergometry as opposed to the everyday situation; nitrates may also provoke silent ischemia by increasing the heart rate. Furthermore, the choice of only one antiischemic drug at a fixed dosage may not be aggressive enough in suppressing ischemia completely.

Adult↗
PubMed1994

Clinical significance of urinary cyclic guanosine monophosphate in diagnosis of heart failure.

We measured concentrations of guanosine 3',5'-monophosphate (cGMP) in plasma and urine of healthy subjects and patients with congestive heart failure, renal impairment, neoplastic disease, and hepatic cirrhosis. There was no correlation between cGMP concentrations in urine and in plasma. In all patients except those with renal impairment, urinary cGMP concentrations were significantly higher than in healthy persons. Only patients with heart failure or renal impairment showed significantly increased plasma cGMP concentrations. In contrast, cGMP in urine does not relate to the clinically assessed severity of heart failure (New York Heart Association functional classes). Determination of cGMP in plasma results in higher sensitivity and specificity for diagnosing heart failure than measurement of cGMP in urine.

Adult↗
PubMed1991

Release of cyclic guanosine monophosphate evaluated as a diagnostic tool in cardiac diseases.

Concentrations of atrial natriuretic peptide (ANP) are increased in plasma of patients with impaired cardiac and renal function. The second messenger of ANP, cyclic guanosine monophosphate (cGMP), is released into the plasma specifically upon stimulation of cells with ANP. Although nitrates can also activate intracellular cGMP synthesis, we detected no increase in plasma cGMP concentrations after infusions of glycerol trinitrate. Because immunoreactive ANP is highly susceptible to degradation and nonspecific influences in blood samples, determinations of ANP require immediate centrifugation and storage of plasma at -20 degrees C. In contrast, we found that cGMP is stable for five days in vitro in blood samples containing EDTA. In 147 healthy blood donors, the upper cutoff value for plasma cGMP was 6.60 nmol/L, not significantly different (P greater than 0.05) from that for 222 patients with disorders other than cardiovascular and renal. In 69 patients with manifest congestive heart failure (NYHA stages II-IV), 65 had increased cGMP values. Using the above cutoff value for cGMP gave diagnostic sensitivity of 94.2% and specificity of 93.7%. Plasma cGMP may thus provide an alternative for routine clinical measurements of ANP in cardiac diseases in the absence of renal disorders.

Adolescent↗
PubMed1990

[Expectations of stroke patients and their relatives of rehabilitation].

The expectations towards rehabilitation held by 45 stroke patients and their relatives were investigated. It was found that the expectations held by the relatives are more realistic and not quite as optimistic as those held by the patients. The patients above all hoped for physical-vocational restoration, the relatives on the other hand more for emotional-social recovery. Also dealt with are the expectations and notions of patients and relatives in respect of duration, location and material rank of rehabilitation. Pointed out are the difficulties to be reckoned with on account of the divergent expectancies of patients and relatives toward rehabilitation.

Activities of Daily Living↗
PubMed1990

[Validity of potential support--a pilot study of myocardial infarct patients].

This investigation examines the validity of potential (anticipated) support as an indicator of social action. A comparison of anticipated support with received support in the past is problematic; other research variants have to be found. A comparison of two samples offers possible validation: asking one sample about the potential support, with regard to a possible crisis, and asking the second sample about actually received crisis support. This study examines received social support in a population of 30 myocardial infarction patients, and anticipated social support among 30 healthy individuals (on the assumption that they would suffer from a cardiac-infarct). The findings suggested that patients self-reported support values are lower than the expected support of the disease-free population. In particular, the healthy individuals expected support from their spouses and grown-up children. On the contrary the patients often name their doctors in this context. In general the findings suggested that the expected support with regard to an imagined crisis is a problematical indicator (validity problem). Alternative explanations are possible; the explanation that results are effects of patients perception bias is less likely.

Adaptation, Psychological↗
PubMed1988

[Stress management in migraine].

The aim of this study was to investigate the physiological and psychological mechanisms underlying migraine, 21 patients with migraine, 21 healthy controls and a group of 21 asthmatics participated in the investigation. All patients and controls were female. Using flicker frequency analysis we determined unspecific cortical activation, whereas autonomic activation was measured by means of the skin conductance level and the skin conductance response. Furthermore, stress management was objectivated by a self-rating scale (SVF). Our findings suggest the hypothesis of inadequate regulation of autonomic especially sympathetic reactions, which along with inadequate stress overcoming mechanisms appear to be of importance in the triggering of migraine attacks.

Adaptation, Psychological↗
PubMed1988

[Clinical prognostic criteria in the rehabilitation of cerebral infarct patients].

79 patients with ischaemic stroke were investigated, with 31 patients showing a pure hemiparesis, 22 an additional depressive syndrome and 26 a dementia. After an average time intervall of 28 months, a follow-up investigation was performed on these 3 groups relative to their course and rehabilitation outcome. No significant differences were present between the 3 groups as regards age and sex distribution as well as hemisyndrome severity. The neurological and psychiatric findings at follow-up differed significantly from the primary findings. Also, significant differences were found in the degree of disability, and in the self- and family ratings of rehabilitation outcome, with a poorer long-term course, i.e. a higher degree of disability, significantly more frequent in the dementia group. Comparison of self- and family-ratings showed that self-ratings given were significantly worse in the dementia and depressive groups, whereas patients with purely neurological symptoms rated themselves better than their relatives did.

Cerebral Infarction↗
PubMed1986

Variable spectrum and prognostic implications of left and right ventricular ejection fractions in patients with and without clinical heart failure after acute myocardial infarction.

To determine the spectrum and prognostic implications of left and right ventricular (LV and RV) ejection fractions (EFs) in acute myocardial infarction (AMI), radionuclide ventriculography was performed in 114 consecutive patients, admitted without (Killip class I, 78 patients) or with (killip class II, 36 patients) clinical signs of pulmonary congestion within 24 hours of onset of symptoms of a transmural AMI. Mean LVEF was significantly lower in patients in Killip class II than in those in class I (0.32 +/- 0.11 vs 0.46 +/- 0.15, p less than 0.001) and in patients with anterior than inferior AMI (0.34 +/- 0.11 vs 0.52 +/- 0.14, p less than 0.001). Of the 36 patients with a severely depressed (0.30 or less) LVEF, 15 (42%) were in Killip class I. Mean RVEF did not differ significantly between Killip class I and II patients (0.42 +/- 0.11 vs 0.40 +/- 0.12, difference not significant) but was significantly lower in patients with inferior than anterior AMI (0.38 +/- 0.09 vs 0.44 +/- 0.11, p = 0.005). In patients with inferior AMI, a depressed RVEF (0.38 or less) was associated with a normal LVEF in 30% and a depressed LVEF in 20%, whereas in those with anterior AMI, a depressed RVEF, observed in 25% of patients, occurred only in association with a depressed LVEF.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1986

[Complete AV block in a heart catheter study using a Swan-Ganz catheter].

A case of complete heart block during right heart Swan-Ganz balloon-tipped flow-directed catheterization in a patient with intermittent left bundle branch block after aortic valve replacement is reported. After entrance into the right ventricle with the catheter tip as well as after insertion of a temporary balloon-floated pacemaker electrode symptomatic complete heart block occurred. This case demonstrates that in a patient with intermittent left bundle branch block a complete AV block may occur and therefore the possibility of cardiopulmonary resuscitation and temporary pacing has to be taken in account.

Aged↗
PubMed1985

[Pulmonary hypertension and chronic obstructive ventilatory disorders--correlation between hemodynamic parameters and pulmonary function].

We evaluated 74 patients with pulmonary hypertension secondary to chronic obstructive pulmonary disease and compared pulmonary function tests as well as capillary blood gas values with pulmonary hemodynamic parameters. Thirty-four patients demonstrated pulmonary hypertension only at exercise, fourty patients had pulmonary hypertension at rest (mean pulmonary artery pressure greater than 20 mm Hg). There was a significant correlation between capillary oxygen tension and mean pulmonary artery pressure as well as pulmonary vascular resistance, both at rest and during exercise. The relation between capillary PCO2 and pulmonary hemodynamics were statistically less significant. The correlation between criteria of pulmonary obstruction and/or increased lung volumes and mean pulmonary artery pressure and pulmonary vascular resistance were not as significant. The 34 patients with pulmonary hypertension only at exercise differed significantly from the other groups of patients with pulmonary hypertension at rest as seen in all pulmonary function parameters. Furthermore there was also a difference in the capillary oxygen tension during exercise, but not in the capillary carbon dioxide tension. In conclusion, of all pulmonary function tests the most efficient criteria for pulmonary hypertension are reduced FEV1/VC and low oxygen tension at rest respectively a fall during exercise.

Adult↗
PubMed1985

[Pulmonary hypertension in chronic respiratory tract obstruction: a combined study on haemodynamics and radionuclide ventriculography].

In 44 patients with chronic obstruction of the respiratory passages pulmonary artery pressures were measured by Swan-Ganz catheter and right-ventricular ejection fraction by radionuclide ventriculography (equilibrium method). Although there was no linear correlation between the haemodynamic parameters of afterload or preload of the right ventricle and global right-ventricular ejection fractions, sensitivity and specificity of radionuclide ventriculography were very good (87% and 83%, respectively) for the recognition of pulmonary hypertension during exercise tests. Global right-ventricular ejection fraction in patients without pulmonary arterial hypertension had a normal and significant rise from 52% to 58% on exercise. In the group with pulmonary hypertension mean right-ventricular ejection fraction fell during exercise from 47% to 46%. Radionuclide ventriculography in the assessment of right ventricular function, especially during exercise, provides useful pointers to the diagnosis of pulmonary hypertension due to chronic respiratory-tract obstruction.

Adult↗
PubMed1985

Scintigraphically detected predominant right ventricular dysfunction in acute myocardial infarction: clinical and hemodynamic correlates and implications for therapy and prognosis.

To determine the clinical and hemodynamic correlates as well as therapeutic and prognostic implications of predominant right ventricular dysfunction complicating acute myocardial infarction, 43 consecutive patients with scintigraphic evidence of right ventricular dyssynergy and a depressed right ventricular ejection fraction (less than 0.39) in association with normal or near normal left ventricular ejection fraction (greater than or equal to 0.45) were prospectively evaluated. All 43 patients had acute inferior infarction, forming 40% of patients with acute inferior infarction, and only eight (24%) had elevated jugular venous pressure on admission. On hemodynamic monitoring, 74% of patients had a depressed cardiac index (less than or equal to 2.5 liters/min per m2), averaging 2.0 +/- 0.05 for the group. Of these, 30% did not demonstrate previously described hemodynamic criteria of predominant right ventricular infarction (right atrial pressure greater than or equal to 10 mm Hg or right atrial to pulmonary capillary wedge pressure ratio greater than or equal to 0.8, or both). The left ventricular end-diastolic volume was reduced to 49 +/- 11 ml/m2 (n = 22) and correlated significantly with the stroke volume index (r = 0.82; p less than 0.0001) and cardiac index (r = 0.57; p = 0.005). The follow-up right ventricular ejection fraction, determined in 33 patients, showed an increase of 10% or greater in 26 (79%), increasing from a mean value of 0.30 +/- 0.06 to 0.40 +/- 0.09 (p less than 0.0001) without a significant overall change in the mean left ventricular ejection fraction (0.56 +/- 0.10 to 0.56 +/- 0.11, p = NS).(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗