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Biomedical subjects

M Wehr

Publications and source records attributed to M Wehr.

At least 37 records · Page 2Linked to original sources
PubMed1990

[Influence of surgical intervention on the course of patients with rheumatic mitral valvular defects].

A retrospective study of 798 patients from Essen University Medical Hospital during the period 1960-1987 with operation performed due to valvular heart disease was undertaken. Among them were 324 suffering from mitral stenosis, 12 from mitral regurgitation, 462 from mixed mitral valvular diseases. The surgical treatment consisted of commissurotomy in 611 patients, and prosthetic valve replacement in 187 patients. Follow-up studies showed: Before and after operation, occurrence of embolism was 16.5 vs 8.7%; status of class of cardiac function (NYHA) from group with commissurotomy was 3.1 vs 2.0; NYHA classification in group of prosthetic replacement was 3.1 vs 1.9; 10 years survival rate after commissurotomy was 95.2%; after valve replacement it was 80.2%; early letality rate after operation (at or within 2 months after operation) depended on 1) the type of operation: commissurotomy 2.8%, valve replacement 10.2%; 2) the state of cardiac function: in class IV it was 12.9%, in class III 4.6%; 3) the number of operations: in only operation it was 4.8%, in reoperations 19.5%. Thus the following fact will lead to false judgement: though the area is the same, the regurgitant volume may vary with the brightness of coloration. Furthermore the left auricle will be enlarged consequently following the increase of regurgitant volume, also causing misinterpretation. It is of practical importance to consider some other factors in quantifying the regurgitant volume.

Adult↗
PubMed1990

[Successful treatment of flecainide (Tambocor) poisoning--effect of hemodialysis/hemoperfusion?].

After suicidal ingestion of 3 g flecainide a 34-year-old woman showed somnolence, cerebral convulsion, disturbances of atrioventricular and intraventricular conduction and ventricular asystole. The maximum flecainide plasma level was 4900 ng/ml; this level is extremely high and exceeds the maximum therapeutic level by five times. After initial cardiopulmonary resuscitation and stabilization by intensive care treatment we performed a combined hemodialysis/hemoperfusion therapy (with activated charcoal). This procedure led to a rapid decrease of flecainide plasma levels and simultaneous improvement of ECG-alterations. The initial decrease in flecainide plasma levels during extracorporeal elimination occurred much quicker (4.5-8.5 h plasma halflife) than the spontaneous decrease rate of flecainide in humans (12-20 h plasma half-life). We conclude that, perhaps, hemodialysis/hemoperfusion therapy is an efficient method for decreasing toxic plasma levels of flecainide and for improvement of the clinical course of this intoxication.

Adult↗
PubMed1989

[Atrial myxoma and signs of autoimmune disease].

Raised erythrocyte sedimentation rate, mild proteinuria, erythrocyturia and slightly impaired renal function were revealed in a 45-year-old patient complaining of general physical fatigue, fever and pain in the right flank. Interstitial nephritis was confirmed by biopsy. Therefore, an autoimmune disease with renal involvement was diagnosed. Three years later a myxoma of the left atrium was found. After surgical removal of the myxoma the signs of the systemic disease receded and disappeared unexpectedly. At follow-up after 10 years the patient was completely free of symptoms. It is concluded that the signs of the autoimmune disease had been caused by the myxoma.

Autoimmune Diseases↗
PubMed1989

[Recurrent gastroparesis following abdominal irradiation. Therapy with cisapride].

Following abdominal radiation a 16-year-old male patient developed nausea and vomiting secondary to gastric stasis, dilatation and impairment of antral motility. Symptoms improved after 2 months of treatment with a cholinergic agonist. Now, 7 years later, symptoms recurred. Cisapride, a newly developed agent which stimulates gastrointestinal motility probably evoked a prompt increase of antral motility and gastric emptying. We conclude that abdominal irradiation may cause gastrointestinal motility disturbances which may respond to medical therapy.

Adolescent↗
PubMed1986

Skin testing for chymopapain allergy in chemonucleolysis.

Chemonucleolysis with chymopapain (Chymodiactin, Discase) bears the risk of unpredictable anaphylactic reactions. The rate of anaphylaxis is reported to be between 0.35% and 1.5%. Serological in vitro tests such as RAST (radio-allergo-sorbent test) or ChymoFAST (fluorescent allergo-sorbent test) are used to determine increased specific immunoglobulin E antibody titers against chymopapain in patients submitted to chemonucleolysis. Alternatively, skin prick tests have also been applied in clinical trials. A skin prick test including Discase, Chymodiactin, and Solutrast 250 M, which is a radiopaque dye, has been performed in a total of 257 patients; 222 patients were tested before, and 35 patients were tested after chemonucleolysis with chymopapain. From the group tested before chemonucleolysis, 2.3%-3.3% had positive skin tests. After chemonucleolysis, the overall allergy rate to chymopapain increased to 42.9%. Positive skin reactions seem to be time-dependent--between the 3rd and 12th weeks after chemonucleolysis, more than 70% of the patients had positive skin tests. There was no correlation between a history of previous allergy and the skin test result. Patients with positive skin tests should be excluded from chemonucleolysis. This procedure increases the safety for patients submitted to chemonucleolysis. No anaphylactic reaction has been observed hitherto in more than 350 patients who were treated with the intradiskal injection of chymopapain after a negative skin prick test.

Anaphylaxis↗
PubMed1986

[QT time and the ventricular refractory period in programmed electrical stimulation of the heart in patients with ventricular and supraventricular tachycardias--effect of sotalol].

The QT-interval in the surface electrocardiogram (usually lead II) and the effective refractory period of the right ventricle (ERP-V) were investigated in 16 patients with documented supraventricular tachycardia (SVT) and in 18 patients with documented ventricular tachycardia (VT) during basic pacing (QT1) and programmed stimulation of the right ventricular apex (QT2) (single-test stimulation at 3 different rates, BCL: 600 ms, 500 ms, 430 ms). The effects of intravenous and oral Sotalol were analysed in the SVT-group. An increase in heart rate was followed by a significant decrease of the QT-intervals and ERP-V in both groups. The QT-intervals and the ERP-V were statistically significantly prolonged by intravenous Sotalol. The VT-group showed a statistically significant longer shortest QT2-interval during programmed stimulation, which can be explained by a greater dispersion of action potentials leading to an inhomogenous ventricular recovery process, which may represent the electrical substrate for the arrhythmia.

Adult↗
PubMed1985

Catecholamines in the plasma and urine of patients with alcoholic liver damage under resting and exercise conditions.

Heart rate and plasma catecholamines were determined in 16 patients with alcoholic fatty liver and 14 patients with alcoholic cirrhosis of the liver. The measurements were performed at rest and after exercise on the bicycle ergometer, on average 11 days after admission to hospital. In comparison with a control group, the mean heart rate of the patient group was significantly increased at rest and under graduated loading. Significantly increased plasma catecholamine concentrations under resting conditions were observed in both groups of patients, the increase being more pronounced in the cirrhotics (increased with progressive liver damage, significant differences being found between the control group and each of the two groups of patients). During exercise under a load of 50 or 100 watts, the increases in adrenaline, noradrenaline and dopamine concentrations were greatest in patients with alcoholic cirrhosis. With reference to the initial values, however, the increases in concentration were identical in all three groups. In the patients, metabolism of the catecholamines remained unchanged after an average of 11 days abstinence from alcohol; they showed a significantly diminished elimination of vanillylmandelic acid in the urine and, compared with the greatly elevated plasma catecholamine levels, they showed only a moderate increase in the excretion of catecholamines. The results reported here support the assumption that changes in catecholamine metabolism compatible with an increased sympathetic activity are present in chronic alcoholics without advanced liver damage.

Adult↗
PubMed1985

[The so-called paling of the heart muscle and its value as an expression of ischemic myocardial damage].

Postmortem examination of human hearts demonstrated that fluorescent microscopic evidence of damage to the myocardium is present in most cases with so-called "paling". "Paling" is insufficient, however, to verify irreversible damage of the myocardium since nearly 1/3 of such cases have negative fluorescence microscopic reactions. In cases of acute coronary death with and without grossly visible signs of an ischemic myocardial damage necroses are demonstrable by fluorescence microscopy. This finding is not influenced by advanced autolysis. A fluorochromation with acridinorange at pH 7.0 is recommended in all cases of acute coronary death with and without paling or other macroscopic signs of acute ischemic damage to the heart muscle.

Adolescent↗
PubMed1984

Clinical efficacy and electrophysiologic effects of intravenous and oral encainide in patients with accessory atrioventricular pathways and supraventricular arrhythmias.

The electrophysiologic effects and clinical efficacy of intravenous (i.v.) and oral encainide were studied in 13 patients with accessory atrioventricular (AV) pathways (7 overt, 1 intermittent and 5 concealed) and drug-resistant supraventricular arrhythmias (5 paroxysmal atrial fibrillation, 1 atrial tachycardia and 7 with orthodromic circus movement tachycardia). Previously, therapy had failed with a mean of 3 conventional antiarrhythmic agents. In 5 patients, amiodarone administration had also been unsuccessful. All patients underwent programmed electrical stimulation of the heart before and after 1.5 mg/kg of i.v. encainide. Seven patients were restudied during oral encainide therapy (mean 155.8 +/- 54.2 mg/day) 3 days to 6 weeks (average 21 days) later. Anterograde conduction over the accessory AV pathway blocked in 4 of 7 patients after i.v. encainide. Oral encainide blocked anterograde conduction over the accessory pathway or prolonged the refractory period of the accessory pathway in 3 of 4 patients. This change in anterograde conduction was independent of the predrug value for the anterograde refractory period of the accessory AV pathway. Intravenous and oral encainide had minimal effects on retrograde conduction over the accessory AV pathway. The clinical effect of oral encainide was studied in 12 patients. Four patients responded to oral encainide and have been free of arrhythmia or side effects for 2 to 20 months (average 10.5). Encainide failed to prevent the clinical arrhythmia in 2 patients. In 4 patients with atrial arrhythmias, circus movement tachycardia developed during oral encainide therapy. In 1 patient the frequency of circus movement tachycardia increased with oral encainide treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral↗
PubMed1984

Ventricular tachycardia with alternate ventriculo-atrial Wenckebach conduction due to two-level block.

A 54-year-old patient was studied because of ventricular tachycardia following an inferior myocardial infarction. During one episode of non-sustained ventricular tachycardia a 9:4 alternating ventriculo-atrial Wenckebach block was noted. This was based upon a 2:1 block between the ventricles and the bundle of His and a 5:4 Wenckebach block between the bundle of His and the atria. Our study shows that alternate Wenckebach periods during ventriculo-atrial conduction may be caused by two or more levels of block in the ventriculo-atrial conduction system.

Cardiac Pacing, Artificial↗
PubMed1984

Irregular pacemaker tachycardia in a patient with WPW syndrome and an A-V universal pacemaker.

We describe a case of an irregular pacemaker circus movement tachycardia in a patient with the Wolff-Parkinson-White syndrome and a normally functioning A-V universal (DDD) pacemaker (Cordis Sequicor 233 D). The mechanism of the artificial circus movement tachycardia, which uses the pacemaker as the anterograde limb and a septally located accessory atrioventricular pathway as the retrograde limb, is discussed.

Atrioventricular Node↗
PubMed1984

[The influence of drug liberation from drug forms on local therapy of infected bone cavities].

With regard to an optimum local pharmaco-therapy in infected bone cavities, in vitro examinations by means of a flow model based on the half-change method had been performed to liberate Gentamycin from globular embeddings in polymethylmethacrylate. The Gentamycin had been determined in a micro-biological manner. The release behaviour of the polymere carrier could be controlled by adding Polyethylenglycol 400 as softener or butane dioldimethacrylate as wettener. Adding 20 vol.-% of Polyethylenglycol 400, the Gentamycin release could be increased to the 8-fold, whereas the addition of 5 vol.-% of butane dioldimethacrylate resulted in a decrease amounting to 7/8 exit value.

Bacterial Infections↗