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Biomedical subjects

M Weissel

Publications and source records attributed to M Weissel.

At least 19 recordsLinked to original sources
PubMed1992

Laboratory monitoring of thromboprophylaxis with low molecular weight and standard heparin.

This study was made to evaluate assays for monitoring of low dose heparin thromboprophylaxis and to evaluate its efficacy in reduction of hypercoagulation. Patients with medical diseases scheduled for routine thromboprophylaxis were subcutaneously treated with either 5.000 anti XaU low molecular weight (LMW) heparin once daily (n = 20) or 5.000 IU standard (ST) heparin 3 times daily (n = 19). On days 1,2,3, before, 1 and 4 hours after heparin injection APTT, TCT, anti Xa, Heptest, thrombin-antithrombin complexes (TAT), and D-Dimer levels were measured. In the LMW heparin group, median values of APTT and TCT slightly increased after heparin and the ranges of pre- and postinjection values showed extensive overlap. However, values of anti Xa and Heptest markedly increased, showing complete separation of ranges. In the ST heparin group neither APTT, TCT, anti Xa, nor Heptest were significantly different comparing pre- and postheparin values. Half of the patients in both groups had subclinical hypercoagulation at baseline (TAT greater than 5 ng/ml, D-Dimer greater than 200 ng/ml). On day 3 of prophylaxis this percentage was not significantly decreased. Moreover, several patients in both groups increased in TAT and D-Dimer. In the LMWheparin group, negative correlations between body weight and 4 h postinjection heparin levels were found (anti Xa R = -0.50, Heptest R = -0.31) and between 1 h postinjection heparin and TAT and D-Dimer levels 3 h later (TAT-anti Xa R = -0.58, TAT-Heptest R = -0.64, D-Dimer-anti Xa R = -0.32, D-Dimer-Heptest R = -0.33).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1992

Thyroid autoimmunity and hypothyroidism during long-term treatment with recombinant interferon-alpha.

Forty-five patients with myeloproliferative or myelodysplastic syndromes, treated with recombinant interferon-alpha (rIFN-alpha) for a minimum of 1 up to 4 years, were examined for the occurrence of thyroid autoimmunity. During treatment, the rate of thyroid autoimmunity rose to more than 20%. The decrease in severity and frequency of thyroid autoimmunity after withdrawal of IFN shows that this is a potentially reversible side effect. The key determinant for the manifestation of this IFN-related autoimmune phenomenon seems to be a predisposition for autoimmunity, since patients with initially detectable thyroid antibodies are prone to exacerbations of thyroid autoimmunity. Concurrent with thyroid autoimmunity, hypothyroidism occurred but did not correlate with the levels of thyroid antibodies, although severe hypothyroidism in two patients was accompanied by increased levels of thyroid antibodies. This investigation shows that thyroid autoimmunity and consecutively hypothyroidism must be expected in certain patients treated with rIFN-alpha during long periods. Furthermore, it may be assumed that IFN-alpha does not induce the development of autoimmunity, but rather enhances the levels of pre-existent thyroid antibodies.

Adult↗
PubMed1991

Raised circulating plasma levels of atrial natriuretic peptide in adolescent and adult patients with cystic fibrosis and pulmonary artery hypertension.

Since pulmonary artery hypertension (PH) complicates advanced stages of cystic fibrosis (CF), we wondered whether plasma concentrations of h-ANP would be increased in adult patients with CF. Furthermore, if only the right ventricle is faced with an increased afterload in these patients, the increased h-ANP plasma levels should stem primarily from the right atrium. To test this hypothesis we studied 12 adult patients with CF in a clinically stable condition using right heart catheterization. Mean pressures were measured in the right atrium (Pra) and pulmonary artery (Ppa), pulmonary capillary wedge (PCWP) position, and blood were drawn from the pulmonary artery and from a peripheral vein to determine h-ANP. Plasma levels in the pulmonary artery were significantly higher than in a peripheral vein (54.3 +/- 6.0 pg/ml vs. 32.2 +/- 4.4 pg/ml; p less than 0.001). Four of the 12 patients had PH (Ppa, 25.8 +/- 2.9 mmHg) whereas 8 patients exhibited normal pulmonary artery pressures (Ppa, 15.9 +/- 0.7 mmHg). Patients with PH had higher Pra (4.2 +/- 0.4 mmHg) than patients with CF without PH (1.9 +/- 0.7 mmHg; p less than 0.05). Plasma h-ANP concentrations were significantly higher in patients with CF with PH (70 +/- 10.4 pg/ml in the pulmonary artery; 42.6 +/- 4 pg/ml in a peripheral vein) than in patients with normal pulmonary artery pressure (43 +/- 3.3 pg/ml in the pulmonary artery; p less than 0.01; 24.7 +/- 5.6 pg/ml in a peripheral vein; p less than 0.05). Although our results are derived from a small group of patients with CF, we conclude from our results that in patients with CF PH may cause increased h-ANP secretion. The right atrium seems to be a major source.

Adolescent↗
PubMed1991

Clinical evaluation of new assays for determination of serum calcitonin concentrations.

In order to test the clinical usefulness of new commercially available kits for determination of calcitonin serum concentrations, we investigated the family (N = 10) of a patient with medullary thyroid carcinoma and bilateral pheochromocytoma including his affected son, 10 athyreotic patients, totally thyroidectomized for non-medullary thyroid cancer, and 4 normal volunteers. Pentagastrin tests were performed in all subjects. Serum calcitonin levels before and after pentagastrin were determined by 4 kits. Kits A and B are immunoradiometric assays of the sandwich-type, kits C and D are radioimmunoassays, D being the one hitherto routinely used. Our results show that the new assays (kits A, B and C) have a better diagnostic accuracy in screening for medullary thyroid cancer than the RIA (kit D), hitherto used, where basal values overlapped with normals. Although basal values of normals were mostly near the detection limit of all 4 kits, kits A and B were sensitive enough to detect stimulation of calcitonin secretion by pentagastrin in all subjects with intact thyroid glands and kit C in most of them. The lack of increase in calcitonin after pentagastrin observed by kits A, B and C in athyreotic patients suggests deficiency of secretion of this hormone. Only kit D was unable to show this deficiency.

Adrenal Gland Neoplasms↗
PubMed1991

[Iodine containing drugs and thyroid gland function. A diagnostic and therapeutic problem].

Iodine-induced thyroid dysfunction will become more important in Austria in the near future, because of the augmentation of the iodine content in salt in 1990. This review therefore tries to summarize the diagnostic and therapeutic problems that may arise in iodine-induced thyroid disease. After discussion of the physiologic reaction of the normal thyroid to iodine the most frequently used iodine-containing drugs used in Austria are presented. Special emphasis is laid on iodine containing antiseptics and on the antiarrhythmic drug amiodarone. The influence of iodine supplementation on the reaction of diseased thyroid glands to iodine overload is stressed. The diagnosis of iodine induced thyroid dysfunction is relatively simple, once it is thought of. Amiodarone-iodine induced thyroid disease may be an exception, because of the intrinsic effect of this drug on thyroid hormone metabolism. Since high intra-thyroidal iodine content inhibits the action of thyrostatics, therapy of iodine-induced hyperthyroidism may be complicated. Alternative possibilities such as cortisone, perchlorate or surgery in thyroid storm are presented. Substitution with 1-thyroxine in iodine-induced hypothyroidism may be harmful in elderly patients with cardiac problems. In conclusion, this review tries to present the state of the art of the solution of diagnostic and therapeutic problems in thyroid dysfunction due to iodine administration.

Amiodarone↗
PubMed1990

Felodipine is more effective than hydrochlorothiazide when added to a beta-blocker in treating elderly hypertensive patients.

This randomized, double-blind, parallel-group study compared felodipine and hydrochlorothiazide (HCT) given in addition to a beta-blocker in 134 elderly hypertensive patients aged 56-79 years (mean of 66 +/- 5 years). In the felodipine-treated group (n = 57), supine blood pressure (BP) was reduced from 171 +/- 16/101 +/- 6 mm Hg at randomization to 147 +/- 12/86 +/- 6 mm Hg after 8 weeks, whereas in the HCT-treated group (n = 66), BP was reduced from 170 +/- 4/101 +/- 5 to 151 +/- 16/89 +/- 9 mm Hg. The reduction in diastolic blood pressure (DBP) was significantly greater in the felodipine than in the HCT group (p less than 0.003). In the felodipine-treated group, 87% of the patients were controlled (DBP less than or equal to 90 mm Hg) compared with 58% in the HCT group (p less than 0.001). Reported adverse events were generally mild. Six patients withdrew from the study due to adverse events, five in the felodipine group and one in the HCT group.

Adrenergic beta-Antagonists↗
PubMed1990

[Can the thyrotropin (TSH) suppressive dose of L-thyroxine (T4) be individually predicted in athyroid patients?].

TSH-suppressive doses of L-thyroxine (T4) are needed in the treatment of athyreotic cancer patients in order to prevent metastases. We were interested to know whether the TSH-suppressive dose can be predicted on a body weight-or body surface basis in athyreotic individuals, which might save them the control TRH-test. 92 athyreotic patients (22 men, 70 females; age 25-81, mean 50.4 yrs; body weight ranging from 48-114 kg, mean 73), who have been operated for differentiated thyroid cancer and who have had at least one treatment ablative doses of 131-I, were investigated. After 4 weeks without thyroid hormone supplementation (checked by TSH serum concentration above 20 microU/ml) patients were set on 150 mcg of L-T4/day. TSH serum concentration before and 20' after 200 mcg of TRH were measured by the ultrasensitive TSH kit of Behringwerke. Total and free T4 as well as total T3 were also measured by radioimmunoassay kits. TRH tests were performed 6 weeks after start of treatment in 51 patients and 8 or more weeks respectively in 41 patients. Only the inclusion of the influence of age (multiple correlation) yielded a significant positive correlation between basal TSH and L-T4 dose/body weight.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Interpretation of plasma concentrations of human atrial natriuretic peptide (hANP) in congestive heart failure.

The present study reports about novel findings concerning the interrelationship between release of human atrial natriuretic factor (hANP) and the clinical situation of patients suffering from congestive heart failure. Estimations of plasma hANP were done by specific and sensitive extraction-based RIA. The normal range was 5 to 80 ng/l, mean +/- SEM = 30 +/- 15 ng/l, n = 106. Influence of response to therapy on hANP-release was studied in altogether 14 patients. 12 of these patients had elevated plasma hANP at admittance, surprisingly peptide levels were normal in 2 patients throughout the study. 9 out of the 14 patients responded well to therapy (shift from NYHA IV/III to NYHA II within about 10 days), hANP-levels decreased to normal values: 235 +/- 104 ng/l vs. 65 +/- 13 ng/l; p less than 0.001. The 5 residual patients responded to therapy only partially (shift from HYHA IV to NYHA III within an observation interval of about 2 weeks). Plasma hANP values decreased from 225 +/- 94 ng/l to 137 +/- 22 ng/l (p less than 0.02), but were still supranormal. Atrial fibrillation, which persisted in 8 out of the 14 patients after therapy did not influence hANP levels: hANP levels paralleled clinical signs of improvement, irrespective of atrial fibrillation. Right heart catheterization revealed very high mean right atrial pressures in those 2 patients mentioned above, who had normal pretherapeutic hANP.(ABSTRACT TRUNCATED AT 250 WORDS)

Atrial Fibrillation↗
PubMed1989

Prostacyclin I2 (PGI2) increases left ventricular ejection fraction (LVEF).

In order to evaluate the effect of PGI2 on left ventricular ejection fraction (LVEF) an intravenous infusion in 10 patients (3 males, 7 females; 36 to 63 years) with an impaired LVEF (34.7 +/- 14.8%) was performed. LVEF was determined by means of 99mTc-pertechnetate radionuclide ventriculography. An increase of LVEF to 36.2 +/- 13.5% during administration of PGI2 at a rate of 1 ng/kg/min for 15 min and to 43.8 +/- 15.8% during a rate of 5 ng/kg/min (p less than 0.01) for an additional 15 min was observed. Analyzing the data in more detail in 6 patients, an improvement in LVEF became obvious during the administration of 1 ng/kg/min (108, 109, 116, 118, 121, and 123% of pre-infusion value, respectively). In 5 out of these 6 patients a dose-increment to 5 ng/kg/min further increased LVEF (139, 179, 187, 148, and 128% of pre-infusion value, respectively). In contrast, in the other 4 patients no response of LVEF to PGI2 at a rate of 1 ng/kg/min could be observed. However, in 2 out of these 4 patients LVEF increased during the administration of 5 ng/kg/min (111 and 117% of pre-infusion value). Individual changes in hemodynamic parameters showed no correlation to the improvement seen in LVEF in response to PGI2. It is concluded that PGI2 may exert beneficial effects on LVEF, and might be used in certain clinical conditions, such as before heart transplantation, to achieve a temporary improvement in LVEF.

Adult↗
PubMed1989

[Hypertriglyceridemia: an independent risk factor for cardiovascular diseases?].

This review deals with the question whether hypertriglyceridemia represents an independent risk factor for the development of cardiovascular disease. The accepted definition of hyper- and "borderline"-hypertriglyceridemia is presented as well as its most frequent causes. After discussion of the hypotheses of the possible ways of mechanisms by which elevated serum triglycerides may be atherogenic the available epidemiologic data are analysed: summarizing these results it can be stated that in contrast to previous statements hypertriglyceridemia seems to be an independent risk factor for the development of cardiovascular disease, even after correction for other risk factors like total cholesterol, smoking, familial history, age or similar well known factors. Even the Framingham study that in earlier studies denied an independent role of the serum triglycerides showed recently that serum triglycerides correlated significantly with coronary heart disease after correction of other risk factors, especially in women. In conclusion, the recommendations of the European and American Consensus Conferences for patients with hypertriglyceridemia are presented: these conferences agree that even borderline hypertriglyceridemia should be investigated for its cause and treated by diet and if this fails by drugs.

Coronary Disease↗
PubMed1987

[Thyrostatic drug therapy of Basedow disease. Combination with thyroid hormones and/or beta blockers].

Basing on the results of the European and Austrian survey on the management of hyperthyroidism due to Graves' disease the theoretical backgrounds of the combination of thyrostatic treatment with thyroid hormones and with beta blocking agents are discussed. A suspected lack of compliance of a hyperthyroid patient is probably the only strong argument for the use of combination therapy with thyroid hormones. Some countries in Europe prefer this way of treatment, whereas other countries decline it. In Austria the opinion of the necessity of thyroid hormones in thyrostatic treatment is also not unanimous, the majority, however, preferring it. In contrast, the supporting use of beta blocking agents especially in highly symptomatic patients stands beyond debate. However, monotherapy with beta blockers for preparation of subtotal thyroidectomy in hyperthyroid patients is generally declined, probably because of the danger of a postoperative thyrotoxic crisis. Most colleagues agree (as well in Europe as in Austria) that the combination of thyrostatic drugs with beta-blockers is the best choice for the preparation of subtotal thyroidectomy, saving time and thereby costs and reducing the danger of a postoperative thyrotoxic crisis.

Adrenergic beta-Antagonists↗
PubMed1987

[Value of calcitonin and 6-oxo-prostaglandin Fl alpha in the differentiation of lung cancers].

Plasma calcitonin and 6-oxo-Prostaglandin-F1 alpha (6-oxo-PGF1 alpha), one of the stable metabolite of prostacyclin, were determined in patients with malignant and non-malignant diseases of the lung. 11 out of 14 patients with small cell carcinoma and only 3 out of 17 patients with other histological types of lung cancer had abnormally elevated plasma calcitonin levels. 6-oxo-PGF1 alpha levels were significantly higher in patients with different types of lung cancer, compared to a control group with non-malignant lung disease. Combining the results of calcitonin and 6-oxo-PGF1 alpha measurements led to improved specificity and efficiency for the correct differentiation between small cell and non-small cell carcinoma of the lung; the predictive value for the diagnosis of small cell carcinoma approached 90%.

6-Ketoprostaglandin F1 alpha↗