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Biomedical subjects

O Wagner

Publications and source records attributed to O Wagner.

At least 91 records · Page 5Linked to original sources
PubMed1990

Additive benefit of PGI2 and PGE1 (via different mechanisms?) on inhibition of activation of human vascular smooth muscle cells?

It seems likely that the antiplatelet action of antiaggregatory prostaglandins (PGE1, PGI2) is not the pivotal mechanism of action involved in clinical improvement of peripheral vascular disease. Based upon earlier results that both of these agents may have a certain effect on proliferation of vascular smooth muscle cells, we approached that question of an "optimal therapeutic regimen" going one step further. Patients having to undergo amputation were given a randomized "last choice" therapy with either PGI2 (once or twice a day, 6 h, 5 ng/kg/min i.v.), PGE1 (once or twice a day, 1 ng/kg/min i.a.) or a combination of both with a 6 h interval in between for 5 consecutive days. The ones who underwent surgery had a pathomorphological examination of vascular segments removed during amputation. The counting of activated smooth muscle cells indicates a significant drop induced by both of the PG's alone. A second infusion a day with the same compound, however, did not induce a further decrease in the activation state. In contrast administering the complimentary PG caused a comparable, significant decrease (p less than 0.01) in activation of smooth muscle cells in the intima and the media as well. It thus seems, that different mechanisms may be involved inducing additive therapeutic benefit. PGI2 is hypothesised to act predominantly by blocking PDGF-release and interference with PDGF, whereas PGE1 may have a more direct vascular action. From these findings, as well as the beneficial clinical results to be reported elsewhere, a combined therapy by the infusion scheme used may be the optimal one for a PG-therapy at the moment, based upon platelet and smooth muscle cell action.

Age Factors↗
PubMed1990

Effect of endothelin-1 in man.

The effect of an intravenous infusion of human endothelin-1 on blood pressure and plasma concentrations of endothelin-1, potassium, sodium, renin, aldosterone, and atrial natriuretic factor was investigated in six healthy, sodium-loaded men. During the peptide's exogenous application (1.0, 2.5, and 5.0 ng/kg.min), its plasma concentrations rose from a basal value of 1.2 +/- 0.3 to 3.2 +/- 1.9, 9.9 +/- 7.6, and 56.5 +/- 50.3 pmol/l (p less than 0.01), respectively, and mean blood pressure rose from a basal value of 87.1 +/- 7.3 to 92.6 +/- 8.2 mm Hg (p less than 0.01). A rise in serum concentrations of potassium (from 4.0 +/- 0.3 to 4.6 +/- 0.2 mmol/l; p less than 0.005) and a concomitant fall in serum concentrations of sodium (from 142.7 +/- 1.0 to 139.5 +/- 2.3 mmol/l; p less than 0.05) was seen in each subject. Plasma concentrations of renin, aldosterone, and atrial natriuretic factor did not change during the infusion of endothelin-1. Thus, in the doses used, endothelin-1 induces a rise in blood pressure and serum potassium concentrations.

Adult↗
PubMed1988

Glucose metabolism as the site of the primary abnormality in early-onset dementia of Alzheimer type?

Global cerebral blood flow, oxidative brain metabolism, and the cerebral arteriovenous differences of amino acids and ammonia were studied in 20 clinically diagnosed patients with early-onset dementia of Alzheimer type (DAT). Eleven healthy age-matched subjects and 15 healthy young volunteers served as controls. The most prominent abnormality in patients with early-onset DAT was a 44% reduction in the cerebral metabolic rate of glucose and a fourfold increase of lactate production, whereas cerebral blood flow and the cerebral metabolic rate of oxygen were found not to be altered. The cerebral amino-N balance substantially changed in patients with early-onset DAT, showing a massive loss of amino acids and ammonia from the brain, which was indicative of excess protein catabolism due to cell degeneration in the acutely diseased brain. The abnormality found in glucose metabolism may suggest a perturbed control of glycolytic breakdown of glucose and its first oxidation step at the pyruvate dehydrogenase complex level, this thus being of pivotal significance in early-onset DAT.

Adult↗
PubMed1988

Kawasaki disease: monitoring of circulating immune complexes.

We followed the levels of circulating immune complexes (CIC) in 27 patients with Kawasaki disease (KD) from the acute stage of the disease through convalescence, using the test for platelet-reactive IgG-IC, and C1q-binding and conglutinin-binding enzyme immunoassays. CIC were detected by one or more techniques in all but one patient. Positive results were obtained most often with the test for platelet-reactive IgG-IC. Measurement of complement components C3 and C4 in 14 patients revealed an increase in C3 levels during the first few weeks of the disease and normal levels of C4. The blood platelet count correlated directly with the level of platelet-reactive IgG-IC. The highest levels of CIC were found during weeks 3 through 7 after the onset of disease. Measurement of CIC is, however, not applicable to the clinical follow-up of patients with KD.

Antigen-Antibody Complex↗
PubMed1987

[Cooperation between the general practice and the hospital--the 1st situation].

The Austrian health care system is characterised by highly different ways of organising and financing the hospitals and practising physicians. This has resulted in an inflation of expansive hospital beds and a quality drop and financial restriction for the more economic family doctors. Therefore a financing system based on actual achievement and provided by one single financially responsible institution for the health system is postulated, to reverse this development. Furthermore nursinghomes, rehabilitation centres, social services should be provided more efficiently.

Austria↗
PubMed1987

Prostaglandin I2 reduces activation of human arterial smooth muscle cells in-vivo.

Patients suffering from peripheral vascular disease have been "ultima ratio"-treated with PGI2 at a rate of 5 ng/kg/min for 6 hours a day and 5 consecutive days i.v. 20 of them underwent surgery thereafter as therapy was not sufficient. A histological examination and quantification of vascular tissue revealed that the number of activated smooth muscle cells was significantly lower in treated patients vascular segments than in untreated ones in all the different age groups. A comparable suppression was found in the intima and the media as well. It is thus concluded, that PGI2 inhibits smooth muscle cell proliferation most probably by inhibiting PDGF-release from the platelets and stimulation of smooth muscle cell cAMP. To achieve a more beneficial PGI2-effect at the vascular level, a prolonged PGI2-therapy looks rather promising.

Arteries↗
PubMed1987

The place of profundaplasty in the surgical treatment of superficial femoral artery occlusion.

One-hundred and sixty-three patients in whom an isolated profundaplasty was performed as treatment for superficial femoral artery occlusion were evaluated for postoperative improvement, taking into consideration the degree of stenosis of the profunda origin and the patency of peripheral vessels. One-hundred and eleven (68.1%) patients achieved clinical improvement. Fifty-two patients had to undergo amputation (27 below the knee and 19 above the knee) or distal reconstruction (6 patients) because of unrelieved ischaemia. In patients with Fontaine stage II and III disease (89% and 70% respectively) improvement was observed more often than in those with stage IV disease (53%). Half of the patients had an increase of the resting systolic ankle-brachial arterial pressure index, but the rise was only slight (0.12 +/- 0.1). While radiological information of the presence and degree of a stenosis had little influence on the operative outcome stenosis at the origin of the profunda, when seen and described at operation, resulted in a more frequent improvement in the clinical state and systolic ankle-brachial arterial pressure index. A patent popliteal artery was not necessary for a favourable outcome but the number of patent tibial arteries was important. Whenever two tibial vessels were patent, relief was achieved in 75% of the cases: the existence of one patent tibial artery produced improvement in 64% but if all were occluded only 31% showed improvement. In cases of severe ischaemia, success following profundaplasty is limited and the results are often inadequate. If at least one tibial artery is patent, the alternative is a femoro-crural reconstruction.(ABSTRACT TRUNCATED AT 250 WORDS)

Amputation, Surgical↗
PubMed1987

Pattern of fibrinolytic parameters in patients with gastrointestinal carcinomas.

Changes in the plasma levels of components of the fibrinolytic system have been investigated in 80 patients suffering from gastrointestinal carcinomas. Urokinase antigen (RIA), tissue-type plasminogen activator antigen (ELISA) and plasminogen activator inhibitor (functional assay) were determined. Patients with pancreatic and colorectal carcinoma and metastases as well as those without metastases revealed significantly increased plasma urokinase levels. Those with gall bladder or gastric carcinoma did not show significantly elevated urokinase antigen levels compared to age-matched controls. Determination of tissue-type plasminogen activator antigen in all four carcinoma groups did not reveal significant differences when compared to an age-matched healthy control group. The concentrations of plasminogen activator inhibitor were significantly increased in all carcinoma groups; there being no differences between the patient groups with or without metastases. No correlations between the different parameters of the fibrinolytic system could be obtained.

Adult↗
PubMed1987

Differences in coagulant and fibrinolytic activities of cultured human endothelial cells derived from omental tissue microvessels and umbilical veins.

Large vessel and microvascular endothelial cells were compared in their capacity to synthesize and secrete coagulant and fibrinolytic factors. Human omental tissue microvascular endothelial cells (HOTMEC) and human umbilical vein endothelial cells (HUVEC) were isolated, grown to confluency under identical conditions, and studied in primary cultures. After an incubation period of 12 hours in serum-free medium, the conditioned medium of confluent HOTMEC contained 100-fold higher levels of tissue plasminogen activator (tPA) antigen than that of HUVEC. The conditioned media as well as the lysates of both cell types did not contain any free tPA activity, but the free plasminogen activator inhibitor capacity was found intracellularly as well as extracellularly. Although von Willebrand factor was detected in both cell types by immunofluorescence, measurable amounts were only found in HUVEC using an enzyme-linked immunosorbent assay. The kinetics of protein C activation by thrombin on the surface of once-passaged cells were identical for HOTMEC and HUVEC. The present study indicates that cultivated HOTMEC produce larger quantities of tPA than HUVEC do, possess smaller amounts of von Willebrand factor than HUVEC do, and express thrombomodulin for protein C activation as effectively as HUVEC.

Adult↗
PubMed1986

[Autologous venous bypass in the therapy of arterial occlusive disease of the femoropopliteal area: long-term results].

The outcome of 532 femoro-popliteal vein grafts performed electively during the years 1970 to 1985 for obliterative arterial disease, was analyzed using the documentation-system of the Austrian Society for Vascular Surgery, as well as SAS and BMDP-software on an IBM 4381 computer of the Medical Faculty. The probability of function was estimated according to the Kaplan-Meier method, statistical differences were checked with Breslow's and Mantel's test, the proportional hazards regression model (Cox) was used to elucidate the influence of different risk factors on each own and in combination of each other. In the univariate analysis, the preoperative clinical status was found to be of prognostic significance, but technical details such as intraoperative as well as postoperative arteriography or site of the distal anastomosis were not important. A postoperative coumarine treatment had no demonstrable impact on graft function, but positively influenced the probability of patient survival. Taking into account the factors found to be of significance in the univariate analysis (e.g. set of factors: site of distal anastomosis, diabetic state and smoking habits) were analyzed using the proportional hazards regression model but were found of no major influence. The factors preoperative clinical status, patients age, and coumarine therapy significantly influenced the probability of patient survival, but diabetes mellitus and smoking were found to be not important.

Aged↗
PubMed1986

Influence of anticoagulant treatment in preventing graft occlusion following saphenous vein bypass for femoropopliteal occlusive disease.

Seventy-one patients underwent a classical reversed saphenous vein graft for femoropopliteal occlusive disease and were enrolled in a controlled clinical trial. During the second postoperative week the patients were allocated randomly into one of two groups; group 1 consisted of 34 patients who received coumarin, group 2 (37 patients) served as a control group without any anticoagulant treatment. The mean follow-up was 18 months. After 12 months the cumulative patency rate was 81 per cent and after 18 months 75 per cent; for patients receiving coumarin treatment, the respective figures were 90 and 82 per cent and for those with no anticoagulant treatment 72 and 67 per cent, the decrease being significant. When the bypass operation was performed for limb salvage (clinical stages III and IV) the overall results were worse (12 months, 72 per cent; 18 months, 68 per cent) than in stage II and stage II-III (12 months, 90 per cent; 18 months, 85 per cent). In limb salvage surgery the positive effects of anticoagulant treatment were significant (with treatment: 12 months, 87 per cent; 18 months, 87 per cent; without treatment: 12 months, 60 per cent; 18 months, 53 per cent). The site of the distal anastomosis (above knee: 12 months, 81 per cent; 18 months, 73 per cent versus below knee: 12 months, 80 per cent; 18 months, 75 per cent) did not have any demonstrable influence on the patency rate.

Aged↗
PubMed1986

Early postoperative changes after desobliteration of the carotid artery. Subsequent diagnostic control using a high resolution ultrasonic-real-time-duplex-scanner.

The ultrasonic morphology of the carotid artery following 55 endarterectomies in 50 patients (36 males, 14 females, mean age 68 (53-83) years) was studied using a high resolution ultrasound duplex system (HUDS). The examinations were done 1-3 days before as well as 2-4 days and 1, 2, 4 and 8 weeks after surgery, respectively. The following typical appearance after carotid endarterectomy was found: At the site of endarterectomy the new vessel wall showed the following details: lack of the "sonographic tunica intima" the thickness of the vessel wall was reduced with less pronounced ultrasonic structure compared with healthy subjects the surface toward the lumen was less smooth "ultrasonic soft" thrombotic layers with irregular surface, individual distribution (sometimes only spots) and thickness (0.5 to 4.0 mm) were seen in the majority of patients. The edge of the tunica intima was always visible in the common carotid (edge of endarterectomy) whereas in the internal carotid artery there was often an interference of the jaw. The change of caliber at the site of the edge of the tunica intima was dependent on the thickness of the "sonographic intima" as well as on the layer of the vessel wall in which endarterectomy was done. At the site of arterial clamping, intramural hematomas, lesions of the tunica intima with thrombotic layers causing some stenosis were observed after 9 of 55 procedures. Vascular sutures were always visible as bright spots. A "normalization" of local flow patterns could be seen in dependence on the morphological "normalization".(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1985

Validity of the ischemic score in degenerative and vascular dementia and depression in old age.

Thirty six male and 45 female patients (mean age 66 years) suffering from either dementia of Alzheimer type (DAT) or dementia of vascular type (DVT) with comparable severity and suffering from depression in old age were included in the investigation. The study was performed to evaluate the diagnostic value of Ischemic Score, EEG and CT scan of the brain in differentiating dementia types and depression in old age. The patients underwent physical, psychiatric, psychometric, neurological, neurophysiological and CT scan examinations. Clinical diagnosis and diagnosis related to Ischemic Score were consistent in 86% of DAT and in 65% of DVT. Patients suffering from DVT showed significantly higher incidence of distinct Ischemic Scale items than was found in DAT patients. The Ischemic Scale items were found to be of major importance in differentiating vascular dementia from both DAT and depression. However, it was insufficient to distinguish between the latter two. In EEG, general slowing predominated in DAT (68%), and focal disturbances in DVT (71%). Patients with DAT and depression could not be differentiated on the basis of their EEG findings. CT scans of the brain yielded a higher incidence of brain atrophy in patients with DAT (71%) and DVT (70%) as compared to depressive patients (37%). In DAT, ventricular enlargement seems to be rather disease- than age-related. Psychological testing showed abnormalities in attention and memory performance in DAT and DVT to a significantly greater extent as compared to depression. This study demonstrated that the combination of Ischemic Score and EEG was found to be most valid in differentiating DAT from DVT. Additional cranial computerized tomography and the psychological testing of attention and memory were able to confirm the diagnosis of dementia and to differentiate dementia from depression in old age.

Aged↗
PubMed1985

The influence of monotherapy with oxprenolol and nitrendipine on ambulatory blood pressure in hypertensives.

We investigated whether beta-blockers or calcium-antagonists might be preferred in baseline antihypertensive therapy. In middle-aged male patients with essential BP readings did not differ between patients on Oxprenolol or on Nitrendipine (average BP: 123 +/- 12/81 +/- 14 vs. 129 +/- 17/80 +/- 10 mmHg), when clinical casual BP was within the normotensive range. Average BP at work was lower than clinical casual BP taken at the same day (125 +/- 14/80 +/- 12 vs. 133 +/- 12/87 +/-13 mmHg). A linear dependency between SBP at work and level of self reported physical activity (F(3,413) = 7.6; p less than or equal to 0.001) and arousal was found (F(3,374) = 5.2; p less than or equal to 0.02). Patients on Oxprenolol consistently had lower SBP at a particular level of physical activity and at lower levels of arousal than patients on Nitrendipine. We conclude that both regimen were equally effective as baseline antihypertensive monotherapy.

Adult↗