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Biomedical subjects

P Alter

Publications and source records attributed to P Alter.

At least 19 recordsLinked to original sources
PubMed2002

[Amiodarone induced pulmonary toxicity].

BACKGROUND: Antiarrhythmic therapy with class III drug amiodarone (Cordarex(R)) for supraventricular and ventricular tachycardia is commonly used because of its high efficacy and absent negative inotropy. Pulmonary toxicity of amiodarone possibly leading to lung fibrosis is a rare, but severe side effect of chronic therapy. In contrast to patients with coronary artery disease, there are only a few data about pulmonary toxicity in patients with dilated cardiomyopathy. CASE REPORT: We report on two patients with dilated cardiomyopathy who received amiodarone because of symptomatic non-sustained or sustained ventricular tachycardia. After 6 weeks resp. 8 months of treatment with amiodarone both patients developed pulmonary toxicity. Other causes of pulmonary toxicity were ruled out by bronchoscopy, bronchoalveolar lavage and biopsy. Pulmonary function improved in both patients within some weeks after discontinuation of amiodarone. CONCLUSIONS: This report deals with two cases of amiodarone induced pulmonary toxicity in dilated cardiomyopathy leading to respiratory insufficiency. Pulmonary toxicity is a rare, but potentially lethal side effect of amiodarone. Reversibility of pulmonary changes in case of an early drug discontinuation is shown. Because of severe reduced left ventricular function in dilated cardiomyopathy, heart failure symptoms could conceal clinical signs of pulmonary amiodarone toxicity. Therefore, pulmonary function should be controlled periodically during amiodarone therapy including bronchoscopy, bronchoalveolar lavage, biopsy and measurement of diffusion capacity.

Adult↗
PubMed2001

[Possibilities and limits of outpatient antibiotic therapy of infective endocarditis].

BACKGROUND: Infective endocarditis has a high morbidity and lethality. Therefore antibiotic treatment has to be intravenous to achieve high blood levels and has to last several weeks without an interruption of treatment at the weekends. PATIENT SELECTION FOR OUTPATIENT THERAPY: It is therefore crucial to select the patient group that is suited for an outpatient, antibiotic therapy very carefully. In general only hemodynamically stable patients without complications in whom the responsible organism has been identified should be considered. TREATMENT: From a pharmacological point of view intravenous or intramuscular application for the complete duration of therapy is obligatory. Endocarditis caused by penicillin-susceptible streptococci, the biggest group of organisms responsible for endocarditis, can be treated with Ceftriaxon once daily for 4 weeks. For other organisms there are at present no data available which support the feasibility of an outpatient therapy. In particular antibiotic therapy with a complex regimen for those organisms is not practicable for outpatient usage. Possibly, in the near future computer controlled pumps might overcome this disadvantage. LIMITS: Every outpatient therapy should be initiated under inpatient conditions and only after an initial response to the antibiotic therapy continued in an outpatient setting. Today reliable outpatient therapy and follow-up 7 days a week under the given outpatient infrastructure is problematic and remains an exception. However, considering cost-effectiveness outpatient as compared to inpatient antibiotic therapy could be an interesting economically advantageous alternative.

Adult↗
PubMed2001

Angiography, CT and MR imaging of a high vena cava inferior interruption in a patient with Hirschsprung disease.

We report on a high vena cava inferior interruption immediately at the insertion to the right atrium in a patient with Hirschsprung disease assessed by angiography, CT, and MRI. Hirschsprung disease is frequently associated with Down, Undine, Waardenburg, Bardet-Biedl, Smith-Lemli-Opitz and Goldberg-Sphrintzen syndromes. We suggest that the association of these two malformations are most likely interrelated and should be considered as a new syndrome.

Angiography↗
PubMed2001

Hemorrhagic fever with renal syndrome: diagnostic problems with a known disease.

Hemorrhagic fever with renal syndrome (HFRS), caused by different hantaviruses, is a distinct clinical syndrome endemic in several parts of Asia and Europe. However, the clinical picture can sometimes be indistinguishable from that of other infectious or noninfectious diseases. In this report we describe a clinical case, which is a rare occurrence but is a prime example of the difficulties in the diagnosis of HFRS in areas with a low prevalence of the disease.

Adult↗
PubMed2001

Varicella myocarditis in an adult.

A 24 year old male with varicella myocarditis was admitted with chest pain and fever up to 39 degrees C. The ECG showed J point and ST elevation in leads V2-V4, and inverted T waves in leads V5 and V6. Creatine kinase (CK) was raised to 435 U/l (CK-MB 36 U/l), troponin I was 63.4 microgram/l, and lactate dehydrogenase was 359 U/l, suggesting cardiac involvement of varicella infection. The left ventricle was dilated (58 mm) and left ventricular ejection fraction was globally reduced (ejection fraction 45%). Myocarditis was confirmed by endomyocardial biopsy. The patient was treated with specific varicella hyperimmunoglobulins, aciclovir, and a non-steroidal anti-inflammatory drug. During two months follow up the patient recovered completely. This case report is a reminder that a varicella infection can cause myocarditis in adults. Early diagnosis and appropriate treatment of this rare form of myocarditis may lead to complete recovery.

Adult↗
PubMed2000

[Impediment of cellular immune response under treatment with ticlopidine in a patient with Staphylococcus aureus endocarditis].

A 52-year-old male with coronary artery disease was admitted with acute aortic valve endocarditis and a temperature up to 39.5 degrees C caused by Staphylococcus aureus. The patient was treated with ticlopidine (Tiklyd) after percutaneous transluminal coronary angioplasties to reduce restenosis by inhibiting thrombocyte aggregation. Upon admission c-reactive protein (CRP) was 389 mg/l. Interleukin-6 (IL-6) and Interleukin-2-receptor (IL-2-rec) were distinctly increased. Monoclonal antimyocardial antibodies were found. Leukocyte count never exceeded 9.8 G/l; however, transesophageal echocardiography validated a soft vegetation of the aortic valve. Antibiotic therapy was initiated with imipenem, gentamicin and vancomycin; clarithromycin was added after five days. Temperature normalized after 24 days. The c-reactive protein decreased from 389 mg/l to 6 mg/l, and the elevated cytokine levels decreased accordingly. Agranulocytosis or pancytopenia by ticlopidine through a toxic mechanism have been described, which are normally reversible within three weeks; there has not yet been a description of a missing leukocyte response in endocarditis as in this case report. This is a special situation with lack of or impeded immunological response, which limits the use of ticlopidine, especially since a therapeutic alternative with clopidogrel is available.

Agranulocytosis↗
PubMed1999

[Cell death in inflammatory heart muscle diseases--apoptosis or necrosis?].

Cell death can be induced by 2 different mechanisms: necrosis and apoptosis. Necrosis, on the one hand, is usually caused by unphysiological stress factors such as hyperthermia or hypoxia, apoptosis, on the other hand, is part of the normal organ development and controls for example immune responses. Morphologically, necrosis is characterized by swelling of cells and their organelles leading to the disruption of the cell membrane, which in turn causes an inflammatory reaction in the surrounding tissue. Morphological and biochemical criteria (Figure 1, Table 1) of apoptosis are the condensation of chromatin leading to the development of apoptotic bodies or membrane-enclosed vesicles containing oligonucleosomal DNA fragments. Important diagnostic tools of cell death (Table 2), such as the TUNEL test (Figure 2) or gel electrophoresis of extracted DNA (Figure 3) are based on the above mentioned biochemical characteristics, but a reliable differentiation of apoptotic versus necrotic processes is not always possible. Experimental studies in animals and studies in various diseases of the cardiovascular system were able to show that apoptosis in myocytes can be induced, an issue that has long been discussed controversially. Ischemia, reperfusion, and myocardial infarction were also shown to lead to apoptosis in cardiomyocytes, whereas cell destruction was caused mainly by necrosis. Several authors (Table 3) demonstrated apoptotic indices in cardiomyocytes of patients with dilatated cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy and patients with acute infarction from 0.25 to 35% by the use of the TUNEL test. Others were able to demonstrate an elevated expression of Fas-receptor in cells of atheroslerotic plaques in patients with atherosclerosis and high indices of apoptotic cardiomyocytes in patients with chronic heart failure. We investigated endomyocardial biopsies of patients with inflammatory cardiomyopathy, DCM without inflammatory reaction but the presence of adenoviral or cytomegaloviral genome and idiopathic DCM using the TUNEL test. The percentage of apoptotic cardiomyocytes in biopsies of patients with DCMi was 1.03 and in biopsies of patients with adenoviral genome 0.25, whereas in all other groups no apoptosis was found. If apoptosis plays a major role in myocardial diseases such as heart failure, arrhythmia and others, blocking this mechanism will have to be considered as a therapeutical strategy. Therefore, studies on the extent of apoptotic processes in diseased versus healthy cardiac tissue are of great importance.

Animals↗
PubMed1998

Comparison of geometry-based and CT voxel-based finite element modelling and experimental validation.

The objectives of the paper presented here is the comparison of a geometry-based and voxel-based finite element (FE) method preprocessor of the human femur. The models were experimentally validated by strain gauge measurements (principal stress). The correlation coefficients (r) between the three methods (geometry-based FEM, voxel-based FEM, strain gauge measurements) were found to be in the range 0.91-0.94 (r2: 0.84-0.88). The relationships between the samples are highly significant (P = 0.001), where the strain gauge results are the independent variables. These results suggest that the validity with respect to the principal stress of a voxel-based modelling is similar to the validity of geometry-based modelling. In summary, therefore, we conclude that voxel-based meshing allows a straightforward interfacing with computerized tomography (CT) scans and might contribute to a clinically applicable FEM technology.

Aged↗
PubMed1997

[Fully automated generation of hip prosthesis voxel models of the femur for finite element analysis. Comparison of direct and subsequent prosthesis implantation].

Two means of generating implant-bearing FE voxel models of the human femur are described and compared. The first method consists in the fully automatic production of a femur model from CT data and subsequent implantation of a prosthesis stem on the basis of a redefinition of existing voxel elements using geometrical data control. The second method processes the CT data of a femur already bearing a prosthesis. Here, the prosthesis elements are generated separately from the surrounding bony elements on the basis of the differing CT density thresholds. Although the two implantation algorithms produce comparable results, they have different fields of application. The method of numerical stress analysis involving automatic generation of voxel models can be applied to implant-bearing femurs. Clinical follow-up observations of patients with prostheses made of titanium can be supported by FE calculations.

Algorithms↗