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P Lechleitner

Publications and source records attributed to P Lechleitner.

At least 55 records · Page 3Linked to original sources
PubMed1991

[Therapy-refractory fulminant meningococcal sepsis].

Two cases of the severe form of meningococcal infection are described. A 17-year-old girl and a (unrelated) 2-year-old boy suddenly developed fever and rigor. Several hours later petechiae of the skin were noted: they rapidly spread. On admission the girl was found to have a severe consumptive coagulopathy (prothrombin 24%, partial thromboplastin time 104 sec, fibrinogen 73 mg/dl, platelets 35,000/microliters). She died two-and-a-half hours after admission of treatment-resistant shock. The boy had at first only a low prothrombin value (39%), but later the other coagulation values also became abnormal. He died 16 hours after admission from the consumptive coagulopathy and profound anaemia (haemoglobin 7.4 g/dl, haematocrit 0.23). Neither patient had any clinical signs of meningitis. Isolation of Neisseria meningitidis from blood cultures confirmed the diagnosis.

Acute Disease↗
PubMed1991

[Values of atrial natriuretic peptide (ANP) and cyclic guanosine monophosphate (cGMP) in cardioversion].

We investigated atrial natriuretic peptide (ANP) and cyclic guanosine monophosphate (cGMP) in patients undergoing elective direct current cardioversion (CV group) due to atrial fibrillation (n = 9) or atrial flutter (n = 3). Anesthesia for cardioversion (CV) was induced with propofol 1.5 mg/kg. Conversion was achieved in all patients. Before CV all patients had elevated ANP and cGMP plasma levels. After CV the concentrations of ANP and cGMP decreased significantly within 15 and 30 minutes (p less than 0.01), respectively. Only one patient in the CV group showed increasing ANP and cGMP levels although his heart rate had decreased after CV and his blood pressure remained stable. High concentrations of ANP and cGMP might possibly be a compensatory mechanism of cardiac dysfunction. To study the influence the anesthetic agent on plasma levels of ANP and cGMP, we investigated six patients anesthetized with propofol for high-density radiation (HDR group). The data from this control group showed that propofol did not influence the plasma levels of ANP and cGMP. ANP correlated statistically significantly (p less than 0.05) with cGMP in both groups (r = 0.88 and 0.76 in the HDR and CV groups, respectively). In addition, we found a cGMP release of 149.6 +/- 17.6 per mol ANP in the HDR group, in the CV group the release was 109 +/- 54.2 cGMP per mol ANP. This phenomenon could be due to minor response of target cells to ANP stimulation (receptor down-regulation) in patients with heart disease. In conclusion, ANP and cGMP levels decreased after successful cardioversion.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Propofol for direct current cardioversion in cardiac risk patients.

We investigated 69 patients (most belonging to NYHA classes II and III) undergoing elective direct current cardioversion of atrial fibrillation (46 patients) and atrial flutter (23 patients), respectively. Without premedication anaesthesia was induced with the new soya bean emulsion of propofol ('Diprivan') 1.2 mg.kg-1 over 45 s. Recovery time was measured from the start of the anaesthetic injection to the moment at which the patients regained consciousness. Completeness of recovery was assessed with two methods: opening eyes on command and time orientation. Good amnesia was observed in all patients. Conversion was achieved in all but seven patients (90%). After injection of propofol, the mean arterial pressure decreased slightly (2% below baseline). Induction of anaesthesia and successful DCC effected a statistically significant decrease in both the heart rate and the rate pressure product. Eleven patients required assisted ventilation for 2 min due to respiratory depression. Fifteen patients developed arrhythmias. Side-effects, such as myocloni, recall or vomiting, were not observed. In conclusion, propofol may well prove to be the anaesthetic of choice for DCC in cardiac patients because of good amnesia, low incidence of side-effects and short recovery time (mean 5.3 min).

Adult↗
PubMed1991

Cardiac troponin T in diagnosis of acute myocardial infarction.

Troponin T is a structurally bound protein found in striated muscle cells. We tested concentrations of its cardiac-specific isotype in peripheral venous blood samples serially drawn from 72 patients with confirmed myocardial infarction. Fifty-nine patients received thrombolytic treatment with intravenous streptokinase, urokinase, or recombinant tissue-type plasminogen activator; because of contraindications, the remaining 13 patients did not. Concentrations of troponin T in plasma, measured by an enzyme-linked immunosorbent assay, started increasing within a few hours after the onset of symptoms (median, 4 h; range, 1-10 h). The sensitivity of troponin T for detecting myocardial infarction was 100% from 10 to 120 h after the onset of symptoms; sensitivity on the seventh day after admission was 84%. Concentrations were increased for up to three weeks in some patients with late or high peak values. Successful reperfusion in Q-wave infarction obviously influences the release of troponin T into plasma, with all such cases showing peak values less than or equal to 26 h (median, 14 h) after the onset of symptoms. Troponin T concentrations in these patients returned to within the reference interval more rapidly than in nonreperfused subjects. In the 13 patients without fibrinolytic therapy, troponin T tended to peak approximately 48 h (median) after the onset of chest pain. Troponin T concentrations in patients for whom thrombolysis was unsuccessful resembled those in patients without fibrinolytic therapy. The specificity of the assay was 96% as tested in samples of 96 emergency-room patients. The reference interval (less than 0.5 micrograms/L) was established from samples of 100 healthy blood donors. Troponin T measurements are a specific and sensitive method for the early and late diagnosis of acute myocardial infarction and could, therefore, provide a new criterion in laboratory diagnosis of its occurrence.

Adult↗
PubMed1990

Uneventful self poisoning with a very high dose of captopril.

A 43-year-old patient with mild heart failure attempted suicide by ingesting between 5000 and 7500 mg of captopril. Blood pressure oscillated around 100-120/50-75 mmHg and pulse rate showed no tendency to accelerate (75-100/min). The psychiatric examination showed no drug induced psychopathological symptoms. The calculated half-life of captopril was 4.4 h. Seven hours after ingestion of approximately 50 times the maximal therapeutic daily dose of captopril the serum concentration reached 20 micrograms/ml. The calculated amount of absorbed captopril was approximately 5400 mg. Atrial natriuretic factor (ANF) plasma levels were slightly elevated and showed no tendency to increase or to fall.

Adult↗
PubMed1990

[Preventive drug therapy following coronary bypass surgery or PTCA].

Antiplatelet therapy to prevent occlusion of coronary bypass grafts is widely used. Though the value of this therapy after bypass surgery is not yet settled, some favourable results have been achieved. Many physicians continue to use the Mayo Clinic recommendations (peri- and postoperative administration of aspirin and dipyridamole) while others used dipyridamole and aspirin after surgery, and others use aspirin alone. It is now well established that pretreatment with platelet inhibitors is effective in lowering the incidence of acute vessel closure after angioplasty: Numerous drugs, including warfarin, aspirin and dipyridamole, aspirin and heparin, nifedipine, diltiazem and the experimental antiplatelet agent ticlopidine have proved ineffective in reducing the rate of restenosis after coronary angioplasty. Only high dose administration of an omega-3 fatty acid dietary supplement for 1 week before angioplasty lowers patients' risk for restenosis, but this therapy does not appear effective if begun the night before the procedure or done with somewhat lower dose. Until additional results are available, clinicians must treat patients on extrapolation from the published trials. Low-dose aspirin should be used for several weeks after the procedure. Careful attention to risk factor modification, especially smoking, lipid profile and diabetes control, seems essential in any long-term plan of management in the patient with coronary disease.

Angioplasty, Balloon, Coronary↗
PubMed1990

[Double photon absorptiometry in renal osteodystrophy].

Bone mineral content (BMC) of the lumbar spine (L2-L4), femoral neck, Ward's triangle and the trochanteric region was measured in 52 consecutive patients on maintenance haemodialysis. In the whole group the median BMC value as percentage of sex- and age-matched normal means was significantly decreased only in Ward's triangle (91.7%; p less than 0.02). In patients with chronic interstitial nephritis there was a significant decrease in bone density in Ward's triangle and the trochanteric region (p less than 0.02). There was no correlation between BMC and time on dialysis or intact parathormone. BMC value did not predict the type of renal osteodystrophy, according to Delling. 17 patients underwent a second investigation after one year. There was a slight fall in mean BMC of the lumbar spine (-0.9%) and Ward's triangle (-1.1%). The fall in mean BMC of the trochanteric region was pronounced (-3.2%). We believe that the observed low demineralisation, which was more pronounced in patients with interstitial nephritis, may be attributable to early and carefully monitored therapy with vitamin D metabolites.

Absorptiometry, Photon↗
PubMed1987

[Treatment of aluminum-induced osteopathy with desferrioxamine in dialysis-dependent renal failure].

Presenting two patients on long-term dialysis with marked osteopathy due to aluminium intoxication we described the symptoms, pathogenesis and therapy of the disease. Two patients were treated with the chelating agent desferrioxamine which lead to a striking improvement in clinical symptoms and removal of aluminium from bone. Osteopathy due to aluminium intoxication is refractory to Vitamin D and its metabolites. Using reversed osmosis in dialysis the high aluminium levels in bone result mainly from the long-term use of phosphate binders. Therapy of choice is the treatment with desferrioxamine.

Adult↗
PubMed1987

Improved management of congestive heart failure. Use of continuous ambulatory peritoneal dialysis.

Four patients suffering from end-stage congestive heart failure (CHF) refractory to conventional medical treatment were treated with continuous ambulatory peritoneal dialysis (CAPD) for one to 21 months. All four patients improved from class IV CHF to class II, as defined by the New York Heart Association, and experienced a definite improvement in their sense of well-being. Three patients, women between 42 and 59 years of age with contraindications for heart transplantation, were all professionally rehabilitated. One 21-year-old patient received CAPD until he underwent a successful orthotopic heart transplantation. We thus propose CAPD as an effective treatment for end-stage CHF refractory to conventional medical treatment.

Adult↗