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Biomedical subjects

W Fassbinder

Publications and source records attributed to W Fassbinder.

At least 55 records · Page 3Linked to original sources
PubMed1987

Long-term treatment of severe chronic heart failure with captopril: a double-blind, randomized, placebo-controlled, long-term study.

Twenty-three patients with severe heart failure (NYHA classes III and IV) on treatment with digitalis and diuretics were additionally treated in a randomized double-blind study over a 6-month period with captopril (n = 12; mean daily dose 84 mg) or a placebo (n = 11) and were then reexamined. In the captopril group, the left-ventricular filling pressure decreased by 9 mm Hg (from 23 to 14) at rest and 6 mm Hg (from 35 to 29) during exercise. In the placebo group, there was an increase of 4 mm Hg (from 25 to 29) at rest and 7 mm Hg (from 33 to 40) during exercise; p less than 0.01 (p less than 0.01). In the captopril group, the cardiac index at rest increased 0.7 1/min/m2 (from 2.1 to 2.8) and during exercise 1.2 1/min/m2 (from 2.8 to 4.0). In the placebo group, the increase in cardiac index was considerably less pronounced at rest (= 0.2 1/min/m2; from 1.9 to 2.1) and during exercise (= 0.1 1/min/m2; from 2.7 to 2.8); p less than 0.02 (p less than 0.01). The improved cardiac output had a beneficial effect on the renal blood flow. Hippuran clearance increased by 46 ml/min (from 271 to 318), whereas in the control group it decreased 25 ml/min (from 259 to 234) (p less than 1.02). Both the heart rate and the arterial blood pressure remained constant, whereas the decrease in peripheral vascular resistance was definitely more pronounced in the captopril group (= 562 dyne X s X cm-5, from 1,841 to 1,279) than in the placebo group (= 123 dyne X s X cm-5, from 1,834 to 1,710; p less than 0.02). The heart volume, assessed radiographically, increased slightly in the placebo group, and the left-ventricular end-diastolic diameter remained constant in both groups. In the course of the study, two patients died in the captopril group and three in the placebo group. After six months, eight patients in the captopril group and three in the placebo group had improved by at least one NYHA category. The beneficial effects of captopril are due to its inhibitory effect on the renin-angiotensin system as well as to the inhibition of sympathetic stimulation. Consequently, in the captopril group the quantity of plasma norepinephrine decreased by 188 ng/ml (from 430 to 618); p less than 0.03. The indirect vasodilation caused by this mechanism leads to persistent unloading of the myocardium and an improvement in heart failure without loss of action by counterregulatory mechanisms.

Captopril↗
PubMed1987

Human immunodeficiency virus antibody screening in patients on renal replacement therapy: prevalence of false-positive results.

Patients with terminal renal failure quite frequently receive blood transfusions on renal replacement therapy; therefore they are at increased risk of infection with human immunodeficiency virus (HIV). We investigated sera from 380 patients on haemodialysis or with a renal transplant for anti-HIV, using commercially available enzyme immunoassays (EIA). Persistent EIA-positive sera were additionally examined by Western blot and ELAVIA test, a commercially available indirect EIA. We found 20 patients (5.3%) with a persistently positive EIA screening test. None gave a positive result with confirmatory tests. Cross-reacting leucocyte antibodies seemed to be responsible for most of these false-positive anti-HIV tests; 12 of 20 EIA-positive sera were found positive for HLA antibodies. Sera from patients on haemodialysis or with a renal transplant, particularly when multiply transfused, have to be investigated carefully before infection with HIV is confirmed.

Acquired Immunodeficiency Syndrome↗
PubMed1986

[Prevalence of antibodies against LAV/HTLV-III in patients with terminal renal insufficiency treated with hemodialysis and following renal transplantation].

Sera of 1046 patients undergoing haemodialysis for terminal renal failure or after renal transplantation were tested with the ELISA screening test for anti-LAV/HTLV-III and, if positive, the Western blot and ELAVIA tests. Four patients (0,38%) had "true" antibodies against LAV/HTLV-III, confirmed by the Western blot and ELAVIA tests. These patients had definite signs of cellular immune defects. They had received transplants from drug addict donors. Such kidneys should therefore no longer be used for transplantation. In addition, 29 patients (2.8%) had "false-positive" antibodies against LAV/HTLV-III in the ELISA test, unconfirmed in the Western blot and ELAVIA tests. The "false-positive" result was presumably due to cross-reaction with HLA antibodies. Sera of dialysis and transplantation patients who had received many blood transfusions should therefore be especially carefully tested before a diagnosis of infection with LAV/HTLV-III is made.

Antibodies, Viral↗
PubMed1986

The role of adrenal medulla in endogenous dopaminergic inhibition of aldosterone secretion.

Evidence has accumulated that aldosterone secretion is under endogenous dopaminergic inhibition. To examine potential sources of the dopamine thus inhibitorily acting in the adrenal zona glomerulosa, the responsiveness of aldosterone, plasma renin activity, prolactin, and plasma catecholamines to haloperidol, a dopaminergic antagonist, was studied in rats 6 weeks after unilateral adrenalectomy (Group B), 6 weeks after unilateral adrenal demedullation followed by contralateral adrenalectomy 5 days later (Group C), and in controls without any pretreatment (Group A). In Group C, there were increases in basal levels of norepinephrine (P less than 0.01), prolactin (P less than 0.02), and aldosterone (P less than 0.01). Basal plasma renin activity was also increased (P less than 0.05), epinephrine concentrations were decreased. Two hours after haloperidol 1 mg/kg b.wt. i.p., aldosterone levels were increased in Groups A + B (P less than 0.01) but unresponsive in Group C. Haloperidol-induced stimulation of prolactin and norepinephrine was not impaired by the surgical procedures. Epinephrine levels were increased by haloperidol only in groups A + B (P less than 0.002). In none of the groups were plasma renin activity or dopamine levels influenced by haloperidol. It is concluded that dopaminergic inhibition of aldosterone production is brought about neither by circulating dopamine nor by potential dopaminergic nerves accompanying arterial blood supply of the adrenal cortex but by dopamine originating directly in adrenal medulla.

Adrenal Medulla↗
PubMed1986

[Normalization of uremic skin changes following kidney transplantation].

A clinical dermatological examination was performed on 49 patients (30 males, 19 females; 24-64 years of age) 3.1 years after successful kidney transplantation. Some patients underwent skin biopsy procedures for examination by light and electron microscopy, as well as immunohistological methods. Six patients had already been examined using these methods prior to the transplantation. When sufficient renal function was restored after successful kidney transplantation, the uremic skin alterations disappeared. The increase in sweat secretion, a common symptom in uremic patients was not observed after renal transplantation. The ichthyosiform feature of uremic skin and the increased vulnerability of the skin was observed in only a minority of the transplanted patients examined. In addition, the generalized pruritus and Raynaud phenomenon that are seen so frequently among uremic patients disappeared completely. However, the uremic-induced alterations of the connective tissue, like severe actinic elastosis and Dupuytren's contractures, persisted after renal transplantation. Histological examinations revealed renormalization of the uremic altered skin; in particular, the severe microangiopathy of skin vessels in long-term hemodialysis patients vanished.

Adult↗
PubMed1985

[Transluminal coronary angioplasty in patients with chronic kidney failure].

Six patients with chronic renal failure (two in the predialysis state; four chronically dialysed of whom two were after renal transplantation) were treated by transluminal coronary angioplasty for severe angina and ischaemic ECG changes. In 5 patients the successful dilatation of six stenoses resulted in good clinical and angiographic findings for a follow-up period of up to 3 years. One patient had to have an emergency bypass operation. If coronary revascularisation is indicated, transluminal coronary angioplasty is thus to be preferred to primary bypass operation in patients with chronic renal failure, because it is less invasive, relatively cheap and can be more easily repeated in case of recurrence or new stenoses.

Adult↗
PubMed1985

Aldosterone and prolactin responsiveness after prolonged treatment of congestive heart failure with captopril.

After long-term captopril treatment, an inappropriate increase in aldosterone levels has been observed in hypertensive patients. It is not known, whether a similar change would occur in patients with severe congestive heart failure, and whether it is due to a decrease in endogenous dopaminergic inhibition of aldosterone secretion or to aldosterone stimulation by ACTH or an ACTH-related peptide. Therefore, the aldosterone and prolactin responses to metoclopramide have been studied in 10 patients with severe congestive heart failure (NYHA Class III or IV) after 6 months of captopril treatment, before and 11 h after pretreatment with dexamethasone. 7 placebo-treated patients served as double-blind controls. In captopril-treated patients, the supine aldosterone levels exceeded the normal range and were as high as in placebo-treated patients. The responsiveness of aldosterone and prolactin to metoclopramide was not influenced by captopril. Only in the placebo group were the aldosterone levels decreased by dexamethasone. Captopril increased plasma renin activity and serum potassium, and decreased supine epinephrine and norepinephrine and serum sodium. Thus, previous reports of inappropriately high aldosterone levels after long-term captopril treatment were confirmed in patients with severe congestive heart failure. It is concluded that increased aldosterone is due neither to a decrease in endogenous dopaminergic inhibition nor to dexamethasone-suppressible stimulation of aldosterone secretion.

Adult↗
PubMed1985

Incidence of cytomegalovirus-infection after renal transplantation and first experiences with prophylactic hyperimmunoglobulin.

Incidence and clinical symptomatology of CMV-infection was investigated in 83 patients, who received cadaveric renal transplants in 1982 and 1983. CMV-antibody status was determined using an ELISA-technique, 43 of the 83 patients (52%) were seronegative, and 40 (48%) were seropositive for CMV before transplantation. Seroconversion (i.e. primary CMV-infection) or an increase in titre (i.e. reactivation or reinfection) was found in 18 cases (42% and 45%, respectively) in both groups. 89% of all infections occurred within the first 3 months. Clinical symptomatology was much more severe in the group with primary CMV-infection; all cases with atypical pneumonia (n = 8) and both fatal cases belonged to this group. Preformed CMV-antibodies thus appeared to prevent severe syndromes associated with CMV-infection. Therefore a randomized controlled study was started in 1984 in order to investigate the efficacy of an i.v. applicable CMV-hyperimmunoglobulin passively administered prior to the transplant procedure. The passive immunization was not capable of preventing CMV-infection in every case: 2 (late) seroconversions did occur, but in both cases subclinical infections were diagnosed, whereas in the control group CMV-infections were regularly associated with typical clinical complications (prolonged fever, liver damage, leucopenia etc.). Thus prophylactic CMV-hyperimmunoglobulin seems to be capable of preventing the occurrence of severe CMV-syndromes post transplantation. The study is being continued.

Antibodies, Viral↗
PubMed1984

Therapy and monitoring of hypersiderosis in chronic renal insufficiency.

In RDT hemosiderosis appears to be an inevitable complication only in the small number of patients in need of frequent transfusions. To prevent clinical consequences (e.g. cardiomyopathy) known from polytransfused patients without renal disease, transplantation should be considered in RDT patients in need of frequent transfusions. Iron substitution - preferably oral - to replace dialysis-related iron loss does not cause clinically significant hemosiderosis provided iron stores are monitored adequately. A sufficient method of controlling iron stores in RDT patients under iron substitution or regular transfusion therapy is a twice annual determination of serum ferritin concentration. The treatment of choice for hemosiderosis in nontransfused RDT patients is discontinuation of iron substitution. When polytransfused RDT patients with severe hemosiderosis cannot be transplanted and submitted consecutively to phlebotomy, DFO treatment is indicated. Quantitative data regarding optimal dosage and application of DFO in RDT patients are not yet available. Constant infusion of DFO during hemodialysis may be superior to bolus application.

Aluminum↗