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Biomedical subjects

W Koenig

Publications and source records attributed to W Koenig.

At least 127 records · Page 7Linked to original sources
PubMed1988

Antidepressant combination therapy of endogenous depressions with benzodiazepines or neuroleptics--a study comparing adjuvant treatment with oxazolam versus chlorprothixene.

Antidepressants are routinely administered in combination with benzodiazepine tranquilizers or low-potency neuroleptics. A controlled study was conducted involving 40 endogenous depressive inpatients who were treated with maprotiline in combination with the benzodiazepine oxazolam or the neuroleptic chlorprothixene. After a period of two weeks there was no significant difference in the clinical ratings (HRSD, Bf-S, BL, CGI) of the two groups studied. Only in the factor "anxiety" and the adjective mood scale scores was there a tendency toward quicker onset of action (third day) in the patient group treated with oxazolam, though it was not statistically significant. The clinical global evaluation (efficacy, tolerability) showed more favorable ratings for oxazolam than for chlorprothixene. Both substances were generally tolerated well; oxazolam hardly ever caused any side effects. However, a slight deterioration of some patients' conditions was observed after discontinuation of oxazolam.

Adult↗
PubMed1988

The influence of the type of occupation on return to work after myocardial infarction, coronary angioplasty and coronary bypass surgery.

Between January 1980 and December 1983 the medical and social status of 423 patients who were considered candidates for aortocoronary bypass surgery (ACBS) was assessed by a questionnaire, at a mean of 16 months after coronary angiography. Of these patients 54 had refused surgery, 15 were re-operated, 23 had angioplasty and seven had died on the waiting list. After exclusion of these 117 patients, 306 remained, who form the basis of this report. Fifty three patients (17%) had retired before surgery, four (1.3%) had died perioperatively and 19 were on sick-leave for less than three months. Of those who were still employed pre-operatively, 102 (44.3%) went back to work, 85 (37%) had retired and 42 (18%) were on sick-leave for longer than three months. Significant differences were noted between the 102 working and the 85 retired patients as far as medical and social factors are concerned. Of the medical factors, post-operative freedom of symptoms (P less than 0.0001), postoperative exercise tolerance (P less than 0.0001) and completeness of revascularization (P less than 0.05) seemed to have influence on return to work. Of the social factors, age (P less than 0.0001), type of occupation (P less than 0.0002), duration of preoperative absence from work (P less than 0.001) and heavy manual work (P less than 0.05) showed significant differences between the groups. Since duration of preoperative absence from work is the only preoperative factor that can be modified, strategies for improving the return-to-work rate should aim at the shortening of waiting times for coronary angiography and ACBS.

Angioplasty, Balloon↗
PubMed1988

Noninvasive detection of anterior wall asynergies by cardiokymography compared to electrocardiography.

In order to determine the value of cardiokymography in detecting left ventricular (LV) anterior wall asynergies, 80 consecutive patients had a cardiokymogram (CKG) and an electrocardiogram (ECG) on the day prior to coronary angiography. Technically adequate CKGs were obtained in 72 patients (67 men and 5 women, mean age 53 +/- 6.5 years). For validation of regional contraction abnormalities, quantitative LV angiography was used. Stepwise linear discriminant analysis was applied to investigate the diagnostic power of CKG. Sensitivity of the CKG for LV anterior wall asynergy was 67.9% (ECG: 39.6%) and specificity was 68.4% (ECG: 94.7%) on the basis of 1 SD of the mean values of the radial axis shortening of a control group. For 2 SD, the sensitivity was 65.6% (ECG: 56.3%) and the specificity 47.5% (ECG: 90%). By combined testing, the specificity increased to 98.3%, whereas the sensitivity dropped to 26.9%. The improvement of the post-test likelihood for a positive ECG by a positive CKG is especially pronounced in the intermediate prevalence range, whereas for a negative ECG the post-test likelihood can be further decreased by a negative CKG in the intermediate and high prevalence range. The ECG as a single test seems to be the more appropriate noninvasive method for detecting LV anterior wall asynergies; however, the combined use of both ECG and CKG may considerably improve the diagnostic accuracy.

Cineangiography↗
PubMed1988

Blood rheology associated with cardiovascular risk factors and chronic cardiovascular diseases: results of an epidemiologic cross-sectional study.

As part of an epidemiologic cross-sectional study to determine cardiovascular (CV) risk factors in the population (total serum cholesterol, smoking, blood pressure, and body weight) hemoglobin (Hb) and plasma viscosity (PV) were measured. A two-stage cluster sample of 5,312 persons, aged twenty-five to sixty-four (available 5,069) was selected from a mixed urban-rural target population of 282,279 inhabitants, from which 4,022 (79.3%) participated in the study. Patients with chronic myocardial infarction (MI), cerebral infarction (CI), angina pectoris (AP), and peripheral arterial disease (PAD) were identified by questionnaire. The results show that there is no age or sex dependency of PV in healthy participants, while hemoglobin shows the well-known sex difference. In contrast, PV increases continuously with age in the total population. In men, increased PV is found in untreated hypertension, in hypercholesterolemia, and in smokers. In women, it is raised in hypercholesterolemia and in gross obesity. Male MI patients and patients of both sexes after CI in particular show statistically significantly elevated PV. Finally, in male patients with chronic AP or patients of both sexes with PAD, PV is elevated and a tendency to higher Hb values is seen. These results confirm smaller clinical trials suggesting that blood fluidity is pathologically altered in patients with CV risk factors or diseases. Since impaired blood fluidity may worsen the hemodynamic situation, in particular in patients with limited vasomotor reserve, hemorheologic parameters may be of prognostic relevance. Therapeutic implications of these findings should be considered.

Adult↗
PubMed1988

[The myocardial infarct status of a South German population: results of the Augsburg myocardial infarct register l985].

The Augsburg Myocardial Infarction Register recorded in 1985, 999 coronary events (734 men, 265 women) occurring in 25-74-year-old residents of the city of Augsburg and the counties of Augsburg and Aichach-Friedberg (study population: 156,489 men and 171,093 women). On average, 444 men and 138 women per 100,000 of the population suffered an acute myocardial infarction (AMI) in 1985. The risk of morbidity increased with age in both men and women, but gained significance for women only after their 55th year of life. The 28-day case fatality was 54% for male AMI cases and 66% for females; 34% of the AMI patients died without ever reaching a hospital. Cardiopulmonary resuscitation (CPR) was attempted by a physician in one-in-three of these out-of-hospital deaths. Although one of two out-of-hospital deaths occurred in the presence of a medical lay person; lay CPR was the exception. Broader population education in CPR techniques may thus constitute one method of reducing the number of early AMI deaths. The median prehospital time for interviewed hospital patients (66%) was 5 h, and approximately 2 h for patients with systemic thrombolysis (n = 71). The combination of fatal coronary events from the official cause-of-death statistics and the results from the Augsburg register were used to estimate AMI morbidity for the whole of the FRG in 1985. This leads to an expected morbidity of 210,000 AMI, of which 141,000 AMI will be fatal (both sexes).

Adult↗
PubMed1987

[Determinants of plasma digoxin and digitoxin concentrations in elderly patients. A multivariate analysis].

In 1063 patients (greater than or equal to 60 years, 531 men, 532 women) the plasma concentration during digitalis maintenance therapy (metildigoxin, n = 356, beta-acetyldigoxin, n = 359, and digitoxin, n = 348) was determined and related to sex, age, body weight, serum potassium, renal function and the prescribed daily maintenance dose. Classification of treatment groups according to renal function (Crea less than or equal to 1.3 mg/dl parallel greater than 1.3 mg/dl) did not show any difference of the mean maintenance doses. In multiple linear regression analyses only a weak relationship between plasma digitalis concentration and the studied variables was found, which could be equally attributed to dose, creatinine and serum potassium in the digoxin derivative groups, whereas for digitoxin only body weight had a significant effect on the plasma concentration. During a maintenance dose of 0.07 or 0.1 mg/die which was given to 87% of patients in the digitoxin group, 70% were found to have plasma levels within the therapeutic range.

Acetyldigoxins↗
PubMed1987

Psychotropic drug utilization patterns in a metropolitan population.

Psychotropic drug intake by a random sample of citizens of the city of Munich aged 30-69 years has been assessed. A 1-week prevalence of 9.3% for all psychotropic drug users was found, benzodiazepines accounting for approximately two-thirds (6.6%) of the users. Two-thirds of drug users were women. Drug use in both sexes increased with age. The doses of benzodiazepines prescribed in most cases were less than 10 mg diazepam equivalent per day. Intake of benzodiazepines in combination with analgesics or alcohol (greater than or equal to 40 g/day) did not appear to represent a major problem. Multiple logistic regression analysis showed that the number of chronic diseases was the strongest predictor of benzodiazepine intake in men, whereas stress and age determined intake in women. Long-term use seemed to be relatively rare at 11% of all benzodiazepine users, so it was not considered to be a severe public health problem.

Adult↗
PubMed1987

Comparison of psychotropic drug intake in two populations in West Germany. Results from the Munich Blood Pressure Study 1980/81 and the Luebeck Blood Pressure Study 1984.

Psychotropic drug intake was assessed in participants aged 30-69 years of two identically designed studies (cross-sectional studies based on random samples), the Munich Blood Pressure Study (MBS I 1980/81) and the Luebeck Blood Pressure Study (LBS 1984). A similar increase of drug intake with age and a preponderance of women among drug users were found in both study samples. On the basis of the total drug consumption, which was not substantially different in the two population samples, it is argued that the statistically significantly lower prevalence rate for benzodiazepine use found in the LBS, compared with the findings of the MBS I, suggests a real decline over time and cannot be merely explained by possible regional differences in prescription behavior. This finding is of importance within the context of the ongoing discussion on increasing dependence on benzodiazepine drugs.

Antihypertensive Agents↗
PubMed1986

Treatment of hypertension. Patterns of drug utilization in a metropolitan population.

In the Munich Blood Pressure Study (MBS), a cross-sectional study (MBS I) with follow-up (MBS II) of a random sample of 3,198 citizens aged 30-69 (response rate, 69.3%), treatment and control of hypertension were examined. Of the actual hypertensives 59% (221) in MBS II (373) were on drug treatment and about two-thirds (150) of those being treated had controlled blood pressure (BP). Women's BP was better controlled than men's. Of the 221 treated hypertensives 85% (188) received types of drugs or drug combinations which were in accordance with the recommendations of the German Hypertension League. However, this did not apply to the prescribed dosages of the various drugs. Of the treated hypertensives 52% were either on a diuretic, on a beta-blocker, or on a combination of both drugs. Rauwolfia alkaloids combined with a diuretic were given to 27%. In 79% of the participants who had received a beta-blocker either alone or in combination with other antihypertensive agents and who still had high BP values, the prescribed beta-blocker dosage was below the recommended daily dose. Fatigue was the most frequently reported symptom, possibly attributable to antihypertensive drug treatment. Electrocardiographic signs of left ventricular hypertrophy were found less frequently in controlled hypertensives, in comparison to treated but uncontrolled hypertensives or untreated hypertensives.

Adrenergic beta-Antagonists↗
PubMed1985

Oral contraceptive use and blood pressure in a German metropolitan population.

The relationship between blood pressure (BP) and oral contraceptive (OC) use in women has been examined with the data from the Munich Blood Pressure Study (MBS), a cross-sectional study with follow-up of a random sample of 3198 Munich citizens aged 30-69 (response rate 69.3%). Multiple linear and logistic regression analyses were run with BP as the dependent variable and age, OC use, obesity, alcohol consumption, and smoking habit as the independent variables. All second and third order interactions between the independent variables were tested during a backward stepping procedure. OC use appeared as a significant main effect in most of the analyses. The coefficient of the OC variable was about 3 in the linear regression analyses for both systolic BP and diastolic BP, indicating an increase of about 3 mmHg in the systolic and diastolic BP of the OC users. An analysis of the change in BP after one year in relation to change in OC user status has also been made. It was observed that women ceasing to use OC had a clear decrease in BP while those starting to use OC had on average an increase in BP.

Adult↗
PubMed1985

Empirical development and evaluation of prehospital trauma triage instruments.

The field identification of the patients who should be taken to trauma centers is a major problem of trauma care. This study appears to be the first to use multivariate analysis to systematically design a field triage instrument and to evaluate its performance in terms of a meaningful and plausible criterion for which patients ought to be treated at trauma centers. Four new triage instruments were created and their performance compared to that of two existing measures, the Trauma Score and the CRAMS scale. The new measures appear to perform better than the best of existing instruments tested, although independent validation is necessary. The one purely physiologic instrument tested appeared to be inferior to instruments that included anatomic and historic as well as physiologic indices. Simple checklists performed approximately as well as weighted scales. No instrument was found to be high in both sensitivity and positive accuracy.

Adolescent↗
PubMed1984

[Epidemiology of digitalis medication. Results of the Munich blood-pressure study].

As part of a blood-pressure survey in Munich, some of its inhabitants aged 30-69 years were asked by questionnaire about any digitalis medication. Chemically defined glycosides were taken by 127 of 1827 persons (7%), two-thirds of them older than 60 years, for clinically compensated chronic heart failure. Using the equation of Cockcroft and Gault to calculate creatinine clearance, it was below 80 ml/min and thus indicative of early impairment of renal function in more than 50%. In 44% the prescribed daily dose of glycoside corresponded to the calculated maintenance dose, 29% had less and 27% had taken more. None had clinical signs of digitalis intoxication. ECG changes possibly due to digitalis were much less common than had been expected. Sinus rhythm was present in 93%. More than 50% did not know why they were taking digitalis and 80% were taking two or more drugs at the same time. Since more than half had signs of early renal function impairment, creatinine clearance should be taken into account when determining the dosage of a digoxin preparation especially in elderly patients; alternatively, digitoxin should be prescribed. The survey also showed that a large number of persons on glycoside medication did not take the drug regularly.

Acetyldigoxins↗
PubMed1983

[Effect of atenolol and nitroglycerin ointment on exertion tolerance in coronary disease].

In a randomized, placebo-controlled double-blind cross-over study the effect and duration of effect of 2% nitroglycerin ointment (2 cm/m2 body surface) and 50 mg atenolol, as the only drug or the two in combination, were tested on 16 patients with coronary heart disease. Heart rate at rest and on exercise rose significantly for up to 3 1/2 hours (P less than 0.01) after application of the nitroglycerin ointment. Systolic blood pressure at rest and five minutes after exercise was significantly reduced (P less than 0.01), while on exercise there was no significant difference from the control value. Pressure X heart rate product was significantly raised over the initial value up to 3 1/2 hours after application, at maximal exercise (P less than 0.05), while after atenolol there was a highly significant reduction compared with the placebo (P less than 0.01), even after six hours. S-T depression was reduced at maximal comparable exercise level by 49% after atenolol, 52% after nitroglycerin ointment and 76% after combination of the two (P less than 0.05). Exercise tolerance was on average increased for 1 1/2 hours after atenolol by 36%, after nitroglycerin ointment by 58% and after the combined application by 84%, compared with the placebo (P less than 0.01). In the latter (combination) group the pressure X heart rate product was definitely below that of the nitroglycerin ointment group. Thus additional administration of 50 mg atenolol can decrease the pressure X heart rate product after application of nitroglycerin ointment, at the same time increasing exercise tolerance and reducing the degree of S-T depression.

Aged↗