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Biomedical subjects

W Koenig

Publications and source records attributed to W Koenig.

At least 145 records · Page 8Linked to original sources
PubMed1983

[Mitral valve insufficiency in coronary heart disease].

On 121 consecutive patients with coronary heart disease coronary angiography and quantitative left ventricular angiography was done with the view to aortocoronary bypass surgery. 24 (20%) had mitral regurgitation (MR) by angiographic criteria, 20 of them had MR grade I/IV, four had MR II/IV. In 23 out of 24 patients with MR quantitative left ventriculography revealed localized contraction disorders. MR was clinically diagnosed in 15 out of 24 patients. In eleven patients (48%) contraction abnormalities were localized in the inferior wall, in five cases (22%) in the anterior wall and in seven cases (30%) both in the anterior and posterior wall. Of the latter group patients with MR showed a significantly lower ejection fraction than patients without MR (p less than 0.05). Furthermore the MR-group showed larger akinetic areas, preferentially located in the inferior segments 0 degrees-240 degrees and in the anterolateral segments 60 degrees-90 degrees. Three vessel disease was more frequent in this group (43%) than in the group without MR (23%). Patients with inferior wall asynergy frequently showed combined stenosis or occlusion of the right and circumflex coronary artery. In conclusion, MR in coronary heart disease is most often associated with localized contraction disorders of the left ventricle; posterior wall infarctions, multiple vessel disease and large akinetic areas are more frequent. However, the hemodynamic significance of MR in patients with chronic myocardial infarction is usually insignificant.

Coronary Angiography↗
PubMed1983

[Electrocardiogram and M-mode echocardiography in the diagnosis of chronic transmural infarct. Correlations and determination of the accuracy of both methods based on quantitative levocardiography].

In a comparative study of 121 consecutive patients who had had coronary angiography for coronary heart disease, the diagnostic informations obtained by M-mode echocardiography and electrocardiography in chronic transmural infarction were compared. Wall excursion by echocardiography did not allow sufficient separation of normal and asynergic segments. Changes in systolic wall thickness, on the other hand, provided satisfactory sensitivity and good specificity in the recognition of segmental contraction disorders: posterior wall thickening of 0.64 and 0.76, respectively, septal thickening of 0.45 and 0.91, respectively. In 53% of patients the ECG and echocardiogram provided findings similar to those by angiography. False-positive findings occurred in 10% of electrocardiograms, 14% of echocardiograms. False-negative findings in the ECG occurred in 13%, in the echocardiogram in 25%. Both methods combined had a specificity of nearly 100% with regard to the diagnosis of posterior-wall and anterior-wall infarction, and a positive predictive value of 0.92 (posterior) and 0.93 (anterior wall infarction). M-mode echocardiography and ECG findings provide reliable diagnosis of both the anterior and posterior wall chronic transmural infarction.

Adult↗
PubMed1983

Proximal left anterior descending coronary heart disease and complex ventricular arrhythmias.

In this study, 87 consecutive patients with angiographically proven coronary artery disease (CAD, stenosis greater than 75%) underwent 24-h Holter monitoring, 76 of them having had transmural myocardial infarction, a mean of five months before evaluation. Of the total, 51 patients showed single-vessel disease, in 31 (61%) of them with involvement of the left anterior descending (LAD) artery. In 26 patients with proximal LAD stenosis or occlusion and usually large aneurysms and subsequently impaired left ventricular function relatively low prevalence of significant ventricular premature contraction (VPC, Lown greater than or equal to III) was seen. On the contrary in 19 patients with multivessel disease and proximal LAD stenosis advanced forms of VPCs were present in 63% (p less than 0.01). Further both groups differed significantly in the frequency of postinfarction angina (30% vs. 100%; p less than 0.001) and their incidence in positive exercise stress tests (15% vs. 84%; p less than 0.001). Ejection fractions were comparable in both groups (mean 45% vs. 52%). Finally 17 patients with multivessel disease but without proximal LAD lesion did not differ in any of the above mentioned parameters, when compared to the patients with single-vessel disease and proximal LAD stenosis. We conclude that impaired left ventricular function does not sufficiently explain the high risk of sudden death in postmyocardial infarction patients. The coronary and functional status of the surviving myocardium has to be taken into consideration as well.

Adult↗
PubMed1983

[Qualitative and quantitative analysis of regional contraction disorders using levocardiograms].

In 74 patients with proven myocardial infarction (typical history and enzymes, diagnostic ECG, and stenosis of the vessel supplying the asynergic region of more than 75%) the results of qualitative analysis of left ventricular cineangiograms were compared to those of quantitative analysis using the radial axis method of Mathes. There was a significant difference in interpretation between the two methods if the physiological movements of the heart were not taken into account in the qualitative analysis. After correction for systolic anterior movement and downward movement of the aortic valve during systole, a mean accuracy of 92% resulted. The radial axis method discriminated well between normokinetic and asynergic wall segments. However, this method proved less useful for the detection of asynergies in the apical, anterobasal, and posterobasal regions. A radial axis angle of between 15 degrees and 20 degrees is considered to be optimal. The quantitative analysis seems to be particularly useful for the interpretation of borderline cases, and should be carried out routinely in addition to the qualitative analysis.

Adult↗
PubMed1983

[Significance of the E point-septum distance for the evaluation of left ventricular function in coronary disease--a study using M-mode echocardiography].

In 121 patients (pts) with angiographically proven coronary artery disease, left ventricular (LV) cineangiograms were quantitatively evaluated. 79 pts showed regional wall abnormalities. In this group the relationship between echocardiographic parameters of global (LV) function (mitral-septal separation, systolic and diastolic diameter, and fractional shortening) and ventriculographic parameters was investigated. Mitral-septal separation showed the best correlation to the angiographic ejection fraction (EF) (r = -0.72). The measurement of this parameter allows the diagnosis of a reduced EF independently of the dilatation of the left ventricle, and is easy to perform and to reproduce. Mitral-septal separation discriminated well between the reference group and all infarction subgroups (posterior wall, anterior wall, and double infarction) with reduced EF. The modification of the mitral-septal separation measurement according to D'Cruz et al. showed no advantage over that proposed by Massie et al. Both are clearly dependent upon septal excursion, which has to be taken into consideration when mitral-septal separation is being evaluated. The sensitivity of mitral-septal separation (greater than 7 mm) for the detection of reduced LV function (less than 55%) was 0.66; the specificity was 0.80. There was greater sensitivity for anterior wall infarctions than for posterior wall infarctions (0.73 vs 0.44). Because of the relatively high number of false negatives, only a pathologic mitral-septal separation is diagnostically useful.

Adult↗
PubMed1982

[Electrocardiography and quantitative levocardiography in chronic transmural infarct. A correlative study].

For evaluation of a connection between the electrocardiographic diagnosis and localisation of chronic infarction and the angiographic results left ventriculography data of 97 patients with coronary heart disease were assessed quantitatively according to the method of Mathes. According to electrocardiographic criteria of infarction six subgroups were distinguished: anteroseptal, anterior, anterolateral, inferior, inferiolateral, and posterolateral. Asynergies were demonstrable in 87% of patients with infarct electrocardiograms, normal ventricular function was seen in 80% of patients without infarct ECG. Asynergies were seen in 75% of electrocardiographically diagnosed anterior wall infarcts and in 92% of posterior wall infarcts. The sensitivity of the ECG in chronic infarction was 83%, the specificity 84%. Pronounced differences in the number of involved segments were found between inferior and inferiolateral infarction. In contrast, no clear-cut differentiation of electrocardiographic findings judged by segmental involvement in the left ventriculography was seen for the anterior wall. The extent of the anterior wall infarction diagnosed by electrocardiography did not correlate with results of left ventriculography. The ECG is a suitable means for detection of segmental disturbances of contraction also in the chronic infarction stage. However, localisation and extent of the lesion can only be assessed within limits.

Angiocardiography↗
PubMed1982

Hypoalpha-hyperbeta-lipoproteinemia in a patient with coronary artery disease and occlusive peripheral arterial disease.

This study describes a variant of hypo-alpha-lipoproteinemia in a 57-year-old male patient. The total plasma cholesterol level was 258 mg/dl with 64% in esterified form. The concentration of triglycerides was 205 mg/dl. The lipoprotein electrophoretic pattern revealed the absence of alpha-lipoproteins, whereas the other lipoproteins showed an intermediate electrophoretic mobility. The concentration of HDL cholesterol (heparin: MgCl2 precipitation) was extremely low (3 mg/dl). The activity of lecithin; cholesterol acyltransferase (LCAT) and the postheparinlipolytic activity were within the normal range. Determination of apolipoproteins revealed a marked deficiency of both apoprotein A-I (17 mg/dl) and apolipoprotein A-II (11 mg/dl). The concentration of apolipoprotein-B was elevated (186 mg/dl). Unlike the clinical manifestations of Tangier disease, our patient did not show skin lesion, abnormal tonsils, hepatosplenomegaly, peripheral neurologic abnormalities or corneal deposits. Also in contrast to Tangier disease our patient had coronary artery disease with myocardial infarction accompanied with severe occlusive peripheral arterial disease.

Apoproteins↗
PubMed1982

[Age dependency of pulmonary artery pressure after myocardial infarction at rest and during exercise (author's transl)].

Functional disorders of the left ventricle at rest and under 6 minutes lasting bicycle ergometer exercise of 50 W were studied in 249 patients after myocardial infarction. By means of well defined circumstances, measurement of pulmonary artery diastolic pressure with floating catheter allows evaluation of left ventricular enddiastolic pressure. The upper borderline of this pressure is 20 mmHg which was reached in 45% of patients in the age group under 40, in 75% in those who are 60 and older. Independent to other exercise limiting factors, like angina, ischemic ECG-changes, augmented heart volume, congestive heart failure or critical extrasystoles, it could be shown that measurement of pulmonary artery pressure in these cases is the base for rational therapy like administration of digitalis, vasodilator drugs or beta-adrenergic blocking agents. Furthermore it can be predicted wether physical training could be usefull or dangerous.

Adult↗
PubMed1982

[The lower esophageal sphincter in newborn infants. Manometric study].

Lower esophageal sphincter manometry was conducted in 30 normal neonates aged from 4 hours to 9 days, using a technique known as continuous withdrawal with a constant perfusion rate in the catheter. A zone of raised pressure exists at the cardia level from birth, mean pressure recorded being 24.2 +/- 6.2 mmHg, and mean length of the high pressure zone being 11.1 mm. The sphincter acts in a manner that is comparable in all respects with that observed in older subjects, and the hypothetical "postpartum maturation" of the sphincter is an unlikely event. Manometric techniques need to be adapted to the particularly delicate situation encountered in neonates, the risk of error being high because of the reduced length of the sphincteric zone.

Cardia↗
PubMed1981

[Computer-assisted ECG evaluation in polyclinic patients].

Computer-aided reading of 12-lead scalar ECGs was performed in 2.883 out-patients with a tracing- and processing-system of IBM, Periphere Computer Systeme and Schwarzer using the Bonner analysis-program version 2. After analog-to-digital conversion and storage on a floppy disk the ECG data were transferred by telephone to an IBM-computer at Munich. It the same way the prints were received from there. The review by a cardiologist showed correct interpretation in 95%. The accuracy was calculated as follows: Sensitivity 96%, specificity 96%. The same program can now be used in an ECG-cart with a built in microprocessor, a so-called stand-alone version.

Arrhythmias, Cardiac↗
PubMed1981

[Ventricular arrhythmias and left ventricular function in coronary artery disease. A study by M-mode echocardiography and 24-hour Holter-monitoring (author's transl)].

In 82 patients with coronary artery disease, most of them having had transmural myocardial infarction, left ventricular function was studied with M-mode echocardiography. Furthermore 24-hour Holter-monitoring was done to determine the maximal degree of ventricular premature contractions (VPC's) according to the classification of Lown. The degree of VPC's was then plotted against echocardiographic parameters of left ventricular function. Confronting the subgroup of patients with Lown grade 0--II with those of grades III and IV, for all parameters significant differences of the mean values could be demonstrated. Parameter "distance E-point of the anterior mitral leaflet--left ventricular septal wall" shows 84% sensitivity; fractional shortening gives 88% specificity. Combination of all four parameters shows 90% specificity, which makes M-mode echocardiography a valuable diagnostic method in identifying those patients with coronary artery disease and malignant arrhythmias who have an increased risk of sudden death.

Adult↗
PubMed1979

[Computer-aided reading of ECG (author's transl)].

Computer-aided reading of 12-lead scalar ECGs was performed in 1800 cardiovascular patients with a tracing-and processing-system of IBM, Periphere Computer Systeme and Schwarzer using the Bonner analysis program. After analog-to-digital conversion and storage on a floppy disk the ECG data were transferred by telefone during night because of lower rates to the IBM computer at Munich. In the same way the prints were received from there. The review by a cardiologist showed correct interpretations in about 90%. False negative and other inadequate readings were found in 6% while false positive results were obtained in almost 1%, the remaining percents belonged to technical troubles.

Diagnosis, Computer-Assisted↗
PubMed1979

Contents of trace elements in the human liver before birth.

A multielement analysis was carried out in nine fetal livers (age: 23 weeks of gestation to term) in comparison to an adult control group (n = 37). 15 elements (phosphorus to lead) were analyzed by proton-induced X-ray emission (PIXE). Significant differences between the two groups, expressed as ratios (R) of fetal to adult liver values were observed for copper (R = 16), zinc (R = 2.0), iron (R = 1.5), calcium (R = 1.34), selenium (R = 1.22), manganese (R = 0.7), and molybdenum (R = 0.13). An interesting point seems to be the inverse relation of copper and molybdenum. The negative correlation of these two trace elements which is known from animal experiments has now been confirmed in the human liver.

Adult↗
PubMed1979

Study of sample collection and preparation methods for multi element analysis in liver tissue by proton induced X-ray emission (PIXE).

Large samples of tissue and biopsy specimen were taken from a single human liver, homogenized or paraffin-embedded, then analyzed by PIXE. Homogenates, including those of biopsies, proved to be suitable for PIXE-analysis of P, S, Ca, Mn, Fe, Cu, Zn, Se, Rb, Mo, Cd and, to a limited extent, Pb. Paraffin-embedding leads to a distinct elution of K, Rb, Cl and to a lesser elution of P, Zn, Se, Br and Mo. The contents of Ca and Sr, on the other hand, were higher in the paraffin-embedded sections. Sections of paraffin-embedded biopsies proved to be hardly suitable for PIXE-analysis.

Cations, Divalent↗
PubMed1979

Variation of trace element contents in a single human liver.

Multi element analysis of homogenised samples taken from three different areas of a single human liver was performed for 18 elements by proton induced X-ray emission (PIXE). Small (10--20%) but statistically significant variations between the element contents of these areas were found for Cl, K, Ca, Fe, Cu, Zn, Br, Rb and Mo. These differences are not parallel to each other. The variation of element content within one area of this single liver did not show any distinct correlation between different elements, nor did it significantly exceed the methodical errors of 3--10% except for lead. Thus we conclude from our measurements that the trace element analysis of small liver samples by PIXE is, with the exception of lead, fairly representative for the whole organ.

Anions↗