RESUMEN
Traumatic dislocation of the hip is a severe injury. Even in cases of an early uncomplicated repositioning there is a high risk of associated intra-articular injuries, such as lesions of the labrum, ruptures of the ligament of the head of the femur and loose bodies. The degree of damage caused by dislocation of the hip becomes apparent with a highly increased risk of developing postinjury osteoarthritis after dislocation of the hip. Some of the major intra-articular damage resulting from hip dislocation, e.g. loose bodies, can be detected by computed tomography and magnetic resonance imaging and can be effectively addressed by hip arthroscopy, thus aiming at reducing the acute symptoms and the risk of postinjury osteoarthritis. The force effect which causes dislocation of the hip can generate severe associated extra-articular injures as in the case described with an unstable fracture of the pelvis. This supplementary injury had to be considered while planning the operative therapy and rehabilitation. A patient presented after a traffic accident with a luxatio obturatoria on the right side and a complex fracture of the left pelvis including the posterior ring and the anterior wall of the acetabulum. After reposition of the right hip and operative therapy of the left side, a loose body was identified in the right hip joint during the computed tomography control of the osteosynthesis. Before patient mobilization extraction of the intra-articular loose body was performed arthroscopically. This was done in consideration of the reduced possibility of distraction due to the osteosynthesis on the contralateral side. Attention was particularly paid to the risk of intra-abdominal fluid extravasation (IAFE). This syndrome is described as a severe complication during hip arthoscopy especially in cases of defects of the hip capsule as assumed after hip dislocation and magnetic resonance imaging.
Asunto(s)
Artroscopía/métodos , Fracturas Óseas/cirugía , Luxación de la Cadera/cirugía , Inestabilidad de la Articulación/cirugía , Traumatismo Múltiple/cirugía , Huesos Pélvicos/lesiones , Adulto , Femenino , Fracturas Óseas/complicaciones , Fracturas Óseas/diagnóstico , Luxación de la Cadera/complicaciones , Luxación de la Cadera/diagnóstico , Humanos , Inestabilidad de la Articulación/complicaciones , Inestabilidad de la Articulación/diagnóstico , Traumatismo Múltiple/diagnóstico , Resultado del TratamientoRESUMEN
PURPOSE: To evaluate the efficacy and safety of WX-G250, a chimeric monoclonal antibody that binds to carboxy anhydrase IX, combined with low-dose interferon-alpha (LD-IFNα) in patients with progressive metastatic renal cell carcinoma (mRCC). PATIENTS AND METHODS: Thirty-one patients, nephrectomized for the primary tumor, clear cell progressive mRCC, were enrolled to receive weekly infusions of WX-G250 (20 mg i.v.; week 2-12) combined with LD-IFNα (3 MIU s.c. 3 times/week; week 1-12). At week 16, patients were evaluated for response and stratified into two groups: (a) responders into the extended treatment group for an additional 6 weeks of treatment or (b) the progressive group with no further study treatment. RESULTS: Of the 31 treated patients, 26 were evaluable for response to treatment. Two patients showed partial remission and 14 patients had stable disease as assessed in week 16. One patient experienced partial remission resulting in a complete remission lasting at least 17 months. Nine patients had durable stable disease of 24 weeks or longer. Clinical benefit was obtained in 42% (11/26) patients. The median overall survival achieved was 30 months and the 2-year survival was 57%. Patients receiving extended treatment showed a significantly longer 2-year survival rate than discontinued patients (79 vs. 30%; P=0.0083). In general, treatment was well tolerated with little toxicity. CONCLUSION: Treatment with the antibody WX-G250 in combination with LD-IFNα is safe, well tolerated, led to clinically meaningful disease stabilization and demonstrated clinical benefit in this progressive mRCC patient population.
Asunto(s)
Anticuerpos Monoclonales/uso terapéutico , Interferón-alfa/uso terapéutico , Neoplasias Renales/tratamiento farmacológico , Anciano , Anticuerpos Monoclonales/efectos adversos , Antineoplásicos/efectos adversos , Antineoplásicos/uso terapéutico , Carcinoma de Células Renales/tratamiento farmacológico , Carcinoma de Células Renales/mortalidad , Relación Dosis-Respuesta a Droga , Quimioterapia Combinada , Femenino , Humanos , Interferón alfa-2 , Interferón-alfa/efectos adversos , Neoplasias Renales/mortalidad , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Proteínas Recombinantes , Estudios Retrospectivos , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
AR-L 115 BS (Sulmazol) is a new noncatechol, nonglycosidic cardiotonic agent. In 17 patients with significant coronary artery disease, the influence of AR-L 115 BS on hemodynamics and regional wall motion was investigated under the following conditions: 1) control, 2) the immediate postpacing period without medication, and 3) the postpacing period under the peak influence of AR-L 115 BS, 2 mg/kg intravenously. During the postpacing phase without medication, all patients developed ischemia (angina, ST segment alterations, increase of mean left ventricular end-diastolic pressure from 13 to 30 mm Hg), left ventricular pump function diminished and overall regional wall motion showed a tendency to decrease (p greater than 0.05). However, during the postpacing period with AR-L 115 BS medication, ischemia was abolished (no angina; mean left ventricular end-diastolic pressure decreased to 13 mm Hg; hemodynamic variables returned to control levels and left ventricular pump function showed some improvement while overall regional wall motion showed tendencies to improve. A comparison of alterations of hemodynamics and regional wall motion during the postpacing phase without medication with those under the influence of AR-L 115 BS shows that overall left ventricular pump function and regional wall motion improved while angina and an increase in left ventricular end-diastolic pressure were prevented. It is concluded that AR-L 115 BS improves left ventricular pump function and regional wall motion in coronary artery disease without inducing ischemia, probably by means of a reduction in extravascular resistance.
Asunto(s)
Cardiotónicos/uso terapéutico , Enfermedad Coronaria/tratamiento farmacológico , Imidazoles/uso terapéutico , Angina de Pecho/prevención & control , Cateterismo Cardíaco , Estimulación Cardíaca Artificial , Cardiotónicos/efectos adversos , Humanos , Imidazoles/efectos adversos , Masculino , Persona de Mediana Edad , Contracción Miocárdica/efectos de los fármacos , Volumen Sistólico/efectos de los fármacos , Resistencia Vascular/efectos de los fármacos , Visión Ocular/efectos de los fármacosRESUMEN
Probabilistic maps of neocortical areas and subcortical fiber tracts, warped to a common reference brain, have been published using microscopic architectonic parcellations in ten human postmortem brains. The maps have been successfully applied as topographical references for the anatomical localization of activations observed in functional imaging studies. Here, for the first time, we present stereotaxic, probabilistic maps of the hippocampus, the amygdala and the entorhinal cortex and some of their subdivisions. Cytoarchitectonic mapping was performed in serial, cell-body stained histological sections. The positions and the extent of cytoarchitectonically defined structures were traced in digitized histological sections, 3-D reconstructed and warped to the reference space of the MNI single subject brain using both linear and non-linear elastic tools of alignment. The probability maps and volumes of all structures were calculated. The precise localization of the borders of the mapped regions cannot be predicted consistently by macroanatomical landmarks. Many borders, e.g. between the subiculum and entorhinal cortex, subiculum and Cornu ammonis, and amygdala and hippocampus, do not match sulcal landmarks such as the bottom of a sulcus. Only microscopic observation enables the precise localization of the borders of these brain regions. The superposition of the cytoarchitectonic maps in the common spatial reference system shows a considerably lower degree of intersubject variability in size and position of the allocortical structures and nuclei than the previously delineated neocortical areas. For the first time, the present observations provide cytoarchitectonically verified maps of the human amygdala, hippocampus and entorhinal cortex, which take into account the stereotaxic position of the brain structures as well as intersubject variability. We believe that these maps are efficient tools for the precise microstructural localization of fMRI, PET and anatomical MR data, both in healthy and pathologically altered brains.
Asunto(s)
Amígdala del Cerebelo/anatomía & histología , Mapeo Encefálico/métodos , Corteza Entorrinal/anatomía & histología , Hipocampo/anatomía & histología , Anciano , Anciano de 80 o más Años , Amígdala del Cerebelo/citología , Cadáver , Interpretación Estadística de Datos , Corteza Entorrinal/citología , Femenino , Hipocampo/citología , Humanos , Imagenología Tridimensional , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Tomografía de Emisión de Positrones , Programas Informáticos , Técnicas EstereotáxicasRESUMEN
The effect of hemodialysis (HD) on left ventricular (LV) function and exercise tolerance were measured at rest and during exercise using gated equilibrium radionuclide ventriculography in seven patients with confirmed coronary artery disease (CAD). To separate the effects of fluid removal rate on LV function in CAD, we investigated the same patients with identical overall volume loss of 4 liters during two different treatment times (4 hr and 2 hr). HD significantly increased resting LV ejection fraction (EF) from 55.7 +/- 8% to 64.7 +/- 8% (P less than 0.01) during the 4 hr HD and from 58.1 +/- 9 to 68.1 +/- 10 (P less than 0.05) during the 2 hr HD. Indicating ischemia, EF decreased at pre- and postdialysis peak exercise without differences between both treatments. HD also resulted in an improved segmental wall motion score. Exercise duration as well as S-T segment depression and angina score improved during HD, whereas heart rate, blood pressure and double product remained unchanged. We conclude that HD improves global and regional resting LV function and exercise tolerance in patients with CAD. The degree of interdialytic hydration and not the degree of fluid removal per time affects LV performance in CAD. Since LV function is the major prognostic factor in CAD, those patients require volume restriction and/or shorter interdialytic phases.
Asunto(s)
Gasto Cardíaco , Enfermedad Coronaria/fisiopatología , Esfuerzo Físico , Diálisis Renal , Volumen Sistólico , Adulto , Presión Sanguínea , Enfermedad Coronaria/diagnóstico por imagen , Enfermedad Coronaria/metabolismo , Frecuencia Cardíaca , Humanos , Masculino , Persona de Mediana Edad , CintigrafíaRESUMEN
Systemic IL-2 is an effective treatment for low to intermediate risk mRCC patients, its efficacy is marginal in high-risk cases. Therefore, other treatment approaches are required for this population. Ninety-four high-risk patients with RCC and pulmonary metastases were treated with inhaled plus concomitant low-dose subcutaneous rhIL-2. Clinical response, survival and safety were compared with those from IL-2 given systemically at the registered dose and schedule in 103 comparable historical controls. In the rhIL-2 INH group, treatment consisted of 6.5 MIU rhIL-2 nebulized 5x/day and 3.3 MIU rhIL-2 SC once daily. The rhIL-2 SYS group received treatment which consisted of intravenous infusion of 18.0 MIU/m2/day rhIL-2 or SC injection of 3.6-18.0 MIU rhIL-2. Some patients in both groups also received IFNalpha. Mean treatment durations were 43 weeks rhIL-2 INH and 15 weeks rhIL-2 SYS. Significantly longer overall survival and progression-free survival durations were observed in the rhIL-2 INH group. The probability of survival at 5 years was 21% for the rhIL-2 INH group. No patients survived 5 years in the rhIL-2 SYS group. A multivariate analysis of overall survival adjusting for differences in baseline characteristics between the two treatment groups resulted in a risk ratio of 0.43 (95% CI 0.30-0.63; P < 0.0001). The data suggested an association between the response (SD or better) and survival, especially in the rhIL-2 INH group. The inhalation regimen was well tolerated. This outcome study suggests that administration of rhIL-2 by inhalation is efficacious and safe in high-risk mRCC patients with pulmonary metastases, who have no other treatment option available.
Asunto(s)
Interleucina-2/administración & dosificación , Interleucina-2/uso terapéutico , Neoplasias Renales/tratamiento farmacológico , Proteínas Recombinantes/efectos adversos , Proteínas Recombinantes/uso terapéutico , Administración por Inhalación , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Infusiones Intravenosas , Inyecciones Subcutáneas , Interferón-alfa/administración & dosificación , Interferón-alfa/uso terapéutico , Interleucina-2/efectos adversos , Neoplasias Pulmonares/tratamiento farmacológico , Neoplasias Pulmonares/secundario , Masculino , Persona de Mediana Edad , Proteínas Recombinantes/administración & dosificación , Tasa de Supervivencia , Factores de TiempoRESUMEN
OBJECTIVE: This study aimed to evaluate the impact of darbepoetin alfa (DA) on hemoglobin (Hb) levels and quality of life (QoL) in cancer patients with anemia in current daily practice following several revisions of anemia treatment guidelines. METHODS: This was a prospective, multi-center, observational study across Germany in non-myeloid cancer outpatients with chemotherapy-induced anemia treated with DA. Age, sex, cancer type, stage, and therapy, performance status, anemia status and treatment, and Hb concentrations were recorded for up to 18 weeks in a web-based registry. Optional QoL assessments were collected at baseline and at the end of DA treatment. MAIN RESULTS: Of 984 eligible patients, 978 had complete anemia data, 492 also had complete QoL data. In the 978 patients, mean age was 64 (standard deviation, SD 12) years, 62% of patients were women. Breast (26%) and gastrointestinal (22%) cancer were most prevalent. Therapy was palliative in 44% of patients and initiated with curative intent in 29%. Mean baseline Hb was 9.5 (SD 0.9) g/dL, which increased by an average of 1.2 g/dL. In 67% of patients Hb increased either to 10-12 g/dL or by ≥2 g/dL; no Hb response was seen in 219 patients (22%); increases of 0 to 1, >1 to 2, and >2 g/dl were seen in 216 (22%), 265 (27%), and 278 (28%) patients, respectively. Anemia treatment did not result in any significant differences of performance status. However, QoL improvements were significantly greater in Hb responders, although a linear relationship with Hb increments was lacking. None of 47 fatal cases was considered related to treatment with DA. CONCLUSION: Patients treated with DA in routine clinical practice had increases in Hb and reported improvement in QoL. Due to the uncontrolled design, no conclusions can be made regarding causality to treatment and the clinical relevance of the improvement.
Asunto(s)
Anemia/tratamiento farmacológico , Antineoplásicos/efectos adversos , Eritropoyetina/análogos & derivados , Hematínicos/uso terapéutico , Neoplasias/tratamiento farmacológico , Calidad de Vida , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Anemia/sangre , Anemia/inducido químicamente , Antineoplásicos/uso terapéutico , Biomarcadores/sangre , Darbepoetina alfa , Eritropoyetina/uso terapéutico , Femenino , Alemania , Hemoglobinas/metabolismo , Humanos , Masculino , Persona de Mediana Edad , Guías de Práctica Clínica como Asunto , Estudios Prospectivos , Sistema de Registros , Adulto JovenRESUMEN
We report on a case of an 80-year-old female patient who presented to the emergency room of with right upper quadrant abdominal pain since the day before. During the initial diagnostic an abdominal x-ray study revealed an air-filled colonic section of the bowel under the right hemidiaphragm corresponding to Chilaiditi's sign. The clinical symptoms and laboratory results were mild at this time. After 12 h the patient developed right upper quadrant peritonitis due to a perforated, subdiaphragmatic appendicitis based on Chilaiditi's syndrome. During surgical treatment the cecum and parts of the ascending colon were found to be interposed between the liver and right hemidiaphragm. A right hemicolectomy was performed which led to complete recovery of the patient. In addition to presenting this interesting case this article highlights the regime of the diagnostics and therapy of a complication of the very rare condition of Chilaiditi's syndrome.
Asunto(s)
Apendicitis/complicaciones , Apendicitis/diagnóstico por imagen , Síndrome de Chilaiditi/complicaciones , Síndrome de Chilaiditi/diagnóstico por imagen , Anciano de 80 o más Años , Apendicitis/cirugía , Síndrome de Chilaiditi/cirugía , Colectomía/métodos , Colon Ascendente/diagnóstico por imagen , Colon Ascendente/cirugía , Diagnóstico Diferencial , Femenino , Humanos , Peritonitis/diagnóstico por imagen , Peritonitis/cirugía , Tomografía Computarizada por Rayos XRESUMEN
The availability of one unitised organ replacement model is no longer sufficient for adequate prosthetic care at any time. The first phase of a complex system of prosthetic care was completed by the development of "femi-Form", an epithesis master model, in 1982. Two more variants were introduced in 1986, "femi-Form S" and an interim prosthesis. The complex system of prosthetic care in its totality is considered to be an important step in public health. Great attention is given to it in the GDR for follow-up treatment in the context of tumour diseases. Manufacturers are expected to go to great lengths in developing adequate prosthetic devices for postoperative care. However, it is a challenge to the medical profession to speed up and generally support the introduction of this complex post-mastectomy system.
Asunto(s)
Neoplasias de la Mama/cirugía , Mastectomía , Prótesis e Implantes , Femenino , Humanos , Diseño de PrótesisRESUMEN
From 1972 to 1976, 488 women suffering from cancer of the female breast underwent uniform surgical treatment (Rotter-Halsted-operation), no postoperative irradiation. In 62 cases (12,7%) a lymphoedema could be observed. The author holds the opinion that the oedema of the equilateral arm is caused by dissemination of cancer cells and depends on tumour stage and not the specific kind of treatment.
Asunto(s)
Neoplasias de la Mama/diagnóstico , Linfedema/diagnóstico , Mastectomía , Recurrencia Local de Neoplasia/diagnóstico , Complicaciones Posoperatorias/diagnóstico , Adulto , Anciano , Neoplasias de la Mama/patología , Neoplasias de la Mama/cirugía , Femenino , Humanos , Metástasis Linfática , Linfedema/etiología , Persona de Mediana Edad , Recurrencia Local de Neoplasia/patología , Recurrencia Local de Neoplasia/cirugía , Estadificación de Neoplasias , Complicaciones Posoperatorias/etiología , Factores de TiempoRESUMEN
The existing follow-up standard for breast cancer patients has been reviewed by a representative trial involving 1,004 curatively treated patients, who underwent surgery between 1977 and 1987. The objective of the study has been to establish whether intensive diagnostics of recurrences and metastases will lead, as a result of the follow-up, to life prolongation or improvement of life quality, and which methods will be adequate to achieve this goal. The analysis has shown that metastases are recognized only insignificantly earlier, and that improvement of survival is not achieved. The results of the trial have led to a recommendation for an effective follow-up programme for breast cancer patients, with emphasis on subtle case history data and exact clinical investigations.
Asunto(s)
Neoplasias de la Mama/patología , Neoplasias de la Mama/mortalidad , Estudios de Seguimiento , Humanos , Tablas de Vida , Metástasis de la Neoplasia/diagnóstico , Recurrencia Local de Neoplasia/diagnóstico , Calidad de VidaRESUMEN
The valid follow-up standard for mammary carcinoma was checked by means of a retrospective study with 1,004 curatively treated patients operated between 1977 and 1987. The aim of this study was to find out whether intensive diagnostics of recurrences and metastases resulted in early detection and prolongation of life and/or improvement of life quality. Evaluation of two groups (early detection and treatment as compared to late detection and treatment) showed that diagnosis was only slightly earlier (1,2 months) which did not lead to longer life. These results gave rise to recommendations for an efficient follow-up regime for patients with mammary carcinoma. Exact case history and clinical examinations are more important for asymptomatic patients than intensive diagnostics:
Asunto(s)
Neoplasias de la Mama/patología , Metástasis de la Neoplasia/diagnóstico , Recurrencia Local de Neoplasia/diagnóstico , Femenino , Estudios de Seguimiento , Humanos , Estudios Retrospectivos , Factores de TiempoRESUMEN
A network of national and international guidelines and directives developed in the last few decades by various bodies will lead to a new concept of total quality for medical laboratory services comprising legislative regulations on national and international levels, standardizations backed up by legislation and recommendations of professional societies. One example is the IVD Directive of the European Community. It will not only stimulate accreditation in the field of laboratory medicine, but also necessitate numerous standardization activities which are presently co-ordinated by the European Committee for Standardization (CEN). Another standardization example is the development of quality management systems, mainly by ISO. The ISO 9000 series has become the most successful family of standards world-wide. Meanwhile, specific standards for the needs of laboratories (ISO 17025), and in particular of medical laboratories (ISO 15189), are being worked out. A new trend to develop quality management systems towards total quality management systems can be observed including additional aspects such as economic and quality interests of society, customers and owners of laboratories. The goal of all activities is to create a network of confidence which provides some guarantee to the clients, i.e. the physicians and their patients, that they will receive a high-quality medical laboratory service.
Asunto(s)
Técnicas de Laboratorio Clínico/normas , Laboratorios/legislación & jurisprudencia , Laboratorios/normas , Europa (Continente) , Humanos , Control de CalidadRESUMEN
The adenylate cyclase activator 17 beta-acetoxy-8, 13-epoxy-1 alpha,6 beta,9 alpha-trihydroxylabd-14-en-11-one (forskolin) was studied for its beneficial effect as therapeutic agent for the treatment of dilated cardiomyopathy (DCM). In 7 DCM-patients with normal (group A) and 8 DCM-patients with pathological dP/dtmax-values (group B), we analyzed serially (computer-assisted) the pressure/volume (P/V) effects as P/V-loops (microtip catheter/Tc-99m scintigraphy) and on-line MV02 (indirectly: Bretschneider equation) under dobutamine, 10 micrograms/kg/min i.v., and forskolin, 3 micrograms/kg/min i.v. For the total group (A + B) there was no change of contractility during forskolin (p greater than 0.05); with dobutamine, however, it rose by an average of +25%. The preload decline was more pronounced with forskolin (LVEDP by -27%) as compared to dobutamine (by-19%); while left ventricular (LV-)function improved moderately only with forskolin (by +9%) and significantly (by +34%) with dobutamine. Thus, forskolin improved LV-function primarily via reduction of preload in DCM-hearts and without rising metabolic costs. Beneficial hemodynamic effects with forskolin are quantitatively less as compared to those with dobutamine (accompanied by higher MVO2-costs). It is concluded that residual myocardial reserves in DCM are mobilized by dobutamine rather than forskolin. Serial P/V-loop and on-line MVO2 registration aided in the demonstration of forskolin efficacy as compared to dobutamine.
Asunto(s)
Cardiomiopatía Dilatada/fisiopatología , Colforsina/farmacología , Corazón/fisiopatología , Angiografía , Dobutamina/farmacología , Femenino , Hemodinámica/efectos de los fármacos , Humanos , Masculino , Miocardio/metabolismo , Consumo de Oxígeno/efectos de los fármacosRESUMEN
UNLABELLED: We studied in 11 patients the individual variable pattern of coronary blood supply after the end of diagnostic coronary catheterisation by intracoronary injection of T1201 into the left and J 123-heptadeconic acid into the right coronary artery. In 4 static views computer aided quantitative analysis of circumferential profiles was performed. Based on Schlesinger's criteria three types of coronary arterial patterns were defined (right, left preponderant, balanced) after the presentation in the angiographic projections. CONCLUSIONS: Sharp boders between different perfusion areas could be detected by the gamma camera. If patients with right preponderant circulation are compared with balanced circulation, the perfusion areas of the left coronary artery are greater in all cases with balanced circulation than expected. More important for the indication of coronary artery surgery is that a considerable area of the left ventricular myocardium is perfused by the right coronary artery independent of the anatomical perfusion pattern with the exception of the left preponderant type.
Asunto(s)
Ácidos Grasos , Corazón/diagnóstico por imagen , Radioisótopos de Yodo , Radioisótopos , Talio , Enfermedad Coronaria/diagnóstico por imagen , Vasos Coronarios/diagnóstico por imagen , Femenino , Humanos , Masculino , Métodos , Persona de Mediana Edad , Tomografía Computarizada de EmisiónRESUMEN
TA-064 is a new cardiotonic agent which is also effective orally, according to investigations conducted in Japan. We analyzed computer-assisted alterations of pressure-volume relationships serially and of indirect myocardial oxygen consumption (MVO2) estimations on line during TA-064 influence in 16 patients with congestive cardiomyopathy: left ventricular function was moderately decreased in seven patients (group A) and drastically decreased in nine (group B). Results showed that TA-064, 8 micrograms/kg/min intravenously, exerted positive inotropic effects in both groups and induced mean maximal delta percentage changes at about 5 minutes of infusion as follows: left ventricular stroke work index +65% and +47%; dP/dtmax +61% and 59%; left ventricular efficiency +62% and 53%; MVO2 +31% and +11% (p less than 0.05). TA-064, 20 mg by mouth induced serum levels (group A = 23.8 +/- 12ng/ml and group B = 26.4 +/- 20 ng/ml) corresponding to the effects with dosages of 1 to 2 ng/kg/min intravenously (p greater than 0.05), thus implying that significant changes in left ventricular function require higher oral dosages. We conclude that TA-064 improves left ventricular function, primarily via a contractility increase, also in group B patients without toxic side effects. On-line indirect MVO2 assessment and analysis of serial pressure-volume relationships helped to provide a more complex definition of the mechanism and efficiency of the cardiotonic agent under study.
Asunto(s)
Cardiomiopatías/fisiopatología , Cardiotónicos/farmacología , Etanolaminas/farmacología , Hemodinámica/efectos de los fármacos , Administración Oral , Adulto , Volumen Cardíaco/efectos de los fármacos , Cardiotónicos/administración & dosificación , Cardiotónicos/sangre , Etanolaminas/administración & dosificación , Etanolaminas/sangre , Ventrículos Cardíacos/diagnóstico por imagen , Ventrículos Cardíacos/efectos de los fármacos , Humanos , Infusiones Parenterales , Masculino , Persona de Mediana Edad , Contracción Miocárdica/efectos de los fármacos , Miocardio/metabolismo , Sistemas en Línea , Consumo de Oxígeno/efectos de los fármacos , Presión , Radiografía , Volumen Sistólico/efectos de los fármacosRESUMEN
DPI 201-106 (DPI) as a positive inotropic drug might be useful in treating dilated cardiomyopathy (DCM). In seven DCM patients with normal (group A) and eight DCM patients with abnormal (group B) left ventricular (LV) function, we analyzed serially (computer-assisted) pressure/volume (P/V) effects as P/V loops (microtip catheter/99mTc scintigraphy) using DPI (30 micrograms/kg X min i.v.) and dobutamine (DOB) (10 micrograms/kg X min i.v.) for quantitative comparison of hemodynamic effects. Contractility (dP/dtmax) improvement was greater with DPI (group A, +23%; group B, +47%) than with DOB (group A, +21%; group B, +32%), as was the simultaneous LV end-diastolic pressure decrease--DPI (group A, -39%; group B, -42%) versus DOB (group A, -21%; group B, -18%). LV efficiency increased with DPI (group A, +22%; group B, +55%), but myocardial oxygen consumption (MVO2) did not change significantly. Five of 15 patients showed an increase in dP/dtmax with DPI only; with DPI there were fewer "nonresponders" than with DOB. Thus, DPI increases contractility in DCM hearts while reducing preload rather than causing higher metabolic costs. Such beneficial hemodynamic effects appear to be stronger in the more impaired myocardium (group B patients) and quantitatively superior to those induced by DOB. This might indicate that residual myocardial reserves are more readily accessible to the influences of DPI than to those of DOB. Serial P/V loops and MVO2 assessment aided the demonstration of DPI's efficacy in a more complex way.
Asunto(s)
Cardiomiopatía Dilatada/tratamiento farmacológico , Cardiotónicos/uso terapéutico , Dobutamina/uso terapéutico , Piperazinas/uso terapéutico , Adulto , Femenino , Ventrículos Cardíacos/diagnóstico por imagen , Humanos , Masculino , Microcomputadores , Persona de Mediana Edad , Contracción Miocárdica/efectos de los fármacos , Miocardio/metabolismo , Sistemas en Línea , Consumo de Oxígeno/efectos de los fármacos , RadiografíaRESUMEN
Using a dynamic and symmetrical cardiac phantom different echocardiographic mathematical models (Simpson 7 slices, area-length method, Simpson 2 slices and method according to Teichholz) were compared. 9 different end-diastolic (EDV) and end-systolic (ESV) volumes, 9 different stroke volumes (SV) and ejection fractions (EF) were used. EDV and ESV varied between 39-298 ml; SV between 29-100 ml and EF between 14-46%. In addition 10 fixed volumes of the same shape were evaluated using the same echocardiographic mathematical models. While symmetrical fixed volumes can be assessed correctly (r = 0.97-0.98), apart from the formula according to Teichholz (r = 0.89, significant underestimation of volumes), the correlation coefficients decrease using a dynamic cardiac phantom. In the modification of Simpson with 7 slices the best correlation was found for all parameters (EDV: r = 0.93; ESV: r = 0.94; EF: r = 0.87; SV: r = 0.81). The biplane area-length method has no advantages over Simpson's rule with 2 slices in the short axis; for symmetrical models both methods are comparable, both having high correlation coefficients (for volumes r = 0.85 and r = 0.88; for EF 0.78 and 0.84). Using the method according to Teichholz symmetrical volumes can be well assessed (r = 0.90), for the determination of EF the correlation coefficient decreases to r = 0.65 and for stroke volume to 0.33, reflecting no significant correlation to the actual SV. Possible causes for a poorer correlation are discussed for moving objects as opposed to the fixed volumes.
Asunto(s)
Gasto Cardíaco , Volumen Cardíaco , Ecocardiografía/métodos , Volumen Sistólico , Diástole , Ecocardiografía/instrumentación , Humanos , Modelos Anatómicos , Contracción Miocárdica , SístoleRESUMEN
Endsystolic pressure-volume relationships (ESPVR) were determined using the conductance (volume) catheter-technique and the required rapid load changes by applying vasoactive drugs (nitroprusside = NP; phenylephrine = PE) or brief preload reduction by balloon occlusion of the vena cava inferior (BOVCI). With this load-independent index of contractility, we analyzed the hemodynamically active components of amrinone (AM) over a range of different LV-loading conditions. In 19 patients (study I) with still normal LV-function (LVF) in group A (dP/dtmax 1585 +/- 386 mmHg/s; n = 10) and impaired LVF in group B (dP/dtmax 1044 +/- 164 mmHg/s; n = 9) an infusion of AM, 1.5 mg/kg over 2 min, failed to induce changes in ESPVR (p greater than 0.05), but rather caused load changes, resembling like those seen with NP. During continuously paced heart rates (90/min) brief infusion phases with NP and PE provided the necessary load changes. In 11 patients (study II) with impaired LVF (dP/dtmax = 1177 +/- 163 mmHg/s) 2.5 mg/kg AM i.v. induced an increase in contractility, which was more pronounced after the additional application of dobutamine (DOB) at 10 micrograms/kg/min.; (1) Slope k rose from 0.52 to 0.80 mmHg/ml; (2) dP/dtmax increased by an average of 39% and 57% (p less than 0.01), respectively. The BOVCI provided the necessary load changes. Thus AM demonstrates its contractility-increasing effects in a dose-related fashion, probably (at least in part) via an increase in heart rate; inotropic effects further increased with the combination of AM and DOB. The use of the conductance technique for the assessment of ESPVR during acute decrease of preload by temporary BOVCI is innocuous to the patient, reproducible and can be carried out under the conditions of a routine cardiac catheter procedure. This technique seems to be useful in the assessment of relative inotropic effects of the newer cardiotonic drugs.
Asunto(s)
Amrinona/uso terapéutico , Cateterismo Cardíaco , Insuficiencia Cardíaca/tratamiento farmacológico , Hemodinámica/efectos de los fármacos , Contracción Miocárdica/efectos de los fármacos , Gasto Cardíaco Bajo/tratamiento farmacológico , Cardiomiopatía Dilatada/tratamiento farmacológico , Dobutamina/uso terapéutico , Quimioterapia Combinada , Humanos , Miocardio/metabolismo , Nitroprusiato/uso terapéutico , Consumo de Oxígeno/efectos de los fármacosRESUMEN
In 13 patients with chronic atrial fibrillation, programmed right ventricular pacing was performed before and after intravenous administration of 4 mg gallopamil. Application of the Ca-antagonist resulted in a marked decrease in the ventricular response in all and in a regularization of the ventricular response (variation coefficient of the ventricular cycle length: less than 10%) in 7 of 13 cases, while atrial fibrillation persisted. During regularization right ventricular extrastimulus testing showed a constancy of the postextrasystolic interval irrespective of the changes in the coupling interval of the extrasystole. The postextrasystolic cycle was slightly longer than the basic cycle; the difference amounts to a mean value of 107 +/- 22 ms. During the control period the postextrasystolic cycle showed the same irregularity as the basic cycle. The same random distribution was observed if the first 10 cycles of the spontaneous rhythm were analyzed after a short period of ventricular overdrive pacing. After regularization the first 2-3 postpacing cycles were markedly prolonged, and during the following cycles a gradual adjustment to the length of the basic cycles before overdrive pacing was seen, resembling the warming up of a pacemaker. It is concluded that regularization is most probably due to atrioventricular nodal depression and the occurrence of a junctional escape pacemaker.