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  • 1
    ISSN: 1435-1803
    Keywords: Frank-Starling ; mechanism ; heart failure ; normal donor hearts ; dilated cardio-myopathy ; heart transplantation ; skinned fibres
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The Frank-Starling-mechanism (FSM) was analyzed in isolated intact and skinned human left ventricular myocardium obtained from 11 heart transplantations (normal donor hearts (NDH), n=8; dilated cardiomyopathy (DCM), n=11). The new technique to utilize muscle strips from normal donor hearts which were actually implanted is described in detail. Methods I) In electrically stimulated left ventricular trabeculae (37°C, oxygenated Krebs-Henseleit solution, supramaximal, electrical stimulation, frequency 1 Hz) force development was analyzed as a function of muscle length (NDH=8; DCM=11). II) In an additional series left ventricular myocardium was demembranized (“skinned”) by Triton-X-100. At different sarcomere lengths and calcium concentrations corresponding to pCa values of 4.3, 5.5, and 8.0 force development was measured (DCM=11; NDH=9). Results I) Developed force increased up to an optimum as a function of muscle length in intact NDH- and DCM-myocardium. However, the relative increment of developed force after any length step was smaller in DCM than in NDH. Near “Lmax” (muscle length associated with maximum developed force) passive resting tension was considerably elevated in DCM, indicating significantly incresed diastolic stiffness II) In skinned left ventricular DCM- and NDH-myocardium developed force depended on sarcomere length with an optimum near 2.2 μm. However, a reduction of activator calcium concentration from pCa 4.3 to pCa 5.5 produces a smaller percent decline in force at short sarcomere lengths in DCM than it does in NDH. Conclusion the present study shows that except for diastolic stiffness and a smaller relative force increment after any, length step in DCM the Frank Starling mechanism is still present in isolated human left ventricular DCM-as in NDH-myocardium. The current study does not allow to decide whether in skinned myocardium the smaller percent decline in force after reduction of activator calcium concentrations in DCM is caused by an increased calcium sensitivity at short sarcomere lengths or decreased sensitivity at long sarcomere lengths.
    Type of Medium: Electronic Resource
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  • 2
    Electronic Resource
    Electronic Resource
    Springer
    Supportive care in cancer 8 (2000), S. 33-39 
    ISSN: 1433-7339
    Keywords: Key words Marrow transplantation ; Complications ; Oral mucositis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  In recent years, significant improvements have been made in the management of neutropenia and thrombocytopenia and other potentially life-threatening complications of ablative chemotherapy. While these complications are of particular concern to physicians, patients receiving ablative therapy for bone marrow or blood stem cell transplants are often troubled by other side effects such as nausea, vomiting, diarrhea and mouth sores. The purpose of the study was to gain a better understanding of patients' experiences while undergoing a transplant. The same professional medical interviewer conducted in-depth interviews with 38 subjects (10 men, 28 women; mean age 46.9 years) who had received ablative therapy for bone marrow and/or peripheral blood stem cell transplants. Participants were consecutively identified through physician and patient referrals, cancer and BMT patient support groups, and newspaper advertisements. Twenty-eight patients (74%) received autologous stem cell transplants and 10 patients (26%) received allogeneic transplants. Participants reported mouth sores, nausea and vomiting, diarrhea, and fatigue as the most troubling side effects of their transplants. Mouth sores were selected as the single most debilitating side effect (42%), followed by nausea and vomiting (13%). Many patients mentioned that mouth sores made it difficult or impossible to eat (n=23), swallow (n=21), drink (n=17), and/or talk (n=8). Twenty patients reported pain in the mouth, throat, and/or esophagus. Two-thirds (66%) of patients reported receiving opioid analgesics, most frequently morphine, to relieve oral pain. For many, opioids caused incapacitating side effects, including hallucinations, a feeling of loss of control and a decrease in mental acuity. Patients receiving ablative chemotherapy identify oral mucositis as a significant cause of suffering and morbidity. Effective interventions to alleviate this complication are urgently needed.
    Type of Medium: Electronic Resource
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