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  • 1
    ISSN: 1432-1084
    Keywords: Key words: Tomography, X-ray computed – Coronary disease – Coronary atherosclerosis – Multirow-detector computed tomography
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. This contribution reviews the pathology and morphology of coronary calcifications. It summarizes the indications for investigation of the coronary arteries. The standard protocols for scan acquisition using electron beam and conventional computed tomography are described as well as various methods for evaluation such as the traditional Agatston scoring method and the newer three-dimensional scoring algorithms. Guidelines for interpreting scores are also reviewed. Major limitations of the reproducibility of the calcium score measurement are summarized. Future aspects of multirow-detector spiral computed tomography with retrospective electrocardiographic triggering for quantifying coronary calcium are discussed.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1432-1084
    Keywords: Key words: CT ; Coronary disease ; Coronary arteriosclerosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. To identify patients with increased risk of having coronary artery disease (CAD), electron-beam computed tomography (EBCT) was used for years for quantifying calcifications of the coronary arteries. The first direct comparison between EBCT and conventional CT was performed to determine the reliability of widely available conventional CT for the assessment of the coronary calcium score. Fifty male patients with suspected CAD were investigated with both modalities, EBCT and conventional 500-ms non-spiral partial scan CT. Scoring of the coronary calcification was performed according to the Agatston method. Forty-two of these patients underwent coronary angiography for the assessment of significant luminal narrowing. The correlation coefficient of the score values of both modalities was highly significant (r = 0.982, p 〈 0.001). The variability between the two modalities was 42 %. Mean calcium score in patients with significant coronary luminal narrowing (n = 37) was 1104 ± 1089 with EBCT and 1229 ± 1327 with conventional CT. In patients without luminal narrowing (n = 5) mean calcium score was 73 ± 57 with EBCT and 26 ± 35 with conventional CT. Although images of the heart from conventional CT may suffer from cardiac motion artifacts, conventional CT has the potential to identify patients with CAD with accuracy similar to EBCT.
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 0942-0940
    Keywords: Spinal abscess ; epidural ; subdural ; surgical treatment ; antibiotics ; risk factors ; diagnostic procedures ; MRI
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Bacterial abscesses involving the spinal canal are associated with a high morbidity and mortality. Most frequently, these lesions are found in the epidural, rarely in the subdural space. In this report, our clinical material consists of a series of 16 patients treated during the last seven years. The clinical presentation included local neurological signs (back pain, para-/tetraparesis, bladder dysfunction), disturbances of consciousness (ranging from drowsiness to deep coma) and general inflammatory signs (meningism, fever). All patients presented with risk factors (septic foci, chronic diseases, and iatrogenic causes). Laboratory investigations revealed typically pathological blood sedimentation rate, leucocytosis and CSF-pleocytosis. Radiologically, the diagnosis was confirmed by myelography, CT and preferably MRI. The abscesses were located epidurally in 14 and subdurally in 2 cases. The surgical treatment included laminectomy, or multiple flavectomies in extensive lesions. Drainage systems (either simple silicon outflow drains or suction-/irrigation systems) were installed in all cases, as well as antibiotic treatment. Results of treatment: Following an observation period of 0,5–6 years, we found complete recovery in six (38%) cases, six (38%) others were mildly disabled and four (25%) patients died. Focussing on the results of the two different drainage systems, we found a statistically significant superiority of the inflow-/outflow system. Complications included mandatory re-exploration, post-inflammatory hydrocephalus, syringomyelia, spinal instability, surgical treatment of peripheral septic foci and therapy resistant septicaemia. In conclusion, we propose that spinal epi-or subdural abscesses require surgical evacuation, using a suction-/irrigation drainage system, as well as antibiotic and intensive care treatment.
    Type of Medium: Electronic Resource
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  • 4
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Pacing and clinical electrophysiology 20 (1997), S. 0 
    ISSN: 1540-8159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Patients with a history of sustained ventricular tachyarrhythmias form an extremely inhomogeneous group with respect to presenting arrhythmia, underlying cardiac disease, and therefore, risk of dying suddenly. Eor subgroups such as ventricular tachycardia in the absence of underlying cardiac disease, radiofrequency catheter ablation offers cure. In others, implantation of a cardioverter defibrillator already appears to have gained the therapy of first choice, leaving only a secondary role to antiarrhythmic drugs. It must be emphasized however, that these new therapeutic strategies have their pros and cons like the older, seemingly outfashioned approaches of noninvasively or invasively guided antiarrhythmic drug therapy or empiric amiodarone treatment. Until the advent of controlled randomized trials comparing the implantable cardioverter defibrillator (ICD) with the best other, usually medical form of treatment, physicians must continue to base their individual therapeutic decisions on circumstantial published and personal experience. In doing so, the recent achievements of catheter ablation and defibrillator implantation have definitely improved patient care, but have not made antiarrhythmic drugs jobless. With all the alternatives at hand, it remains a challenging task to weigh the benefits and risks of the various approaches against each other in an attempt to tailor the antiarrhythmic intervention to the very individual need of the patient.
    Type of Medium: Electronic Resource
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  • 5
    Electronic Resource
    Electronic Resource
    Springer
    Zeitschrift für Kardiologie 89 (2000), S. 274-283 
    ISSN: 1435-1285
    Keywords: Key words Holter-ECG – signal averaging – late potentials – ventricular fibrillation – ventricular tachycardia ; Schlüsselwörter Langzeit-EKG – Spätpotentiale – Signalmittelung – Kammerflimmern – Kammertachykardie
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Hintergrund: Ventrikuläre Spätpotentiale sind eher bei Postinfarktpatienten mit rezidivierenden Kammertachykardien als solchen mit überlebtem, Kammerflimmern vorhanden. Möglicherweise unterliegt die Spätpotentialnachweisbarkeit tageszeitlichen Schwankungen. Methode: Deshalb wurde wiederholt zu jeder Stunde im Langzeit-EKG von 160 Postinfarktpatienten (50 Patienten (= VT-Gruppe) mit anhaltenden, rezidivierenden Kammertachykardien (Zykluslänge 〉 230 ms), 50 Patienten (= VF-Gruppe) mit überlebtem, dokumentiertem Kammerflimmern und 60 Patienten ohne anhaltende Kammerarrhythmien (Ø VT/VF-Gruppe)) eine Spätpotentialanalyse im Zeit- und Frequenzbereich durchgeführt und einer konventionellen, nur zu einer Tageszeit durchgeführten Spätpotentialanalyse gegenübergestellt. Ergebnisse: Die konventionelle Analyse im Zeitbereich zeigte Spätpotentiale in 72% der VT-Gruppe, 40% der VF-Gruppe und in 20% der Ø VT/VF-Gruppe. Im Langzeit-EKG hatten 66% der VT-Gruppe, nur 6% der VF-Gruppe und kein Patient der Ø VT/VF-Gruppe durchgehend Spätpotentiale. In wenigstens einer Analyse im Frequenzbereich fanden sich jedoch Spätpotentiale in 84% der VF-Gruppe, 90% der VT-Gruppe und in 18% der Ø VT/VF-Gruppe. Passager nachweisbare Spätpotentiale bei Patienten der VF-Gruppe fanden sich bei morgendlichen Herzfrequenzbeschleunigungen, passageren ST-Segment-Veränderungen oder vorübergehend reduzierter Herzfrequenzvariabilität. Schlußfolgerung: Postinfarktpatienten mit anhaltenden Kammertachykardien haben überwiegend konstant über 24 Stunden nachweisbare Spätpotentiale, so daß eine konventionelle Spätpotentialanalyse zur Risikostratifizierung des Postinfarktpatienten zu jeder Tageszeit erfolgversprechend ist. Bei Postinfarktpatienten, die Kammerflimmern überlebten, sind passager auftretende Spätpotentiale vorhanden, die nur im Langzeit-EKG erfaßt werden können. Bei diesen Patienten könnte die Spätpotentialanalyse im Langzeit-EKG die Risikostratifizierung hinsichtlich des plötzlichen Herztodes verbessern.
    Notes: Summary Background: Ventricular late potentials are found more readily in post-infarction patients who had sustained ventricular tachycardia than in those who survived ventricular fibrillation. Hypothetically, a daytime variability of late potentials might be responsible for this finding. Method: Therefore a conventional late potential analysis only performed once a day was compared to a late potential analysis in time and frequency domain repeatedly performed every hour in the Holter-ECG of 160 post-infarction patients (50 patients (= VT-group) with documented, sustained ventricular tachycardia (cycle-length 〉 230 ms), 50 patients (= VF-group) who survived, documented ventricular fibrillation and 60 patient, without ventricular arrhythmias (= Ø VT/VF-group)). Results: The conventional analysis showed late potentials in time domain in 72% of the patients in the VT-group, in 40% of patients in the VF-group and in 20% of the patients in the Ø VT/VF-group. The Holter-ECG showed late potentials to be permanently present in frequency domain in 66% of the patients in the VT-group, in only 6% in the patients in the VF-group and in no patient in the Ø VT/VF-group. However, in at least one analysis we detected late potentials in 84% of patients of the VF-group, in 90% of patients in the VT-group and in 18% of patients in the Ø VT/VF-group. Transiently detectable late potentials in patients of the VF-group were predominantly seen at heart rate accelerations in the morning hours, ST-segment shifts or transitory decreased heart rate variability. Conclusions: Post-infarction patients with sustained ventricular tachycardia predominantly have constantly detectable late potentials over 24 hours. In these patients conventional late potential is successful for post-infarction risk stratification at any time of the day. However, in post-infarction patients who survived ventricular fibrillation, late potentials are found to be transitory and only detectable by Holter-ECG. Thus, late potential analysis performed in the Holter-ECG might improve post-infarction risk stratification in patients prone to sudden cardiac death.
    Type of Medium: Electronic Resource
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  • 6
    ISSN: 1435-1285
    Keywords: Schlüsselwörter Spätpotentiale – Ergometrie – ventrikuläre Tachykardie – Signalmitteilungs-EKG – Langzeit-EKG ; Key words Late potentials – exercise – signal averaging – ventricular tachycardia – ventricular fibrillation – Holter monitoring
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Background. Electrophysiological abnormalities during ischaemia and increased heart rate may influence the detection of ventricular late potentials in the surface electrocardiogram. Whether the analysis of functional changes adds information to the risk stratification of patients prone to ventricular tachycardia is unclear. Methods. We therefore retrospectively investigated 100 selected patients (25 with documented, sustained ventricular tachycardia (〈230/min) (= VT group), 25 resuscitated from ventricular fibrillation (VF group) and 50 without ventricular arrhythmias (∅ VT/VF group)) in the chronic phase after myocardial infarction. Late potential analysis was performed at rest, during atrial pacing at a rate of 100/min and 120/min (n=60), during and after occlusion of the coronary artery for coronary angioplasty (PTCA) (n=70), and immediately after maximum exercise using selective signal averaging. Results. At rest in 72% of patients in the VT group, in 32% of the VF group, and in 6% of the ∅ VT/VF group late potentials could be found. During atrial pacing in 80% of patients in the VT group, in 72% of the VF group, and in 10% of the patients in the ∅ VT/VF group and during ischaemia because of occluded coronary artery in 86% of patients in the VT group, 70% of the VF group, and in 20% of the patients of the ∅ VT/VF group late potentials were present. Immediately after maximum exercise which let to both ischaemia and increased heart rate, late potentials were detectable in 92% of patients in the VT group, 80% of the VF group, and in 14% of patients in the ∅ VT/VF group. Similar results could be achieved by using the Holter-ECG after exact correction of recorder tape speed variations. 62% of patients with only by ischaemia, increased heart rate or exercise provokable late potentials and all patients with preexistent not by PTCA extinguished late potentials developed recurrent ventricular tachycardias during the one year follow-up period. Patients without late potentials (n=50) and patients with preexistent by PTCA extinguished late potentials (n=11) had no recurrent ventricular tachycardias. Cycle length of recurrent and clinical tachycardia in patients with preexistent not by PTCA extinguished late potentials (n=18) were significantly longer than in patients with only provokable late potentials (n=21). Conclusions. Analysis of functional changes of ventricular late potentials with exercise or in Holter ECG recordings promises considerable improvement of postinfarction risk stratification especially in patients prone to ventricular fibrillation.
    Notes: Zusammenfassung Hintergrund. Veränderte elektrische Leitungseigenschaften während myokardialer Ischämie und Herzfrequenzveränderungen können die Nachweisbarkeit von Spätpotentialen im Oberflächen-EKG beeinflussen. Unklar ist, ob eine Analyse funktioneller Spätpotentialveränderungen Vorteile zur Erkennung von Postinfarktpatienten haben kann, die durch Kammertachykardien oder vom plötzlichen Herztod bedroht sind. Methode. Deshalb wurde retrospektiv bei 100 selektionierten Postinfarktpatienten (25 Patienten mit dokumentierten ventrikulären Tachykardien (〈230/min) in der chronischen Infarktphase (VT-Gruppe), 25 Patienten, die Kammerflimmern überlebten (VF-Gruppe), und 50 Patienten ohne ventrikuläre Rhythmusstörungen (∅ VT/VF-Gruppe) eine Spätpotentialanalyse in Ruhe, während atrialer Stimulation mit 100/min und 120/min (n=60), während und nach Ballonokklusion bei PTCA (n=70) und unmittelbar nach Fahrradausbelastung unter Verwendung selektiver Signalmitteilung durchgeführt. Ergebnisse. In Ruhe hatten 72% der Patienten der VT-Gruppe, 32% der VF-Gruppe und 6% der ∅ VT/VF-Gruppe Spätpotentiale. Während atrialer Stimulation waren bei 80% der untersuchten Patienten der VT-Gruppe, 72% der VF-Gruppe und bei 10% der ∅ VT/VF-Gruppe, während myokardialer Ischämie bei PTCA bei 86% der VT-Gruppe, 70% der VF-Gruppe und 20% der ∅ VT/VF-Gruppe Spätpotentiale nachzuweisen. Die Analyse unmittelbar nach Fahrradausbelastung, die sowohl zu erhöhter Herzfrequenz als auch partiell zu myokardialer Ischämie führen konnte, zeigte Spätpotentialbefunde bei 92% der Patienten der VT-Gruppe, 80% der VF-Gruppe und 14% der ∅ VT/VF-Gruppe. Gleiche Ergebnisse ließen sich auch erzielen, wenn die Analyse nach Signalaufnahme unter Verwendung exakter Korrektur von Rekorder-Gleichlaufschwankungen mit einem Langzeit-EKG-Rekorder erfolgte. 62% der Patienten mit ausschließlich provozierbaren Spätpotentialen und alle Patienten mit vorbestehenden und durch PTCA unbeeinflußbaren Spätpotentialen entwickelten Rezidivtachykardien während der Nachbeobachtungsphase von einem Jahr. Bei Patienten ohne Spätpotentiale auch unter Provokation (n=50) und bei Patienten, deren vorbestehende Spätpotentiale nach PTCA beseitigt waren (n=11), sind keine Rezidive aufgetreten. Die Zykluslängen der klinischen Tachykardie und der Rezidivtachykardie waren bei Patienten mit vorbestehenden, durch PTCA unveränderten Spätpotentialen (n=18) signifikant länger als bei Patienten mit ausschließlich provozierbaren Spätpotentialen (n=21). Schlußfolgerung. Eine Analyse funktioneller Spätpotentialveränderungen bei Ergometrie oder im Langzeit-EKG könnte die nichtinvasive Risikostratifizierung insbesondere des von Kammerflimmern bedrohten Postinfarktpatienten entscheidend verbessern.
    Type of Medium: Electronic Resource
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  • 7
    ISSN: 1433-0407
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 8
    Electronic Resource
    Electronic Resource
    Springer
    Der Internist 39 (1998), S. 19-32 
    ISSN: 1432-1289
    Keywords: Schlüsselwörter Tachyarrhythmie ; Therapie ; Tachyarrhythmie ; supraventrikuläre ; Herzrhythmusstörungen ; Therapie ; Antiarrhythmika ; Therapie ; Antiarrhythmika ; Nebenwirkungen
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Zum Thema In dieser Arbeit wird ein Überblick über die medikamentöse Differentialtherapie supraventrikulärer Tachyarrhythmien unter Berücksichtigung des jeweiligen pathophysiologischen Zustands gegeben. Trotz Katheterablation sind antiarrhythmische Medikamente zur Akutbehandlung und Rezidivprophylaxe supraventrikulärer Tachyarrhythmien unersetzlich. Schon vor Beginn einer antiarrhythmischen Pharmakotherapie sollte der Patient über mögliche unerwünschte Nebenwirkungen, besonders proarrhythmische, aufgeklärt werden (vgl. dazu auch die Arbeit von T. Meinertz et al. In diesem Heft). Bei Risikopatienten mit manifester Herzinsuffizienz, symptomatischer koronarer Herzkrankheit, vorbekannter Proarrhythmie oder Kammertachykardie, muß die Einleitung einer antiarrhythmischen Behandlung unter stationären Bedingungen erfolgen. Der Elektrolythaushalt sollte ausgeglichen sein. Für bestimmte Antiarrhythmika bestehen aufgrund von Vorbefunden Kontraindikationen; kardiale, wie z.B. die negativ inotrope Wirkung von Betarezeptorenblockern, sind dabei ebenso wie extrakardiale Nebenwirkungen zu beachten, z.B. die Lungenfibrose bei Amiodaron. Zusammenfassende Therapieempfehlungen finden sich am Ende der Arbeit im „Fazit”, worauf aus pragmatischen Gründen besonders hingewiesen sei.
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  • 9
    ISSN: 1432-1440
    Keywords: Spectrotemporal mapping ; Fourier Transform ; Ventricular tachycardia ; Late potentials
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Late potentials in the terminal phase of the QRS and early S-T segment are looked upon as a risk marker in patients prone to sustained ventricular tachycardia after myocardial infarction. Since the amplitude of late potentials at the body surface is very low (1–5 μV), most studies use signal averaging of the ECG to increase the signal-to-noise ratio. Two different approaches are generally used to analyze the signal-averaged ECG. In the time domain, the individual channels are combined into a vector magnitude and highpass filtered in a bidirectional mode. Late potentials are suspected if the filtered QRS duration is 〉120 ms and/or the amplitude in the terminal 40 ms of the QRS complex is ≤25 μV. The limitations of this method are that the definition of abnormality differs from one study group to another, highpass filters may introduce artificial signals, patients with bundle branch block in general have to be excluded, and the definitions depend upon the noise level. More recently, spectral analysis of the ECG with Fast Fourier Transform (FFT) has been performed. Late potentials are characterized by a higher frequency content in the otherwise low-frequent S-T wave. We analyzed 25 overlapping segments of the terminal QRS and early S-T wave time shifted in steps of 2 ms with FFT (spectrotemporal mapping). This method was shown to overcome some of the limitations of conventional time domain analysis: no highpass filters have to be applied, noise interference can be detected by a characteristic spectral pattern, and patients with bundle branch block need not be excluded. In this retrospective study spectrotemporal mapping was abnormal in 26/38 patients (67%) after myocardial infarction with sustained ventricular tachycardia. Only 3/21 patients after myocardial infarction without ventricular tachycardia had abnormal values. In healthy persons an abnormal Fourier result is a rare finding. Thus, spectral analysis of the ECG might offer promise for an improved identification of patients prone to sustained ventricular tachycardia after myocardial infarction.
    Type of Medium: Electronic Resource
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  • 10
    Electronic Resource
    Electronic Resource
    Springer
    Monatshefte für Chemie 89 (1958), S. 798-805 
    ISSN: 1434-4475
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology
    Notes: Zusammenfassung 1,5-Dichlor-1-phenyl-2-methyl-3-azapentan (IV) und 1,5-Dichlor-1-phenyl-2,3-dimethyl-3-azapentan (V), aus N-β-Hydroxyäthyl-d,l-norephedrin bzw. N-β-Hydroxyäthyl-d,l-ephedrin durch Austausch der OH-Gruppen gegen Chlor hergestellt, wurden mit primären aliphatischen und aromatischen Aminen zu den entsprechenden substituierten Piperazinen (I) ringgeschlossen. Mit iso-Propylamin versagte die Ringschlußreaktion. Der Grundkörper der Reihe, 2-Methyl-3-phenyl-piperazin, wurde durch katalytische Hydrierung aus 1-Benzyl-2-phenyl-3-methyl-piperazin dargestellt.
    Type of Medium: Electronic Resource
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