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  • 1
    Electronic Resource
    Electronic Resource
    Evaluation of long-term oral levodopa therapy in chronic congestive heart failure (1987)
    Springer
    Journal of molecular medicine 65 (1987), S. 1087-1094 
    Details
    ISSN: 1432-1440
    Keywords: Levodopa ; Inotropic drugs ; Congestive heart failure
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary To evaluate the long-term effects of orally administered levodopa, 11 patients with chronic congestive heart failure (NYHA III–IV) were studied during maintenance therapy (30±1 days) and after withdrawal from levodopa. The daily levodopa dose was 4 g in six patients; because of side effects the levodopa dose was reduced to 2–3 g in the remaining patients. After withdrawal of levodopa, mean pulmonary capillary wedge pressure and mean right atrial pressure increased significantly (from 19±2 to 24±3 and from 7±2 to 9±2 mmHg, respectively). Effective renal plasma flow was 329±57 during levodopa therapy and decreased significantly to 252±27 ml/min after withdrawal of levodopa. The number of ventricular premature contractions and couplets increased during levodopa therapy and decreased again significantly after withdrawal of levodopa. No significant differences between on and off levodopa were observed in resting heart rate, arterial blood pressure, cardiac index, stroke work index, systemic vascular resistance, sodium and water excretion, or creatinine clearance. Seven patients improved on levodopa therapy by one NYHA class; four of these seven patients deteriorated again by one NYHA class after withdrawal of levodopa. Regarding both clinical and hemodynamic changes after withdrawal of levodopa, three patients were classified as responders to long-term levodopa therapy. All three responders received 4 g levodopa per day. Average dopamine plasma level was 5.3±0.8 ng/ml in the responder group and 2.0±0.5 ng/ml in the nonresponder group. Long-term administration of oral levodopa is associated with beneficial clinical and hemodynamic response in only a minority of patients with chronic congestive heart failure.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01736115
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  • 2
    Electronic Resource
    Electronic Resource
    Pharmacokinetics of hydrochlorothiazide in relation to renal function (1983)
    Springer
    European journal of clinical pharmacology 24 (1983), S. 661-665 
    Details
    ISSN: 1432-1041
    Keywords: hydrochlorothiazide ; pharmacokinetics ; renal failure ; dosage adjustment ; excretory mechanism
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology , Medicine
    Notes: Summary The pharmacokinetics of hydrochlorothiazide (HCT) was investigated in 23 subjects with normal renal function or widely varying degrees of renal failure. The half-life of elimination increased from 6.4 h in subjects with normal renal function to 11.5 h in patients with mild renal impairment (endogenous creatinine clearance between 30 and 90 ml/min), and to 20.7 h in patients with an endogenous creatinine clearance below 30 ml/min. The cumulative urinary excretion and the renal HCT clearance were correspondingly reduced in patients with impaired kidney function. In normal subjects HCT was mainly excreted by tubular secretion, but as renal HCT clearance in patients with renal impairment did not differ significantly from endogenous creatinine clearance, it was concluded that the secretory mechanism is most markedly impaired. In patients with an endogenous creatinine clearance of 30 to 90 ml/min, the dosage of HCT should be reduced to 1/2 and in patients with a endogenous creatinine clearance below 30 ml/min to 1/4 of the normal daily dose to avoid dose dependant side-effects.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00542218
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  • 3
    Electronic Resource
    Electronic Resource
    Pharmacokinetics of carteolol in relation to renal function (1985)
    Springer
    European journal of clinical pharmacology 29 (1985), S. 461-465 
    Details
    ISSN: 1432-1041
    Keywords: carteolol ; chronic renal failure ; pharmacokinetics ; dosage adjustment ; metabolism
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology , Medicine
    Notes: Summary The plasma levels and urinary excretion of carteolol and its main metabolites 8-hydroxycarteolol and carteolol glucuronide were investigated in 6 healthy subjects and 9 patients with varying degrees of renal impairment following a single oral dose of 30 mg carteolol hydrochloride. In healthy subjects the half-life of carteolol was 7.1 h. 63% of the administered dose was recovered unchanged in urine, and in all 84% was excreted by the kidneys. The renal clearance of carteolol was 255 ml/min. In chronic renal failure (CRF) the terminal half-life was increased to a maximum of 41 h. Both the elimination rate constant and renal clearance were closely related to the creatinine clearance. In CRF the recovery of carteolol and its metabolites from urine was considerably reduced, suggesting that another pathway of drug elimination becomes relevant in renal disease. To avoid an increase in side-effects due to drug accumulation, the dosage of carteolol should be adjusted in relation to the reduction in creatinine clearance. The maintenance dose should be reduced to a half in patients with a creatinine clearance below 40 ml/min and above 10 ml/min. In those with a creatinine clearance of 10 ml/min or less, the dose should be reduced to 1/4.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00613462
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  • 4
    Electronic Resource
    Electronic Resource
    Long-Term Clinical Experience with the EGM Width Detection Criterion for Differentiation of Supraventricular and Ventricular Tachycardia in Patients with Implantable Cardioverter Defibrillators (2000)
    Oxford, UK : Blackwell Futura Publishing, Inc.
    Pacing and clinical electrophysiology 23 (2000), S. 0 
    Details
    ISSN: 1540-8159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: UNTERBERG, C., et al.: Long-Term Clinical Experience with the EGM Width Detection Criterion for Differentiation of Supraventricular and Ventricular Tachycardia in Patients with Implantable Cardioverter Defibrillators. Inappropriate therapy by ICDs due to SVTs is an important problem. A third generation ICD with a new detection criterion (“EGM width criterion”) for differentiation of SVTs and VTs by measuring the width of the intracardiac EGM was studied in 47 patients. A wide EGM was defined as the longest measured EGM plus 4–12 ms (programmed as EGM width threshold). EGM width detection function was programmed to the “Passive” mode so that no therapy was withheld. During a follow-up of 29.9 ± 8.3 (12–45) months, 489 spontaneous episodes were analyzed. SVTs occurred in ten patients with 305 episodes; 301 were correctly classified by use of the new detection criterion. In four patients four episodes were incorrectly detected as wide QRS tachycardias. Thus specificity for SVT was 98.7% (on a per episode basis) and 60% on a per patient basis. Of 184 VTs in 23 patients, 118 episodes were correctly classified (19 patients), however, in 4 patients 66 VTs were falsely detected as SVTs, 62 (94%) of which occurred in 1 patient with complete left BBB and continuously increasing QRS width in 12-lead surface ECGs. Overall sensitivity (on a per episode basis) for VT detection was 64.1% and 96.7% in patients with stable width of the QRS complex in a 12-lead surface ECG. These data show that this criterion is not superior to data on rate dependent detection criteria and furthermore not applicable in patients with complete BBB.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1460-9592.2000.01611.x
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  • 5
    Electronic Resource
    Electronic Resource
    Influence of Isoproterenol on Contractile Protein Function, Excitation-Contraction Coupling, and Energy Turnover of Isolated Nonfailing Human Myocardium
    Amsterdam : Elsevier
    Journal of Molecular and Cellular Cardiology 26 (1994), S. 1461-1469 
    Details
    ISSN: 0022-2828
    Keywords: Calcium cycling ; Crossbridge cycling ; Human myocardium ; Isoproterenol ; Myocardial energetics
    Source: Elsevier Journal Backfiles on ScienceDirect 1907 - 2002
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1006/jmcc.1994.1165
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  • 6
    Electronic Resource
    Electronic Resource
    Therapie des akuten Herzinfarktes und der akuten Herzinsuffizienz mit vasoaktiven Substanzen (2000)
    Springer
    Intensivmedizin und Notfallmedizin 37 (2000), S. 707-714 
    Details
    ISSN: 1435-1420
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003900070024
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  • 7
    Electronic Resource
    Electronic Resource
    Diagnostik und Therapie des akuten Abdomens (1997)
    Springer
    Intensivmedizin und Notfallmedizin 34 (1997), S. 237-242 
    Details
    ISSN: 1435-1420
    Keywords: Key words Abdominal pain ; diagnostic procedures ; acute management of abdominal pain ; Schlüsselwörter Akutes Abdomen ; Diagnostik des akuten Abdomens ; Therapie des akuten Abdomens
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Patienten mit akuten Abdominalschmerzen, die die Notaufnahme aufsuchen, stellen für den behandelnden Arzt eine Herausforderung dar. Die Differentialdiagnose der verschiedenen Ursachen abdomineller Schmerzen setzt eine sorgfältige Anamnese (Schmerzbeginn und -intensität, Schmerzlokalisation, Schmerzausstrahlung) sowie einen vollständigen körperlichen Untersuchungsbefund voraus. An zahlreiche primär medizinische Krankheitsbilder, die ebenfalls abdominelle Schmerzen verursachen können, sollte unbedingt gedacht werden (Myokardinfarkt, Lungenembolie, diabetische Ketoazidose, usw.). Zu berücksichtigen ist die Tatsache, daß bei Kindern und älteren Patienten sowie bei depressiven Patienten und Patienten, die mit Glukokortikoiden chronisch behandelt werden, die klinischen Zeichen des akuten Abdomens eventuell abgeschwächt oder in atypischer Form auftreten können. Laboruntersuchungen und bildgebende Verfahren müssen sorgfältig evaluiert werden, weil sie manchmal der einzige Schlüssel zur Diagnosestellung sind. Abschließend wird das Vorgehen in Form einer Checkliste bei Patienten empfohlen, die mit abdominellen Schmerzen in die Notaufnahme eingewiesen werden.
    Notes: Summary Patients presenting to the emergency department with acute abdominal pain represent a substantial challenge to the physician. To differentiate among the various causes of abdominal pain, several key features of the history must be explored in depth (onset of pain, location of pain, intensity of pain, particular pattern of pain referral) and a complete physical examination should be meticulously executed. A number of metabolic or primarily medical conditions may cause abdominal pain, and great caution must be maintained if these are to be recognized (pulmonary embolus, myocardial infarction, diabetic ketoacidosis, etc.). There exists several groups of patients in whom the usual symptoms and expected findings are not apparent; children, the elderly, the chronically debilitated, the depressed, and those patients chronically exposed to steroids are examples. Laboratory findings and imaging techniques should be carefully evaluated because they may provide the only clue to a diagnosis not previously considered. A useful guide to the management of patients with abdominal pain in the emergency room concludes this brief review.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003900050043
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  • 8
    Electronic Resource
    Electronic Resource
    Behandlung der Organdysfunktionen beim Intensivpatienten mit SIRS oder Sepsis (1998)
    Springer
    Intensivmedizin und Notfallmedizin 35 (1998), S. 523-534 
    Details
    ISSN: 1435-1420
    Keywords: Key words Sepsis ; shock ; catecholamines ; hemofiltration ; enteral nutrition ; transfusion ; Schlüsselwörter Sepsis ; Schock ; Katecholamine ; Hämofiltration ; Enterale Ernährung ; Transfusion
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Die Erkenntnisse aus experimentellen Sepsis-Modellen und die Ergebnisse klinischer Untersuchungen führten in den 90er Jahren zu einer Ernüchterung hinsichtlich der Behandlung von SIRS/Sepsis mit einheitlichen physikalischen oder „mechanistischen“ Konzepten. Die komplexe, noch nicht völlig überschaubare Interaktion zwischen exogenen Erregern oder Verletzungen und endogenen pro- und antiinflammatorischen Mediatoren, sowie die Heterogenität der zugrundeliegenden Erkrankungen oder Störungen (Infektionen unterschiedlichster primärer Lokalisation, akute Pankreatitis, postoperativer Zustand, Polytrauma, Verbrennungen) charakterisieren die Pathophysiologie der systemischen Entzündungsreaktion (SIRS) des Organismus. Die Wirkung dieser Faktoren auf das kardiovaskuläre System ist dabei von zentraler Bedeutung, da sie zum Abfall des Perfusionsdruckes und zu einer „Flow-Maldistribution“ führt. Die Konsequenz der septischen Kreislaufkonstellation ist eine progrediente Hypoxie und Dysfunktion multipler Organe. Abgesehen von der Eradikation des primären Infektionserregers erscheint eine direkte medikamentöse Unterbrechung des septischen Prozesses durch Immunmodulation nach heutigem Kenntnisstand utopisch. Andererseits hat sich eine standardisierte Therapie der kardiovaskulären Dysfunktion mittels aggressiver Versuche, selbst definierte hämodynamische Ziele zu erreichen, genau so wenig bewährt wie der Versuch einer extrakorporalen Zytokinentfernung mit den derzeit vorhandenen Filtrationsverfahren. Die aktuellen Behandlungsstrategien bleiben daher „supportiv“ und bestehen in einer angepaßten Kombination aus Flüssigkeitssubstitution, Dobutamin und Noradrenalin, gesteuert vorwiegend durch den systemischen Mitteldruck, den Füllungsdruck des rechten oder linken Ventrikels und den Herzindex. Eine klinisch erfaßbare Verbesserung der Organfunktionen ist dabei zuverlässiger für die Beurteilung des Therapieerfolges als der mathematisch ermittelte DO2 bzw. VO2, oder sogar der Serumlaktat- oder pH-Wert. Zur Förderung der gastrointestinalen Durchblutung und somit zur Erhaltung der Schleimhautintegrität und Prävention einer bakteriellen Translokation empfiehlt sich der Beginn der enteralen Ernährung innerhalb der ersten 24 Stunden. Eine adäquate Kalorienzufuhr und – nach Möglichkeit – die Reduktion der Immobilisationsdauer sollten zur Prävention neuromuskulärer Komplikationen angestrebt werden. Schließlich sind die Empfehlungen für die Substitution von Blut- und Plasmaprodukten in Abwägung des Nutzen-Risiko-Verhältnisses restriktiver geworden. Eine Erythrozytentransfusion ist in der Regel erst ab einer Hb-Konzentration von 7 g/dL deutlich indiziert, die Thrombozyten- und FFP-Transfusion bei blutenden Patienten mit entsprechenden Gerinnungsstörungen. Es gibt dagegen keine konkreten Hinweise aus der Literatur, die eine liberale Strategie mit „prophylaktischen“ Transfusionen unterstützen könnten.
    Notes: Summary The systemic inflammatory response syndrome (SIRS) is characterized by the complex interplay between invading microorganisms or nonspecific injury (acute pancreatitis, major surgery, trauma or burns) and the uncontrolled release of endogenous pro- and antiinflammatory mediators. Circulating cytokines reduce myocardial contractility and also have profound vasodilating effects. They thus contribute to a critical decrease in perfusion pressure and maldistribution of flow, particularly affecting the kidneys and the splanchnic bed. The result is peripheral tissue hypoxia and organ failure. Eradication of the infectious organism remains the mainstay of sepsis treatment. Attempts at modulating the immune response by selectively antogonizing certain mediators or removing them from the circulation by extracorporeal hemofiltration have not met initial expectations. Improvement of organ perfusion and oxygenation is traditionally thought to rely on stabilization of mean arterial blood pressure to levels ≥70 mmHg. This is attempted by a combination of fluid replacement and catecholamines, particularly dobutamine and norepinephrine, due to their favorable hemodynamic profile. The treatment is guided by hemodynamic parameters (filling pressures of the heart and cardiac index), clinical evaluation or organ function, as well as signs of catecholamine overdose and toxicity. Aiming at “supranormal” values of systemic oxygen delivery and consumption was generally not shown to improve prognosis in this patient population. Importantly, perfusion, integrity and function of the gastrointestinal mucosa can be preserved by early initiation of enteral nutrition. Finally, a restrictive policy for substitution of blood and plasma products is advocated at present. Transfusions should be preserved for severe symptomatic anemia or coagulation disorders associated with serious bleeding.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003900050175
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  • 9
    Electronic Resource
    Electronic Resource
    Erfolgreiche Behandlung einer fulminanten Myokarditis mit dem biventrikulären MEDOS Assist-System (MEDOS HIA-VAD) (1997)
    Springer
    Zeitschrift für Kardiologie 86 (1997), S. 179-182 
    Details
    ISSN: 1435-1285
    Keywords: Key words Assist device — fulminant myocarditis — MEDOS HIA ventricular assist device ; Schlüsselwörter Assist Device — Fulminante Myokarditis — MEDOS HIA ventricular assist device
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Background: Successful weaning from biventricular mechanical support with full recovery of the myocardial function is extremely rare in fulminant myocarditis. We report on our experience with the new MEDOS HIA ventricular assist device. Methods and Results. We used the MEDOS assist system to support a 30-year-old woman with profound circulatory impairment caused by acute myocarditis. The device provided adequate hemodynamics and recovery of myocardial function. Despite anticoagulation therapy we had to change either the left or right ventricular pump chamber because of clot formation on the surface of the outflow tract. On the 14th postoperative day a surgical reintervention was necessary for bleeding from the cannulation site of the pulmonary artery. After 17 days the myocardial function had recovered and we could remove the assist system. The following parameters were measured before implantation of the MEDOS assist system and after weaning from circulatory support: ejection fraction 15 vs. 45%, cardiac index 0.7 vs. 2.6 L/min/m2, arterial pressure (systolic/diastolic/mean) 81/55/66 vs.113/66/82 mm Hg, pulmonary artery pressure 33/25/29 vs. 34/20/28 mm Hg, pulmonary capillary wedge pressure 24 vs. 19 mm Hg. Conclusions: Despite severe cardiac failure in fulminant myocarditis requiring biventricular mechanical support full recovery of the myocardium is possible.
    Notes: Zusammenfassung Hintergrund: Eine erfolgreiche Entwöhnung nach biventrikulärer mechanischer Kreislaufunterstützung mit voller myokardialer Erholung ist bei fulminanter Myokarditis extrem selten. Wir berichten über unsere Erfahrungen mit dem neuen MEDOS HIA ventricular assist device (VAD). Patient, Methode und Ergebnisse: Wir verwendeten das MEDOS Assist-System zur Kreislaufunterstützung bei einer 30jährigen Frau mit akuter globaler Herzinsuffizienz infolge einer akuten Myokarditis. Das Unterstützungssystem ermöglichte adäquate Kreislaufverhältnisse und die Erholung des Myokards. Trotz Antikoagulation war wegen der Thrombenbildung im Ausflußtrakt mehrfach ein Wechsel sowohl der rechten als auch der linken Pumpkammer erforderlich. Am 14. postoperativen Tag mußte wegen einer starken Blutung aus der Kanülierungsstelle der Pulmonalarterie rethorakotomiert werden. Nach 17 Tagen hatte sich die myokardiale Funktion soweit erholt, daß wir das VAD wieder entfernen konnten. Folgende Parameter wurden vor der mechanischen Kreislaufunterstützung und nach Entfernung des VAD gemessen: linksventrikuläre Ejektionsfraktion 15 vs. 45%, cardiac index 0,7 vs. 2,6 l/min/m2, arterieller Druck (systolisch/diastolisch/mittel) 81/55/66 vs. 113/66/82 mm Hg, Pulmonalarteriendruck 33/25/29 vs. 34/20/28 mm Hg, pulmonaler Verschlußdruck 24 vs. 19 mm Hg. Schlußfolgerung: Auch bei schwerster Herzinsuffizienz infolge fulminanter Myokarditis ist eine weitgehende Erholung des Myokards möglich, wenn ein biventrikuläres Unterstützungssystem verwendet wird.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00007340
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  • 10
    Electronic Resource
    Electronic Resource
    Medikamentöse und interventionelle Therapie der akuten Herzinsuffizienz auf der Intensivstation (1997)
    Springer
    Intensivmedizin und Notfallmedizin 34 (1997), S. 577-582 
    Details
    ISSN: 1435-1420
    Keywords: Key words Therapy of heart failure ; IABP ; counterpulsation ; Schlüsselwörter Therapie der Herzinsuffizienz ; IABP ; Gegenpulsation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Herzinsuffizienz kann als eine verminderte körperliche Leistungsfähigkeit, verursacht in der Regel durch eine ventrikuläre Funktionsstörung definiert werden. Es werden vier verschiedene Schweregrade der Herzinsuffizienz unterschieden (NYHA-Stadien der New York Heart Association I–IV). Die häufigsten zugrundeliegenden Erkrankungen sind die koronare Herzkrankheit (KHK), die arterielle Hypertonie, Herzmuskelerkrankungen (Kardiomyopathien) und Herzklappenerkrankungen. Die Therapie der akuten Herzinsuffizienz besteht, sofern möglich, in der kausalen Behandlung, z.B. in der Wiedereröffnung eines durch einen Herzinfarkt verschlossenen Gefäßes, in Allgemeinmaßnahmen wie Schmerzbekämpfung, Sedierung, Sauerstoffgabe sowie in einer speziellen medikamentösen Therapie. Hierbei ist bei Kreislaufinstabilität primär die Gabe von Katecholaminen indiziert. Bei persistierender Kreislaufinstabilität wird ggf. zusätzlich die Gabe eines Phosphodiesterasehemmers notwendig. In Abhängigkeit von der Grunderkrankung erfolgen weitere Therapiemaßnahmen, z.B. die Gabe eines Diuretikums bei Lungenstauung, bei Myokardinfarkt Acetylsalicylsäure, Heparin, Nitrate, ggf. Betablocker, Lysetherapie oder Akutkoronarangiographie mit Intervention. 12 bis 24 Stunden nach dem akuten Ereignis, z.B. einem Myokardinfarkt, wird gegebenenfalls mit einer ACE-Hemmertherapie begonnen. Die ACE-Hemmertherapie stellt die wichtigste Säule der Therapie der chronischen Herzinsuffizienz dar. Sofern mittels der oben aufgeführten medikamentösen und interventionellen Maßnahmen keine ausreichende hämodynamische Stabilisierung des Patienten zu erreichen ist, besteht die Möglichkeit der Einführung einer intra-aortalen Ballonpumpe. Ziel ist eine Erhöhung des mittleren arteriellen Blutdruckes und der Herzleistung.
    Notes: Summary Heart failure may be defined as a reduced physical per-formance frequently caused by a defect in myocardial contraction. According to the New York Heart Association, the severity of heart failure is classified into four grades (NYHA I–IV). Predominantly underlying causes are coronary artery disease, hypertension, cardiomyopathies and valvular heart diseases. Treatment of acute heart failure: if possible, correction of the underlying cause, e.g. reperfusion of an occluded coronary vessel, application of analgesics, sedation and oxygen supply. In case of hemodynamic instability, the application of sympathomimetic amines becomes necessary; if hemodynamic instability persists a phosphodiesterase inhibitor may be added. According to the underlying disease, additional medications are administered, e.g. diuretics in patients with pulmonary vascular congestion, aspirin, heparin, nitrates, beta-blockers, thrombolytic therapy or acute cardiac catheterization and coronary angioplasty in patients with myocardial infarction. Twelve to 24 hours after the acute event, e.g. myocardial infarction, therapy with an angiotensin-converting enzyme inhibitor may be started. Angiotensin-converting enzyme inhibitors are the basic therapy in patients with chronic heart failure. If these medical and interventional efforts fail to improve the hemodynamic status of the patient an intraaortic balloon pumping system may be introduced to elevate blood pressure and enhance coronary per-fusion.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003900050087
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