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Berlin Brandenburg

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  • 1
    Language: English
    In: Clinical chemistry, February 2002, Vol.48(2), pp.315-22
    Description: In children and adolescents, markers of bone and collagen metabolism reflect the dynamics of skeletal growth and development. The aim of this study was to assess the relationship of the urinary collagen markers deoxypyridinoline (DPD) and hydroxylysine (Hyl) and its glycosides [galactosyl-Hyl (Gal-Hyl) and glucosyl-Gal-Hyl] with growth. Urine samples from 240 apparently healthy children and adolescents (6-19 years; 124 girls) and from 51 prepubertal children with growth hormone (GH) deficiency (3-14 years; 14 girls) were analyzed. Urinary Hyl and its glycosides were quantified by HPLC, and DPD was assessed by chemiluminescence assay. Urinary concentrations of all markers were related to urinary creatinine. Multiple regression analysis revealed that only age and height velocity were independently associated with these markers in healthy children. In GH-deficient patients, the urinary excretion of both analytes after 4 weeks of GH therapy correlated significantly with the height increase during the first treatment year (r = 0.79 for Gal-Hyl; r = 0.70 for DPD; P 〈0.001 each). In a multivariate linear regression model using Gal-Hyl concentrations at 4 weeks, baseline concentrations of insulin-like growth factor 1 and height velocity after 3 months accounted for 80% of the variability in height gain during the first treatment year. A model using DPD concentrations at 4 weeks, in place of Gal-Hyl concentrations, as well as baseline concentrations of insulin-like growth factor 1 and height velocity after 3 months accounted for 83% of the variability. These urinary bone and collagen markers give some early indication of growth response, but the prediction of an individual marker is too imprecise to serve as a basis for clinical decisions. Markers of bone and collagen metabolism might be more useful as components of multivariate growth prediction models.
    Keywords: Growth ; Amino Acids -- Urine ; Collagen -- Urine ; Dwarfism, Pituitary -- Diagnosis ; Glycosides -- Urine ; Hydroxylysine -- Urine
    ISSN: 0009-9147
    E-ISSN: 15308561
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  • 2
    Language: English
    In: American Heart Journal, 1994, Vol.127(4), pp.978-984
    Description: Es ist wichtig, die potentiellen Wechselwirkungen zwischen dem implantierbaren Kardioverter-Defibrillator (ICD) und antiarrhythmischer Therapie in Patienten zu verstehen, die als Adjunkt zur ICD-Therapie pharmakologisch behandelt werden. In der 101 Patienten umfassenden Kohortenstudie der Autoren wurden in 61 % der Patienten im Rahmen der Langzeittherapie aus folgenden Gründen Antiarrhythmika verschrieben: Unterdrückung von ventrikulären Tachykardien bzw. ventrikulären Fibrillationen (50 %), die Frequenz ventrikulärer Tachykardien zu erniedrigen (19 %), supraventrikulären Tachykardien vorzubeugen (21 %) und aus anderen Gründen (10 %). Der wichtigste Punkt ist der potentielle Einfluß von antiarrhythmischen Medikamenten auf die Defibrillationsschwelle (DFT). In Tierstudien erhöhte z.B. Lidocain in einer dosisabhängigen Weise die DFT. Quinidin, Procainamid, Propafenon und Flecainid hatten keinen Einfluß auf die DFT bzw. führten nur in wenigen Fällen zu einer geringen Zunahme. Sotalol verringerte bei interner Defibrillation die benötigte Energie. In einer prospektiven Studie konnten die Autoren belegen, daß der Einsatz von Amiodaron die DFT signifikant von 14,1 + 3,0 auf 20,9 + 5,4 J, p 〈 0.001 erhöhte (400 mg/Tag); Mexiletinin hatte keinen Einfluß (720 mg/Tag). Als Fazit schließen die Autoren, daß vor einer Gabe von antiarrhythmischen Pharmaka die DFT bzw. deren Sicherheitszone bekannt sein muß, wenn Patienten behandelt werden sollen, die einen ICD haben. Liegt nur eine geringe Sicherheitszone vor, so soll nach Beginn der Therapie die DFT neu ermittelt werden.
    Keywords: Medicine
    ISSN: 0002-8703
    E-ISSN: 1097-6744
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  • 3
    In: Circulation, 1992, Vol.86(4), pp.1217-1222
    Description: BACKGROUND: Shock delivery of an implantable defibrillator may cause a change in the amplitude of endocardial electrograms and impair the detection of ventricular fibrillation. Thus, the effects of shock discharges on the amplitude of endocardial electrograms were evaluated in five patients undergoing implantation of a cardioverter-defibrillator in combination with a new nonthoracotomy lead system METHODS AND RESULTS: At implant, bipolar endocardial electrograms were recorded before each shock application, during ventricular fibrillation, during redetection of ventricular fibrillation in case the applied shock was ineffective, and at intervals of 5, 10, 20, 30, 60, and 120 seconds after each shock delivery. The amplitude of the endocardial electrograms decreased from 10.5±3.8 mV during sinus rhythm to 6.3±1.9 mV during initial ventricular fibrillation and declined to 2.2±1.3 mV during redetection of ventricular fibrillation. After successful termination, the following bipolar electrograms could be obtained at the predetermined intervals: 1.9±1.2 mV, 3.1±1.8 mV, 4.5±1.9 mV, 6.5±2.9 mV, 9.5±3.3 mV, and 10.4±3.8 mV. At predischarge testing, failure of redetection of ventricular fibrillation could be documented in two patients, requiring rescue external defibrillation in both cases to restore sinus rhythm. CONCLUSIONS: These findings demonstrate that the implantable cardioverter-defibrillator did not ensure reliable redetection of ventricular fibrillation in patients using the implanted nonthoracotomy lead system. Thus, the potential risk of sudden cardiac death may persist in these patients despite defibrillator therapy.
    Keywords: Medicine ; Anatomy & Physiology;
    ISSN: 0009-7322
    E-ISSN: 15244539
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  • 4
    In: Pacing and Clinical Electrophysiology, April 1992, Vol.15(4), pp.645-648
    Description: The implantable cardioverter defibrillator is designed to prevent sudden cardiac death from ventricular tachyarrhythmias. The long-term efficacy of the implantable cardioverter defibrillator has been demonstrated by several investigators. Up to 70 % of the patients who receive an implantable cardioverter defibrillator will also be maintained on concomitant antiarrhythmic drug treatment for a variety of reasons including suppression of non-sustained ventricular tachycardia, elimination of supraventricular tachyarrhythmias, and decrease of the frequency of sustained ventricular events. Since various antiarrhythmic drugs have been reported to alter defibrillation threshold. It is a major issue to obtain more information about the chronic defibrillation threshold in patients treated by the implantable cardioverter defibrillator. This publication reports details.
    Keywords: Elektrotherapie ; Elektrische Stimulation ; Defibrillator ; Implantation (Chirurgie) ; Kenndaten ; Arzneimittelwechselwirkung ; Arzneimittel ; Reizwahrnehmung ; Tachykardie ; Ventrikel (Herzkammer) ; Medicine;
    ISSN: 0147-8389
    E-ISSN: 1540-8159
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  • 5
    Language: English
    In: American Heart Journal, 1994, Vol.127(4), pp.1179-1184
    Description: Clinical experience suggests that the implantable cardioverter defibrillator (ICD) can reduce sudden cardiac death and total mortality in patients with malignant ventricular arrhythmia who meet the selection criteria for implantation. In addition to surgical problems, patients are faced with psychological and social adjustments. Patient acceptance for such therapy is marked by perceived concerns regarding device discharge, life-style alterations, and complications. We included 57 patients with ICDs in a study of their acceptance of the device. Results of a specially designed questionnaire (state-trait personality inventory) showed that 47 of 57 patients felt that their symptoms improved with the ICD system, 32 were constantly aware of the device, and 24 patients acclimated to the ICD system within less than 2 months. With respect to the need for battery replacement, only 27 patients requested a repeat electrophysiologic evaluation, 20 patients stated fear of ICD discharges, 12 patients revealed physical discomfort from the device, and limited quality of life occurred in eight patients. Fifty-five of 57 patients answered that it was worth having an ICD device implanted, 30 (53%) patients returned to active life, and 56 (98%) would advise another patient to have an ICD implantation if necessary. In conclusion, in general, the acceptance of the ICD as a tool for management of life-threatening ventricular tachyarrhythmias is very high. Quality of life and patient acceptance are important criteria for successful ICD therapy in addition to the improved survival rate.
    Keywords: Medicine
    ISSN: 0002-8703
    E-ISSN: 1097-6744
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  • 6
    Language: English
    In: Journal of the American College of Cardiology, February 1991, Vol.17(2), pp.A366-A366
    Keywords: Medicine
    ISSN: 0735-1097
    E-ISSN: 1558-3597
    Source: ScienceDirect Journals (Elsevier)
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  • 7
    In: Pacing and Clinical Electrophysiology, September 1993, Vol.16(9), pp.1815-1821
    Description: Besides surgical problems, recipierifs of implantable cardioverter defibrillators (ICDs) are faced with psychological and social adjustments. Successful ICD therapy is influenced by the patients’ perceived concerns regarding device, discharge, changes in life style, and complications. In order to assess patients’ acceptance of the ICD, the psychological profile of 57 consecutive patients was evaluated using a specifically designed questionnaire and the State Trait Anxiety Inventory (STAI). The results showed that 20 patients staled fear of ICD discharge, 12 patients revealed physical discomfort due to the device, and limited quality‐of‐life occurred in 8 patients. Fifty‐five of 57 patients answered that it was worth having an ICD device implanted, 30 (53%) patients returned to active life, and 56 (98%) would advise another patient to undergo implantation if necessary. Overall, there was only a slight, but insignificant, decrease in the level of anxiety within the total patient population after ICD implantation. However, a comparison of two subgroups indicated that the state of anxiety was significantly higher in patients 5 shocks versus those 〉 50 years of age and having experienced 〈 5 shocks. In general, the acceptance of the ICD as a tool in managing life‐threatening ventricular tachyarrhythmias is high. Besides the increased survival rate, quality‐of‐life and patient acceptance are important criteria for successful ICD therapy.
    Keywords: Implantable Cardioverter Defibrillator Icd ; Patient Acceptance ; Icd Psychological And Social Aspects
    ISSN: 0147-8389
    E-ISSN: 1540-8159
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  • 8
    In: Pacing and Clinical Electrophysiology, November 1991, Vol.14(11), pp.1762-1766
    Description: The comparative efficacy of two different antitachycardia pacing techniques was evaluated in 22 consecutive patients who received the pacemaker Intertach® with an atrial electrode for drug refractory, recurrent Supraventricular tachycardia (SVT). The Intertach® has two consecutive programmable primary and secondary termination modes. The termination programs investigated were adaptive autodecremental burst pacing and adaptive decremental scanning. Atrioventricular nodal reentrant tachycardia was present in 15 patients and atrioventricular reentrant tachycardia due to Wolff‐Parkinson‐White syndrome in seven patients. The prospective comparison was arranged in a randomized, cross‐over study over a period of 12 months. To assess long‐term efficacy, diagnostic data of the pacemakers were obtained in intervals of 3 months. In addition, noninvasive programmed stimulation was performed to compare the incidence of pacing‐induced atrial fibrillation with both termination programs. During a follow‐up of 12 months the overall success rate of autodecremental burst pacing and decremental scanning was 80% and 95%, respectively. Decremental scanning was more effective in 12 patients and less successful in two patients than autodecremental burst pacing. During noninvasive electrophysiological studies, pacing induced atrial fibrillation could be documented in three often patients (30%) using autodecremental burst pacing, compared to one often patients (10%) using decremental scanning. These data suggest that decremental scanning proved to be more successful in the long‐term management of patients with recurrent S VT than autodecremental burst pacing. Furthermore, the occurrence of pacing‐induced atrial fibrillation could be documented more frequently with autodecremental burst pacing compared to decremental scanning.
    Keywords: Antitachycardia Pacing ; Supraventricular Tachycardia ; Autodecremental Burst Pacing ; Decremental Scanning
    ISSN: 0147-8389
    E-ISSN: 1540-8159
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  • 9
    In: Pacing and Clinical Electrophysiology, February 1992, Vol.15(2), pp.179-187
    Description: Long‐term antitachycardia pacing therapy with the InterTach 262–12 and 262–16 was evaluated in 32 consecutive patients (mean age 50 ± 13 years) with recurrent, drug refractory Supraventricular tachycardia. AV nodal reentrant tachycardia was present in 20 patients, Wolff‐Parkinson‐Whife syndrome in ten patients, and a reentrant tachycardia due to Mahaim fibers in one patient. During follow‐up of 39 ± 17 months, 250 persistent tachycardia episodes occurred in 22 patients. By adjusting detection and termination mode, recurrent Supraventricular tachycardia could be controlled in 19 of 32 patients (60%) by antitachycardia pacing alone. Concomitant antiarrhythmic drug therapy was required in ten of 32 patients (30%). During follow‐up antitachycardia pacing became ineffective in three patients (10%). Thus, chronic antitachycardia pacing proved to be safe and effective in selected patients with drug refractory Supraventricular tachycardia and could significantly improve quality of life by rapid termination of recurrent supraventricular tachycardia episodes.
    Keywords: Antitachycardia Pacing ; Supraventricular Tachycardia ; Microprocessor Based Pacemakers
    ISSN: 0147-8389
    E-ISSN: 1540-8159
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  • 10
    In: Pacing and Clinical Electrophysiology, December 1995, Vol.18(12), pp.2163-2172
    Description: Changes in the amplitude of endocardial electrograms after an unsuccessful shock attempt have been demonstrated to cause failure of redetection of ventricular fibrillation in patients using an integrated sense‐pace defibrillating lead system. Thus, the objective of this study was to compare the effects of defibrillator shocks on the amplitude of endocardial electrograms in 26 patients using two different nonthoracotomy systems, a previous lead (model 0062) or a redesigned version (model 0072). At implant, bipolar endocardial electrograms were obtained before each shock application, during initial detection and redetection of ventricular fibrillation in case the applied shock was unsuccessful, and during intervals of 5, 10, 20, 30, 60, and 120 seconds after each shock delivery. No significant difference was noted in endocardial amplitudes between the lead models 0062 and 0072 during baseline sinus rhythm (12.2 ± 4.6mV vs 11.4 ± 3.8 mV), and during initial ventricular fibrillation (7.0 ± 2.4 mV vs 7.6 ± 2.3 mV). During redetection of ventricular fibrillation, however, there was a significant difference (P = 0.0006) in endocardial amplitudes (3.4 ± 1.9 mV vs 6.6 ± 2.3 mV) between both leads tested. Comparing lead models 0062 and 0072, marked differences were found in endocardial amplitudes during sinus rhythm 5, 10, and 20 seconds after successful arrhythmia termination: 2.8 ± 1.9 mV vs 8.6 ± 2.9 mV (P 〈 0.0001), 4.6 ± 2.9 mV vs 9.2 ± 3.2 mV (P = 0.0007), and 6.4 ± 4.0 mV vs 10.5 ± 3.6 mV (P = 0.01). At predischarge testing, failure of redetection of ventricular fibrillation was documented in two patients with the lead model 0062 requiring external defibrillation to restore sinus rhythm. These findings demonstrate a significant less postshock attenuation of the endocardial electrogram amplitudes during persistent ventricular fibrillation after an unsuccessful shock attempt as well as during sinus rhythm immediately following an effective shock delivery using the redesigned lead system model 0072 compared to the electrogram amplitudes obtained in patients using the previous lead model 0062.
    Keywords: Implantable Cardioverter Defibrillators ; Lead Systems ; Endocardial Electrogram
    ISSN: 0147-8389
    E-ISSN: 1540-8159
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