[CorBene: a new model for collaborative care of patients with congestive heart failure].

Congestive heart failure (CHF) is one of the most common medical disorders. The prognosis tends to be unfavorable and the quality of care needs further improvement. The aim of the CorBene project is to improve the health-related quality of life and the prognosis in patients in all stages of CHF and to reduce the hospitalization rate.

Cardiac risk stratification for high-risk vascular surgery.

Background: The best strategy for cardiac risk assessment before high-risk vascular surgery remains controversial. A cardiac risk stratification protocol was evaluated in patients undergoing high-risk vascular surgery. Our investigation paralleled the elaboration of the American College of Cardiology/ American Heart Association (ACC/AHA) Guidelines for Perioperative Cardiovascular Evaluation for Noncardiac Surgery and is highly comparable to the proposed guidelines.

[Scintigraphic imaging of adrenergic structures of the heart with 123(I)-metaiodobenzylguanidine in cardiomyopathy].

In 14 patients with various kinds of cardiomyopathy (DCM, HCM with and without obstruction, latent cardiomyopathy (= LCM], after confirmation of diagnosis, myocardial imaging with the recently developed substance 123I-metaiodobenzylguanidine (MIBG), an analog to guanethidine, was performed. In comparison, four patients in whom cardiac disease had been excluded, were evaluated. Myocardial uptake and washout were evaluated quantitatively.

[Comparative study of circulatory and ECG-changes after supraclavicular plexus block with bupivacaine-HCl 0.5 per cent in patients with chronic kidney failure].

The systemic effects of local anesthetic drugs, especially bupivacaine, on myocardial conduction and the increase of cardiotoxicity by hypoxemia, acidosis, and hyperkalemia has been proven in numerous animal experiments. In our department, supraclavicular brachial block with bupivacaine is the method of choice for patients with chronic renal failure requiring operations of the upper limb. The question may be raised whether or not these patients with their concomitant disease--electrolyte and acid-base imbalances, uremic cardiomyopathy--are especially endangered by the use of this drug.

[Atropine in intraoperative isorhythmic AV dissociation].

40 patients of the ASA groups I and II in whom intra-operatively an isorhythmic AV dissociation occurred under inhalation narcosis with halothane or enflurane, were examined in a randomized study. Within an observation period of 15 minutes the spontaneous rate of return to the sinus rhythm was 20 per cent (group A, n = 20). Intravenous administration of 0.

Antiplatelet effects of intravenous iloprost in patients with peripheral arterial obliterative disease. A placebo-controlled dose-response study.

The dose-dependent inhibition of platelet aggregation by the chemically stable, prostacyclin-mimetic, iloprost, was studied in patients suffering from stage II-III peripheral arterial obliterative disease (PAOD). The study was designed as a randomized placebo-controlled cross-over trial. Iloprost was administered i.

Vasopressor and vasodepressor hormone-systems in adolescent hypertension.

We investigated the activity of the renin-angiotensin-aldosterone-system, the secretion of catecholamines and the kallikrein-kinin-system in 126 adolescents randomly selected from a large study of 1342 young people examined in an epidemiological survey conducted in Cologne in 1975, 1976 and 1980. 73 of them with arterial blood pressures below 145/90 mm Hg were called "normotensives" (systolic blood pressure 127.2 +/- 1.

Blood viscosity: a pathogenetic factor in the development of essential hypertension?

Inhibition of the ouabain-sensitive Na-K-ATPase by digoxin significantly decreases erythrocyte deformability (5). Since first a decrease in this transport system has been discussed as a pathogenetic factor in the development of essential hypertension and second an increase in blood viscosity, due to an increased hematocrit has been observed in elderly hypertensives, hemorheology and sodium transport systems were examined in adolescent hypertensives and compared with age-matched normotensive controls. 73 normotensives (N; mean blood pressure 127/80 mmHg) and 53 hypertensives (H; mean blood pressure 147/94 mmHg) aged 23-27 yrs were randomly selected from an epidemiological survey, covering 1342 adolescents.

Haemorheology in adolescent hypertensives.

Fifty-three untreated borderline hypertensives and 73 normotensives were randomly selected from 1342 adolescents (age range 23-27 years) who were examined in 1975, 1976 and 1980 in an epidemiological study. Blood pressure was 127.2 +/- 1.

[Arteriosclerotic changes in the carotid arteries in patients with hypersensitive carotid sinus reflex].

Thirty-seven patients (15 female, 22 male; aged 46-89 years, mean age 68.8 years) with III or IV grade carotid sinus reflex carotid arteries were investigated by sonography (B-scan and CW-Doppler). It was demonstrated that stenoses or arteriosclerotic plaques, localized in the region of the carotid bulb or bifurcation, were present on both sides in 27 patients and on one side only in four patients.

Monitoring of antifibrinolytic treatment in subarachnoid hemorrhage.

21 patients (aged 28-81 years) with recent subarachnoid hemorrhage (10 saccular aneurysms, 3 arteriovenous angiomas, 8 normal angiograms) were continuously infused with tranexamic acid at a dosage of 5 g daily for up to 14 days. Therapy was surveyed by daily measurement of the available plasminogen activity (aPl) with the chromogenic substrate S-2251 and by a modified bioassay, whereby the concentration of tranexamic acid was determined thrombelastographically and expressed as antifibrinolytic equivalent. In addition, a battery of blood coagulation tests was performed daily.

High-resolution real-time ultrasound of the carotid bifurcation in patients with hyperactive carotid sinus syndrome.

The carotid bifurcations and the common carotid arteries of 36 patients with the diagnosis hyperactive carotid sinus syndrome (HCSS) were investigated by continuous wave (CW) Doppler ultrasonography and high-resolution real-time B-scan. Using these non-invasive tests, the functional impact of luminal stenosis and the morphological changes resulting from arteriosclerotic deformities could be established. Significant differences were found in comparison with a reference group of 199 patients with a high risk of arteriosclerosis.

Sodium transport and red cell deformability.

Inhibition of the Na-K pump by a circulating factor is thought to be of importance in the pathophysiology of essential hypertension. We tested the correlation between an inhibition of the Na-K pump by digoxin and the deformability of red blood cells (RBC) both in vitro and in vivo. Erythrocytes were incubated with digoxin (0-1.

Prolonged infusion of prostacyclin in patients with advanced stages of peripheral vascular disease: a placebo-controlled cross-over study.

Twelve patients (age 33-77 years, mean age 68.4 years) with peripheral vascular disease (PVD) stage III-IV received continuous intravenous infusions of 5 ng prostacyclin (PGI2)/kg/min and physiological saline for 7 days. The administration was randomized and double-blind with an interval of 7 days between the infusions.

Effect of haemodynamic changes during rapid atrial pacing on determination of sinus node recovery time.

Arterial blood pressure was continuously monitored during rapid atrial pacing in 31 patients with different types of heart disease to determine sinus node recovery time and corrected sinus node recovery time. Pacing was initiated at 70 beats/min and increased stepwise to 160 beats/min. One to one atrioventricular conduction was maintained throughout the one minute stimulation period.

Controlled trial of ancrod in ischemic stroke.

In a randomized, single-blind study, 30 patients with acute ischemic stroke were treated with either low-molecular weight dextran and mannitol alone (group A, mean age, 63.3 +/- 11.8 years, n = 15) or in combination with the viper venom enzyme ancrod (group B, mean age, 67.

No effect of prostacyclin on blood flow, regulation of blood flow and blood coagulation following global cerebral ischemia.

In normothermic cats under light barbiturate anesthesia, cerebral blood flow was arrested for one hour by intrathoracal occlusion of the innominate, the left subclavian, and both mammary arteries. Recirculation of the brain after ischemia resulted in reactive hyperemia, followed by a decrease of blood flow to about 70% of control (post-ischemic hypoperfusion). During postischemic hypoperfusion, CO2-reactivity was completely abolished.

Antithrombin III deficiency in ischaemic stroke.

AT III activity and concentration were measured in 36 patients (mean age 65.5 yrs, range 43-77 yrs) with ischaemic stroke within maximally 48 h of the acute event. In 12 patients (= 33%) AT III activity was reduced below 18.

Norepinephrine release in essential hypertension.

Supine basal plasma norepinephrine was higher in a group of newly diagnosed patients with mild essential hypertension than in age- and sex-matched "laboratory-naive" volunteers. Sympathetic activation by exercise and change of posture increased plasma norepinephrine in both groups, with a tendency toward higher values in the hypertensive patients, but norepinephrine clearance was slower and half-life longer in these patients. Thus the estimate of neuronal norepinephrine release obtained by correction of plasma norepinephrine for individual values of clearance was in the same range in both groups.

[Depression of sinus nodal automaticity during permanent atrial pacing for the determination of the sinoatrial conduction time (author's transl)].

In 36 patients sinoatrial conduction time (SACT) was calculated by the continuous-atrial-pacing technique, first described by Narula et al. (9). Using three different stimulation frequencies, it could be shown that the return cycles A2A3 and the postreturn cycles A3A4 both were linearly correlated with rising stimulation frequency.