509 results on '"Berndt Lüderitz"'
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2. The history of electrocardiography
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Antoni Bayés de Luna and Berndt Lüderitz
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Medical education ,History ,medicine.diagnostic_test ,020209 energy ,MEDLINE ,Historical Article ,Heart ,History, 19th Century ,02 engineering and technology ,History, 20th Century ,Electrocardiography ,0202 electrical engineering, electronic engineering, information engineering ,medicine ,Humans ,Cardiology and Cardiovascular Medicine ,Introductory Journal Article - Published
- 2017
3. The History of the German Cardiac Society and the American College of Cardiology and Their Two Founders
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David R. Holmes, John Gordon Harold, and Berndt Lüderitz
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Arhur Weber ,medicine.medical_specialty ,Vision ,business.industry ,Franz M. Groedel ,Biography ,language.human_language ,American College of Cardiology ,German ,German Cardiac Society ,Internal medicine ,medicine ,language ,Cardiology ,Famous persons ,business ,Cardiology and Cardiovascular Medicine ,Bruno Kisch - Abstract
The German Cardiac Society is the oldest national cardiac society in Europe, founded on June 3, 1927, in Bad Nauheim by Dr. Bruno Kisch and Professor Arthur Weber. They were actively supported by Dr. Franz Groedel, who together with Kisch became co-founders of the American College of Cardiology in 1949. Both Groedel and Kisch would be proud to see the fulfillment of their visions and dreams, which was commemorated at the joint session of the two societies held during the 78th annual meeting of the German Cardiac Society in Mannheim, Germany. “It is ironic that their dreadful years in Germany and their loss to German Cardiology helped to contribute to advances in American and international Cardiology,” said Dr. Simon Dack, American College of Cardiology president in 1956 and 1957. The legacy of Groedel might be reflected by his own words: “We will meet the future not merely by dreams but by concerned action and inextinguishable enthusiasm.”
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- 2013
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4. History
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Berndt Lüderitz
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- 2005
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- View/download PDF
5. Recovery from Ultra-High Dose Organophosphate Poisoning After 'in-the-Field' Antidote Treatment: Potential Lessons for Civil Defense
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Georg Nickenig, H. U. Klehr, Thorsten Lewalter, Christian Rabe, Berndt Lüderitz, and Jan W. Schrickel
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Adult ,Atropine ,Male ,Cholinesterase Reactivators ,Emergency Medical Services ,medicine.medical_specialty ,Resuscitation ,Obidoxime Chloride ,medicine.medical_treatment ,Poison control ,Muscarinic Antagonists ,Aspiration pneumonia ,Organophosphate poisoning ,law.invention ,Polyneuropathies ,Organophosphate Poisoning ,law ,Humans ,Medicine ,Antidote ,Intensive care medicine ,Gastric Lavage ,business.industry ,Middle Aged ,medicine.disease ,Gastric lavage ,Intensive care unit ,Hemoperfusion ,Intensive Care Units ,Respiratory failure ,Emergency Medicine ,Medical emergency ,business - Abstract
Organophosphate poisoning is associated with a high mortality rate due to respiratory failure, dysrhythmias, and multi-organ failure. We report two cases of survival after "in-the field" antidote treatment of very severe organophosphate poisonings. Two patients orally ingested large amounts of the organophosphorous agent oxydemeton-methyl in suicide attempts, resulting in the hypercholinergic syndrome in both. Resuscitation included early administration of antidote by emergency medical personnel as well as high-dose atropine. Plasma levels of pseudo cholinesterase were initially very low in both patients. Long-term mechanical ventilation was necessary, and both patients developed aspiration pneumonia. At discharge, no major neurological deficits were present. Prompt antidote treatment and aggressive supportive emergency and intensive care unit therapy contribute to improved survival after acute organophosphate poisoning. We believe that in cases of mass poisonings--for example, terrorist activity--therapy must be available on the scene as soon as possible. This also may require decentralized antidote storage.
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- 2009
6. The discovery of the stethoscope by T. R. H. Laënnec (1781–1826)
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Berndt Lüderitz
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Stethoscope ,business.industry ,Stethoscopes ,Cardiology ,MEDLINE ,Historical Article ,History, 19th Century ,Biography ,History, 18th Century ,Philately ,law.invention ,Portrait ,law ,Physicians ,Physiology (medical) ,Medicine ,France ,Cardiology and Cardiovascular Medicine ,business ,Classics - Published
- 2009
7. Impact of previous myocardial infarction on the incremental value of myocardial contrast to two-dimensional supine bicycle stress echocardiography in evaluation of coronary artery disease
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Mieczysław Pasowicz, Clemens Troatz, Karol Miszalski-Jamka, Berndt Lüderitz, Stefanie Kuntz-Hehner, Harald H.H.W. Schmidt, Heyder Omran, Alexander Ghanem, Christoph Hammerstingl, Tomasz Miszalski-Jamka, and Klaus Tiemann
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Male ,medicine.medical_specialty ,Supine position ,Myocardial Infarction ,Coronary Artery Disease ,Sensitivity and Specificity ,Coronary artery disease ,Internal medicine ,Supine Position ,medicine ,Stress Echocardiography ,Humans ,Myocardial infarction ,Aged ,business.industry ,Middle Aged ,medicine.disease ,Myocardial contrast echocardiography ,Stenosis ,Exercise Test ,Cardiology ,Female ,Radiology ,Myocardial infarction diagnosis ,Cardiology and Cardiovascular Medicine ,business ,Perfusion ,Echocardiography, Stress - Abstract
If compared to two-dimensional echocardiography (2DE), myocardial contrast echocardiography (MCE) improves detection of coronary artery disease (CAD) during pharmacological stress, but data on MCE vs. 2DE during supine bicycle stress is limited. Although previous myocardial infarction (MI) influences sensitivity of 2DE, its effect on MCE has not been evaluated.The study sought to determine the incremental benefit of MCE over 2DE for evaluation of CAD during supine bicycle stress and to assess the impact of previous MI on diagnostic values of both methods.We studied 103 consecutive patients scheduled for coronary angiography. Prior to coronary angiography, all patients underwent supine bicycle stress. 2DE and MCE were performed during this stress test. The diagnosis of obstructive CAD (or =50% stenosis) was based on the presence of inducible wall motion and perfusion abnormalities.Quantitative coronary angiography revealedor =50% stenosis in 53 of 77 patients without previous MI and in 21 of 26 patients with previous MI. If compared to 2DE, MCE was more sensitive (68% vs. 86%; p0.001) and more accurate (73% vs. 86%; p0.001) to detector =50% stenosis. In patients without previous MI, 2DE and MCE yielded sensitivity of 65% and 85% (p0.01) and accuracy of 71% and 85% (p0.01), whereas in patients with previous MI sensitivity was 79% and 90% (p=NS) and accuracy 79% and 88% (p = NS), respectively.MCE enhances sensitivity and accuracy of 2DE in detection of obstructive CAD during supine bicycle stress. The incremental benefit of MCE is especially present in patients without previous MI.
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- 2009
8. Zirkadiane und wöchentliche Verteilung maligner ventrikulärer Tachyarrhythmien bei Patienten mit koronarer Herzkrankheit oder dilatativer Kardiomyopathie mit implantiertem Kardioverter-Defibrillator
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Werner Jung, Heyder Omran, Burghard Schumacher, Berndt Lüderitz, S. Spehl, Rainer Schimpf, and Christian Wolpert
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medicine.medical_specialty ,business.industry ,Cardiomyopathy ,Dilated cardiomyopathy ,General Medicine ,medicine.disease ,Sudden cardiac death ,Internal medicine ,Ventricular fibrillation ,medicine ,Cardiology ,cardiovascular diseases ,Circadian rhythm ,Myocardial infarction ,Prospective cohort study ,business ,Morning - Abstract
BACKGROUND AND OBJECTIVE Epidemiological studies have demonstrated a circadian distribution of sudden cardiac death (SD) and acute myocardial infarction (AMI), with a maximum frequency of events during the morning hours. Recently an analysis of computer recordings of implanted cardioverter/defibrillators has confirmed these findings with respect to SD. The majority of these studies concerned patients with coronary heart disease. In a prospective study we evaluated the circadian and weekly distribution of malignant ventricular tachyarrhythmias (VTA) in patients with a nonischaemic cardiac disease, namely dilated cardiomyopathy (CMP), and those with coronary heart disease (CHD). PATIENTS AND METHODS Over a mean period of 25 +/- 9 months computer-stored data and cardiac electrograms recorded from the implanted cardioverter/defibrillators (ICD) were analysed in 28 patients with CHD and 11 with DCMP. The circadian and weekly distribution of VTA was obtained, using customary arrhythmia classification and the stored and timed events. RESULTS Patients with CHD had a maximal frequency of VTA or ventricular fibrillation (VF) during the morning, with a peak between 9 and 10 o/c, while those with DCMP were at a higher risk of VTA or VF in the later afternoon and early evening. Regarding the frequency of events during the week, a significantly higher incidence of VTA was recorded on Saturdays in those with CHD, but on Mondays and Wednesdays in those with DCMP. INTERPRETATION The circadian and weekly distribution of VTA differs significantly between patients with CHD and those with DCMP. A possible reason for this difference may be different trigger mechanisms in the two types of cardiac disease, since transient ischaemia is unlikely to be the cause in patients with nonischaemic DCMP.
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- 2008
9. Kardiale Manifestationen bei fortgeschrittener HIV-Infektion
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Santiago Ewig, Juergen K. Rockstroh, W Fehske, Berndt Lüderitz, and Heyder Omran
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medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Incidence (epidemiology) ,General Medicine ,Doppler echocardiography ,medicine.disease ,Pericardial effusion ,Toxoplasmosis ,Pericarditis ,Acquired immunodeficiency syndrome (AIDS) ,Internal medicine ,cardiovascular system ,Cardiology ,Medicine ,Clinical significance ,business ,Chi-squared distribution - Abstract
Incidence, type and clinical significance of cardiac involvement in advanced HIV infection was determined in 32 patients (30 men, two women; mean age 34.2 [21-52] years; mean CD4-cell number 52.2 [0-192]/microliters) over a period of 31 months. Any cardiac involvement was assessed diagnostically by one- and two-dimensional and Doppler echocardiography, complemented by other examinations and results of treatment. 14 patients (43.8%) had abnormal cardiac findings, presumably AIDS-associated. This included left ventricular pump dysfunction of various degrees of severity (n = 11), left ventricular dilatation (n = 2), pericardial effusion (n = 11), as well as cor pulmonale in primary pulmonary arterial hypertension (n = 2). In one patient the first manifestation of AIDS was tubercular pericarditis; in two patients there was a likely connection to disseminated pneumocystis infection and toxoplasmosis, respectively. In 11 patients no specific cause was found for the cardiac involvement. Nine of the 14 patients (64%) had symptoms due to the cardiac involvement. These findings indicate that the incidence and clinical significance of cardiac involvement must be taken into account in any treatment concept for AIDS.
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- 2008
10. Katheterablation als Notfalleingriff bei Wolff-Parkinson-White-Syndrom mit akuten Infarktzeichen
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L. Pizzulli, J. Tebbenjohanns, G. Lauck, Burghard Schumacher, Dietrich Pfeiffer, and Berndt Lüderitz
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Streptokinase ,Catheter ablation ,General Medicine ,Thrombolysis ,medicine.disease ,Angina ,Internal medicine ,cardiovascular system ,Cardiology ,medicine ,cardiovascular diseases ,Circumflex ,Myocardial infarction ,Supraventricular tachycardia ,business ,Orthodromic ,medicine.drug - Abstract
A 53-year-old man known to have Wolff-Parkinson-White syndrome suffered an acute posterior-wall myocardial infarction. Despite successful thrombolysis treatment with streptokinase he continued to have attacks of supraventricular tachycardia with angina. The ECG showed a short P-R interval and pre-excitation with positive delta waves in leads V1-6, as well as signs of re-infarction. The tachycardias could not be satisfactorily suppressed by drug treatment. Coronary angiography revealed triple vessel disease. During this investigation ventricular extrasystoles occurred which initiated orthodromic supraventricular tachycardia and angina, as well as monophasic S-T elevations in leads II, III and aVF. This provided the indication for immediate high-frequency catheter ablation left laterally at the mitral anulus after a left-lateral accessory conduction pathway had been identified. Three days later the stenoses of the circumflex and anterior interventricular branches were dilated. The patient has been free of symptoms for 3 months and can exercise up to 150 W. The tachycardias have not recurred.
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- 2008
11. Indoramin bei schwerer Herzinsuffizienz: Akute hämodynamische Wirksamkeit
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Lauven Gw, Grube E, Manz M, and Berndt Lüderitz
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medicine.medical_specialty ,Cardiac output ,Ejection fraction ,business.industry ,Mean Aortic Pressure ,Hemodynamics ,General Medicine ,medicine.disease ,Indoramin ,medicine.artery ,Internal medicine ,Heart failure ,Heart rate ,Pulmonary artery ,medicine ,Cardiology ,business ,medicine.drug - Abstract
Systemic peripheral resistance, right and left heart pressures, cardiac output and left ventricular ejection fraction were measured in 12 patients with severe heart failure (stages III-IV of the NYHA), before and after intravenous injection of indoramin (0.2-0.4 mg/kg bodyweight). Peripheral resistance decreased from a mean of 2738.5 to 1294.4 dyn X s X cm-5 (P less than 0.001), mean pulmonary artery pressure from 39.4 to 21.4 mm Hg (P less than 0.001), mean aortic pressure from 105.3 to 86.0 mm Hg (P less than 0.001), left ventricular end-diastolic pressure from 35.3 to 18.3 mm Hg (P less than 0.001), arterio-venous oxygen difference from 36.1 to 25.4% (P less than 0.001), while cardiac output rose from 2.1 to 3.3 l X min-1 X m-2 (P less than 0.001), and the ejection fraction increased from 29.0 to 42.5% (P less than 0.001). Heart rate remained nearly unchanged. There were no significant side effects, such as hypotension or arrhythmias. The results indicate that the parenteral injection of indoramin favourable influences haemodynamic parameters of patients in severe heart failure.
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- 2008
12. Herzschrittmacher-Therapie zur Optimierung der Hirndurchblutung: Eine Möglichkeit zur Prävention zerebrovaskulärer Erkrankungen?
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C. Kölsch, Berndt Lüderitz, M. Hümmelgen, Hartmann A, Andreas Hagendorff, Werner Jung, Dietrich Pfeiffer, and C Dettmers
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Cardiac function curve ,medicine.medical_specialty ,Cardiac output ,business.industry ,medicine.medical_treatment ,Atrial fibrillation ,General Medicine ,medicine.disease ,Cerebral autoregulation ,Cardiac pacemaker ,Hypertensive heart disease ,Cerebral blood flow ,Internal medicine ,Anesthesia ,medicine ,Cardiology ,Sinus rhythm ,business - Abstract
History and clinical findings A 78-year-old patient experienced dizziness, impairment of mnemic and cognitive function, chronic fatigue and recurrent syncope. Investigations Hypertensive heart disease, reduced left ventricular function, and ventricular ectopia classification Lown IVb was documented. Computed tomography showed minimal brain atrophia. Stenoses of the brain supplying arteries and of other intracranial diseases were excluded. A distinct correlation between cardiac output and cerebral blood flow in correspondence to changes of heart rate were found (cardiac output 4.2 l/min during sinus rhythm, 7.4 l/min during temporary atrial pacing--AAI-Mode with a pacing rate of 90/min; 4.8 l/min--AAI-Mode with a pacing rate of 120/min; cerebral blood flow: 70, 74 and 62 ml/100 g per minute, respectively). Thus, impairment of cerebral blood flow autoregulation can be assumed. Treatment and course After implantation of a permanent pacemaker the patient was without any complaints. The mnemic and cognitive function improved, dizziness and fatigue disappeared. Synopsis did not occur. 14 months later a sudden onset of complaints occurred caused by atrial fibrillation (heart rate 120/min). Cardiac output and cerebral blood flow were now 4.0 l/min and 35 ml/100 g per minute. After antiarrhythmic drug therapy and restoration of sinus rhythm cardiac output and cerebral blood flow increased and the complaints disappeared again. Conclusion In patients with impaired capacity of cerebral autoregulation a reduced cardiac function and output can induce a reduction of cerebral blood flow. Thus, impairment of mnemic and cognitive function as well as other unspecific neurological deficits can be caused. In these cases pacemaker therapy has to be discussed as an effective therapeutical concept.
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- 2008
13. Behandlung von Herzrhythmusstörungen mit Magnesium*
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Manz M, Berndt Lüderitz, Werner Jung, and Ralph Mletzko
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medicine.medical_specialty ,chemistry ,business.industry ,Magnesium ,Heart rhythm disorders ,Internal medicine ,medicine ,Cardiology ,chemistry.chemical_element ,General Medicine ,business - Published
- 2008
14. Persistenz von Chlamydia pneumoniae in koronarem Plaquegewebe: Ein Beitrag zur Infektions- und Immunhypothese bei instabiler Angina pectoris*
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Gerhard Bauriedel, René Andrié, J. Likungu, Berndt Lüderitz, Armin Welz, U. Welsch, and P. Braun
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Acute coronary syndrome ,Pathology ,medicine.medical_specialty ,Chlamydia ,Unstable angina ,business.industry ,General Medicine ,medicine.disease ,Lesion ,Angina ,Chronic infection ,medicine ,cardiovascular diseases ,Myocardial infarction ,medicine.symptom ,business ,Foam cell - Abstract
BACKGROUND AND OBJECTIVE There is an increasing number of pointers towards a causative connection between Chlamydia pneumoniae and atherosclerosis. But the pathogenetic mechanism and intimal structures that are involved remain unclear. Starting with the hypothesis of a chronic infection, as demonstrated by the presence of the chlamydial stress (heat-shock) protein 60 (HSP 60), the presence and localization of these bacterial products in coronary atheromas was investigated. PATIENTS AND METHODS Coronary atheroma tissue from primary stenoses in 42 patients (36 men, 6 women, mean age 60.2 +/- 7.3 years) was studied immunohistochemically in the course of a retrospective analysis for chlamydial HSP 60. The findings in clinically acute coronary syndrome (Braunwald's classification) present in 27 patients were compared with those in 15 patients with acute angina and evaluated in relation to expression and site of predilection. RESULTS An immune reaction to chlamydial HSP 60 was demonstrated in 27 of 42 atheromas (64%). Intact, non-atherosclerotic vessels, such as the mammary artery and sphenous vein, showed no such signals. Chlamydial HSP 60 was localized in maximally 23% of all plaque cells, mostly in macrophages/foam cells, more rarely in smooth muscle cells. Chlamydia in foam cells most often revealed ultrastructural patterns that pointed to the persistence of the pathogen. Sites of predilection of chlamydial HSP were predominantly foam cell areas and cell-poor regions, more rarely inflammatory infiltrates and areas of rupture. When comparing both types of lesion, signals for chlamydial HSP 60 were present in 21 of the 27 atheromas (78%) with unstable angina or acute myocardial infarction, but in only 6 of the 15 atheromas (40%) with stable angina. Within the group with the acute coronary syndrome, the prevalence of chronic chlamydial infection was independent of a previous myocardial infarction. CONCLUSIONS Chlamydial HSP 60 can often be demonstrated in primary coronary stenosis of symptomatic patients. It is most frequently found in macrophages/foam cells and is highly prevalent in the acute coronary syndrome. In-situ findings suggest a pathogenetically relevant role of chronic persistent infection of Chlamydia pneumoniae in unstable coronary plaques.
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- 2008
15. Kardiovaskuläre Morbidität von Patienten mit obstruktiver Schlafapnoe in Abhängigkeit vom Schweregrad der Atmungsstörung
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S. Tasci, H. Schäfer, E. Hasper, Santiago Ewig, Berndt Lüderitz, and S. Berner
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medicine.medical_specialty ,business.industry ,Mortality rate ,Incidence (epidemiology) ,General Medicine ,Disease ,medicine.disease ,Left ventricular hypertrophy ,nervous system diseases ,respiratory tract diseases ,stomatognathic system ,Internal medicine ,Diabetes mellitus ,Cardiology ,Medicine ,In patient ,Respiratory system ,business ,Body mass index - Abstract
BASIC PROBLEM AND OBJECTIVE Untreated patients with obstructive sleep apnoea (OSA) have an increased risk of death from cardiovascular (cv) disease. This study was undertaken to determine the disease spectrum in patients with sonographically proven OSA (apnoea-hypopnoea index > or = 5), with special reference to cv risk factors and accompanying diseases in relation to the severity of their respiratory abnormalities. The study's aim was to clarify what risk factors and accompanying diseases were associated with different degrees of OSA. PATIENTS AND METHODS A systematic recording of cv risk factors and accompanying diseases as well as their association to the severity of nocturnal respiratory disorders was made for 175 patients (165 men, 10 women, mean age 54 +/- 10.2 years) with sonographically proven OSA (mean apnoea-hypopnoea index 37 +/- 24.4). RESULTS The body mass index (BMI) was significantly related to the severity of the respiratory disorder (apnoea-hypopnoea index, AHI, P or = 20). The incidence of left ventricular hypertrophy rose with an increasing severity of nocturnal OSA. CONCLUSION These data indicate that in patients with high-grade OSA (AHI > or = 20) there is a further grouping together of cardiovascular risk factors, namely increasing body weight, diabetes mellitus, arterial hypertension and left ventricular hypertrophy; they explain the increased mortality rate among these patients from vascular complications.
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- 2008
16. Noduläre Lungenschatten durch eine schwere eitrige Bronchitis und Bronchiektasen
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Torsten T. Bauer, Berndt Lüderitz, Santiago Ewig, and H Müller-Miny
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COPD ,Lung ,Bronchiectasis ,medicine.diagnostic_test ,Exacerbation ,business.industry ,General Medicine ,respiratory system ,medicine.disease ,Rhonchi ,respiratory tract diseases ,medicine.anatomical_structure ,Respiratory failure ,Anesthesia ,medicine ,Bronchitis ,medicine.symptom ,Chest radiograph ,business - Abstract
History and clinical findings A 67-year-old man with chronic obstructive pulmonary disease (COPD) for many years and a heavy smoker was hospitalized because of increasing dyspnoea and moderately productive cough. His general condition was clearly impaired. He was markedly cyanotic, he had a barrel-shaped chest, and there were wheezing rhonchi throughout the lung. Body temperature was 37.8 degrees C. He had mild ankle oedema. The preliminary diagnosis was exacerbation of the COPD with global respiratory failure. Tests There was severe hypoxaemia (pO2 48 mm Hg) with hypercapnia (pCO2 46 mm Hg). Vital capacity was reduced to 1.81, one-second forced expiratory volume 0.91. Chest radiograph revealed multiple nodular opacities, such as seen in bronchial carcinoma with metastases. But computed tomography showed fluid-filled bronchi. Bronchoscopy demonstrated large amounts of dirty-white, sticky secretions as high up as the trachea, confirming the preliminary diagnosis. Klebsiella oxytoca and haemophilus influenzae were cultured from the secretions. Treatment and course Immediate administration of amoxycillin and clavulanic acid (2.2 g daily) quickly led to clinical improvement. Chest x-ray was normalized after 10 days. But long-term oxygen treatment was instituted because of persisting resting hypoxaemia (pO2 46 mm Hg), after which he was discharged free of dyspnoea. Conclusion To clarify nodular pulmonary opacities in a chest radiograph computed tomography should be performed before bronchoscopy.
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- 2008
17. Hemmung der Heparinwirkung durch Glyceroltrinitrat*
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L. Pizzulli, Berndt Lüderitz, and J. Nitsch
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Anticoagulant effect ,medicine.diagnostic_test ,Chemistry ,medicine ,Dosage adjustment ,General Medicine ,Heparin ,Drug interaction ,Pharmacology ,Perlinganit ,Partial thromboplastin time ,medicine.drug - Abstract
The interaction of intravenous (i.v.) nitroglycerin (glyceryl trinitrate) on the anticoagulant effect of heparin was studied in 27 patients. The heparin dose was adjusted (800-1400 IU/h) to achieve partial thromboplastin time (PTT) of more than 100 s (130 +/- 28 s). While the heparin infusion was continued at the same dosage, the patients received 2-5 mg/h nitroglycerin i.v. (Perlinganit without propylene glycol [15 patients] or Gilustenon with propylene glycol [12 patients]). During combined heparin and nitroglycerin (NG) administration PTT decreased significantly (60 +/- 23 s; P less than 0.01). After withdrawal of NG, PTT increased to the initial levels (126 +/- 30 s). The drug interaction was seen in both groups--with or without propylene glycol. In nine of the 27 patients plasma heparin levels were measured; they remained unchanged during NG administration. The results indicate that i.v. NG induces heparin resistance. After NG is withdrawn, a rebound increase in PTT may occur. Adequate monitoring of PTT and heparin dosage adjustment are thus required during combined heparin and NG administration.
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- 2008
18. Supraventrikuläre Tachykardie: Ergebnisse der His-Bündel-Ablation
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Berndt Lüderitz, U. Gerckens, M. Manz, and G. Steinbeck
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Tachycardia ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,General Medicine ,Reentry ,Accessory pathway ,Ablation ,medicine.disease ,Bundle of His ,medicine.anatomical_structure ,Internal medicine ,cardiovascular system ,medicine ,Cardiology ,cardiovascular diseases ,Supraventricular tachycardia ,medicine.symptom ,business ,Electrocardiography ,Atrial flutter - Abstract
Transvenous electrical ablation of AV conduction was performed in 15 patients with drug-resistant supraventricular tachycardia. Eight patients had paroxysmal AV nodal reentry tachycardia, one had permanent junctional reentry tachycardia, five had recurrent atrial flutter and one paroxysmal atrial tachycardia. The intracardiac ablation was done with 150-350 J, on average twice per patient. Permanent 3 degrees AV block was achieved in ten patients, in none of whom there was a recurrence of the tachycardia. In four patients with re-established AV conduction the clinical symptoms had nonetheless improved; despite repeated use of His-bundle ablation, permanent junctional reentry tachycardia could not be controlled satisfactorily and required surgical section of the accessory pathway. Apart from septic fever in one patient there were no serious complications. Implantation of a pacemaker, however, was required in all those patients in whom a permanent 3 degrees AV block had been produced. For this reason alone, His-bundle ablation should only be used in drug-refractory supraventricular tachycardias. But in these this method presents an important advance in treatment.
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- 2008
19. Lebensqualität nach Implantation eines Kardioverters/Defibrillators bei malignen Herzrhythmusstörungen
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Werner Jung, M. Manz, A. Deister, A. Marneros, and Berndt Lüderitz
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medicine.medical_specialty ,Quality of life ,business.industry ,Shock (circulatory) ,Emergency medicine ,medicine ,Mean age ,General Medicine ,medicine.symptom ,business ,Survival rate ,Icd implantation - Abstract
Quality of life after implantation of an automatic implantable cardioverter/defibrillator (ICD) was assessed by questionnaire in 43 patients (38 males, 5 females; mean age 57 +/- 16 years) with treatment-resistant symptomatic ventricular arrhythmias. 37 of the 43 patients felt better after ICD implantation. 23 were always conscious of having an ICD, but 18 had got used to it in less than 2 months. 15 patients reported being afraid of an ICD shock, while eight noted physical discomfort caused by the ICD. Limitations concerning their professional, recreational and social activities were reported by six patients. 41 of the 43 patients confirmed that the ICD had been helpful, enabling 23 to return to an active life. 42 would recommend implantation to others if indicated. These data demonstrate that there is a remarkably high degree of acceptance of the ICD. Survival rate after implantation is thus not the only criterion of success. All aspects of the quality of life should be taken into consideration before implantation is decided upon.
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- 2008
20. Katheterablation von Vorhofflattern: Ein zuverlässiges, kuratives Therapieverfahren
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Thorsten Lewalter, Werner Jung, Burghard Schumacher, Berndt Lüderitz, and Christian Wolpert
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General Medicine - Published
- 2008
21. Szintigraphie mit 123J-markierten Fettsäuren bei koronarer Herzkrankheit
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Reichmann K, Hans-Jürgen Biersack, J. Likungu, Berndt Lüderitz, Joachim Kropp, and Köhler U
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medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Ischemia ,Reference range ,General Medicine ,medicine.disease ,Scintigraphy ,Hypokinesia ,Right coronary artery ,medicine.artery ,Internal medicine ,medicine ,Cardiology ,Myocardial infarction ,Circumflex ,medicine.symptom ,business ,Perfusion - Abstract
Forty-two patients (6 women, 36 men; mean age 55 [39-69] years), with one-, two- or three-vessel disease on coronary angiography, were studied using single-photon emission computer tomography with 15-p-123I-iodophenyl-pentadecanoic acid (IPPA), in order to evaluate this new method of demonstrating abnormalities of myocardial perfusion. The reference range for fatty acid turnover was determined in eleven controls (4 women, 7 men; mean age 41 [20-51] years) with no coronary stenosis. 185 MBq (5 mCi) of IPPA was administered intravenously during submaximal stress on a bicycle ergometer. Comparison between different regions of the tomograms revealed changes in fatty acid utilization typical of ischaemia. The sensitivity, specificity and predictive value of a positive result compared with coronary angiography were 95%, 89% and 93%, respectively, for the area supplied by the anterior interventricular artery, 92%, 91% and 93% for the circumflex branch and 89%, 91% and 90% for the right coronary artery. In 25 out of 31 patients (81%) with myocardial infarction, IPPA scintigraphy infarct localization agreed with the clinical findings. In two cases with unremarkable scintigrams left ventriculography showed hypokinesia, while in four cases neither method demonstrated any abnormality. There was one false-positive scintigram. IPPA scintigraphy has greater sensitivity and specificity than conventional nuclear medicine techniques in the demonstration of coronary heart disease.
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- 2008
22. Radiofrequenzablation akzessorischer Leitungsbahnen beim Präexzitationssyndrom
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J. Tebbenjohanns, Dietrich Pfeiffer, Manz M, Werner Jung, and Berndt Lüderitz
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Paroxysmal tachycardia ,medicine.medical_specialty ,Radiofrequency ablation ,business.industry ,medicine.medical_treatment ,Perforation (oil well) ,General Medicine ,Accessory pathway ,Ablation ,Surgery ,law.invention ,Pericardiocentesis ,law ,medicine ,Tamponade ,business ,Subclavian vein - Abstract
Various parameters relating to the radio-frequency ablation of accessory pathways were studied in 53 patients (27 males, 26 females: mean age 38.5 [14-64] years) with a history of paroxysmal tachycardia (over 1 month to 50 years), shown to be caused by an accessory pathway (Wolff-Parkinson-White syndrome). In all patients the following values were obtained: (1) number of procedures necessary to achieve permanent blockage of the accessory pathway (1-4); (2) duration of each procedure (45-420 min); (3) duration of fluoroscopy (5-102 min); (4) number of necessary radio-frequency applications (1-48); and (5) cumulative energy per procedure. To ablate left-lateral pathways (n = 10) required fewer procedures, shorter duration per procedure, shorter fluoroscopy time, fewer current applications and less total energy than coagulation of right-sided pathways (n = 10). Those various parameters were greatest for ablation of septal and para-septal pathways (n = 9). Pathways which conducted only retrogradely (n = 15) were more difficult to ablate than those with anterograde conduction (n = 38). There were two complications. In one case a tension pneumothorax occurred after faulty puncture of the subclavian vein; in the other, the left ventricle was perforated causing an acute tamponade which required pericardiocentesis with subsequent suture closure of the perforation. It is concluded that, in principle, all accessory pathways, regardless of their conduction potential and site, can be ablated by a radio-frequency current.
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- 2008
23. Funktionsstörungen von Kammer-Demand-(VVI-) und AV-sequentiellen (DDD-)Schrittmachern durch Muskelpotentiale
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Berndt Lüderitz, Gerckens U, and Nitsch J
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medicine.medical_specialty ,business.industry ,Internal medicine ,Physical activity ,Cardiology ,Medicine ,Stimulation ,Physical exercise ,General Medicine ,Pacemaker malfunction ,business - Abstract
Muscle potentials as a cause of pacemaker malfunction are often unrecognized, because control examinations are usually performed without physical exercise. Two observations are cited to illustrate how malfunctioning of different modes of stimulation can be caused by interference from muscle potentials. In addition to the known suppression of impulse production, fixed-rate stimulation may occur. These observations indicate that pacemaker function should be tested also during physical activity. Any malfunction can almost always be stopped by re-programming amplifier sensitivity.
- Published
- 2008
24. Chlamydia pneumoniae in koronarem Plaquegewebe: Vermehrter Nachweis bei akutem Koronarsyndrom*
- Author
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Likungu Ja, Armin Welz, U. Welsch, Gerhard Bauriedel, and Berndt Lüderitz
- Subjects
Pathology ,medicine.medical_specialty ,Acute coronary syndrome ,Intimal hyperplasia ,Chlamydia ,biology ,business.industry ,Unstable angina ,Chlamydiae ,General Medicine ,Disease ,Arteriosclerosis ,biology.organism_classification ,medicine.disease ,Medicine ,Myocardial infarction ,business - Abstract
BACKGROUND AND OBJECTIVE There is seroepidemiologic and experimental evidence for a link between Chlamydia (C.) pneumoniae and arteriosclerosis. However, the clinical importance and the pathogenic pathways implicated remain unclear. In the present study, we sought to evaluate the presence and the location of C. pneumoniae in coronary atheroma, as well as a potential prevalence with unstable versus stable angina. PATIENTS AND METHODS Retrospectively, coronary plaque material of primary lesions from 51 consecutive patients (44 men, 7 women, mean age 59.6 +/- 9.4 years) was examined for the presence of C. pneumoniae by use of immuno-histochemistry and transmission electron microscopy. The findings associated with clinically acute coronary syndrome according to Braunwald's classification (n = 31) were compared to those with stable angina (n = 20) and regarded for potential relations to characteristic intimal features. RESULTS Immunoreaction for C. pneumoniae was found in 32 of 51 (63%) coronary plaques. Signals (% prevalence of specific intimal features) were present with necrotic areas (40%), sparse cellularity (40%), neo-vascularization (29%), thrombi (20%), ruptured plaque areas (19%), and fields rich in foam cells and calcifications (13%). Intimal hyperplasia and inflammatory infiltrates showed no signals. As the central finding in this report, C. pneumoniae immunoreaction was more frequently (P < 0.001) found in 26 of 31 (84%) lesions associated with unstable angina or acute myocardial infarction, compared to 6 of 20 (30%) lesions with stable angina (P < 0.001). Intact vessels devoid of arteriosclerotic disease, such as mammarial arteries and saphenous veins, were without C. pneumoniae signals (negative controls). Ultrastructurally, chlamydial elementary bodies were found in foam cells and phagocytosing macrophages, also in fragmented extracellular matrix adjacent to apoptotic and necrotic intimal cells. CONCLUSIONS Chlamydiae pneumoniae were detected in 32 of 51 (63%) coronary primary lesions of symptomatic patients. Most importantly, there was a highly significant prevalence of lesions associated with acute coronary syndrome. Predilection sites of C. pneumoniae were areas that revealed small healing activity and (or) propensity to plaque rupture. The present in situ findings indicate a pathogenic role of Chlamydiae pneumoniae in human (coronary) plaque rupture.
- Published
- 2008
25. Septisches Aneurysma des Myokards bei Mitralklappenendokarditis: Klinische und pathologisch-anatomische Befunde
- Author
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Dietrich Pfeiffer, H. Reichel, P. Wirtz, U. Pfeifer, Berndt Lüderitz, Werner Jung, Rami Rabahieh, and Heyder Omran
- Subjects
medicine.medical_specialty ,Mitral regurgitation ,business.industry ,Sinus tachycardia ,General Medicine ,medicine.disease ,Pericarditis ,medicine.anatomical_structure ,Aneurysm ,Ventricle ,Internal medicine ,Mitral valve ,Circulatory system ,cardiovascular system ,medicine ,Cardiology ,Endocarditis ,cardiovascular diseases ,medicine.symptom ,business - Abstract
HISTORY AND CLINICAL FINDINGS A 68-year-old woman was hospitalized because of fever and tiredness for 3 months. Her general condition was clearly impaired. She had a mild fever of 38.5 degrees C and on auscultation a 3/6 systolic murmur, maximal parasternally in the 3rd intercostal space, transmitted to the apex. There were distant râles over both lungs, the neck veins were distended and there was ankle oedema. INVESTIGATIONS C-reactive protein was raised to 17.3 mg/dl (normal up to 0.9 mg/dl), WBC count 19,300/microliter. beta-haemolysing streptococcus (S. agalactiae) was grown in the blood culture. The ECG showed sinus tachycardia (rate of 98/min) and transthoracic echocardiography demonstrated a small pericardial, enlarged ventricles, marked mitral regurgitation and a large vegetation on the posterior mitral leaflet, as well as a 3 x 4 cm mass in the posterior wall of the ventricle, originating from the posterior mitral valve ring and communicating with the vegetation on the mitral valve. The posterior mitral leaflet was perforated. TREATMENT AND COURSE As endocarditis of the mitral valve with a complicated course was suspected-abscess of the posterior mitral valve ring and septic myocardial aneurysm with associated pericarditis and haemodynamically insignificant effusion-she was transferred to the intensive care unit where she died suddenly of circulatory arrest only 30 min after transfer. Autopsy confirmed the echocardiographic findings. CONCLUSION Paravalvular abscess in the course of mitral valve endocarditis is rare, but should be looked for at transthoracic echocardiography so that any necessary surgical intervention can be undertaken early.
- Published
- 2008
26. Automatic P Wave Analysis Over 24 Hours in Patients with Paroxysmal or Persistent Atrial Fibrillation
- Author
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Alexander Yang, Markus Linhart, Alexander Bitzen, Georg Nickenig, Jan Wilko Schrickel, Peter David, Thorsten Lewalter, Berndt Lüderitz, Jörg Otto Schwab, Karsten Sternickel, Lars Lickfett, Christian Wolpert, and Werner Jung
- Subjects
Male ,medicine.medical_specialty ,Time Factors ,Statistics, Nonparametric ,Physiology (medical) ,Internal medicine ,Atrial Fibrillation ,Humans ,Medicine ,Sinus rhythm ,In patient ,medicine.diagnostic_test ,business.industry ,P wave ,Healthy subjects ,Signal Processing, Computer-Assisted ,Atrial fibrillation ,Original Articles ,General Medicine ,Middle Aged ,medicine.disease ,Amplitude ,Case-Control Studies ,Persistent atrial fibrillation ,Electrocardiography, Ambulatory ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Electrocardiography - Abstract
BACKGROUND Patients with atrial fibrillation (AF) often exhibit abnormalities of P wave morphology during sinus rhythm. We examined a novel method for automatic P wave analysis in the 24-hour-Holter-ECG of 60 patients with paroxysmal or persistent AF and 12 healthy subjects. METHODS Recorded ECG signals were transferred to the analysis program where 5-10 P and R waves were manually marked. A wavelet transform performed a time-frequency decomposition to train neural networks. Afterwards, the detected P waves were described using a Gauss function optimized to fit the individual morphology and providing amplitude and duration at half P wave height. RESULTS >96% of P waves were detected, 47.4 +/- 20.7% successfully analyzed afterwards. In the patient population, the mean amplitude was 0.073 +/- 0.028 mV (mean variance 0.020 +/- 0.008 mV(2)), the mean duration at half height 23.5 +/- 2.7 ms (mean variance 4.2 +/- 1.6 ms(2)). In the control group, the mean amplitude (0.105 +/- 0.020 ms) was significantly higher (P < 0.0005), the mean variance of duration at half height (2.9 +/- 0.6 ms(2)) significantly lower (P < 0.0085). CONCLUSIONS This method shows promise for identification of triggering factors of AF.
- Published
- 2007
27. Indications for an implantable cardioverter/defibrillator
- Author
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J. O. Schwab and Berndt Lüderitz
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Gynecology ,medicine.medical_specialty ,business.industry ,Internal Medicine ,medicine ,business - Abstract
Der implantierbare Cardioverter/Defibrillator (ICD) ist das einzige Therapiemodul, welches eine lebensbedrohliche ventrikulare Tachyarrhythmie erkennen und den hierdurch hervorgerufenen plotzlichen Herztod durch eine Elektrostimulation oder -schockabgabe verhindern kann. Aufgrund zahlreicher aktueller Studienergebnisse haben sich die Indikationen fur die Primar- und Sekundarpravention erheblich gewandelt. Nach adaquater Identifikation eines Risikopatienten kann durch die Implantation eines ICD die kardiale und daruber hinaus die Gesamtmortalitat positiv beeinflusst werden. Eine genaue Kenntnis der Parameter, die zur Erkennung solcher Risikopatienten fuhren, ist essenzieller Bestandteil des diagnostischen Vorgehens. In der vorliegender Arbeit werden klare Ablaufe der notwendigen Voraussetzungen und der Wahl des ICD-Aggregates vorgestellt, um dem im Alltag tatigen Internisten strukturierte Vorgehensweisen fur eine adaquate Therapie seiner Patienten an die Hand zu geben.
- Published
- 2007
28. Echocardiographic Assessment of Left Ventricular Mass in Neonatal and Adult Mice: Accuracy of Different Echocardiographic Methods
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Alexander Ghanem, Berndt Lüderitz, Oliver Dewald, Willi Röll, Toktam Hashemi, Klaus Fink, Jan Schrickel, Klaus Tiemann, P. Chryso Djoufack, and Thorsten Lewalter
- Subjects
medicine.medical_specialty ,business.industry ,Diastole ,Stroke volume ,Left ventricular mass ,Linear relationship ,Parasternal line ,Internal medicine ,Linear regression ,Cardiology ,medicine ,Radiology, Nuclear Medicine and imaging ,Analysis of variance ,Systole ,Cardiology and Cardiovascular Medicine ,business - Abstract
Echocardiography is an established method to estimate left-ventricular mass (LVM) in mice. Accuracy is determined by cardiac size and morphology and influenced by mathematical models. We investigated accuracy of three common algorithms in three early developmental stages. High-resolution echocardiography was performed in 35 C57/BL6-mice. Therefore, two-dimensional-guided M-mode echocardiography and parasternal short- and long-axis views in B-mode were obtained. LVM was assessed in vivo applying Penn (P), Area Length (AL), and Truncated Ellipsoid (TE) algorithms and validated with histomorphometry. Regression analysis of all mice showed fair estimation of LVM assessed with M-mode-based Penn algorithm (y = 0.6*x - 0.12, r: 0.71). In contrast two-dimensional assessment of LVM revealed close linear relationship with histomorphometry (y(AL)= 1.21*x - 12.1, r: 0.88, y(TE)= 1.38*x - 2.88, r: 0.86). Bias was lowest for LVM-AL at diastole underestimating 3.2%. In concordance with the summarized data, LVM-P revealed lower regression coefficients and significant underestimation in all three subgroups. Small hearts (
- Published
- 2006
29. Identification of 'substrate fibrillators' and 'trigger fibrillators' by pacemaker diagnostics
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Berndt Lüderitz, Thorsten Lewalter, Marc Hochhausler, Dietrich Pfeiffer, B. Esmailzadeh, Alexander Yang, Armin Welz, Georg Nickenig, and Jaap H. Ruiter
- Subjects
Male ,Pacemaker, Artificial ,Time Factors ,Premature atrial contraction ,Population ,Group A ,Group B ,Electrocardiography ,Heart Conduction System ,Physiology (medical) ,Atrial Fibrillation ,medicine ,Humans ,Sinus rhythm ,Diagnosis, Computer-Assisted ,Registries ,education ,Aged ,education.field_of_study ,medicine.diagnostic_test ,business.industry ,Incidence (epidemiology) ,Cardiac Pacing, Artificial ,Atrial fibrillation ,medicine.disease ,Therapy, Computer-Assisted ,Anesthesia ,Female ,Atrial Premature Complexes ,Cardiology and Cardiovascular Medicine ,business ,Algorithms - Abstract
Background The population of patients likely to respond to selected pacing algorithms for maintenance of sinus rhythm is unknown. Objectives The purpose of this study was to identify patients with specific onset patterns of paroxysmal atrial fibrillation (AF). Methods Dual-chamber pacemakers with advanced diagnostic functions were implanted in 112 patients with conventional indications for antibradycardia pacing and a history of paroxysmal AF. Pacemaker diagnostic data were analyzed after 97.5 ± 40.9 days. According to the frequency of premature atrial contractions (PACs) during the 5 minutes before AF onset, patients were assigned to one of three groups: group A (high PAC activity), group B (moderate PAC activity), or group C (low PAC activity). Results AF burden was lower in group A (4.6% ± 2.4%) than group B (15.8% ± 3.0%, P = .003) and group C (15.5% ± 3.1%, P = .003). Fewer AF episodes occurred in group A (2.1 ± 1.3 per day) than group B (3.8 ± 1.2 per day, P = .006). Mean AF episode duration was shorter in group A (11.4 ± 10.2 hours) than group C (41.4 ± 27.5 hours, P = .03). Conclusion The coincidence of low PAC activity before AF onset, high AF burden, and extended arrhythmia episode duration appears to be the consequence of a high atrial substrate factor. In these "substrate fibrillators," the efficacy of pacing algorithms for maintenance of sinus rhythm may be limited. In contrast, "trigger fibrillators" exhibiting low AF burden despite high PAC incidence may represent the target population for specific PAC-suppressing pacing algorithms.
- Published
- 2006
30. Pro-arrhythmic effects of amiodarone and concomitant rate-control medication
- Author
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Alexander Yang, Thorsten Lewalter, Jan W. Schrickel, Alexander Bitzen, Helga Bielik, Berndt Lüderitz, and Joerg O. Schwab
- Subjects
Adult ,Male ,medicine.medical_specialty ,Heart disease ,medicine.drug_class ,Amiodarone ,Coronary Disease ,Digitalis ,QT interval ,Loading dose ,Statistics, Nonparametric ,Heart Rate ,Risk Factors ,Physiology (medical) ,Internal medicine ,Atrial Fibrillation ,Humans ,Medicine ,Beta blocker ,Aged ,Retrospective Studies ,Aged, 80 and over ,Analysis of Variance ,Ejection fraction ,biology ,business.industry ,Arrhythmias, Cardiac ,Atrial fibrillation ,Middle Aged ,medicine.disease ,biology.organism_classification ,Anesthesia ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Anti-Arrhythmia Agents ,medicine.drug - Abstract
Aims Amiodarone is one of the most efficient and safe antiarrhythmic drugs in the treatment of atrial fibrillation (AF). Although pro-arrhythmic effects of amiodarone therapy are rare, the aim of the present study was to identify clinical constellations which may lead to amiodarone-associated pro-arrhythmia. Methods and results Sixty-three consecutive patients (pts) (49 males; 64+ 10.3 years; 35 with coronary heart disease, 17 with lone AF) were retrospectively included in this study. All received an oral (92.1%) or iv (7.9%) loading dose of amiodarone for the treatment of AF. Cardiac diseases, concomitant medical treatment, and incidence of pro-arrhythmic effects were analysed. Three pts (4.8% of the total population) developed a clinical relevant, polymorphic ventricular tachyarrhythmia, 3–48 h after initiation of amiodarone loading. Coronary heart disease was present in all of these pts, and in two of them left ventricular ejection fraction was severely reduced. The mean QTc in these pts was only slightly prolonged; mean heart rate was significantly decreased compared with the total study population (61.0+ 7.5 vs. 74.5+ 24.1 bpm; P � 0.05). In all pts with pro-arrhythmia, amiodarone (two pts iv, one patient oral) was initiated during concomitant beta-blocker/digitalis therapy. Twenty-five per cent of the patients receiving this ‘triple’ therapy developed ventricular arrhythmia. Conclusion The present study implies that initiation of amiodarone therapy in pts with structural heart disease and AF that are concomitantly treated with beta-blockers and digitalis may have an increased risk of amiodarone-associated pro-arrhythmia.
- Published
- 2006
31. Atrial Thrombi-A Prospective Follow-up Study over 3 Years with Transesophageal Echocardiography and Cranial Magnetic Resonance Imaging
- Author
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Heyder Omran, Harald H.H.W. Schmidt, Berndt Lüderitz, Peter Bernhardt, and Christoph Hammerstingl
- Subjects
Male ,medicine.medical_specialty ,Cerebral embolism ,Predictive Value of Tests ,Risk Factors ,Left atrial ,Internal medicine ,Atrial Fibrillation ,Humans ,Medicine ,Carotid Stenosis ,Radiology, Nuclear Medicine and imaging ,Heart Atria ,International Normalized Ratio ,Prospective Studies ,cardiovascular diseases ,Thrombus ,Aged ,medicine.diagnostic_test ,Heparin ,business.industry ,Incidence (epidemiology) ,Follow up studies ,Anticoagulants ,Echogenicity ,Infarction, Middle Cerebral Artery ,Stroke Volume ,Thrombosis ,Magnetic resonance imaging ,Atrial fibrillation ,Middle Aged ,Atrial Function ,medicine.disease ,Magnetic Resonance Imaging ,Survival Analysis ,Echocardiography, Doppler ,Treatment Outcome ,cardiovascular system ,Cardiology ,Female ,Radiology ,Intracranial Thrombosis ,Cardiology and Cardiovascular Medicine ,business ,Biomarkers ,Blood Flow Velocity ,Echocardiography, Transesophageal ,Follow-Up Studies ,circulatory and respiratory physiology - Abstract
Background: Patients with atrial fibrillation (AF) and atrial thrombi have an increased risk for cerebral embolism. However, there is little knowledge about the long-term fate of atrial thrombi and the incidence of cerebral embolism in patients under oral anticoagulation. Methods: Consecutive patients with persistent or permanent AF and left atrial (LA) thrombi were included in the study. We performed serial and prospective transesophageal echocardiography, cranial magnetic resonance imaging, and clinical examinations during a period of 3 years. Oral anticoagulation was continued or initiated in all patients. A target INR of 2.5 was intended in all patients. Results: Forty-three patients with LA thrombi and persistent or permanent AF were included. During the follow-up period 31(72%) of the thrombi disappeared. Patients with disappearance of thrombi had significantly smaller thrombi (P < 0.01), a lower echogenicity of thrombi (P < 0.01), and a lower LA volume (P = 0.02). Twenty-two (51%) patients suffered from cerebral embolism and/or death during the observation period. Five patients died due to embolic events. The only independent predictors of cerebral embolism were an elevated peak emptying velocity of the LA appendage (P < 0.001) and a history of previous thromboembolism (P < 0.01). Conclusions: Patients with persistent or permanent AF and atrial thrombi have a high long-term risk of cerebral embolism and/or death (51%) even despite the oral anticoagulation therapy. Thrombus size may predict thrombus resolution under continued anticoagulation.
- Published
- 2006
32. 'Torsade de Pointes' in Patients with Structural Heart Disease and Atrial Fibrillation Treated with Amiodarone, beta-Blockers, and Digitalis
- Author
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Alexander Yang, Alexander Bitzen, Jan W. Schrickel, Joerg O. Schwab, Berndt Lüderitz, and Thorsten Lewalter
- Subjects
Male ,Tachycardia ,medicine.medical_specialty ,Heart disease ,Adrenergic beta-Antagonists ,Amiodarone ,Digitalis ,Coronary Artery Disease ,QT interval ,Torsades de Pointes ,Internal medicine ,Atrial Fibrillation ,medicine ,Humans ,Proarrhythmia ,Ejection fraction ,biology ,business.industry ,Digitalis Glycosides ,Atrial fibrillation ,General Medicine ,Middle Aged ,medicine.disease ,biology.organism_classification ,Drug Combinations ,Anesthesia ,Cardiology ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Anti-Arrhythmia Agents ,medicine.drug - Abstract
Amiodarone is one of the most efficient and safe antiarrhythmic drugs in the treatment of atrial fibrillation (AF). Yet, though rare, proarrhythmic effects remain a clinical problem. We present three cases of amiodarone-associated "Torsade de pointes" tachycardia (Tdp) in patients treated concomitantly with heart rate controlling medication for AF. Amiodarone loading therapy was started for the treatment of tachyarrhythmic AF in all the three patients. All presented with a history of coronary heart disease, resulting in a severely reduced left ventricular ejection fraction in two patients. One received oral amiodarone loading, in the others, amiodarone was administered intravenously because of hemodynamically relevant AF episodes. Amiodarone therapy was combined with a heart rate controlling medication including a beta-blocking agent and digitalis in all the cases. All the subjects suffered from clinically relevant Tdp in the early run after initiation of amiodarone loading (max. 48 hours). The mean QTc in all patients before induction of Tdp was prolonged. The present case reports imply that amiodarone in combination with beta-blocker/digitalis therapy may be associated with an elevated proarrhythmic risk in selected patients with structural heart disease and AF.
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- 2006
33. CPAP Results in a Sustained Decrease of NT-Pro BNP in Normotensive and Hypertensive Patients with Obstructive Sleep Apnoea Syndrome. Eine CPAP-Therapie fuhrt zu einer anhaltenden Senkung der NT-pro BNP-Spiegel bei normotensiven und hypertensiven Patienten mit obstruktiver Schlafapnoe
- Author
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S. Tasci, S. Lentini, Berndt Lüderitz, Birgit Stoffel-Wagner, and R. Manka
- Subjects
medicine.medical_specialty ,Neurology ,medicine.diagnostic_test ,medicine.drug_class ,business.industry ,medicine.medical_treatment ,Respiratory disease ,Positive pressure ,Polysomnography ,medicine.disease ,nervous system diseases ,respiratory tract diseases ,Endocrinology ,Physiology (medical) ,Internal medicine ,Cardiology ,medicine ,Natriuretic peptide ,cardiovascular diseases ,Continuous positive airway pressure ,business ,hormones, hormone substitutes, and hormone antagonists ,Obstructive sleep apnoea syndrome ,circulatory and respiratory physiology ,Hormone - Abstract
Question of the study We have recently demonstrated that application of CPAP in patients with obstructive sleep apnoea syndrome (OSAS) results in an immediate decrease of N-terminal fragment of BNP pro-hormone (NT-pro BNP) in previously untreated normotensive and, in particular, hypertensive OSAS patients. However, there is uncertainty about whether nasal continuous positive airway pressure (CPAP) has a sustained effect on NT-pro BNP and whether chronic use of CPAP produces a even more pronounced decrease of NT-pro BNP. Therefore, we evaluated the long-term impact of CPAP treatment on B-type natriuretic peptide (BNP) in normotensive and hypertensive OSAS patients.
- Published
- 2006
34. Individualized Selection of Pacing Algorithms for the Prevention of Recurrent Atrial Fibrillation: Results from the VIP Registry
- Author
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Alexander Yang, Markus Linhart, Thorsten Lewalter, B. Esmailzadeh, Dietrich Pfeiffer, Mogens Asklund, Armin Welz, Berndt Lüderitz, Jaap H. Ruiter, Götz Schnitzler, Tilmann Markert, and Oliver Przibille
- Subjects
Male ,Pacemaker, Artificial ,medicine.medical_specialty ,Premature atrial contraction ,Recurrent atrial fibrillation ,Atrial overdrive pacing ,Algorithm Selection ,Recurrence ,Internal medicine ,Atrial Fibrillation ,medicine ,Humans ,Diagnostic data ,Prospective Studies ,Registries ,Aged ,business.industry ,Cardiac Pacing, Artificial ,Atrial fibrillation ,General Medicine ,medicine.disease ,Europe ,Treatment Outcome ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Algorithm ,Algorithms - Abstract
Objectives: The VIP registry investigated the efficacy of preventive pacing algorithm selection in reducing atrial fibrillation (AF) burden. Background: There are few data identifying which patients might benefit most from which preventive pacing algorithms. Methods: Patients, with at least one documented AF episode and a conventional antibradycardia indication for pacemaker therapy, were enrolled. They received pacemakers with AF diagnostics and four preventive algorithms (Selection and PreventAF series, Vitatron). A 3-month Diagnostic Phase with conventional pacing identified a Substrate Group (>70% of AF episodes with
- Published
- 2006
35. Atrial fibrillation
- Author
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Harald H.H.W. Schmidt, Peter Bernhardt, Heyder Omran, Thorsten Sommer, and Berndt Lüderitz
- Subjects
Male ,medicine.medical_specialty ,Comorbidity ,Risk Assessment ,Risk groups ,Cerebral embolism ,Risk Factors ,Left atrial ,Germany ,Internal medicine ,Atrial Fibrillation ,medicine ,Humans ,High risk patients ,medicine.diagnostic_test ,business.industry ,Incidence ,Atrial fibrillation ,Magnetic resonance imaging ,General Medicine ,Middle Aged ,medicine.disease ,Magnetic Resonance Imaging ,Increased risk ,Intracranial Embolism ,Embolism ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Echocardiography, Transesophageal - Abstract
OBJECTIVE Patients with atrial fibrillation (AF) have a risk of cerebral embolism. Echocardiographic parameters elevate this risk significantly. However, there is little knowledge about the long-term fate and the rate of clinically silent cerebral embolism under continued oral anticoagulation. The aims of our study were to assess prognosis of patients with AF and determine a high risk group with an increased risk of cerebral embolism under oral anticoagulation. METHODS Consecutive patients with persistent or permanent AF and left atrial (LA) thrombi, dense spontaneous echo contrast (SEC) and/or reduced LA appendage peak emptying velocities (LAAv) were included in the study (N = 128). Patients with AF and without echocardiographic risk factors (N = 114) served as controls. All patients were examined with transesophageal echocardiography, cranial magnetic resonance imaging and clinically during a period of three years. RESULTS During the three-year follow-up period 6 (5%) of the high risk patients had cerebral embolism with neurological deficits. 4 (3%) patients died due to embolic events and 17 (13%) patients had silent embolism as documented on MRI. In the control group 8 (7%) patients had embolic events (n = 1 clinically apparent and n = 7 silent embolism) documented on MRI, one was clinically apparent. Study patients with an event had more commonly previous thromboembolism (p < 0.0001). CONCLUSIONS Patients with peristent or permanent AF and LA thrombi, dense SEC or reduced LAAv have an explicitly increased risk of cerebral embolism (21%) despite oral anticoagulation. Previous thromboembolic event is another important predictor for an event.
- Published
- 2006
36. Creatine Phosphokinase Elevation in Obstructive Sleep Apnea Syndrome
- Author
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S. Tasci, Robert Manka, Sabine Scholtyssek, Berndt Lüderitz, Birgit Stoffel-Wagner, and Silvia Lentini
- Subjects
Pulmonary and Respiratory Medicine ,Sleep disorder ,medicine.medical_specialty ,biology ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Sleep apnea ,Polysomnography ,Critical Care and Intensive Care Medicine ,medicine.disease ,nervous system diseases ,respiratory tract diseases ,Surgery ,Obstructive sleep apnea ,Apnea–hypopnea index ,Internal medicine ,medicine ,biology.protein ,Cardiology ,Creatine kinase ,Continuous positive airway pressure ,Cardiology and Cardiovascular Medicine ,business ,Body mass index - Abstract
Study objectives To evaluate the impact of obstructive sleep apnea syndrome (OSAS) on serum creatine phosphokinase (CK) levels. Design Single-center prospective cross-sectional study. Setting Academic sleep disorder center. Patients Two hundred one consecutive patients (mean [± SD] age, 54.9 ± 11.0 years; 155 men and 46 women; mean body mass index, 31.3 ± 6.9 kg/m2) with suspected sleep-disordered breathing. Measurements and results OSAS was confirmed in182 patients (apnea-hypopnea index [AHI], > 5 events per hour) and was ruled out in 19 patients (control subjects) by standard polysomnography. Sixty-six OSAS patients and 1 control patient showed an unexplained CK elevation. The mean baseline CK level was significantly higher in patients with severe OSAS (AHI, > 30 event per hour; n = 89) compared to those with mild-to-moderate OSAS (AHI, 5 to 30 events per hour; n = 93) and control subjects (191.4 ± 12.9 vs 134.3 ± 7.5 vs 107.1 ± 7.9 U/L, respectively; p 148 U/L (r = 0.660) for CK, which yielded a positive predictive value of 99%, a sensitivity of 43%, and a specificity of 95% for the diagnosis of OSAS. The mean nocturnal oxyhemoglobin saturation was the main predictor of CK level (r = 0.47; p Conclusions One third of our study population showed a mild-to-moderate elevation in CK level, which was highly predictive of OSAS. The application of CPAP therapy in OSAS patients resulted in a significant decrease in CK level. We speculate that OSAS may account for a substantial number of cases of unexplained CK elevation (ie, hyperCKemia). Further studies should address the prevalence of OSAS in patients with mild-to-moderate hyperCKemia.
- Published
- 2006
37. Mean platelet volume as marker of restenosis after percutaneous transluminal coronary angioplasty in patients with stable and unstable angina pectoris
- Author
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Luciano Pizzulli, Berndt Lüderitz, and Alexander Yang
- Subjects
Blood Platelets ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Coronary Artery Disease ,Hematocrit ,Angina Pectoris ,Coronary Restenosis ,Restenosis ,Angioplasty ,Internal medicine ,medicine ,Humans ,Platelet ,Platelet activation ,Angioplasty, Balloon, Coronary ,Mean platelet volume ,Cell Size ,Retrospective Studies ,medicine.diagnostic_test ,Platelet Count ,Unstable angina ,business.industry ,Hematology ,Middle Aged ,medicine.disease ,Angiography ,Cardiology ,Female ,business - Abstract
Several experimental and clinical studies have demonstrated that platelet size and function correlate since large platelets are hemostatically more reactive than platelets of normal size. Since platelets play a crucial role in vascular remodeling after percutaneous transluminal coronary angioplasty (PTCA), we investigated the influence of the mean platelet volume (MPV), a parameter of platelet size, on restenosis after PTCA.The retrospective study comprised 174 patients who underwent elective PTCA and follow-up angiography within 6 months thereafter. According to the follow-up angiograms, the patients were assigned to group A ("restenosis", n=74) or group B ("no restenosis", n=100). Both groups were compared in regard to pre-procedural hematological routine parameters including MPV, platelet count, hematocrit, white blood cell count and fibrinogen.MPV was significantly increased in group A, compared with that in group B (8.75+/-0.99 fl vs. 8.04+/-0.74 fl, p0.001). This difference in MPV was evident in patients with stable and unstable angina pectoris. In addition, MPV had an impact on the time-related incidence of angiographic restenosis, as early restenosis was associated with higher pre-procedural MPV values. Platelet count correlated inversely with MPV (r=-0.36, p0.01) and was significantly lower in group A than in group B. The remaining hematological parameters were not different in both groups.The MPV seems to be a marker of coronary restenosis in patients undergoing PTCA. Patients with high pre-procedural MPV values might benefit from an intensified antiplatelet therapy after coronary interventions.
- Published
- 2006
38. Pseudomembranous and obstructiveAspergillustracheobronchitis - optimal diagnostic strategy and outcome
- Author
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Berndt Lüderitz, Ernst Molitor, Tilman Sauerbruch, Christian Rabe, S. Lentini, S. Tasci, Klaus Tschubel, Axel Glasmacher, and Santiago Ewig
- Subjects
Adult ,Male ,medicine.medical_specialty ,Antifungal Agents ,Dermatology ,Aspergillosis ,Bronchoalveolar Lavage ,Gastroenterology ,Fatal Outcome ,Bronchoscopy ,Tracheobronchitis ,Internal medicine ,medicine ,Humans ,Bronchitis ,Aged ,Retrospective Studies ,Immunosuppression Therapy ,Microscopy ,medicine.diagnostic_test ,business.industry ,Retrospective cohort study ,General Medicine ,Middle Aged ,Airway obstruction ,medicine.disease ,Respiration, Artificial ,Surgery ,Airway Obstruction ,Exact test ,Aspergillus ,Infectious Diseases ,Bronchoalveolar lavage ,Female ,Tracheitis ,business - Abstract
Pseudomembranous and obstructive Aspergillus tracheobronchitis (PMATB/OATB) are still considered to be refractory to therapy and to have a fatal outcome. To evaluate the optimal diagnostic strategy and to describe factors affecting the outcome of PMATB and OATB. Retrospective analysis of four new cases of PMATB and OATB combined with 16 previously reported cases over a 10-year period (1995-2004). Among the four new cases reported and the 16 published cases, four patients survived their infection. The mortality rate was significantly higher in the group of ventilated patients [94% (15 of 16 patients)] than in the group of non-ventilated patients [25% (1 of 4 patients), P < 0.05, Fisher's exact test]. In all 20 patients, diagnosis was established by bronchoscopy. Culture examination of mucous plugs was positive in 8 of 10, culture of the tracheobronchial aspirate was positive in 8 of 12, and bronchoalveolar lavage was diagnostic in 7 of 13 patients. All bronchoscopic techniques were complementary in improving the yield of bronchoscopy. However, microscopy of mucous plugs and/or necrotic material was the best diagnostic modality [positive in 94% (17 of 18 patients)]. Prognosis of PMATB and OATB remains poor. Microscopy of respiratory specimens is the most sensitive tool to confirm the diagnosis. The characteristic appearance of the disease makes it possible to start antifungal therapy immediately.
- Published
- 2006
39. Arteria-cerebri-Aneurysma, Sepsis und miliare Lungenrundherde bei einer 32-jährigen Patientin
- Author
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S. Tasci, S. Lentini, Christoph Manka, Berndt Lüderitz, and R. Manka
- Subjects
Gynecology ,medicine.medical_specialty ,Tomography x ray computed ,business.industry ,Treatment outcome ,medicine ,Follow up studies ,General Medicine ,business - Abstract
Die Erstmanifestation einer Miliartuberkulose bei einer jungen, nicht immunsupprimierten Patientin in Form eines schwerwiegenden neurologischen Krankheitsbildes stellt die Besonderheit der vorgestellten Kasuistik dar. Exemplarisch zeigt diese Kasuistik die Schwierigkeiten der Diagnosesicherung, die Charakteristika des Krankheitsbildes sowie die im Einzelfall auch ohne mikrobiologische Sicherung erforderliche Entscheidung uber die Einleitung einer antituberkulosen Therapie bei dieser seltenen, aber lebensbedrohlichen Form der Tuberkulose. Eine 32-jahrige marokkanische Patientin zeigte nach neurochirurgischer Versorgung einer intrazerebralen Massenblutung das Bild einer Sepsis. Bei Vorliegen einer normochromen Anamie fanden sich eine deutliche Erhohung des C-reaktiven Proteins, der Kreatininkinase, der Lactatdehydrogenase und der γ-Glutamyltransferase sowie eine Hypokalzamie, Hyponatriamie und Normokaliamie. Anamnestisch und in der weiterfuhrenden Diagnostik (Echokardiographie, Abdomensonographie, Blut-/Urinkulturen) ergaben sich keine Hinweise auf einen Infektfocus. Die radiologische Bildgebung (Rontgen-Thorax in zwei Ebenen, Computertomographie des Thorax) zeigte eine feinnodulare Zeichnungsvermehrung beider Lungen. In der bronchoalveolaren Lavage fanden sich eine negative mikroskopische und PCR-Diagnostik (Polymerase-Kettenreaktion) auf Tuberkuloseerreger. Aufgrund des fehlenden Ansprechens auf eine antimikrobielle Therapie sowie des charakteristischen radiologischen Befunds erfolgte die Einleitung einer antituberkulosen Vierfachtherapie (Rifampicin, Isoniazid, Pyrazinamid, Ethambutol) sowie einer additiven Cortisontherapie. Darunter kam es zu einer raschen Entfieberung, Normalisierung des Blutdrucks und Verbesserung des Allgemeinzustands. Im weiteren Verlauf gelang der kulturelle Nachweis von Mycobacterium tuberculosis. Die ausgepragte hypotone Hyponatriamie wurde als Ausdruck eines assoziierten Schwartz-Bartter-Syndroms (SIADH) gewertet. Im Weiteren normalisierten sich die Natriumwerte. Nach 5-monatiger Therapie zeigte sich eine deutliche Regredienz der miliaren Lungenrundherde. Nach Abschluss der 12-monatigen antituberkulosen Therapie war die Patientin bis auf ein neurologisches Defizit beschwerdefrei. Eine Miliartuberkulose stellt eine seltene Differentialdiagnose beidseitiger infiltrativer Lungenveranderungen dar. Die Diagnosesicherung kann durch eine initial unauffallige mikrobiologische Diagnostik (Mikroskopie, PCR) erschwert sein. Aufgrund der hohen Mortalitat des Krankheitsbildes muss im Einzelfall die Entscheidung zur Einleitung einer spezifischen Therapie aufgrund klinischer und bildgebender Befunde erfolgen.
- Published
- 2005
40. Prävention von Vorhofflimmern durch Schrittmacherstimulation
- Author
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Jörg O. Schwab, Thorsten Lewalter, Berndt Lüderitz, A. Yang, Alexander Bitzen, and Jan W. Schrickel
- Subjects
Cardiology and Cardiovascular Medicine - Abstract
Eine Reihe prospektiver, randomisierter Studien an Patienten mit konventioneller antibradykarder Schrittmacherindikation hat gezeigt, dass die Inzidenz von Vorhofflimmern bei der vorhofbeteiligten, sog. „physiologischen“ Schrittmacherstimulation niedriger als bei der ventrikularen „Demandstimulation“ ist. Ob die atriale Stimulation in diesem Zusammenhang eine eigenstandige antiarrhythmische Wirkung aufweist, ist noch nicht eindeutig geklart. Als gesichert hingegen gilt, dass die ventrikulare Stimulation, selbst bei erhaltener AV-Synchronie, das Auftreten von Vorhofflimmern begunstigt. Die elektrische Sekundarpravention von Vorhofflimmern basiert auf Variationen des atrialen Stimulationsortes sowie in die Schrittmachersoftware integrierten praventiven Stimulationsalgorithmen. Die multifokale atriale Stimulation (rechts-bifokal oder biatrial) hat in klinischen Studien nur einen geringen antiarrhythmischen Effekt gezeigt und spielt daher im klinischen Alltag nur noch eine untergeordnete Rolle. Dagegen war in einigen Studien erkennbar, dass das Rezidivverhalten von Vorhofflimmern bei bestimmten Patientengruppen durch die septale Vorhofstimulation und/oder den Einsatz praventiver Stimulationsalgorithmen gunstig beeinflusst werden kann. Unklar bleibt zurzeit allerdings, wie diese Patientengruppen identifiziert werden konnen. Fur die klinische Praxis bedeutet dies, dass die Wirksamkeit von praventiven Algorithmen und/oder der septalen Stimulation individuell ausgetestet werden muss. Ihr Einsatz sollte insbesondere bei Patienten mit stimulationsbedurftigen Bradykardien und zusatzlich symptomatischem Vorhofflimmern in Erwagung gezogen werden.
- Published
- 2005
41. Post Mortem Analysis of a Left Atrial Appendage Occlusion Device (PLAATO) in a Patient with Permanent Atrial Fibrillation
- Author
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Christoph Hammerstingl, David Hardung, Harald H.H.W. Schmidt, Heyder Omran, Berndt Lüderitz, Reinhard Büttner, Giso von der Recke, and Susanne Haas
- Subjects
medicine.medical_specialty ,Percutaneous ,medicine.medical_treatment ,Atrial Appendage ,Left atrial appendage occlusion ,Fatal Outcome ,Thromboembolism ,Physiology (medical) ,Internal medicine ,Atrial Fibrillation ,medicine ,Humans ,In patient ,cardiovascular diseases ,Aged ,Aged, 80 and over ,Appendage ,business.industry ,Atrial fibrillation ,Equipment Design ,medicine.disease ,Embolization, Therapeutic ,Thromboembolic risk ,Echocardiography ,cardiovascular system ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Complication - Abstract
Thromboemoblism is the most feared complication of atrial fibrillation. Percutaneous left atrial appendage occlusion is a new interventional procedure for reducing thromboembolic risk in patients with atrial fibrillation. The paper reports of a post mortem analysis of the device demonstrating that one year after implantation the atrial surface of the device is completely covered by neo-endothelium and the device occludes the appendage completely.
- Published
- 2005
42. Clinical Prediction of Cavotricuspid Isthmus Dependence in Patients Referred for Catheter Ablation of 'Typical' Atrial Flutter
- Author
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Vinod Jayam, Berndt Lüderitz, Timm Dickfeld, Lars Lickfett, Khurram Nasir, Henry R. Halperin, Gordon Tomaselli, Zayd Eldadah, Charles Leng, Hugh Calkins, Ronald D. Berger, and Kevin Donahue
- Subjects
Male ,medicine.medical_specialty ,Heart disease ,medicine.medical_treatment ,Vena Cava, Inferior ,Catheter ablation ,Risk Assessment ,Electrocardiography ,Electrophysiology study ,Risk Factors ,Physiology (medical) ,Typical atrial flutter ,Internal medicine ,Preoperative Care ,medicine ,Humans ,medicine.diagnostic_test ,business.industry ,Atrial fibrillation ,Middle Aged ,Prognosis ,medicine.disease ,Ablation ,Cardiac surgery ,Atrial Flutter ,Anesthesia ,Catheter Ablation ,Cardiology ,Female ,Tricuspid Valve ,Cardiology and Cardiovascular Medicine ,business ,Atrial flutter - Abstract
Introduction: Typical atrial flutter (AFL) can be cured by catheter ablation of the cavotricuspid isthmus (CTI). The surface electrocardiogram (ECG) is not always diagnostic of isthmus dependence of AFL. The aim of this study was to evaluate clinical parameters for the prediction of isthmus-dependent AFL. Methods and Results: Sixty consecutive adult patients without suspected atriotomy-related AFL, congenital heart disease, or previous AFL ablation, referred for catheter ablation of presumed typical AFL were studied. All patients had distinct flutter waves in the inferior leads, suggestive of CTI-dependent AFL, either on presentation to the electrophysiology (EP) lab or documented on prior ECG. Electrophysiology study was performed in the standard fashion. Patients who presented to the EP laboratory not in AFL underwent arrhythmia induction with a burst pacing protocol. A clinical history of persistent AFL (P = 0.0001) and existence of AFL on presentation to the EP laboratory (P = 0.0001) were strong predictors of CTI dependence. History of atrial fibrillation (P = 0.19), structural heart disease (P = 0.6), hypertension (P = 0.4), and previous cardiac surgery (P = 0.5), as well as the nature of AFL-related symptoms (P = 0.5), were not predictors of CTI-dependent AFL documented during EP study. Conclusion: In patients with ECG suggestive of typical AFL, the presence of persistent rather than paroxysmal AFL and presentation to the EP laboratory in AFL are strong predictors of CTI-dependent AFL. A paroxysmal pattern of AFL predicts noninducibility of CTI-dependent AFL during EP study. CTI ablation may therefore be less effective in these patients.
- Published
- 2005
43. Pharmacological and ablative hybrid therapy of atrial fibrillation
- Author
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Thorsten Lewalter, Berndt Lüderitz, A. Bitzen, N B Shlevkov, Jan W. Schrickel, J. O. Schwab, H. Bielik, and A. Yang
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Catheter ablation ,Risk Assessment ,Pharmacotherapy ,Quality of life ,Risk Factors ,Germany ,Typical atrial flutter ,Internal medicine ,Atrial Fibrillation ,Ablative case ,medicine ,Humans ,Longitudinal Studies ,business.industry ,Atrial fibrillation ,Middle Aged ,Prognosis ,medicine.disease ,Ablation ,Combined Modality Therapy ,Treatment Outcome ,Patient Satisfaction ,Catheter Ablation ,Quality of Life ,Cardiology ,Population study ,Female ,Cardiology and Cardiovascular Medicine ,business ,Anti-Arrhythmia Agents - Abstract
The pharmacological and ablative hybrid therapy of atrial fibrillation (AF) consists of radiofrequency catheter ablation of antiarrhythmic drug-induced typical atrial flutter (AFl) and continuation of drug therapy. The purpose of this study was to determine the effect of this therapy on AF symptoms and quality of life (QoL). Forty-six patients were monitored after isthmus-ablation of drug-induced typical AFl and continuation of their antiarrhythmic drug treatment over a mean follow-up of 22.4+/-11.6 months. AF characteristics, symptoms and QoL before and after ablation were evaluated by the SF-36 question- naire, the Symptoms Checklist-Frequency and Severity Scale and the analysis of ECG recordings. 63% of patients demonstrated recurrences of AF. However, the frequency and duration of symptomatic episodes significantly decreased in 82.6 and 76% of patients. All categories of the SF-36 improved significantly and the AF symptomatology showed a relevant attenuation in 65.8% of the study population.The pharmacological and ablative hybrid therapy significantly reduced the mean number and the duration of symptomatic AF episodes as well as AF-correlated symptoms and was associated with significant QoL improvement.
- Published
- 2005
44. Aktuelle Diagnostik und Therapie tachykarder Herzrhythmusstörungen
- Author
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J. O. Schwab and Berndt Lüderitz
- Subjects
Gynecology ,medicine.medical_specialty ,business.industry ,Internal Medicine ,Medicine ,business - Abstract
Die adaquate Diagnostik und Therapie von supraventrikularen und ventrikularen Herzrhythmusstorungen stellt immer wieder eine Herausforderung dar. Eine Unterscheidung zwischen Vorhof- und Kammerrhythmusstorungen kann anhand mehrerer Kriterien zuverlassig vollzogen werden. Nach korrekter Diagnosestellung konnen Tachykardien im Akutfall verlasslich durch Applikation rhythmuswirksamer Medikamente terminiert werden. Adenosin beendet vor allem supraventrikulare Tachykardien, Amiodaron und Ajmalin sind Medikamente der ersten Wahl zur Terminierung ventrikularer Rhythmusstorungen. Daruber hinaus konnen die AV-Knoten- und die atrioventrikulare Reentrytachykardie sowie das typische Vofhofflattern mittels Radiofrequenzablation kurativ behandelt werden. Diese interventionelle Therapie kommt auch bei Extrasystolien bzw. Tachykardien des rechts- oder linksventrikularen Ausflusstrakts zum Einsatz. Bei Patienten mit koronarer Herzerkrankung steht neben einer Defibrillatorbehandlung die angepasste Pharmakotherapie im Vordergrund.
- Published
- 2005
45. Patients at High Risk with Atrial Fibrillation: A Prospective and Serial Follow-up During 12 Months with Transesophageal Echocardiography and Cerebral Magnetic Resonance Imaging
- Author
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Berndt Lüderitz, Christoph Hammerstingl, Harald H.H.W. Schmidt, Heyder Omran, and Peter Bernhardt
- Subjects
Male ,medicine.medical_specialty ,Administration, Oral ,Comorbidity ,Risk Assessment ,Risk Factors ,Left atrial ,Internal medicine ,Atrial Fibrillation ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Survival rate ,Survival analysis ,medicine.diagnostic_test ,business.industry ,Incidence ,Incidence (epidemiology) ,Anticoagulants ,Atrial fibrillation ,Magnetic resonance imaging ,Middle Aged ,Prognosis ,medicine.disease ,Magnetic Resonance Imaging ,Survival Analysis ,Survival Rate ,Intracranial Embolism ,Embolism ,Cardiology ,Female ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Echocardiography, Transesophageal ,Follow-Up Studies - Abstract
Objective Patients with atrial fibrillation and echocardiographic risk factors have a relevant risk of cerebral embolism. However, there is little knowledge about the long-term fate and the rate of clinical silent cerebral embolism under continued oral anticoagulation. Our aims were to assess the prognosis of patients with atrial fibrillation and determine a high-risk group with an increased risk of cerebral embolism under oral anticoagulation. Methods A total of 173 consecutive patients with persistent or permanent atrial fibrillation and left atrial (LA) thrombi, dense spontaneous echocontrast, reduced LA appendage peak emptying velocities, or a combination of these were included in the study. In all, 169 patients with atrial fibrillation and without echocardiographic risk factors served as control patients. We performed serial and prospective transesophageal echocardiography, cranial magnetic resonance imaging, and clinical examinations during a period of 12 months. Results During the follow-up period 7 (4%) of the patients at high risk had cerebral embolism with neurologic deficits. A total of 4 (2%) patients died because of embolic events and 19 (11%) patients had silent embolism as documented on magnetic resonance imaging. In the control group, 10 (6%) patients had embolic events documented on magnetic resonance imaging; one was clinically apparent. Study patients with an event had more often previous thromboembolism ( P Conclusions Patients with persistent or permanent atrial fibrillation and LA thrombi, dense spontaneous echocontrast, or reduced LA appendage peak emptying velocities have an explicitly increased risk of cerebral embolism (17%) despite oral anticoagulation. Previous thromboembolic event is another important predictor for an event.
- Published
- 2005
46. Influence of obstructive sleep apnea on heart rate turbulence
- Author
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Robert Manka, Berndt Lüderitz, Jörg O. Schwab, Alexander Yang, S. Tasci, René Andrié, H. Schäfer, and Thorsten Lewalter
- Subjects
Adult ,Male ,medicine.medical_specialty ,Physiology ,Disease ,Autonomic Nervous System ,Ventricular Function, Left ,Autonomic regulation ,Heart rate turbulence ,stomatognathic system ,Heart Rate ,Physiology (medical) ,Internal medicine ,medicine ,Humans ,Heart rate variability ,In patient ,Prospective Studies ,Sleep Apnea, Obstructive ,business.industry ,Middle Aged ,medicine.disease ,nervous system diseases ,respiratory tract diseases ,Obstructive sleep apnea ,Increased risk ,Cardiology ,Breathing ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Patients with obstructive sleep apnea (OSA) are at increased risk for cardiovascular disease. Increased sympathetic drive is considered as one of the underlying mechanisms. Both heart rate turbulence (HRT) and heart rate variability (HRV) are parameters to describe autonomic regulation. We investigated the influence of sleep-disordered breathing (SDB) on HRT and HRV in patients with OSA.Sixty-five patients underwent overnight polysomnography for clinically suspected SDB and simultaneous Holter monitoring (11 p.m.-6 a.m.). Patients with diabetes mellitus, a history of cardiac disease, left ventricular dysfunction, periodic breathing pattern, and those on beta-blockers or theophylline were excluded. According to the apnea-hypopnea index (AHI), the patients were assigned to group A (AHI20, n = 31) or group B (AHIor =20, n = 34). HRV (time domain, frequency domain) and HRT (onset, slope) were then related to the severity of SDB.Nighttime turbulence slope (TS) correlated inversely with the AHI (r = -0.45, p = 0.01) and was significantly lower in group B (8.9 +/- 1.6 ms/R-R interval) compared with that in group A (19.8 +/- 4.0 ms/R-R interval, P = 0.01). This relationship remained stable after adjusting TS for the number of ventricular premature contractions. No significant differences in turbulence onset or parameters of nighttime HRV were observed.Alterations in nighttime HRT correlate with the severity of SDB, indicating abnormalities in cardiac autonomic activity in moderate-to-severe OSA even in the absence of overt cardiac disease. These changes may be associated with the subsequent development of cardiovascular disease.
- Published
- 2005
47. Vorhofflimmern und Vorhofflattern - konservative vs. interventionelle Therapie
- Author
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Thorsten Lewalter and Berndt Lüderitz
- Published
- 2005
48. Langzeitergebnisse der intrapleuralen Fibrinolytikatherapie komplizierter parapneumonischer Pleuraerg�sse und Empyeme �ber kleinlumige Katheter
- Author
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Christian Rabe, Alexandra Burghard, Berndt Lüderitz, Santiago Ewig, H. Schäfer, and S. Tasci
- Subjects
Gynecology ,medicine.medical_specialty ,X ray computed ,business.industry ,Treatment outcome ,Follow up studies ,medicine ,Data interpretation ,General Medicine ,business - Abstract
Komplizierte parapneumonische Pleuraergusse (PPE) und Pleuraempyeme (PE) sind mit einer erhohten Morbiditat und Mortalitat assoziiert. Die intrapleurale Fibrinolytikatherapie (IFT) hat sich neben der videoassistierten Thorakoskopie (VATS) als Therapieoption etabliert. Inwieweit kleinlumige Drainagen in Kombination mit einer IFT uber den akuten Krankheitsverlauf hinaus auch im Langzeitverlauf ohne relevante funktionelle Einschrankungen anwendbar sind, war Gegenstand der Untersuchung. In einer prospektiven Untersuchung wurden 15 konsekutive Falle komplizierter PPE und PE mittels IFT uber kleinlumige Drainagen (9, 12, 14 F) behandelt. Neben dem unmittelbaren Therapieerfolg wurden im Langzeitverlauf (3 Monate) funktionelle und morphologische Veranderungen mittels Bildgebung und Lungenfunktionsuntersuchungen beurteilt. In allen 15 Fallen konnte die Akutbehandlung erfolgreich abgeschlossen werden. Im Langzeitverlauf wies lediglich eine Patientin eine relevante residuelle pleurale Verdickung auf; in keinem Fall zeigte sich eine restriktive Ventilationsstorung oder eine respiratorische Insuffizienz. Die durch vielfaltige Studien belegte Anwendbarkeit der IFT uber kleinlumige Drainagen in der Akutbehandlung von komplizierten PPE und PE erscheint auch im Hinblick auf den Langzeitverlauf bestatigt. Multizentrische, kontrollierte Studien zur Anwendung der IFT uber kleinlumige Drainagen sollten initiiert werden.
- Published
- 2005
49. Atrial fibrillation: profit from cardiac pacing?
- Author
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A. Yang, Thorsten Lewalter, and Berndt Lüderitz
- Subjects
Bradycardia ,Pacemaker, Artificial ,medicine.medical_specialty ,Cardiac pacing ,Right atrial ,Electrocardiography ,Internal medicine ,Atrial Fibrillation ,Heart Septum ,Secondary Prevention ,medicine ,Humans ,In patient ,cardiovascular diseases ,Randomized Controlled Trials as Topic ,Secondary prevention ,Atrial pacing ,business.industry ,Atrial fibrillation ,medicine.disease ,Defibrillators, Implantable ,Clinical trial ,Treatment Outcome ,Anesthesia ,cardiovascular system ,Cardiology ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
The impact of cardiac pacing on the prevention of atrial fibrillation is under scientific investigation. Several prospective randomised clinical trials have reported that atrial-based "physiologic" AAI(R)- or DDD(R)-pacing is associated with a lower incidence of paroxysmal and permanent atrial fibrillation than single-chamber ventricular pacing in patients with a conventional pacemaker indication. However, it is still uncertain whether atrial pacing itself has independent antiarrhythmic properties. In contrast, right ventricular pacing is considered to promote atrial fibrillation, even in preserved AV synchrony during dual-chamber pacing. The electrical secondary prevention of atrial fibrillation is mainly based on variations of the atrial pacing site and sophisticated preventive pacing algorithms incorporated in the pacemaker software. Dual-site right atrial and biatrial pacing were reported to exhibit modest to no benefit for the prevention of atrial fibrillation, whereas septal pacing and specific preventive pacing algorithms have been demonstrated to reduce the incidence of atrial fibrillation in a number of clinical trials. However, the role of septal pacing and preventive pacing algorithms still has to be clarified since, overall, study results have been inconsistent so far. One of the main goals of future investigations should be the identification of responder groups of preventive pacing concepts. In clinical practice, the efficacy of pacing algorithms and septal pacing has to be determined in the individual case. These options should be taken into account in patients with symptomatic bradycardia as the indication for cardiac pacing and, in addition, symptomatic atrial fibrillation.
- Published
- 2005
50. Vorhofflimmern - Interventionelle Differentialtherapie unter besonderer Berücksichtigung des Lebensalters
- Author
-
Berndt Lüderitz and Th Lewalter
- Subjects
medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Catheter ablation ,Atrial fibrillation ,General Medicine ,Ablation ,Cardioversion ,medicine.disease ,Catheter ,Internal medicine ,medicine ,Cardiology ,Combined Modality Therapy ,Sinus rhythm ,business ,Survival rate - Abstract
Actual therapy of atrial fibrillation follows either the rate or rhythm control strategy. To stabilize sinus rhythm after cardioversion or in case of paroxysmal atrial fibrillation, medical treatment is currently first line therapy. In patients who develop drug-refractory atrial fibrillation, further invasive treatment modalities like preventive pacing, hybrid therapy or catheter-based ablation techniques including pulmonary vein ablation or linear atrial lesion are available. However, interventional atrial fibrillation therapy should be reserved for the highly symptomatic patient due to its limited efficacy and risk of complication. Due to the higher relevance of the AF substrate in elderly patients, ablation therapy will be of limited use until substrate modification in addition to trigger elimination will reach an established stage as a clinical procedure. Hybrid therapy however, with ablation of the cavotricuspid isthmus is as suitable in elderly patients as in the young or middle-aged.
- Published
- 2005
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