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  • 1
    ISSN: 1573-7241
    Keywords: myocardial stunning ; postischemic myocardial dysfunction ; coronary artery disease ; left ventricular failure ; myocardial ischemia ; coronary artery reperfusion ; regional myocardial function ; hibernating myocardium
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Experimental studies have demonstrated that myocardium reperfused after reversible ischemia exhibits prolonged depression of contractile function (“stunning”). Despite the multiplicity of clinical situations in which myocardial stunning would be expected to occur, investigation of this phenomenon in humans has been hindered by several major problems, including the limited accuracy of the methods available to measure regional left ventricular function, the inability to quantify regional myocardial blood flow during acute ischemia, the difficulty in establishing with certainty the beginning and end of an ischemic episode, and the uncontrolled influence of variables (such as preload, afterload, adrenergic tone, and inotropic therapy) that have a major impact on postischemic dysfunction. The main problem is to discern whether a reversible defect of contractility is caused by stunning, silent ischemia, or hibernation (i.e., chronic ischemia). This differential diagnosis requires the simultaneous measurement of regional myocardial function and flow, which thus far has not been generally possible. Despite these limitations, however, numerous clinical observations suggest that stunning does occur in various settings in which the myocardium is exposed to transient ischemia, including coronary angioplasty, exercise-induced angina, angina at rest (unstable or variant), acute myocardial infarction with early reperfusion, open-heart surgery, and cardiac transplantation. Recognition of this entity is important, amongst other reasons, because it is likely to cause significant morbidity and because it is potentially correctable with inotropic therapy or even preventable with antioxidant therapy. In addition, the appreciation of the phenomenon of myocardial stunning should allow the clinician to assess the efficacy of reperfusion therapy with greater accuracy and to recognize that patients should not be denied mechanical revascularization solely because of an abnormal left ventricular wall motion. Perhaps the most intriguing clinical implication of the concept of myocardial stunning is the possibility that in patients who exhibit frequent episodes of ischemia in the same territory, the myocardium may not be able to fully recover between episodes and thus may remain reversibly depressed for prolonged periods of time, or even chronically, which could account for some cases of “ischemic cardiomyopathy”. Our understanding of myocardial stunning in humans is still relatively crude and will not significantly improve until studies are performed that measure simultaneously regional myocardial perfusion and function (so that stunning can be differentiated from silent ischemia and hibernation). Future important areas of research should also include the elucidation of whether stunning can become chronic and the evaluation of therapies (such as antioxidant treatments) designed to prevent this contractile abnormality. Further knowledge regarding the clinical significance of myocardial stunning will be essential to improve our understanding of the pathophysiology of coronary artery disease and our management of the adverse manifestations associated with this disorder.
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  • 2
    ISSN: 1573-2568
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The effect of sodium taurocholate (NaTC) (5 mM) and ethanol (5%) on H+ absorption by the esophagus was studied duringin vivo perfusion of rabbit esophagus with solutions of graded concentration of H+ containing either one of these agents. Net ion and volume fluxes, changes in osmolality and PD, histological change, absorption of NaTC or ethanol, were correlated with concentration of acid in the perfusate. There was linear correlation between H+ efflux and luminal H+ concentration except for experiments with NaTC at H+ concentrations higher than 100 mM. Both NaTC and ethanol caused greatly increased rate of removal of H+ from the lumen (accompanied by fall in PD), increased transport of other ions in the direction of their chemical gradients, and much structural disintegration. These changes were more severe with NaTC than with ethanol. In neutral solutions NaTC did not cause changes in PD or net ion fluxes, while ethanol depressed PD and increased net ion fluxes to a lesser extent than when acid was present. NaTC was not absorbed in a neutral solution but absorption increased with acidity. Acidity did not affect ethanol absorption. These data suggest that increased permeability of the esophageal mucosa is the basic mechanism underlying esophagitis. Increased permeability is related to absorption of NaTC or ethanol. The synergistic action of bile or alcohol and acid on the esophageal mucosa is compared to that of aspirin/acid on the gastric mucosa.
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1573-2568
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Three cases of perforation of peptic ulcers related to either fiberoptic endoscopy or esophageal dilation are presented. A correct preoperative diagnosis can be made by recognising the onset of acute abdominal symptoms and signs after an uneventful fiberoptic examination or dilation of stricture in patients with preexisting ulcer symptoms. The complication is especially likely to occur in peptic ulcer disease coexisting with esophageal stricture, possibly due to air trapping in the stomach.
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  • 4
    Electronic Resource
    Electronic Resource
    Springer
    Diseases of the colon & rectum 40 (1997), S. 1262-1262 
    ISSN: 1530-0358
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 5
    Electronic Resource
    Electronic Resource
    Springer
    Digestive diseases and sciences 28 (1983), S. 33-38 
    ISSN: 1573-2568
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract To investigate the pathophysiological basis of Courvoisier's law, the gallbladder size and pliability were measured in chronic calculous cholecystitis with (7 patients) or without (25 patients) common duct obstruction, in periampullary malignancy (6 patients), and in the normal state (3 patients). The duration and level of jaundice, when present, were correlated to the gallbladder size and ductal pressure as measured at operation. It was found thatin vitro the gallbladders were equally pliable in all groups. Therefore, the classical explanation, that stone obstruction of the common duct does not result in dilated gallbladders because of less pliable organs from preexisting fibrosis, does not seem to apply for this series of patients. A markedly higher ductal pressure and a longer history of and deeper jaundice were also found in patients with dilated gallbladders. The data of this study support the alternative explanation that chronically increased ductal pressure is the probable cause of dilated gallbladders seen in malignant obstruction of the common duct.
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  • 6
    ISSN: 1573-2800
    Keywords: gynecologic cancer ; sexual behavior
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine , Psychology
    Notes: Abstract The emotional as well as the physical impact of gynecologic cancer may be particularly felt in the area of sexual attitudes and behavior. Women newly diagnosed with gynecologic cancer were interviewed regarding their sexual behavior prior to diagnosis and treatment and how their activities changed after diagnosis. A significant decrease in sexual activity and satisfaction was reported. These findings can be used as a guideline for counseling the women with gynecologic cancer in conjunction with her partner.
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  • 7
    ISSN: 1573-0964
    Source: Springer Online Journal Archives 1860-2000
    Topics: Natural Sciences in General , Philosophy
    Type of Medium: Electronic Resource
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  • 8
    Electronic Resource
    Electronic Resource
    Springer
    Diseases of the colon & rectum 40 (1997), S. 363-365 
    ISSN: 1530-0358
    Keywords: Sigmoid colectomy ; Sigmoid volvulus ; Minimally invasive technique ; Laparoscopic sigmoid colectomy ; Colonic anastomosis ; Laparoscopic-assisted colectomy ; Colonoscopic decompression ; Loop ileostomy ; Surgical technique
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: Volvulus of the sigmoid carries a high mortality. This minimally invasive technique is designed for poor-risk patients. TECHNIQUE: Aided by laparoscopy, the mobile sigmoid is exteriorized through a mini-incision without preliminary dissection. The entire resection and anastomosis is performed on the surface of the abdomen. The options of end colostomy, primary anastomosis with or without fecal diversion, can all be used with this method. RESULTS: No mortality or leakage occurred in four patients. CONCLUSION: This rapid operation does not require advanced laparoscopic skills. Preliminary results should be confirmed by others.
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  • 9
    ISSN: 1432-2218
    Keywords: Therapeutic endoscopy ; Esophageal carcinoma ; Esophageal dilation ; Incision release of stricture
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The combined regimen of irradiation and chemotherapy has been successfully used as a preoperative measure to improve the cure rate for squamous cell carcinoma of the esophagus. In the nonresectable patient, we have seen response to this regimen in the form of conversion of the neoplastic stricture into a fibrous one. Dysphagia remained unchanged due to the persistence of a stricture. In this situation, therapeutic endoscopy can be highly effective for relief of dysphagia, as illustrated by a case report, and is proposed as the palliative procedure of choice when the patient has shown response to combined chemotherapy and radiotherapy.
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  • 10
    ISSN: 1432-2218
    Keywords: Esophageal strictures, dilation of ; Balloon dilators ; Esophageal carcinoma
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Balloon dilators may be safely applied for retrograde dilation of esophageal strictures without the use of fluoroscopy or a pressure-gauge attachment. The turgidity of the dilating balloon is preferred to that of other materials such as polyvinyl, rubber, or metal. The technique enables endoscopic monitoring and can be adapted for strictures elsewhere in the gastrointestinal tract.
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