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  • 1
    Electronic Resource
    Electronic Resource
    Acute and Mid-Term Experiences with the Wiktor Stent in Acute Complications and Restenosis After Coronary Angioplasty (1992)
    Oxford, UK : Blackwell Publishing Ltd
    Journal of interventional cardiology 5 (1992), S. 0 
    Details
    ISSN: 1540-8183
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: We report about the 6-month follow-up of 28 consecutive patients treated with a new tantalum stent (Wiktor™ stent, Medtronic, Inc.). Indication for stenting was the prevention of restenosis in eight patients (restenosis group), and threatening or acute closure after PTCA in 20 patients (acute closure group). Twenty-eight of 30 stents were successfully positioned in 27 of 28 patients (96%), whereas implantation failed twice in one patient. Immediate stent occlusion developed in two patients in the acute closure group (7.4%). Subacute stent occlusion was observed in three patients (11%), one in the restenosis group, two in the acute closure group, between 3 and 5 days after implantation. Coronary bypass surgery had to be performed in four patients (15%): one patient after failed stent placement, two after acute, and one after subacute stent thrombosis. Major bleeding complications related to the anticoagulative drug regimen occurred in nine patients (33%). Three patients (11%) died for reasons most probably not related to stent implantation. A 6-month angiographic follow-up revealed restenosis in two of 19 patients (11%), one patient in each group. Sixteen of the 27 stented patients (59%) reached 6-month follow-up without death, acute or subacute stent thrombosis, or restenosis. It is concluded that the Wiktor stent can be placed with a high rate of success. It may also reduce the risk of restenosis. The stent also offers the possibility to circumvent emergency bypass surgery in case of PTCA related vessel occlusion. Acute and subacute stent occlusion still remains an unsolved topic.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8183.1992.tb00421.x
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  • 2
    Electronic Resource
    Electronic Resource
    Recanalization of Chronic Coronary Occlusions by Low Speed Rotational Angioplasty (ROTACS) (1991)
    Oxford, UK : Blackwell Publishing Ltd
    Journal of interventional cardiology 4 (1991), S. 0 
    Details
    ISSN: 1540-8183
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: From 1988 to 1990 chronic coronary occlusions were treated with a newly developed slowly rotating angioplasty system (ROTACS), which is designed for atraumatic passage of arterial obstructions. In all 152 patients (mean age 55 years, ranging from 29 to 78 years) attempts to recanalize the coronary occlusion with conventional guidewire systems had failed. In 74/152 patients the age of the occlusion could be estimated because of a previous angiogram or clinical event. It ranged from 1–192 months (median 6 months, mean value 14 months; in 20% of patients it was 1–3, in 37% 4–6, in 28% 7–12, and in 15% 〉 12 months). The occlusion was localized in the right coronary artery (RCA) in 86 cases, in the left anterior descending coronary artery (LAD) in 37 cases, and in the circumflex branch of the left coronary artery in 17 cases. Eleven bypass occlusions were treated. One patient had a LAD and RCA occlusion. Out of 152 patients 84 could be recanalized. The success rate rose with experience from 30% to 60%. It was 55% in the LAD, 52% in the RCA, 70% in the circumflex branch, and 63% in bypass grafts. The success rate in relation to the age of the occlusion was 93% in occlusions of 1–3 month duration, 74% in occlusions of 4–6 months duration, 52% in occlusions of 6–12 months duration, and 8% in occlusions older than 12 months. Seventy-six of the successfully treated patients underwent follow-up angiography after 4 months. In 56/76 (74%) the vessel remained open. Twenty-two patients (29%) had restenosis that was successfully dilated in 21 patients. Twenty patients (26%) had reocclusion. Thus, the angiographically determined long-term success rate was 72%. Emergency operation was necessary in two patients in whom reopening of the LAD was attempted although the occlusion was located directly at the take-off of the LAD from the left main. Since this type of occlusion was consequently considered a contraindication, no further serious complications occurred. There was one myocardial infarction, no death, no vessel wall perforation or other complications in the 152 patients. It is concluded that low speed ROTACS is a safe technique that can be applied in chronic coronary occlusions even if the duration of occlusion exceeds 6 months. (J Interven Cardiol 1991; 4:15–165)
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8183.1991.tb00788.x
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  • 3
    Electronic Resource
    Electronic Resource
    Angiographic and Histologic Course after Implantation of Balloon Expandable Intravascular Stents in Miniswine Coronary Arteries: Short- and Mid-Term Observations (1990)
    Oxford, UK : Blackwell Publishing Ltd
    Journal of interventional cardiology 3 (1990), S. 0 
    Details
    ISSN: 1540-8183
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Sixteen balloon expandable Medtronic Wiktor tantalum stents were implanted in the major coronary arteries of six minipigs, which were maintained on a normal diet and given 500 mg aspirin per day. Angiographic and histologic examinations were performed 6 and 26 weeks after implantation. Angiographically reviewed, stenting increased the inner diameter of the coronary arteries from 2.61 ± 0.44 to 3.02 ± 0.34 mm (n = 16, P ≤ 0.001). Six weeks later, this value was reduced from 2.98 ± 0.35 to 2.33 ± 0.46 mm (n = 9, P ≤ 0.05), and between 6 and 26 weeks, an increase from 2.17 ± 0.44 to 2.93 ± 0.40 mm occurred (n = 6, P ≤ 0.05). Histologic evaluation at 26 weeks after stent implantation revealed an increase of the cross-sectional area of the total vessel from 4.30 ± 1.09 to 5.50 ± 1.67 mm2 (n = 9; P ≤ 0.01). This was due to widening of the total vessel and intimal proliferation, which amounted to 1.19 ± 0.46 mm2 within the stented segment, as compared to 0.03 ± 0.03 mm2 in control sections (P ≤ 0.01). The areas of free vessel lumen, media muscularis, and adventitia remained unchanged. In 15 of the 16 hislologically examined coronary arteries, the internal elastica was fractured at the site of stent implantation. Twelve stents had also penetrated through the external elastica without evidence of wall hemorrhage. Thirteen out of 16 stents were angiographically followed, of which 12 were patent at the final reangiography. In one animal, acute thrombosis of the stented vessel after guidewire induced coronary artery spasm caused chronic right heart failure due to right ventricular myocardial infarction. Sudden death occurred in another pig 2 hours after successful implantation of three grossly oversized stents (inner vessel diameter: 2.4 ± 0.2 mm, stent diameter 3.2 ± 0.5 mm). Autopsy revealed extensive dissections of the media with subsequent vessel occlusion. It is concluded that Medtronic Wiktor stents can be placed easily, even in more distal or curved coronary arteries. Despite antiaggregational medication, intimal proliferation is observed early after implantation, reaches a maximum at about 6 weeks, and is followed by a regression 26 weeks poststenting. At 26 weeks follow-up, the free vessel lumen at the stent site was not significantly reduced as compared to control segments. Proper adjustment of internal vessel diameter and stent diameter is necessary to prevent major dissections and thrombotic occlusions.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8183.1990.tb00966.x
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  • 4
    Electronic Resource
    Electronic Resource
    Secondary dystonias (1998)
    Springer
    Journal of neurology 245 (1998), S. 511-518 
    Details
    ISSN: 1432-1459
    Keywords: Key words Secondary dystonias ; Basal ganglia ; Neuroleptics ; Anticholinergics ; Treatment
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Secondary or symptomatic dystonias are (1) often accompanied by other neurological deficits, (2) begin suddenly at rest and occur at rest from the onset, (3) are associated with different hereditary and environmental causes. From an aetiological point of view, secondary dystonias can be caused by focal brain lesions of various origin, neurodegenerative disorders, metabolic disorders of the central nervous system (CNS), and several drugs and chemicals that affect the basal ganglia, thalamus and brain stem. Furthermore, secondary (focal) dystonias can be caused by peripheral injury. In the following review, we will discuss epidemiology, genetics, pathogenesis, neuroimaging, neuropathology, clinical manifestation, clinical course and differential diagnosis of secondary dystonias. Therapeutic options are given depending on the aetiology and the topological type of dystonia.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004150050235
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  • 5
    Electronic Resource
    Electronic Resource
    Sympathetic re-innervation after heart transplantation: dual-isotope neurotransmitter scintigraphy, norepinephrine content and histological examination (1995)
    Springer
    European journal of nuclear medicine 22 (1995), S. 443-452 
    Details
    ISSN: 1619-7089
    Keywords: Cardiac transplantation ; Sympathetic re-innervation ; Iodine-123 metaiodobenzylguanidine ; Thallium-201 ; Dual-isotope technique
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Cardiac transplantation entails surgical disruption of the sympathetic nerve fibres from their somata, resulting in sympathetic denervation. In order to investigate the occurrence of sympathetic re-dnnervation, neurotransmitter scintigraphy using the norepinephrine analogue iodine-123 metaiodobenzylguanidine (MIBG) was performed in 15 patients 2–69 months after transplantation. In addition, norepinephrine content and immunohistochemical reactions of antibodies to Schwarm cell-associated S100 protein, to neuron-specific enolase (NSE) and to norepinephrine were examined in 34 endomyocardial biopsies of 29 patients 1–88 months after transplantation. Anterobasal123I-MIBG uptake indicating partial sympathetic re-dnnervation could be shown in 40% of the scintigraphically investigated patients 37–69 months after transplantation. In immunohistochemical studies 83% of the patients investigated 1–72 months after transplantation showed nerve fibres in their biopsies but not positive reaction to norepinephrine. Significant norepinephrine content indicating re-dnnervation could not be detected in any biopsy. It was concluded that in spite of the lack of norepinephrine content there seemed to be immunohistological and scintigraphic evidence of sympathetic re-dnnervation. An explanation for this contradictory finding may be the reduced or missing norepinephrine storage ability compared to the restored uptake ability of regenerated sympathetic nerve fibres.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00839059
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  • 6
    Electronic Resource
    Electronic Resource
    Noradrenaline depletion in patients with coronary artery disease before and after percutaneous transluminal coronary angioplasty with iodine-123 metaiodobenzylguanidine and single-photon emission tomography (1993)
    Springer
    European journal of nuclear medicine 20 (1993), S. 1129-1129 
    Details
    ISSN: 1619-7089
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00173497
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  • 7
    Electronic Resource
    Electronic Resource
    Serial evaluation of left ventricular function by radionuclide ventriculography at rest and during exercise after orthotopic heart transplantation (1993)
    Springer
    European journal of nuclear medicine 20 (1993), S. 146-150 
    Details
    ISSN: 1619-7089
    Keywords: Cardiac transplantation ; Radionuclide ventriculography ; Left ventricular function ; Cardiac allograft rejection
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Discrepant results have previously been reported concerning long-term left ventricular function in the human transplanted heart as assessed by radionuclide ventriculography. In this study, radionuclide ventriculograms were obtained at rest and during exercise in 19 patients 〈6 months, 7–12 months, 13–24 months and 〉24 months after transplantation. Ejection fraction decreased significantly from 〈6 months to 13–24 months after transplantation (rest: 69.1%±9.7% to 56.7%±8.3%, P〈0.05; exercise: 70.4%±11.3% to 59%±8%, P〈0.05). Heart rate increased significantly during exercise after 〉2 years (90.2±10.5 beats/min to 103.5±15 beats/min, P〈0.05) but not within 6 months after transplantation (98.5±12.8 beats/min to 99.07±15.8 beats/min). Left ventricular end-diastolic volume remained unchanged. Peak filling rate at rest decreased significantly from 4.2±0.96 edv/s 〈6 months after transplantation to 3.3±0.66 edv/s (P〈0.05) 13–24 months and 3.3±0.64 edv/s (P〈0.05)〉24 months after cardiac transplantation. Exercise peak filing rate did not change significantly. It is concluded that radionuclide ventriculography demonstrates a decrease in systolic left ventricular function in the long-term course after cardiac transplantation. A significant increase in exercise peak heart rate may be due to autonomic reinnervation. Differences in the literature concerning left ventricular function may be due to different observation intervals following cardiac transplantation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00168875
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  • 8
    Electronic Resource
    Electronic Resource
    Noradrenaline depletion in patients with coronary artery disease before and after percutaneous transluminal coronary angioplasty with iodine-123 metaiodobenzylguanidine and single-photon emission tomography (1993)
    Springer
    European journal of nuclear medicine 20 (1993), S. 776-782 
    Details
    ISSN: 1619-7089
    Keywords: Coronary artery disease ; Percutaneous transluminal coronary angioplasty ; Noradrenaline depletion ; Metaiodobenzylguanidine
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Iodine-123 metaiodobenzylguanidine (MIBG) is a noradrenaline analogue which can be used as a tracer to investigate the cardiac sympathetic nervous system. Regional ischaemia leads to noradrenaline depletion with functional denervation which can be demonstrated by reduced MIBG uptake. In order to evaluate the reversibility of ischaemia-associated damage to the sympathetic nervous system, neuronal scintigraphy with 123I-MIBG and myocardial rest and stress perfusion scintigraphy with technetium-99m sestamibi was performed in 16 patients with coronary artery disease before and 3–4 months after percutaneous transluminal coronary angioplasty (PTCA). Partial re-innervation ocurred in five patients, the degree of stenosis of remaining lesions being estimated by repeat angiography to be below 40%. Unchanged MIBG defects cold be confirmed in four patients with residual lesions of between 40% and 50%. Increased MIBG defects were shown in three patients with significant restenoses of more than 70%. In all patients the neuronal defects exceeded the ischaemia-induced or scar-associated perfusion defects. Three patients dropped out of this study: one for technical reasons, one due to emergency aortocoronary bypass surgery and one due to diabetic polyneuropathy. This investigation shows that the sympathetic nervous system is highly sensitive to ischaemia. Further studies need to be done to assess the conditions allowing re-innervation after PTCA.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00180908
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  • 9
    Electronic Resource
    Electronic Resource
    A model for cost-effectiveness ratios in amblyopia screening (1998)
    Springer
    Der Ophthalmologe 95 (1998), S. 19-27 
    Details
    ISSN: 1433-0423
    Keywords: Key words Screening • Microtropia • Amblyopia • Cost-effectiveness • Public health ; Schlüsselwörter Siebtest • Mikrostrabismus • Amblyopie • Wirtschaftlichkeit • Gesundheitsökonomie
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Hintergrund und Zielsetzung: Pro Jahrgang sind in Deutschland ca. 750.000 Kinder auf visuelle Entwicklungsstörungen zu untersuchen, wofür die konventionellen U-Vorsorgeuntersuchungen nicht ausreichend effektiv sind. Ziel der Untersuchung war es, den wirtschaftlichen Nutzen für die Sozialgemeinschaft von Alternativen der Amblyopie- und der Mikrostrabismusfrüherkennung im Alter von 24–48 Monaten zu untersuchen. Methode: Es wurden 3 Vorsorgeoptionen modellhaft verglichen: Option 1, eine orthoptische Untersuchung, welche vor Ort, z. B. im Kindergarten, eingesetzt wird; Option 2, eine untersucherunabhängige, gerätegestützte objektive Methode, ebenfalls vor Ort; Option 3, eine augenärztliche Untersuchung in der Praxis. Die Kosten von Früherkennung, Nachuntersuchungen und Behandlung in den 3 Optionen wurden für Prävalenzen amblyogener Faktoren von 1 % (kosmetisch unauffälliges Schielen) und von 5 % (allgemeine Amblyopierate) berechnet. Der „Ertrag“ durch die Behandlung wurde als Vermeidung einer verdienstrelevanten MdE von 3 % bzw. 1 % ermittelt. Die Steuer- und Beitragsmehreinnahmen der gesetzlichen Krankenversicherung wurden eingesetzt, um die Kosten der Vorsorgeprogramme zu decken. Ergebnisse und Schlußfolgerungen: Es wurden für die Optionen 1 und 2 günstige Nutzen-Kosten-Verhältnisse gefunden. Die praxisbasierte Option 3 war dagegen weniger kosteneffektiv. Das Nutzen-Kosten-Verhältnis fiel um so günstiger aus, je höher die Prävalenz war.
    Notes: Background and purpose: In Germany, 750,000 children are born per year who should be screened for developmental visual defects in the age range 24–48 months. However, the established pediatric screening program is not sufficient to prevent amblyopia. The purpose of this study was to examine the cost-effectiveness of alternatives for amblyopia and microtropia screening. Methods: Three options were compared: (1) an orthoptic screening carried out in the field, for instance in kindergartens, (2) an examiner-independent objective apparatus-based screening, and (3) a complete ophthalmological and strabismological examination carried out in a practice. The costs of screening, follow-up examinations and of the treatment were modelled for prevalences of 1 % (microtropia) and 5 % (amblyopia). The benefit due to treatment was calculated as the result of an avoided whole-person impairment of 3 % and 1 %. The income related, increased tax and health care payments were used to cover the costs. Results and conclusions: In options (1) and (2) there were favorable cost-effective ratios. The practice-based option 3 was economically less promising. The higher the prevalence was, the higher the resulting cost-effectiveness.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003470050230
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