[Ergotamine-induced heart valve fibrosis and coronary microangiopathy?].
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Biomedical subjects
Publications and source records attributed to A Creutzig.
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The correlation of the peak systolic velocity (PSV) and the peak velocity ratio (PVR, calculated as intrastenotic PSV divided by proximally recorded PSV) with percent diameter reduction was studied in 62 patients with peripheral arterial occlusive disease. PSV values correlated well with angiographic diameter reduction (r = 0.81, n = 106 stenoses), but due to large variability the sensitivity and specificity in the detection of greater than 50% stenoses were only 66% and 80% (for a cutoff value of 180 cm/s). The PVR showed less interindividual variability and exhibited a strong correlation with percent diameter reduction (r = 0.93,n = 106 stenoses). A 2.4 fold increase of the peak systolic velocity values with respect to the proximal site (i.e., PVR = 2.4) or more indicated a more than 50% stenosis with a sensitivity of 87% and a specificity of 94%. Figures for PVR are provided to quantitate the degree of stenoses in the 50-99% range. Calculation of PVR may normalize for patient variation and allow noninvasive quantification of lumen narrowing with high sensitivity and specificity.
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The symptom of intermittent claudication indicates a generalised arteriosclerosis. The high mortality of these patients is due to myocardial infarction, cerebrovascular events and rupture of aortic aneurysms. Prognostic factors for the progression of peripheral occlusive arterial disease to rest pain and trophical lesions are persistent nicotine consumption, arterial occlusions on more than one extremity, brachiopedal pressure quotient less than 0.5 and diabetes mellitus. Therapy of choice in most cases is the walking exercise. When the claudication distance remains very short or decompensation of peripheral circulation is imminent, reopening procedures like percutaneous transluminal angioplasty should be performed. If they are successless a prostanoid therapy is able to relief the complaints.
14 femoral arteries of twelve patients with peripheral arterial occlusive disease (Fontaine stage II: n = 4, stage III/IV: n = 10) were investigated before, immediately after a series of 26 (ten to 52) intraarterial infusions with prostaglandin E1, and 30 weeks later. Using combined B-mode and pulsed Doppler (duplex) ultrasound blood flow measurements were performed in the common femoral, the superficial femoral, and the deep femoral artery. There was a significant decrease of resting blood flow volume in the common femoral artery after therapy (418.5----362.2 [p less than 0.01]----324.5 ml/min [p less than 0.05]) in the group of patients treated successfully. The peak flow (maximum value of blood flow volume during reactive hyperaemia) in the common femoral artery increased significantly after therapy (597.3----779.1 [p less than 0.05]----843.7 ml/min). The increase of peak flow correlated well with clinical improvement. Other parameters (blood flow velocities, pulse rise time, pulse decrease time, pulsatility index) changed without correlation to clinical outcome. The increase of peak flow after therapy might be caused by an improved collateral circulation, and the decrease of resting blood flow might be due to metabolic effects of prostaglandin E1 (improved oxygen utilization).
Transcutaneous oxygen pressure (tcPo2), laser Doppler flux and capillary microscopy have been used to examine the forefoot skin in 5 healthy men and 8 patients with severe peripheral arterial occlusive disease in order to evaluate the dose dependent effects of iloprost on skin microcirculation. Iloprost was infused IV starting at 0.0625 ng.kg-1.min-1 and doubling the dose every 15 min up to 2 ng.kg-1.min-1. While tcPo2 at an electrode core temperature of 44 degrees C decreased in both patients and controls, there was a significant dose dependent increase in tcPo2 (37 degrees C) in the controls from 0.25 ng.kg-1.min-1. In the patients the reaction was variable: it was decreased in two and increased in 6, with a maximum either at 0.25-0.5 ng.kg-1.min-1 (n = 3) or at the highest dose (1.0 or 2.0 ng.kg-1.min-1; n = 3). Mean laser Doppler flux in both groups was increased, although the reaction was not consistent in the patients. Density of forefoot skin capillaries was reduced in 3 patients, and in the others the flow velocity was very low. During infusion of iloprost, both an increase in capillary density and blood cell velocity were observed. The effects were of variable intensity and occurred at varying doses, some appeared early and diminished as the dose was increased, and others were found only at 2 ng.kg-1.min-1. Adverse effects were numerous, extending from harmless skin flushing to mental changes and a quickly reversible attack of angina pectoris.(ABSTRACT TRUNCATED AT 250 WORDS)
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