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Biomedical subjects

A Essinger

Publications and source records attributed to A Essinger.

At least 37 records · Page 2Linked to original sources
PubMed1988

[Cardiovascular radiology].

Some fifty years ago, the first attempts to visualize cardiac cavities by X-ray were reported, and a few years later right heart catheterization was performed by a physician on himself. After the Second World War, major new developments in cardiothoracic surgery, anesthesiology and extracorporeal circulation allowed surgeons to investigate a new field: cardiac surgery. For successful surgery it was mandatory to establish an exact preoperative diagnosis of congenital and acquired cardiopathies; physicians and engineers developed catheterization techniques which allowed hemodynamic data to be collected. Sophisticated radiologic equipment was designed and cardiovascular radiology was born. A quarter-century after the first cardiac surgery, a new era of treatment for cardiovascular diseases has been opened up with the development of interventional radiology. Gastrointestinal and pulmonary hemorrhages can be treated by occlusion of the feeding artery. Angina pectoris, impending infarct, hypertension and claudication can nowadays be treated not only by vascular surgery but also by interventional radiology using techniques such as balloon angioplasty. Percutaneous revascularization techniques are now under study for the benefit of the patient whose cardiovascular disease can be cured or improved with a hospital stay of one or two days, without surgical intervention or anesthesia.

Angiocardiography↗
PubMed1986

[Prognostic value of the renin-angiotensin system in response to salt restriction and prognosis of alcoholic ascitic cirrhosis].

Prognostic factors in alcoholic cirrhosis with ascites were analyzed in a prospective study of 37 patients (25 men, 12 women), 26 of whom presented with clinically diagnosed ascites. A good therapeutic response following salt restriction was obtained in 50%; this response correlated well with an initially small ascites volume, male sex, daily urinary sodium excretion of greater than 10 mmol, plasma renin activity of less than 5 ng/ml/hr and a normal plasma aldosterone level. On the other hand, age, number of episodes and duration of ascites, hepatic functional parameters, plasma creatinine concentration and portal venous pressure had no predictive value as to therapeutic response. Patients' survival was inversely related to plasma renin activity and positively to sodium excretion. The one-year mortality rate reached 88% in patients with renin of greater than 5 ng/ml/hr or daily urinary sodium excretion of less than 10 mmol, while 70% of patients with renin of less than 5 ng/ml/hr or daily sodium excretion of greater than 10 mmol survived more than two years. No prognostic index of survival could be derived from age, sex, number of episodes, duration and volume of ascites, portal venous pressure or hepatic biochemical parameters. Thus, in cirrhotic alcoholic patients with ascites the determination of daily urinary sodium excretion, which is inversely related to the activity of the renin-angiotensin system, provides a useful prognostic index for the response to salt restriction and longterm survival.

Adult↗
PubMed1986

[Mitral prolapse syndrome: clinical, electrocardiographic and angiocardiographic correlations. Study of 100 patients with healthy coronary vessels].

Mitral valve prolapse frequently resembles coronary heart disease. Retrospective clinical, ECG and angiographic analysis of 100 consecutive patients with mitral prolapse and normal coronary arteries, but complaining of anginal pain, shows how difficult it is to establish the correct diagnosis. When resting, 44% of patients have nonspecific ECG disorders of repolarization phase. During periods of chest pain 3 patients experienced transient ST segment changes very similar to acute myocardial ischemia. The exercise test was positive in 39% of cases, and in 2 patients during exercise a sudden drop in blood pressure suggested coronary perfusion failure. In all patients the coronary arteries were normal, but left ventriculography showed mitral valve prolapse predominantly on the posterior leaflet. At rest, 35% of patients had diastolic compliance failure, 32% had left ventricular hyperkinesia and only in 3% was slight hypokinesia present. Finally, early systolic relaxation of the anteroapical wall was observed in 75% of patients.

Angina Pectoris↗
PubMed1985

[Mechanical recanalization and dilatation of coronary arteries in the acute stage of myocardial infarction].

The time between coronary artery occlusion and reperfusion remains the decisive factor for myocardial function in acute myocardial infarction. Of 110 patients admitted to hospital less than 3 hours after the onset of chest pain, 83 underwent intracoronary thrombolysis with streptokinase or urokinase. 27 patients underwent mechanical recanalization with the aid of a steerable guide wire (Schneider 0.014") followed by transluminal angioplasty of the residual stenosis. 70 of 83 patients (84%) were recanalized by intracoronary streptokinase perfusion within 45 +/- 10 minutes. By mechanical recanalization the occluded artery could be recanalized in 27 patients within 6 +/- 1 minutes. During the same session transluminal angioplasty was performed while the affected coronary artery was perfused for 20 minutes with 20,000-50,000 U streptokinase. 2 patients died after intracoronary thrombolysis (2.4%) and 1 patient died after mechanical recanalization (3.7%). 25 of 26 survivors of the mechanical recanalization group were discharged after bicycle stress testing, and 1 patient underwent a coronary bypass operation. In the intracoronary thrombolysis group, 4 patients presented with reobstruction of the affected vessel within 24 hours of the intervention (4.8%). Of the remaining 66 patients. 20 underwent transluminal coronary angioplasty (285), 16 coronary bypass (22%) and 30 received drug therapy (43%). Left ventricular injection fraction, measured 24 hours after treatment, was 63 +/- 10% in the mechanical recanalization group and 53 +/- 9% in the intracoronary thrombolysis group.

Adult↗
PubMed1983

[Risk factors in coronary arteriosclerosis in women].

108 women aged 28 to 74 years underwent cardiac angiography for evaluation of chest pain or other heart disease. 29 were found to be free of coronary disease and formed a control group. Multi-variable analysis indicated that hypercholesterolemia, hypertension, familial coronary disease and diabetes were the most relevant atherogenic risk factors.

Adult↗
PubMed1983

[Left ventricular function following revascularization for occlusion of a coronary artery lasting 1 to 2 hours].

The time-lag between coronary occlusion and irreversible damage to the myocardium is ill-defined in man. In 10 patients the changes in left ventricular function have been studied after coronary occlusion during diagnostic or therapeutic cardiac catheterization of 1-2 hours' duration. Revascularization was achieved either surgically or through intracoronary streptokinase infusion. The interval between occlusion and onset of extracorporal circulation or reopening was 61 to 119 minutes. Despite enzyme elevation (CPK, CK-MB, SGOT) and appearance of Q-waves in 5 patients, no significant alteration of left ventricular function was noted on repeat cardiac catheterization 10 to 230 days after the accident. These observations, suggest that coronary occlusion of 1-2 hours' duration fails to produce significant irreversible damage to the myocardium despite electrocardiographic and enzymatic signs of myocardial infarction.

Aspartate Aminotransferases↗
PubMed1983

[Intracoronary thrombolysis as a treatment for evolving myocardial infarction].

Myocardial infarction is almost always the consequence of a thrombotic obstruction of one or more coronary arteries. We report our experience with the first 24 cases of intracoronary thrombolysis for recanalization of obstructed coronary arteries. 19 cases were successful, 1 case was partially successful and in 4 instances no reopening was observed. The amount of streptokinase used was 206 000 +/- 107 000 units, and reperfusion was achieved after 37 +/- 27.5 minutes. Recanalization of the vessel was accompanied by cessation of precordial pain and partial or complete normalization of the electrocardiogram. In one case bypass surgery was necessary because of reocclusion. Left ventricular function improvement after thrombolysis was dependent on the time-lag between occlusion and recanalization. These observations confirm others' experience that intracoronary thrombolysis appears to have favorable effects in patients with evolving myocardial infarction.

Coronary Disease↗
PubMed1982

Improvement of left ventricular function after percutaneous transluminal coronary angioplasty.

Cardiac function and left ventricular dynamics were measured in seven consecutive patients 1 day before and 6 months after percutaneous transluminal balloon angioplasty of subtotal proximal stenosis of the left anterior descending coronary artery. Before angioplasty all patients had obvious left ventricular dysfunction during exercise and to a smaller degree during isoproterenol infusion; the condition of all patients was greatly improved 6 months after angioplasty. After angioplasty, left ventricular end-diastolic pressure was normal at rest and decreased from a mean (+/- standard error of the mean) of 33.8 +/- 1.6 to 19.2 +/- 0.5 mm Hg on exercise. Left ventricular ejection fraction, measured by a gated blood pooling technique with technetium-99m, improved on exercise from 46 +/- 5.0 percent to 69 +/- 1.0 percent. Cardiac output and stroke volume index increased significantly with exercise after angioplasty. The peak negative rate of pressure reduction in the left ventricle (dP/dt/min), an index of left ventricular relaxation, was highly abnormal on exercise before (2,307 +/- 260 mm Hg/s) and increased to the normal range (3,154 +/- 200 mm Hg/s) after angioplasty. The improvement in left ventricular function after transluminal angioplasty in these cases of proximal left anterior descending coronary arterial stenosis is extremely encouraging.

Adult↗
PubMed1981

Stones or clots in the biliary tract. A diagnostic dilemma.

Clots, which not uncommonly form in the biliary tract, may cause diagnostic errors. They often result from minor hemobilia, small hemorrhages into the ducts, mostly occurring in connection with gallstone attacks or biliary surgery. Hemobilia may also, as hematuria and epistaxis, complicate anticoagulant therapy. The blood will generally flow inconspicuously into the intestine, and even if it coagulates, the clots tend to dissolve rapidly through the fibrinolytic activity of the bile. For various reasons they may occasionally escape dissolution and remain in the ducts. fibrin clots can also form in inflammatory biliary tract disease. Clots will easily be mistaken for gallstones and treated as such. Cases are presented which illustrate why they are so often overlooked or misinterpreted. Cholangiography may be of diagnostic help since the clots show certain characteristics, appearing as casts of the biliary tract, often adhering to the walls, sometimes with indistinct borderlines. During 1980 we performed 128 cholecystectomies for suspected gallstone disease. Common duct exploration was done in 18 because of contrast defects in the cholangiogram. In 15 cases these were due to gallstones, in 3--one out of six--they were caused by blood clots. The comparatively high frequency with which clot formation in the biliary tract is observed when attention is given to this possibility, compared to the number of misinterpretations that otherwise occur leads to the conclusion that common duct clots are more common and of greater significance than is generally assumed.

Aged↗