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Biomedical subjects

B Meier

Publications and source records attributed to B Meier.

At least 235 records · Page 13Linked to original sources
PubMed1995

[Cardiac interventions in Switzerland 1993].

As in the previous years, a survey of all cardiac invasive, interventional and surgical procedures was carried out 1993 by a detailed questionnaire, which was sent to all Swiss centers. The resulting data are presented here for the whole of Switzerland and per individual center. The outstanding findings are: For the first time, more coronary angioplasties than coronary bypass graft operations were performed. At the same time, angioplasty in two or more vessels during the same session was attempted in 10% only. Overall the coronary stent represents the most frequently used new device in interventional cardiology in Switzerland, but large differences regarding the incidence of stent implantations exist among the centers. Compared with the public or university hospitals, the private centers have increased their interventional and surgical volume dramatically during the past years.

Angioplasty, Balloon, Coronary↗
PubMed1995

[Percutaneous valvuloplasty in the treatment of mitral stenosis: results in Geneva].

Percutaneous balloon valvotomy is a recognized form of treatment of mitral stenosis. In Geneva between 1986 and 1993, 62 procedures were attempted in 60 patients (87% females) aged 48 +/- 17 years (12 to 80 years). Patient selection was based on symptoms (NYHA class), echocardiography (valve area, Boston score), and hemodynamics. 11 patients (18%) had undergone surgical commissurotomy in the past, 28 patients (47%) were in atrial fibrillation, and 12 patients (30%) had a history of peripheral emboli. Mild or moderate mitral insufficiency was present angiographically in 17 patients (28%) and echographically in 42 patients (70%). Esophageal echocardiography was performed in 37 patients (62%) before the procedure. In 52 patients (84%) a single balloon (Inoue technique) was used. Technical success was obtained in 59 procedures (95%). Following the procedure, mitral valve area increased from 1.1 +/- 0.3 to 1.8 +/- 0.3 cm2 (p < 0.0001) at echocardiography and from 1.1 +/- 0.3 to 1.9 +/- 0.5 cm2 (p < 0.0001) based on invasive hemodynamic data. There were 5 complications directly related to the procedure. In two cases cardiac tamponade developed, one after pericardial perforation during the transseptal approach and one because of left ventricular perforation. The second patient required surgical treatment. In two other cases, a moderate pericardial effusion without clinical consequences was observed. In one case the venous sheath malfunctioned, rendering surgical repair of the right femoral vein necessary. A residual atrial septal defect was observed at echography in 13 patients (22%). Mitral insufficiency was increased in 6 patients (10%) angiographically and in 9 patients (15%) at echocardiography.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

[Beta blockers in stable angina pectoris].

A concise overview of the pathophysiologic mechanisms of stable angina pectoris and the attempt to deduce its rational therapy presented. The possible mode of action of are beta-adrenergic blockers and calcium entry blockers is described. It becomes evident that the results of clinical trials do not perfectly correspond to the present pathophysiological models. The pharmacological properties of beta-adrenergic blockers are summarized with regard to the therapy of stable angina pectoris. The value of a combination of beta-adrenergic blockers and calcium entry blockers in the therapy of stable angina pectoris is discussed. Finally, the prognostic importance of silent ischemia with regard to stable angina pectoris and the possible therapeutic consequences are discussed.

Adrenergic beta-Antagonists↗
PubMed1995

[Interventional therapy in unstable angina pectoris].

The presence of unstable angina points to the severity of the culprit lesion, but it does not necessarily inform about the extent of coronary artery disease. Coronary angiography should be performed as soon as possible, with the exception of very old patients. If the lesion identified as the cause of unstable angina is amenable to coronary angioplasty (PTCA), the latter can be performed immediately. However, in patients with unstable angina due to an unstable plaque (fissured atheroma with partial thrombosis), acute occlusions occur more often than with routine PTCA, leading to higher perinterventional infarction and death rates and increased need for emergency bypass surgery. In cases with large intracoronary thrombi that are not completely occlusive, preliminary therapy with heparin for a few days or a fibrinolytic agent for a few hours may be wise to diminish the risk of acute vessel closure after PTCA. Sufficient clearing of the thrombus by these measures obviating the need for further interventions may occur occasionally. The point in time of coronary angiography and PTCA in unstable angina is controversial. Medical stabilization may be tried, and it appears that pretreatment with heparin and aspirin may decrease the high complication rate typical for PTCA in the acute phase. On the other hand, PTCA should not be postponed for too long, because of the risk of intercurrent infarction.

Angina, Unstable↗
PubMed1995

Stenting with the half (disarticulated) Palmaz-Schatz stent.

A total of 110 half (disarticulated) Palmaz-Schatz coronary stents were implanted in 102 patients. Procedural success rate was 98%. Elective stenting was performed in five patients. The others received half stents for bail-out situations, including short dissections, relapsing stenoses, dissections not adequately covered by a full stent, ostial stenoses, and thrombus containing lesions. Seventeen patients received no anticoagulation except aspirin. Complications included one procedural death, three acute occlusions (resulting in one Q and two non-Q wave myocardial infarctions), and one non-Q wave infarction related to side branch closure. Stenting with the half Plamaz-Schatz coronary stent is an effective technique. It allows stenting in situations where a full stent may not be ideally suited. Use of only half a stent reduces thrombogenicity and halves costs.

Adult↗
PubMed1995

Coronary stenting without anticoagulation.

Stents are useful bail-out devices in coronary angioplasty. They are also used electively for situations associated with poor angioplasty results (e.g., restenotic lesions, venous grafts) and may reduce restenosis rates. However, the significant incidence of stent thrombosis necessitated aggressive anticoagulation with associated hemorrhagic complications. This remains a major limitation of stenting. We present our experience of stenting with half (disarticulated) Palmaz-Schatz coronary stents in eight consecutive patients, managed with aspirin alone. No patient experienced acute or subacute stent thrombosis.

Adult↗
PubMed1995

Combined percutaneous balloon mitral valvotomy and coronary angioplasty with stent implantation.

A patient with symptomatic pliable mitral stenosis and a significant lesion in the right coronary artery underwent combined interventional procedures during a single session. After an uneventful transseptal puncture that allowed full anticoagulation with heparin, a percutaneous transluminal coronary angioplasty was performed, yielding an unsatisfactory result and necessitating stent implantation. Thereafter, mitral stenosis was relieved by percutaneous balloon valvotomy. The specific problems arising from the combination of the two procedures are discussed.

Aged↗
PubMed1995

Spontaneous conscious covert cognition states and brain electric spectral states in canonical correlations.

Correlations between subjective, conscious, spontaneous cognitions and EEG power spectral profiles were investigated in 20 normal volunteers (2 sessions each) during relaxation-drowsiness-sleep onset. Four-channel EEG (temporal-parietal and parietal-central, left and right) was continuously recorded. The subjects were prompted 15 times per session to give brief reports of their ongoing thoughts. The reports were rated on 23 scales, and the 16 seconds of EEG recording preceding the prompts were spectral analyzed. Canonical correlation analysis was applied to the data (23 cognition ratings and 124 EEG spectral values for each of the 538 prompts). Four of the 23 pairs of canonical EEG variables and cognition variables were significant (p < 0.016) with correlation coefficients ranging from 0.78 to 0.62. The four pairs of canonical variables showed distinctive features in EEG spectra and cognition styles. The results demonstrate ruleful correspondences between EEG states and spontaneous, conscious, covert, cognitive-emotional states in a no-input, no-task, no-response paradigm.

Adult↗
PubMed1995

Coronary interventions in Europe 1992. The Working Group on Coronary Circulation of the European Society of Cardiology.

The general practice of coronary interventions is influenced by various aspects, traditional, cultural, socioeconomic and personal. The aim of this survey was to collect the data on coronary intervention in all member countries of the European Society of Cardiology. The data from 12 of the 35 national members were missing or grossly incomplete and were therefore excluded from the analysis. CORONARY ANGIOGRAPHY: The total number of coronary angiograms was reported as 683,888, an incidence of 1009 +/- 1021 per million inhabitants (range 9 (Romania) to 3076 (Germany)). Germany (246,115 cases), France (144,754), the United Kingdom (76,296), Italy (45,517) and Spain (43,495) registered 81% of all the coronary angiograms performed. PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY: (PTCA) The total number of reported PTCAs was 147,729, which on average accounted for 19 +/- 11% (range 2 (Lithuania) to 53% (Netherlands)) of the coronary angiograms. Most of the PTCAs (82%) were confined to a single vessel. The highest incidence of multivessel PTCA was reported from Slovakia (28%). PTCA took place immediately after the diagnostic study in only 18% of cases. Adjusted per capita, Germany ranked first with 703 PTCAs per million inhabitants, followed by Iceland (619), France (614), Belgium (568) and Austria (485). A major in-hospital complication was reported in 2.5% of the patients undergoing PTCA: 0.4% hospital deaths, 1.0% emergency CABGs and 1.1% myocardial infarctions. NEW DEVICES: Stents were implanted in 3211 patients (2.7% of all PTCA patients), equally distributed between emergency situations (53%) and elective procedures. Other interventional devices were applied in 4133 cases (2.8% of all PTCA cases): directional atherectomy, rotablator, transluminal extraction catheter, laser and Rotacs accounted for 1452, 1232, 55, 558 and 222, respectively. Coronary ultrasound (1350 cases) and coronary angioscopy (373 cases) were rarely performed. CORONARY ARTERY BYPASS GRAFTING (CABG): A total of 63,477 patients underwent CABG in the reporting centres resulting in a PTCA/CABG ratio of 2.3. A significant under-reporting of surgery in the participating centres must be assumed. CONCLUSIONS: Although partial reporting might bias conclusions, several findings of this survey are noteworthy: (1) PTCA was a well accepted treatment for coronary artery disease, (2) PTCA was applied more frequently than CABG, (3) there was an extremely wide range of coronary angiography and PTCA performed per million inhabitants, (4) the most common additional procedure was stent implantation, but other new devices were only rarely applied.

Angioplasty, Balloon, Coronary↗
PubMed1995

Percutaneous transluminal coronary angioplasty of the left main coronary artery with a 5Fr catheter system.

The protected left main coronary artery (LM) is accessible to percutaneous transluminal coronary angioplasty (PTCA), and the procedure is usually performed with large size catheter systems. This report describes a successful PTCA of a partially protected LM through a 5Fr diagnostic catheter system in a patient with previous coronary artery bypass grafting. Such an approach is time- and cost-efficient when combined with the diagnostic study.

Angioplasty, Balloon, Coronary↗
PubMed1995

The Magnum wire for percutaneous coronary balloon angioplasty in 723 patients.

The experience of the use of the Magnum wire in a single center is reported. Percutaneous balloon coronary angioplasty, using the Magnum 0.021 inch wire, was attempted in 723 patients with 850 lesions; of these, 453 (53%) were chronic total occlusions and 50 (7%) recent occlusions of less than 24 hours (patients presenting with acute myocardial infarction). The overall technical success rate per lesion was 655/850 (77%). It was 255/280 (91%) for non-total lesions, 311/453 (69%) for chronic total occlusions, 53/67 (79%) for functional (TIMI grade I) occlusions, and 36/50 (72%) for recent occlusions. Clinical success was achieved in 196/232 patients (84%) with non-total lesions, in 292/436 (67%) with total chronic occlusions, in 49/65 (75%) with functional occlusions, and in 34/50 (68%) with recent occlusions. Complications (significant creatine kinase rise, new Q-wave infarction, need for coronary bypass surgery or in-hospital death) occurred in 7% (3% if patients presenting with unstable ischemic syndromes were excluded from the analysis). These data confirm that the use of the Magnum wire has success rates competitive with other systems both in setting of chronic total occlusion and in that of routine percutaneous transluminal coronary angioplasty.

Adult↗
PubMed1995

[Blood thinning in heart patients].

Virtually all modalities of anticoagulation play a role in cardiology. For primary prevention, aspirin showed no effect in a British study, but reduced the incidence of myocardial infarction by 44% per year in an American trial concerning men and by 32% concerning women. In patients with pre-existing coronary artery disease, the effect was even more marked. For unstable angina, several regimens were tested. Aspirin and heparin were the drugs most frequently used, either as single therapy or combined. They both proved efficacious, and so did ticlopidine. Promising results were also obtained with hirudin, a specific thrombin antagonist. For the treatment of acute infarction, the roles of aspirin and vitamin-K antagonists are soundly established. Aspirin reduces not only mortality but also other cardiac events. Coumadin has an even more impressive record. It reduces mortality by 25 to 35% and recurrent infarctions by 50%, with an acceptable risk for cerebral hemorrhage (1 to 2% per year). After coronary revascularization, aspirin is the therapy of choice for both coronary angioplasty and bypass surgery, with a few exceptions (poor left-ventricular function, stents in small arteries, etc.). Ticlopidine seems to be a valid alternative. Artificial heart valves require coumadin, with the exception of bioprosthesis in patients without additional risk factors. The same holds true for atrial fibrillation, except for the lone variety in young patients. Every cardiologist has to be cognizant of the armamentarium of anticoagulants and thoroughly trained in their indications and handling.

Adult↗