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Biomedical subjects

J H Vogel

Publications and source records attributed to J H Vogel.

At least 19 recordsLinked to original sources
PubMed1992

Changing trends for surgical standby in patients undergoing percutaneous transluminal coronary angioplasty.

In 1988 the American College of Cardiology/American Heart Association (ACC/AHA) task force subcommittee on Guidelines for Percutaneous Transluminal Coronary Angioplasty (PTCA) recommended that an experienced cardiovascular surgical team be available within the institution for emergency surgery for all angioplasty procedures. The subcommittee felt strongly that this requirement allowed for no exception, stating that it could not condone existing arrangements that required the transportation of patients to off-site surgical facilities for emergency cardiac surgery. Such arrangements failed to meet the necessary standards of care exercised by prudent physicians. Interventional cardiologists are recognizing that it may be prudent for the ACC/AHA task force to revise its 1988 guidelines. Improved operator technique and new technologic advances, such as lasers, atherectomy devices, stents, and perfusion pumps and balloons, have helped extend the reach of PTCA to more seriously ill patients. With new technologies for angioplasty and an increased awareness of risk factors, active standby can be markedly reduced, thereby resulting in enormous cost reductions and in more appropriate patient care.

Angioplasty, Balloon, Coronary↗
PubMed1992

Coronary angioplasty in high-risk patients with left main coronary stenosis: results from the National Registry of Elective Supported Angioplasty.

To assess the outcome of PTCA in circulatory supported patients with left main coronary artery (LMCA) stenosis, the National Registry of Elective Supported Angioplasty data bank was searched. Patients entered in the registry were considered high-risk PTCA and the PTCA was performed using percutaneous cardiopulmonary bypass (PCPB). Criteria for high risk was left ventricular ejection fraction less than or equal to 25% or a target lesion supplying greater than or equal to 50% of functioning myocardium. Of 455 patients entered in the registry, 61 (13.3%) had LMCA stenosis greater than or equal to 60%. There were 42 patients in whom the PTCA target vessel was the LMCA (PTCA-LMCA) and 19 in whom it was vessel(s) other than the LMCA (PTCA-OTHER). The mean age was similar in the 2 groups (65 +/- 10 vs. 68 +/- 9 yrs, p = ns). The left ventricular ejection fraction (LVEF) was higher in PTCA-LMCA than in PTCA-other (38 +/- 16% vs. 27 +/- 16%, p less than 0.05). The number of vessels dilated/patient was higher in PTCA-LMCA than in PTCA-OTHER (2.1 +/- 1.0 vs. 1.1 +/- 0.3, p less than 0.001). There were a total of 10 in-hospital deaths (16%) in patients with LMCA greater than or equal to 60% stenosis. This exceeds the mortality of the patients with less than 60% LMCA stenosis entered in the registry (4.5%, p less than 0.001). There were 6 in-hospital deaths (14%) in PTCA-LMCA and 4 (21%) in PTCA-OTHER (p = ns).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1991

Management of acute myocardial infarction 1990: a perspective.

Rising costs have reached a point at which physicians must assume a major role in dealing with the cost of medicine. Little information is available regarding actual practice at the community hospital level. In order to develop some insight on this issue, a survey of cardiovascular specialists was conducted regarding management of acute myocardial infarction in 1990. The results indicate a major lack of correlation between efficacy, cost, and practice patterns in terms of current knowledge. Perhaps legal concerns have contributed to these current practice patterns. Clearly, aside from choice of thrombolytic agent and/or PTCA, early treatment of acute myocardial infarction has emerged as a most important factor in reducing mortality.

Angioplasty, Balloon, Coronary↗
PubMed1989

Percutaneous (nonsurgical) supported angioplasty in unprotected left main disease and severe left ventricular dysfunction.

A 69-year-old patient with the equivalent of severe, unprotected left main coronary artery disease associated with marked left ventricular dysfunction with ventricular aneurysm who had Class IV angina, underwent supported angioplasty utilizing a total percutaneous approach. The patient tolerated occlusion of his main left coronary artery for a total of 7 minutes without difficulty, during dilatation of left anterior descending and two circumflex lesions. He was discharged the following day, symptom free.

Aged↗
PubMed1988

Intravenous streptokinase in acute myocardial infarction at the community hospital: a six-year experience.

The efficacy of intravenous streptokinase in the initial management of acute myocardial infarction was evaluated over a 6-year period in 130 patients admitted to 3 community hospitals. Most patients were admitted within 2 hours of onset of symptoms and received 1.5 million units of streptokinase over a 30- to 60-minute period. Clinical observations and serial creatine phosphokinase-MB were indicative of vessel patency in 115 (88%) of the patients after initiation of thrombolysis. Of this group, 105 underwent catheterization, and recanalization was demonstrated in 97 (92%). Fifty percent of the patients who underwent reperfusion were subsequently maintained with medical therapy; 50% underwent either percutaneous transluminal coronary angioplasty or coronary artery bypass surgery. Major morbidity was confined to hematomas; no cerebral bleeding was encountered. There was 1 early death from cerebral thrombosis and 2 late deaths, 1 to cancer and 1 to myocardial infarction. These findings suggest the benefit of intravenous streptokinase thrombolysis in patients with acute myocardial infarction presenting within 3 hours of onset of pain, unless specific potential bleeding problems exist or in the case of certain very elderly persons. In addition, the trial demonstrated the feasibility of triaging patients who have undergone lytic therapy to a central facility for catheterization and management.

Adult↗
PubMed1977

A theoretical model of regionally ischemic myocardium.

The isometric tension development of a one-dimensional regionally ischemic muscle was analyzed theoretically. The model consist of a one-dimensional normal segment in series with a one-dimensional ischemic segment. Each segment is modeled as a three-element muscle. The inputs to the various elements, except the contractile element in ischemic segment, were obtained from published data for cat papillary muscles. To be consistent with segment length measurements on ischemic canine hearts, it was assumed that the ischemic contractile element contracted normally at the beginning of contraction and then at some tension, TM, fell behind in its rate of tension development compared to the contractile element in the normal segment. Rate of tension development of various lengths of the ischemic segment and strengths of the ischemic contractile element. At the tension, TM, the ischemic segment begins undergoing paradoxical expansion and, simultaneously, as a result of the expansion. the time derivative of the tension produced by the regionally ischemic muscle exhibits a sudden decrease.

Animals↗
PubMed1976

A simple method for calculating left ventricular functions from angiographic data using a programmable hand calculator.

The end diastolic volume and systolic ejection fraction have gained increasing acceptance as important indicators of ventricular performance. Time consuming calculations and lack of computer facilities have hindered the emergence of these calculations as a routine part of cardiac catheterization studies. The introduction of the programmable hand calculator has provided means for rapid analysis of ventricular volume data in an efficient and inexpensive manner. In this paper the step-by-step procedure for programming the hand calculator is given, as well as instructions for entering raw data and obtaining final calculations. Programs are given for both single plane and biplane cine angiographic studies.

Angiography↗