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Biomedical subjects

M Leschke

Publications and source records attributed to M Leschke.

At least 73 records · Page 4Linked to original sources
PubMed1996

Acute myocardial infarction with origin of the left circumflex coronary artery from the right (anterior) aortic sinus with retroaortic course to the left atrioventricular sulcus.

The case of a 17-year-old boy is described, who had myocardial infarction during scholastic sports 15 minutes after scrotal trauma. Cardiac catheterization revealed a nonstenosed aberrant left circumflex artery originating from the right (anterior) sinus of Valsalva with retroaortic course, which has to be regarded the infarct vessel according to electrocardiographic, ventriculographic, and scintigraphic findings.

Adolescent↗
PubMed1996

[Cardiosurgical therapy of coronary heart disease in terminal kidney insufficiency].

OBJECTIVE: To determine retrospectively the complications and long-term results of aortocoronary bypass grafting in patients with end-stage renal disease. PATIENTS AND METHODS: 65 patients with coronary heart disease (CHD) and on dialysis (54 men, 11 women; average age 56.9 +/- 8.1 years) underwent aortocoronary bypass grafting between 1982 and 1992. Mean duration of dialysis (haemo- or peritoneal) was 41.1 +/- 45.0 (1-215) months. All patients had had haemofiltration treatment in conjunction with the bypass operation. RESULTS: Coronary angiography demonstrated triple-vessel disease in 40 patients (62%). Average number of bypasses was 2.8 per patient. Perioperative death rate was 4.6%. 95% of survivors were free of symptoms 6 months postoperatively. Long-term survival rate was 71% after 3 years and 55% after 5 years. CONCLUSION: Aortocoronary bypass grafting for CHD in patients with end-stage renal disease can be performed with a low perioperative mortality rate and significantly improves symptoms.

Adult↗
PubMed1996

Long-term intermittent urokinase therapy in patients with end-stage coronary artery disease and refractory angina pectoris: a randomized dose-response trial.

OBJECTIVES: This dose-response study was designed to test two low dose regimens of urokinase administered over a prolonged time period in patients with chronic refractory angina pectoris with respect to effects on clinical symptoms and objective variables of myocardial ischemia. BACKGROUND: Patients with severe and chronic refractory angina pectoris in end-stage coronary artery disease represent an increasing clinical problem. Favorable therapeutic effects on myocardial ischemia have been reported for long-term application of low dose urokinase. METHODS: Ninety-eight patients with chronic refractory and end-stage coronary artery disease were randomly assigned to two treatment groups: group A (49 patients) received 50,000 IU and group B (49 patients) 500,000 IU of urokinase as an intravenous bolus infection three times a week over a period of 12 weeks. Variables evaluated were number of weekly anginal events, data from ergometric exercise testing with simultaneous electrocardiographic registration, semiquantitative evaluation of Tc-99m 2-methoxy isobutyl isonitrile (MIBI) scans and rheologic variables. RESULTS: After 12 weeks of treatment, anginal symptoms (events/week) were reduced significantly in group B by 70% compared with 24% in group A (p < 0.001). Fibrinogen decreased by 3% in group A and by 33% in group B (p < 0.001). Plasma viscosity and red blood cell aggregation were reduced by 6.4% (p < 0.001) and 19.9% (p < 0.001), respectively, in group B. Objective variables of myocardial ischemia were improved significantly in group B only. No cumulation of coronary ischemic events was observed in group B. CONCLUSIONS: Long-term intermittent urokinase therapy in an applied dose of 3 X 500,000 IU/week represents an effective anti-ischemic and antianginal approach for patients with refractory angina pectoris and end-stage coronary artery disease. Apart from rheologic improvement, antithrombotic properties and plaque regression are likely anti-ischemic mechanisms.

Aged↗
PubMed1996

Chronic-intermittent urokinase therapy in patients with end-stage coronary artery disease and refractory angina pectoris--a pilot study.

Patients with coronary artery disease and severe angina pectoris refractory to conventional medical treatment (beta blockers, nitrates, calcium antagonists) and without the option for invasive revascularization procedures represent an increasing clinical problem. For these patients, chronic-intermittent urokinase therapy has been developed. Twenty patients received 500,000 IU urokinase as intravenous bolus injection 3 times a week over a period of 12 weeks. The average reduction in anginal symptoms in 19 patients was 74%, from 23.5 +/- 10.8 to 5.2 +/- 4.8 events/week (p < 0.001); 1 patient was excluded from further treatment because of an increase of > 66% in anginal events. Fibrinogen decreased by 34% from 370 +/- 57 to 244 +/- 44 mg/dl (p < 0.001), the rheological parameters plasma viscosity by 6.1% from 1.39 +/- 0.04 to 1.31 +/- 0.03 mPas (< 0.001), and red blood cell aggregation by 18% from 13.9 +/- 2.4 to 11.2 +/- 2.2 (p < 0.001). Exercise tolerance increased by 51%. Average ST-segment depression decreased from 0.16 +/- 0.10 to 0.12 +/- 0.09 (p < 0.01). After 12 weeks of follow-up, angina pectoris and fibrinogen levels were still significantly reduced compared with baseline values. Chronic-intermittent urokinase therapy represents an effective anti-ischemic and antianginal approach in patients with refractory angina pectoris and end-stage coronary artery disease. Improvement of rheological blood properties and thrombolytic effects are likely therapeutic mechanisms.

Aged↗
PubMed1996

Selective impairment of nitric oxide dependent vasodilation in young adults with hypercholesterolaemia.

OBJECTIVE: To investigate comparatively flow response of resistance arteries to exogenous and endogenous nitric oxide in young adults with high serum cholesterol. BACKGROUND: Impaired vascular effectiveness of endogenous and exogenous nitric oxide may be considered to unmask impairment of its anti-atherogenic properties. It may thus represent a valuable early diagnostic index for these young adults at high risk for developing atherosclerosis. METHODS: In 10 patients with elevated plasma levels of low-density lipoprotein (high cholesterol group, age 34 +/- 5 year; (mean +/- SEM) level of low-density lipoprotein 5.2 +/- 0.5 mmol/l) and 12 age-matched control individuals (control group, 34 +/- 3 years; level of low-density lipoprotein < 3.9 mmol/l), forearm blood flow was measured by venous occlusion plethysmography at rest, during reactive hyperaemia after 3 min no-flow ischaemia, and during local intra-arterial infusions of acetylcholine, bradykinin, sodium nitroprusside and adenosine in increasing doses. RESULTS: In both groups resting forearm blood flow was similar and was dose-dependently increased by each vasodilator. In the hypercholesterolaemic patients compared with control subjects maximal forearm blood flow was significantly impaired after stimulation of endogenous nitric oxide synthesis by acetylcholine and bradykinin and during infusion of the nitric oxide donor sodium nitroprusside (acetylcholine: -19%, bradykinin: -29%, sodium nitroprusside: -24% versus control individuals; P < 0.05). In contrast, adenosine-dependent vasodilation and peak flow during reactive hyperaemia were similar in both groups. CONCLUSION: Excess of low-density lipoprotein cholesterol leads to selective impairment of nitric oxide-dependent vasodilation even in young adults, whereas adenylylcyclase-dependent vasodilation of vascular smooth muscle and maximal dilatory capacity are preserved. In view of the anti-atherogenic properties of nitric oxide, it appears highly desirable to detect this selective vascular dysfunction early in these young adults at high risk of developing atherosclerotic lesions.

Acetylcholine↗
PubMed1996

[Isovolemic hemodilution in coronary heart disease--clinical and hemodynamic effects].

Clinical and hemodynamic effects of isovolemic hemodilution (HD) were evaluated in 12 patients (aged 59 +/- 8 years) with severe multivessel coronary artery disease (CAD) and angina pectoris grade III (Canadian Cardiovascular Society classification) despite high-dose medical treatment. In none of these patients was aortocoronary bypass grafting or percutaneous transluminal coronary angioplasty possible. Prior to HD and after 3 months of HD the incidence of angina pectoris was determined by means of questionnaires; hemodynamic measurements were performed with right heart catheterization at rest and during exercise. After 3 months of HD hematocrit was reduced from 46.2 +/- 1.3% to 38.5 +/- 0.5%. The weekly incidence of angina pectoris was unchanged (19 +/- 7 before, 17 +/- 8 after HD). Cardiac index was 2.5 +/- 0.7 1/min/m2 at rest and 3.9 +/- 1.0 1/min/m2 during exercise before, 2.6 +/- 0.5 1/min/m2 at rest and 3.9 +/- 0.8 1/min/m2 during exercise after HD. Stroke volume index did not increase significantly neither at rest nor during exercise after HD. Initially, systemic vascular resistance decreased from 1659 +/- 603 to 1398 +/- 420 dyns/cm5 during exercise; after HD it was 1522 +/- 551 (rest) and 1283 +/- 348 dyns/cm5 (exercise). Mean pulmonary artery pressure (PAP) and wedge pressure (WP) were unchanged at rest (PAP: 19.9 +/- 6.7 mm Hg before, 19.2 +/- 6.5 mm Hg after HD; WP: 10.8 +/- 5.5 mm Hg before, 10.7 +/- 4.3 mm Hg after HD) and during exercise (PAP: 43.0 +/- 9.9 mm Hg before, 42.8 +/- 8.9 mm Hg after HD; WP: 30.8 +/- 4.6 mm Hg before, 30.6 +/- 6.5 mm Hg after HD). In conclusion, in patients with CAD isovolemic HD does not reduce angina pectoris but also does not induce clinical deterioration. Furthermore, isovolemic HD does not worsen the hemodynamic effects of severe CAD with impaired left ventricular function.

Adult↗
PubMed1996

[A Q-fever pneumonia epidemic in Dusseldorf].

There was an unusually high incidence of atypical pneumonias in the catchment area of the Rhine river near the university of Düsseldorf in July 1994 during a long period of hot and dry weather. The 18 patients described in this paper (5 women and 13 men) complained of sudden onset of fever up to over 40 degrees C, often associated with severe headache and dry cough. Almost all of these patients had previously been healthy and active and of young to middle age (average 38 years) without any bronchopulmonary anamnesis. Radiology revealed that all the patients had in most cases defined pulmonary infiltrates without any specific preference for a particular site. Serology was initially negative, but four weeks later the complement fixation reaction titre was positive for Coxiella burnetii antibodies in 14 patients (78%). All patients became symptom-free within a few days'time when treated with a combination of antibiotics which included doxycycline, whereas the infiltrates receded completely only after several weeks. The occurrence of pulmonary Q-fever in a large northern German conurbation had been rare at that time. Such epidemics, however, were also noted in Berlin (1992) and in Dortmund (1993). The epidemic reported in this article probably originated from one of the frequent flocks of sheep grazing along the banks of the Rhine river near Düsseldorf. The infections were probably acquired by inhalation of airborne organisms in infected aerosols derived from infected sheep, promoted by the long-term very hot and dry weather which was at the same time very windy, leading to an unusually extensive spreading of the pathogens throughout a very large infected aerosol area.

Adult↗
PubMed1996

[Endothelin and big endothelin in coronary heart disease and acute coronary syndromes].

Endothelin (ET), the most potent endogenous vasoconstrictor with mitogenic potency, is generated from its precursor big-endothelin (BET) in a proteolytic process and discussed as a pathogenetic factor in coronary artery disease and in the acute coronary syndromes. Several studies documented elevated plasma endothelin concentrations in acute myocardial infarction, but conflicting results were reported in patients with stable and unstable angina. Only few studies determined big endothelin, although it half-life and plasma concentrations are higher in comparison to endothelin. ET and BET levels (Radioimmunoassay, Biomedica GmbH, Vienna) were determined in patients with stable angina (SAP, n = 20), unstable angina (IAP, n = 12), acute myocardial infarction (AMI, n = 12) and healthy subjects (NP, n = 11). The concentrations of ET and BET (median (minimum-maximum) in fmol/ml) of the patients with stable angina (SAP: ET 0.7 (0.3-1.1); BET 1.7 (0.7-2.9)), unstable angina (IAP: ET 1.0(0.5-1.7); BET 2.5 (1.3-4.1)) and acute myocardial infarction (AMI: ET 1.2 (0.6-2.3); BET 3.6 (3.2-5.3)) showed a significant difference compared to controls (NP: ET 0.5 (0.4-0.7); BET 1.4 (1.1-1.7)) (SAP vs. NP: ET p < 0.01; BET p < 0.05; IAP and AMI vs. NP: ET and BET p < 0.001). Also, the concentrations of the peptides differed significantly dependent on the clinical severity of coronary artery disease (AMI vs. SAP: ET and BET p < 0.001; AMI vs. IAP: BET p < 0.05; IAP vs. SAP: ET p < 0.05; BET p < 0.01). Twelve of 15 patients with big endothelin concentrations over 3 fmol/ml suffered acute myocardial infarction. Seven of 12 patients with AMI showed elevated ET and BET concentrations before the increase of creatinecinase. There was no correlation between number of risk factors per patient, cholesterin and subfractions, severity of CAD classified in one-two-three-vessel disease or coronary score according to modified criteria of the American Heart Association (AHA). We conclude that in patients with coronary artery disease endothelin and big endothelin levels are elevated and related to the clinical and not to the morphological severity of coronary artery disease. Big endothelin is the more sensitive parameter in comparison to endothelin and indicates a severe course of myocardial ischemia in patients with unstable angina. The development of assays with the possibility of a quick determination of the peptides may be valuable for risk stratification of acute coronary events.

Adult↗
PubMed1995

[Acute myocardial ischemia in spontaneous coronary artery spasm].

AIM OF STUDY: To discover what factors indicate spontaneous coronary artery spasms as a cause of myocardial ischaemia. PATIENTS AND METHOD: In a retrospective analysis 15 of 1407 consecutive patients who had undergone coronary arteriography (six women and nine men; mean age 47 +/- 11 years) had acute ischaemia due to spontaneous coronary artery spasms. The clinical findings at the time of first investigation and during the follow-up period (mean of 29 [3-65] months) were evaluated. RESULTS: The most common risk factors were hypercholesterolaemia (> or = 200 mg/dl) in ten patients (66%) and heavy nicotine consumption > or = 20 cigarettes per day) in eight patients (55%). Of the patients with angina at rest nine had reversible ST elevations, six had terminal T negativity in the ECG and an increased incidence of ventricular arrhythmias (n = 6). At time of hospitalization ten patients had acute myocardial ischaemia and five had signs of acute myocardial infarction (maximal creatine kinase concentration: 121-2980 U/l). Acute coronary angiography revealed circumscribed coronary artery constriction, reversible with nitroglycerin, with stenosis of < 70% in five patients and of > or = 70% in six, as well as intermittent vessel occlusion in four patients. Angiography showed smooth coronary artery walls in almost all instances. Angiographic evidence of circumscribed arteriosclerotic lesion with maximally 50% narrowing was present in six patients. CONCLUSION: Especially in younger, male patients with hypercholesterolaemia and heavy smoking recurrent anginal pectoris at rest, with reversible ECG signs of myocardial ischaemia but without advanced coronary sclerosis, speaks for spontaneous coronary artery spasms as the cause.

Acute Disease↗
PubMed1995

[Cyclosporin in severe steroid-requiring bronchial asthma].

BASIC PROBLEM: Treatment of chronic severe bronchial asthma with corticosteroids is inadequate in a minority of patients and is often accompanied by considerable side effects. Additional specific immunosuppression appears to be therapeutically promising. PATIENTS AND TREATMENT: Three patients (2 women, aged 44 and 29, a man aged 57 years), all with chronic severe asthma requiring corticosteroids, were given cyclosporin (mean dose 1.8 mg/kg; serum level 72 +/- 35 ng/ml) additional to conventional bronchospasmolytic drugs for 9 to 20 months. COURSE: The frequency and intensity of asthmatic attacks markedly decreased in all three patients. The mean peak-flow measurements in the mornings before broncholysis had increased by 23% over the precyclosporin level of the calculated normal value. Peak flow variability improved by 13%. The mean one-second forced expiratory volume (FEV1) rose from 37 to 66% of the normal value (P < or = 0.05) and correlated with the serum cyclosporin level (correlation coefficient 0.58-0.97). The frequency of acute severe asthmatic attacks (FEV1 < or = 40%) requiring additional hospitalization with intravenous administration of glucocorticoids fell by 30%. The systemic corticosteroid maintenance dosage could be significantly reduced or the drug discontinued in two patients. CONCLUSION: These observations indicate that cyclosporin can be useful in the treatment of selected cases of chronic severe steroid-refractory asthma. Prospective studies are needed to judge its long-term efficacy.

Adult↗
PubMed1994

[Acute coronary artery occlusion after elective percutaneous transluminal coronary angioplasty. Incidence and therapy in 5000 consecutive patients].

Five thousand consecutive percutaneous transluminal coronary angioplasties (PTCA) were electively performed between January 1988 and June 1993. They were analysed for the incidence of acute coronary occlusion, its acute treatment and subsequent course. In 133 patients (2.7%) the occlusion persisted. Recanalization by repeat PTCA was attempted in all of them, but succeeded in only 68 (51%). In 65 patients recanalization was impossible. In 25 of the latter--patients with a small infarct vessel and infarction having already occurred in the vessel's supply area while the haemodynamics remained stable--conservative treatment was practised. Acute surgical revascularization was undertaken in 30 patients (23%) with a large area and/or haemodynamic instability. In all, 14 patients died (overall death rate 0.28%, death rate of patients with occlusion 11%), ten of them before operative intervention was possible.--Not all coronary artery occlusions can be treated nonsurgically. Consequently, availability of surgical intervention at the place of elective PTCA is mandatory.

Acute Disease↗