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P Jerie

Publications and source records attributed to P Jerie.

At least 19 recordsLinked to original sources
PubMed2004

[Thirty years of the balloon catheter--A. Grüntzig and percutaneous balloon angioplasty].

Percutaneous transluminal coronary angioplasty--PTCA--will forever be linked with A. Gruentzig's name. Building on the work of Charles Dotter and Malvin Judkins be developped novel technique of revascularisation and established a new speciality - interventional cardiology. The aim of this article is to sum up the most important data on Gruentzig's revolutionary work. Andreas Roland Gruentzig was born on June 25, 1939 in Dresden, Germany. In 1957 he received his B. A. in Leipzig (German Democratic Republic). In 1958, Andreas emigrated to the German Federal Republic, received another B. A. in Heidelberg, and entered the Medical School in Heidelberg where he qualified in 1964. In 1969 he moved to Zurich, Switzerland, in the Dept of Angiology of the University Hospital. He soon appreciated the potential of recanalising partially occluded lower limb arteries using the Dotter-Judkins catheter but also recognised its risks. In 1972-1973 he developped his balloon catheter and performed the first femoral angioplasty in February 12, 1974, and in January 23, 1975 the first one using his new double-lumen catheter. The first experimental coronaroplasty in a dog followed in September 24, 1975. He presented his results with balloon catheters in November 15, 1976 in Miami. After a further period of arduous experimental research--stil manufacturing the catheters with his small crew in the kitchen--he dilated a stenosed coronary artery in a 37-year-old man on September 16, 1977 in Zurich, with immediate relief of symptoms. The results of PTCA in five first patients were published in the February 14, 1978 issue of Lancet; the coronarography in the first patient, on April 10, 2000, revealed normal patency of the site that had been dilated (Prof. B. Meier, Bern). However, the news in Zurich 1978 was received with a certain incredulity and Gruentzig was unable--in spite of Professor A. Senning's support--to obtain facilities to expand his research program and clinical activities. In September 1980 he accepted the Chair of Medicine (Cardiology) and Radiology with the additional title of Director of the Dept of Interventional Cardiology at Emory University in Atlanta, Georgia. Prof. Hurst gave him half of his office suite at Emory and later even further facilities to expand his program. Here, at Emory, Gruentzig gave 10 angioplasty courses and performed with Dr. S. King and Dr. J. Douglas 5000 PTCAs till 1985. Before reaching the peak of his scientific carrier, he died in a flying accident, with his second wife Margareth Ann, near Forsythe, Monroe County, Georgia, on October 27, 1985. His work was appreciated in tributes from the U.S.A., U.K., Switzerland and Germany, by many international awards and honors; numerous interventional laboratories in the world carry A. R. Gruentzig's name.

Angioplasty, Balloon↗
PubMed2003

[New aspects in clinical cardiology: sex-based differences in cardiovascular morbidity and mortality].

No relevant sex-based differences in hemodynamic parameters have been described until now but the course of any heart disease may be modified by factors that act differently in men and women. In a study comparing the incidence of heart disease and patient survival over the past 50 years, the incidence of heart failure was found to have declined in women but not in men. With increased sodium excretion and obesity, the hazard ratios for cardiovascular mortality were higher in women. A post-hoc subgroup analysis of the DIG study was conducted to assess potential sex-based differences in the effect of digoxin. The authors conclude that digoxin therapy is associated with an increased risk of death in women (P = 0.34). The comparison of the effects of digoxin was limited simply to gender only and no other subgroup analyses were preformed although the characteristics of the patients show significant differences in more than 20 parameters. Hence, the conclusion of these authors can hardly be accepted. Contrary to these partly conflicting data, the primary results from the Women's Health Initiative randomized controlled trial focused on defining the risks and benefits of hormone replacement in postmenopausal women give an unambiguous answer: combined estrogen/progestin therapy should not be initiated or continued for the primary prevention of coronary heart disease, furthermore, it increases the risks of cardiovascular disease, breast cancer, venous thromboembolism and biliary tract surgery.

Cardiotonic Agents↗
PubMed2002

[Cardiology 2001].

A review of the most important topics published during 2001 is presented. The Writing Committee of the American College of Cardiology and the American Heart Association decided to take a new approach to the classification of heart failure that emphasizes both the evolution and the progression of the disease, using potential risk factors and structural disorders as criteria to identify the severity of a heart failure syndrome. Similarly, an ACC/AHA Clinical Competence Statement on electrocardiography and ambulatory electrocardiography was published with a special emphasis on the computer interpretation of the electrocardiogram. Since various drugs were shown to induce electrocardiographic abnormalities as e.g. QT prolongation associated with ventricular tachycardias, the FDA decided to introduce higher regulatory requirements on the cardiac safety of novel drugs. In cardiovascular surgery Octopus off-pump bypass was demonstrated to be a safe procedure for carefully selected patients with multivessel coronary heart disease. Because of the extensive progress made in cardiovascular surgery, the management of severe heart failure has to be improved and early effective preventive measures have to be introduced to reduce the risk of intractable heart failure. The "New guidelines for evaluating acute coronary syndrome" stress the importance of early identifying and early treatment, including invasive strategy as PTCA with stenting.

Cardiology↗
PubMed2002

[The importance of electrocardiography in the development of new drugs--prolonged QT intervals as indicators of adverse effects].

Both experimental animal studies and clinical observations have shown that drugs from various indication areas, such as psychotropic agents and antiarrhythmics can induce disturbances of cardiac rhythm and electrocardiographic abnormalities. Particularly, QT interval prolongation is associated with distinctive polymorphic ventricular tachycardias and often causes syncopes or cardiac arrest that represent a high risk of recurrent events including sudden death. In the last decade, several drugs in different indication areas, possessing these effects were withdrawn from the market and approvals were postponed or even refused. These events led to higher regulatory requirements on the cardiovascular safety of new drugs, with a special emphasis on prolongation of the QT interval. This article reviews the use of preclinical and clinical electrocardiography, as well as the current problems during development of novel drugs and future strategy in clinical studies. Even though ECG proved to be a powerful and reliable tool for detection of cardiac serious adverse effects during development of drugs, it also needs to be used with increased attention in all patients treated with new drugs and drug combinations in clinical and ambulatory practice in order to ensure their safe use in a wide population, as well as in patients with concurrent cardiac risk factors.

Animals↗
PubMed2001

[Cardiology 2000].

In cardiovascular pharmacotherapy, the main focus is now on statins (HMG-CoA-reductase inhibitors) because of their antihyperlipidaemic and antiatherogenic effect. They are suggested to be beneficial also in senile dementia, stroke and osteoporosis and they can reduce incidence of ventricular arrhythmias in patients with cardioverter-defibrillator. In chronic heart failure, statins should be used with caution since reduced cholesterol levels relate to impaired survival. As an alternative to statins and fibrates, niacin therapy may be considered. ACE inhibitors are of proven benefit for patients with left ventricular dysfunction after acute myocardial infarction; however, in long-term treatment, their protective activity is not superior to that of beta-blockers, diuretics and clonidine. Ca-channel antagonists slightly increase the incidence of cardiovascular complications but reduce the incidence of stroke in high-risk patients. Biventricular pacing has been used with success in patients with severe heart failure and conduction disturbances, and the first permanent artificial ventricle was implanted to a patient with irreversible terminal heart failure in summer 2000. Cardiospecific troponin I may be an uninvasive marker of a procoagulant status indicating e.g. graft failure after cardiac transplantation; T-cadherin belongs to the cell-adhesion molecules and has a role in maintenance of cellular contacts which are critical for the vessel wall architecture. Etamoxir, originally developed for the treatment of diabetes II, has recently been shown to be a potential novel drug for heart failure. Routine use of nitric oxide after congenital heart surgery lessens the risk of pulmonary hypertensive crises.

Cardiac Pacing, Artificial↗
PubMed2000

[Cardiology at the end of the 20th century].

In autumn 1999 results of two well-controlled studies were published that are consistent with a frequent association between Helicobacter pylori seropositivity and coronary heart disease (CHD). Concerning the therapy of CHD, attention is mainly focused on new thrombolytic agents, bypass grafting (CABG) and balloon angioplasty (PTCA). In patients with intractable angina where aggressive medical therapy was exhausted and who were no longer candidates for CABG or PTCA, transmural laser revascularisation (TMLR), enhanced external counterpulsation (EECP) and spinal cord stimulation can be considered. TMLR was shown to improve symptoms but not myocardial perfusion; the preoperative mortality accounts for 10-20%. In hypertrophic obstructive cardiomyopathy, alcohol-induced transmural septal myocardial ablation (PTSMA) reduces both the symptoms and the left ventricular outflow tract gradient. Although the prevalence of hypertension emergencies has dramatically diminished, the number of hypertensive patients with heart failure and end-stage renal disease is increasing. It is important to detect and treat mild hypertensives in early stages, especially diabetics and younger women with additional risk factors and/or proteinuria. The choice and dosage of drugs is to be individualised. In chronic heart failure (CHF), the protective effect of ACE inhibitors, metoprolol and carvedilol has been repeatedly shown in CHF stage NYHA II and III. The merit of ACE inhibitor and beta-blockers in high doses remains questionable in old patients and those with severe CHF (NYHA IV). In the latter indication, spirolactone was successfully reintroduced. Eplerenone (epoxymexrenone) is a new aldosterone antagonist with little affinity to other steroid receptors and has therefore less undesirable effects than spirolactone. The body of knowledge in therapeutic and technical progress in medicine of the 20th century are summarised and their positive and negative consequences briefly discussed.

Cardiology↗
PubMed2000

[Clinical cardiology and physiology].

Recent concepts of cardiovascular pharmacotherapy are now mainly based on results of multicentre prospective studies performed in several countries worldwide. The main disadvantage of such studies is the heterogeneity of patient-groups compared, caused by ethnic differences, variability of criteria and diverse concomitant medication. To assert internal validity of data compared, substantial section of patients (80-99%) is often excluded before evaluation. Thus, there is always a lack of external validity--the data cannot be generalised and have only a limited predictive value for management of other groups or individual patients. Consequently, we still need reliable preclinical data from animal and human studies under well defined and uniform conditions. The importance of experimental and clinical physiology is demonstrated by well-established hemodynamic rules and pharmacodynamic correlations. Clinical physiology remains an indispensable foundation of clinical medicine which cannot be replaced by formal statistics.

Animals↗
PubMed1999

[Cardiology 1998].

In 1998, nitric oxide (NO) was extensively explored. First studies demonstrating a beneficial effect of inhaled NO in patients with pulmonary hypertension, right ventricular dysfunction and intractable heart failure were published. It was further shown, that, in patients with essential hypertension, impaired vasodilatation can be improved by vitamin C as an antioxidant, an effect that can be reversed by NO-synthase inhibition. Unlike arotinolol, which has no antioxidat effect, carvedilol is a beta- and alpha-blocker with antioxidative properties that may prevent the development of nitrate tolerance. In clinical cardiology, the main focus is on the prevention and therapy of coronary heart disease, heart failure and hypertension: a Task force report on the prevention of coronary heart disease in clinical practice. Proceedings on anticoagulant therapy and Guidelines for antithrombotic management were published in 1998. There is an agreement that in mild hypertension the decision how to treat should be based on the estimate of cardiovascular risk and not on an arbitrary blood pressure threshold. Diuretics and betablockers should be preferred unless they are contraindicated, or there are positive indications for other drug classes. Studies also strongly suggest that therapy with relatively small doses of two different classes of drugs is the effective way to treat the majority of patients and minimize side effects. In heart failure, the evidence for the current treatment with diuretics, ACE-inhibitors and digoxin, in selected patients, is well established.

Cardiovascular Diseases↗
PubMed1998

[What is arterial hypertension? The balance of 50 years of research and rational therapy].

Over the past years the understanding of the pathogenesis of hypertension has increased considerably and many new antihypertensive drugs have been introduced. However, only a minority of patients are treated effectively and there is still concern about full potential for reversing coronary heart disease in hypertensive patients. It is necessary to distinguish between the treatment of a hypertensive population selected in prospective studies and a representative individual patient. The heterogeneity of the population, the individual variability of blood pressure and the rigid numerical criteria to define hypertension and normotension are the main sources of errors and false evaluations. In the future, ambulatory blood pressure measurement devices and better designed trials that conform better to clinical practice will be introduced. Moreover, initiation of antihypertensive treatment, choice of drugs and their doses and combinations should not be based on the number of millimetres of mercury but rather on a careful evaluation of the pathogenetic mechanism and risk factors, since hypertension is not an isolated elevation of blood pressure; it rather is a metabolic impairment of tissue function at the cellular level, genetically conditioned and triggered by various endogenous and external factors.

Humans↗