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Biomedical subjects

P W Westerhof

Publications and source records attributed to P W Westerhof.

At least 19 recordsLinked to original sources
PubMed1999

Thrombolysis with saruplase versus streptokinase in acute myocardial infarction: five-year results of the PRIMI trial.

BACKGROUND: Short-term safety and efficacy of thrombolysis with saruplase in acute myocardial infarction have been shown in several trials. To assess long-term outcome of patients treated with saruplase or streptokinase for myocardial infarction, a 5-year follow-up of patients included in the Pro-Urokinase in Myocardial Infarction Trial was performed. METHODS AND RESULTS: Follow-up data are available from 8 centers on 255 (92.4%) of 276 included patients. The 5-year mortality rate was comparable with 20.8% of patients in the saruplase group and 16.9% in the streptokinase group (odds ratio 1.29, 95% confidence interval 0.69 to 2.42). In both groups, a considerable number of fatal cardiovascular events occurred more than 1 year after study inclusion. Rates of percutaneous transluminal coronary angioplasty and coronary artery bypass grafting were comparable in both groups. Reinfarction within 5 years occurred in 19.0% of patients in the saruplase group and tended to be less frequent at 10.8% after streptokinase treatment (odds ratio 1.94, 95% confidence interval 0.98 to 3.84). In both groups, the majority of reinfarctions took place more than 3 months after study inclusion. The 5-year stroke rate was 3.6% and 7.2% in the saruplase and streptokinase groups, respectively (odds ratio 0.49, 95% confidence interval 0.16 to 1.47). Subjective symptoms of heart failure and angina pectoris were comparable in both groups. CONCLUSIONS: Our data are consistent with a similar long-term outcome for patients treated with saruplase or streptokinase. Despite the low-risk profile of the patient cohort, there were considerable adverse event rates over a 5-year period.

Aged↗
PubMed1998

[A classic example of infectious endocarditis?].

A 15-year-old girl in whom the diagnosis of infective endocarditis was established was sent to our cardiothoracic centre for mitral valve replacement because of a streptococcal endocarditis resistant to adequate antibiotic therapy. Despite the combination of fever, a 'new' heart murmur, 'positive blood cultures' and 'vegetations' on the mitral valve, the clinical picture gave rise to some doubt about the diagnosis. Finally the diagnosis of systemic lupus erythematosus was made and after treatment with corticosteroids all symptoms disappeared. In our modern era 'simple symptoms' still play a very important part in clinical decision making.

Adolescent↗
PubMed1997

[Misunderstood symptoms in patients with infectious endocarditis].

Infectious endocarditis was diagnosed in four patients, men aged 18, 44, 35 and 22; the bacteria involved were Streptococcus viridans, Eikenella corrodens, Staphylococcus aureus and Streptococcus mutans, respectively. In all patients mycotic aneurysms were observed which had led to seemingly unrelated neurological or abdominal complaints. In one patient an aneurysm of the A. cerebri media resolved in two years, another patient died following fatal bleeding of a ruptured aneurysm in the A. hepatica propria. Mycotic aneurysms may be found in all parts of the body. This complication is often diagnosed too late because it is not considered.

Adolescent↗
PubMed1997

[Syncopes during simultaneous use of terfenadine and itraconazole].

A 36-year-old female was given terfenadine 120 mg/day for hay fever, and itraconazole 100 mg twice daily for mycosis. Nine days after starting these drugs, she had several episodes of syncope. The ECG showed a long QT interval and torsades de pointes. The drugs were withdrawn and the patient temporarily received an infusion of isoprenaline, after which the QT interval returned to normal and no further episodes of torsades de pointes occurred. No other causes than the two drugs were found to explain these episodes.

Adult↗
PubMed1997

Revascularization of patients with coronary artery disease: the interventional cardiologist's perspective.

In the majority of patients with chronic coronary artery disease, treatment is aimed at palliation or prolongation of disease-free intervals and consists of either pharmacologic therapy or coronary revascularization. As a result of continuous refinements and improvements in both surgical and catheter-based revascularization techniques, modalities, and adjunctive pharmacologic therapy, an increasing number of patients may benefit from coronary revascularization. This also engenders difficult choices for the physicians responsible for selecting the most appropriate treatment. To achieve and provide optimal patient care an open and principled discussion with all parties involved is mandatory and must be based on the integration of clinical experience and data from both basic and clinical research. The purpose of this article is to provide the interventional cardiologist's view on the treatment of patients with atherosclerotic coronary artery disease.

Angioplasty, Balloon, Coronary↗
PubMed1995

Clinical relevance of Doppler pulmonary venous flow characteristics in constrictive pericarditis.

The purpose of this study was to determine the diagnostic value of Doppler pulmonary venous flow in constrictive pericarditis, as assessed by transoesophageal echocardiography. It has been demonstrated previously that increased respiratory variation in Doppler pulmonary venous, but not in transmitral flow velocities, can identify patients with constrictive pericarditis, when transoesophageal echocardiography is used. In the present study we compared a group of 10 patients with constrictive pericarditis and a control group of 15 normal subjects with respect to pulmonary venous and transmitral flow velocities and their respiratory variation. Peak velocities and velocity time integrals of the systolic, early diastolic and late diastolic reversed pulmonary venous flow waves were measured. Peak velocities and velocity time integrals of the early and late diastolic transmitral flow waves were also measured. Measurements were made irrespective of the respiratory cycle, at the onset of inspiration and at the onset of expiration. Values for inspiration and expiration were expressed as percent difference of those obtained irrespective of the respiratory cycle. Peak velocity and velocity time integral of the pulmonary venous systolic and diastolic waves were significantly lower than in normal subjects. Furthermore, the difference between peak velocities of the diastolic wave obtained at the onset of inspiration and obtained irrespective of the respiratory cycle was significantly larger in constrictive pericarditis than in the control group (-20% vs -9%, P < 0.05). This also applied to the difference between velocity time integrals of the diastolic wave obtained at the onset of inspiration and obtained irrespective of the respiratory cycle (-22% vs -12%, P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

[Use of sumatriptan (Imigran) in a female patient with coronary spasm].

Sumatriptan (Imigran), an effective drug against symptoms of migraine may cause a sensation of thoracic oppression. In some patients, this is accompanied by ECG alterations. In such cases, the underlying mechanism is probably coronary spasm, although this has never been demonstrated angiographically. The case is described of a young woman who was hospitalized after resuscitation because of ventricular fibrillation. One week previously, after subcutaneous administration of sumatriptan, she had had chest pains for half an hour. A spasm provocation test during coronary angiography gave a positive result. The patient was treated with a calcium antagonist following which she remained free of symptoms. In patients with chest pain after administration of sumatriptan, it is necessary to use this drug cautiously; spasm of the coronary arteries as a cause should be excluded.

Adult↗
PubMed1994

Transesophageal pulsed-Doppler echocardiographic evaluation of transmitral and pulmonary venous flow during ventilation with positive end-expiratory pressure.

During mechanical ventilation with high levels of positive end-expiratory pressure (PEEP) several hemodynamic changes occur, the mechanism of which has been the subject of various previous studies. The effects of increasing levels of PEEP during mechanical ventilation were measured on left atrial and left ventricular filling dynamics, as assessed by pulmonary venous and transmitral flow velocities, respectively. Using transesophageal echocardiography in 12 patients, Doppler flow velocities of pulmonary venous and transmitral flow were studied at baseline (0 cmH2O PEEP) and at 5, 10, 15, and 20 cm H2O with 10-minute intervals, and once more after removal of PEEP. In 2 of the 12 patients, PEEP could not be increased beyond 15 cmH2O, because cardiac index fell below 2.0 L/min/m2. Pulmonary venous flow velocity and velocity time integral during systole significantly decreased from 48 +/- 7 cm/s and 10.3 +/- 2.2 cm at baseline to 35 +/- 6 cm/s and 5.7 +/- 2.5 cm at 20 cmH2O PEEP, respectively (P < 0.01). In contrast, early and late diastolic velocities and velocity time integrals did not change. In regard to transmitral flow, both early and late diastolic velocities significantly decreased from 51 +/- 7 cm/s and 50 +/- 9 cm/s at baseline to 38 +/- 7 cm/s at 20 cmH2O PEEP, respectively (P < 0.01). Early and late diastolic velocity time integrals decreased from 6.1 +/- 1.8 cm and 4.7 +/- 1.0 cm to 4.5 +/- 1.0 cm (NS) and 3.4 +/- 0.7 cm (P < 0.05), respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Nd:YAG laser-assisted angioplasty in femoropopliteal artery occlusions: "hot" versus "cold" recanalization with transparent contact probe.

Percutaneous recanalization of femoropopliteal artery occlusions (1-21 cm; median, 8 cm) was attempted in 50 patients. A 2.2-mm-diameter contact probe catheter connected to a continuous-wave neodymium yttrium aluminum garnet (Nd:YAG) laser was used. The laser was activated (15 W, 1-second pulses) only if too much resistance was met. Balloon angioplasty was performed after successful traversal of the occlusion. Primary success was achieved in 40 of 50 patients (80%). In 20 cases, recanalization was achieved mechanically (cold group). In the other 20 cases, recanalization was achieved with the help of laser irradiation (hot group: 15-405 J; median, 90 J). Except for the length of the obstruction (longer in the cold group), the two groups did not differ in baseline characteristics. Neither the length of the occlusion nor the duration of symptoms correlated with failure or success or with the delivered laser energy. Cold and hot groups did not differ with regard to functional improvement and angiographic patency at 3 and 12 months (94% +/- 4). Thus, brief laser activation doubled the cold primary success rate, but the major action of the laser contact probe is mechanical remodeling of the obstruction.

Adult↗
PubMed1989

[Percutaneous recanalization of occluded upper leg arteries using laser treatment].

Percutaneous transluminal laser recanalization was attempted in 21 patients with occluded superficial femoral arteries and 'life style limiting claudication'. Primary success was achieved in 20 (95%) of these total occlusions. In 7/21 no laser energy was required. At one month only 1 patient had claudication and the mean Doppler ankle/arm systolic pressure ratio had increased by 0.36 +/- 0.19 (p less than 0.001) at rest and 0.47 +/- 0.34 (p less than 0.001) after exercise. Complications directly attributable to the procedure were: perforation (1), peripheral embolic episodes (2), haematoma (1), transient vasospasm (2). All complications could be treated non-surgically. These preliminary data suggest that laser recanalization of relatively short occlusions of the superficial femoral artery, followed by balloon dilatation, may be accomplished with satisfactory acute and short-term results, but not without risk.

Aged↗
PubMed1989

Electrode catheter ablation for ventricular tachycardia: efficacy of a single cathodal shock.

Electrode catheter ablation was used to treat 11 distinct types of sustained ventricular tachycardias in eight patients. Rigid electrophysiological criteria were used to identify five left and five right ventricular arrhythmogenic sites; one of them gave rise to tachycardia with two distinct configurations. A single R-wave-synchronised 250 or 150 J cathodal shock was delivered at each site. One patient had mildly symptomatic episodes of sustained ventricular tachycardia during the first four days after the shock--there were no other complications. At discharge none of the patients was taking antiarrhythmic drugs. They were followed for 8-20 months (mean 14). Ablation abolished five of the 11 ventricular tachycardias. There was no recurrence in three of the eight patients. In two patients identical ventricular tachycardias recurred because the identification of the arrhythmogenic site was incorrect.

Adult↗
PubMed1985

Is there an indication for coronary angiography in patients under 60 years of age with no or minimal angina pectoris after a first myocardial infarction?

Coronary angiography and exercise stress tests were performed in 91 consecutive patients under 60 years of age having either no or only mild angina pectoris with or without medication after a first myocardial infarction. Nine (10%) patients had angiographic high risk coronary artery disease defined as three vessel disease, left main stenosis, or proximal stenosis of the left anterior descending artery. Eighteen patients had a positive electrocardiographic exercise stress test including eight of the nine patients with angiographic high risk coronary artery disease. It may be concluded therefore that coronary angiography to detect high risk coronary artery disease in this group can be restricted to patients with a positive exercise stress test. This policy would obviate the need for about 80% of coronary angiograms performed in this age group.

Adult↗