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Biomedical subjects

U Kaufmann

Publications and source records attributed to U Kaufmann.

At least 91 records · Page 5Linked to original sources
PubMed1989

Intravascular stenting for stenosis of aortocoronary venous bypass grafts.

To test the ability of endoluminal stents to prevent saphenous vein graft restenosis after balloon angioplasty, 13 patients with angina and previous coronary bypass surgery underwent implantation of one or more stents into 14 stenosed grafts. Implantation was technically successful in all cases and there were no major in-hospital complications. During a median follow-up interval of 7 months (range 2 to 26), 10 patients (77%) underwent follow-up angiography. Seven patients remained asymptomatic or in improved condition without further intervention; three patients had further angioplasty with stent implantation for a new stenosis in the same graft. Two patients (20%) developed within-stent restenosis. There was one death from progressive congestive heart failure 7 months after implantation. No patient had a myocardial infarction or needed surgical revascularization during the follow-up period. In selected cases, stent implantation appears to be a promising new technique that may decrease the incidence of restenosis after balloon angioplasty in venous bypass grafts. The rate of complications is low. Further experience and longer follow-up will be needed before definite recommendations can be made about its use.

Aged↗
PubMed1989

[Psychosocial management in pediatric oncology--presentation of a cooperative team model].

This article presents a psychosocial patient-care program for pediatric cancer patients and their families. The program, initiated within the framework of a "cooperative team model", represents a new organisational form of cooperation between somatic and psychosomatic medicine that has been virtually untested in the filed of internal medicine. The advantages of this form lie in the improved availability of the families involved and the inherent possibilities of appropriate and effective assistance in overcoming the burdens of the illness and the treatment. Comparison with a liaison model showed a 3-times higher mean contact quota per patient/family. Problems which can be expected through implementation as well as related conflicts are discussed. Basic rules are formulated which must be followed if successful interdisciplinary cooperation is to be achieved. Areas of responsibility and activity are described for members of the psychosocial team (psychologists, social workers, visiting nurses) and a basis for documentation is illustrated using the evaluating results. The working concept behind an integrated psychosocial care system includes, as its basis, accompanying support to the involved families within the framework of general psychosocial care in which all of the members of the entire oncological team take part. As required, the special capabilities of the various psychosocial professions can then be brought to bear according to their functions and competence (psychosocial counselling and therapy, social-service counselling, medical and nursing care). Due to the conditions, inherent in the situation resulting from the illness and treatment, basic conceptional positions and attitudes become apparent that are of importance of psychosocial work is to be successful in a pediatric oncology ward.

Adaptation, Psychological↗
PubMed1988

[Acute coronary occlusion following transluminal angioplasty: the role of an implanted parietal support via transluminal route].

Acute coronary artery occlusion complicates some 5% of balloon angioplasty procedures and often makes emergency surgical revascularization necessary. Initial experience is reported with emergency implantation of endoluminal stents for acute vessel closure following coronary balloon angioplasty. 10 patients received one stent and 2 patients two stents during the study period. In the study group, implantation was technically successful in all cases: there were no deaths, Q-wave infarctions or cases requiring emergency surgery.--2 patients showed a moderate rise in creatinine phosphokinase in the first 48 hours. During a mean follow-up period of 4 months (range 1-21 months) there have been no deaths and no cases requiring elective coronary bypass surgery. 10 patients underwent control angiography and none have developed significant restenosis within the stented segment. For selected patients, coronary artery stenting appears to be a promising technique as an alternative to emergency bypass surgery after acute vessel occlusion during balloon angioplasty.

Angioplasty, Balloon↗
PubMed1988

[Incidence and treatment of coronary restenosis in spite of the implantation of an endoprosthesis].

Between April 1986 and February 1988, 72 endoprosthesis implantations were carried out in the coronary arteries of 65 patients. The indication for implantation was either abrupt closure post angioplasty or prevention of restenosis. The first 3 cases of restenosis within the stented segment are reported. Two were treated by repeat balloon angioplasty, with temporary improvement. The possible mechanisms underlying this particular form of restenosis are discussed.

Angioplasty, Balloon↗
PubMed1988

Restoration of sinus rhythm with flecainide in patients with atrial fibrillation.

The efficacy of flecainide acetate for conversion of atrial fibrillation into sinus rhythm was assessed in 69 patients (mean age of 63 +/- 14 years). Mean duration of the arrhythmia was 49 +/- 45 days. Mean cardiothoracic index was 0.49 +/- 0.03. Flecainide treatment was started intravenously with a bolus of 2 mg/kg over 10 minutes, followed by oral treatment (200 to 300 mg/day) according to body weight. Conversion to sinus rhythm was obtained in 49 patients (71%). The mean delay between initiation of treatment and restoration of sinus rhythm was 301 minutes (range 5 to 1,600). The left atrial diameter was smaller (40 +/- 1 mm) in patients who had successful cardioversion than in those who did not (46 +/- 1 mm) (p less than 0.05). Patients with atrial fibrillation lasting for less than 10 days had a higher conversion rate (79%) than patients with long-standing atrial fibrillation, in whom the conversion rate was only 38% (p less than 0.05). Conversion to sinus rhythm occurred in 33 patients during the first 5 minutes after injection. Adverse effects necessitated discontinuation of treatment in 4 patients (5.8%). Gastrointestinal disorders and dizziness occurred in 5 other patients but did not necessitate discontinuing treatment. In conclusion, flecainide is an effective drug for converting atrial fibrillation into sinus rhythm. Unlike quinidine, flecainide can be administered intravenously. The conversion rate with flecainide is higher in patients with a shorter duration of atrial fibrillation and smaller atria.

Atrial Fibrillation↗
PubMed1988

Prevention of coronary restenosis by stenting.

Balloon angioplasty fails to provide acceptable long-term results for a significant proportion of patients. An intravascular mechanical support, developed with the aim of preventing restenosis and acute closure of diseased arteries after transluminal angioplasty, was implanted in 44 patients (39 male and five female), aged from 35 to 70 years (mean 56 years) with documented restenosis of native coronary artery (41 stents) and bypass grafts (12 stents). In the group of bypass graft patients there was no local restenosis and no major complication. In patients in whom stents were placed in native coronary arteries, the complication rate was higher (two patients died after coronary bypass surgery). One patient died suddenly at home. Except for one patient, in whom a new lesion developed proximally with extension into the stent, no case of restenosis could be observed. Despite the still relatively high complication rate, we feel that stenting may present a rational approach to the unresolved problem of restenosis after coronary angioplasty.

Adult↗
PubMed1988

Intravenous thrombolytic treatment for acute myocardial infarction. Effects of early intervention and early examination.

Intravenous thrombolytic treatment (streptokinase or anisoylated plasminogen streptokinase activator complex (APSAC) was given to 50 consecutive patients within 3 hours after onset of symptoms of acute myocardial infarction. Left heart catheterisation with coronary angiography and simultaneous double view left ventriculography were performed approximately 4 hours after start of thrombolytic treatment. This examination showed that the acute infarct-related coronary artery was open in 36 patients (72%) and closed in 14 patients (28%). A higher left ventricular ejection fraction was found among patients with open, than among patients with closed infarct-related artery (58.8% vs. 48.4%, p = 0.05). The group with open artery also had a lower score of regional left ventricular dysfunction (1.7 vs. 2.4, p less than 0.05, on a scale from 0-3). Single, double and triple vessel coronary heart disease was found in 22, 14 and 13 patients respectively. Mean age was lower in the group with single vessel disease as compared to double and triple vessel disease (48.4 years vs. 53.4 and 55.4 years, p less than 0.05 and p less than 0.005). Independently of whether the infarct-related artery was open or closed, there tended to be an inverse correlation between number of diseased vessels and preservation of left ventricular function (statistical significance only for single vessel versus triple vessel disease with respect to score of regional left ventricular dysfunction, 1.8 vs. 2.4, p less than 0.05). These findings suggest that early thrombolytic treatment within 3 hours of onset of symptoms may preserve myocardial tissue during the evolution of acute infarction. Furthermore, a presumably better collateralisation from adjacent coronary arteries without stenoses may be important for myocardial preservation. Finally, early angiographic examination can be performed safely and is a good support for determination of further treatment, which in the actual patients was coronary bypass surgery in 8 cases, transluminal angioplasty, PTCA, in 20 cases, and medical treatment alone in 22 cases.

Adult↗
PubMed1988

Emergency stenting for acute occlusion after coronary balloon angioplasty.

Acute coronary artery occlusion complicates 2-12% of the balloon angioplasty procedures, and despite repeat angioplasty, emergency surgical revascularization is often necessary. We report our initial experience with the emergency implantation of endoluminal stents for acute vessel closure after coronary balloon angioplasty. Nine patients received one stent, and two patients received two stents during the study period. Implantation was technically successful in all patients; there were no deaths, no myocardial infarctions as evidenced by Q wave on the electrocardiogram, and no need for emergency surgery. One additional patient, not satisfying the study inclusion criteria, died 16 hours after stent implantation from left ventricular failure and intractable arrythmias. Two patients in the study group had a moderate creatinine phosphokinase rise during the first 48 hours after implantation. During a median follow-up period of 3 months (range, 1-20 months), there have been no deaths and no need for elective coronary bypass surgery. One patient required emergency recanalization 3 months after implantation because of acute occlusion of the stented segment with limited myocardial infarction. Six patients have undergone control angiography, and none has developed chronic restenosis within the stented segment. For selected patients, coronary artery stenting appears to be a promising alternative to emergency bypass surgery after acute vessel occlusion during balloon angioplasty.

Adult↗
PubMed1987

Anisoylated plasminogen streptokinase activator complex versus streptokinase in acute myocardial infarction. Preliminary results of a randomised study.

25 patients with acute myocardial infarction pain lasting more than 20 minutes which was not relieved by nitrates, whose ECGs showed ST segment elevations of 1 mm or more in 2 or more ECG leads, and who presented less than 3 hours after onset of their symptoms were randomly assigned to one of 2 thrombolytic treatment groups: a single intravenous bolus of anisoylated plasminogen streptokinase activator complex (APSAC) 30U in 5 minutes or an intravenous infusion of streptokinase 1,500,000U over 60 minutes. 3 to 4 hours after the administration of the thrombolytic agent, all patients received intravenous heparin at full dosage for 24 hours. The patency of the infarct-related coronary vessels was assessed by angiography 1 to 4 hours after administration of the thrombolytic agent. Clinical signs, ECGs, pulse, blood pressure and temperature were monitored regularly for 24 hours after treatment or as clinically appropriate. APSAC seemed to be at least as effective as streptokinase in terms of patency of the infarct-related vessel (92% vs 63%, respectively). The adverse events were similar and none was life-threatening. APSAC and streptokinase caused similar falls in blood fibrinogen levels. APSAC, given as a bolus injection over 5 minutes, was easier to administer than streptokinase, which was given as an infusion during 60 minutes.

Adult↗