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Biomedical subjects

W Schützenberger

Publications and source records attributed to W Schützenberger.

At least 19 recordsLinked to original sources
PubMed1991

Importance of coronary spasm for recurrences following percutaneous transluminal coronary angioplasty (PTCA).

To examine the importance of coronary spasm for recurrences following coronary angioplasty, the incidence of spontaneous and ergonivine-provoked coronary spasm was studied, during initial and 6 months follow-up coronary angiography, in a consecutive series of 102 patients with single-vessel disease and successful coronary angioplasty. Repeat angiography demonstrated restenosis in 35 patients (34%). In patients with no demonstrable coronary spasm before and 6 months after PTCA, restenosis occurred in 23% (14/61). The recurrence rate for patients with spasms only before PTCA was similar (29%; 6/21). An increase of recurrences was observed in patients with coronary spasm before and 6 months after PTCA (69%; 9/13) and was extremely high in patients with detectable spasms only after PTCA (86%; 6/7). The importance of the severity of underlying coronary stenosis as regards the ergonovine testing result, demonstrated no relationship between the degree of underlying stenosis and the incidence of provokable coronary spasms. Thus, coronary spasms provokable only before PTCA do not increase the risk for recurrences. Spasms persisting after PTCA or seen only after the procedure are associated with a significantly higher rate of restenoses.

Angina Pectoris, Variant↗
PubMed1990

Coronary angioplasty after intravenous streptokinase in acute myocardial infarction: influence of restenosis on clinical outcome and left ventricular function.

The importance of recurrence of stenosis on clinical outcome and left ventricular function was studied in a consecutive series of patients with acute evolving myocardial infarction (maximal duration of pain 4 h) and thrombolysis (1.5 x 10(6) units of streptokinase intravenously over 60 min) with recanalized single-vessel disease and subsequent successful coronary angioplasty. Coronary angioplasty was performed in 76 patients between 24 hours and 8 days (mean interval 3.3 days) after thrombolysis and was successful in 86% (65/76). The in-hospital reinfarction rate was 5.2% (2 acute and 2 in-hospital reinfarctions). Repeat angiography after a mean interval of 5.9 months revealed a 39% (24/62) restenosis rate (21 restenoses, 3 reocclusions). Restenoses were associated with significantly more clinical complaints (21% vs. 62%; p less than 0.001). Left ventricular function analysis showed significant improvement in the mean global ejection fraction (6.6 +/- 6.0%; p less than 0.001) and mean regional wall motion of the infarct zone (6.2 +/- 8.2%; p less than 0.01) only in patients without restenosis. Recovery of left ventricular function was more evident in inferior than in anterior wall infarctions. In contrast, patients with restenosis had no change in left ventricular function. Thus, the present study demonstrates the adverse influence of restenosis on recovery of left ventricular function and clinical outcome.

Angioplasty, Balloon, Coronary↗
PubMed1989

Morphological and immunological changes of hairy cell leukemia during alpha-2-interferon therapy.

We describe a patient who presented with the clinical picture of hairy cell leukemia (HCL). Bone marrow and peripheral blood lymphoma cells showed morphological and immunological features of HCL. Under recombinant alpha-2-interferon (alpha-2-IF) therapy the characteristic morphology changed from HCL to prolymphocytic leukemia (PLL). At diagnosis the lymphoma cells expressed CD24 and FMC7 surface antigen, but stained negative for surface immunoglobulins, light chains and anti-CD5. During alpha-2-IF treatment surface antigen expression changed to CD24, CD5 and FMC7. Surface IgD and lambda light chains became strongly positive. Southern Blot analysis of peripheral blood mononuclear cells showed two rearranged immunoglobulin bands at diagnosis but only one upon alpha-2-IF therapy. These data suggest, that this patient suffered from a biclonal lymphoma, HCL and PLL. While undergoing alpha-2-IF treatment the HCL came into remission, whereas the PLL clone proved to be poorly sensitive to alpha-2-IF therapy.

Aged↗
PubMed1989

Clinical efficacy of intravenous amiodarone in the short term treatment of recurrent sustained ventricular tachycardia and ventricular fibrillation.

The clinical efficacy of intravenous amiodarone in terminating sustained ventricular tachycardia and in preventing recurrences of ventricular tachycardia and ventricular fibrillation was evaluated in 26 patients. All of them presented with organic heart disease accompanied by depressed left ventricular function. Intravenous amiodarone terminated spontaneous ventricular tachycardia in eight of 19 patients. Fifteen of the 26 patients had had at least one episode of ventricular tachycardia or ventricular fibrillation each day in the period immediately before the intravenous administration of amiodarone. Amiodarone controlled ventricular tachycardia or ventricular fibrillation in nine of these 15 patients; in three further cases it was successful when supplemented by additional administration of a previously ineffective antiarrhythmic drug and ventricular pacing. Two patients died despite these measures. In one, the amiodarone infusion had to be stopped because of an arrhythmogenic effect. Sustained deterioration of haemodynamic function or of pre-existing intraventricular conduction disturbances was never seen. Intravenous amiodarone was effective in terminating sustained ventricular tachycardia and in preventing frequent episodes of ventricular arrhythmia that were refractory to other antiarrhythmic drugs.

Amiodarone↗
PubMed1989

[Hyperlipidemia and coronary heart disease].

The relationships between total serum cholesterol levels greater than 200 mg/dl or LDL-cholesterol levels greater than 155 mg/dl (135 mg/dl) and the incidence of coronary heart disease is well established. In contrast an inverse relationship could be shown between HDL-cholesterol levels and the frequency of cardiac death and non fatal myocardial infarction. It also seems to be possible that elevated triglyceride levels (greater than 200 mg) may represent an additional risk factor. Subsequent studies with a large number of patients and longterm observation proved, that fat-modified diets or drug treatment of hyperlipidemia results in a reduction of morbidity and mortality due to coronary heart disease, whereby the reduction of coronary events correlates directly to the degree of reduction of total cholesterol or LDL-cholesterol, respectively. This knowledge allows the clinician to identify persons at high risk for coronary heart disease and to start effective individual therapy in accordance with the recommendations of the European Atherosclerosis Society.

Cholesterol↗
PubMed1988

[Smoking and coronary heart disease].

The importance of risk factors in the development of coronary heart disease was established in many studies. Elevated serum cholesterol, hypertension and cigarette smoking are the major factors beside age and sex. Independent from serum cholesterol and hypertension the average risk for the development of coronary heart disease in cigarette smoking men is one and a half of non smokers. In order of the importance of coronary heart disease for morbidity and mortality in Austria and the knowledge about the risk factors this disease is especially suitable for prophylaxis.

Coronary Disease↗
PubMed1988

Incidence of spontaneous and provoked coronary spasms after percutaneous transluminal coronary angioplasty.

We studied the incidence of spontaneous and ergonovine-induced coronary arterial spasm during repeat coronary angiography in 96 consecutive patients with single-vessel disease who had undergone successful angioplasty. Follow-up angiography was performed after a mean of 6 months (1-8 months). Sixty patients demonstrated no restenosis and in 36 patients restenosis (greater than 50% restenosis) occurred. Spasms of the arteries at the site of dilatation were significantly (P less than 0.001) more frequent in patients with restenosis (18/36; 50%) than in patients without restenosis (4/60; 7%). Before angioplasty, no differences were found in the clinical characteristics between the two groups. Likewise, the morphologic results of angioplasty were identical. Despite long-term treatment with nifedipine (30-60 mg daily) and aspirin (0.5 g daily), 14 of 18 patients with restenosis and coronary spasm suffered from spontaneous angina, as compared to only 3 of 18 patients with restenosis without demonstrable spasm. Three of the 4 patients without restenosis but with detectable spasm were also symptomatic. Thus our findings suggest that spasm of the coronary arteries achieves some importance as a pathophysiological factor for recurrence following coronary angioplasty.

Angina Pectoris↗
PubMed1988

Systemic thrombolysis and percutaneous transluminal coronary angioplasty (PTCA) in acute myocardial infarction.

Intravenous high-dose infusion of streptokinase in acute evolving myocardial infarction is a widely used therapeutic concept with clinically relevant recanalization rates and low complications. In our experience with 150 patients and acute myocardial infarction treated with intravenous streptokinase (1.5 Mio U), 107 (78 p. 100) of 137 patients demonstrated an antegrade perfused infarct artery. In a group of patients (n = 95), in whom early revascularization was performed, the incidence of reinfarction was reduced from 15 p. 100 to 7 p. 100; hospital mortality was not influenced (3.6 p. 100 vs 4.3 p. 100). PTCA was successful in 39 of 48 patients (81 p. 100). The incidence of angiographically determined restenosis amounted to 28 p. 100 (9/32). Patients after successful PTCA without restenosis demonstrated an improvement of left ventricular function in contrast to patients with restenosis or reocclusions. Thus, intravenous streptokinase followed by PTCA presents a clinically practicable and promising method for treatment of acute myocardial infarction.

Adult↗
PubMed1988

[Ischemic reaction in coronary angioplasty (PTCA) as a prerequisite for improving left ventricular function following intravenous thrombolysis in acute myocardial infarct].

The incidence of ischemic ECG-changes and anginal symptoms during PTCA and the influence of PTCA on left ventricular function were studied in a consecutive series of 40 patients with recanalized infarct artery and significant (greater than 50%) single vessel disease. PTCA was performed within the first week (4.1 +/- 2.5 days) after intravenous streptokinase (1.5 Mio U i.v. over 60 min) in acute myocardial infarction (duration of pain less than four hours). The primary success rate of PTCA was 78% (31/40). In 25 of 31 (81%) successfully dilated patients, there were ischemic ECG-changes (ST-segment elevation greater than 0.1 mV), and in 14 patients anginal symptoms were observed during balloon inflation. Follow-up angiography after six months showed restenosis or reocclusion in 5/22 (23%) of the patients with an ischemic reaction, and in 3/6 (50%) without ischemic signs during PTCA. Only patients with an ischemic reaction and without restenosis demonstrated an increase in left ventricular ejection fraction (p less than 0.05) and regional wall motion in the infarct region (p less than 0.01), in contrast to patients with restenosis or without an ischemic reaction during angioplasty. Thus, after intravenous streptokinase an ischemic reaction can be detected in a high percentage (81%) as an indicator of salvaged myocardium. Significant improvement of left ventricular function was only demonstrable in patients with ischemic signs during PTCA without restenosis.

Angioplasty, Balloon↗
PubMed1987

[Intravenous thrombolysis in acute myocardial infarct. Clinical and angiography results in 124 patients and the significance of early revascularization].

124 patients with evolving acute myocardial infarction received high-dose intravenous streptokinase (1.5 Mio U within 60 min i.v.). Hospital mortality was 4% and 11% of the patients suffered from a streptokinase-related complication (most frequent bleeding problems). All complications could be treated medically. The angiographic control in 111 patients (90%) after a mean of 11 +/- 8 days after thrombolysis demonstrated a patent antegrade perfused infarct-artery in 85 patients (77%). From the first 55 patients only 16% had a revascularization procedure. An early revascularization in 39 patients (57%) of the last 69 patients reduced the reinfarction rate from 15 to 7%. The hospital mortality was not influenced (3.6 vs 4.3%). High-dose i.v. streptokinase-application is associated with low treatable complication rates and clinically relevant reperfusion rates. An early revascularization (coronary angioplasty, bypass-surgery) reduces the reinfarction rate to about 50% and improves left ventricular function.

Aged↗
PubMed1987

Enhanced accessory pathway conduction following intravenous amiodarone in atrial fibrillation. A case report.

We observed a dangerous increase of ventricular rate following the intravenous administration of amiodarone in a patient with atrial fibrillation and rapid ventricular response associated with the Wolff-Parkinson-White syndrome. The mechanism of enhanced accessory pathway conduction remains speculative. A possible explanation for the shortened antegrade effective refractory period of the accessory pathway is afforded by the hypotensive action of amiodarone or its dissolvent which might trigger beta-adrenergic reflexes. Intravenous amiodarone should be used with caution in patients with atrial fibrillation and rapid ventricular response via an accessory pathway.

Amiodarone↗
PubMed1986

Influence of a variant angina on the results of percutaneous transluminal coronary angioplasty.

Nineteen (86%) of 22 patients with variant angina and important coronary stenoses (greater than 60%) had successful percutaneous transluminal coronary angioplasty. The acute complications in two patients were not caused by coronary spasms but by dissection with disturbance of perfusion. One of these two patients required a coronary bypass graft; the other was treated conservatively. Myocardial infarction developed in both patients. Despite long term administration of nifedipine (30-80 mg daily), restenoses occurred within six months (on average after 10 weeks) in nine patients with symptoms and one without. In four patients the restenoses exceeded the degree of stenosis before angioplasty. Five patients were revascularised by surgical means. Vessels in three out of four patients were later successfully dilated. After a mean period of observation of 24 months (6-51 months) 18 of the 19 patients are symptom free and do not require medication. The results confirm that angioplasty is an effective method of treating patients with variant angina and important coronary stenoses. The problem of the high frequency of restenosis, however, remains unresolved.

Angina Pectoris, Variant↗
PubMed1986

[Percutaneous pulmonary valvuloplasty in adults].

Percutaneous balloon pulmonary valvuloplasty was performed in 6 adult patients (aged 21-59 years, mean age: 43 years) with congenital pulmonary valve stenosis and systolic pressure gradients of 50 to 120 mm Hg (mean: 78 mm Hg). In 5 patients the procedure was successful: mean systolic right ventricular pressure was reduced from 99 +/- 26 to 55 +/- 7 mm Hg and the trans-stenotic pressure gradient from 77 +/- 28 to 31 +/- 12 mm Hg. Valvuloplasty with a 20 mm balloon was not effective in a patient with a wide pulmonary anulus (diameter 25 mm). In 1 patient only, the balloon occlusion led to severe systemic hypotension with syncope. Short-term follow-up (3 months) demonstrated symptomatic improvement and persistent reduction of the pressure gradient in all successfully treated patients. In conclusion, percutaneous balloon pulmonary valvuloplasty appears to be an effective method with low risk of complications for the treatment of pulmonary valve stenosis in adults.

Adult↗
PubMed1985

[Main coronary artery stenosis: significance of the clinical stage for angiographic and surgical risk].

86 patients with significant main coronary artery stenosis (greater than 50%) were divided into 61 with stable and 25 with unstable angina pectoris. The coronary morphology (isolated main coronary artery stenosis, degree of stenosis, additional vessel disease) and the left ventricular function (ejection fraction, left ventricular end-diastolic pressure) were the same in both groups. Deaths due to coronary angiography amounted to 2.3% and involved two patients with unstable angina. 82% (n = 50) of the patients with stable angina and 83% (n = 19) with unstable angina were considered operable. 69% of the stable and 74% of the unstable group were actually revascularised. Operative deaths amounted to 3.4% and again involved two patients with unstable angina. During an average post-operative follow-up period of 38 months 5% of the operated and 28% of the non-operated patients died (P less than 0.05). The investigation demonstrated that for patients with main coronary artery stenosis operability in stable angina is no different from that in unstable angina. Angiographic and operative deaths in patients with unstable symptomatology, however, were markedly higher than in those with stable angina.

Angina Pectoris↗
PubMed1984

[Ventricle septum rupture in acute myocardial infarct: clinical, electrocardiographic, angiographic and surgical aspects].

The findings in 17 patients with ventricular septal rupture are analyzed retrospectively. Clinically this complication of acute myocardial infarction was characterized by a new holosystolic murmur and simultaneous deterioration in patient condition. Infarct related conduction disturbances were documented in 7 of the 17 patients before the rupture occurred. Early repair of the ventricular septal defect was carried out in 9 patients, 3 of whom died in the perioperative period. Survivors showed a significantly higher ejection fraction (45.5 +/- 4.5%) and significantly fewer asynergic radiants (25.8 +/- 4.5) than nonsurvivors (29.3 +/- 2.5% ejection fraction) and (37.7 +/- 2.5 asynergic radiants). Owing to the high mortality during the first few days, patients with ventricular septal rupture should be assigned urgently to a cardiological center where it is possible to carry out cardiac catheterization, angiography and ventricular septal repair without delay.

Aged↗
PubMed1983

[Aortic valve prolapse].

The aortic valve prolapse which can be diagnosed by echocardiography is usually found in patients with the floppy valve syndrome. The clinical symptoms are identical with those of the mitral valve prolapse. The frequency of aortic valve prolapse in 67 cases of mitral valve prolapse was 8.9%, the frequency of aortic insufficiency 5.9%. A main etiological factor of aortic valve prolapse is a myxomatous degeneration of valvular tissue which can affect one or more cardiac valves.

Aortic Valve↗
PubMed1983

[Intracoronary streptokinase therapy in recent myocardial infarct. Results in patients with pain lasting less than 3 hours].

A report is presented on 14 patients admitted with acute myocardial infarction, in whom pain duration had not exceeded 3 hours. The coronary angiogram revealed occlusion of the supply vessel to the infarcted area in 11 patients and only stenosis in the 3 remaining cases. Intracoronary administration of streptokinase (2000 or 4000 U/min) achieved thrombolysis in 10 out of the 11 patients with thrombotic occlusion. None of the patients with successful recanalization died during hospitalization (3 to 4 weeks); re-infarction occurred in 2 cases. Angiographic control in the 4th week following infarction demonstrated reocclusion of the responsible vessel in 3 cases. Stenosis was unchanged in 5 patients, whilst reduction of the degree of stenosis was recorded in 2 patients. 2 patients required aortocoronary bypass surgery for recurrence of angina during mobilization. There was no change in the mean ejection fraction in the patients with persistent recanalization between the acute and the chronic stage of infarction.

Adult↗