Late improvement of regional wall motion after the subacute phase of myocardial infarction treated by acute PTCA in a 6-month follow-up.

BACKGROUND: The aim of this follow-up study was to investigate the late effects of acute coronary angioplasty (PTCA) on regional wall motion after the subacute phase of myocardial infarction (MI). METHODS AND RESULTS: Seventeen patients were investigated initially at a median of 11 days and again at 6 months after acute PTCA for myocardial infarction (< 8 hours after onset of symptoms) by cardiac magnetic resonance imaging. Corresponding short-axis slices encompassing the left ventricle (LV) were acquired using a standard cine MR for regional wall motion analysis and using delayed contrast enhanced magnetic resonance imaging (ceMRI) for infarct size quantification. The infarct size was similar in the subacute phase and the 6 month follow-up (20.8 and 21.9%, respectively; n.s.). Regional wall motion improved significantly in the area of hyperenhancement [percentage wall thickening (PWT) 21.9% and 37.9%, p < 0.05] in contrast to remote normal myocardium (46.4% and 38.4%; n.s.). Regional wall motion was significantly poorer in transmural compared with nontransmural MI in the subacute stage, and a late improvement could only be observed in transmural MI. CONCLUSION: Transmural areas of hyperenhancement displayed significant late long-term improvement of regional wall motion after acute PTCA, possibly related to prolonged stunning compared with nontransmural areas.

[Quality assurance in diagnostics: are there normal values for IgG-antibodies to cow's milk proteins?]. / Zur Sicherung der Prozessqualität in der Diagnostik: Gibt es Normwerte für die IgG-Antikörper gegen Kuhmilchproteine?

BACKGROUND: The value of IgG-cow's milk antibodies is heavily disputed. Therefore, aim of the study was to establish normal values for these IgG-antibodies and to determine their diagnostic significance especially for gastrointestinal allergic manifestations. PATIENTS AND METHODS: 702 newborns were included prospectively. They received different feedings: mothers milk, cow's milk based formula and a partially or an extensively hydrolyzed formula. All children were examined annually or on occasion of allergic manifestations. An indirect immunofluorescent test was used for the assessment of IgG-antibodies against casein, beta-lactoglobulin, alpha-lactalbumin and bovine serum albumin. Values were expressed as geometric mean titers. RESULTS: IgG-antibody titers rose slowly in the exclusively breast-fed children and peaked rapidly in the cow's milk formula-fed group, especially during the first year of life. There were no significant differences between children with and without allergic manifestations. Because of a large overlap between asymptomatic and symptomatic children it was impossible to establish normal values for the IgG-cow's milk antibodies. CONCLUSIONS: The occurrence of IgG-cow's milk antibodies is a physiologic phenomenon without diagnostic significance. The costs of these determinations can be saved to improve process quality.

Spontaneous platelet aggregation as a predictive risk factor for vascular occlusions in healthy volunteers? Results of the HAPARG Study. Haemostatic parameters as risk factors in healthy volunteers.

The HAPARG Study (haemostatic parameters as risk factors in healthy volunteers) was performed in a subset of volunteers taking part in the MARISK Study (Mainzer Risikoindikatoren Studie für die koronare Herzkrankheit) sponsored by the German Ministry of Research and started in 1984. A previous study (Yamanishi et al., Thromb Haemostas 1985;54:539-543) had shown that spontaneously enhanced platelet aggregation as measured with the PAT-III-test and higher fibrinogen concentrations are significant risk factors for new vascular occlusions in diabetic patients. It was the aim of the HAPARG Study to establish whether spontaneous platelet aggregation and other hemostatic variables are independent risk factors for vascular occlusions in healthy volunteers. Employees of a chemical/pharmaceutical company aged 40-65 years and personnel of the University of Mainz, aged 30-60 years were included in this prospective study. Besides anamnestic data such as on smoking, hypertension and diabetes, blood pressure, the ankle/arm Doppler-index and an ECG were recorded and serum cholesterol, HDL, LDL, triglycerides, uric acid and glucose were measured. Men (1884) and women (989) entered the study and were followed for 4-6 years. In the age group of 30-50 years, more women than men were included. During the observation period 53 vascular occlusions occurred (36 coronary and nine cerebral events and eight peripheral vascular occlusions). Only three of these endpoints occurred in women. Besides age (odds ratio = 1.7, P = 0.02) and gender as expected risk factors, the multivariate logistic stepwise regression analysis revealed smoking (odds ratio = 2.2, P = 0.008), lower HDL-levels (odds ratio = 2.2, P = 0.013), elevated diastolic blood pressure (odds ratio = 1.4. P = 0.004) followed by spontaneous platelet aggregation (odds ratio = 1.1, P = 0.037), and slightly elevated blood glucose (P = 0.0047) as significant risk factors for men. Higher fibrinogen levels missed significance in this analysis (P = 0.059). None of the other hemostatic parameters showed a significant correlation with the vascular events. To our knowledge, this has been the first prospective trial in a large population of healthy individuals in which a platelet function parameter has been studied together with other possible risk factors. Spontaneously enhanced platelet aggregation is probably an independent risk factor and, like elevated fibrinogen and other haemostatic variables, an indicator of an ongoing active atherosclerotic process.

The diagnostic significance of IgG cow's milk protein antibodies re-evaluated.

UNLABELLED: The effect of different feeding regimens, notably the use of hydrolysed cow's milk formulas, on the development of allergic reactions and the development of cow's milk protein-IgG antibodies is still disputed. We prospectively compared the development of allergic manifestations and cow's milk protein-IgG antibodies in a total of 702 infants who were divided into six groups: 1. exclusively breast milk for at least 4 weeks (n = 206). 2. Breast milk plus initial partially hydrolysed formula (n = 104). 3. Breast milk plus extensively hydrolysed formula (n = 50). 4. Breast milk plus initial conventional cow's milk formula (n = 73). 5. Conventional cow's milk with or without breast milk throughout (n = 187). 6. Extensively hydrolysed cow's milk formula for 2 months, followed by conventional cow's milk (n = 82). Cow's milk protein antibodies were determined by an indirect immunofluorescent test. Antibody titres rose slowly in groups 1, 3 and 6. Children in group 5 showed two high peaks. There were no significant differences in the frequency and type of allergic manifestations between the groups. Introduction of cow's milk formula during the first trimenon resulted in elevated antibody titres in all breast fed infants compared with introduction at a later date. CONCLUSION: In contrast to a previous study from the same laboratory, there is no diagnostic significance of cow's milk protein-IgG antibodies for allergic manifestations. The occurrence of these antibodies is a physiological phenomenon: the shorter the breast feeding period and the earlier cow's milk formula is introduced, the higher the antibody levels.

[Effect of the proliferation rate on the course of node negative breast carcinoma]. / Einfluss der Proliferationsrate auf den Krankheitsverlauf von nodalnegativen Mammakarzinomen.

In 250 patients with node-negative breast cancer and no systemic adjuvant therapy the impact on the prognosis of the variables age, histological tumour type, tumour size, histological grade, receptor status and localisation of the tumour within the breast, was studied. Patients were followed over a mean period of 60 (range 7-164) months. In a subset of 124 cases additional examination of the growth fraction rate, detected by immunohistochemical determination of antibody Ki-67 and semiquantitative measurement of the stained tumour cell nuclei was performed. In 43 cases, measurement of S-phase fraction by flow cytometry was also performed. By univariate analysis, the histological tumour type (ductal/non-ductal), histological grade and growth fraction rate (< = 20%/> 20% tumour cell nuclei stained by antibody Ki-67) were found to exert a significant influence on distant disease-free and overall survival. Cox' multivariate regression exhibited histological tumour type and growth fraction rate to be independent predictors of distant disease-free and overall survival. Additionally, age was found to be an independent variable of distant disease-free survival. Measurement of growth fraction rate by immunohistochemical detection of Ki-67 antigen is a fairly simple and easily applicable procedure. It should be discussed whether a growth fraction rate of more than 20% could be an indication for adjuvant chemotherapy in patients with node-negative breast cancer.

Endoventricular patch plasty improves results of LV aneurysmectomy.

From May 1985 to December 1991 52 patients were operated upon for postischemic left ventricular aneurysm (LV-A). Between May 1985 and July 1989 25 patients (group I) with a mean age of 59 (46-72) years underwent conventional aneurysmectomy with direct closure of the left ventricle (LV) and a mean of 1.9 (0-3) additional bypass grafts (54% triple-vessel disease). The hospital mortality was 8% (2/25) and the late mortality during a median follow-up time of 34 months was 28% (7/25) with a 4-year survival of 66%. Improvement in the quality of life (NYHA from 2.6 to 2.1, P = 0.078) and global left ventricular ejection fraction (EF) (from 35 to 38%) proved to be unsatisfactory in conjunction with the high late mortality rate. Between August 1989 and December 1991 a prospective series of 27 consecutive patients (group II) with a mean age of 61 (45-71) years underwent endoventricular patch plasty guided by two-dimensional transthoracic echocardiography (TTE) before and after surgery. The patch size and position were calculated preoperatively by measuring the distances from the mitral annulus to the infarct area which were reproduced during surgery with a simple ruler. A mean of 2.1 (0-4) bypass grafts were added with 62% of the patients having triple-vessel disease and 19% left main stenosis (P = 0.05, group I versus II). All patients have survived to date. One patient had to be excluded, giving a median follow-up time of 14 months for 26 patients. At the 6 months' control, the mean NYHA class was improved from 2.7 to 1.6, (P = 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)

Risk assessment of future myocardial infarction from automated serial ECG analysis.

From 1980 to 1990 a cohort of 7,542 employees took part in the MARISK study. This study was designed in order to explore the utility of computerized electrocardiographic (ECG) measurements for predicting future myocardial infarction. After an initial period of annual examinations, follow-up information was collected by mailed questionnaires and obtained from 89.3% of all study participants with a median follow-up time of more than 7 years. Eighty-three participants suffered from myocardial infarction during the course of the study. Multivariate logistic regression analysis revealed that automated ECG measurements contribute significant additional information to risk estimates obtained from classical risk factors. Serial ECG analysis yields stronger risk indicators than single measurements. Results are represented via receiver operating characteristic (ROC) curves and regression coefficients, which can be used in independent applications. The results of this study indicate that it is useful to include automated serial ECG analysis in cardiovascular screening programs. It still has to be evaluated whether successful preventive measures may be based on such screening programs.

Prognostic parameters in renal cell carcinoma--a new approach.

The prognostic potential of the parameters TNM staging, Robson staging, grading, cell type, growth pattern, and patient age was investigated for 431 patients with operated renal cell carcinoma (RCC). In the individual analyses, staging and grading attained the best results, whereby Robson staging proved to be superior to TNM staging by comparison. Morphological parameters had a more modest effect on the prognosis, but this should not be underestimated. A scale of points based on a comparative biometric evaluation of the various parameters was devised. From this scale, three significantly distinct prognostic groups evolved with a correct prognosis of over 80% on the average for an individual case. In comparison with other proposals for assessing prognosis for RCCs, the suggested scale of points had the greatest prognostic potential.

Automated serial ECG-analysis within an epidemiological study.

Since 1980 we have performed a cohort study in order to develop diagnostic and predictive algorithms for myocardial infarction. These algorithms shall be based on cardiovascular risk factors, ECG-measurements and serial measurement changes. An intermediate analysis of 5524 study participants describes observed measurement changes stratified by age and sex. The values thus obtained may serve for reference purposes and illustrate the influence of age and sex on intraindividual ECG-measurement changes. Specific suggestions are made for future program developments in order to overcome some present problems in serial ECG-analysis.

[Premature cervical ripening--surgical or conservative therapy?]. / Vorzeitige Zervixreifung--operative oder konservative Therapie?

We studied the effect of the cerclage operation as treatment of premature ripening of the cervix in the 15.-35. week of gestation with a retrospective matched pair analysis (n = 142). For each patient in the group treated operatively (n = 71) a patient was selected, who was clinically comparable in parity, gestational age and cervix score at the time of diagnosis but was managed conservatively (n = 71). The study showed that the cerclage operation is not generally advantageous as treatment of premature cervical ripening. Because of the higher perinatal morbidity in the group treated by an operation, the unselected indication for a therapeutical cerclage is questioned. To define indications for cervical cerclage as operative treatment for premature cervical ripening we selected subgroups by history and clinical data treated either operatively or conservatively and evaluated their parameters of gestation, delivery and puerperium as well as the perinatal outcome. We found that the operative treatment was superior to the conservative therapy only in patients with premature cervical ripening before the 25th week of gestation and in patients with an "open cervix" and a history of miscarriage, abortion or premature delivery. The results of this study led to a proposal for the treatment of patients with premature ripening of the cervix, which has to be confirmed by prospective controlled studies.

[Relationship between frequency components of phonocardiography, vectorcardiography parameters and anatomic data]. / Untersuchung von Zusammenhängen zwischen Frequenz-komponenten des Phonokardiogramms, VKG-Parametern und anatomischen Daten

Regarding heart volume, fundamental frequency of the first and second part of first heart sound (SI), vectorcardiographic parameters and constitutional data, the formerly found strong correlation between fundamental frequency of the first part of SI and heart volume was re-established. Heart volume guess got even better utilizing certain VCG-parameters, whereas constitutional measurement data gave no further approach. Correlations between VCG-data and fundamental frequencies of both parts of SI are referred to.