Acute occlusion in multiple lesion coronary angioplasty: frequency and management.

Among 3,548 patients undergoing a percutaneous transluminal coronary angioplasty procedure, 714 had multilesion angioplasty (1,550 lesions) in a single session. Acute occlusion occurred in 22 patients (3.1%) and 29 lesions (1.9%). The patients were classified into a group undergoing multivessel angioplasty (348 patients, 785 lesions) and a group undergoing multilesion single vessel angioplasty (366 patients, 765 lesions). The rate of acute occlusion was similar in both patient groups. The multivessel angioplasty group had a 2.9% rate per patient (n = 10) and a 1.7% rate per vessel; the multilesion single vessel group had a 3.3% rate per patient (n = 12) and a 2.1% rate per lesion. Five of the 10 patients from the multivessel group with acute occlusion, but only 1 of the 12 patients with occlusion in the single vessel multilesion group, required emergency open heart surgery. No patient in either group died as a consequence of coronary angioplasty. Occlusion occurred during angioplasty in 15 of the 22 patients, and 1 to 24 h after angioplasty in 7 of 22 patients. In the group with multivessel angioplasty, acute occlusion during the procedure was mainly linked with hypotension during the second vessel dilation, whereas in this group with delayed vessel closure and in the multilesion single vessel group, existence of intimal tearing constituted the most important factor for acute occlusion (12 of 16 patients). Closure of vessel per major coronary system was evenly distributed in the multivessel group, whereas significantly more left circumflex vessels closed in the single vessel multilesion group (6.1% versus 1.3% in the left anterior descending coronary artery and 1.1% in the right coronary artery; p less than 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)

APP RNA splicing is not affected by differentiation of neurons and glia in culture.

Amyloid precursor protein (APP) gene expression was investigated in primary cultures of neurons, astrocytes, microglial cells and oligodendrocytes. Neurons from various rat brain regions, as well as oligodendrocytes, contained RNA encoding APP695, while astrocytes and microglial cells expressed high levels of RNAs for APP770 and APP751. It was studied whether the cell type-specific regulation of APP gene expression could be modified by induction of cellular differentiation in vitro. While neuronal differentiation of PC12 cells has been shown to correspond with an altered pattern of APP splicing, in the primary cultures neither the time in culture nor a treatment of the cells with appropriate differentiation factors affected this pattern.

Measurement of aqueous flow in rabbits with corneal and vitreous depots of fluorescent dye.

Using pigmented rabbits, two fluorophotometric methods for measuring aqueous flow were compared. A corneal depot of dye was used to measure aqueous flow in one eye of each rabbit while the vitreous depot method of Johnson and Maurice was used to measure aqueous flow over the same period in the fellow eye. After intravenous administration of acetazolamide or mannitol, during the first hour after drug delivery a decrease in aqueous flow was observed in the eye with the corneal depot of dye that was undetected in the eye with the vitreous depot of dye. In rabbits which were water-loaded by orogastric tube, an increase in aqueous flow was observed by the corneal depot method, while the vitreous depot method indicated a decrease in aqueous flow. The vitreous depot method depends on the assumption that the rate of loss of dye from the vitreous remains stable. It is shown that movement of water into or out of the vitreous can cause large changes in the rate of movement of dye from the vitreous to the anterior chamber and can make interpretation of the vitreous method ambiguous. While the vitreous depot method is probably superior for measuring sustained changes of the rate of aqueous flow over tens of hours or days, it is concluded that it cannot be used for measuring changes over shorter periods.

Cortical astrocytes activated by basic fibroblast growth factor secrete molecules that stimulate differentiation of mesencephalic dopaminergic neurons.

In reactive gliosis, astrocytes undergo morphological and biochemical changes which can be mimicked in vitro by treatment with bFGF (basic fibroblast growth factor) or cAMP. To investigate the influence of activated cortical astrocytes on central nervous system (CNSD) neurons, we studied the effect of the supernatant from bFGF-treated astrocytes on the development of dopaminergic neurons from rat mesencephalon. Conditioned medium of untreated astrocytes stimulated dopamine uptake of mesencephalic cultures. After activation of astrocytes with bFGF this effect was greatly enhanced. It was significantly more potent than stimulating effects of other neurotrophic factors. The supernatant of these astrocytes increased the biochemical differentiation but not the survival of dopaminergic neurons in our cell culture system. Trypsin digestion and gel chromatography revealed that the activity was due to one or several proteins with molecular mass above 5 kDa. We excluded the participation of several factors known to be produced by astrocytes or that are neurotrophic for substantia nigra cultures. In particular, we provide evidence that bFGF, BDNF, NT-3, Il-1, Il-6, S100 beta and alpha 2-macroglobulin were not involved in the effect of the conditioned medium. In vitro stimulation of astrocytes therefore triggers the expression of currently uncharacterized factors which influence the biochemical differentiation of mesencephalic dopaminergic neurons, the cells that degenerate in Parkinson's disease.

Ultrasound thrombolysis.

The possibility of lysing clots by the direct intravascular application of ultrasound was described first in 1974 in an animal experiment. However research on therapeutic ultrasound for thrombolysis gained momentum in the early 1980s and is now divided into several directions: 1) pharmacological thrombolysis supported by externally applied ultrasound; 2) pharmacological thrombolysis accelerated by intravascular ultrasound; 3) lysis of intravascular clots by intravascular ultrasound applied as singular treatment; 4) facilitating angioplasty by intravascular ultrasound which may smoothen the rigid surface of calcified arteries by lysing calcified structures out of sclerotic plaques. In acute myocardial infarction first evidence of efficacy in lysing clots by ultrasound was described in two small series of 15 patients in 1997. Furthermore, ultrasound thrombolysis seems to be efficient also in occluded saphenous vein grafts and in completely obstructed peripheral arteries, where the latest clinical experience gives very promising results.

Comparison of a noncardioselective beta-adrenoceptor blocker and a cardioselective blocker in reducing aqueous flow in humans.

In a double-masked crossover study, the dose-response relationship for aqueous flow was determined for four concentrations of betaxolol hydrochloride and levobunolol hydrochloride in 19 normal subjects. One eye of each subject received every concentration of both drugs. Each concentration was administered once daily for 1 week. The fellow eye received a placebo. Aqueous flow was measured for several hours on the last day of administration of each concentration beginning immediately after drug administration. For levobunolol, the mean decrease in aqueous flow compared with baseline was 8% after 1 week's treatment with 0.017% levobunolol, 15% after treatment with 0.05%, 20% after treatment with 0.167%, and 32% after treatment with 0.5%. For betaxolol, the mean decrease in aqueous flow compared with baseline was 3% after 1 week's treatment with 0.017% betaxolol, 12% after treatment with 0.05%, 18% after treatment with 0.167%, and 17% after treatment with 0.5%. Levobunolol-treated eyes but not betaxolol-treated eyes showed a significant drug effect 1 week after discontinuing the drug therapy. The relative potency of the noncardioselective drug was greater than that of the beta 1-cardioselective drug, but the difference in potency was much less than would be expected solely based on their relative affinity for beta 2-receptors in other species and tissues.

Prediction of survival after out-of-hospital cardiac arrest: results of a community-based study in Vienna.

The objective of this study was the assessment of out-of-hospital cardiac arrest and the definition of possible predictive factors for final hospital discharge. Out of a database of 89,557 consecutive missions of the Vienna emergency medical system (EMS) during 1990, there were 623 missions due to a collapse of non-traumatic origin: in 374 cases (60.0%) the patients were declared dead without further attempts at resuscitation. The remaining 249 patients were analysed for predictive factors at site. Survival to hospital admission: 109 patients survived to hospital admission (43.7%); bystander support had a small impact (P < 0.05) on survival to hospital arrival whereas age and gender had no predictive power. Most patients with ventricular tachycardia/fibrillation (VT/VF) survived primarily (69 of 117, i.e. 59.0%). Survival to hospital discharge: 27 patients were discharged from hospital care (10.8%). ECG findings on arrival of the EMS physician at the site proved to be the only powerful predictor for survival: 24 of 117 patients with VT/VF survived compared with only one of 81 with primary asystole, two of 39 with severe bradycardia, and no patient with electromechanical dissociation.

[201-Thalium scintigraphy of the myocardium under conditions of rest and exercise (author's transl)]. / Die 201-Thalliumszintigraphie des Myokards unter Ruhe- und Belastungsbedingungen.

The results of 201-Thallium myocardial scintigraphy at rest and after stress conditions in 30 patients are discussed. Among those there were 4 patients without cardiac disease, 7 patients with anterior wall scars after transmural infarction, and 19 patients with coronary heart disease and at least one coronary stenosis greater than 75%. The obtained results were compared to findings in coronary angiography and perfusion scintigraphy. The noninvasive method of 201-Thalliumscintigraphy shows a good correlation to the results of invasive investigations when performed at rest and under stress conditions. It enables greater sensivity and specifity in selection of patients with coronary heart disease compared to stress electrocardiography alone.

[The accuracy of 201 thalium scintigraphy of the heart under conditions of stress (author's transl)]. / Sensibilität des 201 Thalliumszintigramms des Herzens unter Belastungsbedingungen.

The results of 201 thalliumszintigraphy under stress condition in patients with coronary heart disease with or without myocardial scars have not been uniform. We could show that pathologic stress szintigrams were only found in patients with a singular stenosis in one branch of the left coronary artery. In all those cases who had similar stenosis in both branches of the left coronary artery the stress szintigram appeared to be unchanged or normal. Therefore an unchanged stress szintigram allows no conclusion on the condition of the coronary arteries. A normal stress szintigram can be found as well in patients with normal coronary arteries as in patients with severe coronary heart disease. The examination of 201 thallium szintigrams under stress conditions therefore needs some critical evaluation.

A rapid technique for preparation of human fetal and adult skeletal material.

The techniques described above have been found to provide a rapid method of human skeletal preparation, with advantages of speed and applicability to fresh, fixed, or partially decomposed skeletal materials. While other techniques which can be used include the traditional use of Dermestidae beetle colonies, a five-step anatomical procedure, and other combinations of chemical solvents, the antiformin technique appears to have advantages useful to those involved in forensic medicine.

[Plasma renin activity in essential hypertension: different short- und long-term effects of diuretics (author's transl)]. / Unterschiedliche Wirkung diuretischer Langzeitbehandlung auf die Plasmareninaktivität bei essentieller Hypertonie

In an acute clinical trial 12 patients with essential hypertension on a standardized sodium and potassium dietary intake were given either amilorid (10 mg daily, orally) or potassium canrenoate (200 mg daily, i.v.) for two days. Either treatment caused a significant decrease in blood pressure and an increase in plasma renin activity (PRA). The aldosterone excretion rate was elevated only in the patients receiving amilorid. Furthermore potassium retention and sodium loss were more pronounced in the amilorid group. Long-term treatment (up to 14 weeks) with amilorid (10 mg daily), spironolactone (200 mg daily) or chlortalidone (50 mg daily) significantly lowered the blood pressure of patients with essential hypertension. Plasma potassium and PRA rose significantly in patients receiving either amilorid or spironolactone. However, after three weeks of therapy the mean PRA returned to the pretreatment level in patients on amilorid while it remained persistently elevated in the spironolactone group. On the other hand, chlortalidone caused potassium loss and persistent elevation of PRA. A possible relationship between the changes in plasma potassium levels and PRA in response to diuretics is discussed.

[Measurement of pulmonary artery pressure at rest during volume loading for assessment of ventricular function in coronary artery disease (author's transl)]. / Pulmonalarteriendruckmessung in Ruhe während Volumsbelastung zur Beurteilung der Ventrikelfunktion bei koronarer Herzkrankheit.

Measurements of pulmonary artery (PA) pressure at rest with volume loading of the heart was carried out in a semirecumbent position by standardized positioning of the legs (Positioning test) in 44 patients with angiographically-proven severe coronary artery disease (CAD). The patients reacted differently and were accordingly assigned to one of the three following groups: Group I (23 patients) with normal PA pressures values showed normal results on ventriculography and accordingly, a normal ejection fraction. Group II (13 patients) showed a pathological increase in PA pressure by volume loading. Ventriculography showed hypo- or akinetic areas, with accordingly reduced ejection fraction already at rest. Group III (8 patients) showed pathological PA pressure values already at rest, in accordance with the ventriculographic existence of larger akinetic areas and a marked reduction in ejection fraction. Coronary morphology per se showed no correlation with PA pressure behaviour during volume loading at rest. Therefore, PA pressure measurement in the standardized positioning test can give a relatively accurate estimation of the functional state of the left ventricle, while statements about coronary morphology in CAD are not permissible.

[A case of chronic pulmonary hypertension after fenfluramine intake]. / Ein Fall von chronischer pulmonaler Hypertonie nach Fenfluramineinnahme.

A case of primary vascular pulmonary hypertension (PVPH) in a 53-year old woman (160 cm, 90 kg) is reported. She first complained of symptoms of breathlessness on exertion 2-3 months after completion of three courses of fenfluramine (Ponderax). The courses began in October 1977 and ended in May 1978. Despite persisting symptoms no relevant clinical findings were obtained. The patient was admitted to this hospital after complaining of short syncopal attacks on exertion, in November 1981. Typical signs of PVPH were now demonstrable, with a resting pulmonary pressure of 98/45 mm Hg. Clinical findings showed a similarity to those obtained in patients suffering from aminorex-induced PVPH, although fenfluramine shows some biological differences to aminorex. A causality between the development of PVPH and fenfluramine intake is probable on the basis of the patient's history, but it cannot be proven.

[Secondary prevention following coronary intervention. Survey of 13 intervention centers in Austria]. / Sekundärprävention nach Koronarintervention. Vorgangsweise an 13 Interventionellen Zentren in Osterreich.

Risk factor control has been shown to reduce the incidence of coronary events in patients with or without preceding infarction. Secondary prevention should therefore be borne in mind by every cardiologist. In order to test this concept and/or to promote secondary prevention in our country, the following survey was conducted by our working group for epidemiology and prevention. All interventional centres of the country (7 million inhabitants) were asked to report relevant data of 50 consecutive patients with PTCA in a structured questionnaire. Thirteen centres responded and we report the data of 650 patients. The mean proportion of women was 28%, the mean age 61.1 years and the mean stent rate 49.8%. The indications for PTCA varied widely: stable angina 10-74%, unstable angina 10-86%, primary PTCA 0-22%. The risk factor history was distributed as follows: diabetes 12-46% (mean 22.3%), hypertension 32-68% (mean 54.2%), current smoking 6-56% (mean 21.9%), and total cholesterol (TChol) > 200 mg/dl: 30-78% (mean 60.3%). Current lipid values were available for T chol. in 44-100% (mean 84.5%) and for LDL in 4-100% (mean 67.1%). Dietary counselling by a dietician was done in 4-100% of patients (mean 35.6%) Information concerning the hazards of smoking was given to 25-100% (mean 83.6%) of current smokers. Drug treatment at hospital discharge was as follows: 84-100% (mean 93.1%) received ASA, 24-74% (mean 49.8%) ticlopidine, 6-84% (mean 53.3%) nitrates, 34-82% (mean 60.2%) beta blockers, 10-70% (mean 39.5%) ACE inhibitors, 4-74% (mean 4 7.2%) lipid lowering drugs, 7-48% (mean 17.8%) calcium antagonists, 0-12% (mean 6.1%) digitalis and 0-28% (mean 13.6%) diuretics. Follow-up data were collected in 4 centres at 6 months post discharge and were available for 174 patients. Here we found an increase in the prescription of calcium antagonists, digitalis and statins. The following conclusions were drawn at a conference in which all centres participated: lipid values should be available for each patient at PTCA, dietary counselling should be initiated for every patient during hospitalisation (and continued by the family physician) and the national cardiac society should promote guidelines for the use of drugs in which the variation in use is too wide at present. It should be ensured that these guidelines are implemented not only in patients after AMI but also in those after PTCA.