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  • 1
    Electronic Resource
    Electronic Resource
    Springer
    Monatsschrift Kinderheilkunde 148 (2000), S. 496-497 
    ISSN: 1433-0474
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 2
    Electronic Resource
    Electronic Resource
    s.l. : American Chemical Society
    The @journal of organic chemistry 37 (1972), S. 481-486 
    ISSN: 1520-6904
    Source: ACS Legacy Archives
    Topics: Chemistry and Pharmacology
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1432-1440
    Keywords: Coronary angioplasty ; Excercise ; Atrial natriuretic factor ; Pulmonary artery pressure ; Right atrial pressure
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary According to several reports of close correlations between pulmonary artery pressure and ANF plasma levels it would be convenient to replace invasive pressure monitoring by ANF determination. Mean pulmonary artery and right atrial pressures and pulmonary artery as well as peripheral venous ANF plasma concentrations were measured in 24 patients before and after coronary angioplasty (PTCA) continuously at rest and during exercise: At rest, both pressure and ANF-values remained unchanged before and after PTCA. At exercise, there was a decrease of mean pulmonary artery pressure (from 41.3±8.6 to 31.5±7.4 mmHg,p〈0.001), mean right atrial pressure (from 11.9±3.0 to 9.0±2.3 mmHg,p〈 0.001), pulmonary artery (282.5±191.0 to 207.3±157.2 pg/ml,p〈0.05) and peripheral venous (112.7±48.0 to 97.1±53.2 pg/ml, n.s.) ANF concentration after PTCA. We found no correlation between PTCA-induced changes of right arterial pressures and ANF concentrations, while changes of pulmonary artery pressures were significantly correlated to changes of peripheral venous (r=0.79,p〈0.001) as well as pulmonary artery (r=0.59,p〈0.01) ANF concentrations at exercise. In 6 of the 24 patients, however there was an inverse relationship between changes of pulmonary artery pressures and ANF concentrations. — Our data demonstrate a significant correlation between changes of ANF plasma level and pulmonary artery pressure values at exercise after PTCA. In the individual case however invasive pressure monitoring cannot be replaced by determination of ANF plasma levels.
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  • 4
    ISSN: 1432-1440
    Keywords: Myocardial infarction ; Hodgkin's disease ; Radiation therapy ; Chemotherapy ; Splenectomy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Among a total of 2147 patients admitted to our hospital for acute myocardial infarction between 1978 and 1987, three young patients aged 24, 29, and 39 years had previously been treated for Hodgkin's disease. Staging laparotomy, including splenectomy, had been performed in all three patients. Two patients had both mediastinal irradiation (21 and 27 months before infarction) and chemotherapy. In the first patient, postmortem histologic examination of the coronary arteries revealed fibrotic changes, which were probably induced by radiotherapy. In our second patient, myocardial infarction developed 5 days after vinblastine treatment; early angiography showed thrombotic occlusion of the proximal right coronary artery, which was recanalized using the diagnostic Sones catheter. Subsequent angiography revealed normal coronary arteries. This is, to our knowledge, the first case of documented coronary artery thrombosis after treatment with vinca-alkaloids. In our third patient, neither mediastinal irradiation nor chemotherapy had been performed prior to myocardial infarction. However, a marked increase in platelet counts following splenectomy was observed in this patient. The role of radiotherapy, chemotherapy, and splenectomy with consecutive thrombocytosis as a third possible pathogenic factor for subsequent development of myocardial infarction is discussed.
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  • 5
    ISSN: 1435-1285
    Keywords: Key words Chronic coronary occlusion – coronary angioplasty – stent – intravascular ultrasound ; Schlüsselwörter Chronische Koronarokklusion – Koronarangioplastie – Stent – intrakoronarer Ultraschall
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Chronic coronary occlusions carry a high recurrence rate, and coronary stenting evolves as a preferred therapy of these complex lesions. Insight into the morphology of the occcluded segment by intracoronary ultrasound may provide information which may help to improve the interventional strategy and the long-term outcome. After successful recanalization of chronic coronary occlusions (4 weeks to 33 months; median 3.2 monhs) in 59 patients, 29 patients were treated by balloon angioplasty alone, and 30 patients received one or more coronary stents because of complicated dissections or a high-grade residual stenosis after balloon dilatation. Intracoronary ultrasound was used to assess the lesion morphology and to quantify the angioplasty result. The luminal area, the total vessel area and the extent of the plaque burden were measured proximal and distal to the occlusion and at the narrowest site within the occlusion or the coronary stents, and the elastic recoil was calculated. Plaques in chronic occlusions were predominantly hypodense, and 44% were characterized by a multilayered plaque appearance. The elastic recoil was higher in multilayered plaques than in other plaques (46 ± 19% vs. 34 ± 15%; p 〈 0.05). Based on the quantitative ultrasound measurement after the initial balloon dilatation, it appeared that the initial balloon was undersized in 54%. The lumen area in patients with balloon angioplasty alone was increased from 4.02 ± 1.34 mm2 to 5.49 ± 1.47 mm2 and in the stented patients from 3.58 ± 1.04 mm2 to 7.10 ± 1.92 mm2. The recurrence rate in patients with balloon angioplasty was 48% with 24% reocclusions. Patients with recurrence had a slightly lower lesion area (3.97 ± 1.41 mm2 vs. 4.71 ± 1.44 mm2; n.s.) and minimum diameter (1.82 ± 0.31 mm vs. 2.14 ± 0.40 mm; p 〈 0.05) after dilatation. In stented patients the recurrence rate was 27% with two early stent thrombosis (6.7%) and no late reocclusion. In patients with recurrence the achieved stent area was significantly smaller than in those without restenosis (5.71 ± 0.90 mm2 vs. 7.59 ± 1.96 mm2; p 〈 0.01), and the degree of vascular remodelling at the site of the occlusion was less pronounced. Intracoronary ultrasound showed sonographic plaque characteristics in chronic occlusions which responded poorly to balloon dilatation alone. Stent implantation improved considerably the luminal area gain and could reduce the long-term outcome. To further improve the recurrence rate in stents, an optimized stent expansion should be achieved, and intracoronary ultrasound could provide an ideal tool for this purpose.
    Notes: Zusammenfassung Chronische Koronarokklusionen zeichnen sich durch eine hohe Rezidivrate aus, welche durch eine Stentimplantation verbessert werden kann. Informationen über die Morphologie der Okklusion, wie sie der intrakoronare Ultraschall liefert, könnten helfen, die interventionelle Strategie nach Ballonangioplastie oder Stentimplantation hinsichtlich der Langzeitergebnisse zu optimieren. Nach erfolgreicher Rekanalisation einer chronischen Okklusion (Dauer 1–33 Monate, Median 3,2 Monate) bei 59 Patienten wurden 29 Patienten mit Ballonangioplastie und 30 Patienten mit zusätzlicher Stentimplantation wegen Dissektionen oder unbefriedigendem Angioplastieergebnis behandelt. Intrakoronarer Ultraschall wurde zur Beurteilung der Läsionsmorphologie und zur Quantifizierung des Angioplastieergebnisses eingesetzt. Hiermit wurden die Lumen- und Gefäßflächen sowie die Plaquebelastung im proximalen und distalen Referenzsegment sowie in der Läsion bzw. nach Stentimplantation bestimmt sowie der elastische Recoil ermittelt. Die Echodichte der Plaques in chronischen Okklusionen war überwiegend hypodens, und bei 44% fand sich eine mehrschichtige Zusammensetzung des Plaquematerials. Diese mehrschichtigen Plaques hatten einen höheren elastischen Recoil als die übrigen Plaques (46 ± 19% vs. 34 ± 15%; p 〈 0,05). Bei 54% aller Rekanalisationen erwies sich der initial gewählte Ballon nach der Kontrolle durch intrakoronaren Ultraschall als zu klein. Durch eine angepaßte Ballongröße ließ sich das minimale Lumen im Bereich der Okklusion von 4,02 ± 1,34 mm2 auf 5,49 ± 1,47 mm2 in der Gruppe mit Ballonangioplastie steigern; in der Gruppe mit zusätzlicher Stentimplantation stieg das minimale Lumen im Stent von 3,58 ± 1,04 mm2 auf 7,10 ± 1,92 mm2. Die angiographische Rezidivrate innerhalb der ersten 6 Monate nach Ballonangioplastie lag bei 48%, einschließlich 24% kompletter Reokklusionen. Patienten mit Rezidiv in dieser Gruppe wiesen eine etwas geringere Lumenfläche (3,97 ± 1,41 mm2 vs. 4,71 ± 1,44 mm2; n.s.) und -durchmesser (1,82 ± 0,31 mm vs. 2,14 ± 0,40 mm; p 〈 0,05) nach der Rekanalisation auf. Nach der Stentimplantation war die Rezidivrate nur 27%, wobei hier nur 2 (6,7%) frühe Reokklusionen im Rahmen einer Stentthrombose auftraten und keine späteren Reokklusionen. Bei Patienten mit Rezidiv nach Stent war die Stentfläche deutlich geringer als bei Patienten ohne Rezidiv (5,71 ± 0,90 mm2 vs. 7,59 ± 1,96 mm2; p 〈 0,01). Zudem zeigten die Läsionen mit Rezidiv ein geringer ausgeprägtes Maß an Gefäßremodeling. Durch den intrakoronaren Ultraschall im Rahmen der Rekanalisation chronischer Koronarokklusionen konnte bei einem großen Teil der Patienten eine mehrschichtige Plaquemorphologie erkannt werden, die hohen Recoil nach Ballonangioplastie zeigte. Durch die Stentimplantation konnte der Lumengewinn erheblich verbessert werden, was zur niedrigen Rezidivrate beigetragen haben dürfte. Um diese Ergebnisse weiter zu verbessern, sollte die Stentimplantation so weit wie möglich optimiert werden, wozu der intrakoronare Ultraschall ein wertvolles diagnostisches Hilfsmittel bietet.
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  • 6
    Electronic Resource
    Electronic Resource
    Amsterdam : Elsevier
    Tetrahedron Letters 19 (1978), S. 1467-1470 
    ISSN: 0040-4039
    Source: Elsevier Journal Backfiles on ScienceDirect 1907 - 2002
    Topics: Chemistry and Pharmacology
    Type of Medium: Electronic Resource
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