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  • 1
    ISSN: 1540-8183
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The present report describes a patient with severe mitral stenosis and coronary artery disease who was successfully treated by combined percutaneous mitral valvuloplasty and coronary angioplasty. A few days following these procedures, the patient, probably as a result of thrombus embolization in the LAD artery, developed signs of an evolving anterior myocardial infarction and was successfully treated with intravenous thrombolytic therapy. This case demonstrates the feasibility of the combined appliance of interventional techniques in selected patients as an alternative to cardiac surgery.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1540-8183
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Clinical experience suggests that overlapping coronary stents result in an increased in-stent restenosis. This study investigates the underlying mechanisms in a porcine coronary model. Single or two overlapping self-made stainless steel single wire sinusoidal helical coil stents were randomly deployed in the right coronary artery of 20 cross-bred pigs. The pigs underwent a control angiogram at 6 weeks and were then sacrificed. Quantitative coronary analysis before, immediately after stent implantation, and at 6 weeks was performed using the semiautomated Polytron 1000 system. Morphometry was performed using a computerized morphometric program. Angiographic analysis revealed a decreased recoil in the overlapping group (1% vs 4%: P 〈 0.02) and a significantly larger minimal stent lumen diameter at follow-up in the single stent group (2.87 ± 0.16 vs 2.58 ± 0.22 mm, P = 0.005). Histopathology showed a significantly increased injury (1.27 ± 0.43 vs 0.83 ± 0.44, P = 0.042) and inflammatory reaction (1.51 ± 0.11 vs 1.09 ± 0.54, P = 0.035) surrounding the stent filaments in the overlapping stent group. Morphometric analysis showed a significantly higher neointimal hyperplasia (3.34 ± 0.68 vs 2.16 ± 1.48 mm2, P = 0.034) in the overlapping stent group. Overlapping stents result in a more pronounced coronary vessel injury resulting in more inflammation and neointimal hyperplasia compared to single stents.
    Type of Medium: Electronic Resource
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  • 3
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Science Inc
    Journal of cardiovascular electrophysiology 13 (2002), S. 0 
    ISSN: 1540-8167
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Effect of Instrumentation on AF in a Sheep Model. Introduction: Atrial electrical remodeling, shortening of the atrial effective refractory period (AERP) underlying atrial fibrillation (AF) has been described in different animal models. However, there remains some controversy regarding the time course of this electrical remodeling and the need for secondary factors in the development of AF. We investigated the effect of instrumentation on the inducibility of AF. We hypothesized that epicardial instrumentation could be a confounding factor that accelerates the development of AF. Methods and Results: Thirty sheep were rapidly atrially paced at 600 beats/min for 15 weeks: 15 were endocardially instrumented and paced (endo), and 15 were both endocardially and epicardially instrumented. Six of these animals were endocardially paced (sham) and 9 were epicardially paced (epi). The underlying rhythm was determined at regular intervals, and electrophysiologic study was performed. AF developed significantly faster in the epi group. After 3 weeks of pacing, the cumulative incidence of sustained AF (〉 1 hour) already was 70% in this group versus only 14% and 20% in the endo and sham groups, respectively. After 15 weeks of pacing, this difference was no longer evident. Baseline AERP and minimal AERP, reached before the development of AF, were not significantly different in the three groups. Epicardial instrumentation (epi and sham) increased baseline left and right atrial pressures, but only epicardial stimulation (epi) led to early development of AF. Conclusion: In this sheep model of AF, the experimental setup is a major determinant of the inducibility of AF. Not epicardial instrumentation per se but epicardial stimulation accelerated the development of AF. Different animal models of AF may represent different clinical entities of AF.
    Type of Medium: Electronic Resource
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  • 4
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Science Inc
    Journal of cardiovascular electrophysiology 12 (2001), S. 0 
    ISSN: 1540-8167
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Angiotensin II and Atrial Natriuretic Peptide in AF. Introduction: It is well established that rapid atrial rates, as in atrial fibrillation (AF), cause atrial electrical and structural remodeling leading to the maintenance of AF. The role of neurohumoral changes in this pathophysiologic vicious circle remains unclear. Methods and Results: We followed the concentrations of angiotensin II (AT II) and atrial natriuretic peptide (ANP) in a sheep model of AF. The sheep were atrially paced at 600 beats/min for 15 weeks. Electrophysiologic study was performed at regular intervals, and venous blood samples were taken. There was a slow increase in the vulnerability for AF. The cumulative incidence of sustained AF was 80% after 15 weeks of pacing. This increased vulnerability for AF was accompanied by atrial electrical remodeling and an increase in atrial pressure. AT II increased rapidly and stayed elevated: 17 ± 4 pg/mL at baseline, and 40 ± 11 and 39 ± 7 pg/mL after 1 and 12 weeks of pacing, respectively. ANP rose more progressively: 35 ± 7 pg/mL at baseline, and 72 ± 17, 95 ± 10, and 106 ± 23 pg/mL after 1, 3, and 12 weeks, respectively. ANP levels correlated with atrial pressure and inducibility of AF. There was no relation between these parameters and AT II levels. Conclusion: AT II and ANP increased significantly in this animal model of AF. Elevation of AT II occurs early and seems to be dependent on rapid atrial rate rather than the presence of AF. ANP increased more progressively. It paralleled the inducibility of AF and atrial stretch. Both neurohumoral pathways may form a potential therapeutic target for treatment of patients with AF.
    Type of Medium: Electronic Resource
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  • 5
    ISSN: 1540-8183
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: An abundant healing response resulting in a more pronounced neointimal hyperplasia compared to conventional balloon angioplasty remains the most important clinical problem after coronary stent implantation. In the present study the potential beneficial effect of metal surface treatment using electrochemical polishing on stent thrombogenicity and neointimal hyperplasia was evaluated in a rat A- V model and a porcine coronary model. An electrochemical polishing system was developed to improve surface characteristics of stainless steel stents. Topographic scanning of the stent surface using a profilometer type Taylor Holson Form Taylsurf 120L showed a significant effect on R, (arithmetic mean of the roughness height) (0.14 vs 0.04 μm: P 〈 0.001) and Rt (maximum rouhgness height between a peak and a valley for the sampling length) (1.44 vs 0.43 μm: P 〈 0.001). Thrombogenicity of polished stents (n = 6) was compared to nonpolished stents (n = 5) in a rat A - V shunt model using 125I fibrinogen and 51Cr-labeled platelets. Total clot weight after 30 minutes was significantly lower in the polished stents (32.1 + 2.8 vs 18.1 + 4.4: P 〈 0.001). Also 125I fibrinogen deposition was significantly lower in the polished stents (1.30 + 0.07 vs 0.66 + 0.04: P 〈 0.001). Platelet deposition, however, was not significantly reduced (12.7 + 3.4 vs 9.87 + 1.9, NS). Subsequently, the effect of electrochemical polishing on neointimal hyperplasia was evaluated in a porcine coronary model. Polished (n =10) and nonpolished stents (n =10) were randomly implanted in the right coronary artery of healthy pigs. Neointimal hyperplasia was significantly decreased in the polished stents (0.6 + 0.28 vs 0.9 + 0.34 mm2: P 〈0.01). Electrochemical polishing oj coronary stents results in decreased thrombogenicity and neointimal hyperplasia after stent implantation in different animal models.
    Type of Medium: Electronic Resource
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  • 6
    ISSN: 1546-1696
    Source: Nature Archives 1869 - 2009
    Topics: Biology , Process Engineering, Biotechnology, Nutrition Technology
    Notes: [Auszug] Recombinant plasmids were constructed in which the signal sequence of the sak42D and the sakSTAR staphylokinase genes were replaced by an ATG start codon and which express staphylokinase under the control of a tac promoter and two Shine–Dalgarno sequences in tandem. Induction of transfected ...
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  • 7
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Pacing and clinical electrophysiology 23 (2000), S. 0 
    ISSN: 1540-8159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The treatment of neurocardiogenic syncope is insufficient in many cases. We hypothesized that the repeated exposure of the cardiovascular system to orthostatic stress could have a therapeutic effect on the regulation of cardiovascular reflex mechanisms. We have started a program of tilt training for heavily symptomatic patients. After hospital admission, patients were tilted daily (60-degree inclination), until syncope, or until a maximum of 45–90 minutes. The patients were instructed to continue a program of daily tilt training at home: two 30-minute sessions of upright standing against a vertical wall. No medication was prescribed. A total of 260 tilt table sessions were performed in 42 patients. The first tilt test was positive after 21 ± 13 minutes. The syncope was cardioinhibitory in 14 cases, vasodepressor in 19, mixed in 9. At the time of hospital discharge, 41 patients could support 45 minutes of head-up tilting. After a mean follow-up time of 15.1 (SD 7.8) months, 36 patients remained completely free of syncope. Syncope still occurred in one patient and presyncope in four patients. One patient died from an extensive myocardial infarction. The abnormal autonomic reflex activity of neurocardiogenic syncope can be remedied by a program of continued tilt training without the administration of drugs. This new treatment has proven to be effective for the vasodepressor and the cardioinhibitory type of syncope.
    Type of Medium: Electronic Resource
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  • 8
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Pacing and clinical electrophysiology 21 (1998), S. 0 
    ISSN: 1540-8159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The link between personality and cardiac function is insufficiently characterized. We postulated that in a healthy population, cardiac autonomic function is linked to coping style. In 276 healthy volunteers, between the ages of 18 and 71, the Utrecht Coping List was used to evaluate different coping strategies. Trait anxiety was scored by the Spielberger State Trait Anxiety Inventory. A 24-hour Holter recording was used to calculate heart rate variability (HRV). For HRV parameters and coping mechanisms this study demonstrated gender-specific differences and correlations with age. In men (n = 141) higher active coping was associated with less global autonomic activity or SDANN (rs=−0.27, P 〈 0.001). This relationship was most prevalent in young (18–30 years) men (rs=−0.45, P 〈 0.005). Higher expression of negative emotions or anger was related to both higher vagal (rs= 0.23 for rMSSD, P 〈 0.01) tone and higher LF power (rs= 0.23, P 〈 0.01). In young men expression of negative emotions or anger was associated with LF power (rs= 0.37, P 〈 0.01) and in middle-aged (31–50 years) men with vagal tone (rs= 0.43 for rMSSD, P 〈 0.005) and heart rate (rs=−0.41, P 〈 0.005). Higher comforting ideas was related to higher LF power (rs= 0.23 for LF power, P 〈 0.005), and this especially in middle-aged men (rs= 0.37, P 〈 0.01). In women (n = 135), no significant correlations between coping style and HRV indices were found. We conclude that in normal individuals, at least in men, our findings suggest a relationship between coping style and cardiac autonomic function.
    Type of Medium: Electronic Resource
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  • 9
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Pacing and clinical electrophysiology 21 (1998), S. 0 
    ISSN: 1540-8159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The conduction time over the lower common pathway (LCP) in AVNRT can be assessed by subtracting the H A-interval during tachycardia (HAt) from that during ventricular pacing at exactly the same cycle length (HAp) (ΔHA = HAp - HAt). tt has been suggested that H-A measurements may help in the differentiation of Slow/Fast from Slow/Slow AVNRT. This study evaluated prospectively in 61 consecutive patients with AVNRT (43 ± 15 y; 46 women, all with antegrade conduction during AVNRT over the slaw pathway) how often a reliable measurement of the length of the LCP could be made, and in how far the results were concordant with mapping criteria for the differentiation of Slow/Fast from Slow/Slow A VNRT. A new para-Hisian pacing technique (using only the His bundle catheter) was applied in all patients. Comparison of HAt and HAp was possible in 44 of the 61 patients (72%). In these 44 patients, HAp was longer than HAt in 12 patients, indicating the presence of a LCP. All patients with ΔHA ≥ 15 ms had earliest retrograde atrial activation in the posterior septum (Slow/Slow AVNRT, n = 6) or simultaneously in the anterior and posterior septum (n = 1). On the other hand, 31 of the 32 patients without evidence of a substantial LCP (ΔHA ≤ 0) had typical Slow/Fast AVNRT. Moreover, although it appears logical for Slow/Fast A VNRT to have a shorter HAt than Slow'Slow A VNRT, an HAp of ≥ 70 ms was a better discriminator between the two forms of AVNRT than any HAt value. Therefore, ΔHA ≥ 15 ms (sens. ≥86%; spec. ≥97%) or HAp ≥ 70 ms (sens. = 100%; spec. ≥89%) were highly indicative for the Slow/Slow variant of AVNRT. Using a para-Hisian pacing technique, H-A measurements can be performed in 72% of A VNRT patients. They can be used as an important tool in the differentiation of Slow/Fast and Slow/Slow A VNRT.
    Type of Medium: Electronic Resource
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  • 10
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Pacing and clinical electrophysiology 21 (1998), S. 0 
    ISSN: 1540-8159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Medical treatment of neurocardiogenic syncope is insufficient in many cases. We have observed a therapeutic effect of repeated head-up till testing. Therefore, we have started a program of tilt training for heavily symptomatic patients. After hospital admission, they were tilted daily (60° inclination) until syncope, or until a duration of 45–90 minutes (90 sessions in 13 patients). The mean tilt tolerance, at the first diagnostic head-up tilt table test, was 22.3 minutes (st. dev. 10.9). Before hospital discharge, 12/13 patients could sustain the full duration of tilt table testing without any symptom. In one patient syncope persisted. The patients were instructed to continue a program of daily tilt training at home, by standing against a wall for 30 minutes, one or two times per day. This resulted in a complete disappearance of syncope in all 13 patients.Orthostatic intolerance and the excessive autonomic reflex activity of neurocardiogenic syncope can be remedied by a program of continued tilt training, without the administration of drugs.
    Type of Medium: Electronic Resource
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