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  • 1
    Electronic Resource
    Electronic Resource
    Recanalization of Chronic Coronary Occlusions by Low Speed Rotational Angioplasty (ROTACS) (1991)
    Oxford, UK : Blackwell Publishing Ltd
    Journal of interventional cardiology 4 (1991), S. 0 
    Details
    ISSN: 1540-8183
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: From 1988 to 1990 chronic coronary occlusions were treated with a newly developed slowly rotating angioplasty system (ROTACS), which is designed for atraumatic passage of arterial obstructions. In all 152 patients (mean age 55 years, ranging from 29 to 78 years) attempts to recanalize the coronary occlusion with conventional guidewire systems had failed. In 74/152 patients the age of the occlusion could be estimated because of a previous angiogram or clinical event. It ranged from 1–192 months (median 6 months, mean value 14 months; in 20% of patients it was 1–3, in 37% 4–6, in 28% 7–12, and in 15% 〉 12 months). The occlusion was localized in the right coronary artery (RCA) in 86 cases, in the left anterior descending coronary artery (LAD) in 37 cases, and in the circumflex branch of the left coronary artery in 17 cases. Eleven bypass occlusions were treated. One patient had a LAD and RCA occlusion. Out of 152 patients 84 could be recanalized. The success rate rose with experience from 30% to 60%. It was 55% in the LAD, 52% in the RCA, 70% in the circumflex branch, and 63% in bypass grafts. The success rate in relation to the age of the occlusion was 93% in occlusions of 1–3 month duration, 74% in occlusions of 4–6 months duration, 52% in occlusions of 6–12 months duration, and 8% in occlusions older than 12 months. Seventy-six of the successfully treated patients underwent follow-up angiography after 4 months. In 56/76 (74%) the vessel remained open. Twenty-two patients (29%) had restenosis that was successfully dilated in 21 patients. Twenty patients (26%) had reocclusion. Thus, the angiographically determined long-term success rate was 72%. Emergency operation was necessary in two patients in whom reopening of the LAD was attempted although the occlusion was located directly at the take-off of the LAD from the left main. Since this type of occlusion was consequently considered a contraindication, no further serious complications occurred. There was one myocardial infarction, no death, no vessel wall perforation or other complications in the 152 patients. It is concluded that low speed ROTACS is a safe technique that can be applied in chronic coronary occlusions even if the duration of occlusion exceeds 6 months. (J Interven Cardiol 1991; 4:15–165)
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8183.1991.tb00788.x
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  • 2
    Electronic Resource
    Electronic Resource
    Angiographic and Histologic Course after Implantation of Balloon Expandable Intravascular Stents in Miniswine Coronary Arteries: Short- and Mid-Term Observations (1990)
    Oxford, UK : Blackwell Publishing Ltd
    Journal of interventional cardiology 3 (1990), S. 0 
    Details
    ISSN: 1540-8183
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Sixteen balloon expandable Medtronic Wiktor tantalum stents were implanted in the major coronary arteries of six minipigs, which were maintained on a normal diet and given 500 mg aspirin per day. Angiographic and histologic examinations were performed 6 and 26 weeks after implantation. Angiographically reviewed, stenting increased the inner diameter of the coronary arteries from 2.61 ± 0.44 to 3.02 ± 0.34 mm (n = 16, P ≤ 0.001). Six weeks later, this value was reduced from 2.98 ± 0.35 to 2.33 ± 0.46 mm (n = 9, P ≤ 0.05), and between 6 and 26 weeks, an increase from 2.17 ± 0.44 to 2.93 ± 0.40 mm occurred (n = 6, P ≤ 0.05). Histologic evaluation at 26 weeks after stent implantation revealed an increase of the cross-sectional area of the total vessel from 4.30 ± 1.09 to 5.50 ± 1.67 mm2 (n = 9; P ≤ 0.01). This was due to widening of the total vessel and intimal proliferation, which amounted to 1.19 ± 0.46 mm2 within the stented segment, as compared to 0.03 ± 0.03 mm2 in control sections (P ≤ 0.01). The areas of free vessel lumen, media muscularis, and adventitia remained unchanged. In 15 of the 16 hislologically examined coronary arteries, the internal elastica was fractured at the site of stent implantation. Twelve stents had also penetrated through the external elastica without evidence of wall hemorrhage. Thirteen out of 16 stents were angiographically followed, of which 12 were patent at the final reangiography. In one animal, acute thrombosis of the stented vessel after guidewire induced coronary artery spasm caused chronic right heart failure due to right ventricular myocardial infarction. Sudden death occurred in another pig 2 hours after successful implantation of three grossly oversized stents (inner vessel diameter: 2.4 ± 0.2 mm, stent diameter 3.2 ± 0.5 mm). Autopsy revealed extensive dissections of the media with subsequent vessel occlusion. It is concluded that Medtronic Wiktor stents can be placed easily, even in more distal or curved coronary arteries. Despite antiaggregational medication, intimal proliferation is observed early after implantation, reaches a maximum at about 6 weeks, and is followed by a regression 26 weeks poststenting. At 26 weeks follow-up, the free vessel lumen at the stent site was not significantly reduced as compared to control segments. Proper adjustment of internal vessel diameter and stent diameter is necessary to prevent major dissections and thrombotic occlusions.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8183.1990.tb00966.x
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  • 3
    Electronic Resource
    Electronic Resource
    Acute and Mid-Term Experiences with the Wiktor Stent in Acute Complications and Restenosis After Coronary Angioplasty (1992)
    Oxford, UK : Blackwell Publishing Ltd
    Journal of interventional cardiology 5 (1992), S. 0 
    Details
    ISSN: 1540-8183
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: We report about the 6-month follow-up of 28 consecutive patients treated with a new tantalum stent (Wiktor™ stent, Medtronic, Inc.). Indication for stenting was the prevention of restenosis in eight patients (restenosis group), and threatening or acute closure after PTCA in 20 patients (acute closure group). Twenty-eight of 30 stents were successfully positioned in 27 of 28 patients (96%), whereas implantation failed twice in one patient. Immediate stent occlusion developed in two patients in the acute closure group (7.4%). Subacute stent occlusion was observed in three patients (11%), one in the restenosis group, two in the acute closure group, between 3 and 5 days after implantation. Coronary bypass surgery had to be performed in four patients (15%): one patient after failed stent placement, two after acute, and one after subacute stent thrombosis. Major bleeding complications related to the anticoagulative drug regimen occurred in nine patients (33%). Three patients (11%) died for reasons most probably not related to stent implantation. A 6-month angiographic follow-up revealed restenosis in two of 19 patients (11%), one patient in each group. Sixteen of the 27 stented patients (59%) reached 6-month follow-up without death, acute or subacute stent thrombosis, or restenosis. It is concluded that the Wiktor stent can be placed with a high rate of success. It may also reduce the risk of restenosis. The stent also offers the possibility to circumvent emergency bypass surgery in case of PTCA related vessel occlusion. Acute and subacute stent occlusion still remains an unsolved topic.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8183.1992.tb00421.x
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  • 4
    Electronic Resource
    Electronic Resource
    Is Bax a mitochondrial mediator in apoptotic death of dopaminergic neurons in Parkinson's disease? (2001)
    Oxford, UK : Blackwell Science Ltd
    Journal of neurochemistry 76 (2001), S. 0 
    Details
    ISSN: 1471-4159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Bax is a proapoptotic member of the Bcl-2 family of proteins. It is believed to exert its action primarily by facilitating the release of cytochrome c from the mitochondrial intermembrane space into the cytosol, leading to caspase activation and cell death. Because alterations in mitochondrial respiratory function, caspase activation and cell death with morphologic features compatible with apoptosis have been observed post mortem in the brain of patients with Parkinson's disease, we tried to clarify the potential role of Bax in this process in an immunohistochemical study on normal and Parkinson's disease post-mortem brain and primary mesencephalic cell cultures treated with MPP+. We found that Bax is expressed ubiquitously by dopaminergic (DA) neurons in post-mortem brain of normal and Parkinson's disease subjects as well as in vitro. Using an antibody to Bax inserted into the outer mitochondrial membrane as an index of Bax activation, no significant differences were observed between control and Parkinson's disease subjects, regardless of the mesencephalic subregion analysed. However, in Parkinson's disease subjects, the percentage of Bax-positive melanized SNpc neurons containing Lewy bodies, suggestive of DA neuronal suffering, was significantly higher than the overall percentage of Bax-positive neurons among melanized neurons. Furthermore, all melanized SNpc neurons in Parkinson's disease subjects with activated caspase-3 were also immunoreactive for Bax, suggesting that Bax anchored in the outer mitochondrial membrane of melanized SNpc neurons showing signs of neuronal suffering or apoptosis is increased compared with DA neurons that are apparently unaltered. Surprisingly, MPP+ treatment of tyrosine hydroxylase (TH)-positive neurons in primary mesencephalic cultures did not cause redistribution of Bax, although cytochrome c was released from the mitochondria and nuclear condensation/fragmentation was induced. Taken together, these findings suggest that in the human pathology, Bax may be a cofactor in caspase activation, but our in vitro data fail to indicate a central role for Bax in apoptotic death of DA neurons in an experimental Parkinson's disease paradigm.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1471-4159.2001.00160.x
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  • 5
    Electronic Resource
    Electronic Resource
    Noradrenaline provides long-term protection to dopaminergic neurons by reducing oxidative stress (2001)
    Oxford, UK : Blackwell Science Ltd
    Journal of neurochemistry 79 (2001), S. 0 
    Details
    ISSN: 1471-4159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: To better understand the neurotrophic function of the neurotransmitter noradrenaline, we have developed a model of mesencephalic cultures in which we find low concentrations (0.3–10 µm) of noradrenaline to be remarkably effective in promoting long-term survival and function of dopaminergic neurons. This protective action reproduced the effect of caspase inhibition. It was atypical in that it occurred independently of adrenoceptor activation and was mimicked by some antioxidants, redox metal chelators and the hydroxyl radical detoxifying enzyme catalase. Interestingly, intracellular reactive oxygen species (ROS) were drastically reduced by treatment with noradrenaline, indicating that the neurotransmitter itself acted as an antioxidant. Prevention of oxidative stress was, however, independent of the glutathione antioxidant defense system. Chemical analogues of noradrenaline bearing two free hydroxyl groups in the ortho position of the aromatic ring (o-catechols), as well as o-catechol itself, mimicked the survival promoting effects of the neurotransmitter, suggesting that this diphenolic structure was critical for both neuroprotection and reduction of ROS production. Paradoxically, the autoxidation of noradrenaline and the ensuing production of quinone metabolites may be required for both effects, as the neurotransmitter was spontaneously and rapidly degraded over time in the culture medium. These results support the concept that central noradrenergic mechanisms have a neuroprotective role, perhaps in part by reducing oxidative stress.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1471-4159.2001.00556.x
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  • 6
    Electronic Resource
    Electronic Resource
    Proliferation of microglial cells induced by 1-methyl-4-phenylpyridinium in mesencephalic cultures results from an astrocyte-dependent mechanism: role of granulocyte macrophage colony-stimulating factor (2005)
    Oxford, UK : Blackwell Science Ltd
    Journal of neurochemistry 95 (2005), S. 0 
    Details
    ISSN: 1471-4159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: There is evidence that an inflammatory microglial reaction participates in the pathophysiology of dopaminergic neuronal death in Parkinson's disease and in animal models of the disease. However, this phenomenon remains incompletely characterized. Using an in vitro model of neuronal/glial mesencephalic cultures, we show that the dopaminergic neurotoxin 1-methyl-4-phenylpyridinium (MPP+) stimulates the proliferation of microglial cells at concentrations that selectively reduce the survival of DA neurones. The mitogenic action of MPP+ was not the mere consequence of neuronal cell demise as the toxin produced the same effect in a model system of neuronal/glial cortical cultures, where target DA neurones are absent. Consistent with this observation, the proliferative effect of MPP+ was also detectable in neurone-free microglial/astroglial cultures. It disappeared, however, when MPP+ was added to pure microglial cell cultures suggesting that astrocytes played a key role in the mitogenic mechanism. Accordingly, the proliferation of microglial cells in response to MPP+ treatment was mimicked by granulocyte macrophage colony-stimulating factor (GM-CSF), a proinflammatory cytokine produced by astrocytes and was blocked by a neutralizing antibody to GM-CSF. Thus, we conclude that the microglial reaction observed following MPP+ exposure depends on astrocytic factors, e.g. GM-CSF, a finding that may have therapeutic implications.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1471-4159.2005.03416.x
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  • 7
    Electronic Resource
    Electronic Resource
    The innovation potential of integrated services and its utilisation through co-operation (2004)
    Oxford : Emerald
    Engineering, construction and architectural management 11 (2004), S. 335-341 
    Details
    ISSN: 1365-232X
    Source: Emerald Fulltext Archive Database 1994-2005
    Topics: Architecture, Civil Engineering, Surveying
    Notes: In the last few years an increasing demand for integrated services could be recognised on the construction market. For construction firms this means that there is a wider scope for achieving advantages in competition. Based on a research project on the innovation behaviour of two Swiss contractors this paper presents the innovation potential of integrated services and the advantages and disadvantages of the present organizational structure of medium-sized contractors with respect to the usage of this potential. Moreover, possibilities for construction firms to build up and benefit from internal and external co-operation and to generate innovative constructional solutions are discussed. It is concluded that an innovative construction industry requires the ability of construction firms to co-operate.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1108/09699980410558520
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  • 8
    Electronic Resource
    Electronic Resource
    Relationship Between Selected Overdrive Parameters and the Therapeutic Outcome and Tolerance of Atrial Overdrive Pacing (2003)
    350 Main Street , Malden , MA 02148-5018 , USA . : Blackwell Futura Publishing, Inc.
    Pacing and clinical electrophysiology 26 (2003), S. 0 
    Details
    ISSN: 1540-8159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: ATTUEL, P., et al. : Relationship Between Selected Overdrive Parameters and the Therapeutic Outcome and Tolerance of Atrial Overdrive Pacing. There is a paucity of information on the influence of selected overdrive parameters on the clinical efficacy and tolerance of atrial overdrive algorithms to suppress atrial tachyarrhythmias. Data from a completed clinical trial investigating a new DDD+ overdrive algorithm implemented in a permanent pacemaker were analyzed. One-hundred patients with standard pacing indications and atrial tachyarrhythmias were enrolled and followed for 6 months in DDD and 6 months in DDD+ mode in a randomized, crossover fashion. The overdrive step size was programmed at the discretion of the investigators between 4 and 12 beats/min, overdrive plateau length between 10 and 32 beats, and maximum overdrive rate between 100 and 160 beats/min. The effects of DDD+ versus DDD mode on burden and incidence of atrial tachyarrhythmias stored in the mode switch memory were examined as a function of the programmed overdrive parameters. An overdrive step size between 7 and 12 beats/min, and higher a maximum overdrive rate between 121 and 160 beats/min were slightly more effective than lower programmed values, though 〉500 randomized, crossover observations would have been necessary to verify statistical significance. Overdrive pacing related symptoms mandated early manual deactivation of overdrive pacing in 4.7% of 85 evaluated patients. Overdrive was disabled without testing tolerability of less aggressive overdrive values. There was no link between patient symptoms and programmed overdrive step size or overdrive plateau length values. (PACE 2003; 26[Pt. II]:257–263)
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1460-9592.2003.00028.x
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  • 9
    Electronic Resource
    Electronic Resource
    A model for cost-effectiveness ratios in amblyopia screening (1998)
    Springer
    Der Ophthalmologe 95 (1998), S. 19-27 
    Details
    ISSN: 1433-0423
    Keywords: Key words Screening • Microtropia • Amblyopia • Cost-effectiveness • Public health ; Schlüsselwörter Siebtest • Mikrostrabismus • Amblyopie • Wirtschaftlichkeit • Gesundheitsökonomie
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Hintergrund und Zielsetzung: Pro Jahrgang sind in Deutschland ca. 750.000 Kinder auf visuelle Entwicklungsstörungen zu untersuchen, wofür die konventionellen U-Vorsorgeuntersuchungen nicht ausreichend effektiv sind. Ziel der Untersuchung war es, den wirtschaftlichen Nutzen für die Sozialgemeinschaft von Alternativen der Amblyopie- und der Mikrostrabismusfrüherkennung im Alter von 24–48 Monaten zu untersuchen. Methode: Es wurden 3 Vorsorgeoptionen modellhaft verglichen: Option 1, eine orthoptische Untersuchung, welche vor Ort, z. B. im Kindergarten, eingesetzt wird; Option 2, eine untersucherunabhängige, gerätegestützte objektive Methode, ebenfalls vor Ort; Option 3, eine augenärztliche Untersuchung in der Praxis. Die Kosten von Früherkennung, Nachuntersuchungen und Behandlung in den 3 Optionen wurden für Prävalenzen amblyogener Faktoren von 1 % (kosmetisch unauffälliges Schielen) und von 5 % (allgemeine Amblyopierate) berechnet. Der „Ertrag“ durch die Behandlung wurde als Vermeidung einer verdienstrelevanten MdE von 3 % bzw. 1 % ermittelt. Die Steuer- und Beitragsmehreinnahmen der gesetzlichen Krankenversicherung wurden eingesetzt, um die Kosten der Vorsorgeprogramme zu decken. Ergebnisse und Schlußfolgerungen: Es wurden für die Optionen 1 und 2 günstige Nutzen-Kosten-Verhältnisse gefunden. Die praxisbasierte Option 3 war dagegen weniger kosteneffektiv. Das Nutzen-Kosten-Verhältnis fiel um so günstiger aus, je höher die Prävalenz war.
    Notes: Background and purpose: In Germany, 750,000 children are born per year who should be screened for developmental visual defects in the age range 24–48 months. However, the established pediatric screening program is not sufficient to prevent amblyopia. The purpose of this study was to examine the cost-effectiveness of alternatives for amblyopia and microtropia screening. Methods: Three options were compared: (1) an orthoptic screening carried out in the field, for instance in kindergartens, (2) an examiner-independent objective apparatus-based screening, and (3) a complete ophthalmological and strabismological examination carried out in a practice. The costs of screening, follow-up examinations and of the treatment were modelled for prevalences of 1 % (microtropia) and 5 % (amblyopia). The benefit due to treatment was calculated as the result of an avoided whole-person impairment of 3 % and 1 %. The income related, increased tax and health care payments were used to cover the costs. Results and conclusions: In options (1) and (2) there were favorable cost-effective ratios. The practice-based option 3 was economically less promising. The higher the prevalence was, the higher the resulting cost-effectiveness.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003470050230
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  • 10
    Electronic Resource
    Electronic Resource
    Secondary dystonias (1998)
    Springer
    Journal of neurology 245 (1998), S. 511-518 
    Details
    ISSN: 1432-1459
    Keywords: Key words Secondary dystonias ; Basal ganglia ; Neuroleptics ; Anticholinergics ; Treatment
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Secondary or symptomatic dystonias are (1) often accompanied by other neurological deficits, (2) begin suddenly at rest and occur at rest from the onset, (3) are associated with different hereditary and environmental causes. From an aetiological point of view, secondary dystonias can be caused by focal brain lesions of various origin, neurodegenerative disorders, metabolic disorders of the central nervous system (CNS), and several drugs and chemicals that affect the basal ganglia, thalamus and brain stem. Furthermore, secondary (focal) dystonias can be caused by peripheral injury. In the following review, we will discuss epidemiology, genetics, pathogenesis, neuroimaging, neuropathology, clinical manifestation, clinical course and differential diagnosis of secondary dystonias. Therapeutic options are given depending on the aetiology and the topological type of dystonia.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004150050235
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