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Biomedical subjects

B Höfling

Publications and source records attributed to B Höfling.

At least 109 records · Page 6Linked to original sources
PubMed1989

Sulotroban during and after coronary angioplasty. A double-blind, placebo controlled study.

Sulotroban, a sulphonamide derivative, causes an inhibition of platelet aggregation by blocking thromboxane A2 receptors. We tested the effects of Sulotroban (4 x 800 mg per day) on acute events during and recurrence rate after coronary angioplasty, and compared it with placebo in a double-blind randomized fashion. The follow-up protocol included regular compliance control by pill count, stress testing, and coronary angiography at 6 months. Restenosis was defined as a loss of 50% of the initial gain in luminal diameter. A total of 107 patients were randomized. There were no differences between the groups in terms of age, sex, artery distribution, or left ventricular function. Primary success per vessel was 86% for the Sulotroban group (50/58), and 88% for the placebo group (51/58). Complications occurred in nine patients (8%): five emergency bypass operations and three myocardial infarctions. There were no differences between the centers, or the study groups. The study protocol was completed for 57 patients. There was one death in the placebo group. Restenosis was found in 65% of patients in the Sulotroban group (19/29) and 61% of patients in the placebo group (17/28) (ns). If all patients were included on an intention to treat basis, regardless of primary success and compliance with the protocol, the recurrence rate was 57% in the Sulotroban group (20/35), compared with 56% in the Placebo group (20/36) (ns). This randomized, double-blind study failed to show that Sulotroban is superior to placebo in preventing acute problems during, or restenosis after, coronary angioplasty.

Angioplasty, Balloon↗
PubMed1988

Percutaneous removal of atheromatous plaques in peripheral arteries.

The peripheral Simpson "atherectomy" catheter was used to treat 21 patients with a total of 41 stenotic lesions (5 iliac, 35 superficial femoral, and 1 popliteal). 4 lesions were totally occluded and 16 (39%) were calcified. The mean (SD) degree of obstruction was reduced from 82.7 (14) to 21 (16)% (p less than 0.0001). Mean (SD) standardised walking distance increased from 79.9 (71.9) to 152.6 (89.7) m (p less than 0.0001); doppler index improved from 0.58 (SD 0.17) to 0.81 (0.16) (p less than 0.0001); performance on bicycle stress test rose from 276.3 (range 1-1100) to 584.8 (2-2250) watt-min; and index for 201Tl-scintigraphy of the lower leg increased from 0.68 (0.28) to 0.91 (0.36) (p less than 0.02). The improvement has been maintained for 6 months, the degree of stenosis on repeat angiography at 2-6 months (n = 14 lesions) being 20.7 (SD 13.7)% (unchanged from early post-treatment values). The only restenosis has been corrected by a repeat of the percutaneous procedure.

Aged↗
PubMed1988

Prognostic implications of transient--predominantly silent--ischaemia in patients with unstable angina pectoris.

The occurrence of unstable angina pectoris, despite medical treatment, is generally regarded as an ominous prognostic sign and an indication for invasive diagnosis and revascularization. We investigated 38 consecutive patients with severe unstable angina with a mean of 2.5 days of continuous two-channel, frequency modulated Holter monitoring for ST segment analysis. In 16 patients, transient ischaemic episodes (more than 0.1 mV lasting more than 1 min) occurred despite maximal medical treatment: 82% of the episodes were silent. Compared to the 22 patients without ischaemic episodes there were no significant differences in prevalence of risk factors, numbers of vessels diseased (69% vs. 74% triple-vessel disease) or ejection fraction (54 +/- 15% vs. 53 +/- 16%). The 30-day prognosis, however, varied: of 16 patients with ischaemic episodes, 14 (88%) had a subsequent cardiac event (death, AMI, PTCA or CABG) compared to only 10 of 22 patients (45%) without ischaemic episodes (P less than 0.02 for all events, P less than 0.1 for death/AMI only). Transient ischaemic episodes, predominantly silent, are frequent in patients with severe unstable angina. Objective evidence of ongoing ischaemia despite medical treatment has a guarded short-term prognosis. 'Stabilization' of unstable angina may be incomplete as long as transient ischaemia at rest can still be detected.

Aged↗
PubMed1987

[Percutaneous transfemoral valvuloplasty of calcified and non-calcified aortic valves].

Percutaneous transfemoral valvuloplasty was performed in 20 patients (aged 25-83 years; mean 62) with marked signs of aortic valve stenosis, some calcified, others noncalcified. The transvalvar systolic pressure gradient was reduced from a mean of 104 +/- 7 mm Hg to a mean of 46 +/- 4 mm Hg, the valvar opening area from 0.38 +/- 0.04 cm2 to 0.74 +/- 0.04 cm2. The result was judged to be unsatisfactory in four patients and required aortic valve replacement after initially good results from the balloon dilatation. Serious complications were reversible ventricular fibrillation and reversible cerebral ischemia with partial hemiparesis in one patient each. In three patients the femoral artery had to be repaired at the site of puncture, twice the balloon ruptured without sequelae, once reversible pericardial effusion occurred, and twice there were reactions to antibiotics given after the procedure. Invasive re-catheterizations were performed in four patients, at intervals of three months: no increase in pressure gradient was observed. The results indicate that reduction of the transvalvar pressure gradient by 40 mm Hg can produce rapid reversal of heart failure and a symptom-free state even in patients who were already decompensated.

Adult↗
PubMed1987

[Coronary heart disease and heart valve diseases in patients with terminal kidney insufficiency].

Cardiac catheterisation and coronary angiography were performed in 100 patients preceding a planned renal transplantation. Coronary heart disease was revealed in 64 patients: stenoses of 50-70% in 28, 71-90% in 16, over 90% in 20 patients. For stenoses above 50% the sensitivity of clinical symptoms was 0.52, their specificity 0.64. For stenoses over 70% the specificity was 0.58; over 90% it was 0.70. Typical symptoms of angina were less common in dialysis patients with coronary heart disease than is usual in other patients with coronary heart disease. Total duration of dialysis as well as frequency and severity of coronary heart disease did not correlate. In 19 of the 100 patients valvar disease was also present, with a discrepancy between the severity of clinical and of hemodynamic findings. Incidence and severity of valvar disease increased with the duration of dialysis. Transplantation was postponed in 11 patients (bypass operation in 3, balloon dilatation in 2, valve replacement in 6). Transplantation was advised against in four (severe coronary heart disease in 2, cardiomyopathy in 2).

Adult↗
PubMed1986

[Primary dissection of the left coronary artery with rupture of the ventricle in a 27-year-old patient].

This report of a 27-year-old patient describes an extensive infarction of the anterior wall due to primary dissection of the left coronary artery in the absence of the circumflex artery followed by rupture of the left ventricle. In earlier reports an aortocoronary bypass operation was usually performed in similar situations. Although the final outcome was lethal, this case report shows recanalization by methods of "interventional cardiology" to be a potentially successful alternative which may be of value when bypass operation is not available or contraindicated, as in developing cardiogenic shock. This case report demonstrates an initially successful treatment, which after a stable interval was followed by a lethal complication, namely, rupture of the ventricle due to hemorrhagic infarction.

Adult↗
PubMed1986

Thromboxane receptor blockade versus cyclooxigenase inhibition: antiplatelet effects in patients.

In a randomized pilot study we compared the antiplatelet effects of aspirin and BM 13.177 in two groups of 7 patients each undergoing PTCA. As compared with the pretreatment values template bleeding time was prolonged and collagen induced aggregation was inhibited in PRP and WB in all patients. In the course of angiography and PTCA a rise in platelet factor 4 and beta thromboglobulin was observed in both groups, followed by a decrease below the baseline levels. Thromboxane B2 in plasma and serum decreased in the aspirin group but remained unchanged during BM 13.177 treatment. In PRP and WB aggregation induced by U 46 619 was inhibited after ingestion of BM 13.177 but not following ASA. After three months a control coronary angiography was done. There was no difference in regard to the degree of restenosis between both groups. Medication was well tolerated, compliance was good and no side effects were noted.

15-Hydroxy-11 alpha,9 alpha-(epoxymethano)prosta-5↗
PubMed1986

[Results of SPECT thallium-201 of the myocardium in the diagnosis of coronary disease and the follow-up of percutaneous transluminal coronary angioplasty].

Sensitivity and specificity of 201Thallium-SPECT in rest-exercise studies were evaluated in 129 patients in comparison to coronary morphology. In addition, the results of 70 patients, examined before and after dilatation of coronary stenoses by PTCA were obtained. In this group, quantification of SPECT images was tested. Sensitivity in detection of CAD was 93%, specificity 84%. False negatives were most frequently found in the posterior wall. After PTCA 73% of the segments improved. With quantification, an increase of vitality by 11.6% and a decrease of the redistribution factor by a value of 8 was documented. 201Thallium-SPECT of the myocardium was found to be very useful to both evaluate CAD and follow-up interventional procedures. A quantification of slice-images is useful to objectively reveal therapeutic success.

Angiography↗