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Biomedical subjects

E Pilger

Publications and source records attributed to E Pilger.

At least 55 records · Page 3Linked to original sources
PubMed1998

Successful thrombolysis in massive pulmonary embolism with right ventricular thrombus.

Systemic thrombolytic therapy for pulmonary embolism (PAE) is an established and common procedure. Due to increased risk, however, it is not much used in pulmonary embolism combined with thrombotic mass in the right ventricle. We applied it in a 59-year-old male patient with small intracardiac thrombus in the right ventricle (diameter = 1 cm) and peripheral pulmonary embolism whose diagnosis was obtained with transthoracal echocardiography (TTE) and helix lung CT. Twelve hours after thrombolytic treatment, helix lung CT scan showed a reduction in the size of the pulmonary embolism and no thrombotic masses in the right ventricle. In this patient with a small cardiac thrombus and rather peripheral pulmonary emboli, a systemic thrombolytic therapy proved to be effective and safe.

Diagnostic Imaging↗
PubMed1997

Influence of duration of rapid ventricular pacing on ventricular refractoriness in the presence of propafenone and lidocaine.

Propafenone and lidocaine have a rate dependent negative dromotropic effect on intraventricular conduction. We investigated the use dependent actions of propafenone and lidocaine on intraventricular conduction in isolated guinea pig hearts perfused by the method of Langendorff. Of primary interest was how the number of stimuli of the conditioning train (S1) might influence the ventricular effective refractory period (VERP) when refractoriness is assessed at a high pacing rate. Propafenone (0.3 microM) and lidocaine (50 microM) caused a comparable prolongation of the intraventricular conduction time during sinus rhythm. During ventricular pacing in the presence of propafenone an abrupt decrease of the pacing cycle length (220 to 120 ms) resulted in an initial peak of rate dependent prolongation of the QRS interval that subsequently decreased to a stable steady-state level. Lidocaine also induced a rate dependent increase of the intraventricular conduction time up to a steady-state level. The time constant, characterizing the changes of the intraventricular conduction time after shortening the ventricular pacing cycle length from 220 to 120 ms was significantly (P < 0.01) longer in the presence of propafenone (tau = 31 +/- 4 beats; mean +/- SEM; n = 11) than for lidocaine (tau = 3 +/- 1; n = 10). Both drugs caused the greatest increase of the VERP when the number of conditioning stimuli (S1, interstimulus interval = 120 ms) was in the range of their respective time constant. However, when the number of conditioning stimuli was further increased, VERP progressively diminished. These effects may be explained by a shortening of the action potential during high rates that results in a decreased binding of propafenone to Na+ channels and by the direct shortening of repolarization period by lidocaine (Class IB drug).

Action Potentials↗
PubMed1996

Thrombolytic therapy in acute lower limb ischemia.

Surgical revascularization as the initial therapy in acute lower limb ischemia (ALLI) is associated with a high cumulative mortality and amputation rate. Catheter-directed delivery of low-dose thrombolytic agents (intra-arterial thrombolysis, IAT) offers the possibility for a gentle revascularization with a minimum of stress for the patients. In two randomized studies, the primary rates of revascularization, amputation, and mortality did not differ significantly between IAT and surgical revascularization. However, in one study the 6-month event-free survival rate was 85% in the IAT group, and 63% in the surgical group. Also in the second study the 12-month results were significantly better in the IAT group (event-free survival 75%) than in the surgical group (event free survival 52%). The high-dose urokinase regimen recommended by some authors in IAT is associated with an unacceptable cerebral bleeding rate of up to 2%. Low-dose recombinant tissue-type plasminogen activator (rt-PA) (0.02 to 0.05 mg/h) is the most suitable agent in IAT because of rapid lysis and low bleeding complications. Patients with ALLI, classified as viable or threatened without neurologic deficit, benefit most from the IAT as the initial therapy in ALLI. When IAT is performed as the initial therapy in ALLI, surgical intervention becomes unnecessary in approximately one-third of the patients. In another third the subsequent correction of the cause of the ALLI can be performed electively, which reduces mortality and morbidity rates.

Acute Disease↗
PubMed1994

Thrombolytic treatment and balloon angioplasty in chronic occlusion of the aortic bifurcation.

OBJECTIVE: To evaluate nonsurgical alternatives in reopening chronically occluded aortic bifurcation. DESIGN: Uncontrolled randomized study. SETTING: University-affiliated referral center for vascular diseases. PATIENTS: Twenty-five of 39 consecutive patients with chronic aortoiliac disease including a totally occluded aortic bifurcation were found to be acceptable candidates for an aortobifemoral prosthetic graft. INTERVENTION: Patients were randomly assigned to receive either streptokinase or urokinase or recombinant tissue-type plasminogen activator (rt-PA). In cases of successful thrombolysis and residual obstructions, subsequent balloon angioplasty was attempted. Prosthetic bypass grafting was done if thrombolytic treatment and balloon angioplasty failed. RESULTS: Complete lysis was achieved in 5 of 25 patients (20%). In 10 (40%) patients, lysis showed residual obstructions, which were reopened mechanically in 8 patients; 2 patients had extra-anatomical bypass grafts. Ten patients (40%) without thrombolysis had surgical aortobifemoral bypass grafts. Overall, recanalization and clinical improvement were achieved in 13 of 25 patients (52%) by thrombolytic therapy and subsequent balloon angioplasty. The recanalization rate did not differ among the different thrombolytic drugs. However, rt-PA therapy resulted in reopening after 4 days of treatment; streptokinase, after 6 days; and urokinase, after 9 days (P < 0.005). No major complications or deaths occurred. CONCLUSION: Thrombolytic treatment followed by balloon angioplasty may help avoid the need for aorto-bifemoral prosthetic bypass grafting in more than 50% of patients with chronic aortoiliac disease.

Adult↗
PubMed1994

A prospective evaluation of sensitivity and specificity of the ankle/brachial index in the follow-up of superficial femoral artery occlusions treated by angioplasty.

The aim of this study was to provide estimates of sensitivity and specificity of clinical history, pulses, and ankle/brachial index (ABI) in the follow-up of atherosclerotic occlusions of the superficial femoral artery treated by peripheral transluminal angioplasty (PTA). A total of 116 patients were followed prospectively for 1 year after angioplasty with follow-up visits immediately after angioplasty, and at 3, 6, and 12 months. All patients underwent digital subtraction angiography after 1 year of if they reported a deterioration of their symptoms. Reobstruction was defined as reocclusion or as restenosis exceeding 70%. Patency rates were calculated separately by clinical and ankle/brachial criteria; sensitivity and specificity were derived using angiography as standard. The presence or absence of pulses distal to the treated vessel segment had a sensitivity of 78% and a specificity of 66% for a reocclusion or significant restenosis; subjective complaints evaluated by history had a sensitivity of 83% and a specificity of 51%. The sensitivity of the ABI was 72% and 66%, with a specificity of 82% and 100% for cutoff values of 0.10 and 0.15, respectively. One year after PTA the angiographic patency rate was 39% +/- 5%; the patency rate based on ABI criteria 34% +/- 5%. A deterioration in the ABI by 0.15 indicated with reasonable certainty a reocclusion or significant restenosis whereas the sensitivity of the ABI was poor in detecting significant restenosis after PTA of occlusions of the superficial femoral artery. When only clinical criteria were used, the true patency rate was significantly overestimated as more than half of all reobstructions remained asymptomatic.

Angiography, Digital Subtraction↗
PubMed1994

Iliac artery stent placement: clinical experience with a nitinol stent.

PURPOSE: To determine the effectiveness of a prototype nitinol stent in the iliac arteries. MATERIALS AND METHODS: Fourteen patients with arteriosclerotic lesions of the iliac arteries (nine stenoses, five occlusions) were treated percutaneously with a prototype nitinol vascular stent (Cragg stent) after unsuccessful percutaneous transluminal angioplasty. RESULTS: In 13 patients available for follow-up, the mean ankle-brachial index (ABI) increased from 0.4 +/- 0.32 (standard deviation) before the procedure to 0.81 +/- 0.27 after the procedure (P < .01). After 6, 12, and 24 months, the mean ABI was 0.97 +/- 0.2, 0.87 +/- 0.15, and 0.89 +/- 0.1, respectively. In two patients, radial stiffness of the stent was too low to completely eliminate a high-grade, calcified stenosis; long-term patency of the vessel, however, was preserved. In all other patients, stent placement achieved good vascular reconstitution. No stent occlusion or restenosis was observed. CONCLUSION: The results with the Cragg stent were similar to those with other commercially available stents. These preliminary results require confirmation with a larger series.

Aged↗
PubMed1993

A simplified procedure for intra-arterial thrombolysis with tissue-type plasminogen activator in peripheral arterial occlusive disease: primary and long-term results.

One-hundred and fifty patients with thrombotic and 60 patients with embolic occlusions of the superficial femoral and/or popliteal artery underwent a simplified IAT (intra-arterial thrombolysis) procedure. Ten mg rt-PA combined with 3000 IU Heparin were infused over 6 h, thereafter the extent of thrombolysis was checked fluoroscopically and the above mentioned treatment course repeated up to four times if necessary. The IAT regimen employed did not involve mechanical recanalization attempts; if complete thrombolysis revealed an underlying stenosis, a PTA (percutaneous transluminal angioplasty) was subsequently performed. IAT resulted in complete recanalization of 88 thrombotic occlusions (59%; 95% confidence interval: 50.8%-66.8%) and of 53 embolic occlusions (88%; 95% confidence interval: 77.1%-94.8% P < 0.001). In a further 33 (22%) thrombotic and four (7%) embolic occlusions IAT reduced the length of the occluded segment. At discharge, 102 (67%) patients with thrombotic and 55 (92%) patients with embolic occlusions were clinically improved. Overall, untoward effects occurred in 60 patients (29%): 47 (22%) were minor. Four patients (2%) suffered a systemic haemorrhage (three gastrointestinal, one macrohaematuria). The cumulative potency rate was significantly higher in patients with embolic occlusions throughout follow-up (82% vs 49% for thrombotic occlusions at 2 years, P < 0.001). Although all amputations were carried out in patients with thrombotic occlusions, follow-up mortality did not differ significantly between patients with embolic and thrombotic occlusions.

Adult↗
PubMed1992

Pulsed excimer laser versus continuous-wave Nd:YAG laser versus conventional angioplasty of peripheral arterial occlusions: prospective, controlled, randomised trial.

Early clinical studies of coronary and peripheral laser angioplasty showed that arterial occlusions could be recanalised by continuous-wave lasers delivered with contact probes and by pulsed lasers applied with multifibre catheters. However, whether laser-assisted angioplasty improves success rates in reopening occlusions and in long-term patency rates is unclear. We have compared the primary recanalisation and long-term patency rates after laser-assisted and conventional percutaneous transluminal angioplasty (PTA) of femoropopliteal artery occlusions in 116 consecutive symptomatic patients (excimer laser 37, Nd:YAG laser 40, PTA 39). Primary recanalisation was achieved in 81 patients (70%). The primary recanalisation rate achieved with the excimer laser was significantly lower than that with the Nd:YAG laser (49% vs 78%, p < 0.01) or with PTA (82%, p < 0.003). The overall angiographic recanalisation rate (primary and secondary recanalisation) after laser and PTA was 89%. After 3 months, clinical improvement was recorded in 76% of patients. Clinical long-term results were available in 94 (91%), and angiographic long-term results in 77 (75%), of 103 successfully recanalised patients. Life-table analysis of the long-term results revealed no significant difference of the restenosis rate between the three treatment groups. The 12-month patency rate was 60% as assessed clinically and 39% as judged by angiography. Primary and secondary recanalisation rates and long-term patency rates were significantly correlated with length of the occlusion. Our results suggest that PTA of femoropopliteal artery occlusions is only indicated if the occlusion is short (< 8 cm) and that laser-assisted angioplasty should only be used after failure of conventional PTA.

Aged↗
PubMed1992

Percutaneous transluminal angioplasty of crural arteries.

In 91 patients suffering from peripheral arterial occlusive disease (Fontaine stage IIb-IV) 125 percutaneous transluminal angioplasties (PTA) of crural arteries were performed. Eighty-six of the dilatations were done in combination with a recanalization procedure (PTA, laser angioplasty, fibrinolysis) of a femoropopliteal obstruction in order to improve outflow. PTA was performed with 5 F balloon catheters 2.5 to 4 mm in diameter in combination with steerable guide wires. A primary technical success was achieved in 41 of 42 (97.6%) vessels with a single stenosis, in 64 of 68 (94.1%) vessels with 2 or more stenoses, and 9 of 15 (60%) vessels with total occlusions (overall primary success rate 91.2%). Complications included spasm (n = 3), thrombosis (n = 2), peripheral embolization (n = 2), and dissection (n = 1). None of the complications required surgical intervention. After PTA, accumulative patency rate of 71% at 2 years and 64.2% at 3 years was achieved. These results demonstrated that PTA of crural arteries is a safe procedure with an excellent primary success rate and satisfying long-term results. Thus we believe that even arterial occlusive disease in the clinical stage Fontaine IIb should be accepted as an indication for crural PTA. Furthermore, crural PTA should be used to improve reduced peripheral outflow after femoropopliteal PTA.

Adult↗
PubMed1992

Iliac artery stenting--clinical experience with the Palmaz stent, Wallstent, and Strecker stent.

A total of 82 iliac artery lesions (62 stenoses and 20 occlusions) were treated with 3 different types of endovascular metallic stents (12 lesions with the Palmaz stent, 36 with the Wallstent, and 34 with the Strecker stent). The complication rate was 12%. Occlusion of 2 Wallstents occurred 4 and 12 weeks after stent placement, respectively. Both stents were recanalized by local fibrinolysis. One Strecker stent occluded after 8 months. The observation period was 3 to 26 months (mean 9.7 months). The patency rate with secondary intervention (fibrinolysis) was 100% after 3 and 6 months, and 98% after 9 months. All 3 stent designs turned out to be effective in the treatment of complicated iliac artery occlusive disease.

Adult↗
PubMed1991

Acute effects of the ACE inhibitor lisinopril on cardiac electrophysiological parameters of isolated guinea pig hearts.

Angiotensin-converting enzyme (ACE) inhibitors are of benefit in life-threatening ventricular arrhythmias in patients with congestive heart failure and ventricular tachycardia caused by the onset of myocardial ischemia as well as by reperfusion of an ischemic area. The aim of the present study was to investigate whether direct electrophysiological effects are responsible for these observations. Therefore, we investigated the electrophysiological effects of lisinopril on the whole cardiac conduction and pacemaker system in isolated guinea pig hearts perfused by the method of Langendorff at concentrations of 0.01, 0.1, 1, and 10 microM. Lisinopril did not affect heart rate, atrioventricular, His bundle, or intraventricular conduction at any of the concentrations tested. Likewise the frequency-dependent QT duration was unchanged. At a concentration of 10 microM, lisinopril prolonged effective refractory period evaluated by premature beats (46 +/- 15%, n = 8, p less than 0.01) as well as the rate-dependent effective refractory period (31 +/- 12, n = 8, p less than 0.01) of the atrioventricular conduction. These effects can be explained by lisinopril's action as a minor calcium antagonist at a toxic concentration of 10 microM. The present results show that electrophysiological parameters are not substantially altered by lisinopril. Therefore, several other mechanisms such as the unloading of the left ventricle and/or the suppression of noradrenalin release and the electrolyte (potassium and magnesium) repletion and/or regression of left ventricular hypertrophy as long-term effects may play a major role in the antiarrhythmic efficacy of ACE inhibitors.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1991

[Percutaneous recanalization of pelvic artery occlusions--fibrinolysis, PTA, stents].

In 42 patients with symptomatic chronic iliac artery occlusions with a length of 2-15 cm (mean 4.3 cm), percutaneous recanalization was attempted. The study population was divided into 2 groups: Group I (n = 17) is a retrospective control group, the patients were treated with fibrinolysis (FL) and percutaneous transluminal angioplasty (PTA). In group II (n = 25) the patients were treated according to a prospective protocol including FL, PTA and placement of endovascular self-expandable stents. The recanalization rate for Group I and II together was 83% (35/42). FL was effective in 47%, in 53% the recanalization was performed mechanically only. The patency rate in Group I during a maximum of 69 months was 67%, in Group II, in which residual stenoses were treated with stents, 100% during max. 18 months. Obviously stents help to improve the results after percutaneous recanalization of iliac artery occlusions significantly.

Adult↗