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Biomedical subjects

E Voth

Publications and source records attributed to E Voth.

At least 73 records · Page 4Linked to original sources
PubMed1992

Myocardial ischemia and left-ventricular function after ligation of left coronary artery (Bland-White-Garland syndrome): a long-term follow-up.

Left-ventricular function and myocardial perfusion were studied in 8 patients for between 3 and 21 years (mean 16 years) after ligation of the anomalous left coronary artery from the pulmonary artery. While only one patient complained of exercise-dependent stenocardia, 4 patients had abnormal ST-segments in the exercise ECG and all patients showed myocardial ischemia at exercise scintigraphy. At rest, the ejection fraction of the left ventricle was within normal range in all patients. In 5 patients, it failed to increase adequately under exercise conditions, reflecting impaired ventricular function. These results confirm the advantages of surgical procedures establishing a 2-coronary system.

Adolescent↗
PubMed1992

[Effort-induced myocardial wall motion abnormalities in the magnetic resonance tomogram: a comparison with effort MIBI SPECT].

In 20 patients with an angiographically documented coronary artery stenosis of > or = 70% and normal LV function at rest MRI was performed before and after dipyridamole infusion (0.75 mg/kg BW). In all patients MIBI-SPECT was obtained at rest and after dynamic symptom-limited exercise. In 18 patients MIBI-SPECT showed ischemia and in 18 patients dipyridamole MRI showed a wall motion impairment. In the segments representing the 29 stenosed vessels ischemia in MIBI-SPECT was diagnosed correctly in 24 instances (sensitivity 83%, specificity 90%) and a wall motion abnormality was present in MRI in 23 instances (sensitivity 79%, specificity 90%). Dipyridamole GE-MRI is not superior to MIBI-SPECT in the diagnosis of ischemia.

Aged↗
PubMed1991

Initial clinical results with the Wiktor stent: a new balloon-expandable coronary stent.

The Wiktor stent, a new coronary balloon-expandable tantalum stent, was implanted in 17 patients for other wise nonmanageable occlusion after balloon angioplasty (n = 11) and for recurrent restenosis (n = 6). Stents of 3.0 to 4.0 mm were implanted (right coronary artery: n = 10, left anterior descending artery: n = 4, left circumflex artery: n = 2, venous graft: n = 1). All patients were fully anticoagulated initially with heparin followed by coumadin for 3 months and were treated with acetylsalicylic acid indefinitely. Due to its good radiopacity, the device could be placed easily without complications. Early occlusion occurred in one patient after 8 h probably due to friable atheromatous material prolapsing between the meshes of the stent. Late occlusion occurred in another patient who was admitted in cardiogenic shock after pre-hospital reanimation and was stented after occlusive disection following balloon angioplasty of an occluded right coronary artery. In this patient with severe hypoxic brain damage, reocclusion and reinfarction to which the patient finally succumbed occurred following cessation of anticoagulation. Histology demonstrated occlusive thrombosis without evidence of a neointimal covering of the stent. Another thrombotic occlusion due to inadvertent omission of anticoagulation occurred in another patient two weeks after stenting. Control angiography after 6 months in 12 patients revealed restenosis in two patients (50% and 80%). The patient with 80% restenosis of the right coronary artery and pathologic results during stress testing underwent surgical revascularization. The other patient with a 50% restenosis of the right coronary artery was managed medically as he was asymptomatic and without evidence of ischemia during stress testing.(ABSTRACT TRUNCATED AT 250 WORDS)

Angioplasty, Balloon, Coronary↗
PubMed1991

Kinetics of melphalan leakage during hyperthermic isolation perfusion in melanoma of the limb.

The kinetics of melphalan leakage into the peripheral blood were studied in 21 patients undergoing hyperthermic isolation perfusion of the upper or lower limb as an adjuvant treatment in high-risk melanoma; in 5 patients cisplatin was added. The melphalan concentrations in the peripheral blood rose predominantly during the first 20 min of perfusion and levelled out to an apparent steady state of about 0.28 micrograms/ml in upper extremity perfusions, and 0.34 (without cisplatin) and 0.37 micrograms/ml (with cisplatin) in lower extremity perfusion. Erythrocytes labelled with technetium Tc 99m, which were added concomitantly with melphalan to the perfusion medium, appeared in the systemic circulation of the patients at an almost constant rate of 0.32% (lower and upper limb perfusions without cisplatin and 0.37% (with cisplatin) of total tracer/min. This perfusate flow rate indicated by labelled erythrocytes completely explained the leakage of melphalan from the perfusion circuit into the peripheral blood. Peak concentrations of melphalan in the peripheral blood were observed immediately after reconstitution of normal hemodynamic conditions once isolation perfusion had been terminated. This fraction of melphalan might originate from tissue-binding sites, but also from vascular compartments; therefore, a thorough washing-out procedure might minimize this effect.

Adult↗
PubMed1991

Intravenous streptokinase in acute myocardial infarction (I.S.A.M.) trial: serial evaluation of left ventricular function up to 3 years after infarction estimated by radionuclide ventriculography. I.S.A.M. Study Group.

The Intravenous Streptokinase in Acute Myocardial Infarction (I.S.A.M.) trial was a prospective, placebo-controlled, double-blind multicenter trial of high-dose short-term intravenous streptokinase in acute myocardial infarction administered within 6 h after the onset of symptoms. Global and regional left ventricular ejection fractions were determined by radionuclide ventriculography in a subset of 120 patients 3 days, 4 weeks, 7 months, 18 months and 3 years after acute myocardial infarction. In patients with anterior myocardial infarction, left ventricular ejection fraction was higher in the streptokinase than in the placebo group 3 days after acute infarction (49 +/- 14% vs. 40 +/- 11%, p = 0.02). This difference of about 10% units in ejection fraction persisted during the 3 year follow-up period. Among streptokinase-treated patients, regional left ventricular ejection fraction was higher within the infarct zone as well as in remote myocardium throughout the follow-up period. Among patients with inferior infarction, no significant differences between the treatment and control groups were demonstrable with respect to global and regional left ventricular ejection fraction. Thus, intravenous administration of streptokinase within 6 h after the onset of symptoms of acute myocardial infarction preserves left ventricular function over a period of greater than or equal to 3 years in patients with acute anterior myocardial infarction. It improves regional myocardial function within the infarct zone as well as in remote areas. In patients with acute inferior myocardial infarction, benefit from intravenous streptokinase is of only minor degree.

Creatine Kinase↗
PubMed1991

Excimer laser angioplasty in coronary artery disease.

The results of coronary excimer laser angioplasty were evaluated in 70 patients. Forty-five patients had laser angioplasty of coronary stenoses. Twenty-five patients in a total of 35 attempts had wire-guided laser recanalization of chronic coronary occlusions, resulting in a success rate of 71%. Immediate results in both groups demonstrated the efficacy of this technique without serious side-effects. Stenoses were reduced from 90 +/- 5% to 48 +/- 18% diameter reduction (mean +/- standard deviation) by excimer laser angioplasty. Residual stenosis in recanalized vessels after laser angioplasty was 52 +/- 19%. In slightly more than half of the patients with a residual stenosis greater than 50% after excimer laser angioplasty, subsequent balloon angioplasty was performed for further stenosis reduction. While satisfactory immediate results were achieved by excimer laser angioplasty intermediate follow-up revealed a restenosis rate in the same range as with balloon angioplasty.

Aged↗
PubMed1991

Early heparin therapy in patients with spontaneous intracerebral haemorrhage.

In 68 patients with spontaneous intracerebral haemorrhage the effect of heparin treatment beginning on the second, fourth or tenth day was investigated. Early (day 2) low-dose heparin medication significantly lowered the incidence of pulmonary embolism. An increase in the number of patients with rebleeding was not observed. The results indicate that the early use of heparin in these patients is safe and can be recommended for the prevention of thromboembolic complications.

Adrenal Cortex Hormones↗
PubMed1991

[The early diagnosis of Perthes disease: the value of bone scintigraphy and magnetic resonance imaging in comparison with x-ray findings].

The value of conventional radiology, bone scintigraphy and magnetic resonance imaging (MRI) in the early diagnosis of Legg-Calvé-Perthes disease (LCPD) was assessed. The initial results were compared with the clinical and radiological findings of long-term follow-up in 43 children. Radiological and scintigraphic examination resulted in a relatively high number of equivocal findings (16% and 10%, respectively). MRI findings were less equivocal (3%). Depending on whether such findings were classified as normal or as pathological, the diagnostic accuracy ranged as follows: radiography 88-93%, bone scintigraphy 88-91%, and MRI 97-99%. Therefore, MRI by itself seems to be sufficient to detect or exclude LCPD. The results of this study and the radiation exposure associated with radiography and scintigraphy raise the question whether MRI should be the diagnostic method of choice in patients with suspected LCPD.

Child↗
PubMed1990

Recanalization of chronic total coronary arterial occlusions by percutaneous excimer-laser and laser-assisted angioplasty.

A low primary success and high restenosis rate after recanalization of chronic total occlusions by conventional coronary angioplasty have encouraged the application of new interventional techniques like excimer-laser angioplasty. In 39 patients with a coronary occlusion for 1 to 12 months, recanalization was attempted by laser angioplasty through a multifiber-catheter coupled to a pulsed XeCl excimer laser. After successful passage of the occlusion by a standard guidewire in 27 patients (69%), the laser catheter was advanced over the central guidewire and crossed the occlusion in 25 patients (64%). In 2 patients with unsuccessful passage of the laser catheter, the subsequent attempt with a low profile balloon catheter also failed. In 19 of the 25 patients with successful laser recanalization, the residual stenosis exceeded 50% and was therefore followed by additional balloon angioplasty. The average residual stenosis after laser was 61 +/- 17% of the vessel diameter, and after balloon angioplasty 28 +/- 9% (n = 19), whereas after laser angioplasty alone it was 38 +/- 5% (n = 6). No complications associated with the laser application were observed. Angiographic control after 24 hours showed a reocclusion of 2 (8%) recanalized vessels. In this pilot study, laser angioplasty proved to be a safe and feasible method for the treatment of chronic total coronary occlusions. Because it was necessary to guide the catheter by a central wire, the primary success was limited by a successful passage of the wire of the occlusion. The rate of stand-alone laser angioplasty has to be increased by future improvements of the technique to enable a comparative evaluation of this method with conventional angioplasty.

Angioplasty, Laser↗
PubMed1990

Safety aspects of transcranial brain stimulation in man tested by single photon emission-computed tomography.

Single photon emission-computed tomography (SPECT) using 99mTc-labelled hexamethylpropyleneamine oxime (99mTc-HMPAO), a new method to visualize regional cerebral blood flow (rCBF) and epileptogenic foci, was used to study acute and long-term effects of transcranial brain stimulation. Magnetic and electric brain stimulation increase rCBF not more than voluntary muscle activation mimicking the motor effects of transcranial brain stimulation. Focal rCBF increase, typical for epileptogenic foci, or other pathological findings could not be detected even when the subject had received several thousand stimulations in the past. Transcranial brain stimulation does not produce rCBF patterns indicating acute or chronic adverse effects.

Adult↗
PubMed1990

99mTc-hexamethylpropylene amine oxime SPECT and X-ray CT in acute cerebral ischaemia.

Early diagnosis of acute cerebral ischaemia is still unsatisfactory, because X-ray computed tomography (CT) does not reveal the site and extent of hypoperfusion within the first 24 h. Single photon emission computed tomography (SPECT) using 99mTc-hexamethylpropylene amine oxime (HMPAO) may offer earlier information, since the distribution of HMPAO follows the actual cerebral perfusion pattern. We therefore investigated 53 patients suffering from acute cerebral ischaemia (10 with transient ischaemic attacks, 9 with prolonged ischaemic reversible neurological deficits, 34 with completed stroke). SPECT and CT examinations were performed on days 1, 3, and 14. On day 1, SPECT revealed hypoperfused areas in 42 patients, whereas CT showed hypodensities only in 5. The sensitivity of SPECT was higher in cortical compared with subcortical ischaemia. In patients suffering from reversible neurological deficits SPECT normalized in the follow-up, corresponding to clinical improvement. In completed stroke, SPECT demonstrated variable perfusion patterns with hypo-, normo-, and hypoperfused areas on day 3 and especially on day 14. In contrast to CT, HMPAO SPECT leads to early diagnosis of cerebral ischaemia, in particular within the cerebral cortex.

Aged↗
PubMed1990

Intravenous streptokinase in acute myocardial infarction (I.S.A.M.): assessment of left ventricular function 1 and 7 months after infarction by radionuclide ventriculography.

I.S.A.M. was a prospective, placebo-controlled, double-blind multicentre trial of high-dose short-term intravenous streptokinase in acute myocardial infarction (AMI) within 6 h of the onset of symptoms. Determination of left ventricular ejection fraction (LVEF) by radionuclide ventriculography was performed 1 and 7 months after AMI in a subset of 192 patients at rest and, in 140 of them, also during exercise. Regional myocardial function was analysed in all 145 patients with neither a history of a previous myocardial infarction nor revascularization procedures or reinfarction within the 7-month follow-up period. One month after AMI, mean LVEF was higher in the streptokinase group in patients with anterior AMI (50 +/- 15% vs 42 +/- 16%, P = 0.013). This difference was more marked in the subgroup treated within 3 h (53 +/- 14% vs 42 +/- 15%, P = 0.004), whereas patients treated 3-6 h after the onset of symptoms did not differ from respective controls (41 +/- 16% vs 41 +/- 18%). In patients with inferior AMI, the difference in mean LVEF was small (57 +/- 11% vs 55 +/- 12%, P = 0.47). After anterior AMI benefit due to streptokinase therapy was preserved up to 7 months (52 +/- 14% vs 44 +/- 17%, P = 0.013). During exercise, the increase of mean LVEF was greater in the streptokinase group at both dates, especially 7 months after AMI (4.1 +/- 6.1% vs 1.2 +/- 6.3%, P = 0.015). In streptokinase-treated patients with anterior AMI, regional LVEF at rest was higher at both dates compared with controls, within the infarct zone as well as in remote myocardium. No treatment-control differences were demonstrable in patients with inferior AMI. During exercise, regional contractile reserve was better in the streptokinase group within the infarct zone as well as in remote myocardium, irrespective of the site of infarction. Thus, intravenous streptokinase within 3 h after the onset of AMI preserves global left ventricular function in anterior AMI over a period of at least 7 months. Intravenous streptokinase improves regional myocardial function within the infarct zone as well as in remote areas. In inferior AMI investigation solely at rest may underestimate the benefit of streptokinase therapy.

Aged↗
PubMed1990

[Short- and long-term results following implantation of the new Wiktor stent in acute coronary occlusion following PTCA].

Ten patients, two women and eight men, were treated with the new balloon-expandable Wiktor Stent for acute coronary occlusion after PTCA. Two patients presented with an acute myocardial infarction. Stents with a diameter of 3.0 or 3.5 mm were implanted into the right coronary artery (n = 7), the left anterior descending (n = 2) artery, and the left circumflex coronary artery (n = 1). Stent implantation in the target segment was successful in all cases. Afterwards, patients received coumadine for 3 months and 100 mg acetylsalicyclic acid per day. We observed one acute occlusion after 8 h. Late occlusion occurred in two patients after cessation of anticoagulation within 3 weeks. Control angiography after 6 months in seven patients revealed stenosis within the stent in two cases.

Aged↗
PubMed1990

[The risk of recurrence following the thyrostatic treatment of immunogenic and nonimmunogenic hyperthyroidism].

Data of 196 patients treated for hyperthyroidism exclusively with antithyroid drugs were analyzed retrospectively concerning the relapse rate within a follow-up period of four years. Patients were subdivided for primary or recurrent disease, and for immunogenic or non-immunogenic hyperthyroidism, respectively. In immunogenic as well as in non-immunogenic hyperthyroidism, the relapse rate was significantly lower for patients with primary disease (35% and 52%, respectively) compared to those with recurrent hyperthyroidism (82%, p less than 0.001 and 83%, p less than 0.001, respectively). In patients with primary disease, clinical, biochemical and scintigraphic parameters were tested with respect to their capability of predicting a relapse. For immunogenic hyperthyroidism the highest relapse rates were observed in young patients and in those with large goitres, whereas for non-immunogenic hyperthyroidism they were highest in old patients, in those with nodular goitres and in those without an increased urinary iodine excretion at the time of diagnosing hyperthyroidism.

Adolescent↗
PubMed1989

The development of an epileptogenic focus. A case study with 99mTc-HMPAO SPECT.

A patient is described who developed complex partial seizures with secondary generalization 3 years after a severe viral encephalitis with a CT and EEG identified lesion in the left insular cortex and its surrounding structures. When the seizures first occurred CT and MRI as well as repeated interictal conventional EEG recordings were entirely normal. Single photon emission computed tomography (SPECT), however, revealed an area of increased 99mTc-hexamethyl propyleneamine oxime (HMPAO) uptake in the left insular cortex. After anticonvulsive therapy the seizures and the SPECT findings disappeared. 99mTc-HMPAO SPECT is a highly sensitive method for the demonstration of functional alterations in brain tissue. It can improve diagnosis of epilepsy and may provide additional information to monitor anticonvulsive therapy.

Adult↗
PubMed1989

[Use of the autoperfusion catheter in acute coronary occlusion within the scope of percutaneous transluminal coronary angioplasty (PTCA)].

The procedure of an autoperfusion catheterization after acute coronary occlusion by dissection during percutaneous transluminal coronary angioplasty (PTCA) is described. Multiple side holes proximal and distal to the dissection allow passive myocardial perfusion only by systemic blood pressure. In the case presented, the catheter immediately reestablished coronary blood flow and thereby produced resolution of symptoms and myocardial ischemia. This easy procedure made it possible to perform the subsequent coronary bypass operation as a controlled revascularization and it prevented myocardial necrosis.

Angioplasty, Balloon↗
PubMed1989

Splenic function after splenectomy for trauma. Role of autotransplantation and splenosis.

Follow-up of patients treated for severe trauma to the spleen, with autotransplantation (20 cases) or splenectomy (21 cases) included hepatic and splenic scintigraphy, intracutaneous skin testing with seven recall antigens and hematologic studies (red and white blood count, Howell-Jolly bodies, erythrocyte morphology, immunoglobulins, complements). In all reimplantation cases splenic tissue was scintigraphically demonstrated. After removal of the spleen due to severe traumatic ruptures the incidence of splenosis was 66%. Good clearance function in all reimplantation and splenosis cases was demonstrated by Howell-Jolly bodies and erythrocyte morphology. Autotransplantation of splenic tissue is a simple and safe procedure, without serious complications. As yet, however, there is no proof that it provides adequate resistance to infections. Reimplantation, therefore, should be performed only if spleen-preserving procedures are not feasible.

Adolescent↗