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Biomedical subjects

F Leisch

Publications and source records attributed to F Leisch.

At least 19 recordsLinked to original sources
PubMed1998

Chemotherapy in patients with acquired immunodeficiency virus syndrome associated with non-Hodgkin's lymphoma.

We retrospectively analyzed our chemotherapy results in patients with the Acquired Immunodeficiency Virus syndrome (AIDS) and lymphoma over a 10 year period. Thirty out of 492 (6%) Human Immunodeficiency Virus (HIV) positive patients developed a non-Hodgkin's lymphoma. Thirteen patients with high-grade histology were treated with chemotherapy, 6 patients received CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisolone) and 7 patients received CEOP/IMVP-Dexa (cyclophosphamide, epirubicin, vincristine, prednisolone, ifosfamide, methotrexate, VP-16, and dexamethasone). The overall response rate was 77%, with no difference between the CHOP and CEOP/IMVP-Dexa regimens. There was no difference between the two treatment groups with respect to median overall survival (9 months for CHOP and 11.4 months for CEOP/IMVP-Dexa) or median lymphoma free survival (10.7 months for CHOP and not reached for CEOP/IMVP-Dexa). All patients treated with CEOP/IMVP-Dexa had WHO grade 3 or 4 infections, while only 2 of 6 patients treated with CHOP had WHO grade infections, and no grade 4 infection occurred (P < 0.01). Intensive regimens such as CEOP/IMVP-Dexa seem to be too toxic for patients with HIV-associated non-Hodgkin's lymphoma.

Acquired Immunodeficiency Syndrome↗
PubMed1995

[Symptomatic bradycardia with amiodarone in patients with pre-existing conduction disorders].

Amiodarone has been shown to improve survival in patients with impaired left ventricular function and ventricular trachyarrhythmias. The clinical applicability, however, is limited by numerous often serious adverse effects. 70 patients receiving the treatment with amiodarone for ventricular tacharrhythmias were investigated regarding the development of symptomatic bradycardia. Group 1 consisted of 25 patients with preexisting conduction disorders, 5 had first degree heart block, 10 had right bundle branch block, and 7 had left bundle branch block on electrocardiographic examination. The 3 remaining patients showed asymptomatic sinus node dysfunction defined as sinus arrest or sinuatrial block. Amiodarone caused symptomatic bradycardia in 6 of the group 1 patients (II degrees-III degrees AV block in 3 patients with preexisting I degree AV block or right bundle branch block; intermittent sinus arrest or SA block in the 3 cases with previous sinus node dysfunction). 45 patients had no conduction disorders before the administration of amiodarone (group II). None of these patients developed symptomatic bradycardia. The difference to group I was significant (p < 0.0005). Thus, patients with preexisting conduction disorders have a substantial risk of developing symptomatic bradycardia under amiodarone therapy, with an incidence of 24% in group I patients of our collective.

Aged↗
PubMed1993

[Importance of coronary dilatation in patients after bypass operation].

342 consecutive patients with recurrent angina pectoris were investigated 4.9 +/- 2.9 years after bypass surgery. According to the respective coronary morphology, angioplasty (PTCA) was performed in 110 patients (32%), repeat surgery in 32 (9%) and 200 patients (58%) were treated medically. Angioplasty was undertaken in 113 native coronary arteries (18 via a patent venous graft) and 29 bypass grafts. One vessel was dilated in 84 patients (76%) and more than one vessel in 26 patients (24%), giving an average of 1.3 vessels per patient. The initial success rate was 84% (120 of 142 vessels). The success rate varied from 60% in the midportion of venous grafts to 100% in the bypass protected left main stem. One patient died from complications (0.9%) and 5 patients (4.5%) suffered a myocardial infarction. Revascularisation was complete in 64 patients (58%) and remained incomplete in 40 patients. Clinical state improved in all but 7 patients and 70 patients (64%) became symptom-free. After 6 months 88 patients were clinically reevaluated. 52 patients (59%) still showed improvement in anginal status or remained symptom-free. Due to recurrent symptoms a re-angioplasty was performed on 21 patients and 6 patients had to be reoperated. In conclusion, coronary angioplasty is frequently a feasible alternative to reoperation with calculable risks in patients with recurrence of symptoms after prior bypass surgery.

Adult↗
PubMed1991

Importance of coronary spasm for recurrences following percutaneous transluminal coronary angioplasty (PTCA).

To examine the importance of coronary spasm for recurrences following coronary angioplasty, the incidence of spontaneous and ergonivine-provoked coronary spasm was studied, during initial and 6 months follow-up coronary angiography, in a consecutive series of 102 patients with single-vessel disease and successful coronary angioplasty. Repeat angiography demonstrated restenosis in 35 patients (34%). In patients with no demonstrable coronary spasm before and 6 months after PTCA, restenosis occurred in 23% (14/61). The recurrence rate for patients with spasms only before PTCA was similar (29%; 6/21). An increase of recurrences was observed in patients with coronary spasm before and 6 months after PTCA (69%; 9/13) and was extremely high in patients with detectable spasms only after PTCA (86%; 6/7). The importance of the severity of underlying coronary stenosis as regards the ergonovine testing result, demonstrated no relationship between the degree of underlying stenosis and the incidence of provokable coronary spasms. Thus, coronary spasms provokable only before PTCA do not increase the risk for recurrences. Spasms persisting after PTCA or seen only after the procedure are associated with a significantly higher rate of restenoses.

Angina Pectoris, Variant↗
PubMed1991

[Risk of complications of early coronary angioplasty after thrombolysis in acute myocardial infarct].

The present study reports on the complication rates in 143 patients who underwent percutaneous transluminal coronary angioplasty (PTCA) within 4 weeks after thrombolysis for acute myocardial infarction. The results were analyzed with respect to the time between thrombolysis and PTCA. PTCA was successful in 130 patients (91%). The mortality was 0.7% (1 patient). Severe complications occurred in 9 further patients (7%): 8 reinfarctions (6%) and one patient with a large haematoma of the groin requiring surgical treatment (0.7%). The total complication rate, including milder was 24%. A comparison of patients treated with PTCA within the first 4 days after thrombolysis (group I, n = 67) with patients dilated between 5 and 28 days after thrombolysis (group II, n = 76) resulted in a complication rate of 33% in group I and 16% in group II (p less than 0.01). This important difference was due to the higher frequency of ischaemic complications in group I than in group II (28% versus 12%). Besides reinfarction (7.5% in group I versus 4% in group II), prolonged ischaemic episodes were the most frequent cause of complications. Our results demonstrate a very high risk of complications if PTCA is performed within the first 4 days after thrombolysis for acute myocardial infarction.

Adult↗
PubMed1991

[The effects of delayed transluminal balloon coronary angioplasty in myocardial infarct patients with early thrombolytic recanalization of the coronary artery: the results of dynamic quantitative angiography].

As many as 71 patients with the developing large-focal myocardial infarction (MI) were entered into the study. The purpose was to examine the dynamics of the status of the coronary arteries and left ventricular function in MI patients with early recanalization of the infarct-related artery (IRA) as a result of thrombolytic therapy (TLT) and delayed transluminal coronary angioplasty (TCA). Coronary arteriography and left ventriculography were provided 3 times to all the patients: within the first 4 hours of the disease (in combination with TLT), on days 4-6 of the disease (in combination with TCA of the IRA), and after 6 months of observation. It is concluded that the combined use in MI patients of coronary thrombolysis within the first 4 hours of the disease and delayed TCA (on days 4-6 of the disease) ensure steady recovery of IRA patency, with an insignificant residual stenosis of the artery. At the same time the patients demonstrated improvement of local contractility of the deranged compartment of the left ventricle by the 6th month of observation. Restenosis of the recanalized IRA that occurs during 6 months of observation after the interventions performed does not affect the recovery of left ventricular function.

Angioplasty, Balloon, Coronary↗
PubMed1990

[Restenosis following coronary dilatation].

Restenoses following successful coronary angioplasty occur in about 30 to 35% and are the most important limitative factor of this method. The etiology of restenosis is multifactorial. A beneficial effect in reducing restenosis could not be demonstrated for any drug in the clinical stage. First results with the administration of n-3-fatty acids revealed a favourable influence on recurrence. Further on, the value of newer interventional methods on restenosis rate is also uncertain. Thus, the problem of restenosis remains unresolved.

Angioplasty, Balloon, Coronary↗
PubMed1990

Coronary angioplasty after intravenous streptokinase in acute myocardial infarction: influence of restenosis on clinical outcome and left ventricular function.

The importance of recurrence of stenosis on clinical outcome and left ventricular function was studied in a consecutive series of patients with acute evolving myocardial infarction (maximal duration of pain 4 h) and thrombolysis (1.5 x 10(6) units of streptokinase intravenously over 60 min) with recanalized single-vessel disease and subsequent successful coronary angioplasty. Coronary angioplasty was performed in 76 patients between 24 hours and 8 days (mean interval 3.3 days) after thrombolysis and was successful in 86% (65/76). The in-hospital reinfarction rate was 5.2% (2 acute and 2 in-hospital reinfarctions). Repeat angiography after a mean interval of 5.9 months revealed a 39% (24/62) restenosis rate (21 restenoses, 3 reocclusions). Restenoses were associated with significantly more clinical complaints (21% vs. 62%; p less than 0.001). Left ventricular function analysis showed significant improvement in the mean global ejection fraction (6.6 +/- 6.0%; p less than 0.001) and mean regional wall motion of the infarct zone (6.2 +/- 8.2%; p less than 0.01) only in patients without restenosis. Recovery of left ventricular function was more evident in inferior than in anterior wall infarctions. In contrast, patients with restenosis had no change in left ventricular function. Thus, the present study demonstrates the adverse influence of restenosis on recovery of left ventricular function and clinical outcome.

Angioplasty, Balloon, Coronary↗
PubMed1990

[Complication in rotation angioplasty: removal of an intracoronary metal ring (roentgen marker) using a balloon catheter].

Successful recanalization of an occluded left anterior descending coronary artery, performed by rotational angioplasty was complicated by loosening of a metallic ring (x-ray marker) from the rotational angioplasty system, with embolization into the circumflex artery. The metallic ring was extracted successfully by using a balloon catheter.

Angioplasty, Balloon, Coronary↗
PubMed1989

[Coronary artery spasm with anaphylactoid shock due to low-molecular dextran].

An anaphylactoid shock with S-T segment elevation in leads II and III and total AV block developed in an 81-year-old man, soon after starting an infusion of about 10 ml of low-molecular dextran and just before a planned balloon dilatation of the anterior descending branch. The shock state was caused by an angiographically demonstrated spasm of the, previously normal, right coronary artery. Intracoronary injection of 0.3 mg nitroglycerin resolved the spasm within two minutes and the patient's general condition returned to normal.

Aged↗
PubMed1989

Clinical efficacy of intravenous amiodarone in the short term treatment of recurrent sustained ventricular tachycardia and ventricular fibrillation.

The clinical efficacy of intravenous amiodarone in terminating sustained ventricular tachycardia and in preventing recurrences of ventricular tachycardia and ventricular fibrillation was evaluated in 26 patients. All of them presented with organic heart disease accompanied by depressed left ventricular function. Intravenous amiodarone terminated spontaneous ventricular tachycardia in eight of 19 patients. Fifteen of the 26 patients had had at least one episode of ventricular tachycardia or ventricular fibrillation each day in the period immediately before the intravenous administration of amiodarone. Amiodarone controlled ventricular tachycardia or ventricular fibrillation in nine of these 15 patients; in three further cases it was successful when supplemented by additional administration of a previously ineffective antiarrhythmic drug and ventricular pacing. Two patients died despite these measures. In one, the amiodarone infusion had to be stopped because of an arrhythmogenic effect. Sustained deterioration of haemodynamic function or of pre-existing intraventricular conduction disturbances was never seen. Intravenous amiodarone was effective in terminating sustained ventricular tachycardia and in preventing frequent episodes of ventricular arrhythmia that were refractory to other antiarrhythmic drugs.

Amiodarone↗
PubMed1989

[Hyperlipidemia and coronary heart disease].

The relationships between total serum cholesterol levels greater than 200 mg/dl or LDL-cholesterol levels greater than 155 mg/dl (135 mg/dl) and the incidence of coronary heart disease is well established. In contrast an inverse relationship could be shown between HDL-cholesterol levels and the frequency of cardiac death and non fatal myocardial infarction. It also seems to be possible that elevated triglyceride levels (greater than 200 mg) may represent an additional risk factor. Subsequent studies with a large number of patients and longterm observation proved, that fat-modified diets or drug treatment of hyperlipidemia results in a reduction of morbidity and mortality due to coronary heart disease, whereby the reduction of coronary events correlates directly to the degree of reduction of total cholesterol or LDL-cholesterol, respectively. This knowledge allows the clinician to identify persons at high risk for coronary heart disease and to start effective individual therapy in accordance with the recommendations of the European Atherosclerosis Society.

Cholesterol↗
PubMed1988

[Imipenem/cilastatin as monotherapy in neutropenic patients with fever].

We treated 20 febrile episodes in 14 patients with granulocytopenia under 1.0 x 10(9)/L. 6 episodes were pretreated, in 14 Imipenem/Cilastatin was the initial therapy. The age was between 36 and 78 years, mean 57 years. Predominant underlying disease was acute leukemia. 8 out of 20 episodes became afebrile. Counting only proven bacterial infections the response rate was 6 out of 12. There was a statistical difference between not pretreated and pretreated patients. The treatment had no success in the latter. There was also a significant difference between febrile episodes of patients with granulocytes increasing under treatment to those remaining unchanged. 5 of 6 of the first group but none of the 9 episodes of the second group resolved. 7 patients died while on treatment between the 9th and 32nd day after therapy had started. There was no connection between the Imipenem treatment and the deaths. Tolerance of therapy was good. The most common side effect was nausea, which was reversible with reduction of the infusion rate. Most important advantage of imipenem is the easy handling and the low inconvenience to the patient. We had only moderate efficacy in our series.

Adult↗
PubMed1988

Incidence of spontaneous and provoked coronary spasms after percutaneous transluminal coronary angioplasty.

We studied the incidence of spontaneous and ergonovine-induced coronary arterial spasm during repeat coronary angiography in 96 consecutive patients with single-vessel disease who had undergone successful angioplasty. Follow-up angiography was performed after a mean of 6 months (1-8 months). Sixty patients demonstrated no restenosis and in 36 patients restenosis (greater than 50% restenosis) occurred. Spasms of the arteries at the site of dilatation were significantly (P less than 0.001) more frequent in patients with restenosis (18/36; 50%) than in patients without restenosis (4/60; 7%). Before angioplasty, no differences were found in the clinical characteristics between the two groups. Likewise, the morphologic results of angioplasty were identical. Despite long-term treatment with nifedipine (30-60 mg daily) and aspirin (0.5 g daily), 14 of 18 patients with restenosis and coronary spasm suffered from spontaneous angina, as compared to only 3 of 18 patients with restenosis without demonstrable spasm. Three of the 4 patients without restenosis but with detectable spasm were also symptomatic. Thus our findings suggest that spasm of the coronary arteries achieves some importance as a pathophysiological factor for recurrence following coronary angioplasty.

Angina Pectoris↗
PubMed1988

Systemic thrombolysis and percutaneous transluminal coronary angioplasty (PTCA) in acute myocardial infarction.

Intravenous high-dose infusion of streptokinase in acute evolving myocardial infarction is a widely used therapeutic concept with clinically relevant recanalization rates and low complications. In our experience with 150 patients and acute myocardial infarction treated with intravenous streptokinase (1.5 Mio U), 107 (78 p. 100) of 137 patients demonstrated an antegrade perfused infarct artery. In a group of patients (n = 95), in whom early revascularization was performed, the incidence of reinfarction was reduced from 15 p. 100 to 7 p. 100; hospital mortality was not influenced (3.6 p. 100 vs 4.3 p. 100). PTCA was successful in 39 of 48 patients (81 p. 100). The incidence of angiographically determined restenosis amounted to 28 p. 100 (9/32). Patients after successful PTCA without restenosis demonstrated an improvement of left ventricular function in contrast to patients with restenosis or reocclusions. Thus, intravenous streptokinase followed by PTCA presents a clinically practicable and promising method for treatment of acute myocardial infarction.

Adult↗
PubMed1988

[Thrombolysis and myocardial infarct].

Thrombolytic therapy in acute myocardial infarction is able to recanalize thrombotic occluded infarct arteries in about 35 to 90%. The results depend on the thrombolytic agent and the route of administration (i.c., i.v.). Successful recanalization causes a reduction of hospital- and one year mortality and reduction of the infarct size in a close correlation to duration of ischemic pain at the beginning of thrombolysis. Significant residual stenoses persist in about 80 to 90% after successful reperfusion. In these patients, PTCA can be performed with high success rates and with a low incidence of complications. Successful PTCA is associated with a reduction of reinfarction and further improvement of left ventricular function. Thus, the value of thrombolysis in acute myocardial infarction in patients with pain duration shorter than 3 to 4 hours is established. The value and optimal point of time for performing PTCA after thrombolysis remains to be defined.

Angioplasty, Balloon↗
PubMed1988

[Ischemic reaction in coronary angioplasty (PTCA) as a prerequisite for improving left ventricular function following intravenous thrombolysis in acute myocardial infarct].

The incidence of ischemic ECG-changes and anginal symptoms during PTCA and the influence of PTCA on left ventricular function were studied in a consecutive series of 40 patients with recanalized infarct artery and significant (greater than 50%) single vessel disease. PTCA was performed within the first week (4.1 +/- 2.5 days) after intravenous streptokinase (1.5 Mio U i.v. over 60 min) in acute myocardial infarction (duration of pain less than four hours). The primary success rate of PTCA was 78% (31/40). In 25 of 31 (81%) successfully dilated patients, there were ischemic ECG-changes (ST-segment elevation greater than 0.1 mV), and in 14 patients anginal symptoms were observed during balloon inflation. Follow-up angiography after six months showed restenosis or reocclusion in 5/22 (23%) of the patients with an ischemic reaction, and in 3/6 (50%) without ischemic signs during PTCA. Only patients with an ischemic reaction and without restenosis demonstrated an increase in left ventricular ejection fraction (p less than 0.05) and regional wall motion in the infarct region (p less than 0.01), in contrast to patients with restenosis or without an ischemic reaction during angioplasty. Thus, after intravenous streptokinase an ischemic reaction can be detected in a high percentage (81%) as an indicator of salvaged myocardium. Significant improvement of left ventricular function was only demonstrable in patients with ischemic signs during PTCA without restenosis.

Angioplasty, Balloon↗