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Biomedical subjects

F van de Werf

Publications and source records attributed to F van de Werf.

13 recordsLinked to original sources

Thrombolytic therapy and acute aortic dissection.

Thrombolytic (tissue plasminogen activator) and antithrombotic treatment (heparin and aspirin) were given to a 47-year-old man with an acute type II aortic dissection presenting as an acute anterior myocardial infarction. During treatment he developed cardiac tamponade and an ischaemic stroke. Transoesophageal echocardiography (but not computed tomographies of the chest) revealed the correct diagnosis. After surgical repair (Bentall procedure) there was a complete recovery.

Aortic Dissection

Left ventricular function changes during pharmacological and physiological interventions and routine activities monitored in healthy volunteers by a portable radionuclide probe (VEST).

A miniaturized radionuclide cardiac probe incorporated in a semi-rigid plastic chest garment has made ambulatory left ventricular (LV) function evaluation possible, with gated nuclear data being stored on tape together with electrocardiographic data, for subsequent off-line processing. After red blood cell labelling with 555 MBq (15 mCi) 99mTc and standard gated blood pool imaging in 45 degrees LAO, we performed a continuous monitoring of LV function in 20 healthy male volunteers (age range: 22-25 years), in resting control conditions as well as during activities (standing, walking, climbing stairs) and after interventions (isosorbide dinitrate intake, Trendelenburg position, inflation of cuffs around the thighs). VEST-monitoring proved to be a reliable method that gave reproducible results: changes of ejection (EF) in basal conditions were lower than 5% in 95% of the patients. Changes in LV function caused by daily activities were easily demonstrated. While standing effected no significant EF changes, walking and climbing increased EF by 6.9% (p less than 0.05) and 21.2% (p less than 0.05) respectively. Changes in LV volumes caused by alterations in venous return were also demonstrated. Compared with baseline, Trendelenburg increased end-diastolic volume (EDV) by 2.9% while isosorbide dinitrate and inflation of cuffs decreased it by 5.7% and 2.2% respectively.

Adult

An expert system for the labeling and 3D reconstruction of the coronary arteries from two projections.

In this paper we present a rule-based expert system for the automatic delineation and 3D reconstruction of the left coronary artery on standard RAO and LAO angiographic projections. The approach is based on the application of a general blood vessel model and on anatomical models which take into account the normal variations of the coronary artery structure. In a first step, the arteries are delineated by detecting the maximum intensity on the centerline of the vessels. Then, we label the blood vessel segments according to an anatomical model of the left coronary artery. In general, only 1-2 labels remain for each blood vessel segment. Finally, these results are used for an automatic 3D reconstruction of the left coronary artery from two projections. Results from clinical RAO and LAO angiograms will be presented.

Algorithms

Comparison of angiographic methods for the assessment of the extent of experimental anterior myocardial infarction in dog hearts.

Infarction was provoked in the dog by introducing a copper coil into the left anterior descending coronary artery. Eight groups, each of 6 dogs, were studied which received various treatments and were evaluated after 24 hours or 1 week. The anatomical extent of infarction was measured by the triphenyltetrazoliumhydrochloride method; size was evaluated angiographically by the centerline, chord and radial method and by ejection fraction. The extent of infarction was similar in groups studied after 24 hours and 1 week. Angiographical changes were most marked after 24 hours, and the ejection fraction was related to the extent of infarction (r = -0.5; P less than 0.02). Some parameters of the radial and centerline method showed also a relation to the extent of infarction (r = 0.47 to 0.57; P less than 0.05). After one week, the ejection fraction was no longer correlated to the extent of infarction. The correlation between the parameters of the chord, radius and centerline method and the extent of infarction improved to r-values of 0.58 to 0.63 (P less than or equal to 0.01). There was no difference between the 3 methods.

Adrenergic beta-Antagonists

Bolus alteplase.

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Clinical Trials as Topic

Long term spontaneous evolution of left ventricular function after experimental acute coronary occlusion.

In a canine model of acute occlusion of the left anterior descending artery (LAD), left ventriculography was performed before and immediately after occlusion and also one and three weeks later. Regional left ventricular function was evaluated by the centreline method. Global and regional left ventricular function were significantly depressed immediately after occlusion and showed no significant recovery after one and three weeks, except for a decrease in the paradoxical motion of the LAD territory, which was probably due to stiffening of the infarct area.

Angiocardiography

Pharmacokinetics and thrombolytic properties of a nonglycosylated mutant of human tissue-type plasminogen activator, lacking the finger and growth factor domains, in dogs with copper coil-induced coronary artery thrombosis.

The pharmacokinetics and thrombolytic properties of a variant of human tissue-type plasminogen activator (t-PA), obtained by deletion mutagenesis of the NH2-terminal fibronectin-like finger (F) and epidermal growth factor (E) domains, and substitution of the three known glycosylated Asn residues by Gln (t-PA-delta FE3X), were studied in dogs with a copper coil-induced thrombosis of the left anterior descending coronary artery. Bolus injections were given during 2 min to groups of three dogs. Injection of 0.15 mg/kg resulted in peak antigen levels in plasma of 1.58 +/- 0.72 micrograms/ml (mean +/- SEM) and caused reperfusion within 14 +/- 6 min. With 0.075 mg/kg, corresponding values of 0.81 +/- 0.20 micrograms/ml and 31 +/- 15 min were obtained. A bolus of 0.038 mg/kg yielded plasma peak levels of 0.43 +/- 0.20 micrograms/ml but did not cause coronary recanalization within 3 h. A bolus injection of natural t-PA (Mel-t-PA) at a dose of 0.1 mg/kg in four dogs resulted in plasma peak levels of 0.46 +/- 0.09 micrograms/ml and caused partial coronary artery reperfusion within 3 h in one of four dogs (after 31 min). None of these injections caused a significant decrease of the fibrinogen level. Pharmacokinetic parameters for t-PA-delta FE3X were alpha half-life (t1/2) 14-18 min, beta t1/2 72-125 min, and plasma clearance 21-36 ml/min. For Mel-t-PA, the corresponding values were 3 min, 8 min, and 520 ml/min. We conclude that the variant t-PA-delta FE3X has a markedly longer plasma t1/2 than does Mel-t-PA and, when administered as a bolus injection, a higher thrombolytic efficacy.

Animals

Coronary thrombolysis in dogs with intravenously administered human pro-urokinase.

Coronary thrombolysis was induced by infusion of highly purified human pro-urokinase isolated from a transformed kidney cell line (ACHN) or by infusion of urokinase of urinary origin in anesthetized dogs with 1-hr-old clots in the left anterior descending coronary artery. The clots were induced with a copper coil and thrombolysis was detected by repeat coronary angiography. Intravenous infusion of pro-urokinase at a rate of 10 micrograms/kg/min for 30 min in two dogs did not induce thrombolysis, which was only obtained after 8 and 15 min of its subsequent intracoronary administration. Intravenous infusion of pro-urokinase at a rate of 20 micrograms/kg/min for 30 min in four dogs induced coronary thrombolysis within 23 +/- 2 min (mean +/- SEM). This was not associated with systemic fibrinolytic activation because the alpha 2-antiplasmin and fibrinogen levels did not decrease. Intravenous infusion of urokinase at a rate of 10 micrograms/kg/min for 30 min elicited thrombolysis in four of seven dogs within an average of 19 +/- 2 min. In the other three dogs thrombolysis was only obtained within 11 +/- 3 min of its subsequent intracoronary infusion. Administration of urokinase was associated with systemic fibrinolytic activation as evidenced by a decrease of alpha 2-antiplasmin to about 10% and of fibrinogen to 43 +/- 13% of the preinfusion value. It is concluded that intravenous infusion of pro-urokinase at a sufficiently high rate produces coronary thrombolysis without systemic fibrinolysis in dogs.

Animals

Influence of moxaprindine treatment on ventricular arrhythmias occurring during maximal exercise stress testing.

Moxaprindine, a new anti-arrhythmic drug, with characteristics similar to aprindine, has been demonstrated to be highly effective in suppressing ventricular arrhythmias occurring before, during and after maximal exercise stress testing. This effect was obtained both in subjects with clinically normal hearts and in a limited number of patients with ischemic heart disease. These findings demonstrate the efficacy and safety of anti-arrhythmic treatment by drugs prolonging ventricular depolarization for ventricular arrhythmias occurring during exercise.

Adult