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Biomedical subjects

K Leitz

Publications and source records attributed to K Leitz.

17 recordsLinked to original sources
PubMed1995

Characteristics of repeat trauma patients, San Diego County.

Data on 22,312 admissions to the San Diego County Trauma System were used to identify 185 trauma patients admitted repeatedly to trauma units. These patients were compared with the entire group of nonrepeating trauma patients admitted during the 80-month period of the study. In comparison with nonrepeaters, the repeaters were younger, were more often men, were more often Black, and were much more frequently victims of assault. Forty-eight percent of the repeaters were injured by the same general mechanism on both admissions.

California↗
PubMed1992

Converting enzyme inhibition and blood pressure reactivity to psychological stressors.

There is considerable interest in blood pressure reactivity to psychological stressors. Because the sympathetic nervous system and the renin-angiotensin system are so responsive to stressors and are themselves the targets of many antihypertensive medications, many investigators have wondered if such medications decrease the blood pressure response to stressful stimuli. We studied 25 normotensive and 21 hypertensive men in a double-blind crossover study during which they received either placebo for 4 days or captopril (25 mg b.i.d.) for 4 days while they were hospitalized in a clinical research center. Patients were studied at resting baseline, while performing a mathematics task, and while reading out loud a disturbing newspaper article. Although captopril lowered the resting blood pressure levels, it had no effect on the amplitude of reactivity to stressors.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1990

[Immediate bypass operation prevents heart infarct in PTCA emergencies].

UNLABELLED: Between December 1984 and June 30, 1989, we performed PTCAs on 1438 patients. The procedures were performed with strict cardiosurgical standby. In 24 patients (22 X LAD, 2 X RCA), abrupt coronary occlusion necessitated immediate bypass surgery. In 19 cases, abrupt coronary closure occurred during PTCA in the cath lab; in five patients, during the following 24 h on the intermediate care ward. No patient died. Immediate bypass surgery prevented myocardial infarction (MI) in 79.2% of the cases. None of the 19 patients with abrupt coronary closure in the cath lab had a Q-wave myocardial infarction postoperatively. One of these 19 patients had an R-wave reduction (non-Q-MI) and one patient had a new terminally negative T-wave in the postoperative ECG. Two of the five patients with evidence of acute coronary occlusion on the intermediate care ward had small Q-wave MIs and one had a non-Q-wave MI postoperatively. Time of ischemia (defined als time interval between the end of PTCA and the beginning of extracorporal circulation) was 65 +/- 28 min in the former group and 122 +/- 30 min in the latter. CONCLUSION: Because immediate bypass surgery prevents Q-wave MI after abrupt closure during PTCA, strict temporal and spatial cooperation with the cardiac surgeon is mandatory.

Angioplasty, Balloon, Coronary↗
PubMed1983

[Ventricular septal defect as a complication of myocardial infarct].

Between 1978 and 1982 emergency closure of postinfarction ventricular septal defect was performed in 4 patients (51--74 years) on the 3rd-7th day after acute myocardial infarction. All patients had a large left-to-right shunt and were in intractable acute heart failure; all of them survived the operation (3 patients had additional aortocoronary bypass grafts), and follow-up (0.5--4.5 years) was uncomplicated. The favorable clinical and functional results of surgical therapy indicate that postinfarction ventricular septal defects should be operated on even in patients over 70 years of age.

Aged↗
PubMed1981

Intracoronary streptokinase thrombolytic recanalization and subsequent surgical bypass of remaining atherosclerotic stenosis in acute myocardial infarction: complementary combined approach effecting reduced infarct size, preventing reinfarction, and improving left ventricular function.

In 48 patients with acute myocardial infarction (AMI) the acutely thrombus-occluded coronary artery was successfully recanalized nonsurgically via catheter with intracoronary streptokinase (SK) infusion after a mean occlusion time of 3.1 +/- 1.6 hours. In all cases residual high-grade fixed atherosclerotic stenosis remained after percutaneous transluminal coronary recanalization (PTCR). Subsequent aortocoronary bypass surgery (ACBS) circumventing the stenotic coronary artery was performed during the acute stage of myocardial infarction (within 10 days of AMI onset) in 34 patients and electively (longer than 10 days after AMI onset) in 14 patients. No patient died from early PTCR or from ACBS intervention. There were two late post-ACBS arrhythmogenic deaths, two patients suffered nonfatal reinfarction post ACBS several months after hospital discharge, only two had occasional post-ACBS angina pectoris, and one patient had post-ACBS mild heart failure. The remaining 41 post-ACBS patients were completely asymptomatic throughout long-term follow-up evaluation. In the left ventricular (LV) segment supplied by the initially occluded coronary artery, which was recanalized early by means of SK therapy and subsequently grafted, wall motion improved significantly from the acute to the postoperative stage in patients who underwent early surgery (from 13.6% +/- 1.9% to 40.3% +/- 2.7%, p less than 0.001) and in the electively operated group (from 18.0% +/- 7.1% to 48.2% +/- 6.3%, p less than 0.001). Ischemic wall motion was improved irrespective of whether or not the bypass graft circumventing the residual stenosis of the infarct vessel remained patent. Wall motion of nonischemic segments remained essentially unchanged. In the patients who underwent surgery in the early stage, the closure rate of the bypass graft to the infarct-related vessel was 17%, and in the electively operated group no graft was found to be occluded. In conclusion, coronary artery recanalization, achieved by means of early SK-PTCR therapy with subsequent ACBS, can be performed safely in patients with AMI, and the result will be marked improvement in LV segmental wall motion and global function, diminished reinfarction rate, and reduced incidence of angina pectoris, all benefits that are consistently maintained during long-term evaluation.

Angioplasty, Balloon↗
PubMed1979

[Reopening of infarct-occluded vessel by transluminal recanalisation and intracoronary streptokinase application (author's transl)].

Coronary angiography was performed 2 hours after onset of complaints in a 57-year-old patient with acute anteroseptal infarction. Using a wire spiral in the coronary catheter the acutely occluded anterior interventricular branch was reopened. With intracoronary streptokinase (120 000 units in 50 minutes) the recanalisation canal was enlarged. The clinical picture and electrocardiographic findings improved under the influence of treatment. An aorto-coronary bypass operation was performed on the following day. The post-operative angiogram showed marked improvement of left ventricular function. The results indicate that this intervention prevented widespread necrosis.

Angiography↗
PubMed1979

Acute myocardial infarction: intracoronary application of nitroglycerin and streptokinase.

In five patients with acute myocardial infarction, the effects of both intracoronary nitroglycerin (NTG) and subsequent intracoronary streptokinase application were evaluated. In addition, transluminal recanalization was performed in one of these patients. Injection of NTG into the infarct-related coronary artery resulted in improved distal filling of the subtotally occluded left circumflex artery in one patient, and in transient patency of the completely occluded right coronary artery in a second patient. In a third patient patency of the totally occluded left anterior descending artery (LAD) was achieved by transluminal recanalization with a guide wire. In a forth patient with occulsion of the LAD, there was no response to intracoronary NTG and mechanical recanalization was not attempted. Subsequent intracoronary infusion of streptokinase (1,000--2,000 U/min for 15--60 min) resulted in a further and long-term reduction of narrowing at the site of acute occlusion in patients I-III and in opening of the completely occluded LAD in patient IV. Improvement of lumen was paralleled by alleviation of symptoms. In a fifth patient, in whom the LAD was subtotally occluded, the degree of coronary obstruction could not be changed by intracoronary application of NTG or by lysis. In this patient, symptoms and ECG changes improved with reduction of pathologically elevated blood pressure values. The findings suggest that myocardial infarction had been caused by thrombotic occulsion in four patients, and that spasm of the infarct vessel could have been an additional factor in two of these patients. In the fifth patient, an increase of afterload in the presence of a subtotal lesion might have caused the critical imbalance between oxgen supply and demand, resulting in cell death.

Cardiac Catheterization↗
PubMed1978

[Clinical behaviour after aorto-coronary vein bypass grafting related to the degree of revascularization (author's transl)].

The clinical behaviour after bypass-surgery was analysed with regard to anginal symptoms at rest and during daily exercise, working habits and postoperative medication in 135 patients, 3 to 28 months (average 18 months) postoperatively. All patients underwent postoperative coronary and left ventricular angiography, allowing a close correlation between postoperative clinics and patency-rate (average 84%) as well as the degree of revascularization (average 64%). 80% of the patients were clinically improved and, furthermore, there was a close correlation between the degree of improvement and revascularization. In contrast, only 42% of the patients were back to work and there was no correlation between the working habits and patency-rate or the degree of revascularization. Finally, postoperatively clearly improved patients showed a signif. smaller consumption of antianginal drugs, esp. nitrates.--This analysis of postoperative clinics and angiography suggests that improvement of symptoms through bypass-surgery is primarily due to the improvement of local perfusion in previously underperfused myocardial areas.

Angina Pectoris↗
PubMed1975

Complications of permanent transvenous cardiac pacing.

Clinical experience with permanent transvenous pacing during a 6 year period at Hannover Medical School is presented. A total of 1,376 pacemaker operations were performed in 799 patients, with a mortality rate of 1.1 per cent. The most common complications were premature battery failure, dislocation of endocardial electrodes, infections of the generator and/or electrodes, and skin ulcerations. In our cumulative follow-up period of 1,225 years, a complication necessitating a reoperation is to be expected after an average function-time of 31 months. Including normal battery exhaustion in this calculation will make reoperation necessary every 21.9 months.

Adult↗