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Biomedical subjects

K Speiser

Publications and source records attributed to K Speiser.

9 recordsLinked to original sources
PubMed1988

[Fibrinolysis in acute myocardial infarct. Treatment rate, assessment and follow-up treatment in the Zürich hospitals].

We report the results of i.v. fibrinolysis in patients with acute myocardial infarction treated in four major hospitals in Zürich. Between 1986 and 1988 only 96 (9%) of 1069 patients admitted to intensive care units with acute myocardial infarction received thrombolytic therapy (less than 3 hours after onset of symptoms), 7% (50/703) during the first treatment period (streptokinase for 14 months), 13% (46/306) during the second treatment period (rt-PA for 8 months). The hospital mortality was 4% and severe complications of fibrinolytic therapy occurred in 4%. Coronary angiography was performed in 60% of patients in 1986/87 and in 87% in 1987/88. Despite this significant increase in invasive diagnostic procedures the percentage of patients after thrombolysis qualifying for invasive therapy remained unchanged at 53%. The indications for PTCA or bypass surgery were postinfarct angina in 41%, silent ischemia in 5%, left main coronary artery stenosis or multivessel disease with reduced left ventricular ejection fraction in 16%, and residual high grade stenosis with preserved contractility of the infarct-related myocardium in 38%. The mean in-hospital stay was 16 days, with significant variation from 13 to 22 days between the different hospitals (p less than 0.05). In the follow-up of 65 men aged below 65 years, 75% of the patients undergoing invasive therapy and 65% of those treated medically had returned to work 6 months after myocardial infarction. Due to the limited possibility of detecting viable myocardium by non-invasive methods, and the high rate of invasive therapy necessary in our patients, further management after thrombolysis should generally include large scale coronary angiography.(ABSTRACT TRUNCATED AT 250 WORDS)

Anticoagulants↗
PubMed1985

Platelet inhibitors versus anticoagulants for prevention of aorto-coronary bypass graft occlusion.

The effects of the antiaggregant substance ticlopidine and of the anticoagulant acenocoumarol on patency rates of aorto-coronary bypass grafts were compared in a prospective randomized trial. Ticlopidine, 250 mg b.i.d. was administered orally from the first postoperative day till angiography, while anticoagulation with acenocoumarol was initiated on the second to third postoperative day. Side-effects of ticlopidine were rare and patient management with the standard dosage of this drug was easier than oral anticoagulation. From an initial group of 166 randomized patients 149 completed the trial by coronary angiography three months postoperatively. The 78 patients in the ticlopidine group showed a compliance of 85%. The average prothrombin time in the 71 patients receiving acenocoumarol was 26.9%. Detailed statistical analysis of the two study groups revealed no reason to doubt the correctness of randomization. Coronary angiography showed an average patency rate per patient of 84% with ticlopidine and of 82% with acenocoumarol. This and various other measures of graft occlusion did not reveal any substantial difference in graft patency of patients receiving ticlopidine or acenocoumarol. It is concluded that ticlopidine may well be used instead of anticoagulants for prevention of postoperative occlusion of aorto-coronary bypass grafts.

Acenocoumarol↗
PubMed1983

[Progression of coronary stenosis following aorto-coronary bypass surgery].

In a prospective study (238 men, mean age 53 years) the changes in native vessels were studied 3 months after aorto-coronary bypass operation and 5 months after preoperative angiography. Progression was defined as increase in stenoses of at least 20% or new total occlusion. Progression was significantly more frequent in vessels with bypass than without; it was located proximally to the anastomoses in most cases, less frequently at the anastomoses and very rarely distally to the anastomoses. Proximal progression was significantly more frequent with open bypasses than with occluded ones. Stenoses at the anastomoses were significantly more frequent with occluded bypasses than with open ones. More severe stenoses had a stronger tendency to progression than less severe stenoses. Regression was rare and nearly always caused by surgery.

Aortic Valve Stenosis↗
PubMed1983

[Prognosis in complications of acute myocardial infarction requiring artificial respiration].

From 1978 to 1981, 818 consecutive patients with acute myocardial infarction were admitted, 112 (13.7%) of whom required artificial ventilation because of complications. Their mean age (62) corresponded to the mean age of all acute myocardial infarction patients (63). 28 (25%) survived the hospitalization and were followed after discharge. 2 were lost to follow-up. After a mean follow-up period of 26 months, 8 patients had died and 18 were still alive, none of them free of symptoms. There was no difference of age, duration of respirator therapy and maximal creatine kinase activity between survivors (group A) and nonsurvivors (group B). In 50% of patients cardiac failure leading to endotracheal intubation was triggered or made worse by arrhythmias. The remaining 50% of patients showed pure pump failure. Again in these two subsets, cardiac failure was significantly less marked in group A than in group B according to the hemodynamic findings. In conclusion, inpatient mortality in patients with acute myocardial infarction requiring artificial ventilation was high (75%) and hemodynamic findings were significantly worse in those not surviving. Patients discharged from the hospital also had a reduced life expectancy (less than 50% after 3 years).

Arrhythmias, Cardiac↗
PubMed1983

[Changes in the unmodified vessels after aortocoronary bypass surgery].

In a prospective study (238 men, mean age 53 years) the changes of the native vessels were studied 3 months after a-c-bypass operation and 5 months after preop. angiography. Progression was defined as increase of stenoses of at least 20% or new total occlusion. Progression was significantly more frequent in vessels with than without bypass and was located proximally to the anastomoses in most cases, less frequently at the anastomoses and very rarely distally to the anastomoses. Proximal progression was significantly more frequent with patent than with occluded bypasses. Stenoses at the anastomoses were significantly more frequent with occluded than with patent bypasses. Stenoses of higher degrees had a stronger tendency for progression than slighter stenoses. Regression was rare and nearly always caused by surgery.

Angina Pectoris↗
PubMed1982

[Occupational rehabilitation following aorto-coronary bypass operations].

Resumption of work after aorto-coronary bypass surgery was studied in 317 patients with a mean age of 51 years. 217 patients who underwent surgery between 1975 and 1978 were studied retrospectively (group I) and 100 patients operated upon between 1979 and 1980 prospectively (group II). A coronary control study was performed in 106 patients of group I and in all patients of group II. Age, postoperative NYHA class, and pre- and postoperative ejection fraction did not differ in the two groups. Significant differences between the two groups were found regarding preoperative NYHA class (2.9 vs 2.5), amount of diseased coronary vessels (2.3 vs 2.6), number of bypass grafts (2.4 vs 3,2, all p's less than 0.001) and graft patency rate (70 vs 80%, p less than 0.025). One year after surgery 78% in group I and 84% in group II were back at work (ns). However, among the patients not working before surgery, 54% in group I and 73% in group II had returned to work (p less than 0.005), which indicates a greater success rate for aorto-coronary bypass grafting in recent years. Best predictors for resumption of work after surgery are relief of symptoms, normal work capacity in the bicycle test, duration of inability to work before surgery and type of occupation.

Adult↗
PubMed1980

[How reliable is echocardiography in evaluating the severity of mitral stenosis].

40 patients with mitral stenosis were examined by M-mode and 2-dimensional echocardiography. E-F slope, mitral valve closure index and mitral valve area were compared with the invasively determined mitral valve area. E-F slope and closure index correlated with the valve area by an r of 0.65 and 0.62 respectively. The mitral valve area as calculated by 2D echocardiogram showed a correlation with the invasively determined valve area of 0.86 and was even better in patients with sinus rhythm (0.91). However, in severe mitral stenosis (less than 1 cm2) this correlation was only 0.62 by estimating 22% of patients with severe mitral stenosis as only moderate (greater than 1 cm2). It is concluded that whereas E-F slope and closure index are not of use in the quantification mitral stenosis, determination of mitral valve areas by 2D echo is reliable. However, in the severe mitral stenosis group 22% of mitral valve areas were estimated purely numerically by 2D echo as moderate (greater than 1 cm2).

Adult↗