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Biomedical subjects

L Benesch

Publications and source records attributed to L Benesch.

17 recordsLinked to original sources
PubMed1999

[Lipid intervention and coronary heart disease in men less than 56 years of age. The Coronary Intervention Study: CIS].

UNLABELLED: The CIS was undertaken with the aim to evaluate the effects of lipid modifications on angiographic progression and regression of CAD in patients with CAD and hypercholesterolemia. The design included a multicenter randomized, double-blind, parallel, placebo-controlled comparison, with target and safety limits for adjusting the trial medication depending on the LDL cholesterol level (LDL-C) achieved, i.e., up to 40 mg of simvastatin (S) or placebo (P) daily, add-on medication (up to 3 x 4 g Colestyramin), and diet counselling. Male patients, average age 49 (< or = 56) years, were included with angiographic CAD and a screening total cholesterol of 207-350 mg/dl, who were not due to undergo coronary bypass surgery or PTCA, who did not suffer from serious other disease (e.g., diabetes mellitus), and who had not undergone coronary bypass surgery previously. RESULTS: All baseline variables were comparable in the treatment groups, with 129 patients taking S and 125 taking P. Of these 254 patients 217 had their final study visit and 207 underwent a second angiography after an average treatment time of 2.3 years under an average daily dose of 37 mg S. 205 pairs of films were available for analysis. Vital information was obtained of all patients until closure of the data bank, half a year after the last study angiography. Five deaths occurred within the study period, 12 through March 15, 1995 (S: 1/6, P: 4/6). 37 patients (S: 18, P: 19) discontinued trial drug and protocol. Concomitant CAD medication was comparable in both groups, except lipid-lowering add-on medication which was significantly higher in the P group (38% versus 13%). Significant changes in lipid levels, on treatment, were observed in the S group amounting to a mean difference in LDL-C of -35%, in Apo-Protein B (ApoB) of -30%, in VLDL-C of -37%, and in triglycerides (TG) of -27%, and in HDL-C of +6%, in comparison to the control group; these differences were even greater in 137 fully compliant patients: -41, -36, -39, -31, and +7%, respectively. Progression in the S group was significantly less, as defined by the two primary target criteria: 1) the minimum obstruction diameter (MOD), determined by quantitative coronary angiography (QCA), decreased about five times less in comparison to the control group (S: by -0.017; P: -0.0954 mm), and 2) the standardized visual global change score (GCS) deteriorated almost three times less in the S group (by +0.20) than in the P group (+0.58). Of the secondary target criteria, the mean lumen diameter (QCA) also developed a significant difference (S: -0.20; P: +0.23 mm; p = 0.0006) with a trend toward regression in the S group. The QCA-%-stenosis deteriorated three- to four-times less in the S group as compared to the control group (S: by 0.69%; P: by 2.73%; p = 0.0022), and the number of patients with angiographic progression was nearly halved (S: 30%; P: 56%; p < 0.0000). These differences were determined by intention to treat analysis (ITT), and they were obtained in spite of lipid lowering add-on medication in 38% of the P patients; they turned out to be more pronounced in 137 fully compliant patients, in an analysis "as treated". The mean decrease in LDL-C serum level caused by S was significantly correlated to the decrease in progression, and multivariate regression analysis of both treatment groups identified LDL-C (or ApoB) and TG as independent predictors of progression. Progression appeared to be most pronounced in low and medium sized lesions, and the beneficial effect of lipid intervention dominated in lesions with 12-56% QCA stenosis severity. A small fraction of patients who suffered from exercise-induced angina, with ST-segment-depression at the beginning of the study, experienced a significant improvement under S as compared to P treatment. Although the study was not designed to show differences in clinical events, the combined number of all major cardiovascular events tended to be less frequent in the S than in the C gr

Anticholesteremic Agents↗
PubMed1998

[Ambulatory vs. inpatient rehabilitation after established myocardial infarct--contra ambulatory rehabilitation].

Outpatient cardiac rehabilitation, as compared to inpatient rehabilitation, has substantial disadvantages for several patient groups. These drawbacks may lead to insufficient results in long term secondary prevention and to inadequate quality of life in patients with chronic heart disease. As outpatients, they remain in life circumstances which were, at least in part, causative for their heart diseases. Especially in elderly patients, those with a complicated course of disease, those who find adjusting their life style to the chronic disease state a daunting task, and those who find coping with the fact of being chronically ill as surpassing their psychological skills will find only in an inpatient setting all the relevant support delivered by a team of experts complementing each other for the benefit of the patient. A flexible system for inpatient or/and subsequent outpatient cardiac rehabilitation should be adopted which can be tailored to the individual patient's needs. It remains to be seen whether outpatient cardiac rehabilitation will really lower costs in the long run. This can be expected at best for a small group of relatively young patients with reasonably good physical fitness and no major problems in coping behaviour. The majority of patients needing cardiac rehabilitation does not fall into this group.

Aftercare↗
PubMed1997

The effect of simvastatin on progression of coronary artery disease. The Multicenter coronary Intervention Study (CIS).

BACKGROUND: In several angiographic trials, HMG-CoA reductase inhibitors have shown a beneficial effect on the progression of coronary artery disease. Using 20 mg simvastatin, day-1, a treatment period of up to 4 years was necessary to show a significant reduction in coronary artery disease progression. The question remains however whether higher dosages of simvastatin would be more advantageous in respect to the magnitude of the effect and the required time interval to demonstrate treatment efficacy. METHODS AND RESULTS: In the Coronary Intervention Study (CIS), a multicentre randomized double-blind placebo-controlled study, the effects of lipid-lowering therapy with simvastatin on progression of coronary artery disease in 254 men with documented coronary artery disease and hypercholesterolaemia were investigated. Following a period of lipid-lowering diet, treatment with 40 mg simvastatin or placebo was maintained for an average of 2.3 years. Two primary angiographic endpoints were chosen: the global change score (visual evaluation according to the method of Blankenhorn) and the per patient mean change of minimum lumen diameter (evaluated by the CAAS I system). The mean simvastatin dose was 34.5 mg day-1. In the placebo group, the serum lipids remained unchanged; in comparison to the placebo group the simvastatin group showed a 35% LDL-cholesterol decrease. Coronary angiography was repeated in 205 patients (81%) and 203 film pairs (80%,) were evaluable by quantitative coronary angiography. In the simvastatin and placebo groups, the mean global change scores were +0.20 and +0.58 respectively, demonstrating a significantly slower progression of coronary artery disease in the treatment group (P = 0.02). The change in minimum lumen diameter assessed by computer-assisted quantitative evaluation with the CAAS I system was -0.02 mm in the simvastatin group and -0.10 mm in the placebo group (P = 0.002). In the simvastatin group, there was a significant correlation between the LDL cholesterol levels achieved therapeutically and the per patient mean loss of minimum lumen diameter (r = 0.29; P = 0.003). During the study period, there was no significant difference in the incidence of serious cardiac events (15 of 129 patients in the simvastatin group and 19 of 125 patients in the placebo group, ns). CONCLUSION: Treatment with 40 mg simvastatin day-1 reduces serum cholesterol and slows the progression of coronary artery disease significantly within a short period of treatment time. In the treatment group, retardation of progression is inversely correlated to the LDL-cholesterol levels achieved.

Adult↗
PubMed1996

[Comprehensive life style changes by coronary patients--an intervention study].

In an intervention trial 31 coronary patients participated in a comprehensive lifestyle change program and 43 control patients received the usual care of the conventional cardiac rehabilitation system. First preliminary findings show that the patients in the intervention group not only improved their health related lifestyle but also increased their exercise capacity and reduced depression, while there was no substantial improvement in the control group. Up to the present, the existing data indicate that German heart patients are able to make comprehensive lifestyle changes and that these changes have positive effects on biomedical and psychosocial variables.

Adult↗
PubMed1992

[Reliable Quick value management by self determination].

Because of the considerably increased risk of thrombembolic complications after implantation of mechanical heart valves, lifelong anticoagulation is required. In the face of frequently unsteady prothrombin-time (PT)-values, a stable anticoagulation is one of the most difficult tasks in attending patients with heart-valve-prosthesis. If PT is out of the therapeutic range, the risk of bleeding or of thrombembolism increases disproportionately. Two differently trained groups of phenprocoumon-treated patients monitored their PT themselves for 6 months by means of a coagulometer, and they also determined their weekly dose of phenprocoumon. PTs were therapeutic 80.5% resp. 93.8% of the time. Intensive training and care maximized safety of anticoagulation.

Coumarins↗
PubMed1978

[Coronary angiographic findings in 308 patients with the clinical diagnosis of intramural myocardial infarction (author's transl)].

308 patients with the clinical diagnosis of intramural myocardial infarction made elsewhere were re-investigated more than eight weeks after the acute event. ECGs and pulmonary "wedge" pressures were recorded at rest and during exercise and coronary angiography performed (Sones' or Judkin's technique). In the first group (1973/74) of 77 patients, 35 (45.5%) had a normal coronary angiogram, compared with 0.7% in a control group with transmural myocardial infarction. A normal coronary angiogram was found in 85% of the 40 patients who had no angina during exercise. In a second group (1974/77) of 231 patients, there was a steady decrease in the number of patients without angina pectoris during exercise, in parallel with a decrease in the number of those with normal coronary angiograms. This change in pattern was apparently due to improved diagnosis in the referring hospitals. Of the 37 patients (first group) with angina during exercise, all but one were subsequently found to have significant coronary arteriosclerosis. It is suggested that most patients with a normal coronary angiogram had sustained a myocarditis and (or) pericarditis which produced the symptoms and the altered ECGs, leading to the misinterpretation of "intramural myocardial infarction".

Adult↗
PubMed1978

Pharmacokinetic and clinical studies with carfecillin.

The pharmacokinetics of carfecillin (Carbenicillin-phenyl-ester) were studied in 10 healthy subjects, in 5 patients with hepatic cirrhosis and in 5 cases of renal insufficiency. In healthy subjects maximal carbenicillin serum levels attained by therapeutic doses were about 20 microgram/ml; concentrations in the urine surpassed 1000 mu/ml. The phenol moiety was detectable as free phenol in sera (less than 1 microgram/ml) and urine (less than 3 microgram/ml), but its major part was transformed to glucuronide and sulphate conjugates. Pharmacokinetics were not altered significantly by hepatic lesion. In renal insufficiency, serum levels of both carbenicillin and conjugated phenol were higher and their decrease delayed, while urine concentration was low. Carfecillin treatment was successful in 20 out of 30 patients with UTI.

Bacterial Infections↗
PubMed1976

[Experimental investigation of cardiac lymph vascular system (author's transl)].

Ligatures of the supracardiac lymph vessels and the cardiac lymph nodes have been performed in fifty mongrel dogs. Comparative electrocardiographical, light microscopical, scanning and transmission electron microscopical investigations were done one day to three months after surgery. The demonstrated findings confirmed former results concerning the topography and the microstructure of the cardiac lymph vascular drainage system. In addition, the comparative functional and morphological examinations made evident the pathogenetic importance of cardiac lymphostasis. Lymphostatic oedema has been discussed as a pathogenetic co-factor for human heart diseases. Therapeutic attempts on experimental cardiac lymphostasis with i.v. - application of Coumarin-Troxerutin were without effect.

Animals↗