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Biomedical subjects

M Elsner

Publications and source records attributed to M Elsner.

27 records · Page 2Linked to original sources
PubMed1998

[Methods for coronary functional assessment].

Functional evaluation of coronary vasomotion encompasses the assessment of dynamic changes in coronary lumen, vessel wall, blood flow, intracoronary pressure and myocardial perfusion in response to specific pharmacologic stimuli. These parameters are obtained to characterize mechanisms of physiologic regulation and to evaluate pathophysiologic processes and potential therapeutic strategies, especially with regard to the development of coronary atherosclerosis. To this end, a variety of direct (invasive) and indirect (non-invasive) diagnostic tools are employed. Among the invasive methods are registration of intracoronary Doppler flow, coronary pressure measurements, quantitative coronary angiography and intravascular ultrasound. The non-invasive modalities consist of coronary Doppler echocardiography, positron emission tomography, myocardial scintigraphy and magnetic resonance imaging. Because of the different technical and physiological principles involved, these methods are complementary by providing independent access to different aspects. The combined invasive functional testing as employed in the cardiac catheterization laboratory allows for a simultaneous synopsis of high-resolution coronary imaging and direct measurement of physiologic parameters during local application of defined pharmacologically active substances. However, the demands in terms of equipment, time and operator skills are high and limit this combined invasive approach to specialized centers. Besides these research purposes, a number of functional methods has entered the clinical arena. They are employed to evaluate the hemodynamic significance of coronary lesions and to assess functional outcome of therapeutic interventions in the catheterization laboratory. The underlying principles and applications of the different methods are described and an overview of selected results is presented.

Blood Pressure↗
PubMed1997

Platelet glycoprotein IIIa polymorphisms and risk of coronary stent thrombosis.

BACKGROUND: Coronary stents are an effective treatment for selected coronary stenoses. However, thrombosis of the stented segment is a major adverse complication. Platelet aggregation has a key role in stent thrombosis. We investigated whether a polymorphism of platelet glycoprotein IIIa gene (PIA2) is associated with an increased risk of coronary stent thrombosis. METHODS: 318 consecutive patients were followed up for 30 days after coronary stent insertion. The primary endpoints were death, myocardial infarction, stent-vessel occlusion, and coronary artery bypass surgery. Gel electrophoresis of PCR products was used to identify the PIA1 and PIA2 alleles. The relative risk of stent occlusion was calculated from the odds ratio on logistic regression analysis. FINDINGS: 63 (19.8%) of patients had the PIA2 allele and 255 (80.2%) were homozygous for PIA1. Baseline clinical, angiographic, and procedural features did not differ between the groups with and without the PIA2 allele. Occlusion of the stent vessel occurred in five (1.9%) patients homozygous for PIA1 and six (9.5%) patients with PIA2 allele (odds ratio 5.26 [95% CI 1.55-17.85]). On multivariate regression analysis PIA1/A2 genotype was the only significant independent predictor of stent thrombosis. INTERPRETATION: Patients with the pIA2 allele have an increased risk of coronary stent thrombosis, which may warrant antiplatelet therapy with glycoprotein-IIb/IIIa inhibitors, although bleeding complications may also increase.

Alleles↗
PubMed1996

Intracoronary loss of balloon-mounted stents: successful retrieval with a 2 mm-"Microsnare"-device.

Intracoronary loss of balloon-mounted stents prior to deployment is a rare event but may result in clinically relevant cardiac ischemia or peripheral embolization during rescue attempts. In a consecutive series of nearly 400 patients undergoing elective stenting, we encountered six instances of intracoronary misplacement. We describe four cases of successful percutaneous retrieval using a 2 mm closed loop nitinol device ("Microsnare"). Our proposed method of extraction seems to hold advantages over those previously described.

Aged↗
PubMed1995

[The perforation of a right-coronary sinus of Valsalva aneurysm into the right atrium].

HISTORY AND CLINICAL FINDINGS: A 58-year-old man [correction of woman] without previous cardiac symptoms developed exertional dyspnoea and peripheral oedema which markedly increased within a two-week period. Auscultation revealed a 4/6-5/6 holosystolic and diastolic machinery murmur. EXAMINATIONS: Transthoracic and multiplane transoesophageal echocardiography established the diagnosis of a 3 cm aneurysm of the right coronary sinus of Valsalva with clearly demarcated rupture into the right atrium, with a large left to right shunt shown on colour-Doppler echocardiography. These findings were confirmed on cardiac catheterisation. There was no sign of coronary heart disease. TREATMENT AND COURSE: At open-heart surgery the aneurysm was resected, the defect closed with an autologous pericardial patch and the tricuspid valve reconstructed. On follow-up examination the result remained excellent and the patient was free of symptoms. CONCLUSION: In ruptured aneurysm of the coronary sinus of Valsalva, multiplane transoesophageal echocardiography provides exact diagnosis and optimal planning of the operative procedure.

Aortic Rupture↗
PubMed1995

[Cardioversion in atrial fibrillation. Results and complications in 1,152 prospective patients. Study Group of the Working Society of Leading Cardiologic Hospital Physicians].

BACKGROUND: Pharmacological and direct-current cardioversion of atrial fibrillation are often performed interventions. Little is known about results and complications of cardioversion in daily practise. PATIENTS AND METHODS: Demographic, procedural and outcome data from patients with cardioversion of atrial fibrillation were collected in a prospective, multicenter registry of 61 hospitals. RESULTS: Between July 1994 and December 1994 1152 patients with a mean age of 64 +/- 11 years were registered on an intention-to-treat basis. 62% were male. The most prevalent underlying disorders were coronary artery disease (34.7%), valvular heart disease (18.1%), and cardiomyopathy (6.9%). 16.4% of patients had lone atrial fibrillation. New onset atrial fibrillation was reported in 21%, paroxysmal in 32% and chronic in 47% of patients. The mean duration of atrial fibrillation was 7 +/- 26 weeks (range 1 day to 7 years, median 5 days). In 3.8% of patients no cardioversion attempt was made and follow-up was not possible in another 5.5%. 19.2% of patients cardioverted spontaneously. Direct current cardioversion was attempted in 39.7% and pharmacological cardioversion in 31.8% of patients. Cardioversion was successful (sinus rhythm at discharge) in 96.4% of spontaneous cardioversion, in 73.1% of direct current cardioversion and in 84.4% of pharmacological cardioversion. Success of cardioversion was significantly related to duration of atrial fibrillation, NYHA functional class and left atrial diameter (p < 0.001). In 55 (4.8%) cases complications were reported of which 14 were fatal. Five cases of sudden death occurred, all of which were related to quinidine therapy for pharmacological cardioversion. Five cases of embolism were reported. Two were not associated with cardioversion attempts and 3 occurred within 24 hours after successful direct current cardioversion. Two of these patients were effectively anticoagulated at the time of cardioversion. A total of only 62% of patients with atrial fibrillation of more than 48 hours duration were anticoagulated for cardioversion with coumadine or i.v. heparin. CONCLUSIONS: The main risks of cardioversion are fatal proarrhythmic events in pharmacological attempts to restore sinus rhythm. The risk of embolism is despite low rates of effective anticoagulation low.

Aged↗
PubMed1994

[Detection of the intermediate trophoblast as evidence of intrauterine pregnancy].

With spontaneous abortion the conceptus is often expelled and lost right at the beginning, and uterine curettings then contain only endometrial fragments and clotted blood. Even complete embedding of all available material for histologic examination will not reveal any chorionic villi, and ectopic pregnancy can thus not be excluded. In such cases, the intermediate trophoblast can sometimes still be demonstrated within the endometrial tissue. This highly invasive trophoblast is difficult to identify using conventional staining, but cytokeratin antibodies are reliable markers of this cell type. Using immunohistochemistry, these fetal components could be demonstrated in 27 of 95 specimens (28.5%), proving the intrauterine nature of the aborted pregnancy. In some cases the fetal derivation of intermediate trophoblast was demonstrated by using in situ hybridisation to mark repetitive sequences on the Y-chromosome in the interphase nucleus.

Abortion, Spontaneous↗
PubMed1993

Effects of indomethacin on muscarinic inhibition of endogenous noradrenaline release from rat isolated trachea.

The release of endogenous noradrenaline from rat isolated tracheae was evoked by electrical field stimulation (3 Hz, 540 pulses) in the presence of yohimbine, desipramine and tyrosine. The muscarine receptor agonist oxotremorine concentration-dependently inhibited the evoked release of noradrenaline by 95% at 1 mumol/l, EC50 values in two series of experiments 41 and 57 nmol/l, respectively. The effect of oxotremorine was antagonized by the non-selective muscarine receptor antagonist scopolamine (10-1000 nmol/l) in a manner suggesting a simple competitive interaction (slope of Schild plot -0.94; pA2 value 8.88). However, the M2 selective muscarine receptor antagonist methoctramine (0.1-10 mumol/l) affected the action of oxotremorine in a manner suggesting a complex interaction (slope of Schild plot -0.47). Addition of indomethacin (3 mumol/l) caused an increase of the evoked release of noradrenaline by 45% and low concentrations of oxotremorine (0.01 and 0.1 mumol/l, but not 1 mumol/l) became less effective resulting in a slight shift to the right of the concentration response curve (EC50 169 nmol/l). Moreover, in the presence of indomethacin methoctramine (0.1-10 mumol/l) antagonized the effects of oxotremorine in a manner suggesting a simple competitive interaction (slope of Schild plot -0.93, pA2 value 7.61). In the presence of indomethacin, the concentration response curve of oxotremorine was only slightly shifted to the right in the presence of the M1 receptor selective antagonist pirenzepine (1 mumol/l, -log KB 6.1) and not significantly affected by the M3 receptor selective antagonist p-fluoro-hexahydrosiladifenidol (1 mumol/l). In conclusion, the release of noradrenaline in the rat trachea is inhibited via presynaptic muscarine heteroreceptors of the M2 subtype.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1991

Characterization of endogenous noradrenaline release from intact and epithelium-denuded rat isolated trachea.

1. Overflow of endogenous noradrenaline (NA) from the in vitro incubated rat trachea evoked by two periods of electrical field stimulation (S1, S2 at 3 or 15 Hz) or by high potassium (60 mM) was determined by high performance liquid chromatography (h.p.l.c.) with electrochemical detection. 2. In the presence of the neuronal uptake inhibitor desipramine, the alpha 2-adrenoceptor antagonist, yohimbine, enhanced the overflow of NA evoked by stimulation at 3 Hz by about 100% suggesting the presence of presynaptic inhibitory autoreceptors on the sympathetic nerves innervating the trachea. 3. When desipramine and yohimbine were present throughout the experiments, the overflow of NA evoked by the second period of electrical stimulation (S2) was significantly smaller than that evoked by the first (S1). This decline of overflow was prevented when the NA precursor, tyrosine, was additionally present throughout the experiments. 4. After removal of the epithelium, the tissue content of NA was reduced by about 30%, suggesting that part of the NA may be present and released within the epithelium. However, the overflow of NA evoked by stimulation at 3 Hz or 15 Hz was reduced by 70-80%, indicating that the epithelium may additionally exert a permissive role on the release of NA within the airways, possibly by suppressing inhibitory factors. 5. Stimulation by high potassium (60 mM for 10 min) caused a large overflow of NA (about 45% of the tissue NA), both from epithelium-free and epithelium-denuded tracheae. Thus the 'endogenous inhibition' of NA release after removal of the epithelium is surmountable when a high potassium stimulus is applied.

Animals↗