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Biomedical subjects

R Rienks

Publications and source records attributed to R Rienks.

10 recordsLinked to original sources
PubMed1996

Abnormal postprandial apolipoprotein B-48 and triglyceride responses in normolipidemic women with greater than 70% stenotic coronary artery disease: a case-control study.

Because remnants of triglyceride-rich lipoproteins (TRLP) are potentially atherogenic, the postprandial lipoprotein metabolism was studied in 12 normocholesterolemic, normotriglyceridemic women, aged 60 +/- 2 years, with angiographically proven coronary artery disease (CAD+; cholesterol 5.7 +/- 0.1 (S.E.) mmol/l, triglyceride 1.35 +/- 0.10 mmol/l) and in 12 individually matched controls, aged 59 +/- 2 years, without angiographical abnormalities (CAD-; cholesterol 5.1 +/- 0.2 mmol/l and triglyceride 1.16 +/- 0.13 mmol/l). Following an oral retinyl palmitate-fat load, the CAD+ women showed a significantly higher triglyceride response in the chylomicron, or Sf > 1000, fraction (P < 0.05 vs. controls). Total plasma apolipoprotein (apo) B and retinyl palmitate concentrations were similar in both groups. Fasting apo B-48 levels in the d < 1.006 g/ml fraction were significantly higher in CAD+ cases (0.25 +/- 0.03 integrated optical density (iod) units) than CAD- controls (0.15 +/- 0.03; P < 0.05). Furthermore, after the fat load, a greater absolute and incremental apo B-48 response in the intermediate density lipoprotein (IDL) fraction (d = 1.006-1.019 g/ml) was observed in CAD+ cases (incremental area under the curve (Delta-AUC)8: 0.40 +/- 0.12 h.iod) than CAD- controls (0.01 +/- 0.06 h.iod; P = 0.01). Post-heparin hepatic lipase (HL) activities were higher in the CAD+ group: 422 +/- 22 mU/l vs 288 +/- 20 mU/ml in the CAD- group (P < 0.001) while lipoprotein lipase (LPL) activities were identical. The results provide evidence that the metabolism of intestinal TRLP is significantly different in normolipidemic women with angiographically proven CAD compared with individually matched controls without coronary disease. Fasting apo B-48 levels in d< 1.006 g/ml fractions represent a potentially useful marker in women at risk for CAD.

Analysis of Variance↗
PubMed1995

The significance of coumarin anticoagulation in laser assisted percutaneous transluminal angioplasty of femoropopliteal arterial obstructions.

The optimal regime of drugs to prevent thrombocyte aggregation leading to reocclusion after percutaneous transluminal angioplasty (PTA) of peripheral vessels is not established. Both antiplatelet and antithrombotic drugs are prescribed. Prospective observations of two different anticoagulation regimes were made during an ongoing multicenter study of laser-assisted PTA (PTLA) of the femoropopliteal artery. Group I (129 patients) received coumarin at least during the first month, Group II (n = 71) did not get oral anticoagulation. Seventy-eight patients (61%) in Group I and 29 patients (47%) in Group II received platelet inhibitors. Groups I and II did not differ in baseline characteristics and PTLA complications (20.9 vs. 18.2%). Ankle brachial indices at 1, 3, 6 and 12 months were similar in both groups. This observational study does not provide evidence for superiority of oral anticoagulation in the management of patients undergoing PTLA of the femoropopliteal tract.

Administration, Oral↗
PubMed1992

[Eve's risk].

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Adult↗
PubMed1992

Nd:YAG laser-assisted angioplasty in femoropopliteal artery occlusions: "hot" versus "cold" recanalization with transparent contact probe.

Percutaneous recanalization of femoropopliteal artery occlusions (1-21 cm; median, 8 cm) was attempted in 50 patients. A 2.2-mm-diameter contact probe catheter connected to a continuous-wave neodymium yttrium aluminum garnet (Nd:YAG) laser was used. The laser was activated (15 W, 1-second pulses) only if too much resistance was met. Balloon angioplasty was performed after successful traversal of the occlusion. Primary success was achieved in 40 of 50 patients (80%). In 20 cases, recanalization was achieved mechanically (cold group). In the other 20 cases, recanalization was achieved with the help of laser irradiation (hot group: 15-405 J; median, 90 J). Except for the length of the obstruction (longer in the cold group), the two groups did not differ in baseline characteristics. Neither the length of the occlusion nor the duration of symptoms correlated with failure or success or with the delivered laser energy. Cold and hot groups did not differ with regard to functional improvement and angiographic patency at 3 and 12 months (94% +/- 4). Thus, brief laser activation doubled the cold primary success rate, but the major action of the laser contact probe is mechanical remodeling of the obstruction.

Adult↗
PubMed1991

Percutaneous coronary and peripheral angioscopy with saline solution and carbon dioxide gas in porcine and canine arteries.

To obtain a clear view with angioscopy, blood must be displaced. Carbon dioxide (CO2) gas has proved to be a safe intraarterial contrast agent, and it may have advantages over saline solution as an infusion medium for angioscopy. This study compared the use of CO2 gas and saline solution in the femoral artery, in the presence and absence of a proximal occlusion, in nine pigs and six dogs. The applicability of CO2 gas in the coronary arteries was also evaluated. In total 185 angioscopy procedures were evaluated. With proximal occlusion, angioscopy with CO2 gas was successful in all 28 peripheral procedures, whereas with saline solution only 65% of the procedures resulted in a clear view (p less than 0.005). Without proximal occlusion, angioscopy was successful with CO2 gas and saline solution in 61% and 3% of procedures, respectively (p less than 0.0001). Cardiovascular parameters and blood gases showed minor changes after administration of CO2 gas. During coronary angioscopy with CO2 gas, mechanical heart failure occurred in all instances, which was lethal in 12 animals. None of the animals died as a result of saline angioscopy. In conclusion, CO2 gas is a safe medium for angioscopy in the peripheral arteries and in general offers a better view than saline solution. In contrast to saline solution, without proximal balloon occlusion CO2 gas provided a clear view in 61% of the peripheral procedures. In the coronary arteries, however, CO2 angioscopy was generally fatal in both animal models.

Animals↗
PubMed1990

Loss of blood platelet adhesion after heating native and cultured human subendothelium to 100 degrees Celcius.

STUDY OBJECTIVE: Balloon angioplasty produces mechanical vessel wall injury that leads to substantial blood platelet deposition at the angioplasty site. The aim of the study was to determine whether thermal angioplasty might, by contrast, reduce platelet adhesion by denaturation of subendothelial adhesive proteins. DESIGN: Native and cultured human subendothelium was briefly heated to greater than or equal to 100 degrees C by laser irradiation or to 50-100 degrees C by immersion in preheated phosphate buffered saline (PBS). Subsequently, the subendothelium was exposed for 5 min to flowing human blood at a shear rate of 1300 s-1. Blood platelet adhesion to the subendothelium was determined quantitatively. EXPERIMENTAL MATERIAL: Human umbilical arteries were used and the subendothelial matrix derived from cultured umbilical vein endothelial cells. MEASUREMENTS AND RESULTS: After heating arterial subendothelium by laser irradiation to greater than or equal to 100 degrees C, zero platelet adhesion was found v 36(SD 2)% adhesion to the non-heated surface (p less than 0.001). After laser heating of the subendothelial matrix to greater than or equal to 100 degrees C, platelet adhesion was absent in 10/10 experiments (p less than 0.01). After heating the matrix to 100 degrees C by immersion in PBS, platelet adhesion was reduced to 5(5)% v 31(7)% at 37 degrees C (p less than 0.001). CONCLUSIONS: These in vitro results, if extrapolated to catheter interventions, suggest that thermal injury to the vessel wall by laser angioplasty or other thermal angioplasty methods may provide a basic and clinically relevant advantage over mechanical angioplasty modalities, because of a potentially reduced risk of complications related to platelet adhesion.

Angioplasty, Balloon, Coronary↗
PubMed1989

Laser ablation and the need for intra-arterial imaging.

In 48 patients with severe claudication due to a total obstruction of the femoropopliteal artery, percutaneous recanalization was attempted with a 2.2 mm diameter rounded sapphire contact probe in conjunction with a continuous wave Nd:YAG laser. In eight patients the contact probe laser catheter took a subintimal course that could not be redressed. Laser recanalization needs high-resolution diagnostic information on the complex anatomy of the obstruction. Intra-arterial ultrasound imaging may provide the necessary information to evaluate, monitor or guide novel angioplasty techniques. The design of an ultrasound catheter which combines high-resolution diagnostic imaging with steerability, flexibility and controlled ablation is now the major engineering challenge in interventional cardiology.

Angioplasty, Balloon↗
PubMed1988

Nd-YAG laser energy distribution in an artificial obstruction: influence of lasing parameters in a model of laser angioplasty.

A Nd-YAG laser (1064 nm) coupled to a silica fiber (0.6 mm core diameter) was used to create defects in a model of arterial vascular obstruction. We employed transparent agar doped with black ink as atheromatous material and studied the size and shape of defects created by various lasing parameter settings. By adding calcium sulphate to the agar its scattering properties were enhanced. The created defects correspond to a temperature boundary. The optical properties of the agar greatly influenced the size and shape of the created defects. In the agar with enhanced scattering properties, the created defects showed an unfavourable penetration width-depth ratio. Maximum width of penetration always exceeded the fiber diameter. This may contribute to an increased risk of vessel wall perforation in small vessels and, if the fiber is positioned close to the vessel wall, even when a coaxial position is maintained. With increasing cumulative energy, both maximum depth and width of penetration leveled off in both agars. The results suggest that agar can be used to obtain empirically the lasing parameters that will minimize the risk of vessel wall perforation by an axially positioned fiber. The agar model needs further study to determine its limitations, but agar seems to be a useful substitute for atheroma in the study of laser catheter angioplasty.

Agar↗