Biomedical subjects
S Zbinden
Publications and source records attributed to S Zbinden.
Influence of diabetes mellitus on coronary collateral flow: an answer to an old controversy.
OBJECTIVES: To determine the influence of diabetes mellitus on coronary collateral flow by accurate means of collateral flow measurement in a large population with variable degrees of coronary artery disease. METHODS: 200 patients (mean (SD) age 64 (9) years; 100 diabetic and 100 non-diabetic) were enrolled in the study. Coronary collateral flow was assessed in 174 stenotic and in 26 angiographically normal vessels with a pressure guidewire (n = 131), Doppler guidewire (n = 36), or both (n = 33) to calculate pressure or flow velocity derived collateral flow index (CFI). Diabetic patients were perfectly matched with a non-diabetic control group for clinical, haemodynamic, and angiographic parameters. RESULTS: CFI did not differ between the diabetic and the non-diabetic patients (0.21 (0.12) v 0.19 (0.13), not significant). Likewise, CFI did not differ when only angiographically normal vessels (0.20 (0.09) v 0.15 (0.08), not significant) or chronic total coronary occlusions (0.30 (0.14) v 0.30 (0.17), not significant) were compared. Fewer patients in the diabetic group tended to have angina pectoris during the one minute vessel occlusion (60 diabetic v 69 non-diabetic patients, p = 0.15). CONCLUSION: Quantitatively measured coronary CFI did not differ between diabetic and non-diabetic patients with stable coronary artery disease.
Effect of statin treatment on coronary collateral flow in patients with coronary artery disease.
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Direct demonstration of coronary collateral growth by physical endurance exercise in a healthy marathon runner.
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[Phytotherapy in cardiovascular medicine].
There is widespread use of herbal medicine in patients suffering from cardiovascular diseases. The discussion about the benefit of these drugs is still controversial because of lack of scientific evidence. Ginkgo biloba, Crataegus and Garlic are often recommended substances for patients with cardiovascular diseases. For these substances there is a lot of data available from experimental and clinical studies, unfortunately not always adhering to the criteria of evidence based medicine. Extracts from ginkgo biloba contain several active constituents, mainly flavonoids and terpens, which have antioxidative properties and an inhibitory effect on platelet aggregation by inhibiting platelet activation factor PAF. Ginkgo is mainly used in vascular dementia and peripheral vascular disease. Garlic shows a modest lipid-lowering effect in the same range as a low-cholesterol diet. Effect on blood pressure seems to be at best minor. Crataegus is often used in patients with heart failure because of its positive inotropic effect. Additionally, crataegus acts as an antiarrhythmic substance by prolonging refractory period of the action potential.
Endothelin-1 induces vasodilation in human skin by nociceptor fibres and release of nitric oxide.
AIMS: Endothelin is a peptide produced by endothelial cells with many biological properties. In the human skin microcirculation endothelin induces neurogenic vasodilation associated with burning pruritus. We investigated the mechanisms involved in this response. METHODS: The effects of prolonged pretreatment with capsaicin, a specific inhibitor of polimodal nociceptor fibres, and of the nitric oxide synthase inhibitor L-NMMA on endothelin-1-induced vasodilation were studied in 15 human subjects. Furthermore, we investigated the effects of the ET(A)-selective antagonist PD147953 on bradykinin-induced vasodilation. RESULTS: After local injection, endothelin-1 caused vasoconstriction at the injection site and a profound vasodilation in the surrounding area (flare reaction, P<0.01). This response was specific and not induced by saline, albumin, acetylcholine or an ET-antagonist. Prolonged capsaicin pretreatment inhibited endothelin-1 induced vasodilation in the area surrounding the injection site, but not the central vasoconstriction at the injection site. Bradykinin also induced a marked vasodilation in the area surrounding the injection site; this was not inhibited by an ETA-selective antagonist, while the flare reaction was. L-NMMA applied at the site of the flare reaction prevented endothelin-1-induced vasodilation. CONCLUSIONS: Endothelin-1 in the human skin microcirculation stimulates polimodal nociceptor fibres leading to the release of nitric oxide. This response may play a pathophysiological role in inflammatory processes in the human skin.
Fibreoptic bronchoscopy and double-lumen endobronchial tubes.
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Severe intraoperative anaphylaxis to surgical gloves: latex allergy, an unfamiliar condition.
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Detection of oesophageal intubation: the cola complication.
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[The Tube-Stat: a useful aid in difficult intubation].
A patient (ASA class I) scheduled for an elective gynecological operation, could not be intubated by conventional means, as no part of the glottis could be seen on direct laryngoscopy. Endotracheal intubation was successful on the first attempt using a lighted intubation stylet (Tube-Stat, Concept Corporation, Clearwater, Florida, USA). Transillumination of the neck tissues acted as a guide for correct placement of the endotracheal tube. Postoperatively, the patient complained of hoarseness and sore throat that cleared up completely within 5 days. Cases of difficult-intubation are often impossible to recognize preoperatively [3]. When problems arise, a difficult-intubation drill should be instituted without delay. The view obtained at laryngoscopy in our patient corresponded to a Grade III case according to the classification of Cormack and Lehane [3]. Our usual routine in such cases calls for blind intubation using a flexible introducer passed posteriorly to the epiglottis or blind nasal intubation. Recent reports testify to the potential dangers of blind procedures [4, 19, 23]. Light-wand-guided intubation has been reported to be an easily learned, atraumatic alternative to laryngoscopic or blind nasal intubation [6, 9]. We employed the Tube-Stat light-wand in a series of routine surgical cases with encouraging results. Our case report documents our first patient intubated with the light-wand after failure of conventional larnygoscopy. The first lighted stylet was described some 30 years ago, and the method of transillumination as an aid in difficult intubation developed over the following years.(ABSTRACT TRUNCATED AT 250 WORDS)
The lightwand as an atraumatic alternative to blind stylet intubation.
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[International Red Cross Committee's mission in Uganda. Refugee within one's own country].
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