Biomedical subjects
Publications and source records attributed to W Knopf.
Femoral closure devices help early ambulation after cardiac catheterization without incurring additional risk to the patients. This report summarizes the safety and efficacy data of the 6Fr Angio-Seal device.
BACKGROUND: Percutaneous transmyocardial laser revascularisation (PTMR) is a proposed catheter-based therapy for refractory angina pectoris when bypass surgery or angioplasty is not possible. We undertook a randomised trial to assess the safety and efficacy of this technique. METHODS: 221 patients with reversible ischaemia of Canadian Cardiovascular Society angina class III (61%) or IV (39%) and incomplete response to other therapies were recruited from 13 centres. Patients were randomly assigned PTMR with a holmium:YAG laser plus continued medical treatment (n=110) or continued medical treatment only (n=111). The primary endpoint was the exercise tolerance at 12 months. Analyses were by intention to treat. FINDINGS: 11 patients died and 19 withdrew; 92 PTMR-group and 99 medical-treatment-group patients completed the study. Exercise tolerance at 12 months had increased by a median of 89.0 s (IQR -15 to 183) with PTMR compared with 12.5 s (-67 to 125) with medical treatment only (p=0.008). On masked assessment, angina class was II or lower in 34.1% of PTMR patients compared with 13.0% of those medically treated. All indices of the Seattle angina questionnaire improved more with PTMR than with medical care only. By 12 months there had been eight deaths in the PTMR group and three in the medical treatment group, with similar survival in the two groups. INTERPRETATION: PTMR was associated with increased exercise tolerance time, low morbidity, lower angina scores assessed by masked reviewers, and improved quality of life. Although there is controversy about the mechanism of action, and the contribution of the placebo effect cannot be quantified, this unmasked study suggests that this palliative procedure provides some clinical benefits in the defined population of patients.
OBJECTIVES: This study sought to describe the economic outcomes from a prospective multicenter registry of primary coronary angioplasty. BACKGROUND: Interest in coronary angioplasty without preceding thrombolytic therapy as a primary reperfusion strategy has increased as a result of three recent randomized trials showing outcomes equivalent to or better than standard thrombolytic therapy. METHODS: The Primary Angioplasty Registry enrolled 270 patients with acute myocardial infarction at six private tertiary care medical centers. Baseline and follow-up medical costs and counts of resources consumed were collected from enrollment to the 6-month follow-up visit. Correlates and predictors of cost were identified with multivariable linear regression modeling. RESULTS: Ninety-five percent of patients had a revascularization procedure during the baseline hospital period: 85% had coronary angioplasty only; 4% had coronary bypass surgery only; 6% had both procedures. The total mean baseline hospital cost (not charge) was $13,113, with mean physician fees of $5,694. During the follow-up period, repeat coronary angiography was performed in 21% of patients, whereas 13% had repeat angioplasty and 3% bypass surgery. Mean hospital follow-up costs were $3,174, with mean physician fees of $1,443. Independent correlates of higher baseline hospital costs included older age (p = 0.049), anterior infarction (p = 0.03), initial Killip class (p < 0.0001), more severe coronary disease (p = 0.0015), need for bypass surgery alone or in addition to angioplasty (p < 0.0001) and recurrent ischemia (p < 0.0001). CONCLUSIONS: Costs of primary angioplasty for patients with acute myocardial infarction eligible for thrombolysis were strongly influenced by infarction- and procedure-related complications but only modestly influenced by patient selection factors.
During a 14-month period, 6 experienced centers prospectively enrolled 271 patients into a registry in which percutaneous transluminal coronary angioplasty was the primary treatment for acute myocardial infarction. Patients age > 18 years who presented with ST-segment elevation on the 12-lead electrocardiogram were enrolled if symptom duration was < 12 hours and there was no proclivity for bleeding. An independent core angiographic laboratory processed the angiographic data. Of 271 patients giving informed consent, 245 (90%) were deemed anatomically suitable and underwent angioplasty therapy. Upon leaving the catheterization laboratory 98% of patients had achieved reperfusion; 92% had a residual visual stenosis < or = 50%. Emergency bypass surgery was required in 14 patients (5%) for either failed angioplasty (n = 3) or presumed life-threatening anatomy (n = 11). The in-hospital mortality rate was 4%, whereas the reinfarction rate was 3% and the stroke rate was 1%, with 1 intracranial hemorrhage and 2 embolic events. Bleeding requiring > or = 2 units of blood occurred in 46 patients (18%); 14 of these transfusions were related to coronary artery bypass surgery. Primary angioplasty is associated with a high reperfusion rate, low in-hospital mortality and few recurrent myocardial ischemic events. These results point to the need for a large-scale trial comparing angioplasty with thrombolytic therapy in the setting of acute myocardial infarction.
BACKGROUND: After direct angioplasty in the setting of acute myocardial infarction, patients were followed clinically and angiographically for 6 months at six experienced centers to evaluate outcomes. METHODS AND RESULTS: Of 258 patients with 6-month follow-up after surviving initial hospitalization, 5 (2%) died, 8 (3%) had nonfatal infarctions, 56 (22%) had chest pain, of whom 25 (10%) required hospitalization, and 42 (16%) patients needed repeat angioplasty. Of 203 eligible patients, 154 (76%) had angiographic follow-up. The infarct-related artery remained patent (defined as TIMI 2 or 3 flow) in 87%, while 13% developed reocclusion (TIMI 0 or 1 flow) by 6 months after discharge. Patients with reocclusion were more likely to have adverse events, including 35% with clinically evident reinfarction and 59% requiring repeat angioplasty. The median ejection fraction improvement from acute to follow-up study was 6%, with no improvement in patients with a reoccluded infarct-related artery and an 8% improvement in patients with a patent infarct-related artery. CONCLUSIONS: The positive clinical outcomes recorded immediately after direct angioplasty persisted through 6 months of follow-up. Although the incidence of clinical end points was equivalent to or lower than thrombolytic therapy trials, restenosis is a substantial problem. These findings provide evidence beyond the initial hospitalization that direct angioplasty is a reasonable choice for the treatment of acute myocardial infarction.
In a period of 13 years 978 cases of severe head injuries were operated on in our clinic. An analysis of the medical reports includes injuries of the superficial dural sinus (39 cases = 4%): among these injuries of the anterior and central part of the superior sagittal sinus (66 per cent), injuries of the transverse sinus (18 per cent), injuries of the posterior part of the superior sagittal sinus (8 per cent), and combined injuries of different dural sinuses (8 per cent). Clinical data, i.e. the causes of accident, radiological examination results, intracranial lesions, operation techniques and outcome are analysed and discussed. The analysis of cases with dural sinus injuries shows a high mortality rate (total mortality rate: 16 patients = 41%; intra-operative mortality rate: 8 patients = 20%).
Within the scope of catamnestic investigation and a follow-up examination 170 fractures of the cervical spinal cord, operated in a period of 8 years, were explored. Dependent on the neurological starting point the length of stay in hospital, the time of temporary disablement and the results of social rehabilitation were evaluated. The examination results are appraised.
918 patients were operated because a severe head injury in our Neurotraumatological Clinic during a period of 12 years. 733 patients (80 per cent) could been evaluated as well with regard to the Glasgow Coma Scale and the Glasgow Outcome Scale as analysed in four diagnose groups corresponding to the period of live. Patients with epidural haematoma and open head injuries showed a better forecast than patients with acute subdural haematoma. Those with contusion of the brain and less than 8 points in the Glasgow Coma Scale or those in a higher age had a bad prognosis.
The author reports about 183 patients with frontobasal injuries. 50 per cent of them were operated immediately because open injuries or intracranial complications. The other half was operated in an interval of 5 to 10 days after injury. The localisation of the frontobasal lesion, clinical results according to the Glasgow Coma Scale and Glasgow Outcome Scale as well as the operation methods are demonstrated and discussed. The operative closure of the dura failure with an unipedicled periosteal flaps ensures good results in the most cases.
Simultaneous computer tomographic and cerebrospinal fluid dynamics examinations in patients with high-pressure hydrocephalus, normal pressure hydrocephalus and cerebral atrophic processes are presented and discussed. Exclusive CT and MR examinations do not allow a differentiation of patients with normal pressure hydrocephalus and patients with cerebral atrophy. In the simultaneous examinations the morphological substrate during the intrathecal infusion test is represented.
Indications for and results of the intrathecal infusion test including 50 patients with chronic disturbances of the circulation of the cerebrospinal fluid are presented and discussed. The computer-aided infusion test permits in 93 per cent a reliable differentiation between patients with a normal-pressure hydrocephalus and those with cerebro-atrophic processes. Functional checking of the valve systems is a further indication for the intrathecal infusion test. In patients with a classical pressure hydrocephalus or subdural hygromas, however, we do not see an indication for this invasive examination procedure.
A survey on 34 cases of odontoid process fractures treated by means of axial osteosynthesis since 1981. In cases of acute fractures rate of bony consolidation was 100%, in cases of pseudoarthrosis 50%. 6 complications until the first 20 weeks were successfully treated. No later complications. Removal of implanted material is usually not necessary. Operative treatment of non union by means of bony grafting, axial osteosynthesis and atlanto-axial arthrodesis seems to be helpful. Investigations for the best implantation model must be continued.
The article presents the results of examination of 170 patients with a cervical spine injury, who had been operated by ventral interbody fusion. It presents operative procedures and discusses the results concerning to neurological deficit before treatment. Cloward-Crock's and Bailey-Badgley's technique together with anterior plate fixation yields immediate stabilization and provides the best functional outcome.
Report on examination of 31 patients with fractures of spine in thoracolumbar region. All patients were treated by external fixation without accomplishing a plastic of spongiosa. The permanent SI-Index after operation is coming to 0.85. The outcome by use of external fixation is attesting our opinion, that with this method a plastic of spongiosa isn't necessary.
We have attend operatively exstirpated tissue of intervertebral disks to solution with 250.000 I. E. and 500.000 I.E. aprotinin. After preparation and colouring of the tissue we examinate by microscope. We couldn't find out neither a macroscopic nor microscopic evident effect of chemonucleolysis of aprotinin. Our opinion is, that an application of aprotinin to reduction of intradiscal pressure or to chemonucleolysis isn't effectively.
A survey on 31 injuries of thoracolumbar spine, 27 were accompanied with neurological deficiency. Treatment was exclusively by means of percutan attached f.e. until bony consolidation. An average treatment time of 152 days took place. Mean rate of correction was about 0.24 (Beck's SI-Index). The former applied frame construction was substituted by self developed spindle fixateur system, adapted to the requirements of traumatology of the spine in emergency situations.
One hour after intravenous doses of 50 mg/d fluconazole for 6 days or 100 mg/d for seven days to healthy subjects, the cerebrospinal fluid concentrations of fluconazole were 1.26 mg/L and 2.74 mg/L, respectively. These values were approximately 52% and 62% those of serum. Four patients with an initial clinical diagnosis of meningitis also had significant concentrations of fluconazole in the cerebrospinal fluid.
In the presence of Spondylosis hyperostotica an isolated spondylophytary ventral ossification leads to the stiffening of the vertebral column with a considerable loss of elasticity. Patients with a rarely occurring participation of the cervical vertebral column are particularly endangered by traumata. Even a trivial trauma may lead to the fracture or a spinal canal diameter in the lower normal range lead to neurological symptoms. The degree of the instability and the neurological symptoms determine the therapeutical approach. The strategy of the treatment is discussed on the basis of the example of six patients from two neurosurgical clinics.