70 research outputs found
FX MiniRAIL catheter usage for treatment of de novo complex coronary lesions: results from the "OFFAR"
No full textGradual prolonged balloon angioplasty may cause less arterial trauma, higher success rates, and fewer complications than conventional angioplasty (POBA). The OFFAR aimed to determine the safety and effectiveness of the FX MiniRAIL (FX) catheter, used with a slow, stepwise inflation protocol
Differential effect of Photofrin II on growth of human smooth muscle cells from nonatherosclerotic arteries and atheromatous plaques in vitro.
No full textThe effect of dihematoporphyrin-ester or -ether (DHE), a photosensitizing porphyrin with different amounts of aggregates, on the growth of cultured smooth muscle cells obtained from nonatherosclerotic arteries and from atheromatous plaques (primary stenosing and restenosing lesions) was examined without photoactivation of the drug. Clinically relevant DHE concentrations ranging from 0.1 to 25 micrograms/ml were used. In all proliferation studies with cells of second and third passage (approximately 10 cumulative population doublings in vitro), the growth rates decreased in a dose-dependent manner. Smooth muscle cells from atherosclerotic lesions were significantly more sensitive than smooth muscle cells from normal arteries. Cells derived from restenosing lesions retained their increased sensitivity even after eight passages in culture (approximately 20 cumulative population doublings). Cell size measurements showed that the decreased proliferative activity mainly occurred in smooth muscle cell subpopulations consisting of small cells. A cytotoxic effect of DHE was observed at concentrations above 5 micrograms/ml, causing cytoplasmic protrusions, vacuoles, and even complete cell lysis. At a DHE concentration of 5 micrograms/ml, the number of viable cells was 73% +/- 14% (means +/- SD) for smooth muscle cells from nonatherosclerotic arterial media and only 38% +/- 11% (means +/- SD) for smooth muscle cells from atherosclerotic plaques. In all experiments, no significant difference in response to DHE treatment was observed between cells from primary stenosing and restenosing lesions, suggesting a specific mechanism for plaque-derived cells causing an increased sensitivity in comparison to smooth muscle cells from nonatherosclerotic arteries. The pronounced sensitivity of plaque cells against DHE treatment suggests that this drug--even without photoactivation--is potentially valuable in vivo as a therapeutic approach to vascular stenoses.</jats:p
Effects of salinity on establishment of \u3ci\u3ePopulus fremontii\u3c/i\u3e (cottonwood) and \u3ci\u3eTamarix ramosissima\u3c/i\u3e (saltcedar) in southwestern United States
Get PDFThe exotic shrub Tamarix ramosissima (saltcedar) has replaced the native Populus fremontii (cottonwood) along many streams in southwestern United States. We used a controlled outdoor experiment to examine the influence of river salinity on germination and first year survival of P. fremontii var. wislizenii (Rio Grande cottonwood) and T. ramosissima on freshly deposited alluvial bars. We grew both species from seed in planters of sand subjected to a declining water table and solutions containing 0, 1, 3, and 5 times the concentrations of major ions in the Rio Grande at San Marcia, NM (1.2, 10.0, 25.7 and 37.4 meq 1-1; 0.11, 0.97, 2.37, and 3.45 dS m-1). Germination of P. fremontii declined by 35% with increasing salinity (P = .008). Germination of T. ramosissima was not affected. There were no significant effects of salinity on morality or above- and belowground growth of either species. In laboratory tests the same salinities had no effect on P. fremontii germination. P. fremontii germination is more sensitive to salinity outdoors than in covered petri dishes, probably because water scarcity resulting from eavaportion intensifies the low soil water potential associated with high salinity. River salinity appears to play only a minor role in determining relative numbers of P. fremontii and T. ramosissima seedlings on freshly deposited sandbars. However, over many years salt becomes concentrated on floodplains as a result of evaporation and salt extrusion from saltcedar leaves. T. ramosissima is known to be more tolerant of the resulting extreme salinities than P. fremontii. Therefore, increases in river salinities could indirectly contribute to decline of P. fremontii forests by exacerbating salt accumulation on floodplains
The prognostic utility of the SYNTAX score on 1-year outcomes after revascularization with zotarolimus- and everolimus-eluting stents: a substudy of the RESOLUTE All Comers Trial
No full textThis study assessed the ability of the SYNTAX score (SXscore) to stratify risk in patients treated with percutaneous coronary intervention (PCI) using zotarolimus-eluting or everolimus-eluting stents
Comparison of zotarolimus-eluting and everolimus-eluting coronary stents
Get PDFBACKGROUND: New-generation coronary stents that release zotarolimus or everolimus have been shown to reduce the risk of restenosis. However, it is unclear whether there are differences in efficacy and safety between the two types of stents on the basis of prospectively adjudicated end points endorsed by the Food and Drug Administration. METHODS: In this multicenter, noninferiority trial with minimal exclusion criteria, we randomly assigned 2292 patients to undergo treatment with coronary stents releasing either zotarolimus or everolimus. Twenty percent of patients were randomly selected for repeat angiography at 13 months. The primary end point was target-lesion failure, defined as a composite of death from cardiac causes, any myocardial infarction (not clearly attributable to a nontarget vessel), or clinically indicated target-lesion revascularization within 12 months. The secondary angiographic end point was the extent of in-stent stenosis at 13 months. RESULTS: At least one off-label criterion for stent placement was present in 66% of patients. The zotarolimus-eluting stent was noninferior to the everolimus-eluting stent with respect to the primary end point, which occurred in 8.2% and 8.3% of patients, respectively (P<0.001 for noninferiority). There were no significant between-group differences in the rate of death from cardiac causes, any myocardial infarction, or revascularization. The rate of stent thrombosis was 2.3% in the zotarolimus-stent group and 1.5% in the everolimus-stent group (P = 0.17). The zotarolimus-eluting stent was also noninferior regarding the degree (±SD) of in-stent stenosis (21.65±14.42% for zotarolimus vs. 19.76±14.64% for everolimus, P = 0.04 for noninferiority). In-stent late lumen loss was 0.27±0.43 mm in the zotarolimus-stent group versus 0.19±0.40 mm in the everolimusstent group (P = 0.08). There were no significant between-group differences in the rate of adverse events. CONCLUSIONS: At 13 months, the new-generation zotarolimus-eluting stent was found to be noninferior to the everolimus-eluting stent in a population of patients who had minimal exclusion criteria
Umgang mit ICD-Patienten an ihrem Lebensende: Einstellungen, Wissen und Verhalten von Ärzten und Patienten. Eine kritische Literaturanalyse.
No full textHintergrund. Der implantierte Kardioverter/Defibrillator (ICD) erlaubt einen wirksamen Schutz vor malignen Herzrhythmusstörungen. Dass am Lebensende das ICD-Gerät mit wiederholten Schockabgaben zu einem traumatisierenden Sterbeprozess führen kann, ist ein ethisches Dilemma. Wir untersuchten den empirischen Stand des Wissens und Handelns der Ärzte und die Bedürfnisse der betroffenen ICD-Patienten in dieser kritischen Lebensphase.Methode. Die Literaturrecherche zwischen 8/2010 und 3/2011 in PubMed mit Publikationen ab 1990 führte zu 32 Einzelarbeiten, von denen 25 als themenrelevant angesehen wurden.Ergebnisse. In praktisch keiner klinischen Einrichtung in Europa (96%) werden Fragen zum Umgang mit dem ICD am Lebensende routinemäßig dem ICD-Patienten angeboten. Nur bei rund 25% der sterbenden Patienten kommt es zu einer vom Arzt initiierten Aussprache, die in den meisten Fällen erst in den letzten Stunden vor dem Tod des Patienten stattfindet. Bei rund der Hälfte der Ärzte bestehen Unsicherheiten über die Legalität einer Gerätedeaktivierung. Ärzte haben oft unrealistische Vorstellungen über den Wissensstand der Patienten und sind über Einzelheiten der ICD-Schocktherapie unzureichend informiert. Nur sehr wenige Daten existieren über Patientenwünsche. Insgesamt scheinen ICD-Patienten einer Diskussion über dieses Thema reserviert gegenüber zu stehen und mehrheitlich den Wunsch zu haben, eine Entscheidung dem Arzt zu überlassen.Schlussfolgerung. Trotz mangelhafter empirischer Basis sprechen die vorhandenen Daten für eine geringe Bereitschaft der ICD-Patienten, sich mit Fragen des Lebensendes auseinander zu setzen und für ausgeprägte Wissenslücken der Ärzte, die als Barrieren für ein angemessenes Verhalten verantwortlich sind
Coronary dissection and total coronary occlusion associated with percutaneous transluminal coronary angioplasty: significance of initial angiographic morphology of coronary stenoses.
No full textCoronary dissection and total coronary occlusion leading to emergency coronary surgery are the most frequent complications of percutaneous transluminal coronary angioplasty (PTCA) and their occurrence usually is unpredictable. To identify angiographic characteristics of coronary stenoses that may affect the incidence of these complications, the diagnostic pre-PTCA coronary angiograms of 38 consecutive patients (group I) undergoing emergency coronary surgery for dissection or occlusion were reviewed and compared with the angiograms of a random sample of 38 patients (stratified for left anterior descending and right coronary arteries) from a group of 1151 who did not need emergency coronary surgery (group II). Stenosis morphology before angioplasty was considered "complicated" if at least one of the following criteria was present: irregular borders, intraluminal lucency, and localization of stenosis in curve or at bifurcation. Baseline characteristics, maximum inflation pressures, types of balloon catheters used, and routinely registered angiographic stenosis properties (severity, length, eccentricity, and calcification) were similar in both groups. Irregular borders before PTCA were present in 22 of 38 patients in group I vs 10 of 38 in group II (p less than .05), intraluminal lucency in 22 of 38 vs nine of 38 (p less than .05), localization in curve in 27 of 38 pts vs 16 of 38 (p less than .05), and localization at bifurcation in 11 of 38 vs 15 of 38 (NS). Complicated angiographic morphology of coronary stenosis may represent a risk factor for dissection or occlusion. Therefore, although the predictive value of these findings is low, detailed evaluation of angiographic morphology of coronary stenoses may improve patient selection and reduce complication rates of PTCA.</jats:p
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