Wertigkeit der EKG-Telefon-Telemetrie in der Erfassung symptomatischer Herzrhythmus-Störungen

Summary The ECG-telephone-transmission (TTM) was used to record an ECG-strip during a typical symptomatic period in patients complaining of symptoms possibly caused by arrhythmias (palpitations, dizziness, paroxysm tachycardia, pulse irregularities; angina and dyspnea only if other reasons could be excluded). Patients complaining of syncope only were not admitted, because of the inability to make a telephon call successfully during such a symptomatic period. The ECG was transmitted to the CCU using a frequency modulation technique. In 60% of 196 patients an ECG-TTM could be achieved during a typical symptomatic period, whereas arrhythmias as cause for the symptoms could be excluded in 51 patients (26%). The remaining 66 patients (34%) demonstrated various arrhythmias ranging from simple SVPB and PVC to total AV-block and sustained VT.TTM, an easy-to-perform and cost-effective method allowed a successful ECG registration during a symptomatic period in almost two-thirds of symptomatic patients. In these patients arrhythmias could be verified or excluded as cause of the symptoms.

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Abkürzungsverzeichnis TTM EKG-Telefon-Telemetrie - HF Herzfrequenz - SA-Block sinu-aurikulärer Block - AV-Block atrio-ventrikulärer Block - SVES supraventrikuläre Extrasystole(n) - VES ventrikuläre Extrasysteole(n) - KHK koronare Herzkrankheit - VH-Flimmern Vorhof-Flimmern - parox. paroxysmal - C.C.I.T.T. Internationale Post-Organisation - Ö.P.T. Österreichische Post- u. Telegraphen-Verwaltung - LZ-EKG Langzeit-EKG     

Die Bolusinjektion von anisoyliertem Plasminogen-Streptokinase-Aktivator-Komplex (BRL 26921) als alternatives Konzept der systemischen Lyse bei akutem Myokardinfarkt

Summary The thrombolytic properties of anisoylated plasminogen streptokinase activator complex (BRL 26921) and clinical results of the treatment were studied in 10 consecutive patients with acute myocardial infarction. Exclusion criteria were general contraindications against thrombolytic therapy and a time interval of more than 4 h between the onset of symptoms and admission to the hospital. All patients received a 250-mg bolus of prednisolone prior to intravenous injection of 30 mg BRL 26921 within 2 min. A continuous infusion of heparin at a dose of 1,000 USPU/h was started 2 h after the injection. Blood pressure was monitored via an arterial line. Arrhythmias and changes in the ST segments were documented by conventional ECG recording and computerbased ECG monitoring. Coronary arteriography and left ventriculography were carried out within 72 h. Besides routine laboratory tests, serial CK and CK-MB activity measurements were carried out. We determined the following hemostaseological parameters before and 15 min, 30 min, 1 h, 4 h, and 12 h after application of BRL 26921: prothrombin time, activated partial thrombosplastin time, thrombin time, thrombin coagulase time, fibrinogen, streptokinaseplasminogen activator activity, plasminogen and alpha-2-antiplasmin.Our results (reperfusion in all patients angiographically and in 7 to 8 of 10 patients from noninvasive criteria) show that BRL 26921 is a highly effective thrombolytic agent in patients with myocardial infarction, when compared with highdose systemic fibrinolysis. Applied in dosages required for early reperfusion, it does not appear to be selectively thrombolytic and is not free of hypotensive effects in man. The decrease of fibrinolytic activity is biphasic with a half-disappearance time of 112 min.

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Abkürzungsverzeichnis A Akinesie - aPTT aktivierte partielle Thromboplastinzeit - T.C. Thrombinkoagulasezeit - F.A. Fibrinolytische Aktivität - Fib. Fibrinogen - AV atrioventrikulär - CK Creatinkinase - CX R. Circumflexus - DA Diagonalast - EF Ejektionsfraktion - H Hypokinesie - HWI Hinterwandinfarkt - INT Intermediärast - LCA linke Kranzarterie - LVEDP linksventrikulärer enddiastolischer Druck - m Mittelwert - M männlich - PLA Posterolateralast - RCA rechte Kranzarterie - RIVA R. interventricularis anterior - RIVP R. interventricularis posterior - s Standardabweichung - Sta Stamm - TZ Thrombinzeit - VWI Vorderwand-infarkt - W weiblich     

Therapie der terminalen Herzinsuffizienz durch Herztransplantation

Summary Heart transplantation (HTx) has now become an accepted treatment modality for end-stage heart disease. The limited supply of suitable donor organs imposes constraints upon the decision of who should be selected for transplantation. Usually patients are candidates for HTx, who remain NYHA functional class III or IV despite maximal medical therapy. Further criteria are low left ventricular ejection fraction (<20%) with heart rhythm disturbances class IIIA-V (LOWN), which are associated with poor prognosis. Additionally, the suffering of the patient and also the course of heart failure are essential for judging the urgency of HTx. Contraindications are absolute in patients with untreated infections, fixed pulmonary vascular resistance (PVR) above 8 WOOD-degrees, severe irreversible kidney and liver disease, active ventricular or duodenal ulcers and acute, psychiatric illness. HTx is relatively contraindicated in patients with diabetes mellitus, age over 60 years, PVR above 6 WOOD-degrees and an unstable psychosocial situation. To prevent rejection of the transplant heart, livelong immunosuppressive therapy is needed. Most immunosuppressive regimes consist of Cyclosporine A and Azathioprin (double drug therapy) or in combination (tripple drug therapy) with Prednisolone. For monitoring of this therapy, control of hole blood cyclosporine A level and white blood count is needed. Rejection episodes can be suspected if there is a greater than 20 mmHg decrease of systolic blood pressure, elevated body temperature, malaize, tachycardia or heart rhythm disturbance. The diagnosis of cardiac rejection can be established by endomyocardial biopsy. Measurement of the voltage of either the surface or intramyocardial ECG, echocardiography with special consideration to early left ventricular filling time as well as immunological methods are additionally used tools. Graft sclerosis as the main risk factor of the late transplant period remains an unsolved problem.

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Abbkürzungen HTx Herztransplantation - PVR pulmonal vasculärer Widerstand - ATG Antithymocytenglobulin - ALG Antilymphocytenglobulin - IDDM insulinabhängiger Diabetes mellitus - ECG EKG     

Enhancement of low-quality fetal electrocardiogram based on time-sequenced adaptive filtering

Extraction of a clean fetal electrocardiogram (ECG) from non-invasive abdominal recordings is one of the biggest challenges in fetal monitoring. An ECG allows for the interpretation of the electrical heart activity beyond the heart rate and heart rate variability. However, the low signal quality of the fetal ECG hinders the morphological analysis of its waveform in clinical practice. The time-sequenced adaptive filter has been proposed for performing optimal time-varying filtering of non-stationary signals having a recurring statistical character. In our study, the time-sequenced adaptive filter is applied to enhance the quality of multichannel fetal ECG after the maternal ECG is removed. To improve the performance of the filter in cases of low signal-to-noise ratio (SNR), we enhance the ECG reference signals by averaging consecutive ECG complexes. The performance of the proposed augmented time-sequenced adaptive filter is evaluated in both synthetic and real data from PhysioNet. This evaluation shows that the suggested algorithm clearly outperforms other ECG enhancement methods, in terms of uncovering the ECG waveform, even in cases with very low SNR. With the presented method, quality of the fetal ECG morphology can be enhanced to the extent that the ECG might be fit for use in clinical diagnostics.

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Graphical abstract The extracted fetal ECG signals from non-invasive abdominal recordings still contain a substantial amount of noise. The time-sequenced adaptive filter provides a relatively accurate estimate of the underlying fetal ECG signal when the quality of the reference channels is enhanced prior to filtering.

     

Seltene Sepsisursache bei chronischem Dialysepatienten: Maltafieber (Febris undulans melitensis)

Summary A 45-years-old Greek patient developed septicaemia in his 10th year of hemodialysis treatment. Clinical investigation was directed first on bacterial infection of the arteriovenous shunt, on urosepsis or bronchopulmonary infection. Then, serologically (Widal's reaction and ELISA-test) and in different blood-cultures Brucella melitensis was detected as causative agent for Malta fever (Febris undulans). The focus of infection is suspected in unpasteurized sheep-milk cheese of mediterranean origine, wherein Brucella species can survive for months. The patient was treated effectively by a combination of amoxycilline and clavulanic acid.

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Abkürzungen GOT Glutamat-Oxalat-Transpeptidase - GPT Glutamat-Pyruvat-Transpeptidase - gamma-GT -Glutamyl-Transpeptidase - ELISA enzyme-linked immunosorbent assay     

Angiofollikuläre lymphatische Hyperplasie mit Plasmozytom und Polyneuropathie: Ein Fallbericht mit immunhistochemischer Untersuchung

Summary A rare case of a 43-year-old man with polyneuropathy, monoclonal gammopathy, myeloma and Castleman's disease of plasma cell type was diagnosed. Immunohistological examination of the lymph node with Castleman's disease showed polyclonal binding while the myeloma was monoclonal containing IgA with -light chains. At the immunoelectrophoresis IgA/IgA paraprotein was demonstrated. The possible pathogenetical relationship between polyneuropathy and plasmacytoma as well as Castleman's disease will be discussed.

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Abkürzungsverzeichnis AFLH Angiofollikuläre lymphatische Hyperplasie - AFP Alpha-Foetoprotein - CEA Carcinoembryonaler Antigen - HIV Human immunodeficiency virus - PEP polyneuropathy, edema, plasmacelldyscrasia - POEMS polyneuropathy, organomegaly, endocrinopathy, M-protein, skin lesions     

Identification of Sleep Apnea Severity Based on Deep Learning from a Short-term Normal ECG

BackgroundThis paper proposes a novel method for automatically identifying sleep apnea (SA) severity based on deep learning from a short-term normal electrocardiography (ECG) signal.MethodsA convolutional neural network (CNN) was used as an identification model and implemented using a one-dimensional convolutional, pooling, and fully connected layer. An optimal architecture is incorporated into the CNN model for the precise identification of SA severity. A total of 144 subjects were studied. The nocturnal single-lead ECG signal was collected, and the short-term normal ECG was extracted from them. The short-term normal ECG was segmented for a duration of 30 seconds and divided into two datasets for training and evaluation. The training set consists of 82,952 segments (66,360 training set, 16,592 validation set) from 117 subjects, while the test set has 20,738 segments from 27 subjects.ResultsF1-score of 98.0% was obtained from the test set. Mild and moderate SA can be identified with an accuracy of 99.0%.ConclusionThe results showed the possibility of automatically identifying SA severity based on a short-term normal ECG signal.     

Computerized two-lead resting ECG analysis for the detection of coronary artery stenosis after coronary revascularization

Background: Resting electrocardiogram (ECG) shows limited sensitivity and specificity for the detection of coronary artery disease (CAD), where patients with a history of coronary revascularization may pose special challenges. Several methods exist to enhance sensitivity and specificity of resting ECG for diagnosis of CAD, but such methods are not better than a specialist''s judgement. We compared a new computer-enhanced, resting ECG analysis device, 3DMP, to coronary angiography to evaluate the device''s accuracy in detecting hemodynamically relevant CAD.Methods: A convenience sample of 172 patients with a history of coronary revascularization scheduled for coronary angiography was evaluated with 3DMP before coronary angiography. 3DMP''s sensitivity and specificity in detecting hemodynamically relevant coronary stenosis as diagnosed with coronary angiography were calculated as well as odds ratios for the 3DMP severity score and coronary artery disease risk factors.Results: The 3DMP system accurately identified 50 of 55 patients as having hemodynamically relevant stenosis (sensitivity 90.9%, specificity 88.0%). Positive and negative predictive values for the identification of coronary stenosis as diagnosed in coronary angiograms were 62.7% and 97.8% respectively. Risk and demographic factors in a logistic regression model had a markedly lower predictive power for the presence of coronary stenosis in these patients than did 3DMP severity score (odds ratio 2.04 [0.74-5.62] vs. 73.57 [25.10-215.68]). A logistic regression combining severity score with risk and demographic factors did not add significantly to the prediction quality (odds ratio 80.00 [27.03-236.79]).Conclusions: 3DMP''s computer-based, mathematically derived analysis of resting two-lead ECG data provides detection of hemodynamically relevant CAD in patients with a history of coronary revascularization with high sensitivity and specificity that appears to be at least as good as those reported for other resting and/or stress ECG methods currently used in clinical practice.     

Addition of N-terminal Pro-B-type Natriuretic Peptide Levels to Electrocardiography Criteria for Detection of Left Ventricular Hypertrophy: The ARIRANG Study

The utility of electrocardiography (ECG) in screening for left ventricular hypertrophy (LVH) in general populations is limited mainly because its low sensitivity. B-type natriuretic peptide (BNP) is released due to the remodeling processes of LVH and could improve the diagnostic accuracy for the ECG criteria for LVH. We hypothesized that addition of BNP levels to ECG criteria could aid LVH detection compared with ECG alone in a general population. We enrolled consecutive 343 subjects from a community-based cohort. LVH was defined as LV mass index > 95 g/m² for females and > 115 g/m² for males according to echocardiography. The area under the receiver operator characteristic (ROC) curve to detect LVH was 0.55 (95% confidence interval [CI], 0.50-0.61) in Sokolow-Lyon criteria and 0.53 (0.47-0.59) in the Cornell voltage criteria. After addition of N-terminal-proBNP levels to the model, the corresponding areas under the ROC were 0.63 (0.58-0.69) and 0.64 (0.59-0.69), respectively. P values for the comparison in areas under the ROC for models with and without N-terminal-proBNP levels were < 0.001. These data suggest that addition of N-terminal-proBNP levels to ECG criteria could significantly improve the diagnostic accuracy of LVH in general populations.

Graphical Abstract

相似文献   

HLA und Schilddrüsencarcinom

Summary HLA typing was performed in 51 patients to analyse the pathogenetic background of differentiated and medullary thyroid carcinomas. A higher incidence of Bw62 and DR5 was observed in patients with papillary carcinoma (n=24), DRw6 antigen in follicular carcinoma (n=13), and DR3 antigen in patients with medullary carcinoma (n=11). The DR3 antigen was present in one of two patients with a familial history of medullary thyroid carcinoma. Therefore, HLA typing is not suitable as a screening method for the detection of early thyroid carcinoma.

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Abkürzungen FC follikuläres Schilddrüsencarcinom - HLA human leucocyte antigens - MC medulläres (C-Zell) Carcinom - PC papilläres Schilddrüsencarcinom In Auszügen vorgetragen auf dem 15. Acta Endocrinologica-Kongreß, 5.–9. August 1985, Helsinki     

Regression zerebraler Posttransplantationslymphome unter Cyclosporin-A-Reduktion

Summary 4.5 months after successfull kidney transplantation a Non-Hodgkin-lymphoma with polymorph centroblastic appearance of the tonsillar gland developed in a 21 years old male patient during immunosuppressive therapy with cyclosporine A and prednisone parallel to infection with Epstein Barr virus. Focal epileptic seizures occurred and were due to cerebral posttransplantation lymphomas as proven by brain biopsy. Reduction of immunosuppressive therapy led to complete remission as shown by CCT and MRI.

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Abkürzungsverzeichnis ALG Antilymphozytenglobulin - CsA Cyclosporin A - ZNS Zentrales Nervensystem - HSV Herpes simplex virus - IIF Indirekte Immunfluoreszenz - EEG Elektroenzephalogramm - NMR Kernspintomographie - KM-CCT Schädel-Computertomogramm mit Kontrastmittelgabe - EBV Epstein Barr Virus     

Die Spektralanalyse des EKG zur Erkennung von Spätpotentialen als Marker für die Gefährdung durch bedrohliche Rhythmusstörungen des Herzens

Summary Late potentials in the terminal phase of the QRS and early S-T segment are looked upon as a risk marker in patients prone to sustained ventricular tachycardia after myocardial infarction. Since the amplitude of late potentials at the body surface is very low (1–5 V), most studies use signal averaging of the ECG to increase the signal-to-noise ratio. Two different approaches are generally used to analyze the signal-averaged ECG. In the time domain, the individual channels are combined into a vector magnitude and highpass filtered in a bidirectional mode. Late potentials are suspected if the filtered QRS duration is >120 ms and/or the amplitude in the terminal 40 ms of the QRS complex is 25 V. The limitations of this method are that the definition of abnormality differs from one study group to another, highpass filters may introduce artificial signals, patients with bundle branch block in general have to be excluded, and the definitions depend upon the noise level.More recently, spectral analysis of the ECG with Fast Fourier Transform (FFT) has been performed. Late potentials are characterized by a higher frequency content in the otherwise low-frequent S-T wave. We analyzed 25 overlapping segments of the terminal QRS and early S-T wave time shifted in steps of 2 ms with FFT (spectrotemporal mapping). This method was shown to overcome some of the limitations of conventional time domain analysis: no highpass filters have to be applied, noise interference can be detected by a characteristic spectral pattern, and patients with bundle branch block need not be excluded. In this retrospective study spectrotemporal mapping was abnormal in 26/38 patients (67%) after myocardial infarction with sustained ventricular tachycardia.Only 3/21 patients after myocardial infarction without ventricular tachycardia had abnormal values. In healthy persons an abnormal Fourier result is a rare finding.Thus, spectral analysis of the ECG might offer promise for an improved identification of patients prone to sustained ventricular tachycardia after myocardial infarction.

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Abkürzungsverzeichnis FFT schnelle Fourier Transformation - RMS Amplitude mittlere Amplitude in den terminalen 40 ms des QRS Komplexes in V Herrn Professor Dr. F. Scheler zum 65. Geburtstag gewidmet.     

Plasma-Katecholamin-Verlauf bei Alkylphosphat-Intoxikationen und deren Therapie

Summary In connection with the endogenous acetylcholine-poisoning due to organophosphorous compounds beside the clinical important muscarinic and nicotinic symptoms an activation of the sympathetic nervous system (adrenal medulla, sympathetic ganglia) is expected. Therefore a kinetic profile of norepinephrine and epinephrine in the plasma of two patients with severe parathionpoisonings was taken up through the whole period of the intensive-medical treatment. The method used was HPLC with electrochemical detection. The parathion-concentration of the same plasma samples were measured, too. The result were individual different courses with periodically appearing, markedly increased plasma catecholamine values. A direct correlation of catecholamines with the parathion-concentration was not recognizable. A possible influence of the atropine-treatment as well as of stress-factors is discussed but estimated as not responsible for the observed peaks.

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Abkürzungsverzeichnis Amp. Ampulle - ChE Cholinesterase - HPLC High pressure liquid chromatography (Hochdruckflüssig-Chromatographie) - Li Lithium - m-Rezeptoren muskarinische Rezeptoren - n-Rezeptoren nikotinische Rezeptoren - ® eingetragenes Warenzeichen - ZVD Zentraler Venendruck     

Progressive multifokale Leukoenzephalopathie bei Wegener'scher Granulomatose unter Therapie mit Cyclosporin A

Summary A female patient with Wegener's granulomatosis developed severe bone marrow depression after two years treatment with cyclophosphamide. Corticosteroids alone could not sufficiently suppress disease activity, therefore additive therapy with Cyclosporin A was started. Four weeks later the patient developed a central nervous system disorder with affective disturbances and progressive somnolence. However, inspite of intensive diagnostic procedures, no definite diagnosis could be established. After another two months she died. Post-mortem-examination showed progressive multifocal leukoencephalopathy. An association between immunosuppressive therapy and reactivation of JC-Virus is suggested.

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Abkürzungsverzeichnis PML Progressive multifokale Leukoenzephalopathie - WG Wegener'sche Granulomatose - CyA Cyclosporin A - (C)CT (Craniale)Computertomographie - NMR Nuclear Magnetic Resonance (Kernspintomographic) - ZNS Zentralnervensystem - AIDS Acquired Immuno-deficiency Syndrome     

Bedeutung klinischer und laborchemischer Parameter für Verlauf und Prognose der Non-Hodgkin-Lymphome

Summary Using a regression model, the prognostic significance of clinical and biochemical parameters as well as of histology was analyzed in a group of 336 patients with Non-Hodgkin's lymphoma. A stochastic process model was used for evaluation of the course of disease. With respect to overall survival, serum-LDH-activity, performance status, and the histologically defined grade of malignancy were found to be the most important prognostic parameters, as well as age, though that to a lesser extent. In the course of disease, stage was the most relevant factor for achievement of a complete remission. In patients without remission, survival was determined mainly by histology and serum-LDH-activity; the latter was also of importance for duration of remission. Our study shows that histology is not the only prognostic factor in NHL but that other parameters, mainly serum-LDH-activity and performance status, also have to be considered in comparing different groups of patients.

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Abkürzungen AP alkalische Phosphatase - BSG Blutkörperchensenkungsgeschwindigkeit - GOT Glutamat-Oxalazetat-Transaminase - LDH Lactatdehydrogenase - NHL Non-Hodgkin-Lymphom Herrn Prof. Dr. H.D. Waller zum 60. Geburtstag gewidmet     

Neopterin im Serum und Urin zur Differentialdiagnose von Nierenfunktionsstörungen nach Nierentransplantation

Summary In a period of 10 months neopterin in serum and urine was determined by radioimmunoassay in 33 renal allograft recipients treated with cyclosporin A. While in allograft rejections the highest neopterin concentrations were found in the serum, patients with viral infections after renal transplantation showed the most elevated concentrations in the urine. For early diagnosis of allograft rejection the ratio of neopterin clearance and serum-neopterin was the most significant criterion of the parameters measured in this study. Patients without complications during the follow-up showed slightly elevated and stable neopterin levels in serum and urine. The presented results indicate that neopterin is a useful parameter for the follow-up after renal allograft transplantation and for the diagnosis of immunological complications.

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Abkürzungen CyA Cyclosporin A - Kr-Cl Kreatinin-Clearance - NPT-Cl Neopterin-Clearance - sKr Kreatinin im Serum - sNPT Neopterin im Serum - uNPT Neopterin im Urin     

Pseudohypoparathyreoidismus und Nebennierenrindeninsuffizienz

Summary Since his childhood a now 31-year-old male showed typical symptoms of parathyroid hormone deficiency with hypocalcemia and hyperphosphatemia.We found a target organ resistance to parathyroid hormone and diagnosed pseudohypoparathyroidism. In addition adrenal insufficiency with hypocortisolism was seen. Both hormone systems act by stimulating adenylate cyclase. A defective receptor-adenylate cyclase complex may cause this — for the first time described — combination of endocrine insufficiency.

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de|Abkürzungen AHO Albright's Hereditary Osteodystrophy - PHP Pseudohypoparathyreoidismus - hPTH humanes Parathormon - cAMP cyclisches Adenosinmonophosphat - GTP Guanosintriphosphat - ACTH Adrenocorticotropes Hormon - LH-RH Luteinisierendes Hormon — Releasing-Hormon - TRH Thyreotropin-Releasing-Hormon - CRH Corticotropin-Releasing-Hormon     

Neutralisierung von niedermolekularem Heparin Kabi 2165 mit Protaminchlorid

Summary Low molecular weight (LMW) heparin Kabi 2165 possesses improved pharmacodynamic properties compared with conventional heparin. It is currently investigated in the prophylaxis of thromboembolism. The neutralization of Kabi 2165 by protamine chloride was analysed after i.v. injection of both the agent and the antidot in healthy persons. The anticoagulant effects of the LMW heparin on the activated partial thromboplastin time, thrombin, and thromboelastography are completely and immediately suppressed by protamine chloride. The inhibition of factor X a is antagonized up to 50%–60%. The bleeding time remained unaffected. The data indicate that protamine chloride may be used in clinical situations as an antidot to the LMW heparin Kabi 2165. A rebound phenomenon of the anticoagulant effect does not occur.

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Abkürzungen aPTT aktivierte partielle Thromboplastinzeit - MW Molecular weight - R-Zeit Reaktionszeit - TEG Thrombelastogramm     

Erfolgreiche Behandlung einer Thrombose der Arteria mesenterica superior durch lokale,hochdosierte Urokinasetherapie

Summary A 56 year old man presented with increasing abdominal pain. He suffered from arterial occlusive disease with occlusion of the right A. iliaca communis. Angiography revealed partial thrombotic occlusion of the superior mesenteric artery.Urokinase (UK) at a dose of 150 IU/kg × minutes and heparin (1,000 U/h) was infused through the 7F angiographic catheter for 180 minutes. After 70 min of treatment, angiography showed improvement, and after 120 min the thrombus was nearly completely lysed. A stenosis of approximately 50% was still present after 180 min. Two hours after treatment the patient was pain free without analgesics. laboratory studies showed systemic fibrinogenolysis, but fibrinogen was still within the upper normal range. Only slight systemic fibrinolytic activity (<5 IU UK/ml) could be determined. However, ₂-antiplasmin was depleted. The catheter was drawn 15 h after thrombolysis without bleeding. While under concurrent heparin and phenprocoumon therapy, the patient developed an infected gluteal hematoma as a result of i.m. injections prior to this treatment. A repeat angiography approximately one month after thrombolysis revealed further improvement and patency. The patient is well and free of abdominal angina and under oral anticoagulant therapy.

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Abbreviations A Arteria - AMS Arteria mesenterica superior - UK Urokinase - TIA Transitorische ischämische Attacke - aPTT Aktivierte partielle Thromboplastinzeit - TZ Thrombinzeit - RZ Reptilasezeit - ₂-APL ₂-Antiplasmin - PLG Plasminogen - RID Radiale Immundiffusion - IU International Unit - E Einheiten - U Units - h Stunden - HQ Hepatoquick