Comparison of Arterial and Venous Blood Flow Between Patients with Pressure Dressing or a New Hemostatic Puncture Closure Device After Cardiac Catheterization

The aim of the study was to compare arterial and venous flow volume in the punctured leg in patients given a conventional pressure dressing and those given a new hemostatic puncture closure device (Angio-Seal) after cardiac catheterization. We prospectively measured blood flow in 25 patients with pressure dressing (group A) and 25 patients with Angio-Seal (group B) after cardiac catheterization. Duplex sonographic measurements were performed at the superficial femoral artery and vein of the punctured leg. In group A measurements were performed before catheterization, during pressure dressing, and after removal of pressure dressing. In group B we performed the measurements before catheterization and after closure of the puncture site with Angio-Seal. Mean arterial and venous blood flow of the superficial femoral artery and vein were calculated. Statistical evaluation was performed using the one-sample Wilcoxon test. In group A there was a significant reduction of blood flow volume in both the femoral artery, from a mean of 119 mL/min before puncture to 78 mL/min with pressure dressing, and the femoral vein, from 114 mL/min before puncture to 82 mL/min with pressure dressing (P < 0.0001). After removal of pressure dressing the blood flow rose to 119 mL/min in the femoral artery and 116 mL/min in the femoral vein. In group B there was no change in flow volume before and after catheterization (femoral artery: 117 vs 118 mL/min, femoral vein 119 vs 120 mL/min, P = ns). We conclude that the use of pressure dressing after cardiac catheterization caused a significant reduction in arterial and venous blood flow (about 30%) during immobilization. The new Angio-Seal closure device did not affect arterial or venous flow.     

The New ACS Multilink Coronary Stent: Single Center Experience in 103 Consecutive Patients With and Without Oral Anticoagulation

Since the introduction of this stent, anticoagulant regimens have changed from an aggressive protocol (aspirin, heparin, and warfarin) to a simplifed regimen (aspirin and ticlopidine). In this study our experience with this stent is reviewed, and acute and chronic outcomes with the two anticoagulant protocols are compared. All patients undergoing ACS Multilink stent implantation between July 1993 and June 1996 were included. The clinical and angiographic characteristics were documented and outcomes recorded. The two anticoagulant groups were compared: 103 patients (94 males, age range 41–80 years, mean 59) received 124 stents: 68% had Canadian Cardiac Society (CCS) grade III or IV angina prior to the procedure; and 73% underwent bail-out stenting. High pressure inflations (> 14 a) were used in 40% of cases. Eighty-four (85%) received aspirin and ticlopidine only. The initial success rate was 99%. Two patients underwent emergency surgery. There were no deaths and no cases of subacute stent thrombosis. Clinical follow-up is available on 66 patients (mean 190 days). Of these, 56 patients (54%) are in CCS grade 0 or 1. One patient has required surgical revascularization. There is one case of documented restenosis within the stented segment .     

MUCOLIPIDOSIS II (I-CELL DISEASE) A Clinical and Biochemical Study

The diagnosis of mucolipidosis I1 (I-cell disease) was made in a patient with a Hurler like appearance but only borderline muco-polysacchariduria. The cultured fibroblasts of high doses of prednison, which resulted in a further increase in the enzyme activity. On the ultrastructural level there was the storage of polymorphous material in the liver and in the peripheral nerve. Vacuolated cells were present in the peripheral leucocytes and in the bone marrow. These findings indicate that the lysosmal enzyme depletion in the cells in the patient could be similar to that found in cultured cells. However, the clinical picture could also be caused by the excess activity of lysosomal enzymes in the extracellular fluids which are able to degrade the matrix substance of the connective tissues and could mimic a mucopolysaccharidosis.     

Effects of bile and bile acids on cultured human fibroblasts

Impaired healing induced by leakage of bile has been postulated as one factor responsible for complications after reconstructive bile duct surgery. The cytotoxicity of human bile and its major bile acids on cultured human fibroblasts was therefore studied by evaluation of their effects on cell morphology and growth, on synthesis and secretion of 35SO4-mucopolysaccharides and on release of a lysosomal enzyme. Normal human fibroblasts derived from a standard culture strain (MRC-5) were grown to confluence and exposed to: (1) sterile human T-tube bile, (2) a mixture of bile acids resembling that of human bile, or (3) various concentrations of the glycine- and taurine conjugates of cholic, chenodeoxycholic or deoxycholic acid. Medium containing whole bile (total bile acid concentration 0.25, 0.75 or 1.6 mmol/l) exerted time and dose dependent cytotoxic effects on morphology and growth and release of lysosomal enzyme. Synthesis and secretion of 35SO4-mucopolysaccharides were markedly inhibited. The bile acid mixture exhibited the same time and dose dependent effects. The conjugates of deoxycholic acid were found to be the most toxic of the individual bile acids studied.     

Coagulation of Ventricular Myocardium Using Radiofrequency Alternating Current: Bio-Physical Aspects and Experimental Findings

Within the last years, a variety of different energy sources has been investigated to test their feasibilty for catheter ablation of myocardial tissue. This report summarizes our experience of the use of radiofrequency alternating current (500 kHz, unipolar mode) for coagulation of ventricular myocardium in canine experiments. Under standardized in vitro conditions, we found a significant correlation between actually delivered radiofrequency energy and assesed myocardial necrosis (r = 0.87). However, this did not hold for percutaneous application of radiofrequency alternating current to the beating dog heart (r = 0.32). In the intact dog heart, the size of induced lesions paralleled catheter contact pressure which was varied until ST-egment elevation was either 0–2 mV or 5–7 mV. However, no statistical significant differences in either calculated energy or tissue impedance were observed. Under in vivo conditions, a significant improvement in the predictability of the resulting size of lesions was observed when catheter tip temperature, measured via a built-in Ni/CrNi thermoelement, was monitored (r = 0.07). Changes in tip temperature during coagulation also indicated the quality of catheter contact, catheter damage and the appearance of carbonization at the tip of the ablation catheter. Total perforation of the myocardial wall and proarrhythmogenic effects were only rarely observed. In conclusion, catheter coagulation of myocardial tissue using radiofrequency energy can be considered as safe and effective. Since changes in catheter tip temperature occurring during coagulation were found to predict the extent of induced tissue necrosis, the development of temperature controlled radiofrequency devices seems promising and necessary.     

Trends in oral contraceptive use in a Southern German population: Results of the MONICA project Augsburg: surveys 1984/85 and 1989/90

In the surveys of the MONICA project Augsburg, conducted in1984/85 (S1) and 1989/90 (S2), data on oral contraceptive (OC)use were gathered in two independent representative population-basedsamples of women aged 25–44 years (medication historyover the previous seven days). OCs were categorized accordingto their oestrogen content (< 50mg, 50mg) and according totheir progestogen component. The prevalence of OC use was unchangedbetween the two points in time (23.4% in S1 and 23.7% in S2).OCs with low oestrogen content were used in 49.0% of the OCusers in S1 and in 76.6% in S2. The use of the progestogen componentchanged also: norethindrone (acetate), levonorgestrel, and lynestrenolwere used less, desogestrel more often in S2. Gestoden and norgestimatewere used by 15% of the OC users in S2. In conclusion, we cansay that there was no change in the prevalence of OC use inthe study population; however, a change in hormone content towardspreparations with lower hormone content was observed.     

Clinical Applicability of in vivo Reflectance Confocal Microscopy for the Diagnosis of Actinic Keratoses

BACKGROUND In vivo reflectance confocal microscopy (RCM) has been used for evaluation of the morphologic features of nonmelanoma skin cancer. The application of RCM for diagnosis of basal cell carcinoma has been reported; however, the evaluation of actinic keratoses (AKs) has only been the subject of preliminary studies.
STUDY GOAL The goal of this study was to evaluate the applicability of RCM in the diagnosis of AK in correlation with routine histology.
MATERIALS AND METHODS Forty-four Caucasians with a minimum of one AK participated in this study. Evaluation consisted of clinical examination, RCM, and routine histology, including a total of 46 AKs in the final analysis. Ten normal skin sites served as controls. RCM features of AK included parakeratosis, architectural disarray, and keratinocyte pleomorphism. Following blinded evaluations, sensitivity/specificity, kappa analysis, and Spearman's correlation were performed on all parameters.
RESULTS Sensitivity/specificity values of RCM features ranged from 80% to 98.6%. The presence of architectural disarray and cellular pleomorphism appeared to be the best predictor of AK.
CONCLUSION In summary, RCM may be a promising technology for the noninvasive detection of AK and as adjunct tool to clinical diagnosis and monitoring. However, the preliminary nature of this study warrants further investigations.     

Divergent Effect of Acute Ventricular Dilatation on the Electrophysiologic Characteristics of d,I-Sotalol and Flecainide in the Isolated Rebbit heart

Ventricular Dilatation and d,l-Sotalol/Flecainide in Isolated Rabbit Heart. Introduction: The interaction between acute ventricular dilatation (AVD) as one aspect of ventricular dysfunction and Class I and III antiarrhythmic drugs is uncertain. We therefore investigated the effects of AVD on the electrophysiologic properties of d,l-sotalol and flecainide. Methods and Results: The isolated rabbit heart was used as a model of AVD. The ventricular size and, therefore, the diastolic pressure were modified by sudden volume changes of a fluid-filled balloon placed in the left ventricle. Pacing was performed alternately using epi- and endocardial monophasic action potential (MAP)-pacing catheters at cycle lengths from 1,000 to 300 msec. d,l-Sotalol (10 μM) resulted in a significant (P < 0.05) lengthening of refractoriness (+13.5%± 3.1%), MAP duration (+14.9%± 3.2%), and QT interval (+15.5%± 4.1%) (mean ± SEM at 1,000 msec). These effects had a reverse rate-dependence. AVD to a diastolic pressure of 30 mmHg reduced refractoriness and left ventricular MAP duration. In comparison with the control group with the same extent of WD, d,l-sotalol still led to a significant prolongation of repolarization for all cycle lengths except 300 msec, so that its effects were not absolutely but relatively preserved. In contrast, flecainide (2μM) had no significant effects on refractoriness or MAP duration. It led to a significant, rate-dependent increase of pacing thresholds (+47.6%± 8.2%), prolongation of QRS (+48.8%± 5.6%), and conduction time (+78.6%± 8.6%) (mean ± SEM at 300 msec). In the flecainide group, AVD significantly increased the normal rate-dependent prolongation of QRS (+16.7%± 5.5%) and conduction time (+17.1%± 4.3%). Conclusion: Our data demonstrate that, during AVD, the Class III effect of d,l-sotalol is preserved, whereas flecainide's effect of slowing conduction is exaggerated. This may contribute to flecainide-related proarrhythmia in certain clinical situations.