Intracoronary thrombolysis: Organizational prerequisites,technique, and results

Reestablishing myocardial perfusion during evolving myocardial infarction may limit the ultimate extent of infarction if viable myocardial tissue is present when recanalization of the occluded vessel is achieved. This will result in improved left ventricular function and decreased mortality. In addition to their therapeutic benefits, recanalization procedures have contributed greatly to our knowledge of acute myocardial infarction. It has been demonstrated that myocardial infarction most often occurs after thrombotic occlusion of a coronary artery. This has settled a controversy that has preoccupied cardiologists for decades. Selective intracoronary administration of fibrinolytic agents is followed by recanalization in approximately 80% of cases. Therapeutic failures are attributable to occlusion caused by other factors, to inactivation of streptokinase by high antibody concentrations, and to insufficient concentrations of streptokinase at the thrombus as a results of unfavorable flow conditions. This study is dedicated to Prof. Dr. Med. Horst Schmutzler on the occasion of his 60th birthday.     

The relationship of scoring systems and mortality in the surgical intensive care unit

To determine the relationship between severity of illness and mortality, therapeutic intervention score (TISS) and acute physiology score (APS) were determined on admission to the Surgical Intensive Care Unit (SICU). Patients were divided into survivors and nonsurvivors and differences were compared by chi-square analysis. The 1524 patients admitted to the SICU during a 12-month period had a mean TISS of 3.03 and a mean APS of 13. The average length of stay (LOS) was 3.75 days. Of the 1524 patients, 97 (6.4%) died. The number of nonsurvivors increased with higher TISS and APS scores (P less than 0.001). There were no deaths in the TISS Category 1 patients or in the APS 0-5 group. Mortality rates dramatically increased with APS greater than 20 (P less than 0.001). There were 1286 patients with APS less than 20, and 24 (2%) of these patients died, whereas 73 (31%) of 238 patients with APS greater than 20 died. Nonsurvivors had a mean TISS of 3.6, mean APS of 27, and LOS of 4.88 days, all of which totals were higher than the survivors' totals. In this study population, risk of death was one in three if the APS was greater than 20. These data indicate that TISS and APS scores are effective means of assessing mortality risk in SICU patients.     

A path-analytical approach to differentiate between direct and indirect drug effects on negative symptoms in schizophrenic patients

The hypothesis that differences in drug effects of risperidone and haloperidol on negative symptoms in schizophrenia are secondary to effects on positive, extrapyramidal, and depressive symptoms was investigated by means of an analysis of the data from the USA-Canada risperidone double-blind randomized clinical trial of 523 chronic schizophrenic patients. Regression analyses in the total sample and within treatment groups confirmed a strong relationship between changes in negative symptoms and the other variables studied (R²=0.50–0.51,p<0.001). Only depressive symptoms did not contribute significantly to these results (p>0.10). Path analysis showed that the greater mean change (p<0.05) of negative symptoms with risperidone compared to haloperidol could not be fully explained by correlations with favourable effects on positive and extrapyramidal symptoms. The relationship between shift in extrapyramidal symptoms and shift in negative symptoms failed to reach statistical significance; however, there was a clear tendency in the expected direction in both treatment groups.     

A Pharmacoeconomic Model to Evaluate Antibiotic Costs

Study Objectives . To characterize patient sociodemographics and health, describe vancomycin treatment parameters and clinician-rated outcomes, and determine costs associated with treatment including preparation and administration, adverse events, and toxicity. Design . A prospective study to develop a model for costs associated with antibiotic treatment (vancomycin). Setting . A community hospital. Patients . One hundred adults with active infections. Interventions . Mean duration of therapy was 10 days, and most patients received 2000 mg/day. Serum concentrations were monitored in two of three patients. Detailed cost analyses were completed on a subset of 26 patients selected at random from the overall sample. Measurements and Main Results . Sepsis and skin and skin structure infections were the most common indications for vancomycin therapy. Treatment was effective in 81 patients, failed in 9, and was not evaluable in 10. Thirty-eight percent of patients experienced adverse events attributable to the drug. Phlebitis was common, and red man syndrome, nephrotoxicity, and ototoxicity were infrequent. Conclusions . Total cost of vancomycin treatment for 100 patients was $30,251: $23,855 for preparation and administration, $1710 for monitoring serum concentrations, and $4686 for treating adverse reactions. Drug costs accounted for only 55% of the total cost. Vancomycin is safe and effective, but phlebitis is underreported and significantly affects cost.     

Highly oxygen-permeable copoly(methacrylate/siloxane)s with perfluoroalkyl ester groups

Basic materials for contact lenses were obtained by radical copolymerization of linear α,ω-bis(methacryloyloxy)-terminated oligo- and poly(dimethylsiloxane)s, methyl methacrylate and 2,2,3,3,4,4,4-heptafuorobutyl methacrylate. Oxygen permeabilities, contact angles and ball indentation hardness were determined.     

Disorders of color perception in subtoxic and toxic digoxin and serum digoxin concentrations

Using the Farnsworth-Munsell 100-hue test, investigations were carried out in 14 patients with subtoxic to toxic serum concentrations of digoxin (greater than 2.0 ng/ml) and 13 patients with subtoxic to toxic serum concentrations of digitoxin (greater than 30 ng/ml), in order to detect color vision deficiencies related to serum levels of digitalis. As compared to the control group (n = 24) the total error scores were significantly increased for both glycosides and all serum level ranges. No evidence was found indicating that digoxin and digitoxin influence color vision differently. The FM 100-hue test indicated definite improvements in the digoxin group within one day of discontinuing the glycosides, while the digitoxin group only started to normalize a week later. The results are discussed, taking the different pharmacokinetics of the two digitalis glycosides into account.     

Grenzen und Möglichkeiten der Glaskörperchirurgie bei diabetischer Retinopathie

Hintergrund: Verschiedene Indikationen für glask?rperchirurgische Eingriffe bei Komplikationen der diabetischen Retinopathie haben sich etabliert. Jedoch gibt es wenig Daten zu der Frage, in welchen Situationen auf einen Eingriff wegen aussichtsloser funktioneller Prognose verzichtet werden sollte. Material und Methode: Die Krankengeschichten von 389 Patienten, die zwischen 1990 und 1994 in unserer Klinik wegen Komplikationen der diabetischen Retinopathie vitrektomiert worden sind, wurden retrospektiv analysiert. Die Nachbeobachtung betrug mindestens 6 Monate, im Median 26 Monate. Mit multivariaten, logistischen Regressionsanalysen wurden Faktoren ermittelt, die mit schlechten postoperativen, funktionellen Ergebnissen korrelieren. Ein mathematisches Modell wurde entwickelt, welches die Einsch?tzung der Prognose für verschiedene Ausgangssituationen erlaubt. Ergebnisse: Bei 45 Augen (12%) stieg der postoperative Visus nicht über 1/50. Risikofaktoren waren Ablatio der Makula, Ausdehnung der Ablatio, Rubeosis und Dauer der Visusminderung. ?hnliche Risikofaktoren gelten auch für Revisionsoperationen. Bei einem Auge mit totaler Traktionsablatio von über 6 Monaten Dauer und Rubeosis liegt die berechnete Wahrscheinlichkeit für einen postoperativen Visus über 1/50 lediglich bei 2%. Schlu?folgerungen: Bei totaler Traktionsablatio, insbesondere bei Rubeosis und l?ngerem Bestehen der Ablatio, ist die Prognose extrem schlecht. Auf operative Ma?nahmen sollte hier verzichtet werden.      

25-Hydroxyvitamin D3 metabolism in a human leukemia cell line

Summary 1,25-dihydroxyvitamin D₃ (1,25(OH)₂D₃) is a potent inducer of monocytic differentiation of the human promyelocytic leukemia cell line, HL-60. We have noted that 25-hydroxyvitamin D₃ (25(OH)D₃) in high doses is also capable of promoting monocytic differentiation of this cell line. To test the possibility that the latter activity is due to conversion of 25OHD₃ to 1,25(OH)₂D₃ by HL-60, we exposed HL-60 cells to 25OHD₃ and analyzed the products by HPLC and radioreceptor assay. When chromatographed in the traditional solvent system (isopropanol-hexane), a new peak appears which migrates with authentic 1,25(OH)₂D₃. However, in a solvent system containing dichloromethane, 90% of the peak migrates with another metabolite, 19-Nor-10-Keto-25OHD₃ (19-Nor-25OHD₃). Production of this metabolite is enhanced by living cells and is synthesized by both virgin HL-60 and those which have undergone differentiation. We next determined if authentic 19-Nor-25OHD₃ also promotes differentiation of this cell. As assessed by appearance of the monocyte-specific surface antigen (63D3) and macrophage-specific esterase activity, we find that this metabolite does, in fact, induce monocytic differentiation of HL-60 with a potency of approximately 1/200 that of 1,25(OH)₂D₃ and similar to that of 25OHD₃. In agreement with the effect upon cell maturation, 19-Nor-25OHD₃ displaces³H-1,25(OH)₂D₃ from its HL-60 receptor with an efficiency comparable to 25OHD₃. Hence, HL-60 cells convert 25OHD₃ to 19-Nor-25OHD₃, and 19-Nor-25OHD₃ induces monocytic differentiation of HL-60 with comparable efficiency to its precursor, 25OHD₃.