No abstract is provided for this article.
The effect of repeated (3 to 10 second) and transient (15 to 75 second) abrupt coronary occlusion on the global and regional chamber stiffness was studied in nine patients undergoing angioplasty of a single proximal left anterior descending coronary artery stenosis. The left ventricular high fidelity pressure and volume relation was obtained before and after the procedure as well as during coronary occlusion, after 20 seconds (n = 9) and after 50 seconds (n = 5). During ischemia, there was an upward shift of the pressure-volume relation. The nonlinear simple elastic constant of chamber stiffness increased from 0.0273 ± 0.017 before angioplasty (mean ± SD) to 0.0621 ± 0.026 after 20 seconds of occlusion (p < 0.05) and 0.0605 ± 0.015 after 50 seconds of occlusion (p < 0.01). In five patients, the postangioplasty value remained higher than the control value, but at the group level the mean value (0.0529 ± 0.037) was not statistically different. The regional stiffness was determined from the changes in the length of six segmental radii during diastole, from the lowest diastolic to the end-diastolic pressure. The regional constant of elastic stiffness was unaffected in the nonischemic zone. In the adjacent and ischemic zones, the regional stiffness was increased during occlusion (p < 0.05). These regional abnormalities in diastolic function persisted at the time of postangioplasty measurements, 12 minutes after the end of the procedure. This suggests that recovery of normal diastolic function after repeated ischemic injuries is delayed after restoration of normal blood flow and systolic function.
Journal Article Thrombolytic therapy for acute coronary thrombosis Get access M. L. Simoons, M. L. Simoons Erasmus Universiteit, RotterdamThe Netherlands Search for other works by this author on: Oxford Academic PubMed Google Scholar J. Lubsen, J. Lubsen Erasmus Universiteit, RotterdamThe Netherlands Search for other works by this author on: Oxford Academic PubMed Google Scholar P. W. Serruys, P. W. Serruys Erasmus Universiteit, RotterdamThe Netherlands Search for other works by this author on: Oxford Academic PubMed Google Scholar P. G. Hugenholtz P. G. Hugenholtz Erasmus Universiteit, RotterdamThe Netherlands Search for other works by this author on: Oxford Academic PubMed Google Scholar European Heart Journal, Volume 8, Issue suppl_F, September 1987, Pages 78–87, https://doi.org/10.1093/eurheartj/8.suppl_F.78 Published: 01 September 1987
Objectives We investigated the efficacy of paclitaxel-eluting stents (PES) compared to sirolimus-eluting stents (SES) when used without restriction in unselected patients. Background Both SES and PES have been separately shown to be efficacious when compared to bare stents. In unselected patients, no direct comparison between the two devices has been performed. Methods Paclitaxel-eluting stents have been used as the stent of choice for all percutaneous coronary interventions in the prospective Taxus-Stent Evaluated At Rotterdam Cardiology Hospital (T-SEARCH) registry. A total of 576 consecutive patients with de novo coronary artery disease exclusively treated with PES were compared with 508 patients treated with SES from the Rapamycin-Eluting Stent Evaluated At Rotterdam Cardiology Hospital (RESEARCH) registry. Results The PES patients were more frequently male, more frequently treated for acute myocardial infarction, had longer total stent lengths, and more frequently received glycoprotein IIb/IIIa inhibitors. At one year, the raw cumulative incidence of major adverse cardiac events was 13.9% in the PES group and 10.5% in the SES group (unadjusted hazard ratio [HR] 1.33, 95% confidence interval [CI] 0.95 to 1.88, p = 0.1). Correction for differences in the two groups resulted in an adjusted HR of 1.16 (95% CI 0.81 to 1.64, p = 0.4, using significant univariate variables) and an adjusted HR of 1.20 (95% CI 0.85 to 1.70, p = 0.3, using independent predictors). The one-year cumulative incidence of clinically driven target vessel revascularization was 5.4% versus 3.7%, respectively (HR 1.38, 95% CI 0.79 to 2.43, p = 0.3). Conclusions The universal use of PES in an unrestricted setting is safe and is associated with a similar adjusted outcome compared to SES. The inferior trend in crude outcome seen in PES was due to its higher-risk population. A larger, randomized study enrolling an unselected population may assist in determining the relative superiority of either device.
Corticosteroids are the most effective therapy currently available for asthma and improvement with corticosteroids is one of the hallmarks of asthma. By contrast, corticosteroids have little or no place in the management of COPD. Inhaled corticosteroids have revolutionized asthma treatment and have become the mainstay of therapy for patients with chronic disease. There is now a much better understanding of the molecular mechanisms whereby corticosteroids suppress inflammation in asthma and this has led to changes in the way corticosteroids are used and may point the way to the development of more specific therapies in the future. This chapter discusses current understanding of the mechanism of action of corticosteroids and how corticosteroids are used in the management of asthma. The lack of benefit of corticosteroids in COPD is also discussed.
There may be an overlap between the clinical pictures of asthma and chronic obstructive pulmonary disease which hampers a clear distinction between the two diseases. Most symptoms presented by patients do not clearly belong exclusively to either asthma or chronic obstructive pulmonary disease. By the nature of their discipline and training, general practitioners focus mainly on symptoms presented, which do not give a decisive answer in the differential diagnosis between the two diseases. Therefore, general practitioners must rely on objective parameters, such as determining the presence and degree of reversibility of airway obstruction, diurnal peak flow variability, bronchial hyper-responsiveness and allergy. This paper puts forward a pragmatic, primary care definition of asthma and chronic obstructive pulmonary disease.
A Karger 'Publishing Highlights 1890–2015' title The prevalence of allergic diseases has increased dramatically over recent decades, both in terms of the number of sufferers and the number of allergies. This is a trend that has frequently been referred to as 'the epidemic of the 21st century'. As described in ancient texts, allergies have been known for over 2,000 years, but the term 'allergy' was only coined at the beginning of the 20th century when doctors began to understand their pathophysiological basis.This book presents a detailed and varied historical overview of the field of allergology. Beginning with insights on allergy from antiquity to the 20th century and the development of the associated terminology, it compiles historical reflections on the understanding of the most common allergic diseases. Important milestones in the discovery of mechanisms of allergy are described, followed by historical accounts of the detection of allergens such as pollen, dust mites, peanuts and latex, and of environmental influences such as pollution and the relationship between farmers and their environment. Several chapters illustrate the progress made in allergy management to date. Particular highlights of this book are the personal reflections of and interviews with a number of pioneers of allergy, including F. Austen, J. Bienenstock, K. Blaser, A. de Weck, A.W. Frankland, K. Ishizaka, and many more. Concluding with portrayals of allergy societies and collections, as well as being supplemented by two films, this book represents a veritable treasure trove of fascinating and richly illustrated information.Not only researchers, physicians and medical historians, but also students and even non-scientists will find History of Allergy a scientific adventure well worth reading.
Transcatheter aortic valve replacement emerged ≈20 years ago and changed the landscape of structural interventional cardiology. The first experiments in animal models provided proofs of the concept and the substrate for the first percutaneous valve implantation in patients. The initial promising results in a clinical setting drew the attention of the industry and of the scientific community, and an effort was made for the past 12 years to address the limitations of the technology, facilitate the procedure, minimize the risk of complications, and broaden the applications of transcatheter aortic valve replacement. This article reviews the evolution of transcatheter aortic valve replacement, presents the first steps in this field, cites the evidence from registries and clinical trials, highlights the limitations of this treatment, and discusses the future perspectives and the developments proposed to address the current pitfalls.
