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Aims Current data concerning the influence of X-ray contrast media on the incidence of thrombotic complications in interventional cardiology are controversial. The effect of ionic contrast media on acute (≤72h) and subacute (≤30 days) stent thrombosis has not been investigated. Methods Three thousand, nine hundred and ninety consecutive patients underwent coronary stent placement. Group I (n=1808) received non-ionic contrast media while group II (n=2182) was given the ionic Ioxaglate. All patients were treated with a standard regimen of aspirin and ticlopidine for 4 weeks post intervention. Results Both acute and subacute stent occlusion occurred more frequently in patients receiving non-ionic contrast media compared to ionic contrast media (acute stent occlusion: 1·3% in group I vs 0·3% in group II, P =0·001; subacute stent occlusion: 2·4% in group I vs 0·7% in group II, P =0·001). The incidence of the combined clinical end-point of coronary artery bypass grafting, target lesion revascularization, and overall mortality within 12 months was significantly reduced by the use of Ioxaglate (22·9% vs 16·3%, P =0·001). Conclusions Based upon these data, we recommend the use of Ioxaglate in coronary interventions when stent placement is anticipated.

BACKGROUND Coronary revascularization using exclusively arterial grafts holds the promise of improved long-term patency. The T-graft approach achieves this goal with only two arterial grafts in coronary 3-vessel disease. Arterial grafts in diabetics, however, exhibit more frequently atherosclerotic wall abnormalities, and higher levels of endothelin-1 were found in diabetic arterial grafts, which may be associated with a higher incidence of vasoconstriction. The objective of this prospective study was to compare functional und angiographic parameters of arterial T-grafts in diabetics and nondiabetics. METHODS Coronary angiography was performed consecutively in 20 patients with insulin-dependent diabetes mellitus (IDDM), 20 patients with non-insulin-dependent diabetes mellitus (NIDDM), and 100 non-diabetics one week after complete arterial revascularization with T-grafts. Graft patency was assessed, and the diameter of the proximal left internal mammary artery (IMA) graft was measured using quantitative coronary analysis. Absolute flow volume in the proximal left IMA was measured using the flow-wire technique at baseline and after an adenosine injection into the graft to induce maximal hyperemia. Coronary flow reserve (CFR) was calculated as the ratio of maximal to baseline flow. RESULTS There was no difference between patients with IDDM, patients with NIDDM and non-diabetics with respect to patency (98.3% vs. 98.8% vs. 97,8%, n.s.), graft lumen diameter (3.42 +/- 0.48 vs. 3.36 +/- 0.50 vs. 3.38 +/- 0.41 mm, n.s.), baseline flow (78.4 +/- 34.3 vs. 83.1 +/- 36.6 vs. 81.5 +/- 39.0 ml/min, n.s.), and CFR (1.85 +/- 0.37 vs. 1.89 +/- 0.44 vs. 1.90 +/- 0.40, n.s.). CONCLUSION Baseline parameters (graft diameter and quantitative graft flow), patency and CFR are identical in diabetics and non-diabetics. Our results suggest that diabetic patients with coronary 3-vessel disease take comparable profit from complete arterial revascularization using the T-graft technique as non-diabetics.

Anamnesis A 68-year-old woman was admitted to the emergency unit with symptoms of an acute coronary syndrome. She complained about a feeling of chest oppression for two hours. The cardiac history was unremarkable. Her husband had died few hours before the onset of her cardiac symptoms. Investigations Blood pressure was 80/40 mmHg, heart rate 110/min. Cardiac enzymes were normal. The ECG showed significant ST elevation in V2 to V6. Laevoangiocardiography revealed a severe reduction of left ventricular systolic function with an ejection fraction of 27 %. Akinesia was seen in the anterior wall region as well as apical, inferior, and poserolateral. Coronary heart disease could be excluded. Diagnosis, therapy and course Hemodynamic support with catecholamines was needed for one day. After two days hemodynamic recovery occurred. The creatine kinase peak level was surprisingly low (357 U/l). Echocardiographies performed in short intervals showed a continuous, rapid recovery of the ventricular function. Two weeks later the left ventricular function was normal. There was no evidence of myocarditis. In consideration of the history of emotional stress, absence of coronary lesions, a low CK peak and rapid recovery of left ventricular function, Tako-Tsubo cardiomyopathy was diagnosed. Medical treatment with beta blockers was initiated: the further clinical course was unremarkable. Conclusion Tako-Tsubo cardiomypathy should be considered in patients with findings and symptoms of an acute coronary syndrome.

A 68-year-old woman was admitted to the emergency unit with symptoms of an acute coronary syndrome. She complained about a feeling of chest oppression for two hours. The cardiac history was unremarkable. Her husband had died few hours before the onset of her cardiac symptoms.Blood pressure was 80/40 mmHg, heart rate 110/min. Cardiac enzymes were normal. The ECG showed significant ST elevation in V2 to V6. Laevoangiocardiography revealed a severe reduction of left ventricular systolic function with an ejection fraction of 27 %. Akinesia was seen in the anterior wall region as well as apical, inferior, and poserolateral. Coronary heart disease could be excluded.Hemodynamic support with catecholamines was needed for one day. After two days hemodynamic recovery occurred. The creatine kinase peak level was surprisingly low (357 U/l). Echocardiographies performed in short intervals showed a continuous, rapid recovery of the ventricular function. Two weeks later the left ventricular function was normal. There was no evidence of myocarditis. In consideration of the history of emotional stress, absence of coronary lesions, a low CK peak and rapid recovery of left ventricular function, Tako-Tsubo cardiomyopathy was diagnosed. Medical treatment with beta blockers was initiated: the further clinical course was unremarkable.Tako-Tsubo cardiomypathy should be considered in patients with findings and symptoms of an acute coronary syndrome.

In Diagnostik, Therapieplanung und Verlaufskontrolle bei Patienten mit chronischer thombembolischer pulmonaler Hypertonie sind die Erfassung der Hamodynamik im kleinen Kreislauf und die angiographische Darstellung der Lungenstrombahn entscheidende Bausteine und insbesondere vor einer geplanten Thrombendarterektomie obligat. Die Druck-und Widerstandsmessung gibt nicht nur Hinweise auf die Schwere des Krankheitsbildes, sondern erlaubt auch uber Druckkurvenanalysen in Grenzen eine differenzialdiagnostische Abgrenzung gegenuber anderen Formen der pulmonalen Hypertonie. Die typischen angiographischen Befunde zentraler pulmonalarterieller Embolien sind am besten in biplanen lappen- und seitengetrennten Darstellungen der arteriellen und venosen Phase zu erfassen; hierbei ist auf eine Begrenzung der Gesamtkontrastmittelmenge zu achten. Bei der invasiven Koronarangiographie zum Ausschluss einer arteriosklerotischen koronaren Herzerkrankung finden sich gelegentlich Residuen paradoxer Koronarembolien uber ein offenes Foramen ovale und Kompressionsphanomeme des Hauptstamms der linken Kranzarterie.

The hemodynamic assessment and angiographic visualization of the pulmonary artery system are the mayor components for the diagnostic and therapeutical planning for patients with known or suspected pulmonary hypertension due to chronic thromboembolism. The pulmonary artery pressure and the pulmonary arterial resistance both reflect the severity of the disease. Pulmonary wave form analysis allows to some degree an etiologic differentiation of pulmonary hypertension. The typical angiographic findings of central pulmonary embolism are best identified by biplane side and lobe selected angiography of the arterial and venous phase with simultaneous consideration of the overall contrast medium exposure. Typical occasional coronary findings are residues of coronary embolism in patients with patent foramen ovale and excentric compression of the left main stem probably due to dilatation of the pulmonary artery.

A 53-year old woman without a previous history of cardiac disease was successfully resuscitated from ventricular fibrillation. Despite a normal two dimensional echocardiogram, tissue Doppler analysis of left ventricular long-axis contraction revealed marked postsystolic contractions in the territory of the left coronary artery suggesting ischemia as the underlying pathogenetic mechanism. This was confirmed by coronary angiography which revealed a high-grade ostial stenosis of the left main stem. After coronary artery bypass surgery, the tissue Doppler findings normalized.Assessment of regional long axis function by tissue Doppler echocardiography may yield important additional findings even if two-dimensional echocardiography is apparently normal.

BACKGROUND The T-graft procedure achieves complete arterial coronary revascularization with only two conduits. In this technique, all the bypass anastomoses are supplied by the left internal mammary artery (IMA). Changes in flow conditions or flow redistribution in the subclavian artery may thus sigificantly influence coronary perfusion. The objective of this study was to determine whether changes in blood flow in the subclavian artery affect the flow in IMA grafts in patients who have undergone complete arterial revascularization with T-grafts. METHODS Quantitative flow volume and flow profiles in the IMA graft and the proximal subclavian artery were measured with a flow-wire in 20 patients one week postoperatively. Following baseline measurements, brachial artery constriction was achieved by applying a blood pressure measurement cuff to the patient's left upper arm. After 5 minutes, quantitative flow in the IMA and in the proximal subclavian artery was assessed. The cuff was then released and the measurements repeated. RESULTS Flow in the subclavian artery changed significantly (p < 0.01) from baseline (355.4 +/- 95.2 ml/ min) to constriction (171.2 +/- 61.3 ml/min) and hyperemia (679.3 +/- 195.1 ml/min). Flow in the IMA graft remained constant irrespective of subclavian artery flow (75.4 +/- 26.2 ml/min vs. 78.0 +/- 28.9 ml/min vs. 75.5 +/- 29.3 ml/min, respectively). The flow profile in the IMA was similarily unchanged. CONCLUSION In patients in whom the coronary bypass blood flow is dependent on the left IMA, neither the quantitative flow volume nor the flow profile are altered by changes in blood flow of the subclavian artery.

BACKGROUND The prognostic benefit of arterial grafts appears to be particularly high in patients with diabetes mellitus, but has been limited by availability of grafts and sternal complications. Complete arterial coronary artery bypass grafting (caCABG) using skeletonized grafts, radial arteries (RA) and the T-graft approach may reduce the perioperative risk particularly in the diabetic patient. METHODS The perioperative data of 174 diabetic (group I) and 402 non-diabetic patients (group II) who underwent caCABG were studied retrospectively. The operations were performed using bilateral internal thoracic arteries (ITA) (I: 20%; II: 21%; ns) or ITA and RA (I: 80%; II: 79%; ns). Diabetic patients presented with a higher incidence of 3-vessel disease (I: 93%; II: 83%; p

Coronary revascularization using exclusively arterial grafts holds the promise of improved long-term patency. The T-graft approach achieves this goal with only two arterial grafts in coronary 3-vessel disease. Arterial grafts in diabetics, however, exhibit more frequently atherosclerotic wall abnormalities, and higher levels of endothelin-1 were found in diabetic arterial grafts, which may be associated with a higher incidence of vasoconstriction. The objective of this prospective study was to compare functional und angiographic parameters of arterial T-grafts in diabetics and nondiabetics.Coronary angiography was performed consecutively in 20 patients with insulin-dependent diabetes mellitus (IDDM), 20 patients with non-insulin-dependent diabetes mellitus (NIDDM), and 100 non-diabetics one week after complete arterial revascularization with T-grafts. Graft patency was assessed, and the diameter of the proximal left internal mammary artery (IMA) graft was measured using quantitative coronary analysis. Absolute flow volume in the proximal left IMA was measured using the flow-wire technique at baseline and after an adenosine injection into the graft to induce maximal hyperemia. Coronary flow reserve (CFR) was calculated as the ratio of maximal to baseline flow.There was no difference between patients with IDDM, patients with NIDDM and non-diabetics with respect to patency (98.3% vs. 98.8% vs. 97,8%, n.s.), graft lumen diameter (3.42 +/- 0.48 vs. 3.36 +/- 0.50 vs. 3.38 +/- 0.41 mm, n.s.), baseline flow (78.4 +/- 34.3 vs. 83.1 +/- 36.6 vs. 81.5 +/- 39.0 ml/min, n.s.), and CFR (1.85 +/- 0.37 vs. 1.89 +/- 0.44 vs. 1.90 +/- 0.40, n.s.).Baseline parameters (graft diameter and quantitative graft flow), patency and CFR are identical in diabetics and non-diabetics. Our results suggest that diabetic patients with coronary 3-vessel disease take comparable profit from complete arterial revascularization using the T-graft technique as non-diabetics.

Complete arterial coronary artery bypass grafting seems to be an alternative surgical approach in the treatment of coronary artery disease. Complications in the long-term follow-up due to degeneration of venous grafts may be reduced using arterial conduits. Prolonged operating times and increased trauma due to harvesting of multiple arterial grafts have been arguments for the conventional operative approach. We present our experience using new operative techniques, such as skeletonization of arterial grafts and the T-graft configuration.Between 3/96 and 7/99, 405 patients with multiple coronary artery disease underwent complete arterial revascularization at our institution. The operations were performed using only two skeletonized grafts, both internal thoracic arteries in 105 patients (25.9%), internal thoracic artery and radial artery in 299 patients (73.8%) and 1 radial artery in 1 patient (0.3%).In 346 patients (85.4%) a T-graft configuration was used. A mean of 4.1 +/- 0.9 coronary anastomoses were performed per patient. In hospital mortality was 2%. Sternal dehiscence or infection occurred in 0.8% of patients. Harvesting of the radial artery was performable with a low morbidity. One week postoperatively, coronary angiography showed 96.7% of coronary anastomoses free of stenosis50%.Complete arterial coronary revascularization using skeletonized grafts and the T-graft approach is a safe technique in the treatment of multiple coronary artery disease. Low perioperative morbidity and mortality make its usage on a routine basis possible.

OBJECTIVE: To describe the self-reported prevalence and patterns of self-care and health care use for colds and flu. DESIGN: Using the expert panel method, a questionnaire was developed to explore self-care practices, attitudes, pharmaceutical use, and health care use for a range of cold and flu symptoms. SETTING: London and Windsor, Ont. PARTICIPANTS: Using a random-digit-dialing survey method, 210 residents were interviewed between November and December 1993. Of 1484 telephone numbers called, 1179 calls were ineligible. Two hundred ten questionnaires were completed for 305 eligible respondents. MAIN OUTCOME MEASURES: Demographic data, typical self-care practices, actual practice during respondents' last cold, opinions on appropriate practices, and knowledge of how to treat colds. RESULTS: Self-care was respondents' treatment of choice, and most respondents use over-the-counter drugs. Prescription drug use was low. Only 1% reported seeing a physician for their last cold. As the number of symptoms increased, however, reported use of over-the-counter drugs and calls or visits to doctors increased. CONCLUSIONS: Results are congruent with other studies showing that the health care practices of most respondents are consistent with low use of the health care system and high levels of self-care for colds and flu.

Die Geschichte der Kardiologie an den Universitatskliniken des Saarlandes ist eng mit der Geschichte ihres Katheterlabors verbunden. Die erste Herzkatheteruntersuchung im Juli 1959 wird als die Geburtsstunde der Kardiologie in Homburg/Saar angesehen. Zuvor hatte der damalige Assistent Dr. med. Ludwig Bette zusammen mit Herrn Prof. Dr. med. Friedrich Doenecke die wesentliche Aufbauarbeit der Abteilung betrieben.

For invasive catheter procedures both ionic and nonionic contrast media (CM) with excellent tolerability are available. The governing practical factors for CM are X-ray opacity and biocompatibility. Tolerability of a contrast medium is governed among its physical properties by its viscosity, osmolality, and ionic concentration. In Germany the nonionic CM are currently preferred. Because of its low thrombotic complications, the ionic CM Ioxaglat is an important alternative in high risk interventions. In patients with known CM incompatibility, the prophylactic application of H1-receptor antagonists and corticosteroids allows catheterization safely without complications. In impaired renal function, hydration is the most effective prophylactic measure to be taken.

CD69 is a disulfide-linked homo-dimer expressed on the surface of activated T cells, B cells, natural killer cells, neutrophils and platelets. Antibody crosslinking of CD69 in the presence of phorbol ester results in cellular activation events including proliferation and the induction of specific genes. Using an expression cloning strategy we have isolated cDNA encoding human CD69 from a CD4+ T cell clone. Transfection of the cDNA clone in CV-1/EBNA cells results in the expression of a covalently linked homodimer. The cDNA insert hybridizes to a 1.7-kb mRNA in phorbol 12-myristate 13-acetate- or phytohemoagglutinin-stimulated human T cells. Using the human clone we have isolated cDNA encoding mouse CD69, which, when expressed in human T cells allowed those cells to respond to anti-mouse CD69 antibodies by secreting interleukin-2 and interferon-gamma. Sequence analysis showed that both mouse and human CD69 are type II membrane glycoproteins related to the NKR-P1 and Ly-49 families of natural killer cell activation molecules.

CD27 is a surface antigen found on T and B cells that has homology to a family of molecules including the receptors for tumor necrosis factor (TNF) and nerve growth factor. A cDNA encoding a ligand for CD27 was isolated by a direct-expression cloning strategy using a fusion protein composed of the extracellular domain of CD27 linked to the constant domain of a human immunoglobulin G1 molecule as a probe. The predicted protein product is a type II transmembrane protein whose gene maps to 19p13 and that shows homology to TNF and the ligand for CD40. Biological characterization indicates that the cloned ligand induces the proliferation of costimulated T cells and enhances the generation of cytolytic T cells.

The effects of a fish oil concentrate with an omega-3 fatty acid content of 42% was determined in two dosages in a double-blind, placebo-controlled study with a parallel group comparison over a period of 5 weeks with 30 healthy subjects. The daily intake chosen was four and eight capsules corresponding to 1.26 or 2.52 g omega-3 fatty acids. Plasma viscosity, erythrocyte rigidity and systolic blood pressure were significantly decreased (p less than 0.01) after a 5-week administration of 2.52 g omega-3 fatty acid daily. The reduction in vitamin E concentration was significant (p less than 0.01) only in the low-dose fish oil group. Lipids and lipoproteins remained unchanged throughout this experiment.