[Limits of intensive care medicine. Medical and legal aspects].

Modern intensive care can extend life. However, it may also extend the dying period. Because of this fact, doctors have been publicly accused of extending dying beyond human dignity, rather than accepting the end of life.

[Single or multiple balloon inflations in coronary angioplasty? Acute results and long-term angiography results of a prospective, randomized study of 300 patients].

325 coronary lesions in 300 consecutive patients (257 male, 43 female, 52 +/- 8 years) undergoing either single-vessel (n = 275) or double-vessel PTCA in two independent procedures (n = 25) were prospectively randomized to either one (group A, n = 167) or three (group B, n = 168) balloon inflations. By clinical and angiographic criteria, PTCA was successful in 295/325 lesions (90.8%) with no significant difference for group A (88.

[Electrocardiographic diagnosis of acute graft rejection after heart transplantation].

In order to evaluate the diagnostic value of standard-ECG (ST-ECG) and precordial mapping-ECG with 63 unipolar leads (PM-ECG) for detection of acute cardiac allograft rejection, 15 patients (12 male, 3 female; age range 24-64 years) were studied. ST-ECG and PM-ECG were recorded along with 94 endomyocardial biopsies. Twenty-four acute rejections were detected histologically.

[Heart damage after electric injury].

Death from electrical accident due to low voltage (220 Volt/380 Volt) is usually caused by ventricular fibrillation. In humans who sustain non fatal electrical injury abnormal ECG findings due to myocardial damage are rare. 243 (76%) of 320 ECGs of survivors of an electrical accident were diagnosed as normal.

[Long-term results of elective percutaneous transluminal coronary angioplasty. A clinico-angiography study of 289 consecutive patients].

289 consecutive patients (255 male, 34 female, 50 +/- 6 years) had an elective single-vessel-PTCA between October 1978 and March 1983. A clinical long-term follow-up was obtained after 4.7 (3-10) years.

[Incidence of pathologic ECG findings in survivors of electric accidents].

ECGs of 320 male survivors of electrical accidents were examined. The results were compared with findings in normal populations reported in previous epidemiological studies. 243/320 electrocardiograms (75.

[ECG in acute myocardial infarct. Continuous registration in thrombolytic therapy].

For 35 patients with acute myocardial infarction undergoing thrombolytic therapy (31 patients with streptokinase and 4 with rt-PA), the treatment effect was assessed angiographically and correlated with ECG changes. These ECG changes were found by continuous registration of eight "strategically" located precordial leads in patients with anterior myocardial infarction, and five precordial leads plus three limb leads in those with posterior myocardial infarction. In 31 patients (group A), successful reperfusion could be verified by angiography, while in 4 patients the infarct-related vessel remained closed.

The geometry of the aortic root in health, at valve disease and after valve replacement.

For the design of aortic valve prostheses with a separation-free flow field and minimum pressure drop the geometry of the aortic root is of high importance, since an appropriate adjustment of the prostheses to the surrounding geometry could largely reduce the risk of thromboembolic complications. For the investigation of the geometry of the aortic root 604 angiographic films out of a total stock of 15,000 of the Medical Clinic I were evaluated. The film material was preclassified into five clinical categories according to the patient's data.

Controversial aspects of coronary endarterectomy.

Between 1980 and 1987, 635 patients underwent coronary bypass grafting combined with coronary endarterectomy. A total of 728 vessels were endarterectomized and grafted. There were 15 early deaths (2.

Evolution of left ventricular function after intracoronary thrombolysis for acute myocardial infarction.

The temporal evolution of left ventricular (LV) function after intracoronary streptokinase therapy for acute myocardial infarction (AMI) was assessed from the data of 264 patients who had complete occlusion of either the left anterior descending or the right coronary artery before treatment. Angiography was performed immediately, and at 3 days and 6 months after AMI in 91%, 71% and 47% of the study group, respectively. Wall motion was measured by the centerline method.

Late results after intracoronary thrombolysis and early bypass grafting for acute myocardial infarction.

Successful thrombolysis for acute myocardial infarction reduces early mortality. For definite correction of the underlying arteriosclerotic lesion, invasive treatment is mandatory. Early bypass grafting has been performed in 70 patients with an ischemic interval of less than 4 hours before reperfusion by thrombolysis.

Early recovery of left ventricular function after thrombolytic therapy for acute myocardial infarction: an important determinant of survival.

Thrombolytic therapy for acute myocardial infarction reduces early mortality, but full recovery of left ventricular function after reperfusion is delayed. Therefore, the relations among reperfusion, survival and the time course of left ventricular functional recovery were examined in 226 patients treated with intracoronary streptokinase; 77% (134 patients) had sustained reperfusion and 31 patients had no reperfusion or had reocclusion by day 3. Wall motion was measured from contrast ventriculograms performed in the acute period and 3 days later in the central and peripheral infarct regions and the noninfarct region by the centerline method in 165 patients.

[Reocclusion following successful thrombolytic therapy in acute myocardial infarct].

Following successful reperfusion of the previously occluded coronary artery in acute myocardial infarction, reocclusion remains an at least partially unsolved problem. The literature reports figures between 10 and 30%. In the present study, 130 out of 543 patients with successful thrombolysis by means of intracoronary streptokinase underwent a follow-up angiography at the 3rd day (106/130, 80%) and/or 6 months (76/130, 59%) after the acute intervention.

Residual coronary stenosis after thrombolysis with rt-PA or streptokinase: acute results and 3 weeks follow-up.

Ninety-one patients with acute myocardial infarction were assigned to intravenous treatment with streptokinase or rt-PA as part of the randomized trial carried out by the European Study Group for Recombinant Tissue-Type Plasminogen Activator (rt-PA). A patent coronary artery was found in 37 of 45 (82%) patients treated with rt-PA and in 27 of 46 (59%) patients treated with streptokinase 75-90 minutes after start of infusion. Patients were subsequently anticoagulated with heparin or dicoumarol up to a repeat angiography 3 weeks after the infarction.

[Potentials of invasive cardiological diagnosis and therapy in West Germany. A comparison with other European states and the USA].

On the basis of a market analysis on the part of industry, the cardiological and cardiosurgical investigation and treatment capacities in 13 West European countries and in the USA are examined. With 2.0 adult left-heart catheter centers per million inhabitants or about 500,000 inhabitants per center, West Germany takes fourth place behind the USA (4.

Localization of significant coronary arterial narrowings using body surface potential mapping during exercise stress testing.

The ability of body surface potential mapping to localize coronary arterial narrowings during exercise stress testing was investigated. An array of 48 chest wall electrodes, simultaneously recorded, was used. Digital filtering and signal processing, data reduction techniques and discriminant analysis were applied to process the information.

[Heart valve replacement in patients over 60].

Unlabelled: Between 1976 and 1984, 182 patients over 60 years with valvular defects were examined invasively and valve replacement was performed. 34 patients (19%) were older than 70 years. Hospital mortality was 2% in aortic valve replacement, 4% in mitral valve and 8% in double valve replacement.

Right ventricular volume determination in isolated human hearts.

For right ventricular volume determination a new method was developed that took into account right ventricular imaging by apical two-dimensional echocardiography in the four- and two-chamber views. Right ventricular volume was calculated by subtraction of the partial volume of the left ventricle and interventricular septum from the total heart volume of the right and left ventricles including the interventricular septum. Accuracy of the subtraction method was evaluated in isolated human hearts by two-dimensional echocardiography and radiography.

Intracoronary thrombolysis and early bypass surgery for acute myocardial infarct: five years' experience.

During the five-year period between March 1980 and February 1985 selective intracoronary thrombolysis with streptokinase was performed in 469 patients with clinical and ECG signs of acute transmural myocardial infarct. Coronary arteriography prior to thrombolysis showed the infarct related vessel still or again patent in 21% of the patients. Among 372 patients with complete occlusion streptokinase infusion was successful in 87%, but failed in 13%.