Coronary angioplasty in the young: procedural results and late outcome.

Procedural outcome of coronary angioplasty in 89 patients < or = 40 years was compared to an older group of 1,916 patients > 40 years. Young patients were more often male (98% vs. 81%), smokers (89% vs.

Improving results of bailout coronary stenting after failed balloon angioplasty.

Stent implantation can be a valuable alternative to emergent bypass surgery to treat established or threatening abrupt closure following coronary balloon angioplasty. To evaluate several sequentially introduced changes in our practice of bail-out stenting, we compared the first (group I) and second half (group II) of our single center experience (n = 88). Use of bailout stenting increased over time (2% of all angioplasty procedures in group I vs.

In-hospital monitoring after coronary angioplasty.

At the University Hospital of Geneva there are three postcoronary angioplasty monitoring levels: (A) intensive care unit; (B) optional ECG monitoring (cardiology unit); and (C) no monitoring (other unit). To assess the adequacy of patient monitoring after coronary angioplasty, we studied the clinical outcome of 200 consecutive patients undergoing coronary angioplasty at different monitoring levels. Thirty-nine patients (20%) were in level A.

Evaluation of the systematic use of a new type of diagnostic/interventional 6F catheters for coronary angiography and angioplasty.

Coronary angioplasty performed immediately after coronary angiography has raised interest to develop diagnostic catheters potentially usable for interventions (i.e. Diaventional catheters).

Coronary angioplasty for isolated non-dominant left circumflex coronary artery disease.

The study describes the clinical findings and results of coronary balloon angioplasty in 134 patients with non-dominant left circumflex coronary artery disease. The immediate angiographic success rate was 97% versus 95% for left anterior descending (P = NS), and 90% for right coronary lesions (P < 0.002).

Expression in yeast of three allelic cDNAs coding for human liver P-450 3A4. Different stabilities, binding properties and catalytic activities of the yeast-produced enzymes.

Three natural allelic cDNAs coding for P-450 3A4, the major form in human liver, namely NF25, NF10 and hPCN1, have been expressed in Saccharomyces cerevisiae. NF25 and hPCN1 were functionally expressed in yeast microsomes, yielding proteins with an absorption maximum at 448 nm in the CO-reduced difference spectrum. Some catalytic activities and substrate binding properties of P-450 NF25 and P-450 hPCN1 in yeast microsomes have been compared; no striking difference was found, showing that the two point substitutions between their amino-acid sequences (Trp392 and Thr431 in P-450 NF25 are replaced by Val392 and Ile431 in P-450 hPCN1) have no significant effect on the functional properties of these two variants.

[Thrombosis of the right auricle in pulmonary embolism: value of echocardiography and indications for thrombolysis].

The presence of a right atrial thrombus is a recognized predictive factor of high mortality in patients with pulmonary embolism. In this report we describe two cases in which a free-floating thrombus in the right atrium was demonstrated by echocardiography; it resolved rapidly in both cases after thrombolytic therapy which resulted in a rapid clinical improvement and favorable outcome. During the acute phase of pulmonary embolism, a dilated right ventricle, a dilated pulmonary artery, a left ventricle of small size and paradoxical motion of the interventricular septum can be detected by echocardiography.

Recombinant yeast in drug metabolism.

The usefulness of cDNA-directed expression of human hepatic P450s in yeast for the in vitro study of drug metabolism is emphasized. The major advantages of yeast expression are: (i) relatively high yields of heterologous P450 (approximately 5-10 nmol/l of culture medium) can be obtained; (ii) the expressed P450s are directly active in yeast microsomes, allowing the determination of specific catalytic activities of individual isoforms, which is a prerequisite for the prediction of metabolic pathways for new drug candidates; (iii) transformed yeast microsomes can also be used to study the specific affinity of individual P450s for various substrates and the formation of P450-metabolite complexes by difference visible spectroscopy; such studies can help to predict drug interactions. The advantages of expression in yeast with respect to biochemical studies of drug metabolism are illustrated with data about P450 NF25 (P450 3A4), the major form of human liver.

Brachial approach directional coronary atherectomy of a left coronary artery saphenous vein bypass graft.

Directional coronary atherectomy (DCA) of a saphenous vein bypass graft to the left coronary artery was performed percutaneously from the brachial artery approach using a 7F endomyocardial biopsy sheath. Initial positioning was accomplished with a left bypass graft catheter inserted in the sheath. This technique permits use of smaller catheters than usual for DCA in patients in whom larger guides cannot be used.

Coronary angioplasty through 4 French diagnostic catheters.

In 50 consecutive patients subjected to coronary angioplasty immediately following a 4 French (F) diagnostic study, the technical feasibility and economical aspects of angioplasty through 4F catheters of 54 lesions were assessed. The patients were selected, but multiple, eccentric, and long lesions were not a priori excluded. 4F diagnostic catheters (Cordis), and fixed-wire dilatation catheters (Ace, Scimed) were used in all cases.

Balloon recanalisation of a chronically occluded left internal mammary artery graft.

A patient in whom balloon recanalisation of a chronically occluded left internal mammary artery graft was successful is described. A Magnum-Magnarail system was used, and a four month follow up showed no restenosis.

[Delay in management and treatment of patients with suspected acute myocardial infarction: role of the public, of extra- and intra-hospital structures and transportation methods].

The potential impact of thrombolytic agents on mortality and morbidity from coronary artery disease is weakened by in- and out-of-hospital delays occurring in the management of acute myocardial infarction. The goals of this study were to review the situation 5 years after the publication of the GISSI study. From October 1, 1991 to March 31, 1992, all the events occurring between symptom onset and in-hospital treatment were analyzed for 620 consecutive patients with suspected myocardial infarction seen in the emergency ward of the University Hospital, Geneva.

The oculo-auricular phenomenon. Findings in normals and patients with brainstem lesions.

The oculo-auricular phenomenon consists of bilateral coactivation of external ear muscles during lateral gaze. The electromyogram of the transverse auricular muscle was recorded in 25 healthy volunteers and 1186 patients. In normal subjects bilateral coactivation was observed with lateral gaze (96%), convergence (61%), active and intended head rotation (100%) and passive head rotation (50%).

Somatosensory evoked potentials in workers exposed to toluene and styrene.

Somatosensory evoked potentials (SEPs) were used to evaluate possible subclinical impairment of the nervous system due to occupational exposure to toluene and styrene. A group of 36 rotogravure printers with severe exposure to toluene, 20 workers with severe exposure to styrene in a glass laminate manufacturing plant, and a comparison group of healthy subjects were studied. The severity of exposure was documented by measurements of toluene and styrene concentrations in breathing zone air, by hippuric acid concentration in urine in the group exposed to toluene, and by urinary mandelic acid concentration in the group exposed to styrene.

[Coronary angioplasty in octogenarians].

Coronary balloon angioplasty was performed on 33 lesions during 28 procedures in 23 octogenarians (median age 83, range 80 to 87 years) between January 1989 and December 1991. 96% of the patients had grade III-IV angina pectoris. The median left ventricular ejection fraction was 64% (range: 38-85%).

[Closure of patent ductus arteriosus using interventional catheterization].

Percutaneous closure of patent ductus arteriosus can be performed with the Rashkind technique. This procedure has been performed in 16 patients in Geneva since 1989. The age of the patients varied from 2 to 44 years (4 boys, 7 girls, and 5 women).

Enhanced in vivo monooxygenase activities of mammalian P450s in engineered yeast cells producing high levels of NADPH-P450 reductase and human cytochrome b5.

We have engineered yeast genomic DNA to construct a set of strains producing various relative amounts of yeast NADPH-P450 reductase (Yred) and human cytochrome b5 (Hb5). Expression of cDNAs encoding human P450 1A1, 1A2, 3A4, 19A and mouse P450 1A1 in the different oxido-reduction backgrounds thus constituted were achieved after strain transformation by plasmid-based P450-encoding expression cassettes. The results indicate that the level of Yred strongly affects all activities tested.

Coronary stenting through 6 French guiding catheters.

Most stent implantation procedures currently require the use of large-diameter guiding catheters. We describe our preliminary successful experience with 6 French guiding catheters to deliver balloon-expandable Palmaz-Schatz stents to the coronary arteries.

Engineered yeast cells as model to study coupling between human xenobiotic metabolizing enzymes. Simulation of the two first steps of benzo[a]pyrene activation.

Human microsomal epoxide hydrolase and cytochrome P450 (P450) 1A1 were coexpressed in Saccharomyces cerevisiae from expression cassettes integrated respectively into the host chromosomal DNA and on a multicopy plasmid in a strain already overexpressing yeast NADPH-cytochrome P450 reductase (P450 reductase). A styrene-oxide-hydrolase activity (2 nmol.min-1.

IgD paraproteinemias.

In a series of 2038 paraproteinemic sera, 9 IgD paraproteins (0.44%) were found. Clinical diagnosis of all the 9 was multiple myeloma.

Effect of dibutyryl cyclic AMP and isoproterenol on 7 beta-hydroxycholesterol cytotoxicity and esterification in spontaneous transformed cell lines derived from astrocyte primary cultures.

Incubation of spontaneous transformed cells derived from astrocyte primary cultures with 30 microM 7 beta-hydroxycholesterol (7 beta-OH-CH) which is lethal to the cells or with 150 microM isoproterenol reduces the intracellular level of cAMP (4- and 2-fold respectively). Treatment of the cultures with 0.5 mM dibutyryl (db)-cAMP and 7 beta-OH-CH increases 3-fold the intracellular level of cAMP and both, db-cAMP and isoproterenol, raise the lethal effect of 7 beta-OH-CH and its esterification on C-3-OH by naturally occurring fatty acids (metabolite).