[Proximal myopathy and fulminant heart failure in a 57 year-old female patient with lupus erythematosus]. / Proximale Muskelschwäche und fulminante Herzinsuffizienz bei einer 57-jährigen Patientin mit Lupus erythematodes.

A case report is presented of fulminant hydroxychloroquine-induced cardiomyopathy in a 57 year-old female patient with a long history of systemic lupus erythematosus. Diagnosis was established based on clinical findings, imaging (echocardiography and cardiac magnetic resonance imaging) as well as endomyocardial biopsy. Despite immediate discontinuation of the medication, the patient died from heart failure within a few days. Since the rare adverse effect described here might be reversible, early diagnosis and discontinuation of hydroxychloroquine are crucial for the prognosis of these patients.

[Available transvenous occluder designs and implantation techniques]. / Verfügbare transvenöse Okkluder-Designs und Implantationstechnik.

In this article, most of the present or available in the near future left atrial appendage (LAA) occlusion devices are discussed in terms of structure of the devices and principle technique for implantation. Thus, the Watchman™ device from Boston, the Amulet™ device from Abbot, the Lambre™ device from Lifetech, the Occlutech® device from Occlutech®, and the WaveCrest® device from Biosense Webster (former Coherex) are discussed. The systems differ in terms of the concept of occlusion. Several devices consist of only one part (Watchman™ and Occlutech®) that is implanted in the body, ending up in the orifice of the LAA. Others like the Amulet™ or Lambre™ device have an additional disc covering the orifice of the LAA from the left atrial side. The distal anchoring system is implanted first in the body of the LAA; thereafter, the disc is placed upon the orifice. With the WaveCrest® device, covering of the orifice is performed as the first step followed by rolling in the anchoring system to fix the device to the body of the LAA.

[Peri-interventional risk in 1,384 cardiac catheterizations in patients aged 80 years or older]. / Peri-interventionelles Risiko von Herzkatheteruntersuchungen bei > -- = 80-jährigen Patienten.

BACKGROUND AND OBJECTIVE: Because of the rising life expectancy in the industrialized countries, ever more cardiac catheterizations are performed in patients aged 80 years or older. Little is known about the incidence of peri-interventional events in this age group. PATIENTS AND METHODS: Between January 1996 and September 2000, a total of 1,085 patients of that age (mean 82.6 +/- 2.6 years) underwent cardiac catheterization and intervention (3% of a total of 43,517 cardiac catheterizations). RESULTS: 827 patients (77%) had significant coronary artery stenoses. 373 of them (45%) were treated with balloon angioplasty, with or without stenting, and 331 (40%) underwent aortocoronary bypass procedures. 31 patients died while in hospital, 17 of them having been in cardiogenic shock on admission. Peri-interventional events, including damage to artery at the site of catheter entry occurred in 2.1% of patients undergoing diagnostic cardiac catheterization and in 11.6% in connection with a percutaneous interventional procedure. CONCLUSION: Both cardiac catheterization and interventional procedures can be done with a justifiable risk in patients aged 80 years or older. These cardiac investigations/interventions should not be withheld in this group of patients for reasons of age.

[Rate of restenosis after coronary stent implantation depending on regional left ventricular function]. / Restenoserate nach koronarer Stentimplantation in Abhängigkeit von der regionalen linksventrikulären Funktion.

At present the rate of restenosis after PTCA and stent implantation is approximately 30% in clinical routine practice. The aim of the present study was to investigate the influence of regional disturbances of left ventricular contractility, e.g. due to scars, on the development of restenosis after PTCA and stent implantation. In 310 patients with single stent implantation in the LAD, quantitative coronary angiography and ventricular analysis with the centerline wall motion model (Cardiovascular measurement systems, Medis, The Netherlands) were performed before, immediately after stent implantation and at angiographic follow-up after 3 to 6 months. Thirty-nine percent of all patients (121 patients) showed regional dysfunction of the left ventricular anterior wall. Increase of percent stenosis (relative late lumen loss) between stent implantation and follow-up angiography showed no correlation to left ventricular wall motion abnormalities (r = 0.243). There was no significant difference in restenosis rates between patients with or without left ventricular wall motion abnormalities (28.9% vs. 30.7%, p = 0.74). In conclusion, this study provides evidence that kinetic disorders of the left ventricular wall have no significant influence on long-term results after PTCA and stent implantation.

[Mediastinal space-occupying lesion as a rare cause of atrial arrhythmia]. / Mediastinale Raumforderung als seltene Ursache atrialer Rhythmusstörungen.

HISTORY AND CLINICAL FINDINGS: A 61 year old man presented with newly developed tachyarrhythmia. Echocardiographically a tumour of unclear origin in the left atrium was diagnosed. INVESTIGATIONS: The heart rate in the ECG was arrhythmic at 146/min; intermittently sinus rhythm was established. Transoesophageal echocardiography revealed a 90 x 50 mm tumour with sharp borders displacing both atria. The chest x-ray showed a mediastinal rounded mass in the dorsal part overlapping the right mediastinal border. Computer tomography was unable to discriminate the atrial wall from the tumour masses; hence the difference between an (intra-)cardiac tumour (i.e. myxoma) and a tumour of extracardiac (mediastinal) origin could not be established. Additional magnetic resonance tomography led to the most probable diagnosis of a bronchogenic cyst, which spread ventrally up to the ascending aorta and dorsally to the paravertebral region, thus displacing and shrinking the left pulmonary artery and the left atrium. THERAPY: For certain exclusion of malignancy and because of displacement of other thoracic structures the patient was operated on this mediastinal mass by anterolateral thoracotomy. Histologically a dysontogenetic, benign cyst with an inner layer of mesothel and nerval as well as vascular structures in the capsule was diagnosed. Since the operation the patient has persistent sinus rhythm without symptoms of relevant rhythm disorders. An overview of different kinds of intrathoracical cysts is given.

[Comparative studies of the rate of restenosis after implantation of Palmaz-Schatz and AVE-Micro stents]. / Vergleichende Untersuchungen zur Restenoserate nach Implantation von Palmaz-Schatz- und AVE-Micro-Stents.

Late results of interventional procedures utilizing coronary stents are largely determined by the rate of restenosis. So far few data are available addressing the effect of stent design, implantation pressure and morphologic factors on this crucial variable. Therefore we analyzed the coronary angiograms obtained in 259 patients before, immediately after and at 3 to 6 months following stent implantation for obstructive coronary disease. A total of 196 AVE-Micro-Stents and 142 Palmaz-Schatz-Stents were implanted into 307 stenoses. In 126 stenoses there were implanted only Palmaz-Schatz-Stents, in 170 only AVE-Micro-Stents and in 11 stenoses there were implanted Palmaz-Schatz- as well as Micro-Stents. Restenosis was defined as an over 50% stenosis at follow up. No significant difference was detected with regard to global restenosis rate at an average of 4 months following implantation (Palmaz-Schatz 33%, Micro-Stent 27%). If results were analyzed according to implantation pressure however, there was a significantly lower restenosis rate for AVE-Micro-Stents implanted with > 10 atm (17%) as compared to < or = 10 atm (35%, p < 0.02) and as compared to Palmaz-Schatz-Stents (34%, p < 0.02), which were also implanted with high pressure over 10 atm. In addition to implantation pressure, vessel segment and morphology of stenosis proved to be important determinants of late results. In this series of patients the AVE-Micro-Stent compared favourably to the Palmaz-Schatz-Stent not only with respect to a significantly lower restenosis rate, when implanted with pressures > 10 atm, but also with regard to its superior flexibility and handling characteristics.

An immortalized cell line expresses properties of activated microglial cells.

Murine cultured microglial cells were immortalized after infection with a v-raf/v-myc recombinant retrovirus. This immortalized cell line (BV-2) shares properties with body macrophages with respect to the antigen profile, their phagocytic capacity and antimicrobial activity. BV-2 cells are not constitutively able to kill tumor cells in vitro, but acquire antitumor activity following an increase in [Ca++]i. BV-2 cells, like microglial cells, are however, distinct from peripheral macrophages by their expression of inwardly rectifying K+ channels in concert with a lack in outwardly rectifying K+ channels and the formation of spineous processes. The BV-2 cell line thus represents a suitable model for in vitro studies of activated microglial cells.

Amplification of serotonin-induced contractions of isolated porcine coronary arteries after pretreatment with therapeutic doses of beta-methyldigoxin.

The present experiments demonstrate that after pretreatment of isolated porcine coronary arteries with therapeutic (2.5 X 10(-9) M) was well as with toxic (10(-6) M) doses of beta-methyldigoxin the serotonin-induced contractions were significantly amplified. Since serotonin released from destroyed thrombocytes may be one of the triggering factors eliciting coronary spasms, caution must be taken in the use of digitalis in coronary disease of spastic origin.