http://repub.eur.nl/res/aut/1342/ List of Publications en http://repub.eur.nl/static-eur/img/logo.png http://repub.eur.nl http://repub.eur.nl/res/pub/12874/ 2000-05-01T00:00:00Z AIMS: To determine very long-term survival and incidence of recurrent interventions following aorto-coronary bypass surgery using venous grafts. METHODS AND RESULTS: A group of 1041 consecutive patients operated upon between 1971 and 1980 were followed for a median of 19 years (range 13-26). Peri-operative mortality was 1.2%. Survival probability at 5, 10, 15, and 20 years was 92%, 77%, 57%, and 40%, respectively. After 5 or more years following operation the mortality was higher than in the matched Dutch population. Age, extent of coronary artery disease, and ejection fraction are independent predictors of mortality. Of the 593 deceased patients at least 63% died of a probable cardiac cause, while cardiovascular mortality is 40% in the general Dutch population. Repeat revascularization procedures (aorto-coronary bypass surgery or percutaneous transluminal coronary angioplasty) were performed in 343 patients (33%), with an increasing incidence after 7 years. CONCLUSION: Aorto-coronary bypass surgery using vein grafts is safe and has a reasonable long-term prognosis for survival, although less than a matched population. After approximately 7 years both mortality and the need for repeated revascularizations increased. Since a majority of patients died of a cardiac cause and a substantial number of patients required repeated revascularization, aorto-coronary bypass surgery is a palliative treatment of a progressive disease. http://repub.eur.nl/res/pub/5524/ 1996-01-01T00:00:00Z In the GUSTO-I ECG ischaemia monitoring substudy, 1067 patients underwent continuous ST segment monitoring, using vector-derived 12-lead (406 patients), 12-lead (373 patients) and 3-lead Holter (288 patients) ECG recording systems. Simultaneous angiograms at 90 or 180 min following thrombolytic therapy were performed as a part of the prospective study in 302 patients. Infarct vessel patency was established as TIMI perfusion grades 2 or 3 and occlusion as TIMI perfusion grades 0 or 1. Coronary artery patency was predicted from ST trends up to the time of angiography. Predictive values at 90 and 180 min after the start of thrombolysis were 70% and 82% for patency and 58% and 64% for occlusion, respectively. In retrospect, accuracy appeared greatest (79-100%) in patients with extensive ST segment elevation (> or = 400 microV), if both speed of ST recovery and extent of ST segment elevation were taken into account. Although the three recording systems differed considerably in signal processing, no significant difference in accuracy was demonstrated among these systems. We conclude that continuous ECG monitoring may help select high risk patients without apparent reperfusion who may benefit from additional reperfusion therapy. As ST recovery may occur early after the start of thrombolytics and accuracy of the test is related to peak ST levels, the use of on-line ECG monitoring devices on emergency wards and cardiac care units is recommended. http://repub.eur.nl/res/pub/21618/ 1995-04-26T00:00:00Z In 1787 Aloysio Luigi Galvani (1737-1798), at that time Professor of Anatomy at the University of Bologna, demonstrated that the muscles of the hind limbs of a frog manifested "electromotive phenomena." A partly dissected frog's leg with a metal scalpel accidentally left in contact with an exposed nerve showed muscle contractions whenever a nearby electrostatic apparatus was rotated. Ensuing experiments led him to describe a method for stimulating tissues electrically by simply touching a muscle or nerve with two rods of clissimilar metals bound together, believing that it was due to electricity generated within the tissues. Allesandro Volta (1745-1827), Professor of Physics at the University of Pavia, challenged Galvani's interpretation by denying the existence of animal electricity, believing that the stimulation was due to electricity generated at the points of contact of the two metals. Thus arose a famous scientific controversy. To meet Volta's objection Galvani develo ped an experiment in which muscle contraction was induced using living tissue instead of metal rods. He showed that if a nerve was made to touch another tissue a two points, one injured and the other uninjured, the muscle supplied by the nerve would contract. This was the first unequivocal demonstration of the existence of electricity in living tissue and also the first description of the current of injury. Since then many researchers were "galvanized" by all kinds of electrical phenomena in various animal models, some of these related to the heart. http://repub.eur.nl/res/pub/5479/ 1994-01-01T00:00:00Z