Ultrasound-assisted versus conventional catheter-directed thrombolysis for acute iliofemoral deep vein thrombosis

BACKGROUND For patients with acute iliofemoral deep vein thrombosis, it remains unclear whether the addition of intravascular high-frequency, low-power ultrasound energy facilitates the resolution of thrombosis during catheter-directed thrombolysis. METHODS AND RESULTS In a controlled clinical trial, 48 patients (mean age 50±21 years, 52% women) with acute iliofemoral deep vein thrombosis were randomized to receive ultrasound-assisted catheter-directed thrombolysis (N=24) or conventional catheter-directed thrombolysis (N=24). Thrombolysis regimen (20 mg r-tPA over 15 hours) was identical in all patients. The primary efficacy end point was the percentage of thrombus load reduction from baseline to 15 hours according to the length-adjusted thrombus score, obtained from standardized venograms and evaluated by a core laboratory blinded to group assignment. The percentage of thrombus load reduction was 55%±27% in the ultrasound-assisted catheter-directed thrombolysis group and 54%±27% in the conventional catheter-directed thrombolysis group (P=0.91). Adjunctive angioplasty and stenting was performed in 19 (80%) patients and in 20 (83%) patients, respectively (P>0.99). Treatment-related complications occurred in 3 (12%) and 2 (8%) patients, respectively (P>0.99). At 3-month follow-up, primary venous patency was 100% in the ultrasound-assisted catheter-directed thrombolysis group and 96% in the conventional catheter-directed thrombolysis group (P=0.33), and there was no difference in the severity of the post-thrombotic syndrome (mean Villalta score: 3.0±3.9 [range 0-15] versus 1.9±1.9 [range 0-7]; P=0.21), respectively. CONCLUSIONS In this randomized controlled clinical trial of patients with acute iliofemoral deep vein thrombosis treated with a fixed-dose catheter thrombolysis regimen, the addition of intravascular ultrasound did not facilitate thrombus resolution. CLINICAL TRIAL REGISTRATION URL http://www.clinicaltrials.gov. Unique identifier: NCT01482273.

Vollständige Nachrichten über eine polizeyliche Untersuchung gegen jüdische, durch ganz Deutschland und dessen Nachbarstaaten verbreitete Gaunerbanden

Karl Stuhlmüller

Patrizia "Ich kann nicht widerstehen... : Schnapp-Hahnsky "Ich bin ganz entzückt ...

Bibliograph. Nachweis: Wolf, Sylvia: Politische Karikaturen in Deutschland 1848/49. Mittenwald 1982. – vgl. 1.52 Nr. 1

Mittel zur Hebung des Handwerksstandes: I. Eine allgemeine Ordnung für die Handwerker und technischen Gewerbe ganz Deutschland's, gestützt auf folgende Grundsätze ...

Welsch (Projektbearbeiter): Entwurf einer für ganz Deutschland gültigen zünftigen Gewerbeordnung mit dem Ziel, das Handwerk vor der industriellen Massenproduktion des In- und Auslandes zu schützen. Wahrscheinlich vom Allgemeinen Handwerker- und Gewerbekongreß der Frankfurter Nationalversammlung als Petition unterbreitet (15. August 1848)

Extra-Blatt: Aufruhr in Sachsen für die Anerkennung der Reichs-Verfassung: Ganz Sachsen ist in furchtbarer Gährung ...

Welsch (Projektbearbeiter): Reichsverfassungskampagne in Sachsen

Die Landwehr in Berlin unter Waffen: Nachdem wir seit dem 18. März durch eine unterbrochene Reihe halber oder ganz verfehlter Maaßregeln ...

Welsch (Projektbearbeiter): Protest gegen die Einberufung der landwehrpflichtigen Mannschaften Berlins durch den Kriegsminister

Five-year follow-up after catheter ablation of persistent atrial fibrillation using the stepwise approach and prognostic factors for success

BACKGROUND In the meantime, catheter ablation is widely used for the treatment of persistent atrial fibrillation (AF). There is a paucity of data about long-term outcomes. This study evaluates (1) 5-year single and multiple procedure success and (2) prognostic factors for arrhythmia recurrences after catheter ablation of persistent AF using the stepwise approach aiming at AF termination. METHODS AND RESULTS A total of 549 patients with persistent AF underwent de novo catheter ablation using the stepwise approach (2007-2009). A total of 493 patients were included (Holter ECGs ≥ every 6 months). Mean follow-up was 59 ± 16 months with 2.1 ± 1.1 procedures per patient. Single and multiple procedure success rates were 20.1% and 55.9%, respectively (80% off antiarrhythmic drug). Antiarrhythmic drug-free multiple procedure success was 46%. Long-term recurrences (n=171) were paroxysmal AF in 48 patients (28%) and persistent AF/atrial tachycardia in 123 patients (72%). Multivariable recurrent event analysis revealed the following factors favoring arrhythmia recurrence: failure to terminate AF during index procedure (hazard ratio [HR], 1.279; 95% confidence interval [CI], 1.093-1.497; P = 0.002), number of procedures (HR, 1.154; 95% CI, 1.051-1.267; P = 0.003), female sex (HR, 1.263; 95% CI, 1.027-1.553; P = 0.027), and the presence of structural heart disease (HR, 1.236; 95% CI, 1.003-1.524; P = 0.047). AF termination was correlated with a higher rate of consecutive procedures because of atrial tachycardia recurrences (P = 0.003; HR, 1.71; 95% CI, 1.20-2.43). CONCLUSIONS Catheter ablation of persistent AF using the stepwise approach provides limited long-term freedom of arrhythmias often requiring multiple procedures. AF termination, the number of procedures, sex, and the presence of structural heart disease correlate with outcome success. AF termination is associated with consecutive atrial tachycardia procedures.

Use of a perineural coiled catheter at the sciatic nerve in dogs after tibial plateau levelling osteotomy – preliminary observations

The analgesic effects of peripheral nerve blocks can be prolonged with the placement of perineural catheters allowing repeated injections of local anaesthetics in humans. The objectives of this study were to evaluate the clinical suitability of a perineural coiled catheter (PCC) at the sciatic nerve and to evaluate pain during the early post-operative period in dogs after tibial plateau levelling osteotomy. Pre-operatively, a combined block of the sciatic and the femoral nerves was performed under sonographic guidance (ropivacaine 0.5%; 0.3 mL kg−1 per nerve). Thereafter, a PCC was placed near the sciatic nerve. Carprofen (4 mg kg−1 intravenously) was administered at the end of anaesthesia. After surgery, all dogs were randomly assigned to receive four injections of ropivacaine (group R; 0.25%, 0.3 mL kg−1) or NaCl 0.9% (group C; 0.3 mL kg−1) every 6 h through the PCC. Pain was assessed by use of a visual analogue scale (VAS) and a multi-dimensional pain score (4Avet) before surgery (T-1), for 390 min (T0, T30, T60, T120, T180, T240, T300, T360 and T390) as well as 1 day after surgery (Day 1). Methadone (0.1 mg kg−1) was administered each time the VAS was ≥40 mm or the 4Avet was ≥5. At T390 dogs received buprenorphine (0.02 mg kg−1). Data were compared using Mann–Whitney rank sum tests and repeated measures analysis of variance. Regardless of group allocation, 55% of dogs required methadone. VAS was significantly lower at T390 (P = 0.003), and at Day 1 (P = 0.002) and so was 4Avet at Day 1 (P = 0.012) in group R than in group C. Bleeding occurred in one dog at PCC placement and PCC dislodged six times of 47 PCCs placed. Minor complications occurred with PCC but allowed four repeated administrations of ropivacaine or saline over 24 h in 91.5% of the cases.

Length of the Mitral Isthmus But Not Anatomical Location of Ablation Line Predicts Bidirectional Mitral Isthmus Block in Patients Undergoing Catheter Ablation of Persistent Atrial Fibrillation: A Randomized Controlled Trial

INTRODUCTION Mitral isthmus (MI) ablation is an effective option in patients undergoing ablation for persistent atrial fibrillation (AF). Achieving bidirectional conduction block across the MI is challenging, and predictors of MI ablation success remain incompletely understood. We sought to determine the impact of anatomical location of the ablation line on the efficacy of MI ablation. METHODS AND RESULTS A total of 40 consecutive patients (87% male; 54 ± 10 years) undergoing stepwise AF ablation were included. MI ablation was performed in sinus rhythm. MI ablation was performed from the left inferior PV to either the posterior (group 1) or the anterolateral (group 2) mitral annulus depending on randomization. The length of the MI line (measured with the 3D mapping system) and the amplitude of the EGMs at 3 positions on the MI were measured in each patient. MI block was achieved in 14/19 (74%) patients in group 1 and 15/21 (71%) patients in group 2 (P = NS). Total MI radiofrequency time (18 ± 7 min vs. 17 ± 8 min; P = NS) was similar between groups. Patients with incomplete MI block had a longer MI length (34 ± 6 mm vs. 24 ± 5 mm; P < 0.001), a higher bipolar voltage along the MI (1.75 ± 0.74 mV vs. 1.05 ± 0.69 mV; P < 0.01), and a longer history of continuous AF (19 ± 17 months vs. 10 ± 10 months; P < 0.05). In multivariate analysis, decreased length of the MI was an independent predictor of successful MI block (OR 1.5; 95% CI 1.1-2.1; P < 0.05). CONCLUSIONS Increased length but not anatomical location of the MI predicts failure to achieve bidirectional MI block during ablation of persistent AF.

An die Landleute! Ihr habt den Wienern in herzlichen Worten gedankt für das, was sie in den März- und Maitagen für ganz Oesterreich ...

Welsch (Projektbearbeiter): Aufruf an die Landbevölkerung zu Spenden an einen Unterstützungsfonds zugunsten der notleidenden Gewerbetreibenden Wiens

Ein offener Brief an Rothschild: Zu den merkwürdigen Veränderungen der letzten Zeit, welche ganz Europa umstalteten, gehört auch der große Verlust, den das Haus Rothschild erlitten ...

Welsch (Projektbearbeiter): Vergleich der gemeinnützigen Aktivitäten des Bankiers Rothschild mit denen des verstorbenen Wiener Industriellen und Philanthropen Herman Tedesco: "... jeder Bedrängte erhielt da eine Unterstützung; den Herrn Baron aber [Rothschild] kann man nur in Geschäftsangelegenheiten sprechen ... Eine Vergrößerung der jährlichen Spenden mit 100.000 fl. Conv. Münze würde diesem Manne [Rothschild] auch jetzt nichts schaden und sehr viel Elend von den Leidenden abwenden"

Ganz Berlin und halb Preußen in Anklagestand: Wenn ganz Berlin und das halbe Preußen sich auch noch nicht im Anklagestande befinden, so stehen sie doch jeden Augenblick in Gefahr, in Anklagestand versetzt zu werden ...

Welsch (Projektbearbeiter): Aufzählung der nach den noch gültigen Gesetzen der absoluten Monarchie möglichen Straftatbestände aus Anlaß des Prozesses gegen die Revolutionäre Urban, Lövinson, Korn und Siegerist. Aufruf zur Einreichung von Petitionen an die Nationalversammlung, "daß alle Gesetze und Verordnungen, welche mit den Errungenschaften der Märzrevolution, resp. den königlichen Zusicherungen ... im Widerspruche stehen, aufgehoben und die darauf hin Verurtheilten in Freiheit zu setzen seien. ... Denn sonst kann auch aus der glorreichsten Revolution niemals etwas Gescheidtes werden."

Ganz Berlin muß nach Wien, Jegen die Croaten ziehn! Dann is Windischjrätz verloren! Karbe hat es uns jeschworen: Eene Rede, jered't von Herr Karben, am 31. October, uf de Kummödientreppe, un wortjetrei abjekuppirt: Freinde! Brüder! Mitbürger! Berliner! Souveränet Volk! ...

Welsch (Projektbearbeiter): Satire auf den Werdegang der sehr weitgehenden und radikalen Forderungen der Berliner Volksredner, der immer nach demselben Muster abläuft: die Forderungen werden auf einer Volksversammlung vom Redner formuliert und von der Versammlung gutgeheißen. Darauf wird eine Deputation gebildet, die die fraglichen Forderungen der Nationalversammlung als Petition übergibt. Nach dem Empfang der Deputation durch die Nationalversammlung macht sich der Abgeordnete D'Ester die Petition zu eigen und übergibt sie dem Präsidenten, der sie in die Kommissionen verweist. Die Kommissionen wiederum beraten darüber und erstatten am nächsten Tag Bericht. "Un so war et, un so is et, un so wird et bleiben." Geschildert vor dem Hintergrund der Niederschlagung der Wiener Revolution am Beispiel einer - fiktiven - Rede von Adolph Friedrich Karbe