Professor Heinz-Peter Schultheiss, medical director at the Berlin University Clinic (Berlin, Germany), has criticized the German government's DRG (diagnosis related group) system as pressuring physicians into providing medical treatments based too much on economic feasibility rather than medical desirability. He cited the development of drug-eluting stents aimed at reducing restenosis as an example. "Soon it will be irresponsible to implant a stent that is not drug-eluting. But this real innovation comes at a price," Schultheiss said.

Professor Ludwig Seipel, medical director of the University Clinic of Tubingen (Tubingen, Germany) commented that there was an increasing demand for implantable defibrillators and pacemakers but hospitals did not have the resources to finance such technology. "The limiting of pacemaker prescriptions is not consistent with demographic developments," he said.

The new DRG system would not provide sufficient support to specialist units like the Deutsche Herz Zentrum (Berlin, Germany), said Professor Roland Hetzer, the center's medical director. He said he felt that unless a separate DRG group was set up for new procedures, the use of innovative heart support systems would be "unachievable."

Protein C for meningococcal clotting

Clinical trials are currently under way in Britain to assess the feasibility of using active Protein C as an inhibitor of clotting in patients with meningococcal septicemia, a blood poisoning form of meningitis.

Professor Michael Levin of Imperial College (London) and his team of researchers in Britain and the U.S. have demonstrated for the first time that patients suffering from meningococcal septicemia have lost two key proteins necessary to activate Protein C on the lining of blood vessels: thrombomodulin and endothelial protein C receptor. Absence of the two proteins results in an inability to control the formation of clots in arteries and veins, resulting in widespread clot formation and to death or at least to loss of limbs or digits.

The finding has suggested this novel approach to treatment. "A defect in the activitation of Protein C could, theoretically, be treated by administration of Protein C in its active form, thereby bypassing the requirements for activation on the surface of blood vessels," Levin said.

Actelion's Tracleer effective

Pulmonary arterial hypertension (PAH) is a life-threatening chronic condition which starts as shortness of breath, fatigue and a reduction in exercise capability. In untreated patients, the survival rate after two years from onset is only 40% to 55%. Advanced stages need intravenous prostacyclin therapy via a line implanted directly into the heart or even lung transplantation. Tracleer (bosentan) from Actelion (Allschwil, Switzerland) is a dual endothelin receptor antagonist. In oral therapy it has shown significant patient improvement in exercise capacity, in functional status and in the time to clinical worsening.

U.S., European and Australian regulatory authorities have already granted bosentan orphan drug status. In addition, the Cardiovascular and Renal Drugs Advisory Committee of the FDA has voted unanimously to recommend approval. "We are nearing a milestone in the treatment of pulmonary arterial hypertension," said principal investigator Lewis Rubin, MD, of the University of California-San Diego (San Diego, California). "For the first time, patients and their families can have realistic hope that an oral treatment demonstrating very promising results may soon be made available."

Wrist blood pressure monitor

The Vasotrac APM 205A is a cuff-free blood pressure (BP) monitoring system. Using a proprietary algorithm, the noninvasive wrist sensor measures blood pressure directly from the radial pulse, without the use of an upper-arm cuff. Information from the sensor is transmitted to a monitor where systolic, diastolic, mean arterial pressure wave forms and pulse rates are displayed. Measurement is continuous and the monitor updates its LCD display every 15 heartbeats.

Vasotrac measurements have been found to have a close correlation with invasive arterial lines. The system finds applications in the CCU, the cath lab, with outpatients and for tilt-table testing to assess orthostatic hypertension. It has been designed to obtain regular, accurate and noninvasive BP data from more difficult patient groups including those presenting with low cardiac output or dysrhythmias.

MRI and cath lab in one room

Phillips Medical Systems (PMS, Best, the Netherlands) has installed at the Medical Center at the University of California, San Francisco (San Francisco, California) the first combined installation of the 1.5T Intera I/T magnetic resonance scanner with an Integris Vascular angiography system in an XMR suite. Although X-ray is capable of providing precise details of the vasculature, and is still the modality of choice for catheter guidance and endovascular interventions, magnetic resonance can provide better soft tissue contrast as well as additional functional input.

The availability in the same room of the two modalities means for ischemic stroke victims there is less time lost between diagnosis and treatment. The combined system can also be helpful in the treatment of heart disease. Using a combination of X-ray and MR guidance in lengthy procedures positioning stents and performing PTA procedures can greatly reduce the total X-ray exposure for patients, of particular benefit in pediatric interventions.

Doppler U/S for emboli detection

DWL Elektronische Systeme (Sipplingen, Germany) has developed the Embo-Dop detection system, which can not only detect emboli, but also make a distinction between solid emboli and gaseous ones. It is known that solid emboli reflect ultrasound waves of different frequencies in a different manner than do gaseous emboli. A special probe is therefore used which can emit two different frequencies (2 MHz and 2.5 MHz) simultaneously. Multi-Range technology is used to differentiate reliably between real emboli and artefacts. In addition to emboli detection, the system can also be used for transcranial, extracranial and peripheral Doppler applications using a range of normal probes of 2-16 MHz.

Briefly noted

Tissuepatch V is a contact-adhesive sealant film for vascular surgery that has now gained full European regulatory approval. Produced by Tissuemed (Leeds, England), Tissuepatch is manufactured from clinically pure porcine albumin, polymers and elastomers, all of which are absorbed in approximately 30 days. Tissuepatch V has been designed to save surgeons' time and to help patient care during operations. The product is simply wrapped around the stitches joining blood vessels and grafts, where it sticks and seals. Tissuepatch T is a similar but highly elastic sheet for pulmonary applications. It is used to seal air leaks, a cause of major problems in thoracic surgery.

Among French men less than 54, the weekend can be fatal for the heart. That is the conclusion of a recent epidemiological study by Jean Ferri res, cardiologist and epidemiologist at INSERM, the French national health research organization. He reviewed, over a period of 10 years, the records of 17,000 men aged 25 to 84 who died from a myocardial infarct. He noted that during the weekend, 20% more men aged less than 54 died. The cause of death in a majority of cases was violent physical exercise, with tennis, jogging and sexual activity as the most frequent causes.

Peter de Jaegere and his team at University Medical Center (Utrecht, the Netherlands) have published results in Circulation of a 281-patient study comparing coronary bypass surgery with beating-heart (off-pump) and traditional techniques using a heart-lung machine (on-pump). Although de Jaegere found that the beating-heart technique using Medtronic's (Minneapolis, Minnesota) Octopus tissue stabilizer was more demanding than operating on a stopped heart (on-pump), 13% of the on-pump group needed transfusions during the procedure, compared to only 3% of off-pump patients. There was no statistical difference between outcomes from the two groups, although hospitalization for off-pump patients was one day less than for on-pump patients, while procedure costs were on average 12% more in off-pump patients.

The Bracco group (Milan, Italy) is launching in Europe a new ultrasound-based diagnostic system for use in oncology and cardiovascular sectors. The new Esatune system consists of the Megas U/S platform developed by Bracco subsidiary Esaote (Firenze, Italy), Bracco's second-generation Sonovue contrast agent and a new image enhancement system called Contrast Tuned Imaging. The initial European launch is in Britain, Germany and Italy, with a second wave in France, the Benelux countries and Spain scheduled for early next year.

The "white coat syndrome" shows itself by a rise in blood pressure measurements when taken in a physician's office or clinic. "When a patient presents with this syndrome," said Professor Girard of the Broussais Hospital (Paris), "I ask him to take his blood pressure measurements himself over a period of three days morning and evening." The patient takes each series of readings before each consultation. "This allows us to work with readings closer to reality, so we can adapt the therapy most effectively."