Recanalization of chronic coronary occlusions

Recanalization of occluded coronary arteries is the aim of percutaneous interventions with acute myocardial infarction. Moreover, chronic coronary occlusion is a common finding during diagnostic coronary angiography and is often a contributing factor in the choice of revascularisation by surgery rather than by percutaneous coronary interventions (PCI). An occluded coronary artery with some degree of collateral supply is functionally comparable to a severe coronary stenosis. Therefore, recanalization of chronic occluded coronary arteries results in less angina and often in improvement of left ventricular function. Success is limited in particular in longer lasting occlusions. Characterization of lesions, where recanalization can performed successfully is warranted. We correlated primary success rates of attempted coronary recanalizations with localisation of lesions and procedural characteristics. We analyzed records of 124 consecutive patients, who underwent attempted coronary recanalization of chronically occluded coronary arteries at our institution in 1998. Revascularisation was successful in 84 (64 male, 20 female) of 124 (92 male, 32 female) patients. Therefore, success rate was 67.7% (69.9% in men, 62.5% in women, p = 0.42). Target vessel was the left anterior descending artery (LAD) in 49 cases. Success rate in the LAD did not differ significantly from that in "non-LAD"-vessels (65.3% versus 69.3%; p = 0.35). Successful recanalizations were performed using only one guide-wire in 77.3%. More than one guide-wires were used during procedures without success in 44.5% and exceeded use in successful interventions (p < 0.05). Procedures, failing to be successful after an attempt with a first guide-wire, could be performed successfully using at least a second wire in 50%. Coronary stenting after recanalization has been performed in 84.4% in the LAD and in 59.7% in non-LAD vessels (p < 0.01). Success rate of attempted recanalizations of chronic occluded coronary arteries in unselected patients is high. Most procedures can be performed successfully using only one guidewire. Additional use of other wires can increase success rates in procedures with primary failure to pass the occlusion. Stenting has been performed in three out of four patients with successful recanalization of chronically occluded coronary arteries.     

Fibrofatty changes in the muscles in arterial occlusions of the extremities

Widespread muscle alterations in the form of partial or full muscle fiber replacement by the fibrofatty tissue within the borders of the fascial sheath with the retention of the volume and topography of the muscles are observed in the obliterating atherosclerosis of the lower limbs arteries. These alterations are connected with a slowly progressing degenerative process due to chronic ischemia. The limb with a fibrofatty replacement (FFR) of the muscles is more resistant to the gangrene resulting from acute occlusion of the main arteries. The FFR should be correctly interpreted and considered when acute arterial occlusion of the lower limbs is diagnosed.     

Treatment of patients with chronic idiopathic urticaria

Treatment of patients with chronic idiopathic urticaria (CIU) involves reducing symptoms with the least invasive therapy and carefully balancing risk and benefit. The mainstay of therapy is the use of antihistamines with or without the use of intermittent pulses of corticosteroids. Alternative therapies to chronic corticosteroids include leukotriene antagonists, plasma-phoresis, dapsone, stanazolol, hydroxychloroquine, methotrexate, cyclosporin, tacrolimus, and warfarin. A practical approach to CIU bases treatment and severity on the patients' previous response to therapy. Therapy goals are to reduce symptoms until spontaneous resolution occurs. Management of CIU patients can be both frustrating and rewarding.     

Treatment of chronic idiopathic urticaria with terfenadine

The usefulness of antihistamines is impaired by their sedative side effects. In a double blind crossover study of twenty-four patients with chronic idiopathic urticaria, we have found terfenadine to be a non-sedative and highly effective drug.