Experiences in the invasive treatment of acute coronary syndrome

INTRODUCTION: Primer percutaneous coronary intervention is a very powerful tool in the treatment of acute coronary syndrome. The aim of the authors was to work out and analyse the methods of making the upto-date percutaneous coronary intervention available for patients living far from the Heart Institute. PATIENT AND INTERVENTIONS: Between 1st January 2000 and 31st October 2002, 221 patients with acute coronary syndrome were sent to intensive treatment from Kaposvár to the Heart Institute in Pécs partly by helicopter. The average age of patients was 54 years. 103 of them with acute myocardial infarction and 118 others with unstable angina were catheterised. Revascularization was achieved in 133 cases, and coronary operation in 63 cases. Primary intensive therapy was applied on 34 patients with infarction. RESULTS: No lethal complications arose during transport or operation. Mortality rate coming from cardial complications was only 4% during the first two years. These results are based on well organised cooperation between the Department of Internal Medicine Kaposvár and Heart Institute Pécs. CONCLUSION: Given suitable logistic background and adequate indication the risk of transporting patients can be taken. The percutaneous coronary intervention proved to be successful.     

New methods for the diagnosis of acute pulmonary embolism

INTRODUCTION: Pulmonary embolism is a high mortality cardiovascular disease, which is difficult to diagnose even today. AIM AND METHOD: In this study the symptoms and the results of diagnostic methods were analysed in 81 patients with acute pulmonary embolism, admitted during a one-year period to Kaposi Mór County Hospital. The patient records were examined with special emphasis on the diagnostic value of novel methods such as D-dimer assay and chest computed tomography scanning along with the routine techniques used in the management of pulmonary embolism. RESULTS: In all patients ECG, in 88% of the cases chest X-ray, in 57% blood gas analysis and in 53% D-dimer assay results were evaluated. 14.8% of the patients died during hospitalisation. The following diagnostic imaging procedures were undertaken: in 80.2% of the cases lung scan, in 59.3% echocardiography and in 8.7% of the cases spiral computed tomography scan were prepared. In 12.3% of all cases thrombolysis proved necessary. The results were compared with data from International Cooperative Pulmonary Embolism Registry Study, which analyses 2454 patient cases. CONCLUSION: It is foreseen that the increasing use of echocardiography, lower limb ultrasound and highly informative spiral computed tomography scanning as an additional means in pulmonary embolism diagnostics may in some cases spare the use of pulmonary scintigraphy.     

Struma ovarii coexisting with mucinous cystadenoma detected by radioactive iodine

The authors describe a case of struma ovarii coexisting with mucinous cystadenoma. Ultrasonography and magnetic resonance imaging showed a multilocular cystic mass with a solid component. The ovarian tumor demonstrated uptake of I-123 sodium iodide, allowing a preoperative diagnosis of struma ovarii. In women with an unexplained increase in thyroid function and low I-123 uptake in the cervical thyroid gland, scintigraphy of the pelvis should be considered.     

Complications during epilepsy surgery. Experience after 102 interventions between 1997 and 2001

OBJECTIVES: To describe perioperative complications in different approaches to surgery for epilepsy. PATIENTS AND METHODS: All patients undergoing surgery related to epilepsy between January 1997 and December 2001 were studied. We gathered information on patient characteristics, diagnosis, anticonvulsant treatment, surgical procedure, type of anesthesia and perioperative complications. RESULTS: Ninety-eighty patients underwent 90 procedures under general anesthesia and 12 procedures with local anesthesia and sedation. Surgery was for anteromedial temporal resection in 74 patients, electrode implantation through the foramen ovale in 10 patients, extratemporal excisions in 7 patients, callosotomy in 3 patients, functional hemispherectomy in 3 patients, implantation of electrode grids in 2 patients, and craniotomy with an awake patient in 3 cases. Complications related to the surgical procedure were intraoperative bradycardia (5 cases), dural tension at the start of surgery (3), bleeding (2) and seizure (1). Complications related to anesthesia were bronchospasm (2 cases), histamine-releasing reaction upon administration of the muscle relaxant (1), and difficult intubation (1). During recovery we saw 1 case of postoperative aphasia, 1 of polyuria, 1 of pulmonary condensation, and 1 of factor VII deficit requiring plasma transfusion. CONCLUSIONS: The rate of perioperative complications in surgery for drug-resistant epilepsy is low, the most common complication being self-limiting bradycardia related to surgical maneuvers.     

Visualization of pulmonary arteriovenous malformation by three dimensional computed tomography: a case report

Pulmonary arteriovenous malformation (PAVM) is an anomaly condition characterized by abnormal vascular communications between arteries and veins in the lungs. Hereby we describe a 60-year-old female with PAVM. Although the patient was asymptomatic, an abnormal round opacity was found on a chest X-ray film. Computed tomography (CT) of the lung disclosed nodules connected with enlarged vessels. Because PAVM was suspected, the patient was further evaluated by spiral CT coupled with three dimensional reconstruction of the images (3D-CT). As a result, PAVM was clearly visualized and invasive procedures such as angiography was not performed. The present case illustrates that 3D-CT is a diagnostic procedure of choice when PAVM is suspected.     

Combination chemotherapy with irinotecan and ifosfamide as second-line treatment of refractory or sensitive relapsed small cell lung cancer: a phase II study

This phase II study was conducted to investigate the efficacy and safety of irinotecan (CPT-11) and ifosfamide as second-line chemotherapy for relapsed small cell lung cancer (SCLC). Eligibility criteria included histologically or cytologically confirmed SCLC, prior chemotherapy including platinum + etoposide, and measurable or evaluable disease. CPT-11 (80 mg/m(2)) was administered intravenously on days 1, 8 and 15, while ifosfamide (1.5 g/m(2)) was given on days 1 through 3 every 4 weeks. Thirty-four patients (29 men) with a median age of 69 years (range 42-77) and a median Eastern Cooperative Oncology Group (ECOG) performance status of 1 (range 0-2) were enrolled. The response rate was 52.9% (95% confidence interval: 29.8-64.9%) with 2 complete responses and 16 partial responses. Our analyses of prognostic factors showed risk factors assessed before receiving second-line chemotherapy, which were the number of metastatic sites, performance status and the type of relapse. WHO grade 3-4 neutropenia was recorded in 52.9% of the patients, grade 3 diarrhea in 5.9%. The combination of CPT-11 and ifosfamide demonstrated clinical efficacy in relapsed SCLC with a favorable toxicity profile, particularly for performance status 0-1 and sensitive cases with only one metastatic site.     

Crossover learning of gestures in two ideomotor apraxia patients: A single case experimental design study

Crossover learning may aid rehabilitation in patients with neurological disorders. Ideomotor apraxia (IMA) is a common sequela of left-brain damage that comprises a deficit in the ability to perform gestures to verbal commands or by imitation. This study elucidated whether crossover learning occurred in two post-stroke IMA patients without motor paralysis after gesture training approximately 2 months after stroke onset. We quantitatively analysed the therapeutic intervention history and investigated whether revised action occurred during gesture production. Treatment intervention was to examine how to influence improvement and generalisation of the ability to produce the gesture. This study used an alternating treatments single-subject design, and the intervention method was errorless learning. Results indicated crossover learning in both patients. Qualitative analysis indicated that revised action occurred during the gesture-production process in one patient and that there were two types of post-revised action gestures: correct and incorrect gestures. We also discovered that even when a comparably short time had elapsed since stroke onset, generalisation was difficult. Information transfer between the left and right hemispheres of the brain via commissural fibres is important in crossover learning. In conclusion, improvements in gesture-production skill should be made with reference to the left cerebral hemisphere disconnection hypothesis.