Prolonged application of pressure in transluminal coronary angioplasty

We investigated the morphologic structure and fluid content of atherosclerotic specimens of fresh human postmortem artery segments before and after application of a pressure of 5 atmospheres simulated by a weight of 5 kg per 1 cm². After applying pressure in nonorganized atheromata, we noticed a marked reduction in thickness while in fibrotic atheromata we observed only smaller differences in thickness. Reduction in fluid content was significantly more pronounced in nonorganized atheromatous tissue. Reduction in thickness was closely related to reduction in weight (i e, fluid content). The time of pressure application necessary to achieve the optimal result averaged 60 sec. The conclusions drawn from these experiments were incorporated into clinical application of coronary angioplasty. Prolonged balloon inflation was applied to the last 400 out of a total of 600 coronary angioplasty procedures, performed between October 1977 and October 1983. Stenoses not sufficiently responsive to balloon inflation periods of 5–10 sec were exposed to periods of 60 sec (30–120 sec). The number of “non dilatable” stenoses was 15% with the standard short pressure procedure, but only 5% with the prolonged pressure application. No serious complications related to prolonged pressure application were observed. Thus, from experimental data and clinical experience the application of longer pressure periods appears justified and beneficial.     

Hyperparathyroidism in the elderly

Primary hyperparathyroidism seems to be increasing in incidence in elderly patients. Their symptoms are somewhat different from those encountered in younger patients, the most striking difference being the increase in the number of patients with mental changes. Twenty-nine patients, 23 women and 6 men, were treated at two community hospitals. Surgery was successful in all instances with no postoperative mortality and a low rate of complications. When properly evaluated, elderly patients tolerate parathyroid exploration very satisfactorily.     

Steroid hormone receptors and prognosis in breast cancer

Summary The importance of steroid receptors for the prognosis of mammary carcinoma has been evaluated by investigating the course of disease in 163 patients for a median follow up time of 66 months after mastectomy. Multivariate analysis including estrogen receptor (ER), progesterone receptor (PgR), the presence of 8S and 4S ER together or 4S ER only, and the lymph node status revealed only the latter to have significant (p<0.001) predictive potency. Lymph node positive (N-pos) patients had a 3.3 (1.7–6.2) fold risk of death and 2.8 (1.7–4.7) fold risk of recurrence relative to node negative (N-neg) patients.When we compared overall survival (OAS) and disease-free survival (DFS) in the various receptorpositive groups with the groups that displayed neither ER nor PgR, significant differences in prognosis were only seen in N-neg patients. PgR did not turn out to be a better prognostic factor than ER, nor was the 8S ER a sing of increased OAS and DFS compared to total ER. However, the number of patients in this group was too small to allow a definite statement.     

Intestinal injuries in rectosigmoidoscopy in expert opinion

Based on criteria of evaluation in the field of rectoscopy, questions are derived which concern expert opinions on rectal lesions during rectoscopy. Excluding a dereliction, the authors take the view that, owing to the rare occurrence of rectal perforations in the course of an instrumental examination of the rectum, criteria can now be given in each case for applying the law on the extended material support of persons in the case of lesions due to surgical operations.