Experience with using balloon dilatation of the coronary arteries

The paper presents the analysis of balloon dilations of the coronary arteries in 18 patients with ischemic heart disease. A multimodality clinical examination of the patients involving provocative tests and echocardiography is recommended to be performed both preoperatively and postoperatively.     

Injuries of the spine and spinal cord associated with other injuries]

In the article is presented an analysis of treatment of 28 patients with wounds of spine and spinal cord, associated with the other extravertebral damages. The author considers these wounds to be the most severe damage and treatment of patients of the kind should be performed with participation of the related specialists, provided with the urgent complex, instrumental examination and with due regard for the degree of criticism of wounded person. Methods and terms of treatment are strictly individual with regard to the degree of criticism of spine and associated injury.     

Subcutaneous chronic implantable defibrillation systems in humans

The recent introduction of subcutaneous implantable cardioverter defibrillator (S-ICD) has raised attention about the potential of this technology for clinical use in daily clinical practice. We review the methods and results of the four studies conducted in humans for approval of this innovative technology for daily practice. Two studies using a temporary S-ICD system (acute human studies) were conducted to search for an appropriate lead configuration and energy requirements. For this purpose, 4 S-ICD configurations were tested in 78 patients at the time of transvenous (TV)-ICD implantation. The optimal configuration was tested in 49 more patients to comparatively assess the subcutaneous defibrillation threshold (S-DFT) versus the standard TV-ICD. Long-term implants were evaluated in 55 patients using an implanted system (chronic human study). The acute humans studies led to an optimal S-ICD configuration comprising a parasternal electrode and left anterolateral thoracic pulse generator. Both configurations successfully terminated 98% of induced ventricular fibrillation (VF), but significantly higher energy levels were required with S-ICD than with TV-ICD systems (36.6?±?19.8 J vs. 11.1?±?8.5 J). In the chronic study, all 137 VF episodes induced at time of implant were detected with a 98% conversion rate. Two pocket infections and four lead revisions were required during 10?±?1 months of follow-up. During this period, survival was 98%, and 12 spontaneous ventricular tachyarrhythmias were detected and treated by the device. These data show that the S-ICD systems here consistently detected and converted VF induced at time of implant as well as sustained ventricular tachyarrhythmias occurring during follow-up (248).     

Fibrinolytic therapy of patients with pulmonary artery thromboembolism by tissue plasminogen activator and streptokinase preparations

Changes in clinical and hemodynamic indices, hemostatic system during therapy with plasminogen tissue activator and streptokinase drugs were studied in 49 patients with massive and submassive forms of pulmonary thromboembolism. Conduction of fibrinolytic therapy with plasminogen tissue activator vs streptokinase produced more marked and rapid change in the main hemodynamic parameters which characterized blood recovery in pulmonary artery. A correlation was revealed between the change in hemostatic system after thrombolytic therapy and development of hemorrhagic complications. Preferable introduction of plasminogen tissue activator is shown when thromboemboli locate in the trunk or in both main pulmonary arteries and in the presence of an occlusive lesion in lobular arteries.     

Serum Ornithine Carbamoyl Transferase as a Surrogate Marker in Malaria

Ornithine carbamoyl transferase (OCT) activity and other liver function tests were studied in a total of 50 patients of clinical malaria and 15 controls. They were grouped as group I (positive for malarial parasite on peripheral blood smear, n=18), group II (negative for malarial parasite on peripheral blood smear (PBS) but responded to antimalarials, n=17) and group III (peripheral blood smear negative and did not respond to antimalarial therapy, n=15). The mean OCT levels were significantly raised in group I (6.79 ± 1.84 IU/L, p value = 0.006) and group II (5.0 ± 1.15 IU/L, p value = 0.014) as compared to controls (2.5 ± 1.13 IU/L) and returned to normal after treatment In contrast, group III had normal levels except in a case of kala azar and septicemia where OCT levels were high and increased further on treatment. Taking PBS positivity as a gold standard of diagnostic criteria, OCT had a sensitivity of 83% and specificity of 86% with a high positive predictive value of 88% as compared to ALT which had a lower sensitivity of 55% and specificity of 80%. The clinical response rate in PBS negative cases of fever having high OCT level was 83% as compared to 35% in cases with normal OCT level, making OCT a good surrogate marker of malaria. OCT levels could also be of prognostic significance as 2 cases of cerebral malaria had high OCT levels of 11.1 UAL and 10.7 IU/L, respectively.Key Words: Malaria, Ornithine carbamoyl transferase