Evaluation at patients with ventricular arrhythmias and coronary artery disease of myocardial revascularization effects.

UNLABELLED: The aim of this study was to determine the relations between myocardial revascularization therapy--coronary artery bypass graft (CABG) and coronary angioplasty (PTCA)--and ventricular potentially malignant arrhythmia (VPMA) (coupled VPC, VPC > 10/hour, NSVT--Morganroth classification), in patients (pts) with stable CAD. METHODS: 765 patients with stable angina and ventricular potentially malignant arrhythmia were evaluated angiochoronarographically, echographically, by programmed electrical stimulation (PES), standard ECG, Holter ECG, radiologically, and by stress test. From 765 patients with CAD and VPMA 169 pts. (22.9% of cases) were revascularized, 77 pts. (10.06% of cases) by CABG surgery and 82 pts. (10.71% of cases) by PTCA with or without stenting. RESULTS: From pts. with inducible sustained ventricular tachycardia by programmed electrical stimulation PES + (129 pts. 16.86% of cases), 19 pts. (2.5% of cases) were with CABG vs 9 pts. (1.17% of cases) with PTCA (p > 0.05). In 333 pts. with arrhythmogenic myocardic ischemia detected by Holter ECG/24 hours (Holter +) the distribution of myocardial revascularization was similar (40 pts., 5.22% of cases with CABG vs 46 pts., 6.01% of cases with PTCA) (p > 0.05). The study included 225 pts. with positive stress test, 45 pts. were revascularized, 18 pts. (2.35% of cases) with CABG and 27 pts. (3.52% of cases) with PTCA (p > 0.05). Revascularized pts. represent an increased percent with prior myocardial infarction in the subgroup with CABG vs. PTCA (39% of cases, p < 0.05 vs. 25% of cases, p < 0.05). Revascularized pts. presented similar distributions of VPMA in subgroups with CABG and PTCA. CONCLUSIONS: VPMA was not influenced by myocardial revascularization, CABG or PTCA, the incidence being similar (50.94% vs 47.2%; p < 0.05) with pts. drug treated.

Microcoil embolization for ablation of septal hypertrophy in hypertrophic obstructive cardiomyopathy.

BACKGROUND: Percutaneous transcatheter occlusion with ethanol injection of septal arteries is an efficient treatment procedure of hypertrophic obstructive cardiomyopathy (HOCM). The aim of our study is to evaluate the feasibility and efficiency of septal artery embolization with microcoils. METHODS: The microcoils were delivered through the guide-wire lumen of a 2mm-diameter coaxial balloon positioned inside the target vessel as distally as possible. One or more 0.018"-straight microcoils (Hilal straight coils, Cook, USA) were used for each target vessel until complete flow obstruction was noted. The intraventricular pressure gradient was measured before, during and after the procedure. Septal branch occlusion was finally documented by coronary angiography. RESULTS: We treated 7 patients (pts) (male: 5 pts; mean age: 48 (10 years). All patients were symptomatic (NYHA class 3 or 4). The target vessels were successfully occluded in all patients, without complications. Moderate pain was recorded during and after the procedure and the CK level increased five- to ten-fold. The pressure gradient diminished during the procedure from 72 +/- 21 mm Hg to 30 +/- 15 mm Hg. The number of coils delivered ranged from 3 to 7 / patient. The embolized septal branches: 1 vessel in 5 patients; 2 vessels in 1 patient; 3 vessels in 1 case. After the procedure the pressure gradient, evaluated by transthoracic echocardiography, was 34 +/- 16 mm Hg and 42 +/- 12 mm Hg at 3 month-follow-up. Clinical improvement was recorded in all patients after the procedure (NYHA class 1 or 2). Temporary pacing was necessary in 3 patients during and immediately after the procedure but no patient needed permanent pacing. CONCLUSIONS: Microcoil embolization is an efficient and safe approach for transcatheter ablation of septal hypertrophy in HOCM. This technique induced myocardial necrosis without the toxic effects of alcohol, reducing the risk of complications (permanent pace-maker implantation, ethanol flow to other myocardial regions).

[The epidemiological aspects and prevalence of markers in those with viral hepatitis C in some population categories in 1994-1997 in Iasi County]. / Contributii la cunoasterea unor aspecte epidemiologice si a prevalentei posesorilor de markeri pentru virusul hepatitei C, în unele categorii populationale, în perioada 1994-1997, în judetul Iasi.

The results of the epidemiological, clinical and laboratory investigations, carried out in the 1994-1997 interval in the Iasi district, on various populational groups, to indicate the prevalence of the antibodies anti-HVC possessors are presented. In 3611 patients with clinical-epidemiological HCV diagnosis, it was recorded a prevalence of the anti-HCV antibodies (AcHCV) presence of 22.7%. Posttransfusional hepatitis, epidemiologically diagnosed in 205 hospitalised patients was attributed to HCV in 11.6% of the cases, and in 94 patients with neurological diseases, AcHCV were identified in 9.6%. The presence of AcHCV at 825 persons in medico-sanitary staff, from risk domains, has recorded a prevalence of 8.0%. In the January 1997-September 1997 interval, the investigation by IIIrd generation ELISA of 51,149 blood samples of donors from various areas indicated the presence of AcHCV with an interval average of 2.6%.

[Seroepidemiological considerations of the incidence of viral hepatitis C in some population groups]. / Consideratii sero-epidemiologice privind incidenta hepatitei virale C în unele grupuri populationale.

In the interval 1985-1994, in the Iasi district, the reported cases of viral hepatitis (VH) have recorded annual morbidity rates ranging between 67/100,000 inhabitants in 1993 and 373/100,000 in 1990. VH attributed to HAV and HBV has represented, with yearly differences, 62% to 94% of all cases. Posttransfusion viral hepatitis (PTVH) has determined a morbidity of 0.51/100,000 inhabitants in 1986 and 8.34/100,000 in 1994. PTVH without AgHBs ranged from 16.3% in 1993 to 94.0% in 1987, as compared to 6.0% in 1987 and 1988 and 75.0% in 1985 for PTVH with AgHBs. In the interval under study 70.9% of the PTVH cases were most likely determined by HCV and 28.9% by HBV (AgHBs+). From all PTVH cases, 64.0% were from urban areas, 59.3% were females, 92.5% belonged to over 20 years age groups, and 31.3% were industrial workers, the remainder belonging to other 5 occupational groups. In 241 patients (18.2%) admitted for liver disorders, posttransfusion hepatitis included, AcHCV was present in 39.4%, of which 45.2% belonged to the age groups 20-60 years. The results of some investigations carried out on 4471 blood donors (72.4% males, 85.4% aged between 21 ad 50 years, 86.4% from urban areas, 62.1% workers in industry and building) are presented. Out of these, 217 (4.9%) presented to hepatitis C virus (AcHCV). Occupational distribution of AcHCV possessors shows that 44.2% are workers in the heavy industry, 14.8% in the light industry and 12.9% unemployed. Sera were tested by Monolisa New Antigens, and those with AcHCV were reassessed with Monolisa, Murex anti HCV, ORTO-HCV 3.0 and confirmed by Immunoblot DECISCAN, with 5 antigens.

[The clinico-anatomical aspects of myasthenia gravis]. / Aspecte clinico-anatomice în miastenia gravis.

Based on muscle biopsies from 3 patients with stage II myasthenia gravis, the morphological alterations of the neuromuscular junction and the enzymatic disorders in the muscle fibres are studied. Abnormalities in the structure of nerve-endings (tumescence, irregularities and elongations of the fibres), more collaterals for the axon and motor plate, lymphocytic infiltrates, presence of antibodies for striated muscle fibre, rendered evident by immunofluorescence, were found. The enzymatic alterations (ATP-ase, succinyl dehydrogenase) induce a disturbance in the muscular energy metabolism.