[Clinical aspects of arteriosclerotic stenosis of the left coronary artery main stem]. / A bal koszorúsér fötörzs arteriosclerotikus szükületének klinikai jellemzöi.

Authors have found 37 significant (greater than 50%) or severe (greater than 75%) cases of left main stem stenosis (LMS) (3.4%, 35 male and 2 female) during 1097 consecutive selective coronarography. Retrospective analysis of the clinical data of the 35 male pts. showed severe effort or resting anginal complaints in the 2/3 of the pts., however this was not in tight connection with the degree of the LMS stenosis or the number of associated peripheral coronary stenoses respectively, similar to the ischaemic disorders of the resting ECG. In the bycicle ergometry ECG data lone the double index showed statistically significant difference between the groups of less than or equal to 2 and 3 vessel diseases connected to the severe LMS. Myocardium scintigraphy was performed out in 6 pts., all of them has given positive result. They emphasise the necessarity of urgent revascularisation against the higher risk of the intervention because of the pour results of the medical treatment.

[Late post-infarction angina]. / A késöi postinfarctusos angina.

The authors survey the clinical features and therapeutic results of 88 patients suffering from late postinfarctional angina. The results of the bicycle ergometer ECG tests were negative only in the case of 8 patients. Exercise-induced silent myocardial ischaemia was registered in 45.4%. Coronary angiography revealed that 54 (61%) of the patients suffered from multivessel disease. Coronary bypass surgery was carried out in 56.8% and the rate of peripheral anastomoses was 3.1/patient. The authors consider it to be essential to detect the ischaemia in the infarct survivors with chest pain. Taking into consideration the clinical feature and the results of exercise tests, the authors propose cardiac catheterization. Myocardial revascularization is recommended if the medical therapy is not successful or the patients suffered from left main, triple-vessels disease and the myocardium is jeopardized to a large extend.

A study of plasma and cardiac tissue concentrations of ceftriaxone (Rocephin) in open heart surgery.

Postoperative infection following cardiac surgery procedures is a serious complication. Cephalosporines are frequently used in prophylaxis. The aim of this study was to determine whether adequate therapeutic concentrations of ceftriaxone were present in cardiac tissues and plasma after 2 g single dose administered intravenously. Twenty-four consecutive patients undergoing open heart surgical procedures enrolled in the study. The antibiotic concentration was measured by agar well diffusion method. Samples of plasma were taken simultaneously of tissue removal in order to determine the antibiotic penetration. Tissue concentrations in the cardiac appendage, in the mitral and aortic valves and in the vessels of the graft exceeded MIC of the anticipated pathogens and especially high concentration was detected in pericardiac tissue during the time of operation. Therapeutic level was achieved against only certain strains of Pseudomonas.

Monitoring of the plasma concentration of a beta blocker with retarded effect (Slow Trasicor, 160 mg) in humans.

The plasma oxprenolol concentrations were measured in nine cases for 3 days following the application of 1 dragee (160 mg) daily of Slow Trasicor (CIBA). Blood sampling was carried out at the 1st, 6th, 12th, and 24th h during the 1st day, and at the 12th and 24th h during the 2nd and 3rd days, respectively. Oxprenolol reached a considerable plasma level already after the 1st h: 140 ng/ml on the average during the 1st day. The average concentrations were 284 and 202 at the 6th and 12th h, respectively. It decreased to 43 ng/ml by the 24th h. During the 2nd and 3rd days 124 and 122 ng/ml values were found at the 12th h, and 42 and 50 ng/ml at the 24th h. The results of these studies prove the good absorption of Slow Trasicor, as well as its prolonged presence in the plasma. The corresponding clinical improvements in the patients indicate the therapeutic effect of the plasma levels.

Data on sisomicin effect: human pharmacokinetic and bacteriological studies.

Antibiotic sensitivity of bacteria cultured from 1020 pulmonological, medical and surgical cases was determined. Inhibitory effect on the bacterial growth was observed most frequently with sisomicin among the antibiotics of aminoglycoside type. Sisomicin levels were studied in the serum and lung tissue in 20 cases of pulmonary operations. Fifty to ninety minutes subsequent to an intramuscular administration of 1 mg sisomicin per 1 kg body weight, the serum levels amounted to 4.0 mcg/ml, whereas the apparently healthy, the inflamed and tumourous parts of the removed lung tissue contained 2.2, 1.2 and 0.2 mcg/g. The serum level remained unchanged even after 110-150 min, when the lung tissue levels were 3.0, 1.5 and 2.1 mcg/g. The sisomicin concentrations found in the lung tissue are of bactericid effect only against a part of the bacteria studied. This fact emphasizes the importance of exact indication and use of doses of sisomicin.

Amikacin: in vitro bacteriological studies, levels in human serum, lung and heart tissue, and clinical results.

The amikacin sensitivity of bacteria cultured from 3282 clinical cases of mixed type was determined. Gentamicin and amikacin were equally effective against E. coli strains. Amikacin inhibited the growth of more Pseudomonas aeruginosa strains than did gentamicin. Against Gram-positive bacteria gentamicin proved to be more effective. Many of the gentamicin-resistant strains were sensitive to amikacin. Amikacin levels were measured during 21 pulmonary and 14 heart operations, subsequent to a intramuscular administration of 500 mg amikacin. The serum contained 17-20 microgram/ml amikacin, in the intact, inflamed and tumourous parts of removed lung tissue 9, 6 and 6 microgram/g concentrations were detected, respectively, whereas the cardiac auricle and the pericardial fluid contained 3-4 and 2-4 microgram/ml, respectively. These amikacin levels reach or in most cases even exceed the minimal inhibiting concentrations against the bacteria. Therefore, amikacin is excellent for the treatment of respiratory infections, pericarditis and endocarditis caused by Gram-negative, gentamicin-resistant bacteria. Amikacin treatment of 8 patients with grave diseases as well as the successful local administration of amikacin based on the therapy of 55 cases of surgical suppurations is reported.