The twisted structure of the Achilles tendon unraveled: A detailed quantitative and qualitative anatomical investigation.

The Achilles tendon (AT) consists of fibers originating from the soleus muscle (SOL), which lies deep, and the medial (GM) and lateral (GL) heads of the gastrocnemius muscle, which lie superficial. As the fibers descend toward the insertion of the AT, the individual subtendons twist around each other. The aim of this study was to investigate the twisted structure of the AT and its individual subtendons. Specimens of the AT, with preserved calcaneal bone and a fragment of the triceps surae muscle, were obtained from 53 fresh-frozen, male cadavers (n=106 lower limbs). The angle of torsion of each of the AT's subtendons was measured using a specially designed and 3D-printed tool. The mean distance between the most distal fibers of the triceps surae muscle and the superior border of the calcaneal bone was 60.77±14.15 mm. The largest component of the AT at the level of its insertion into the calcaneal bone is the subtendon from the GL (44.43%), followed by the subtendon from SOL (27.89%), and the subtendon from GM (27.68%). The fibers originating from the GM rotate on average 28.17±15.15°, while the fibers originating from the GL and SOL twist 135.98±33.58° and 128.58±29.63°, respectively. The torsion of superficial fibers (GM) comprising the AT is significantly lower than that of deeper fibers (GL and SOL). The cross-sectional area of the AT is smaller at the level of the musculo-tendinous junction than at the level of its insertion. This study illustrates the three types of the AT with differently twisting subtendons, as well as a generalized model of the AT. Types of AT torsion may potentially alter the biomechanical properties of the tendon, thus possibly influencing the pathophysiologic mechanisms leading to the development of various tendinopathies.

Circulating endothelial progenitor cells are inversely correlated with in-stent restenosis in patients with non-ST-segment elevation acute coronary syndromes treated with EPC-capture stents (JACK-EPC trial).

AIM: Aim of the study was to evaluate the association between circulating endothelial progenitor cells (EPCs) and angiographic outcomes after implantation of GenousTM stent in patients with non-ST-segment elevation acute coronary syndromes (ACS) (NSTE-ACS) undergoing urgent percutaneous coronary intervention (PCI). METHODS: Sixty patients treated with EPC-capture stent (N.=30) or bare metal stents (BMS) (N.=30) receiving 80 mg atorvastatin and dual antiplatelet therapy (DAT) for 12 months. Restenosis was assessed after 6 months by quantitative coronary angiography (QCA) and major acute coronary events (MACE) evaluated after 6 and 12 months. INCLUSION CRITERIA: de novo lesion >70% in native vessel, diameter 2.5-4 mm, lesion length <30 mm. EXCLUSION CRITERIA: diabetes, previous revascularization, significant left main stenosis, chronic total occlusions (CTO) and multivessel disease. RESULTS: Majority of patients in EPC-capture stent and BMS groups presented with NSTEMI (73.3% and 70%, respectively). Mean stent length was 20.1±8 and 19.9±10 mm, diameter 3±0.97 and 3.1±0.88 mm in respective groups. The binary restenosis was significantly lower in GenousTM (13 vs. 26.6%, P=0.04). Risk of MACE after 6 and 12 months were comparable in both groups. There was no stent thrombosis. Numbers of circulating EPCs were significantly approximately 2-fold higher during the ACS than after 6 months. Mobilization of EPCs during acute ischemia was significantly lower in patients who developed restenosis after 6 months (3 vs. 4.5 cells/µL, P=0.002) and it was negatively correlated with late-loss after 6 months (R=-0.42; P<0.03). CONCLUSION: Use of GenousTM stents in NSTE-ACS is associated with lower restenosis rate than BMS at 6 months. There was no ST through 1 year. The number of circulating EPCs is inversely correlated with in-stent late loss (LL).

Selectin-P and interleukin-8 plasma levels in coronary heart disease patients.

BACKGROUND: Alterations of the immune system are now believed to play crucial role in the pathogenesis of atherosclerosis. The aim of this study was analysis of soluble forms of selectin-P and interleukin-8 levels in patients with different form of coronary heart disease. MATERIALS AND METHODS: In the study took part 18 patients with stable coronary heart disease, 20 patients with unstable coronary heart disease and 15 healthy persons from control group. Soluble selectin-P and interleukin-8 levels were measured in EDTA plasma with the use of enzyme immunoassay ELISA. RESULTS: The level of soluble selectin-P was significantly higher in unstable coronary heart disease patients in comparison to the stable coronary heart disease patients (P < or = 0.01) and nonsignificantly higher in comparison to the control group. The level of interleukin-8 were significantly higher in unstable coronary heart disease patients in comparison to the stable coronary heart disease patients (P < or = 0.01) and in comparison to the control group (P < or = 0.02). CONCLUSION: Our findings suggest that soluble form of selectin-P and interleukin-8 may be useful clinical predictors of unstable coronary heart disease. The assessment of the risk for the development of coronary heart disease requires further serial investigation.

Overview of the results of recent beta blocker trials.

Results of the studies published or reported within the last 2 years provide convincing evidence that beta-blockers can decrease mortality in patients with chronic symptomatic heart failure because of left ventricular systolic dysfunction. The Cardiac Insufficiency Bisoprolol Study (CIBIS)-II and Metoprolol CR/XL Randomised Intervention Trial in Congestive Heart Failure (MERIT-HF) trials showed a 34% reduction in all-cause death with bisoprolol and metoprolol therapy in patients with class II-III heart failure. Data from Carvedilol Prospective Randomized Cumulative Survival (COPERNICUS), with a 35% mortality reduction, extended this benefit to class IV patients treated with carvedilol who do not require intravenous diuretics or positive inotropes. Ongoing beta-blocker studies address new topics, such as treatment of older patients, in whom diastolic heart failure may be more common, and direct comparison of different drugs. Although the use of beta-blockers for heart failure tends to increase, implementation of the knowledge from the trials in clinical practice still remains a challenge.

[Subjective quality of life in patients with coronary artery disease after percutaneous coronary angioplasty in elderly patients after 65 years of age]. / Subiektywna ocena jakosci zycia chorych na chorobe wiencowa poddanych przezskórnej angioplastyce wiencowej po 65 r.z.

UNLABELLED: The aim of our study was to determine the quality of life in elderly patients after PTCA using the SF 36 questionnaire measuring post procedural physical and mental health. STUDY GROUP: 71 pts > 65 years (M-46, F-25), mean age 70.92 +/- 3.49, post PTCA were examined with SF 36 questionnaire. CONTROL GROUP: 73 pts < 65 years (M-61, F-12) mean age 53.6 +/- 7.37, post PTCA. The mean follow-up time was 19.3 +/- 3.2 month in the study group and 18.8 +/- 8.5 month in the control group (NS). The mean physical component summary score was 67.2 vs 69.7 points (NS) in the control group. The mean mental component summary score was 72.3 vs 74.4 points (NS) respectively. There were no significant differences between the groups in the following multi item domains: general health, vitality, social functioning, emotional role functioning and mental health, except physical functioning: 73.5 vs 76.3 points, p < 0.008 respectively. Additional questions asked revealed high satisfaction with performed PTCA, similar in both groups: 65 pts (91.6%) vs 71 pts (98.6%) (NS). 70 (99%) elderly pts considered this method most valuable and would undergo this procedure eagerly again, if necessary. During the observation 21 (29.6%) elderly pts required hospitalization because of the chest pain, 2 pts (2.8%) had nonfatal myocardial infarction and 3 pts (4.2%) underwent surgical revascularisation (CABG). In the control group 12 pts (16.4%) were re-hospitalized, 1 pt (1.4%) required CABG and no acute cardiac events were observed. Smoking was continued significantly more frequently in the younger pts: 12 (16.4%) vs 2 (2.8%) p = 0.05. 72 (98.6%) younger pts and 60 (84.5%) elderly pts reported regular cholesterol level control (NS). Our data suggest that PTCA in elderly pts with symptomatic coronary artery disease, is well tolerated and reflects positively in their quality of life after the procedure.

[Long-term observation of exercise capacity and left ventricular function in patients with coronary heart disease treated surgically and conservatively]. / Odlegla obserwacja wydolnosci wysilkowej i funkcji skurczowej lewej komory serca u pacjentów z choroba wiencowa leczonych operacyjnie i zachowawczo.

[1] CASS Principal Investigators and their Associates.: Coronary Artery Surgery Study (CASS): a randomized trial of coronary artery bypass surgery. Survival data. Circulation 1983; 68: 951-960. [2] Danchin N i wsp. Effect of late percutaneous angioplastic recanalization of total coronary artery occlusion on left ventricular remodeling, ejection fraction, and regional wall motion. Am J Cardiol 1996; 78: 729-735. [3] Dilsizian V i wsp.: Enhanced regional left ventricular function after distant coronary bypass by means of improved collateral blood flow. J Am Coll Cardiol 1989; 14: 312-318. [4] European Coronary Surgery Study Group.: Long-term results of prospective randomized study of coronary artery bypass surgery in stable angina pectoris. Lancet 1982; 27: 1173-1183. [5] Frick MH, Harjola PT, Valle M. Persistent improvement after coronary bypass surgery: ergometric and angiographic correlations at 5-years. Circulation 1983; 67: 491-496. [6] Gasior Z i wsp. Chirurgiczna rewaskularyzacja miesnia serca a funkcja skurczowa lewej komory. Kardiol Pol 1997; 46: 200-211. [7] Hirnle T i wsp.: Badanie histologiczne wycinków tetnicy piersiowej wewnetrznej, zyly odpiszczelowej wielkiej i aorty pobranych w czasie operacji kardiochirurgicznych. Kardiol Pol 1991; 34: 155-159. [8] Hultgren HN i wsp.: The 5 year effect of bypass on relief of angina and exercise performance. Circulation 1985; 72: (suppl V) 79-89. [9] Kmiec G, Zwirski W, Moczurad K. Ocena odleglych wyników leczenia operacyjnego choroby niedokrwiennej serca w oparciu o testy wysilkowe, badanie polikardiograficzne oraz powrót do pracy zawodowej. Kardiol Pol 1990; 3: 179-183. [10] The Veterans Administration Coronary Artery Bypass Surgery Cooperative Study Group.: Eleven-year survival in the Veterans Administration randomized trial of coronary bypass surgery for stable angina. N Engl J Med 1984; 311: 1333-1339.

[Normalization of lipid metabolism disturbances and clinical course after percutaneous coronary angioplasty: 6 month observation]. / Normalizacja zaburzen gospodarki lipidowej a przebieg kliniczny po zabiegu przezskórnej angioplastyki wiencowej: 6-miesieczna obserwacja.

UNLABELLED: The recurrent stenosis of previously successfully dilated coronary arteries still remains a matter of concern despite of the improved short and long term results of percutaneous coronary angioplasty. The role of dyslipidaemia in the origin of restenosis after coronary angioplasty is still controversial. The aim of our study was to evaluate the efficacy of hypolipemic treatment in patients undergoing coronary angioplasty and to find out whether successful lowering of lipid parameters to normal limits is related to improvement exercise capacity and systolic function of left ventricle. The study group comprised 152 patients (17 women, 135 men), aged 52 +/- 8.8 years, who were reffered for percutaneous coronary angioplasty (PTCA). The patients were divided, according to the ratio of total cholesterol to HDL cholesterol (CH/ch-HDL), into two subgroups: subgroup I with CH/ch-HDL > 5.0 and subgroup II with CH/ch-HDL < or = 5.0. In all patients following parameters: total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides and body mass index were measured before PTCA, 1 month and 6 months after the procedure. At the same times a treadmill test and echocardiography were performed. Baseline total cholesterol, HDL cholesterol and triglycerides were significantly higher in subgroup I. In subgroup I Ch/ch-HDL ratio was at baseline 7.4 +/- 2.0 and decreased 6 months after PTCA to 5.2 +/- 1.7, p < 0.001. The CH/ch-HDL ratio was 4.2 +/- 0.6 in subgroup II before PTCA and remained the same 4.1 +/- 1.2 after 6 months. Before PTCA, the exercise capacity did not differ between groups 9.1 +/- 2.5 vs 9.6 +/- 3.3 MET, p = ns. A significant improvement of exercise capacity was observed in subgroup I 1 month after PTCA 9.1 +/- 2.5 to 11.2 +/- 2.7 MET, p < 0.001, remaining at the same level after 6 months. The differences seen in group II did not reach the statistical significance. Echocardiography revealed improvement of left ventricle contractility in both subgroups, with statistically significant increase in group I (1.24 +/- 0.36 to 1.14 +/- 0.27, p < 0.001). The left ventricle systolic function was within normal limits in all patients before coronary angioplasty and increased significantly 1 month after PTCA in subgroup I (56.1 to 60.4%, p < 0.001). 6 months after PTCA no further significant changes were observed. CONCLUSIONS: The dyslipidaemic state recognised before PTCA does not influence clinical outcomes after the procedure. Lipid lowering therapy should be offered to every patient undergoing coronary angioplasty regardless of the baseline value of total cholesterol to HDL cholesterol ratio. Optimal treatment of dyslipidaemia leading to lower total cholesterol, triglycerides and total cholesterol to HDL cholesterol ratio, to normal limits, is associated with improved exercise capacity and systolic function of left ventricle six months after successful coronary angioplasty.

[Percutaneous transluminal coronary angioplasty--personal experience]. / Przezskórna plastyka tetnic wiencowych--doswiadczenia wlasne.

Percutaneous transluminal coronary angioplasty was employed in a group of 178 patients (151 males and 27 females) aged 24 to 68 years (mean 42 +/- 12 years). Stable angina was diagnosed in 136 patients, unstable angina in 38, and an acute infarct in 4. In 150 patients there was one, in 25 two and in 5 patients 3 target stenoses. Lesions were localised in the left anterior descending artery in 130 cases, in the circumflex artery in 32 cases and in the right coronary artery in 49 cases. The attempts to dilate 78 stenoses with a fixed-wire, non-guided system was successful in 78% of cases. Success rate with the over-the-wire system was 85%. In total, we successfully dilated 173 patients, i.e. 82%. The highest success rate, 85%, was achieved in lesions localized in the left anterior descending artery and lowest in lesions localized in the left circumflex artery. Success rate in the groups with stable and unstable coronary artery disease was similar. Complications occurred in 6% of the cases. Experience of the operators involved in PTCA is an important factor influencing the success rate. In the first year of using this technique, good results were achieved in 48% of patients, in the second year in 63%. During the next two years 86% of the stenoses were successfully dilated.

[Complete atrioventricular block in Becker-type muscular dystrophy]. / Calkowity blok przedsionkowo-komorowy w przebiegu dystrofii miesniowej typu Beckera.

A case is described of Becker type muscular dystrophy in a man aged 52 years, in whom complete atrioventricular block was found with Morgagni-Adams-Stokes attacks. The pathogenesis of the syndrome and the necessity of implantation of a pacemaker are discussed.