[Coronary revascularization in diffuse atherosclerosis of the anterior descending coronary artery]. / Chirurgické moznosti revaskularizace srdce pri difuzním aterosklerotickém postizení prední mezikomorové vetve (RIVA).

The authors present surgical possibilities of treatment of diffuse atherosclerotic changes of the left anterior descending coronary artery. In such serious disease they choose the procedure of endarterectomy performed from long arteriotomy under direct eye control followed by reconstruction by long bypass anastomosis. Endarterectomy of the left anterior descending artery was performed in 32 patients during the period between 1988-1996. This represents 1.38% of patients operated for ischemic heart disease during that period (32/2324). Two patients died in consequence with the operation (6.25%), also there was one myocardial infarction as a perioperative complication (3.1%). Endarterectomy of the diffusely diseased left anterior descending coronary artery can, when carefully indicated and using proper technique, contribute to complete revascularization in patients with end-stage coronary artery disease.

Iatrogenic clubbing of the fingers.

We report on a 39-year-old female who had been operated on for an atrial septal defect at the age of 14 years. On operation the inferior vena cava was iatrogenically misdirected into the left atrium. The cyanotic patient, in functional group IV of the NYHA classification, with polyglobulia and clubbing of the fingers was successfully reoperated after 25 years.

[Evaluation of the kinetics of the left ventricular wall using the Cardio 200 computer]. / Hodnocení kinetiky sten levé komory srdecní pomocí pocítace Cardio 200.

The WALLMO program was used in comparing normal kinetic values of left ventricle wall with those obtained from control patients and literature sources. Authors concluded that, when based on the original data for RAO projection, the evaluation of regional LV wall contractility gives erroneous results in estimating whether a given section is normo- hypo- or hyperkinetic. Therefore, the set of normal kinetic values of LV motion has been formed for individual numbers of radials. This set may be used also at other working sites.

Contribution to the problems of volume parameters of the left heart ventricle of patients with ischaemic heart disease.

The authors studied some methodological questions associated with evaluation of the X-ray of the left ventriculogram (VTG). On the basis of their results they suggest that, in addition to the usual comprehensive volume parameters of the left ventricle (EDVI, ESVI, and EF), further indices, obtained either by drawing the cardiac contour frame-by-frame (norm dV/dtmin), or by dividing the diastole into halves or thirds (the indices norm FF 1/2 or norm FF 1/3), should be used. These indices allow more sensitive differentiation of patients with impaired left ventricular function.

[Experience with implantation of a permanent electrode for cardiac pacing directly through the subclavian vein in 2,309 patients]. / Zkusenosti se zavádením stimulacních elektrod pro trvalou srdecní stimulaci prímo pres podklíckovou zílu u 2,309 nemocných.

Since April 1975 to the end of 1988 permanent cardiac stimulation was employed in 2,309 patients. The stimulating electrode was placed in the right ventricle in 2,258 patients and in the right atrium in 29 patients. Two electrodes were introduced in 22 patients one in the right ventricle and the other in the right atrium. All electrodes were introduced directly through the subclavian vein. No other approach was used. Serious complications appeared in 4 patients (i. e. in 0.17%). Pneumothorax on the side of the introduced electrode occurred in 3 patients. One woman of 80 died in connection with this complication. Another woman, who was overdosed with Pelentan, experienced hemothorax on the side of electrode insertion. After drug discontinuation and thoracic puncture the patient was doing well. In our opinion the subclavian approach for permanent electrode introduction is much more convenient than the introduction via either the cephalic or the jugular vein respectively. The former approach is considerably quicker and less traumatic in use. This method may be used in practically all patients. The repetitive introduction of the electrode through the same subclavian vein is much appreciated in patients in whom a new electrode has to be introduced. This method may be used for right atrium stimulation and for sequential pacing as well.

Role of dopaminergic system(s) in mediation of the behavioural effects of bombesin.

To test the effects of dopamine receptor blockade on bombesin (BN)-induced behavioural changes, adult male Sprague-Dawley rats were administered fluphenazine (0.01, 0.025, 0.1, 0.25 mg/kg, IP) followed 30 min later by BN (1 micrograms in 5 microliter) or saline (5 microliter) intracerebroventricularly (ICV). Subsequent behavioural effects were monitored in chambers equipped with strategically located infrared beam grids, controlled by a microprocessor. The following behaviours were monitored: locomotor activity (distance traversed), floor activity (horizontal or lateral displacement) and rearing activity (frequency of vertical displacement extending 17.8 cm above the floor). At all but the highest dose (0.25 mg/kg, which suppressed floor activity), fluphenazine failed to significantly alter any of the behavioural parameters monitored. Whereas at doses of 0.025 or lower, fluphenazine failed to alter BN-induced behavioural output, at doses of 0.1 mg/kg or greater, it significantly blocked the behavioural effects BN. In the next experiment, dopamine neurons of adult male Sprague-Dawley rats were lesioned using 6-hydroxydopamine (6-OHDA) (250 micrograms/10 microliter, ICV). The 6-OHDA and sham-lesioned (control) rats were administered BN (0.001, 0.01, 0.1 or 1.0 microgram, ICV) and their behaviour monitored. In the control animals, BN stimulated locomotor, floor and rearing activity in a dose-dependent manner. However, these behavioural effects of BN were markedly attenuated or absent in the 6-OHDA-lesioned animals. These data further support our contention that centrally administered BN may mediate its behavioural effects, through the dopaminergic system(s).