Comparison of the effect of knee synovectomy in haemophilic patients with 153Sm- and 90Y-labelled hydroxyapatite 1 year after.

To compare the use of 740 Mbq (20 mCi) of (153) Sm and 185 Mbq (5mCi) of (90) Y, both labelling hydroxyapatite (HA), for knee synovectomy in haemophilic patients, 1 year after the intervention. Thirty three men (36 knees) were studied, divided into two groups: 1 - treatment using 740 Mbq of (153) Sm-HA: 20 knees of 18 patients, with mean age of 21.4 ± 13.3 years (ranging from 7 to 56 years) and mean Pettersson score of 5.3; 2 - treatment using 185 Mbq of (90) Y-HA: 16 knees of 15 patients, with mean age of 26.3 ± 10.3 (ranging from 7 to 51 years) and mean Pettersson score of 6.3. The following criteria were adopted for the evaluation before and 1 year after synovectomy: reduction in haemarthrosis episodes and pain using a visual analogue scale, as well as improved joint mobility. The occurrence of adverse events in the treatment was also considered. The chi-square, Wilcoxon and Mann-Whitney tests were used with P ≤ 0.05 set as significant. The occurrence of haemarthrosis declined by 65.7% with the use of (153) Sm-HA and 82.6% for (90) Y-HA, with no statistical difference between the groups (P = 0.632); pain reduction was 42.5% in group 1 and 30.7% in group 2, once again with no statistical difference (P = 0.637). Improvement in joint mobility was not significant for both groups. Two cases of mild reactive synovitis were observed in group 1 and one in group 2, which cleared up without medical intervention. Although the beta energy from (90) Y is the gold standard for knee synovectomy, higher activities of (153) Sm may be used in places which have only production of this material.

Ventriculotomy repair during revascularization of intracavitary anterior descending coronary arteries.

Optimal revascularization of the rare variant anomolous intracavitary left anterior descending coronary artery requires, by definition, entrance into the right ventricular cavity. We present a simple method to repair the ventriculotomy without risk of obliterating the left anterior descending coronary artery, septal perforators, or diagonal branches.

Severe deformity of a Palmaz-Schatz stent after normal surgical manipulation.

This report describes a case in which normal surgical manipulation during dissection of the heart while performing a repeat revascularization procedure produced a significant deformity in Palmaz-Schatz stents previously implanted in a saphenous vein graft. The graft had shown satisfactory angiographic appearance immediately before the operation, and consideration was given to leaving it in place. Its replacement, however, prevented a major intraoperative mishap.

Successful myocardial revascularization and neurologic recovery in a patient with prolonged refractory cardiac arrest and a chronically occluded left internal carotid artery.

Heretofore, the longest successfully treated cardiac arrest reported in the literature, secondary to myocardial ischemia, was one that required 45 minutes of cardiopulmonary resuscitation before coronary bypass surgery. We present a unique case of successful resuscitation after a cardiac arrest secondary to myocardial ischemia. The arrest lasted 78 minutes (30 minutes of closed cardiac massage and 48 minutes of open cardiac massage). As soon as a perfusionist was available, cardiopulmonary bypass was initiated. After completion of the distal anastomosis and upon removal of the aortic cross clamp, the patient spontaneously recovered sinus rhythm for the 1st time since her cardiac arrest 2 hours and 10 minutes earlier. This 70-year-old woman, with a history of chronic occlusion of the left internal carotid artery, recovered fully, without evidence of neurologic or myocardial insult. We believe that vigorous closed and open cardiac massage, followed by cardiopulmonary bypass and the correction of myocardial ischemia, enabled this patient to survive a prolonged refractory cardiac arrest.

Awake discography. A comparison study with magnetic resonance imaging.

This study was undertaken to determine the correlation between awake discography findings and magnetic resonance imaging in the evaluation of symptomatic lumbar disc disease. The study included 164 consecutive patients who underwent evaluation with discography and magnetic resonance imaging for lumbar disc disease from August 1987 to September 1989. Chronic low-back pain, with or without radicular symptoms, was the presenting complaint in each case. Each patient had previously failed conservative treatment. The average age was 36 (range, 19-66 years). Magnetic resonance images were performed before discography in each case. Discography was performed with patients minimally sedated and under local anesthesia. A lateral approach was used. Magnetic resonance imaging and discography correlated in 90 cases (55%) and differed in 74 (45%). Considering disc levels, discography and magnetic resonance imaging correlated in 371 discs (80%). There were 172 normal discs and 199 abnormal discs. Of the abnormal discs, 151 (76%) reproduced symptoms. In 60 discs (13%), magnetic resonance images showed abnormal findings and the discogram normal findings. Discs levels classified as abnormal on magnetic resonance imaging demonstrated that 108 discs (37%) were asymptomatic. Magnetic resonance imaging showed normal findings and the discogram abnormal findings in 34 discs (7%), of which 21 (5%) recreated exact symptoms and 13 (2%) caused no pain. Magnetic resonance imaging is a static test and discography the only available dynamic test for disc evaluation. Awake discography is a diagnostic study that can determine which abnormal discs are symptomatic via the pain response.

Verapamil versus placebo in relieving stable angina pectoris.

Verapamil and placebo were compared in patients with stable, effort-induced angina. Single-blind dose titration (240, 360 and 480 mg/day) preceded a double-blind crossover. Among the 18 patients who completed graded exercise stress tests with reproducible pretreatment effort-limiting angina, exercise duration increased from 348 +/- 127 seconds (SD) before treatment to 494 +/- 182 seconds after verapamil (p less than 0.001), but did not change after placebo. Compared with placebo, verapamil reduced the weekly number of anginal episodes from 4.54 +/- 5.03 to 2.44 +/- 3.30 (p less than 0.05) and reduced nitroglycerin consumption from 3.46 +/- 5.30 to 1.55 +/- 2.89 tablets per week (p less than 0.05). Of 26 patients who completed the single-blind dose titration, 16 were improved (greater than 1 minute) at a dosage of 240 or 360 mg/day. No patient improved (greater than 1 minute) on 480 mg/day who had not already improved on a lower dose, but side effects requiring reduction in dosage occurred in seven patients receiving 480 mg of verapamil per day. Verapamil is an effective antianginal drug that appears most efficacious at a dose of 360 mg/day, but side effects are common at a dose of 480 mg/day.

Exercise duration to angina at two and twelve hours after timolol.

Eight patients who improved their exercise duration to angina or marked fatigue (greater than or equal to 25%) on timolol 10 to 30 mg twice daily over that on placebo 8 to 14 mo previously were subjects in a double-blind, randomized, crossover 4-wk study of the effect of timolol on exercise duration 2 and 12 hr after medication. One patient was discontinued from the study because unstable angina developed on placebo. Mean exercise duration on timolol over control was increased at 12 hr (p less than 0.02) and at 2 hr ( p less than 0.001) after drug. There was an increase in exercise duration greater than or equal to 25% on timolol over control compared with placebo in three of seven patients (43%) 12 hr after drug and in seven of seven (100%) 2 hr after drug. Timolol 10 to 30 mg twice daily prolongs exercise duration to angina or marked fatigue at 2 hr after drug and in some responders at 12 hr after drug.

Effect of acebutolol and propranolol on premature ventricular complexes.

A double-blind, randomized study comparing the efficacy of intravenous acebutolol with propranolol on frequent premature ventricular complexes (PVCs) in 24 patients is reported. Frequent PVCs were abolished or reduced by 75% or more in 10 of 12 patients (83%) given acebutolol and in 10 of 12 patients (83%) given propranolol. The therapeutic effect of acebutolol lasted for at least 1 hr in 4 of 12 patients (33%), for at least 3.5 hr in 3 of 12 patients (25%), and for at least 4 hr in 2 of 12 patients (17%). The effect of propranolol lasted for at least 1 hr in 6 of 12 patients (50%), for at least 3.5 hr in 4 of 12 patients (33%), and for at least 4 hr in 4 of 12 patients (33%). Hence, intravenous acebutolol and propranolol were equally effective.

Verapamil in atrial fibrillation and atrial flutter.

A double-blind randomized study was performed to compare the efficacy of intravenous verapamil with saline in 28 patients with a rapid ventricular rate and atrial fibrillation or atrial flutter. Conversion of atrial fibrillation to sinus rhythm occurred in none of 14 patients after saline and in 3 of 20 patients (15%) 7 to 160 min after verapamil. The ventricular rate in atrial fibrillation was slowed greater than or equal to 15% in 2 of 14 patients (14%) by saline, in 17 of 20 patients (85%) by 1 dose of verapamil (p less than 0.001), and in 19 of 20 patients (95%) by 1 or 2 doses of verapamil (p less than 0.001). Conversion of atrial flutter to sinus rhythm occurred in none of 4 patients after saline and in 1 of 7 patients (14%) 105 min after verapamil. The ventricular rate in atrial flutter was slowed greater than or equal to 15% in none of 4 patients by saline, in 4 of 7 patients (57%) by 1 dose of verapamil, and in 7 of 7 patients (100%) by 1 or 2 doses of verapamil (p less than 0.001).