[Use of coronary vessel prosthesis. Complex coronary angioplasty under general anesthesia]. / Koszorúér-protézisek alkalmazása. Altatásban végzett komplex coronaria angioplasztika.

In 1995 we attempted to treat with PTCA 437 ischemic patients. We stended 29 patients (6.6%) with 34 stents. Emergency stenting was done in 5, semi-elective stenting in 6, and elective stents were applied in 18 patients with restenosis. We have achieved good angiological results without occurrence of myocardial infarction, with no emergency open heart surgery or death. No intracoronary thrombosis was observed during one-month follow-up with combined aspirin and ticlopidin treatment. Hemodynamical and angiological high-risk patients were treated under general anesthesia with assisted respiration. No complications were observed during the procedures. In cases of in-stent restenosis (17%) we redilated the coronary artery. This technique proved to be promising and is routinely applied world-wide to optimise immediate and long-term results of PTCA. The realisation of such interventional cardiological centers with appropriate financial background is an absolute requirement for spreading this technique in Hungary.

Life-threatening arrhythmias stopped by cough.

In the course of 131 coronary angiographies, a non-ionic hyperosmolar contrast medium (Uromiro 75%, Bracco, Milano) provoked transient arrhythmias in 92 cases: 50 marked sinus bradycardias, 11 asystoles, 21 low-rate idiojunctional rhythms, 1 first-degree AV block, 7 third-degree AV blocks and 2 ventricular fibrillations. In 90 cases the rhythm disturbance was stopped by mere repeated cough. In the 2 cases of ventricular fibrillation direct current shock was used. If instructed coughing started within 8 seconds after the onset of arrhythmia, the patient maintained consciousness and the cough, as an internal cardiac massage, proved to be an adequate resuscitation method. In case prodromal signs of artificial bradycardiac arrhythmias were present, immediate cough could usually prevent the loss of consciousness and could also stop the arrhythmia. Therefore it seems logical to apply this method in patients at risk of Adams-Stokes attacks. A certain number of sudden deaths could be avoided.

[Hemodynamic effects of verapamil in pulmonary hypertension caused by heart valve disease]. / Verapamil haemodinamikai hatásainak vizsgálata billentyübetegségek kapcsán kialakult pulmonalis hypertoniában.

The authors have investigated the haemodynamic effects of verapamil on the pulmonary circulation by 24 patients suffering from secondary pulmonary hypertension, caused by mitral and/or aortic valve diseases. For this purpose the numeric and graphometric analysis of intracavitary right ventricle pressure curve and pulmonary artery pressure tracing was applied. It was observed a selective antihypertensive effect on the lesser circulation. The pulmonary and systemic systolic tension decreased comparing in percentage 3:1, in case of diastolic tension this comparison was 2:1. The decrease in pulmonary circulation was strongly significant. The diminishing of heart rate and the improving of right heart function was not significant. The elevation of end-diastolic pressure of the right ventricle, just as the shape-analysis of pressure curves suggested right ventricle overload.

Information obtained from tussigrams and the possibilities of their application in medical practice.

The physiology of cough was studied using 2008 voluntary coughs. The tussiexpirograms verify that in a cough-series there are "double-flow" phases. The tussitachogram enables a more precise observation, for example, one can recognise five flow phases within one single cough. It proves, furthermore, that in the first five coughs the speed of airflow is always higher in the intermediate deceleration than in the acceleration phase. On the tussiphonogram one can differentiate seven phonetic phases. The simultaneously recorded tussigrams and tussiphonograms allow identification of two sounds, two intervals and noises. There are at least two possibilities for use of these data in clinical practice, 1) the measurement of the volume during the first second on the tussiexpirogram is a suitable control for the forced expiratory volume in one second (FEV1), 2) analysis of the voluntary prolongation of the intermediate deceleration during respiratory physiotherapy.

Graphometric analysis of cough tachogram.

The tachogram shows that the flow of cough is neither continuous nor steady. Within a cough, 5 different phases can be differentiated: 1) acceleration, 2) initial fast decleration, 3) intermediary decleration, 4) terminal fast decleration, and 5) the flow-pause. Only in the course of phases 1) and 3) is the air flowing out from the lungs. In cough series the peak-flows of subsequent coughs are growing smaller and smaller. This decrease follows the form of an isosceles hyperbola. A cough can be short or elongated. From the flow-phases the 1-st, 2-nd and 4-th ones are of fairly stable duration. The wide deviation of the intermediary deceleration shows that this phase makes it possible to elongate voluntarily the cough.