[The possible failing reasons of balloon catheter dilation procedure in the management of chronic rhinosinusitis].

Objective:To investigate the effectiveness of balloon catheter dilation (BCD) in the treatment of chronic rhinosinusitis, and to analyse the possible factors which lead to BCD failure, as well as to provide basic reference for BCD clinical usage.Method:Forty-six sinuses of 32 patients with chronic rhinosinusitis were underwent "Balloon-only" BCD or "FESS assisted" BCD at our institution between September 2014 and December 2016. By recording details of the operation of all the subjects in this study and following up the clinical symptoms, nasal endoscopy, computed tomography of the sinuses, and postoperative complications six months after operation, to evaluate the difficulty, safety, effectiveness and especially, the failing reasons of BCD.Result:BCD was approached in 46 sinuses (19 maxillary sinus, 22 frontal and 5 sphenoid), and succeeded in 13 maxillary sinuses, 19 frontal sinuses, and 4 sphenoid sinuses. Of the 13 maxillary sinuses, there were 9 sinuses underwent "Balloon-only" procedure, other 4 cases underwent "FESS assisted" procedure. There were 3 cases of frontal sinus failed, because of the frontal recess anatomical complexity and the twisted drainage. Of the 5 sphenoid sinuses, 4 cases succeeded, including fungal sphenoiditis cases, in which the mould was completely cleared through the dilated ostia, and 1 case failed. All the patients were followed up for 1, 3 and 6 months of patient's quality of life, nasal endoscope, computed tomography of the sinuses. The results showed that the SNOT-20 scores of the quality of life in significant relief of symptoms, nasal mucosa status improved significantly compared with the preoperative, dilated ostium remains open, no obvious scar formation, no severe operative complications.Conclusion:Balloon catheter dilation in the treatment of chronic rhinosinusitis is safe and effective. But the operation indications is limited, and many factors influence the success rate of BCD, so, preoperatively gaining the information of nasal cavity and anatomical structure around ostium according to patients' nasal endoscopy and sinus CT is critical to success of BCD.

R wave changes in patients with myocardial infarction during treadmill stress testing.

A graded multistage treadmill exercise test was performed on 78 patients with myocardial infarction (65 males and 13 females, ranging in age from 30 to 76). The amplitude of the R wave in CC5 was measured at rest and during the periods of peak exercise. The exercise-induced R wave changes were classified into 3 groups: increased, 39.1%; no changes, 39.7% and decreased, 22.2%. Acute attacks of myocardial infarction were more severe in the patients whose R wave decreased during exercise than in those whose R wave increased. Heart rate, blood pressure and pressure rate products were not different among the groups. However, oxygen consumption was greater in the R-increased group than in the R-decreased group. Therefore, an increase in R wave amplitude during exercise in post-myocardial infarction patients indicates a good efficiency of the myocardium and skeletal muscles. Exercise-induced changes of the mean electrical axes of the transverse plane were significantly related to changes of the R wave amplitude in CC5 (r = 0.50, p less than 0.001). Therefore, change in the transverse plane axis is one of the important determinants of exercise-induced R wave changes.

Exercise capacity of the patients with myocardial infarction.

This study was conducted to investigate the functional capacity in postmyocardial infarction. Eighty-four multistage treadmill exercise tests were performed on 60 patients, none of whom had had any formal rehabilitation or regular exercise. There were 50 men and 10 women, ranging in age from 30 to 81 with an average age of 60. The time interval between the acute attack and the exercise test ranged from one month to 9 years. Even though severe infarction affects the exercise capacity for a long time after an acute attack, its effect on cardiac function was more obvious than that on physical capacity. Age was the most important determinant of physical capacity, and the slope of decreasing physical capacity with age in patients with infarct was the same as that in normal subjects. Cardiac function also decreased with age. However, during the early recovery phase, cardiac function was influenced by the severity of infarction and the influence of age could not be established. There was no significant correlation between early ambulation and physical capacity. The beneficial effects of early ambulation may be lost if physical activity is discontinued for some time after the acute attack. The physical capacity increased 2-3 years after the acute attack, but myocardial function did not change significantly.

Polarcardiographic study of inferior myocardial infarction: global projection of heart vector.

The sensitivity of electrocardiographic, vectorcardiographic and polarcardiographic criteria for inferior myocardial infarction was studied. ECG and Frank system VCG were recorded in 50 normal cases and 40 cases of inferior myocardial infarction, whose acute phase was documented by typical electrocardiographic and serum enzymatic changes. The records were made from one month to 16 years after acute attacks. Polarcardiograms were obtained by a specially-designed analogue computer from X, Y and Z signals of the VCG, and recorded at a paper speed of 1000 mm/sec by Mingograph. The polarcardiographic tracings were measured at every 5 msec after onset of the QRS wave, and plotted on the Aitoff's equal-area projection. In normal cases, the QRS vectors plotted on Aitoff's projection passed through the narrow area between 15 to 35 msec after the QRS onset. Electrocardioraphic diagnosis of myocardial infarction was correctly made in 22 cases (55%), and by VCG the sensitivity was improved to 32 cases (80%). Polarcardiographic diagnosis was made in 33 cases (82.5%). Global plots of heart vector on Aitoff's projection were a useful display to visualize the sequential changes of heart vector. In inferior myocardial infarction, the QRS vector passed through the more superior portion to normal, and the diagnosis was accurately made in 33 cases (82.5%).

Prinzmetal's variant angina induced only by alcohol ingestion.

Prinzmetal's variant agina occurred in a 52-year-old man 10-11 h after the ingestion of alcohol, when blood levels of alcohol decreased almost to the zero level. Coronary arteriograms revealed significant narrowing in the left circumflex artery and the left anterior descending artery and minimal wall irregularity in the right coronary artery; however, both exercise and pharmacologic stress tests were negative. A withdrawal from an acute exposure to alcohol was discussed as a possible causative mechanism of the alcohol-induced Prinzmetal's variant angina in this case.

Primary thrombocythemia and myocardial infarction in a 26-year-old woman with normal coronary arteriogram.

Acute myocardial infarction occurred in a 26-year-old woman with normal coronary arteriogram and primary thrombocythemia (500,000 approximately 1,500,000/mm3). Hyperaggregability of platelets was also demonstrated by stimulation with adenosine diphosphate, collagen, and epinephrine administration. A stillbirth at the 8th month of gestation in her past history was referred to the complication of primary thrombocythemia, too. Since discharge, the patient has been on 750 mg of aspirin and then free of any thromboembolic symptoms and signs, even during pregnancy and labour.

Hemodynamic effects of nifedipine in congestive heart failure.

Nifedipine, a potent coronary vasodilator, was administered in a single sublingual dose of 20 mg to eight patients with mild to moderate congestive heart failure. Nifedipine produced a slight increase in heart rate (mean +/- standard error of the mean 73.3 +/- 3.2 versus 80.9 +/- 2.1 beats/min, p < 0.025) and an increase in cardiac index (from a control value of 3.51 +/- 0.22 to 4.06 +/- 0.31 liters/min per m2, p < 0.01). Arterial blood pressure decreased from 112.9 +/- 6.2/67.7 +/- 4.2 (mean 84.9 +/- 4.0) to 100.8 +/- 4.4/56.4 +/- 11.0 (mean 76.1 +/- 4.3) mm Hg (p < 0.01) and total systemic vascular resistance also decreased from a control value of 15.6 +/- 1.0 to 12.4 +/- 0.8 units (p < 0.01) after administration of nifedipine. These data suggest that nifedipine may be useful for vasodilation in congestive heart failure.

Effects of right and left ventricular pressure overload on left ventricular function and metabolism in dogs.

The effects of acute pressure overload of the right and left ventricle on the left ventricular hemodynamics, coronary circulation, and myocardial metabolism in dogs were investigated by banding of the main pulmonary artery and by producing two models of aortic constriction with (type B) and without (type A) aortocoronary bypass. Pulmonary artery banding (left ventricular preload reduction) showed right ventriculr systolic pressure (RVSP), right ventricular end-diastolic pressure (RVEDP), and right ventricular dP/dtmax significantly elevated, but left ventricular systolic pressure (LVSP), left ventricular (dP/dtmax)/IIP slightly decreased, contrary to a slight increase of left ventricular end-diastolic pressure (LVEDP). The blood flow of the left coronary circumflex artery (CBF) was slightly decreased, but the aortic blood flow (AoF) and left ventricular work per minute (LVW) were significantly reduced. As to myocardial metabolism, the coronary arteriovenous difference (delta) of carbohydrate, mainly glucose (G) and lactate (L), increased, while that of non-esterified fatty acid (NEFA) showed a significant reduction. Aortic coarctation (left ventricular afterload increase) showed, both in types A and B, left ventricular systolic pressure, left ventricular end-diastolic pressure, and left ventricular work per minute were increased. However, aortic systolic and diastolic pressure were significantly decreased. The blood flow of the left coronary circumflex artery tended to increase in both types. The myocardial carbohydrate uptake tended to increase after aortic constriction in both types. However, the uptake of non-esterified fatty acid was increased after aortic constriction in type A, but decreased in type B. This difference in uptake of non-esterified fatty acid might be induced by the difference of the functional state of the left ventricle.

Experimental studies on the effect of glucocorticoids on cardiac muscle.

Abnormal electrocardiographic changes were found in some patients on long-term glucocorticoid treatment. In experimental animals, chronic glucocorticoid administration resulted in an increase of amplitude of the QRS complex and abnormal ST and T changes. Changes of action potential were somewhat different in the subendocardial and the subepicardial layers. Diffuse mitochondrial alterations were found, particularly in the subepicardial layer. In rabbits treated with glucocorticoids, no significant changes were found in either serum or myocardial potassium content. Slightly decreased Vmax was the observed hemodynamic change.