[Percutaneous transluminal angioplasty of the subclavian artery]. / Az arteria subclavia perkután transzluminális angioplasztikája.

Over a period of 12 years, percutaneous transluminal angioplasty was used to dilate 227 subclavian obliterations (216 stenoses, 11 occlusions) in 208 patients. Immediate success rate was 96%. 152 dilated arteries long-term patency are known. The average follow-up time was 32 months (1-120 months). 14 restenosis occurred. In 7 of the 14 patients redilation were performed. Complication: 3 puncture site thrombosis, 1 haematoma, 4 transient confusion occurred. In 2 patients shoulder pain developed with unknown origin, and last for a few weeks. There were no irreversible neurologic deficit. Percutaneous transluminal angioplasty of subclavian artery stenoses should be the procedure of choice in symptomatic patients.

Effects of intravenous streptokinase and CLS 2210 (calcium dobesilate) on the biochemical markers of early acute myocardial infarction: a historic comparison with both studies.

In a previous double-blind, randomized study, CLS 2210 (a new formulation of calcium dobesilate) or placebo was administered by intravenous infusion to 41 patients having their first acute myocardial infarction. In the present study 19 comparable patients were treated intravenously with streptokinase under identical conditions and the results compared with those from the previous study. In all patients administration was begun within three hours of onset of symptoms and continued over seventy-two hours. Blood samples were taken for the measurement of serum activity of creatine kinase and its isoenzyme MB, and the serum and urinary concentrations of myoglobin and glycosaminoglycans were also measured. The purpose of this study was to determine the effects of CLS 2210, placebo, and streptokinase on these biochemical markers of acute myocardial infarction, thereby assessing their actions in limiting myocardial necrosis. In the CLS 2210-treated patients, the levels of serum creatine kinase and serum and urinary myoglobin were significantly lower than in the placebo patients throughout the seventy-two hours (p = 0.01, 0.005, 0.004 respectively). The levels of creatine kinase MB and serum glycosaminoglycan in the CLS 2210 patients were initially higher than in the placebo patients but fell below placebo levels between the fortieth and fifty-fifth hours, respectively (p = 0.89, 0.02). Only the glycosaminoglycan urinary concentrations were higher in the CLS 2210 group than in the placebo group throughout (p = 0.0005). The values for the six variables investigated showed no statistically significant difference between placebo and streptokinase.(ABSTRACT TRUNCATED AT 250 WORDS)

[Percutaneous transluminal angioplasty in atypical aortic coarctation in an adult patient]. / Felnöttkori atípusos coarctatio aortae percutan transzluminális angioplasztikája.

In the reported case, coarctation of the aortic arch (Coa) was the cause of hypertonia. Coa diminishes the expected lifetime, and operative treatment is required. PTA is contradictory in the treatment of coarctation. In the reported case coarctation was located on the aortic arch, and because of the risk of the operation PTA was performed. The dilatation was successful, hypertension resolved, and there was no significant difference in the blood pressure on the extremities. 16 months after the dilatation the patient is symptomless. The result of this case indicates that PTA of the Coa of the aorta is feasible. More experience is needed to establish its role.

The influence of CLS 2210 on the course of myocardial infarction: a pilot study in man.

To assess the effect of CLS 2210 (a new formulation of calcium dobesilate) on the evolution of acute myocardial infarction, 100 patients presenting their first infarct were distributed, according to their sequential admissions to the hospital, into CLS 2210-treated group (50 patients) or a comparison group (50 patients not receiving CLS 2210). The two groups were similar in age, sex, predisposing factors, and site of infarction. Intravenous infusion of CLS 2210 was begun within six hours of onset of chest pain and continued for seventy-two hours. Thereafter, it was given, as oral capsules, in a dose of 1,000 mg every eight hours throughout the hospitalization. Before and during the trial, blood samples were drawn for the measurements of serum concentrations of creatine kinase (CK), and twelve-lead electrocardiograms (ECGs) were obtained serially in each patient. All objective data were analyzed on a coded basis without reference to the treatment. In the comparison group, thirty-six to forty-eight hours was required for CK to fall to 50% of the baseline value, whereas in the CLS 2210-treated group it reached 50% of the baseline in eighteen to twenty-four hours. For each infarction site, a statistically significant fall was reached earlier in the CLS 2210 group. CK, the ECG index, and the sum of the ST segments showed earlier and more rapid improvement in the CLS 2210 group than in the comparison group. The consumption of narcotic analgesic agents and nitroglycerin was substantially less in the CLS 2210 group than in the comparison group.(ABSTRACT TRUNCATED AT 250 WORDS)

[ A case of successfully treated duodenal hemangioma]. / Duodenum haemangioma gyógyult esete.

In some cases the radical removal of gastrointestinal hemangiomas involves an excessive risk or too extensive operation. Consequently some other solution has to be applied. At our patient with duodenum haemangioma the combination of angiographic embolism and endoscopic sclerotization was successfully employed.

Calcium dobesilate (CLS 2210) protects the myocardium in early acute myocardial infarction: a preliminary randomized, double-blind, placebo-controlled study of its effects on biochemical markers.

To determine the effect of calcium dobesilate (CLS 2210) on biochemical markers of acute myocardial infarction, and thereby assess its action in limiting myocardial necrosis, this compound was administered intravenously by a randomized, double-blind technique to 23 of 41 patients suffering their first infarction. The remaining 18 patients received a placebo. Administration was begun within 3 h of onset of symptoms and continued for 72 h. Before and during treatment, blood samples were taken for measurement of the serum activity of creatine kinase and its isoenzyme MB, and the serum and urinary concentrations of myoglobin and glycosaminoglycans. Serum creatine kinase and serum and urinary myoglobin were significantly lower in the CLS 2210-treated patients than in the placebo patients throughout the 72 h (p = 0.01, 0.005, and 0.004, respectively). Serum creatine kinase MB and serum glycosaminoglycan in the CLS 2210 patients were initially higher than in the controls, but fell below the control levels between the 40th and 55th hours (p = 0.89 and 0.02, respectively). The glycosaminoglycan urinary concentrations alone were higher in the CLS 2210 group than in the placebo group throughout (p = 0.0005). These findings suggest that CLS 2210 reduces myocardial infarct size in human subjects, as it is already known to do in animals.

Salvage of ischemic myocardium by CLS 2210 in the dog: a preliminary double-blind study.

To assess whether a cardiac lymphagogue, CLS 2210, would reduce myocardial infarct size after coronary artery ligation, studies were performed in 14 dogs. The left anterior descending coronary artery was ligated in each dog, and the dogs were randomized to either placebo or CLS 2210 treatment, which was carried on for seven days. After seven days the animals were sacrificed and the volume of infarcted myocardium was determined macroscopically on a double-blind basis, supported by histologic examination. CLS 2210 treatment resulted in a highly significant reduction in the volume of infarcted myocardium (p less than 0.001). Since CLS 2210 is chemically and pharmacologically unrelated to hyaluronidase but shares an action with hyaluronidase as a cardiac lymphagogue, the results offer further support for a role of myocardial lymphatics in the evolution of myocardial necrosis following coronary artery occlusion and provide an explanation for the mechanism by which these agents reduce myocardial infarction size.

Early disappearance of lymphatics draining ischemic myocardium in the dog.

To assess myocardial lymphatics during the evolution of myocardial infarction we performed lymphangiographic studies thirty and three hundred sixty minutes after occlusion of the left anterior descending coronary artery in 92 dogs. A morphometric index was employed on a coded basis to assess the lymphangiograms. Well before myocardial necrosis was evident, at thirty minutes, a striking reduction was evident in lymphatic filling in the ischemic zone: similar changes were seen three hundred sixty minutes after occlusion. Heparin in doses that rendered blood incoagulable did not prevent the lymphatic occlusion or collapse, but they were prevented by two agents that act as cardiac lymphagogues, hyaluronidase and CLS 2210. Lymph flow from the heart was assessed in another 23 dogs. Lymph flow fell sharply after coronary artery occlusion in placebo-treated dogs but was well maintained in dogs treated with hyaluronidase and with CLS 2210. The reduction in cardiac lymphatic filling and lymph flow occurred too early to be a consequence of myocardial necrosis. To the extent that reduced lymphatic drainage allows the local accumulation of potentially toxic products, it could contribute to the local damage. Treatment with the lymphagogues not only maintained lymphatic patency but also reduced evidence of myocardial damage evident on examination by light and electron microscopy. These studies provide an alternative to commonly held concepts on how hyaluronidase reduces myocardial infarction after coronary artery occlusion and support the concept that lymphatic occlusion or collapse plays a role in myocardial infarction.

Influence of a lymphagogue, CLS 2210, on regional cardiac lymphatics and the electrocardiogram after coronary artery occlusion in the dog.

To examine the role of cardiac lymphatic drainage in myocardial infarction, we quantified the effect of a lymphogogue, CLS 2210, on the number and appearance of myocardial lymphatics as well as the electrocardiogram following coronary occlusion in the dog. Thirty minutes and six hours after intravenous administration of the benzenesulfonate compound, (CLS 2210) cardiac lymphatics in the distribution of the left anterior descending coronary artery (LAD) were determined and further delineated by postmortem cardiac lymphangiograms. The results were compared with treated and untreated dogs without and with descending coronary artery ligation including the noninfarcted zone; that is, myocardium within the distribution of left circumflex coronary (LCC) artery. After 30 minutes in dogs receiving CLS 2210 without LAD ligation, number of lymphatics (point count/cm2, see Methods) were respectively--LAD zone: 2.62 +/- 0.11 or 10.9% of left ventricular (LV) surface; LCC zone: 2.87 +/- 0.10, whereas after six hours--LAD zone 8.04 +/- 0.03 or 32.3% LV surface; LCC zone--8.13 +/- 0.06 compared with untreated controls--LAD zone 1.71 +/- 0.11 or 6.6% of LV surface; LCC zone 1.65 +/- 0.12 (p less than 0.0001). At similar intervals in dogs with LAD ligation, the findings were at 30 minutes LAD zone 0.78 +/- 0.07 or 3.1% of LV surface and at 360 minutes was 0.80 +/- 0.08 or 3.3% of LV surface. In conjunction with CLS 2210 administration, however, LAD zone showed at 30 minutes 2.50 +/- 0.12 or 10% of LV surface (p less than .01) and at 360 minutes was 10.34 +/- 0.03 or 35.1% of LV surface.(ABSTRACT TRUNCATED AT 250 WORDS)

CLS 2210, hyaluronidase and the cardiac lymphatic system.

Earlier studies have shown that hyaluronidase exerts a potent influence upon the lymphatic system of the myocardium and that it reduces the size of myocardial infarcts after coronary occlusion. In this study we compared, in mongrel dogs, the effect of intravenous hyaluronidase or CLS 2210 upon the cardiac lymphatic vessels. We observed that in CLS 2210-treated animals the number of visualized cardiac lymphatic vessels was significantly higher than in the hyaluronidase-treated control group. We have previously demonstrated a cardioprotective effect of hyaluronidase in the treatment of acute myocardial infarction. The present experimental data indicate that intravenous CLS 2210 may have a definite role in the management of acute coronary occlusion. Further studies are needed to confirm these preliminary findings.

Surgical treatment of renovascular hypertension in children and adolescents.

Renovascular disorders are rather rare in children and adolescents but have severe consequences due to complicating hypertension. Six cases successfully treated by surgery are described. The importance of early diagnosis and vascular correction is stressed; normalization of blood pressure has been achieved in every case.

Arteriovenous fistula after partial nephrectomy--successful surgical repair. Report of a case.

The postnephrectomy arteriovenous fistula is a very rare condition. There have been 49 cases reported in the world literature to date. Our case is the 50th of this series, and, to our knowledge, the first one following partial nephrectomy. Recurrence of the hypertension after nephrectomy, increasing heart failure, lumbar or upper abdominal bruit are the most characteristic clinical signs suggesting the presence of an arteriovenous communication. The basic diagnostic procedure is angiography. The proper surgical treatment is the separate ligature of the 2 vessels involved.

Ultrastructural and electrophysiologic changes of experimental acute cardiac lymphostasis.

Experimental impairment of cardia lymph flow in dogs produced histologic and electrophysiologic changes in the heart. Interstitial edema, lipid swelling of myofibrils, dilatation of lymph vessels, and fibrinoid degeneration of small coronary arteries occurred in and near the sinus node and the atrioventricular conduction system. On electrical stimulation of the heart, significant shortening of the atrial and ventricular effective refractory periods, increases in the sinus node recovery time and in the atrioventricular conduction time, and ventricular extrasystoles and ventricular fibrillation were observed. Many of these EKG changes are similar to those observed in sick sinus syndrome in man. An attempt was made to create dynamic lymphatic insufficiency by rapid electrical stimulation of the heart. EKG abnormalities observed in these cases could be prevented by intravenous injection of calcium dobesilate.