[Plasma fibrinogen during the acute stage of angina or myocardial infarct]. / El fibrinógeno plasmático durante la etapa aguda de angina o infarto del miocardio.

We prospectively studied the fibrinogen plasma levels of patients with acute myocardial infarction (AMI) and unstable angina (UA) whose diagnosis was based on clinical, electrocardiographical, enzymatic or pirophosphate scintigraphy data. Forty patients were included, 21 with AMI and 19 with UA, each group as well as both were compared to 10 normal individuals. The AMI group consisted of 15 male and 6 female with ages ranging from 35 to 69 years (mean 56.4); the UA group included 15 male and 4 female with an range from 38 to 69 (mean 53.1); the control group was made up 4 male and 6 female with an age range from 28 to 62 years (mean 52.3). All patients had plasma determination of fibrinogen, protrombin time, partial tromboplastin time, platelet count, cholesterol and risk factor for coronary artery disease were obtained on admission. There were no significant differences in regard to platelet count or coagulation times. Fibrinogen was elevated (> 450 mg/ dL) in 27 patients: 15 with AMI: 9 with UA and 3 normal individuals. The comparison of plasma fibrinogen levels between the control group and AMI patients was 397 +/- 131 vs 695 +/- 174, respectively (p < 0.001). Comparison between control group and the UA patients was 397 +/- 131 vs 455 +/- 108, respectively (p = 0.19 NS), and the comparison between the control group and AMI and UA patients gives 397 +/- 131 vs 534 +/- 164 (p < 0.001): Elevated fibrinogen seems to be a contributing factor for coronary artery disease and seems to be a risk factor with as much weight as any other.

[Heart catheterization in Mexico. Results of the 1996 census of heart catheterization services by the Mexican Society of Cardiology]. / Cateterismo cardiaco en México: Resultados del censo 1996 de Servicios de Cateterismo Cardiaco por la Sociedad Mexicana de Cardiología.

The findings of the 1996 Cardiac Catheterization Laboratory Survey of the Sociedad Mexicana de Cardiología are presented. There are 52 cardiac catheterization laboratory departments distributed in 16 cities of which Mexico City has 20, Guadalajara 6 and Monterrey 5. Ninety-six percent are in hospitals where heart surgery can be performed and 8 (17%) have a training program in cardiac catheterization. Only two (3.8%) are exclusively dedicated to pediatric cardiac catheterization. In 1995, 19,214 diagnostic procedures and 2,429 PTCAs were done. A total of 270 physicians were reported to have privileges to perform cardiac catheterization. The geographical distribution of the cath labs, procedure volumes and number of physicians performing catheterization are discussed.

[In vitro effects of argon laser radiation the human healthy and atherosclerotic aorta]. / Efectos in vitro de la radiación del laser de argón en aorta sana y aterosclerosa.

Argon laser exposures in vitro were done on human aortas. The laser energy applied on a fresh aorta section (A) was from 100mw to 1000mw. A second aorta section (B), formalin fixed, was irradiated under saline solution by a fiberoptic system. Laser energy was from 400mw to 720mw. The time exposures were all different in both sections. A and B histologic findings of thermal damage were similar Three zones of tissue injury were observed: I) crater because of tissue vaporization; II) coagulative necrosis surrounding it; and III) multiple vacuoles in the adjacent tissue produced by acoustic or shock injury. Tissue damage was related directly with total energy delivered: less than or equal to 500mw showed inner vascular wall necrosis, and at greater than or equal to 720mw it was perforated. Atherosclerotic tissue was more resistant to laser thermal injury than normal tissue. We could not find time relation with thermal damage. This preliminary information is an early step for the possible use of Argon laser on cardiovascular area.

[Complex coronary angioplasty. Report of 3 cases]. / Angioplastía coronaria compleja. Informe de tres casos.

Although coronary angioplasty is currently applied to a wide variety of obstructive coronary artery lesions, its indications have been reduced to certain selected cases. We present three cases of complex coronary angioplasty: in the elderly patient, after bypass surgery, and multiple lesions in one vessel comment about different causes that justify its use. We conclude emphasizing that currently percutaneous coronary angioplasty is a secure and successful alternative of treatment even in complex cases, if they are properly selected.

[Transluminal coronary angioplasty using ultrasound]. / Angioplastía coronaria transluminal por ultrasonido.

The application of ultrasonic energy for ablation of atherosclerotic plaques was studied. This study was performed in 92 segments obtained from human coronary arteries which belonged to eleven hearts obtained from patients who have died from acute myocardial infarction. An ultrasound generating system (Cavitron 600) was used, and an ultrasonic probe wire (P-150 Endosonic), was attached to it. A stainless steel wire (0.36 mm in width and 145 cm length), was fixed to this probe. Sonic pulsed stimulations 20 sec long and 25 kHz in frequency were performed. The sound transmitting characteristics of the angioplasty guide wire were studied, as well as the ultrasound effects upon atherosclerotic plaques, blood elements, coagulation, and it's lysis effects upon recently formed clots. The anatomic pieces were filmed in cineangiocoronary graphy in two planes, anterior right oblique an anterior left oblique, to be studied later under light microscopy. The results were as following: in the 100% obstructions, a 41% recanalization was obtained; in the 95% obstructions, a 79%, in the 75% obstructions, a 37%. We did not work in the 50% or less obstructions. Under the procedure, no artery suffered perforations. Under Light microscopy, a plaque fragmentation was observed in 24% of the cases; rupture and fragmentation, in 14%, cavitations in 10%; ondulations in 9%; plaque rupture and thermic lesion in 8%; 22% did not present changes. The collected detritus had 110 +/- microns diameter. Erythrocytes exposed to 30 or 60 sec of ultrasound were found to present crenocytosis, central cavitation, hypochromia, and poikilocytosis; these ones exposed less than 22 sec did not show changes. The fibrinogen levels after the application of ultrasound were 19% lower. Coagulation time did not change with exposure 20 sec long at 20 kHs. The angioplasty guide wires attenuation coefficients were: with the guide wire outside the Miller's catheter, 44%; and with the guide wires inside, 65%. Coronary transluminal angiosonoplasty is a new interventionist technic designed to remodel an obstructive lesion of the coronary arteries, in order to diminish or nullify the obstruction. It's clinic use in the acute myocardial infarction, as a mechanical method to achieve clot's lysis, could be an alternative or a co-helper therapeutics to thrombolysis.

[Coronary angioplasty. Results observed in 14 cases]. / Angioplastía coronaria. Resultados observados en 14 casos.

Between December, 1985, and May, 1988 we have performed coronary angioplasty of 14 lesions in 12 patients. Before angioplasty 8 patients had a history of unstable angina, and 3 developed angina after streptokinase because of an acute myocardial infarction. We attempted angioplasty of 11 proximal and 3 distal lesions; these included a coronary bypass graft lesion, and 3 lesions in one vessel. We successfully dilated 12 lesions (85%). The coronary stenosis was reduced on average from 84.2 +/- 9 to 17.5 +/- 7 per cent (P less than 0.0001); and the pressure gradient was reduced from 74 +/- 16.25 to 18.3 +/- 9 mmHg (P less than 0.001). Procedure-related complications included: coronary occlusion in 4 patients (28.5%) that were successfully resolved during angioplasty in 3 patients, but one developed myocardial infarction (8.3%); and one urgent surgery and death in a patient with 3 vessel disease. Twelve patients (83%) with no evidence of myocardial ischemia returned to their normal activities. These initial data confirm coronary angioplasty as a safe, efficatious and successful alternative in the management of selected patients with coronary artery disease.