Angiology
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The purpose of this study is to examine how frequently myocardial ischemia was manifested on the surface electrocardiogram (ECG) during percutaneous transluminal coronary angioplasty (PTCA) and to select the most sensitive leads for the duration of ischemic ST changes. The study population consisted of 126 patients (pts), 116 men and 10 women, who underwent PTCA for one-vessel coronary artery disease. A 12-lead ECG was recorded in all patients before inflations and at ten-second intervals during each inflation. ⋯ The most sensitive ECG leads for detection of ST elevation were V2 or V3, V4 and V1 for the LAD, leads a VF and II for RCA, and leads III, aVF, or II, and V6 for LCX. The best leads for detection of ST depression were III, aVF and II for LAD, V2 or V3 and aVL for RCA, and V2 or V3, V1, and V4 for LCX. In conclusion, surface ECG represents a simple and very sensitive method for myocardial ischemia monitoring during PTCA.(ABSTRACT TRUNCATED AT 250 WORDS)
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Case Reports
Reversal of gangrenous lesions in the blue toe syndrome with lovastatin--a case report.
A seventy-six-year-old man with ischemic heart disease, peripheral vascular disease, and chronic renal failure developed bilateral cyanotic toes, which upon muscle biopsy, were shown to be caused by atheromatous emboli. The probable source was atheromatosis of the abdominal aorta. ⋯ With lovastatin therapy there was complete healing and except for transient cyanosis related to temporary cessation of therapy, there has been no recurrence for the past thirty months. The possible role of lovastatin in the conservative treatment of this disorder is discussed.
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An anatomic landmark is identified and described that simplifies the technique of central venous cannulation via the subclavian vein. The commonly used techniques are an approach to the subclavian at the junction of the medial and middle thirds of the clavicle or at the midclavicular line. ⋯ Using this technique, the authors have successfully cannulated the subclavian vein in 92.7% (51/55) of attempts with a 5.5% (3/55) complication rate. The only complications were arterial punctures, which were treated with pressure and were of no consequence to the patient.
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Between 1982 and 1990, 76 patients (33 women, 43 men, mean age 71.4 +/- 10 years) affected with limb-threatening peripheral vascular disease (claudication < 20 m: 3 patients; rest pain: 10 patients; necrosis1 smaller than 3 cm2: 28 patients; necrosis2 larger than 3 cm2: 35 patients) not amenable to medical and/or surgical therapy, were treated by epidural spinal cord electrical stimulation (ESES). Effectiveness of ESES was evaluated by consideration of pain control, walking distance, and healing of ischemic lesions. At a mean follow-up of twenty-six months (range: one to seventy-six) 44 limbs (58%) were amputated (rest pain 2; necrosis1 13; necrosis2 29) and 39% of necrotic lesions smaller than 3 cm2 healed. ⋯ Moreover, the authors noticed a good ESES effect on pain relief, maximal in the early and intermediate postimplant periods. In conclusion ESES must be considered the last resort in peripheral vascular disease in patients in whom medical and/or surgical therapies are ineffective or impossible. Necrotic lesions larger than 3 cm2 contraindicate, in their opinion, ESES implant.
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At present surgery is accepted as the most effective mode of therapy for carcinoma of the lung. Because the lack of respiratory reserve is the major determinant of postoperative function, it is useful to identify the patient, who is at significant risk. Eighteen patients with lung cancer (mean age = 56 +/- 6.5 years) were studied preoperatively (preop) and postoperative (postop) (three to four months after lung resection) by spirometry, measurement of arterial blood gases, and quantitative lung scanning (99mTc). ⋯ A predicted FEV1 of 0.8 L does not permit a surgical program, because, below this level, carbon dioxide retention becomes more frequent and exercise intolerance is increasingly severe (poor quality of life). The method proposed to predict the postoperative respiratory function is simple and routinely useful. The authors choose a perfusion instead of ventilation scan, because the former provides similar predicted postoperative data, and can be done routinely.