[Arterial revascularization of the myocardium: the future?].
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Biomedical subjects
Publications and source records attributed to J Roquette.
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It is unusual the association between hypertrophic cardiomyopathy and atrial septal defect. We present in this paper the results of the tests done to one patient with these two diseases and profit to make an update of the bibliography on this subject.
OBJECTIVE: To determine the curve of cardiac creatine-kinase (MB-CK) plasma activity, in patients with coronary heart disease who were submitted to Coronary Artery Bypass Graft (CABG) and/or aneurysmectomy, in order to evaluate the degree of a eventual myocardial lesion occurring during the first 72 hours after surgery. DESIGN: Assay of the plasma MB-CK activity and of the 12 lead electrocardiogram (EGC) during the first 72 hours after surgery. SETTING: Patients undergoing surgery in a Department of Cardiac Surgery. PATIENTS: 49 consecutive patients included in 2 groups: Group A: 38 pts submitted to CABG. Group B: 11 pts submitted to aneurysmectomy (6 of them with simultaneous CABG). INTERVENTIONS: Determination of plasma MB-CK activity and execution of 12 lead EGC before surgery and at 0, 6, 12, 24, 36 and 72 hours after surgery. RESULTS: Using as a reference the MB-CK values in a control group undergoing surgery for either aortic or mitral valvulopathy, the patients in group A were subdivided: Group A1: 25 pts which curves of MB-CK activity were similar to the control group; none showed sign of myocardial infarction in the EGC. Group A2: 13 pts which curves of MB-CK activity showed a increased value when compared to controls (at least, two Standard Deviation above the medium control value). In 6 of them the EGC were compatible with acute myocardial infarction. Group B patients were also divided in 2 subgroups: Group B1: 10 pts with a similar MB-CK activity to the control group. Group B2: 1 patient with MB-CK activity similar to the patients in Group A2 and whose EKG showed a pattern of "the new" myocardial infraction. CONCLUSIONS: The method used in our work allowed us to define a MB-CK activity curve that translates the expected variability after surgery in patients submitted to CABG and/or aneurysmectomy. This curve allows the distinction between myocardial lesion due to surgical aggression and a ischemic lesion. The EGC although a method with high specificity has apparently a low sensitivity for the detection of myocardial necrosis after CABG. The aneurysmectomy "per se" does not influence the MB-CK activity.
Since 1968 we have treated with antiblastic drugs 164 malignant tumors recurrent or incurable by surgery or radiotherapy in 151 cases. Different therapeutic methods were employed. Today we have the possibility of selecting alternative options with incipient or relatively delimited carcinomas, principally the substitution of radical surgery by initial associated physical and chemical treatment, so that if there is a cure the consequences of radical surgery can be avoided. We emphasize the curve of two primary cancers of the uvula with 300 mg bleomycin exclusively and the results observed in oropharyngeal and laryngeal carcinomas by using three intermittent Schabel cycles and 4,000 rad Telecobalt, avoiding a radical surgery.
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We have developed a new functional surgical technique for cancers of the larynx specially those situated glottically and subglottically which are considered remedial to a total laryngectomy. Specifically an infravestibular horizontal partial laryngectomy can be performed to remove neoplasms together with the glottis and subglottis. The larynx then may be reconstructed by suturing the bands to the ascended trachea and the conserved upper half of the tyroid cartilage. The results have been encouraging. Swallowing, phonation and respiration by the natural vias has been obtained in 8 of the 12 patients so operated.
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32 rabbits suffering from simple hereditary glaucoma were studied from the ophthalmological, otological and histopathological point of view. Gonioscopy, tonometry, ophthalmo- and retinography, otoscopy, tympanometry, ABR and the corresponding histopathological studies of the eye and of the cochlea were performed. The simple hereditary glaucoma seems to be causally related with concomitant hearing loss due to congenital endolymphatic hydrops. Further studies are planed.
Brain stem auditory evoked potentials using skin electrodes have been studied in rabbits. The obtained records are integrated by 6 consecutive waves ranging up to 10 ms. of latency time. The most important, constant and well-performed waves were the I, II and IV waves, which persist until the auditory threshold by 10 dB. The obtained results in 50 ears have been statistically treated. Subsequently, a normal pattern of the BAEP in rabbits has been performed as a base for upcoming papers.
The authors have studied four cases of vestibular neuronitis. General and special ENT exploration were performed and repeated every month. The observation period was three months. ABR and ENG were used for evaluation. The cochlear part of the VIII cranial nerve ist affected without subjective clinical expression. So the patients were diagnosed as having vestibular neuronitis.
The subject presented for its rarity is a case of rhabdomyosarcoma embryonal ear in girl patient 6 years old. Her clinic first gave a wrong diagnosis of chronic otitis of the middle ear with otorrhea and facial paralysis. A malignant tumour was suspected during the operation. A histopathology study confirmed the diagnosis of rhabdomyosarcoma. A review of the literature is made and details given of how often it occurs, and incidence, histopathology types, treatment and prognosis.
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Valvular cardiac prosthesis have dramatically altered the prognosis of patients with valvular cardiac disease; however, they are not free of complications. Prosthesis disfunction and problems related to anticoagulation are the more common, but hemolytic anemia should also be considered. In this case, hemolytic anemia appears as the major complication of a mitral bioprosthesis; the decision concerning the presentation of this case report rests upon its rarity and peculiar circumstances of appearance. A brief revision of the diagnostic work-up is also made.