Polski tygodnik lekarski (Warsaw, Poland : 1960)最新文献

The laser Doppler flowmetry is a new technique for evaluating microcirculation. It is based on the Doppler phenomenon-reflected light changes its frequency when it interacts with moving objects such as red blood cells. The source of light is 2 mW He-Ne laser. The light penetrates into the tissue to the depth of 1 mm, and measures microvascular blood flow throughout it. This technique is objective, harmless even during prolonged exposition, repeatable, and very sensitive even to small changes in the blood flow. Because of difficulties with determination of the perfusion normal values and several factors disturbing microcirculation, the most objective results are obtained with dynamic tests. They measure a response of microcirculation to local ischemia, cooling or given medicines. A disadvantage is its high sensitivity to motion-produced disturbances. Laser Doppler flowmetry may be used not only in scientific investigations. It is of diagnostic value in plastic surgery, vascular surgery, dermatology, internal medicine, dentistry, and neurology.

During a 4-year period, 59 patients with the acute myocardial infarction were treated at the ICU of the district hospital. Streptokinase, used for the treatment, was given i.v. after and average period of 3 hours following the onset of stenocardia. Elaborated protocol was observed as to the selection of patients for thrombolytic therapy and its tactics. Basing on the indirect criteria of reperfusion, a recanalization of the occluded artery was noted in 74.6% of the treated patients. Complications occurred most frequently during the first 24 hours of the hospitalisation. None was serious enough to require special therapeutic measures. Complications of the thrombolytic treatment were less frequent after the first day of the hospitalisation. Thrombolytic treatment of the acute myocardial infarction with intravenous streptokinase is safe and effective, and may successfully be carried out also in district hospitals in which cardiac catheterization and cardiosurgery are inaccessible.

Exercise echocardiography seems a relatively reliable diagnostic technique for evaluation of patients with coronary artery disease. The prognostic aspects of the stress echo have widely been documented with the use of various stressors (exercise, dipyridamole, dobutamine, pacing). Rapid atrial pacing echocardiography is highly specific and sensitive technique for the detection of the coronary disease, especially in patients who are unable to perform an active stress test. This technique minimizes the factors decreasing image quality during exercise (chest wall movements and hyperventilation). Exercise echocardiography is safe, relatively cheap, and can be done in every hospital.

The activation of polymorphonuclear granulocytes between 2 and 5 hours from the beginning of the pain was examined in patients with myocardial infarction. The efficient neutrophils activated in the first day of illness, take part in recanalization of coronary vessels, thus limiting the extent of myocardial infarction.

A 24-hour ECG monitoring was carried out in 130 patients with stable exercise angina pectoris and history of myocardial infarction. A diagnosis of ischemic heart disease was based on anamnesis, positive result of exercise test and dipyridamole test, and the result of coronary angiography in some patients. Patients with unchanged repolarization period in ECG were classified to the study. Electrocardiogram was registered with Holter technique in patients performing their usual activities. Recorded ECG was analysed with visual technique in Medilog 3000 system. Two hundred thirty seven ischemic episodes were shown in the examined patients, including 69% of painless ischemic attacks and 31% of ischemic attacks with anginal pain. Duration of painless ischemic attacks with anginal pain. Duration of painless ischemic attacks was longer, heart rate slower, and ST segment elevation did not differ in both types of myocardial ischemia.

One of the complications of femoral artery synthetic prostheses are anastomotic aneurysms. In 1985-1993, 38 patients were treated for anastomotic aneurysms. Diagnosis was based on clinical and ultrasound examinations. A retrospective analysis has shown an occurrence of fever in 12 patients, and superficial pus oozing in 10 patients. Bacteriological cultures of intra-operatively collected specimens were positive in 25 patients. An infection with staphylococci was predominating. Repeated reconstructive surgery was performed within 6 months to 5 years after the primary one, mean 1.6 years. Aneurysm with the segment of prosthesis was excised and replaced by a fragment of new prosthesis (26 patients) or the vessel after excision of aneurysm was sutured with additional sutures on the whole anastomosis circumference (6 patients). On 7 patients bypass grafting was performed with ligation of vessels supplying anastomotic aneurysm. In all patients flow drainage was used. Positive result of re-operation was achieved in 21 (68.4%) patients. Limb was amputated in 10 cases (26.3%), and 2 patients (5.3%) died. An analysis of the treated patients showed an important role of the anastomotic infection in the anastomotic aneurysms formation. The treatment should include prolonged antibiotic therapy prior to the operation. In case of reoperation possible infection should always be considered.