Local Thrombolysis in High-Risk Pulmonary Embolism-13 Years Single-Center Experience.

To evaluate the prognosis after local thrombolysis compared to systemic thrombolysis in high-risk pulmonary embolism. Observational study during 13 years which included 37 patients with high-risk pulmonary embolism treated with local thrombolysis and 36 patients with systemic thrombolysis (streptokinase, 250 000 UI/30 minutes followed by 100 000 UI/h). Cardiogenic shock has totally remitted in the group with local thrombolysis (P = .002). The decrease in pressure gradient between right ventricle and right atrium was comparable in both groups in the acute period (the results being influenced by the higher in-hospital mortality after systemic thrombolysis), but significantly better in the next 24 months follow-up after in situ thrombolysis. Major and minor bleeding did not have significant differences. In hospital, mortality was significantly lower in the group with local thrombolysis (P = .003), but for the next 24 months follow-up, the survival was comparable in both groups. Local thrombolysis, during the hospitalization, was associated with lower mortality rate comparing with systemic thrombolysis. In the next 24 months follow-up, the evolution of residual pulmonary hypertension was significantly better after in situ thrombolysis.

[Systemic amyloidosis. Case report]. / Amiloidoza sistemica. Prezentare de caz.

The amyloid deposition in skeletal muscle is well known but a rare occurrence. The study reflects the morphoclinical picture in cardiac amyloidosis in a 51 years old woman, having progressive cardiac failure and sinus node disease. A complete clinical evaluation of the patient showed a concomitant malignancy, plasma-cell myeloma. Muscle-cutaneous biopsy and a sulfated blue alcian staining was routinely performed to screen for amyloid. Histologically, amyloid was confirmed by the presence of deposits in the interstitium around perivascular region, or rarely, in the endomysial region. Focally, the muscles showed a small group atrophy and scattered regenerating muscle fibers and some degenerating myofibers. Generally, is known that prevalence rate of amyloid myopathy in muscle biopsy specimens is low (0.004%), and, as in our case, only a minority of patients have multiple myeloma, as well.