High risk percutaneous transluminal coronary angioplasty in the treatment of severe coronary artery disease.

We report on 27 "high risk" patients out of 171 consecutive patients undergoing percutaneous transluminal coronary angioplasty from June 1984 to August 1985. The ages ranged from 31-80 years (mean 62.7 +/- 10) years. High risk percutaneous transluminal coronary angioplasty was defined as: salvage cases (3 patients) where the patients presented in cardiogenic shock or the vessels were not bypassable; multivessel coronary artery disease (22 patients) where a large area of jeopardized myocardium was dependent on the angioplasty vessel(s); left ventricular dysfunction (7 patients) as defined by two of the three criteria: left ventricular end-diastolic volume index greater than 100 ml/m2; ejection fraction less than 30%; and left ventricular end-diastolic pressure greater than 20 mm Hg. The initial success rate in the high risk patients was 85.2%. Emergency coronary artery bypass surgery in these patients was 7.4%. There was one death in the high risk group, as one of the salvage cases died 24 hours after successful percutaneous transluminal coronary angioplasty due to severe underlying myocardial disease. In conclusion percutaneous transluminal coronary angioplasty can be successfully performed in high risk patients with a low complication rate and should be considered as an alternative to coronary artery bypass graft surgery in selected high risk patients.

Photoionization of radiation-induced traps in quartz and alkali feldspars.

For the optimization of luminescence dating and dosimetry techniques on the basis of the optically stimulated luminescence, the stimulation spectra of quartz and alkali feldspars were measured in the spectral region of 250-1100 nm using optically stimulated afterglow. Optically stimulated luminescence in all studied spectral regions is induced by the same kind of deep traps, that produce thermoluminescence in the regions of palaeodosimetric peaks for both minerals. The mechanism for photoionization of deep traps was proposed as being due to delocalization of the excited state of the corresponding lattice defects. The excited state overlaps the zone states; i.e. is situated in the conduction band. Because of the high quantum yield of deep electron trap ionization in the UV spectral region, the present aim was to study the possibility of using UV-stimulation for palaeodose reconstruction.

Gamma-ray dose assessment after the 1994 radiation accident in Kiisa (Estonia): preliminary results.

Dose reconstruction using thermoluminescence (TL) of quartz, extracted from the ceramic plant pots, and using EPR of the sugar samples, was performed after the 1994 radiation accident in the village Kiisa (Estonia). A gamma-ray source 137Cs was located during approx. 28 days in one of the village dwelling houses. On the basis of preliminary results, some important details of the history of the accident have been clarified. It was shown, that the gamma-ray source most of the time was placed in the kitchen table drawer. Thus, the absorbed dose rate of whole-body exposure for three inhabitants of the house in Kiisa was defined by this location of the source.

Glutaraldehyde revisited.

January 1994 and the Control of Substances Hazardous to Health Regulations (COSHH) are being amended to include among others anaesthetic gases. For COSHH to be effective it has to be enforced. In order to see how this might be achieved one can perhaps look at the effectiveness of the Regulations since 1989.

Hypnotherapy and acute pain control.

With the increasing acceptance of various forms of alternative medicine as coping strategies for the stresses and strains of modern life, hypnotherapy is becoming more and more established as an adjunct to orthodox medical practice. Scientific research methods applied to hypnotism, as well as improved communication and education, have done much to raise the image of hypnotherapy generally.

Percutaneous transluminal coronary angioplasty of the "very proximal" coronary artery stenosis.

We report on 11 patients with "very proximal" lesions out of a total of 300 consecutive patients who underwent percutaneous transluminal coronary angioplasty (PTCA). Eight patients had native left anterior descending (LAD) lesions and three had LAD saphenous vein grafts lesions. Lesions were considered to be "very proximal" when one half or more of the balloon was inflated in the left main coronary artery for the native LAD lesions or the aorta for the LAD coronary artery saphenous vein bypass graft (CABG) lesions. There was a mean reduction in stenosis from 88.3% (range 75-99) to 13.8% (range 0-60) and a mean reduction in transtenotic gradient from 47.2 mmHg (range 20-80) to 8.3 mmHg (range 0-20). The initial success rate was 90.9% (10 out of 11 patients) with a partial success in the other patient. No complications occurred in any of the patients. Two patients had restenosis (18.2%) at 3 months and 6 months, respectively, post-PTCA. It is concluded that "very proximal" lesions can be successfully dilated with a high initial success rate and low complication rate. Nevertheless, these lesions may present problems with guiding catheter stability and, because of the potential risk of circumflex (CX) occlusion, this vessel may have to be protected with a second guidewire.