Three-year follow-up of the Argentine Randomized Trial of Percutaneous Transluminal Coronary Angioplasty Versus Coronary Artery Bypass Surgery in Multivessel Disease (ERACI).

OBJECTIVES: The purpose of this study was to report the 3-year follow-up results of the ERACI trial (Argentine Randomized Trial of Percutaneous Transluminal Coronary Angioplasty Versus Coronary Artery Bypass Surgery in Multivessel Disease). BACKGROUND: Although coronary angioplasty has been used with increased frequency in patients with multivessel coronary artery disease, its value, compared with bypass graft surgery, has not been established. Thus, controlled, randomized clinical trials such as the ERACI are needed. METHODS: In this trial 127 patients who had multivessel coronary artery disease and clinical indication of myocardial revascularization were randomized to undergo coronary angioplasty (n = 63) or bypass surgery (n = 64). The primary end point of this study was event-free survival (survival with freedom from myocardial infarction, angina and new revascularization procedures) for both groups of patients at 1, 3 and 5 years of follow-up. RESULTS: Freedom from combined cardiac events (death, Q-wave myocardial infarction, angina and repeat revascularization procedures) was significantly greater for the bypass surgery group than the coronary angioplasty group (77% vs. 47%; p < 0.001). There were no differences in overall (4.7% vs. 9.5%; p = 0.5) and cardiac (4.7% vs. 4.7%; p = 1) mortality or in the frequency of myocardial infarction (7.8% vs. 7.8%; p = 0.8) between the two groups. However, patients who had bypass surgery were more frequently free of angina (79% vs. 57%; p < 0.001) and required fewer additional reinterventions (6.3% vs. 37%; p < 0.001) than patients who had coronary angioplasty. CONCLUSIONS: 1) Freedom from combined cardiac events at 3-year follow-up was greater in patients who had bypass surgery than in those who had coronary angioplasty. 2) The coronary angioplasty group had a higher incidence of recurrence of angina and the need for repeat revascularization procedures. 3) Cumulative cost at 3-year follow-up was greater for the bypass surgery group than for the coronary angioplasty group.

Treatment of advanced ovarian cancer with cisplatin, adriamycin and cyclophosphamide (PAC).

Forty two ovarian cancer patients with residual disease after the first laparotomy were treated with the combination of cisplatin (80 mg/m2 day 1), adriamycin (50 mg/m2 i.v. day 2) and cyclophosphamide (500 mg/m2 i.v. day 2) (PAC). Forty women were considered evaluable for analysis, with an overall response rate (partial, plus complete responses) of 62.5%. Twelve patients (30%) obtained a complete response (histologically confirmed after second look surgery in 6 cases, surgical complete response, residual tumor completely resected in the second look-in 5 cases and maintained complete clinical remission without second look confirmation in 1 case). Main side effects were nausea and vomiting (90%), leukopenia (70%), mucositis (45%), and anemia (37%). Seventeen percent of the patients were free of disease at 60 months, after a median follow-up of 48 months. The prognostic factors that showed significant influence on survival were the Karnofski index (90-100 vs 80 or less), stage of the disease (II + III vs IV) and the volume of residual tumor after the first surgical procedure (less than or equal to 2 cms vs greater than 2 cms). Patients who achieved a complete remission have not reached the median 5 years survival, which was 10 months for the remaining patients. These results confirm the activity of PAC in ovarian cancer, mainly in those patients with residual tumor of less than 2 cms and good performance status.

Ultrastructure of the oviductal mucosa of the rat. III. Basal and peg cells.

In an E.M. analysis of the rat oviduct the authors report the morphology of the so-called indifferent basal cells and peg cells. The hallmark of the former are desmosomes and clear cytoplasm; these elements may detach themselves from the basal membrane, migrating towards the lumen and showing prominent ciliogenesis. Peg cells appear to be the morphological image of necrobiotic cells, either ciliatd or secretory.

Disappearing signs of acute myocardial infarction in a patient with viral myocarditis.

A case of acute viral myocarditis with the rapid appearance and disappearance of clinical, laboratory, electrocardiographic, and vectorcardiographic signs of acute myocardial infarction is described in this report. Although segmentary alterations in contractility were demonstrated by ventriculography, coronary angiography revealed normal coronary arteries.

Mass vaccination campaign against rabies: are dogs correctly protected? The Peruvian experience.

In a mass vaccination campaign conducted in Peru in March 1985, 270,000 dogs (65% of the estimated dog population) were vaccinated over the course of 1 month with an inactivated tissue culture vaccine. Since that time no human rabies cases have been reported; in addition, the number of animal rabies cases has declined to only three from a previous mean of 292 cases per year since 1980. A serologic survey was also done to determine the immune response among randomly selected vaccinated dogs, with titers determined 3, 6, 9, and 12 months after vaccination. Twelve months after vaccination, 97% of the dogs had a rabies neutralizing antibody titer of greater than or equal to 0.5 IU/mL, and 87% had a titer of greater than or equal to 1.0 IU/mL. Thus, this tissue culture rabies vaccine given under field conditions induced antibodies that lasted for at least 1 year in 97% of vaccinated dogs.