[Clinical, immunological and radioimmunological diagnosis of lung cancer detected in prophylactic fluorographic surveys]. / Kliniko-immunologicheskaia i radioimmunologicheskaia diagnostika raka legkogo, vyiavlennogo pri profilakticheskikh fliuorograficheskikh obsledovaniiakh naseleniia.

A comprehensive survey, including clinical, X-ray, thermographic, immunological, and radioimmunological studies, was made in 56 patients with lung cancer detected on prophylactic fluorographic surveys and erroneously referred to the Lvov Regional Clinical and Diagnostic Phthisiopulmonological Center for suspected active pulmonary tuberculosis. Routine clinical and laboratory studies provided preliminary information in only 26.8% of cases and 73.2% needed additional examination by using currently available laboratory and instrumental studies. Of the most informative value for diagnosing malignancy is radioimmunocompetitive assay of serum levels of cancer embryonic antigen.

Modified repair of mixed total anomalous pulmonary venous connection.

Mixed total anomalous pulmonary venous connection (TAPVC) is a rare condition, accounting for only 5% of diagnosed TAPVC. It is associated with a poor prognosis unless surgically corrected by connecting the pulmonary venous sinus to the left atrium and optionally dividing the abnormal connection to the systemic venous system. We report a modified technique of complete intracardiac repair of mixed supracardiac and cardiac TAPVC in a 3-year-old child without pulmonary venous sinus-to-left atrium anastomosis.

Acute and chronic effects of transmyocardial laser revascularization in the nonischemic pig myocardium by using three laser systems.

BACKGROUND AND OBJECTIVE: Transmyocardial laser revascularization (TMLR) improves symptoms in patients with coronary heart disease. It is based on the hypothesis of direct perfusion of ischemic myocardium by means of laser-created channels. Three different lasers were used to study alternative effects on myocardium. STUDY DESIGN/MATERIALS AND METHODS: The present study was conducted to evaluate comprehensively and compare the short and long-term tissue effects and the basic interaction mechanisms of CO2, Ho:YAG, and Er:YAG laser radiation with myocardium. The dynamics of laser-induced impacts in gel used as tissue phantom was visualized by time-resolved flash photography. Pressure measurements performed during perforation of myocardium in vitro revealed the explosive character of the ablation process. Channels made into the left ventricle of normal pig hearts were examined immediately and 6 weeks after creation. RESULTS: Regardless of laser source, all channels became occluded within 6 weeks by scar. Minimal acute thermal damage by Er:YAG laser corresponded to smaller scars. Pulsed Ho:YAG caused stronger tissue tearing than continuous wave CO2 irradiation. An increased volume density of intramyocardial vessels was found about the scars 6 weeks after treatment with all lasers. CONCLUSION: The laser sources permitted to study outcome of pressure effects and thermal damage in vivo. There were only minor differences between the three laser systems used. Rapid channel occlusion suggests that rather than revascularization, subsidiary physiologic tissue effects elicited by the thermal, oxidative, or mechanical action of the laser impact may contribute to the beneficial clinical effects of TMLR.

Evaluation of coronary bypass flow with color-Doppler and magnetic resonance imaging techniques: comparison with intraoperative flow measurements.

OBJECTIVES: After coronary artery bypass surgery, patency and flow assessment is based on invasive methods such as angiography and intravascular ultrasound or flow wire techniques. The aim of the study was to compare intraoperative transit time flow measurements of coronary bypass grafts with early postoperative color-Doppler and MR-imaging assessment. METHODS: In 22 patients (62+/-8.5 years) undergoing elective coronary bypass surgery the flow was measured in all internal mammary artery grafts (IMA) and saphenous vein grafts using the transit time flow technique. Postoperatively (days 5-7) all patients had a color-Doppler IMA graft assessment followed by a MR-angiography and flow measurement (navigator echo phase contrast technique with and without contrast bolus application) to determine patency and graft flow. RESULTS: Data are expressed as the mean +/- SD). (1) In all patients the left IMA graft to the left anterior descending coronary artery (LAD) could be identified and flow could be assessed with both color-Doppler and MRI. Venous grafts could only be visualized by MRI. The use of an intravenous contrast bolus enhanced the visualization of coronary artery bypass grafts. (2) The mean IMA to LAD flow was 33+/-17 ml/min intraoperatively by transit time and postoperatively 36+/-25 ml/min by MR respectively 66+/-54 ml/min by color-Doppler technique. (3) The systolic/diastolic flow ratio was 0.44+/-0.12 intraoperatively and 0.43+/-0.17 postoperatively by MR respectively 0.67+/-1.0 by color-Doppler. (4) A statistically significant correlation could be demonstrated between intraoperative transit time and postoperative MR flow measurements (r = 0.57; P < 0.04), whereas the correlations to color-Doppler flow were poor. Postoperatively MR and color-Doppler showed a good correlation of systolic/diastolic flow ratio (r = 0.88; P < 0.008). CONCLUSIONS: The color-Doppler method during echocardiography and MR-imaging are useful non-invasive techniques to visualize postoperative IMA grafts for patency assessment. The quantification of IMA flow is still difficult with either technique, but MR flow measurements showed the best correlation to the intraoperatively measured transit time flow. The MR technique is the most promising non-invasive method for postoperative evaluation of coronary bypass grafts, since it allows visualization and reliable flow quantification.

Transit-time flow measurement for detection of early graft failure during myocardial revascularization.

BACKGROUND: A low-flow situation in arterial and venous grafts has been associated with high rates of perioperative infarction and mortality. This study was designed to look at intraoperative graft flow and resistance in patients with coronary artery disease. METHODS: Coronary artery bypass graft flow was measured in 46 patients. Transit-time flow was used for coronary flow measurements at rest as well as after maximal vasodilation with adenosine infusion. RESULTS: Forty-three of the 46 patients showed normal internal mammary artery graft flow (>20 mL/min); 3 patients had no or minimal graft flow. Redoing the graft anastomosis in these 3 patients resulted in normalization of graft flow. The mean flow increased significantly after correction from 0.5 +/- 0.7 mL/min to 15.7 +/- 9.6 mL/min (p < 0.02). Conversely, vascular resistance decreased significantly from 138 +/- 10 to 4.8 +/- 1.8 Ohmv (p < 0.0001), as did the pulsatility index (from 146.9 +/- 95.7 to 3.4 +/- 1.8; p < 0.001). After correction, coronary flow reserve was 2.5 +/- 1.1. CONCLUSIONS: Measurements of intraoperative flow and resistance as well as derived variables allow assessment of early graft function and thus help prevent graft failure and reduce perioperative infarction. Transit-time volume flow might be a simple tool for quality control in coronary bypass procedures.