Experience with predeposition of autologous blood in elective orthopaedic and plastic surgery: the role of oral iron medication.

The risk of transmission of transfusion-associated infections, mainly AIDS, led to the increased use of autologous transfusion by four methods: predeposition of autologous blood, haemodilution, intraoperative and postoperative blood salvage. We started a program of autologous predeposition at blood transfusion centre of Saint Andrews General Hospital of Patras in co-operation with orthopaedic and plastic surgery in 1992. To date, 617 autologous units have been collected from 257 patients undergoing various operations. Our protocol was as follows: the minimum Hb value before each donation was 12 g/dl, body weight over 50 kg, age 18-70 years and 8-10 day intervals between donations. The exclusion criteria were anaemia, evidence of blood loss, renal disease, chronic and acute inflammatory or malignant disorders, pregnancy and lactation. We chose 40 patients with haemoglobin values of 13-15 g/dl and ferritin levels > 50 ng/ml, who gave three autologous units. They were separated in two groups of twenty patients. Those in group 1 received 300 mg of elemental iron in three daily oral doses, while the others in group 2 received no iron medication. We studied haematologic variables, reticulocytes and ferritin levels in both groups before each autologous donation. We also studied the possible complications and their incidence in patients over 60 years old. According to our results, haematologic variables such as Hb, mean corpuscular Hb (MCH), mean corpuscular volume (MCV) and reticulocytes were not influenced by oral iron therapy. We observed a slight increase in MCV in both study groups which means the production of larger red blood cells. We also noticed a higher decrease of ferritin in patients with no iron therapy, but without a fall of ferritin levels under the normal values. We conclude that oral iron therapy in non-iron deficient patients undergoing a moderate program of three autologous units is not necessary. In addition, autologous blood donation is also feasible in patients over 60 years old without severe complications.

Hypertrophic peripheral neuropathy (Dejerine-Sottas disease) associated with heart block. Case report presentation and review of the literature.

We present a case of a male suffering from hypertrophic peripheral neuropathy (Dejerine-Sottas disease) and severe involvement of the cardiac conductive tissue causing syncopal attacks. It is the first time that an association of this neuromuscular disease with cardiac involvement is described.

The ST segment axis as a differential diagnostic feature between acute pericarditis and acute inferior myocardial infarction.

The ST segment electrical axis in the frontal plane was calculated in 20 patients with an acute inferior myocardial infarction (AIMI) and another 20 patients with the acute phase of pericarditis (AP). The ST segment axis of patients with AIMI ranged from 100 degrees-120 degrees (mean 114 degrees). The ST segment axis of patients with AP ranged from 30 degrees-60 degrees (mean 45 degrees). Thus, the ST segment axis can be used for the differential diagnosis in the early acute phase, especially when there are no other important distinguishing factors between these two conditions.

The effects of long-term antithrombotic treatment on left ventricular thrombi in patients after an acute myocardial infarction.

Sixty patients (48 men and 12 women; aged 36 to 72 years, mean 48 +/- 9), who survived an acute anterior myocardial infarction and in whom left ventricular thrombus was detected by cross-sectional echocardiography 1 to 2 days before they were discharged from the hospital, were prospectively studied. All had evidence of left apical wall motion abnormalities. They were randomly divided into three groups of 20 patients each. Group A was given a full dose of oral anticoagulants, group B was given aspirin, 650 mg/day, and group C received no antithrombotic therapy. Echocardiography was performed every 3 months in all patients, and they were followed for 9 to 24 months (mean 16 +/- 5 months). Twelve patients in group A had complete resolution of the thrombus and three had a significant decrease in the size of the thrombus (greater than or equal to 50% of initial thickness) during the first trimester after acute infarction. In group B the thrombus resolved in nine patients and was significantly diminished in four during the first trimester of follow-up. In group C the thrombus resolved in two patients during the first trimester and showed a significant decrease in size in two patients during the second trimester of follow-up. Two patients in group C initially had recurrent transient cerebral ischemic attacks, which did not recur after aneurysmectomy. One patient in group C had a peripheral embolic episode in the femoral artery.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of nifedipine on the sick sinus syndrome.

The effect of nifedipine (N) on sinus node (SN) function was studied in 15 patients (9 males, 6 females) sixty-two to seventy-six (mean 68.1 +/- 11) years old, with sick sinus syndrome (SSS). SSS was characterized electrophysiologically by a prolonged corrected sinus node recovery time (CSNRT greater than 535 msec) and/or prolonged sinoatrial conduction time (SACT greater than 125 msec), assessed by applying premature atrial stimulation. Ten mg N was given sublingually, and CSNRT and SACT were again evaluated sixty minutes after N administration, and again ten minutes after 1.5 mg atropine (A) was given IV. Heart rate increased significantly after N (p less than 0.005), systolic blood pressure (SBP) diminished significantly (p less than 0.005), and CSNRT and SACT shortened significantly (p less than 0.005, p less than 0.005) and became normal in 7 and 5 patients respectively. After A administration, a further significant increase of heart rate (p less than 0.005) and decrease of CSNRT (p less than 0.005) and SACT (p less than 0.005) were observed. CSNRT and SACT became normal in 8 and 7 patients respectively. SBP remained stable.

The effective treatment of multifocal atrial tachycardia with amiodarone.

Multifocal atrial tachycardia (MAT) was observed in 9 patients aged 60-85 (mean 72.1 +/- 8.6) years during exacerbation of their chronic lung and/or cardiac disease. Four, in whom the rapid heart rate caused symptoms of pulmonary congestion, were treated with intravenous amiodarone (450-900 mg over 2 hours) with restoration of sinus rhythm soon after the termination of the drug infusion. In 1, with recurrence of MAT, the same intravenous dosage was repeated for 2 consecutive days, with final achievement of stable sinus rhythm. Five patients, apart from the conventional management of their underlying disease (digitalis, diuretics, aminophylline) were treated with oral amiodarone (600 mg/day). Sinus rhythm was restored in all and remained stable during their hospitalization, under alpha maintenance dosage of 200-400 mg daily. Amiodarone may be the drug of choice for the treatment of MAT, for which up to now no effective therapy has been established.

Atrial septal defect and constrictive pericarditis. An unusual combination.

We describe a case of atrial septal defect associated with constrictive pericarditis. This combination is extremely rare and clinically misleading, since it may simulate other more common conditions. A variety of techniques, such as computerized tomography, echocardiography and cardiac catheterization were necessary for establishing the right diagnosis. Although there are suggestions of a possible association of atrial septal defect with pericardial disease, it is difficult to prove that this combination is other than coincidence.

Q and non-Q wave myocardial infarction: current views.

The new terminology "Q and non-Q wave myocardial infarction" (MI) tends to replace the traditional terms "transmural" and "subendocardial" MI since the anatomy cannot be accurately predicted by electrocardiography. Although some subtypes of non-QMI display a favorable early or in-hospital prognosis, the long-term outlook seems less benign, particularly when early or late recurrence of MI occurs. Coronary arteriograms show an equal number of diseased vessels in both types of MI, but complete coronary artery occlusion is less frequent in non-QMI. The management of patients with non-QMI should be mainly directed to preventing extension or recurrence of MI by using either drugs such as thrombolytic agents and drugs against coronary artery spasm or invasive techniques like percutaneous transluminal coronary angioplasty.

Arrhythmogenic right ventricular dysplasia: case report presentation and review of the literature.

A man complaining of palpitations was found to have ventricular tachycardia (VT) with LBBB configuration. From the investigations which followed, he was diagnosed as having arrhythmogenic right ventricular dysplasia (ARVD). The patient has been treated with amiodarone and propafenon for 7 months without VT recurrence. ARVD and Uhl's anomaly, which is its most extreme form, may be familial and represent an important cause of sudden death among young people: Prophylactic antiarrhythmic therapy and sometimes surgical treatment are required in case of refractory VT.