Invasive and anticoagulant treatment for coronary ectasia: a single operator's experience in a tertiary hospital in South Africa.

INTRODUCTION: Coronary artery ectasia (CAE) is a rare but well-recognised condition involving dilatation of a coronary artery to more than 1.5 times the diameter of the adjacent portion of the artery. As far as we are aware, the disease has not been described in any local literature and no other research has been conducted in Africa. We carried out this research in order to establish the incidence of the condition in South Africa, as well as the possible preferred method of treatment. METHODS: Cases were identified from the database of the practice. The study involved only patients who were classified to have Markis type I, II and III disease. From a total of approximately 2,000 angiographies performed during the study period, CAE types I, II and III were diagnosed in 20 patients. Patients with type IV CAE were excluded from the group. Nineteen patients were male and were in their fourth or fifth decade of life, and one was female. Three of the patients were Indian, one was black, and the rest were white. RESULTS: Four patients in the group had diabetes, 13 were smokers and eight had hypertension. Dyslipidaemia was observed in seven patients. The most commonly affected area of the coronary artery was the RCA-19 (isolated, or in combination). Patients were treated mainly with anticoagulation and, when necessary, with angioplasty and stent implantation. Morbidity was seen in 5% of the patients and no mortality was observed. CONCLUSION: Most of the patients were male, and the occlusion involved mostly the right coronary artery. The cause of occlusion is still unknown, but it is thought to be due to slow blood flow, damaged endothelium, or a combination of the two. The best therapeutic approach is not known as yet.

Invasive and Anticoagulant Treatment for Coronary Ectasia : a Single Operator's Experience in a Tertiary Hospital in South Africa : Cardiovascular Topics

Introduction: Coronary artery ectasia (CAE) is a rare but well-recognised condition involving dilatation of a coronary artery to more than 1.5 times the diameter of the adjacent portion of the artery. As far as we are aware; the disease has not been described in any local literature and no other research has been conducted in Africa. We carried out this research in order to establish the incidence of the condition in South Africa; as well as the possible preferred method of treatment. Methods: Cases were identified from the database of the practice. The study involved only patients who were classified to have Markis type I; II and III disease. From a total of approximately 2 000 angiographies performed during the study period; CAE types I; II and III were diagnosed in 20 patients. Patients with type IV CAE were excluded from the group. Nineteen patients were male and were in their fourth or fifth decade of life; and one was female. Three of the patients were Indian; one was black; and the rest were white. Results: Four patients in the group had diabetes; 13 were smokers and eight had hypertension. Dyslipidaemia was observed in seven patients. The most commonly affected area of the coronary artery was the RCA-19 (isolated; or in combination). Patients were treated mainly with anticoagulation and; when necessary; with angioplasty and stent implantation. Morbidity was seen in 5of the patients and no mortality was observed. Conclusion: Most of the patients were male; and the occlusion involved mostly the right coronary artery. The cause of occlusion is still unknown; but it is thought to be due to slow blood flow; damaged endothelium; or a combination of the two. The best therapeutic approach is not known as yet

A two-year, single-group experience with rotational atherectomy.

Rotational atherectomy was introduced with a view to approaching percutaneously, cases that were suboptimal or unsuitable for conventional percutaneous transluminal coronary angioplasty (PTCA). In this article we present our findings for a period of two years starting in April 2001, when 60 procedures were performed on 54 patients. We found the procedure to be successful in B2 and C type lesions. It is our opinion that the lower burr-to-artery ratio used in our cases was significantly beneficial in decreasing immediate complications related to the procedure. Complimentary PTCA and stenting improved the angiographic end result. Using this strategy, we have achieved very acceptable clinical results.

Cardiovascular complications of acute cocaine poisoning: a clinical case report.

We present a case of an accidental cocaine overdose with various cardiovascular and neurological complications and ECG features of Brugada syndrome. It is imperative that clinicians know how to recognise and manage the symptoms of cocaine overdose because of the exceedingly rapid progression of the 'cocaine reaction' to a fatal outcome.

Transoesophageal atrial pacing stress echocardiography in coronary artery disease: role, principles and methodology.

This article reviews the physiology and methodology of transoesophageal atrial pacing stress echocardiography (TAPSE) and clarifies its place among the other stress modalities. TAPSE correlates well with myocardial perfusion stress scintigraphy and coronary angiography and is a simple and safe diagnostic option for patients with suspected or known CAD, including those with recent myocardial infarction. Furthermore, the results of TAPSE have prognostic significance in patients with uncomplicated MI. Although, it is a highly feasible and safe technique, the cardiologist should be directly involved in the procedure and the personnel must be well trained in a large number of tests, as for any other stress echocardiographic modalities.

"Low pressure" left ventricular tamponade in a patient with rheumatic mitral stenosis and HIV-related acute pericarditis.

A case report of isolated left ventricular tamponade in a patient with rheumatic mitral stenosis and effusive pericarditis is presented. The haemodynamics and management of this under-diagnosed pathology is discussed.

'Quadrileaflet' mitral valve associated with paravalvular aneurysms and complicated by mitral incompetence: a case report of a rare pathology identified by 2-dimensional echocardiography.

A case is reported of a rare pathology involving the left atrioventricular valve with excessively developed scallops in association with subvalvular aneurysms, together with an acquired, probably HIV-related, chronic effusive pericarditis. The possible aetiology is discussed.

Platelet glycoprotein IIb/IIIa receptor blockade with integrilin (eptifibatide) for early postinfarction angina in a patient with coronary arterial ectasia.

A middle-aged male with multivessel proximal coronary ectasia presented with thrombosis-related acute myocardial infarction and early postinfarct angina, and was successfully treated with a combination of intravenous integrilin (eptifibatide) and unfractionated heparin. The possible aetiology, prognosis and available management strategies are discussed.

Echocardiographic features of extreme mitral valve prolapse vs mitral valve aneurysm.

This report presents clinical observations and brings up for discussion the differential diagnosis of echocardiographic features of extreme mitral valve prolapse and inflammatory and non-inflammatory mitral valve aneurysms.

Congenital left ventricular aneurysm in an adult.

A rare case of idiopathic massive apical ventricular aneurysm in a young man is reviewed. Secondary infection was present in the aneurysm. No features of left ventricular failure were observed.

Myocardial viability--mechanisms of reversible myocardial dysfunction and diagnosis in coronary artery disease.

The natural history of ischaemic myocardium and numerous revascularisation studies have proved that it is clinically important to distinguish viable but dysfunctional myocardium from irreversibly injured muscle in patients with coronary disease. A large variety of invasive and non-invasive methodologies are available for the detection of myocardial viability. This review focuses on the value and limitations of the current diagnostic approach to the recognition of stunned and hibernating myocardium in the light of the current understanding of their pathophysiological mechanisms.

Transoesophageal echocardiographic demonstration of mechanism for right-to-left shunting across a patent foramen ovale in acquired tricuspid regurgitation.

This case report describes a patient who presented with left middle cerebral artery infarction and was found to have a systolic right-to-left shunt across a patent foramen ovale. These features were secondary to severe acquired tricuspid regurgitation.

A new retroviral AIDS-like disease and/or acute leukemia induced in mice by alloimmune stimuli.

We have shown a new phenomenon demonstrating that BALB/c female mice mated to C57BL/6 males during a year (7-10 pregnancies) develop AIDS-like disease or acute leukemia after an additional immunization with fixed ConA activated paternal (C57BL/6) lymphocytes. The AIDS-like disease is sexually and vertically transmissible and easily transferable to intact BALB/c and C57BL/6 mice by filtered plasma of affected animals.

A new transmissible AIDS-like disease in mice induced by alloimmune stimuli.

The search for a suitable and reliable animal model for human AIDS that is easy to use on a large scale continues. Here we describe a new condition in mice that closely resembles human AIDS, namely, chronic lymphoproliferation with dramatic depletion of CD4-positive cells, progressive impairment of the immune responses, and Kaposi's sarcoma-like tumors or terminal B-lymphomas. The AIDS-like disease was primarily induced by mating BALB/c female mice to C57BL/6 males during a 1-year period (7-10 allogeneic pregnancies) followed by immunization with paternal lymphocytes. The disease is sexually and vertically transmissible, transferrable by cell-free plasma and is associated with autoimmune reactions to major histocompatibility complex antigens and CD4 cells. We hope that this becomes a model for studying the mechanisms of AIDS immunopathogenesis and immune-based treatment approaches.

[Blood loss in the placental period in relation to the type of prophylaxis]. / Kruvozaguba v platsentarniia period v zavisimost ot vida na profilaktikata ì.

The aim of this study is to asses the blood loss in third period of labor according the method of its prophylactic. The material consist of 144 prospective and 192 retrospective cases. The blood loss is assessed visually and after that it is weighted. Up to the delivery of placenta the visually assessed blood loss is insignificantly greater than the weighted one. All cases are subdivided in three groups according the management of third period: -with methergin, with oxytocin and without uterostonic. The blood loss associated with the separation and delivery of the placenta is not different in the groups, but the early postpartum haemorrhage is significantly greater in the cases without uterostonics for the delivery of placenta. In premature labors the blood loss associated with the separation of placenta is significantly greater that in term labor.

Autoimmunity and counter-autoimmunity in the mechanisms of retrovirus-induced leukemogenesis.

The role of autoimmune mechanisms in the pathogenesis of retrovirus-induced leukemia was studied using as models different forms of Rauscher leukemia virus (RV) infection in mice of different strains. It was found that mice undergoing progressive course of leukemia ("progressors") produce (a) autoantibodies to a series of antigens intimately involved on immune response regulation (class II MHC antigens, cell surface markers of helper and suppressor T-lymphocytes and erythrocaryocytes, receptors for IL-2, etc.); (b) antiidiotypic antibodies which suppress both antiviral responses and autoimmune reactions against class I MHC antigens. Passive transfer of these antibodies into genetically resistant mice prior to RV inoculation breaks their resistance. Completely resistant C57BL/6 mice and mice undergoing "spontaneous" regression of leukemia ("regressors") were found to be genetically capable of (a) suppressing autoimmune reactions of "progressors" type by active synthesis of antiidiotypic antibodies; (b) producing autoantibodies to MHC class I antigens. Immunization with monoclonals to H-2Db as well as with "anti-autoimmune" antiidiotypes prior to RV infection leads to abrogation of appropriate immune reactions and development of leukemia in C57BL/6 mice.

[Autoimmune reactions against interleukin-2 receptors in patients with blood system diseases and in experimental Rauscher retrovirus leukemia]. / Autoimmunnye reaktsii protiv retseptorov dlia interleikina-2 u bol'nykh s nekotorymi zabolevaniiami sistemy krovi i pri éksperimental'nom retrovirusnom leikoze Raushera.

Apart from autoimmune reactions, antibodies to IL-2 receptors were identified in blood sera of linear mice during leukemogenesis. It is indicated that in the course of leukemia establishment, there can be demonstrated antibodies capable of blocking IL-2 receptors on the membrane of activated T lymphocytes and inhibiting IL-2-dependent proliferation of T cells. The blood sera of patients suffering from chronic lymphoid leukemia, acute lymphoblastic leukemia, lymphocytomas, pure red-cell aplasia, and aplastic anemia showed antibodies against IL-2 receptors. Out of the total number of 52 patients, 23 demonstrated those antibodies. The data obtained should be taken into account in the patients' management using IL-2.

[Holter diagnosis of the cardiac biorhythm in young persons]. / Kholterova diagnostika na biorituma na surtseto pri mladezhi.

The cardiac biorhythm was studied in 30 young persons 17-28 years of age. Holter's technique for a 24 hour ECG recording was used. In 15 persons the arterial pressure was recorded simultaneously. Supraventricular and ventricular extrasystoles were found and in one person preventricular tachycardia during sleep was recorded. Bradycardia of 34. min-1 was recorded in one person and bradycardia below 40. min-1 during sleep without accompanying rhythm and conduction disturbances was recorded in 30% of the examined persons. No pathologic variations of the arterial pressure were found. An attempt is made to find out correlations between the ECG changes and the activity of the sympathetic/parasympathetic system.