Manifestations of Lyme carditis.

The first data of Lyme carditis, a relatively rare manifestation of Lyme disease, were published in eighties of the last century. Clinical manifestations include syncope, light-headedness, fainting, shortness of breath, palpitations, and/or chest pain. Atrioventricular (AV) electrical block of varying severity presents the most common conduction disorder in Lyme carditis. Although is usually mild, AV block can fluctuates rapidly and progress from a prolonged P-R interval to a His-Purkinje block within minutes to hours and days. Rarely, Lyme disease may be the cause of endocarditis, while some studies and reports, based on serological and/or molecular investigations, have suggested possible influence of Borrelia burgdorferi on degenerative cardiac valvular disease. Myocarditis, pericarditis, pancarditis, dilated cardiomyopathy, and heart failure have also been described as possible manifestations of Lyme carditis. The clinical course of Lyme carditis is generally mild, short term, and in most cases, completely reversible after adequate antibiotic treatment.

Coiling of the right external iliac artery with atherosclerotic plaque as a cause of ischemic ulcer on the toe: report of a case.

Coiling of the artery is a rare morphologic entity, most frequently found in the internal carotid arteries. Coiling of other arteries is rarely reported because it is usually asymptomatic. We report a case of 360 degrees coiling of the right external iliac artery found by color duplex scan and arteriography. The patient was a 72-year-old man who presented with a 2-month history of an ischemic ulcer on his right toe and a right ankle-brachial-pressure index (ABPI) of 0.0 and 0.4 on admission. We resected 7 cm of the affected artery and performed end-to-end reconstruction. After 2 months of follow-up, his ischemic ulcer had healed and the ABPI of the right foot was 0.0 and 0.8.

A randomized trial of the Tubulcus multilayer bandaging system in the treatment of extensive venous ulcers.

BACKGROUND: Venous ulcers are a major health problem because of their high prevalence and associated high cost of care. Compression therapy is the most widely used treatment for this condition. The vast majority of published articles on compression therapy present the results in the treatment of venous ulcers usually up to 15 to 20 cm(2). However, there are no published data in English medical literature on the efficacy of compression therapy in the treatment of extensive venous ulcers (ulcers >20 cm(2) of more than 6 months' duration) with regard to healing rate, time to healing, and recurrence rate at 12 months after healing. METHODS: A total of 138 patients with extensive venous ulceration (ulceration surface, 20-210 cm(2); duration, 7 months to 28 years) were randomized into 2 groups: (1) a treatment group (72 patients who were treated by using a multilayer bandaging system with the Tubulcus (a heelless open-toed elastic compression device knitted in tubular form) and elastic bandages and (2) a control group (66 patients treated with a multilayer bandaging system with elastic bandages only). The patients were treated on an ambulatory basis; the primary end point of the study was complete ulcer healing at 500 days. The secondary end point was to assess the ulcer recurrence rate during continuation of below-knee compression of different degrees of compression. In the treatment group, patients were instructed to continue to wear the Tubulcus (35 mm Hg), and patients in the control group were instructed to wear compression stockings with compression of 20 to 25 mm Hg. The exclusion criteria from the study were heart insufficiency with an ejection fraction <35, an ankle-brachial pressure index less than 0.8, and pregnancy. RESULTS: The cumulative healing rate was 93% in the treatment group and was 51% in the control group (P < .001). The median healing time in the treatment group was 133 days (range, 28 to 464 days), and in the control group it was 211 days (range, 61 to 438 days). The recurrence rate at 12 months in the treatment group was 24% (16/67) and was 53% (18/34) in the control group (P < .05). After additional compression treatment with the same treatment protocol, all 16 recurrent ulcers in the treatment group healed. In the control group, the healing rate of recurrent ulcers was 89% (16/18). CONCLUSIONS: This study suggests that for extensive venous ulceration, multilayer compression therapy with the Tubulcus provides an extremely high healing rate. Compression of more than 30 mm Hg results in decreased ulcer recurrence. However, recurrence cannot be completely avoided.

Prevention of pocket related complications with fibrin sealant in patients undergoing pacemaker implantation who are receiving anticoagulant treatment.

AIM: The aim of our study was to establish the efficiency of fibrin sealant in the prevention of pocket related complications in patients undergoing pacemaker implantation who are receiving anticoagulant treatment. METHODS: The study was performed on 40 and 41 patients prospectively randomized into treatment and control groups who underwent pacemaker implantation procedure between January 2002 and July 2004 at the Pacemaker Center - Clinical Centre Nis, Serbia. Both groups of patients were receiving anticoagulant treatment with either heparin or warfarin. Surgical procedures between the groups differed only in the application of fibrin sealant prior to wound closure in the treatment group. RESULTS: In the treatment group, there were no pocket related complications while in the control group six patients (14.63%) had minor haematomas that required no treatment. Four patients (9.76%) had significant haematomas (two patients were treated conservatively while the other two needed reintervention). The INR in the treatment group was 2.76+/-0.85 and in the control group 2.65+/-0.79 (P=ns). In the follow-up period (2-27 months) no late complications were registered in either group. CONCLUSION: Fibrin sealant is an effective haemostatic agent. The results obtained in our study show that the administration of fibrin sealant in patients receiving anticoagulant treatment eliminates postoperative haematomas after pacemaker implantation.