[Efficacy and tolerance of trimetazidine, a metabolic antianginal, in combination with a hemodynamic antianginal in stable exertion angina. TRIMPOL I, a multicenter study]. / Efficacité et tolérance de la trimétazidine, antiangoreux métabolique, en association avec un antiangoreux hémodynamique dans l'angor d'effort stable. TRIMPOL I une étude multicentrique.

OBJECTIVE: Assess the antianginal and anti-ischemic effect of trimetazidine in patients with stable exercise-induced angina insufficiently controlled with conventional antianginal drugs. PATIENTS AND METHODS: The study population included patients with coronarographically documented stable exercise-induced angina and no other serious concomitant condition. For inclusion, patients had to have two comparably positive treadmill exercise tests. Conventional antiangina drugs (long-acting nitrate derivatives, beta-blockers or calcium antagonists) were continued as was any other therapy having no effect on the ECG ST segment. The patients were given a 4-week regimen of trimetazidine (20 mg t.i.d.) after the second positive treadmill test and final inclusion. At the end of this period, a final exercise test was performed. The study population included 700 patients (mean age 54 +/- 8.4 years, range 32-71 years, 615 men, 85 women) who completed the entire treatment protocol. RESULTS: The main findings observed after 4 weeks of treatment with trimetazidine were: significant lengthening of the total duration of exercise (486.6 s versus 443.7 s, p < 0.01)), increase in total work (10.6 METS versus 9.4 METS, p < 0.01), significant lengthening of delay to 1 mm ST depression (389.9 s versus 337.8 s, p < 0.01) and of the delay to onset of angina (450.3 s versus 251.7 s, p < 0.01). The other results were a significant reduction in the number of daily episodes of angina (2.47 versus 3.66, p < 0.01) and a reduction in mean use of complementary trinitrine (1.8 versus 2.94, p < 0.01). CONCLUSIONS: Four weeks of treatment with trimetazidine in combination with conventional antiangina drugs leads to a longer delay to development of 1 mm ST depression (ischemia threshold), significant lengthening of total duration of treadmill exercise, increased total work, and longer delay to angina theshold. Clinically, there was a reduction in the mean number of episodes of angina and a reduction in the use of trinitrine.

The antiischemic effects and tolerability of trimetazidine in coronary diabetic patients. A substudy from TRIMPOL-1.

Diabetes mellitus, a disease with a wide prevalence, has major cardiovascular effects, being a risk factor for the development of ischemic heart disease and congestive heart failure. The aim of this open, multicenter study was to assess the antiischemic efficacy and tolerability of trimetazidine, a metabolic agent acting at the myocardial mitochondrial level, in diabetic patients with stable effort angina treated previously with a single conventional antianginal drug. Fifty diabetic patients (mean age 58 years) with proven coronary artery disease, stable effort angina for at least 3 months, and positive, comparable results of two initial treadmill exercise tests separated by a 1-week interval were included in the study. They continued their conventional antianginal monotherapy with a long-acting nitrate, beta-blocker, or calcium channel blocker. After stabilization, 4-week therapy with trimetazidine, three times daily, 20 mg was initiated in combination with previous treatment. The results showed a significant improvement in exercise tolerance (440.2 vs. 383.2 s; P < 0.01), time to 1-mm ST-segment depression (358.3 vs. 301.6 s; P < 0.01), time to onset of anginal pain (400.0 vs. 238.3 s; P < 0.01), and total work (9.39 vs. 8.67 metabolic equivalents, P < 0.01). Maximal ST-segment depression was attenuated compared with baseline (1.82 vs. 1.91 mm). Other findings included a significant decrease in the mean frequency of anginal episodes (3.06 vs. 4.79 per week; P < 0.01) and in mean nitrate consumption (2.29 vs. 4.2 doses/week). These results suggest that trimetazidine may be effective and is well tolerated as combination therapy for diabetic coronary artery disease patients uncontrolled with a single hemodynamic agent.

[Acute respiratory failure in the course of thyroid disease]. / Ostra niewydolnosc oddechowa w przebiegu schorzen tarczycy.

During the past 10 years, we have treated 11 patients who were admitted with acute respiratory failure due to goiter. Multinodular goiter was examined in four patients, one patient suffered from Graves disease and six patients had malignant thyroid lesions. Four patients required emergency intubation and in two cases we performed tracheostomy because of significant narrowing of trachea lumen. Diagnosis was made in most cases based on chest x-ray films, laryngoscopic examination, CT scans of the neck and goiters fine needle aspiration biopsy. All patients underwent mostly subtotal thyroidectomy with the standard cervicotomy approach. Five patients required tracheostomy procedures after surgery, three because of local advanced malignancy and two because of postoperative respiratory failure. In two cases pneumonia developed as a postoperative complication. One patient with advanced malignant goiter died. The goiters with progress of trachea compression symptoms should be operated in elective surgery to avoid sudden life-threatening complications like severe dyspnea. When the hoarseness is present the possibility of malignant goiter is particularly high. In our opinion patients with suspected respiratory failure should be referred to the centres with special interest in thyroid surgery.

[Personal observations for diagnosis and radical surgical treatment of thyroid neoplasms]. / Wlasne doswiadczenia w rozpoznaniu i radykalnym leczeniu operacyjnym raka tarczycy.

Among 59 patients with thyroid cancer, we have analysed the diagnostic procedures as: ultra sonography, scintiscan, fine needle aspiration biopsy, intraoperative frozen section examination and extent of surgery. The cancer was often overlooked in patients with multinodular goitre. We suggest to perform total lobectomy on side with greater changes and subtotal lobectomy on the other side of thyroid gland, in patients with multinodular goitre. The decision whether to reoperate should depend on the final pathology report.

[Restorative proctocolectomy in treatment of ulcerative colitis and familial polyposis]. / Proktokolektomia odtwórcza w leczeniu wrzodziejacego zapalenia jelita grubego i polipowatosci rodzinnej.

The results of surgical management (restorative proctocolectomy) in 15 patients operated on for familial polyposis and ulcerative colitis were presented. The comparison of ileo-anal, hand-sewn anastomosis with endorectal mucosectomy and double-stapled ileo-rectal anastomosis indicates both methods equally useful in surgical practice. In all patients J-pouch was created. The choice of anastomosis should be carefully considered before operation in every patient, but sometimes changed intraoperatively.

[Pancreatoduodenectomy by Whipple's method--a method of dealing with the pancreatic stump]. / Pankreatoduodenektomia sposobem Whipple'a--sposób zaopatrzenia przewodu trzustkowego.

Different methods of pancreatic stump management are possible to perform after pancreaticoduodenectomy. The group of 24 patients after pancreaticoduodenectomy with pancreaticojejunostomy, pancreaticogastrostomy and occlusion of the pancreatic duct by Neopren or Ethiblock were analysed. According to the literature and own results pancreatogastrostomy or occlusion of the pancreatic duct seems to be the safer procedure, but sometimes the choice is made intraoperatively.

[Bile duct injuries and surgical reconstruction of their sequelae in patients surgically treated for cholelithiasis]. / Uszkodzenia dróg zólciowych i postepowanie chirurgiczne w ich nastepstwie u pacjentów operowanych z powodu kamicy zólciowej.

27 patients operated for bile duct injuries as a complication of cholecystectomy were analyzed. The methods of surgical management in "fresh" bile duct injuries and delayed complications such as stenosis of bile ducts or anastomosis and recurrent cholangitis were discussed. Mucosa to mucosa, Roux-en-Y anastomosis, without splinting drains seems to be the best way to restore bile flow to digestive tract.

Antilymphocyte globulin with a small dose of cyclosporine A and prednisone as the induction of immunosuppression in renal allograft recipients.

In attempt to avoid a detrimental synergism between CsA and renal ischemia in the immediate postoperative period, ALG (425 lymphocytotoxic units/kg) with small doses of CsA (6-8 mg/kg) and P were applied as the initial immunosuppressive therapy in 14 recipients of cadaveric kidneys. ALG was administered for 5 to 14 days and 2 days before withdrawing ALG, Aza (2 mg/kg) was introduced. Results of this protocol were compared with those of 19 pts treated with CsA (12 mg/kg) and P. All the pts were followed for at least 12 months. The duration of posttransplant anuria was significantly reduced in the ALG/CsA/P group (p < 0.02). The sCr concentration after 12 months of observation was significantly lower (p < 0.05), no alterations in urinalysis were detected, the number of hypertensive pts was decreased. The acute rejection rates were equivalent in both groups, however 3 of 4 rejections in ALG/CsA/P group were resistant to steroids and occurred in pts with shortened period of ALG administration. The one year patient and graft survival in the ALG/CsA/P and control groups were respectively: 78.5%, 71.4% and 89.4%, 78.9%. Severe infectious complications in the group treated with ALG/CsA/P occurred in pts who were subsequently treated with OKT3.