Representación gráfica del aporte vascular intraóseo y extraóseo del astrágalo. Anatomía ilustrada / Graphic Representation of Intraosseous and Extraosseous Talus Blood Supply. Illustrated Anatomy

Introducción: La anatomía vascular del astrágalo ha sido motivo de investigación por parte de muchos autores, la complejidad de su análisis ha llevado a que no siempre sea fácil de comprender. Sus características anatómicas hacen que algunas áreas sean más susceptibles de sufrir daños y compromisos vasculares tras lesiones traumáticas. El objetivo de este estudio es describir la vascularización del astrágalo, tanto a nivel intraóseo como extraóseo, para obtener una representación gráfica que permita fácilmente conocer su red de irrigación vascular. Material y métodos: Se han realizado las disecciones y los análisis de 19 piezas anatómicas de cadáver humano. Quince de esas piezas se han seccionado en diferentes planos, y se han preparado utilizando la técnica de Spalteholz modificada con inyección de látex con tinta azul y negra para visualizar la red vascular. Además, el estudio se ha complementado con una revisión bibliográfica exhaustiva sobre el tema. Resultados: Los hallazgos han permitido concluir que la arteria tibial posterior aporta la irrigación más importante al cuello y cuerpo del astrágalo a través de la arteria del canal tarsiano y la rama deltoidea. La arteria tibial anterior se divide en la arteria dorsal del pie para la cabeza y el cuello, y la arteria tarsal lateral que a través de las anastomosis origina la arteria del seno del tarso. La arteria peronea perforante, procedente de la arteria peronea, crea una anastomosis intraósea para el cuerpo y el proceso posterior. Conclusión: Los resultados obtenidos han permitido elaborar una representación ilustrada de las áreas de irrigación propias y comunes, que permite comprender de forma gráfica y sencilla la vascularización intraósea y extraósea del astrágalo.(AU)

Background: The vascular anatomy of the talus attracts intense research being not always easy to understand. The high intraosseous variability together with the anatomical characteristics makes some areas of the talus more prone to vascular compromise. The aim of this study is to describe the vascularization of the talus, both intraosseous and extraosseous. Material and methods: From the literature reviewed, we have developed a graphic scheme that allows easy observation of the irrigation distribution. To this end, nineteen anatomical dissections of human cadaveric feet have been carried out. Fifteen fresh-frozen slices have been cut in different planes and prepared using the modified Spalteholz technique and latex injection with blue and black ink to visualize the vascular network. In addition, the study has been complemented with a comprehensive literature review on this subject. Results: The findings allowed us to conclude that the posterior tibial artery provides the most important blood supply to the neck and body of the talus through the tarsal canal artery and the deltoid branch. The anterior tibial artery splits in the dorsal pedis artery, for the head and neck, and the lateral tarsal artery which throughout anastomoses breeds the tarsal sinus artery. The perforating peroneal artery branches out from the peroneal artery, creating an intraosseous anastomosis for the body and the posterior process. Conclusion: The results obtained have contributed to develop a graphical representation that we present in this study, which allows a simple understanding of the intraosseus and extraosseus vascularization of the talus.(AU)

[Translated article] Graphic representation of intraosseous and extraosseous talus blood supply. Illustrated anatomy / Representación gráfica del aporte vascular intraóseo y extraóseo del astrágalo. Anatomía Ilustrada

Introducción: La anatomía vascular del astrágalo ha sido motivo de investigación por parte de muchos autores, la complejidad de su análisis ha llevado a que no siempre sea fácil de comprender. Sus características anatómicas hacen que algunas áreas sean más susceptibles de sufrir daños y compromisos vasculares tras lesiones traumáticas. El objetivo de este estudio es describir la vascularización del astrágalo, tanto a nivel intraóseo como extraóseo, para obtener una representación gráfica que permita fácilmente conocer su red de irrigación vascular. Material y métodos: Se han realizado las disecciones y los análisis de 19 piezas anatómicas de cadáver humano. Quince de esas piezas se han seccionado en diferentes planos, y se han preparado utilizando la técnica de Spalteholz modificada con inyección de látex con tinta azul y negra para visualizar la red vascular. Además, el estudio se ha complementado con una revisión bibliográfica exhaustiva sobre el tema. Resultados: Los hallazgos han permitido concluir que la arteria tibial posterior aporta la irrigación más importante al cuello y cuerpo del astrágalo a través de la arteria del canal tarsiano y la rama deltoidea. La arteria tibial anterior se divide en la arteria dorsal del pie para la cabeza y el cuello, y la arteria tarsal lateral que a través de las anastomosis origina la arteria del seno del tarso. La arteria peronea perforante, procedente de la arteria peronea, crea una anastomosis intraósea para el cuerpo y el proceso posterior. Conclusión: Los resultados obtenidos han permitido elaborar una representación ilustrada de las áreas de irrigación propias y comunes, que permite comprender de forma gráfica y sencilla la vascularización intraósea y extraósea del astrágalo.(AU)

Background: The vascular anatomy of the talus attracts intense research being not always easy to understand. The high intraosseous variability together with the anatomical characteristics makes some areas of the talus more prone to vascular compromise. The aim of this study is to describe the vascularization of the talus, both intraosseous and extraosseous. Material and methods: From the literature reviewed, we have developed a graphic scheme that allows easy observation of the irrigation distribution. To this end, nineteen anatomical dissections of human cadaveric feet have been carried out. Fifteen fresh-frozen slices have been cut in different planes and prepared using the modified Spalteholz technique and latex injection with blue and black ink to visualize the vascular network. In addition, the study has been complemented with a comprehensive literature review on this subject. Results: The findings allowed us to conclude that the posterior tibial artery provides the most important blood supply to the neck and body of the talus through the tarsal canal artery and the deltoid branch. The anterior tibial artery splits in the dorsal pedis artery, for the head and neck, and the lateral tarsal artery which throughout anastomoses breeds the tarsal sinus artery. The perforating peroneal artery branches out from the peroneal artery, creating an intraosseous anastomosis for the body and the posterior process. Conclusion: The results obtained have contributed to develop a graphical representation that we present in this study, which allows a simple understanding of the intraosseus and extraosseus vascularization of the talus.(AU)

[Translated article] Graphic representation of intraosseous and extraosseous talus blood supply. Illustrated anatomy.

BACKGROUND: The vascular anatomy of the talus attracts intense research being not always easy to understand. The high intraosseous variability together with the anatomical characteristics makes some areas of the talus more prone to vascular compromise. The aim of this study is to describe the vascularisation of the talus, both intraosseous and extraosseous. MATERIAL AND METHODS: From the literature reviewed, we have developed a graphic scheme that allows easy observation of the irrigation distribution. To this end, nineteen anatomical dissections of human cadaveric feet have been carried out. Fifteen fresh-frozen slices have been cut in different planes and prepared using the modified Spalteholz technique and latex injection with blue and black ink to visualise the vascular network. In addition, the study has been complemented with a comprehensive literature review on this subject. RESULTS: The findings allowed us to conclude that the posterior tibial artery provides the most important blood supply to the neck and body of the talus through the tarsal canal artery and the deltoid branch. The anterior tibial artery splits in the dorsal pedis artery, for the head and neck, and the lateral tarsal artery which throughout anastomoses breeds the tarsal sinus artery. The perforating peroneal artery branches out from the peroneal artery, creating an intraosseous anastomosis for the body and the posterior process. CONCLUSION: The results obtained have contributed to develop a graphical representation that we present in this study, which allows a simple understanding of the intraosseus and extraosseus vascularisation of the talus.

Graphic Representation of Intraosseous and Extraosseous Talus Blood Supply. Illustrated Anatomy. / Representación gráfica del aporte vascular intraóseo y extraóseo del astrágalo. Anatomía ilustrada.

BACKGROUND: The vascular anatomy of the talus attracts intense research being not always easy to understand. The high intraosseous variability together with the anatomical characteristics makes some areas of the talus more prone to vascular compromise. The aim of this study is to describe the vascularization of the talus, both intraosseous and extraosseous. MATERIAL AND METHODS: From the literature reviewed, we have developed a graphic scheme that allows easy observation of the irrigation distribution. To this end, nineteen anatomical dissections of human cadaveric feet have been carried out. Fifteen fresh-frozen slices have been cut in different planes and prepared using the modified Spalteholz technique and latex injection with blue and black ink to visualize the vascular network. In addition, the study has been complemented with a comprehensive literature review on this subject. RESULTS: The findings allowed us to conclude that the posterior tibial artery provides the most important blood supply to the neck and body of the talus through the tarsal canal artery and the deltoid branch. The anterior tibial artery splits in the dorsal pedis artery, for the head and neck, and the lateral tarsal artery which throughout anastomoses breeds the tarsal sinus artery. The perforating peroneal artery branches out from the peroneal artery, creating an intraosseous anastomosis for the body and the posterior process. CONCLUSION: The results obtained have contributed to develop a graphical representation that we present in this study, which allows a simple understanding of the intraosseus and extraosseus vascularization of the talus.

Assessment of micro-scale anaerobic digestion for management of urban organic waste: A case study in London, UK.

This paper describes the analysis of an AD plant that is novel in that it is located in an urban environment, built on a micro-scale, fed on food and catering waste, and operates as a purposeful system. The plant was built in 2013 and continues to operate to date, processing urban food waste and generating biogas for use in a community café. The plant was monitored for a period of 319days during 2014, during which the operational parameters, biological stability and energy requirements of the plant were assessed. The plant processed 4574kg of food waste during this time, producing 1008m3 of biogas at average 60.6% methane. The results showed that the plant was capable of stable operation despite large fluctuations in the rate and type of feed. Another innovative aspect of the plant was that it was equipped with a pre-digester tank and automated feeding, which reduced the effect of feedstock variations on the digestion process. Towards the end of the testing period, a rise in the concentration of volatile fatty acids and ammonia was detected in the digestate, indicating biological instability, and this was successfully remedied by adding trace elements. The energy balance and coefficient of performance (COP) of the system were calculated, which concluded that the system used 49% less heat energy by being housed in a greenhouse, achieved a net positive energy balance and potential COP of 3.16 and 5.55 based on electrical and heat energy, respectively. Greenhouse gas emissions analysis concluded that the most important contribution of the plant to the mitigation of greenhouse gases was the avoidance of on-site fossil fuel use, followed by the diversion of food waste from landfill and that the plant could result in carbon reduction of 2.95kg CO2eq kWh-1 electricity production or 0.741kg CO2eq kg-1 waste treated.

Modelling the anaerobic digestion of solid organic waste - Substrate characterisation method for ADM1 using a combined biochemical and kinetic parameter estimation approach.

This work proposes a novel and rigorous substrate characterisation methodology to be used with ADM1 to simulate the anaerobic digestion of solid organic waste. The proposed method uses data from both direct substrate analysis and the methane production from laboratory scale anaerobic digestion experiments and involves assessment of four substrate fractionation models. The models partition the organic matter into a mixture of particulate and soluble fractions with the decision on the most suitable model being made on quality of fit between experimental and simulated data and the uncertainty of the calibrated parameters. The method was tested using samples of domestic green and food waste and using experimental data from both short batch tests and longer semi-continuous trials. The results showed that in general an increased fractionation model complexity led to better fit but with increased uncertainty. When using batch test data the most suitable model for green waste included one particulate and one soluble fraction, whereas for food waste two particulate fractions were needed. With richer semi-continuous datasets, the parameter estimation resulted in less uncertainty therefore allowing the description of the substrate with a more complex model. The resulting substrate characterisations and fractionation models obtained from batch test data, for both waste samples, were used to validate the method using semi-continuous experimental data and showed good prediction of methane production, biogas composition, total and volatile solids, ammonia and alkalinity.

[Medium-term results of arthroscopic debridement in osteochondral talar lesions]. / Resultados a medio plazo del desbridamiento artroscópico en las lesiones osteocondrales de astrágalo.

BACKGROUND: Retrospective review of the clinical and functional results and the degree of satisfaction of patients with osteochondral talar lesions treated with arthroscopic debridement, curettage and microfractures at our center. MATERIAL AND METHODS: Between January 2008 and December 2011, a total of 30 patients with osteochondral talar lesions were seen. They all had failed conservative treatment and underwent arthroscopic debridement, curettage and microfractures. The data analyzed included etiology, location and size of the lesion, and lesion grade according to the Berndt & Hardy classification. The functional clinical assessment was done using the American Orthopedic Foot and Ankle Society classification and the visual analog scale. The degree of satisfaction was assessed using a simple survey. Associated lesions, complications and reoperations were also recorded. RESULTS: Mean follow-up was 12 months; mean age was 43 years. The main cause was trauma (10/30 patients). Mean size of lesions was 0.86 cm2. The mean American Orthopedic Foot and Ankle Society score was 92 and the visual analog scale dropped from 7 to 1. All patients were satisfied with the treatment they received. No complications or reoperations were recorded. CONCLUSIONS: Osteochondral talar lesions in patients over 40 years of age have specific characteristics and the results of arthroscopic treatment are similar to those seen in the younger population.

Glomus tumor of the hallux. Review of the literature and report of two cases.

A glomus tumor is a rare and benign vascular tumor. It can originate in multiple locations on the body, although it has most frequently been found in subungeal areas of the hand. This two cases report describes a glomus tumor of the hallux, including a recurrence and a review of the related literature. We believe this case study might be of interest due to the unusual location of this tumor.

Comparación de la presión de oclusión y de la tolerancia al torniquete de isquemia en la pantorrilla y en el tobillo para cirugía ambulatoria de antepié / No disponible

Introducción: En la cirugía de antepié el torniquete de isquemia puede colocarse en la pantorrilla o en el tobillo. La presión de inflado necesaria para ocluir la circulación arterial es proporcional al diámetro de la extremidad y varía con la posición del torniquete. Comparamos la presión de oclusión y la tolerancia al torniquete en la pantorrilla y en el tobillo. Material y métodos: Estudio prospectivo en 50 pacientes programados para cirugía de hallux valgus a los que se les realizó la valoración en ambas localizaciones del torniquete en orden aleatorio. Se monitorizó la onda de pulso en el primer dedo del pie y el doppler pulsado en la arteria tibial posterior. La presión de inflado inicial del torniquete se ajustó al valor de la presión sistólica y se incrementó progresivamente hasta la desaparición completa de la onda de pulso y del doppler. A los 5 minutos se registró el grado de disconfort en una escala verbal de 0 a 10. Resultados: La presión de oclusión fue significativamente inferior en el tobillo, medida tanto por doppler (183 ± 20 vs.196 ± 30mmHg; p < 0,0001), como por onda de pulso (183 ± 20 vs.193 ±27 mmHg; p = 0,0002). No hubo diferencias entre la presión de oclusión medida por onda de pulso y el doppler pulsado en el tobillo, pero la presión de oclusión medida por doppler fue significativamente mayor en la pantorrilla (193 ± 27 vs.196 ± 30 mmHg; p =0,02). El grado de molestia también fue significativamente menor en el tobillo (2 ± 2 vs. 5 ± 3; p < 0,0001). Conclusiones: La presión de oclusión del manguito de isquemia en el tobillo es significativamente menor, es mejor tolerada que en la pantorrilla y puede medirse fácilmente sólo con un pulsioxímetro (AU)

Introduction: The pneumatic tourniquet can be placed at the calf or at the ankle for forefoot surgery. The cuff pressure needed to occlude arterial blood flow (OP) is proportional to the diameter of the extremity, varying with the position of the cuff. We compared the OP and patient tolerance to calf versus ankle tourniquet. Methods: We prospectively studied 50 patients scheduled forhallux valgus repair, who were assessed for both cuff positions in random order. OP was measured by pulse waveform on the first toe and pulsed doppler of the posterior tibial artery. The cuff was progressively inflated in 10 mmHg increments starting from the systolicpressure value until complete loss of pulse waveform and pulsed doppler. This pressure was maintained during 5 minutes to assess the discomfort in a verbal scale (0-10).Results: OP was significantly lower in the ankle measured bypulsed doppler (183 ± 20 vs.196 ± 30 mmHg; p < 0.0001), and pulse waveform (183 ± 20 vs.193 ± 27 mmHg; p = 0.0002). No differences were found between OP measured by pulse waveform and by pulsed doppler at the ankle. However the OP measured bypulsed doppler was significantly higher than pulse waveform at the calf (193 ± 27 vs.196 ± 30 mmHg; p = 0.02). Patients reported lower discomfort scores when the tourniquet was placed at the ankle(2 ± 2 vs.5 ± 3; p < 0.0001).Conclusions: The OP is lower when the tourniquet is placed at the ankle and can be easily measured by pulse waveform placed on the toes. The ankle tourniquet is also better tolerated than the calf tourniquet (AU)

Enfermedad de Charcot-Marie-Tooth: consideraciones ortopédicas / Charcot-Marie-Tooth syndrome: orthopaedic considerations

La enfermedad de Charcot-Marie-Tooth es una enfermedad heredodegenerativa del sistema nervioso periférico. La alteración es progresiva, y provoca deformidades en pies y manos. La musculatura de la pierna y el pie es la más afectada. La forma de presentación es muy diversa debido a que la afectación muscular es diferente en cada paciente. El pie cavo-varo es la forma de presentación habitual. El tratamiento conservador consiste en férulas correctoras, plantillas y rehabilitación. La indicación quirúrgica se plantea cuando fracasa el tratamiento conservador. La deformidad y el dolor son los problemas principales. En las deformidades flexibles se plantean cirugías para preservar las articulaciones. Los dedos en garra se tratarán con transferencias tendinosas o artroplastias. La deformidad en garra del dedo gordo se produce por el descenso del primer metatarsiano y la hiperactividad del músculo extensor hallucis longus. El tratamiento de esta deformidad del dedo gordo se realiza mediante la técnica de Jones. El descenso del primer metatarsiano necesitará una osteotomía dorsiflexora en la base del primer metatarsiano. Para el varo de retropié se utiliza la osteotomía valguizante de calcáneo. La retracción de la fascia plantar, gastrocnemio y Aquiles se trata con elongación de las estructuras retraídas. Cuando las deformidades son rígidas, será necesario realizar una artrodesis de las articulaciones afectadas. La artrodesis más utilizada es la triple artrodesis (AU)

Charcot-Marie-Tooth disease is a degenerative hereditary disease of the peripheral nervous system. The change is progressive and causes deformities in the feet and hands. The musculature of the leg and foot are most affected. The form of presentation is very diverse owing to the muscle involvement being different in each patient. The high-arched foot is the most common form of presentation. Conservative treatment consists of correction splints, insoles and rehabilitation. Surgery may be indicated when conservative treatment fails. The deformity and pain are the main problems. In flexion deformities surgery is indicated to conserve the joints. Claw hammer toes should be treated with tendon transfers and arthroplasty. The claw deformity in the big toe is caused by the descent of the first metatarsal and hyperactivity of the hallucis longus extensor muscle. The Jones technique is performed as treatment for this deformity of the big toe. The descent of the first metatarsal requires a dorsiflexion osteotomy in the base of the first metatarsal. For the hind foot varus a calcaneal vagus osteotomy is used. The tightening of the plantar fascia, gastrocnemius and Achilles is treated with an extension of the muscle contractures. When the deformities are rigid, it will be necessary to perform an arthrodesis of the affected joints. The arthrodesis most used is the triple arthrodesis (AU)

Resultados funcionales en artroplastia total de tobillo / Functional outcomes in total ankle arthroplasty

Introducción. La artroplastia total de tobillo (ATT) está indicada en pacientes que sufren dolor incapacitante y limitación funcional severa en los que no es posible realizar otro tipo de técnica reconstructora. Objetivo. Valorar los resultados clínicos y funcionales de las ATT realizadas en nuestro hospital en los últimos 10 años. Pacientes y método. Estudio descriptivo transversal que incluye a 14 pacientes. Se analizan variables demográficas (edad, sexo), clínicas (etiología, dolor, balance articular [BA], balance muscular [BM]) y resultados funcionales mediante estudio posturográfico (amplitud del paso, longitud del paso y velocidad de la marcha, tiempo de transferencia de sedestación a bipedestación y desplazamiento del centro de gravedad en bipedestación) y calidad de vida mediante cuestionario EQ-D5. Resultados. Media de edad, 62,11±12,46 años; el 85,7% mujeres. Principales etiologías: artritis reumatoide y artrosis postraumática. La puntuación media de dolor fue de 2,47±2,21 en la escala visual analógica. El BA medio encontrado fue de 31,53±11,55° de flexión plantar y 6±5,67° de flexión dorsal. El BM medio fue 116±66,98 N para la flexión plantar y 88,35±70,02 N para flexión dorsal. Se obtuvo una puntuación media de 0,6903±0,2313 en el cuestionario EQ-5D. Conclusiones. La artroplastia total de tobillo proporciona buena amplitud de movilidad y funcionalidad para las actividades básicas de la vida diaria(AU)

Background. Total ankle arthroplasty (TAA) is indicated in patients with disabling pain and severe functional limitation, for whom no other surgical technique that preserves the mobility is possible. Objective. To evaluate the clinical and functional results of the TAA in the Hospital Clinic of Barcelona in the last 10 years. Patients and methods. A cross-sectional, descriptive study including 14 patients. We analyzed demographic variables (age and gender), clinical (etiology, pain, articular range of motion [AM] and muscular balance [MB]) and functional outcomes with several posture-graphic tests (step width range, step length range and gait velocity, transference time from sedestation to bipedestation and shifting of the center of gravity in bipedestation) and quality of life with the EQ-D5 questionnaire. Results. Mean age 62.11±12.46 years, 85.7% women. Main etiologies found were rheumatoid arthritis and posttraumatic osteoarthritis. Mean pain score was 2.47±2.21 in the visual analogue scale. The average articular range of motion was found: plantar flexion 31.53°±11.55°, dorsiflexion 6°±5.67°. Muscular strength was 116±66.98 N for plantar flexion, 88.35±70.02 N for dorsiflexion. We obtained a mean score of 0.6903±0.2313 in the EQ-D5 questionnaire. Conclusions. Total ankle arthroplasty provides a good range of motion and functionality to the basic activities of daily living(AU)

Use of freeze-dried bone allograft with platelet-derived growth factor for revision of a glenoid component.

Glenoid replacement is technically challenging. Removal of a cemented glenoid component often results in a large osseous defect which makes the immediate introduction of a revision prosthesis almost impossible. We describe a two-stage revision procedure using a reversed shoulder prosthesis. Freeze-dried allograft with platelet-derived growth factor was used to fill the glenoid defect. Radiological incorporation of the allograft was seen and its consistency allowed the placement of a screwed glenoid component. There were no signs of new mature bone formation on histological examination. The addition of platelet-derived growth factor to the allograft seems to contribute to an increase in incorporation and hardness, but does not promote the growth of new bone.

Modificación técnica al sistema USS fracturas para columna vertebral / Alternative design for a USS fractures

El sistema USS Fracturas permite reducir, fijar y aportarinjerto por vía transpedicular con buenos resultados en lasfracturas por flexión y compresión o por aplastamiento dela columna toracolumbar. La preparación de los pedículosde la vértebra fracturada para efectuar la espongioplastiaimpide el posterior agarre de los clavos roscados de Shanz.Por otro lado el diseño del fijador no permite colocar losclavos en la vértebra fracturada una vez montado el sistema.Hemos diseñado una modificación técnica que permitereducir la fractura, montar el sistema en los niveles superiore inferior de la vértebra fracturada, efectuar laespongioplastia con la fractura reducida y desplegada ysintetizar la vértebra lesional sin necesidad de desmontarla instrumentación. Los casos efectuados tras esta modificaciónno han demostrado aflojamientos de material niarrancamiento («pull out») de los tornillos

The USS Fracture Device allows to reduce, to fix and tobring graft by transpedicular way in wedge and burst typesof thoracolumbar fractures with good results. The cannulationof pedicles in a fractured vertebra for a graft avoida strong fixation of the Schanz nails. On the other side,the hardware design does not allow putting the nails in thefractured vertebra after locking the system. We havedesigned a technical modification to perform a reductionof the fracture, set the device above and below the lesionlevel and do a transpedicular bone grafting, including aosteosynthesis in the broken vertebra after hyperextensionmanoeuvre without hardware deconstruction. All the casesoperated after this alternative technical design show goodresults without device debreakings or pull out

[The ergometric test after a heart transplant: its usefulness and limits]. / Test ergometrico dopo trapianto cardiaco: utilità e limiti.

Aim of this study was to analyze the cardiovascular response to graded physical exercise in patients who have undergone cardiac transplantation and to assess the ability of exercise stress testing in early detection of coronary artery disease. We studied 114 transplanted subjects (100 men and 14 women, mean age 46.6 +/- 11.3 years), who performed exercise stress testing 6 months after bypass and then every 6 (+/- 1) months during a 5-year follow-up. Variations of hearth rate (HR), systolic blood pressure (SBP), heart rate-pressure product (RPP) values and exercise stress tolerance were studied both in basal and maximum workload conditions. Mean HR values at basal conditions (103.9 +/- 11.3 b/min at 6 months and 89 +/- 12.7 b/min at 60 months, p < 0.05) and maximum workload tolerance (67.7 +/- 20.4 W at 6 months and 100 +/- 17 W at 60 months, p < 0.05) were significantly different at the beginning and at the end of follow-up. SBP values both at basal conditions and at peak exercise had always been constant. Exercise was stopped for leg muscle fatigue in 92% and dyspnea in 7% of the subjects; isolated T-wave and ST segment changes were found in 29.8% and in 10.5% of the patients respectively, whereas 11.4% exhibited both ST-T variations. Angiographic examination (performed in 80/114 patients) showed significant coronary disease (stenosis > 50%) in 8, coronary atherosclerosis (CAD) of minor degree in 4 and provoked spasm in 2 subjects. In this subgroup exercise stress testing induced ischemic ECG changes (ST segment depression > or = 1 mm) without angina in 1 patient, ST-T segment variations only in 5 and no electrocardiographic alterations (negative tests) in 2 patients. Four subjects with CAD and 1 with coronary spasm induced by angiography showed isolated ST segment and T-wave changes. Our work demonstrated that exercise stress testing plays a relevant role in the study of the denervated heart response to dynamic exercise. The rise in workload tolerated, observed in our population, seems to be related to time elapsed from surgery, improvement in clinical conditions, psychological stability and patient's confidence in his own abilities. The tolerance to exercise 6 months after graft seems to predict the quality of performance in the following tests. Our angiographic results reveal a low sensitivity of the exercise stress test in detecting CAD in this population according to traditional electrocardiographic criteria for myocardial ischemia.(ABSTRACT TRUNCATED AT 400 WORDS)

[Lipoprotein (a) [Lp(a)] and ischemic cardiopathy: correlation between radial immunodiffusion (RID) and radioimmunoassay methods (RIA)]. / Lipoprotéine (a) [Lp(a)] et cardiopathie ischémique: corrélation entre les méthodes d'immunodiffusion radiale (RID) et d'immunoradioactivité (RIA).

The anomalous lipemic values are considered as a risk factor in coronarial pathology. We are separately studying different lipemic factors, Lp(a) in the present paper. May be our 38 clinical cases are still a too small number to demonstrate any correlation between Lp(a) haematic content and arterial pathology, and we will continue this study in the evolution of the pathology, eventually until the infarctus. For the moment, we established the significance of correlation between two methods in two laboratories of ours (in Pavia, Italy, and in Lisboa, Portugal). Correlation is more than 0.9. Assays were done on the same air mailed samples.