Atherosclerosis presents a serial of highly specific cellular and molecular responses, and could be described as inflammatory diseases. Accordingly, for development of acute myocardial infarction ...(AMI), structure and vulnerability of atherosclerotic plaque are more important than the extent of stenosis of infarct-related artery. Consequently, inflammation and atherosclerosis and its complications are in good correlation. C-reactive protein (CRP) as nonspecific inflammatory marker, has prognostic significance in coronary artery diseases. The aim of this study was to establish the correlation between inflammatory response expressed as levels of CRP and fibrinogen in serum and extent of coronary artery stenosis.
Study included 35 patients with acute myocardial infarction, as the first manifestation of coronary artery disease, which were treated with thrombolytic therapy according to the guidelines. All the patient had a reperfusion. The patients with acute or chronic inflammatory diseases, an increased value of sedimentation, fibrinogen, CK > or = 190 U/L, early and late complications of AMI were excluded. CRP was measured on admission, after 24, 48 and 72 hrs, and 21 days latter, while fibriogen only on admission.
All the patients underwent coronary angiography, and were divided into two groups: the group 1 (23 patients), with significant stenosis of infarct-related artery (stenosis > or = 75%), and the group 2 (13 patients) without significant stenosis (< 75%). Mean value of CRP serum level on admission in the group 1 was 4.4 mg/L, and in the group 2 7.2 mg/L (p < 0.001). The mean value of fibrinogen on admission in the group 1 was 2.7 g/L, and in the group 2 3.0 g/L (p < 0.001). The mean CRP value after 48 hrs in the group 1 was 21.7 mg/L, and in the group 2 42.4 mg/L. (p < 0.001). After three weeks, the mean CRP value was 4 mg/L in the group 1 and 5.5 mg/L in the group 2 (p < 0.001). There was no significant difference between the groups 1 and 2 related to gender, age, localization of AMI, CK, EF value, and risk factors for coronary artery disease.
The patients with nonsignificant stenosis of infarct-related artery had increased inflammtory responses according to the CRP value, as a result of inflammatory process in atherosclerotic plaque and/or enhanced individual reactivity.
Primary heart tumors are very rare. They can be benign and malignant. Benign ones make about two thirds of all heart tumors. However, they are benign only by their biologic characteristics, but ...potentially malignant by their localization. About three forths of benign tumors are myxomas. Their growth is usually slow and they can be for a long time silent, particularly if they do not compromise vital functional parts of the heart. Myxomas grow in the atria, mostly in the left one and very rarely in the ventricles.
We presented two patients with myxomas in the left, and, in the right atrium which are representative samples of the most common localization of heart myxoma considering previous knowledge of these tumors. Analysis of the clinical course in the two presented patients with characteristic localizations showed general characteristics of the clinical course of heart myxoma. The patients did not have characteristic symptoms for a rather long period of time and the findings obtained by standard examinations did not raise suspicion of heart tumor. Pulmonary symptomatology in one patient and cardial in the other, when tumor had already occupied almost the entire atrium, suggested necessity of cardiologic examination. Indication for operation was in both patients confirmed after performed echocardiography, computed tomography of the thorax and angiography with ventriculography. The size of the removed atrial tumors and their localization explained some of the patients' troubles, but it was also amazing that they had not caused more serious problems. Operation as the only method of treatment was successful in both female patients and its effect was permanent. At annual controls neither recurrence of the tumor nor troubles possibly associated with it were observed.
Patients with heart myxoma usually pass through asymptomatic or oligosymptomatic phase, but when troubles become manifested, they do not much differ from those due to other causes. For this reason this tumor can be diagnosed just when complications caused by its localization and growth develop. Modern cardiologic diagnostics, primarily preventive non-invasive echocardiography, enables timely diagnosis and removal of the tumor because only then it may take a name benign tumor.
Introduction/Aim. Atherosclerosis presents a serial of highly specific
cellular and molecular responses, and could be described as inflammatory
diseases. Accordingly, for development of acute ...myocardial infarction (AMI),
structure and vulnerability of atherosclerotic plaque are more important than
the extent of stenosis of infarct-related artery. Consequently, inflammation
and atherosclerosis and its complications are in good correlation. C-reactive
protein (CRP) as nonspecific inflammatory marker, has prognostic significance
in coronary artery diseases. The aim of this study was to establish the
correlation between inflammatory response expressed as levels of CRP and
fibrinogen in serum and extent of coronary artery stenosis. Methods. Study
included 35 patients with acute myocardial infarction, as the first
manifestation of coronary artery disease, which were treated with
thrombolytic therapy according to the guidelines. All the patient had a
reperfusion. The patients with acute or chronic inflammatory diseases, an
increased value of sedimentation, fibrinogen, CK ?190 U/L, early and late
complications of AMI were excluded. CRP was measured on admission, after 24,
48 and 72 hrs, and 21 days latter, while fibriogen only on admission.
Results. All the patients underwent coronary angiography, and were divided
into two groups: the group 1 (23 patients), with significant stenosis of
infarct-related artery (stenosis ? 75%), and the group 2 (13 patients)
without significant stenosis (< 75%). Mean value of CRP serum level on
admission in the group 1 was 4.4 mg/L, and in the group 2 7.2 mg/L (p <
0.001). The mean value of fibrinogen on admission in the group 1 was 2.7 g/L,
and in the group 2 3.0 g/L (p < 0.001). The mean CRP value after 48 hrs in
the group 1 was 21.7 mg/L, and in the group 2 42.4 mg/L. (p < 0.001). After
three weeks, the mean CRP value was 4 mg/L in the group 1 and 5.5 mg/L in the
group 2 (p < 0.001). There was no significant difference between the groups 1
and 2 related to gender, age, localization of AMI, CK, EF value, and risk
factors for coronary artery disease. Conclusion. The patients with
nonsignificant stenosis of infarct-related artery had increased inflammtory
responses according to the CRP value, as a result of inflammatory process in
atherosclerotic plaque and/or enhanced individual reactivity.
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The coronary angiography provides information on the anatomical state of the coronary tree, while myocardial perfusion scintigraphy (MPI) facilitates the evaluation of the grade of ischaemia that a ...particular stenosis produces. The purpose of MPI is to detect the coronary stenosis that provokes the ischaemia and is termed the "culprit lesion". The aim of this study was to evaluate the accuracy of 1-day DypEX 99mTc-tetrofosmin tomography in the identification and localization of culprit lesion in the patients with known coronary artery disease (CAD).
Ninety-one (91) patients with known CAD were studied. In all of them significant coronary narowing (> 75% luminal stenosis) was angiographically detected. All the patients were submitted to 2 i.v. injections of 99mTc-tetrofosmin, one in a peak of pharmacologic dipyridamole stress protocol with concomitant low level bicycle exercise 50W (DypEX) and the other 3 h after exercise. Quantification of regional tetrofosmin uptake was performed using short-axis myocardial tomogram that was divided on 17 segments for each study. Reversibility score (RS) > or =3 determinated culprit lesion. Two of segments with scor 5 (index of reversibility scor--IRS) in the territory of coronary artery stenoses determinated culprit lesion.
A total of 273 vascular territories (4641 segments) were analyzed before percutaneous coronary intervention (PCI). Overall sensivity, specificit, and accuracy using RS > or =3 and IRS were 90.1%, 87.1%, 89.4%, with positive predictive value 95.8%, and 94.1%, 93.3%, 94%, with positive predictive value 98%, respectively.
RS and IRS significantly improve sensitivity, specificity, and accuracy for determination of culprit lesion in patients undergoing PCI.
Introduction: Precision medicine is an approach that considers genetics, environment and lifestyle factors when prevent and treat different diseases. The important part of precision medicine is ...pharmacogenetics, a branch of clinical pharmacology that analyzes how genetic makeup affects the response to the drugs. Methods: Since oncology is a field of particular interest in precision medicine, this article summarizes the basic principles of pharmacogenetics testing in cancer treatment. Topic: The following topics have been discussed: Samples for pharmacogenetics testing (peripheral blood, tumor biopsy, liquid biopsy), methods in pharmacogenetics testing (conventional hotspot methods and comprehensive genome profiling), comprehensive genome profiling (CGP) in clinical settings and oncology therapy in Serbia that depends on genetic testing. Conclusion: Pharmacogenetics testing provides the delivery of safe and efficient therapy. The usage of CGP methods opens up the possibility for the usage of therapies directed to genetic markers across tumor types. However, this approach needs evaluation through well-designed research projects and clinical trials.
Prolaps mitralnog zalistka predstavlja najcescu urodjenu srcanu manu kod odraslih osoba. Ehokardiografski nalaz ima kljucnu ulogu prilikom postavljanja dijagnoze, ustanovljavanja lokalizacije ...zahvacenih segmenata i procene obima bolesti. Takodje, omogucuje identifikaciju bolesnika sa najvecim rizikom za pojavu komplikacija i daje kljucne podatke pri donosenju odluke o rekonstrukciji mitralnog zalistka.
Acute myocardial infarction of the right ventricle (AMI-RV) is a separate subgroup within the scope of inferoposterior infarction of the left ventricle. It still represents the population of patients ...at high risk due to numerous, often hardly predictable complications and high mortality rate.
In fifteen-year period (1987-2001) 3,765 patients with the acute myocardial infarction (AMI) of different localizations of both sexes--2,283 males and 1,482 females of the average age 61.4 +/- 4.6 years were treated in our institution. Anterior myocardial infarction was diagnosed in 2,146 (56.9%) patients, inferior in 1,619 (43.1%) patients, out of whom right ventricular infarction (RVI) was confirmed in 384 (23.7%). Thrombolytic therapy was administered in 163 (42.4%) patients with RVI, and in 53 (41.7%) of these patients balloon dilatation was performed with coronary stent implantation in 24 (45.2%).
Favorable clinical effect of the combined thrombolytic therapy and percutaneous transluminal coronary angioplasty (PTCA) was achieved in 51 (96.1%), and in only 2 (3.9%) of patients the expected effect wasn't achieved. Myocardial revascularization was accomplished in 6 (3.6%) and 1 patient died. In 3 (3.4%) patients primary balloon dilatation with the implantation of intracoronary stent was performed within 6 hours from the onset of anginal pain. In the other group of 221 (57.5%) patients with RVI who did not receive thrombolytic therapy, or it had no effect, 26 (11.7%) patients died, which indicated the validity and the efficacy of this treatment (p < 0.01). In the whole group of patients with myocardial infarction of the right ventricle 31 (8.1%) died; in the group that received thrombolytic therapy and PTCA 5 (3.1%) died, while in the group treated in a conservative way 26 (11.7%) died.
Combined therapy was successful in the treatment of patients with RVI and should be administered whenever possible, since it was the best prevention of life-threatening complications and the decrease in the mortality of those patients.
Ishemijska bolest mozga je po slozenosti patofizioloskih procesa svakako najslozeniji klinicki entitet savremene medicine. Ovo, takodje, vazi i za etiopatogenetske procese vezane za njen nastanak i ...razvoj. Pored znacajnog napretka u razumijevanju etiopatogeneze i patofiziologije IBM, a takodje i razvoja visokosofistikovanih dijagnostickih procedura ukljucenih u algoritam etioloskog razjasnjenja i potvrde IBM, svjedoci smo velikog ucesca nerazjasnjenih uzroka IBM. Ateroskleroza aortnog luka, posebno tezeg stepena izrazenosti, uz postojanje ulceracija i tromboticnih mobilnih naslaga na ateromskim plakovima, etiopatogentski i patofizioloski, a rezultatima brojnih klinickih studija potvrdjeno, predstavlja novi nezavisni faktor rizika za nastanak ishemijske bolesti mozga. Ovo je posebno nacajno kod bolesnika starijih od 60 godina.
Sepsa, odnosno septicka encefalopatija predstavlja uobicajeni termin koji ukazuje na razvoj znakova mozdane disfunkcije u toku i u vezi sa prisustvom mikroorganizama i njihovih toksina u krvi. ...Septicka encefalopatija po pravilu nije izolovana, vec je pracena razvojem ostecenja mnogih organskih sistema. Razlikovanje septicke encefalopatije i encefalopatskih sindroma kao posljedice drugih oboljenja - poremecaja, a koja su pracena febrilnim stanjem predstavlja imperativ radi planiranja i sprovodjenja adekvatnog i pravovremenog dijagnostickog, terapijskog i preventivnog programa, sto daje najvece izglede oboljelim.
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