Current possibilities of surgical treatment of arrhythmia

The up-to-date methods for the diagnosis and surgical treatment of tachyarrhythmias are analysed. Particular attention is drawn to the indications and contraindications for surgery. The author analyses the main results of the treatment of patients suffering from ventricular tachyarrhythmias, multiple arrhythmias, arrhythmias combined with congenital or acquired heart diseases, ischemic disease of the heart. The results of treatment of the WPW syndrome were good (over 95%). This broadens the indications for surgery. High efficacy of treatment and low lethality were noted in cases with supraventricular tachycardias. Good results were achieved in 77-85% of cases with ventricular tachycardias. Despite the obvious results, there are some serious problems in each of the listed branches; the leading clinics of the world are working on these problems.     

Mutational analysis of the SOX9 gene in campomelic dysplasia and autosomal sex reversal: lack of genotype/phenotype correlations

It has previously been shown that, in the heterozygous state, mutations in the SOX9 gene cause campomelic dysplasia (CD) and the often associated autosomal XY sex reversal. In 12 CD patients, 10 novel mutations and one recurrent mutation were characterized in one SOX9 allele each, and in one case, no mutation was found. Four missense mutations are all located within the high mobility group (HMG) domain. They either reduce or abolish the DNA-binding ability of the mutant SOX9 proteins. Among the five nonsense and three frameshift mutations identified, two leave the C-terminal transactivation (TA) domain encompassing residues 402-509 of SOX9 partly or almost completely intact. When tested in cell transfection experiments, the recurrent nonsense mutation Y440X, found in two patients who survived for four and more than 9 years, respectively, exhibits some residual transactivation ability. In contrast, a frameshift mutation extending the protein by 70 residues at codon 507, found in a patient who died shortly after birth, showed no transactivation. This is apparently due to instability of the mutant SOX9 protein as demonstrated by Western blotting. Amino acid substitutions and nonsense mutations are found in patients with and without XY sex reversal, indicating that sex reversal in CD is subject to variable penetrance. Finally, none of 18 female patients with XY gonadal dysgenesis (Swyer syndrome) showed an altered SOX9 banding pattern in SSCP assays, providing evidence that SOX9 mutations do not usually result in XY sex reversal without skeletal malformations.      

Left ventricular regional function in patients with dilated cardiomyopathy (computerized echocardiographic data)

Computerized echography was used to assess left-ventricular dysfunction in 40 patients with dilatation cardiomyopathy (DCM). The so-called "floating" system was shown to be the most acceptable model for the correction of DCM-associated superposition. An original system was used for segment division by two- and four-chamber projections. Total left-ventricular hypokinesia and a significant reduction of the total ejection fraction (32.5 +/- 1.9%) were demonstrated.     

First experience with the use of bone marrow stem cells for regeneration therapy of ischemic heart disease.

AIM: To elucidate feasibility of the use of autologous bone marrow stem cells in candidates to myocardial revascularization- patients with ischemic heart disease and cardiosclerosis after myocardial infarction. METHODS: Between January 2003 and January 2004 25 men aged 56.3+/-5.4 years with ischemic heart disease were subjected to cell therapy including 4 patients with heart failure and 5 - with acute coronary syndrome. Subgroup of patients with postinfarction cardiosclerosis consisted of 16 men satisfying the following criteria: (1) history of myocardial infarction with scar formation; (2) class III-IV angina; (3) presence of indications for endovascular or surgical intervention on coronary arteries. Study protocol included clinical examination, coronary angiography; dobutamine stress-, contrast- and tissue echocardiography with assessment of segmental myocardial perfusion, systolic and diastolic left ventricular function. RESULTS: There were no complications during bone marrow sampling and administration of cells. All patients were restudied 1 month after transplantation. Improvement of clinical state without complications and adverse effects of the procedure noted in all patients was associated with lowering of mean angina class (from 3.4 to 1.4, p<0.05); decrease of NYHA heart failure class (from 3.1 to 1.5); rise of left ventricular ejection fraction (from 42.9 to 56.3%); decrease of average number of asynergic segments (from 5.3+/-0.7 to 2.1+/-0.3, p<0.01). Systolic velocity before intervention was 2.3 cm/s, after procedure in segments subjected to isolated revascularization it increased up to 4.8 cm/s, while in those subjected to revascularization combined with administration of stem cells - up to 6.2 cm/s. Contrast echocardiography in 9 patients demonstrated augmented myocardial perfusion in regions exposed to cell therapy. CONCLUSION: Transplantation of autologous bone marrow stem cells to ischemic heart disease patients - candidates for myocardial reperfusion - turned out to be safe and well tolerated procedure. Combination of myocardial revascularization with administration of stem cells into regions of postinfarction scars was associated with improvement of total and local myocardial contractility and normalization of left ventricular diastolic filling. Cell therapy facilitated augmentation of myocardial perfusion.     

Comparative evaluation of three semi-quantitative radiographic grading techniques for knee osteoarthritis in terms of validity and reproducibility in 1759 X-rays: report of the OARSI-OMERACT task force

OBJECTIVE: The objective of this work was to compare the measurement properties of three categorical X-ray scoring methods of knee osteoarthritis (OA), both on semiflexed and extended views. METHODS: In data obtained from trials and cohorts, X-rays were graded using Kellgren and Lawrence (KL), the OA Research Society International (OARSI) joint space narrowing score, and measurement of joint space width (JSW). JSW was analyzed as a categorical variable. Construct validity was assessed through logistic regression between X-ray stages and Western Ontario and McMaster Universities OA Index. Inter-observer reliability was assessed in 50 subjects for extended views by weighted kappa. Intra-observer reliability and sensitivity to change were assessed separately for extended and semiflexed views in 50 patients who had both views performed, over a 30-month interval, by weighted kappa and standardized response mean (SRM). RESULTS: Extended views were available from three trials and two cohorts (1759 X-rays), including one trial in which both extended and semiflexed views (antero-posterior) were obtained. Correlation with clinical parameters was low for the three scoring methods, except for the single community-based cohort. Inter-rater reliability was higher for categorical JSW in extended views (kappa, 0.86 vs 0.56 and 0.48 for KL and OARSI, respectively). Intra-rater reliability was higher for categorical JSW, both in extended views (0.83 vs 0.61 and 0.71) and in semiflexed views (0.89 vs 0.50 and 0.67). Sensitivity to change was also higher for categorical JSW, particularly in semiflexed views (SRM, 0.49 vs 0.22 and 0.34). CONCLUSION: These results indicate categorical JSW, in particular on semiflexed views, may be the preferred method to evaluate structural severity in knee OA clinical trials.     

Telethermographische Untersuchungen der Wundnaht im Tierexperiment

It is known from clinical practice that the healing of wounds is influenced by the type of wound suture applied. In general, the scar resulting from an intracutaneous suture looks better than that produced by an uninterrupted suture or by knotted suture. With respect to the appearance of the scar, the intracutaneous suture is normally superior to other wound sutures. As suggested by the results of our investigations, this may be due to an undisturbed microcirculation within the wound. Thermovision shows that a local temperature increase appears sooner in a wound closed by intracutaneous suture, whereas the temperature increases more slowly in case of uninterrupted or knotted suture. We suppose that the alterations of microcirculation in a wound closed by one of the latter types of wound suture can be considered as disturbance in blood circulation which may be followed by healing disturbances and proliferations of connective tissue.