Clinical parallels in cardiology

Acute coronary syndrome is a complex of symptoms which manifests itself as a chest pain. A diagnostic search in cardialgia requires exclusion of a number of diseases including acute surgical pathology. The patient management strategy and the volume of examinations often not only depend on the time from the beginning of an anginal attack till hospitalization but also on a correct interpretation of the results of the patient's clinical examination.

The effectiveness of resuscitation in patients with acute myocardial infarction according to the population register

Aim To study clinical and anamnestic features and tactics of managing patients with acute myocardial infarction (MI) in groups with different effectiveness of resuscitation procedures.Materials and methods Patients were selected using the “Acute Myocardial Infarction Registry” epidemiological program. 219 cases of acute MI recorded from 2007 through 2017, which required emergency life support, were studied. Two groups were formed based on success of the resuscitation: group 1 consisted of patients with acute MI who survived due to the cardiovascular life support (n=61); group 2 included fatal cases after resuscitation failure (n=158). Quantitative variables were described as median and interquartile range, Ме (Q1; Q3); comparison was performed in two independent samples using the Mann-Whitney test. Qualitative variables were presented as absolute and relative values (n (%)). Statistical significance of differences in nominal properties was determined with contingency tables (Pearson χ2; two-tailed Fisher’s exact test). Critical level of two-tailed significance was set equal to 0.05.Results The groups consisted of severe cases at baseline. The groups were sex- and age-matched. Mean age of patients in groups 1 and 2 was 63.5±13.1 and 60.9±14.8 years, respectively (р=0.2); in both groups, females were considerably older than males. Analysis of preceding drug therapy showed that comparable proportions of patients received antihypertensive and/or anti-ischemic treatment; however, the qualitative composition of the therapies was significantly different in these group. Thus, survived patients more frequently than deceased patients received drugs from vitally important groups, including β-blockers (93 % and 13 %, р<0.001), antiplatelets (97 % and 13 %, р<0.001), statins (84 % and 5 %, р<0.001), and angiotensin-converting enzyme (ACE) inhibitors (90 % and 8 %, р<0.001). In additions. success of resuscitation procedures was interrelated with the clinical picture. Thus, in atypical MI, the rate of fatal outcomes was higher (89 % and 56.5 %, р<0.001) despite the life support.Conclusion The patients who survived due to resuscitation procedures more frequently had a history of adequate drug therapy for ischemic heart disease and arterial hypertension with β-blockers, ACE inhibitors, antiplatelets, and statins. In this group, MI mostly had a clinical picture of a prolonged anginal attack. The long-term prediction for survivors after successful resuscitation presently remains important and requires further study.

Analysis of the clinical efficiency of eradication therapy in patients with coronary heart disease associated with gastroduodenal pathology

Aim. To comparatively analyze the clinical efficiency of eradiation therapy (ET) in patients with coronary heart disease (CHD) concurrent with gastroduodenal pathology (GDP). Subjects and methods. The study was conducted in three steps. In Step 1, 1588 patients with chronic CHD were examined. In Step 2, the characteristics of the course of CHD concurrent with Helicobacter pylori-associated GDP in 147 patients with these conditions compared to the same number of CHD patients without GDP. In Step 3, the impact of a GDP treatment option on the efficiency of treatment was investigated in the patients with CHD. Group 1 received ET + basic therapy (BT); Group 2 used antisecretory therapy + BT; Group 3 consisted of CHD patients without concomitant GDP who received BT only. The time course of changes in clinical and quality-of-life (QOL) indicators was assessed. Results. The patients with CHD concurrent with GDP have a more severe course of the disease as manifested by deterioration in clinical status and QOL. After ET, anginal attack rates were decreased by 62.6% in Group 1, by 30.7% in Group 2 (during antisecretory therapy), and by 29.5% in Group 3. The level of physical QOL increased by 23.7% in Group 1, which was not observed in Groups 2 and 3. Conclusion. Inclusion of ET in an algorithm for treating CHD patients with GDP promotes the angina stability and normalizes QOL in the patients.

The Safety and the Risk of Allogeneic Bone Marrow and Peripheral Blood Stem Cell Donation; Results of Nation-Wide Consecutive Pre-Transplant Registration of Related Donors in Japan.

Background The safety and the risk in normal healthy BM/PB donors are serious concerns. Several retrospective surveys reported adverse events in healthy donors, but the real incidence of these events may be underestimated in related donors while it has been fully monitored in unrelated donors by BM/PB donor registries. Methods JSHCT has conducted a nation-wide consecutive pre-registration of related donors in Japan, for PB since April 2000 and for BM since April 2005. JSHCT mandatory requires all members to register every related donors and to report any severe adverse events in donors in the first 30 days and then annually for 5 years after donation. These early and late severe events were categorized into definitely severe; life-threatening, treatment-required or long-lasting and relatively severe to mild; transient and not treatment-required. Pre-registration to the JSHCT as a BM/PB donor is made into the conditions of personal-accident-insurance subscription. Results 1. The preceding retrospective survey on related BM donors by a governmental research committee in 2005 reported four A-events (0.07%) including one death and 21 B-events (0.35%) in 5921 donors. 2. 3975 PB donors (3264 before and 711 after April 2005) and 999 BM donors (after April 2005) have been registered to this prospective registration by the end of July 2007. 3. There has been no death in PB /BM donors. 4. 64 events (1.6%) have been reported in PB donors as early events. 11 A-events include interstitial pneumonitis(2), hypoxemia(2), ascites, SAH, retroperitoneal hematoma, anginal attack, precordial discomfort, vein thrombosis and cholangitis. 5. Four-B events (0.4%) have been reported in BM donors as early events. 6. Relatively severe early (acute) adverse events occurred in 1.39% of those donors who fulfilled donor eligibility standards of the JSHCT guideline (N=3097), and 3.85% of those with one or more exclusion criteria (N=78) (P=0.09) 7. 35 late adverse events were reported in 3167 PB in the five year observation period. Although these late events were not proved to be related to G-CSF administration or apheresis, the relationship could not be completely denied. These occurred in 1.10% of those fulfilled the JSHCT donor eligibility standards (N=3097) and in 1.28% of those with exclusion criteria (N=78)(P=0.88). 8. Late adverse events have not been reported in BM donors because of short observation period. Conclusion Both BM and PB collection in related donors were shown to be safe in general. But several serious adverse events were reported. Prospective donor registration has enabled us to accurately monitor the real incidence of adverse events and has been useful for transplant physicians to observe the safety guideline for BM /PB collection by JSHCT, which results in lowering the rate of avoidable adverse events in related donors with known risk factors. Our seven year experience suggests the importance and usefulness of the prospective registration system of related PB /BM donors, and international collaboration is required to clarify and to improve the safety and the risk of PB /BM donation both in related and in unrelated donors.