Early insole support is successful in reducing plantar pressure. A repeated adjustment should be performed every 6 months to prevent foot pressure increases. The comparison of foot pressure development between the two groups showed constant levels in the treatment group. In the control group a marked increase of the pressure values was found. Identification and subsequent support of patients with high ulceration risk may help to reduce the high amputation rate.

A b s t r a c tBackground: Artificial chord implantation to repair a flail or prolapsing mitral valve leaflet requires open heart surgery and cardiopulmonary bypass.Aim: Transapical off-pump artificial chordae implantation is a new surgical technique proposed to treat degenerative mitral valve regurgitation. The procedure is performed using the NeoChord DS1000 system (NeoChord, Inc., St. Louis Park, MN, USA), which facilitates both implantation and lenght adjustment of the artificial chordae under two (2D)-and three (3D)--dimensional transoesophageal echocardiographic (TEE) guidance on a beating heart. Methods: Two male patients aged 60 and 55 years with severe mitral regurgitation due to posterior leaflet prolapse underwent transapical off-pump artificial chordae implantation on September 3, 2015. The procedure was performed by left minithoracotomy under general anaesthesia in a cardiac surgical theatre, using 2D and 3D TEE guidance. Results:Early procedural success as confirmed by 3D TEE was achieved in both patients, with implantation of 6 artificial chordae in the first patient and 3 artificial chordae in the second patient. Both procedures were uneventful, and no postoperative complications were noted. The patients were discharged home on the 8 th and 6 th postoperative day, respectively. Conclusions:The NeoChord DS1000 system allows both implantation and lenght adjustment of artificial chordae under 2D and 3D TEE guidance on a beating heart. Our initial experience in 2 patients with posterior mitral leaflet prolapse indicates that the procedure is feasible and safe.

The influence of blood coagulation factors in pat. with acute respiratory insufficiency of adults, especially of the so called “pancreatitis lungs” is still unknown. In order to find out the effect of elastase, possibly activated by trypsin in pat. with acute pancreatitis, on blood coagulation factors, we performed some studies. In vitro elastase induces in plasma and blood in correlation to the dosages Enhancement of thrombingeneration in the TGT, a shortening of PTT, Thrombin time and of r- and k-time in the TEG, a loss of fibrinogen and an increase of fibrinmono-mercomplexes. In another study, elastase (960 U/ kg b.w.) was injected intravenously in rats. 30 min. later there was found a loss of fibrinogen, number of platelets, Prothrombin and a prolongation of PTT and Thrombin time and an increase of fibrinomonomercomplexes, especially in these rats, which received beside elastase Kalikreininhibitors or antifibrinolytic drugs. After repeated injections (3 times within 30 h) we found histomorpholgically thrombi as well as bleeding complications. In another study we performed (150 min) an infusion of elastase (333 U/kg b.w./h) to 9 pigs. We determined a loss of fibrinogen of platelets, of F. II, F. VII and F. XIII, a prolongation of PTT. F. VIII and F. V remained within the normal range But there was found an enhancement of Thrombin generation in the TGT, too. Compariening the results of blood coagulation tests and of histomorphological findings, elastase induced a DIC. We have to discuss their influence on ARIA and “Pancreatic lungs”.

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Streptokinase, aplicated by intracoronary infusion in pat. with acute myocardial infarction has proven to be successfull in recanalisation of occluded coronary arteries. The good clinical, angiographic, chemical and EKG results suggests that jeopardized myocardium was salvaged by acute recanalisation. Till now, we infused Streptokinase (about 2000 U/min) in 78 pat. into the ischemia related occluded coronary artery. In this presentation we intend to demonstrate the results of these pat. and of a study, done before starting intracoronary Streptokinase infusion to be safe for bleeding complication. Neither after the infusion of 50 000 U.(n = 24) of 100 000 U. (n = 15) nor in 20 pat. who received SK equal to their ASTK-titres plus 50 000 U. SK whe found severe alterations of the blood-coagulation system. Only in the last group there was a small decrease of Fibrinogen of about 100 mg% and of Plasminogen 4 mg%. In none of the 78 pat., treated by intracoronary SK aplication, we resulted bleeding complication and the mean values of blood coagulation test remained within the normal range. On the other hand, we infused SK by veins and controlled the thrombolytic effect by coronarangiography. In 5 of 6 pat. we succeded in recanalisation of occluded coronary arteries within 45 Used very high dosages of SK, (about 2 Mill U) there was only a small decrease of 210 mg of Fibrinogen and no bleeding complications.