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The urgent coronary surgery performed in patients with high risk unstable angina (rest pain greater than 48 h) shows still different results. We found in 57 urgent operated patients the same functional and clinical results as after elective bypass grafting. A higher in hospital mortality after urgent coronary surgery based on a higher number of grafts are occluded in the early postoperative period. The better prognosis concluded that the use of urgent coronary surgery is the therapy of choice in patients with refractory unstable angina pectoris.

Macroscopic and microscopic studies on the anterior interventricular ramus of left coronary artery, internal thoracic artery, and great saphenous vein were carried out 50 dead, aged 21 to 60 years. The internal thoracic artery was always normal whereas in 40 cases stenosing coronary sclerosis was found. At mammography, 25 patients with operable coronary obstruction also showed no degenerative alterations of this systematic artery. With a diameter of 1.5 mm in the 5th intercostal space the internal thoracic artery was fit for performing an anastomosis.

In comparative studies in 36 mongrel dogs it was tried to find out how far intraaortic balloon pumping (IABP) applied solely and in combination with glucose-insulin-potassium (GIK) might influence the degree of acute myocardial ischemia. The ischemia lasted 3 hours. After 60 min myocardial ischemia IABP, the isolated GIK infusion, or the combination of IABP plus GIK were used. The directed GIK application into the aortic root was carried out by electronic triggering during the diastolic augmentation via a precoronary catheter. In the ischemic and in the non-ischemic myocardium of the left ventricle, ATP, creatine phosphate, and lactate were determined. Electronmicroscopical studies were carried out qualitatively as well as quantitatively. The isolated use of IABP suggested no protection of the energy-rich phosphates. The most significant morphological changes were found when exclusively the coronary ligature was applied and when only IABP was used, respectively. The best protective effect was achieved by our technique of the triggered GIK infusion via the precoronary catheter in combination with IABP. The ATP value (n mol/mg w.w.) in the ischemic area was 3.06 and in the non-ischemic one 4.96 in comparison to 1.96 and 3.99, respectively, in the control group. The creatine phosphate (n mol/mg w.w.) was 4.18 in the ischemic and 9.38 in the non-ischemic area in contrast to 2.36 and 6.99, respectively, in the control group. The technique of the triggered drug supply in combination with IABP offers the following advantages: --additive summation of IABP and substrate supply directed to the myocardium --high drug concentration in the myocardium --smaller drug load of the whole organism --clinical use of instable substances.

In a complex experimental study on 52 dogs the myocardium was examined after ischemia and reperfusion of various duration. Morphologic, metabolic, and functional findings proved that a short-term reperfusion after coronary occlusion for more than 2 hours has disadvantageous effects on the regression of ischemic lesions. During the early period (up to 3 days) this is caused by the "no-reflow" phenomenon. Combined qualitative and quantitative findings are required for correct appraisal of the ultrastructural alterations after reperfusion. In acute coronary occlusion, early revascularization after passing the crucial initial phase is advantageous, because the extent of myocardia necrosis is decreased by the prolonged reperfusion, thus leaving a larger myocardiac reserve in case of re-infarction. Clinical conclusions are drawn.

An animal experimental study was carried out in order to compare the therapeutical value of two different surgical methods for excising the subcutaneous implanted Lewis lung carcinoma - tumor excision with scalpel or with carbon dioxide laser. The radicalism of operation methods, the survival time, and the tumor local recurrences were performed. The therapeutic effectivity of tumor excision with the carbon dioxide laser is more favourable than the scalpel method.

The authors examined the effects of reperfusion after temporary ischemia in 50 dogs. The morphologic alterations were documented by methods of electron microscopy, fluorescence microscopy, and histochemistry. Lactate and activity of glycogen phosphorylase were assessed. According to the results, the optimal ischemia interval is 30 to 60 minutes for rational application of reperfusion, while it is just possible after 120 minutes. After a 4-hours-period of ischemia reperfusion increase morphologic damage of myocardium and impairment of myocardial metabolism. Prolonged reperfusion of 7 days resulted in a reduced extent of infarction compared with controls. In non-ischemic myocardium the morphologic and metabolic alterations were less expressed. The effects of "no-reflow"-phenomenon and conclusions for clinical practice are discussed.