Harry Soroff

Efficacy of Enhanced External Counterpulsation in the Treatment of Angina Pectoris

Eighteen patients with chronic angina despite surgical and medical therapy were treated with an improved system of enhanced external counterpulsation (EECP) (1 hour daily for a total of 36 hours). Patients underwent a baseline treadmill thallium-201 stress test. After EECP treatment, a thallium stress test was repeated for the same exercise duration. One week after treatment, patients also underwent a maximal stress test. All patients improved in anginal symptoms and generally decreased antianginal medications, with 16 obtaining complete relief from angina. Pre- and post-thallium stress testing performed for the same duration showed complete resolution of ischemic defects in 12 patients (67%), reduction in the area of ischemia in 2 (11%), and no change in 4 (22%). Thus, a decrease in myocardial ischemia was observed in 14 patients (78%; p less than 0.01). The exercise duration of maximal stress testing after EECP significantly improved from 8.14 +/- 0.71 to 9.72 +/- 0.77 minutes (p less than 0.005), although the double product did not change significantly. Analysis of these 2 tests in the subgroup of 14 patients with improvement in thallium studies showed significant increases in both exercise duration (8.58 +/- 0.66 to 10.44 +/- 0.59 minutes; p less than 0.001) and double product (21,827 +/- 2,044 to 24,842 +/- 1,707 mm Hg.beats/min; p less than 0.01). The improvement in reperfusion defects and increase in exercise duration are reflections of improved perfusion to ischemic regions of the myocardium. EECP uses additional thigh balloons and sequenced balloon inflation, effecting a significant increase in diastolic augmentation over previously available methods.(ABSTRACT TRUNCATED AT 250 WORDS)

Combined thiotepa and mitomycin C instillation therapy for low-grade superficial bladder tumor

Fifteen patients with superficial low‐grade bladder tumors were treated with combined thiotepa and mitomycin C instillation as definitive therapy. The amount of both thiotepa and mitomycin C used in each instillation in the presenting protocol was one half the conventional dose of either used alone. Patients with multiple bladder tumors, bladder tumors inaccessible to endoscopic resection, or lesions too extensive to completely resect, or with medial contraindications for endoscopic resection procedures, were included in these studies. No serious adverse effect was revealed in these 15 patients. Ten of the 15 patients (66.7%) had a complete response and 4 (26.7%) had a partial response. One patient (6.6%) did not respond to this regimen. This protocol seems to provide a therapeutic modality that is more effective than conventional single‐drug therapy, less toxic than thiotepa used alone, and less expensive than mitomycin C used alone.

The Evolution of the External Left Ventricular Assist Device

External counterpulsation is a noninvasive method of applying external pressures to vascular beds of the lower extremities synchronous with the cardiac cycle. Numerous animal experiments and a number of clinical trials have been conducted over the years in patients with various forms of cardiac disease to evaluate the effectiveness of external counterpulsation. The external counterpulsation machines (known as ECP and EECP machines) are currently widely available for use in the treatment of angina by applying positive pressure to the lower extremities during cardiac diastole to increase coronary flow. External counterpulsation has also been shown to be capable of perfusing the ischemic myocardium following an AMI and of assisting the failing left ventricle in patients with CHF. In these applications, positive pressure is applied externally to the lower extremities during cardiac diastole and negative pressure during cardiac systole so as to increase coronary flow and reduce the work of the heart. This paper provides a review of the developments in the area of external counterpulsation and the related devices. The paper also reviews the experimental evidence that provides the scientific basis for the design of a device now under development and called external left ventricular assist device (XLVAD) that should provide effective support of the left ventricle of a patient in congestive heart failure or following an AMI. The evolutionary development of the external counterpulsation devices into the XLVAD is presented in detail. The clinical and mechanical advantages as well as the shortcomings of each device are described.