High-speed rotational atherectomy: six-month serial quantitative coronary angiographic follow-up

One hundred twenty-three patients treated with high-speed rotational atherectomy (HSRA) were restudied 6.9 +/- 1.2 months later. At the follow-up, the number of focal concentric lesions increased from 32.2 percent to 63.0 percent, p<0.01, with decrease of type C lesions from 54.8 percent to 30.8 percent, p<0.05. Comparison of the degree of the net gain (NG) showed more severe baseline lesions in the high-gain group (NG >20 percent) compared with the moderate-gain group (20 percent > NG > 0 percent) and to the loss group (minimal luminal diameter [MLD] 0.8 +/- 0.4 mm vs 1.0 +/ 0.4 mm, p<0.05; and 1.2 +/- 0.5 mm; p<0.01, respectively). Highest initial gain (36.5 percent +/- 26.2 percent vs 24.5 percent +/- 18.1 percent; p<0.015; and 19.0 percent +/- 23.2 percent; p<0.001) as well as lowest late loss (1.8 percent +/- 21.7 percent vs 14.0 percent +/-18.4 percent; p<0.01 and 28.1 percent +/- 25.0 percent; p<0.01) were found in the high NG group. A higher interaction between burr and atheroma resulted in the lowest restenosis rate of 6 percent.     

Stent by stent crush: procedural outcome and angiographic follow-up

Intraleucocytic malaria pigment has been suggested as a measure of disease severity in malaria. We have tested this hypothesis by studying 146 children aged 6 months to 14 years in 4 categories--cerebral malaria, mild malaria, asymptomatic malaria and 'no malaria'--in Ibadan, Nigeria, an area of intense malaria transmission in Africa. Children with cerebral malaria were studied at the university hospital, those with mild malaria at 2 primary health centres and the other 2 groups were studied in a primary school. The proportion of pigment-containing neutrophils showed a clear rise across the spectrum no malaria--asymptomatic malaria--mild malaria--cerebral malaria (median values 2.0%, 6.5%, 9.0% and 27.0%, respectively; P < 0.0001). The proportion of pigment-containing monocytes did not differ significantly between the mild malaria, asymptomatic malaria and no malaria groups but the cerebral malaria group had a higher median value than the other 3 groups. The ratio of pigment-containing neutrophils to pigment-containing monocytes showed the same trend across the groups of subjects as was observed with the number of pigment-containing neutrophils. It is concluded that the pigment-containing neutrophil count is a simple marker of disease severity in childhood malaria in addition to the parasite count.     

Comparative clinical and angiographic analysis of the initial efficacy and long-term follow-up of Wiktor stent implantation with conventional balloon angioplasty

This study was retrospectively designed to examine if the Wiktor stent, a balloon-expandable tantalum coil stent, provides a more favorable procedural and long-term clinical and angiographic outcome than does conventional coronary balloon angioplasty (POBA). From April 1995 to April 1996, we implanted 56 Wiktor stents in 46 lesions (LAD: 23, RCA: 16, CX: 7) in 42 patients (average age 53 +/- 10 years). Coronary lesions from the stent group were matched with similar lesions of another 42 POBA patients whose characteristics were identical to the Wiktor group. Revascularization indications in the Wiktor and POBA groups, respectively, were recent myocardial infarction (RMI) (45%, 40%), unstable (31%, 39%) and stable (24%, 21%) angina pectoris. 7% of the stents and 17% of the POBA balloons were less than 3 mm in diameter (p > 0.05). Procedural success was significantly greater in the Wiktor group than in the POBA group (100% vs. 92%, p < 0.05). Neither major cardiac event (death, CABG, acute myocardial infarction) nor (sub)acute occlusion was encountered in the Wiktor group during the hospitalization period and 1 month follow-up. There was 1 urgent CABG and 4 subacute occlusions in the POBA group. Control angiography at 8 months was performed in patients of both groups, of whom some were symptomatic at long-term follow-up or completely event free for 8 months. Angiographic restenosis (> 50% diameter stenosis) occurred in 25% of the Wiktor patients and in 43% of those in the POBA group (p < 0.05). For an 18 month clinical follow-up, 91% of the patients in the Wiktor group were asymptomatic and without ischemia in radionuclide imaging (RI), whereas 79% of the POBA patients were angina-free and 74% were without ischemia in the RI study. In conclusion, Wiktor stent implantation, with no major cardiac event or subacute occlusion, provides a more favorable procedural and long-term clinical and angiographic outcome than does conventional POBA.     

Single-center experience with the Palmaz-Schatz intracoronary stent: the immediate results and medium- and long-term follow-up

The yeast SEC14 gene product is required for the transport of proteins from the Golgi complex. We have cloned the homologous Candida albicans SEC14 gene (CaSEC14) by functional complementation of a Saccharomyces cerevisiae thermosensitive mutant, sec14ts. Some putative TATA boxes have been identified in CaSEC14 and, contrary to S. cerevisiae SEC14, no introns were found in the Candida homologue. Sequence analysis revealed that CaSec14p is a 301 amino acid protein, 67% identical to S. cerevisiae and Kluyveromyces iactis Sec14p, and 61% identical to the 300 amino-terminal residues of Yarrowia lipolytica Sec14p. Hydrophatic profile analysis of CaSec14p suggests a soluble protein without transmembrane domains as has been described for the S. cerevisiae counterpart. While it was easy to disrupt one allele of SEC14 in C. albicans, repeated attempts to disrupt the second allele were unsuccessful, thus suggesting that the gene could be essential for vegetative growth in C. albicans.     

Intimal hyperplasia thickness at follow-up is independent of stent size: a serial intravascular ultrasound study

The purpose of this study was to determine whether the thickness of the intimal hyperplasia (IH) layer that accumulates within Palmaz-Schatz stents is dependent on stent size. Intravascular ultrasound (IVUS) and quantitative angiographic (QCA) studies were performed after stent implantation and at follow-up (5.4 +/- 3.8 months) in 161 patients with 177 lesions treated with 221 Palmaz-Schatz stents. Stent and lumen cross-sectional area (CSA) were measured. IH CSA and thickness at follow-up were calculated and compared with stent CSA and circumference. Maximum IH CSA and thickness were measured at the smallest follow-up lumen CSA; mean IH CSA and thickness was averaged over the length of the stent. Maximum IH CSA measured 4.8 +/- 2.4 mm2, and mean IH CSA measured 2.8 +/- 2.2 mm2. Maximum IH thickness (at the smallest follow-up lumen CSA) measured 0.60 +/- 0.36 mm, and mean IH thickness (over the length of the stent) measured 0.30 +/- 0.19 mm. There was a weak, but significant correlation between mean and maximum IH CSA versus stent CSA (r = 0.215, p <0.0001 and r = 0.355, p <0.0001, respectively). However, there was no correlation between mean or maximum IH thickness versus stent CSA (r = 0.018, p = 0.643 and r = 0.056, p = 0.463, respectively) or stent circumference (r = 0.002, p = 0.956 and r = 0.069, p = 0.361, respectively). IH thickness was found to be independent of the stent size. This explains the known higher frequency of restenosis in smaller stents compared with larger stents.     

Arteriovenous malformation: a 22-year angiographic follow-up

A case is reported of an unoperated giant arteriovenous malformation with a progressive deterioration ending in a severe dementia and invalidism. Angiographic documentation is over a 22 year interval. The presentation, diagnosis and treatment of this disease are discussed. It is concluded that early surgical intervention should have a primary role in the management of giant arteriovenous malformation.     

Initial experience with laparoscopic adrenalectomy

We present the first experience with laparoscopic adrenalectomy, which was in Slovakia introduced to the surgical practice on March 3, 1996. We analyse first seven patients who underwent completed laparoscopic adrenalectomy (five leftsided, two right-sided). Four patients had cortex adenoma (clinically 2 incidentalomas and 2 Cishing syndroma), three patients had cortex hyperplasia (clinically Conn syndroma). Average duration of operation was 120 minutes, there were no postoperative complications. Average postoperative hospital stay was 5 days. Our initial experiences are comparable with that of surgical departments which has more than two-years experiences. Laparoscopic adrenalectomy is a perfect method for the small adrenal tumors and it is better than traditional transabdominal approach.     

Surgical experience with intracardiac myxomas: long-term follow-up

BACKGROUND: Myxomas are the most common benign intracardiac tumors. This report summarizes our 20-year experience with these tumors. METHODS: Sixty-six patients (25 male) with a median age of 39 years (range, 6 to 70 years) underwent surgical excision of primary or recurrent intracardiac myxomas during the years 1976 to 1996. Symptom duration ranged from 2 to 8 months. There were 55 left atrial myxomas, 10 right atrial myxomas, and 1 biatrial myxoma. Three of the patients were in one family. The surgical approach comprised complete wide excision. RESULTS: There were two early deaths. Late follow-up is 89% (57/64) complete. There was one late death, which was not due to a cardiac cause. Echocardiography at a mean follow-up of 66.9 months (range, 7 to 241 months) showed no recurrence of sporadic myxomas. However, 2 of the 3 patients with familial myxomas had recurrence. CONCLUSIONS: Surgical excision of atrial myxoma gives excellent short-term and long-term results leading to eventual cure of nonfamilial myxomas. However, familial myxomas retain a strong tendency to recur even 20 years after excision.     

Traumatic carotid cavernous sinus fistula: serial angiographic studies from the day of trauma

BACKGROUND AND PURPOSE: The purpose of this study was to ascertain the early angiographic features characteristic of traumatic carotid cavernous sinus fistulas (CCFs). METHODS: Eight patients with severe craniofacial injuries underwent emergency diagnostic and therapeutic angiography for intractable oronasal bleeding, starting on an average of 6.7 hours after trauma. Carotid angiograms and the clinical manifestation of traumatic CCFs were then reviewed retrospectively to determine characteristic angiographic features. RESULTS: In four of the eight patients, no arteriovenous fistulas were found in the cavernous sinuses and symptomatic CCF did not occur during the follow-up period. In the remaining four patients, dural CCFs (Barrow type B) were observed, unilaterally in three patients and bilaterally in one. One of these four patients subsequently became symptomatic and required transarterial coil embolization. CONCLUSION: Traumatic dural CCFs are frequently observed in the early stage of severe craniofacial trauma, if investigated. Although their spontaneous disappearance is known, some of these do become symptomatic and need treatment.     

Initial experience with the fish-shaped incision in mastectomy

The authors are showing their early experiences with the modified mastectomy with the use of the fish-shape incision, first published by Nowacki and Towpik in 1988. The fish-shaped incision reduces the amount of the skin in the axilla by adding two triangles on the lateral edge of the incision, prevents the "dog ear" deformity and makes the clearance of the axilla easier.     

Preliminary clinical experience with the Bard XT coronary stent

PURPOSE: The purpose of this work is to show how variations in inhalation speed of xenon gas affect cerebral blood flow (CBF) values obtained using the end-tidal method on xenon-enhanced CT (Xe-CT). We tried to clarify whether arterial xenon concentration could keep up with end-tidal xenon concentration by evaluating the effect of xenon inhalation speed on calculated CBF values. METHOD: The same subject underwent two or three consecutive Xe-CT examinations, varying xenon inhalation speed. The rate constants of applied inhalation speeds were 0.1-0.15 min-1 (low speed), 0.25-0.3 min-1 (middle speed), and 1-2 min-1 (high speed), respectively. RESULTS: No significant difference was observed among the CBF values of the same subject obtained under different inhalation speeds. CONCLUSION: End-tidal xenon can closely reflect arterial xenon under the customary method of xenon supply. The end-tidal method can provide reliable absolute CBF values, assuming actual CBF values are substantially unchanged regardless of the inhalation speed variation applied in this work.     

Transjugular intrahepatic portosystemic shunt: midterm clinical and angiographic follow-up

The synthesis of a series of azabicyclic indole esters is described and their potency reported as 5-HT4 receptor antagonists. Optimization of the most potent compound (19) by preparing the corresponding oxazino[3,2-a]indole ester afforded 34, which had a pIC50 of 9.5 in the guinea pig distal colon longitudinal muscle myenteric plexus preparation.     

Placement of a coated stent in esophagotracheal fistula: initial experience with an "aortic stent"

Clinical and biological pitfalls that lead to incorrect or delayed diagnoses of airport malaria are described based on 7 cases reported from the Paris region in the summer of 1994. We also report the outcome and the epidemiological features of these patients.     

Initial experience with clozapine in Woodbridge Hospital

OBJECTIVES: This study was performed to evaluate the efficacy and side-effect profile of the atypical neuroleptic clozapine in local Asian patients with treatment-resistant schizophrenia. METHOD: Patients were treated with 12 weeks of clozapine after undergoing a washout of all previous neuroleptics. They were assessed weekly on the Brief Psychiatric Rating Scale (BPRS), Clinical Global Impression (CGI) and the Simpson-Angus Scale for Extrapyramidal Side-Effects. RESULTS: Clinical improvement (according to criteria established a priori) at study end point was shown in 78.9% of the patients. There was no statistical difference in the incidence of the extrapyramidal side-effects at starting and end points. The mean daily dosage was 356.6 mg. The most common adverse effect was hypersalivation. CONCLUSION: Clozapine is effective and well tolerated in local patients with treatment-resistant schizophrenia.     

Expandable metallic stent placement in patients with benign esophageal strictures: results of long-term follow-up

Prosthetic mandibular advancement (PMA) was applied to nine patients with obstructive sleep apnea syndrome (OSAS) and its therapeutic usefulness, mechanism of action, and clinical indication were discussed based on polysomnographic findings and serial examination of upper airway before and during PMA treatment. Apnea hypopnea index significantly decreased during PMA treatment compared with the value before treatment (P < 0.01) and the rate of the treatment responder counted 78.1%. Cephalometric variables indicated forward and inferior advancement of mandible in our subjects. Magnetic resonance imaging of the upper airway during sleep revealed a marked improvement of velophanryngeal obstruction in most subjects. In addition, intraesophageal negative pressure during sleep decreased significantly. Our results confirmed the high therapeutic efficacy of PMA for OSAS and indicated forward advancement of the mandible and decrease of negative pressure loading on upper airway with PMA might suppress velopharyngeal collapse. Thus, PMA was regarded as one of the treatments of choice for OSAS occurring based on with velopharyngeal narrowing.