Influence of patient age and stenosis location on wingspan in-stent restenosis

BACKGROUND AND PURPOSE

Wingspan is a self-expanding, microcatheter-delivered microstent specifically designed for the treatment of symptomatic intracranial atherosclerotic disease. Our aim was to discuss the effect of patient age and lesion location on in-stent restenosis (ISR) rates after percutaneous transluminal angioplasty and stenting (PTAS) with the Wingspan system.

MATERIALS AND METHODS

Clinical and angiographic follow-up results were recorded for all patients from 5 participating institutions. ISR was defined as >50% stenosis within or immediately adjacent (within 5 mm) to the implanted stent and >20% absolute luminal loss. For the present analysis, patients were stratified into younger (</=55 years) and older (>55 years) age groups.

RESULTS

ISR occurred at a rate of 45.2% (14/31) in the younger group and 24.2% (15/62) in the older group (odds ratio, 2.6; 95% confidence interval, 1.03-6.5). In the younger group, ISR occurred after treatment of 13/26 (50%) anterior circulation lesions versus only 1/5 (20%) posterior circulation lesions. In the older group, ISR occurred in 9/29 (31.0%) anterior circulation lesions and 6/33 (18.2%) posterior circulation lesions. In young patients, internal carotid artery lesions (10/17 treated, 58.8%), especially those involving the supraclinoid segment (8/9, 88.9%), were very prone to ISR. When patients of all ages were considered, supraclinoid segment lesions had much higher rates of both ISR (66.6% versus 24.4%) and symptomatic ISR (40% versus 3.9%) in comparison with all other locations.

CONCLUSION

Post-Wingspan ISR is more common in younger patients. This increased risk can be accounted for by a high prevalence of anterior circulation lesions in this population, specifically those affecting the supraclinoid segment, which are much more prone to ISR and symptomatic ISR than all other lesions.

Systemic sclerosis sine scleroderma associated with Wolff-Parkinson-White syndrome

The term "systemic sclerosis sine scleroderma" (ssSSc) has been used to designate a rare progressive systemic sclerosis of visceral organs without skin manifestations. A variety of visceral organs, including the gastrointestinal tract, lung, heart, and kidney, can be involved. We describe a case of 59-year-old female patient with both Wolff-Parkinson-White (WPW) syndrome and ssSSc. She was diagnosed as having ssSSc with Raynaud's phenomenon, anti-nuclear antibody (ANA) and anti-topoisomerase antibody positivity, interstitial pulmonary infiltrates, suspected pulmonary hypertension, subclinical oesophageal dysmotility but no skin thickening. She had a history of paroxysmal tachycardia together with Raynaud's phenomenon and exercise-induced dyspnoea. Electrophysiological study confirmed WPW syndrome with left posterior bypass tract. This case highlights cardiac arrhythmia caused by WPW syndrome as a clinical manifestation of the heart in ssSSc.

Association of nodular regenerative hyperplasia of the liver with porto-pulmonary hypertension in a patient with systemic lupus erythematosus

A 37-year old woman with systemic lupus erythematosus (SLE) complicated by pulmonary hypertension (PHT) was admitted to evaluate abnormal liver function. Radiological imaging study, including ultrasonography, computed tomography and magnetic resonance imaging and upper gastrointestinal endoscopy, revealed multiple hepatic nodules, hepatosplenomegaly and esophageal varices. Percutaneous needle liver biopsy showed non-cirrhotic hepatic nodules with hyperplastic hepatocytes surrounded by atrophic hepatocytes, confirming the diagnosis of nodular regenerative hyperplasia (NRH) associated with non-cirrhotic portal hypertension (PT). NRH of the liver is known to be a very rare hepatic manifestation in rheumatic diseases. This case shows the association of NRH with porto-pulmonary hypertension in SLE.

Spinons in the strongly correlated copper oxide chains in SrCuO2

We have investigated the spin dynamics in the strongly correlated chain copper oxide SrCuO2 for energies up to greater, similar 0.6 eV using inelastic neutron scattering. We observe a gapless continuum of magnetic excitations, which is well described by the "Müller ansatz" for the two-spinon continuum in the S=1/2 antiferromagnetic Heisenberg spin chain. The lower boundary of the continuum extends up to approximately 360 meV, which corresponds to an exchange constant J=226(12) meV.

Quantum magnetic excitations from stripes in copper oxide superconductors

In the copper oxide parent compounds of the high-transition-temperature superconductors the valence electrons are localized--one per copper site--by strong intra-atomic Coulomb repulsion. A symptom of this localization is antiferromagnetism, where the spins of localized electrons alternate between up and down. Superconductivity appears when mobile 'holes' are doped into this insulating state, and it coexists with antiferromagnetic fluctuations. In one approach to describing the coexistence, the holes are believed to self-organize into 'stripes' that alternate with antiferromagnetic (insulating) regions within copper oxide planes, which would necessitate an unconventional mechanism of superconductivity. There is an apparent problem with this picture, however: measurements of magnetic excitations in superconducting YBa2Cu3O6+x near optimum doping are incompatible with the naive expectations for a material with stripes. Here we report neutron scattering measurements on stripe-ordered La1.875Ba0.125CuO4. We show that the measured excitations are, surprisingly, quite similar to those in YBa2Cu3O6+x (refs 9, 10) (that is, the predicted spectrum of magnetic excitations is wrong). We find instead that the observed spectrum can be understood within a stripe model by taking account of quantum excitations. Our results support the concept that stripe correlations are essential to high-transition-temperature superconductivity.

Alpha-interferon 2a and 1 3-cis-retinoic acid for the treatment of metastatic renal cell carcinoma

BACKGROUND

It is suggested that immunotherapy may have a better role than cytotoxic chemotherapy in the treatment of metastatic renal cell carcinoma.

AIMS

A phase II study of alpha-interferon 2a (IFN2a) and 13-cis-retinoic acid (CRA) in the treatment of metastatic renal cell carcinoma.

METHODS

Twenty-two patients with no previous systemic therapy were treated with IFN2a daily at 3 million units (MU) and escalated to 6 and 9 MU if tolerated, together with CRA given orally at 1 mg/kg per day in two divided doses. Changes in quality of life were also assessed.

RESULTS

Twenty patients were available for assessment. Three patients (14%) achieved a partial response and five patients (23%) had stable disease. No patient achieved a complete response. A durable response was observed in partial responders with median length of response of 44 weeks (range 32-59 weeks). Therapy was stopped in seven (35%) patients due to treatment-related toxicities, and quality of life was worsened in the majority of patients.

CONCLUSION

IFN2a and CRA has a low response rate and significant toxicity, and the combination as standard treatment of metastatic renal cell carcinoma is not recommended, despite the suggestion that CRA may lengthen the response to IFN2a.

Evaluation of several respirometry-based activated sludge toxicity control strategies

Four different strategies including influent storage and reintroduction, step-feeding, rapid sludge recycle and waste sludge storage were evaluated using the denitrification layout of the IWA simulation benchmark. The control objective was to minimise deterioration in effluent quality caused by a certain toxic input event. In these strategies the maximum specific respiration rate (Rmax) was selected as a measured and controlled variable. To simplify the analysis, the toxicant was assumed to be a soluble and nonbiodegradable substance. Two toxic influent files were developed with square-wave input lasting 3 hours. To detect the influent toxicity, a pseudo-online flow-through respirometer was applied. A number of simulations were performed and the results suggested that the influent storage and reintroduction strategy provided the most optimistic results and other strategies could not mitigate the toxic effect. The influent storage and reintroduction strategy strongly depended on reintroduction flow rate from the storage tank. The simulation according to reintroduction flow could estimate the time required for completely treating toxic wastewater stored in the storage tank. Also the IWA simulation benchmark was enhanced to evaluate toxicity effect on the activated sludge process.

Genetic algorithms for the application of Activated Sludge Model No. 1

The genetic algorithm (GA) has been integrated into the IWA ASM No. 1 to calibrate important stoichiometric and kinetic parameters. The evolutionary feature of GA was used to configure the multiple local optima as well as the global optimum. The objective function of optimization was designed to minimize the difference between estimated and measured effluent concentrations at the activated sludge system. Both steady state and dynamic data of the simulation benchmark were used for calibration using denitrification layout. Depending upon the confidence intervals and objective functions, the proposed method provided distributions of parameter space. Field data have been collected and applied to validate calibration capacity of GA. Dynamic calibration was suggested to capture periodic variations of inflow concentrations. Also, in order to verify this proposed method in real wastewater treatment plant, measured data sets for substrate concentrations were obtained from Haeundae wastewater treatment plant and used to estimate parameters in the dynamic system. The simulation results with calibrated parameters matched well with the observed concentrations of effluent COD.

Effects of hand massage on anxiety in cataract surgery using local anesthesia

PURPOSE

To evaluate the effects of hand massage on patient anxiety during cataract surgery.

SETTING

Kangnam St. Mary's Hospital, Seoul, Korea.

METHODS

This study comprised 59 patients having cataract surgery from December 11, 1996, to February 12, 1997. The patients were divided into those having a hand massage 5 minutes before surgery (experimental group, n = 29) and those not receiving a hand massage (control group, n = 30). Patients' anxiety levels were measured using the Visual Analog Scale and by assessing the systolic blood pressure, diastolic blood pressure, and pulse rate before and after the hand massage and 5 minutes before the end of surgery. Epinephrine, norepinephrine, cortisol, blood sugar levels, neutrophil, and lymphocyte percentages in white blood cells were also measured.

RESULTS

After the hand massage, the psychological anxiety levels, systolic and diastolic blood pressures, and pulse rate were significantly lower than before the massage. The hand massage significantly decreased epinephrine and norepinephrine levels in the experimental group. Epinephrine, norepinephrine, and cortisol levels increased in the control group. The differences between groups were significant. There were no significant between-group differences in blood sugar levels or neutrophil and lymphocyte percentages in white blood cells.

CONCLUSION

The findings indicate that hand massage decreases the psychological and physiological anxiety levels in patients having cataract surgery under local anesthesia.

Natural history of brainstem cavernous malformations

OBJECTIVE

To review the natural history and determine the rates of intra- and extralesional hemorrhaging of brainstem cavernous malformations (cavernomas) monitored by one neuro-ophthalmology service.

METHODS

A record review of all patients with brainstem cavernomas who were evaluated by a neuroophthalmology service between 1987 and 1999 was performed. We recorded the clinical symptoms and Rankin disability grade at presentation, during the worst clinical episode, and at the last follow-up examination. Magnetic resonance imaging scans were reviewed for evidence of intralesional hemorrhage (a bleeding episode), edema, or venous anomalies, and the cavernoma size was assessed.

RESULTS

Thirty-seven patients (age range, 6-73 yr; mean age at presentation, 37.5 yr) underwent a mean of 4.9 years of follow-up monitoring. At presentation, there were 27 bleeding events and 8 nonhemorrhagic events; 2 patients did not exhibit symptoms. Patients who were at least 35 years of age exhibited a lower risk of bleeding episodes (odds ratio, 0.15; 95% confidence interval, 0.1-0.4). Cavernomas of at least 10 mm were associated with a higher risk of bleeding episodes (odds ratio, 3.48; 95% confidence interval, 1.3-9.4). Thirty-nine bleeding episodes occurred in 31 patients, yielding a bleeding rate of 2.46%/yr. There were eight rebleeding episodes, yielding a rebleeding rate of 5.1%/yr. Three patients experienced extralesional bleeding episodes; all of these patients experienced rebleeding. Of the 39 follow-up magnetic resonance imaging scans, the cavernoma size was unchanged in 66.7%, smaller in 18%, and larger in 15%. At the last follow-up examination, the mean Rankin grade was 1.0 for all patients, 0.6 for the 25 nonsurgically treated patients, and 1.4 for the 12 surgically treated patients.

CONCLUSION

Rebleeding is not more common among patients who first present with bleeding, and it often has little effect on the neurological status of patients. Significant morbidity attributable to a brainstem cavernoma occurred in 8% of patients during follow-up monitoring of medium duration.

Relative efficacy of sildenafil compared to other treatment options for erectile dysfunction

OBJECTIVE

We examined and compared the efficacy of sildenafil in patients previously using other agents or devices for erectile dysfunction (ED) treatment.

METHODS

We identified 47 patients with organic ED who had tried other therapies (intracavernosal injection therapy [ICIT], intraurethral prostaglandin suppositories [IPS], vacuum erection devices [VEDs], or yohimbine) before using sildenafil. Comparisons of the efficacy of sildenafil to the previously used agent or device were assessed by telephone questionnaire. Responses were compared using nonparametric Wilcoxon rank sum and analysis of variance testing.

RESULTS

Sildenafil therapy was no more effective than ICIT or VEDs but was more effective than IPS. No significant difference occurred in response to sildenafil with age. Of 22 patients achieving erections adequate for intercourse with their previous therapy, 14 (63%) achieved equal or improved erections with sildenafil. Of the remaining 18 patients who had erections inadequate for intercourse with previous therapy, 5 (27%) had adequate erections with sildenafil.

CONCLUSIONS

Oral sildenafil therapy provides results comparable to those of other available ED treatment modalities. A trial of this drug in this patient population is warranted.