[Perioperative antiplatelet therapy of patients with coronary stents]

The most feared complication after coronary stent implantation is the acutely occurring stent thrombosis, which usually leads to a myocardial infarction with its relatively high mortality. Dual antiplatelet therapy with acetylsalicylic acid and clopidogrel is currently the standard therapy after coronary stent implantation to prevent a life-threatening stent thrombosis. Surgery appears to increase the risk of stent thrombosis, myocardial infarction, and death, particularly when patients undergo surgery early after stent implantation. The incidence of complications is further increased when dual-antiplatelet therapy is discontinued preoperatively. This article reviews the current data of perioperative problems in patients after percutaneous coronary intervention.

Coagulation of soil suspensions containing nonionic or anionic surfactants using chitosan, polyacrylamide, and polyaluminium chloride

Effective coagulation and separation of particles in a soil-washed solution is required for a successful soil washing process. The effectiveness of chitosan (CS), a polycationic biodegradable polymer, as a coagulant was compared to polyacrylamide (PAA) and polyaluminium chloride (PAC) for the coagulation of a soil suspension (5 gL(-1)). The effect of surfactants in the coagulation process was investigated using Triton X-100 (TX-100), a nonionic surfactant, and sodium dodecyl sulfate (SDS), an anionic surfactant. CS (5 mgL(-1)) removed 86% and 63% of the suspended soil in the presence of TX-100 (5 gL(-1)) and SDS (5 gL(-1)), respectively, after 30 min at a pH of 6. The results prove that coagulation in the presence of TX-100 is more effective than with SDS. CS was found to be more efficient compared to PAA and PAC under all coagulation conditions. The optimum concentration of CS required for maximum coagulation of soil suspension was 5 mgL(-1). PAA and PAC could not achieve the same degree soil removal as CS even after increasing their concentrations up to 50 mgL(-1). Maximum levels of 50% and 60% soil removal were achieved using PAA (50 mgL(-1)) and PAC (50 mgL(-1)), respectively, after 30 min from a 5 gL(-1) suspension containing TX-100 (5 gL(-1)). The soil coagulation process was found to decrease with an increase in the pH of the suspension, and maximum coagulation was achieved with an acidic pH.

[Percutaneous aortic valve replacement in high risk patients]

The degenerative, calcified aortic stenosis is the most common form of adult valvular heart disease. Surgical aortic valve replacement is the method of choice and can be performed at low risk in suitable candidates. However, a fair amount of patients is rejected from surgery due to old age and preexisting comorbidities increasing operative mortality. For this reason frequently operation is not accomplished. Today, with the development of percutaneous aortic valve replacement, the treatment of aortic stenosis has entered a new era providing a new durable treatment option.

[Regenerative therapy in cardiology]

The aim of regenerative medicine is the reconstitution of the physiological structure of critically damaged organs. Bone marrow derived stem cells (BMDCs) show promising therapeutic potential. BMDCs are already used in oncology and are ideally suited for regenerative medicine due to their regenerative potential and safety profile. A variety of cells have been contemplated in cardiology, and there is emerging preclinical and clinical data on the feasibility and safety of different cell lines in the setting of acute myocardial infarction and chronic heart failure. In this review, the various concepts and cells will be discussed in further detail.

[Positive influence on cardiovascular risk factor by blocking the endocannabinoid system]

Intra-abdominal fat mass, or central adiposity, and cardiovascular risk are strongly correlated. Adipose tissue is an endocrine organ that secretes hormones and cytokines influencing appetite, energy metabolism, and atherosclerosis. Rimonabant is the first selective blocker of the cannabinoid-1 receptor in development for the treatment of obesity, diabetes mellitus typ 2, and cardiometabolic risk factors. This article provides an review of efficacy of rimonabant the first selective blocker of the cannabinoid-1 receptor.

Acquired von Willebrand's disease associated with gastrointestinal angiodysplasia: a case report

Acquired von Willebrand syndrome (AVWS) is a rare and probably underestimated bleeding disorder which mimics most of the clinical symptoms and laboratory features of hereditary von Willebrand disease (VWD) in patients devoid of both personal and family history of bleeding diathesis. In this study, we present a case of 55 yrs male patient, presented with gastrointestinal bleeds since three years, diagnosed to have AVWS with inhibitors. From this study it is concluded that AVWS is rare and it is important to diagnose this bleeding disorder so that appropriate treatment with plasmapheresis and IV:Ig can effectively correct the haemostatic defect and manage severe bleeding in these patients.

Disseminated Langerhans cell histiocytosis-an interesting case report with concise review of literature

A 2-year-old boy presented with fever, recurrent infections and multiple skin lesions. He had anemia, eczematous skin lesions, cervical lymph node enlargement, hepatomegaly and lytic lesions on skull x-ray. The skin infiltrates were CD 68, CD 1a positive and S100 positive. He was diagnosed as disseminated langerhans cell histiocytosis. The occurrence of histiocytosis is reviewed and possible treatment is discussed.

Angiogenesis in myelodysplastic syndromes (MDS) in Indian patients

Angiogenesis plays an important role in the pathogenesis of haematological neoplasms and may be correlated with the prognosis. We recently evaluated the microvessel densities in trephine biopsy sections of seventeen patients of myelodysplastic syndromes (MDS). Of the 17 cases, 2 were RAEB-t, 3 were RAEB, one was RARS and 11 were of the subtype RA (FAB subtyping). The microvessel counts were measured in the bone marrow biopsy sections by immunohistochemical staining, using CD34 reactive monoclonal antibodies. MVD was significantly higher in the cases of RAEB and RAEB-t as compared to the cases of RA. The average MVD per x400 in the cases of RA was 5.7 +/- 4.7 with a median value of 4.65 (range 19) whereas it was 45.4 +/- 10.0 and 44.0 (range 27.3) respectively in RAEB and RAEB-t (p <.001), the 95% confidence interval being (2.94, 8.5) and (36.6, 54.3), for the two groups respectively. This finding may imply that subtypes of MDS with a higher tendency for converting to acute leukaemia are associated with increased angiogenesis as compared to other subtypes where the risk of progression to acute leukaemia is much lower.

Percutaneous transcatheter closure of patent foramen ovale

In presence of a patent foramen ovale (PFO) with cryptogenic cerebral embolism, traditional therapy consists of oral anticoagulation or antiplatelet therapy. Surgery was considered only in case of recurrence. Transcatheter closure of PFO is currently performed. The availability of new user friendly devices and the increasing knowledge of pathophysiology, epidemiology, and follow-up of these patients has broadened the indications and marked reduced morbidity related to interventional PFO closure. This review presents the current knowledge and our own data concerning transcatheter closure of PFO.

[Contrast-media-induced nephrotoxicity]

The use of diagnostic and therapeutic catheterization is increasing and so is the exposure to radiocontrast media. As a consequence, an increasing incidence of contrast media-associated nephropathy is being observed. This article reviews pathogenesis, clinical symptoms and preventive measures of contrast media-associated nephropathy. Most important prophylactic measures is identification of high-risk patients, careful selection to be exposed to contrast media, application of non-ionic low osmolality or -- most recently -- iso-osmolality contrast media, adjusted hydration with isotonic saline before/during catheter interventions, and potentially the administration of acetylcysteine.

Comparative evaluation of whole blood D-dimer test to plasma D-dimer test for diagnosis of disseminated intravascular coagulation

Three rapid D-dimer test methods were compared for the diagnosis of acute disseminated intravascular coagulation (DIC). These were (a) SimpliRED, an autologous red cell agglutination assay. (b) DIMERTEST latex agglutination assay, containing monoclonal antibody DD-3B6/22(6), and (c) D-DI latex agglutination assay containing mouse anti-human D-dimer monoclonal antibodies. The D-DI latex method having higher sensitivity (100%) and specificity (81%) in clinically acute DIC was postulated as the gold standard and compared with the other two methods. The results suggest that D-DI latex agglutination assay containing mouse anti-human D-Dimer monoclonal antibodies are the better assay methods amongst all the three kits analyzed. It is advisable to look for the nature of the antibody used to coat the latex particles in plasma based kits. In emergency setting RBC kits may be of some use as rapid diagnosis is advantageous.

Clinical, haematological and histomorphological profile of adult myelodysplastic syndrome. Study of 96 cases in a single institute

Myelodysplastic syndromes (MDS) are clonal haematopoietic stem cell disorders characterised by ineffective and dyspoietic haematopoiesis. The natural history of these disorders is variable and ranges from a chronic to a rapid course towards leukaemic progression. Certain shortcomings have been encountered in the French-American-British (FAB) classification over the years, and therefore there is a need for an alternative method of classification. In 1999, the WHO published a revised classification of MDS. In the present study, we have analysed the clinical, haematological and histomorphological features in 96 cases of primary MDS seen in the department of haematology at the All India Institute of Medical Sciences (AIIMS) over a 6-yr period (1996-2001). Both FAB and WHO classifications have been incorporated and the Bournemouth scoring system applied in each case at presentation. The Bournemouth scoring system, in the absence of a cytogenetic study, offers a good prognostication and long-term survival estimate.

Synchronous occurrence of breast carcinoma and acute myeloid leukemia: case report and review of the literature

We present a case of breast carcinoma, which was followed by acute leukemia within 1 month of diagnosis of the former. She had undergone a modified radical mastectomy for her breast cancer and had not received chemotherapy or radiotherapy. Acute leukemia as a result of chemotherapy for breast carcinoma is well known. However, patients developing synchronous breast carcinoma and acute leukemia, in the absence of any chemotherapy or radiotherapy, are rare.

Successful brachytherapy of coronary vasospasm

Brachytherapy is a proposed treatment for in-stent restenosis and is the subject of several clinical trials and debates. The standard treatment of patients with variant angina is to eliminate vasoconstrictive factors and to administer vasodilating drugs. This is the first description of successful brachytherapy for coronary spasm.

Needle necropsy in AIDS

The value of autopsy in understanding the natural course of any disease is beyond any argument. The reluctance of pathologists to perform autopsy in HIV infected cadavers is justified due to the risks involved to the prosector and the morgue attendants. A relative low risk needle necropsy protocol is proposed using fine needle aspiration cytology, tru-cut biopsies and microbiological examination. Diagnosis could be offered in all the forty-four needle necropsies performed. Disseminated tuberculosis in 18/44 (40.9%) cases, disseminated cryptococcosis in 12/44 (27.2%) cases, poly-microbial infections in 27.2% cases and non-Hodgkin's lymphoma in 9% cases were detected in the study. Infectious agents like Histoplasma capsulatum, Isospora belli, tachyzoites of Toxoplasma gondii, Candida sp and Cryptococcus sp could be demonstrated in the samples obtained in the study. Lack of material for study of gross pathology, inaccessibility of deep-seated lesions and risk of needle stick injury to the prosector though low are the limitations of this procedure.