WITHDRAWN: Effect of Intensive Diuretic Treatment over Right Ventricular Behaviour. Evidence Provided from Colour and Pulsed-wave Doppler Echocardiography

The publisher regrets that this was an accidental duplication of an article that has already been published in Eur. J. Echocardiogr., 4 (2003) 226-228, . The duplicate article has therefore been withdrawn.

Electrosurgical endoscopic cordectomy with microdissection electrodes: a comparative study with CO2 laser

Microdissection electrodes (MEs) have previously been used to perform endoscopic cordectomies. We designed a prospective study in order to compare the ME with the CO2 laser technique. Over two years, 20 patients with T1 glottic carcinoma were operated on with CO2 laser and 20 with MEs. The device was chosen alternatively for each new patient. Two patients in both treatment groups had slight glottic incompetence. Three patients in each group showed web formation. The only granuloma was observed in a CO2 laser patient. Seven of the ME patients developed slight dysphonia, 10 developed medium grade dysphonia and three developed severe dysphonia. Seven of the CO2 laser patients developed slight dysphonia, seven developed medium grade dysphonia and six developed severe dysphonia. No statistically significant differences were observed on comparing the grade of dysphonia with patient age, T stage, type of cordectomy or surgical device. We consider the ME to be a useful and inexpensive alternative to CO2 laser.

Fatal infection after rapamycin eluting coronary stent implantation

Septic complications after coronary stenting are extremely rare. The occurrence of cardiac related sepsis after rapamycin eluting stent deployment has not been previously reported. The potential role of drug eluting stents in locally blunting the innate response to bacterial agents is discussed.

An improvised depth gauge using a hypodermic needle

A simple solution to the problem of a broken depth gauge is suggested. A hypodermic needle is bent to simulate the shape of a depth gauge and used in a similar way. This allows measurement of the screw length against the scale on the set. We would advocate this method only when there is no suitable alternative depth gauge available.

[Patient with rhinorrea, destruction of nasal cartilage and hypochronic lesions of the skin]

The leprosy is a chronic illness caused by M. leprae, which affects mucosa mainly at the level of the nasal region. The important destruction of the bone produces the facies leonina. We present the case of a patient with nasal leprosy, describing the clinical characteristics and the diagnostic and therapeutic methods that were carried out on her.

Findings of intravascular ultrasound during acute stent thrombosis

OBJECTIVE

To evaluate the potential role of intravascular ultrasound (IVUS) in evaluating patients experiencing an episode of acute stent thrombosis.

DESIGN AND SETTING

Prospective observational study in a cardiac catheterisation laboratory in a university teaching hospital.

PATIENTS AND INTERVENTIONS

IVUS was used to examine 12 patients undergoing coronary interventions for stent thrombosis to gain further mechanistic insights and to guide treatment. IVUS studies were obtained before and after intervention with a motorised pullback device.

MAIN OUTCOME MEASURES

Qualitative and volumetric IVUS analyses.

RESULTS

Angiographically, 10 patients had occluded vessels and two patients had intraluminal filling defects within the stent. IVUS showed an occlusive thrombus in all patients. Thrombus volume was 90 (77) mm3, which was 51 (21)% of total stent volume. There was evidence of severe stent underexpansion in most patients and no patient fulfilled standard criteria for optimal stent implantation. Stent malapposition was detected in four patients, edge dissections were seen in two patients, and significant inflow-outflow disease was present in 11 patients. During interventions IVUS findings led to the use of higher pressures or larger balloons than those used during initial stenting in 10 patients. In addition, four patients required additional stenting, whereas a thrombectomy device alone was selected for one patient. After the procedure final minimum stent area (7.1 (2.1) v 5.3 (2) mm2, p < 0.005) and stent expansion (83.2 (17) v 62.1 (15)%, p < 0.005) improved compared with pre-interventional values. However, residual lining thrombus was still visualised in eight patients (25 (19) mm3, accounting for a 17% of final stent volume).

CONCLUSIONS

IVUS provides an attractive technique to characterise fully the pattern of stent thrombosis, to identify readily the underlying mechanical predisposing factors, and to guide repeated coronary interventions.

[Study of immutable variables determining rHuEPO dose requirements on hemodialysis patients]

Patients receiving recombinant human erythropoietin (rHuEPO) therapy show wide variability in their responsiveness to the drug. Variables that affect rHuEPO dose requirements can be broadly divided into modificable and immutable characteristics. Most of the scientific research on rHuEPO hyporesponsiveness has focused on modificable variables (iron status, dialysis adequacy), while immutable variables such as gender, etiology of chronic renal failure (CRF) and age have been insufficiently explored. A cross sectional study was performed in order to evaluate if immutable patient characteristics determine rHuEPO dose requirements among 215 patients (52% males; mean age 66 +/- 14 years) on hemodialysis (HD) for more than twelve months. Data were collected at 10 hemodialysis units in Aragon. Patients were divided into three groups according to their gender, their cause of CRF (diabetic nephropathy, vascular nephropathy, tubulointerstitial nephropathy and primary glomerulonephritis) and their age (younger than 60 years, from 60 to 75 years, older than 75 years). Despite a similar dose of rHuEPO, women had lower mean hemoglobin (11.1 +/- 1.5 versus 11.6 +/- 1.7 g/dl; p = 0.0258) than men. The greater hemoglobin in men than women may be attributed to greater serum albumin in men (3.5 +/- 0.3 versus 3.7 +/- 0.3 mg/dl; p = 0.0001). Requirements of rHuEPO were higher in the patients with etiology of primary glomerulonephritis compared with those with the other etiologies, even those with diabetic nephropathy (p = 0.0374). The rHuE-PO doses required to obtain similar hemoglobin levels were higher in patients younger than 60 years (p = 0.0249). We conclude that women, patients with primary glomerulonephritis as cause of CRF, and patients younger than 60 years showed the highest requirements of rHuEPO doses.

Predictors of failure in direct stenting in the real world

INTRODUCTION

Stent implantation without predilation simplifies a large proportion of coronary intervention procedures, with a significant reduction in costs and procedure time.

OBJECTIVES

To determine the variables associated with a higher probability of failure in direct stent implantation in daily practice in a wide range of clinical contexts and types of lesions.

POPULATION AND METHODS

Over a period of 28 months, direct implantation of 931 stents was attempted in our Center (811 patients, 83% male, mean age 62 +/- 12 years; 1.1 stent per patient). In 59 patients (7.3%), balloon predilation was necessary, and the factors associated with direct implant failure were determined.

RESULTS

The vessels treated were: anterior descending (373 lesions: 40.1%), right coronary artery (306 lesions: 32.9%, circumflex (210 lesions: 22.6%), saphenous vein (35 lesions: 3.8%), left main (5 lesions: 0.4%) and internal mammary artery (2 lesions: 0.2%). 54% of the lesions were of type B2/C (ACC/AHA classification). The characteristics significantly associated with, or with statistical tendency towards, a lower success rate in direct stent implantation were: Lesion in the circumflex (11% vs. 5.5%, p = 0.012); reference vessel diameter less than 3.0 mm (9.8% vs. 6.2%, p = 0.097); age over 65 years (8.5% vs. 4.5%, p = 0.017); left main disease, irrespective of the vessel treated (23.5%% vs. 6.5%, p = 0.023); B2/C lesion (7.8%, vs. 4.8%, p = 0.086); calcification (9.9% vs. 4.9%, p = 0.012); vessel angulation greater than 45 degrees (9.9% vs. 4.9%, p = 0.009); and Express stent implant (19.6% vs. 6.0%, p < 0.001). On multivariate analysis, independent predictors of failure in direct stent implantation were: left main lesion (RR 6.6; 95% CI 1.73-24.93; p = 0.013), presence of calcium (RR 1.9; 95% CI 1.02-3.37; p = 0.049), vessel curvature (RR 2.0; 95% CI 1.13-3.64; p = 0.018), reference vessel diameter less than 3 mm (RR 2.2; 95% CI 1.15-4.32; p = 0.023), lesion type B2/C (RR 1.9; 95% CI 1.0-3.52; p = 0.044) and Express stent (RR 2.7; 95% CI 1.07-6.79; p = 0.05).

CONCLUSION

In a large and heterogeneous series of patients, direct stenting was not possible in 7.3% of cases, which required balloon predilation. Certain clinical and angiographic features can predict when this is more like to occur.

[Coverage of the 23-valent pneumococcal vaccine in those older than 64 years of age in the region of Castellon and Valencia, Spain]

The different serotypes of Streptococcus pneumoniae isolated from adults aged over 64 years in the Valencia and Castellon health region of Spain from June 1999 to December 2003 were analyzed. A total of 163 strains were evaluated; 58.3% were invasive, 47.24% were from respiratory source, and 4.9% were from exudates. The greatest percentage of samples was obtained from the group of patients aged 65 to 75 years (60.7%), while the lowest percentage was obtained from the group of patients aged over 85 years (10.4%). In the latter group, 53% of the strains were invasive and 29.4% were isolated from sputum. A total of 21 serotypes were identified, with the most common (> 3%) being: serotype 3 (22.1%); serotype 19 (12.9%); serotype 6 (12.3%); serotype 9 (8.6%); serotype 14 (10.4%); serotype 23 (8%); serotype 29 (3.7%); and serotype 18 (3.1%). Serotype 3 was the most common serotype found in all samples, with the exception of exudate, while serotype 23 was not isolated in blood. In this population group, the coverage of the 23-valent vaccine was 88.4%. Serotypes not included in this vaccine but isolated from invasive samples were serotypes 16, 24, 29 and 35. No changes were observed in serotype distribution over the 4-year period of the study. However, it is necessary to continue epidemiological monitoring to determine whether serotype substitution occurs.

Two-dimensional cellular automaton model for mixed-culture biofilm

Structural and microbial heterogeneity occurs in almost any type of biofilm system. General approaches for the design of biofilm systems consider biofilms as homogeneous and of constant thickness. In order to improve the design of biofilms systems, models need to incorporate structural heterogeneity and the effect of inert microbial mass. We have improved a 2D biofilm model based on cellular automata (CA) and used it to simulate multidimensional biofilms with active and inert biomass including a self-organizing development. Results indicate that the presence of inert biomass within biofilm structures does not change considerably the substrate flux into the biofilm because the active biomass is located at the surface of the biofilm. Long-term simulations revealed that although the biofilm system is highly heterogeneous and the microstructure is continuously changing, the biofilm reaches a dynamic steady-state with prediction of biofilm thickness and substrate flux stabilizing on a delimited range.

Genotipo y expresión fenotípica de la hemocromatosis hereditaria en España

INTRODUCTION

The prevalence of C282Y homozygosity in patients with hereditary hemochromatosis (HH) has been reported to be markedly lower in the Mediterranean Basin than in northern Europe. In Spain, the available data are contradictory and limited to small series in specific regions. The objective of this study is to determine the prevalence of the 2 main HFE gene mutations in a large series of unrelated Spanish patients with HH from different geographical origins.

PATIENTS AND METHOD

The criteria for HH diagnosis were: repeat serum transferrin saturation index (> 45% plus C282Y homozygosity and/or hepatic iron index (> 1.9 of dry liver weight in non-cirrhotic patients or (> 4.1 in patients with liver cirrhosis. Cases in related individuals were excluded. Demographic data, clinical expression, iron parameters and HFE gene mutations (C282Y and H63D) were assessed in 222 patients.

RESULTS

A total of 83.3% of patients were C282Y homozygous and 5% were compound heterozygous (C282Y/H63D). No significant differences in phenotypic expression or in the frequency of C282Y homozygosity were observed between patients born in the North and South of Spain.

CONCLUSION

The genotypic and phenotypic expression of HH in Spain is very similar to that reported in Northern Europe. Thus, the genetic heterogeneity described in some Southern European regions cannot be considered a common feature to all countries of the Mediterranean Basin.

Isovolumic Contraction Time by Pulsed-Wave Doppler Tissue Imaging in Aortic Stenosis

BACKGROUND

Doppler Tissue Imaging (DTI) has been evaluated in ischaemic heart disease and some cardiomyopathies. In patients with aortic stenosis (AS), left ventricular contraction is slowered. This study aimed to evaluate the possible role of the measurement of isovolumic contraction time (ICT) by DTI in the evaluation of AS severity.

METHODS

The study population constitutes 30 patients: 15 with AS (nine severe and six non-severe) and 15 control subjects. All of them had normal systolic function, sinus rhythm, and absence of ischaemic heart disease of conduction abnormalities. ICT was defined as the time from the onset of the QRS complex to the beginning of the DTI systolic wave. The correlation between ICT and aortic area obtained by continuity equation, as well as the diagnostic value of ICT in the identification of severe AS were studied.

RESULTS

ICT was significantly increased in patients with severe AS (98+/-27 versus 65+/-21 ms, p=0.024). There was a significant correlation between ICT and aortic area (r=-0.56; p=0.035). The receiver operator characteristic curve of ICT in the identification of severe AS yielded an area under the curve of 0.852 (95% confidence interval: 0.665-1.0). The two best cut-points were >73 ms (88% sensitivity, 77% specificity) and >85 ms (78% sensitivity, 83% specificity). A value of >41 ms had a 100% sensitivity, but only a 17% specificity, and >91 ms showed a 100% specificity, but only a 44% sensitivity.

CONCLUSIONS

ICT measured by pulsed-wave DTI is increased in patients with aortic stenosis.