PRospective Observational Registry Evaluating the Safety and Effectivenessof Orsiro Stent in Chilean Patients - ROSES Registry

BACKGROUND

There is little information on the performance of the new generation of stents with bioabsorbable polymers in the Latin American population. This registry aimed to further validate the safety and efficacy of the Orsiro bioresorbable-polymer sirolimus-eluting stent (BPSES) in unselected patients undergoing percutaneous coronary intervention (PCI) in Chilean centers.

METHODS

We prospectively enrolled patients undergoing PCI with BPSES in 6 Chilean centers. The primary endpoint was defined as the composite of cardiac death, target vessel-related myocardial infarction (MI), and clinically driven target lesion revascularization at 1-year follow-up.

RESULTS

From April 2017 to February 2019, 520 patients were enrolled in the registry, more frequently male (74.6%), with a mean age of 62.7 ± 10.8 years and a high prevalence of diabetes (40.2%). The clinical presentation was stable angina in 41.1% (n = 214), acute MI in 52.5% (n = 167 [32.1%] ST-elevation MI and n = 106 [20.4%] non-ST-elevation MI), and unstable angina in 6.3% (n = 33). Of 610 treated lesions, 425 (69.7%) were American College of Cardiology/American Heart Association type B or C lesions. Device and procedural success were achieved in 99.4% and 98.7% of the patients, respectively. The primary endpoint of the study occurred in 4%, primarily driven by cardiac death.

CONCLUSIONS

The results of the ROSES multicenter registry indicated good clinical outcomes of BPSES Orsiro in all-comers Latin Americann patients undergoing PCI, despite the high-risk patients and treated lesions.

[Long-term survival of patients with severe aortic stenosis undergoing transcatheter aortic valve implantation]

BACKGROUND

Transcatheter aortic valve implantation (TAVI) is an effective and safe option for low, medium and high-risk patients with severe aortic stenosis (SAS).

AIM

To analyze the clinical results and long-term survival of TAVI in our center.

MATERIAL AND METHODS

Prospective analysis of 53 patients aged 73 ± 10 years with a Society of Thoracic Surgeons (STS) score of 7.3 ± 3.9%.

RESULTS

In 96% a transfemoral access was used and, in most patients, ProGlides™ as vascular closure device was used. General anesthesia and conscious sedation were used in 79 and 21% of cases, respectively. Fifty-three valves were implanted, 42 self-expandable (SEV) and 11 balloon-expandable (Edwards Sapiens). The implant was successful in 49 patients (92,4%). The transaortic gradient after TAVI was almost zero mmHg in all patients and one had a severe aortic regurgitation. Permanent pacemakers were needed in 17% of patients. Two patients had a pericardial effusion, and one had a major vascular complication. No strokes were recorded, and 30-day mortality was 3.7%. At long-term follow up (23.4 ± 21.6 months) the global survival was 85% and the rate of cardiovascular mortality was 5.9%.

CONCLUSIONS

In this series of intermediate to high-risk patients, TAVI was associated with an excellent early and long-term survival.

The acoustical properties of tetraethyl orthosilicate based granular silica aerogels

Available data suggests that granulated aerogels can be of interest in terms of their sound absorption performance in the audio frequency range. However, there is still no thorough understanding of the complex physical phenomena which are responsible for their observed acoustical properties. This work is an attempt to address this gap through advanced material characterization methods and mathematical modelling. Aerogel samples are produced through a two-step, acid-base sol-gel process, with sol silica concentration and density being the main variables. Their pore structure is carefully characterized by nitrogen sorption analysis and scanning electron microscopy. The acoustical properties of hard-backed granular silica aerogels are measured in an impedance tube and the results predicted accurately with the adopted theoretical model. Although silica aerogels have over 90% of open interconnected pores, this was neither reflected in the measured acoustical properties nor the parameter values predicted with the model. Novel results show that only a proportion of the micro and mesopores in the direct vicinity of the grain surface influenced the acoustical properties of aerogels. Further work in the hierarchical pore structure of aerogels is required to better understand the roles of different pore scales on the measured acoustical properties of a granulated aerogel.

Low frequency sound propagation in activated carbon

Activated carbon can adsorb and desorb gas molecules onto and off its surface. Research has examined whether this sorption affects low frequency sound waves, with pressures typical of audible sound, interacting with granular activated carbon. Impedance tube measurements were undertaken examining the resonant frequencies of Helmholtz resonators with different backing materials. It was found that the addition of activated carbon increased the compliance of the backing volume. The effect was observed up to the highest frequency measured (500 Hz), but was most significant at lower frequencies (at higher frequencies another phenomenon can explain the behavior). An apparatus was constructed to measure the effective porosity of the activated carbon as well as the number of moles adsorbed at sound pressures between 104 and 118 dB and low frequencies between 20 and 55 Hz. Whilst the results were consistent with adsorption affecting sound propagation, other phenomena cannot be ruled out. Measurements of sorption isotherms showed that additional energy losses can be caused by water vapor condensing onto and then evaporating from the surface of the material. However, the excess absorption measured for low frequency sound waves is primarily caused by decreases in surface reactance rather than changes in surface resistance.

Staining for intracytoplasmic lumina and CAM5.2 increases the detection rate for bile duct cancers

BACKGROUND AND STUDY AIMS

Endoscopic biopsies have a low sensitivity for diagnosing malignant bile duct strictures. Tumor markers detected by mucin staining and immunohistochemistry may help to determine the malignancy of a biopsy specimen where histologic evaluation alone is nondiagnostic.

PATIENTS AND METHODS

61 patients who underwent forceps biopsies were retrospectively identified, yielding 49 and 40 biopsy specimens for strictures finally diagnosed as benign and malignant, respectively. Biopsy specimens were histologically evaluated and stained for p53, Ki-67, carcinoembryonic antigen (CEA), CA19-9, CAM5.2, and presence of intracytoplasmic lumina (ICL). Sensitivity, specificity, positive and negative predictive values (PPV and NPV), and positive and negative likelihood ratios (PLR and NLR) were calculated to evaluate the performance of each test.

RESULTS

Histology alone provided sensitivity and specificity of 53 % and 100 %. Addition of ICL or CAM5.2 increased sensitivity to 73 % or 60 %, respectively, and provided excellent specificity, PPV, and PLR (ICL, 98 %, 97 %, and 36; CAM5.2, 100 %, 100 %, and infinite). Both stains in combination increased the sensitivity to 75 %. Staining for Ki-67, p53, CEA, and CA19-9 increased the sensitivity to detect malignancy (range 60 % to 83 %), but significantly reduced the specificity, PPV and PLR (ranges 73 % to 90 %, 72 % to 86 %, and 3 to 7, respectively). Markers in all combinations performed poorly as a negative test (NPV 69 % to 87 %, and NLR 0.19 to 0.55).

CONCLUSIONS

Staining for tumor markers ICL and CAM5.2 can improve the diagnostic value of endoscopic biopsies, and may change the course of management for patients with indeterminate histological findings.

Red wine reduces oxidative stress in patients with acute coronary syndrome

BACKGROUND

Moderate red wine consumption improved endothelial function in normal volunteers. Herein we explored the effects of moderate red wine consumption in endothelial function and in oxidative stress in patients with an acute coronary syndrome.

METHODS

20 patients treated with percutaneous coronary interventions after an acute coronary syndrome were randomized to a red-wine group (n=9, 250 ml daily, Cabernet Sauvignon) or to a control group (n=11, abstinence from alcoholic beverages). Studies were performed at baseline and after 2 months. Endothelial function was estimated by flow-mediated vasodilatation of the brachial artery. Plasma antioxidant capacity was measured by total antioxidant reactivity and ferric reducing antioxidant power. Oxidative damage was evaluated by measurements of 8-OH deoxyguanosine content in leukocyte deoxyribonucleic acid.

RESULTS

The endothelium dependent/independent dilatation ratio significantly improved compared to baseline in both groups. The 8-OH deoxyguanosine content decreased significantly in both groups; this effect was more pronounced with wine (p<0.002 vs. control). Oxidative deoxyribonucleic acid damage in controls decreased from 13.1+/-1.1 to 10.0+/-1.0 (p<0.003); with wine from 13+/-0.8 to 5.6+/-0.7 per 10(5) guanosines (p<0.001; p<0.002 vs. control). Total antioxidant reactivity increased from 240+/-18 to 268+/-18 microM in the control group and from 273+/-20 to 330+/-15 microM in the wine group (p<0.03 vs. control). Ferric reducing antioxidant power increased from 1106+/-60 to 1235+/-42 microM in the control group and from 1219+/-82 to 1450+/-63 microM in the wine group (p<0.001 vs. control).

CONCLUSIONS

The addition of moderate amounts of red wine did not improve endothelial function beyond conventional therapy, whereas it showed benefits in parameters of oxidative stress in these patients.

[Catastrophic antiphospholipid syndrome and acute heart failure. Report of a case]

A 33 years old woman was admitted to the hospital after four days with cough, dyspnea, orthopnea and hemoptysis. Blood pressure was 170/90 mmHg, pulse was 112 and temperature was normal. She had cyanosis and a left ventricular gallop, without heart murmurs. A chest radiograph revealed pulmonary edema and echocardiogram showed a global left ventricular systolic disfunction. Oxygen and furosemide were started, but cardiopulmonary collapse ensued. The patient was supported with mechanical ventilation and treated with inotropic drugs. A right sided cardiac catheterization showed pulmonary wedge pressure of 18 mmHg and a cardiac index of 3 l/min/m2. The levels of creatinine and urea nitrogen were elevated and a urine protein was 97 mg/dl. Coagulation tests were normal except by a positive lupic anticoagulant. Markers of connective tissue diseases or vasculitis were negatives. The clinical evolution suggested that a catastrophic antiphospholipid syndrome was ongoing. Intravenous corticoids, gammaglobulin and cyclophosphamide were administered with transient improvement. On her fourth day of treatment, the patient presented sudden pulmonary bleeding and embolism. A plasmapheresis was performed with improvement of renal, cardiac and pulmonary function. After this episode, the patient has been treated with prednisone and oral anticoagulants treatment for the last two years, without further clinical events.

[Digoxin plasma levels in four different prescription schedules of common use in clinical practice]

BACKGROUND

The different therapeutic schedules used for the prescription of digoxin have little theoretical support.

AIM

To measure digoxin plasma levels in patients using four different prescription schedules.

PATIENTS AND METHODS

Four groups of patients were studied. Group I corresponded to 56 patients taking digoxin 0.25 mg/day, from Monday to Friday. Group II corresponded to 30 patients taking digoxin 0.25 mg/day, from Monday to Saturday. Group III corresponded to 53 patients taking digoxin 0.25 mg/day continuously. Group IV corresponded to 36 patients taking digoxin 0.125 mg/day continuously. Plasma digoxin levels were measured in two consecutive Mondays before taking the daily dose of the drug. Serum creatinine was also measured and creatinine clearance was calculated. The therapeutic plasma concentration range was set between 0.5 and 2 ng/ml.

RESULTS

Mean plasma digoxin levels were 1.15 +/- 0.8 ng/ml in group I, 1.4 +/- 0.55 ng/ml in group II, 1.68 +/- 0.7 ng/ml in group III and 1.14 +/- 0.43 ng/ml in group IV. 93% of patients in group I, 80% of patients in group II, 75% of patients in group III and 94% of patients in group IV had therapeutic digoxin levels. A low creatinine clearance, an age over 65 and interactions with other drugs were risk factors associated with supratherapeutic levels, mostly seen in group II and group III with 20% and 24% respectively.

CONCLUSIONS

Most patients using digoxin with different therapeutic schedules had plasma drug levels within the therapeutic range.

Atypical chondroma of the cricoid cartilage: fine-needle aspiration cytologic and histopathologic findings

Chondroma of the laryngeal skeleton is a rare, benign neoplasm manifested either as a neck mass or, if situated within the airway, as slowly progressive obstruction, hoarseness, or dyspnea. The most common site is the posterior plate of the cricoid cartilage. An atypical perichondrial chondroma arising from the anterior plate of the cricoid cartilage membrane as a neck mass in a young female is presented. The diagnosis was made on a fine-needle aspiration of the mass and subsequently confirmed by histologic examination of the excised mass. Although rare, cartilaginous tumors of the laryngeal skeleton can manifest as a neck mass, and the diagnosis can be made by fine-needle aspiration biopsy in combination with radiographic and clinical examinations. Therefore, the existence and inclusion of these tumors in the differential diagnosis of neck masses by aspiration biopsy should be considered by clinicians and pathologists, and especially cytopathologists, when cartilaginous components are encountered.

Carcinoma of the male breast metastatic to both orbits

We report the case of a 43-year-old man who presented with painless proptosis of the right eye of 6 weeks' duration. Examination demonstrated a tense right orbit and decreased vision and extraocular motility bilaterally. Diagnostic evaluation included computed tomographic imaging of the head and orbits, a therapeutic trial of high-dose systemic corticosteroids, and orbital biopsy, which revealed the presence of metastatic adenocarcinoma. The primary tumor was found to be an estrogen-receptor-positive, infiltrating ductal adenocarcinoma of the right breast. Therapy included lumpectomy of the breast mass, orbital irradiation, and hormonal therapy. Metastatic carcinoma of the breast should be considered in the differential diagnosis of orbital neoplastic disease in the male patient.

Detection of axillary lymph node metastasis of breast carcinoma with technetium-99m sestamibi scintimammography

Several investigators have advocated management of breast cancer patients without axillary dissection, obviating the morbidity associated with this procedure. Approximately 30-40 per cent of all patients with breast carcinoma will have lymph node metastasis. Axillary dissection offers no therapeutic benefit to node-negative patients, and it may lead to unnecessary morbidity. It is apparent that a noninvasive test to determine the presence of axillary metastases may obviate the need for axillary dissection. The aim of this study was to determine the role of scintimammography (SMM) with technetium-99m sestamibi in the detection of axillary node metastasis in breast carcinoma. Thirty-one women with the diagnosis of breast carcinoma who had SMM and axillary lymphadenectomy were included. SMM was done following an intravenous injection of 20 mCi of Tc-99m sestamibi. Planar scintigraphic imaging was acquired in a lateral prone and an anterior view of the breasts for the evaluation of the axilla. SMM scans were interpreted by two nuclear medicine physicians blinded to the clinical presentation and histologic results. The correlation of SMM with histologic assessment showed a sensitivity of 75 per cent, specificity of 82 per cent, positive predictive value of 88 per cent, and negative predictive value of 64 per cent. The interobserver correlation of SMM interpretation between the two nuclear medicine physicians showed good agreement, with kappa = 0.49. Consistency in the interpretation of Tc-99m SMM was obtained when two independent radiologists reviewed the studies. Based on these data, we are unable to show that SMM is a reliable test for the detection of axillary metastases in patients with breast cancer. However, a high positive value of 88 per cent is encouraging and deserves further study.

Technetium-99m-sestamibi scintimammography of breast lesions: clinical and pathological follow-up

Mammography and physical examination combined have a sensitivity of 85% for the detection of breast carcinoma. Mammography also has a positive predictive value of 15%-30%. The aim of this study was to evaluate the usefulness of scintimammography using 99mTc-sestamibi as a complementary technique to mammography for the detection of breast carcinoma to improve mammography's sensitivity and specificity.

METHODS

We studied 100 consecutive patients (mean age 48.3 +/- 10.8 yr) who had 106 lesions warranting biopsy (67 lesions) or fine needle aspiration cytology (FNA) (39 lesions) of the breast. There were 85 palpable and 21 nonpalpable lesions. The size of the lesions on the mammograms were moderate (2.3 +/- 1.8 x 1.9 +/- 1.5 cm). Each patient received 20 mCi 99mTc-sestamibi intravenously. Five and 60 min postinjection, planar breast images in the lateral prone position were obtained. An anterior erect projection was then obtained to visualize the axilla and, if needed, a posterior oblique prone projection.

RESULTS

Scintimammography was true-positive in 30 lesions with biopsy-confirmed breast carcinoma; it was true-negative in 65 lesions subsequently proved to be benign. There were nine breast lesions with benign findings in which the scintimammography result was positive (false-positive scintimammography) for cancer. Finally, two lesions with pathologically proven carcinomas demonstrated a negative scintimammographic result. Therefore, in this group, the sensitivity of scintimammography was 93.7% with a specificity of 87.8%; the positive predictive value was 76.9%. The negative predictive value was 97%.

CONCLUSION

Scintimammography is a highly sensitive test that improves the specificity of conventional mammography for the detection of breast carcinoma.

Prone scintimammography in patients with suspicion of carcinoma of the breast

Mammography and physical examination have a sensitivity of 85 percent for detection of carcinoma of the breast. Mammography also has a positive predictive value of 15 to 30 percent. The aim of this study was to evaluate the usefulness of scintimammography (SMM) as a screening technique for the detection of carcinoma of the breast and compare the test's sensitivity and specificity with that of mammography. We conducted SMM on 59 female patients in whom abnormal mammogram and physical examination warranted biopsy of the breast or fine needle aspiration cytology of the breast, or both. Each patient received 20 millicuries of 99mTc Sestamibi intravenously. Five and sixty minutes postinjection, planar breast images in lateral and posterior oblique views were obtained. In 23 patients with biopsy-confirmed carcinoma of the breast, the SMM result was positive. In 33 patients with benign breast lesions, no increased uptake of Sestamibi was noted in the breast. Five other patients with benign lesions of the breast had false-positive scans. There was one patient with an intraductal carcinoma and a cluster of microcalcifications on mammography without an associated mass, for whom the 99mTc Sestamibi scan was negative. In the group of patients studied, the sensitivity of SMM was 95.8 percent, specificity was 86.8 percent, positive predictive value was 82.1 percent and, most importantly, the negative predictive value for the detection of carcinoma of the breast was 97.1 percent. We conclude in this pilot study that SMM is a highly sensitive test that improves the specificity of conventional mammography for the detection of carcinoma of the breast and deserves further study as a screening technique to potentially reduce the number of mammographically "indicated" biopsies of the breast that yield negative results for carcinoma.

Fine needle aspiration cytology of breast ductal carcinoma in situ

To evaluate the role of fine needle aspiration cytology (FNAC) in identifying in situ breast carcinoma, we reviewed 19 FNACs of histologically confirmed pure or predominantly ductal carcinoma in situ (DCIS). The cytologic diagnosis was positive for malignancy in 53%, suspicious in 31% and nondiagnostic in 16%. An intraductal lesion was suggested prospectively in 21%. Retrospective review showed three distinctive cytologic criteria in cases with DCIS: (1) cohesive groups of atypical ductal cells associated with scattered, individual malignant cells or a necrotic background; (2) hyperplastic ductal cells with associated malignant cells or necrosis; and (3) true tissue fragments composed of cohesive epithelial cells with a cribriform pattern. One or more findings were present in 81% of the malignant or suspicious FNACs; 19% could not be distinguished cytologically from invasive carcinoma. We studied a control group of 30 invasive ductal carcinomas; one or more criteria were found in 35% of cases with no or a minor DCIS component but in 73% of those with an extensive DCIS component. We conclude that these three criteria deserve further study as an aid in suggesting DCIS on FNAC.

Ion channels from the Bacillus subtilis plasma membrane incorporated into planar lipid bilayers

Fusion of Bacillus subtilis plasma membrane vesicles with planar lipid bilayers induced the appearance of discrete current fluctuations characteristic of ion channels. These channels showed a wide range of conductances and kinetic behaviors. In 300 mM KCl, their conductances ranged from a few hundreds of pS to more than 1 nS, and most of them exhibited several sub-states. The channels poorly discriminated between small univalent anions and cations. Some of them showed voltage dependence and most of them presented a complex gating kinetics. The results are consistent with the hypothesis of the presence in the B. subtilis plasma membrane of pores composed of subunits that function cooperatively.

Choledochal fungal ball. An unusual cause of biliary obstruction

A 31-year-old patient with sickle-cell disease who had previous cholecystectomy developed acute onset of jaundice and abdominal pain. An endoscopic retrograde cholangiography demonstrated multiple filling defects within the bile ducts. Microscopic examination of "calculi" removed at surgery revealed that a fungal ball composed of Candida was the cause of biliary obstruction in this case. The patient eventually recovered after removal of the fungal masses and intrabiliary instillation of amphotericin.