Value of eptifibatide during salvage angioplasty with coronary stenting after failure of thrombolysis. Report of a series of 41 patients

AIM: To evaluate the risks and the significance of the use of an anti-GPIIb/IIIa, in this case Eptifibatide, during angioplasty following presumed failure of thrombolysis in the acute phase of myocardial infarction. METHOD: Patients thrombolyzed following MI < 6 hours. Presumed failure of reperfusion with full dose thrombolysis. Analysis evaluated the success of angioplasty associated with anti-GPIIb/IIIa treatment and the hospital phase outcome. RESULTS: 41 consecutive patients, 32 male (78%) and 9 female (22%), were included. Infarction concerned the anterior region in 22 cases (54%) and inferior in 19 cases (46%). Fibrinolysis was performed using Alteplase in 28 patients (68%) and Reteplase in 13 patients (32%). Radial access was performed in 32 cases (78%). All of the patients received Eptifibatide with a bolus then infusion from their admission to the haemodynamic suite, on average 1 h 30 after the start of thrombolytic treatment. A total of 49 stents were implanted in 41 patients. A flux of TIMI 3 was obtained in 37 patients (90.2%). TIMI 2 in 2 patients (4.9%) and no reflow in 2 patients (4.9%). Four counter-pulsions by intra-aortic balloon were necessary (9.8%) for cardiogenic shock. No decrease in TIMI flux was observed after the angioplasty procedure. The main complications were a death from cardiogenic shock in one patients (2.4%), a non-fatal digestive tract haemorrhage in 2 cases (4.9%) and a single femoral haematoma requiring transfusion. CONCLUSION: The initial results were encouraging: high success rates, rare vascular complications, a probable consequence of the radial approach. The association of an anti-GPIIb/IIIa, Eptifibatide, therefore appears achievable during angioplasty with the positioning of a coronary endoprosthesis following the presumed failure of full dose thrombolysis.     

Perceived Physical and Mental Health and Healthy Eating Habits During the COVID-19 Pandemic in Korea

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has disrupted the lives of people around the world since 2020. This study aims to reveal perceived impact of the coronavirus pandemic on physical and mental health and eating behaviors among people with disabilities and without disabilities in South Korea, as compared to other countries.MethodsA secondary analysis of a prospective cross-sectional study which was conducted with a web-based global survey.ResultsAmong the 3,550 responses from 65 countries, 2,621 responses with nation information were set as full data, 189 for South Korea and 2,432 for other countries. In Korea, there was no significant difference in healthy lifestyle behaviors between people with and without disabilities before the COVID-19 pandemic. Perceived physical and mental health and changes in eating habits during the COVID-19 pandemic showed no significant difference between people with and without disabilities in Korea. There were significant differences in physical health and dietary habits, but no differences in its effect on mental health between people living in Korea and other countries in both people with and without disabilities groups. In other words, more than 60% of people in all groups (disability vs. non-disability, Korea vs. non-Korea) reported worse mental health than before the COVID-19 pandemic.ConclusionIn Korea and other countries, mental health showed a tendency to deteriorate regardless of the presence or absence of disability during the COVID-19 pandemic. In terms of healthy eating habits, Koreans were relatively less affected than people from other countries.     

Fragmentation of a right atrial myxoma presenting as a pulmonary embolism.

We report here a tricky case of right atrial myxoma with a pulmonary localization mimicking pulmonary thromboembolism. The diagnosis on imaging investigation was delayed because of its atypical appearance. This case report emphasizes the leading role of transthoracic and transesophageal echocardiography in the management of this condition. In autopsy series, the incidence of primary tumors of the heart is evaluated at 0.0017% to 0.19%.(1) Nearly half of them are myxoma.(1, 2) Myxoma are more frequently observed in adults and are commonly localized in the left atrium. Signs and symptoms are comparable to those arising in other cardiovascular and systemic conditions, including variable cardiac murmur, uneasiness, blackout, systemic embolism, cardiac insufficiency, lasting fever, or sudden death.(3) Rare cases of pulmonary embolism have been described. We report here an atypical case of right atrial myxoma with a pulmonary localization mimicking pulmonary embolus.     

Dramatical improvement of chemoresistant bone lymphoma with rituximab

Non-Hodgkin's lymphoma of the bone is a very rare disease that accounts for approximately 5% of all extranodal non-Hodgkin's lymphomas and for 7–10% of primary bone tumours. We report the case of a 28-year-old man who, in June 2001, presented with a right humerus showing painful destructive lesions with pathological fractures. Biopsy revealed diffuse, large B-cell non-Hodgkin's lymphoma expressing CD20. The patient received six cycles of conventional chemotherapeutic regimen, including cyclophosphamide, doxorubicin, vincristine and prednisone, and VP-16 (etoposide), ifosfamide and mitoxantrone. His arm pain worsened, and x-rays demonstrated progressive disease. He began a trial of rituximab, 750 mg/week, for 4 weeks. There was improvement in pain after the first infusion. Radiographic studies conducted 3 months after rituximab therapy showed marked improvement in his humerus disease. MRI showed a decrease of tumour volume with residual minor signal abnormalities of the bone marrow. He had no evidence of recurrent lymphoma 24 months later.     

Employment outcome four years after a severe traumatic brain injury: results of the Paris severe traumatic brain injury study

Objective: To describe employment outcome four years after a severe traumatic brain injury by the assessment of individual patients’ preinjury sociodemographic data, injury-related and postinjury factors.

Design: A prospective, multicenter inception cohort of 133 adult patients in the Paris area (France) who had received a severe traumatic brain injury were followed up postinjury at one and four years. Sociodemographic data, factors related to injury severity and one-year functional and cognitive outcomes were prospectively collected.

Methods: The main outcome measure was employment status. Potential predictors of employment status were assessed by univariate and multivariate analysis.

Results: At the four-year follow-up, 38% of patients were in paid employment. The following factors were independent predictors of unemployment: being unemployed or studying before traumatic brain injury, traumatic brain injury severity (i.e., a lower Glasgow Coma Scale score upon admission and a longer stay in intensive care) and a lower one-year Glasgow Outcome Scale–Extended score.

Conclusion: This study confirmed the low rate of long-term employment amongst patients after a severe traumatic brain injury. The results illustrated the multiple determinants of employment outcome and suggested that students who had received a traumatic brain injury were particularly likely to be unemployed, thus we propose that they may require specific support to help them find work.

• Implications for rehabilitation

• Traumatic brain injury is a leading cause of persistent disablity and can associate cognitive, emotional, physical and sensory impairments, which often result in quality-of-life reduction and job loss.

• Predictors of post-traumatic brain injury unemployment and job loss remains unclear in the particular population of severe traumatic brain injury patients.

• The present study highlights the post-traumatic brain injury student population require a close follow-up and vocational rehabilitation.

• The study suggests that return to work post-severe traumatic brain injury is frequently unstable and workers often experience difficulties that caregivers have to consider.

     

Ecological validity of the Dysexecutive Questionnaire: Results from the PariS-TBI study

The Dysexecutive Questionnaire (DEX; Wilson, Pettigrew, & Teasdale, 1998 Wilson, J. T. L., Pettigrew, L. E. L., & Teasdale, G. M. (1998). Structured interview for the Glasgow Outcome Scale and the Extended Glasgow Outcome Scale: Guidelines for their use. Journal of Neurotrauma, 15, 573–585. doi: 10.1089/neu.1998.15.573[Crossref], [PubMed], [Web of Science ®] , [Google Scholar]) has been designed to assess executive dysfunctions in daily life. However, its relationships with cognitive testing, mood, and the ability to fulfil daily life demands, have not yet been systematically addressed. The objective of this study was to address these issues in a prospective four-year follow-up study of patients with severe traumatic brain injury (TBI) (PariS-TBI study). One hundred and forty seven patients were included. The DEX (self-version) showed a good internal consistency. The total DEX score was significantly inversely correlated with years of education, but did not significantly correlate with any initial injury severity measure. The DEX was significantly and positively related to cognitive deficits, as assessed with the Neurobehavioral Rating Scale–Revised (NRS-R); with mood disorders, as assessed with the Hospital Anxiety and Depression Scale (HADS); with dependency in elementary and extended activities of daily living; and with non-return to work. In multivariate analyses, cognitive and mood impairments were significantly and independently related to the total DEX score. These results suggest that the DEX is a multidetermined sensitive questionnaire to detect everyday life difficulties in patients with severe TBI at a chronic stage.     

Detailed biopsy pathologic features as predictive factors for initial reclassification in prostate cancer patients eligible for active surveillance

ObjectiveTo evaluate the impact of detailed biopsy characteristics such as positive cores location or multifocality on the risk of initial reclassification in prostate cancer (CaP) patients eligible for active surveillance (AS).Materials and methodsWe reviewed data from 300 consecutive men eligible for AS (PSA ≤ 10 ng/ml, clinical stage T1c, Gleason score ≤6, <3 positive cores, extent of cancer in any core < 50%) who have undergone a radical prostatectomy (RP). Reclassification was defined as upstaged disease and/or upgraded disease in RP specimens.ResultsBiopsy features showed 36% of CaP involving 2 cores and a mean total tumor length of 2.63 mm. The 2 most frequently positive sites were base and apex. Mean total tumor length was significantly associated with upgraded disease (P = 0.025). In a multivariate model taking into account PSA, PSAD, number of positive cores and total tumor length, a total tumor length > 5 mm were independently predictor for a upgraded disease (OR 1.93, P = 0.046). The number, the multifocality and the bilaterality of positive cores were not associated with reclassification. Upgraded disease was significantly less reported in case of positivity at midline zone compared with positivity at base, apex, or transition zone (P = 0.013).ConclusionsDetailed biopsy data provide additional information on the initial risk of reclassification in AS patients. Patients having a total tumor length < 5 mm and positive cores at midline zone are more likely to have favorable pathologic characteristics at diagnosis. These variables can be used for selection and monitoring improvement in AS programs.     

Intra-individual variability of the platelet anti-aggregation effect of aspirin in coronary patients

Several studies have reported a biochemical resistance to aspirin in 5 to 10% of coronary patients. However, the stability of the platelet anti-aggregation effect with aspirin over time remains poorly understood. OBJECTIVE: To study the intra-individual variability at 6 months of the anti-platelet action of aspirin in coronary patients. METHOD: Prospective study including 40 consecutive patients with acute coronary syndrome and taking regular aspirin (250 mg a day). The biochemical impact of aspirin was determined by measuring the time to occlusion (TO) on a collagen/epinephrine cartridge with PFA-100. The determination of the TO was performed 2 months (TO1) and then 8 months (TO2) after starting aspirin. In our population, a resistance to aspirin was defined as a TO < or =125 sec. RESULTS: The median value for TO was generally stable over the two periods, at 158 sec for TO1 and 179 sec for TO2 (p = 0.29). Among the 9 initially resistant patients (22.5%), 4 became sensitive to aspirin without changing the dosage, while only one of the 31 initially sensitive patients became biochemically resistant. CONCLUSION: the existence of a medium term intra-individual variability in the antiplatelet response to aspirin in coronary patients underlines the importance of biochemical surveillance in these high vascular risk patients.     

Stevens-Johnson syndrome complicating adalimumab therapy in rheumatoid arthritis disease

The efficacy of adalimumab, a fully human anti-tumor necrosis factor-α recombinant antibody, has dramatically improved the quality of life of patients with rheumatoid and psoriatic arthritis and Crohn’s disease. Because it is fully human, one should not expect immune reactions to this molecule. Adverse reactions to adalimumab are limited mainly to injection site reactions and are very common. We, however, report a case of Stevens-Johnson syndrome that required hospitalization and cessation of adalimumab in a patient with rheumatoid arthritis (RA). In this case report, a 53-year-old woman with RA developed severe mucositis, peripheral rash and desquamation and fever concomitant with the fifth dose of 40 mg adalimumab. Infective etiologies were excluded. The patient responded rapidly to IV hydrocortisone and was able to be commenced on infliximab without recurrence of the Stevens-Johnson syndrome. Severe skin reactions induced by TNF-α antagonists can be very serious, and prescribers need to be aware of the potential for the mucocutaneous adverse effects from the use of these agents, particularly due to the significant morbidity and mortality that are associated with SJS.