Improved Short-Term Outcomes of Primary Coronary Stenting Compared to Primary Balloon Angioplasty in Acute Myocardial Infarction at Experienced Centers: The PAMI Study Group Experience

To study the additive benefits of routine stent implantation in patients undergoing primary percutaneous transluminal coronary angioplasty (PTCA) at experienced centers, we compared the outcomes of the 982 patients undergoing PTCA for acute myocardial infarction (AMI) in the Primary Angioplasty in Myocardial Infarction-2 (PAMI-2) trial (only 1% of whom were stented) to the 312 patients in the PAMI Stent Pilot Trial (236 [76%] of whom were stented). The inclusion and exclusion criteria, PTCA methodology, and definitions used were prespecified to be identical between the two trials. Compared to the primary PTCA approach in PAMI-2, the strategy of stenting all eligible lesions in the PAMI Stent Pilot Trial was associated with reduced rates of in-hospital death (0.6% vs 2.7%, P = 0.03), reinfarction (1.3% vs 4.6%, P = 0.008), recurrent ischemia (3.5% vs 11.6%, P < 0.0001), target vessel revascularization (7.3% vs 11.4%, P = 0.04), and a shorter hospital stay (6.4 ± 4.4 vs 7.1 ± 6.2 days, P = 0.01). By multiple logistic regression analysis in 1,294 patients, stent implantation versus PTCA only was the strongest predictor of freedom from the composite in-hospital end point of death, reinfarction, or target vessel revascularization (TVR) (8.3% vs 15.0%, multivariate odds ratio = 0.4, P < 0.0001). These data strongly suggest that despite the excellent results achieved when primary PTCA is performed by experienced operators, the short-term outcomes of mechanical reperfusion can be further improved by a primary stent strategy.     

Recombinant human epidermal growth factor treatment of radiation-induced severe oral mucositis in patients with head and neck malignancies

Mucositis of the oral cavity and pharynx is a major dose-limiting factor in the application of radiotherapy (RT) to patients with head and neck cancer. Therefore, we evaluated the wound healing effect of human recombinant epidermal growth factor (rhEGF) in head and neck cancer and lymphoma patients with irradiation (with or without combined chemotherapy-induced oral mucositis). Patients at Asan Medical Center who had undergone definitive RT of the head and neck region with or without combined chemotherapy and who had developed severe oral mucositis (higher than the Radiation Therapy Oncology Group grade 3) were treated with topical rhEGF twice daily for 7 days. The evaluation of response with regard to oral mucositis was performed 1 week later. Of the 11 treated patients, three had nasopharyngeal carcinoma, three had carcinoma of the oropharynx, two had carcinoma of the oral cavity, one had carcinoma of the hypopharynx and two had lymphoma of the head and neck. Six patients received RT only, and five patients received concurrent chemoradiotherapy. All patients showed improvements in their oral mucositis after topical treatment with rhEGF in that the Radiation Therapy Oncology Group grade was significantly decreased ( P  = 0.0000). This finding suggests that rhEGF is effective and safe for the treatment of radiation-induced mucositis. Further studies are needed to determine the optimal dosage and fractionation schedule.     

In vivo comparison of force development with various materials of implant-supported prostheses

Summary  The purpose of this study was to measure axial loading, generating bending moments on fibre reinforced composite (FRC) implant prostheses using strain-gauged customized abutment in vivo . Bending moments of conventional implant prosthetic material were also measured and the data were compared with those for FRC. Three unit fixed dental prostheses were made for two dental implant fixtures, which had been functioning properly for more than one year using Tescera^TM ATL^TM, porcelain fused to metal and gold as occlusal material. Three patients participated in this study; two patients had two implants on one side of the mandible and one had two implants on both sides of the mandible. Five sets of fixed dental prostheses were fabricated for each material and these were cemented with Temp-bond^® on strain-gauged customized abutments, which were screwed into the underlying implant fixtures. Axial loadings and bending moments were measured when a patient bit the experimental fixed dental prosthesis. anova and the Tukey HSD test (α = 0·05) were used for statistical analysis. There were no significant differences in normalized bending moments among the three different implant prosthetic materials. Within the limitations of this study, Tescera^TM ATL^TM generated bending moments similar to conventional implant prosthetic materials such as gold and porcelain.     

Effects of Electrocautery on Transvenous Lead Insulation Materials

Introduction: Insulation defects are a leading cause of transvenous lead failure. The purpose of this study was to determine the effects of electrocautery on transvenous lead insulation materials.
Methods: A preparation was done to simulate dissection of a transvenous lead from tissues. Radiofrequency energy was delivered using a standard cautery blade at outputs of 10, 20, and 30 W, for 3 and 6 seconds, using parallel and perpendicular blade orientations on leads with outermost insulations of silicone rubber, polyurethane, and silicone–polyurethane copolymer. Damage to each lead segment was classified after visual and microscopic analysis.
Results: Significant insulation damage occurred to almost all polyurethane leads. Full insulation breaches were observed with 30 W regardless of application duration with a parallel direction and with all power outputs with a perpendicular direction. Thermal insulation damage to copolymer insulation was similar to that of the polyurethane leads. In contrast, there was no thermal damage to silicone leads, regardless of the power output and duration of power delivery. However, mechanical insulation damage was observed to all silicone leads when at least 20 W was applied in a direction perpendicular to the lead.
Conclusions: Polyurethane (PU55D) and copolymer materials have low thermal stability and are highly susceptible to thermal damage during cautery. Implanting physicians should be aware of the lead insulation materials being used during implant procedures and their properties. The use of direct contact cautery on transvenous leads should be minimized to avoid damage to the lead, especially on leads with polyurethane or copolymer outer insulations.     

Pigmented nail with atypical melanocytic hyperplasia

We report two cases showing black discoloration of the thumb nail which were histologically found to be acral lentiginous melanoma (ALM) in situ. A pigmented subungual lesion is more frequently malignant than benign and it is generally believed that diagnosis of subungual melanoma during the radial-growth phase is very difficult. Our cases are particularly interesting because atypical melanocytic hyperplasia was confined to the epidermis despite the lesion being present for a long time.     

Nonsurgical Electrical Ablation of Tachycardias: Importance of Prior in Vitro Testing of Catheter Leads

Nonsurgical electrical ablation of tachycardia pathways or foci has been attempted or carried out using a variety of temporary pacing catheter leads. To determine the ability of such leads to withstand the high energies used in such procedures, 34 leads were suspended in saline, and subjected to repeated electrical shocks. Small (4 French) temporary pacing leads made by a variety of manufacturers tolerated multiple shocks up to 100 joules; above this level, failures became increasingly common, although usually the failure mode was benign with respect to patient care implications. Testing of 6, 7, and 8 French leads revealed considerable inter-and intra-manufacturer differences in the ability to withstand higher energy shocks, reflecting differences in materials and fabrication techniques. It is concluded that careful in vitro lead testing is required prior to using identical models in humans for arrhythmia ablation procedures.     

Glycemic Control of Surgical Patients. What is Correct,What is Not

Perioperative hyperglycemia is very common among critically ill patients with or without diabetes mellitus (DM). Perioperative elevated levels of blood glucose (BG) have been linked with increases in morbidity, infections, anastomotic failure, autoimmune dysfunction, and raised mortality and prolongation of hospitalization. A variety of different approaches have been taken for the control of BG in the perioperative period, and different methods of measurement have been proposed, among which, point of care (POC) meters, arterial blood gas analysis and venous plasma analysis prevail. The aim of this literature review was to provide evidence-based answers as to how BG levels should be monitored. We conclude that more conservative glycemic control is preferable to “tight glycemic control” (TGC), in order to avoid complications associated with episodes of hypoglycemia.     

Percutaneous Retrieval of Dislodged Left Atrial Appendage Occlusion Devices through the Transseptal Approach

Percutaneous left atrial appendage (LAA) occlusion is a promising treatment option in patients with atrial fibrillation who have a high risk of embolic stroke and are not eligible for chronic oral anticoagulation therapy. This procedure, however, can induce several complications. Device embolization can result in a serious situation, requiring immediate and safe device removal. We report two cases in which dislodged LAA occlusion devices were flitting in the left atrium or entrapped in the mitral valve leaflets and were successfully retrieved through a transseptal approach without complications.