Nationwide Trends in the Utilization of Multivessel Percutaneous Coronary Intervention (MVPCI) in the United States across Different Gender and Ethnicities

Background: To evaluate nationwide trends in the utilization of Multivessel Percutaneous Coronary Intervention (MVPCI) in the past compared to recent years using a large database from 1988 to 2004.
Method: The Nationwide Inpatient Sample (NIS) database was utilized to calculate the age-adjusted rate for multivessel percutaneous coronary intervention (MVPCI) from 1988 to 2004. Specific ICD-9-CM codes for MVPCI were used to compile the data. Patient demographic data were also analyzed from the database.
Results: According to the NIS database, MVPCI was performed in 241,319 patients from 1988 to 2004. Males underwent MVPCI twice as many as compared to females (male: 67.87%, female 32.13%). The mean age for these patients was 64.89 ± 11.84 years old. From 1988, the age-adjusted rate for MVPCI gradually increased to more than three times in 1998 [(6.62 per 100,000 (95%CI = 5.92–7.33) in 1988 to 23.92 per 100,000 (95%CI = 21.62–26.22, P < 0.01) in 1998] and accelerated to more than 6 times that of 1988 at the end of the study in 2004 (41.50 per 100,000 (95%CI = 37.84–45.16). In recent years, this trend was similar for both genders and ethnicities.
Conclusion: The utilization of MVPCI has increased six times from 1988 to 2004, with acceleration in recent years. The cause of this acceleration is most likely related to the advancement in the percutaneous coronary interventional techniques.     

Visualization of Aortopulmonary Window by Transesophageal Echocardiography

Transthoracic two-dimensional echocardiography, and Doppler and color flow imaging techniques were utilized to diagnose aortopulmonary window in an infant. Transesophageal echocardiography was used intraoperatively for precise definition of this lesion and its differentiation from other defects in aortopulmonary septation. (ECHOCARDIOGRAPHY, Volume 8, May 1991)     

Clinically Significant Nondominant Right Coronary Artery Disease

The literature is scarce regarding the management of ischemia due to disease of the nondominant right coronary artery (NDRCA). We describe two patients who suffered from myocardial ischemia due to significant disease of the NDRCA. Both were managed with balloon angioplasty. Disease of the NDRCA can be a source of ischemia and should be dealt with like other coronary vessels . (J Interven Cardiol 1996;9:59–64)     

Microcy stic Adenoma of the Pancreas — An Incidental Finding

Microcystic adenoma of the pancreas is a rare benign pancreatic tumour usually occurring in elderly females. These tumours have characteristic radiological appearances that should allow their differentiation from the potentially malignant macrocystic adenoma as well as other cystic lesions of the pancreas. A case of a large micro-cystic adenoma of the pancreas found incidentally in a patient with carcinoma of the kidney is presented.     

PHARMACOLOGY AND THERAPEUTICS ETRETINATE THERAPY FOR PSORIASIS AND OTHER KE RATINIZING DISORDERS: A 10-YEAR RETROSPECTIVE STUDY IN SINGAPORE

Background. Etretinate, a second generation retinoic acid, has been reported to be useful in the treatment of psoriasis and other keratinizing disorders. The effectiveness of etretinate for these disorders are studied in a 10-year retrospective study of all patients treated with etretinate in a skin clinic in Singapore. Methods. The case records of 190 cases of psoriasis and other keratinizing disorders treated with etretinate were analyzed. Information collected included demographic data, dosage of etretinate taken, response and side effects, clinical follow-up, and relapse. Results. Most of the cases (72.6%) had psoriasis (138/190). The others had different keratinizing disorders. The dose of etretinate used was 0.15 to 1 mg/kg/day (median 0.36 mg/kg/day), and the duration of the treatment varied from 1 to 120 months (median 6 months). Etretinate was coadministered with UVB (ReuvB) or PUVA (RepuvA) in 89 (46.8%) patients. In psoriasis, the response to treatment was excellent in 41.3% (57/138), good in 36.2% (50/138), fair in 15.9% (22/138), and poor in 6.5% (9/138) of the cases. Patients with plaque-type psoriasis did better with combination therapy than with monotherapy. Those with keratinizing disorders showed excellent, good, fair, and poor responses in 32.7% (17/52), 32.7% (17/52), 25.0% (13/52), and 9.6% (5/52) respectively. Adverse effects were noted in 102 (53.7%) cases and were generally mild and tolerable. Etretinate was discontinued in 24 (12.6%) patients due to significant toxicity. Conclusions. Etretinate is effective for treating psoriasis and other keratinizing disorders. Combination therapy is preferred in chronic plaque psoriasis. Adverse effects are common, but mild and tolerable.     

Retrograde (Transseptal) Activation of Right Bundle Branch During Sinus Rhythm

Retrograde Right Bundle Branch Activation. A 40-year-old man undergoing electro-physiologic study for recurrent palpitations was found to have a right bundle branch block during sinus rhythm and right bundle potentials occurring after ventricular activation. The sequence of activation of the proximal and distal right bundle potentials was suggestive of a retrograde invasion of the right bundle during sinus rhythm. This transseptal activation of the right bundle via the left bundle exhibited decremental conduction characteristics during atrial as well as ventricular stimulation. Observations made in this case may provide some important information concerning the electrophysiologic behavior of transseptal impulses.     

Efficacy of Different Treatment Strategies for Neurocardiogenic Syncope

Objectives: The purpose of this study was to evaluate the efficacy of different therapeutic approaches for patients with a history of syncope and positive head-up tilt testing. Background: Head-up tilt testing has gained broad acceptance as a reliable diagnostic method for the assessment of patients with recurrent unexplained syncope. However, once the diagnosis is established, there is no consensus on the most appropriate treatment. In this respect, efficacy of drug therapy in preventing recurrence of symptoms in such patients is not entirely clear, and controversies exist regarding the need to confirm the effects of pharmacological interventions. Methods: Clinical follow-up was obtained in 303 patients with a history of syncope and positive head-up tilt testing. After the diagnostic head-up tilt, patients were assigned to different therapeutic approaches according to their preference or logistic impediments. Of 303 patients, 44 received empiric therapy, 210 were treated with medications proven effective during repeated head-up tilt testing, and 49 refused or discontinued medical therapy. The three groups were similar with regard to age, sex, and clinical presentation. The mean follow-up was 2.8 ±1.8 years. Among the patients treated according to head-up tilt guided therapy, 130 were on beta blockers, 35 on theophylline, 10 on ephedrine, 31 on disopyramide, and 4 on miscellaneous regimens. Empiric treatment consisted of beta blockers in 37 of 44 patients and other drugs in the remaining patients. Results: During the follow-up, recurrence of symptoms was experienced in 12 (6%) of the 210 patients receiving the head-up tilt guided therapy, 16 (36%) of 44 in the empiric therapy group, and 33 (67%) of 49 in the no therapy group. Recurrence of symptoms in patients on empiric or no therapy was significantly more frequent as compared to the head-up tilt guided therapy group (P<0.01). Conclusions: In patients with unexplained syncope and positive upright tilt testing, therapeutic strategies identified on the basis of response during head-up tilt have a more positive impact on the recurrence of symptoms during follow-up.