Drug‐Eluting vs. Conventional Balloon for Side Branch Dilation in Coronary Bifurcations Treated by Provisional T Stenting

Objective

The origin of the side branch (SB) is the most common site for restenosis in coronary bifurcations. The end‐point is to compare the results of SB dilation with drug‐eluting balloon (DEB group) versus conventional balloon (BAL group) in bifurcations treated with provisional T stenting.

Methods and Results

Each group included 50 patients. In DEB, the origin of SB was dilated with a Sequent^® Please balloon. In both groups, a Taxus Liberté^® stent was implanted in the main vessel, with kissing balloon postdilation. If the outcome for the SB was suboptimal, a Taxus stent was implanted in BAL and a bare stent in DEB group. An angiographic follow‐up and IVUS were scheduled for 12 months later. Adverse events (MACE) were 24% in BAL versus 11% in DEB (P = 0.11), with greater revascularization (TLR) in the BAL group (22% vs. 12%, P = 0.16). At angiographic follow‐up, there was a lower percentage of SB restenosis in the DEB group (20% vs. 7%, P = 0.08), with less late loss (0.40 mm vs. 0.09 mm, P = 0.01).

Conclusion

Side branch dilation with a drug‐eluting balloon resulted in better angiographic outcomes than with a conventional balloon, with less late loss and restenosis at the 12‐month follow‐up. (J Interven Cardiol 2013;26:454‐462)

     

THE TREATMENT OF GROSS HEMATURIA SECONDARY TO PROSTATIC BLEEDING WITH FINASTERIDE

Purpose

We evaluate the use of finasteride to control gross hematuria secondary to prostatic bleeding.

Materials and Methods

We reviewed retrospectively 42 patients treated with finasteride to treat gross hematuria.

Results

There were 28 evaluable patients who had taken finasteride for at least 6 months to control gross hematuria and hematuria ceased in 25 (91%). In 1 patient clot retention developed requiring transurethral resection of the prostate and 2 patients had 1 or more minor episodes of bleeding that resolved spontaneously.

Conclusions

Finasteride appears to be an effective agent for controlling gross hematuria secondary to prostatic bleeding.     

Mechanisms of cutaneous vasoconstriction during upright posture

The cutaneous circulation is thought to participate in the neurocirculatory adjustments during orthostatic stress, but the underlying mechanisms mediating such reflex cutaneous vasoconstriction are poorly understood. The aim of this study was to assess the relative importance of baroreceptor (cardiopulmonary and arterial) and positional (vestibular, exercise, veno-arteriolar and myogenic) reflexes in triggering cutaneous vasoconstriction during upright posture. First, hypotensive lower body negative pressure (LBNP) was compared with actual postural changes to assess the relative contributions of baroreceptor reflexes and positional reflexes. Then changes in body position were compared with changes in limb position in the absence or presence of proximal (axillary) or distal (local cutaneous) nerve blocks, to assess the relative contributions of vestibular, exercise, veno-arteriolar and myogenic reflexes. Skin sympathetic nerve activity was determined by microneurography, and skin blood flow was determined by laser Doppler velocimetry. LBNP of –50 mmHg (cardiopulmonary + arterial baroreceptors) had no effect on skin sympathetic nerve activity or skin vascular resistance. In contrast, an upright posture with the arms dependent (baroreceptor+vestibular+exercise+veno-arteriolar reflexes) caused a two- to threefold increase in skin vascular resistance. In the supine position, passive movement of the arm into a dependent position to activate veno-arteriolar reflexes alone evoked an increase in skin vascular resistance which approximated the response to normal upright posture. Blocking central sympathetic nerve impulses by application of an axillary blockade did not influence the cutaneous vasoconstrictor response to an upright posture or changes in limb position. In contrast, application of a distal nerve block by local cutaneous surface anaesthesia completely blocked vasoconstrictor responses evoked by these manoeuvres. In conclusion, these experiments in human subjects identify a primary role for veno-arteriolar reflexes in triggering vasoconstriction in the cutaneous circulation during upright posture.     

TOLERABILITY OF CLONAZEPAM IN DEMENTED AND NON-DEMENTED GEROPSYCHIATRIC PATIENTS

Objective. The tolerability of clonazepam in geropsychiatric inpatients was examined in patients with and without a diagnosis of dementia. Design. Forward-looking retrospective study comprising consecutive patients placed on clonazepam. Setting. A geropsychiatry unit of a large Veterans Affairs Medical Center. Patients. All geropsychiatry inpatients placed on clonazepam over a 21-month period of time. Measure. Mini-Mental State Examination, Brief Psychiatric Rating Scale, Cohen-Mansfield Agitation Inventory and the Rating Scale for Side Effects were performed at admission and discharge as part of an ongoing database. Results. Twenty-four geropsychiatric inpatients were treated with clonazepam (mean dose of 1.2 mg for a minimum of 2 weeks) during the 21 months studied. About one half of the patients had a primary diagnosis of dementia and the remainder had a diagnosis of an affective or psychotic disorder. Two of these patients were discontinued because they had responded to the acute need for clonazepam and a third patient was discontinued because of the development of sedation and confusion. For the remaining 21 patients, scores improved significantly on the Brief Psychiatric Rating Scale (p=0.017), the Cohen-Mansfield Agitation Inventory (p=0.011), the Rating Scale for Side Effects (0.004) and the Global Assessment of Functioning (p=0.000), with no differences in amount of improvement between demented and non-demented patient groups. Scores on the Mini-Mental State Examination remained unchanged. Conclusion. Clonazepam shows promise as a benzodiazepine with good tolerability in the elderly. © 1997 John Wiley & Sons, Ltd.     

An integrated approach to meta-analysis in alcohol studies*

The research design and methods utilised by the Collaborative Alcohol-Related Longitudinal Project are described. The project design addresses the critical need to develop procedures to assess the replicability of research results in alcohol studies. Key features of the research plan include: re-analysis of original data from multiple longitudinal studies of drinking behavior in the general population; centralization of all data analyses, developed and implemented by an interdisciplinary core staff; development of the research plan and interpretation of results in co-operation with original investigators of studies included in the project; and use of modeling procedures from meta-analysis to quantify the relative contribution of factors influencing the distribution of effect estimates across studies, including both methodological differences and aggregate level variables. The final section describes statistical methods for meta-analysis used by the project, including procedures for the calculation and combination of estimates of effect magnitude, categorical and continuous modeling procedures for use with effect sixes, and random effects models.     

A meta-analysis of life course variation in drinking*

Meta-analysis combines remits from multiple longitudinal studies to describe life course variation by age and sex for quantity of drinking per typical occasion (20 studies) and frequency of drinking during one month (27 studies). There is cross-study heterogeneity for the Time 1 means of the drinking variables blocking for age and sex. Age distributions for the Time I means are similar by gender within nations; in the aggregate, males exceed females in the magnitude of drinking. Dramatic shifts in the standarized mean difference (M₂ - M₁) occur among the young; greater homogeneity and moderate change (declines) occur later in life. Implicated in improving cross-study homogeneity for M ₂– M₁ among the young are interval between measurements, nation, Time 1 per capita consumption (PCC), difference in PCC and the Time 1 mean. Lower unstandardized regression coefficients are found for quantity among youth, but are not consistently homogeneous within nations; the association for frequency becomes increasingly stable with increasing age. Nation and interval are implicated in improving homogeneity. Decline in quantity occurs among the old. M₂-M₁, produces homogeneously higher regressions for groups of the young who increase quantity v. those who do not. Linkage of the group-level and individual-level findings is discussed.     

Maternal Acceptability of a Dietary Intervention Designed to Lower Children''s Intake of Saturated Fat and Cholesterol: The Dietary Intervention Study in Children (DISC)

Objective This report examined the acceptability to mothers of a dietary educational and behavioral intervention for preadolescent children with elevated levels of serum low-density lipoprotein cholesterol (LDL-C) who were enrolled in the Dietary Intervention Study in Children (DISC).Design DISC is a randomized, controlled clinical trial. Subjects were randomly assigned to either an intervention or usual-care (control) group.Subjects/setting To be eligible for the study, participants were required to have the average of 2 fasting LDL-C values fall between the 80th and 98th sex-specific percentiles. Three hundred thirty-four 8- to 10-year-old children and their families were randomly assigned to an intervention group, and 329 were assigned to a usual-care (control) group. This study examined data from 232 subjects in the intervention group. Data were collected at 6 intervention sites around the United States.Intervention Those assigned to the intervention group participated in a multidisciplinary dietary intervention that included a series of group and individual sessions over a 3-year period. Children and their caretakers were taught to follow a nutritionally adequate diet that was low in total fat, saturated fat, and cholesterol and high in polyunsaturated fat.Main outcome measures Three nonconsecutive 24-hour diet recalls were collected at baseline and at 1 year by trained and certified dietitians. A questionnaire designed to assess diet acceptability was administered at months 4, 8, 11, and 15. Demographic measures were collected at the onset of the study.Statistical analysis performed Statistical procedures included factor analysis and regression analysis.Results Regression analysis suggested that perceived effectiveness of the dietary intervention and mothers’ having few concerns about disadvantages of the diet were significantly related to higher overall fat intake in children in one-parent families. Maternal willingness to implement the diet was significantly related to lower saturated fat intake.Applications/conclusions In attempts to change eating behavior of children, interest and cooperation of the parents are essential to achieving successful results. These analyses further suggest that maternal acceptability translates into willingness to implement the diet and may facilitate changes that are associated with reduced saturated fat intake in children. J Am Diet Assoc. 1998;98:31-34.     

Infected Myxomas:Report of a Case and Review of the Literature

Myxomas, the most common primary cardiac tumors, rarely become infected. This report describes a patient with a right atrial myxoma and a very unusual and life-threatening complication: infection with resultant bacteremia. The few cases reported in the literature are reviewed. The relevance of transesophageal echocardiography (TEE) in the diagnosis and assessment of atrial masses is emphasized.     

Deletion of chromosome 13 (band ql4) but not trisomy 12 is a clonal event in B-chronic lymphocytic leukaemia (CLL)

Summary. Chromosomal abnormalities are detected by conventional cytogenetic or FISH analysis in 50% of chronic lymphocytic leukaemias (CLL). Trisomy 12 and del 13ql4 account for 70% of these abnormalities. The incidence of these two abnormalities was studied in CLL patients by Southern blot analysis using a highly purified B-cell malignant population (CD5>95%, CD3 < 5%). Probes for the Dl 3S25 marker on chromosome 13 band ql4 and for the RBTN3 gene on chromosome 12 band pi2-13, were used. Deletion of the Dl 3S2 5 was detected in 17/42 patients (43%) in a homozygous (9-5%) or heterozygous (30%) configuration. Deletion of the D13S25 marker appears to be a clonal and early event in CLL development since it is detected in >95% of the malignant clonal population. Conversely, trisomy 12 is rarely a clonal event (5/33 patients, 15%) and a varying proportion of cells carrying this abnormality can be demonstrated in 30% of CLL patients (10/33 patients).     

The Role of Contrast Angiography in Gastrointestinal Bleeding with the Advent of Technetium Labelled Red Blood Cell Scans

This study suggests that in cases of GI bleeding emergency angiography is likely to be more rewarding when it follows a Tc-99m RBC scintigram which demonstrates active GI bleeding. The added advantages of angiography include more accurate anatomical localization and the possibility of therapeutic radiological intervention. These advantages should be considered in the individual patient before deciding to proceed directly to surgical intervention based on positive scintigraphy alone. Where the scintigram does not demonstrate active bleeding there is no need to perform emergency angiography, however, elective angiography may demonstrate a possible cause for bleeding. Chronic GI bleeding remains a diagnostic dilemma, however, elective angiography has a small but definite role in the diagnostic workup of these cases because of its ability to demonstrate a possible causative lesion.