Efficiency,Safety, and Long‐Term Follow‐up of Retrograde Approach for CTO Recanalization: Initial (Belgrade) Experience with International Proctorship

Background: Retrograde approach increases the success rate for percutaneous recanalization of complex chronic total occlusion (CTO) of coronary arteries. Objectives: The purpose of this study was to describe our initial experience of retrograde percutaneous coronary intervention for CTO program, focusing on its safety and feasibility, and long‐term clinical follow‐up. Methods: The study was a single center retrospective registry which included a total of 40 patients, of 590 CTO treated patients (6.7%), between January 2008 and October 2011, who underwent retrograde approach for CTO recanalization. Results: Mean occlusion duration was 37.8 ± 40.3 months. Overall success recanalization rate was 87.5% (35/40). Septal collaterals were used to access the occlusion in all cases (100%). Retrograde guidewire crossing of collateral channels was successful in 36/40 (90.0%) patients with success rate of CTO recanalization in these patients of 97.2%. Retrograde approach as the primary strategy was applied in 23/40 (57.5%) patients, retrograde approach immediately after antegrade failure attempt was performed in 8/40 (20.0%) patients, and retrograde approach as elective procedure, after previously failed antegrade attempt, was performed in 9/40 (22.5%) patients. The success rate of these strategies was: 87.0% (20/23 patients) for primary, 87.5% (7/8 patients) for retrograde immediately after antegrade failure, and 88.9% (8/9 patients) for retrograde after previous failed antegrade attempt, respectively. Total in‐hospital major adverse cardiac events (MACE) rate was 5.0% (2 non‐Q‐wave myocardial infarctions). The MACE free survival at median follow‐up of 20 months was 89% (95% CI: 78–100%). Conclusions: This study has demonstrated that adequate training and international proctorship for this complex and demanding technique is a necessity and prerequisite to achieve high overall success rates, with acceptable complication rates and excellent long‐term survival rate. (J Interven Cardiol 2012;25:540–548).     

METABOLIC BONE DISEASE INDUCED BY PROSTATE CANCER: RATIONALE FOR THE USE OF BISPHOSPHONATES

PURPOSE: Increasing evidences indicate that despite the osteoblastic nature of metastatic bone lesions due to prostate cancer osteolysis is a regular feature and may cause skeletal morbidity. This observation provides the rationale for the use of bisphosphonates for managing bone metastatic prostate cancer. MATERIALS AND METHODS: We reviewed the literature on the mechanisms by which prostate cancer affects bone cell function and disrupts physiological bone turnover. We also summarized the clinical results of bisphosphonate for treating bone pain in patients with prostate cancer. RESULTS: Metastatic prostate cancer in bone interferes with physiological bone remodeling by abnormal release of the hormones and paracrine factors physiologically involved in the modulation of osteoblastic and osteoclastic activity. Tumor induced bone formation and resorption develop within the same metastasis but excessive new bone is deposited away from bone resorption sites and does not contribute to bone strength. The increase in bone resorption may also be a generalized phenomenon that is most likely due to iatrogenic osteoporosis or related to hyperparathyroidism in response to the increased calcium demand. The bone resorption index in patients with bone metastatic prostate cancer correlates with bone pain and is an independent predictor of adverse skeletal events. However, small clinical studies of the efficacy of bisphosphonates for controlling bone pain in patients with prostate cancer show contradictory results. CONCLUSIONS: Improved understanding of the pathophysiology of prostate cancer induced metabolic bone disease implies that bisphosphonates may have a role in the treatment of this disorder. This issue is being addressed by large-scale ongoing randomized studies.     

Prognostic Value of Exercise Myocardial Scintigraphy in Patients with Coronary Chronic Total Occlusions

Objectives: To evaluate the prognostic value of exercise myocardial scintigraphy in patients undergoing incomplete revascularization by means of percutaneous coronary intervention (PCI) with at least a residual chronic total occlusion (CTO) left untreated. Methods: Of 569 consecutive patients with multivessel disease undergoing myocardial scintigraphy after incomplete revascularization by PCI between March 1997 and December 2004, 126 (79% male, 64±10 years) with ≥ 1 residual CTO fulfilled the eligibility criteria and entered in the study. Hard events defined as cardiac death and myocardial infarction, soft events defined as incidence of unstable angina and PCI procedures, and their composite were assessed at a median follow‐up period of 44 months. Results: Hard events were observed in six patients (4.8%). All of them had severely abnormal perfusion defects detected by myocardial scintigraphy. Soft events occurred in 0 (0%), 10 (7.9%), and 15 (11.9%) patients with normal, mildly abnormal, and severely abnormal perfusion, respectively. In the Kaplan–Meier analysis, the log‐rank test was statistically significant across patients stratified by summed stress score either in terms of hard, soft and hard, or soft events. Univariate and multivariate Cox proportional‐hazards showed an incremental significant information when the scintigraphic variables were added to clinical, angiographic, left ventricular ejection fraction, and Duke treadmill score, for prediction of the composite of hard and soft cardiac events (P < 0.006). Conclusions: Among patients with a residual CTO left untreated after PCI, myocardial perfusion imaging provides significant independent information concerning the subsequent risk of cardiac events. (J Interven Cardiol 2010;23:139‐148)     

Effect of Different β-Adrenergic Agonists on the Intestinal Absorption of Galactose and Phenylalanine

Nutrient transport across the mammalian small intestine is regulated by several factors, including intrinsic and extrinsic neural pathways, paracrine modulators, circulating hormones and luminal agents. Because β-adrenoceptors seem to regulate gastrointestinal functions such as bicarbonate and acid secretion, intestinal motility and gastrointestinal mucosal blood flow, we have investigated the effects of different β-adrenergic agonists on nutrient absorption by the rat jejunum in-vitro. When intestinal everted sacs were used the β₂-agonist salbutamol had no effect either on galactose uptake by the tissue or mucosal-to-serosal flux whereas mixed β₁- and β₂-agonists (isoproterenol and orciprenaline) and β₃-agonists (BRL 35135, Trecadrine, ICI 198157 and ZD 7114) inhibited galactose uptake and transfer of D-galactose from the mucosal-to-serosal media across the intestinal wall (although the inhibiting effects of isoproterenol and Trecadrine were not statistically significant). In intestinal everted rings both Trecadrine and BRL 35135 clearly reduced galactose uptake, the effect being a result of inhibition of the phlorizin-sensitive component. Total uptake of phenylalanine by the intestinal rings was also reduced by those β₃-adrenergic agonists. These results suggest that β₁ and β₃-adrenergic receptors could be involved in the regulation of intestinal active transport of sugars and amino acids.     

Human Chorionic Gonadotropin Immunoreactivity in Serum of Patients With Malignant Neoplasms

ABSTRACT: The beta-human chorionic gonadotropin (HCG) radioimmunoassay was used to determine the presence of HCG immunoreactivity in serum of patients (n = 71) with diagnosis of cancer. Of patients with active neoplasia, 60.5% showed HCG immunoactivity above controls (>> 5 mlU/ml). An apparent degree of correlation was observed with tumor activity in that a case with widespread metastases due to a colonic carcinoma exhibited the highest HCG levels while, in one patient, the level of HCG decreased progressively according to therapeutic response. A high frequency of immunoactive HCG was found in patients with carcinomas of the cervix, breast, gonad digestive system and in patients with melanoma. Trophoblastic cells were not evident in the tumors biopsied. Immunologic similarity of HCG secreted by tumors and that contained in serum of pregnant women, of patients with hydatidiform mole of males injected with exogenous HCG was shown by parallel inhibition curves in the radioimmunoassay. The positivity of HCG was predominant in cases of cervix carcinoma.