Evaluation of the phase-plane ECG as a technique for detecting acute coronary occlusion

OBJECTIVE: To evaluate the phase plane (PP) ECG as a method for detecting acute coronary occlusion (ACO). BACKGROUND: Balloon inflation in a coronary artery during PTCA produces acute myocardial ischemia. The sensitivity of the standard ECG for detecting ACO is approximately 50%, depending on the number of leads recorded. METHODS: The standard ECG signals of 18 patients (91 leads), undergoing PTCA were sampled and converted to digital data, prior to, and during acute coronary occlusion. PPs were constructed by projecting the ECG signals and their first derivatives onto a two-dimensional plane. Standard ECG signals and PPs, prior to ACO, were compared to their respective recordings and PPs during ACO. RESULTS: Using the standard ECG analysis, the acute occlusion was detected in 39 of 91 leads (43%), and in 15 of 18 patients (83%), whereas using the PP analysis it was detected in 82 of 91 leads (90%), and in all 18 patients (100%) (P<0.001, for leads). The median number of leads per patient demonstrating standard ECG changes was 2.0, whereas for the PP analysis it was 5.5 (P<0.001). The specificity of the PP method was 83.5%. CONCLUSIONS: The sensitivity of the PP method for detecting ACO during PTCA was superior to that of the standard ECG analysis. A smaller lead system is required to detect changes of ACO, during PTCA, when the PP method is used. The PP method is simple, low-priced, and may serve to detect acute myocardial ischemia in a number of clinical settings.     

Benign Neck Metastasis of a Testicular Germ Cell Tumor

Germ cell tumors (GCTs) are relatively rare neoplasms considered to be curable malignancies since the introduction of cisplatin. The presence of neck metastasis has been reported, with fewer reports of metastatic mature teratoma. In this study, 3 cases of “benign neck” metastasis in patients with GCT between 1998 and 2010 were reviewed retrospectively. In all 3 cases the presenting clinical sign was a left lower neck mass, leading to the diagnosis of the primary site in the testis. All had surgical salvage following chemotherapy, with benign lesions or mature teratoma in histopathology of the neck mass. Chemotherapy was followed by salvage lower-half neck dissection showing benign features in the neck specimen, even though malignancy was proven histologically in other areas. Only 1 patient had a postoperative chyle leak, which resolved spontaneously after several days. Neck dissection is recommended in those patients because malignancy cannot be excluded.Key words: Germ cell tumor, Metastasis, Neck, TeratomaTeratoma comes from the Greek words terato, meaning “a monster,” and onkoma, meaning “swelling or mass.” Both teratomas and germ cell tumors (GCTs) arise from postmeiotic germ cells and may occur in both gonadal and extragonadal locations. GCTs are relatively rare neoplasms that account for 0.8% of all cancers in males, and they comprise 95% of testicular neoplasms.¹ GCTs are the most common malignancy among men ages 15 to 44 years, with a peak incidence between the age of 25 and 35 years.^2,3 GCTs have been considered to be curable malignancies, even in the advanced stage, since the introduction of cisplatin,⁴ and a dramatic improvement has been shown by using a treatment protocol of neoadjuvant cisplatin-based chemotherapy followed by surgical resection of residual tumor mass, with a complete response rate of 70% to 80%.⁵Testicular teratomas may present in both prepubertal and adult males. The prognosis differs greatly between these two groups. In children, teratomas most often occur before the age of 4 years, and they have a benign behavior in this age group. In adults, teratomas are usually part of mixed GCTs and have the potential to metastasize. The presence of neck metastasis in patients with testicular GCT is a rare but known phenomenon and has been reported to be present in up to 5% of cases.^6,7 Metastatic disease from the testis first involves the retroperitoneal lymph nodes, and then the tumor spreads via the thoracic duct to its emptying site near the junction of the left internal jugular and subclavian veins. Hence, the left supraclavicular region is one of the possible places where testicular teratomas can metastasize.^8,9 Because testicular carcinoma is the most common malignancy in men ages 20 to 30 years, a left supraclavicular mass in this age group should raise suspicion for a concomitant testicular mass.Our literature search has shown few reports of mature teratomas in patients who had been treated for GCT with neoadjuvant chemotherapy and surgical resection.^10–13 We present here our experience with 3 patients who were treated with neoadjuvant chemotherapy and surgical resection of highly malignant lesion, followed by surgical resection of a metastasis in the left lower neck, with benign histology.     

Peri-implant disease affects systemic complete blood count values—an experimental in vivo study

Objectives

To assess complete blood count (CBC) dynamics following ligature removal and open flap debridement in experimental peri-implantitis in dogs.

Materials and methods

Seven male beagle dogs were included in the study. Four rough-surface implants were placed pair-wise in both sides of the mandible 14 weeks after tooth extraction. Second stage surgery was performed after 14 weeks. Experimental peri-implantitis was initiated 3 weeks later by ligature placement around the healing caps thus facilitating plaque accumulation and inducing inflammation and destruction of peri-implant tissues. Ligature removal and open flap debridement were performed 11 weeks later. The CBC values were compared with baseline after each procedure. Wilcoxon paired tests were conducted in order to identify statistically significant differences between baseline data and values obtained after each procedure.

Results

Following experimental peri-implantitis, statistically significant (p < 0.05) increases were noted for white blood cells—WBC (9.62 ± 4.34 vs. 6.48 ± 1.34 cells per microliter of blood × 1000), hemoglobin—Hb (15.25 ± 0.94 vs. 13.52 ± 1.46, grams per deciliter), red blood cells—RBC (7.26 ± 0.79 vs. 5.9 ± 0.61 cells per microliter of blood × 1000), mean corpuscular hemoglobin—MCH (23.64 ± 0.96 vs. 23.16 ± 0.83 picograms/cell), platelets—PLT (349.86 ± 51.05 vs. 277.57 ± 66 cells per microliter of blood × 1000), and mean corpuscular hemoglobin concentration—MCHC (35.83 ± 0.27 vs. 31.04 ± 0.48 grams per deciliter). A statistically significant (p < 0.05) decrease in values was noted only for after ligature removal and open flap debridement. Mean corpuscular volume—MCV values were significantly lower (65.99 ± 2.31 vs. 74.65 ± 2.85 femtoliter) following 1^st ligature. Values returned to baseline after open flap debridement.

Conclusions

Within its limits, the present data suggest that experimentally induced peri-implantitis affects CBC values. Following surgical treatment, CBC values returned to normal.

Clinical relevance

This is the first study suggesting possible relationships between peri-implantitis and CBC values. Future studies, confirming such correlation, may provide an insight into the importance of peri-implant maintenance and treatment to minimize supporting tissues disease and reduce systemic effects.

     

Left-ventricular outflow tract ventricular-tachycardia event following CoreValve transcatheter aortic-valve implantation

We describe a patient with severe aortic stenosis who underwent CoreValve (Medtronic) implantation and presented several days later with a tachyarrhythmic episode. The electrocardiographic features of the arrhythmia were compatible with left-ventricular outflow tract ventricular-tachycardia. The life-threatening event was not associated with ischemia or an electrolyte disorder and was not drug-induced. A probable cause was the irritation of the myocardium by the prosthetic valve. Clinicians should be aware that the presence of anatomical parameters that increases the risk for myocardial injury and the need for pacemaker implantation might indicate an increased risk of a tachyarrhythmic episode.     

Histomorphometric analysis of newly formed bone after bilateral maxillary sinus augmentation using two different osteoconductive materials and internal collagen membrane

Deproteinized bovine bone mineral (DBBM) and human freeze-dried bone allograft (FDBA) were compared in five patients undergoing bilateral maxillary sinus floor augmentation using DBBM on one side and FDBA on the contralateral side. After 9 months, core biopsy specimens were harvested. Mean newly formed bone values were 31.8% and 27.2% at FDBA and DBBM sites, respectively (P = .451); mean residual graft particle values were 21.5% and 24.2%, respectively (P = .619); and mean connective tissue values were 46.7% and 48.6%, respectively (P = .566). Within the limits of the present study, it is suggested that both graft materials are equally suitable for sinus augmentation.     

A longitudinal study of the survival of interproximal root caries lesions restored with glass ionomer cement via a minimally invasive approach

The prevalence of gingival recessions and the number of root surfaces exposed to the oral environment both increase with age. In turn, these increases place the older population at increased risk for caries; it is estimated that 23.7% of those over the age of 65 have root caries.1 Glass ionomer (GI) seems particularly suitable for restoring root lesions, as it has good esthetic and anti-cariogenic properties, allows for chemical bonding to teeth, and has gained wide acceptance. This article describes a minimally invasive approach for restoring interproximal root caries lesions with GI; in this study, 66 such lesions were restored and followed for up to 80 months. The results show that the radiographic quality score was the single most important predictor for restoration survival. High-quality restorations survived an average of 74 months (SE = 2.7), with a cumulative survival rate of 77.4% at 80 months. Age, gender, and periodontal status were unrelated to restoration survival.