Coronary Angioplasty and Stent Placement by a Single Operator Without the Assistance of a Second Interventional Cardiologist and Nurse

Traditionally, not only the use of several devices, but plain angioplasty is performed by at least two interventional cardiologists and one specialized nurse. The aim of our study was to investigate the feasibility, effectiveness, and safety of angioplasty with stent implantation by a single operator, without the assistance of a second interventional cardiologist or a nurse. A total of 153 patients participated. Angioplasty with stent implantation was performed in 151 consecutive patients. The angioplasty was performed by a single cardiologist in the presence of a backup operator. Angioplasty and stent placement were successful in 151 of 153 cases (success rate = 98.7%). No death occurred and no case of acute stent occlusion was observed. In no case was the backup operator called for assistance. In conclusion, angioplasty with stent placement by a single operator without the assistance of a second interventional cardiologist or a specialized nurse was feasible, effective and safe . (J Interven Cardiol 2000;3-6)     

Evidence for direct interaction between mast cells and Leishmania parasites

When stimulated through IgE- (or IgG-) immune complexes with parasite antigens, mast cells can release several cytokines, including IL-4, IL-6, IL-10, IL-12, Interferon-γ (IFN-γ) and tumour necrosis factor-α (TNF-α) that may influence the host response to Leishmania major in modulating lesion size and persistence during experimental infection in the mouse. Moreover, recent data demonstrated that mast cells are able to be antibody-independently activated by direct contact with bacteria, making them important elements in innate immunity. Given these data, we asked whether cell-parasite contact could directly induce mast cell mediator release and whether mast cells could be infected by L. major or L. infantum parasites.    In this study, we showed that a pure homogeneous population of mouse bone marrow derived mast cells (BMMC) in contact with living L. major or L. infantum promastigotes, but not with attenuated parasites or soluble parasite antigens, released preformed mediators such as β-hexosaminidase and the preformed pool of TNF-α within minutes. Furthermore, direct cell-parasite contact induced TNF-α synthesis by mast cells within hours. Moreover, we demonstrated by in vitro co-culture experiments that metacyclic L. major or L. infantum promastigotes are directly infective for a significant proportion of BMMC and are transformed into intracellular amastigotes. Taken together, these data suggest that mast cell can participate in the first line of defence, i.e. innate immunity, during local cutaneous infection with Leishmania parasites.     

Comparison of Signal-Averaged Electrocardiograms with Different Levels of Noise: Time-Domain, Frequency-Domain, and Spectrotemporal Analysis

In order tn test the effect of noise on the various parameters of the SAECG, 83 patients underwent three consecutive recordings at different noise levels. The high noise (HN) recordings had a noise level of 0.60–0.74 μV. the intermediate noise (IN) had 0.31–0.59 μV, and the low noise (LN) had ≤ 0.30 μV. For the calculation of noise we used the standard deviation of the mean noise of the composite lead high pass filtered at 40 Hz. The recordings were compared using time-domain, frequency-domain, and spectrotemporal analysis. The time-domain parameters of the LN recordings, using 25-Hz, 40-Hz, and 60-Hz high pass cutoffs, were significantly different from those of the HN or IN recordings (P < 0.05). In the frequency-domain analysis, significant differences were found in some of the parameters of the LN compared to the HN. The spectrotemporal analysis of the X and Z leads also showed significant differences among the LN and the other recordings. In the time-domain analysis, both at 40 Hz and 25 Hz, there were more abnormal LN compared to the HN recordings (P < 0.05). In the spectrotemporal analysis, there were significantly more abnormal HN and IN recordings compared to the LN (P < 0.001 and P < 0.01. respectively). Therefore, the level of noise, even within the acceptable range, can significantly affect the SAECG. In the time domain at the lower noise levels the parameters become more abnormal, while the opposite seems to occur in the spectral and the spectrotemporal analysis.     

The Role of the Selective Serotonin Re‐Uptake Inhibitor Sertraline in Nondepressive Patients with Chronic Ischemic Heart Failure: A Preliminary Study

Background: Selective serotonin re‐uptake inhibitors (SSRIs) have been associated with better psychiatric status, functional capacity, and fewer arrhythmias in depressive patients with heart failure (HF). In this study, we tested the impact of sertraline (an SSRI) on patients with HF, but not clinical depression. Methods: We studied 62 clinically stable, nondepressive patients with ischemic HF (New York Heart Association class: I‐II), and implantable cardioverter‐defibrillator (ICD). Following psychiatric evaluation and quality of life (QoL) assessment, 24‐hour electrocardiogram recordings including heart rate variability (HRV) and ICD interrogation were performed every 4 months for 1 year. Ventricular effective refractory period (ERP) at 600‐, 500‐, and 400‐ms cycle length and the inducibility of ventricular tachycardia (VT) were assessed via the ICD. After that, sertraline 50 mg/day was administered for 12 months and the whole evaluation was repeated. Results: Sertraline was associated with fewer ventricular extrasystoles per 24 hours and a significant change in HRV (increase in mean R‐R, 5‐minute standard deviation of RR intervals, and root mean‐square difference of successive RR intervals, and reduction in ultra and very low frequency). It was also followed by an improvement in patients’ QoL. A trend toward a decrease was observed in the number of recalled nonsustained VTs. The episodes of sustained VT were not significantly reduced. Ventricular ERPs and VT inducibility remained unaltered. Conclusion: In clinically stable, nondepressive patients with ischemic HF and ICD, sertraline is associated with reduced ventricular extrasystoles, better QoL, and a possible improvement in some HRV indexes. This suggests that SSRIs may have a favorable clinical impact on these patients, independent of the improvement in depressive symptoms. (PACE 2010; 33:1217–1223)     

Clinical and polysomnographic determinants of snoring

Snoring is considered one of the hallmarks of sleep‐disordered breathing, but its determinants remain obscure in both obstructive sleep apnoea (apnoeic) and non‐apnoeic snorers. We aimed to document positional dependency of snoring along with its association with clinical and polysomnographic variables. Seventy‐seven apnoeic and 27 non‐apnoeic snorers who complained for every‐night loud snoring and slept in supine and lateral positions in all sleep stages during overnight polysomnography were included. Snoring (i.e. sound intensity > 40 dB) was quantified by measuring the mean and maximum sound intensity, and snoring frequency. In apnoeic and non‐apnoeic snorers, mean snoring intensity and snoring frequency were higher in supine than in lateral positions irrespective of sleep stage, and were also usually higher in N3 in comparison to rapid eye movement and/or N2 sleep stage in any given position. Positional change in snoring intensity as expressed by the ratio of mean intensity in the supine to lateral positions was independently and positively correlated with body mass index, tonsils size and age in the total of patients. Snoring is more prominent in the supine position and in N3 sleep stage in apnoeic and non‐apnoeic snorers. Snoring positional dependence is determined by body mass index, tonsils size and age.     

BLOCKAGE OF THE POSITIVE FEEDBACK EFFECT OF OESTRADIOL DURING PROLONGED ADMINISTRATION OF CLOMIPHENE CITRATE TO NORMAL WOMEN

The effect of clomiphene citrate on the occurrence and timing of the endogenous LH surge in superovulated cycles is unclear. To study further this event, five normally ovulating women were treated with clomiphene citrate 100 mg per day in two different cycles, that is, for 5 days in one cycle (days 2 to 6, CC-5) and for 15 days in another cycle (days 2 to 16, CC-15). During the CC-5 cycle, the normal pattern of LH levels seen in spontaneous cycles was observed with an endogenous LH surge in all women followed by ovulation and normal luteal function. In contrast, during the CC-15 cycle, a continuous and progressive increase of basal LH levels was seen with no surge, resulting in follicular luteinization but no ovulation. The results suggest that in normal women treated with clomiphene the occurrence of an endogenous LH surge is dependent on a significant decrease in the circulatory concentration of clomiphene at mid-cycle.     

Carotid Sinus Hypersensitivity is Common in Patients Presenting with Hip Fracture and Unexplained Falls

Background: We tried to determine the prevalence of carotid sinus hypersensitivity (CSH) in patients with hip fractures with and without a clear history of an accidental fall.
Methods: We studied 51 patients hospitalized for a hip fracture and 51 matched controls from our outpatients department. All patients were subjected to a carotid sinus massage in the supine and upright position . Patients were categorized in accidental (Group A) and unexplained (Group B) fallers.
Results: Six of 33 (18.2%) patients in Group A and 12 of 18 (66.7%) patients in Group B ( P < 0.001) had a positive response to the carotid sinus massage. Nine controls (17.6%) also demonstrated CSH. Patients in Group B were older (A: 75.5 ± 8.5 years vs B: 80.1 ± 5.9 years, P = 0.029) and were more likely to have a history of unexplained falls or syncope in the past (A: 0% vs B: 66.7%, P < 0.0001) than individuals in group A. Vasodepressor/mixed forms accounted for the majority of CSH responses in Group B (75%). When compared with the control group, CSH was still more common in Group B (B: 66.7% vs control: 17.6%, P < 0.0001) but not in Group A (A: 18.2% vs control: 17.6%, P = 1.000).
Conclusions: The prevalence of CSH is increased in elderly patients with hip fractures, only in those who present with an unexplained fall and report a history of syncope or unexplained falls in the past. The vasodepressor/mixed forms account for the majority of CSH responses in the group of unexplained fallers.