Comparison of two platelet glycoprotein IIb/IIIa inhibitors,eptifibatide and abciximab: outcomes,complications and thrombocytopenia during percutaneous coronary intervention

BACKGROUND: Platelet glycoprotein IIb/IIIa inhibitors have significantly reduced the incidence of 30-day ischemic events during percutaneous coronary interventions (PCI). However, each of the three currently available agents has different pharmacological characteristics, safety, efficacy and costs. There has not been a direct comparison between eptifibatide and abciximab in the rates of major adverse cardiac events, major complications and thrombocytopenia. METHODS: A total of 642 consecutive patients underwent PCI at our institution between January 2000 and December 2001 and were treated with either eptifibatide (n = 342) or abciximab (n = 300) during the procedure. The selection of the IIb/IIIa inhibitor was arbitrary and left to the discretion of the operator. Complete blood counts were performed by routine protocol on all patients 2 and 4 hours after initiation of the drug. We analyzed the in-hospital clinical outcomes and the incidence of thrombocytopenia in this cohort. RESULTS: Baseline clinical and angiographic characteristics and concomitant drug treatment were similar between the 2 groups, except for a higher incidence of diabetes in the eptifibatide group. The rates of in-hospital death (1.2% eptifibatide group versus 1.0% abciximab group; p = 0.7), stroke (0% for both groups), target vessel revascularization (1.2% eptifibatide group versus 1.0% abciximab group; p = 0.8) and major bleeding complications (1.7% eptifibatide group versus 0.7% abciximab group; p = 0.2) were similar between the 2 groups. Thrombocytopenia was more frequent in the abciximab-treated patients (6%, versus 0% in the eptifibatide group; p < 0.001), including 5 patients who developed profound thrombocytopenia (< 20,000 cells/mm3). CONCLUSION: Both agents, eptifibatide and abciximab, proved to have the same rates of in-hospital major adverse cardiac events, bleeding and vascular complications. Abciximab therapy was associated with a significantly higher incidence of thrombocytopenia within 4 hours of drug initiation, which prompted immediate drug discontinuation, but was not associated with increased risk of bleeding, vascular or other complications.     

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.     

Heparanase procoagulant activity is elevated and predicts survival in non-small cell lung cancer patients

Background

Heparanase is implicated in angiogenesis and tumor progression. We had earlier demonstrated that heparanase may also affect the hemostatic system in a non-enzymatic manner. It forms a complex and enhances the activity of the blood coagulation initiator- tissue factor (TF). Although increased heparanase antigen level in the plasma and biopsies of cancer patients was previously demonstrated, in the present study we evaluated, for the first time, the heparanase procoagulant activity in the plasma of patients with lung cancer.

Materials and Methods

Sixty five patients with non-small cell lung cancer at presentation and twenty controls were recruited. Plasma was studied for TF / heparanase procoagulant activity, TF activity and heparanase procoagulant activity using chromogenic assay and heparanase antigen levels by ELISA.

Results

Heparanase antigen levels were higher in the study group compared to control (P = 0.05). TF / heparanase activity, and even more apparent, heparanase procoagulant activity were significantly higher in the study group compared to controls (P = 0.008, P < 0.0001, respectively). No significant difference was observed in the TF activity between the groups. Survival of patients with heparanase procoagulant activity higher than 31 ng/ml predicted a mean survival of 9 ± 1.3 months while heparanase procoagulant activity of 31 ng/ml or lower predicted a mean survival of 24 ± 4 months (P = 0.001). Heparanase procoagulant activity was higher than 31 ng/ml in the four cases of thrombosis detected during the follow-up period.

Conclusions

Elevated heparanase procoagulant activity in patients with lung cancer reveals a new mechanism of coagulation system activation in malignancy. Heparanase procoagulant activity can potentially be used as a predictor for survival.     

Correction to: Sinus augmentation analysis of the gradient of graft consolidation: a split-mouth histomorphometric study

Clinical Oral Investigations - Figure 1 was reused with permission from "Wiley", the publisher of a previous article by the same authors, DOI:10.1111/cid.12518.     

Increased prevalence of obstructive lung disease in patients with obstructive sleep apnea

Study purposes

This study aims to determine whether there is an increased prevalence of obstructive lung diseases (OLDs) in patients with obstructive sleep apnea (OSA). We also determined whether among the OLD patients there is a difference in the prevalences of specific chronic disease co-morbidities between patients with and without OSA.

Methods

The prevalences of COPD, asthma, and COPD combined with asthma (ICD-9 coding) were compared between 1,497 adult OSA patients and 1,489 control patients, who were matched for age, gender, geographic location, and primary care physician. The prevalences of specific co-morbidities were measured in the OLD groups between patients with OSA and the matched control group.

Results

COPD, asthma, and COPD combined with asthma were found to be more prevalent among OSA patients compared to the matched controls. Prevalences among patients with and without OSA, respectively, were COPD—7.6 and 3.7 % (P?<?0.0001), asthma—10.4 and 5.1 % (P?<?0.0001), COPD plus asthma—3.3 and 0.9 % (P?<?0.0001). The Charlson Comorbidity Index was greater for OSA patients (2.3?±?0.2) than for controls (1.9?±?1.8; P?<?0.0001). These trends held for all severity ranges of OSA. Patients with OSA and COPD were characterized by more severe hypoxia at night compared with the OSA patients without OLD.

Conclusion

OSA was associated with an increased prevalence of OLDs.     

Long-term results of prolapse recurrence and functional outcome after vaginal hysterectomy

ObjectiveTo evaluate the incidence of prolapse and prolapse-related symptoms following vaginal hysterectomy.MethodsData were reviewed from women who underwent vaginal hysterectomy between 1988, and 1995, at St George's Hospital, London, UK, and attended long-term follow-up. Outcome measures included a questionnaire for prolapse, urinary, bowel, and sexual symptoms; and a vaginal examination.ResultsAmong 94 women attending long-term evaluation, the mean follow-up time was 100.7 months (range 67.0–156.0 months). Before vaginal hysterectomy, urgency was noted among 23 (24.5%), urge incontinence among 11 (11.7%), and stress incontinence among 8 (8.5%) women. At follow-up, these symptoms were observed among 23 (24.5%), 13 (13.8%), and 6 (6.4%) women, respectively. De novo urge incontinence and de novo stress incontinence were observed among 3 (3.2%) and 2 (2.1%) women, respectively. Vaginal examination data were compared for 70 women, of whom 18 (25.7%) had grade 1, 40 (57.1%) had grade 2, and 6 (8.6%) had grade 3 uterine prolapsed before surgery. Postoperatively, vaginal vault prolapse occurred in 7 (10.0%) women and correlated with degree of posterior prolapse (P = 0.007), but not with severity of uterine descent (P = 0.205) or previous prolapse surgery (P = 0.573).ConclusionThe incidence of post-hysterectomy vault prolapse correlated with the degree of preoperative rectocele.