Experimental Evaluation of a New Tubular Coronary Stent (V-Flexª)

The safety, efficacy, angiographic and histological effects of a new 316 L, SS seamless stainless steel tubular stent (V-Flexa, Global Therapeutics, Broomfield, Colorado) was evaluated in a porcine coronary and peripheral artery model. Implantation in the right coronary artery was successful in all 16 pigs. Eight pigs were angiographically controlled after 6 weeks and then sacrificed for morphometric analysis. All stented coronary vessels were widely patent at this moment and morphometric analysis showed only a mild fibromuscular neointimal hyperplasia resulting in a neointimal hyperplasia of 1.15 +/- 0.38 mm2. The remaining 8 pigs were controlled and sacrificed at 12 weeks. At that time, all stented vessels were patent and neointimal hyperplasia was 1.22 +/- 0.34 mm2. Comparison with the Palmaz-Schatza coronary stent (Cordis, Miami, Florida) in a porcine peripheral artery model demonstrated significantly less neointimal hyperplasia at 6 weeks (1.11 +/- 0.73 vs. 2.40 +/- 0.36, p = 0.001) and at 12 weeks (1.53 +/- 0.42 vs. 2.47 +/- 0.63, p = 0.003) for the V-Flex stent. In conclusion, V-Flex coronary stent implantation in a porcine coronary and peripheral arteries results in a high procedural success rate without subacute thrombotic occlusions, despite no further anticoagulation nor antiplatelet therapy. Six and 12 week histopathological and morphometric evaluation demonstrated only a mild fibromuscular neointimal hyperplasia. Comparison with the Palmaz-Schatz coronary stent in a peripheral artery model showed significantly less neointimal hyperplasia in the V-Flex stent.     

Non surgical management of pseudoaneurysms

Background: The incidence of pseudoaneurysm has increased due to the large number of vascular procedures performed and the widespread use of anticoagulation therapy during procedures. Non-invasive methods for management of pseudoaneurysms comprise of ultrasound guided compression (USGC), thrombin therapy, arterial embolisation and endovascular stent graft insertion. We discuss our experience in the management of fourteen cases of pseudoaneurysms using non surgical techniques.     

Impact of Multidetector CT on 3D CT Angiography

3D Computed Tomographic Angiography (CTA) is a noninvasive volumetric imaging technique increasingly used for evaluation of vascular system. The introduction of Multidetector CT (MDCT) has increased scanning speed, allowing shorter acquisition time, greater volume coverage and decreased contrast requirement while diminishing respiratory motion artifacts. Thin-slice collimation protocols are routinely used which generate isotropic 3D voxels that improve image quality. The ideal CTA study requires scanning at peak vascular enhancement for optimal opacification of arteries with separation of arteries and veins. MDCT has enabled complete lower extremity inflow and runoff studies with a single injection, as well as thin-section CTA covering the entirety of the Carotid arteries and Circle of Willis. Sixteen row MDCT has increased scanning speed further facilitating the development of novel applications such as coronary CTA. CTA when perfomed with MDCT offers a “one scan – many views” option useful in imaging vascular diseases. CTA has important advantages over conventional angiography, such as reduced risk, diminished time and better patient acceptance. With MDCT, 3D CTA is crossing vessel tortuosity and evaluation of vessel fragility.Key Words: Multidetector CT, CT angiography, Volume Rendering     

Relationships between dietary intake and cognitive function level in Korean elderly people

We examined the relationship between dietary intake and cognitive performance in Korean elderly people. Data for dietary intake, anthropometric measurements and cognitive function tests were collected and the relationships of the variables were analyzed. A random sample of 210 men and 239 women in Korea, aged 60 and over, was selected. Subjects were free-living elderly people who had not experienced major cognitive function impairment. Main outcome measures, 24 h dietary recall method, food behaviour variables, anthropometrics indices, health variables, and Kwon's Mini-Mental State Examination for Koreans (MMSE-K) for cognitive function test. The prevalence rate of poor cognitive function (MMSE-K score < or = 19) of Korean elderly was 22.3%: women with poor cognitive function had a higher rate (31.0%) than that in men (12.3%). Cognitive ability was related negatively with age and positively with school education level. Female subjects of poor cognitive function had significantly lower intakes of total amount of foods, cereals, vegetables, fruits, milk, spices, and also, energy, protein, fat, carbohydrate, Ca, P, Fe, vitamin A, thiamin, riboflavin, and niacin than those of the normal cognitive score (> or = 24) group (P < 0.05). Male subjects of poor cognitive function had significantly lower intakes of fruits, fiber, and vitamin C than the normal subjects (P < 0.05). The MMSE-K score of female subjects showed a significant positive correlation with total amount of foods, cereals, beans, fruits, milk, oil, spices, and energy, protein, fat, carbohydrate, Ca, Fe, P, riboflavin and niacin intakes. The consumption of adequate nutrients, by taking sufficient amounts and variety of foods, may be important in maintaining adequate cognitive function in elderly Koreans.     

Effect of wound infiltration with bupivacaine on pulmonary function after elective lower abdominal operations

Background

Subcutaneous or intrafascial wound infiltration of local anaesthetic with systemic opioids has been shown to enhance patient comfort with improved analgesia and reduced opioid requirements.

Objective

To demonstrate improved pulmonary function when postoperative analgesia was provided by combined bupivacaine wound infiltration and systemic opioid.

Methods

In a prospective, randomized, placebo-controlled study, 46 patients (23 per group) scheduled for elective gynaecological surgery under general anaesthesia had subcutaneous and intrafascial wound infiltration of 40 ml, 0.25% bupivacaine (study patients) or 40 ml 0.9% saline (control) just before the end of surgery. Forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1) and peak expiratory flow rate (PEFR) were done before surgery and at 6, 12 and 24 hours postoperatively. Student''s T and chi-square tests were used for tests of significance set at P < 0.05.Postoperative analgesia was provided with intramuscular morphine 0.15mg/kg 4hourly and 10mg/kg of intravenous paracetamol as rescue analgesia.

Results

PEFR, FVC and FEV1 were reduced in both the control and study groups but the reduction was greater in the control group.

Conclusion

Bupivacaine wound infiltration produced statistically significant elevations in pulmonary function tests results at all assessment periods.     

The histopathological effects of reabsorbable polyethylene glycol hydrogel (Coseal) on epidural fibrosis in an experimental postlaminectomy model in rats

Background/aimTo investigate the histopathological effects of reabsorbable polyethylene glycol hydrogel (RPGH, Coseal) on epidural fibrosis (EF) following laminectomy in rats.Materials and methodsA total of 24 rats were equally divided into three groups. In the first group, no treatment was applied after laminectomy (control group, Group 1). In the second group, hemostasis was achieved after laminectomy, and 2 mm absorbable gelatin sponge soaked in saline was placed over the epidural space and the wound was closed (Group 2). In the third group, hemostasis was achieved following laminectomy, and 0.5 mL RPGH (Coseal, Group 3) was squeezed over the dura mater, and the wound was closed. A histopathological examination was undertaken to evaluate arachnoidal invasion and EF.ResultsThe results of EF in the Group 2 and Group 3 were significantly lower compared to the Group 1 (p = 0.023 and p = 0.002, respectively). No statistically significant difference was found between the Group 2 and Group 3 in terms of EF (p = 0.957). There was also no statistically significant difference between the mean arachnoidal invasion of the three groups (p > 0.171). However, the rate of arachnoidal invasion was the lowest in the Group 3.ConclusionIntraoperative Coseal, a polyethylene glycol polymer, tends to reduce the risk of epidural fibrosis, although this is not statistically significant.     

Evaluation of the relationship between cranial magnetic resonance imaging findings and clinical status in children with cerebral palsy

Background/aimThe objective of this study was to evaluate the relationship between cranial magnetic resonance imaging (MRI) findings and clinical features in cerebral palsy (CP).Materials and methodsChildren aged 3 to 18 years, who were followed with the diagnosis of CP between January 2012 and September 2015, were included. The type of CP was classified using the European Cerebral Palsy Monitoring Group’s classification system and then, patients were divided into two groups as spastic or nonspastic groups. The Gross Motor Function Classification System (GMFCS) was used to determine the level of mobility. According to the GMFCS, levels 1, 2, and 3 were grouped as mobile, and levels 4 and 5 were grouped as immobile. Cranial MRI findings were reevaluated by a voluntarily radiologist and grouped as periventricular leukomalacia (PVL) (grades 1, 2, and 3), cerebral atrophy, migration anomaly, cerebellar involvement, basal ganglion involvement, and normal MRI findings.ResultsSixty-two patients were enrolled. The rate of mobile patients did not differ between the spastic and nonspastic groups. The incidence of PVL was significantly higher in cases of prematurity and spastic CP ( p < 0.05). The rate of mobilization was significantly lower and the rate of epilepsy was significantly higher in patients with PVL. Immobile patients were more common among cases of grade 3 PVL ( p < 0.05). Conclusion The most common cranial MRI pathology was PVL, and the presence of PVL and its grade might help clinically assess the patient’s CP type and level of mobilization. While pathology was observed mostly in cranial MRI in cases of CP with similar clinical features, the fact that cranial MRI was completely normal for 14.5% of the cases suggests that there may be some pathologies that we could not identify with today’s imaging technology.