The relationship between corrected TIMI frame count and myocardial fractional flow reserve

Thrombolysis in myocardial infarction (TIMI) frame count (TFC) is a reproducible, objective and quantitative index of coronary flow that allows standardization of TIMI flow grades. After myocardial infarction (MI), hyperemic and basal flows decrease in the infarct region due to residual stenosis and increased resistance in the microvasculature subtended by this infarct-related artery (IRA). Myocardial fractional flow reserve (FFRmyo) is a lesion-specific index for epicardial stenosis. FFRmyo can also be used as a criterion for assessing the success of revascularization therapy. The aim of this study was to investigate the relationship between improvement of the corrected TFC (CTFC) and change in FFRmyo, which were determined in the IRA in patients with recent MI who underwent mechanical revascularization. METHODS: Forty-one patients (28 male; age, 58.3 +/- 12.3 years) early after MI with > 60% narrowing in the IRA who underwent stent implantation for this residual stenosis were included in this study. After angiography, a fiber-optic pressure monitoring guidewire was positioned distal to the stenosis to be dilated. Means of aortic (Pa) and distal (Pd) pressures were recorded simultaneously under baseline and hyperemic conditions. FFRmyo (Pd/Pa) was determined under adenosine hyperemia before and after stent implantation, as was TFC. Percentage of the improvement in the CTFC and FFRmyo was calculated for each lesion. The first frame used for TFC was defined by a column of contrast extending across > 70% of the arterial lumen and last frame counted was that in which contrast first appeared in the distal, pre-defined landmark branches for each vessel. CTFC was calculated for the LAD by dividing TFC of the LAD by a factor of 1.7. RESULTS: Eighteen patients had LAD, 10 had CX and 13 had RCA lesions. After stent implantation, the CTFC improved by 41% (from 32.3 +/- 3.4 to 19.2 +/- 2.1; p < 0.0001) and FFRmyo improved by 69% (from 0.53 +/- 0.11 to 0.90 +/- 0.15; p < 0.0001). There was a statistically significant correlation between the change in FFRmyo and improvement in the TFC (r = 0.85). CONCLUSION: Improvement in CTFC is associated with change in FFRmyo in the IRA undergoing mechanical revascularization. After mechanical revascularization, CTFC decreases proportionally to improvement of the FFRmyo. These two parameters support each other in terms of successful revascularization and this relationship shows the recruitability of CTFC in terms of FFRmyo as well.     

Extended release lipophilic indomethacin microspheres: formulation factors and mathematical equations fitted drug release rates.

Extended release liphophilic microspheres of indomethacin were prepared using cetostearyl alcohol (CsA), stearyl alcohol (SA) and cetyl alcohol (CA) in the various drug-lipid ratios. The release of indometacin was studied on the basis of USP criteria and the effects of drug-lipid ratio, the size of microspheres and carboxymethylcellulose sodium (CMC-Na) added as a hydrophilic polymer on the drug release were investigated. In vitro dissolution studies were performed using USP XXIII apparatus I at pH 6.2. Release profiles were evaluated according to first order, Higuchi square root of time and Hixson-Crowell cube root models. The best fit was found with the square root of time model (r2=0.991) for the microspheres (125-250 microm) prepared in 1:4:1 drug-lipid-copolymer ratio using stearyl alcohol. With a further regression analysis, an excellent equation (Release%=-10.721+42.549*square root of (t)-4.027*t) was developed for empirical drug estimation (r2=0.998).     

Immune thrombocytopenia associated with pulmonary tuberculosis

Many hematological abnormalities, such as pancytopenia, anemia, and leukocytosis, can be associated with tuberculosis (TB). Immune thrombocytopenic purpura (ITP) is an extremely rare event in TB. We report a 46-year-old male patient who was admitted to hospital with a history of weight loss, combined with hemoptysis, fever, cough, sputum, general malaise, and night sweats. Physical examination revealed a body temperature of 38.8°C, and petechiae distributed over the lower extremities. Laboratory findings were as follows: erythrocyte sedimentation rate, 84 mm/h; white blood cells, 7070/mm³; hemoglobin, 11.7 g/dl; and platelet count, 4000/mm³. On Ziehl-Neelsen stain of sputum, acid-fast bacilli were observed. Anti-tuberculosis therapy was started, together with prednisolone, 0.5 mg/kg per day, from the day of admission. He was treated successfully with the steroid and antituberculous drugs.     

Spontaneous vaginal expulsion of an infected necrotic cervical fibroid through a cervical fistula after uterine artery embolization: a case report

BACKGROUND: Uterine artery embolization (UAE) is promising, minimally invasive therapy being offered to women for treatment of fibroids. Although it seems to be safe and effective, major complications and adverse outcomes have been reported. CASE: A patient treated with UAE for a huge cervical fibroid presented with an infected, necrotic cervical mass lesion 4 weeks after the procedure. Spontaneous vaginal expulsion of the infected cervical fibroid from the left lateral cervical fistula tract occurred 3 weeks later while the patient was receiving antibiotic therapy. After 6 months of intervention, an approximately 99% regression rate in the fibroid volume was achieved. The patient gave birth to a healthy, female infant following a spontaneous, uneventful pregnancy and vaginal delivery. CONCLUSION: UAE appears to be associated with a significant reduction in fibroid volume. Expulsion of the infected, necrotic parts of the fibroid after UAE may be accepted as a natural process. Warning the patient about this potential risk, early recognition of infective complications and lose follow up seem to be crucial to avoiding potentially fatal septic shock.     

Partial caecal necrosis

Non-occlusive caecal infarction is a rare condition that has been described in association with a variety of clinical entities, generally due to a low-flow state, and has been reported to occur in association with chronic heart disease, open-heart surgery, certain drugs, and haemodialysis.     

Chronic toxicity of pesticides to the mRNA expression levels of metallothioneins and cytochrome P450 1A genes in rainbow trout

The hazardous effects of pesticides on various metabolic pathways are a great problem for environmental health and should be well determined. In the present study, the authors treated rainbow trout with 0.6 μg/L deltamethrin for 28 days and 1.6 mg/L 2,2-dichlorovinyl dimethyl phosphate for 21 days. After this time period, the authors observed alterations in mRNA expression levels of MT-A, MT-B and CYP-1A. Chronic exposure to low levels of pesticides may have a more significant effect on fish populations than acute poisoning. While both pesticides caused a significant increase on mRNA levels of MT-A and CYP-1A, MT-B mRNA levels were increased significantly only upon deltamethin administration. The significant increase in mRNA levels of the corresponding genes may be considered as a defence mechanism in addition to the antioxidants against oxidative stress, as well as a detoxification mechanism against adverse effects of pesticides.     

Phosphodiesterase Inhibition in the Treatment of Preeclampsia: What Is New?

Purpose of Review

The present study intends to review the possibility of using phosphodiesterase inhibitors as a treatment option for preeclampsia, addressing potential risks and benefits.

Recent Findings

Preeclampsia is the most common hypertensive disorder of pregnancy, often responsible for severe maternal and fetal complications, which can lead to early pregnancy termination and death. Despite the numerous studies, its pathophysiology is still unclear, although it seems to involve a multiplicity of complex factors related to angiogenesis, ineffective vasodilation, oxidative stress, inflammatory cytokines, and endothelial dysfunction. It has been hypothetically suggested that the use of phosphodiesterase inhibitors is capable of improving placental and fetal perfusion, contributing to gestational scenario, by decreasing the symptomatology and severity of this syndrome. In this literature review, it has been found that most of the studies were conducted in animal models, and there is still lack of evidence supporting its use in clinical practice. Research in human indicates conflicting findings; randomized controlled trials were scarce and did not demonstrate any benefit in morbidity or mortality. Data regarding to pathophysiological and interventional research are described and commented in this review.

Summary

The use of phosphodiesterase inhibitors in the treatment of preeclampsia is controversial and should not be encouraged taking into account recent data.

     

Prevalence of Prothrombotic Abnormalities in Patients with Acute Mesenteric Ischemia

Acute mesenteric ischemia (AMI) is a rare condition that may be associated with a variety of congenital prothrombotic disorders (PDs). The purpose of this study was to assess the prevalence of these disorders in 28 AMI patients compared with 103 healthy individuals from the northeastern region of Turkey. They were screened for protein C, antithrombin III, and protein S deficiencies; and gene analysis was performed using the polymerase chain reaction. A PD was revealed in 16 (57%) patients and 33 (32%) controls (p = 0.020). Factor V Leiden (FVL), prothrombin G20210A mutation, and TT677 homozygous mutation of methylenetetrahydrofolate reductase was detected in 10 (36%) patients versus 16 (15%) controls (p = 0.035), 3 (11%) patients versus 10 (9%) controls (p = 1.00), and 1 (3%) patient versus no controls, respectively. Consistent with caucasian ethnic groups, there was high prevalence of PDs, especially FVL; and these abnormalities might be a significant predisposing factor in the pathogenesis of AMI.     

The influence of olanzapine on immune cells in patients with schizophrenia

In vitro and preclinical studies show that biochemical and behavioral effects of olanzapine are quite similar to those of clozapine. In recent years, some cases of reported agranulocytosis due to olanzapine have been published. However, none of these studies compared the hematological and immune parameters before and after treatment. The present study is aimed at investigating the influence of olanzapine on the immune cell parameters by comparing these before and in the third month of olanzapine treatment in patients of schizophrenia. Twenty patients who were diagnosed as schizophrenic depending on the DSM-IV diagnostic criteria were included in the study. The immune parameters of patients were compared by measuring them before the treatment and 3 months after treatment. Immune parameters were analyzed by using flow-cytometry equipment labeled Coulter Epics Elite ESP. The positivity of cell-surface antibody was evaluated as percentage. The rates of CD8 in the third month of the treatment were considerably increased relative to pretreatment. Furthermore, rates of CD4/CD8 were significantly decreased in the third month of the treatment relative to before treatment. These findings suggest that immune impairment may occur during olanzapine treatment in patients with schizophrenia.