What Can Be Expected of Balloon Aortic Valvuloplasty in Adults?

Introduced more than 15 years ago, balloon aortic valvuloplasty (BAV) has clearly delineated indications and limitations. Although, aortic valve replacement is undoubtedly the treatment of choice for healthy patients with aortic stenosis, BAV has been demonstrated as a valuable and safe palliative procedure for patients considered too risky or old for current day surgery. Between January 1991 and December 1999, 858 patients (mean age 76 ± 11 years, 479 [57%] women) underwent BAV at our center. Indications for BAV were contraindication to surgery in 16.2% of the patients, high risk in 40.4%, refusal of surgery in 10.7%, personal decision in 18.5%, and other in 14.2%. The mean gradient decreased from 65 ± 23 to 27 ± 12 mmHg and the valve area increased from 0.56 ± 0.19 cm² to 1.0 ± 0.38 cm². Eleven (1.1%) patients died during the procedure. The other severe complications were complete AV block in 18 (1.8%) patients, stroke in 8 (0.8%), tamponade in 6 (0.6%), and massive aortic insufficiency in 4 (0.4%). In conclusion, BAV does not replace valve replacement, even in the elderly. All those who can be operated on, should be. However, if surgical intervention is not considered reasonable, BAV offers good immediate results with an acceptable complication rate. Furthermore, previous published series have demonstrated that BAV is particularly indicated in specific subgroups, such as very old patients with high operative risk, end-stage heart failure, cardiogenic shock, or general anesthesia for noncardiac surgery.     

003 胺碘酮可作为心房纤颤转复为窦性心律的首选药物

在美国,胺碘酮仅被批准用于治疗致命性室性心律失常,而在其他国家,尤其是南欧,也被广泛用于心房纤颤(Af)的治疗。然而有关胺碘酮复律效果报道不一,其成功率在16％～92％。本文前瞻性随机对照研究胺碘酮作为Af复律的首选药物的疗效及安全性。 连续208例症状性Af,男性102例,女性106例,年龄27～78(65±10)岁。将受试者随机分为胺碘酮治疗组与安慰剂组。胺碘酮用法：300mg静脉注射,持续1小时,然后以20mg/kg静脉滴注,持续24小时,继之口服200mg,tid,共1周,400mg/d共3周。如果受试者此前未用地高辛,则给予地高辛0.5mg静脉注射,2小时后再静脉注射0.25mg,继之静脉注射0.25mg,q6h,共24小时,此后调整地高辛剂量以维持治疗剂量的血清浓度,对Af持续48小时以上或持续时间不明、未用抗凝药物者均应用醋硝香豆素(acenocoumaro1),至少21天,复律成功者继续用药21天,未成功者用药时间不定。本研究将Af持续1个月以上者定义为慢性Af,＜24小时者定义为新近发作Af,其余定义为持续性Af。     

A retrospective study on chemical and radioactive synovectomy in severe haemophilia patients with recurrent haemarthrosis

Between 1970 and 1994, 116 chemical and 90 radioactive synovectomies were performed in 107 patients with severe haemophilia and two with type 3 von Willebrand's disease. The products used were osmic acid (OA) in 100 cases, 90-Yttrium in 35 cases, 186-Rhenium in 48, 169-Erbium in two, hexacetonide triamcinolone in 16 and radioactive gold in five cases. The use of radioactive colloids is not allowed in France in patients under 15 years of age. Twenty-nine patients had more than one synovectomy per joint. All patients were evaluated for 6 months post-synovectomy, using both a clinical and a radiological score. Six months after synovectomy, a good or excellent result was obtained for 81% of the joints treated with isotopes, compared with 44% of those treated with OA, P<0.001. This superiority of isotopes over osmic acid was still observed after 6 months for the 89 joints that were re-evaluated, with follow-up ranging from 1 to 9 years. It was possible to calculate a radiological score in 84 cases. With OA the best results were from the joints with the lowest scores pre-synovectomy (<7). No correlation could be established between the clinical and the radiological scores, due to the small size of the sample. In summary: (1) chemical and radioactive synovectomy are simple and safe procedures for haemophilic arthropathy, (2) in our series, after 6 months the efficacy of isotopic synovectomy was greater than that of chemical synovectomy, and this benefit seems to persist after 6 months, and up to 9 years in the group of patients with longer-term follow-up.     

Validation of a low-cost laser scanner device for the assessment of three-dimensional facial anatomy in living subjects

The present study compared the reliability of a low-cost laser scanner device to an already-validated stereophotogrammetric instrument. Fifty volunteers underwent duplicate facial scans through laser scanner and stereophotogrammetry. Intra- and inter-instrument reproducibility of linear distances, angles, facial surface area and volume was verified through the Bland–Altman test and calculation of absolute (TEM) and relative (rTEM) technical errors of measurement; rTEM was then classified as follows: <1% excellent; 1–3.9% very good; 4–6.9% good; 7–9.9% moderate; >10% poor. The scans performed through different devices were registered and superimposed to calculate the root mean square (RMS) (point-to-point) distance between the two surfaces. The same protocol was applied to a mannequin head. In inter-instruments comparison, 12/26 measurements showed a “good” rTEM; 5 were “very good”. In intra-instrument comparison, most performances worsened, with only 10 of 26 measurements classified as “good” and “very good”. All the measurements made on mannequin scans were at least “good”, and 14/26 were “very good”. Surface area was “very good” only in intra-instrument comparison; conversely, volumes were poorly repeatable for all the comparisons. On average, RMS point-to-point distances were 0.65 mm (inter-devices comparison), 0.56 mm (mannequin scans), 0.42 mm (intra-device comparison). In conclusion, the low-cost laser scan device can be reliably applied to inanimate objects, but does not meet the standards for three-dimensional facial acquisition on living persons.     

An uncommon case of right ventricular dilatation: ventricular noncompaction

A 32 years old asymptomatic woman had the echocardiographic finding of right ventricular dilatation and underwent a CMR in another institution which confirmed the findings; fat right ventricular wall infiltration was reported and Arrhythmogenic Right Ventricular Dysplasia was diagnosed; no arrhythmia was inducible by electrophysiologic test. The patient remained asymptomatic for eight years else; she came to our attention for control and because of normal EKG and absence of arrhythmias another CMR was performed. Examination showed right ventricular dilatation and mild systolic dysfunction, along with findings of right ventricular noncompaction; additionally typical left ventricular noncompaction was found. Right ventricular noncompaction should be included in the differential diagnosis of right ventricular dilatation. Due to the superior anatomic and physiologic definition, CMR is crucial in right ventricular evaluation. Old diagnosis of ARVD, if not entirely convincing, should be reevaluated.     

In vivo biologic effects of PIXY321, a synthetic hybrid protein of recombinant human granulocyte-macrophage colony-stimulating factor and interleukin-3 in cancer patients with normal hematopoiesis: a phase I study

PIXY321 is a novel fusion protein of recombinant human granulocyte- macrophage colony-stimulating factor and interleukin-3 that exhibits biologic effects of both its parent cytokines in vitro and in preclinical studies. To evaluate the clinical safety and hematopoietic effects of this hybrid cytokine, PIXY321 was administered by subcutaneous injection twice daily at doses of 25 to 1,000 micrograms/m2/day over 14 days to 24 patients with sarcoma before chemotherapy as part of a phase I trial. The treatment was associated with significant increases in white blood cell, neutrophil, platelet, and reticulocyte counts (all P < .001). The increase in neutrophil count was dose-related and was seen during treatment with the cytokine, whereas the increase in platelet count was gradual and peaked after the cessation of the cytokine treatment and was not clearly dose related. PIXY321 treatment also increased bone marrow (BM) cellularity and the percentage of BM cells in S phase (P < .001). In addition, there was a significant increase in the number of CD34+ cells and committed and multipotential progenitors in the peripheral blood. The ex vivo expansion capacity of peripheral blood and BM progenitor cells was preserved after the in vivo treatment with PIXY321. The treatment was well tolerated, with the most common side-effect being injection site reactions. The results of this study show the biologic and clinical activity of a genetically engineered fusion molecule of two hematopoietic cytokines in humans with normal hematopoietic function.     

Human platelets exert cytotoxic effects on tumor cells

Monocytes are thought to play a role in host resistance to tumor cell growth in animals and humans. In addition, platelets are known to be involved in tumor metastases. To investigate the interaction of these two cell types and their effect on tumor cells, human monocytes and platelets were examined using an in vitro monocyte-tumor cell cytotoxicity assay. Monocytes alone resulted in 32% +/- 1.5 (mean +/- SEM) tumor cell kill. When platelets were added to monocytes in a 1:1 ratio, an increase in cytotoxicity to 61% +/- 3.2 was observed. The cytotoxicity noted when platelets were added to a fixed number of monocytes and tumor cells was dependent on the number of platelets added. A decrease in cytotoxicity from 32% +/- 1.5 to 12% +/- 2.3 was observed when contaminating platelets were removed from monocyte preparations. Platelets added to tumor cells in the absence of any monocytes were also toxic, resulting in a maximum kill of 95% at a 4:1 platelet/tumor cell ratio. Secreted products of freshly isolated platelets may be responsible for much of the observed cytotoxicity, since supernatants from the platelets were toxic for tumor cells. Platelets pretreated with a cyclooxygenase inhibitor (ASA) or a lipoxygenase inhibitor had decreased cytotoxicity compared with untreated platelets. Our results indicate that products of platelet arachidonate metabolism are toxic for tumor cell lines. They also suggest that the role of the platelet must be considered when studying monocyte-tumor cell cytotoxicity.