Current role of laser angioplasty of restenotic coronary stents

Treatment of in-stent restenosis (ISR) with conventional percutaneous transluminal coronary angioplasty (PTCA) causes significant recurrent neointimal tissue growth in 30-85%. Therefore, laser ablation of intrastent neointimal hyperplasia before balloon dilation can be an attractive alternative. However, the long-term outcomes of such treatment have not been studied thoroughly enough. This prospective case-control study evaluated angiographic and clinical outcomes of PTCA alone and a combination of excimer laser coronary angioplasty (ELCA) and adjunct PTCA in 125 patients with ISR. ELCA was performed before balloon dilation in 67 patients, PTCA alone was performed in 58 patients. Basic demographic and clinical data were comparable in both groups. Lesions included in ELCA group were longer (17.1+/-9.9 vs 13.6+/-9.1 mm; p = 0.034), more complex (36.5% type C stenoses vs 14.3%; p = 0.006), and more frequently had reduced distal blood flow (TIMI <3: 18.9% vs 4.8%; p = 0.025) compared to lesions in the PTCA group. Immediate angiographic results of PTCA and ELCA + PTCA appeared to be comparable. PTCA alone was successful in 57 patients (98.3%), ELCA + PTCA, in 66 patients (98.5%). The rates of hospital complications were comparable (3.0% in ELCA group vs 8.6% in PTCA group). The 1-year follow-up showed that the rates of major adverse cardiac events (MACE) were comparable in the 2 groups (37.3% in ELCA group vs 46.6% in PTCA group). The rates of target vessel revascularization (TVR) within 1 year after the intervention were also similar in the 2 groups (32.8% vs 34.5%). The data mean that ELCA in patients with complex ISR is efficient and safe. Despite a higher complexity of lesions in the ELCA group, no increase in the rate of complications was registered.     

Scimitar etcetera--the dysmorphic right lung

'Dysmorphic lung' is introduced as a term to describe any complex congenital malformation which involves both abnormal vascular morphology and disordered growth of a whole lung. The major group within this definition is the scimitar syndrome, which we choose to mean a hypoplastic lung with anomalous venous drainage and various degrees of collateral arterial supply. Nine typical cases of scimitar are presented, with three closely related cases. Six other cases of dysmorphic lungs are also present. The relationships between the groups are discussed, and an effort is made to clarify the nomenclature used in this condition.     

One stop shop approach for the diagnosis of liver hemangioma

Hepatic hemangioma is usually detected on a routine ultrasound examination because of silent clinical behaviour. The typical ultrasound appearance of hemangioma is easily recognizable and quickly guides the diagnosis without the need for further investigation. But there is also an entire spectrum of atypical and uncommon ultrasound features and our review comes to detail these particular aspects. An atypical aspect in standard ultrasound leads to the continuation of explorations with an imaging investigation with contrast substance [ultrasound/ computed tomography/or magnetic resonance imaging (MRI)]. For a clinician who practices ultrasound and has an ultrasound system in the room, the easiest, fastest, non-invasive and cost-effective method is contrast enhanced ultrasound (CEUS). Approximately 85% of patients are correctly diagnosed with this method and the patient has the correct diagnosis in about 30 min without fear of malignancy and without waiting for a computer tomography (CT)/MRI appointment. In less than 15% of patients CEUS does not provide a conclusive appearance; thus, CT scan or MRI becomes mandatory and liver biopsy is rarely required. The aim of this updated review is to synthesize the typical and atypical ultrasound aspects of hepatic hemangioma in the adult patient and to propose a fast, non-invasive and cost-effective clinical-ultrasound algorithm for the diagnosis of hepatic hemangioma.     

Thrust joint manipulation utilization by U.S. physical therapists*

Study Design: Online survey study.

Objective: To determine physical therapists’ utilization of thrust joint manipulation (TJM) and their comfort level in using TJM between the cervical, thoracic, and lumbar regions of the spine. We hypothesized that physical therapists who use TJM would report regular use and comfort providing it to the thoracic and lumbar spines, but not so much for the cervical spine.

Background: Recent surveys of first professional physical therapy degree programs have found that TJM to the cervical spine is not taught to the same degree as to the thoracic and lumbar spines.

Methods: We developed a survey to capture the required information and had a Delphi panel of 15 expert orthopedic physical therapists review it and provide constructive feedback. A revised version of the survey was sent to the same Delphi panel and consensus was obtained on the final survey instrument. The revised survey was made available to any licensed physical therapists in the U.S.A. using an online survey system, from October 2014 through June 2015.

Results: Of 1014 responses collected, 1000 completed surveys were included for analysis. There were 478 (48%) males; the mean age of respondents was 39.7 ± 10.81 years (range 24–92); and mean years of clinical experience was 13.6 ± 10.62. A majority of respondents felt that TJM was safe and effective when applied to lumbar (90.5%) and thoracic (91.1%) spines; however, a smaller percentage (68.9%) felt that about the cervical spine. More therapists reported they would perform additional screening prior to providing TJM to the cervical spine than they would for the lumbar and thoracic spines. Therapists agreed they were less likely to provide and feel comfortable with TJM in the cervical spine compared to the thoracic and lumbar spines. Finally, therapists who are male; practice in orthopedic spine setting; are aware of manipulation clinical prediction rules; and have manual therapy certification, are more likely to use TJM and be comfortable with it in all three regions.

Conclusion: Results indicate that respondents do not believe TJM for the cervical spine to be as safe and efficacious as that for the lumbar and thoracic spines. Further, they are more likely to perform additional screening, abstain from and do not feel comfortable performing TJM for the cervical spine.

Clinical Relevance: Our research reveals there is a discrepancy between utilization of TJM at different spinal levels. This research provides an opportunity to address variability in clinical practice among physical therapists utilizing TJM.     

Electrical pacing of the Roux limb resolves delayed gastric emptying

This study compares antegrade gastric and Roux-limb electrical pacing in the evaluation and treatment of delayed gastric emptying following vagotomy, antrectomy and Roux-Y enterostomy. Twenty-four male Sprague-Dawley rats (250 g) underwent midline laparotomy, truncal vagotomy, antrectomy, and Roux-Y jejunostomy. Pacemaker leads were implanted 1 cm apart in both the gastric fundus and proximal Roux limb. Pacing was accomplished using a 0.5 mA, 50 msec, 0.33 Hz signal and monitored by an oscilloscope. Animals were fasted for 2 hr and then gavaged with 1.0 cc of 99mTc-labeled egg white. At 1 hr rats were anesthetized. The stomach, Roux limb, small intestine, and colon were doubly ligated and excised without disturbing their contents. The total number of counts per minute per rat was determined in a gamma radiation counter, and percentage gastric emptying (GE) was evaluated. Group I controls (n = 8) retained 76 +/- 15.8% for a GE of 24%. Group II gastric paced rats (n = 8) retained 64.5 +/- 19.2% (GE 35.5%) and Group III Roux-limb paced rats (n = 8) retained 46.8% +/- 13.2 (GE 53.2%) (P less than 0.005 III vs I, P less than 0.05 III vs II). The amount of radioactive meal distal to the Roux limb was also evaluated. Group I had 15.7 +/- 16.1%, Group II (gastric paced) 20.5 +/- 19.0%, and Group III (Roux-limb paced) 37.2 +/- 11.9% (P less than 0.005 III vs I, P less than 0.05 III vs II). These data imply that Roux-en-Y limb dysmotility may contribute to delayed gastric emptying following vagotomy, antrectomy, and Roux-Y enterostomy.(ABSTRACT TRUNCATED AT 250 WORDS)     

Breast Implant–Associated ALCL: A Unique Entity in the Spectrum of CD30+ Lymphoproliferative Disorders

CD30⁺ lymphoproliferative disorders represent a spectrum of diseases with distinct clinical phenotypes ranging from reactive conditions to aggressive systemic anaplastic lymphoma kinase (ALK)⁻ anaplastic large cell lymphoma (ALCL). In January 2011, the U.S. Food and Drug Administration (FDA) announced a possible association between breast implants and ALCL, which was likened to systemic ALCL and treated accordingly. We analyzed existing data to see if implant-associated ALCL (iALCL) may represent a distinct entity, different from aggressive ALCL. We conducted a systematic review of publications regarding ALCL and breast implantation for 1990–2012 and contacted corresponding authors to obtain long-term follow-up where available. We identified 44 unique cases of iALCL, the majority of which were associated with seroma, had an ALK⁻ phenotype (97%), and had a good prognosis, different from the expected 40% 5-year survival rate of patients with ALK⁻ nodal ALCL (one case remitted spontaneously following implant removal; only two deaths have been reported to the FDA or in the scientific literature since 1990). The majority of these patients received cyclophosphamide, doxorubicin, vincristine, and prednisolone with or without radiation, but radiation alone also resulted in complete clinical responses. It appears that iALCL demonstrates a strong association with breast implants, a waxing and waning course, and an overall good prognosis, with morphology, cytokine profile, and biological behavior similar to those of primary cutaneous ALCL. Taken together, these data are suggestive that iALCL may start as a reactive process with the potential to progress and acquire an aggressive phenotype typical of its systemic counterpart. A larger analysis and prospective evaluation and follow-up of iALCL patients are necessary to definitively resolve the issue of the natural course of the disease and best therapeutic approaches for these patients.     

Positron Emission Tomography Combined With Computed Tomography as an Integral Component in Evaluation of Primary Cardiac Lymphoma

We present a case of primary cardiac lymphoma (PCL) that was initially manifest through syncopal episodes. In the diagnostic evaluation, positron emission tomography combined with computed tomography (PET‐CT) made a significant contribution—beyond that which would have been possible if only conventional imaging modalities such as magnetic resonance imaging (MRI) and transthoracic echocardiography (TTE) were utilized—and played a major role in follow‐up. Copyright © 2010 Wiley Periodicals, Inc.     

A Comparative Study of Splint Effectiveness in Limiting Forearm Rotation

Study DesignCase Study Series.IntroductionRestriction of forearm rotation may be required for effective management and rehabilitation of the upper limb after trauma.Purpose of the StudyTo compare the effectiveness of four splints in restricting forearm rotation.MethodsMuenster, Sugartong, antipronation distal radioulnar joint (DRUJ), and standard wrist splints were fabricated for five healthy participants. Active range of motion (AROM) in forearm pronation and supination was measured with a goniometer for each splint, at the initial point of sensory feedback and during exertion of maximal force.ResultsRepeated-measures analysis of variance indicated significant differences between splints for all four AROM measures. Post hoc paired t-tests showed that the Sugartong splint was significantly more restrictive in pronation than the Muenster splint. The antipronation DRUJ splint provided significantly greater restriction in pronation than the standard wrist splint. No splints immobilized the forearm completely.ConclusionsThe Sugartong splint is recommended for maximal restriction in pronation, but individual patient characteristics require consideration in splint choice.Level of EvidenceIV