Trifurcation stenting using two guide catheters

Trifurcating coronary artery disease is a complex atherosclerotic process involving the origin of one or more of three side branches arising from a main trunk. The approach to treat trifurcation lesions has not been standardized. We describe a technique to percutaneously treat this lesion using routine day‐to‐day hardware and a unique two guide catheter technique. © 2009 Wiley‐Liss, Inc.     

Does Use of a “Rim Cutter” Improve Quality of Cementation of the Acetabular Component of Cemented Exeter Total Hip Arthroplasty?

A randomized controlled trial was performed to assess the effect of a rim cutter device on cement mantles in modern elective total hip arthroplasty using a flanged acetabular component. Forty patients were randomized to a rim cutter (21) or control (19) group. A statistically significant improvement in cement penetration was demonstrated in zone 1 (10.1 vs 8.6 mm, P = .023), and in cement mantle thickness in zones 2 and 3 (7.8 and 6.7 mm vs 5.7 and 5.4 mm [P < .001 and P = .017]), with a reduced incidence of bottoming out of the socket (1/21 vs 8/19 [P = .007]). Cement mantle thicknesses greater than 8 mm were achieved more consistently in the rim cutter group (30% vs 2%). This technique improves cement penetration and mantle thickness in a reliable manner.     

Is heart failure more prevalent in patients with peripheral arterial disease? A meta-analysis

Because risk factors for heart failure (HF) cluster in persons with peripheral artery disease (PAD), the authors conducted a meta-analysis to examine the prevalence of HF in individuals with PAD. MEDLINE searches were performed to review all PAD clinical trials (1966-2003). Expected control population prevalence rates for HF were derived from the National Health and Nutrition Examination Survey (NHANES) database. In total, 11,304 patients were evaluated. The average age of the patients was 67+/-5 years. The prevalence of HF in patients with PAD was 7.9% (range, 5.3%-13.9%) compared with an expected prevalence of 4.1%(range, 3.7-4.5%). The relative risk for increased HF prevalence among those with PAD was 1.9 (range, 1.35-3.10; P<.001). Thirteen (range, 7-19) PAD patients needed to be screened to detect 1 case of HF. The presence of PAD is associated with a 2-fold increase in the prevalence of HF. The use of PAD as a risk marker for underlying HF may enhance the effectiveness of screening criteria for HF detection.     

Endovascular management of acute ischemic stroke: advances in patient and treatment selection

Selection of patients for acute-stroke therapy has traditionally been based on rigid time criteria in clinical trials. Recent advances in radiographic imaging have allowed clinicians to estimate brain physiology and thus utilize radiographic parameters to select patients for acute-stroke therapies. Both a better understanding and the quantification methods of salvageable tissue versus irreversibly injured tissue can help guide clinicians to which treatment modality to utilize. The evolution of endovascular techniques to treat acute stroke has resulted in treatment modalities that include mechanical and chemical methods to revascularize occluded cerebral arteries. Prior technical limitations to accessing distal-cerebral arteries have been partially overcome by modifications in technology. Patient and treatment-modality selection can help reduce hemorrhagic complication rates and also potentially increase revascularization rates, which may translate into improved clinical outcomes. We review the recent advances in radiographic imaging that have advanced patient selection in treating acute ischemic stroke and also consider current endovascular treatment options that are available to interventionalists performing these procedures.     

IV levetiracetam in the management of non-convulsive status epilepticus

Introduction  

Status epilepticus (SE) is a medical emergency requiring prompt treatment to try to limit mortality and improve outcome. So far, newer antiepileptic drugs (AED) have not assumed a noticeable role in the treatment of SE. This may be in part due to the lack of IV forms for the newer AEDs. The IV form of Levetiracetam (IV-LEV) has recently become available and has a potential role in the treatment of SE.     

Risk of Thromboembolism Following Acute Intracerebral Hemorrhage

Introduction  Intracerebral hemorrhage (ICH) is the most feared complication of oral anticoagulant therapy (OAT). While anticoagulated patients have increased severity of bleeding following ICH, they may also be at increased risk for thromboembolic events (TEs) given that they had been prescribed OAT prior to their ICH. We hypothesized that TEs are relatively common following ICH, and that anticoagulated patients are at higher risk for these complications. Methods  Consecutive patients with primary ICH presenting to a tertiary care hospital from 1994 to 2006 were prospectively characterized and followed. Hospital records were retrospectively reviewed for clinically relevant in-hospital TEs and patients were prospectively followed for 90 day mortality. Results  For 988 patients of whom 218 (22%) were on OAT at presentation, median hospital length of stay was 7 (IQR 4–13) days and 90-day mortality was 36%. TEs were diagnosed in 71 patients (7.2%) including pulmonary embolism (1.8%), deep venous thrombosis (1.1%), myocardial ischemia (1.6%), and cerebrovascular ischemia (3.0%). Mean time to event was 8.4 ± 7.0 days. Rates of TE were 5% among those with OAT-related ICH and 8% among those with non-OAT ICH (P = 0.2). After multivariable Cox regression, the only independent risk factor for developing a TE was external ventricular drain placement (HR 2.1, 95% CI 1.1–4.1, P = 0.03). TEs had no effect on 90-day mortality (HR 0.7, 95% CI 0.5–1.1, P = 0.1). Conclusions  The incidence of TEs in an unselected ICH population was 7.2%. Patients with OAT-related ICH were not at increased risk of TEs.     

Potential of Azadirachta indica against Salmonella typhimurium-induced inflammation in BALB/c mice

Objective:  To evaluate the potential of Azadirachta indica leaf extracts against Salmonella typhimurium-induced inflammation in BALB/c mice. Design:  Qualitative tests of A. indica leaf extracts were conducted for screening of various phytochemicals. The antiinflammatory potential of A. indica leaf extracts on S. typhimurium and its outermembrane proteins (OMPs)-induced inflammation was assessed by hyperalgesic (flicking) response of the mice inflammed paws. The monokines (IL-1α, IL-6 and TNF-α) activities in the culture supernatants of macrophages (infected with bacteria and interacted with OMPs) in the presence or absence of A. indica leaf extracts was assessed by ELISA. Results:  Aqueous and petroleum ether A. indica leaf extracts reduced the inflammation caused by S. typhimurium and its OMPs as assessed by paw flicking response. Petroleum ether A. indica leaf extract was found to be more effective than aqueous A. indica leaf extract. Significantly lower levels of monokines (IL-6 and TNF-α) were also observed in the presence of petroleum ether A. indica leaf extracts than aqueous A. indica leaf extract. These observations may be due to the presence of steroids and triterpenoids observed in petroleum ether extract. Conclusion:  Petroleum ether A. indica leaf extract seems promising to combat S. typhimurium-induced inflammation. Received 6 June 2008; accepted 29 October 2008