Use of stents to treat kinks causing obstruction in a left internal mammary artery graft

Left internal mammary arteries (LIMA) are used routinely as grafts to the left anterior descending coronary artery (LAD) in selected patients undergoing coronary artery bypass graft (CABG) surgery because of better long-term patency rates. Pathology other than fibrointimal hyperplasia, accelerated atherosclerosis, or thrombus can sometimes cause obstructive lesions in such grafts. This report illustrates a kink in a LIMA graft to the LAD causing an obstructive lesion shortly after surgery and describes the subsequent management of this lesion with intracoronary stents. Cathet. Cardiovasc. Intervent. 46:223–226, 1999. © 1999 Wiley-Liss, Inc.     

Evaluation of Organelle Changes in Promastigotes of Unresponsive Leishmania Tropica to Meglumine Antimoniate in Comparison with Sensitive and Standard Isolates by Electron Microscopy

Background:

The control of leishmaniasis faces serious challenges because of resistance to the first-line antimonial drugs. We aimed to evaluate the differences in organelle changes of cultivated promastigotes obtained from skin lesions of sensitive and unresponsive isolates to meglumine antimoniate (Glucantime) by electron microscopy.

Material and Methods:

This study was done in Bam city, southeastern Iran, in which the incidence of disease has sharply increased since the earthquake in 2003. The samples were taken from 66 patients who were referred to the cutaneous leishmaniasis (CL) treatment center in Bam. A questionnaire was completed for each individual, recording their demographic characteristics and CL status. The scraping smears provided from the edge of active lesions with sterile blades were fixed with methanol, stained by Giemsa, and examined under a compound light microscope for amastigote form simultaneously. To prepare the specimens for transmission electron imaging, promastigotes were centrifuged and resuspened.

Results:

Transmission electron microscopic study of the cultivated promastigotes revealed that there were alterations in the organelles and structures of sensitive isolates compared with unresponsive and standard ones. Organelles and structures such as mitochondria, kinetoplast, microtubules, cytoplasmic vacuoles, plasma membrane and vesicles were studied. The alterations such as disintegration of kinetoplast into thin filaments and condensation of kinetoplast DNA core, changes in size, number and location of vesicles and microtubules were observed. We noted intense cytoplasmic vacuolization, and considerable swelling of mitochondria.

Conclusion:

The significance and relevance of these changes might help understand drug resistance patterns and help localize the best target site for inactivating the organism.     

Could Helicobacter pylori play an important role in axonal type of Guillain-Barré Syndrome pathogenesis?

In this case-control study, ELISA and Western blot with whole bacterial protein lysate were performed on serum and cerebrospinal fluid (CSF) of 15 controls and 15 patients. According to Griffin subtypes, 10 of our patients were in acute inflammatory demyelinating polyradiculoneuropathy (AIDP) group, 3 in acute motor axonal neuropathy (AMAN) group, and 2 in acute motor sensory axonal neuropathy (AMSAN) subtype. 86.6% of patients were positive for Helicobacter pylori (H. pylori) IgG. Serum anti-H. pylori IgG of patients and controls were significantly different. CSF anti-H. pylori IgG was significantly higher in patients than controls. In patients, the titer of anti-H. pylori IgG in serum was significantly higher than CSF, which may indicate extra-neural antibody synthesis. CSF IgG titer was higher in patients having axonal pattern. Western blot was positive in CSF of 13 patients and negative in all controls. There was a correlation between the number of antibody types against H. pylori particles and the titer of anti-H. pylori IgG in CSF and serum. Also, antibody against cytotoxin associated protein (CagA) was associated with primary axonal pattern.     

Pattern of alcohol consumption and its effect on gastrointestinal symptoms in inflammatory bowel disease

Alcohol consumption is a potential trigger for flare in inflammatory bowel disease (IBD) flare because of alcohol's pro-oxidant effects and its deleterious effects on gut barrier function. The association with alcohol consumption and IBD flare is unclear. To test this hypothesis, we evaluated the pattern of alcohol consumption and its self-reported effect on gastrointestinal (GI) symptoms in patients with IBD. We recruited 129 consecutive patients: 52 patients with Crohn's disease, 38 patients with ulcerative colitis, and 39 patients with irritable bowel syndrome (IBS). All the participants completed a validated questionnaire on disease activity (the Crohn's disease activity index or ulcerative colitis clinical activity index, respectively) validated questionnaires to quantify alcohol consumption by National Institute of Alcohol Abuse and Alcoholism criteria, and two structured questionnaires we designed to access patients' perception of the effect of alcohol on their GI symptoms and on overall GI symptom severity. The pattern of current, light, moderate, and heavy alcohol consumption in inactive IBD was similar to the general U.S. population. Specifically, of the 90 inactive IBD patients, 56 (62%) were current drinkers, compared with 61% in the general U.S. population. Of current drinkers, 75% of IBD (N = 42) and 43% of IBS (N = 9) reported a worsening of GI symptoms with alcohol consumption (P = .01); however, overall GI symptom severity did not differ when compared with quantity of alcohol consumed. Patients with inactive IBD drink alcohol in quantities similar to the general population. Current drinkers with inactive IBD are more likely to report worsening of GI symptoms with alcohol than current drinkers with IBS.     

Mortality in Patients Admitted for Concurrent COPD Exacerbation and Pneumonia

It is unclear whether concurrent pneumonia and chronic obstructive pulmonary disease (COPD) have a higher mortality than either condition alone. Further, it is unknown how this interaction changes over time. We explored the effect of pneumonia and COPD on inpatient, 30-day and overall mortality. We used a Veterans Health Affairs database to compare patients who were hospitalized for a COPD exacerbation without pneumonia (AECOPD), patients hospitalized for pneumonia without COPD (PNA) and patients hospitalized for pneumonia who had a concurrent diagnosis of COPD (PCOPD). We studied records of 15,065 patients with the following primary discharge diagnoses: (a) AECOPD cohort (7,154 individuals); (b) PNA cohort (4,433 individuals); and (c) PCOPD (3,478 individuals), comparing inpatient, 30-day and overall mortality in the three study cohorts. We observed a stepwise increase in inpatient mortality for AECOPD, PNA and PCOPD (4.8%, 9.5% and 13.2%, respectively). These differences persisted at 30 days post-discharge (AECOPD = 6.7%, PNA = 12.4% and PCOPD = 14.6%; p < 0.0001), but not throughout the study period (median follow-up: 37 months). With time, the death rate rose disproportionally in patients who had been admitted for AECOPD (AECOPD = 64.5%; PNA = 57.4% and PCOPD 66.2%; p < 0.001). In multivariate analysis, PCOPD predicted the greatest inpatient mortality (p < 0.001). The data showed a progression in inpatient and 30-day mortality from AECOPD to PNA to PCOPD. Pneumonia and COPD differentially affected inpatient, 30-day and overall mortality with pneumonia affecting predominantly inpatient and 30-day mortality while COPD affecting the overall mortality.     

Effect of Social Stimuli on Postural Responses in Individuals with Autism Spectrum Disorder

This study was aimed to investigate the effects of social versus non-social stimuli on postural responses in 21 boys with autism spectrum disorder (ASD) (mean age of 11.6?±?1.5) compared with 30 typically developing (TD) boys (mean age of 11.7?±?1.8). Postural control of children was examined while they were standing on a force plate and viewing images of an object, male face, or female face in sequence. Each image was shown in two trials and each trial lasted for 20 s. Results indicated a significant interaction between group and task (p?<?0.05), meaning that children with ASD but not TD children showed an increased postural sway during face tasks than during object task. Furthermore children with higher autism severity compared to those with lower severity showed an increased change in response to social stimuli (p?<?0.01). It seems that the postural control of children with ASD was more affected by the social stimuli than TD children.