Primary coronary angioplasty in the elderly.

BACKGROUND: Primary coronary angioplasty is the best therapeutic approach in acute myocardial infarction (AMI), and more so in the population aged over 75 years, in whom the hemorrhagic risk of thrombolysis becomes almost unacceptable. AIM: To evaluate age-related influences on clinical evolution and in-hospital mortality in patients with AMI who undergo primary percutaneous coronary interventions (PCI). METHODS: We studied 245 consecutive patients (aged between 31 and 90, 63+/-13), who underwent primary PCI between January 2000 and December 2001. Forty-six patients (18.8%) aged over 75 years were compared with the rest. The following parameters were analyzed: risk factors for coronary artery disease including hypertension, diabetes, smoking, hypercholesterolemia and family history, previous AMI, PCI or angina, extent of coronary disease, angiographic results and in-hospital mortality. RESULTS: Female gender was more frequent in older patients (56.5% vs. 23.1%; p<0.001) and smoking was more prevalent in the younger group (54.3% vs. 13.0%; p<0.001), as was previous AMI (p<0.05). PCI success was high in both groups (93.5% in the older population and 96.7% in the rest; p=NS), multivessel coronary disease was significantly more frequent in the elderly group (41.3% vs. 26.2%; p<0.05), and glycoprotein IIb/IIIa inhibitors were used less (80.4% vs. 91%; p<0.05). Killip class evolution was more favorable in the younger group (class I in 88.4% vs. 69.8% in older patients; p<0.001). The number of hemorrhagic complications and in-hospital mortality were higher in elderly patients (3.5% vs. 13.0%; p<0.05 and 4.5% vs. 19.6%; p<0.001, respectively). CONCLUSIONS: Primary PCI has a similarly high success rate in elderly patients, although this age-group still has higher mortality. The increased rate of hemorrhagic complications in this population should lead to greater caution in the use of adjuvant antithrombotic drugs.     

The vasopressinergic innervation of the lateral septum of the rat after chronic alcohol consumption and withdrawal

We have recently reported that ethanol ingestion induces morphological changes in the vasopressinergic neurons of the supraoptic nucleus and that withdrawal from alcohol partially reverses these alterations. Since the production of vasopressin is not restricted to the magnocellular neurons of the hypothalamus, we investigated the effects of long-term ethanol intake and withdrawal on the lateral septum, an area heavily innervated by vasopressinergic fibers. Besides, as ethanol leads to a decrease of the plasma levels of testosterone, a hormone which plays a pivotal role in the development and maintenance of the vasopressinergic innervation of the lateral septum, we included groups of alcohol-fed animals submitted to testosterone replacement both in physiological and supraphysiological doses. In ethanol-treated rats there was a marked reduction in the number of vasopressin-immunoreactive fibers in the lateral septum. Following ethanol withdrawal a partial recovery in the number of vasopressin-immunoreactive fibers was observed. In both groups of ethanol + testosterone-treated animals the vasopressinergic innervation was increased when compared to the alcohol-fed group, although a complete reversal was not achieved. Therefore, two mechanisms might be regarded as underlying the impoverishment of the vasopressinergic innervation in the lateral septum after prolonged alcohol consumption: alcohol-induced cell death in the bed nucleus of the stria terminalis, from where these fibers arise, and/or alcohol-induced decrease in testosterone plasma levels.     

Should aortography be used routinely in the elective management of abdominal aortic aneurysm?

Until recently aortography was performed routinely for elective abdominal aortic aneurysm at our institution. A death resulting from this procedure prompted us to evaluate this policy by a retrospective study of 105 elective aneurysm patients. These studies identified 21 renal artery stenoses, 2 renal artery aneurysms, 2 cases of multiple renal arteries, 8 celiac stenoses, 6 superior mesenteric artery stenoses or occlusions, and a number of peripheral occlusive processes and associated iliac aneurysms. However, the impact of these findings on surgical management was limited to six renal artery reconstructions: one for reimplantation of a renal artery arising from the aneurysm, one for serious hypertension, and four in normotensive patients with severe arterial stenosis. No celiac or mesenteric reconstructions were undertaken, and no visceral complications ensued. In only one patient, the one with renal artery reimplantation, was the angiographic information unsuspected and significant for operative management. This did not appear to justify the risk and expense involved in routine preoperative aortography.     

Does Combined Dry Land Strength and Aerobic Training Inhibit Performance of Young Competitive Swimmers?

The aim of the current study was twofold: (i) to examine the effects of eight weeks of combined dry land strength and aerobic swimming training for increasing upper and lower body strength, power and swimming performance in young competitive swimmers and, (ii) to assess the effects of a detraining period (strength training cessation) on strength and swimming performance. The participants were divided into two groups: an experimental group (eight boys and four girls) and a control group (six boys and five girls). Apart from normal practice sessions (six training units per week of 1 h and 30 min per day), the experimental group underwent eight weeks (two sessions per week) of strength training. The principal strength exercises were the bench press, the leg extension, and two power exercises such as countermovement jump and medicine ball throwing. Immediately following this strength training program, all the swimmers undertook a 6 week detraining period, maintaining the normal swimming program, without any strength training. Swimming (25 m and 50 m performances, and hydrodynamic drag values), and strength (bench press and leg extension) and power (throwing medicine ball and countermovement jump) performances were tested in three moments: (i) before the experimental period, (ii) after eight weeks of combined strength and swimming training, and (iii) after the six weeks of detraining period. Both experimental and control groups were evaluated. A combined strength and aerobic swimming training allow dry land strength developments in young swimmers. The main data can not clearly state that strength training allowed an enhancement in swimming performance, although a tendency to improve sprint performance due to strength training was noticed. The detraining period showed that, although strength parameters remained stable, swimming performance still improved.

Key points

• This study investigated the effect of dry land strength training on sprint performance in young competitive swimmers.
• A combined strength and aerobic swimming training allow dry land strength developments in young swimmers.
• The main data can not clearly state that strength training allowed an enhancement in swimming performance, although a tendency to improve sprint performance due to strength training was noticed.
• The detraining period showed that, although strength parameters remained stable, swimming performance still improved.

Key words: Children, combined training, detraining, hydrodynamics, cross training     

Pancreatic intraductal papillary mucinous neoplasm associated colloid carcinoma

Colloid carcinomas are rare pancreatic tumors characterized by the presence of mucin pools with scarce malignant cells. Most of these neoplasms arise from intestinal-type intraductal papillary mucinous neoplasms (IPMNs). We report a case of a 77-year-old male patient who presented with weight loss, asthenia, lumbar pain and diabetes. Imaging studies revealed a mixed-type IPMN with high-risk features and a possible invasive component. The patient underwent surgical resection and the histology confirmed an invasive colloid carcinoma of the pancreas associated with an intestinal-type IPMN. Although invasive ductal and colloid carcinomas may look similar on imaging studies, its distinction is important because the latter have a better prognosis.     

Direct intra-aneurysm sac pressure measurement using tip-pressure sensors: in vivo and in vitro evaluation

OBJECTIVE: Direct intra-aneurysm sac pressure measurement with percutaneous translumbar puncture is a new method for follow-up after endovascular aneurysm repair. The purpose of this study was to evaluate a tip-pressure sensor system for intra-aneurysm pressure measurement in an in vitro aneurysm model and in vivo in patients by studying intraobserver variability. METHODS: We used 0.014-inch guide wire-mounted tip-pressure sensors. For the in vitro aneurysm model, saccular aneurysms filled with thrombus were inserted in a left-heart-driven aneurysm model. Pressure was measured simultaneously with guide wire pressure sensors in the lumen of the model and within the aneurysm thrombus. In vivo, intraobserver variability was evaluated with double percutaneous translumbar puncture of the abdominal aortic aneurysm (AAA) with pressure measurement in 15 patients (14 men, 1 woman; median age, 75 years [63-80 years]; median AAA diameter, 55 mm [47-80 mm]) at a median of 32 months (2-100 months) after endovascular aneurysm repair. Mean pressure index was calculated as the percentage of mean intraaneurysm pressure relative to simultaneous mean systemic pressure. RESULTS: In vitro, the difference in pressure between the tip-sensor measurements and the pressure output of the aneurysm model was 2 mm Hg (1-4 mm Hg) when the output varied between 150/50 and 200/100 mm Hg (n = 90). Mean pressure in the lumen of the model and within the aneurysm thrombus differed by 1 mm Hg (-5-15 mm Hg (n = 10). In vivo, intraobserver variability of mean pressure index (Bland-Altman plot) was 0% (-7%-17%; n = 15%). CONCLUSION: Direct intra-aneurysm sac pressure measurement with tip-pressure sensors mounted on 0.014-inch guide wires is a reliable and reproducible technique for measuring intra-AAA pressure both in vitro and in vivo.     

The utility of preoperative routine carotid artery duplex scanning in patients undergoing aortic valve replacement

Patients with aortic valve disease (AVD) typically have a cardiac murmur that radiates to the neck and may be indistinguishable from a cervical bruit secondary to carotid artery occlusive disease. The purpose of this report was to determine the prevalence of significant asymptomatic carotid artery occlusive disease in patients undergoing aortic valve replacement (AVR). All patients scheduled for AVR were prospectively studied. Preoperative carotid artery color-flow duplex was performed in all patients. A total of 204 patients were included in the study and significant carotid disease (>50% stenosis of the internal carotid artery) was found in 17 (8%). In patients with isolated aortic valve disease, 4/129 (3%) had significant stenosis. Of the patients with concurrent aortic valve and coronary artery disease, 13/75 (17%) had significant stenosis. The incidence of significant carotid stenosis in patients with aortic valve disease was over five fold higher in patients with concurrent coronary artery disease (3% vs. 17%, p <0.001). The yield of routine carotid duplex scanning for patients undergoing isolated AVR is low. However, in the subset of patients with concurrent coronary disease, the yield is higher. This finding supports the use of routine carotid duplex scanning in patients with coexistent aortic valve and coronary artery disease.     

Infection by Plasmodium changes shape and stiffness of hepatic cells

Infection of liver cells by Plasmodium, the malaria parasite, is a clinically silent, obligatory step of the parasite's life cycle. The authors studied the progression of Plasmodium infection in hepatic cells by atomic force microscopy, measuring both topographical and nanomechanical changes upon infection. In recent years, several studies have suggested that cellular nanomechanical properties can be correlated with disease progression. The authors' results show that infected cells exhibit considerable topographical changes, which can be correlated with the presence of the parasite, leading to a significant roughening of the cell membrane. The nanomechanical measurements showed that infected cells were significantly stiffer than noninfected cells. Furthermore, the stiffening of the cells appeared to be a cellular reaction to the Plasmodium infection, rather than a result of the stiffness of the invading parasites themselves. This article provides the first evidence of mechanical changes occurring in hepatic cells in response to Plasmodium infection. FROM THE CLINICAL EDITOR: The authors have studied the progression of Plasmodium infection in hepatic cells by atomic force microscopy, measuring topographical and nanomechanical changes upon infection. The nanomechanical measurements demonstrated that infected cells were significantly stiffer than noninfected cells.     

Neuron-specific proteotoxicity of mutant ataxin-3 in C. elegans: rescue by the DAF-16 and HSF-1 pathways

The risk of developing neurodegenerative diseases increases with age. Although many of the molecular pathways regulating proteotoxic stress and longevity are well characterized, their contribution to disease susceptibility remains unclear. In this study, we describe a new Caenorhabditis elegans model of Machado-Joseph disease pathogenesis. Pan-neuronal expression of mutant ATXN3 leads to a polyQ-length dependent, neuron subtype-specific aggregation and neuronal dysfunction. Analysis of different neurons revealed a pattern of dorsal nerve cord and sensory neuron susceptibility to mutant ataxin-3 that was distinct from the aggregation and toxicity profiles of polyQ-alone proteins. This reveals that the sequences flanking the polyQ-stretch in ATXN3 have a dominant influence on cell-intrinsic neuronal factors that modulate polyQ-mediated pathogenesis. Aging influences the ATXN3 phenotypes which can be suppressed by the downregulation of the insulin/insulin growth factor-1-like signaling pathway and activation of heat shock factor-1.