Carotid Artery Percutaneous Transluminal Angioplasty and Stenting: Indications, Technical Approach, and Complications

Carotid percutaneous transluminal angioplasty and stenting are relatively new tools in the field of vascular therapeutics. They are products of the evolution of the techniques used in the therapy of coronary and peripheral vascular disease. Carotid endarterectomy is still the "criterion standard" to which all other carotid interventions are compared. This status has been achieved on the basis of extensive studies on symptomatic and asymptomatic patients. For carotid percutaneous transluminal angioplasty and stenting to become a proven alternative for the therapy of carotid disease, their precise use and role still need to be defined by randomized prospective trials. If performed by experienced operators with meticulous technique, the risk of complications is very low. Outpatient-based 1-day hospitalization, well tolerated, and avoiding anesthesia related complications make their future in the therapy of carotid disease very optimistic.     

Paclitaxel activity for the treatment of non-Hodgkin's lymphoma: final report of a phase II trial

In order to determine the activity of paclitaxel in patients with relapsed or refractory non-Hodgkin's lymphoma (NHL), we conducted a phase II clinical trial in which eligible patients received paclitaxel 200 mg/m² intravenously over 3 h. Treatment was repeated every 3 weeks. Patients achieving complete or partial responses after two courses of paclitaxel continued to receive therapy for a maximum of eight courses, otherwise they were removed from the study. Of 96 evaluable patients, 45 (47%) had primary refractory disease, and 51 (53%) had relapsed lymphoma. The median number of prior treatment regimens was two (range one to 10 regimens). 45 patients had low-grade, 44 had intermediate-grade, and seven had mantle cell lymphoma. 24/96 patients responded (10 complete and 14 partial remissions) for an overall response rate of 25% (95% CI 17–35%). Patients with relapsed lymphoma had a higher response rate than those with primary refractory disease (19/51=37% v 5/45 =11%; P  < 0.01), and patients with relapsed intermediate-grade lymphoma had a higher response than those with relapsed low-grade lymphoma (9/18=50% v 10/31 = 32%; P  = 0.22). The treatment was very well tolerated with the most common side-effects being alopecia (100%), peripheral neuropathy (35% of ≥ grade II), and arthralgia/myalgia (25% of ≥ grade II). After the first course of paclitaxel, grade III/IV thrombocytopenia and neutropenia were observed in 21% and 23% of the patients respectively. 23 episodes of neutropenic fever developed after 250 courses of paclitaxel therapy (8%). We conclude that paclitaxel, at this dose and schedule, is an active new drug for the treatment of non-Hodgkin's lymphoma. The activity of paclitaxel combination programmes are currently under investigation.     

A NEW METHOD FOR THE BIOLOGICAL ASSAY OF CURARIZING AGENTS

A method for the bio-assay of curarizing agents is described.Suxamethonium is injected intravenously into anaesthetized andintubated rats. The response is measured as the time of respiratorydepression. Doses ranging from 0.311 to 1.05 µg/g giverise to linear responses when the time of respiratory depressionis plotted against log dose. The assays are performed withinthis range. High and low doses, both of the standard and unknown,are injected into two animals each. The index of precision is0.14. Precision, specificity, cheapness and the possibilityof a wider use (cholinesterase determination) are emphasized.     

PROCAINE DOSAGE AND INTERACTION WITH GALLAMINE IN CHILDREN

The dose of procaine (in mg/kg/min) necessary to obtain a satisfactorylight level of general anaesthesia in children from 18 to 168months old, diminishes with increasing age. There is no differencein the procaine requirement between sexes. When higher dosesof procaine are injected, greater amounts of gallamine are neededto maintain satisfactory relaxation. Young children requirehigher doses of gallamine than the older ones. A curvilinearregression has been constructed so that mg/kg/min doses of procainein relation to sex and age can easily be found.     

AMOXICILLIN AND CLAVULANIC ACID IN THE TREATMENT OF ACTINOMYCETOMA

Background. Mycetoma is a relatively frequent disease in tropical countries. Drugs commonly used need a long period of treatment, and some cases are resistant to these drugs, especially those with bone or visceral involvement. The combination of amoxicillin-clavulanic acid has shown effectiveness against strains of Nocardia brasiliensis in vitro. Methods. We have used this combination in two cases of mycetoma caused by N. brasiliensis, both with bone involvement and resistance to the drugs usually used. A dose of three tablets a day for 5 to 6 months was given (each tablet contains 500 mg of amoxicillin and 125 mg of clavulanic acid). Results. Clinical and mycologic amelioration was observed in the two cases after completing the treatment. There were no side effects or relapses after 3 to 6 months of follow-up after treatment. Conclusions. We propose this antibiotic as a new option for the treatment of some special cases of actinomycetoma with bone or visceral involvement or resistance to the drugs commonly used in this disease.     

Left‐Sided Atrial Flutter Originating in the Coronary Sinus after Radiofrequency Ablation of Atrial Fibrillation

We describe a case of atypical atrial flutter presenting 1 year after radiofrequency ablation for atrial fibrillation (AF). Electrophysiologic study showed a reentry circuit involving the inferolateral aspect of the mitral annulus and the coronary sinus (CS); however, a mitral isthmus line did not terminate the arrhythmia. Participation of the proximal CS musculature in the circuit suggested a possible target for ablation. Radiofrequency energy applications from within the CS terminated the tachycardia. Mapping and ablation within the CS should be considered in patients with post‐AF ablation arrhythmias, particularly when the mitral annulus appears to be involved in the tachycardia circuit. (PACE 2010; 33:e96–e99)