Isolated Pharmacomechanical Thrombectomy for the Management of Chronic DVT

Thrombo‐reduction in the setting of deep vein thrombosis (DVT) to prevent the postthrombotic syndrome has not been traditionally managed by interventional cardiologists. We report a case series of successful chronic DVT management with pharmacomechanical thrombectomy utilizing the Trellis device. (J Interven Cardiol 2011;24:99–104)     

Inhibitory effect of cetirizine 2HCl on eosinophil migration in vivo

The effect of a potent antihistamine, cetirizine, was studied on allergic patients and normal subjects by means of an in-vivo 'skin window' technique. All subjects showed significant inhibition of skin-test responses to grass pollen, compound 48/80, histamine and methacholine, after administration of a single dose (10 mg) of cetirizine. Compared to placebo, cetirizine significantly decreased the eosinophils attraction at skin sites challenged with grass pollen and compound 48/80. In allergic patients no change in eosinophil migration pattern was noted with histamine and methacholine skin-tested sites. In normal subjects, compound 48/80 and histamine did not induce eosinophil accumulation and cetirizine did not modify cellular patterns as compared to placebo. These results suggest that cetirizine acts on eosinophil migration by inhibiting the release of mast cell mediators or inhibiting the eosinophilotactic mediators themselves.     

The Long QT Syndrome with Impaired Atrioventricular Conduction: A Malignant Variant in Infants

Distal Conduction Disease in the Long QT Syndrome. Introduction : The long QT syndrome (LQTS) is occasionally complicated by impaired AV conduction, mostly 2:1 AV block. This form of LQTS can manifest before birth or during neonatal life, and it is more sporadic than familial. It is usually an isolated disorder, although it can be accompanied by a variety of cardiovascular and other anomalies. In spite of different treatment modes, mortality is high.
Methods and Results : The reported case presented not only with 2:1 AV conduction, but also with Wenckebach episodes with impaired right and left bundle branch conduction, and decremental conduction in the His-Purkinje axis. We also observed sinus pauses and accelerated AV junctional escape beats.
Conclusion : Our findings, and similar observations by others., suggest involvement of the sinus node and the distal conduction system in this form of the LQTS. Several histologic studies have documented abnormalities within the conduction system, including apoptosis. Because of the rare occurrence and poor prognosis of the LQTS with impaired AV conduction, international guidelines for diagnosis and treatment are needed. Development of an internal cardiac defibrillator for this young age group is necessary.     

Social aspects of dental caries in the context of mother-child pairs

The relationship between mother and child in the context of oral health has traditionally been exposed by the scientific literature in microbiology, which lacks a broad and necessary discussion of health and illness seen as processes, both biological and social.

Objective

Investigate the family social determinants associated with the caries history of children and the need for dental treatment (NDT) among their mothers was the objective of this study.

Material and methods

This research employed a cross-sectional study of mother-child pairs living in southern Brazil. Data collection occurred in public institutions of early childhood education. The instruments included a structured questionnaire administered to mothers and clinical oral examinations of the mothers and children. The social variables considered were marital status, maternal education, number of children, income, employment status, and frequency of visits to a dental professional. The measured outcomes were the maternal NDT and child caries history. Data were analyzed by the chi-square test (χ2) and by discriminant analysis.

Results

The final sample consisted of 272 mother-child pairs and it was found that the greatest need for treatment was among mothers with low educational level and low family income who rarely or never visited a dentist. Tooth decay was less frequent in only child, and most frequent in children of mothers with low educational attainment, and in children in lower income households who rarely or never visited the dentist. The social determinants of caries in children and of the maternal NDT were similar. It follows that the maternal NDT and caries history among children were strongly associated with maternal education (p<0.0001), household income (p<0.0001), and frequency of visits to a dental professional (0.0018). Caries history among children was also associated with number of children in the household (p<0.0001).

Conclusions

The results suggest that the caries experience in children depended less on the family social variables than on the maternal NDT.     

Peri-operative complications following surgical closure of atrial septal defect type II in 232 patients--a baseline study

This study intends to provide a detailed overview of the typesand rates of peri-operative complications after surgical correctionof an isolated ASD II. The transvenous approach to the occlusionof atrial septal defects has yielded promising results duringits first 5 years of clinical trials, but before it can be establishedas a routine measure, definite proof is needed to demonstratethat its rate of serious complications does at least not exceedthat of the surgical closure. Between 1985 and 1992, 232 consecutive patients underwent surgicalclosure of a secundum atrial septal defect. Among the patients118 were children (<18 years; 79 girls and 39 boys) witha mean age of 8.9± 5 2 years (4 months-17 years) and114 adults (74 women and 40 men) with a mean age of 28.5 ±10.8years (18–69 years). Pre-operatively eight children (6.8%)and eight adults (7%) were treated for right heart failure.Mean pulmonary artery pressure was 20.4 ± 10.4 mmHg forthe children and 19.3 ±7 mmHg for the adults. The averagepulmonary artery to systemic flow ratios were 2.9:1 and 3:1for children and adults, respectively. Thirty children (25.4%)and 15 adults (13.2%) underwent patch closure while direct suturewas the method used for the remaining patients. Average cardiopulmonarybypass time was 35.7 /'b1 17.9 min for the children and 41.5±19.9 min for the adults. The length of the procedure (skin toskin) was a mean of 116 min in the young group, and 141 minin the adult group. One adult patient died during his hospital stay as a consequenceof sepsis (0.4% total mortality rate). Severe early complications(pericardial tamponade, renal failure, sepsis) occurred in threechildren (2.5%) and ten adults (8.8%), moderately severe complications(pneumonia, pleural effusion requiring thoracocenthesis) infour children (3.4%) and seven adults (6.1%) and mild complications(atelectasis, gastrointestinal, urinary tract infection, pleuraleffusion) in 86 children (72.9%) and 77 adults (67.5%). Only25 children (21.2%) and 20 adults (17.5%) experienced an uneventfulperi-operative period. The results show that an isolated secundum atrial septal defectcan be surgically closed with a minimal mortality but significantcomplications can occur. The majority of the early complicationsfor the patients were of minor significance, and severe complicationswere observed more often in adults than in children.     

Successful Percutaneous Balloon Valvuloplasty for Combined Congenital Tricuspid and Pulmonary Stenosis

Percutaneous balloon valvuloplasty was successfully performed in a 13-month-old symptomatic infant with congenital tricuspid and pulmonic valve stenosis. Both valves were dilated in the same setting, resulting in a significant hemodynamic and clinical improvement.