Successful use of a balloon catheter to facilitate guidewire placement in an occluded coronary artery with extreme angulations

The present report describes the case of a 77-year-old man with unstable angina, in which the culprit vessel was extremely angulated and precluded placement of a guidewire for subsequent coronary interventions. A novel technique is reported, using an undersized, uninflated and distally placed balloon catheter, which easily facilitated guidewire placement.     

The impact of time, legislation, and geography on the epidemiology of traumatic brain injury.

In 1991, a population-based epidemiologic traumatic brain injury (TBI) study was done in urban and rural areas of Taiwan; this was 5 years before the helmet use law was passed and 8 years before the drink driving law was passed. In order to evaluate the impact of three major determinants (time, geography, and legislation) on the epidemiology of TBI, we conducted a prospective study in 2001 and used the 1991 data to examine the differences in TBI distribution in urban and rural Taiwan a decade after these laws were passed. In 2001, 5754 TBI cases were collected from the urban area of Taipei City, and 1474 TBI cases were collected from the rural area of Hualien County. The TBI incidence rate in Taipei City in 2001 was estimated to be 218/100,000 population (285/100,000 for males and 152/100,000 for females). When compared to the 1991 data, the incidence rate in 2001 had increased by 20%. The TBI incidence rate in Hualien County in 2001 was estimated to be 417/100,000 population (516/100,000 for males and 306/100,000 for females); this was a 37% increase over the 1991 data. Our study found that the distribution of causes and age distribution had shifted significantly over the 10-year period. In 2001, the age group with the highest incidence was 20-29 years, while in 1991 it had been the over 70 years age group. While traffic-related TBI had decreased, falls and assaults had increased in 2001. We also found that legislation, such as the helmet law, affects TBI distribution by decreasing the traffic-related TBI rate, decreasing the admission severity of TBI, and reducing TBI-related mortality. Finally, geography plays a crucial role in the outcome of TBI; over the 10 year period, Taipei had an increase in moderately severe outcomes, while Hualien had an increase in more severe outcomes. Comparative studies of TBI in urban and rural areas have shown that time, legislation, and geography are crucial determinants of TBI epidemiology. Although time and legal interventions seem to have more of an impact, geography does affect TBI outcomes.     

Myocardial and peripheral concentrations of beta-endorphin before and following myocardial ischemia and reperfusion during coronary angioplasty

There is substantial evidence indicating that endogenous opioid peptides are involved in the pathophysiology of myocardial ischemia and reperfusion. We measured the myocardial and peripheral concentrations of beta-endorphin before and following myocardial ischemia and reperfusion during coronary angioplasty. The results indicate that in patients with coronary artery disease, there was an augmented myocardial concentration of beta-endorphin. Moreover, there was an increased peripheral concentration of beta-endorphin following myocardial ischemia and reperfusion. The data support the previous notion that endogenous opioid peptides are involved in the pathophysiology of ischemic heart disease.     

A novel intermittent negative air pressure device ameliorates obstructive sleep apnea syndrome in adults

Purpose

Patients with obstructive sleep apnea syndrome (OSAS) have difficulties in compliance with continuous positive airway pressure (CPAP) and the treatment outcome is heterogeneous. We proposed a proof-of-concept study of a novel intermittent negative air pressure (iNAP®) device for physicians to apply on patients who have failed or refused to use CPAP.

Methods

The iNAP® device retains the tongue and the soft palate in a forward position to decrease airway obstruction. A full nightly usage with the device was evaluated with polysomnography. Subgrouping by baseline apnea–hypopnea index (AHI) and body mass index (BMI) with different treatment response criteria was applied to characterize the responder group of this novel device.

Results

Thirty-five patients were enrolled: age 41.9?±?12.2 years (mean?±?standard deviation), BMI 26.6?±?4.3 kg/m², AHI 41.4?±?24.3 events/h, and oxygen desaturation index (ODI) 40.9?±?24.4 events/h at baseline. AHI and ODI were significantly decreased (p?<?0.001) by the device. Patients with moderate OSAS, with baseline AHI between 15 to 30 events/h, achieved 64% response rate; and non-obese patients, with BMI below 25 kg/m², achieved 57% response rate, with response rate defined as 50% reduction in AHI from baseline and treated AHI lower than 20. There were minimal side effects reported.

Conclusions

In a proof-of-concept study, the device attained response to treatment as defined, in more than half of the moderate and non-obese OSAS patients, with minimal side effects.

     

Congenital midline nasal mass: cases series and review of the literature

Encephalocele, glioma and dermoid cyst are the most common midline nasal masses. Given their potential for intracranial extension, prompt treatment is necessary to prevent complications. Herein, we present two cases of midline nasal masses. A comparison was made to delineate the differences between their clinical courses, treatments and outcomes. Case 1 was a baby girl with respiratory distress beginning at birth. Nasal glioma without definite intracranial extension was present. The mass was completely excised with the aid of a video-assisted endoscope without complications. At follow-up two years after surgery, no recurrence was noted. Case 2 was a two-year-old boy with a midline nasal dermoid cyst. Extirpation of the lesion through a vertical-dorsal approach was performed. He was discharged three days after surgery with a satisfactory aesthetic result.     

“Do Not Resuscitate” Orders Among Deceased Patients Who Received Acute Neurological Care: An Observation Analysis

There were many reports about the “do not resuscitate” (DNR) order while practicing in the critical care units and conducting hospice affairs but limited in the neurological issues. This study investigated the possible flaws in the execution of the DNR order among patients who received acute neurological care in Taiwan.Over a 3-year period, we retrospectively reviewed the medical records of 77 deceased patients with neurological conditions for DNR orders. Registry and analysis works included demography, hospital courses, DNR data, and clinical usefulness of the lab and image examinations.Sixty-seven DNR orders were requested by the patients’ families, and more than half were signed by the patients’ children or grandchildren. The main DNR items were chest compression, cardiac defibrillation, and pacemaker use, although several DNR patients received resuscitation. The mean duration from the coding date to death was 7.6 days. Two-thirds of the patients with DNR requests remained in the intensive care unit, with a mean stay of 6.9 days. Several patients underwent regular roentgenography and blood tests on the day of their death, despite their DNR orders.Hospital courses and DNR items may be valuable information on dealing with the patients with DNR orders. The results of this study also suggest the public education about the DNR orders implemented for neurological illnesses.     

Empty sella, hypogonadism and hypopituitarism secondary to moyamoya disease.

We report the case of a young male who presented at the age of 34 years with intracranial hemorrhage due to moyamoya disease. He was later diagnosed with hypogonadism and hypopituitarism. Chromosomal evaluation revealed a normal karyotype. The results of further neuroradiological studies led to the diagnosis of empty sella syndrome.     

Endurance training accelerates exhaustive exercise-induced mitochondrial DNA deletion and apoptosis of left ventricle myocardium in rats

Even though exhaustive exercise-induced oxidative stress increases the risk of tissue damage, regular endurance training is widely assumed to improve cardiac function and protects against heart disease. We tested the hypothesis that an endurance training program prevents exhaustive exercise-induced increases in cardiac dysfunction and apoptosis in left ventricle (LV). Thirty-two male Sprague-Dawley rats were randomly divided into four groups: sedentary control (C), trained (T), exhaustively exercised (E), and trained plus exhaustively exercised (TE). Rats in T and TE groups ran on a motorized treadmill for 12 weeks. Rats in groups E and TE performed an exhaustive running test on a treadmill. The main effects of training were indicated by increased running time to exhaustion (80 ± 5 and 151 ± 13 min for groups E and TE, respectively, P = 0.0001), myocardial hypertrophy (0.38% and 0.47% for untrained and trained rats, respectively, P = 0.0002), decreased LV ejection fraction (88% and 71% for untrained and trained rats, respectively, P < 0.0001), accelerated mitochondrial DNA 4834-bp large deletion (mtDNA⁴⁸³⁴ deletion), and up-regulated protein levels of heat shock protein-70, cytochrome C, cleaved capsase-3, and cleaved PARP in LV following a bout of exhaustive exercise. Contrary to our hypothesis, these results suggest that endurance training induced significant impairment of regional systolic and diastolic LV myocardial function and ejection fraction in rats. Our findings show that endurance training accelerates exhaustive exercise-induced mtDNA⁴⁸³⁴ deletion and apoptosis in the LV.