Relative risk of plaque erosion among different age and sex groups in patients with acute coronary syndrome

Postmortem studies reported plaque erosion is frequent in young women. Recent in vivo studies failed to show age and sex differences in the plaque erosion prevalence. The aim of this study was to investigate the prevalence of plaque erosion by age and sex among acute coronary syndromes (ACS) patients. From 1699 ACS patients, 1083 with plaque erosion or rupture were analyzed. Patients were categorized as 5 age groups (≤?50, 51–60, 61–70, 71–80,?≥?81 years). Overall prevalence of plaque erosion was similar between males and females (p?=?0.831). Males age?≤?50 had higher (p?=?0.018) and age 71–80 had lower (p?=?0.006) prevalence of plaque erosion. Females age 61–70 had higher (p?=?0.021) and age 71–80 had lower (p?=?0.045) prevalence of plaque erosion. In advanced age groups (≥?71 years), rupture was the dominant etiology in both sexes. In multivariate analysis of males, age?≤?50 demonstrated a trend to increase (OR 1.418, 95% CI 0.961–2.093, p?=?0.078) the erosion risk. Females age?≤?70 independently increased (OR 2.138, 95% CI 1.249–3.661, p?=?0.006) the risk for erosion. The prevalence of plaque erosion was similar between males and females. Plaque erosion risk was increased in the males age?≤?50 and in the females age?≤?70 among ACS patients.

     

Combination of helical CT and Doppler sonography in the follow-up of patients with clinical N0 stage neck disease and oral cancer

BACKGROUND AND PURPOSE: Correctly diagnosing metastatic nodes is important for the follow-up of patients with clinical N0 stage neck disease and oral cancer. A combination of helical CT and Doppler sonography may facilitate the accurate detection of lymph node metastasis in patients with clinical N0 stage neck disease. METHODS: A combination of contrast-enhanced helical CT and Doppler sonography was performed to monitor the necks of 58 patients with initial clinical N0 stage neck disease. Of these patients, 17 underwent surgery; nodal metastasis in the neck was histopathologically confirmed. A node was diagnosed as metastatic if it fulfilled the CT criteria for metastatic nodes (short-axis diameter equal to or greater than the cutoff points for each level of the neck or central nodal necrosis) and if, additionally, it did not exhibit sonographic features for nonmetastatic nodes (normal hilar echogenicity and hilar flows). The presence of metastasis was confirmed histopathologically. RESULTS: During the follow-up periods, metastatic nodes were histologically confirmed in 17 (29%) patients. Of 30 metastatic nodes from the 17 patients with metastatic nodes, 22 (73%) appeared within the first year and 28 (93%) within the first 2 years; 20 developed from nonmetastatic nodes, and 10 were newly detectable. The combined criteria were effective in revealing 26 (87%) nodes, yielding 87% sensitivity, 100% specificity, and 100% positive and 99% negative predictive values. The independent use of one of these techniques alone resulted in low (67%) or moderate (87%) positive predictive values for sonography and CT, respectively. Seven hundred forty-one (97%) of 761 nodes that were nonmetastatic at initial examination remained nonmetastatic (737 nodes) or had disappeared (four nodes). As a result, a combination of CT and sonography was effective in revealing all 17 cases of metastatic nodes. CONCLUSION: A combination of contrast-enhanced helical CT and Doppler sonography is useful for the follow-up study of clinical N0 stage neck disease.     

A survey on contrast radiography and adverse reaction in the radiology departments of university dental hospitals in Japan

We analyzed the results of a questionnaire regarding the use of contrast radiography and computed tomography (CT), and the reactions to contrast media during 1993, which was sent to 28 Radiology Departments of University Dental Hospitals throughout Japan. Replies were received from 23 departments (82.1%). Sialography was performed in less than 40 cases during the year in 70% of the institutions, although the frequency varied widely among the institutions. Arthrography was performed in less than 30 cases during the year in 90% of the institutions, although, again, there was wide variation. Both ionic and nonionic contrast media were used for sialography and arthrography. Cyst contrast radiography of the maxillofacial region was not performed at all at 80% of the institutions. CT (plain CT and contrast-enhanced CT) was performed in 462.2±335.7 (mean±SD) cases annually per institutions. In 60% of the institutions, contrast-enhanced CT was performed in less than 20% of the total CT cases, although there was wide variation among institutions. Nonionic contrast media was used at almost all for contrast-enhanced CT. The over all incidence of adverse reactions to contrast media was 2.1%.     

Deep facial infections of odontogenic origin: CT assessment of pathways of space involvement.

PURPOSEWe investigated the pathways of spread of odontogenic infection in the facial and neck spaces.METHODSCT scans of 45 patients with extensive spread of odontogenic infection into the facial and neck spaces were analyzed to document pathways of spread.RESULTSOdontogenic infections arising in the mandible first spread upward, into the masseter and/or medial pterygoid muscles in the masticator space, and downward, into the sublingual and/or submandibular spaces, and then spread into the spaces or muscles adjacent to one or more of these locations. Infections from the masseter muscle spread into the parotid space to involve the temporalis and lateral pterygoid muscles. Infections from the medial pterygoid muscle spread into the parapharyngeal space to involve the lateral pterygoid muscle. Infections in the maxilla did not spread downward; instead, they tended to spread upward and superficially into the temporal and/or masseter spaces and deeply involve the lateral and/or medial pterygoid muscles in the medial masticator space.CONCLUSIONCT may be useful to depict the extent of infection and to plan treatment of extensive odontogenic infection, which can be life threatening when therapy is ineffective.     

The Relation Between Optical Coherence Tomography-Detected Layered Pattern and Acute Side Branch Occlusion after Provisional Stenting of Coronary Bifurcation Lesions

Background/purposeLayered pattern (presumed to be healed plaque after a thrombotic event) can be observed by optical coherence tomography (OCT). We sought to assess the ability of OCT-detected plaque composition to predict acute side branch (SB) occlusion after provisional bifurcation stenting.MethodsThis is a retrospective observational study using pre-intervention OCT in the main vessel to predict Thrombolysis in Myocardial Infarction (TIMI) flow grade ≤1 in a SB (diameter ≥ 1.5 mm) after provisional bifurcation stenting. OCT-detected layered pattern was defined as plaque with a superficial layer that had a different optical intensity and a clear demarcation from underlying tissue.ResultsOverall, 207 patients with stable coronary disease were included. SB occlusion occurred in 26/207 (12.6%) bifurcation lesions. Operators decided not to perform additional treatment, and TIMI flow did not improve to ≥2 in cases with SB occlusion. The prevalence of OCT-detected layered pattern was more common in lesions with versus without SB occlusion (88.5% versus 33.7%, p < 0.0001); OCT-detected layered pattern was more often located on the same side of the SB (73.9% versus 21.3%, p < 0.0001) circumferentially compared to lesions without SB occlusion. Multivariable analysis showed that OCT-detected layered pattern was an independent predictor of SB occlusion (odds ratio 18.8, 95% confidence interval 5.1–68.8, p < 0.0001) along with true bifurcation lesion and wider angiographic bifurcation angle.ConclusionsThe presence of an OCT-detected layered pattern near its ostium was a strong predictor of SB occlusion after provisional bifurcation stenting.