Favorable effect of gamma-radiation for in-stent restenosis: effect of diabetes on angiographic and clinical outcomes.

The purpose of this study was to examine the effect of vascular brachytherapy with gamma-radiation (gamma-RT) in patients with diabetes mellitus (DM) with coronary in-stent restenosis (ISR). In the Washington Radiation for In-Stent Restenosis (WRIST) trial, 130 patients with ISR were treated with (192)Ir or placebo. Of the patients enrolled, 44 (34%) had DM (18 of them treated with gamma-RT and 26 with placebo).

Adjusting for publication bias: modelling the selection process.

Unlabelled: RATIONALE, AIMS AND BACKGROUND: Systematic review with meta-analysis, a statistical technique for combining results of several studies, is progressively being used to guide decisions in medicine. Publication bias is acknowledged as a threat to the validity of systematic reviews and its existence may lead to inappropriate decisions about patient management or health policy. It is said to occur when the results of research available in the literature are not representative of the totality of all research.

Relation of final lumen dimensions in saphenous vein grafts after stent implantation to outcome.

Larger final lumen dimensions after percutaneous coronary interventions in native coronary arteries lead to lower restenosis rates. We sought to determine the impact of stent expansion, as assessed by intravascular ultrasound, on clinical results of stent implantation in saphenous vein grafts (SVGs). We identified 226 consecutive patients who underwent intravascular ultrasound-guided stenting of 234 de novo SVG lesions.

Optimal final lumen area and predictors of target lesion revascularization after stent implantation in small coronary arteries.

Despite similar early clinical events, patients who undergo treatment of small vessels are at an increased risk for target lesion revascularization (TLR) after coronary artery stenting. We sought to determine predictors of TLR after stent implantation in small coronary arteries. We identified 423 consecutive patients who underwent intravascular ultrasound (IVUS)-guided small vessel stenting procedures in 465 coronary lesions with an angiographic reference vessel diameter of <2.

Outcomes of bail-out stenting for suboptimal balloon angioplasty during primary intervention in acute myocardial infarction (The CADILLAC trial).

The results of bail-out stenting after unsuccessful primary balloon angioplasty compared with routine stenting or successful balloon angioplasty in acute myocardial infarction are unknown. In the CADILLAC trial, 168 of 1,044 patients (16.1%) randomized to balloon angioplasty crossed over to stenting after unsuccessful dilatation.

Outcomes following bail-out abciximab administration during primary intervention in acute myocardial infarction (The CADILLAC Trial).

The utility of glycoprotein IIb/IIIa receptor inhibitors as a "bail-out" modality after unsuccessful primary percutaneous coronary intervention for acute myocardial infarction is unknown. In the CADILLAC trial, of 1,030 control patients, 62 patients (6.0%) crossed over and received abciximab for procedural complications or suboptimal angioplasty results.

Using disease registries for pharmacoepidemiological research: a case study of data from a cystic fibrosis registry.

Background: The Epidemiologic Registry of Cystic Fibrosis (ERCF) was a multicentre, longitudinal follow-up project of cystic fibrosis patients enrolled at some 200 centres in nine European countries between 1994 and 1999.

Purpose: We aimed to assess and improve the quality of a subset of data from the ERCF relating to seven English centres (1184 patients), prior to using the data for a long-term cost-effectiveness analysis of dornase alfa (Pulmozyme). Specifically we wanted to assess the completeness and accuracy of the data and the comparability of cases across centres.

Safety of an aspirin-alone regimen after intracoronary stenting with a heparin-coated stent: final results of the HOPE (HEPACOAT and an Antithrombotic Regimen of Aspirin Alone) study.

Background: Stent thrombosis is an infrequent complication of intracoronary stenting that often has devastating clinical consequences. This study assesses the additional benefit of heparin coating with the BX VELOCITY Balloon-Expandable Stent with HEPACOAT, Carmeda end-point attached heparin (HEPACOAT) in patients with de novo or restenotic native coronary artery lesions treated with aspirin monotherapy after optimal stenting.

Methods And Results: This was a multicenter, prospective, nonrandomized, pilot study.

Relation between the degree of procedural anticoagulation and complications after coronary stent implantation.

The impact of the degree of anticoagulation in patients who underwent stent implantation without glycoprotein IIb/IIIa inhibitors was examined in 1,020 patients. High levels of procedural anticoagulation with heparin were found to increase hemorrhagic complications without improving clinical or angiographic outcomes.

Long-term follow-up of patients after gamma intracoronary brachytherapy failure (from GAMMA-I, GAMMA-II, and SCRIPPS-III).

We report the long-term outcome of 225 patients who failed gamma-brachytherapy for in-stent restenosis. Total adverse events, target vessel revascularization, and myocardial infarction were higher after repeat percutaneous coronary intervention versus coronary artery bypass grafting. Therefore, coronary artery bypass grafting may be the preferable first-line therapy in these patients until other therapies (i.

Thrombosis prevention trial: compliance with warfarin treatment and investigation of a retained effect.

Background: The Thrombosis Prevention Trial was a primary prevention factorial trial that reported a reduction in the risk of coronary heart disease (CHD) with warfarin and/or aspirin. This article examines compliance (duration of treatment) with warfarin treatment and whether warfarin has a retained effect.

Methods: Risk of CHD while complying with warfarin treatment was compared with risk of CHD in all participants randomized to placebo.

Calcineurin controls the expression of numerous genes in cerebellar granule cells.

The Ca(2+)/calmodulin-dependent phosphatase calcineurin plays a crucial role in gene expression in different cell types such as T-lymphocytes, cardiac myocytes, and smooth muscle cells. A possible role for calcineurin in gene expression was recently found in neurons, where calcineurin regulates the expression of several genes involved in Ca(2+) homeostasis. To detect additional genes regulated in a calcineurin-dependent way in neurons we analysed gene expression profiles of cerebellar granule cells cultured in depolarising conditions in the presence or absence of the calcineurin inhibitory agents FK506 and CsA.

Smooth muscle cholinergic denervation hypersensitivity in diverticular disease.

Background: Evidence from clinical and laboratory investigations into the causes of diverticular disease suggests that disturbances in cholinergic activity are important, the effector mechanisms of which have yet to be established. We aimed to investigate the role of smooth muscle and neural cholinergic activity in the pathogenesis of this disease.

Methods: Two investigators independently did a blinded immunohistochemical image analysis of localising antibodies to choline acetyltransferase, co-localised with protein gene product (PGP)--a marker of general neural tissue-and smooth muscle muscarinic M3 receptors, on three histological sections of sigmoid colons from ten patients with diverticular disease and ten controls, after resections for rectal tumours.

Biventricular pacing for severe mitral regurgitation following atrioventricular nodal ablation.

A 69-year-old woman developed acute pulmonary edema and severe mitral regurgitation (MR) 2 days following an uncomplicated AV nodal (AVN) ablation and insertion of VVI pacemaker for chronic atrial fibrillation. There was no history of significant mitral valve disease. Left ventricular function was normal and there was no evidence of an acute cardiac ischemic event.

Effect of percutaneous coronary interventions for in-stent restenosis in degenerated saphenous vein grafts without distal embolic protection.

Objectives: This study was designed to investigate the impact of percutaneous coronary interventions (PCIs) in degenerated saphenous vein grafts (SVGs) without distal embolic protection.

Background: Distal embolic protection devices have been shown to reduce the incidence of no reflow/slow flow during PCI of de novo lesions in degenerated SVGs. It is unclear whether PCI of in-stent restenosis (ISR) lesions in degenerated SVGs is associated with no reflow/slow flow and whether distal embolic protection is beneficial in these cases as well.

Impact of gender on the incidence and outcome of contrast-induced nephropathy after percutaneous coronary intervention.

Background: Contrast-induced nephropathy (CIN) is a recognized complication after percutaneous interventions (PCI). We sought to determine the impact of gender on incidence and clinical outcome of CIN.

Methods And Results: Of a total 8,628 patients who underwent PCI, there were 1,431 (16.

Coronary artery spasm associated with a moderately severe atherosclerotic stenosis in the proximal LAD.

Treatment of coronary artery spasm can be difficult; up to 25% of patients continue to have episodes of chest pain despite maximal therapy with calcium antagonists and nitrates. We describe the case of a 42-year-old female with severe coronary artery spasm associated with a moderately severe atherosclerotic stenosis of the proximal left anterior descending coronary artery. We discuss the diagnostic value of intravascular ultrasound and treatment options for spasm associated with atherosclerotic plaques.

Radiocontrast-induced acute renal failure: allocations and outcomes.

Radiocontrast-induced nephropathy causes significant morbidity and mortality with increase in hospital length of stay and costs. It can be largely prevented by identifying the patients at risk before the procedure. Once the at-risk patient is identified, ways to prevent the development of acute renal failure are: avoiding volume depletion, aggressive saline hydration with the aim of keeping the urine output over 150 mL/hour, and the use of low-osmolality contrast agents, with as little volume used as possible.

A retrospective case study to assess the value of the implantable loop recorder for the investigation of undiagnosed syncope.

If not diagnosed by history, examination, or ECG, the diagnosis of syncope can be difficult with a low yield from echocardiography, ambulatory ECG recording, electrophysiological study, and tilt table testing. During 2 years, 48 patients with unexplained syncope or presyncope from three hospitals in one city underwent the implantation of a Medtronic Reveal implantable loop recorder capable of cardiac monitoring for 14 months. All patients had at least two prior episodes of syncope or presyncope.