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Selected AbstractsStenting of Bifurcation Lesions: A Rational ApproachJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 6 2001FSCAI, THIERRY LEFÈVRE M.D. The occurrence of stenosis in or next to coronary bifurcations is relatively frequent and generally underestimated. In our experience, such lesions account for 15%,18% of all percutaneous coronary intervention > (PCI). The main reasons for this are (1) the coronary arteries are like the branches of a tree with many ramifications and (2) because of axial plaque redistribution, especially after stent implantation, PCI of lesions located next to a coronary bifurcation almost inevitably cause plaque shifting in the side branches. PCI treatment of coronary bifurcation lesions remains challenging. Balloon dilatation treatment used to be associated with less than satisfactory immediate results, a high complication rate, and an unacceptable restenosis rate. The kissing balloon technique resulted in improved, though suboptimal, outcomes. Several approaches were then suggested, like rotative or directional atherectomy, but these techniques did not translate into significantly enhanced results. With the advent of second generation stents, in 1996, the authors decided to set up an observational study on coronary bifurcation stenting combined with a bench test of the various stents available. Over the last 5 years, techniques, strategies, and stent design have improved. As a result, the authors have been able to define a rational approach to coronary bifurcation stenting. This bench study analyzed the behavior of stents and allowed stents to be discarded that are not compatible with the treatment of coronary bifurcations. Most importantly, this study revealed that stent deformation due to the opening of a strut is a constant phenomenon that must be corrected by kissing balloon inflation. Moreover, it was observed that the opening of a stent strut into a side branch could permit the stenting, at least partly, of the side branch ostium. This resulted in the provocative concept of "stenting both branches with a single stent." Therefore, a simple approach is currently implemented in the majority of cases: stenting of the main branch with provisional stenting of the side branch, The technique consists of inserting a guidewire in each coronary branch. A stent is then positioned in the main branch with a wire being "jailed" in the side branch. The wires are then exchanged, starting with the main branch wire that is passed through the stent struts into the side branch. After opening the stent struts in the side branch, kissing balloon inflation is performed. A second stent is deployed in the side branch in the presence of suboptimal results only. Over the last 2 years, this technique has been associated with a 98% angiographic success rate in both branches. Two stents are used in 30%,35% of cases and final kissing balloon inflation is performed in > 95% of cases. The in-hospital major adverse cardiac events (MACE) rate is around 5% and 7-month target vessel revascularization (TVR) is 13%. Several stents specifically designed for coronary bifurcation lesions are currently being investigated. The objective is to simplify the approach for all users. In the near future, the use of drug-eluting stents should reduce the risk of restenosis. [source] ,2 -adrenoceptors are critical for antidepressant treatment of neuropathic pain,ANNALS OF NEUROLOGY, Issue 2 2009Ipek Yalcin PharmD Objective Tricyclic antidepressants (TCAs) are one of the first-line pharmacological treatments against neuropathic pain. TCAs increase the extracellular concentrations of noradrenaline and serotonin by blocking the reuptake transporters of these amines. However, the precise downstream mechanism leading to the therapeutic action remains identified. In this work, we evaluated the role of adrenergic receptors (ARs) in the action of TCAs. Methods We used pharmacological and genetic approaches in mice to study the role of ARs in the antiallodynic action of the TCA nortriptyline. Peripheral neuropathy was induced by the insertion of a polyethylene cuff around the main branch of the sciatic nerve. The specific role of ,2 -AR was evaluated by studying ,2 -AR,/, mice. We used von Frey filaments to assess mechanical allodynia. Results The antiallodynic action of nortriptyline was not affected by cotreatment with the ,2 -AR antagonist yohimbine, the ,1 -AR antagonists atenolol or metoprolol, or the ,3 -AR antagonist SR 59230A. On the contrary, the ,-AR antagonists propranolol or sotalol, the ,1/,2 -AR antagonists alprenolol or pindolol, or the specific ,2 -AR antagonist ICI 118,551 blocked the action of nortriptyline. The effect of nortriptyline was also totally absent in ,2 -AR,deficient mice. Interpretation Stimulation of ,2 -AR is necessary for nortriptyline to exert its antiallodynic action against neuropathic pain. These findings provide new insight into the mechanism by which antidepressants alleviate neuropathic pain. Our results also raise the question of a potential incompatibility between ,-blockers that affect ,2 -AR and antidepressant drugs in patients treated for neuropathic pain. Ann Neurol 2009;65:218,225 [source] Electrophysiological effects of endothelin-1 and their relationship to contraction in rat renal arterial smooth muscleBRITISH JOURNAL OF PHARMACOLOGY, Issue 4 2000Luisa C Betts The electophysiological effects of endothelin-1 (ET-1) and their relationship to contraction remain unclear in the renal circulation. Using endotheliumdenuded arteries from the main branch of the renal artery proximal to the kidney of the rat, we have examined its effects on tension and conducted parallel patch-clamp measurements using freshly isolated smooth muscle cells from this tissue. Pharmacological experiments revealed that ET-1 produced constriction of renal arteries dependent on the influx of extracellular Ca2+, mediated solely through ETA receptor stimulation. Current-clamp experiments revealed that renal arterial myocytes had a resting membrane potential of ,32 mV, with the majority of cells exhibiting spontaneous transient hyperpolarizations (STHPs). Application of ET-1 produced depolarization and in those cells exhibiting STHPs, either caused their inhibition or made them occur regularly. Under voltage-clamp conditions cells were observed to exhibit spontaneous transient outward currents (STOCs) inhibited by iberiotoxin. Application of voltage-ramps revealed an outward current activated at ,,30 mV, sensitive to both 4-AP and TEA. Taken together these results suggest that renal arterial myocytes possess both delayed rectifying K+ (KV) and Ca2+ -activated K+ (BKCa) channels. Under voltage-clamp, ET-1 attenuated the outward current and reduced the magnitude and incidence of STOCs: effects mediated solely as a consequence of ETA receptor stimulation. Thus, in conclusion, activation of ETA receptors by ET-1 causes inhibition of KV and BKCa channel activity, which could promote and/or maintain membrane depolarization. This effect is likely to favour L-type Ca2+ channel activity providing an influx pathway for extracellular Ca2+ essential for contraction. British Journal of Pharmacology (2000) 130, 787,796; doi:10.1038/sj.bjp.0703377 [source] Long-term outcomes of bifurcation lesions after implantation of drug-eluting stents with the "mini-crush technique"CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 7 2007Alfredo R. Galassi MD, FSCAI Abstract Objectives: To evaluate clinical and angiographic long-term outcome of "the mini-crush" technique for treating bifurcation lesions. Background: Despite proven efficacy of drug-eluting stent (DES) within most lesions subsets, bifurcation lesions continue to exhibit high restenosis rate using current DES stenting technique. Methods: We report a new stenting technique which was employed in 45 consecutive patients (52 lesions) between April 2004 and July 2005 to treat true bifurcation lesions using DES in both branches. Results: Using this technique procedural success was obtained in 100% of cases, without complications and with excellent angiographic result in 96.1% and 98.1% of main vessel and side branch. Preprocedure reference vessel diameter and minimal lumen diameter (MLD) were 2.68 ± 0.48 and 0.90 ± 0.55 mm for the main branch, respectively and 2.28 ± 0.34 and 1.14 ± 0.47 mm for the side branch, respectively. Postprocedure MLD was 2.56 ± 0.39 mm for the main branch and 2.16 ± 0.29 mm for the side branch. There were no in-hospital major adverse cardiac events (MACE). At 72 days after procedure there was one case of side branch stent thrombosis (2.2%), which resulted in non Q-wave MI. Angiographic follow up was obtained in 100% of patients at 7.5 ± 1.3 months. Target lesion revascularization (TLR) was 12.2%; no death and Q-wave MI were observed; reference vessel diameter and MLD for the main branch were 2.79 ± 0.51 and 1.99 ± 0.65 mm respectively and for the side branch 2.28 ± 0.40 and 1.63 ± 0.48 mm respectively. Restenosis rate in the main branch was 12.2% while in the side branch was 2.0%. Conclusions: In-hospital outcome indicates that the mini-crush technique for bifurcation lesions with DES can be easily performed. It provides very low total MACE rate and restenosis at 8-month follow-up. These results confirmed the advantage of this specific technique to give complete coverage of the ostium of the side branch using two stents technique. © 2007 Wiley-Liss, Inc. [source] Validation of the murine aortic arch as a model to study human vascular diseasesJOURNAL OF ANATOMY, Issue 5 2010Christophe Casteleyn Abstract Although the murine thoracic aorta and its main branches are widely studied to gain more insight into the pathogenesis of human vascular diseases, detailed anatomical data on the murine aorta are sparse. Moreover, comparative studies between mice and men focusing on the topography and geometry of the heart and aorta are lacking. As this hampers the validation of murine vascular models, the branching pattern of the murine thoracic aorta was examined in 30 vascular corrosion casts. On six casts the intrathoracic position of the heart was compared with that of six younger and six older men of whom contrast-enhanced computer tomography images of the thorax were three-dimensionally reconstructed. In addition, the geometry of the human thoracic aorta was compared with that of the mouse by reconstructing micro-computer tomography images of six murine casts. It was found that the right brachiocephalic trunk, left common carotid artery and left subclavian artery branched subsequently from the aortic arch in both mice and men. The geometry of the branches of the murine aortic arch was quite similar to that of men. In both species the initial segment of the aorta, comprising the ascending aorta, aortic arch and cranial/superior part of the descending aorta, was sigmoidally curved on a cranial/superior view. Although some analogy between the intrathoracic position of the murine and human heart was observed, the murine heart manifestly deviated more ventrally. The major conclusion of this study is that, in both mice and men, the ascending and descending aorta do not lie in a single vertical plane (non-planar aortic geometry). This contrasts clearly with most domestic mammals in which a planar aortic pattern is present. As the vascular branching pattern of the aortic arch is also similar in mice and men, the murine model seems valuable to study human vascular diseases. [source] Impact of advanced exercise ECG analysis on cost of coronary artery disease managementJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 4 2010Riccardo Bigi PhD Abstract Background, Conventional analysis of exercise electrocardiogram (EX-ECG) has limited accuracy. This study aims to evaluate the potential impact of improving EX-ECG accuracy on costs of diagnosis and number of misdiagnoses of coronary artery disease (CAD). Methods, A decision-tree model was simulated including sequential application of diagnostic procedures for suspected CAD. The model was structured in two main branches (presence or absence of CAD). A probabilistic sensitivity analysis was then performed for several combinations of improvement in test sensitivity and specificity. Results, A clear trend in cost reduction was observed at improving EX-ECG specificity (about 8,8.5 million dollars, corresponding to a 5.6,7.6% reduction according to the prevalence level). Wrong diagnoses counted for 9,13% of test. Improvements in test parameters lead to reductions in wrong diagnoses, especially when increasing specificity (8.8,12.5%). Conclusions, A proper improvement in EX-ECG sensitivity and specificity would have a relevant impact on the costs of CAD management, while reducing the number of misdiagnoses. [source] Expression and immunogenicity of NY-ESO-1 in hepatocellular carcinomaJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 8 2006Shinichiro Nakamura Abstract Background and Aim:, The present study was designed to investigate the expression of and humoral response against NY-ESO-1 in patients with hepatocellular carcinoma and to analyze the relationship between expression of NY-ESO-1 mRNA and clinicopathological features. Methods:, NY-ESO-1 mRNA and protein expression in surgically resected hepatocellular carcinoma specimens, adjacent non-cancerous liver and non-tumor bearing liver were examined by reverse transcription-polymerase chain reaction and immunohistochemical staining using a monoclonal antibody against NY-ESO-1 (ES121), respectively. The antibody response to NY-ESO-1 was examined by enzyme-linked immunosorbent assay using recombinant NY-ESO-1 protein. Results:,NY-ESO-1 mRNA was detected in 18 of 41 (43.9%) hepatocellular carcinomas. No NY-ESO-1 mRNA was expressed in 41 paired non-cancerous specimens and 18 specimens histologically diagnosed as liver cirrhosis or chronic hepatitis. Immunohistochemistry revealed heterogeneous expression of NY-ESO-1 protein in three of 18 NY-ESO-1 mRNA-positive hepatocellular carcinomas. None of 23 NY-ESO-1 mRNA-negative hepatocellular carcinomas expressed NY-ESO-1 protein. Antibody against NY-ESO-1 protein was detected in two of 92 patients with hepatocellular carcinoma. Both of these patients had tumors invading main branches of the portal vein. Conclusions:, The present study has demonstrated the expression of NY-ESO-1 mRNA in hepatocellular carcinoma and NY-ESO-1 antibody production in patients with advanced hepatocellular carcinoma. Although the enhancement of NY-ESO-1 protein expression and the activation of immune response of the patients with hepatocellular carcinoma are necessary, NY-ESO-1 has the potential to be a good target molecule for immunotherapy against advanced hepatocellular carcinoma. [source] Endoscopic Treatment of Salivary Gland Injuries due to Facial Rejuvenation ProceduresTHE LARYNGOSCOPE, Issue 5 2008Oded Nahlieli DMD Abstract Objective: The purpose of this article is to describe innovative surgical techniques for treatment of salivary gland injuries caused by facial rejuvenation procedures. Methods: Between 2001 and 2007, a total of 14 patients, all females ages 46 to 70 who suffered from salivary gland injuries caused by facial rejuvenation procedures, were treated, primarily by an endoscopic-guided technique that involved location of the injury and endoscopic repair. Results: There were four types of postsurgical injuries of the salivary glands that were caused by operations for facial rejuvenation: 1) compression of salivary ducts with temporary swelling (n = 1); 2) laceration of the capsule of the salivary gland (n = 3); 3) stretching and compression of the ducts with penetration of the capsule of the duct leading to sialocele and long-term swelling (types 1 and 2 combined) (n = 5); and 4) complete cut or penetration of the main salivary duct or of one of its main branches resulting in sialocele (n = 5). The endoscopic technique treatment was successful in all cases. Conclusion: The main reasons for salivary gland injuries due to facial rejuvenation procedures in our patients were: poor anatomical identification of the border between the superficial muscular aponeurotic system (SMAS) and the parotid capsule; penetration of the salivary gland capsule by blunt or sharp dissection; unnecessary use of sharp-tip scissors; and a tear of the salivary duct by hooks during a face-lift procedure. Plastic surgeons should be aware of these complications and try to improve their techniques accordingly. To avoid atrophy of the salivary gland, once the diagnosis it made, it is advisable to send the patient to a maxillofacial or ENT surgeon skilled in endoscopy. [source] Morphology of Haemal Nodes in the Roe Deer (Capreolus capreolus)ANATOMIA, HISTOLOGIA, EMBRYOLOGIA, Issue 5 2010Y. Akaydin Bozkurt With 5 figures Summary The present study was aimed at the determination of the morphology of haemal nodes in the roe deer (Capreolus capreolus). The morphology of haemal nodes located in the abdominal and thoracic cavities of six roe deer (two adult male, two adult female and two foetuses) was studied by gross inspection and histological methods. Oval- and round-shaped haemal nodes with colours varying from pink to dark red were observed particularly between the abdominal aorta and caudal vena cava, and at the beginning of the main branches of the abdominal aorta. These nodes, having connection only with blood vessels, were covered with a thin or thick capsule of connective tissue in the foetus and the adult respectively. Trabeculae were not observed in foetal nodes. In adults, the capsule, trabeculae and, in particular, the sinuses were strongly supported by reticular fibres and cells. The morphology of these nodes displayed similarity to that of other ruminant species. [source] Rudimentary Coronary Artery in Syrian Hamsters (Mesocricetus auratus)ANATOMIA, HISTOLOGIA, EMBRYOLOGIA, Issue 4 2009A. C. Durán Summary Congenital underdevelopment of one or more main branches of the coronary arteries has been reported in man, but not in non-human mammals. In man, this defective coronary artery arrangement may cause myocardial ischaemia and even sudden death. The main goal of this study was to describe the coronary artery distribution patterns associated with the presence of a markedly underdeveloped (rudimentary) coronary artery in Syrian hamsters. Moreover, an attempt was made to explain the morphogenesis of these patterns, according to current knowledge on coronary artery development. Eleven affected hamsters belonging to a laboratory inbred family were examined by means of internal casts of the heart, great arterial trunks and coronary arteries. The aortic valve was tricuspid (normal) in seven hamsters and bicuspid in the other four. A rudimentary coronary artery arose from the right side of the aortic valve in four specimens, from the left side of the aortic valve in a further three, and from the dorsal aortic sinus in the remaining four. In all cases, a second, well-developed coronary artery provided for all the coronary blood flow. Except for the existence of a rudimentary coronary artery, the present anomalous coronary artery distribution patterns are similar to coronary artery patterns reported in Syrian hamsters, dogs and humans in association with a solitary coronary ostium in aorta. We suggest that an unusual prolonged time interval in the development of the embryonic coronary stems might be a key factor in the formation of coronary arteries displaying significantly dissimilar developmental degrees. [source] Aortic arch variation analyzed by using plastinationCLINICAL ANATOMY, Issue 6 2002Mircea-Constantin Sora Abstract Different ramification patterns can be observed during the development of the aortic arch. In this study a common trunk (CT), which subsequently branched into the brachiocephalic trunk (BT) and left common carotid artery (LCCA), arose from the aortic arch. The LCCA arose from the CT 10.27 mm above the aortic arch. After crossing the ventral aspect of the trachea and esophagus, the LCCA became situated on the left side of the esophagus. The caliber and length of the main branches of the aortic arch were determined and compared to reports in the literature. This variation was discovered in the context of producing transverse body slices using an E12 plastination process. Clin. Anat. 15:379,382, 2002. © 2002 Wiley-Liss, Inc. [source] | |||||||||||||