ABSTRACT
The transradial approach (TRA) is an effective and safe alternative to transfemoral access for diagnostic neuroangiography and craniocervical interventions. While the technical aspects of supraclavicular intervention are well-described, there are little data on the TRA for thoracolumbar angiography and intervention. The authors describe the feasibility of the TRA for preoperative thoracic tumor embolization, emphasizing technique, device selection, navigation, and catheterization of thoracolumbar segmental arteries. This approach extends the benefits of TRA to spinal interventional neuroradiology.
ABSTRACT
To evaluate the prognosis of primary percutaneous coronary intervention [PPCI] and medical therapy [MT] in elderly patients presenting with ST-elevation myocardial infarction [STEMI]. A total of 238 STEMI patients aged above 80 and treated with PPCI [n = 186] and MT [n = 52] at Harefield Hospital, London were included in this study. Patients who did not have true STEMI based on non-diagnostic electrocardiogram [ECG] for STEMI and negative troponin, who presented with left bundle branch block [LBBB] and had normal coronaries were excluded from this study. Primary PCI was defined as any use of a guidewire for more than diagnostic purposes in patients with STEMI, whereas conventional MT was defined as treatment of patients with anti-platelets and anti-thrombotic medications without thrombolysis. The survival rate of PPCI patients was 86% [n = 160] at month 1 followed by 83.9% [n = 156] at month 6, and 81.2% [n = 151] at month 12. The survival rate of MT patients was 44.2% [n = 23] at month 1 followed by 36.5% [n = 19] at month 6, and 34.6% [n = 18] at month 12. Compared to MT, significantly fewer comorbidities were found in the PPCI group. Ventricular fibrillation [VF] [4.8%] and consequent admission to intensive care unit [7%] were the major complications of the PPCI group. PPCI has a higher survival rate and, compared to MT, fewer comorbidities were observed in the PPCI group of elderly patients presenting with STEMI
Subject(s)
Humans , Male , Female , Myocardial Infarction , Prognosis , Aged , Survival RateABSTRACT
To compare the efficacy and tolerability with that of letrozole, an oral aromatase inhibitior, with tomoxifen as first-line therapy in postmenopausal women with advanced breast cancer. Nine hundred seven patients were randomly assigned tetrolzole 2.5 mg once daily [453 patients] or tamoxifen 20 mg once daily [454 patients]. Patients had estrogen receptor- and/or progesterone receptor-positive tumor, or both receptors were unknown. Recurrence during adjuvant antiestrogen therapy or within the following 12 months or prior endocrine therapy for advanced disease precluded enrollment. One prior chemotherapy regimen for metastatic disease was allowed. The primary end point was time to progression [TTP]. Secondary end points included overall objective response [ORR], its duration, rate and duration of clinicalbenefit, time to treatment failure [TTF], overall survival, and tolerability. TTP was significantly longer for letrozole than for tamoxifen [median, 41 v 26 weeks]. Treatment with letrozle reduced the risk of progression by 30% [hazards ratio, 0.70; 95% confidence interval, 0.60 to 0.82, P=.0001]. TTP was significantly longer for letrozole irrespective of dominant site of disease, receptor status, or prior adjuvant antiestrogen therapy. Similarly, TTF was significantly longer for letrozole [median, 40 v 25 weeks]. ORR was higher for letrozole [30% v 20%; P= .0006], as was the rate of clinical benefit [49% v 38%; P= .001]. Survival date are currently immature and not reported here. Both treatment were well tolerated. Letrozole was significantly superior to tamoxifen in TTP, TTF, ORR, and clinical benefit rate. Our results supports its use as first-line endocrine therapy in postmenopausal women with advanced breast cancer