Safety of autologous intramuscular platelet lysate injections in patients with critical limb ischaemia: A pilot, exploratory study

Background & objectives: Platelet concentrate contains a rich cocktail of growth factors that support growth and proliferation of cells. The primary goal of this study was to investigate the safety of platelet lysate (PL) in patients with critical limb ischaemia (CLI) not suitable for standard revascularization. Data on the preliminary efficacy are also presented. Methods: Seven patients (18-70 yr) with CLI classified in the Rutherford grades 3-5, with history of intermittent claudication for more than eight weeks and were not suitable for standard revascularization, underwent autologous intramuscular injections of PL. These patients were examined physically alongside other parameters such as TcPO2, toe pressure, and ankle brachial index, at baseline and were followed up for 12 months. Results: The procedure was well tolerated with no serious adverse or any adverse events reported during follow up. Although not the primary aim of this report, preliminary data showed significant clinical improvement in Rutherford stage, ankle-brachial index and toe pressure which persisted for a year. Interpretation & conclusions: Intramuscular injection of PL was well tolerated with no major adverse events reported in our study participants. With the observed satisfactory safety data, preliminary efficacy data of PL should be further validated.

Vascular complications following cardiac catheterization at Jordan University Hospital

Objective: This study evaluates the rate of vascular complications following diagnostic cardiac catheterization and percutaneous intervention [PCI] at Jordan University Hospital

Methods: We reviewed the records of 1000 consecutive patients who underwent cardiac catheterization or PCI. Vascular complications including: minor hematoma > 5 cm in diameter, pseudoaneurysm, arteriovenous fistula and major bleeding with a hemoglobin drop >/=3 gm/dl or bleeding requiring transfusion, limb ischemia and death related to the vascular complication. In addition, clinical variables associated with increased risk of vascular complications were recorded including age, hypertension, diabetes mellitus, chronic kidney disease, congestive heart failure, indication for the procedure, emergency vs. elective, and diagnostic catheterization vs. PCI

Results: 1000 consecutive cases [746 catheterization, and 256 PCI] that were performed in the period from January 1st to Aug 25th 2011 were evaluated. There were six [0.6%] complications: one major [bleeding; requiring blood transfusion] and five minor [3 hematomas and 2 pseudoaneurysms] . A higher vascular complication rate was recorded in certain groups, PCI versus diagnostic catheterization [1.9% vs. 0.1%, P=0.005], emergency versus elective procedures [6.8% vs. 0.3% P= 0.001], and myocardial infarction versus angina [4.3% vs. 0.2%, P= 0.002]. None of the clinical variables studied in this series had an association with increased risk for vascular complications

Conclusions: Vascular complications rate following cardiac catheterization and PCI was comparable to other published series, suggesting that manual compression with proper monitoring by doctors and nurses continues to be a safe procedure. PCI, emergency procedures, and myocardial infarction carried a significantly higher vascular complication rate

Solitary fibrous tumor arising from the mediastinal pleura: case report

Solitary fibrous tumor is a rare mesenchymal tumor affecting mainly the pleura, the visceral pleura is the most commonly affected. It is usually a benign tumor but may have an unpredictable behavior and a malignant potential, complete excision is the standard of treatment. We present a case of solitary fibrous tumor of the mediastinal pleura which is a very rare incidence. Also, we reviewed the literature related to the condition

Difficult CABG in the era of stenting

For the past three decades, coronary artery bypass grafting has been the standard treatment for patients with severe multivessel ischemic heart disease. In the past few years, however, it has been increasingly challenged by precutaneous coronary intervention. The increasing tendency to report interventional treatments being based on "patient or physician preference" is both inadequate and inappropriate, discussion of all interventions by a multidisciplinary team should be a minimum standard of care. In this report we present a patient with coronary artery disease who underwent coronary catheterization and stenting many times, and finally the decision was to do a coronary artery bypass grafting in which the saphenous vein anastomosis to the distal right coronary artery was done over an old stent