Clinical variables related with in-stent restenosis late regression after bare metal coronary stenting

In-stent restenosis (ISR) has an incidence between 20% and 30% using bare metal stents. ISR late regression phenomenon (ISRLR) has been previously described, but clinical variables related with this phenomenon remain unclear. The aim of the study was to identify the variables related with ISRLR. METHODS: We identified from our data base 30 patients between November 1995 and September 2002 that fulfilled the following criteria: 1) Documented ISR at follow-up angiography (CA-1); 2) treated medically; and 3) Referred for a second follow-up angiography (CA-2). at least 3 months after CA-1. ISRLR was defined as a > 0.2 mm increase in MLD between CA-1 and CA-2, calculated as the 2-fold of our inter-observer variability. ISR late progression was defined as a > 0.2 mm decrease in minimum lumen diameter (MLD) between CA-1 and CA-2. RESULTS: At the time of CA-2 only 2 patients (6.7%) had symptoms related with the previously stented vessel. We found a mean MLD of 1.03+/-0.34 mm and 1.54+/-0.48 mm at CA-1 and CA-2 respectively (AMLD = 0.51 +/-0.34 mm; p < 0.001). Twenty four patients (80.0%) had ISRLR. Two variables were related to the presence or absence ISRLR: Current smoking at the time of coronary stenting (70.8% vs 20.0% respectively, p = 0.026) and acute coronary syndrome as clinical indication for coronary stenting (and 83.5% vs 40.0% respectively, p = 0.029). CONCLUSION: ISRLR is a frequent phenomenon in patients with ISR treated medically, probably contributing to the benign long-term clinical outcome that has been previously described in patients with asymptomatic or mildly symptomatic ISR. Current smoking at the time of coronary stenting and acute coronary syndrome as clinical indication for coronary stenting are associated with this phenomenon.

La fiebre tifoídea en el niño / The typhoid fever in children

Los países, con elevada incidencia de fiebres tíficas comprometen a todos los médicos-independientemente de su especialidad- a conocer las medidas preventivas y las características clínico-terapéuticas de estas afecciones. Por este motivo a los editores de Pediatría al día nos ha parecido de mucho interés hacer una revisión en profundidad sobre el tema. En esta comunicación, cuya primera parte presentamos en este número de la revista, se analizarán principalmente los aspectos clínicos de las fiebres tíficas en general y la influencia que han tenido los tratamientos quimioterápicos actuales. En una publicación posterior se abordaran los aspectos epidemiológicos, terapéuticos y preventivos