ABSTRACT
BACKGROUND: There are no data comparing the long-term outcome of bare-metal stents (BMS) vs drug-eluting stents (DES) in patients with hepatitis C virus (HCV) infection. HYPOTHESIS: In patients with HCV infection, the rate of major adverse cardiac events (MACE) would be less, and the mortality rates similar, in patients treated with DES than in patients treated with BMS. METHODS: The incidence of major adverse cardiac events (MACE) during long-term follow-up, including death, myocardial infarction, and target-vessel revascularization, was investigated in HCV-infected patients who also underwent percutaneous coronary intervention with bare-metal or drug-eluting stents. RESULTS: Of 78 patients studied, BMS were placed in 41 patients and DES stents in 37 patients. Stepwise Cox regression analyses were performed to identify significant independent risk factors for MACE. At 42 +/- 11-month follow-up, MACE occurred in 9 of 41 patients (22%) in the BMS group (mean age 63 +/- 11 years, 66% men) vs in 7 of 37 patients (19%) in the DES group (mean age 61 +/- 9 years, 65% men). There was no significant difference in MACE in the BMS group vs the DES group. This persisted even after controlling for length of the stent, complexity of lesion, and other comorbidities. All-cause mortality was not significantly different in the BMS group vs the DES group (7% vs 5%). CONCLUSIONS: At long-term follow-up of HCV-infected patients with stable liver function, the rates of MACE and of all-cause mortality were similar in the BMS and DES groups.
Subject(s)
Angioplasty, Balloon, Coronary/instrumentation , Coronary Artery Disease/therapy , Drug-Eluting Stents , Hepatitis C/complications , Metals , Myocardial Infarction/etiology , Stents , Aged , Angioplasty, Balloon, Coronary/adverse effects , Angioplasty, Balloon, Coronary/mortality , Chi-Square Distribution , Coronary Artery Disease/complications , Coronary Artery Disease/mortality , Female , Hepatitis C/mortality , Hepatitis C/physiopathology , Humans , Liver/physiopathology , Liver/virology , Male , Middle Aged , Myocardial Infarction/mortality , New York , Proportional Hazards Models , Prosthesis Design , Retrospective Studies , Risk Assessment , Risk Factors , Time Factors , Treatment OutcomeABSTRACT
Tricyclic antidepressants (TCAs) remain a common cause of fatal drug poisoning as a result of their cardiovascular toxicity manifested by electrocardiographic abnormalities, arrhythmias, and hypotension. The principal mechanism of toxicity is cardiac sodium channel blockade. Brugada electrocardiographic pattern (BEP) has also been described in TCA overdose. Currently, very little is known about the relationship between the Brugada syndrome and TCAs. We report the case of a patient who presented with BEP after intake of a high dose of amitriptyline. The patient was treated with continuous sodium bicarbonate infusion leading to resolution of BEP.
Subject(s)
Amitriptyline/poisoning , Antidepressive Agents, Tricyclic/poisoning , Brugada Syndrome/chemically induced , Electrocardiography , Amitriptyline/adverse effects , Antidepressive Agents, Tricyclic/adverse effects , Arrhythmias, Cardiac/drug therapy , Drug Overdose/drug therapy , Humans , Male , Middle Aged , Sodium Bicarbonate/antagonists & inhibitorsABSTRACT
A middle-aged woman presented with insidious onset swelling of bilateral lacrimal and parotid glands. Mikulicz syndrome is a symptom complex caused by a variety of systemic disorders like lymphoma, sarcoidosis, amyloidosis, human immunodeficiency virus infection, tuberculosis, etc. Biopsy from her lacrimal glands revealed mantle cell lymphoma. Although involvement of salivary and lacrimal glands as a part of generalized lymphomatous involvement is not uncommon, Mikulicz syndrome as a presenting manifestation of a lymphoma is very rare.
