Drug-Eluting Balloons-A New Tool in the Treatment of Cardiac Allograft Vasculopathy: A Case Series.

Percutaneous coronary intervention in patients with cardiac allograft vasculopathy is burdened with a lot of difficulties. Although they have allowed significant progress in comparison with plain balloon angioplasty and bare metal stents, drug-eluting stents have not fully overcome problems of diffuse lesions and small-vessel disease that are so common in transplant coronary artery disease. There is growing evidence that drug-eluting balloons might be a better choice for patients with small vessel atherosclerotic coronary disease and yet there is no experience with this technology in patients with cardiac allograft vasculopathy. Herein we report a case series of successful percutaneous coronary interventions in patients with cardiac allograft vasculopathy.

Incidental extraction of a temporary epicardial pacemaker wire with right ventricular perforation during endomyocardial biopsy: a case report.

INTRODUCTION: Right ventricular perforation during endomyocardial biopsy is an unusual, although potentially life-threatening, complication caused with the tip of the bioptome. The majority of perforations in heart transplant patients can be managed without surgery owing to adhesions nearly obliterating pericardial space. CASE REPORT: We report a case of heart transplant patient who suffered right ventricular perforation as a consequence of incidental extraction of a temporary epicardial pacemaker wire during a routine endomyocardial biopsy sampling. CONCLUSIONS: The patient suffered no clinical consequences.

Management of heparin-induced thrombocytopenia with fondaparinux in a patient with left ventricular assist device.

Heparin-induced thrombocytopenia is an immune-mediated serious adverse effect of heparin therapy. It is a relatively frequent complication among patients with mechanical circulatory support. Herein, we present a patient with severe heart failure and sepsis who developed heparin-induced thrombocytopenia shortly after implantation of left ventricular assist device as a bridge to transplantation and who was successfully treated with fondaparinux.

Myocardial motion and deformation: What does it tell us and how does it relate to function?

The assessment of cardiac pump function and the potential of local myocardium to contribute to the overall performance are of great importance in many cardiovascular abnormalities. Assessing intrinsic cardiac function requires obtaining information on the true contractility of the heart muscle, assessed locally but interpreted in the context of its contribution to the global ejection performance and potential to adapt to changing circumstances. Contemporary imaging techniques offer the possibility of noninvasive quantification of myocardial deformation. These new clinical tools are attractive to use for the assessment of ventricular function. However, it is of great importance to understand cardiac mechanics - a complex interplay between the tissue structure/shape, force development, and interaction with the environment/neighbors - to interpret alterations in deformation and to extract clinically relevant conclusions. The combination of insight into the measurement techniques and their limitations, together with knowledge of myocardial mechanics and physiology, opens new perspectives to improve the assessment and management of fetal, pediatric, and adult patients.

Corynebacterium jeikeium endocarditis: a systematic overview spanning four decades.

Skin flora is an important source of microorganisms that cause infective endocarditis. While staphylococcal and beta-hemolytic streptococcal species are well-recognized components of skin flora that can cause infective endocarditis, other skin flora rarely produce endocardial infection. One species of Corynebacterium has received the most attention, Corynebacterium jeikeium. This bacterium, a gram-positive rod that is a strict aerobe, is known to cause mechanical prosthetic valve infection and vancomycin is generally required for treatment of this multidrug-resistant organism. Following treatment of an unusual case of bioprosthetic valve endocarditis due to C. jeikeium, a Medline search for English-language articles published from January 1966 to October 2004 was performed. Reports of C. jeikeium endocarditis cases with culture of either blood or cardiac surgery tissue samples positive for C. jeikeium and with clinical and echocardiographic findings of infective endocarditis were reviewed. Clinical data and results of diagnostic procedures were examined. All 38 patients with C. jeikeium endocarditis reported in the literature had at least one predisposing condition for the development of infective endocarditis. The majority of patients (74%) had involvement of a prosthetic heart valve. The mortality attributed to C. jeikeium endocarditis was 33% and was similar in patients who did and did not undergo valve replacement. This relatively high mortality rate mandates that clinicians be aware of this rare endocardial infection. C. jeikeium is a rare cause of endocarditis and it more commonly infects prosthetic valves. Careful scrutiny is required when C. jeikeium is isolated from a blood culture, particularly in patients with underlying prosthetic cardiac valves.

Retrogenic expression of receptors for growth factors in neoplasia.

Hormone-dependent tumors have a decreased requirement for growth stimulating hormones compared with the normal tissues from which the tumors originate. This property of hormone-dependent tumors is due to an inappropriate expression of hormone receptors in and by cancer cells making these cells highly sensitive to growth stimulating effects of hormones, and a variety of growth factors, compared with their normal counterparts. In the early stages of tumor development, the ectopic receptors for hormones are inappropriately expressed in cancer cells. The expression of multiple ectopic receptors for hormones and growth factors confers an apparent autonomy on cancer cells. In some instances, cancer cells have been found to exhibit hormonal sensitivity and hormone receptor content as do their normal counterparts at earlier developmental stages.

[Chemical adrenalectomy induced by aminoglutethimide in the treatment of breast cancer. A review]. / Surrénalectomie médicale par l'aminoglutéthimide dans le traitement du cancer du sein.

The clinical profile of aminoglutethimide (AG), an amino derivative of the hypnotic agent glutethimide, is described. AG suppresses estrogen formation in postmenopausal women by its inhibitory effect on steroid synthesis in the adrenal glands as well as in the peripheral tissues. The results of treatment of 959 breast cancer patients by AG and glucocorticoids in several studies are reviewed. The treatment of these patients, who were not selected according to the hormonal receptor status in their tumors, resulted in about 30% objective responses. About 50% of the patients with estrogen receptor positive tumors responded with an objective regression. The favorable effect of medical adrenalectomy is comparable to that of hypophysectomy or surgical adrenalectomy; the advantage of medical adrenalectomy compared to ablative endocrine surgery is reversibility of the inhibitory effect on the production of adrenal hormones and estrogens after cessation of treatment. The AG-glucocorticoid regimen appears to exert a greater effect on skeletal metastases than tamoxifen. Patients who fail on tamoxifen and other endocrine regimens can still benefit from AG-glucocorticoid treatment. The value of medical adrenalectomy as adjuvant treatment is not yet known. At present, several agents with a selective effect on androgen-to-estrogen conversion in the peripheral tissues are under study. Their potential as inhibitors of the estrogen production in breast cancer patients is considerable.

Endolymphatic stromal myosis. Surgical and hormonal treatment of extensive abdominal recurrence 20 years after hysterectomy.

This report describes the clinicopathologic features of a 49-year-old woman who was reoperated on for bulky abdominal metastases 20 years after hysterectomy for endometrial stromal myosis (ESM). The levels of estrogen (ER) and progesterone (PR) receptors measured in the resected tumorous tissue amounted to 48.3 and 71.4 femtomoles (fmol)/mg cytosol protein, respectively. After medroxyprogesterone acetate (Depo-Provera; Upjohn) treatment of 16 months duration, the unresected pelvic tumor mass compressing the bladder and the left ureter had decreased in volume and hydroureteronephrosis had regressed. The efficacy of the therapy was monitored by computed tomography. Two years and nine months after surgery, the evolution of the tumor seems well-controlled by continuous progestin therapy and the patient is living without symptoms.

Microfluorometric analysis of anti-complement and indirect immunofluorescence tests for human papovavirus (JCV and BKV) T antigens.

The anti-complement immunofluorescence (ACIF) test was compared with the conventionally used indirect IF (IIF) in regard to its usefulness for the detection of low amounts of human papovavirus tumor (T) antigen. Fluorescence microscopic analysis revealed that it is significantly more sensitive. Microfluorometric measurements on the intensity of staining of T-antigen-positive nuclei demonstrated that JCV T in HJC-15 cells was 35-fold and BKV T in BK-L3 cells 94-fold more intensively stained in the ACIF then in the IIF. It appears that the lower the actual amount of a given antigen the more valuable is the ACIF test.

[Selection of patients with breast cancer with regard to endocrine therapy]. / Sélection des patientes atteintes de cancer du sein en vue d'une thérapeutique endocrinienne.

Predictive tests assisting in selection of breast cancer patients for endocrine therapy have been reviewed. Information gained from histologic sections, such as degree of the tumor differentiation, degree of elastosis, Barr-body count and the DNA content, are valuable predictors of prognosis and response to endocrine therapy. The length of time between mastectomy and recurrence of metastasis is an important factor in predicting response to ablative endocrine surgery. The presence of various enzymes in the tumor tissue, blood groups, immunologic competence, altered metabolism of tryptophan, urinary excretion of steroids and in vitro hormonal responsiveness of the tumor tissue have not been widely used as predictors of tumor response to endocrine therapy. The determination of hormone receptors in primary or metastatic breast tumors is at present the most reliable test in selecting breast cancer patients for endocrine therapy. Future developments in hormone receptor assay may provide a means of tailoring endocrine therapy to the individual patient.

Interspecies-, species- and type-specific T antigenic determinants of human papovaviruses (JC and BK) and of Simian virus 40.

Immunofluorescence tests, absorption studies and quantitative analysis by a very sensitive 51Cr microcomplement fixation (CF) technique were used to define the degree of relatedness between the tumor (T) antigens induced by human papovaviruses, strain JC and BK, with simian virus 40(SV40) and mouse polyoma virus (PyV). Antisera against JCV, BKV, SV40 and PyV T were raised in tumor-bearing hamsters. The data obtained indicate that T antigens of JCV, BKV and SV40 possess various subspecificities which can be distinguished and looked upon as interspecies-, species- and type-specific antigenic determinants. It was found that JCV T and BKV T synthesized in transformed hamster cells share about the same amount (20%) of interspecies cross-reacting antigen with SV40 T from H-50 cell extracts (transformed hamster cells). Although hamster cells transformed by PyV showed definite PyV T reactivity, no cross-reactivity, at least with the sera used, was found with human papovavirus and SV40 T antigens. Furthermore, degree of heterogeneity was observed within the T antigen complex derived from different SV40-transformed cells.

Antigenic changes in cultured murine lymphomas after retransplantation into syngeneic hosts.

When cultured murine lymphomas were retransplanted into syngeneic hosts, the quantitative representation of H-2 antigens and Moloney leukemia virus-determined cell-surface antigens tended to revert to the antigenic pattern characteristic of the corresponding lines propagated in vivo. In some instances, a complete reversion of both the virus-specific and H-2 antigens was observed after a single passage of cultured lymphoma cells in syngeneic hosts.

An improved quantitative micro-complement fixation test.

The technical procedures for a simple quantitative micro-complement (C) fixation test are described. Major advantages of the present technique compared with the previously described method are: a) a simple measurement of the residual hemolytic activity of C by counting the radioactivity released from 51Cr-labeled sensitized sheep erythrocytes (51Cr-EA); b) an increased sensitivity of the test, brought about by the use of a relatively small number of 51CR-EA per reaction volume; and c) an increased specificity of the test, achieved by maintaining a constant amount of C available for the specific antigen--antibody reaction.