Percutaneous revascularization of ostial saphenous vein graft stenoses.

OBJECTIVES: This study sought to evaluate the short-term results and long-term outcome of percutaneous revascularization of ostial saphenous vein graft stenoses in a large patient series. BACKGROUND: Previous studies have demonstrated that the results of balloon angioplasty for native coronary ostial stenoses are significantly worse than those for nonostial lesions. However, it is controversial whether interventions in patients with ostial saphenous vein grafts carry a similar prognosis. METHODS: We identified 68 consecutive patients with ostial (group I) and 72 consecutive patients with proximal, nonostial (group II) saphenous vein graft stenoses who underwent percutaneous angioplasty or directional atherectomy for a single new stenosis at the Cleveland Clinic between 1986 and 1992. RESULTS: Success was achieved in 61 patients (89.7%) in group I and 64 (88.9%) in group II (p = 0.88). There were no differences in major procedural complications (death, Q wave infarction and bypass surgery) between the two groups. At a mean (+/- SD) follow-up of 23 +/- 17 months, 36 patients (64%) in group I had one or more adverse events (death, infarction, repeat coronary revascularization or cardiac-related hospital admission) compared with 34 patients (58%) in group II (p = 0.87). Twenty-eight patients (50%) were angina free in group I compared with 33 (56%) in group II (p = 0.65). During the follow-up period in group I, 7 patients died (13%), 10 had a myocardial infarction (18%), 11 had repeat bypass surgery (20%), 8 had repeat percutaneous interventions (14%), and 30 had one or more cardiac-related hospital admissions (54%). The incidence of these events was similar in group II except for a slightly higher incidence of myocardial infarction: 6 patients died (10%), 3 had a myocardial infarction (5%), 12 had repeat bypass surgery (20%), 12 had repeat percutaneous interventions (20%), and 26 had one or more cardiac-related hospital admissions (44%). CONCLUSIONS: Unlike ostial native coronary disease, the clinical, procedural and follow-up profile of ostial saphenous vein graft revascularization is not significantly worse than proximal nonostial disease. This finding may be related to the overall suboptimal results of percutaneous revascularization in saphenous vein grafts compared with native coronary arteries or to the unfavorable intrinsic properties of ostial native coronary arteries compared with ostial vein grafts.

Discrepancies in outcome of a control program for schistosomiasis haematobia in Fayoum governorate, Egypt.

A large scale mollusciciding and chemotherapy program in the Fayoum area of Egypt was reported to have decreased prevalence of schistosomiasis haematobia from 46% to 7% in approximately 12 years. In order to assess the uniformity of results reported, we have studied the prevalence and intensity of urinary tract disease in a random sample of children aged 6 months-12 years in 3 areas selected on the basis of distance from the main canal supplying Fayoum and where mollusciciding was applied. Only 1 location near the main canal showed low prevalence (2.2%), while in the other 2 areas prevalence was 75.3% and 61.3%. Intensity of infection and disease were significantly more in the latter 2 locations. Following chemotherapy, a marked reduction in prevalence and intensity of infection and reversal of pathology was seen. Since the reported favorable results of the Fayoum project were used to implement a wider control program in southern Egypt, an independent assessment must be included in future plans.

Immunofluorescent analysis of renal biopsies in uncomplicated Schistosoma haematobium infections in children.

Renal biopsies were studied by light and immunofluorescent microscopy in 13 young individuals with uncomplicated Schistosoma haematobium infections. Slight mesangial cell proliferation and matrix increase were found in three biopsies and focal interstitial inflammatory infiltrates were noted in six. However extensive IgG (nine cases) and IgM (seven cases) granular deposits were found in the mesangial areas. C3 was found in only three of these cases. Clq, fibrinogen, IgA and IgE were not found deposited except for one case with IgE. Schistosome antigen was identified in mesangial areas in four biopsies after acid treatment of the sections. It appears the immune complexes are deposited consistently in the renal glomeruli in S. haematobium infections but their role in inducing clinical renal disease is minimal.