Initial report of rotational ablation: the Toronto Hospital experience.

OBJECTIVE: To describe the initial experience of rotational ablation (using the Rotablator device), in terms of safety and the effectiveness as a proportion of final angiographic outcome when combined with adjunctive balloon angioplasty. DESIGN: Retrospective analysis of single-centre experience, including operator learning curve. SETTING: Tertiary care hospital, Cardiac Catheterization Laboratory. PATIENTS: Consecutive subjects (14 men, 11 women) selected for rotational ablation based on ostial/bifurcation lesions (n = 10), 'long' (more than 10 mm) stenoses (n = 11) or extensive dystrophic calcification (n = 4). INTERVENTIONS: Rotational ablation (Rotablator) with routine adjunctive balloon angioplasty. Quantitative coronary arteriography using the Cardiac Measurement System. RESULTS: Rotational ablation reduced coronary obstruction, as demonstrated by minimal lumen diameter (preprocedure, 0.57 =/- 0.28 to 1.17 +/- 0.32 mm, P<0.05), with further improvements following adjunctive balloon angioplasty (1.93 +/- 0.35 mm). Similar changes were observed in relative stenosis after Rotablator (preprocedure, 79.7 +/- 7.6 to 56.1 +/- 13.1% diameter), with typical post-angioplasty residual narrowings (29.7 +/- 8.2% diameter). Estimated stenotic flow reserve was improved by the interventional procedures (preprocedure, 0.94 +/- 0.70; rotational ablation 3.07 +/- 1.14; and angioplasty, 4.73 +/- 0.25 times baseline). Complications were acceptable, and included three acute occlusions requiring balloon angioplasty recanalization and three non-Q wave myocardial infarctions (with creatine phosphokinase levels of 270, 417 and 602 IU, respectively). CONCLUSIONS: The Rotablator is a relatively user-friendly device with a reasonable safety profile, accounting for approximately 50% of minimum lumen diameter gains when used in conjunction with routine balloon angioplasty. The precise role of rotational ablation, particularly in the context of preselected lesion specific uses (bifurcations, long lesions, dystrophic calcification), requires prospective, randomized studies.

Rating the urgency of coronary angiography: results of an expert panel process. Ontario Coronary Angiography Panel.

OBJECTIVE: To rate the urgency of coronary angiography for patients with ischemic heart disease. Ratings were made for patients with varying degrees of symptoms and noninvasive cardiac test results. DESIGN: A panel of 10 cardiologists rated 354 case scenarios which presented varying combinations of clinical factors that may affect urgency. MEASUREMENTS: The case scenarios were rated by each panelist on a waiting time scale consisting of six categories which ranged from the requirement for emergency angiography to a delay of up to three months. A seventh category represented the lack of urgent need for angiography. The contribution of each clinical factor to urgency of coronary angiography was determined. MAIN RESULTS: Symptom class as defined by a modification to the Canadian Cardiovascular Society grading scale for angina pectoris, results of exercise stress tests and results of imaging studies were the major determinants of urgency. In cases of unstable angina, rest electrocardiography is of importance. These factors explained at least 95% of the variance in the case urgency scores. There was agreement by at least five of the panelists on urgency score in 84% of cases. The assigned urgency varied from 6.7, representing no urgent need for angiography, for minimally asymptomatic angina with no positive noninvasive test results, to immediate angiography for cardiogenic shock. Other factors had minimal or negligible effects on urgency. CONCLUSIONS: The urgency of need for coronary angiography was addressed by an explicit method incorporating the judgements of a panel of expert cardiologists, permitting derivation of a scoring system for rating priority of individual patients in the face of waiting lists. These methods illustrate an approach to problems presented by procedure waiting lists.

Development of the Sertoli cell in the fetal mouse.

Ultrastructural changes were observed in the organelles of the Sertoli cells of the mouse during fetal development. At day 13 of development, the cells contained predominantly rough-surfaced tubular endoplasmic reticulum, numerous polysomes and multiple Golgi complexes. Day 14 appears to be a transition stage with equal amounts of tubular and vesicular endoplasmic reticulum. But by day 15 and through day 16, only vesicular endoplasmic reticulum, some profiles of which exhibited oligogranularity, annulate lamellae and lipid droplets were observed. This appearance suggests steroid synthesis. Days 17-20 were characterized by a gradual decrease in vesicular elements with a concomitant increase in rough endoplasmic reticulum and polysomes.