Fibrinolytic therapy for mechanical pulmonary valve thrombosis.

Treatment of prosthetic heart valve thrombosis using intravenous thrombolytics, although an acceptable alternative to surgery, is not complication free, and the literature has a dearth of data on the subject. This study analyzed the results of fibrinolytic treatment (FT) among a single-center group of patients with mechanical pulmonary valve thrombosis. Between 2000 and 2013, 23 consecutive patients with 25 episodes of pulmonary valve thrombosis received FT. The diagnosis of mechanical pulmonary valve thrombosis was established by fluoroscopy and echocardiography. Streptokinase (SK) was used in 24 cases and alteplase in 1 case. The FT was continued a second day for 14 patients (58.3%), a third day for 1 patient, and a fourth day for 1 patient. Echocardiography and fluoroscopy were performed every day until improvement of malfunction was achieved. Of the 23 patients, 19 had complete resolution of hemodynamic abnormalities after FT, 1 had partial resolution, and 2 showed no change. No patient had major complications. Five minor complications were detected, namely, fever, nausea, thrombophlebitis, epistaxi, and pain. Seven patients (30%) experienced recurrence of thrombosis, whereas four patients had surgery (biological pulmonary valve replacement) without re-thrombolytic therapy, one patient was treated with Alteplase, one patient received SK, and one patient received intense anticoagulation using heparin and warfarin. Overall, FT had a success rate of 84%. The results indicate that regardless of the time to pulmonary valve replacement and echocardiographic and fluoroscopic findings, FT was effective in most cases of mechanical pulmonary valve thrombosis. The efficacy increased with second-day thrombolytic therapy. Major complications were not common after lytic therapy for mechanical pulmonary valve thrombosis.

Effect of transcranial magnetic stimulation on Parkinson motor function--systematic review of controlled clinical trials.

The objective of this study was to evaluate the effects of repetitive Transcranial Magnetic Stimulation (rTMS) on motor signs in Parkinson's disease (PD). Medline, Embase, CINAHL, Web of Science, Scopus bibliographic, and Google Scholar databases were searched. Relevant controlled clinical trials published between January 1985 and October 2007 were extracted, reviewed, and validated according to the study protocol. The outcome of interest was the motor section of the Unified Parkinson's Disease Rating Scale (UPDRS). We calculated the effect size for the included studies. Sensitivity analysis was performed to further assess factors that may change the results. Ten randomized, controlled clinical trials were included in the meta-analysis. Pooling of the results from these trials yielded an effect size of -0.58 in UPDRS for high-frequency rTMS studies and no significant effects for low-frequency rTMS studies. The benefit of high-frequency rTMS on motor signs in PD was confirmed by the meta-analysis. Lower frequency rTMS had little effect on motor signs in PD.