Changing the coronary bifurcation angles after stenting procedures: the relevance to the technique and unfavorable outcome (Three-dimensional analysis).

AIM: Percutaneous transluminal balloon co-ronary angioplasty (PTCA) of coronary bifurcations is associated with a low success rate, higher rate of complications and need for revascularazation. We sought to analyze: 1) the change in 3D measurement of angles following stenting of coronary bifurcations; and 2) if changes in these angles might predict unfavourable outcomes. METHODS: Coronary angiograms of 102 patients with bifurcation lesions were analyzed with 3D software (CardiOp-B) before and after stenting. The change in angle between the proximal main artery and side branch (BA), and between the distal main artery and side branch (BS) were measured. A change of ≥ 5° after stenting was considered significant. The results were compared with clinical follow-up. RESULTS: Bifurcation lesions included 66 left anterior descending/first diagonal (LAD/D1) lesions, 15 left main stem (LMS) lesions, 19 atrioventricular circumflex/obtuse marginal (AVCx/OM) lesions, and 2 coronary artery (RCA) crux lesions. BA and BS measured 138.3° ± 17.2° and 64.3° ± 20.6° respectively. Stent deployment altered BA and BS significantly in 80-90% of cases. Furthermore, BS correlated positively with the magnitude of change in BS after stenting. BA was unaffected by the complexity of the stenting procedure, whereas BS increased significantly in complex versus simple stenting strategies (P<0.05). Procedure related complications occurred in 15.6% of patients. The incidence of in-hospital complications was lower when BA was increased (P<0.05). The one year incidence of the composite of in-hospital complications and late complications was also significantly lower when BA was increased by ≥ 5° (P=0.027). A decrease of BA was associated with 80% more complications compared to cases where BA was increased. No correlation was found between the change of BS and procedural or late complications. CONCLUSION: 3D measurements of coronary bifurcation angles prior to stenting can predict changes in bifurcation geometry after stenting. A decrease in BA after stenting is a strong predictor for less favourable outcomes of coronary bifurcation stenting procedures.

Benign acute childhood myositis in Kuwait.

Ten children, three girls and seven boys, aged 4-10 years, were admitted with benign acute childhood myositis during spring and winter months (March 1988 to March 1990). They presented with an acute onset of symmetrical calf muscle pain and tenderness, weakness and inability to walk a few days after a flu-like illness. All had raised serum creatine kinase and a normal erythrocyte sedimentation rate, and the majority had low peripheral white blood cell counts with relative lymphocytosis. Serum aspartate aminotransferase, alanine aminotransferase and lactate dehydrogenase were found to be raised in four patients. Virological studies performed in six children gave negative results. Full clinical recovery was achieved within 1-7 days. One child developed a second episode. These ten cases of benign acute childhood myositis are the first to be reported from this region.

Cerebral perfusion abnormalities in therapy-resistant epilepsy in mentally retarded pediatric patients. Comparison between EEG, X-ray CT, and Tc-99m HMPAO.

Thirteen mentally retarded pediatric patients aged 4 to 13 years with therapy-resistant epilepsy underwent Tc-99m HMPAO brain perfusion SPECT studies. The results (abnormal in 12 of the 13 patients) were compared with EEG results in 12 of the 13 patients (abnormal in all 12) and x-ray CT in 11 of the 13 patients (normal in 9). Patients with spikes on EEG had foci of increased uptake on HMPAO. This study confirms that HMPAO is sensitive in detecting perfusion abnormalities and localizing epileptic foci in this group of patients.

Urofacial syndrome associated with hydrocephalus due to aqueductal stenosis.

The urofacial syndrome is an autosomal recessive disorder of distorted facial expression and neurogenic bladder with resultant urogenital tract damage. We report on an 8-year-old boy of consanguineous Arab parents with inverted facial expression upon laughing and renal changes as a consequence of a neurogenic bladder in addition to hydrocephalus due to stenosis of the aqueduct of Sylvius. We suggest that the association is not fortuitous and probably widens the spectrum of urofacial syndrome or represents a distinct entity mimicking the urofacial syndrome.

Intervertebral discitis in childhood.

Many paediatricians are unaware of the disease entity of discitis, which must be included in the differential diagnosis of several acute and subacute diseases of infancy and childhood. In order to draw attention to this disorder, three Swedish and two Arabic children, aged from 9 months to 3 years, are jointly presented. The onset of symptoms was 2-4 weeks prior to admission. The clinical diagnosis was verified by plain X-ray of the spine and bone scanning. Two of the children had low grade fevers. The erythrocyte sedimentation rates were moderately elevated, while white blood cell counts were normal or slightly increased. Blood cultures were negative. The children were treated with immobilization, and three of them received antibiotics. Full recovery was achieved in all children after 1-2 months. The diagnostic procedure and the rationale of using or not using antibiotic treatment is discussed.

Macrosomia, microphthalmia, +/- cleft palate and early infant death: a new autosomal recessive syndrome.

An Arab girl with macrosomia, severe microphthalmia and early infant death is reported. Four other sibs were similarly affected; three of them had median cleft palate. All five sibs showed respiratory infections in early life and died either unexpectedly or because of a documented overwhelming infection. Parental consanguinity and affected sibs of both sexes strongly suggest autosomal recessive inheritance in this apparently new syndrome.