A successful treatment for a lesion of chronic total occlusion with contralateral angiography in a single radial access.

A 50-year-old man was admitted due to effort chest pain. Coronary angiogram showed a total occlusion of LAD. The 5-French JL 3.5 was engaged into the left coronary artery. The XT-A guidewire was advanced to the distal of the occluded lesion. Contralateral angiography was performed using JL 3.5. The guiding catheter was pullback from the left coronary orifice leaving the guidewire at LAD, and the catheter tip was rotated clockwise to right coronary cusp for right coronary angiography. We could confirm that the guidewire was in the true lumen vessel.

Relationship between the bone density estimated by cone-beam computed tomography and the primary stability of dental implants.

OBJECTIVES: The aims of this study were to objectively assess bone quality with density values obtained by cone-beam computed tomography (CBCT) and to determine the correlations between bone density and primary stability of dental implants. MATERIAL AND METHODS: Eighteen Straumann implants were inserted into 18 fresh femoral heads of swine. The bone densities of implant recipient sites were preoperatively determined by the density value using CBCT. The maximum insertion torque value of each implant was recorded using a digital torque meter. Resonance frequency, which represented a quantitative unit called the implant stability quotient (ISQ), was measured using an Osstell Mentor immediately after the implant placement. Spearman's correlation coefficient was calculated to evaluate the correlations among density values, insertion torques, and ISQs at implant placement. RESULTS: The density values ranged from 98 to 902. The mean density value, insertion torque, and ISQ were 591 ± 226, 13.4 ± 5.2 Ncm, and 67.1 ± 8.1, respectively. Statistically significant correlations were found between the density values and insertion torque (r(s) =0.796, P<0.001), density values and ISQ (r(s) =0.529, P=0.024), and insertion torque and ISQ (r(s) =0.758, P<0.001). CONCLUSIONS: The bone quality evaluated by specific CBCT showed a high correlation with the primary stability of the implants. Hence, preoperative density value estimations by CBCT may allow clinicians to predict implant stability. Whether the density values obtained by the CBCT device used in the present study could be applied to other devices requires further elucidation.

The clinical and hemodynamic factors that influence the concentrations of biomarkers of myocyte injury measured by high sensitive assay PATHFAST.

BACKGROUND: Subclinical myocyte injury plays an important role in the progression of congestive heart failure. However, the clinical and hemodynamic factors that influence the concentrations of biomarkers of myocyte injury have not been clarified. METHODS: Blood was sampled during diagnostic cardiac catheterization from 108 consecutive patients without acute coronary syndrome and acute cardiac decompensation. The serum concentrations of B-type natriuretic peptide (BNP), cardiac troponin I (cTnI), creatine kinase (CK)-MB, and myoglobin were measured simultaneously by high sensitive PATHFAST assay. Single and multiple variable regression analyses were carried out in search of correlations between clinical and hemodynamic variables and concentrations of biomarkers. RESULTS: By multiple variable analysis, hemoglobin concentration, pulmonary capillary wedge pressure (PCWP), left ventricular (LV) ejection fraction, and estimated glomerular filtration rate (GFR) were independently correlated with a BNP concentration ≥ median 72.1 pg/ml. The only factors independently correlated with a concentration of cTnI ≥ median 0.01 ng/ml were PCWP and estimated GFR. Cardiac index emerged as a single, powerful, independent correlate of CK-MB concentration ≥ median 0.66 ng/ml, and estimated GFR emerged as a single independent correlate of myoglobin concentration ≥ median 40.1 ng/ml. CONCLUSIONS: Clinical and hemodynamic factors influence the concentrations of BNP, cTnI, CK-MB, and myoglobin. These factors should be considered when interpreting the concentrations of these biochemical markers.

Persistently increased serum concentrations of cardiac troponin in patients with acutely decompensated heart failure are predictive of adverse outcomes.

BACKGROUND: Persistently increased serum concentrations of cardiac troponin (cTn) are a prognostic marker in patients suffering from chronic congestive heart failure (CHF), but the significance in acute cardiac decompensation is unclear. METHODS AND RESULTS: Serial blood samples were collected from 52 patients presenting with acute cardiac decompensation in the absence of an acute coronary event. Serial serum concentrations of cTnI, creatine kinase (CK)-MB, and brain natriuretic peptide (BNP) were measured by rapid assay. BNP and CK-MB steadily decreased from 902+/-529 pg/ml and 2.3+/-1.6 ng/ml at baseline to 453+/-427 pg/ml and 1.2+/-1.6 ng/ml on day 7, respectively, (p<0.0001 for both comparisons). In contrast, cTnI did not decrease significantly and, in 17 patients (35%), increased from 0.063+/-0.047 ng/ml at baseline to 0.167+/-0.181 ng/ml on day 1 (p<0.05). By single variable regression analysis, systolic blood pressure (SBP), use of inotropes or inodilators, vasodilators, and an initially elevated cTnI were predictors of elevated cTnI on day 1. By multiple variable analysis, an elevated SBP (as a mitigating factor) (odds ratios (OR) 0.12; 95% confidence intervals (CI): 0.02-0.76; p=0.0248), and high baseline cTnI (OR 13.85; 95%CI: 1.97-97.54; p=0.0083) were significant predictors of an elevated cTnI on day 1. Patients with elevated cTnI on day 1 had higher rates of worsening CHF and death from CHF than patients without such an increase (p<0.05). CONCLUSIONS: Persistently increased serum concentrations of cTn in patients with acutely decompensated heart failure are predictive of adverse outcomes.

[Infusion therapy at outpatient clinic in chronic end-stage heart failure].

OBJECTIVES: To determine whether drug infusions at ambulatory clinic in patients with end stage congestive heart failure are safe and reduce the period of hospitalization. METHODS: Between May 2000 and November 2006, 21 ambulatory patients with end stage congestive heart failure were treated with infusions of the natriuretic peptide, carperitide (6 patients, 43 infusions of mean 0.033 microg/kg/min for mean 3.7 hr), the phosphodiesterase inhibitor, olprinone (19 patients, 75 infusions of mean 0.11 microg/kg/min for mean 3.8 hr), or the catecholamines, dopamine or dobutamine(5 patients, 89 infusions of mean 3.3 microg/kg/min for mean 3.2 hr). RESULTS: Systolic and diastolic blood pressure was lower after infusion of carperitide, whereas catecholamines increased systolic blood pressure and heart rate (all differences from baseline p < 0.0001). Olprinone changed neither blood pressure nor heart rate. No adverse effect was observed, including arrhythmias or change in blood pressure requiring cessation of drug infusion. Mean urinary output per infusion was 979 ml for carperitide, 720ml for olprinone, and 594ml for catecholamines. There was no correlation between mean urinary output and dose of furosemide administered during intermittent infusion therapy. There was a close correlation between pre-infusion blood pressure and urinary output(systolic: p < 0.05; diastolic: p < 0.0001). Infusion therapy reduced the length of hospitalization (p < 0.05) in 7 patients from April 2005. CONCLUSIONS: Ambulatory, low-dose infusion therapy may not decrease the mortality of patients in end-stage congestive heart failure, but was safe and might represent an acceptable end-of-life therapeutic option.