The Magnum wire for percutaneous coronary balloon angioplasty in 723 patients.

The experience of the use of the Magnum wire in a single center is reported. Percutaneous balloon coronary angioplasty, using the Magnum 0.021 inch wire, was attempted in 723 patients with 850 lesions; of these, 453 (53%) were chronic total occlusions and 50 (7%) recent occlusions of less than 24 hours (patients presenting with acute myocardial infarction). The overall technical success rate per lesion was 655/850 (77%). It was 255/280 (91%) for non-total lesions, 311/453 (69%) for chronic total occlusions, 53/67 (79%) for functional (TIMI grade I) occlusions, and 36/50 (72%) for recent occlusions. Clinical success was achieved in 196/232 patients (84%) with non-total lesions, in 292/436 (67%) with total chronic occlusions, in 49/65 (75%) with functional occlusions, and in 34/50 (68%) with recent occlusions. Complications (significant creatine kinase rise, new Q-wave infarction, need for coronary bypass surgery or in-hospital death) occurred in 7% (3% if patients presenting with unstable ischemic syndromes were excluded from the analysis). These data confirm that the use of the Magnum wire has success rates competitive with other systems both in setting of chronic total occlusion and in that of routine percutaneous transluminal coronary angioplasty.

Bailout coronary stenting with 6F guiding catheters for failed balloon angioplasty.

Between July 1992 and February 1994, we attempted bailout Palmaz-Schatz stent implantation through a 6F guiding catheter after 52 failed coronary balloon angioplasty procedures to reverse (14 [27%] cases) or prevent (38 [73%] cases) abrupt vessel closure. The stents or half-stents were manually crimped onto a monorail balloon catheter for delivery. Thirty-nine (75%) procedures involved a single stent, and 13 (25%) involved two or three stents. Technical success was achieved in 50 (96%) procedures, and clinical success without major complications was obtained in 45 (87%) cases. Target vessel occlusion was documented angiographically or suggested clinically in 2 (4%) cases. Two (4%) patients underwent semielective bypass surgery, and in 4 (8%) patients a non-Q-wave and in 1 (2%) a Q-wave myocardial infarction developed. There were no deaths. Major bleeding occurred in 2 patients: 1 had an important groin hematoma that was treated with local surgery followed by coronary bypass surgery, and one had macroscopic hematuria that required interruption of anticoagulation therapy on day 4. Three (6%) femoral pseudoaneurysms were diagnosed by ultrasound and could be obliterated by external compression alone. Bailout coronary stent implantation through 6F guiding catheters after failed balloon angioplasty is technically reliable, safe, and cost-efficient. As a consequence, use of 6F guiding catheters is a good option for a large majority of routine balloon angioplasty procedures.

[Hypersensitivity myocarditis. A case of myocarditis following drug administration]. / Hypersensitivitätsmyokarditis. Ein Fall von Myokarditis nach Medikamenteneinnahme.

Based upon the findings of eosinophilia and concomitant ECG changes, hypersensitivity myocarditis was diagnosed in a patient who had been given longstanding antibiotic therapy. With cessation of drug treatment the disease resolved spontaneously.

[Detection of dissection of the thoracic aorta: improved specificity by magnetic resonance tomography in comparison with echocardiography techniques]. / Nachweis der thorakalen Aortendissektion: Verbesserte Spezifität durch Magnetresonanztomographie gegenüber echokardiographischen Techniken.

The purpose of this study was to assess the reliability of conventional transthoracic and transoesophageal two-dimensional echocardiography combined with color-coded Doppler flow imaging (TEE) and ECG-triggered magnetic resonance imaging (MRI) for the diagnosis of thoracic aortic dissection and associated epiphenomena. A total of 53 patients with clinically suspected aortic dissection were subjected to a transthoracic and transoesophageal ultrasound examination and magnetic resonance imaging; the results of each imaging modality were compared and validated against the morphological standards of contrast angiography (n = 53) and/or intraoperative findings (n = 27) or autopsy (n = 7). In this series no deleterious events were encountered with either non-invasive imaging method. In contrast to conventional echocardiography the sensitivities of both MRI and TEE were 100% for detecting a dissection of the thoracic aorta, irrespective of its location. However, the specificity of TEE was lower than the specificity of MRI for a dissection (TEE 68.2% versus MRI 100%; p less than 0.005), which resulted from false positive TEE findings mainly confined to the ascending segment of the aorta (specificity of TEE 78.8% versus 100% by MRI; p less than 0.01). In addition, MRI proved to be more sensitive than TEE in detecting the formation of thrombus in the false lumen of both the aortic arch (p less than 0.01) and the descending segment of the aorta (p less than 0.05). There were no discrepancies between the two imaging techniques in detecting the site of entry to a dissection, aortic regurgitation or pericardial effusion. Both MRI and TEE are atraumatic, safe, and highly sensitive methods to identify and classify acute and subacute dissections of the entire thoracic aorta. However, TEE is associated with lower specificity for lesions in the ascending aorta. These results may still favor TEE after a precursory screening transthoracic echogram in suspected aortic dissection, but will establish MRI as an excellent method to avoid false positive findings. Anatomical mapping by MRI may emerge as a promising comprehensive approach and, eventually, as a morphological standard to guide surgical interventions.

Diagnosis of thoracic aortic dissection. Magnetic resonance imaging versus transesophageal echocardiography.

BACKGROUND: Aortic dissection requires prompt and reliable diagnosis to reduce the high mortality. The purpose of this study was to assess the reliability of both ECG-triggered magnetic resonance imaging (MRI) and transesophageal two-dimensional echocardiography combined with color-coded Doppler flow imaging (TEE) for the diagnosis of thoracic aortic dissection and associated epiphenomena. METHODS AND RESULTS: Fifty-three consecutive patients with clinically suspected aortic dissection were subjected to a dual noninvasive imaging protocol in random order; imaging results were compared and validated against the independent morphological "gold standard" of intraoperative findings (n = 27), necropsy (n = 7), and/or contrast angiography (n = 53). No serious side effects were encountered with either imaging method. In contrast to a precursory screening transthoracic echogram, the sensitivities of both MRI and TEE were 100% for detecting a dissection of the thoracic aorta irrespective of its location. The specificity of TEE, however, was lower than the specificity of MRI for a dissection (TEE, 68.2% versus MRI, 100%; p less than 0.005), which resulted mainly from false-positive TEE findings confined to the ascending segment of the aorta (TEE, 78.8% versus MRI, 100%; p less than 0.01). In addition, MRI proved to be more sensitive than TEE in detecting the formation of thrombus in the false lumen of both the aortic arch (p less than 0.01) and the descending segment of the aorta (p less than 0.05). There were no discrepancies between the two imaging techniques in detecting the site of entry to a dissection, aortic regurgitation, or pericardial effusion. CONCLUSIONS: Both MRI and TEE are atraumatic, safe, and highly sensitive methods to identify and classify acute and subacute dissections of the entire thoracic aorta. TEE, however, is associated with lower specificity for lesions in the ascending aorta. These results may still favor TEE as a semi-invasive diagnostic procedure after a precursory screening transthoracic echogram in suspected aortic dissection, but they establish MRI as an excellent method to avoid false-positive findings. Anatomic mapping by MRI may emerge as the most comprehensive approach and morphological standard to guide surgical interventions.

Tumor antigens in neoplasms of the human parotid gland.

In a collection of parotid gland tumors the presence of different antigens was studied by immuno-histochemical methods. The series was composed of different tumors: adeno- and cystadenocarcinomas, adenoid-cystic carcinomas, salivary duct carcinomas, mucoepidermoid tumors, squamous cell carcinomas and anaplastic carcinomas. The following substances were studied: 1. Substances normally present in salivary glands like lysozyme and lactoferrin. 2. Oncofetal antigens: carcinoembryonic antigen (CEA) and alpha-fetoprotein (AFP). 3. Different classes of intermediate-sized filaments: prekeratin and vimentin. The presence of lactoferrin and carcinoembryonic antigen could be demonstrated in the glandular differentiated tumors, whereas the squamous cell carcinomas, although CEA positive, were lactoferrin negative. The anaplastic carcinomas were negative for lactoferrin and CEA. Lysozyme and AFP could not be demonstrated in the tumors of our material. Mucoepidermoid tumors and squamous cell carcinomas were clearly positive for prekeratin filaments whereas the stromal part showed a vimentin filaments in the cytoplasm of fibroblasts. These antigens provide a useful tool to distinguish between the epithelial and mesenchymal tumors.

Immunohistochemical detection of carcinoembryonic antigen (CEA) in parotid gland carcinomas. Analysis of 52 cases.

The presence of CEA in parotid gland tumours was studied by immunohistochemical methods. 52 cases were analysed. 7 of 8 adenocarcinomas, 3 of 5 cystadenocarcinomas, 3 of 4 adenoid cystic carcinomas and all 3 salivary duct carcinomas were positive for CEA. 5 of 8 squamous cell carcinomas and 9 of 21 carcinomas in a pleomorphic adenoma were also positive for CEA. The anaplastic carcinomas were negative. The distribution pattern of the presence of CEA in the carcinomatous and the adjacent normal or inflamed tissue was analysed. The results are discussed with regard to their histogenetic and diagnostic implications.

Lactoferrin and lysozyme in carcinomas of the parotid gland. A comparative immunocytochemical study with the occurrence in normal and inflamed tissue.

Lactoferrin and lysozyme, parts of the non-specific defense system, were studied in normal and diseased parotid glands, using the immunohistochemical PAP-method. 31 normal and inflamed glands were investigated. The presence of lactoferrin and lysozyme was demonstrated in the acinar cells and some duct cells. The amount of these substances was increased in obstructive parotitis. The 52 carcinomas showed a distinct distribution pattern for lactoferrin (positive cases: adenocarcinomas 5 of 8; cystadenocarcinoma: 3 of 5; adenoid cystic carcinomas 2 of 4; salivary duct carcinomas 2 of 3). Some of the carcinomas in pleomorphic adenomas were positive for lactoferrin. Squamous cell carcinomas and anaplastic carcinomas were constantly negative. All carcinomas were negative for lysozyme. These observations are discussed with respect to their physiological and pathological significance.

Presence of carcinoembryonic antigen (CEA) in the normal and inflamed human parotid gland. An immunohistochemical study of 31 cases.

Carcinoembryonic antigen (CEA) was analysed in the human parotid gland. Specimens of 31 normal and inflamed parotid glands were studied by the indirect immunoperoxidase technique. The presence of CEA could be demonstrated at the border of the acinar cells and the intercalated duct cells as well as in the undifferentiated duct cells as observed in chronic obstructive parotitis. These observations may explain the presence of CEA in normal human saliva and may provide a new basis for histogenetic interpretation of pathological lesions of the parotid gland, especially of the tumors of the salivary gland tissue.