Drug-eluting stent fracture occurred within 2 days after stent implantation.

Recently the cases of stent fracture after sirolimus-eluting stent (SES) implantation have been reported in the real world. All of them were found several months later during the follow-up of coronary angiogram (CAG), and some were related to in-stent restenosis (ISR). We report a case of stent fracture after percutaneous coronary intervention (PCI) with SES within 2 days after stent implantation. Further investigation is required to elucidate the mechanism and clinical significance of stent fracture of SES.

The effects of QRS duration and pacing sites on the acute hemodynamic changes during right ventricular pacing.

BACKGROUND: Has been reported that patients exhibiting prolonged paced QRS duration tend to have more serious heart disease, and the paced QRS duration can be an effective indicator of impaired left ventricular function. However, the acute and chronic hemodynamic effects of paced QRS duration and pacing sites during right ventricular (RV) pacing remain unknown. METHODS: A total of 14 patients who underwent electrophysiologic study for paroxysmal supraventricular tachycardia were examined. RV pacing was performed at 10 different sites with cycle lengths of 600 ms and 500 ms utilizing a 6-7F deflectable quadripolar electrode catheter. Systolic, diastolic, and mean blood pressures during pacing were measured once the blood pressure was stabilized. RESULTS: During RV pacing, blood pressures (systolic/diastolic/mean) decreased. The change of post-pacing QRS duration and pre-pacing the systolic blood pressure (SBP) were greater in the group with paced QRS duration. The differences overall were greater than 140 ms. The SBP decrease during pacing was larger in the group exhibiting paced QRS duration of greater than 140 ms. The SBP decrease during pacing showed relation to QRS duration during pacing (r = 0.500, p = 0.001), the change of QRS duration post-pacing (r = 0.426, p = 0.001), and SBP during sinus rhythm (r = 0.342, p = 0.001) on linear correlation analysis. The pacing site, on the other hand, did not affect acute hemodynamic changes during pacing. CONCLUSION: Ventricular pacing of less than 40 ms at the area of paced QRS duration is recommended.

Clinical characteristics of hypervagotonic sinus node dysfunction.

BACKGROUND: Sinus node dysfunction (SND) is caused not only by intrinsic sinus node disease, but also by the extrinsic factors. Among the extrinsic factors, autonomic imbalance is most common. Symptomatic SND usually requires permanent pacemaker therapy. However, the clinical characteristics and patient response to medical therapy for hypervagotonic SND have not been properly clarified. MATERIALS AND METHODS: Thirty two patients (14 men, 18 women, 51 +/- 14 years) with hypervagotonic SND were included in this study, but those patients who had taken calcium antagonists, beta-blockers or other antiarrhythmic drugs were excluded. Hypervagotonic SND was diagnosed if the abnormal electrophysiologic properties of the sinus node were normalized after the administration of atropine (0.04 mg/kg). RESULTS: The presenting arrhythmias were 16 cases of sinus bradycardia (50.0%), 12 of sinus pause (37.5%), 3 of sinoatrial block (9.4%) and 1 of tachy-bradycardia (3.1%). Nine (28.1%) patients had hypertension, 7 (21.9%) smoked, 2 (6.3%) had diabetes mellitus, and 1 (3.1%) had hypercholesterolemia. Among the patients, 3 had no remarkable symptoms, 13 had dizziness, 7 had syncope, 3 had weakness and 6 had shortness of breath. Twenty five (78.1%) patients were treated with theophylline, 1 patient with tachy-bradycardia syndrome was treated with digoxin and propafenone, and 6 (18.8%) were treated with no medication. During the 43 +/- 28 month follow-up, 25 patients remained asymptomatic, but 6 who took no medication developed mild dizziness. One patient needed permanent pacemaker implantation owing to recurrent syncope despite of theophylline treatment. CONCLUSION: These results show that hypervagotonic SND has a benign course and most of the patients can be managed safely without implanting a pacemaker. (Ed note: I like the abstract. It is short and direct, as it should be.)

Anticancer effect of combined intratumor cisplatin injection and interstitial KTP laser therapy on xenografted squamous cell carcinoma.

OBJECTIVE: This study was conducted to evaluate the synergistic effect of cisplatin and interstitial KTP laser therapy induced hyperthermia in vitro and in vivo (interstitial laser chemotherapy, ILCT). METHODS: In vitro study: human hypopharyngeal squamous carcinoma cell line (SNU-1041) was incubated in 1 mL of media containing various concentrations (0, 1, 2, 5, 10, 20, 50, 100 ng/mL) of cisplatin in 37 degrees and 43 degrees C for 2 hours. The viability of the cell was evaluated by MTT assay. In vivo study: human squamous cell carcinoma tumors were grown as subcutaneous transplants in nude mice and injected into tumor with cisplatin-epigel 100 microg, followed by interstitial laser therapy (ILT) via 0.6-mm diffuser fiber tips (532 nm, 1.0J/mm(3)). RESULTS: In vitro study: the viability of tumor cells incubated with 10 ng/mL of cisplatin was 62% and 28% in 37 degrees C and 43 degrees C, respectively (p = 0.02). In vivo study: the tumor volume in 4 weeks after treatment was 179 mm(3) in ILT group and 27 mm(3) in ILCT group. The ILCT group showed 8 (80%) complete remission of tumors at 4 weeks follow up, while tumor remission occurred in only 3 (30%) in ILT group (p < 0.05). CONCLUSION: These results suggest ILCT may become an effective treatment for head and neck carcinoma with minimal functional deficit.

Localization of ZO-1 and E-cadherin in the nasal polyp epithelium.

The tight junction and adherens junction complex of epithelial cells, which show disturbed localization in some inflammatory conditions, serve as an important paracellular barrier in polarized epithelial cells. However, very little information is available about the expression of the tight-junction protein, ZO-1, and the adherens-junction protein, E-cadherin, in nasal polyp epithelium. The aim of this study was to investigate the localization of ZO-1 and E-cadherin in nasal polyp epithelia by means of immunohistochemistry. We classified nasal polyp epithelia from 20 patients into pseudostratified ciliated columnar epithelia, basal and mucous cell hyperplasia and squamous metaplasia according to their dominant cell type. The expression of ZO-1 and E-cadherin in each epithelial cell type was analyzed and compared with normal ethmoidal mucosa, which was taken as a control. In pseudostratified ciliated columnar epithelia, as in the normal control epithelia, ZO-1 showed a spot-like distribution on the apicolateral junction of the adjoining cells. E-cadherin labeling was seen as a distinct basolateral staining on the mid-portion of the lateral walls. In basal and mucosal cell hyperplasia-dominant epithelia, the localization of ZO-1 positivity was similar to that in the normal mucosa, whereas the E-cadherin on the lateral walls showed a more intense distribution along the lateral cell-to-cell junction. In the nasal polyp epithelia showing squamous metaplasia, ZO-1 was rarely expressed; by contrast, E-cadherin exhibited stronger expression on the periphery of the cells in a circumferential fashion. In conclusion, in nasal polyp epithelia, ZO-1 showed down-regulation as in the worsening of epithelial dedifferentiation, whereas E-cadherin exhibited up-regulation with the increasing severity of epithelial remodeling.

Mucociliary transport and histologic characteristics of the mucosa of deviated nasal septum.

OBJECTIVE: To investigate differences in mucociliary clearance, histologic characteristics, and surface structure of the bilateral nasal septal mucosa in patients with nasal septal deviation. DESIGN: Mucociliary transport was measured by saccharin clearance time in both nasal cavities of 20 patients with nasal septal deviation. Their septal mucosae were taken during septoplasty, and the ciliary population was studied by scanning electron microscopy. Histologic differences in the lamina propria of septal mucosae were compared under a light microscope. RESULTS: The concave side showed longer saccharin clearance time than the convex side and revealed much more severe loss of cilia. Inflammatory cells more heavily infiltrated the concave side, and seromucinous glands were less densely distributed. CONCLUSION: Concave-side septal mucosae have impaired mucociliary transport, presumably due to ciliary loss, increased inflammation, and decreased density of the glandular acini.