Usefulness of a Nonsuture Closure Device in Patients Undergoing Diagnostic Coronary and Peripheral Angiography.

Vascular access site complications can follow diagnostic coronary and peripheral angiography. We compared the complication rates of the Catalyst vascular closure device, with the complication rates after manual compression in patients undergoing diagnostic angiographic procedures via femoral access. We studied 1,470 predominantly male patients undergoing diagnostic coronary and peripheral angiography. Catalyst closure devices were used in 436 (29.7%) patients and manual compression was used in 1,034 (70.3%) patients. The former were allowed to ambulate after 2 hours, while the latter were allowed to ambulate after 6 hours. Major complications occurred in 4 (0.9%) patients who had a Catalyst device and in 14 (1.4%) patients who had manual compression (odds ratio [OR]: 0.67, 95% confidence interval [CI]: 0.22-2.1, p = 0.49). Any complications occurred in 51 (11.7%) patients who had a Catalyst closure device and in 64 (6.2%) patients who had manual compression (OR: 2, CI: 1.4-3, p < 0.01). After adjustment for other variables and for a propensity score reflecting the probability to receive the closure device, the association of major complications with the use of the closure device remained not significant (OR: 0.54, 95% CI: 0.17-1.7, p = 0.29), while the association of any complications with the use of the Catalyst device remained significant (OR: 1.9, 95% CI: 1.3-2.9, p < 0.01). The Catalyst device was not associated with an increased risk of major groin complications but was associated with an increased risk of any complications compared with manual compression. Patients receiving the closure device ambulated sooner.

New Right Bundle Branch Block as a Criterion for Emergent Coronary Angiography.

CONTEXT: ST-segment elevations in two or more contiguous leads or new left bundle branch block (LBBB) on electrocardiography (ECG) in a patient with acute onset chest pain are diagnostic criteria for acute myocardial infarction (AMI) and generally warrant urgent coronary angiography and cardiac catheterization. However, the significance of new right bundle branch block (RBBB) without other acute ECG changes is unclear and is currently not considered a criterion. CASE REPORT: We present a patient with chest pain, positive biomarkers of myocardial necrosis and isolated new right bundle block on ECG. He was diagnosed with AMI but did not undergo urgent reperfusion therapy in the absence of ST-segment elevations or new LBBB. However, angiography ultimately demonstrated complete coronary occlusion. CONCLUSION: The established criteria for emergent catheterization may prove to be more sensitive with the inclusion of the presence of new RBBB on ECG.

Influence of carbohydrate, intense exercise, and rest intervals on hormonal and oxidative changes.

This study compared effects of carbohydrate (CHO) and rest on oxidative stress during exercise. Cyclists (N = 12) completed 4 randomized trials at 64% Wattsmax under 2 conditions (continuous cycling for 2 h [C] and cycling with 3-min rest every 10 min for 2.6 h [R]). Subjects cycled under each condition while receiving 6% CHO and placebo (PLA). CHO and PLA were given preexercise (12 mL/kg) and during exercise (4 mL x kg(-1) x 15 min(-1)). Blood was collected preexercise, postexercise, and 1 h postexercise and assayed for F2-isoprostanes, hydroperoxides (LH), nitrite, antioxidant capacity, glucose, insulin, cortisol, and epinephrine. F2-isoprostanes and LH were lower in CHO. Glucose, cortisol, and epinephrine exhibited significant effects, with postexercise levels of glucose higher and cortisol and epinephrine lower in CHO during the R condition. This pattern was identical in the C condition (21). Oxidative stress during cycling was unaffected by use of short rest intervals but was diminished by CHO.

Ibuprofen use during extreme exercise: effects on oxidative stress and PGE2.

PURPOSE: Oxidative stress was examined with use (N = 29) or nonuse (N = 25) of ibuprofen in ultramarathoners after the Western States Endurance Run. METHODS: Oxidative stress was assessed by measuring plasma and urinary F2-isoprostanes, plasma nitrite, and plasma urate. A urinary prostaglandin E2 metabolite (PGE-M) was used as an end point to assess ibuprofen use. Ibuprofen users consumed 600 and 1200 mg of ibuprofen the day before and on race day, respectively, and nonusers avoided all antiinflammatory medications. Blood and urine were collected in the morning before the race and immediately after the race. RESULTS: Use compared with nonuse of ibuprofen significantly increased plasma (P