Protective effect of telmisartan against endothelial dysfunction after coronary drug-eluting stent implantation in hypertensive patients.

OBJECTIVES: The aim of this prospective, randomized study was to evaluate the effects of telmisartan, compared with the calcium-channel blocker amlodipine, on endothelial function after coronary drug-eluting stent (DES) implantation in hypertensive patients. BACKGROUND: DES implantation impairs local endothelial function, which may be associated with future cardiovascular events. Telmisartan, which has unique peroxisome proliferator-activated-receptor-gamma-mediated effects in addition to its renin-angiotensin system-inhibition effects, has favorable effects on endothelial function. METHODS: Fifty-one hypertensive patients with coronary artery stenosis but without coronary artery spasm, treated with a sirolimus-eluting stent, were randomly assigned to either the telmisartan (25 cases) or amlodipine (26 cases) treatment groups. At baseline and at 3 months after DES implantation, endothelium-dependent and -independent vasomotion were evaluated by quantitative coronary angiography under the condition of medication withdrawal. The mean luminal diameter of a 20-mm coronary segment, beginning 5 mm distal to the stent, was measured before and after infusion of intracoronary acetylcholine (10(-7), 10(-6) mol/l) and then again after infusion of nitroglycerin. RESULTS: Blood pressure was comparable between groups at baseline and after 3 months. Vasoconstriction after acetylcholine infusion at 3 months (impaired endothelial function) was less pronounced in the telmisartan group than in the amlodipine group (p<0.0001), although there was no significant difference between the 2 groups before DES implantation. The response to nitroglycerin did not differ between groups before or at 3 months after DES implantation. CONCLUSIONS: Telmisartan, compared with amlodipine, significantly ameliorated endothelial dysfunction after DES implantation in terms of vasoconstriction induced by acetylcholine.

Accuracy and reproducibility of stent-strut thickness determined by optical coherence tomography.

BACKGROUND: Optical coherence tomography (OCT) has been increasingly used to evaluate stent apposition following implantation. Since stent struts are visualized as linear structures with strong surface reflection and typical dorsal shadowing, apposition of struts is evaluated by measuring the distance between the strut surface reflection and adjacent vessel surface in consideration of strut thickness. However, there are no data available to validate the measurements of strut thickness by OCT. The aim of this in vitro study is to validate the accuracy of OCT measurement of stent-strut thickness of different commercially available stents in evaluating stent apposition. METHODS: We performed the in vitro study after implantation of 5 commonly used stents in a phantom model artery. Stent-strut thickness was measured by a commercially available OCT system and was compared to the manufacturers' nominal strut-thickness data for each stent. Intra- and interobserver variability were also assessed. RESULTS: A total of 239 stent struts were evaluated. The differences in stent-strut measurements as compared to the manufacturers' nominal strut thickness data were low. The intra- and interobserver measurement differences were low (6 +/- 7 microm, and 6 +/- 7 microm, respectively), with high correlation coefficients (r = 0.957 and r = 0.957, respectively; p < 0.0001). CONCLUSIONS: This in vitro study demonstrates that OCT analysis measuring stent-strut thickness provides accurate data with high reproducibility, suggesting that assessment of stent-strut apposition using OCT is feasible.

[Quality of life following endocrine therapy for advanced prostate cancer: a comparative study between LH-RH agonist 1-month depot and 3-month depot].

PURPOSE: There were few studies which reported the longitudinal quality of life (QOL) for Japanese men who received endocrine therapy for advanced or metastatic prostate cancer. A pilot randomized trial was conducted to assess QOL and the incidence of hot flash following endocrine therapy using luteinizing hormone-releasing hormone (LH-RH) agonist goserelin acetate 1-month or 3-month depot alone in patients with advanced or metastatic prostate cancer. MATERIAL AND METHODS: A total of 28 patients with advanced or metastatic prostate cancer who received LH-RH analogue goserelin acetate depot alone for 12 months were randomized (1:1) to two different formulations. Fifteen patients received the 1-month depot and thirteen patients received 3-month depot, namely Zoladex 3.6 mg depot and Zoladex LA 10.8 mg depot, respectively. We measured health related QOL using European Organization for Research and Treatment of Cancer (EORTC) and EuroQol (EQ-5D) questionnaire and evaluated the incidence of hot flashes between the two groups for one year after diagnosis. Moreover, we evaluated the incidence of hot flashes between the 1M and 3M depot. A baseline interview was conducted before treatment. Follow-up interviews were conducted in person at scheduled study visits of 3, 6, 9 and 12 months after treatment. RESULTS: Five (18%) patients dropped out of the study. Thus, we analyzed 23 eligible patients (11 in the 1M arms and 12 in the 3M arms). No significant differences between the two treatment arms were detected in categories of age, average pre- PSA values, Gleason scores and clinical T stage. According to EORTC, each treatment group showed similar QOL scores in all domains before and after treatment. With regard to EQ-5D, the 1M-treatnent arm reported better utility scores than 3M treatment arm, which was no significant statistically. The overall incidence of hot flash was 61% (58% in 1M group and 64% in 3M group). CONCLUSION: There were no differences with regard to general and disease specific HRQOL between the both formulations of goserelin acetate. Hot flashes are the major adverse effects of endocrine therapy for Japanese patients with prostate cancer.

Neointimal coverage of sirolimus-eluting stents 6 months and 12 months after implantation: evaluation by optical coherence tomography.

BACKGROUND: Optical coherence tomography (OCT) is a new imaging modality with resolution of approximately 10 microm and can be employed to visualize intracoronary characteristics. Sirolimus-eluting stents (SES) are susceptible to late thrombosis due to delayed re-endothelialization over the stent struts, which may result in acute myocardial infarction or death. This study was designed to evaluate the re-endothelialization and neointimal coverage of SES with OCT 6 months and 12 months after implantation. METHODS: A total of 36 patients enrolled in the study underwent OCT examination 6 months (17 patients) and 12 months (19 patients) after SES implantation. The strut apposition to the vessel wall and neointimal coverage on SES struts were evaluated by OCT. RESULTS: Forty-six SES and 6561 struts were analyzed. At 6 months, 3041 struts (98.7%) were well-apposed and 39 struts (1.3%) were malapposed. At 12 months, 3434 struts (98.6%) were well-apposed and 47 struts (1.4%) were malapposed. Furthermore, only 4 SES at 6 months (18.2%) and 10 SES at 12 months (41.7%) were fully covered by neointimal growth. The average neointimal thicknesses covering the analyzed struts at 6 months and 12 months were (42+/-28) microm and (88+/-32) microm, respectively. There were 1989 struts at 6 months (72.1%) and 1461 struts at 12 months (45.6%) with neointimal thickness <100 microm. CONCLUSIONS: OCT was able to visualize the strut apposition to the vessel wall and neointimal coverage on SES struts. At 6-month and 12-month follow-up examinations most struts were covered with thin neointima, but few of the entire SES showed full coverage. To prevent late-stent thrombosis in the presence of uncovered stent struts, longer dual antiplatelet drugs therapy should be recommended.

Natural history of small renal cell carcinoma: evaluation of growth rate, histological grade, cell proliferation and apoptosis.

PURPOSE: We investigated the natural history of incidentally discovered small renal cell carcinomas (RCCs), and we evaluated growth rate, apoptosis, cell proliferation and histological grade. MATERIALS AND METHODS: A total of 18 patients with RCCs extirpated after at least 12 months of observation were reviewed retrospectively. The period of observation ranged from 12 to 63 months (median 22.5). Median patient age was 56.5 years, ranging from 37 to 71. Annual tumor growth rate was calculated from diameter obtained from computerized tomography or ultrasound. Cell proliferation and apoptosis were assessed by immunostaining using Ki-67 and TUNEL. RESULTS: Average tumor growth rate was 0.42 cm per year (standard error 0.09, 95% confidence interval 0.24 to 0.61). Of the 18 tumors 7 were grade 1, 8 were grade 2 and 3 were grade 3. Tumor growth rate and Ki-67 positive ratio were not correlated. In contrast, growth rate and positive ratio of TUNEL were significantly correlated. A significant difference in growth rate was observed between grade 2 and 3 tumors but not between grade 1 and 2 tumors. CONCLUSIONS: The growth rate of RCCs correlates with apoptosis and grade. Most incidentally found RCCs are slow growing. However, those with certain histopathological features can grow rapidly and have a poor prognosis. More attention should be given to the observation of small renal masses.