Biodegradable stents.

Bioabsorbable stents must be biocompatible and as well as their degenerated products. The challenge is to find material that exhibit minimal recoil and remain in situ for several months before complete bio-absorption. There are now some worthy polymer based and metallic bioabsorbable stents with encouraging preclinical and clinical data. Their behaviour will not only redefine current percutaneous coronary intervention but may also have a wider role in the cardiovascular system as whole.

Takotsubo cardiomyopathy in myasthaenia gravis crisis confirmed by cardiac MRI.

Myasthaenia gravis crisis and Takotsubo cardiomyopathy are rare conditions that can be precipitated by emotional or physical stress. Myasthaenia gravis has a variety of cardiac manifestations but Takotsubo cardiomyopathy, particularly in male patients, has rarely been reported. We describe a unique case of a 70-year-old man who developed Takotsubo cardiomyopathy during his first presentation with a myasthaenia gravis crisis. He had not received plasmapharesis or immunoglobulin therapy. Striking ECG traces and cardiac MRI helped to confirm the diagnosis. Cardiac manifestations of myasthaenia gravis and myasthaenia gravis itself have overlapping symptoms; the importance of cardiac monitoring and clinical vigilance in such cases is discussed. The utility of cardiac MRI in assessing cardiac manifestations of myasthaenia gravis is also highlighted.

The effect of HIV-1 infection on the lipid fatty acid content in the membrane of cultured lymphocytes.

Elevations in the levels of unsaturated fatty acids (FAs) in membrane lipids lead to an increase in cell membrane fluidity and may also be involved in cell fusion and death through the loss of normal membrane function and integrity. Since the infection of susceptible cells with HIV leads to cell fusion and subsequent loss of viability, the present study was undertaken to see whether HIV infection can alter the relative content of unsaturated FAs in the host cell membrane and to determine whether this change correlates with cell death. Peripheral lymphocytes (PBLs) of a healthy donor and two CD4+ cell lines were chosen: MT-4, which is killed following HIV infection, with significant cell death being observed 5 days postinfection, and H9 which is not killed. Measurements of FA content of the two cell lines and PBLs, either before or at 6, 24, and 48 h after infection, showed a significant rise in the concentration of unsaturated FAs followed by a drop in the concentration of saturated FAs in the MT-4 cell line. With regard to the H9 cell line similar results were obtained at 6 h from infection. However, at 24 and 48 h the concentrations of saturated FAs returned to preinfection levels while the concentrations of unsaturated FAs dropped to levels even lower than those obtained at zero time. No significant changes in FA composition were found with PBLs.

Neurologic complications of AIDS: new concepts and treatments.

As patients progress from seroconversion to progressive HIV-1 disease, a variety of neurologic disorders may occur. These include diseases of the central and peripheral nervous systems as well as primary muscle disorders. This presentation focuses on clinical, laboratory, and pathologic features of these disorders. Theories of pathogenesis and currently available treatments are reviewed.

In-office management of common geriatric foot problems.

Foot disorders can be a major source of pain, discomfort, and disability for older adults. Neuropathy, impaired leukocyte function, vascular insufficiency, and trauma predispose older diabetics to limb-threatening complications. Therefore, examine the diabetic patient's foot during each visit. Painful foot disorders and lower extremity joint impairment represent major causes of treatable gait disturbance. Treatment of hyperkeratotic lesions (corns, calluses) consists of aseptic debridement and weight dispersion. Interspace maceration, fungal infections, and ulceration must also be managed with care. It is important to distinguish mycotic nail infections from nail dystrophies secondary to systemic disease, vascular insufficiency, and trauma.

Lower extremity manifestations of neuromuscular diseases.

Neuromuscular disorders must be considered when a patient presents with a pes cavus deformity; lower extremity weakness; difficulty in walking; or cramps, stiffness, fatigue, pain, or paresthesia in the extremities. In those instances in which a neurologic disease is considered, distinctions between central and peripheral nervous system origin, focal versus generalized pathology, and static versus progressive course are critical in the diagnosis and treatment of the disorder. The complexities of the nervous system often result in missed or delayed diagnosis of these syndromes. Patients affected with neurologic diseases often require diagnostic and therapeutic interventions from various specialists. This article presents a systematic approach to the patient with a neurologic disorder, with special emphasis on neuromuscular manifestations in the lower extremities. Key observations to aid in the recognition of neuromuscular dysfunction are presented, along with an approach to diagnostic evaluation and management for these patients.

Effect of anticoagulants in vitro on the viability of lymphocytes and content of free fatty acids in plasma.

These authors attempted to test the effect of anticoagulants on lymphocytes viability by reproducing the procedure used for lymphocyte isolation for various immunologic tests in which blood specimens are allowed to stay at room temperature for 2 h before lymphocytes are isolated. Blood was obtained with three different anticoagulants i.e. heparin, citrate, and CPDA (citrate, phosphate, dextrose, and adenine). Plasma was lyophilized and extracted with ethanol. Dried ethanol extracts were suspended in medium (RPMI 1640 + 10% fetal bovine serum) and incubated with a lymphocyte cell line (MOLT-4). After 24 h of incubation the viability of cells was examined. The following death rates of the cells were observed: heparin -63 +/- 4.6% (mean +/- SEM), citrate -27 +/- 6.7%, and CPDA 6.2 +/- 0.6% (P less than 0.0005). A significant correlation was found between these results and changes in the concentrations of free fatty acids in the extracts. These results emphasize the importance of choosing the right anticoagulant when the viability of lymphocytes is obligatory.

Treatment of congenital convex pes valgus with navicular excision and subtalar arthroereisis: a case study.

This article presents a case study of a 4-year-old female with a delayed diagnosis of congenital convex pes valgus. The severe soft-tissue contractures and osseous abnormalities in this case necessitated excision of the navicular and subtalar arthroereisis in addition to standard soft-tissue releases in order to achieve and maintain adequate reduction. A review of the literature and a discussion of these adjunctive techniques is provided to examine the concepts relevant to treatment of this condition.