Prevalence and timing of regional myocardial dysfunction after rotational coronary atherectomy.

OBJECTIVES: This study aimed to evaluate the prevalence and time course of wall motion abnormalities associated with rotational coronary atherectomy. BACKGROUND: Although initial clinical studies found evidence of transient wall motion abnormalities after rotational coronary atherectomy, the prevalence and duration of these wall motion abnormalities are unknown. METHODS: Using simultaneous echocardiography, we prospectively evaluated 22 patients undergoing rotational atherectomy and compared their wall motion abnormalities with those of 10 patients undergoing coronary angioplasty alone. The extent of wall motion abnormality was quantified and plotted against time to produce curves of abnormal wall motion development and recovery for the two groups. RESULTS: The cumulative ischemic time was similar for the two groups ([mean +/- SD] 10.3 +/- 6 min for rotational atherectomy vs. 9.6 +/- 4.2 min for coronary angioplasty, p = 0.73). The rate of return to baseline function was significantly lower in the rotational atherectomy group than in the coronary angioplasty group (rotational atherectomy rate constant 0.069 +/- 0.079/min vs. coronary angioplasty rate constant 1.250 +/- 0.47/min, p = 0.0001). The mean time to recovery of baseline wall motion in the rotational atherectomy group (153 min, 95% confidence interval [CI] 6.5 to 3,600) was significantly longer than in the coronary angioplasty group (2.6 min, 95% CI 1.3 to 5.5, p = 0.0001). Rotational atherectomy burr time was longer in the patients who developed myocardial infarction than in those without myocardial infarction (4.7 +/- 2.4 vs. 3 +/- 1.4 min, p = 0.045). CONCLUSIONS: Transient wall motion abnormalities are common after rotational coronary atherectomy and have a longer duration than those observed after coronary angioplasty. This disparity may be a consequence of differences in the mechanisms by which rotational coronary atherectomy and coronary angioplasty produce their effect.

Radiographic appearance of frontal osteomyelitis in two patients with extradural abscess.

Extradural abscess can be a complication of frontal sinusitis. The chronicity of this condition can give rise to extreme frontal hyperostosis which can be an important radiological sign in a condition which may be clinically obscure.

Oesophageal tuberculosis: four cases.

Four Asian patients presented with dysphagia. In each case the oesophagus was involved by adjacent tuberculous subcarinal glands. The lungs were clear and symptoms of systemic illness were minimal. Findings at oesophagoscopy were non-specific and early diagnosis rested on a high index of suspicion and a strongly positive Mantoux test. Bacteriological proof was obtained early in only two of the cases.

Contemporary mediastinal tuberculosis.

Mediastinal lymphadenopathy is a prominent feature of adult tuberculosis in immigrant groups in the United Kingdom. Chest radiography of 95 tuberculous immigrants showed mediastinal gland enlargement in 29 cases, whereas none of the 42 Europeans showed this feature. An analysis has been made of the distribution of the disease in all groups together with a more detailed evaluation of mediastinal involvement in the immigrants. Pericardial effusions were seen in eight patients together with the following three unusual complications: (1) broncho-oesophageal fistula; (2) bronchial erosion; (3) superior mediastinal obstruction.

Dilatation in the duplex kidney: 3 unusual cases.

Dilatation in the upper limb of a duplex ureter is usually secondary to obstruction and may be associated with a ureterocele. By contrast, vesicoureteric reflux is the usual cause of a dilated lower moiety ureter. We report 3 cases in which unusual or complex causes of dilatation of 1 limb of a duplex ureter were demonstrated.

Cranial blind-ending branch of a bifid ureter. Report of 3 cases.

Three cases of cranial blind-ending branches of bifid ureters are presented, all occurring in women. None was associated with complications requiring surgery, suggesting that they were of little clinical significance in these patients. The anomaly was best shown with oblique views at intravenous urography.

[Percentage of epithelial cells, fibroblasts and endothelial cells in the dog thyroid]. / Etude du pourcentage de cellules épithéliales, fibroblastes et cellules endothéliales dans les thyroïdes de Chien.

The proportions of various cells types were studied in the thyroids of a variety of dogs used for laboratory experiments. A remarkable constancy was found with epithelial cells accounting for 70% of the total number of cells. The relative proportions of luminal and epithelial cells spaces were also very similar in different animals (47% and 26% respectively).

Malignant phaeochromocytoma: report of a case and a critical review.

A right adrenal phaeochromocytoma is described in a 64-year-old man. Metastases to bone and subsequent death following cord compression occurred within 2 years of diagnosis. Twenty-seven cases in the English literature have been reviewed since 1968. In three of these, the pathological proof was unsatisfactory for the diagnosis of malignancy, and one further case was inadequately documented. The variation in incidence of malignancy found in large retrospective series may relate to inconsistency in pathological criteria, as well as to selective reporting of cases.