The necessity of follow-up for radiation skin injuries in patients after percutaneous coronary interventions: radiation skin injuries will often be overlooked clinically.

BACKGROUND: Percutaneous coronary intervention (PCI) offers great benefit that could improve a patient's quality of life. However, numerous case reports of patient radiation injury resulting from PCI are being published, these reports likely represent a small fraction of the actual cases. PURPOSE: To demonstrate the appropriate duration of patient follow-up after PCI to identify radiation effects. MATERIAL AND METHODS: We evaluated 400 consecutive PCIs. The radiation dose (dose-area product, cumulative dose, maximum skin dose), number of cine runs, and fluoroscopic time were recorded for all patients. The skin on the patients' backs was reviewed periodically after PCI. RESULTS: Radiation skin effects occurred in six patients from PCI of the right coronary artery in chronic total occlusion (CTO) patients (mild erythema; occurrence rate 1.5%). Skin injury in two patients appeared in cycles. In most cases, erythema was vividly seen at 4 weeks after PCI. CONCLUSION: Careful observation for skin injury is needed. At a few days following PCI, early erythema can be detected through careful observation by well-trained staff. At 7-10 days after PCI, most erythematous pigmentation can be detected. At 4 weeks after PCI, most skin erythema appears clearly, however, some cases of skin erythema occur without back pain. After that, follow-up every 6 months is needed to detect the reappearance of erythema.

Measurement of high-molecular-weight adiponectin is not useful in assessing coronary stenosis.

BACKGROUND: In many studies, high-molecular-weight (HMW) adiponectin has been considered the active form of adiponectin. However, whether HMW adiponectin is a good surrogate marker for coronary artery disease still needs to be elucidated. METHODS: We conducted a hospital-based cross-sectional study to examine the relationship between total, HMW or non-HMW adiponectin concentrations and coronary stenosis in 83 male patients and 138 male controls. RESULTS: Patients with coronary stenosis had significantly lower total adiponectin concentrations compared with controls. Non-HMW adiponectin concentrations in cases were significantly lower than the controls. However, there were no significant differences between cases and controls in HMW adiponectin concentrations. From the receiver operating characteristic (ROC) analysis, the area under the curve (AUC) for total and non-HMW adiponectin was significantly larger than that for HMW adiponectin concentrations. Of the three models, that for non-HMW adiponectin showed the largest AUC (total adiponectin 0.74, HMW adiponectin 0.54, and non-HMW adiponectin 0.79). CONCLUSIONS: Despite associations between total adiponectin levels and coronary stenosis, our data go against any apparent association between HMW adiponectin concentrations and coronary stenosis.

Feasibility evaluation of a remote monitoring system for implantable cardiac devices in Japan.

The number of implanted cardiac devices has been growing steadily over the last several years. Systems to monitor device data remotely have been introduced with the goal of reducing follow-up burden for both patients and physicians. Since the introduction of telemedicine depends greatly on the situations that are unique to each country, the acceptance of cardiac device remote monitoring in Japan was analyzed.A total of 203 patients who had previously undergone cardiac device implantation were enrolled. The subjects were provided with a CareLink Monitor that performed interrogation and transmission of device data at home, and then the physicians reviewed the data via a website at one and 3 months after baseline visits. A total of 470 transmissions were made. Questionnaires were completed by subjects and physicians to evaluate acceptance, ease of use, and satisfaction with the system. More than 87% of the subjects felt the Monitor was easy to use and nearly all of the physicians were satisfied with the system. A majority of patients felt reassured by having their devices assessed from a remote location and preferred the decreased number of clinic visits that were possible when using the Monitor. The patients spent an average of 168.2 minutes per clinic visit, whereas follow-up time was reduced to 13.0 minutes by remote monitoring. Physician consultation time was reduced by 2.7 minutes.The CareLink Network was well accepted by both the patients and physicians. Underlying issues did emerge, but once they are overcome, the system appears to have great potential to improve the quality of care given by healthcare providers.

Interaction of low serum adiponectin levels and smoking on coronary stenosis in Japanese men.

BACKGROUND: The relationship between serum adiponectin levels and coronary stenosis and the interaction of low serum adiponectin levels and smoking on coronary stenosis have not been clarified. METHODS: We conducted a hospital-based case-control study to examine serum adiponectin levels and smoking in 86 male patients with coronary stenosis and 145 male controls, using multiple logistic regression analyses. Serum adiponectin levels were grouped into quartiles for the analysis of the relationship between serum adiponectin levels and coronary stenosis, and into dichotomy for the analysis of the interaction of low serum adiponectin levels and smoking status. RESULTS: Decreasing serum adiponectin levels were significantly associated with increased risk of coronary stenosis in a dose-dependent manner. As for the interaction of low serum adiponectin levels and smoking on coronary stenosis, adjusted odds ratios were 14.00 (95% Confidence Interval 5.45-37.48) among ever-smokers with low serum adiponectin levels, 3.84 (95% CI: 1.44-10.21) among ever-smokers with high serum adiponectin levels and 3.79 (95% CI: 1.38-10.45) among never-smokers with low serum adiponectin levels, compared with the reference group of never-smokers with high serum adiponectin levels. CONCLUSIONS: The interaction of low serum adiponectin levels and smoking on coronary stenosis was likely to be a synergic effect. This study suggests that the combination of low serum adiponectin levels and smoking is the most useful predictor for coronary stenosis among Japanese men.

Inestabilidad de hombro en adolescentes: Indicaciones para cirugía. Reporte de caso y estado del arte / Shoulder instability in adolescents: Indications for surgery. Case report

La inestabilidad de hombro es una condición frecuente en personas involucradas en actividades deportivas de alta demanda física. Debido a sus particularidades anatómicas, los adolescentes presentan mayor riesgo de recidiva luego de un primer episodio de luxación de hombro. El sexo masculino, edad y participación en actividades deportivas de alto impacto son los principales factores de riesgo para recurrencia. En esta publicación, reportamos el caso de una adolescente porrista con inestabilidad anterior de hombro con evolución favorable luego de estabilización abierta complementado por una revisión del estado del arte de las aproximaciones terapéuticas de la inestabilidad recurrente de hombro en adolescentes.

Shoulder instability is a frequent condition in people involved in sport activities of high-physical demand. Due to their anatomical features, adolescents are at greater risk of recurrence after a first episode of shoulder dislocation. Male gender, age and participation in high-impact sport activities are the main risk factors for recurrence. We report the case of a cheerleader teenager with anterior shoulder instability with favorable evolution after open stabilization complemented by a review of the state of the art of the therapeutic approaches of recurrent shoulder instability in adolescents.

Prevalence and phenotypic spectrum of cholesteryl ester transfer protein gene mutations in Japanese hyperalphalipoproteinemia.

A patient with cholesteryl ester transfer protein (CETP) deficiency presents with marked hyperalphalipoproteinemia (HALP). To investigate the contribution of CETP deficiency to the cause of HALP (HDL-C> or =1.94 mmol/l, 75 mg/dl), we investigated the CETP activities and the prevalence of genetic CETP mutations among 624 Japanese HALP subjects. The subjects were screened for four known genetic CETP mutations (intron 14 splicing defect (In14), exon 15 missense mutation (Ex15), intron 10 splicing defect (In10) and exon 6 nonsense mutation (Ex6)). We found the frequency of the patients with reduced CETP activity (<75% of normal controls) to be 55.5 and 64.1% in a high HDL group (1.94< or =HDL-C<2.59 mmol/l) and a marked HALP group (HDL-C> or =2.59 mmol/l, 100 mg/dl), respectively. At least one of the four mutations was identified in 65.7% of subjects with reduced CETP activities and 57.5% of subjects with marked HALP. The In14 and Ex15 mutations were very common in HALP subjects and the frequency of In10 mutation and Ex6 mutation was quite low. To investigate the impact of genetic CETP mutation on the phenotypes, we compared the plasma lipid levels and CETP activities between the subjects with two common mutations. All In14 homozygotes showed marked HALP, while marked HALP is less frequent (64.3%) in Ex15 homozygotes. HDL-C levels in Ex15 heterozygotes were significantly higher than those of In14 heterozygotes, suggesting the mutation has dominant negative effects on CETP activity in vivo. Some cases with In14 (5.7%) or Ex15 (7.2%) mutation showed low HDL-C levels. We conclude that CETP deficiency is a major cause of HALP; nevertheless CETP deficiency is not necessarily HALP.

Fundamental study on the characteristics of a radiophotoluminescence glass dosemeter with no energy compensation filter for measuring patient entrance doses in cardiac interventional procedures.

Cardiac interventional procedures have been increasing year by year. However, radiation skin injuries have been still reported. There is a necessity to measure the patient entrance skin dose (ESD), but an accurate dose measurement method has not been established. To measure the ESD, a lot of radiophotoluminescence dosemeters (RPLDs) provide an accurate measurement of the direct actual ESD at the points they are arrayed. The purpose of this study was to examine the characteristics of RPLD to measure the ESD. As a result, X-ray permeable RPLD (with no tin filter) did not interfere with the percutaneous coronary intervention procedure. The RPLD also had good fundamental performance characteristics. Although the RPLD had a little energy dependence, it showed excellent dose and dose-rate linearity, and good angular dependence. In conclusion, by calibrating the energy dependence, RPLDs are useful dosemeter to measure the ESD in cardiac intervention.

Evaluating the maximum patient radiation dose in cardiac interventional procedures.

Many of the X-ray systems that are used for cardiac interventional radiology provide no way to evaluate the patient maximum skin dose (MSD). The authors report a new method for evaluating the MSD by using the cumulative patient entrance skin dose (ESD), which includes a back-scatter factor and the number of cineangiography frames during percutaneous coronary intervention (PCI). Four hundred consecutive PCI patients (315 men and 85 women) were studied. The correlation between the cumulative ESD and number of cineangiography frames was investigated. The irradiation and overlapping fields were verified using dose-mapping software. A good correlation was found between the cumulative ESD and the number of cineangiography frames. The MSD could be estimated using the proportion of cineangiography frames used for the main angle of view relative to the total number of cineangiography frames and multiplying this by the cumulative ESD. The average MSD (3.0 ± 1.9 Gy) was lower than the average cumulative ESD (4.6 ± 2.6 Gy). This method is an easy way to estimate the MSD during PCI.

Is Helicobacter pylori infection a risk factor for acute coronary syndromes?

OBJECTIVES: To elucidate risk factors for acute coronary syndromes (ACS), the present study examined whether Helicobacter pylori infection is a risk factor for patients with ACS. METHODS: We studied 33 male patients with acute coronary syndromes (ACS). All patients were incidence cases of ACS that they did not have a past history of IHD and were at the first onset of ACS. A control group was consisted of 66 males. Controls were at random selected from outpatients. All controls had normal resting electrocardiogram and had no history of IHD. H. pylori seropositivity was determined by an IgG-specific enzyme linked immunosorbent assay (ELISA). We serologically confirmed the presence of antibodies specific to the antigen CagA of H. pylori, using CagA ELISA. RESULTS: Seropositive rate of IgG antibodies in patients with ACS was 87.9%. A rate of in controls was 66.7%. After adjustment for age, a statistically significant association was found in H. pylori seropositivity between ACS and controls (OR, 3.74; 95% CI, 1.15-12.13). This relation was also significant after adjusted for potential confounding factors (OR, 4.09; 95% CI, 1.10-15.17). Anti-CagA positive H. pylori were significantly recognized in ACS (adjusted OR, 3.58; 95% CI, 1.08-11.82). However, this significant association was disappeared after adjusted for potential confounding factors (P=0.054). CONCLUSIONS: We confirmed a significant link between H. pylori infection and ACS. H. pylori infection is likely to be a risk factor for ACS.