[First trends of change in mortality by suicide in Nord-Pas-de-Calais since VigilanS]. / « Premières analyses de mortalité par suicide en Nord-Pas-de-Calais depuis l'implantation de VigilanS ¼.

INTRODUCTION: In terms of suicide prevention, population-based prevention devices often struggle to demonstrate an effect in terms of reducing suicidal acts of suicide, often focusing on the evolution of the number of suicide attempts, on time too short to statistically interpret changes in mortality. The consolidated figures for mortality in France are provided by the CepiDC with a delay of approximately three years. We therefore had to try to work with an approximation of the phenomenon, and we tested the proxy value of the enumeration of corpses, body examinations and medico-legal autopsies for suicide by the forensic doctors of the Nord-Pas-de-Calais region in France. In parallel, we conducted a comprehensive mortality study for 2016 in the VigilanS cohort. METHOD: By measuring the evolution of the number of body lifts for suicide by the Department of Forensic Medicine of the region, for the 3 years before VigilanS (2012-2014) compared to the 3 years since VigilanS (2015-2017). The deaths of patients of the VigilanS cohort were identified by calling the city halls of birth and domicile of all patients integrating the device in 2016. The cause of death was then characterized by contact of the attending physician. RESULTS: We observe an average decrease in suicide mortality of 9.9% (-12% for men, +0.3% for women). The exhaustive analysis of suicide mortality in the VigilanS cohort in 2016 found 19 deaths, of which 14 by suicide, or 0.4% of patients. This observed mortality rate in the VigilanS cohort in 2016 is significantly below the expected threshold in the literature (1 to 2% in the year following TS). CONCLUSION: It seems possible to reach the 2020 target for a 10% decrease in suicidal behavior in industrialized countries by 2020. The VigilanS device could therefore be protective in terms of suicide mortality.

Cyclodextrin curcumin formulation improves outcome in a preclinical pig model of marginal kidney transplantation.

Decreasing organ quality is prompting research toward new methods to alleviate ischemia reperfusion injury (IRI). Oxidative stress and nuclear factor kappa beta (NF-κB) activation are well-described elements of IRI. We added cyclodextrin-complexed curcumin (CDC), a potent antioxidant and NF-κB inhibitor, to University of Wisconsin (UW) solution (Belzer's Solution, Viaspan), one of the most effective clinically approved preservative solutions. The effects of CDC were evaluated on pig endothelial cells and in an autologous donation after circulatory death (DCD) kidney transplantation model in large white pigs. CDC allowed rapid and lasting uptake of curcumin into cells. In vitro, CDC decreased mitochondrial loss of function, improved viability and lowered endothelial activation. In vivo, CDC improved function recovery, lowered histological injury and doubled animal survival (83.3% vs. 41.7%). At 3 months, immunohistochemical staining for epithelial-to-mesenchymal transition (EMT) and fibrosis markers was intense in UW grafts while it remained limited in the UW + CDC group. Transcriptional analysis showed that CDC treatment protected against up-regulation of several pathophysiological pathways leading to inflammation, EMT and fibrosis. Thus, use of CDC in a preclinical transplantation model with stringent IRI rescued kidney grafts from an unfavorable prognosis. As curcumin has proved well tolerated and nontoxic, this strategy shows promise for translation to the clinic.

Autochthonous case of dengue in France, October 2013.

In October 2013, autochthonous dengue fever was diagnosed in a laboratory technician in Bouches-du-Rhone, southern France, a department colonised by Aedes albopictus since 2010. After ruling out occupational contamination, we identified the likely chain of local vector-borne transmission from which the autochthonous case arose. Though limited, this second occurrence of autochthonous dengue transmission in France highlights that efforts should be continued to rapidly detect dengue virus introduction and prevent its further dissemination in France.

[Prospective forensic study on the characterization of genital examination in women with consented sexual activity]. / Étude médico-légale prospective sur la caractérisation de l'examen génital chez des femmes ayant une activité sexuelle consentie.

OBJECTIVE: The number of women victims of sexual assault remains high, despite prevention and information campaigns. These victims can be adolescent girls, women of childbearing age or postmenopausal women. As part of examinations of victims of sexual assault, the morpho-anatomical diversity of the female genitalia requires knowledge of the physiological variations existing by the practitioners caring for these victims. Our work aimed to describe and characterize the genital examination of women with consented sexual activity. METHOD: Our cohort consisted of 196 women aged 14 to 81, examined in the context of medical gynecology consultations in two French maternity hospitals. RESULTS: Recent genital traumatic injuries were found in 12.8% of women whose last sexual intercourse was less than 5days old. Intact hymens, free from traumatic tearing despite regular sexual activity, were present in 10.7% of these women. CONCLUSION: Thus, in many cases, genital examination alone cannot confirm or deny the existence of prior sexual intercourse, whether or not it was consented to. The development of work on data on female genital anatomy would make it possible to optimize the medico legal care of victims of sexual assault.

Examining men as victims of intimate partner violence in a French forensic department.

OBJECTIVE: Intimate partner violence (IPV) is a particular type of interpersonal violence, in which violence is performed between individuals involved in an intimate relationship. Johnson developed a typology in which he differentiates common couple violence (CCV) from intimate terrorism (IT). We led a descriptive review of the cases of men treated at the victimology unit of the forensic department of Nancy for IPV-related abuse. METHOD: We retrospectively investigated our database to extract every file of male patient treated at the victimology unit of the forensic department of Nancy (France) from 2014 to 2019 for IPV-related abuse. We studied several parameters relating to the protagonists and their relationship, the violence endured, and the statements made during the forensic consultation. An attempt to perform Johnson's typology was made. RESULTS: We had a total of 226 consultations. The age of the patients ranged from 18 to 88 years old. Almost all patients experienced physical violence. Psychological violence was noted in 138 files. Concerning Johnson's typology, we identified 92 cases consistent with the definition of CCV and 46 cases compatible with IT. CONCLUSION: Male victims of IPV are now backed by an ever-growing corpus of studies that sheds an opportune light upon this challenging topic. Sadly, too many remain discredited and unaccounted for. We believe that escaping a gender-opposing conception in favor of a global understanding of this phenomenon would be of benefit to both men and women.

Determinants of total incapacity to work duration among 231 victims of school violence in France.

INTRODUCTION: This study aimed to identify the factors that may influence the duration of the total incapacity to work (TIW) among victims of school violence from the perspective of clinical forensics practice. METHODS: It used a cross-sectional design to collect data from school violence victims examined at a French forensic unit following a judicial requisition. Logistic regression models were used to identify whether the victim's characteristics, the circumstances of the violence, or the evaluation itself could predict a TIW duration equal to or greater than 2 days. RESULTS: Among 231 victims of school violence, the presence of traumatic injuries such as sprains or broken bones (OR=19.8; 95% CI, 1.7-23.4, p = 0.018), bruises (OR=6.3; 95% CI, 1.5-26.8, p = 0.007), and muscle contractures (OR=7.3; 95% CI, 2.0-26.2, p = 0.007) were the main risk determinants for a longer TIW. Factors with a mild impact were the presence of ecchymosis (OR=3.8; 95% CI, 1.4-9.9, p = 0.007), anxiety (OR=3.4, 95% CI, 1.6-7.1, p = 0.001), female physician (OR=2.5, 95% CI, 1.2-5.1, p = 0.016), and the presence of a psychological follow-up for the victim or the need for a psychological consultation (OR=3.6, 95% CI, 1.2-10.7 and OR=4.7, 95% CI, 1.9-11.5, p = 0.001). CONCLUSION: These results highlight the importance of developing a more uniform model in determining TIW, whatever the physician's characteristics, through screening and reporting methods for both physical and psychological symptoms.

A performance evaluation of three membrane bioreactor systems: aerobic, anaerobic, and attached-growth.

Water sustainability is essential for meeting human needs for drinking water and sanitation in both developing and developed countries. Reuse, decentralization, and low energy consumption are key objectives to achieve sustainability in wastewater treatment. Consideration of these objectives has led to the development of new and tailored technologies in order to balance societal needs with the protection of natural systems. Membrane bioreactors (MBRs) are one such technology. In this investigation, a comparison of MBR performance is presented. Laboratory-scale submerged aerobic MBR (AMBR), anaerobic MBR (AnMBR), and attached-growth aerobic MBR (AtMBR) systems were evaluated for treating domestic wastewater under the same operating conditions. Long-term chemical oxygen demand (COD) and total organic carbon (TOC) monitoring showed greater than 80% removal in the three systems. The AnMBR system required three months of acclimation prior to steady operation, compared to one month for the aerobic systems. The AnMBR system exhibited a constant mixed liquor suspended solids concentration at an infinite solids retention time (i.e. no solids wasting), while the aerobic MBR systems produced approximately 0.25 g of biomass per gram of COD removed. This suggests a more economical solids management associated with the AnMBR system. Critical flux experiments were performed to evaluate fouling potential of the MBR systems. Results showed similar critical flux values between the AMBR and the AnMBR systems, while the AtMBR system showed relatively higher critical flux value. This result suggests a positive role of the attached-growth media in controlling membrane fouling in MBR systems.

[Para-arortic lymhadenectomy and pelvic gynecological cancers: Extraperitoneal or transperitoneal laparoscopy?] / Curage lombo-aortique et cancers gynécologiques pelviens : cœlioscopie rétroperitonéale ou transpéritonéale ?

INTRODUCTION: Para-aortic lymphadenectomy plays a fundamental role in the surgical management of pelvic gynecological cancers. Two laparoscopic approaches exist: the transperitoneal (TP) and the extraperitoneal (EP). The aim of this study was to compare these 2 approaches in terms of surgical outcomes, specially the number of removed lymph nodes according to the surgical technique, and morbidity. MATERIALS AND METHOD: A single-center retrospective study was carried out at the Lariboisiere University Hospital between January 2011 and March 2020 including all patients who underwent para-aortic lymphadenectomy for the management of a pelvic gynecological cancer (cervix, endometrium, ovary). Univariate and multivariate analysis (logistic regression) were performed to compare the TP and the EP groups. RESULTS: 143 patients were included: 74 in the TP group and 69 in the RP group. The total duration of surgery was 220.8minutes in the TP group and 166.4minutes in the EP group (P<0.001 in multivariate analysis). No significant difference between groups were found in the average total number of lymph nodes removed but there was a statistically significant difference in the average latero-aortic number of lymph nodes removed: 8.5 lymph nodes in the TP group and 11.3 lymph nodes in the group RP (P<0.001 in multivariate analysis). There was no difference between groups in peri and postoperative morbidity. CONCLUSION: EP para-aortic lymphadenectomy reduces duration of surgery and increases the average latero-aortic number of lymph nodes removed with same morbidity compared to TP para-aortic lymphadenectomy, this confirming its preferred indication in endometrial and in cervical cancers.

Characterisation of severe obliterative bronchiolitis in rheumatoid arthritis.

The characteristics of patients with rheumatoid arthritis (RA) who develop obliterative bronchiolitis characterised by severe airflow obstruction have been hitherto poorly investigated. A retrospective study of 25 patients with RA and functional evidence of obliterative bronchiolitis (forced expiratory volume in one second (FEV(1))/forced vital capacity (FVC) <50% and/or residual volume (RV)/total lung capacity (TLC) >140% predicted) was conducted. Patients (mean+/-SD age 64+/-11 yrs) included 17 never-smokers and eight ex-smokers (10.5+/-5.4 pack-yrs). The diagnosis of RA preceded respiratory symptoms in 88% of cases. Dyspnoea on exertion was present in all patients and bronchorrhea in 44%. High-resolution computed tomography findings included: bronchial wall thickening (96%), bronchiectasis (40%), mosaic pattern (40%), centrilobular emphysema (56%), and reticular and/or ground-glass opacities (32%). Pulmonary function tests showed: FEV(1) 41+/-12% pred, FEV(1)/FVC 49+/-14%, FVC 70+/-20% pred, RV 148+/-68% pred and RV/TLC 142+/-34% pred. Lung biopsy, available in nine patients, demonstrated constrictive, follicular and mixed bronchiolitis. Patients were followed for 48.2+/-49 months. Treatment was poorly effective. Chronic respiratory failure occurred in 40% of patients, and four patients died. Obliterative bronchiolitis associated with rheumatoid arthritis is a severe and under-recognised condition leading to respiratory failure and death in a high proportion of patients.

Prosthetic carotid bypass grafts for atherosclerotic lesions: a prospective study of 198 consecutive cases.

OBJECTIVES: Carotid endarterectomy (CEA) is the standard treatment for atherosclerotic lesions involving the carotid bifurcation. However, CEA can be challenging under some conditions. The goal of this study was to determine the outcome and durability of prosthetic carotid bypass grafting (PCB) with polytetrafluoroethylene (PTFE) grafts as an alternative to CEA. METHODS: This is a prospective series of 198 consecutive patients with PCB, representing 12.4% of 1595 patients with a carotid reconstruction procedure performed in our department between September 1986 and December 2006. Qualifying event was stroke in 67 patients (34%) and transient ischaemic attack (TIA) in 45 (23%), and 86 patients (43%) were asymptomatic. Primary indications for PCB were extensive atherosclerotic lesions (n=71; 36%), carotid stenosis associated with kinking (n=49; 25%), recurrent stenosis (n=47; 23%), stenosis after radiation therapy (n=18; 9%) and technical failure of CEA (n=13; 7%), with excessive arterial wall thinning and perforation after endarterectomy (n=10) or intimal flap on completion digital angiography (n=3). RESULTS: The combined stroke and death rate at 30 days were 0.5% (one stroke). Median follow-up was 9.5 years (interquartile range (IQR): 6.2-18.3 years). At 10 years, primary patency was 97.9+/-3.4%. Six PCBs (3.0%) became occluded during follow-up; one patient had a restenosis greater than 50% and 18 patients (9.1%) had a restenosis of less than 50%. Five patients had an ipsilateral stroke (one postoperative stroke, one at 103 days with a patent PCB and three related to occlusion of the PCB at 4, 13 and 15 years after the procedure). At 10 years, cumulative stroke-free survival was 98.4+/-3.2%, and cumulative survival was 78.8+/-7.0%. CONCLUSIONS: PCB is a safe surgical alternative and is durable, with a low incidence of graft restenosis, when CEA seems hazardous.

[Thoracic hyperinflation and COPD. Beyond respiratory mechanics and dyspnea]. / Distension thoracique et BPCO, au-delà de la mécanique respiratoire et de la dyspnée.

INTRODUCTION: The interactions between thoracic hyperinflation and respiratory mechanics, as well as their importance in the development of dyspnoea, are now well understood. We discuss here other aspects of thoracic hyperinflation that are relevant in the context of COPD. BACKGROUND: Both clinical examination and imaging have a limited role in the detection of thoracic hyperinflation for which respiratory function tests remain the gold standard. Imaging, however, has led us to a better understanding of how the chest wall accommodates for hyperinflation, which mainly affects the diaphragm, particularly its vertical portion. More recently the adverse effects of hyperinflation on both pulmonary and systemic haemodynamics and life expectancy have been highlighted. VIEWPOINTS AND CONCLUSIONS: Thoracic hyperinflation affecting patients with COPD has important consequences that extend far beyond the framework of respiratory mechanics. In the future the importance of hyperinflation as a determinant of the prognosis should be confirmed and the most relevant parameter, in this context, defined. The potential links between thoracic hyperinflation and systemic inflammation should also be clarified.

Vehicle-assisted ligature decapitation: A case report and a review of the literature.

Decapitation resulting by vehicle-assisted ligature strangulation is a suicide method rarely described in the literature. The lesions observed at autopsy have a common morphology with to those found in post-hanging decapitation. They depend on the force applied by the acceleration of the vehicle, the slope of the road and the characteristics of the link used. They can also mimic a stabbing homicide. We report the case of a 43-year-old man who used a long steel rope, attached between his neck and a streetlight, and started his vehicle, causing a complete decapitation. The results of the autopsy provided information on the morphology of the cervical lesions, but also on the causes of death. In spite of decapitation, the histological examination of the organs confirmed the presence of asphyxiation process by a mechanical origin that occurred before decapitation.

A predictive nutritional model for plant cells and hairy roots.

A structured nutritional model is proposed to describe growth and nutritional behavior of Eschscholtzia californica suspension cells and Catharanthus roseus and Daucus carota hairy roots in in vitro culture. The model describes the cells specific growth rate from concentration of intracellular nutrients such as inorganic phosphate (Pi), nitrogen sources (NO(3) (-) and NH(4) (+)) and sugars. Two-level Michaelis-Menten kinetics are used to describe Pi and NO(3) (-) uptake and simple Michaelis-Menten kinetics for description of sugars uptake. Model parameters for each cell line were calibrated using data from batch cultures. The predictive capacity of the model was tested using data from medium exchange hairy root cultures. The model describes growth and nutritional behavior for the cell and hairy root lines. A sensitivity analysis was performed to identify critical model parameters and effect of initial conditions. The cell and hairy roots lines are also compared from their kinetic parameters. The kinetic model is efficient for describing and predicting growth and nutritional behaviors of suspension cells and hairy roots.

Pulmonary rehabilitation in chronic obstructive pulmonary disease.

Pulmonary rehabilitation, a multidisciplinary and structured intervention for patients with chronic pulmonary diseases, has been shown to improve exercise tolerance, reduce dyspnea and improve health-related quality of life. Pulmonary rehabilitation appears to be cost-effective, since it reduces health care utilization. Exercise training represents the cornerstone of every pulmonary rehabilitation program. To obtain clinically relevant effects, training should closely supervised, of high intensity, lasting 30-45 min for at least 3 days/week. Patients should undertake a minimum of 20 sessions, but longer programs result in larger and more long-lasting effects. Education and self-management programs have been shown to result in a substantial reduction in hospital admissions. Nutritional intervention should be considered for patients who are underweight or those with body composition abnormalities. Patients reporting fear and anxiety may benefit from psychosocial support, and the integration of occupational therapy in a pulmonary rehabilitation program can improve independence in activity. Multidisciplinary pulmonary rehabilitation is preferably implemented in an outpatient hospital- or community-based setting. Inpatient programs are suited for patients with limited transportation capabilities or severe deconditioning. The most convincing effects of home-based rehabilitation are in maintaining the improvements obtained in an outpatient setting.

[Arterial blood pressure and arterial stiffness in adolescents are related to gestational age]. / Impact de l'âge gestationnel sur la pression et la rigidité artérielles à l'adolescence.

BACKGROUND: Recent studies show that low birth weight (LBW) infants are at risk of increased arterial blood pressure (BP) in adulthood. Previous work from our centre and others suggests that arterial stiffness (AS) is increased in such patients. However, the respective roles of preterm birth and of intrauterine growth restriction (IUGR) are unclear. AIM: To characterize AS and BP in adolescents who were: born at term with an appropriate birth weight for gestational age (GA) (group 1, n=41); born preterm with an appropriate birth weight for GA (group 2, n=25); born at term and small for GA (group 3, n=24). PATIENTS AND METHODS: Systemic BP was measured with an automated oscillometric device. AS was assessed by measuring pulse wave velocity (PWV) between carotid and radial arteries. RESULTS: 90 adolescents were studied at a mean (SD) age of 13.9 (1.2) years. Subjects from group 2 were born with a 33.6 (1.5) GA. Systolic BP, mean BP, and PWV were significantly increased in group 2 subjects in comparison to both group 1 (123 +/- 11 vs. 117 +/- 11 mmHg, p = 0.04; 88 +/- 7 vs. 83 +/- 7 mmHg, p = 0.03; 7.7 +/- 1.0 vs. 7.0 +/- 0.9 m/s, p = 0.02 respectively) and to group 3 (114 +/- 15 mmHg, p = 0.03: 79 +/- 8 mmHg, p = 0.001; 6.8 +/- 0.9 m/s, p = 0.005 respectively) subjects. Systolic BP, mean BP, and PWV were similar in group 1 and group 3 subjects. CONCLUSION: BP and AS are increased during adolescence in subjects born with a LBW due to preterm birth, while they are not altered in subjects when LBW is related to IUGR. It may be speculated that such changes predispose to long term hypertension and that preterm birth is involved in the early programming of arterial diseases in adulthood.

[Idiopathic chronic eosinophilic pneumonia]. / Pneumopathie chronique idiopathique à éosinophiles.

INTRODUCTION: Idiopathic chronic eosinophilic pneumonia (ICEP) is one of the hypereosinophilic lung diseases. BACKGROUND: ICEP is a rare disease of unknown cause that combines non-specific respiratory and general symptoms with predominantly peripheral radiological infiltrates. The presence of blood and alveolar eosinophilia points strongly to the diagnosis. ICEP is very sensitive to systemic corticosteroids but relapses are common following stopping treatment or reducing the dose. A background of asthma is commonly found and many patients with ICEP develop severe asthma which, together with the relapses, often necessitates prolonged systemic corticosteroid treatment. The long term prognosis, however, remains excellent. VIEWPOINT: The role of inhaled corticosteroids in non-asthmatic patients remains uncertain and should be evaluated further. The links between asthma and ICEP could lead to a better understanding of the mechanisms underlying hypereosinophilic lung diseases. CONCLUSION: ICEP is a rare disease that is important to recognise on account of its potentially disabling nature and its good response to corticosteroid treatment though long term maintenance is some times necessary on account of relapses or the development of severe asthma.

Long-term reproducibility and significance of provokable ventricular arrhythmias after myocardial infarction.

The long-term reproducibility and significance of inducible ventricular arrhythmias were assessed in 21 survivors of a myocardial infarction. Programmed ventricular stimulation performed a mean of 12 +/- 2 days (range 8 to 18) after infarction provoked ventricular fibrillation in 2 patients, sustained monomorphic ventricular tachycardia in 8 and nonsustained ventricular tachycardia in 11. Patients were restudied using the same protocol a mean of 8 +/- 2 months (range 4 to 11) after infarction. All patients underwent programmed ventricular stimulation studies in the absence of antiarrhythmic drug treatment. Ventricular tachyarrhythmias could be reinitiated in 16 patients (76%): ventricular fibrillation in 2, sustained ventricular tachycardia in 5 (monomorphic in 4) and nonsustained ventricular tachycardia in 9. A preponderance of inferior infarction was observed among patients with reinducible tachycardias (9 of 16 patients versus 0 of 5 with noninducible tachycardias) (p less than 0.05). No significant difference existed between patients with and without reinducible arrhythmias with respect to severity of coronary artery disease, degree of left ventricular dysfunction, occurrence of ventricular fibrillation in the acute phase of infarction and ventricular arrhythmias detected by 24 hour ambulatory electrocardiographic (Holter) monitoring. There was no significant difference between patients with and without a positive late study in stimulation thresholds, ventricular refractory periods, time interval between initial and repeat testing and use of beta-adrenergic blocking agents. During a mean follow-up period of 17 months (range 10 to 23) one patient with inducible sustained monomorphic ventricular tachycardia at both studies died suddenly. The remaining patients have survived follow-up without experiencing an arrhythmic event.(ABSTRACT TRUNCATED AT 250 WORDS)

Optimal coronary balloon angioplasty with provisional stenting versus primary stent (OCBAS): immediate and long-term follow-up results.

OBJECTIVE: This study sought to compare two strategies of revascularization in patients obtaining a good immediate angiographic result after percutaneous transluminal coronary angioplasty (PTCA): elective stenting versus optimal PTCA. A good immediate angiographic result with provisional stenting was considered to occur only if early loss in minimal luminal diameter (MLD) was documented at 30 min post-PTCA angiography. BACKGROUND: Coronary stenting reduces restenosis in lesions exhibiting early deterioration (>0.3 mm) in MLD within the first 24 hours (early loss) after successful PTCA. Lesions with no early loss after PTCA have a low restenosis rate. METHODS: To compare angiographic restenosis and target vessel revascularization (TVR) of lesions treated with coronary stenting versus those treated with optimal PTCA, 116 patients were randomized to stent (n=57) or to optimal PTCA (n=59). After randomization in the PTCA group, 13.5% of the patients crossed over to stent due to early loss (provisional stenting). RESULTS: Baseline demographic and angiographic characteristics were similar in both groups of patients. At 7.6 months, 96.6% of the entire population had a follow-up angiographic study: 98.2% in the stent and 94.9% in the PTCA group. Immediate and follow-up angiographic data showed that acute gain was significantly higher in the stent than in the PTCA group (1.95 vs. 1.5 mm; p < 0.03). However, late loss was significantly higher in the stent than the PTCA group (0.63+/-0.59 vs. 0.26+/-0.44, respectively; p=0.01). Hence, net gain with both techniques was similar (1.32< or =0.3 vs. 1.24+/-0.29 mm for the stent and the PTCA groups, respectively; p=NS). Angiographic restenosis rate at follow-up (19.2% in stent vs. 16.4% in PTCA; p=NS) and TVR (17.5% in stent vs. 13.5% in PTCA; p=NS) were similar. Furthermore, event-free survival was 80.8% in the stent versus 83.1% in the PTCA group (p=NS). Overall costs (hospital and follow-up) were US $591,740 in the stent versus US $398,480 in the PTCA group (p < 0.02). CONCLUSIONS: The strategy of PTCA with delay angiogram and provisional stent if early loss occurs had similar restenosis rate and TVR, but lower cost than primary stenting after PTCA.