Optical coherence tomography-verified longer balloon inflation time may provide better stent apposition and optimal index parameters.

BACKGROUND: Incomplete stent expansion and inadequate apposition predispose to stent thrombosis following percutaneous coronary intervention. Recent studies have shown that increasing the duration of balloon inflation during stent employment was beneficial. Thus, the balloon inflation time required for optimal stent expansion and apposition in patients receiving second-generation drug-eluting stents (DES) were determined using optical coherence tomography (OCT). PATIENTS AND METHODS: Between April 2014 and March 2015, 38 patients (28 men, 10 women; mean age 60.5 ± 11.4 years) with stable angina pectoris due to single significant de novo coronary artery stenosis were prospectively enrolled. All patients were administered aspirin and clopidogrel and received weight-adjusted intravenous unfractionated heparin. Images of basal lesions were obtained using the C7XR LightLab Dragonfly OCT catheter. RESULTS: Expansion and apposition parameters improved with increasing duration of balloon inflation (30 s or 60 s) with nominal pressure (12 atm). Mean lesion length was 19.8 ± 7.6 mm. Mean stent diameter and length were 2.8 ± 0.36 mm and 24.9 ± 7.6 mm, respectively. CONCLUSION: With deployment of a stent at nominal pressure with conventional duration, inadequate stent expansion and malapposition frequently occurred as detected by OCT; however, a balloon inflation duration of 60 s markedly improved stent expansion and apposition parameters without significant complications.

Are Down syndrome children more vulnerable to tooth wear?

BACKGROUND: An oral condition that has largely been ignored in the Down syndrome population is pathological tooth wear. This study is aimed to create more awareness of the reasons underlying the tooth wear observed in patients with Down syndrome and to suggest different methods to prevent this condition. This research also potentially serves as a platform for future researchers to perform an in-depth analysis of the factors we identified. The aim of this study was to determine if children with Down syndrome are more prone to tooth wear than children who do not have Down syndrome. METHODS: Our sample consisted of 120 children with Down syndrome who were compared with 120 children with no disabilities. The parents or guardians were asked to complete a questionnaire and a 3-day diet chart, while the wear on each tooth was recorded using the standardised Simplified Smith and Knight Tooth Wear Index. RESULTS: Children with Down syndrome experience tooth wear more frequently than non-Down syndrome children. A history of asthma, mouth breathing and gastro-oesophageal reflux disease as well as the intake of acidic diet and drinks has exerted significant effects on the prevalence of tooth wear. CONCLUSIONS: The early diagnosis and analysis of the underlying aetiology are important for the management of tooth wear in children with Down syndrome who have shown a greater tendency to develop erosive lesions.

Does obstructive sleep apnea affect oral and periodontal health in children with down syndrome? A preliminary study.

OBJECTIVE: Children with Down syndrome (DS) are at increased risk for obstructive sleep apnea (OSA) compared with children without DS, with reported prevalence of 31 ± 75% among clinical-based samples. We aimed to find out whether there is any effect of OSA on periodontal and dental health in children with DS. MATERIAL AND METHODS: Overnight polysomnography (PSG) was performed. OSA was defined as Apnea-Hypopnea Index (AHI) ≥ 1/h. Children received a full mouth periodontal and dental examination that included probing depths (PD), plaque index (PI), gingival index (GI), and bleeding on probing (BOP) on six sites per tooth. Decay, decay - Missing, missing - Filling, filling - Tooth, tooth (DMFT-for permanent tooth/dmft-for primary tooth) scores were calculated. RESULTS: Children were divided into two groups depending on whether they were diagnosed with OSA or no OSA. Group 1 (DS with OSA) and Group 2 (DS without OSA) included 11 children (age = 11.5 ± 2.2) and 7 children (mean age = 9.7 ± 2.3), respectively. Subjects in Group 1 displayed statistically significantly higher levels of GI (P = 0.020) and BOP (P = 0.006) than Group 2. CONCLUSION: OSA is an important problem for DS and may affect oral health negatively. Based on our findings, OSA can be associated with impaired gingival health in DS children and close follow-up may be necessary for this group.

Outcomes of direct stenting in patients with ST-elevated myocardial infarction.

BACKGROUND: We compared direct stenting (DS) with conventional stenting (CS) - i.e., stenting after predilation - during primary percutaneous coronary intervention (P-PCI) in terms of procedural results and long-term mortality in patients with ST-elevated myocardial infarction (STEMI). METHODS: We retrospectively analyzed 2306 patients (mean age 59 years, 22% female) who underwent P­PCI within 12 h of symptom onset. Patients were then followed up prospectively for clinical events. Patients were divided into a DS group (n = 597) and a CS group (n = 1709). The CS group was further divided into a CS-1 group (baseline thrombolysis in myocardial infarction [TIMI] flow grade ≥ 1) and a CS-2 group (baseline TIMI flow grade 0). Main outcome measures were postprocedural myocardial reperfusion and all-cause mortality in long-term follow-up. RESULTS: Patients in the DS group had a higher percentage of final TIMI-3 flow, myocardial blush grade 3 and complete ST-segment resolution, better left ventricular ejection fraction, and a lower incidence of distal embolization compared with CS patients. In-hospital (1.5 vs. 4.6%, respectively, p = 0.001) and long-term all-cause mortality (8.8 vs. 17.0%, respectively, p < 0.001) were significantly lower in the DS group than in the CS group. Kaplan-Meier survival analysis showed similar survival rates in the DS and CS-1 groups (log-rank p = 0.40), but significantly worse survival in the CS-2 group than in the other groups (log-rank p < 0.001). After adjusting for risk factors, DS was not found to be a predictor of long-term mortality. CONCLUSION: DS in P­PCI was associated with better postprocedural angiographic results and long-term survival. However, the DS group had similar in-hospital and long-term mortality to matched patients in the CS group.

Microleakage of Different Adhesive Systems in Primary Molars Prepared by Er: YAG Laser or bur.

BACKGROUND AND AIM: This study aimed to examine the microleakage of class V cavities of primary molars prepared by either a conventional dental bur or Er:YAG laser and one of two different adhesive systems. METHODS: A total of 50 tooth samples from primary molars were used in this study. They were randomly assigned into five experimental groups of 10 samples each, according to the cavity preparation technique and the type of adhesive system applied to the cavities. Following cavity preparation, etching, bonding, and filling steps, samples were dyed using basic fuchsine and were sectioned longitudinally in buccolingual direction. Percentages of dye penetration at gingival and occlusal margins were calculated for each group. RESULTS: Overall, microleakage scores of gingival margins were significantly higher than those of occlusal margins (P < 0.001). The group that underwent laser preparation, laser etch, and self-etch bonding procedures had worse microleakage scores for gingival margins. However, all groups had similar occlusal scores (P > 0.05). CONCLUSION: Self-etch bonding systems and cavity preparation with Er:YAG laser may be an alternative to conventional restoration of primary molars with compomers. Further studies are warranted to fully elucidate the effect of laser-based etching techniques in cavities prepared by laser.

Resin infiltration technique and fluoride varnish on white spot lesions in children: Preliminary findings of a randomized clinical trial.

AIM: To clinically assess the efficacy of resin infiltration versus fluoride varnish for arresting white spot lesions (WSLs) on permanent teeth in children. SUBJECTS AND METHODS: Among the children referred to the our University, Faculty of Dentistry, Department of Pediatric Dentistry, 23 aged between 8-14 with 81 anterior WSLs were included in the study. The participants were randomly assigned to either the resin infiltration group or the fluoride varnish group. WSLs were assessed using a laser fluorescence device (DIAGNOdent pen, Kavo, Germany) and were characterized at baseline, immediately following resin infiltration application and at a 6-month follow-up. For the statistical analyses, the IBM SPSS Statistics 22 (IBM SPSS, Turkey) program was used to assess the findings of the study. RESULTS: Participant retention was 100% at 6 months. There was no significant difference between the two groups when baseline DIAGNOdent (DD) values were compared (P > 0.05). The reduction in 6-month follow-up DD values were statistically significant in both groups relative to baseline values. The 6-month values of the resin infiltration group were statistically lower than those of the fluoride varnish group (P = 0.028, P < 0.05). CONCLUSIONS: Resin infiltration and fluoride varnish are clinically feasible and efficacious methods for the treatment of anterior WSLs. The inhibition of caries progression by resin infiltration should now be considered an alternative to fluoride treatment.

Subclinical left ventricular systolic dysfunction in diabetic patients and its association with retinopathy: A 2D speckle tracking echocardiography study.

AIM: It is important to diagnose diabetic cardiomyopathy in the early stages to prevent development of evident heart failure in the future. The primary objective of this study was to evaluate the presence of subclinical left ventricular (LV) dysfunction with two-dimensional (2D) speckle tracking echocardiography (STE) and the secondary objective was to compare retinopathy-positive and -negative diabetic patients. PATIENTS AND METHODS: A total of 82 patients with type II diabetes mellitus (DM) and 90 gender-matched healthy controls were included. Retinopathy was present in 55 patients in the study group. All study participants underwent conventional 2D echocardiography and STE. RESULTS: All diabetic patients had preserved LV ejection fraction (LV-EF ≥ 50). Compared with the control group, diabetic patients had a larger left atrium (47.3 ± 19.9 mm vs. 36.9 ± 17.8 mm, p < 0.001) and a higher E/Em ratio (12.0 ± 2.9 vs. 10.5 ± 3.7, p = 0.004). The LV-EF, LV end diastolic and end systolic volumes, E/A ratios, deceleration times, and tissue Doppler parameters were compared between groups. The study group was observed to have statistically significant lower four-chamber (4C; 17.7 ± 3.0 % vs. 19.3 ± 3.5 %, p = 0.002), three-chamber (3C; 17.5 ± 3.0 % vs. 19.2 ± 3.4 %, p = 0.001), and two-chamber (2C; 18.5 ± 3.5 % vs. 20.1 ± 2.4 %, p = 0.001) peak longitudinal strain values compared with the control group. Moreover, LV global strain values were found to be significantly lower in the DM group than in the control group (17.9 ± 2.7 % vs. 21.1 ± 3.2 %, p < 0.001). By contrast, basal rotation (4.9 ± 3.3° vs.2.8 ± 4.5°, p = 0.001), apical rotation (15.3 ± 6.7° vs. 12.1 ± 5.3°, p = 0.001) and LV twist (20.2 ± 7.2° vs. 16.9 ± 6.5°, p = 0.002) in the DM group were significantly increased compared with those of controls. CONCLUSION: The STE procedure can be a useful novel technique in the determination of subclinical LV dysfunction in diabetic patients. Diabetic patients have lower longitudinal myocardial mechanics, and circumferential and rotational mechanics are impaired. There was no significant association between diabetic retinopathy and LV function.

Terminal QRS distortion and severity of coronary artery disease in ST-elevation myocardial infarction.

BACKGROUND: Grade 3 ischemia (G3I) is defined as ST elevation with distortion of the terminal portion of the QRS complex on electrocardiograms (ECGs) of patients with ST-segment elevation myocardial infarction (STEMI). Although the association between G3I and short- and long-term cardiovascular events is well established, its mechanism is unclear. We assessed the association between G3I on the admission ECG and SYNTAX score (SS) in patients with STEMI undergoing primary percutaneous coronary intervention. PATIENTS AND METHODS: The study population consisted of 312 patients with STEMI. Baseline ECGs of the patients were analyzed for grade of ischemia; the online latest updated version (2.11) of the SS calculator was used to determine the SS (http://www.syntaxscore.com). Patients were divided into two groups according to their grade of ischemia: grade 2 ischemia (G2I) or G3I. Also, patients were classified according to their SS as SS < 22 (low) or SS ≥ 22 (high). RESULTS: There were 211 patients in the low SS group and 101 patients in the high SS group. G3I was present in 31.1 % (n = 97) of the study population. SS was significantly higher in patients with G3I than in patients with G2I (20.1 ± 8.8 vs. 13.7 ± 7.1, p < 0.001). G3I was significantly higher in patients with high SS (50.5 % vs. 21.8 %, p < 0.001). Multivariate logistic regression analysis revealed that G3I (p < 0.001), diabetes (p = 0.013), age (p = 0.016), and anterior MI (p = 0.011), were independent predictors of high SS. CONCLUSION: In conclusion, G3I was independently related to high SS. We suggest that elevated SS in patients with G3I may explain the relationship between G3I and the poor outcome observed in these patients. Furthermore, the prediction of high SS by means of G3I in patients with STEMI may help determine the most appropriate revascularization method and prevent procedure failure.

Oral health and related factors in a group of children with cystic fibrosis in Istanbul, Turkey.

BACKGROUND: Cystic fibrosis (CF) patients can be considered as high caries risk patients because they frequently consume sugar-rich food between meals and they have a high intake of sugar containing syrups, aerosols, and salivary flow reducing medication. Variable caries prevalences were reported in CF patients in previous studies. There are no studies related to CF and salivary thromboplastic activity, which can be presented as a marker of wound healing and bleeding tendency of oral cavity. OBJECTIVE: The aim of this study was to compare oral health status and salivary pH, flow rate, and thromboplastic activity in children with CF and healthy controls. MATERIALS AND METHODS: A sample of 35 children with CF (23 girls and 12 boys), and 12 healthy control subjects (6 girls and 6 boys) were selected. Caries experience, oral hygiene, and dental erosion were assessed. Salivary flow rate, pH, thromboplastic activity, and total protein content were determined. Differences between the groups were evaluated using Chi-square test with a significance level set at 0.05. RESULTS: The differences between children with CF and healthy controls in tooth brushing frequency, use of fluoride tablets, caries experience, dental erosion index, oral hygiene index, salivary flow rate and total protein levels were not statistically significant (P > 0.05). Salivary thromboplastic activity of the CF group was significantly lower than the healthy controls (P < 0.01). CONCLUSION: Large population studies may be necessary to establish the role of salivary thromboplastic activity in children with CF considering our findings related to the decreased salivary thromboplastic activity, which may indicate delayed oral wound healing process.

Contrast-induced neurotoxicity after coronary angiography.

BACKGROUND: Contrast-induced neurotoxicity (CIN) is a very rare complication of coronary angiography. Clinical presentations include encephalopathy, seizures, cortical blindness, and focal neurological deficits. An inherent difficulty in understanding the natural history of the condition as well as its risk factors and prognosis is the rarity of its occurrence. To date, there are only case reports published on this complication. PATIENTS AND METHODS: This was a retrospective analysis of 9 patients with CIN (8 men, 1 woman; mean age, 64.6 ± 7.8 years; range, 47-72 years) and coronary artery disease who were administered iopromide contrast agent. RESULTS: In the last 3 years, we diagnosed 9 patients with CIN. Of these, 8 patients (89 %) had hypertension. The clinical presentations of the patients were different on admission: 6 patients had acute coronary syndrome and 3 patients had stable angina pectoris. One patient had history of previous contrast agent exposure. All patients underwent coronary angiography with a low-osmolar nonionic monomer contrast agent (iopromide; Ultravist®-300, Bayer Healthcare). The mean volume of contrast injected was 177 ± 58 ml. The mean time between contrast agent administration and clinical symptoms was 100 ± 71 min (range, 30-240 min). While in 5 of the patients (56 %) the clinical sign of CIN was confusion, 2 had ophthalmoplegia, 1 had cerebellar dysfunction, and 1 had monoplegia. In 8 of 9 patients (89 %), neurological symptoms resolved after giving supportive medication and hydration. Only 1 female patient, who had bilateral ophthalmoplegia, did not recover. Neurological recovery occurred at a mean time of 14.2 ± 6.7 h (range, 8-30 h). CONCLUSION: CIN is a very rare condition. Advanced age, male gender, and hypertension are the greatest risk factors for CIN. Although the prognosis of CIN is benign, it can potentially cause permanent neurological deficits or death. We found that patients with ophthalmic involvement had a higher propensity for persistent deficit. On the basis of the current data, we propose 170 ml as the maximal recommended dose for coronary procedures.

Temporomandibular disorders in young people with an intellectual disability: prevalence of signs and symptoms.

AIM: To assess the prevalence of signs and symptoms related to TMJ disorders in a group of young people with intelectual disability (ID) and a matched group of healthy adolescents. MATERIALS AND METHODS: A group of 105 young Special Olympics (SO) athletes (ID group) aged from 14 to 25 years and a control group were examined for the presence or absence of signs and symptoms of TMD through interview and clinical examination. RESULTS: A total of 64 young people with ID (61%) had at least one sign of TMD compared to 41 (39%) of the individuals screened that was free of any TMD symptoms. A significantly higher prevalence of TMJ sounds (palpation and stethoscope), TMJ tenderness, maximum vertical opening, headaches were observed among SO athletes compared to the healthy control group (p<0.05). A significant difference was recorded only for the Temporalis tenderness between the girls and boys (p<0.05). CONCLUSION: TMJ disorders are noticeable problem for intellectually disabled patients and a possible cause of pain that should be examined more in detail. We suggest that oral screening in people with a mental disability should be modified by including basic TMJ examination parameters in order to allow better understanding of the pathological aspects so as to address effective preventive and therapeutic measures.

The role of oxidative stress in diabetic cardiomyopathy: an experimental study.

BACKGROUND: Diabetes mellitus (DM) has a negative effect on cardiovascular functions. Little, however, is known of the overall effect of DM on the cardiac histology or the pathophysiological basis of this. AIM: We aimed to investigate the role of oxidative stress on the pathogenesis of diabetic cardiomyopathy in an experimental model. MATERIALS AND METHODS: 12 week-old female Sprague Dawley rats were randomly allocated into a healthy control group (n=6) and an DM group (n=6). After 12 weeks of alloxan induced DM, the groups' cardiac tissues were histopathologically analyzed and examined for determination of oxidant and antioxidant enzymes [activities of catalase (CAT), superoxide dismutase (SOD), and myeloperoxidase (MPO) and amount of reduced glutathione (GSH) and lipid peroxidation (LPO)]. RESULTS: When compared to the control group, the DM group showed cardiomyopathic changes. In the DM group, activities of CAT (144 +/- 0.9 vs. 112 +/- 1.4, p < 0.05) and LPO amount (27.0 +/- 0.74 vs. 14.4 +/- 0, 20, p < 0.05) were significantly increased whereas activities of SOD (142 +/- 0.2 vs. 146 +/- 0.7, p < 0.05) and amount of GSH (3.48 +/- 0.01 vs. 3.73 +/- 0.01, p < 0.05) were significantly decreased when compared to the control group. Besides, activities of MPO (7.3 +/- 0.02 vs. 8.6 +/- 0.11, p < 0.05) were comparable between groups. CONCLUSIONS: Using the experimental animal model, we were able to demonstrate that DM causes cardiomyopathic changes, and we propose that these changes could be mediated by an oxidative stress.

The effect of laser-activated Acidulated Phosphate Fluoride on enamel submitted to erosive solution only: an in vitro preliminary evaluation.

AIM: The purpose of this in vitro study was to evaluate the potential effect of laser therapy on the prevention of erosive demineralisation either alone or combined with acidulated phosphate fluoride gel on human enamel. It was hypothesized that such a treatment would decrease enamel solubility. STUDY DESIGN: Efficacy of 2940 nm Er:YAG laser with preset parameters--alone or combined with APF (Acidulated Phosphate Fluoride) gel--was tested on freshly extracted human permanent molars. MATERIALS AND METHODS: Ten sound human third molars were sectioned into 5 surfaces (2 x 3 mm) with hard tissue microtome and were randomly allocated into different treatment groups as follows. The Vicker's hardness of each surface was obtained at the baseline. Group 1, negative control group: no treatment. Group 2, positive control group: only 1.23% APF gel (Denti-Care gel, Medicom) 1 minute application. Group 3: irradiated with surface modification mode (2940 nm, 1.2j/cm², 10 Hz, 300 µm) Er:YAG laser. Group 4: Er:YAG laser application following 1.23% APF gel. Group 5: 1.23% APF gel following Er:YAG laser application. The demineralisation process was obtained by immersion of specimens in a soft drink for 10 minutes and then the Vickers hardness was reevaluated. STATISTICS: For statistical analyses within groups the Kruskal Wallis test was used, while for comparing groups the paired sample t test (significance p<0.05) was used. RESULTS: The difference in microhardness values of each group obtained following the treatments was not statistically significant (p>0.05). Beside, no statistical difference was found in Vickers value related to the application of fluoride prior or after laser therapy. Conclusion Er:YAG laser irradiation alone or combined with APF decreased the enamel solubility but combined treatment did not show any significant additional effect.

Effect of Using Methylphenidate on Salivary Flow Rate and Salivary Buffering Capacity in Children with Attention-deficit/Hyperactivity Disorder

ABSTRACT Objective: Most drugs used to treat attention-deficit/hyperactivity disorder treatment can affect saliva secretion. Methylphenidate is the most commonly prescribed drug for the treatment of attention-deficit/hyperactivity disorder and was approved for use in children over the age of 6 years. However, limited information is available on the use and long-term adverse effects of methylphenidate in preschool children (< 6 years). We explored the effects of methylphenidate on salivary flow rate and salivary buffering capacity during treatment for attention-deficit/hyperactivity disorder. Methods: Children who were diagnosed with attention-deficit/hyperactivity disorder by expert psychiatrists, under medical treatment, and those who had no other systemic diseases were included. Stimulated saliva samples were collected before prescription of methylphenidate and after 15 days, 30 days and 3 months of regular drug intake. The samples were analysed for Streptococcus mutans, as well as salivary buffering capacity and salivary flow rate. Twenty children (age range, 6-15 years) with attention-deficit/hyperactivity disorder were included. Results: The mean salivary buffering capacity value at month 3 was significantly lower than that at baseline and at day 15. Regarding the distribution according to salivary flow rate, statistically significant differences were found between baseline and the first month and between baseline and month 3 These results indicate that methylphenidate consumption in children with attention-deficit/hyperactivity disorder leads to reduced salivary buffering capacity and salivary flow rate after 3 months of follow-up. Conclusion: Parents should be informed about necessary preventive dental treatments to minimize the negative oral and dental effects of long-term drug use in children.

[Determination of caries activity levels in children aged 4-6 years by the modified Snyder test]. / 4-6 yas arasindaki çocuklarda modifiye Snyder testi ile dis çürük aktivitesinin saptanmasi.

Modified Snyder Test, which is a good instrument in motivating the patient and determining the effectiveness of preventive programs, is used commonly in Public Health Research programs for measuring the the caries activity levels. In our study, by using modified Snyder Test instead of Snyder Test, which is more preferable because of its' simplicity in application, we determined the caries activity levels of the children, aged between 4-6 years, which remained as an unexamined group in our population up to date. In our study, consisting of fifty children, caries rate was found to be 36% depending on WHO's criteria, while caries percentile for each tooth was 5.8% and df index was 1.18. According to the modified Snyder Test results, 46% of the children had positive results at the end of the 48 hours, which indicates a mild caries activity degree. This result is also in accordance with the caries of the group.

Clinical features of incontinentia pigmenti with emphasis on dermatoglyphic findings.

Incontinentia pigmenti is a syndrome characterized by both systemic and oral manifestations. Presented here are the dental, clinical, radiological, genetic and dermatoglyphic findings of a 6 year old female case and her family members. The following features were apparent: oligodontia in maxillary and mandibular arches in both dentition, peg-shaped incisors and brown lesions on the body surface. No other problems were observed. The case had remarkable dermatoglyphic findings such as hypothenar loops associated with distally displaced axial triradii on both palms, reduced total finger and summed palmar a-b ridge-counts, decreasing plantar pattern intensity on the left sole. The other family members had similar dermatoglyphic characteristics. The paternal grand father, the father and the brother had eye defects.

Inhaler medicament effects on saliva and plaque pH in asthmatic children.

The purpose of the present study was to investigate the effect on saliva and plaque pH of beta 2 agonist (salbutamol 400 mcg) and inhaler corticosteroid (fluticasonepropionate 250 mcg). The interproximal plaque pH responses to these medicaments and examine the effect of chewing gum after the usage of these inhalers. Thirty children of both sexes, from six to fourteen years old, participated in the study. The pH microelectrode was used in the study. The interdental sites chosen were those between the premolars in the 4 quadrants. The pH measurements were made baseline and 1, 5, 10, 20, 30 minutes after the use of medicaments as inhaler and also saliva was stimulated by sugar free chewing gum (Vivident). Data analyses were conducted using a statistical package through the University's computing center. The resulting pH values decreased in all four plaque sites and saliva during 30 minutes after inhaler drugs. After rinsing with water, the pH values also decreased (p < 0.001). Decreasing pH increased with chewing gum (p < 0.001). The hypothesis is that a decrease in pH in medicated asthmatics could be caused by inhaler drugs. Conclusive evidence for the relative role of the disease and the drug in saliva secretion and composition seems to require a longitudinal study on asthmatics before and after the onset of drug administration. We suggest that children with bronchial asthma treated with inhaler drugs should receive special preventive attention.

A mysterious case of fatal embolism after the repair of tetralogy of Fallot: secondary to arrhythmia?

Tetralogy of Fallot (TOF) is a common cyanotic congenital heart disease. The most important late complications observed after repair of TOF are atrio-ventricular arrhythmias and sudden cardiac death. We present a rare case of fatal embolism and sudden cardiac death in a 36-year-old patient, 30 years after the operation for TOF.

Femoral pseudoaneurysm in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction: incidence, clinical course and risk factors.

AIM: Various peripheral vascular complications may be observed after cardiac catheterization. However, no data are available about femoral pseudoaneurysm (FPA) after urgent primary percutaneous coronary intervention (PCI). We sought to determine the in-hospital incidence, clinical course and predictors of FPA in patients with ST elevation myocardial infarction (STEMI) undergoing primary PCI. METHODS: Two thousand six hundred consecutive STEMI patients (mean age: 56.5 ± 11.7 years; 2158 men) undergoing primary PCI were retrospectively enrolled into this study. Patients were evaluated with Doppler ultrasonography following PCI and categorized into two groups according to whether FPA developed or not. All the parameters were compared between FPA and non-FPA groups. RESULTS: The incidence of FPA after primary PCI was determined to be 2.3%. The mean age was higher in the FPA group compared to the non-FPA group (mean age: 60.6 ± 11.6 vs. 56.5 ± 11.8, respectively, P=0.007). Furthermore, the FPA developing group experienced prolonged hospitalizations compared to the non-FPA group, but no differences in in-hospital or long term mortality were noticed. In the multivariate analysis of this study, female gender and age (>75 years), after primary PCI, were found to be independent predictors of FPA. CONCLUSION: High incidence of FPA was noticed in STEMI patients undergoing primary PCI, which prolonged in-hospital stay. Extra care must be given, especially to women and those who are >75 years of age, for this complication.

Spontaneous coronary artery dissection associated with Leriche syndrome.

Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome. SCAD has been observed in three groups of patients; those with coronary atherosclerosis, women in the peripartum period, and those with an idiopathic cause. SCAD may also be associated with other conditions. Herein, we present a 44-year-old man who developed SCAD concomitant with Leriche syndrome.