Improvement in quality of life and angina pectoris: 1-year follow-up of patients with refractory angina pectoris and spinal cord stimulation.

AIMS: Spinal cord stimulation (SCS) is a treatment for patients with refractory angina pectoris (RAP) who remain symptomatic despite optimal medical therapy and without revascularisation options. Previous studies have shown that SCS improves the quality of life in this patient group and reduces the severity of the angina pectoris. The aim of this prospective, single-arm observational study is to show this effect in a single-centre cohort using a multidisciplinary team approach to the selection process, with a follow-up period of 1 year. METHODS AND RESULTS: Between July 2010 and March 2017, 87 patients with RAP referred to our centre received SCS. The Seattle Angina Questionnaire (SAQ) and RAND 36-Item Health Survey (RAND-36) were completed at baseline, prior to implantation, and 1 year post-implantation. After 1 year of follow-up there was a statistically significant decrease in the frequency of angina pectoris attacks from more than 4 times a day to 1-2 times a week (p < 0.001). The SAQ showed statistically significant improvement in four of the five dimensions: physical limitation (p < 0.001), angina frequency (p < 0.001), angina stability (p < 0.001) and quality of life (p < 0.001). The RAND-36 showed statistically significant improvement in all nine dimensions: physical functioning (p = 0.001), role/physical (p < 0.001), social functioning (p = 0.03), role/emotional (p < 0.05), bodily pain (p < 0.001), general health (p < 0.001), vitality (p < 0.001), mental health (p = 0.02) and health change (p < 0.001). CONCLUSION: This study showed a significant improvement in quality of life and reduction of angina pectoris severity after 1 year of follow-up in patients treated with SCS for RAP.

Right ventricular failure in acute respiratory distress syndrome.

Right ventricular failure can be the result of acute respiratory distress syndrome (ARDS). A patient with eclampsia and sepsis with Staphylococcus aureus developed life-threatening right ventricular failure as a result of ARDS. She finally stabilized after treatment with inhaled nitric oxide (NO). The pathophysiology of right ventricular failure in ARDS is described.

Scalp cooling by cold air for the prevention of chemotherapy-induced alopecia.

A new system is described for cooling the scalp with cold air in order to prevent chemotherapy-induced alopecia. Compressed air was cooled by means of a vortex tube built into a hair-drier cap. This system reduced the blood flow in the scalp to 35%, the surface temperature to 14.2 degrees C and the intradermal temperature at hair follicle level to 29.2 degrees C. The low temperature could be kept constant for at least one hour of cooling. By means of comparison, with cryogel packs the lowest epidermal temperature attained was 17.9 degrees C; moreover, once this was reached after 10 min, it rapidly rose again to 20.6 degrees C after 40 min. Forty-eight patients receiving cytostatic treatment for breast cancer were subjected to scalp cooling with the cold air system, starting 15 min before chemotherapy and lasting for 90 min. With the system set at an air temperature of -12 degrees C, the treatment was well tolerated. Of the 13 patients treated with 40 mg/m2 doxorubicin in combination with other cytostatics, 6 had hair loss less than WHO grade 3, in contrast to 1 of 4 patients given cryogel packs. However, patients treated with epirubicin at 75 mg/m2 all showed grade 3 hair loss in spite of air cooling. In view of the possibility of achieving and maintaining low scalp temperatures, the cold air system is to be preferred to cryogel packs. Whether better clinical results may be obtained with cooling for longer periods and/or to lower temperatures remains to be determined.

Percutaneous transluminal coronary angioplasty more than twice for the same coronary lesion.

To determine outcome and predictors of restenosis after three or more PTCAs for the same coronary lesion we studied 23 patients (17 patients three PTCAs; five patients four PTCAs; one patient six PTCAs). The primary success rate was 100%. Myocardial infarction was seen in one patient; there was no emergency surgery or mortality. Duration of follow-up after the last PTCA was 11-58 months (mean 26 months). Restenosis occurred in 6 of 23 patients (26.1%) after the last PTCA. The symptom-free interval before the last PTCA was less than or equal to 3 months in five of these six patients, a larger balloon for the last PTCA was used in two patients. After the last PTCA 17 of the 23 patients (73.9%) were asymptomatic; repeat angiography in seven of them revealed no restenosis. The symptom-free interval before the last PTCA was less than 3 months in eight patients, and a larger balloon was used in six of these. In nine patients the interval was greater than 3 months, and a larger balloon was used in two. When the symptom-free interval before the last PTCA was less than or equal to 3 months, restenosis occurred in two of eight patients (25%) in whom a larger balloon was used, but in three of five patients (60%) in whom a larger balloon was not used. When the interval before the last PTCA was less than or equal to 3 months five of 13 patients (38.5%) developed restenosis, but when it was greater than 3 months only one of 10 patients did so.