Protocol description and initial experience in kidney graft perfusion using infrared thermography.

PURPOSE: Protocol description for renal perfusion study using thermographic technology and description of the thermographic and clinical behavior of the transplanted kidneys before and after unclamping. METHODS: Infrared thermographic images of renal grafts are obtained before kidney reperfusion, 10 min after and just before closing the surgical wound. Thermographic data is evaluated together with the type of graft and donor, cold ischemia time, hypovascularized areas determined by the surgeon during surgical intervention, alterations in vascular flow in postoperative echo-Doppler, time at the beginning of graft function and serum creatinine monitoring during postoperative follow-up. RESULTS: 17 grafts were studied. The mean temperature of the grafts before reperfusion, 10 min after and at the end of the surgery were 18.7 °C (SD 6.27), 32.36 °C (SD1.47) and 32.07 °C (SD1.78) respectively. 4 grafts presented hypoperfused areas after reperfusion. These areas presented a lower temperature compared to the well perfused parenchyma surface using thermographic images. CONCLUSION: The study of the usefulness and applicability of thermography can allow the development of tools that provide additional objective information on organ perfusion in real time and non-invasive manner. Our protocol and initial results can contribute to provide new evidence. Further analyses should be developed to shed light on the role of this technology.

[Exclusive coronary revascularization with both mammary arteries. Analysis of 73 patients]. / Resultados a 5 años de la revascularización exclusiva con dos arterias mamarias en pacientes con enfermedad coronaria multivaso.

BACKGROUND: Exclusive coronary revascularization with both mammary arteries could result in lower rates of adverse events in the long term. AIM: To describe the five-year evolution of a cohort of patients operated on with this technique. MATERIAL AND METHODS: Follow up analyzing survival of 73 patients aged 59 ± 9 years (82% men) who underwent exclusive coronary surgery with two mammary arteries between December 1,2010 and April 12,2017. We studied their clinical characteristics, surgical results, operative morbidity and mortality and adverse events up to June 30, 2018. RESULTS: Six patients had two-vessel lesions and 67 three-vessel lesions. The operative risk calculated by additive and logistic EuroSCORE was 2.5 and 2.3%, respectively. A mean of 3.75 anastomoses /patient were performed, 116 with left mammary artery (73 to the anterior descending artery, 38 to a diagonal artery and 5 for other objectives) and 158 with right mammary artery (69 to a first marginal artery, 23 to a second marginal artery and 64 to posterior descending artery). There was one case of mediastinitis and one (1.5%) patient died. The mean follow-up was 64.6 ± 23.7 months. The 5-year survival was 90.4%. CONCLUSIONS: Coronary revascularization with two exclusive mammary arteries allowed a complete revascularization of the heart with a low rate of complications and adverse effects at five years.

Resultados a 5 años de la revascularización exclusiva con dos arterias mamarias en pacientes con enfermedad coronaria multivaso / Exclusive coronary revascularization with both mammary arteries: analysis of 73 patients

Background: Exclusive coronary revascularization with both mammary arteries could result in lower rates of adverse events in the long term. Aim: To describe the five-year evolution of a cohort of patients operated on with this technique. Material and Methods: Follow up analyzing survival of 73 patients aged 59 ± 9 years (82% men) who underwent exclusive coronary surgery with two mammary arteries between December 1,2010 and April 12,2017. We studied their clinical characteristics, surgical results, operative morbidity and mortality and adverse events up to June 30, 2018. Results: Six patients had two-vessel lesions and 67 three-vessel lesions. The operative risk calculated by additive and logistic EuroSCORE was 2.5 and 2.3%, respectively. A mean of 3.75 anastomoses /patient were performed, 116 with left mammary artery (73 to the anterior descending artery, 38 to a diagonal artery and 5 for other objectives) and 158 with right mammary artery (69 to a first marginal artery, 23 to a second marginal artery and 64 to posterior descending artery). There was one case of mediastinitis and one (1.5%) patient died. The mean follow-up was 64.6 ± 23.7 months. The 5-year survival was 90.4%. Conclusions: Coronary revascularization with two exclusive mammary arteries allowed a complete revascularization of the heart with a low rate of complications and adverse effects at five years.

[Comparative analysis between orthopaedic manual therapy and osteopathy : focus on the Belgian situation]. / Analyse comparative entre la thérapie manuelle orthopédique et l'ostéopathie une mise au point sur la situation en Belgique.

Orthopaedic manual therapy (OMT) and osteopathy have been coexisting since a long time in Belgium to manage musculoskeletal disorders (MSDs). There are millions of consultations per year in these both disciplines. Both of them offer good clinical outcomes as well as patient satisfaction with care, good cost-effectiveness, as well as minor side effects. Nevertheless, a major misunderstanding remains in Belgium concerning these both professions. A narrative review by Belgian experts in osteopathy and/or in OMT has been undertake. In Belgium, both professions present several major differences concerning the primary first care access, the recognition as health care profession, tailored reimbursement systems, types and organization of education, the use of rehabilitation and motor control, the integration of evidence based practice concept, the reasons/indications of consultation, the degree of confidence within the therapeutic touch concept. In the meantime, several similarities also exist including the integration of the bio-psycho-social model, the evaluation of the neuromusculoskeletal system and the treatment of MSDs using sometimes identical manual techniques, as well as the use of therapeutic education of the patient and specific clinical reasoning. This analysis may help health professionals, students and patients to better understand the convergences and divergences between these both disciplines of musculoskeletal care in Belgium.

La thérapie manuelle orthopédique (TMO) et l'ostéopathie coexistent depuis longtemps en Belgique pour prendre en charge les troubles musculosquelettiques (TMS). On comptabilise des millions de consultations par an pour ces deux disciplines. Chacune offre, à la fois, une bonne satisfaction des patients et une bonne efficacité clinique, un bon rapport coût-efficacité, ainsi que des effets secondaires mineurs. Néanmoins, une méconnaissance majeure demeure en Belgique au sujet de ces approches thérapeutiques. Une revue narrative rédigée par des experts Belges en ostéopathie et/ou en thérapie manuelle a été réalisée. La TMO et l'ostéopathie présentent plusieurs différences majeures en Belgique. Elles concernent l'accès direct, la reconnaissance comme profession de santé, les systèmes de remboursement, les types et l'organisation de l'enseignement, l'utilisation de la rééducation et du contrôle moteur, l'intégration du concept d' «evidence-based-practice¼, les motifs/indications de consultation, le degré de confiance dans le toucher à des fins diagnostiques et thérapeutiques. Cependant, plusieurs similitudes existent également, dont l'intégration du modèle bio-psycho-social, l'évaluation du système neuro-musculo-squelettique, l'utilisation de techniques manuelles parfois identiques pour le traitement des TMS, une éducation thérapeutique du patient ainsi que l'utilisation d'un raisonnement clinique, propre, cependant, à chacune des disciplines. Cette analyse devrait aider les professionnels de la santé, les étudiants, ainsi que les patients à mieux comprendre les convergences et les divergences entre ces deux disciplines en Belgique.

Estudio cualitativo de la práctica fonoaudiológica en el contexto de la atención primaria de la salud, en la Quinta Región de Valparaíso / Speech and language pathology practice in primary health care of the fifth region of Valparaíso

La fonoaudiología chilena, en el contexto de la salud, concentra su práctica en el segundo y tercer nivel (hospitalario), existiendo una fuer te tradición biomédica en el área. Las orientaciones disciplinares y el contexto de la salud pública nacional invitan a fortalecer la atención primaria de la salud, desde un punto de vista preventivo y promotor. OBJETIVO: Describir las acciones del fonoaudiólogo en Atención Primaria de Salud (APS) en la Quinta Región de Valparaíso y revisar su pertinencia respecto al modelo propuesto por el Ministerio de Salud. MÉTODOS: Estudio cualitativo con enfoque fenomenológico. Se aplicó una entrevista semiestructurada a fonoaudiólgos(as) que se desempeñaban en APS y la información recopilada fue sometida a análisis de contenido. RESULTADOS: El contexto laboral de los fonoaudiólogos se circunscribe a convenios con programas que dan cobertura a un segmento específico de la población (infantil). Los fonoaudiólogos no cuentan con jornadas de trabajo completa en APS. Las acciones fonoaudiológicas se concentran en el diagnóstico, la habilitación y rehabilitación comunicativa. CONCLUSIONES: La práctica fonoaudiológica no responde actualmente al modelo de APS chileno. Es necesario incorporar una visión biopsicosocial y comunitaria a la práctica fonoaudiológica, con el fin de dar respuesta a las necesidades de la salud pública nacional.

The Community Based Rehabilitation (CBR) approach represents a strategy whose purpose is to achieve full social integration and inclusion of people with disabilities. Considering that communica tion and human language represent tools of expression of thought, the American Speech, Language and Hearing Association (ASHA) advocates the development of effective communication promotion, as a human right accessible to all people, considering its inherent dignity. OBJECTIVE: to analyze speech and language pathologist 's CBR practices in the fifth region of Valparaíso. METHOD: qualitative research, with a phenomenological approach. A semi-structured interview was conducted followed by a content analysis. RESULTS: speech and Language pathologists carry out actions related to the five CBR key components and also the practice of actions in accord to intersector. CONCLUSIONS: The professionals adopt the CBR approach incorporating the institutional vision of service in which they are inserted and adopting a profile oriented to transdisciplinary.

[Orthopaedic manual therapy : definition, characteristics and update on the situation in Belgium]. / La thérapie manuelle orthopédique : définition, caractéristiques et mise au point sur la situation en Belgique.

Although orthopaedic manual therapy (OMT) has existed for decades, and although a recent Belgian Royal Decree, published in 2014, recognized it as a particular professional qualification in physiotherapy for the treatment of neuromusculoskeletal dysfunctions, OMT remains little known by patients, but also by healthcare professionals. Yet, this professional qualification, based on clinical reasoning, using highly specific treatments, guided by the best available scientific and clinical evidence and the specific biopsychosocial characteristics of each patient, is the subject of a growing number of scientific studies pointing out its effectiveness. This article summarizes the knowledge related to OMT (definition, history, characteristics, techniques, indications, access and reimbursement) and describes its situation in Belgium.

Bien que la thérapie manuelle orthopédique (TMO) existe depuis des décennies et qu'un récent arrêté royal belge reconnaissant cette discipline comme une qualification professionnelle particulière en kinésithérapie pour la prise en charge des troubles neuro-musculo-squelettiques ait été publié en 2014, la TMO demeure méconnue des patients, mais également du monde médical. Pourtant, cette discipline, basée sur un raisonnement clinique, utilisant des approches thérapeutiques hautement spécifiques guidées par les meilleures évidences scientifiques et cliniques disponibles ainsi que par la spécificité biopsychosociale propre à chaque patient, fait l'objet d'un nombre croissant d'études scientifiques mettant en évidence son intérêt. Cet article vise à synthétiser les connaissances relatives à la TMO (sa définition, son historique, ses caractéristiques, ses techniques, ses indications, son accès et son remboursement, ainsi que son enseignement) en décrivant la situation en Belgique.

Alteraciones en la dispensación de medicamentos en las boticas del distrito de Chiclayo / Alterations in drug dispensation by private sector pharmacies in the district of Chiclayo

Objetivos: Determinar las alteraciones más frecuentes en la dispensación de medicamentos en las cadenas de boticas del distrito de Chiclayo: El estudio La población accesible fueron 30 boticas, de las cuales sólo 28 boticas se encontraron y evaluaron. Se visitó cada una de las boticas y mediante una receta médica, una lista de medicamentos y una relación de síntomas que respondan, respectivamente, al análisis de nuestros objetivos secundarios. Hallazgos: Se encontró que en el 21% de las boticas visitadas se cambió la prescripción médica por personal laboral, en el 100% de las boticas visitadas se vendió medicamentos sin receta médica y en 100% de aquellas se indicó una medicación sin haberla ésta prescrito por ningún médico. Conclusiones: En el 21% de las cadenas de boticas del distrito de Chiclayo, la prescripción médica puede ser cambiada; en el 100% de las cadenas de boticas de este distrito los medicamentos pueden ser fácilmente adquiridos sin la necesidad de presentar una receta; y en el 100% de las cadenas de boticas de dicho distrito podría indicarse medicación por el personal laboral.(AU)

bjective: To determine the most frequent alterations in the drug dispensation in pharmacy chains in the Chiclayo District. The study: Accessible population was 30 pharmacies, of which only 28 pharmacies were found and evaluated. He visited each of the pharmacies and used a prescription drug list and a list of symptoms that correspond respectively to the analysis of our secondary objectives. Findings: We found that in 21% of the pharmacies visited the prescription was changed by working staff, 100% visited sold drugs as if they were over the counter medications and 100% of those indicated a drug without having a doctor prescribed it. Conclusions: in 21% of the pharmacy chains in the district of Chiclayo, the prescription can be changed, in 100% of the pharmacy chains in this district drugs can be easily purchased without a prescription file, and also can drugs be sold indicated by working staff and not a doctor.(AU)

Short-term physical activity intervention decreases femoral bone marrow adipose tissue in young children: a pilot study.

Mechanical stimulation is necessary for maximization of geometrical properties of bone mineralization contributing to long-term strength. The amount of mineralization in bones has been reciprocally related to volume of bone marrow adipose tissue and this relationship is suggested to be an independent predictor of fracture. Physical activity represents an extrinsic factor that impacts both mineralization and marrow volume exerting permissive capacity of the growing skeleton to achieve its full genetic potential. Because geometry- and shape-determining processes primarily manifest during the linear growth period, the accelerated structural changes accompanying early childhood (ages 3 to 6 y) may have profound impact on lifelong bone health. The objective of this pilot study was to determine if a short-term physical activity intervention in young children would result in augmentation of geometric properties of bone. Three days per week the intervention group (n=10) participated in 30 min of moderate intensity physical activity, such as jumping, hopping and running, and stretching activities, whereas controls (n=10) underwent usual activities during the 10-week intervention period. Femoral bone marrow adipose tissue volume and total body composition were assessed by magnetic resonance imaging and dual-energy X-ray absorptiometry, respectively, at baseline and after 10 weeks. Although after 10-weeks, intergroup differences were not observed, a significant decrease in femoral marrow adipose tissue volume was observed in those participating in physical activity intervention. Our findings suggest that physical activity may improve bone quality via antagonistic effects on femoral bone marrow adipose tissue and possibly long-term agonistic effects on bone mineralization.

El final de la vida en la Unidad de Cuidados Intensivos desde la perspectiva enfermera: un estudio fenomenológico / The end of the life in the Intensive Unit Care from the nursing perspective: a phenomenological study

IntroducciónLas Unidades de Cuidados Intensivos no se adaptan a la realidad social y sanitaria con respecto al fenómeno de la muerte, lo que produce un alto grado de insatisfacción entre profesionales, familiares y pacientes. Las características especiales de estas unidades adjudican a la enfermera el puesto protagonista como cuidadora del paciente crítico moribundo. El objetivo principal de este estudio es conocer las vivencias y actitudes del profesional de enfermería ante el fenómeno de la muerte en la Unidad de Cuidados Intensivos.Participantes y métodosEstudio cualitativo descriptivo de carácter fenomenológico. Comparación constante e incorporación progresiva de participantes mediante muestreo intencional hasta llegar a la saturación de datos (n=16). La técnica de recogida de datos empleada fue la entrevista en profundidad semiestructurada, las entrevistas fueron grabadas y transcritas literalmente. Los datos recogidos fueron verificados por los informantes y analizados siguiendo los pasos propuestos por Taylor-Bogdan.ResultadosEl análisis reveló cinco categorías temáticas: la muerte y las creencias, trabajo emocional, factores ambientales, toma de decisiones frente a la limitación del soporte vital y relación con la familia.ConclusionesEl modelo de gestión de la muerte en la Unidad de Cuidados Intensivos se centra en la intervención médica y deja de lado la opinión de enfermeras, familiares y pacientes. Este estudio refleja las contribuciones que el profesional de enfermería puede realizar en la toma de decisiones y atención al paciente moribundo ingresado en estas áreas (AU)

IntroductionIntensive Care Units do not adapt to the social and health reality regarding the phenomenon of death and this results in a high degree of dissatisfaction among professional, relatives and patients. The special characteristics of these units give the nursing staff a main roll as carers of critical dying patients. The principal aim of this study is to know the nursing staffs’ experiences and attitudes towards the phenomenon of death in the intensive care units.Participants and methodA descriptive qualitative study of phenomenological character was performed. Constant comparison and progressive incorporation of participants was made, using intentional sampling up to data saturation (n=16). The data collection technique used was a semi-structured in-depth interview, which were recorded and literally transcribed. The data collected was verified by the informants and analyzed according to the steps proposed by Taylor-Bogdan.ResultsThe analysis shows 5 thematic categories: death and beliefs, emotional work, environmental factors, decision-making management of death in intensive care units and relationships with relatives.ConclusionsThe management model of death in intensive care units focuses on medical intervention and overlooks the opinions of the nurses, relatives and patients. This study shows the contributions that can be provided by the nursing staff in decision making and in the care of the dying patients in these wards (AU)

Suicidio por decapitación con sierra mecánica / Suicide by decapitation using a tapesaw

Se expone un caso de decapitación suicida realizada con una sierra de cinta para cortar metales. Precisó una laboriosa preparación previa en el taller de metalistería donde se ubicaba la máquina. El corte se realizó de delante a atrás con dirección oblicua, seccionando la escama del occipital en gran parte (AU)

A suicide decapitation case is presented that was committed using a tapesaw to cut metals. It required a previous laborious preparation at the metalwork place where the machine was located. Cut was made from the front to back with an oblique direction which caused the cut of a large part of the occipital squama (AU)

[The end of life in the intensive care unit from the nursing perspective: a phenomenological study]. / El final de la vida en la Unidad de Cuidados Intensivos desde la perspectiva enfermera: un estudio fenomenológico.

INTRODUCTION: Intensive Care Units do not adapt to the social and health reality regarding the phenomenon of death and this results in a high degree of dissatisfaction among professional, relatives and patients. The special characteristics of these units give the nursing staff a main roll as carers of critical dying patients. The principal aim of this study is to know the nursing staffs' experiences and attitudes towards the phenomenon of death in the intensive care units. PARTICIPANTS AND METHOD: A descriptive qualitative study of phenomenological character was performed. Constant comparison and progressive incorporation of participants was made, using intentional sampling up to data saturation (n=16). The data collection technique used was a semi-structured in-depth interview, which were recorded and literally transcribed. The data collected was verified by the informants and analyzed according to the steps proposed by Taylor-Bogdan. RESULTS: The analysis shows 5 thematic categories: death and beliefs, emotional work, environmental factors, decision-making management of death in intensive care units and relationships with relatives. CONCLUSIONS: The management model of death in intensive care units focuses on medical intervention and overlooks the opinions of the nurses, relatives and patients. This study shows the contributions that can be provided by the nursing staff in decision making and in the care of the dying patients in these wards.

Guía de buenas prácticas clínicas: asma bronquial en el niño / Guide to good clinical practices: bronchial asthma in children

El Asma Bronquial es la enfermedad crónica no transmisible de mayor prevalencia en la infancia mundialmente y en Cuba por lo que se considera un problema de salud. Su prevalencia ha aumentado en las últimas décadas siendo mal diagnosticada y tratada. Existe desinformación del personal médico, paramédico, enfermos y familiares sobre su prevención, correcto diagnóstico, pronóstico y tratamiento. Por lo que desde el año 2006 el servicio de respiratorio y alergia del Hospital Pediátrico Universitario de Holguín realiza talleres y cursos de capacitación, con el fin de actualizar los conocimientos y unificar criterios en el manejo integral del niño asmático en todos los niveles de atención y de esta forma mejorar la calidad de vida de los mismos, para lo que se elaboró esta Guía de Buenas Prácticas Clínicas.

Diagnóstico ocasional de endometriosis vesical por ecografía transvaginal / The rare diagnosis of bladder endometriosis with transvaginal scanning

La endometriosis vesical es una manifestación poco frecuente de una enfermedad muy comúnmente descrita por el ginecólogo. Se asocia a una elevada morbilidad dadas su dificultad diagnóstica y la baja sospecha. Debemos pensar en esta afección en mujeres con síntomas urinarios irritativos de presentación cíclica. Orientan hacia el diagnóstico las imágenes cistoscópicas, siendo necesaria la histología para su confirmación (AU)

Short-cycle structured intermittent treatment of chronic HIV infection with highly active antiretroviral therapy: effects on virologic, immunologic, and toxicity parameters.

Although continuous highly active antiretroviral therapy (HAART) is effective for many HIV-infected patients, it can be toxic and prohibitive in cost. By decreasing the total amount of time patients receive medications, intermittent HAART could reduce toxicity and cost. Therefore, we initiated a pilot study in which 10 HIV-infected individuals receiving effective therapy that resulted in levels of HIV RNA <50 copies per ml of plasma and CD4(+) T cell counts >300 cells per mm(3) of whole blood received repeated cycles of 7 days on HAART followed by 7 days off of HAART. Patients maintained suppression of plasma viremia for 32-68 weeks. There was no significant increase in HIV proviral DNA or replication-competent HIV in peripheral CD4(+) T cells or HIV RNA in peripheral blood or lymph node mononuclear cells. There was no significant change in CD4(+) T cell counts, no significant increase in CD4(+) or CD8(+) T cells expressing activation markers or producing IFN-gamma in response to HIV, no increase in CD4(+) T cell proliferation to p24 antigen, and no evidence for the development of resistance to HAART medications. There was a significant decrease in serum cholesterol and triglyceride levels. Thus, in this proof-of-concept study, short-cycle intermittent HAART maintained suppression of plasma viremia as well as HIV replication in reservoir sites while preserving CD4(+) T cell counts. In addition, there was a decrease in serum cholesterol and triglyceride levels. Intermittent therapy may be an important strategy to reduce cost and toxicity for HIV-infected individuals.

Cistadenoma hepatobiliar papilar gigante del hígado: presentación de un caso: discusión patogenética / Cistadenoma to hepatobiliar to papilar giant of the liver: presentation of a case: patogénica discución

Presenta un caso de cistadenoma papilar de lóbulo derecho de hígado, en una mujer de 50 años de edad, que tuvo dolor abdominal y masa tumoral de un año y medio de evolución. A la cirugía se extrajeron 7 litros de líquido del tumor, que estuvo formado por numerosas pequeñas cavidades en la periferia y una gran cavidad central. El epitelio que revestía las cavidades era desde simple cilíndrico hasta muy complejo papilar sobre estroma conjuntivo simple ramificado. La presencia de zonas con atipias nucleares nos hizo pensar en patogénicas con otros tumores quísticos de hígado, y se descarta el diagnóstico de cistadenoma con estroma mesenquimal (CMS). La paciente se encuentra bien y libre de enfermedad al cabo de 24 meses de operada.

Comparative study of the angiographic morphology of coronary artery lesions treated with PTCA, directional coronary atherectomy, or high-speed rotational ablation.

To evaluate trends in morphology-based intervention selection, series of 110 consecutive procedures of each of three devices, percutaneous transluminal balloon coronary angioplasty (PTCA), directional coronary atherectomy (DCA), or high-speed rotational ablation (HSRA), were reviewed. PTCA was used mainly in discrete, concentric, smooth, ACC/AHA type A and B1 lesions. PTCA was used less frequently on a bend, branching points or in calcified lesions. Using PTCA as a reference, DCA was used more often for the treatment of discrete, proximal, eccentric, and noncalcified lesions, often complicated with thrombus and located on straight segments. HSRA was used more frequently in diffuse, calcified multiple complicated and B2+C type lesions with frequent side branches and bend points. These results suggest that directional atherectomy and rotational ablation may be helpful in expanding the capacity of the operator to approach prognostically unfavorable lesions.

Coronary stenting with a new ultra-short balloon expandable device: early and late animal results.

The early and late effects of a new balloon-expandable coronary stent (Boneau II) were studied in 16 adult mongrel dogs. Thirty-three balloon-expandable stents were deployed using standard transfemoral coronary angioplasty technique. Single stents were placed in eight dogs and multiple (two to four) stents were placed in eight dogs. Intravenous heparin (3,000 units) was administered at the beginning of the procedure. Aspirin, dipyridamole, dextran, and warfarin were not administered before or after the procedure. All stent deployments were successful. Angiographic or pathologic examinations were performed within 24 hr of deployment on two of the dogs, at 2 weeks on two of the dogs, at 2 months on three of the dogs, at 6 months on six of the dogs, and at 1 year on three of the dogs. All successfully deployed stents were noted to be widely patent. There was no evidence of side-branch vessel occlusion. There was no evidence of acute or late vessel thrombosis. Histologic examination at 2 months showed a mean intimal thickness of 153 microns. The stainless steel Boneau II coronary stent is relatively short and easily deployed. This balloon-expandable coronary stent was successfully deployed in normal canine arteries without the use of anticoagulation or antiplatelet therapy before or after the procedure. The Boneau II intracoronary stent has a very low thrombogenic potential in dogs.

Coronary rotational ablation: initial experience in 302 procedures.

OBJECTIVES: The aim of this study was to assess the utility of percutaneous transluminal coronary rotational ablation in the treatment of coronary artery disease. BACKGROUND: Although numerous advances have been made in the treatment of coronary artery disease, there are lesions with complex morphology that are not amenable to current intravascular therapy. METHODS: A consecutive series of 242 patients having 302 coronary rotational ablation procedures was analyzed. One hundred nineteen (49%) of the patients had previously undergone attempted coronary angioplasty, which was unsuccessful in 31 patients (13%). The left ventricular ejection fraction was normal in 196 patients (81%). The ablation procedure was attempted in 308 vessels and 346 lesions. Of the 346 lesions treated, 26 (7.5%) were classified as American College of Cardiology/American Heart Association type A, and 320 (92.5%) as either type B or type C. RESULTS: Procedural success was achieved in 284 (94%) of the 302 procedures and 330 (95.4%) of the 346 lesions in which ablation was attempted. Five procedures (1.7%) were unsuccessful, but no cardiac event occurred during the hospital stay. A major cardiac event occurred in 13 cases (4.3%); 9 (3%) of these complications were due to the ablation procedure. Six patients sustained a Q wave myocardial infarction alone, two had a Q wave infarction and required emergency surgery and one needed emergency surgery but did not have a Q wave infarction. No procedural deaths were attributed to the ablation procedure. Follow-up has been obtained in 182 of the 242 patients at a mean interval of 9 +/- 5 months. Of the 182 patients, 174 (95.6%) were alive and free of myocardial infarction. Angiographic follow-up is available thus far in 87 patients. By combining angiographic and clinical outcome, an overall estimated restenosis rate of 37.4% (68 of 182) was calculated. CONCLUSIONS: These data suggest that coronary rotational ablation can be performed on lesions with a variety of morphologic features with high initial success rates. The overall rate of restenosis is similar to that of balloon angioplasty.