Common femoral artery anatomy is influenced by demographics and comorbidity: implications for cardiac and peripheral invasive studies.

We assessed the angiographic size of the common femoral artery (CFA) and the influence of demographics and comorbidites. In addition, the location of the CFA bifurcation and the site of femoral puncture were also assessed. Consecutive CFA angiograms (n = 200) were prospectively analyzed. CFA diameter was 6.9 +/- 1.4 mm and length 43.3 +/- 16.2 mm. By multivariate analysis, only diabetes (P < 0.001), female gender (P < 0.0005), and small body surface area (P < 0.01) predicted small vessel size. Vessel length correlated with patient height (P < 0.0005). CFA bifurcation occurred at or below the femoral head center in 98.5%. The femoral puncture was into a vessel other than the CFA in 13%, and 54% of punctures were in a less than ideal anatomical location. In conclusion, the CFA is a relatively small diameter vessel, particularly in diabetics and women. Puncture above the femoral head center and below the superior margin of the acetabulum accurately predicts an ideal puncture site. Thus, routine fluoroscopic guidance should be considered. Cathet Cardiovasc Intervent 2001;53:289-295.

Rheolytic thrombectomy with the Possis AngioJet: technical considerations and initial clinical experience.

Percutaneous revascularization of thrombus-containing lesions has an increased incidence of adverse events such as abrupt vessel closure, periprocedural myocardial infarction and death. Various pharmacologic and mechanical approaches have demonstrated modest angiographic success with significant periprocedural complications. The AngioJet (Possis Medical, Inc., Minneapolis, Minnesota) is a dual lumen catheter that uses the principle of rheolytic thrombectomy to remove unorganized thrombus. A previously unreported scoring system based on clinical and angiographic data may help to select patients most likely to benefit from AngioJet treatment. When compared with urokinase in the randomized VeGAS 2 Trial, AngioJet therapy yields greater angiographic success with a lower incidence of 30-day major adverse events. Technical considerations and complications are reviewed in detail.

Multivessel coronary thrombosis treated with abciximab (ReoPro) in a patient with essential thrombocythemia.

A 50-year-old man was admitted with acute inferior and anterior myocardial infarction. The patient was diagnosed with essential thrombocythemia (ET) based on the findings of marked thrombocytosis of 1,113 x 10(3)/mm3, splenomegaly, and numerous clumping megakaryocytes on bone marrow biopsy. Emergent coronary angiography revealed extensive multivessel thrombosis involving the left main coronary artery and completely occluding the proximal right coronary artery. In addition to standard therapy with aspirin, heparin, and primary angioplasty of the right coronary artery, the patient received additional antiplatelet therapy with ticlopidine, hydroxyurea, and the platelet glycoprotein IIb/IIIa receptor-inhibiting monoclonal antibody drug abciximab (ReoPro). Serial coronary angiograms 1 and 5 days following the infarction showed progressive thrombus resolution. The pathophysiologic mechanisms and therapeutic challenges of ET-associated coronary thrombosis are discussed in this report.

Combined PTCA and aortic valvuloplasty for acute myocardial infarction complicated by severe aortic stenosis and cardiogenic shock.

Percutaneous aortic valvuloplasty (PAV) performed in patients with critical aortic stenosis has been shown to increase aortic valve area, decrease aortic valve gradient, and improve left ventricular function. However, the procedure is limited by rapid restenosis. Aortic valvuloplasty in the setting of critical aortic stenosis with cardiogenic shock can be a life-saving procedure, although morbidity and mortality remain high. We describe a patient with critical aortic stenosis who presented with an acute anterior myocardial infarction treated with primary angioplasty. Despite rapidly achieving patency of the culprit vessel, the patient spiraled into cardiogenic shock, which prompted an emergent PAV.

Acute myocardial infarction. Recommendations for medical management and primary angioplasty.

Deaths from acute myocardial infarction have declined in recent years, thanks to the introduction of thrombolytic drugs and therapy with other types of medication that are beneficial when appropriately used. In this article, the authors review the mechanism of action of these agents and focus on recent clinical trials, indications and contraindications, and proper administration. They also discuss the place of primary angioplasty as an alternative to thrombolytic therapy.

Argon laser oral safety parameters for teeth.

Argon lasers have been reported to prevent or reduce demineralization of enamel in extracted teeth and to polymerize dental composites (using 25-100 J/cm2). Prior to clinical trials on caries prevention and curing composites, safety parameters for intraoral use of the argon laser need to be established. This study was conducted to determine the enamel damage, pulp temperature changes, and associated pulpal tissue damage following irradiation at various argon laser energy levels using 1.6-6.0 watts, approximately 1 and 2 mm diameter beam for 0.2-5.0 seconds. To evaluate pulpal damage, selected dogs' teeth were irradiated in vivo, extracted 7 days postlasing, fixed, decalcified, sectioned, stained, and read for pulpal damage. Pulp temperature and enamel damage tests utilized extracted dog and human teeth. Temperature probes were inserted in the pulp chambers and temperature changes recorded as enamel surface was lased. Enamel surface damage was evaluated by visual and microscope examination. Results showed that histologic pulpal damage occurred at > 600 J/cm2. Temperature changes were < 6 degrees F in human teeth with approximately 900 J/cm2. No enamel damage was observed at these energy densities. At energy densities needed for proposed uses, no apparent damage would be expected to pulp or enamel.

Comparison of three lasers for dental instrument sterilization.

The sterilization of dental instruments is an area of great interest and recent concern in the field of dentistry. The purpose of this study was to compare the ability of three lasers (argon, CO2, and NdYAG) to sterilize dental instruments. Endodontic reamers were contaminated with microorganisms, lased at various levels of energy, placed in Trypticase soy broth, incubated, and read for growth or no growth to determine sterility. Results indicated that the argon laser is capable of sterilizing selected dental instruments at the lowest energy level (1 watt for 120 seconds) of the three lasers tested. The other two lasers were able to sterilize the instruments also, but at higher energy levels. Results indicated all three lasers capable of sterilizing selected dental instruments; however, the argon laser was able to do so consistently at the lowest energy level of 1 watt for 120 seconds.

The presence and identification of organisms transmitted to dental laboratories.

The potential for infection of dental personnel in the office and dental laboratory by transmission of microorganisms between dentists' offices and commercial dental laboratories does exist. Sixty-seven percent of all materials sent from dental offices to dental laboratories sampled in four cities were contaminated with bacteria of varying degrees of opportunistic pathogenicity. Dental offices and dental laboratories need to practice adequate infection control procedures to prevent possible cross-contamination.

Carbon dioxide laser oral safety parameters for teeth.

The carbon dioxide laser is used in the oral cavity for a variety of procedures. Although the procedures may not involve the teeth directly, precaution should be exercised to preserve their integrity. The results of this study indicate that the most limiting parameter for oral use of the CO2 laser is damage to the enamel surface, which could be inflicted with as little as 5 W for 0.2 second and a 1 mm beam. Care should be exercised to prevent inadvertent damage to the surface enamel of teeth even at very low energy levels.

Enhancement of physical properties of resin restorative materials by laser polymerization.

A study was conducted to compare the compressive strength, diametral tensile strength, transverse flexural strength, and flexural modulus of a microfilled and a small particle composite resin restorative material following argon laser and conventional visible light polymerization techniques. All physical properties examined in this study were enhanced by laser polymerization. The diametral tensile strength of both types of restorative materials was significantly greater following laser polymerization, as were the transverse flexural strength and the flexural modulus of the microfilled resin restorative material. Additionally, these results were obtained with a laser polymerization time that was one-fourth that used for visible light activation. It was concluded that the argon laser is a potentially advantageous means of initiating the polymerization of dental composite resin restorations.

Correlation of histopathologic evidence of disease activity with the presence of immunoglobulin-containing cells in the colons of patients with inflammatory bowel disease.

Immunofluorescence of formalin-fixed, paraffin-embedded tissues was performed to study the plasma cell population in 114 colonic specimens from 58 patients. Correlation of the histopathologic stage of disease activity with the isotypes and numbers of immunoglobulin-containing cells in the lamina propria demonstrated highly significant (P less than 0.001) increases in the mean numbers of IgG- (18-fold), IgA- (twofold) and IgM- (sixfold) containing cells in specimens from patients with active inflammatory bowel disease as compared with control specimens. Increased numbers of immunoglobulin-containing cells were uncommon in inactive inflammatory bowel disease and in reactive mucosa. No deposition of immunoglobulin-containing immune complexes was found at any stage of disease activity. These findings suggest that immune complex-mediated damage does not play a major role in the epithelial damage in inflammatory bowel disease. In future studies, it will be of importance to determine whether the antibody from immunoglobulin-containing cells seen in patients with inflammatory bowel disease can effect damage via an antibody-dependent cell-mediated cytotoxicity mechanism.