Angiographic predictors of aberrant circumflex artery during cardiac catheterization.

OBJECTIVES: To identify angiographic predictors of aberrant left circumflex artery (LCx) by comparing left main (LM) length and bifurcation angle between patients with aberrant LCx and normal anatomy. BACKGROUND: Failure to recognize aberrant LCx during a cardiac catheterization may hamper correct diagnosis, delay intervention in acute coronary syndromes, and result in increased contrast volume, radiation exposure, and infarct size. METHODS: We retrospectively analyzed angiograms of aberrant LCx patients and normal anatomy matched controls, in three-participating centers. LM-length, bifurcation angle between the left anterior descending (LAD) and the first non-LAD branch of the LM, and procedural data were compared. RESULTS: Between 2003 and 2020, 136 patients with aberrant LCx and 135 controls were identified. More catheters (2.4 ± 0.6 vs. 2.2 ± 0.9, p = 0.009), larger contrast volumes (169 ± 94 ml vs. 129 ± 68 ml, p < 0.0005), and prolonged fluoroscopy time (652.9 ± 623.7 s vs. 393.1 ± 332.1 s, p < 0.0005), were required in the aberrant LCx-group compared with controls. Patients with aberrant LCx had a longer LM-length and a more acute bifurcation angle, both in caudal and cranial views, compared with controls (24.7 ± 8.1 vs. 10.8 ± 4.5 mm, p < 0.0005 and 26.7 ± 7.4 vs. 12 ± 5.5 mm, p < 0.0005, respectively, and 45.2° ± 12° vs. 88.8° ± 23°, p < 0.0005 and 51.9° ± 21° vs. 68.2° ± 28.3°, p < 0.0005, respectively). In ROC analysis, LM-length showed the best diagnostic accuracy for detecting aberrant LCx. In multiple logistic regression analysis, a cranially measured LM-length > 17.7 mm was associated with a 5.3 times greater probability of predicting aberrant LCx [95% CI (3.4-8.1), p < 0.0001]. CONCLUSIONS: Our study suggests that a long LM-length and an acute bifurcation angle can indicate the presence of aberrant LCx. We present a practical algorithm for its rapid identification.

Ecotoxicity and biodegradation of the bacteriostatic 3,3',4',5-tetrachlorosalicylanilide (TSCA) compared to the structurally similar bactericide triclosan.

This article studies the ecotoxicity of 3,3',4',5-tetrachlorosalicylanilide (TCSA) using different bioassays and examines its fate in activated sludge batch experiments. Despite of the common use of TCSA as chemical uncoupler in wastewater treatment systems and as preservative in several products, limited data has been published for its ecotoxicity, while no information is available for its biodegradation. Among different bioassays, the highest toxicity of TSCA was noticed for Daphna magna (48-h LC50: 0.054 mg L-1), followed by Vibrio fischeri (15-min EC50: 0.392 mg L-1), Lemna minor, (7-d EC50: 5.74 mg L-1) and activated sludge respiration rate (3-h EC50: 31.1 mg L-1). The half-life of TSCA was equal to 7.3 h in biodegradation experiments with activated sludge, while use of mass balances showed that 90% of this compound is expected to be removed in an aerobic activated sludge system, mainly due to biodegradation. A preliminary risk assessment of TSCA using the Risk Quotient methodology showed possible ecological threat in rivers where wastewater is diluted up to 100-fold. Comparison with the structurally similar 5-chloro-2-(2,4-dichlorophenoxy)phenol (triclosan, TCS) showed that both compounds have similar biodegradation potential and seem to cause analogous toxicity to Vibrio fischeri and activated sludge. Specifically, TCS was biodegraded quite rapidly by activated sludge (half-life: 6.2 h), while EC50 values equal to 0.134 mg L-1 and 39.9 mg L-1 were calculated for Vibrio fischeri, and activated sludge respiration rate. Future research should focus on monitoring of TSCA concentrations in the environment and study its effects in long-term toxicity and bioaccumulation tests.

Cardiac arrhythmias in arterial hypertension.

Patients with arterial hypertension frequently manifest various cardiac rhythm disturbances, ranging from bradyarrhythmias to supraventricular premature beats, atrial fibrillation, or other supraventricular and ventricular tachyarrhythmias. These cardiac arrhythmias may either cause symptoms or be completely asymptomatic, depending on the underlying cardiac function. Degenerative electrical disease and left ventricular hypertrophy constitute the principal pathophysiological mechanisms. This review summarizes all important existing evidence on cardiac arrhythmia manifestation in the setting of arterial hypertension, and it highlights known underlying pathophysiological mechanisms and therapeutic considerations.

Large infrapatellar ganglionic cyst of the knee fat pad: a case report and review of the literature.

INTRODUCTION: Large ganglionic cystic formations arising from the infrapatellar fat pad are quite uncommon and only a few are mentioned in the literature. An open excision in these cases is mandatory. CASE PRESENTATION: We report the case of a large infrapatellar fat pad ganglion in a 37-year-old Greek man with chronic knee discomfort. The ganglionic cyst originated from the infrapatellar fat pad and had no intrasynovial extension. The final diagnosis was determined with magnetic resonance imaging of the knee, and the lesion was treated with surgery. CONCLUSIONS: These lesions are asymptomatic in most cases but often are misdiagnosed as meniscal or ligamentous lesions of the knee joint. Nowadays, the therapeutic trend for such lesions is arthroscopic excision, but when there is a large ganglion, as in this case report, the treatment should be an open and thorough resection. This report is intended mostly but not exclusively for clinical physicians and radiologists.

Pacemaker extrusion in a severely demented patient. Device reimplantation via the femoral approach.

Extrusion of the generator is an infrequent complication following pacemaker implantation. Occlusion or stenosis of the deep venous system is common in elderly patients and can cause significant difficulties in transvenous pacing. The present study reports a rare case of pacemaker extrusion in an elderly patient with an inaccessible upper extremities deep venous system, requiring device reimplantation via the femoral route.

Intramedullary nailing for the treatment of aseptic femoral shaft non-unions after plating failure: effectiveness and timing.

This retrospective, multicentre study aimed to evaluate reamed intramedullary nailing (IMN) for the treatment of 30 cases of aseptic femoral shaft non-union after plating failure. Following nailing, 29 non-unions had healed by a mean 7.93 months. In one case a hypertrophic non-union required renailing after 8 months, using a nail of greater diameter, and united within five further months. Healing times were not related to whether the fracture was open or closed, the type non-union or the type of fracture. The delay from the initial plating to intramedullary nailing had a statistically significant effect on healing time and final outcome. This treatment is cost effective and should be implemented as soon as the non-union is diagnosed.

Degree of activity at the onset of myocardial infarction and thrombolysis outcome.

BACKGROUND: The aim of this study was to evaluate the possible relationship between the degree of physical activity at the onset of myocardial infarction and thrombolysis outcome. METHODS: A total of 351 consecutive patients, who underwent thrombolysis due to ST elevation acute myocardial infarction, were prospectively studied. Patients were classified into three groups according to a generally accepted scale: group I patients had experienced symptoms during exertion, group II when sitting and group III during sleep or when reclining. RESULTS: There was a significantly increased chance of either intravenous thrombolysis effectiveness or cardiac survival probability with increasing physical activity at the onset of myocardial infarction. In particular, group I patients had a significantly higher incidence of complete ST-segment resolution (P<0.001 for both II vs. I and III vs. I groups) or TIMI 3 flow in the infarct-related artery (II vs. I: P=0.002, and III vs. I: P<0.001) and less compromised left ventricular function (P<0.001 for both II vs. I and III vs. I) by both univariate and multivariate analysis. Moreover, although the degree of physical activity was associated with lower in-hospital (II vs. I: P=0.048, and III vs. I: P=0.01), and cardiac mortality at 39 months (II vs. I: P=0.002, and III vs. I: P<0.001) by univariate analysis, this did not hold true by multivariate analysis. CONCLUSIONS: In conclusion, the degree of physical activity at the onset of myocardial infarction may be positively associated with acute success of intravenous thrombolysis and this may favorably influence short- and long-term cardiac survival.