[Leonine facies in carcinoid syndrome]. / Facies leonina en el síndrome carcinoide.

Carcinoid syndrome is a rare disorder caused when elevated levels of vasoactive substances secreted by a carcinoid tumor fail to be metabolized by the liver. This can occur for a variety of reasons including metastatic invasion of the organ. Carcinoid syndrome results in elevated levels of 5-hydroxyindoleacetic acid in the urine. Clinical manifestations include: flushing, diarrhea, bronchospasm, and heart failure. We describe a patient with carcinoid syndrome and hepatic metastases, in whom the key symptom of persistent facial edema resulted in conspicuous leonine facies; there was a partial response to treatment with oral isotretinoin and intramuscular lanreotide. Differential diagnosis was made with other conditions causing facial edema. A review is performed of the various skin manifestations of carcinoid syndrome, highlighting their role in the early diagnosis and treatment of the disorder.

Sequence analysis of five exons of SLC6A4 gene in Mexican patients with anorexia nervosa and bulimia nervosa.

BACKGROUND: Accumulating evidence indicates that alterations in the serotonin system are related to changes in eating behavior. The serotonin transporter is encoded by the SLC6A4 gene and has been an interesting candidate for anorexia nervosa- restrictive type (AN-R) and bulimia nervosa (BN). Interestingly, functional variants have been identified in the coding region that could contribute to understand the role of this gene in eating disorders. The aim was to identify genetic variants in five exons of SLC6A4 gene using Sanger-sequencing in anorexia nervosa-restrictive and bulimia nervosa patients, and a control group. METHOD: The sample consisted of 86 patients and 50 control subjects. We obtained DNA samples from all subjects and performed Sanger-sequence analysis of the 1, 2, 3, 8 and 9 exons. The sequences were compared with the reference sequence of the SLC6A4 gene. RESULTS: The sequence analysis of the five exons of the gene identified several variants. In the AN-R, we observed two novel variants (g.130delA and c.1740G > A), three synonymous variants (rs57172732, rs55908624, rs74478645) and a missense variant (L90F) reporting a probably deleterious and damaging variant. In BN, we identified two novel variants (g.295C > G and c.1725G > A), and the non-synonymous (rs28914832/I425V), reported as benign. Interestingly, we observed the 425V variant in three patients in the BN, variant that previously was reported in patients with a spectrum obsessive-compulsive disorder. CONCLUSION: The results of our study suggest that variants of the SLC6A4 gene are related with a possible damaging or gain-of-function and may be involved in the susceptibility to AN-R and BN patients. However, the present findings should be considered as preliminary until replicated in large samples.

Primary cutaneous T-cell lymphoproliferative disorder of donor origin after allogeneic haematopoietic stem-cell transplantation.

A 56-year-old male patient had a history of mantle-cell lymphoma, which was treated with polychemotherapy and reduced-intensity conditioning allogeneic haematopoietic stem cell transplantation (ASCT) from his healthy sister with an identical human leucocyte antigen profile. Six years after transplantation, the patient developed asymptomatic eczema-like cutaneous lesions. Histologically the lesions contained a dense superficial lichenoid infiltrate, mainly consisting of CD4+ atypical medium to large lymphocytes showing indented hyperchromatic nuclei. In situ hybridization for Epstein-Barr virus was negative. PCR amplification of the T-cell receptor-gamma chain gene from several lesions revealed a monoclonal rearrangement without clonal variation. Two-colour fluorescence in situ hybridization (X and Y chromosomes) and microsatellite genotyping were used to compare samples from the patient (transplant recipient), his sister (donor) and the skin biopsy sample, which confirmed that the origin of the neoplastic cells was the donor graft. To our knowledge, this is the first case of post-transplant primary cutaneous T-cell lymphoproliferative disorder after ASCT.

Review of the scientific evidence and technical opinion on noncaloric sweetener consumption in gastrointestinal diseases. / Revisión de la evidencia científica y opinión técnica sobre el consumo de edulcorantes no calóricos en enfermedades gastrointestinales.

The present review of noncaloric sweeteners (NCSs) by the Asociación Mexicana de Gastroenterología was carried out to analyze and answer some of the most frequent questions and concerns about NCS consumption in patients with gastrointestinal disorders, through a thorough review of the medical literature. A group of gastroenterologists and experts on nutrition, toxicology, microbiology, and endocrinology reviewed and analyzed the published literature on the topic. The working group formulated conclusions, based on the scientific evidence published, to give an opinion with respect to NCS ingestion. Current evidence does not confirm the carcinogenic potential of NCSs. However, the studies analyzed showed that saccharin could have a proinflammatory effect and that polyols can cause gastrointestinal symptoms and manifestations, depending on the dose and type of compound. The ingestion of xylitol, erythritol, sucralose, aspartame, acesulfame K, and saccharin could increase the secretion of the gastrointestinal hormones that regulate intestinal motility, and stevia and its derivatives could have a favorable effect on the percentage of liver fat. Caution should be taken in recommending aspartame consumption in patients with chronic liver disease because it reduces the ratio of branched-chain amino acids to aromatic amino acids. In addition, NCS ingestion could modify the composition of the intestinal microbiota, having an effect on gastrointestinal symptoms and manifestations. It is important to continue conducting causality studies on humans to be able to establish recommendations on NSC consumption.

Ophthalmic features of spinocerebellar ataxia type 7.

PurposeTo analyze the relation between ophthalmologic and motor changes in spinocerebellar ataxia type 7 (SCA7).Patients and methodsThis was a case series study. Sixteen SCA7 patients underwent a comprehensive ophthalmic examination, including ocular extrinsic motility testing, color vision test, and optical coherence tomography of the optic nerve and macula. Changes in the corneal endothelium, electroretinographic patterns, and a complete neurologic evaluation using the Scale for the Assessment and Rating of Ataxia (SARA) were evaluated. Correlations of endothelial cell density (ECD) with number of CAG repetitions and the SARA scores were estimated.ResultsAll patients showed various degrees of visual impairment mainly due to macular deterioration. Notably, they also presented decreased ECD. Pairwise correlations of ECD with number of CAG repeats and severity of motor symptoms quantified with the SARA scores were inverse (r=-0.46, P=0.083 and r=-0.64, P=0.009, respectively). Further analyses indicated an average ECD decrease of 48 cells/mm2 (P=0.006) per unit of change on the number of CAG repeats, and of 75 cells/mm2 (P=0.001) per unit of change on the SARA scores.ConclusionsThe results agree with previous ophthalmological findings regarding the widespread effect of SCA7 mutation on the patient's visual system. However, the results also show a significant negative correlation of decreased ECD with both CAG repetitions and SARA scores. This suggests that motor systems could degenerate in parallel with visual systems, although more research is needed to determine whether the degeneration is caused by the same mechanisms.

Aplicabilidad de los criterios de alto riesgo hemorrágico del Academic Research Consortium al síndrome coronario agudo sometido a intervención coronaria percutánea / Applicability of the Academic Research Consortium for High Bleeding Risk in acute coronary syndrome undergoing percutaneous coronary intervention

Introducción y objetivos: La reciente propuesta del Academic Research Consortium for High Bleeding Risk (ARC-HBR), por consenso, no considera el síndrome coronario agudo (SCA) un criterio de hemorragia per se a pesar de tratarse de una situación de alto riesgo hemorrágico (ARH). En este artículo, se investiga la aplicabilidad de la clasificación y los criterios del ARC-HBR a los pacientes con SCA. Métodos: Se clasificó retrospectivamente a los pacientes con SCA sometidos a implante de stent coronario entre 2012 y 2018 en un hospital terciario como ARH si cumplían al menos 1 criterio mayor o 2 o más criterios menores del ARC-HBR. El objetivo primario fue la incidencia acumulada a 1 año de hemorragias de grado Bleeding Academic Research Consortium (BARC) 3-5. Resultados: De los 4.412 pacientes incluidos, el 29,5% estaba en ARH. La incidencia de hemorragias fue mayor en el grupo con ARH que en el de no ARH (el 9,4 frente al 1,3%; p < 0,01). Las tasas de hemorragias hospitalarias periprocedimiento y tras el alta también fueron mayores en el grupo con ARH (el 4,3 frente al 0,5% y el 5,3 frente al 0,9% respectivamente; p < 0,01). El riesgo hemorrágico se incrementó gradualmente a medida que aumentaban los criterios ARC-HBR: el 1,8, el 5,0, el 9,4, el 16,8, el 25,2 y el 25,9% con, respectivamente: solo 1 criterio menor, 2 o más criterios solo menores, 1 criterio mayor (solo o sumado a 1 criterio menor), 1 criterio mayor con 2 o más criterios menores, 2 o más criterios mayores (solos o sumados a 1 criterio menor) y 2 o más criterios mayores con 2 o más criterios menores. De los 20 criterios del ARC-HBR, 16 (80%) cumplieron los cortes predefinidos del riesgo hemorrágico BARC 3-5. Conclusiones: Este estudio respalda la aplicación de la clasificación y los criterios del ARC-HBR en el contexto del SCA. La clasificación ARC-HBR proporciona una estimación precisa del riesgo de hemorragia mayor y parece adecuada para la identificación y el tratamiento de los pacientes con ARH (AU)

Introduction and objectives: The recent Academic Research Consortium for High Bleeding Risk (ARC-HBR) proposal did not consider acute coronary syndrome (ACS), by consensus, a bleeding criterion per se despite being a high bleeding risk (HBR) scenario. We investigated the applicability of the ARC-HBR classification and criteria in ACS patients. Methods: Patients with ACS undergoing coronary stenting between 2012 and 2018 at a tertiary hospital were retrospectively classified as being at HBR if they met ≥ 1 major or ≥ 2 minor ARC-HBR criteria. The primary endpoint was the 1-year cumulative incidence of Bleeding Academic Research Consortium (BARC) 3 or 5 bleeding.Results: Among 4412 patients, 29.5% were at HBR. The incidence of bleeding was higher in the HBR group than in the non-HBR group (9.4% vs 1.3%; P < .01). The rates of in-hospital periprocedural and postdischarge bleeding were also higher in the HBR group (4.3% vs 0.5% and 5.3% vs 0.9%, respectively; P < .01). Bleeding risk gradually increased with increasing ARC-HBR criteria: 1.8%, 5.0%, 9.4%, 16.8%, 25.2%, and 25.9% for 1 isolated minor criterion, ≥ 2 isolated minor criteria, 1 major criterion (isolated or plus 1 minor criterion), 1 major plus ≥ 2 minor criteria, ≥ 2 major criteria (isolated or plus 1 minor criterion), and ≥ 2 major plus ≥ 2 minor criteria, respectively. Sixteen (80%) out of 20 ARC-HBR criteria satisfied the ARC-HBR predefined cutoffs for BARC 3 or 5 bleeding risk. Conclusions: This study supports the use of the ARC-HBR classification and criteria in the ACS setting. The ARC-HBR classification provides an accurate major bleeding risk estimate and it seems suitable for the identification and management of patients at HBR (AU)

Large-scale screening of yeast artificial chromosome libraries using PCR.

The construction of physical maps of the human genome using sequence-tagged site content mapping requires that thousands of PCR amplifications be performed. On this scale, measures to reduce cost and to increase throughput become serious considerations. We describe relatively simple measures developed in our laboratory that increase the rate at which these reactions can be performed in a cost-effective manner. These measures have been extensively tested in our laboratory and are readily applicable in other laboratories including those performing library screening on a more modest scale.

Effect of Bdellovibrio bacteriovorus infection on the phosphoenolpyruvate:sugar phosphotransferase system in Escherichia coli: evidence for activation of cytoplasmic proteolysis.

Intact cells of Bdellovibrio bacteriovorus strain 109J were found to be incapable of taking up 14C-methyl alpha-glucoside, mannitol or fructose, and extracts derived from these cells exhibited negligible activities of the protein components of the phosphoenolpyruvate:sugar phosphotransferase system (PTS). Escherichia coli strain ML35 cells exhibited high in vivo sugar uptake activities that were progressively lost over a period of 2 h at 30 degrees C following the entry of B. bacteriovorus into the periplasm of E. coli. In vitro complementation assays revealed that the E. coli PTS enzymes, enzyme I, HPr, and the glucose- and mannitol-specific enzymes II, were all lost almost in parallel with the disappearance of uptake activity. Thus, loss of activity in vivo was not due to membrane leakiness, energy depletion, or preferential inhibition or inactivation of any one protein component of the PTS. Instead, loss of PTS activity was attributed to digestion of the protein constituents of the system by proteases present in the cytoplasm of the host cell after bdellovibrio entry. Both ethylenediaminetetraacetate and phenylmethylsulphonyl fluoride partially protected against inactivation in vitro, and the two inhibitors together gave full protection, suggesting that both metallo- and seryl-proteases were responsible for the inactivation. Protease activity increased progressively with time following bdellovibrio entry and appeared to degrade the E. coli PTS enzymes in vivo. Preliminary evidence suggested that the proteases responsible for PTS enzyme degradation may be encoded by the B. bacteriovorus chromosome.

Intrapleural fibrinolysis with streptokinase as an adjunctive treatment in hemothorax and empyema: a multicenter trial.

To test the efficacy of intrapleural fibrinolytic therapy in patients with loculated pleural effusions, we conducted an open, prospective, and multicenter trial among five hospitals in Mexico. We enrolled patients with hemothorax or empyema, clotted and/or loculated, that was not resolved through conventional pleural drainage with chest tube and antibiotics in patients with empyema. All patients received repeated doses of 250,000 IU of streptokinase through chest tube. Effectiveness criteria were before and after intrapleural streptokinase (IPSK) drainage, and poststreptokinase radiographic and respiratory function test improvement. Forty-eight patients were studied; there were 30 patients with empyemas, 14 with hemothorax, and 4 patients with malignant pleural effusions without lung trapping. Successful fibrinolysis was obtained in 44 patients, with complete resolution of the pleural collection and adequate radiologic and spirometric improvement. In three of four patients with multiloculated malignant hemothorax with high-yielding pleural drainage, IPSK allowed successful lysis of loci and an adequate pleurodesis was achieved. Only four patients required surgical treatment. The overall success rate in our series was 92%, similar to previous reports. The results in this first prospective and multicentric trial suggest that intrapleural fibrinolysis is an effective and safe adjunctive treatment in patients with heterogeneous pleural coagulated and loculated collections to restore the pulmonary function assessed by respiratory function tests and can obviate surgery in most cases.

Altered pulsatile pattern of luteinizing hormone in men with idiopathic normogonadotropic oligospermia.

Gonadotropin serum levels and pulsatile secretion of gonadotropin-releasing hormone (GnRH) and luteinizing hormone (LH) are regulated by sexual steroids and perhaps inhibin, but the relative rates of LH and follicle-stimulating hormone (FSH) secretion are modulated by the frequency of GnRH pulses. This study evaluated LH pulsatility in patients with idiopathic normogonadotropic oligospermia (INO) and normal men before and after clomiphene citrate (CC) administration. INO patients evidenced a lower mean LH levels (P less than 0.001), a higher mean pulse frequency (P less than 0.05) and similar pulse amplitude than normal men. CC induced in normal men a higher LH and testosterone (T) increments and increased pulse amplitude only in normal men. Estradiol (E2) showed no difference in either group. Patients with INO might evidence a hypothalamic disorder that may alter pulsatile GnRH secretion. A different response to CC in patients with INO seems to lend support to a primary hypothalamic lesion. A probable gonadotropin imbalance might alter intratesticular concentrations of T and E2 and be the cause of spermatogenic failure.

Study of genetic expression of intrauterine growth factors IGF-I and EGFR in placental tissue from pregnancies with intrauterine growth retardation.

To investigate the possibility of altered gene expression of growth factors in prenatal growth retardation, we assessed expression of the genes for insulin-like growth factor-I (IGF-I) and epidermal growth factor receptor (EGFR) by RT-PCR from human placentas at term delivery in two groups: appropriate for gestational age (AGA) and pregnancies complicated with IUGR. The placentas from IUGR gestations showed reduced IGF-I expression with a significance of p = 0.008, whereas we did not find any significant differences in EGFR gene expression.

Intrauterine growth retardation: study of placental apoptosis.

We studied the rate of apoptosis in the placental tissue of pregnancies complicated with intrauterine growth retardation (IUGR) and compared it with the results obtained in normal placentas. Our results clearly demonstrate a strongly increased rate of apoptosis in placentas of children born with IUGR, suggesting severe placental dysfunction. The significance of these findings needs further study.

[Intracoronary prosthesis (stent): an approach to the analysis of cost-effectiveness]. / Prótesis intracoronarias (stent): una aproximación al análisis de coste-efectividad.

Stents have emerged as one of the major therapeutic tools for percutaneous intracoronary revascularization procedures. In fact, a stent is implanted in at least 30% of lesions attempted. Their clinical impact is huge because stenting has produced a decrease int the need for emergency surgery to 0.5%, with an incidence of acute myocardial infarction related to angioplasty of 2% and a death rate of < 1% despite unfavourable clinical and anatomical conditions treated. The initial price of stenting was a high frequency of subacute stent thrombosis and peripheral vascular complications, which has been solved. In this context, the cost of stenting procedures increased by more than 30% in relation to the cost of conventional balloon angioplasty. But, the use of new antiplatelet regimes, implantation with high atmospheres and the achievement of a minimal residual narrowing after stenting practically promotes the disappearance of the two major initial problems, making possible a decrease in the restenosis rate to 20% with a parallel reduction of 10% in the need for new revascularization procedures during the first years after stent implantation. This means a reduction in the midterm costs. The incremental rate of cost/effectiveness after stenting in one vessel disease has been estimated as 23,600 dollars/years of adjusted quality of life gained ($/QUALY) ($20-40,000/QALY is acceptable in pharmaeconomic studies). From another point of view, stenting implies 19 QALYS gained at a mean cost of $52,700. The incremental cost of stenting may be more favourable if a reduction of $1,800 in the total cost of stenting procedures could be achieved, or if the stent cost were reduced by at least $700. In Spain, each patient who was event-free during the first year of follow-up would cost 1,674,000 ptas. A 10% reduction of new revascularization procedures x 100 patients would cost 20 million pesetas. Despite the enormous interest of socioeconomic analysis these data only reflect a partial point of view, because of the complexity of evaluating the contribution of new technologies, the true quality of life gained for patients, the societal point of view, or that of the National Health Service. Moreover, we assume that in the current socioeconomic context there are finite resources and a limitless demand.

[Conventional percutaneous transluminal coronary angioplasty as the form of treatment of complex intra-stent restenosis]. / Angioplastia coronaria transluminal percutánea convencional como forma de tratamiento de reestenosis compleja intra-stent.

We report the case of a patient with unstable refractory angina due to a coronary narrowing because of in-stent restenosis affecting the first diagonal, first septal and left anterior descending coronary artery. The lesions were successfully dilated with a conventional balloon catheter and a triple guide-wire system was placed through the inter-filaments space of the stent, to protect and recanalize the branch vessels involved. The patient evolved well and was discharged asymptomatic.

[Left superior vena cava drainage to the coronary sinus. Fetal cardiac doppler]. / Vena cava superior izquierda drenando a seno coronario. Doppler cardíaco fetal.

We report a fetus of 35 weeks gestation in which a continuous flow was detected in the lower portion of the right atrium with a peak velocity of 0.8 m/s. After delivery the echo-doppler study showed a dilated coronary sinus in the long axis parasternal view, and a bilateral superior vena cava in the short axis suprasternal notch view. Comments about the cause of this anomalous continuous flow are discussed.

[Informed consent in cardiology. The Committee on Informed Consent of the Commission on Professional Matters of the Sociedad Española de Cardiología]. / El consentimiento informado en cardiología. Comité de Consentimientos Informados de la Comisión de Asuntos Professionales de la Sociedad Española de Cardiología.

In the last thirty years, the clinical relationship between physicians and patients has been rather modified. There are several factors that have contributed to this change: a) New ways to execute medical practises, specially referred to the development of new techniques; b) Cultural changes in our western society, mainly in the mediterranean area, where there has been progress in the recognition of patients' autonomy to decide about their own lives, health and their own bodies; c) The increasing number of lawsuits, complaints and judgements about the problems that clinical information involves, particularly the informed consent in clinical practise. We consider it necessary to make an extensive and deep discussion from all of the areas in Medicine and Law, to analyze the different ethical and legal parts of the informed consent. For that reason the Spanish Society of Cardiology offers their members a basic document in order to reflect about these facts, developing arguments, justifications and supports. This document has also considered models, conditions to their applicability according to Spanish law, and the experience we have had. Finally, there is a list of diagnostic procedures and interventional practises in cardiology that might be preceded by a written informed consent document. We considered them by the name of Spanish Society of Cardiology recommendations.

[Congenital anomalies of coronary artery origin: a diagnostic challenge]. / Anomalías congénitas del origen de las arterias coronarias: un reto diagnóstico.

From a series of 4,313 consecutive patients who underwent a diagnostic coronary angiogram, 16 (0.37%) presented a congenital anomalous origin of the coronary arteries. None of these patients had other congenital cardiac anomalies associated. Age was 57 +/- 9 years and 13 (81%) were male. The diagnostic catheterization was performed for unstable angina in 8 patients (50%), for stable angina in five (32%), for dyspnea in two and for atypical chest pain in the remaining patient. A previous myocardial infarction was present in 6 patients (37%) whereas one patient had apical hypertrophic cardiomyopathy. We observed absence of coronary lesions in 4 patients and severe coronary stenosis lesions in 12 patients (75%), five of those with lesions located in the anomalous vessel. The most frequent abnormality found was an anomalous origin of left circumflex coronary artery in 8 cases (50%), followed by an abnormal origin of the right coronary artery in 5 cases (31%), and an abnormal origin of the left coronary tree in 3 cases (19%) (left anterior descending coronary artery arising from the right coronary artery, a single coronary artery which originated in the left coronary sinus, and a left main coronary artery which originated in the noncoronary sinus). The relationship of the anomalous coronary artery to the great vessels was the following: A retro-aortic course in 11 patient (69%), by the anterior free wall in two (12.5%), interarterial in two (12.5%), and septal in one (6%). Finally, as an index of the difficulty to visualize the anomalous coronary artery, an unusual catheter was needed in six (37%) of the diagnostic procedures to reach the target vessel.(ABSTRACT TRUNCATED AT 250 WORDS)

[The evaluation of the results after coronary angioplasty by intracoronary Doppler and quantitative angiography. The correlation of both methods]. / Valoración del resultado tras angioplastia coronaria con Doppler intracoronario y angiografía cuantitativa. Correlación de ambos métodos.

To study the importance of measuring coronary flow reserve immediately after coronary angioplasty we have analysed the results obtained after 28 angioplasties performed in 21 patients. Coronary flow reserve was measured with a 3F intracoronary catheter selectively placed in the dilated artery. Corresponding coronary angiography was analysed with an automatic edge detection program (ARTREK) and visual estimation. Coronary flow reserve increased in 26/27 cases after angioplasty from 2.4 +/- 1.3 to 4.1 +/- 2.7 (p less than 0.001). A correlation was found between minimal luminal area and minimal luminal diameter after coronary angioplasty, and coronary flow reserve (r = 0.46; p less than 0.05 and r = 0.47; p less than 0.05, respectively). The finding of a normal coronary flow reserve (greater than or equal to 3.5), had a 100% specificity but only 56% sensitivity to detect angiographic success (residual stenosis less than 50%). However 47% of patients with angiographic success did not reach normal values of coronary flow reserve. Visual estimation of the stenosis had a good correlation with automatic evaluation but significant scattering was observed at visual levels less than or equal to 25%. Visual assessment underestimated residual stenosis in all but one of the procedures. We conclude that coronary flow reserve is a potentially useful index for assessing the results after angioplasty that may complement coronary angiography. Nonetheless substantial differences between both methods exist in a significant number of cases. The relative merits of both methods, as well as the particular circumstances in which coronary flow reserve should be used, require further studies.

[Guided coronary atherectomy: preliminary results]. / Aterectomía coronaria dirigida: resultados preliminares.

Coronary atherectomy implies removing atheromatous material from the diseased coronary arterial wall. This technique has emerged as an attractive alternative to conventional percutaneous transluminal coronary angioplasty procedures, in an attempt to diminish both initial procedural failure and restenosis rate. Among different technologies, the Simpson's atherotome provides a means of performing directional (i.e. selective) coronary atherectomy (DCA). This device implements a coaxial catheter which is advanced into the lesion over a steerable guidewire. Its distal tip includes a hollow metallic cylinder with a lateral window. Removal of the material is accomplished by a rotating cutter which can be moved distally, once the device's window has been orientated facing the lesion. We have performed 14 DCA in 14 patients. Mean age was 58 years and 12 patients were male. The technique was indicated for unstable angina (7 patients), stable angina (4 patients) and silent myocardial ischemia (3 patients). Fifteen lesions were attempted (13 original and two with restenosis), located as follows: nine in the left anterior descending coronary artery, three in the right coronary artery and three in the left circumflex artery. Eleven lesions were proximal and four were located in mid coronary segments. Twelve lesions (80%) were eccentric, and five (33%) were irregular. Initial angiographic success (residual stenosis less than 50%) was obtained in all 15 lesions (100%). Pre-DCA stenosis was 84 +/- 5% and post-DCA stenosis was 16 +/- 6%. There was no need for urgent coronary artery by-pass surgery and no patient developed an acute myocardial infarction in relation to the procedure. A 82-year-old woman died after the procedure in cardiogenic shock.(ABSTRACT TRUNCATED AT 250 WORDS)

[A comparison of the clinical and angiographic evolution of diabetic and nondiabetic patients treated by conventional angioplasty versus stent implantation in native coronary arteries]. / Comparación de la evolución clínica y angiográfica de pacientes diabéticos y no diabéticos tratados con angioplastia convencional frente a implantación de stent en arterias coronarias nativas.

INTRODUCTION AND OBJECTIVES: Diabetic patients have a high restenosis risk after balloon coronary angioplasty. Stent implantation in these patients appears to be a potential beneficial therapeutic option. The aim of this study was to compare the clinical and angiographic outcome of diabetic patients vs non-diabetic patients, treated with conventional angioplasty vs stent implantation in lesions located in native coronary arteries. MATERIAL AND METHODS: A total of 302 patients (58 diabetics and 244 non-diabetics) underwent a coronary angioplasty of one vessel in native coronary arteries with initial success and after at least six months clinical and angiographic follow-up were included in the study. Of the total number of patients, 100 were treated with conventional balloon angioplasty and 202 with stent implantation. Major adverse clinical events and angiographic restenosis rate were evaluated at follow-up. RESULTS: Mean age of patients was 65 years and 74% were male. Angiographic restenosis rate was similar in diabetic vs non-diabetic patients with stent implantation (24% vs 23% respectively). Nevertheless, diabetic patients treated with balloon angioplasty compared to diabetic patients treated with stenting, evolved with a higher restenosis rate (64% vs 24%; p < 0.05), and at the end of follow-up diabetics had need a higher rate of target vessel revascularization (40% vs 24%; p < 0.05), a lower major event free survival (56% vs 70%; p < 0.05) and worse symptomatic status (72% vs 36%; p < 0.05). CONCLUSIONS: Diabetic patients treated with conventional one vessel coronary balloon angioplasty evolved with a high restenosis rate and a bad mid-term clinical outcome. Stent implantation was able reduce to the restenosis rate and improve the mid-term clinical outcome, in a comparable population of diabetic patients.