Uncomplicated moderate coronary artery dissections after balloon angioplasty: good outcome without stenting

OBJECTIVETo study the relation between moderate coronary dissections, coronary flow velocity reserve (CFVR), and long term outcome.METHODS523 patients undergoing balloon angioplasty and sequential intracoronary Doppler measurements were examined as part of the DEBATE II trial (Doppler endpoints balloon angioplasty trial Europe). After successful balloon angioplasty, patients were randomised to stenting or no further treatment. Dissections were graded at the core laboratory by two observers and divided into four categories: none, mild (type A-B), moderate (type C), severe (types D to F). Patients with severe dissections (n = 128) or without available reference vessel CFVR (n = 139) were excluded. The remaining 256 patients were divided into two groups according to the presence (group A, n = 45) or absence (group B, n = 211) of moderate dissection.RESULTSFollowing balloon angioplasty, there was no difference in CFVR between the two groups. At 12 months follow up, a higher rate of major adverse cardiac events was observed overall in group A than in group B (10 (22%)v 23 (11%), p = 0.041). However, the risk of major adverse events was similar in the subgroups receiving balloon angioplasty (group A, 6 (19%) v group B, 16 (16%), NS). Among group A patients, the adverse events risk was greater in those randomised to stenting (odds ratios 6.603v 1.197, p = 0.046), whereas there was no difference in risk if the group was analysed according to whether the CFVR was < 2.5 or ⩾ 2.5 after balloon angioplasty.CONCLUSIONSModerate dissections left untreated result in no increased risk of major adverse cardiac events. Additional stenting does not improve the long term outcome.

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Comparison of the long-term outcome of cemented Charnley low-friction arthroplasty with hybrid arthroplasty in patients with congenital hip disease

The Bone & Joint Journal ◽

10.1302/0301-620x.101b9.bjj-2018-1208.r1 ◽

2019 ◽

Vol 101-B (9) ◽

pp. 1050-1057

Author(s):

Kalliopi Lampropoulou-Adamidou ◽

George Hartofilakidis

Keyword(s):

Operating Time ◽

Long Term Results ◽

Low Friction ◽

Term Outcome ◽

Long Term Outcome ◽

Significant Difference ◽

Hip Disease ◽

Group A ◽

Group B

Aims To our knowledge, no study has compared the long-term results of cemented and hybrid total hip arthroplasty (THA) in patients with osteoarthritis (OA) secondary to congenital hip disease (CHD). This is a demanding procedure that may require special techniques and implants. Our aim was to compare the long-term outcome of cemented low-friction arthroplasty (LFA) and hybrid THA performed by one surgeon. Patients and Methods Between January 1989 and December 1997, 58 hips (44 patients; one man, 43 woman; mean age 56.6 years (25 to 77)) with OA secondary to CHD were treated with a cemented Charnley LFA (group A), and 55 hips (39 patients; two men, 37 women; mean age 49.1 years (27 to 70)) were treated with a hybrid THA (group B), by the senior author (GH). The clinical outcome and survivorship were compared. Results At all timepoints, group A hips had slightly better survivorship than those in group B without a statistically significant difference, except for the 24-year survival of acetabular components with revision for aseptic loosening as the endpoint, which was slightly worse. The survivorship was only significantly better in group A compared with group B when considering reoperation for any indication as the endpoint, 15 years postoperatively (74% vs 52%, p = 0.018). Conclusion We concluded that there was not a substantial difference at almost any time in the outcome of cemented Charnley LFAs compared with hybrid THAs when treating patients with OA of the hip secondary to CHD. We believe, however, that after improvements in the design of components used in hybrid THA, this could be the method of choice, as it is technically easier with a shorter operating time. Cite this article: Bone Joint J 2019;101-B:1050–1057.

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BT-7 Long-term outcome and late adverse effects of intracranial primary germ cell tumor

Neuro-Oncology Advances ◽

10.1093/noajnl/vdab159.105 ◽

2021 ◽

Vol 3 (Supplement_6) ◽

pp. vi27-vi27

Author(s):

Mitsuto Hanihara ◽

Tomoyuki Kawataki ◽

Ryu Saito ◽

Masakazu Ogiwara ◽

Hiroyuki Kinouchi

Keyword(s):

Physical Activity ◽

Radiation Therapy ◽

Germ Cell ◽

Late Complications ◽

Cell Tumor ◽

Term Outcome ◽

Long Term Outcome ◽

Group A ◽

Group B

Abstract Background: Current standard of care for intracranial germ cell tumor (IGCT) have favorable cure rates. However, long-term treatment-related adverse event data are limited. The present study examined the long-term outcome of IGCT.Methods: The data from 27 patients with IGCT treated at our institutes from 1993 to 2020 were retrospectively analyzed. The patients were divided into two groups: group A; who received whole-ventricle RT (30 Gy) or focal RT (40-50Gy) from 1993 to 2012, group B; who received whole-ventricle RT (23.4 Gy) from 2013 to 2020. Complications and physical-activity level after treatment were retrospectively analyzed.Results: Pathological diagnosis was germinoma in all cases, and chemotherapy was CARE in 19 cases and ICE in 2 cases. Radiation therapy was performed in 15 cases in group A and 6 cases in group B. The follow-up period was 8–19 years (mean 11.3 years) in group A and 0.4–7 years (mean 3.6 years) in group B. Radiological cure was obtained in all cases, there was no recurrence. Hypopituitarism requiring hormone replacement therapy was observed in 53% of patients in group A and 50% of patients in group B. Late complications were cerebral hemorrhage from venous malformation (4 years after treatment), symptomatic cerebral atrophy in 2 cases (3 years / 6 years after treatment), radiation induced malignant glioma (19 years after treatment) in group A. The rate of good physical-activity was 71% of group A and 100% of group B.Discussion/Conclusions: CARE + whole-ventricle radiation therapy is appropriate as a standard treatment for ICGT. Late complications are directly linked to poor quality of life and may be radiation dose dependent. Optimize radiation therapy to further improve outcomes is required.

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Abstract 1516: Does A Normal Coronary Angiography Really Mean A Good Prognosis In Patients With Acute Coronary Syndromes?

Circulation ◽

10.1161/circ.116.suppl_16.ii_314-a ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Dariusz Dudek ◽

Rafal Depukat ◽

Bernadeta Chyrchel ◽

Zbigniew Siudak ◽

Artur Dziewierz ◽

...

Keyword(s):

Mortality Rate ◽

Coronary Angiography ◽

Cardiac Events ◽

Term Outcome ◽

Long Term Outcome ◽

Adverse Cardiac Events ◽

Normal Coronary Angiography ◽

Coronary Lesions

Introduction: Coronary angiography remains gold standard for diagnosis of coronary artery disease (CAD) and acute coronary syndrome (ACS). Among patients (pts) referred to cath-lab with diagnosis of ACS exists a subgrup presenting symptoms of myocardial ischaemia and no criticial coronary lesions in angiography. The long-term outcome is not well established and managing treatment for such patients is still challenging. Aim: Evaluation of clinical outcome and received pharmacotherapy in pts with ACS and no significant coronary lesions. Methods: We collected data of consecutive pts admitted to cath-lab between July 2004 and June 2006 with diagnosis of ACS and coronary angiography considered as normal or near-normal (lesions under 50% of stenosis assessed visually). We analyzed demographic data, angiographic, electrocardiographic and laboratory tests results. During long-term follow-up received treatment, major adverse cardiac events were assessed. Results: One hundred eight pts (56 females; mean age 58.5 +/−13.5 years) admitted to cath-lab with diagnosis of acute myocardial infarction (38%) or unstable angina (62%) had normal or near normal coronary angiography. Mean LVEF was 52.6 +/− 12.9%, prevalence of CAD risk factors was: hypertension 72.2%, hypercholesterolemia 51.8%, diabetes mellitus 13.0%. The treatment administered during the hospitalization and follow-up is shown in table . During the mean follow-up of 16.5 months (range 6–30 months) all-cause mortality rate was 9.3%, cardiovascular mortality rate was 7.4%, repeat hospitalization for cardiovascular reasons 20.4%. Conclusions: Long-term outcome of patients with ACS and nonobstructive coronary angiography is not as benign as it is commonly thought. These patients have high rate of major adverse cardiac events and rehospitalization for cardiovascular reasons. They also are not receiving therapy directed at aggressive antiatherosclerotic therapy with statins, ACE-I and b-blockers. Treatment administered during the hospitalization, at discharge and during the follow-up

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