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At least 289 records · Page 16Linked to original sources

PubMed1992

Finite element analysis (FEA) studies in 2.5-mm round bar design: the effects of bar length and material composition on bar failure.

The round bar/overdenture prosthesis is commonly used in the restoration of the totally edentulous implant patient. The length of bar span and types of alloys used in clinical cases have raised questions related to beam flexure and its role as a possible etiology of reported clinical failures in cast alloy systems. Three-dimensional finite element analyses were thus conducted on a 2.5-mm round bar for investigation of mechanical performance with respect to failure potential as a function of bar length and bar material property. Specifically, three bar lengths (6 mm, 12 mm, and 18 mm) and three alloy materials were analyzed, representing a clinical range of usage. The ends of each bar were modeled fixed to a 2.5-mm coping which was attached to a 3.8-mm root-form-type implant. The implant was modeled rigidly fixed in a representative block of bone. A 200-N occlusal force was applied to the model, as would be transmitted through an attachment clip, 5 mm in length, for the three respective bar lengths. The results of these analyses suggested possible yielding (or failure) in the 18-mm case. Bar length was found to play a stronger role in the adequacy of the overall design as compared with changing material properties in the range of alloy stiffnesses tested. Factors of safety with respect to static yield strength ranged from 2.82 to 66.46 for the designs evaluated. Fatigue factors of safety ranged from 1.63 to 38.88. A factor of safety of 5 or greater is suggested for the design of round bar systems in order for bar failure to be prevented.

Computer Simulation↗

PubMed2001

[Effect of mm-LDL on NF-kB activation in endothelial cell].

OBJECTIVE: To investigate the signal transduction pathway of NF-kB activated by minimally modified low density lipoprotein (mm-LDL) in endothelial cells and the effect of NF-kB on platelet derived growth factor b (PDGFb) mRNA expression. METHODS: mm-LDL was prepared through iron oxidation by dialyzing the native LDL against FeSO4 in PBS. Endothelial cells were incubated in a medium containing mm-LDL, TNF, and IL-1 respectively and electrophoretic mobility shift assay (EMSA) was displayed to check on the activation of NF-kB. Luciferase reporter gene was analysed to investigate the effect of nuclear factor inducing kinase (NIK), inhibitor of NF-kB kinase alpha (IKK alpha) and inhibitor of NF-kB kinase beta (IKK beta) on NF-kB activation. In addition, endothelial cells were transfected using PDGFb promoter-luciferase for reporter gene analysis or transfected with mut-NIK for slot blot analysis to study the effect of NF-kB on PDGFb mRNA expression. RESULTS: mm-LDL was able to activate NF-kB in endothelial cells. mut-NIK and mut-IKK beta inhibited luciferase activity induced by mm-LDL. mm-LDL could also enhance luciferase activity controlled by upstream sequence of PDGFb promoter which contains element interacting with NF-kB. Result of slot blot showed inhibition of PDGFb mRNA expression by mut-NIK in the endothelial cells stimulated by mm-LDL. CONCLUSION: mm-LDL may activate NF-kB through NIK-IKK beta pathway and promote PDGFb mRNA expression in endothelial cells.

Cells, Cultured↗

PubMed1989

Heterogeneity of serum creatine kinase isoenzyme MM in myocardial infarction: clinical significance and post-synthetic conversion of "abnormal" sub-bands.

We investigated the "abnormal" sub-bands of serum creatine kinase (CK; EC 2.7.3.2) isoenzyme MM in acute myocardial infarction (AMI), using isoelectric focusing in polyacrylamide gels, and compared the patterns with those for non-AMI patients and for athletes with increased CK. The "abnormal" sub-bands a (pI 7.55), b (pI 7.35), c (pI 7.25), d (pI 7.05), e (pI 6.85), f (pI 6.72), g (pI 6.50), h (pI 6.40), i (pI 6.28), j (pI 6.20), and k (pI 6.15), in common with "normal" sub-bands 1 (pI 6.91), 2 (pI 6.65), and 3 (pI 6.35), were less uniformly distributed in the AMI and demonstrated a faster rate of anodal conversion than in the non-AMI patients and athletes. "Abnormal" sub-bands a and b were detected only in the AMI patients. Incubation of myocardial CK-MM, predominantly CK-MM 1, with 2-mercaptoethanol, 15 mmol/L, resulted in conversion to the "abnormal" sub-bands b and c. Incubation of myocardial CK-MM with normal serum of low total CK yielded CK-MM 3, which on further incubation with 2-mercaptoethanol, 15 mmol/L, resulted in conversion to the "abnormal" sub-bands f and g. Comparable in vitro incubation of serum from AMI patients gave pattern changes consistent with conversion of CK-MM 1 to b, c; CK-MM 2 to d, e; and CK-MM 3 to f, g.

Adult↗

PubMed1986

Creatine kinase isoenzyme MM variants in skeletal muscle and plasma from marathon runners.

We investigated the patterns of variants of creatine kinase isoenzyme MM (CK-MM) in gastrocnemius muscle and plasma sampled from male and female long-distance runners before and after a marathon race. The proportions of CK-MM variants MM1 (pI 6.90) and MM2 (pI 6.62), identified in the skeletal muscle from both sexes, did not differ significantly from those in skeletal muscle from nonrunning controls or from heart muscle. CK-MM1 was the major (84-85% of total CK-MM) variant form. Patterns of CK-MM in plasma collected from male runners 24, 48, 72, and 96 h after the race were similar to those for female runners, but we detected two new additional variants, which we designate MM1B (pI 6.76) and MM2B (pI 6.49). For both sexes the total CK-MM activities in plasma were significantly (p less than 0.05) greater after the race, but the women's total CK-MM activities were significantly (p less than 0.05) less than the men's. The rates of disappearance of MM1, MM2, and MM3 from plasma after the race differed significantly (p less than 0.05) between men and women, MM1 clearing the fastest. Determination of the CK-MM variants in plasma after strenuous exercise may be of help in assessing CK release from injured skeletal muscle.

Adult↗

PubMed1993

The natural history of patients with claudication with toe pressures of 40 mm Hg or less.

PURPOSE: This study was performed to determine the natural history of patients with symptoms of claudication and systolic toe pressures (TP) of 40 mm Hg or less. METHODS: We followed the clinical course of 56 men with stable claudication and TP of 40 mm Hg or less. All TP measurements were performed on at least two occasions 6 months apart. Primary end points included development of rest pain, tissue loss, or gangrene. The clinical course of 56 case controls with TP greater than 40 mm Hg matched for age, sex, and race was used for comparison. RESULTS: During a mean (+/- SD) follow-up time of 31 +/- 4 months, 37 (66%) patients with TP of 40 mm Hg or less remained stable, and 19 (34%) had ulceration (n = 10), rest pain (n = 6), or gangrene (n = 3). Nine (24%) of the 37 stable patients had gradual improvement of TP values greater than 40 mm Hg. Among the 19 patients whose conditions deteriorated, eight (42%) patients underwent successful bypasses, and five (26%) patients required amputations. Two patients who had rest pain had spontaneous resolution, and three patients who had ulcerations healed without intervention. In contrast, five (9%) of the case controls with TP greater than 40 mm Hg had rest pain (n = 2) or gangrene (n = 3) (p = 0.003). Among patients with TP of 40 mm Hg or less, there were no statistically significant differences between the stable patients and patients with deteriorating conditions in age, ankle-brachial indexes, or risk factors (including diabetes mellitus). However, diabetes conferred a higher probability of clinical deterioration (p = 0.005, Kaplan-Meier). CONCLUSIONS: In patients with symptoms of intermittent claudication, TP of 40 mm Hg or less portends clinical deterioration. Patients with diabetes in this group have a significantly higher risk of development of critical ischemia. Close scrutiny is warranted.

Adult↗

PubMed1996

The 20 mm Medtronic Hall prosthesis in the small aortic root.

BACKGROUND AND AIMS OF THE STUDY: The choice of prosthesis becomes crucial in the narrow aortic annulus. The 20 mm Medtronic Hall valve has a reduced sewing ring that fits in an annulus where only a 19 mm valve would fit. This study assesses the hemodynamic performance of this prosthesis at rest and at exercise, and compares it with two 19 mm mechanical prostheses. MATERIALS AND METHODS: Forty-two patients were studied by Doppler echocardiography, a mean of 34 months following surgery. Twenty-six had a 19 mm prosthesis implanted (12 standard St. Jude Medical and 14 Monostrut valves) and 16 had a 20 mm Medtronic Hall. Parameters studied were peak velocity and transvalvular gradient, both at rest and at exercise, effective orifice area and valve index. RESULTS: No differences were found between the two 19 mm valves, but when compared with the Medtronic Hall valve at rest, this valve showed significantly lower peak velocity and gradient (2.9 vs. 3.3 m/sec, p < 0.01, and 17 vs. 23 mmHg, p < 0.003, respectively) and higher effective orifice area and valve index (1.3 vs. 1.0 cm2, p < 0.01 and 0.81 vs. 0.62 cm2, p < 0.006, respectively). There were also significant differences under exercise. CONCLUSIONS: The 20 mm Medtronic Hall prosthesis shows a significantly better hemodynamic performance, both at rest and under exercise, than other, 19 mm mechanical prostheses and represents a superior choice in valve replacement with a small aortic root.

Aged↗

PubMedDate not supplied

Digital vs 35-mm photography. To convert or not to convert?

OBJECTIVES: To compare the quality of images generated from a conventional 35-mm camera with those generated from various digital cameras; and to note the costs of the cameras and ease of use. DESIGN: A prospective, randomised, independent analysis of specific facial images taken with a 35-mm camera and 3 digital cameras by 3 facial plastic surgeons who were blinded to camera type. SETTING: An academic medical center. SUBJECTS: Thirteen volunteer subjects ranging from age 27 to 58 years. MAIN OUTCOME MEASURES: The overall quality, focus, distortion, trueness of color, resolution, contrast, and presence of shadows were evaluated for each image. Attributes were scored on an ordinal scale of 1 to 5. A 1-way analysis of variance was used to test whether the average scores across cameras were significantly different. Results using analysis of variance did not differ from the results using a nonparametric Kruskal-Wallis test. When significant differences were found, the Duncan multiple range test was used to group significantly different scores. RESULTS: The null hypothesis that there is no difference between photographs taken with the various cameras was rejected (P < .001) for each of the image attributes. The images produced by the 35-mm camera (Nikon 6006) had the best overall quality, followed by the Olympus D600L, Kodak DCS 315, and Olympus D320L digital cameras. Differences in individual attributes between several of the cameras in each category were statistically significant (P < .05). CONCLUSIONS: The 35-mm camera produced the best overall image quality and ranked first for each of the individual attributes analyzed in this study. The Olympus D600L digital camera placed second in overall quality, but there was no statistically significant difference in focus, distortion, and resolution compared with the images generated by the 35-mm camera. The Olympus D600L digital camera also ranked second in color, contrast, and shadow. The Kodak DCS 315 and D320L digital cameras finished well behind the 35-mm camera in most categories. Although the 35-mm photographs were superior to the digital images, the surgeon should also consider other factors before selecting a system for photodocumentation of surgical results.

Adult↗

PubMed2005

Is overdilatation of 3.0 mm sirolimus-eluting stent associated with a higher restenosis rate?

We evaluated the safety and effectiveness of postdilating a 3.0 mm sirolimus-eluting stents (SESs; six cells) with a 3.5-4.0 mm balloon. We identified 254 consecutive patients who underwent percutaneous coronary interventions using SESs with a nominal diameter of 3.0 mm (six cells). Patients were divided into two groups based on whether they were subsequently postdilated with a 3.0 mm (group 1: 168 patients, 251 lesions) or a 3.5-4 mm balloon (group 2: 86 patients, 102 lesions). There were no significant differences regarding the incidence of in-hospital and long-term follow-up. Angiographic follow-up was available in 72% and 74% of groups 1 and 2, respectively. The two groups had no significant differences regarding late lumen loss (0.51 +/- 0.36 vs. 0.52 +/- 0.33; P = 0.3) and binary restenosis rates (10.7% vs. 8.8%; P = 0.1). Six-month clinical follow-up was available in all patients. At long-term follow-up (mean: 10.6 +/- 3.7 for group 1 and 11.3 +/- 3.9 months for group 2), there were no significant differences between the two groups regarding major adverse cardiac events (8.9% vs. 9.2%; P = 0.9). Implantation of a 3.0 mm SES with postdilation with a 3.5-4 mm balloon did not result in any significant difference in complications, in-hospital non-Q-wave myocardial infarction, binary restenosis, or target lesion revascularization. These data should lessen concern that overdilation may dilute the beneficial effects of SESs.

Catheterization↗

PubMed2004

Mammographic tumor features can predict long-term outcomes reliably in women with 1-14-mm invasive breast carcinoma.

BACKGROUND: The radiologic images of 1-14-mm invasive breast carcinomas can be classified into 5 separate categories. The use of these mammographic indicators to predict patient outcome has important prognostic and therapeutic implications. METHODS: To verify the results of previous studies conducted with smaller numbers of patients, the authors studied the 24-year survival of 714 women with 1-14-mm invasive breast carcinoma according to mammographic prognostic factors. The association of mammographic features with lymph node status, histologic malignancy grade, and 24-year survival in 714 women with invasive breast carcinomas that measured 1-14 mm also was evaluated. Adjustments were made for tumor characteristics and treatment factors in the survival analysis. RESULTS: The most common mammographic feature was a stellate lesion with no associated calcifications (420 women; 59%). Patients with stellate lesions had excellent long-term survival (95%). Casting-type calcifications were observed in 52 women (7%) and were associated significantly with a positive lymph node status (odds ratio [OR], 3.29; 95% confidence interval [95% CI], 1.41-7.67), poorer histologic grade (OR, 7.04; 95% CI, 3.77-13.16), and an increased risk of death from breast carcinoma (HR, 9.19; 95% CI, 4.18-20.17). Except for women who had tumors with associated casting-type calcifications, all other women with tumors < 10 mm in size had excellent survival regardless of lymph node status, histologic grade, or treatment. For women who had casting-type calcifications, survival was poorer even in the group with tumors that measured 1-9 mm (72% at 20 years). For women with 10-14-mm tumors, the 20-year survival rate was 52% for those who had casting calcifications and 86-100% those for those who had other mammographic features. CONCLUSIONS: The subgroup of women who had small invasive breast carcinomas accompanied by casting-type calcifications had an unexpectedly poor prognosis for this tumor-size category. The process of neoductgenesis offers a possible explanation for the unexpectedly poor outcome. There is a need to develop treatment protocols for this group and to reevaluate the present TNM classification system for mammographically detected 1-14-mm breast carcinomas. After excluding women who had tumors associated with casting-type calcifications, the remaining women had an extremely good prognosis when they were treated with surgery alone. Due to their already excellent survival, adjuvant therapeutic regimens are unlikely to offer further benefit for these patients.

Adult↗

PubMed2006

The accuracy of 1- and 3-mm slices in coronary calcium scoring using multi-slice CT in vitro and in vivo.

The accuracy of coronary calcium scoring using 16-row MSCT comparing 1- and 3-mm slices was assessed. A thorax phantom with calcium cylinder inserts was scanned applying a non-enhanced retrospectively ECG-gated examination protocol: collimation 12 x 0.75 mm; 120 kV; 133 mAs(eff). Thirty-eight patients were examined using the same scan protocol. Image reconstruction was performed with an effective slice thickness of 3 and 1 mm. The volume score, calcium mass and Agatston score were determined. Image noise was measured in both studies. The volume score and calcium mass varied less than the Agatston score. The overall measured calcium mass compared to the actual calcium mass revealed a relative difference of +2.0% for 1-mm slices and -1.2% for 3-mm slices. Due to increased image noise in thinner slices in the patient study (26.1 HU), overall calcium scoring with a scoring threshold of 130 HU was not feasible. Interlesion comparison showed significantly higher scoring results for thinner slices (all P<0.001). A similar accuracy comparing calcium scoring results of 1- and 3-mm slices was shown in the phantom study; therefore, the potentially necessary increase of the patient's dose in order to achieve assessable 1-mm slices with an acceptable image-to-noise-ratio appears not to be justified.

Aged↗

PubMed2000

[Interventional occlusion of atrial septum defects larter than 20 mm in diameter].

UNLABELLED: Over the last few years, various devices for the interventional closure of atrial septal defects (ASD) up to a diameter of 20 mm have been developed. We report our clinical experience in closing ASD with a diameter larger than 20 mm diameter with the Amplatzer Septal Occluder (ASO). METHOD: The stretched diameter of the ASD was measured by inflating a sizing balloon within the defect until an indentation in the circumference in the balloon could be observed. An ASO with a stent diameter 2-4 mm larger than the indentation in the circumference of the balloon was chosen and implanted via 9-12 French sheaths. In contrast to the closure of smaller defects, pullback of the device onto the atrial septum was only performed when the connecting stent of the ASO was completely deployed in order to achieve maximal centering characteristics and optimal support of the retention skirt of the left atrial disc on the edges of the defect. Only then was the right atrial disc deployed and actively configured by advancing the sheath and the delivery cable against the atrial septum. Implantation was only attempted if the atrial septal rims (except the anterior rim around the aorta) measured more than 7 mm by echocardiography to avoid injury or disturbance of sensitive intracardiac structures. After placement, the fixation of the device and the mechanical stability was proven by an extensive "Minnesota wiggle". The ASO was released only when TEE showed no or a trivial residual color flow through the connecting stent; otherwise repositioning was performed. RESULTS: Out of 352 patients (P) with successful closure of interatrial defects, 70 P (age: 1.1-77.3 years) had stretched defects larger than 20 mm diameter (median 22 mm diameter (20-36), 25/75% quartiles = 20/26 mm). Mean shunt size was Qp:Qs 2.1:1 (0.7-3.9:1), mean fluoroscopy time 10.9 min (0-63). Complete closure could be achieved in 85.7/93.1/100% after 3 months, 1 and 2 years, respectively. Besides 3 P with persistent atrial fibrillation, only 5 P showed transient atrial tachyarrhythmias, 2 only periprocedural and 3 within the first 3 months after implantation were treated with beta-blocker. In one patient, an acute embolization of the device occurred because a diminished posterior rim was not visualized by a monoplane TEE probe necessitating surgical explantation and defect occlusion. Despite oversizing the device, no "mushrooming" misconfiguration were observed. CONCLUSION: Transcatheter closure of large atrial septal defects with the Amplatzer Septal Occluder is feasible, safe and effective. Risk of complications do not seem to occur more frequently than after closure of smaller defects if one adheres to certain sizing and implantation measures. The incidence of transient atrial tachyarrhythmias seems to be low.

Adolescent↗

PubMed2006

New technique of laparoscopic colectomy with the LAP DISC and a 5-mm flexible scope.

PURPOSE: We devised a new method for the safe introduction of the first trocar and induction of pneumoperitoneum for laparoscopic excision of the large intestine. METHODS: With this method, a small laparotomy is first conducted according to the size of the exposed affected intestinal tract or tumor size, prior to the application of a LAP DISC (LD) to the wound and introduction of a 12-mm trocar for the establishment of pneumoperitoneum. The method is advantageous in that organ injury and vessel injury are avoided when the small laparotomy is conducted first, and prompt transition to a conventional laparotomy is possible. The diaphragm of the iris bulb can be controlled in a non-stepwise manner. In addition, trocars, the stapler, and other instruments, can be inserted under the pneumoperitoneum. Furthermore, the use of a 5-mm flexible scope allows surgical maneuvers, except for application of LD, to be conducted via 5-mm trocars. In addition, the 5-mm scope can be inserted through any trocar, allowing multidirectional avoidance of dead space and intraperitoneal observation. When only 5-mm trocars are used, it is not necessary for the sites of trocar puncture to be closed by sutures, and this minimizes the risk of adhesions and port-site herniation. The method is also considered to be excellent from the point of view of esthetics. RESULTS: We employed this surgical approach in 50 patients with colorectal cancer at our hospital. None of the patients developed any traumatic complications associated with the insertion of trocars, and none of the patients, even those with a past history of abdominal operation, required conversion to conventional laparotomy. CONCLUSIONS: Based on these results, this method involving a small laparotomy prior to the application of an LD and introduction of a 12-mm trocar for establishing pneumoperitoneum, with the efficient use of a 5-mm flexible camera, is considered to be safe and useful for laparoscopic excision of the large intestine.

Adult↗

PubMed2005

Molecular cloning, expression and chromosomal localization of mouse MM-1.

The protooncogene product Myc associates with many proteins. The isolation of the mouse MM-1; c-Myc binding protein (Myc-Modulator 1) cDNA is described. The cDNA contains a 462 bp open reading frame that encodes a polypeptide of 154 amino acid residues. The deduced amino acid sequence indicates that mouse MM-1 has a 99% identity with the sequence of human MM-1. The expression of mouse MM-1 mRNA was detected in the fetal liver, but its level was 3-fold higher than that in the normal adult liver, and was slightly increased after a partial hepatectomy. It is expressed widely in a variety of adult mouse tissues. Thus, MM-1 may play a role in liver development and growth. A bioinformatics analysis indicates that mouse MM-1 gene consists of 6 exons. Furthermore, the chromosomal location of the mouse MM-1 gene was on the F2-F3 band of chromosome 15, as determined by fluorescence in situ hybridization.

Amino Acid Sequence↗

PubMed1988

Spreading depression induced by 100 mM KCl in caudate is blocked by local anesthesia of the substantia nigra.

Pressure-ejection of 100 mM KCl was used to induce voltammetric signals in the rat caudate. The signals, detected chronoamperometrically with Nafion-coated carbon fiber microelectrodes, were reproducibly generated at 20-min intervals up to distances of 1600 micron from the KCl stimulus site. Unilateral 6-hydroxydopamine lesions of the substantia nigra (SN) demonstrated that over 90% of the voltammetric signal generated was dopamine. Evaluation of the signal onset at two widely spaced electrodes suggested that injection of nl volumes of 100 mM KCl into the rat caudate generates voltammetric signals which resemble spreading depression (SD) produced by more classical methods (e.g. 1 M KCl). We further investigated this phenomenon by simultaneous evaluation of extracellular K+ ion concentration changes, field potential (FP) and voltammetric signals or multiunit activity following stimulation with 100 mM or 1 M KCl. The results show that the signals generated by 100 mM KCl have many of the attributes of 'classical' SD, although the extracellular K+ ion concentration changes and FP changes were smaller in magnitude. However, the characteristic burst of multiunit activity followed by a marked quiescent period found during 1 M KCl stimulation was not observed with 100 mM KCl stimulation. Furthermore, application of 0.5% lidocaine to the SN reversibly blocked all signals generated by 100 mM KCl in the caudate while similar treatment with up to 2% lidocaine was ineffective when 1 M KCl was used as the stimulus. The results suggest that the signals generated by 100 mM KCl may represent an attenuated form of SD which requires a functioning SN, and that this stimulation could be a useful model for studying neurotransmitter interactions in the propagation of the SD phenomena.

Action Potentials↗

PubMed1993

35 mM K(+)-stimulated 45Ca2+ uptake in cerebellar granule cell cultures mainly results from NMDA receptor activation.

In primary cultures of cerebellar granule cells, the Ca2+ influx resulting from K+ depolarization (35 mM) was equal to one-third of that observed with 100 microM N-methyl-D-aspartate (NMDA) and was reduced in a major part (90%) by NMDA receptor antagonists. The rank order of potency of these competitive and non-competitive NMDA receptor antagonists was very close to their affinity for the NMDA and phencyclidine sites respectively. Granular cell depolarization with 35 mM K+ also induced a large increase in the extracellular glutamate concentration. Repeated washes of the culture wells, addition of glutamate pyruvate transaminase (+2 mM pyruvate), or pretreatment of the cells with tetanus toxin resulted in a parallel reduction of the extracellular glutamate concentration and 45Ca2+ uptake measured after a 35 mM K+ stimulation. Dihydropyridine (BAY K-8644) stimulated the release of glutamate in a nifedipine-sensitive manner in the presence of 15 mM K+. However, nifedipine (1 microM), which decreased by 60% the K(+)-induced 45Ca2+ uptake, did not reduce the 35 mM K(+)-evoked glutamate release. Taken together, these results demonstrated that in cerebellar granule cell cultures, 90% of the 35 mM K(+)-stimulated 45Ca2+ influx resulted from the release of glutamate and the consecutive activation of NMDA receptors. Activation of these glutamate receptors then allows Ca2+ influx to occur through L-type voltage-operated Ca2+ channels.

3-Pyridinecarboxylic acid, 1,4-dihydro-2,6-dimethy↗

PubMed2004

Treatment of very small vessels with 2.25-mm diameter sirolimus-eluting stents (from the RESEARCH registry).

A total of 91 patients with 112 lesions received 2.25-mm sirolimus-eluting stents (SESs), and these lesions were compared with those treated with SESs of > or =2.5-mm diameter in the same procedure (n = 109). The reference diameters were 1.88 +/- 0.34 and 2.52 +/- 0.57 mm, respectively (p <0.01). At follow-up, the late lumen loss was 0.07 +/- 0.48 mm for the 2.25-mm SES versus 0.03 +/- 0.38 mm for the larger SES (p = 0.5), and the binary restenosis rate was 10.7% versus 3.9%, respectively (p = 0.1). The 12-month target lesion revascularization rate was 5.5%. In conclusion, 2.25-mm SESs were associated with low rates of clinical and angiographic late complications.

Aged↗

PubMed2006

Safety and efficacy of the 2.25-mm sirolimus-eluting Bx Velocity stent in the treatment of patients with de novo native coronary artery lesions: the SIRIUS 2.25 trial.

Smaller reference vessel diameter is a recognized determinant of in-stent restenosis. The SIRIUS 2.25 trial was a prospective, nonrandomized study including 100 patients (mean age 63.4 years; 64% men, 40% with diabetes mellitus) assessing the safety and efficacy of the 2.25-mm sirolimus-eluting Bx Velocity stent in patients with de novo native coronary lesions. Using propensity score matching for gender, diabetes mellitus, left anterior descending artery target vessel, lesion length, and reference vessel diameter, the outcomes were compared with historical control groups (angioplasty and Palmaz-Schatz stent arms from the STRESS/BENESTENT I/II trials and the Bx Velocity bare metal stent arm from the RAVEL and SIRIUS trials having a reference vessel diameter <3 mm). Use of the 2.25-mm sirolimus-eluting Bx Velocity stent was associated with a high rate of procedural success (97%) and a low rate of in-hospital major adverse cardiac events (2%). The primary end point, 6-month in-lesion binary angiographic restenosis, occurred less frequently in patients treated with the 2.25-mm sirolimus-eluting Bx Velocity stent than in each of 3 historical controls (16.9% vs 30.6%, p = 0.12; 36.5%, p <0.001; 45.9%, p <0.001, respectively). This translated into lower rates of 6-month target lesion revascularization in the 2.25-mm sirolimus-eluting Bx Velocity stent group (4.0% vs 15.0% in each of 3 control groups, p = 0.01 to <0.001). By multivariate analysis, in-lesion binary restenosis was predicted by multiple implanted stents (odds ratio 10.4, p = 0.002). Four of 13 patients who developed restenosis (30.8%) had a diffuse pattern of restenosis. In the long lesion tertile (mean lesion length 19.5 mm), the in-lesion binary restenosis rate was 27.6%. In conclusion, use of the 2.25-mm sirolimus-eluting Bx Velocity stent was safe and provided favorable 6-month clinical outcomes. Use of multiple stents (in longer lesions) was an independent predictor of in-lesion restenosis.

Angioplasty, Balloon, Coronary↗

PubMed2006

Variation in the length of the tibial tunnel in anterior cruciate ligament reconstruction: is it safe to use a 35-mm screw?

Tibial fixation is the key to success in anterior cruciate ligament (ACL) surgery using the hamstring tendon technique. Interference screws are popular intratunnel fixation devices not exceeding 35 mm in length. A mismatch between the lengths of the tibial tunnel and the interference screw can cause protrusion of the screw inside the knee or outside the anterior tibia, with a poor postoperative outcome. Our objective was to evaluate the safety length that exists with the use of a 35-mm screw in the tibial tunnel. For this purpose, 27 patients with ACL reconstruction were included. All measurements were performed directly during surgery. The lengths were recorded along with the patients' data. Our study group included 16 male and 11 female patients with an average age of 30.9 years. The average tibial tunnel length was 43.4 mm (range, 40 to 48 mm). This means that for a tibial tunnel drilled at a 55 degrees angle, its length will be at least 5 mm longer than the 35-mm screw. In the same way, the distance between the graft fixation and the articular surface will not exceed 13 mm if the screw is completely inside the tunnel.

Adolescent↗