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PubMed1996

Trabeculectomy--success rates in a Singapore hospital.

Previously published papers on the success of trabeculectomy as a treatment for glaucoma show success rates between 67% and 84%. The success rate of trabeculectomy in Afro-Carribean patients was observed to be lower than in Caucasian patients. It has been commonly believed that the success rate of trabeculectomy in Oriental/Asian eyes would lie somewhere between these. We reviewed the records of 51 consecutive trabeculectomies performed in the National University Hospital, Singapore and found that our success rate was lower-43.1% overall and 48.7% for primary glaucomas.

Adult↗

PubMedDate not supplied

A qualitative and quantitative method for evaluating implant success: a 5-year retrospective analysis of the Brånemark implant.

A proposed protocol and differentiated success criteria for long-term evaluation of oral implants are presented. The protocol and criteria were applied to a retrospective patient material treated during a 1-year period and followed for 5 years. The protocol comprised a two-stage analysis of the collected clinical data. First, a quantitative analysis of the outcome was made using a life table. Based on the information obtained during the follow-up, each implant was categorized into one of three groups: unaccounted for, failure, or survival. A qualitative analysis of the survival group was then performed by active testing against defined criteria. Depending on the modes of clinical and radiographic examinations and their results, surviving implants were either further assigned to one of three success grades or remained in the survival group. The data are presented in a four-field table at one level of success. Strict success criteria together with individual stability testing and radiographic examination of each consecutive implant should be used when a new implant system is evaluated or when a new application is explored. Radiography alone and more moderate success criteria may be used to document routine treatments, provided that an already well-documented implant system is studied.

Adult↗

PubMed1997

Distribution of eosinophils along and across successive segments of the rat digestive tract: a quantitative study.

Density of eosinophils stained by substrateless DAB reaction was measured in the successive segments and the successive layers of rat digestive tract using a semiautomatic computerized image analysis system. The results were calculated in a dual way: per area of the entire layer and per area of its connective tissue compartment, in which the eosinophils were located (extremely small number of intraepithelial and intramuscular eosinophils was not included in the analysis). The density of eosinophils in the successive segments of the digestive tract seemed to depend primarily on the time of contact between the contents and the wall of the segment, being the highest in regions of food/content retention (fundus of the stomach, cecum) and the lowest in regions of rapid passage (esophagus, pylorus, duodenum). When eosinophil density in the successive layers was compared, its gradual decrease in the successive layers (villi>lamina propria>submucosa>muscularis) was observed in almost the entire small intestine and lower values in submucosa compared to mucosa were also evident in the stomach, duodenum and small intestine. It seems that there is a decreasing gradient of chemoattractants for eosinophils dependent of the distance from the lumen and the contents of the digestive tract. However, this decreasing pattern appeared only when the density was calculated for the area of the connective tissue compartment suggesting that this method of calculation more reliably reflects the distribution of eosinophils and should be used in future quantitative studies on tissue eosinophils.

Animals↗

PubMedDate not supplied

Analysis of local electrograms at successful and unsuccessful sites for slow pathway ablation of atrioventricular nodal reentrant tachycardia.

Anatomic and electrogram approaches have been described for ablation of slow pathway in patients with atrioventricular nodal tachycardia. The purpose of this study was to identify parameters to predict successful slow pathway ablation using the anatomic approach. Local electrograms at successful and unsuccessful sites were compared in 36 patients undergoing slow pathway ablation using anatomic approach. A total of 208 local electrograms were studied. Fragmented atrial electrogram was seen in 24/36 (67%) of successful and in 46/172 (26%) of unsuccessful sites (p < 0.001). The sensitivity, specificity and positive and negative predictive values of fragmented atrial electrogram were 67, 73, 34 and 91 percent respectively. A slow pathway potential was noted in three of successful sites. There was no difference in the atrial to ventricular amplitude ratio in these sites. In conclusion, fragmentation of atrial electrogram and presence of possible slow pathway potential are seen more often at successful than at unsuccessful sites. In our opinion, while using an anatomic approach for slow pathway ablation, an analysis of local electrogram may help in identifying the proper site and avoiding unnecessary radiofrequency energy delivery.

Adult↗

PubMed1976

[Success and failure of the ventriculoperitoneal shunt in the treatment of hydrocephalus].

In ventriculoperitoneal shunting, the intraperitoneal location of the drainage site can be an additional cause of failure. In our series of 70 ventriculoperitoneal shunts, performed in infants and adults for treatment of hydrocephalus from various cause and of various type, failures of this kind manifested themselves usually early in the postoperative period either as a reflux of liquid, not attributable to the operative technique, into the subcutaneous pericatheter tract, or as a reappearance of the intracranial hypertension, without faulty functioning of the ventricular drain. The total success rate was 61% (43/70) but the age of the patient made a clear difference. In patients aged less than 5 months, we observed 11 successes in 33 cases (33%), in those aged less than 1 year, 14 successes in 36 (39%); patients with myelomeninogocele, wherein the shunting was usually done during the first month of life, fared badly; the role of age seems herein predominant. In patients aged more than 1 year, 29 successes in 34 cases (85%) were obtained; results were notably good in nearly all hydrocephalus of tumoral origin. We think the possible role of the "tightness" of the hydrocephalus has to be invoked as also the possibility of spontaneous remission. Ventriculoperitoneal shunting, devoid of the serious complications of ventriculocardiac shunting, is a simple and effective procedure in many cases of hydrocephalus. Means for more accurate prediction of the chances of success in the individual case are needed.

Adolescent↗

PubMed1998

[Alarm training also successful in 5 to 7 year olds with nocturnal enuresis].

OBJECTIVE: To determine how many bed-wetting children aged 5-7 years unlearn the habit using the alarm treatment. DESIGN: Descriptive. SETTING: TNO Prevention and Health, Leiden, the Netherlands. METHODS: The population consisted of all children aged 5 to 7 with nocturnal enuresis (defined as > or = 2 wettings per week) who ordered an Elther alarm set (Elther BV, Tilburg) in May or June 1996 (n = III). The parents and the child were asked to keep notes during the treatment of whether the child had remained dry and of whether the alarm had sounded. When at the time of cessation of the alarm training the results were insufficient, the parents were asked about the reason to stop. When the child had remained dry for 14 nights in succession (the definition of 'success'), a questionnaire was sent 6 months later to inquire if the child was still dry or had relapsed. RESULTS: The totals of success for children aged 5, 6 and 7 years were 70% (n = 7/10), 73% (n = 29/40) and 90% (n = 55/61), respectively. Seven-year-olds were significantly more successful than the children aged 5 or 6 (p = 0.02). No significant correlations were found between results of treatment and sex, the nature of the enuresis (purely functional or not), familial occurrence and frequency of bed-wetting at the start of the treatment. The average times until success were 53 days for the 5-year-olds (range: 31-78), 65 days for the 6-year-olds (26-154) and 59 for the 7-year-olds (17-141). The proportions of relapse after 6 months were 0%, 14% and 9%, respectively. CONCLUSION: Alarm training with pad and buzzer appears to be a suitable method of treatment even for children younger than 8 years.

Age Factors↗

PubMedDate not supplied

Creating a research culture: what we can learn from residencies that are successful in research.

BACKGROUND AND OBJECTIVES: Despite a growing need for family practice to contribute to the national primary care research agenda, the specialty is ill-equipped to assume a more active role. Information about residency programs that are successful in research is a valuable resource for increasing family medicine's research capacity. METHODS: A three-stage investigation was completed in May 1996, consisting of 1) a telephone survey of family practice residency program directors, 2) a mail survey of recent graduates from relatively successful programs identified in stage 1, and 3) in-depth interviews with the program directors or research directors identified by combining data from the first two stages. RESULTS: Most residents in the programs included in stage 2 completed a research project (68.7%) and currently have an interest in practice-based research (57.2%). Residents from programs selected for the study's final stage were more likely to have published a research article (32% versus 20.3%) and to have completed a project while a resident (81% versus 60.1%) than those from the programs not selected. Virtually unanimous characteristics of successful programs include program director support of research, time for research, faculty involvement, a research curriculum, professional support, and opportunities for presenting research. CONCLUSIONS: Individual family practice residencies can be considered to be at one of three levels with respect to their level of research activity: 1) relatively undeveloped, 2) developing, or 3) relatively developed. Programs can expect successful results if they make research a priority, and means are needed for communicating successful strategies between programs.

Family Practice↗

PubMed1998

Determining factors for successful adoption of dogs from an animal shelter.

OBJECTIVE: To determine whether certain characteristics of dogs offered for adoption are associated with successful adoption. DESIGN: Retrospective cohort study. ANIMALS: 1,468 relinquished dogs offered for adoption at a local humane society. PROCEDURE: Data regarding dogs offered for adoption were obtained from surveys completed by previous owners. Data were analyzed by use of bivariate statistics and multivariable logistic regression. RESULTS: Of dogs offered for adoption, 1,073 were successfully adopted, 239 were not adopted, and 157 were returned to the shelter after adoption. Terrier, hound, toy, and nonsporting breeds were found to be significantly associated with successful adoption (P < 0.05, chi 2 analysis). Certain coat colors (gold, gray, and white), small size, and history of an indoor environment were also significant predictors of successful adoption. The correlation coefficient (0.048) indicated that only a small percentage of variance in adoption success could be explained by the multiple logistic regression model. CLINICAL IMPLICATIONS: Animal shelter managers with limited kennel capacity may wish to periodically use surveys to determine whether the type of dog being offered to the public reflects the type of dog the public will adopt.

Adoption↗

PubMed2005

Profile and repair success of vesico-vaginal fistula in Lahore.

OBJECTIVE: To describe the profile of patients with vesico-vaginal fistula (VVF) and success rate of the surgery. DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Sir Ganga Ram Hospital and Ghurki Trust Hospital, Lahore, between 1998 and 2002. patients and METHODS: All patients diagnosed as cases of vesico-vaginal fistula were included in the study. Those patients, who had previous unsuccessful surgery for vesico-vaginal repair, whether done in the hospital or outside, were also included. Their demographic profile and repair success was determined. RESULTS: Out of 2570 gynaecological admissions, 14 women had vesico-vaginal fistulae showing the prevalence of 0.55 / 100 gynaecological admissions. Obstetrical cause was found in 71.4% of the cases. The mean age of the patients was 34.85 +/- 6.3 years (range 25-45) with parity varying from 0-9 (median 4). The position of majority of the fistulas (57.2%) was high (vault, juxta-cervical). Success rate of the surgery in the study was 85.7%. Majority of the repairs (78.6%) were done through vaginal route. CONCLUSION: The most common cause of vesico-vaginal fistula in this study was obstetrical, either prolonged labour or caesarean hysterectomy. Although the success rate of repair was high, yet the attempt should be focussed on prevention.

Adult↗

PubMed2006

Anterior and posterior cartilage graft dimensions in successful laryngotracheal reconstruction.

OBJECTIVE: To describe the dimensions of cartilage grafts used for successful laryngotracheal reconstruction, with the goal of establishing appropriate sizes for "off-the-shelf" tissue-engineered cartilage grafts. DESIGN: A retrospective review of prospectively maintained operative illustrations of a single surgeon's experience. SETTING: Two tertiary children's hospitals. PATIENTS: A consecutive sample of 54 patients (tracheotomized or intubated) with a diagnosis of subglottic stenosis. INTERVENTIONS: Each patient underwent anterior (n = 30), posterior (n = 3), or anterior and posterior (n = 22) laryngotracheal reconstruction. Rib cartilage was used in 51 patients and thyroid cartilage was used in 3 patients. MAIN OUTCOME MEASURE: Successful or failed extubation. RESULTS: Of the 54 patients, 48 (89%) were successfully decannulated. The mean +/- SEM length of the anterior graft was 20.7 +/- 10.3 mm, and the mean width of the anterior graft was 7.7 +/- 2.5 mm. The mean length of the posterior graft was 13.9 +/- 2.9 mm, and the mean width of the posterior graft was 4.2 +/- 0.9 mm. CONCLUSIONS: With the prospect of tissue-engineered cartilage implants becoming available for laryngotracheal reconstruction, the most appropriate templates for designing these implants should be based on the geometric dimensions of grafts carved from native tissues in cases that have been successfully decannulated. Based on our analysis, the use of 2-mm increments for the posterior grafts suggests a set of molds that are 2, 4, and 6 mm wide and 22 mm long. Using 2 x 2-mm increments for the anterior grafts indicates that 36 mold sizes will be sufficient for 90% of predicted cases.

Cartilage↗

PubMed2002

Determinants for successful percutaneous image-guided drainage of intra-abdominal abscess.

HYPOTHESIS: Characteristics of intra-abdominal abscess can be used to predict successful outcome for percutaneous catheter drainage (PCD). METHODS: We performed a multicenter prospective study of patients who had intra-abdominal infections treated with PCD and intravenous antibiotics. Multivariate regression analysis determined predictors of successful outcome. RESULTS: The study included 96 patients (59% men; mean +/- SD age, 48 +/- 17 years; mean +/- SD Acute Physiology and Chronic Health Evaluation II score, 7.4 +/- 4.9). Postoperative abscess was present in 53% of patients. Isolated microorganisms included Bacteroides species (17%), Escherichia coli (17%), Streptococcus species (14%), Enterococcus species (10%), and fungi (11%). Single abscesses were present in 83% of patients. Computed tomographic guidance was used for drainage in 80% of patients, and ultrasound was used in 20%. The duration of abscess drainage was less than 14 days in 64%. Complete resolution of the infection with a single treatment of PCD was achieved in 67 patients (70%), and with a second attempt in 12 (12%). Thirty-three patients (34%) had PCD for the resolution of intra-abdominal sepsis prior to an elective, definitive procedure. Open drainage as a result of PCD failure was required in 15 (16%) and was more likely in patients with yeast (P<.001) or a pancreatic process (P =.02). Postoperative abscess (P =.04) was an independent predictor of successful outcome. CONCLUSIONS: Percutaneous catheter drainage of intra-abdominal infections was effective with a single treatment in 70% of patients and increased to 82% with a second attempt. A successful outcome is most likely with abscesses that are postoperative, not pancreatic, and not infected with yeast. Percutaneous catheter drainage is now a commonly used staging method for the resolution of intra-abdominal sepsis prior to corrective operation.

Abdominal Abscess↗

PubMed2003

High success with nonoperative management of blunt hepatic trauma: the liver is a sturdy organ.

HYPOTHESIS: Nonoperative management of liver injuries (NOMLI) is highly successful and rarely leads to adverse events. DESIGN: Prospective observational study. SETTING: High-volume academic level I trauma center. PATIENTS: For 26 months, 78 consecutive unselected patients with liver injuries were followed up prospectively. In the absence of hemodynamic instability or signs of hollow visceral trauma, NOMLI was offered irrespective of the magnitude of the liver injury. Main Outcome Measure Failure of NOMLI, defined as a laparotomy after an initial decision to treat the patient nonoperatively. RESULTS: Of the 78 patients, 23 (29%) were operated on immediately, but only 12 (15%) for bleeding from the liver. All 12 patients required packing in addition to other maneuvers (hepatorrhaphy [n = 8], resection [n = 4], and liver isolation [n = 1]). Of the remaining 55 patients selected for NOMLI, the method failed in 8 for reasons unrelated to the liver injury: 2 underwent a splenectomy, 1 underwent a nephrectomy, 1 had a small-bowel repair, 1 underwent abdominal decompression for abdominal compartment syndrome, and 3 underwent a nontherapeutic laparotomy. The success rate of NOMLI was 85% (47 of 55 patients), but the liver-specific success rate was 100%. Compared with those in whom NOMLI was successful, patients in whom it failed had a higher Injury Severity Score and underwent more blood transfusions, but they had similar liver injury grades. In total, 66 (85%) of liver injuries did not bleed significantly. No adverse events were attributed to NOMLI. CONCLUSIONS: Nonoperative management of liver injuries is safe and effective regardless of the grade of liver injury. Failure of NOMLI is caused by associated abdominal injuries and not the liver. Fluid and blood requirements, the degree of injury severity, and the presence of other abdominal organ injuries may help predict failure.

Abdominal Injuries↗

PubMed2004

Toxic success and the mind of a surgeon.

In his role of invited lecturer to the 75th Annual Meeting of the Pacific Coast Surgical Association in Maui, Hawaii, Dr Pearsall shared some of the results of his clinical study of highly successful persons and how their success and their pursuit of it often resulted in health and family problems. He highlighted 15 of his findings related directly to the physicians and surgeons included in his sample and suggested that healthy success is related less to time management than attention management. He pointed out that hard work, time pressure, stress, and a demanding schedule had less of a toxic effect than a lack of mindful engagement with life and those with whom we share it. He concluded with 5 ancient Hawaiian principles of healthy success Hawaiian style, the concept of po'okela, meaning achieving excellence through mindful awareness of shared values rather than individual objectives.

Attitude of Health Personnel↗

PubMed1997

Flap selection as a determinant of success in pressure sore coverage.

OBJECTIVE: To establish a treatment algorithm for the long-term surgical management of pressure sores. DESIGN: Retrospective case series. SETTING: University-based teaching hospital. PATIENTS: From March 1979 to July 1995, 280 unselected pressure sore reconstructions (113 ischial, 94 sacral, and 73 trochanteric sores) were performed in 201 patients (130 men and 71 women; age range, 16-90 years; mean, 50 years). Of the patients, 90% had severe spinal cord injuries (paraplegia or quadriplegia). Forty-one percent of the wounds were chronic (present longer than 3 months). MAIN OUTCOME MEASURES: Length of stay, postoperative morbidity and mortality, and flap success (defined as a completely healed wound). RESULTS: Overall, 89% of the flaps healed primarily (ischium, 83% [94/113]; sacrum, 91% [86/94]; trochanter, 93% [68/73]). Three fourths of cases were treated in a single stage (debridement and reconstruction). The inferior gluteus maximus island flap (ischium) (94% [32/ 34]), the V-Y gluteus maximus advancement flap (sacrum) (97% [36/37]), and the tensor fascia lata flap (trochanter) (95% [42/44]) had the highest success rates. Flap success was not significantly affected by the size of the pressure sore or the number of previous flaps used. Postoperative hospital stays averaged 20 days. The overall complication rate was 28%, most commonly from a slight wound edge dehiscence. CONCLUSIONS: Flap selection and the appropriate short- and long-term sequence of flap use significantly improve success rates for pressure sore coverage. Reconstruction can be reliably performed in a single stage with a relatively short hospitalization.

Adolescent↗

PubMed1988

Attributes of successful smoking cessation interventions in medical practice. A meta-analysis of 39 controlled trials.

Meta-analysis was used to examine 108 intervention comparisons in 39 controlled smoking cessation trials. Type of intervention (face-to-face advice being better than all others), type of intervenor (both physician and nonphysician counselors better than either alone), the number of reinforcing sessions, and the duration of reinforcing sessions were related to success six months after the initiation of intervention. The number of modalities used by the intervention predicted success with borderline statistical significance. Multivariate analysis predicted that a team of physicians and nonphysicians using multiple intervention modalities to deliver individualized advice on multiple occasions would produce the best result. Program success 12 months after the initiation of intervention was related to the type of intervention session (group and individual sessions combined better than either alone), the number of intervention modalities, and the number of reinforcing sessions. With multivariate adjustment for confounding, the number of intervention modalities alone had a positive association with intervention success.

Analysis of Variance↗

PubMed2004

Vaccination success rate and reaction profile with diluted and undiluted smallpox vaccine: a randomized controlled trial.

CONTEXT: Additional smallpox vaccine doses are needed to augment current US national stockpile. Aventis Pasteur smallpox vaccine (APSV), initially manufactured in the 1950s from the New York Board of Health vaccinia strain in a frozen preparation, appears as effective as lyophilized vaccine but the effectiveness of diluted doses of APSV is unclear. OBJECTIVE: To compare the vaccination success rate and the reaction profile of various APSV dilutions. DESIGN, SETTING, AND PARTICIPANTS: A double-blind, randomized controlled trial of 340 healthy vaccinia-naive adults aged 18 to 32 years from 3 academic medical centers who were vaccinated with 1 of 3 strengths of APSV dilutions (undiluted, 1:5, and 1:10) between October 9, 2002, and February 24, 2003. Volunteers were followed up every 3 to 5 days until the vaccination site healed for bandage changes, vaccine response assessment, and adverse event evaluation, followed by 1- and 2-month clinic evaluations and 6-month telephone interview. MAIN OUTCOME MEASURES: Successful vaccination, defined by presence of a vesicle or pustule at the inoculation site 6 to 11 days postvaccination, and local and systemic reactions to vaccination. RESULTS: A total of 340 volunteers were vaccinated (vaccine dose: undiluted, n = 113; 1:5 dilution, n = 114; and 1:10 dilution, n = 113). Following vaccination, 99.4% (95% confidence interval [CI], 97.9%-99.9%) of all volunteers had successful vaccinations. Success rates did not differ between the dilution groups (undiluted, 100.0%; 95% CI, 96.8%-100.0%; 1:5 dilution, 98.2%; 95% CI, 93.8%-99.8%; 1:10 dilution, 100.0% 95% CI, 96.8%-100.0%; P =.33). Overall, 99.7% of volunteers reported at least 1 local symptom at the vaccination site, and 61.8% had axillary lymphadenopathy, 15.0% developed satellite lesions, and 7.6% developed a rash away from the vaccination site. Fever developed in 21.5%. No differences were noted in local or systemic reactions between the 3 dilution groups (P>.05 for each comparison). A total of 25% of volunteers missed scheduled duties due to vaccine-related symptoms. CONCLUSIONS: Even at diluted doses, APSV is an effective smallpox vaccine, allowing for expansion of the current stockpile. However, reactogenicity was not reduced with dilution of the vaccine and, as with other smallpox vaccines, may impair daily activities.

Adult↗

PubMed1996

Predictors of successful pulmonary balloon valvuloplasty: 10-year experience.

At our institution, 55 infants and children (ages 0.3-21 yr, median 2.5 yr) underwent pulmonary balloon valvuloplasty between August 1983 and May 1993. Systolic pressure gradients fell acutely following balloon valvuloplasty from 63.5 +/- 24.8 mmHg (mean +/- standard deviation) to 26.7 +/- 12.9 mmHg (P < 0.001) with a decrease in systolic pressure ratio from 0.81 +/- 0.25 to 0.42 +/- 0.12 (P < 0.0001). Fifty of the 55 patients had long-term echocardiographic evaluation performed > 2 yr following balloon valvuloplasty. Thirty-four of the 50 patients (Group A; 68%) were classified as having successful (residual systolic gradients < 25 mmHg, ventricular systolic pressure ratios < 0.6) long-term outcomes. Their peak systolic gradients fell acutely from 58.8 +/- 16.6 mmHg to 22.7 +/- 11.2 mmHg (P < 0.001). At 4.6 +/- 2.3 yr postvalvuloplasty, peak instantaneous pressure gradients were 17.8 +/- 5.7 mmHg (P = ns vs. acute postvalvuloplasty). Fifteen of the 50 patients (Group B; 30%) had unsuccessful (residual systolic gradients > or = 25 mmHg and/or ventricular systolic pressure ratios > 0.6) long-term outcomes. Their peak instantaneous systolic gradients fell acutely from 76.5 +/- 33.1 mmHg to 36.6 +/- 11.4 mmHg (P < 0.05). At 3.8 +/- 1.7 yr postvalvuloplasty, peak instantaneous pressure gradients were 35.1 +/- 9.1 mmHg (P = ns vs. acute postvalvuloplasty). One 3-yr-old patient (Group C, 2%) required repeat balloon valvuloplasty on two separate occasions for recurrent stenosis. There was no significant prevalvuloplasty difference between Groups A and B with regard to age, weight, or Z scores of the pulmonary annuli or balloon/annulus ratio; however, patients in Group A had significantly lower prevalvuloplasty gradients and lower systolic pressure ratios than patients in Group B. Total systolic gradient reduction between patients with successful and unsuccessful outcomes was not significantly different (Group A: 36.1 +/- 16.6 mmHg; Group B: 41 +/- 22.3 mmHg). At long-term follow-up, patients in Group A had fewer symptoms and a significantly lower rate of electrocardiographic right ventricular hypertrophy than Group B patients. Successful outcomes defined by our criteria following balloon valvuloplasty were achieved in 68% of patients with greatest long-term success in patients with prevalvuloplasty systolic gradients < 60 mmHg and systolic pressure ratios < 0.8. Intervention at lesser systolic gradients (40-60 mmHg) appears indicated to achieve lower long-term gradients and fewer symptoms as total systolic gradient reduction by this technique is limited.

Adolescent↗

PubMed1997

Exaggerated luminal loss a few minutes after successful percutaneous transluminal coronary angioplasty in patients with recent myocardial infarction compared with stable angina: an intracoronary ultrasound study.

This study investigates the mechanisms of exaggerated acute luminal loss after successful coronary angioplasty in patients with recent myocardial infarction compared with stable angina by angiography and intracoronary ultrasound (ICUS). We studied 15 consecutive patients (group 1) who, after a successful thrombolysis for myocardial infarction, underwent delayed (8 +/- 2 days after the myocardial infarction) successful balloon coronary angioplasty. Group 1 patients were individually matched with 15 stable angina patients (group 2). The percentage of stenosis and acute luminal loss were measured by quantitative coronary analysis. The ultrasound characteristics of lumen pathology were described as soft, hard, calcified, eccentric, concentric, thrombotic, and dissection lesions. Matching by stenosis location, reference diameter, sex, and age resulted in 2 comparable groups of 15 lesions with identical baseline characteristics. Immediately after percutaneous transluminal coronary angioplasty (PTCA), the minimal luminal diameter increased from 0.5 +/- 0.3 mm to 2.4 +/- 0.3 mm and from 0.5 +/- 0.2 mm to 2.4 +/- 0.3 mm in groups 1 and 2, respectively. Similar balloon sizes were used in both groups. The acute luminal loss (the difference between the maximal dilated balloon diameter and the minimal luminal diameter) immediately after PTCA was 0.4 +/- 0.2 mm and 0.3 +/- 0.3 mm (14 +/- 8% and 10 +/- 11% of balloon size) (P = not significant [NS]) in groups 1 and 2, respectively. After ICUS (mean 24 min after the last balloon deflation), the acute luminal loss was 0.9 +/- 0.3 mm and 0.5 +/- 0.4 mm (29 +/- 11% and 17 +/- 8% of balloon size) (P = 0.01) in groups 1 and 2, respectively. There was a significantly higher prevalence of intracoronary thrombus formation as detected by ICUS in group 1 compared with group 2 (80% vs. 20%; P < 0.001). In matched groups of successfully treated coronary angioplasty, patients with recent myocardial infarction had a similar magnitude of acute gained luminal loss immediately after the procedure. However, an exaggerated luminal loss a few minutes after the last balloon deflation in patients with recent myocardial infarction was noted because of mural thrombus formation compared with patients with stable angina.

Aged↗