In Stent Restenosis Predictors after Carotid Artery Stenting

Purpose. The long-term efficacy of carotid artery stenting is debated. Predictors of stent restenosis are not fully investigated. Our aim was to assess the incidence of long term restenosis after CAS and to identify some predictors of restenosis. Methods. We retrospectively selected 189 treated patients and we obtained the survival Kaplan-Meier curves for overall survival, for freedom from stroke or death and from restenosis. To correlate clinical, radiological, and procedural variables to stent restenosis, an univariate analysis was performed while to determine independent predictors of restenosis, a multivariate analysis was applied. Results. At 1, 3, and 5 years, the cumulative overall survival rate was 98%, 94%, and 92% with a cumulative primary patency rate of 87%, 82.5%, and 82.5%. The percentage residual stenosis after CAS and multiple stents deployment were independent predictors of restenosis, while diabetes and tumors are suggestive but not significant predictors of restenosis. Conclusions. In our CAS experience, encouraging long-term results seem to derive from both neurological event free rate and restenosis incidence. Adequate recanalization of the treated vessel is important to limit the development of stent restenosis. Multiple stents deployment, and with less evidence, diabetes, or neoplasms has to be considered to facilitate restenosis

Selenium and the Course of Mild Graves' Orbitopathy

Background Oxygen free radicals and cytokines play a pathogenic role in Graves' orbitopathy. Methods We carried out a randomized, double-blind, placebo-controlled trial to determine the effect of selenium (an antioxidant agent) or pentoxifylline (an antiinflammatory agent) in 159 patients with mild Graves' orbitopathy. The patients were given selenium (100 mu g twice daily), pentoxifylline (600 mg twice daily), or placebo (twice daily) orally for 6 months and were then followed for 6 months after treatment was withdrawn. Primary outcomes at 6 months were evaluated by means of an overall ophthalmic assessment, conducted by an ophthalmologist who was unaware of the treatment assignments, and a Graves' orbitopathy-specific quality-of-life questionnaire, completed by the patient. Secondary outcomes were evaluated with the use of a Clinical Activity Score and a diplopia score. Results At the 6-month evaluation, treatment with selenium, but not with pentoxifylline, was associated with an improved quality of life (P <0.001) and less eye involvement (P = 0.01) and slowed the progression of Graves' orbitopathy (P = 0.01), as compared with placebo. The Clinical Activity Score decreased in all groups, but the change was significantly greater in the selenium-treated patients. Exploratory evaluations at 12 months confirmed the results seen at 6 months. Two patients assigned to placebo and one assigned to pentoxifylline required immunosuppressive therapy for deterioration in their condition. No adverse events were evident with selenium, whereas pentoxifylline was associated with frequent gastrointestinal problems. Conclusions Selenium administration significantly improved quality of life, reduced ocular involvement, and slowed progression of the disease in patients with mild Graves' orbitopathy. (Funded by the University of Pisa and the Italian Ministry for Education, University and Research; EUGOGO Netherlands Trial Register number, NTR524.

Monte Carlo Study and Experimental Measurements of Breast Tumor Detectability with the YAP-PEM prototype

Abstract-- A prototype for positron emission mammography is under development within a collaboration of the Italian Universities of Pisa, Ferrara, Bologna and Roma. The device is composed of two stationary detection heads, each with an active area of 6 cm × 6 cm, made of 30×30 YAP:Ce finger crystals of 2 mm × 2 mm × 30 mm. The EGSnrc Monte Carlo code has been used to perform a complete simulation of this camera. We have used a fast three-dimensional iterative algorithm (30 s per iteration on a PC-Pentium III 800 MHz processor) for image reconstruction. The performed study indicates that tumors of 5 mm diameter, i.e., 0.065 cm 3 volume, with 37 kBq/cm 3 (1 µCi/cm 3) specific activity embedded in a breast active phantom, are detectable in 10 minutes for a 10:1 tumor/background ratio with an 8.7 Signal-to-Noise Ratio value. Experimental measurements with the small animal tomograph YAP-PET have validated the Monte Carlo predictions. I