Closure of patent foramen ovale for secondary prevention of cerebrovascular events

Stroke is the most debilitating cardiovascular event. It has a variety of causes that may be present simultaneously. In young or otherwise healthy people a patent foramen ovale (PFO) is increasingly searched for. In stroke of the elderly atherosclerosis and atrial fi brillation are in the foreground but the PFO should not be ignored. The risk of a PFO related stroke over time is controversial and so is its prevention by PFO closure. Percutaneous PFO closure is a minimally invasive procedure which can be performed with high success and low morbidity. We review the rationale for PFO closure for secondary prevention of embolic events

Rex Asiae et Ponti. Poklonitveno delo Cypriana de Roreja

Rex Asiae et Ponti. Poklonitveno delo Cypriana de Rorej

Closure of Atrial Septal Defect and Patent Foramen Ovale, the Simple Way

Catheter based closure of atrial septal defects was first described in 1974 but has only been used widely since the nineties. In 1992 the focus turned to closure of the patentforamen ovale which today is the most common atrial shunt closure. While the majority of centers advocate use of transesophageal or intracardiac echocardiographic guidance during implantation, fluoroscopy guided implantation is feasible, faster, cheaper, and more patient-friendly. Closure of a patent foramen ovale with an Amplatzer occluder (currently the preferred device) may take as little as 10 minutes with the possibility to return to full physical activity a couple of hours later. Complications are exceedingly rare (<1%). They include (about in the order of frequency) inguinal access problems, thrombus on the device, device embolization, cardiac perforation, erosion of the atrial wall by the device, or infection of the device. So far there are no reports of late complications although atrial fibrillation is one to be looked out for

Use and Abuse of Coronary Stenting

The introduction of the coronary stent in 1986 remains the only real asset to balloon angioplasty introduced about 10 years earlier. Unfortunately, the undeniable advantages of stenting in terms of preventing abrupt closure and reducing restenosis are not fully exploited. The prognostic benefit to be expected from judicious stenting has been given up by default stenting. Infarctions and lives saved initially by stenting are lost again by stent thrombosis after hospital discharge fraught with a mortality of about 50% by late infarctions. They do not exist after plain balloon angioplasty and are due to stent thrombosis. Because of the comfort benefit that prevails (reduced need for intervention), virtually all interventional cardiologists have subscribed to a policy of 100% stenting and are currently about to adopt active (drug eluting) stents as their default devices for it. Once more, active stents do not confer any prognostic benefit over passive stents but they further reduce restenosis and are appealing to operators and patients. Evidence based medicine condones stenting only in about 50% and active stents in may be 80%. Yet this is ignored for rather irrational reasons

Seasonal Fluctuations of Bacterial Community Diversity in Agricultural Soil and Experimental Validation by Laboratory Disturbance Experiments

Natural fluctuations in soil microbial communities are poorly documented because of the inherent difficulty to perform a simultaneous analysis of the relative abundances of multiple populations over a long time period. Yet, it is important to understand the magnitudes of community composition variability as a function of natural influences (e.g., temperature, plant growth, or rainfall) because this forms the reference or baseline against which external disturbances (e.g., anthropogenic emissions) can be judged. Second, definition of baseline fluctuations in complex microbial communities may help to understand at which point the systems become unbalanced and cannot return to their original composition. In this paper, we examined the seasonal fluctuations in the bacterial community of an agricultural soil used for regular plant crop production by using terminal restriction fragment length polymorphism profiling (T-RFLP) of the amplified 16S ribosomal ribonucleic acid (rRNA) gene diversity. Cluster and statistical analysis of T-RFLP data showed that soil bacterial communities fluctuated very little during the seasons (similarity indices between 0.835 and 0.997) with insignificant variations in 16S rRNA gene richness and diversity indices. Despite overall insignificant fluctuations, between 8 and 30% of all terminal restriction fragments changed their relative intensity in a significant manner among consecutive time samples. To determine the magnitude of community variations induced by external factors, soil samples were subjected to either inoculation with a pure bacterial culture, addition of the herbicide mecoprop, or addition of nutrients. All treatments resulted in statistically measurable changes of T-RFLP profiles of the communities. Addition of nutrients or bacteria plus mecoprop resulted in bacteria composition, which did not return to the original profile within 14days. We propose that at less than 70% similarity in T-RFLP, the bacterial communities risk to drift apart to inherently different state

Thoracic Radionecrosis Following Repeated Cardiac Catheterization

Radiodermatitis is a known complication in patients having undergone radiotherapy. It usually appears 2 to 5 years after irradiation. We are reporting on a case of radiodermatitis that occurred within months after coronary dilatation and stenting. It started with painful swelling, followed by a typical appearance on the skin surface. Histological finding confirmed the diagnosis. However, magnetic resonance imaging showed changes in the subcutaneous tissue extending into the ribs. A radical debridement was performed including removal of a partially necrotic 4th rib. The defect was closed with a latissimus dorsi transposition flap. Our findings are compared with the literature reports