EXCISÃO DE MUCOCELE COM TESOURA DE TECIDOS GOLDMAN-FOX

Este relato tem como objetivo descrever uma técnica para remoção cirúrgica de mucocele labial com pinça de Goldman-Fox para tecidos moles e analisar os aspectos clínicos. Materiais e Métodos: A mucocele do lábio inferior foi totalmente removida com pinça de tecido mole Goldman-Fox. A lesão foi encaminhada para análise histopatológica, que confirmou o diagnóstico clínico de mucocele. Resultados: Após a excisão, houve sangramento mínimo e margens regulares foram obtidas, o que contribuiu para sutura e reparação suave. A lesão foi totalmente removida sem extravasamento de mucosa. Não houve recidiva da lesão após 2 anos de proservação. Conclusões: A excisão com pinça de Goldman-Fox para tratar a mucocele do lábio inferior foi eficaz e sem complicações, com menor tempo operatório, o que é especialmente bom para crianças e para pacientes menos cooperativos. Além disso, esta técnica permitiu a análise histopatológica para confirmar o diagnóstico.Este informe tiene como objetivo describir una técnica para la extracción quirúrgica de mucoceles labiales con fórceps de Goldman-Fox para tejidos blandos y analizar los aspectos clínicos. Materiales y Métodos: El mucocele del labio inferior se eliminó por completo con pinzas para tejidos blandos Goldman-Fox. Se envió la lesión para análisis histopatológico, que confirmó el diagnóstico clínico de mucocele. Resultados: Después de la extirpación, hubo sangrado mínimo y se obtuvieron márgenes regulares, lo que contribuyó a la sutura y reparación suave. La lesión se eliminó por completo sin extravasación de la mucosa. No hubo recurrencia de la lesión después de 2 años de seguimiento. Conclusiones: La escisión con fórceps de Goldman-Fox para el tratamiento del mucocele del labio inferior fue eficaz y sin complicaciones, con un tiempo operatorio más corto, lo que es especialmente bueno para los niños y para los pacientes menos cooperativos. Además, esta técnica permitió el análisis histopatológico para confirmar el diagnóstico.  Purpose: This report aims to describe a technique for surgical removal of lip mucoceles with Goldman-Fox soft tissue nipper and analysis the clinical aspects.  Materials and Methods: Mucocele of the lower lip was completely removed with a Goldman-Fox soft tissue nipper. The lesion was sent to histopathological analysis, which confirmed the clinical diagnosis of mucocele. Results: After excision, there was very minimal bleeding and regular margins were obtained, which contributed for suture and soft repair. The lesion was completely removed with no extravasations of mucous. There was no recurrence of the lesion after 2-years follow-up.   Conclusions: The excision with Goldman-Fox soft tissue nipper to treat the mucocele of the lower lip was effective and had not complications, with shorter operative time, which is especially good for children and for less cooperative patients. Besides, this technique allowed the histopathological analysis to confirm the diagnosis.Objetivo: Este relato tem como objetivo descrever uma técnica para remoção cirúrgica de mucocele labial com pinça de Goldman-Fox para tecidos moles e analisar os aspectos clínicos. Materiais e Métodos: A mucocele do lábio inferior foi totalmente removida com pinça de tecido mole Goldman-Fox. A lesão foi encaminhada para análise histopatológica, que confirmou o diagnóstico clínico de mucocele. Resultados: Após a excisão, houve sangramento mínimo e margens regulares foram obtidas, o que contribuiu para sutura e reparação suave. A lesão foi totalmente removida sem extravasamento de mucosa. Não houve recidiva da lesão após 2 anos de proservação. Conclusões: A excisão com pinça de Goldman-Fox para tratar a mucocele do lábio inferior foi eficaz e sem complicações, com menor tempo operatório, o que é especialmente bom para crianças e para pacientes menos cooperativos. Além disso, esta técnica permitiu a análise histopatológica para confirmar o diagnóstico

Egy nagyvállalat környezetvédelmi politikájának és tevékenységének bemutatása

Background Among the 3 approved oral P2Y12 inhibitors for the treatment for patients with acute coronary syndrome (ACS), ticagrelor, but not prasugrel or clopidogrel, has been associated with off-target properties, such as improved endothelial-dependent vasomotion and increased adenosine plasma levels. Methods The HI-TECH study (NCT02587260) is a multinational, randomized, open-label, crossover study with a Latin squares design, conducted at 5 European sites, in which patients free from recurrent ischemic or bleeding events ≥30 days after a qualifying ACS were allocated to sequentially receive a 30 ± 5-day treatment with prasugrel, clopidogrel, and ticagrelor in random order. The primary objective was to evaluate whether ticagrelor, at treatment steady state (ie, after 30 ± 5 days of drug administration), as compared with both clopidogrel and prasugrel, is associated with an improved endothelial function, assessed with peripheral arterial tonometry. Thirty-six patients undergoing evaluable endothelial function assessment for each of the assigned P2Y12 inhibitor were needed to provide 90% power to detect a 10% relative change of the reactive hyperemia index in the ticagrelor group. Conclusion The HI-TECH study is the first randomized, crossover study aiming to ascertain whether ticagrelor, when administered at approved regimen in post-ACS patients, improves endothelial function as compared with both clopidogrel and prasugrel

APpropriAteness of percutaneous Coronary interventions in patients with ischaemic HEart disease in Italy: The APACHE pilot study

OBJECTIVES: To first explore in Italy appropriateness of indication, adherence to guideline recommendations and mode of selection for coronary revascularisation. DESIGN: Retrospective, pilot study. SETTING: 22 percutaneous coronary intervention (PCI)-performing hospitals (20 patients per site), 13 (59%) with on-site cardiac surgery. PARTICIPANTS: 440 patients who received PCI for stable coronary artery disease (CAD) or non-ST elevation acute coronary syndrome were independently selected in a 4:1 ratio with half diabetics. PRIMARY AND SECONDARY OUTCOME MEASURES: Proportion of patients who received appropriate PCI using validated appropriate use scores (ie, AUS 657). Also, in patients with stable CAD, we examined adherence to the following European Society of Cardiology recommendations: (A) per cent of patients with complex coronary anatomy treated after heart team discussion; (B) per cent of fractional flow reserve-guided PCI for borderline stenoses in patients without documented ischaemia; (C) per cent of patients receiving guideline-directed medical therapy at the time of PCI as well as use of provocative test of ischaemia according to pretest probability (PTP) of CAD. RESULTS: Of the 401 mappable PCIs (91%), 38.7% (95% CI 33.9 to 43.6) were classified as appropriate, 47.6% (95% CI 42.7 to 52.6) as uncertain and 13.7% (95% CI 10.5% to 17.5%) as inappropriate. Median PTP in patients with stable CAD without known coronary anatomy was 69% (78% intermediate PTP, 22% high PTP). Ischaemia testing use was similar (p=0.71) in patients with intermediate (n=140, 63%) and with high PTP (n=40, 66%). In patients with stable CAD (n=352) guideline adherence to the three recommendations explored was: (A) 11%; (B) 25%; (C) 23%. AUS was higher in patients evaluated by the heart team as compared with patients who were not (7 (6.8) vs 5 (4.7); p=0.001). CONCLUSIONS: Use of heart team approaches and adherence to guideline recommendations on coronary revascularisation in a real-world setting is limited. This pilot study documents the feasibility of measuring appropriateness and guideline adherence in clinical practice and identifies substantial opportunities for quality improvement. TRIAL REGISTRATION NUMBER: NCT02748603

Rivaroxaban with or without aspirin in stable cardiovascular disease

BACKGROUND: We evaluated whether rivaroxaban alone or in combination with aspirin would be more effective than aspirin alone for secondary cardiovascular prevention. METHODS: In this double-blind trial, we randomly assigned 27,395 participants with stable atherosclerotic vascular disease to receive rivaroxaban (2.5 mg twice daily) plus aspirin (100 mg once daily), rivaroxaban (5 mg twice daily), or aspirin (100 mg once daily). The primary outcome was a composite of cardiovascular death, stroke, or myocardial infarction. The study was stopped for superiority of the rivaroxaban-plus-aspirin group after a mean follow-up of 23 months. RESULTS: The primary outcome occurred in fewer patients in the rivaroxaban-plus-aspirin group than in the aspirin-alone group (379 patients [4.1%] vs. 496 patients [5.4%]; hazard ratio, 0.76; 95% confidence interval [CI], 0.66 to 0.86; P<0.001; z=−4.126), but major bleeding events occurred in more patients in the rivaroxaban-plus-aspirin group (288 patients [3.1%] vs. 170 patients [1.9%]; hazard ratio, 1.70; 95% CI, 1.40 to 2.05; P<0.001). There was no significant difference in intracranial or fatal bleeding between these two groups. There were 313 deaths (3.4%) in the rivaroxaban-plus-aspirin group as compared with 378 (4.1%) in the aspirin-alone group (hazard ratio, 0.82; 95% CI, 0.71 to 0.96; P=0.01; threshold P value for significance, 0.0025). The primary outcome did not occur in significantly fewer patients in the rivaroxaban-alone group than in the aspirin-alone group, but major bleeding events occurred in more patients in the rivaroxaban-alone group. CONCLUSIONS: Among patients with stable atherosclerotic vascular disease, those assigned to rivaroxaban (2.5 mg twice daily) plus aspirin had better cardiovascular outcomes and more major bleeding events than those assigned to aspirin alone. Rivaroxaban (5 mg twice daily) alone did not result in better cardiovascular outcomes than aspirin alone and resulted in more major bleeding events