Early bare-metal stent thrombosis presenting with cardiogenic shock: a case report

<p>Abstract</p> <p>Introduction</p> <p>Although stents have improved the safety and efficacy of percutaneous coronary interventions, coronary stent thrombosis remains a serious complication.</p> <p>Case presentation</p> <p>We present the case of a 64-year-old Caucasian man from Greece, with symptoms and electrocardiographic findings suggestive of acute inferior myocardial infarction, who complained of chest pain and rapidly developed cardiogenic shock 48 hours after primary percutaneous coronary intervention.</p> <p>Conclusion</p> <p>The most common cause of early bare-metal stent thrombosis is stent malapposition. Intravascular ultrasound is the preferred method to recognize predictors of coronary events that are not detected by angiography.</p

Objective evaluation of compliance after orthodontic treatment using Hawley or vacuum-formed retainers: A 2-center randomized controlled trial over a 3-month period

Introduction: The aim of this 2-arm parallel trial was to assess patient compliance objectively with Hawley or vacuum-formed retainers in the maxillary arch in a 3-month period after active orthodontic treatment through the use of the thermosensitive microsensor TheraMon. Methods: Patients who had just completed orthodontic treatment in the Postgraduate Orthodontic Clinic, School of Dentistry, National and Kapodistrian University of Athens and in a private orthodontic practice were randomly allocated to either the Hawley or vacuum-formed group for retention. Eligibility criteria included patients aged 12-18 years who had undergone orthodontic treatment in both arches for ≤ 5 years. The main outcome was the average objective daily difference in compliance measured with TheraMon between patients receiving either Hawley or vacuum-formed retainers in the maxillary arch for 3 months. Secondary outcomes pertained to the average objective difference in compliance between the 2 retainers for the first month in retention and the association between objective measurements of compliance and diary-reported duration of wear for both the first and 3- month periods. Randomization was implemented with a computer-generated randomization list; allocation was concealed in sequentially numbered, sealed, opaque envelopes. Blinding to the study protocol was not feasible either for the patient or orthodontist. Patients were instructed to wear the retainer full-time. Data were analyzed using nonparametric statistics and linear regression with standard errors based on the bootstrap method. Results: Seventy-seven patients (median age 14.8 years; interquartile range 1.5; range 12.1-17.6) were randomized in a 1:1 ratio to either a Hawley or vacuum-formed retainer. Baseline characteristics did not present significant differences between groups. One patient from the Hawley group was excluded from 3 months&apos; follow-up owing to a microsensor fault. Objectively assessed median daily wear time for the Hawley group was 15.3 hours (interquartile range 6.8), whereas for the vacuum-formed group it was 18.3 hours (interquartile range 4.6) for the 3-month interval. Patients allocated to vacuum-formed retainers had higher wearing values of 2.10 h/d compared with the Hawley group, after adjusting for trial settings (mean difference 2.10; 95% confidence interval 0.32-3.89; P = 0.02). Patients from private orthodontic practice had an increased potential for compliance of 2.16 h/d compared with university settings after adjusting for type of appliance (mean difference 2.16; 95% confidence interval 0.34-3.97; P = 0.02). A significant correlation was detected between objective assessment and self-reported compliance for both retention protocols in the first and 3-month intervals. No harm was observed during follow-up. Conclusions: This study found relatively high compliance in the short-term retention phase for both appliances. Vacuum-formed retainers were better accepted by adolescent patients, whereas those proceeding to private orthodontic practice were more compliant. There was a positive and statistically significant correlation between objective and subjective measures of compliance. Registration: This trial was registered in ClinicalTrials.gov: NCT03683862. Funding: No funding or conflict of interest to be declared. Protocol: The protocol was not published before trial commencement. © 2019 American Association of Orthodontist

Very late thrombosis after implantation of sirolimus eluting stent

Stent thrombosis after sirolimus eluting stent implantation has been reported to occur at six hours to 375 days after the procedure and usually within the two weeks after discontinuation of antiplatelet medication. A case is reported of very late stent thrombosis after 17 months of sirolimus eluting stent implantation and eight months after clopidogrel discontinuation despite aspirin continuation. This case underlines the possible need for long term antiplatelet medication among patients receiving sirolimus eluting stents

Primary fallopian tube carcinoma associated with ovulation induction; a case report

The potential relationship between ovulation induction and gynecological cancer has been raised recently. Primary fallopian tube carcinoma (PFTC) is an uncommon malignancy, not previously associated with fertility drugs use. We describe a case of a 38-year-old woman with primary infertility and a history of three ovulation inductions with gonadotropin-releasing hormone agonist and gonadotrophins, referred for treatment of bilateral ovarian cysts, which were discovered in the beginning of the last cycle. During laparotomy, bilateral adnexal masses were identified, presumed to be of ovarian origin, and total abdominal hysterectomy, bilateral salpingo-oophorectomy, infracolic omentectomy, and retroperitoneal lymph nodes sampling were performed. Histologic examination showed a primary right fallopian tube endometrioid adenocarcinoma and bilateral adnexal endometriosis. Surgery was followed by six cycles of combination chemotherapy using paclitaxel and carboplatin without significant complications. Although evidence of a direct causal link between ovarian stimulation and PFTC does not yet exist, this case highlights the importance for careful evaluation of all discovered adnexal masses in women undergoing ovulation induction treatment

Clinicopathologic features of two rare cases of mesenchymal metastatic tumors in the pancreas: Review of the literature

OBJECTIVES: A clinicopathologic presentation of 2 unusual cases of metastatic mesenchymal neoplasms in the pancreas. METHODS: The first case concerns a 26-year-old man with a history of intracranial mesenchymal chondrosarcoma (since the age of 17), 2 left lung operations, and 3 right thigh operations. Distal pancreatectomy and splenectomy was performed because of suspicious mass in the pancreas. The second case concerns a 66-year-old woman with a history of uterus leiomyosarcoma (10 years ago) with left axillary and right femoral metastases. She underwent distal pancreatectomy and splenectomy because of suspicious mass measuring 4 × 4 cm, in the pancreatic body. RESULTS: In the first case, the pathological examination revealed a tumor measuring 3.8 × 3.5 cm and histologically compatible with mesenchymal chondrosarcoma, developing in a vessel lumen and invading into the pancreatic parenchyma. In the second case, the pathological examination showed metastatic leiomyosarcoma of high-grade malignancy. The incidence of metastatic pancreatic tumors has been reported to be only 1.6% to 3%. Most of these tumors were of epithelial origin, and the most common sites of the primary lesions were the lung, kidney, and gastrointestinal tract. CONCLUSIONS: The cases of metastatic uterus leiomyosarcoma and the metastatic intracranial chondrosarcoma are, to our knowledge, the first to be described. Copyright © 2006 by Lippincott Williams &amp; Wilkins

Unusual presentation of Mönckeberg&apos;s sclerosis in the thyroid vessels of three female patients

Histopathological findings of Mönckeberg&apos;s sclerosis in the thyroid vessels of three female patients are described. Two of the patients presented with papillary carcinoma and the third presented with two cystic adenomatous nodules. Lesions of chronic lymphocytic thyroiditis were observed in two of the cases. The presence of Mönckeberg&apos;s sclerosis is an indication for further examination of patients vascular systems because of the high risk for cardiovascular events. © 2009 Pulsus Group Inc. All rights reserved

Ischemic postconditioning decreases iNOS gene expression but ischemic preconditioning ameliorates histological injury in a swine model of extended liver resection

Background: Both pre- and postconditioning have been shown to protect the liver parenchyma from ischemia/ reperfusion (I/R) injury during hepatectomy by altering the production of NO. However, to date there is no study to compare their effect on the inducible nitric oxide synthase (iNOS) and endothelial nitric oxide synthase (eNOS) gene expression, who are the main modulators in the pathway of NO during the acute phase of I/R injury. Methods: We designed a prospective experimental cohort comprising of three groups (sham group- SG, preconditioning-PrG and postconditioning group-PoG) and consisting of 10 animals per group. All animals underwent extended hepatectomy (70%) under prolonged warm ischemia either after preconditioning or followed by postconditioning or without any protective maneuver (SG). Following reperfusion blood samples and liver biopsies were obtained at the start of reperfusion (0 hours), at 6 and 12 hours post reperfusion. iNOS and eNOS gene expression was assessed on liver tissue by polymerase chain reaction (PCR); in addition, the extent of hepatocellular injury was histologically assessed. Results: At the beginning of reperfusion iNOS expression was significantly reduced in the PoG in comparison to the SG (Kruskal-Wallis test, P=0.012; Mann-Whitney U test, P&lt;0.0005 Bonferroni correction) and continued to remain at low levels until 6 hours post reperfusion (Kruskal-Wallis test, P=0.01; Mann-Whitney U test, P&lt;0.0005-Bonferroni correction) This difference was eliminated by 12 hours. No significant differences were found in the expression of eNOS between groups and within time measurements. Aspartate aminotransferase (AST) and Alkaline phosphatase (ALP) were found increased at the start of reperfusion; their levels continued to increase by 6 hours in all groups, however only in the PoG the increase attended statistical significance at 12 hours after reperfusion. ALT levels presented only minor alterations during the course of reperfusion. The PrG was found to have more intense hepatocellular injury at the start of reperfusion than the PoG however, that appeared to gradually settle by 12 hours in contrast to PoG where the hepatocellular injury continued to deteriorate. Conclusions: PoG appeared to decrease iNOS overexpression more effectively than PrG in comparison to animals who have undergone no protective maneuver (SG). However, PrG was more effective than PoG in ameliorating the hepatocellular injury observed at 12 hours after the ischemic insult. © 2019 Translational Gastroenterology and Hepatology