Retrospective comparison of clinical and angiographic outcomes after primary stenting using sirolimus-eluting and bare-metal stents in nonrandomized consecutive 568 patients with first ST-segment elevated myocardial infarctions

SummaryBackground and purposeThe long-term safety and efficacy of primary stenting using drug-eluting stents (DES) in patients with ST-segment elevation myocardial infarction (STEMI) are not fully understood in Japan. Therefore, we retrospectively examined the midterm clinical and angiographic outcomes in STEMI patients after primary stenting using sirolimus-eluting stents (SES) in a clinical setting through a historical comparison with those of bare-metal stents (BMS).Methods and resultsThe study design was a retrospective, nonrandomized, and single-center study. The clinical outcomes for 568 consecutive patients who presented within 12h of their first STEMI and who were treated with BMS (n=198; 184 STEMIs from June 2003 to August 2004 and 14 STEMIs from September 2004 to May 2007) or SES (n=370; from August 2004 to May 2007) at our medical center in Japan were retrospectively investigated in February 2010. The incidence of post-discharge events (comprising cardiac death and nonfatal recurrent MI) after SES placement (3.9%) was not significantly different from that after BMS placement (6.7%). SES was not related to the risk of post-discharge events (mean follow-up for SES, 1327±415 days; BMS, 1818±681 days) (hazard ratio of 0.369 at 95% CI, 0.119–1.147, p=0.085). The incidence of definite stent thromboses after SES placement (0.54%) was not significantly higher than that after BMS placement (0%). The incidence of binary in-stent restenosis (% diameter stenosis of more than 50% at secondary angiography) after SES placement (8.3%) was significantly lower than that after BMS placement (25.7%; p<0.001).ConclusionsFrom the present historical comparison of SES and BMS, we conclude that primary stenting using SES in a clinical setting has favorable clinical and angiographic outcomes in Japanese STEMI patients

Variations of dissolved inorganic carbon in the Southern Ocean

第2回極域科学シンポジウム　共通セッション「海氷圏の生物地球化学」 11月16日（水） 統計数理研究所 3階リフレッシュフロ

Nissen fundoplication for gastroesophageal reflux: No deterioration of gastric emptying measured by 13C-acetate breath test

Aim: To study the gastric emptying 30 days after laparoscopic Nissen fundoplication (NF) in gastroesophageal reflux. Materials and Methods: Three patients were evaluated with 13 C-acetate breath test (ABT) performed pre and post-NF. The liquid test meal consisted of Racol TM mixed with 13 C-acetate. Results: In the patient without neurological impairment (NI), the preoperative t 1/2 ex and t lag were 0.900 and 0.510 hours, respectively. The postoperative t 1/2 ex and t lag were 0.959 and 0.586 hours, respectively. In one patient with NI, the preoperative t 1/2 ex and t lag were 1.828 and 1.092 hours, respectively. The postoperative t 1/2 ex and t lag were 2.081 and 1.025 hours, respectively. In the other patient with NI, the preoperative t 1/2 ex and t lag were 2.110 and 0.980 hours, respectively. The postoperative t 1/2 ex and t lag were 1.118 and 0.415 hours, respectively. Conclusions: Our findings suggest that 13 C-ABT parameters did not worsen in any of the children after laparoscopic NF

Factors Associated with the Risk of Persistent Gastrostomy Site Infection Following Laparoscopic or Open Nissen Fundoplication

Background: Gastrostomy for feeding disorders or swallowing dysfunctions can be complicated by persistent gastrostomy site infection (PGSI). PGSI causes nutrient leakage, with dilated PGSI requiring gastrostomy reconstruction. The purpose of this study was to evaluate the causes, patient characteristics, and perioperative management of PGSI after Nissen fundoplication and gastrostomy for patients with gastro-oesophageal reflux. Patients and Methods: The records of all patients who underwent Nissen fundoplication and gastrostomy for gastro-oesophageal reflux over the past 12 years were retrieved. Risk factors were analysed, including age at surgery, gender, operative procedure, use of postoperative ventilator management, gastrostomy tube migration towards the pylorus, bacterial culture results, and length of hospital stay. PGSI as a cause of inflammation was analysed statistically. Results: Forty patients were identified, ranging in age from 1 to 49 years (median, 11 years) surgically. Twenty each underwent laparoscopic and open surgery, with all undergoing gastrostomy using the Stamm technique. Four patients developed PGSI. Gastrostomy tubes had migrated postoperatively to the pyloric side in three of these four patients (P < 0.005), increasing intragastric pressure. Three of these four patients also required positive pressure ventilation during the perioperative period (P < 0.001). Conclusion: PGSI correlates with the perioperative management of positive pressure and with increased intragastric pressure resulting from pyloric obstruction, which is caused by aberrant distribution of the gastrostomy tube to the pyloric side. Statistical Analysis Used: Factors in the two groups were compared statistically by Mann–Whitney U-test to determine whether PGSI caused inflammation. Statistical significance was defined as P < 0.05