The post-procedural elastic recoil in 133 lesions treated with the Palmaz-Schatz stent was compared to 133 matched lesions treated with balloon angioplasty to determine the role of prevention of elastic recoil in the creation of a larger initial luminal diameter. Elastic recoil was defined as the difference between the maximal diameter of the inflated balloon and the minimal luminal diameter of the dilated segment immediately after the procedure and was evaluated by quantitative coronary angiography. Overdilatation was defined as a dilatation induced by a balloon with a maximal diameter larger than the pre-procedure reference diameter. The percent diameter stenosis was reduced from 73% to 31% in the balloon angioplasty group and from 72% to -4% in the stent group (31% vs. -4%, p < 0.01). Elastic recoil was significantly larger in the balloon angioplasty group than in the stent group (0.94 +/- 0.29 mm vs. 0.09 +/- 0.09 mm, p < 0.01). Overdilatation and lesion morphology had no significant effects on elastic recoil in the stent group. In the balloon angioplasty group, overdilatation, noncalcified lesions and eccentric lesions were associated with increased elastic recoil. These results indicated that the larger post-procedural luminal diameter associated with the Palmaz-Schatz stent was primarily the result of prevention of elastic recoil, which was not influenced by the degree of overdilatation or lesion morphology.

Angioplasty, Balloon, Coronary↗

PubMedDate not supplied

Hemodynamic alterations in hemiplegic patients as a cause of edema in lower extremities.

The purpose of the study is to investigate the relationship between the hemodynamic change and the production of edema in the hemiplegic leg. This study was designed to compare the hemodynamics in the involved edematous leg with that in the unaffected non-edematous leg in hemiplegic patient using straingauge plethysmography and photo-plethysmography. Examinations were undertaken in 20 patients with hemiplegia. Arterial Inflow Ratio [healthy side; hemiplegic side (100/ml ml/min)]: 19.2 +/- 16.2; 27.6 +/- 23.4. Venous Distensitivity: 1.5 +/- 0.8; 1.9 +/- 1.0. Maximum Venous Outflow: 90.8 +/- 43.1; 120.0 +/- 52.9. Tissue Flow Ratio: 1.1 +/- 0.5; 1.6 +/- 0.6. The values for hemiplegic side were significantly higher than those for healthy side in all patients. It was confirmed by using photo-plethysmography that none of the patients had arterial obliterative disease. It was suggested that one of the causes of the production of edema in a hemiplegic limb was due to the dilated capillary vessels and congested lower extremity.

Aged↗

PubMedDate not supplied

Cost effectiveness of radiofrequency catheter ablation versus medical treatment for paroxysmal supraventricular tachycardia in Japan.

This study evaluated the cost of performing radiofrequency catheter ablation in Japanese patients with paroxysmal supraventricular tachycardia refractory to antiarrhythmic drug therapy in comparison with the cost of continuing pharmacologic treatment. Twenty patients (mean age 44 +/- 14 years) underwent successful ablation: 15 patients with Wolff-Parkinson-White syndrome and five with atrioventricular nodal reentrant tachycardia. The mean duration of symptoms was 77 +/- 60 months. The patients had been treated with 2.6 +/- 1.7 antiarrhythmic drugs before undergoing ablation. Charges derived from hospital bills were compared with the outpatient charges for the year before ablation. The mean hospital stay for the ablation procedure was 4.3 +/- 0.5 days. The mean total charge for ablation was 982,806 yen +/- 103,195, and 5.7 +/- 0.7 times the outpatient charges in the previous year. The majority of radical cure charges were the costs of the electrode catheters used in the ablation procedure. All patients had a successful outcome and required no additional antiarrhythmic drug therapy. If medical treatment were continued without ablation, the mean total life-expectancy charges were estimated at 7,064,726 yen +/- 3,116,621, 41.0 +/- 19.2 times the outpatient charges. The total life charges of medical treatment were significantly more than the total ablation charges (p < 0.001). This study suggests that radiofrequency catheter ablation is of clinical benefit in treating paroxysmal supraventricular tachycardia, and markedly reduces the cost of definitive therapy. This strategy appears to be more economical than pharmacologic treatment.

Adult↗