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B-lines (also termed ultrasound lung comets) obtained with lung ultrasound detect experimental acute lung injury (ALI) very early and before hemogasanalytic changes, with a simple, noninvasive, nonionizing and real-time method. Our aim was to estimate the correlation between B-lines number and the wet/dry ratio of the lung tissue, measured by gravimetry, in an experimental model of ALI. Seventeen Na-pentobarbital anesthetized, cannulated (central vein and carotid artery) minipigs were studied: five sham-operated animals served as controls and, in 12 animals, ALI was induced by injection of oleic acid (0.1 mL/kg) via the central venous catheter. B-lines were measured by echographic scanner in four predetermined chest scanning sites in each animal. At the end of each experiment, both lungs were dissected, weighed and dried to determine wet/dry weight ratio by gravimetry. After the injection of oleic acid, B-lines number increased over time. A significant correlation was found between the wet/dry ratio and B-lines number (r = 0.91, p < 0.001). These data suggest that in an experimental pig model of ALI/ARDS, B-lines assessed by lung ultrasound provide a simple, semiquantitative, noninvasive index of lung water accumulation, strongly correlated to invasive gravimetric assessment.

Percutaneous coronary intervention (PCI) via radial approach has been shown to be an alternative to femoral approach in emergency cases; however, its feasibility has been questioned. This single-center study was performed to compare the outcomes and complication rates between transradial (TR) and transfemoral (TF) PCI in ST-segment-elevation myocardial infarction (STEMI).The clinical and angiographic data of 582 consecutive STEMI patients treated with PCI between 2001 and 2006 were evaluated in a retrospective study. Forty-three patients were excluded from the present study due to cardiogenic shock or rescue PCI. Patients (n=539) were categorized into the TR group (n=167) or the TF group (n=372), and several parameters were evaluated to assess the advantages and drawbacks of TR access: access-site crossover, rate of access-site complications, procedure time, fluoroscopy time, X-ray area dose, major adverse cardiac events (MACE) at 1 month, and consumption of angioplasty equipment.In the TR group, the crossover rate to femoral access was 5%, while in the TF group, it was 0.8% (P.05). There was a significant difference, in both major and minor access-site complications, between the TR group and the TF group (0% vs. 5%, P.05, and 4% vs. 9%, P.05, respectively). Consumption of angioplasty equipment proved to be the same for the two groups. The MACE rate was 4% in the TR group and 11% in the TF group (P.05).Our results suggest that the TR approach is a safe and effective way to treat STEMI; furthermore, site-related complications are less common with this approach.

Post-ischaemic flow mediated dilation of peripheral arteries (FMD) is transiently reduced during mental stress. This experiment was aimed at assessing whether hypnosis, which is a powerful relaxation technique, modulated the FMD response to mental stress in subjects with different hypnotic susceptibility. Results showed that hypnotic relaxation prevented the expected stress-related reduction of FMD only in highly hypnotizable subjects, suggesting a protective role of hypnotisability against vascular damage.

Abnormalities in endothelium-dependent vasodilation may be detected in arteries before the development of overt atherosclerosis, and their presence may predict stress-induced ischemia as assessed by ST-segment depression and/or perfusion defects. Brachial artery ultrasound during reactive hyperemia is a noninvasive method of assessing peripheral vasomotion, measured by flow-mediated vasodilation (FMD). The purpose of the current study was to assess whether endothelium-dependent FMD of the brachial artery, by ultrasound imaging, predicts the presence of angiographically assessed coronary artery disease (CAD).One hundred ninety-eight in-hospital patients (age, 59 +/- 9 years; 78 women) with chest pain syndrome and without previous myocardial infarction or revascularization procedures were enrolled in the present study. All of the patients, at testing time, were not receiving nitrate therapy and underwent, on different days, coronary angiography and endothelium-dependent FMD testing of the brachial artery by high-resolution ultrasound. The result of the flow-mediated dilation (%FMD) is defined as the percent change in the internal diameter of the brachial artery during reactive hyperemia related to baseline. A coronary vessel was considered to have a significant obstruction if its diameter was narrowed by 50% or more on quantitative computer-assisted analysis. A prognostically validated angiographic Duke score (from 0 = normal to 100 = severe left main disease) was calculated.The %FMD was lower in patients with (n = 69) compared with those without (n = 129) CAD (4.64% +/- 4.36% vs 7.39% +/- 5.68%; P =.01). By multivariate analysis, the %FMD (P =.01; odds ratio [OR], 1.13; 95% confidence interval [CI], 1.05 to 1.23), male sex (P =.01; OR, 3.47; 95% CI, 1.64 to 7.36), and cigarette smoking habit (P.01; OR, 4.00; 95% CI, 2.50 to 6.35) were independent predictors of CAD. %FMD was poorly albeit significantly correlated with the severity of CAD (%FMD Duke score, P.01, r = -0.25). The receiver operator characteristic curve showed the %FMD optimal cutoff value asor =8.84, with sensitivity of 90%, specificity of 37%, negative predictive value of 90%, and positive predictive value of 43%.In patients with chest pain, a depressed FMD of the brachial artery was a sensitive indicator of CAD, but it showed poor specificity, and it appeared to be unable to predict both the extent and the severity of angiographically assessed CAD.

Percutaneous coronary intervention (PCI) with stent implantation has become the first choice of treatment for acute myocardial infarction [1]. The most often used metals and metallic alloys for manufacturing stents have a net positive electrical charge on their surface [2]. Dental procedures that use amalgam are the most frequent restoration techniques worldwide. In contrast with the alloys used for stent manufacturing, most alloys used in dental fillings tend to be electronegative. Oral galvanic currents and the elucidated metallic vapor release have long been recognized as a potential source of oral discomfort [3]. The phenomenon of oral galvanism results from the difference in electrical potential between dissimilar restorative metals located in the mouth. Whether electrical potential difference between coronary stents and metals located in the mouth has any clinical implication is uncertain. A 54-year-old male, with 2-hour chest pain and ST elevation in anterior ECG leads has been admitted to our invasive cardiology center for primary percutaneous coronary intervention (PCI). A diagnosis of anterior ST-elevation myocardial infarction (STEMI) was made and the subsequent coronary angiography described an occlusion of a left anterior descendent coronary artery. A successful revascularization was performed with implantation of an endothelial progenitor cell capture 3.0×23 mm stent (Genous Bio-engineered R stentTM, OrbusNeich Medical Technologies, Fort Lauderdale, FL, USA). Three days after the PCI, the patient was discharged without symptoms. One month after the PCI a progressive severe disturbance in sense of taste with metallic taste and inability to distinguish between

Critical hand ischaemia (CHI) of the upper extremity is rarely encountered. Axillary, brachial and below-the-elbow (BTE) disease is often asymptomatic due to highly developed collaterals, but in diffuse- multiple and thrombotic disease CHI can develop. The aim of this prospective study was to assess