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Stafne cyst, named after Edward Stafne, was first described in 1942 when he noticed asymptomatic radiolucent cavities in intraoral radiographs of 35 different patients. It is usually a well-defined, round, ovoid or occasionally lobulated radiolucency of size 1–3 cm typically located in the submandibular gland fossa. In this paper, we present two cases of Stafne cyst, one with an unusual presentation having trapezoid-shaped radiolucency with scalloped margin involving the inferior border of the mandible and another with the usual presentation. In both the cases, diagnosis was based on clinical and radiological features alone without any surgical exploration. With the condition remaining static throughout the follow-up period, it is proven that noninvasive diagnostic radiography such as computed tomography scan with three-dimensional reconstruction and cone beam computed tomography can be very helpful for the definite diagnosis of Stafne cyst, rather than invasive procedures.

International audience; BACKGROUND: We hypothesized that in patients with stable coronary artery disease and stenosis, percutaneous coronary intervention (PCI) performed on the basis of the fractional flow reserve (FFR) would be superior to medical therapy. METHODS: In 1220 patients with stable coronary artery disease, we assessed the FFR in all stenoses that were visible on angiography. Patients who had at least one stenosis with an FFR of 0.80 or less were randomly assigned to undergo FFR-guided PCI plus medical therapy or to receive medical therapy alone. Patients in whom all stenoses had an FFR of more than 0.80 received medical therapy alone and were included in a registry. The primary end point was a composite of death from any cause, nonfatal myocardial infarction, or urgent revascularization within 2 years. RESULTS: The rate of the primary end point was significantly lower in the PCI group than in the medical-therapy group (8.1% vs. 19.5%; hazard ratio, 0.39; 95% confidence interval [CI], 0.26 to 0.57; P\textless0.001). This reduction was driven by a lower rate of urgent revascularization in the PCI group (4.0% vs. 16.3%; hazard ratio, 0.23; 95% CI, 0.14 to 0.38; P\textless0.001), with no significant between-group differences in the rates of death and myocardial infarction. Urgent revascularizations that were triggered by myocardial infarction or ischemic changes on electrocardiography were less frequent in the PCI group (3.4% vs. 7.0%, P=0.01). In a landmark analysis, the rate of death or myocardial infarction from 8 days to 2 years was lower in the PCI group than in the medical-therapy group (4.6% vs. 8.0%, P=0.04). Among registry patients, the rate of the primary end point was 9.0% at 2 years. CONCLUSIONS: In patients with stable coronary artery disease, FFR-guided PCI, as compared with medical therapy alone, improved the outcome. Patients without ischemia had a favorable outcome with medical therapy alone. (Funded by St. Jude Medical; FAME 2 ClinicalTrials.gov number, NCT01132495.).

Background The effectiveness of radial access ( RA ) in ST ‐elevation myocardial infarction ( STEMI ) has been predominantly established in primary percutaneous coronary intervention ( pPCI ) with limited exploration of this issue in the early postfibrinolytic patient. The purpose of this study was to compare the effectiveness and safety of RA versus femoral ( FA ) access in STEMI undergoing either a pharmacoinvasive ( PI ) strategy or pPCI . Methods and Results Within ST rategic Reperfusion Early After Myocardial Infarction ( STREAM ), we evaluated the relationship between arterial access site and primary outcome (30‐day composite of death, shock, congestive heart failure, or reinfarction) and major bleeding according to the treatment strategy received. A total of 1820 STEMI patients were included: 895 PI (49.2%; rescue PCI [n=379; 42.3%], scheduled PCI [n=516; 57.7%]) and 925 pPCI (50.8%). Irrespective of treatment strategy, there was comparable utilization of either access site ( FA : PI 53.4% and pPCI 57.6%). FA STEMI patients were younger, had lower presenting systolic blood pressure, lesser Thrombolysis In Myocardial Infarction risk, and more ∑ ST ‐elevation at baseline. The primary composite endpoint occurred in 8.9% RA versus 15.7% FA patients ( P RA persisted (adjusted odds ratio [ OR ], 0.59; 95% CI , 0.44–0.78; P pPCI (adjusted OR , 0.63; 95% CI , 0.43–0.92) and PI cohorts (adjusted OR , 0.57 95% CI , 0.37–0.86; P interaction=0.730). There was no difference in nonintracranial major bleeding with either access group ( RA vs FA , 5.2% vs 6.0%; P =0.489). Conclusions Regardless of the application of a PI or pPCI strategy, RA was associated with improved clinical outcomes, supporting current STEMI evidence in favor of RA in PCI . Clinical Trial Registration URL : https://www.clinicaltrials.gov/ . Unique identifier: NCT 00623623.

Einleitung: Narbenhernien (NH) sind – mit einer Häufigkeit von 9–20% (randomisiert kontrollierte Studien (RCTs) – die häufigsten Spätkomplikationen nach konventionellen Laparotomien. Wenngleich dies durch eine Metaanalyse (EBM Level 1a) nach kolorektalen Operationen[for full text, please go to the a.m. URL], 132. Kongress der Deutschen Gesellschaft für Chirurgie

Langerhans cell histiocytosis (LCH) is characterized histologically by a monoclonal proliferation of large mononuclear cells accompanied by a prominent eosinophil infiltrate. The pathogenesis of LCH is unknown. Hand–Schuller–Christian (HSC) disease is a rare proliferative disorder in which pathological Langerhans cells (LCs) accumulate in various organs. The clinical manifestations arise as a result of accumulation and infiltration of the Langerhans cells in organs and tissues. HSC is characterized by a classic triad of exophthalmos, diabetes insipidus, and lytic lesions in the skull. It is usually manifested in children but can also affect adults. Here, we present a case of HSC disease in a 12-year-old boy with oral manifestations.

We aimed to validate the technique of measuring the coronary flow reserve (CFR) with coronary pressure measurements against an established thermodilution technique. The CFR has traditionally required measurement of coronary blood flow velocity with the Doppler wire and, more recently, using a thermodilution technique with the coronary pressure wire. However, recent work has suggested that the CFR may be derived from pressure measurements alone (the ratio of the square root of the pressure drop across an epicardial stenosis during hyperemia to that value at rest). This depends on the assumption that friction losses across a coronary stenosis are negligible. We compared pressure-derived CFR values with those obtained by the thermodilution technique using the intracoronary pressure wire in 38 stenoses in 34 patients with significant coronary stenoses undergoing percutaneous intervention. We also compared these two techniques of measuring CFR in 25 stenoses (6 vessels) artificially created by inflating small balloons within a stented coronary artery after percutaneous intervention. There is a close linear relationship between pressure-derived and thermodilution CFR in native (r 2 = 0.52; p < 0.001) and artificial stenoses (r 2 = 0.54; p < 0.05), although the pressure-derived technique appears to systematically underestimate CFR values in both situations. This applies to native and artificial stenoses. Coronary flow reserve cannot be measured merely with pressure alone, and it cannot be safely assumed that friction losses are negligible across a native coronary stenosis. These data suggest that friction loss is an important determinant of the pressure gradient along an atherosclerotic coronary artery. © 2005 by the American College of Cardiology Foundation.

A b s t r ac t Background The preferred initial treatment for patients with stable coronary artery disease is the best available medical therapy. We hypothesized that in patients with functionally significant stenoses, as determined by measurement of fractional flow reserve (FFR), percutaneous coronary intervention (PCI) plus the best available medical therapy would be superior to the best available medical therapy alone. Methods In patients with stable coronary artery disease for whom PCI was being considered, we assessed all stenoses by measuring FFR. Patients in whom at least one stenosis was functionally significant (FFR, ≤0.80) were randomly assigned to FFR-guided PCI plus the best available medical therapy (PCI group) or the best available medical therapy alone (medical-therapy group). Patients in whom all stenoses had an FFR of more than 0.80 were entered into a registry and received the best available medical therapy. The primary end point was a composite of death, myocardial infarction, or urgent revascularization. Results Recruitment was halted prematurely after enrollment of 1220 patients (888 who underwent randomization and 332 enrolled in the registry) because of a significant between-group difference in the percentage of patients who had a primary endpoint event: 4.3% in the PCI group and 12.7% in the medical-therapy group (hazard ratio with PCI, 0.32; 95% confidence interval [CI], 0.19 to 0.53; P

Objective: Arg16Gly and Gln27Glu polymorphism of β2-adrenergic receptors (β2AR) have been associated with several risk factors for coronary atherosclerotic disease (CAD). Nevertheless, conflicting data have been reported concerning their influence on CAD and cardiovascular clinical events. Aim: To investigate whether (a) β2AR polymorphisms are associated with CAD; and (b) the potential impact, if any, of these polymorphisms on cardiovascular clinical events in patients presenting with angina-like pain or silent ischemia. Methods and results: We screened 786 consecutive patients referred to cardiac catheterization because of angina-like pain or silent ischemia for Arg16Gly, Gln27Glu, Thr164Ile β2AR polymorphisms. Patients were divided in 2 groups according to the presence or absence of CAD at the angiography. Hundred subjects from blood donor center served as controls. Clinical endpoints were evaluated at baseline and up to 6 years follow-up. Glu-27 homozygous genotype and Glu-27 allele (Glu-27, allele frequency: 47% CAD versus 39% NO CAD, p < 0.05) were more frequent in patients with CAD. At multivariate analysis, patients carrying Glu-27 allele showed a significantly higher risk of developing CAD (OR: 1.78, 95% CI: 1.21-2.63, p = 0.004). At clinical follow-up, a higher incidence of coronary revascularization was noted in Glu-27 homozygotes as compared with Gln-27 homozygote patients. Conclusions: In patients at high risk for CAD and/or angina-like pain, Glu-27 allele of β2 adrenergic receptor polymorphism is an independent risk factor for CAD and appears to be associated with higher incidence of myocardial revascularization. © 2006 Elsevier Ireland Ltd. All rights reserved.

OBJECTIVES: The purpose of this work was to establish the normal range of maximal renal hyperemic response in humans and to identify the ideal renal vasodilatory stimuli. BACKGROUND: Stenotic renovascular atherosclerosis is increasingly treated by percutaneous transluminal renal intervention but with an unpredictable outcome. This may be due to hemodynamically non-significant stenosis or the presence of irreversible damage to the glomerular circulation. We propose that the renovascular hyperemic response may help identify appropriate patients. METHODS: In 28 normotensive patients, quantitative angiographic measurements of the renal artery were obtained, and renal artery pressure and flow velocity were continuously recorded after various hyperemic agents. RESULTS: In a first group of 11 patients, a significant increase in renal artery average peak velocity (APV) was observed after intrarenal (IR) bolus injection of 600 μg isosorbide dinitrate (41 ± 19%), 30 mg papaverine (50 ± 34%), 50 μg dopamine (94 ± 54%), 0.8 μg·kg-1 fenoldopam (80 ± 25%), and during IR infusion of 1 μg·kg-1·min-1 fenoldopam (86 ± 28%). A second group of 17 patients received intravenous infusion of dopamine (3, 5, 10, 20, 30, and 40 μg·kg -1·min-1). The 3 and 5 μg·kg -1·min-1 of dopamine modestly reduced renal resistance index (RI) (-13 ± 15% and -25 ± 20%, respectively). At higher dosages, no further decline in RI was observed. No significant change in vessel diameter was observed before and after the administration of the pharmacological stimuli suggesting that changes in APV corresponded with changes in absolute renal blood flow. CONCLUSIONS: The normal renal flow reserve averages approximately 2 in humans with normal renal function. An IR bolus injection of 50 μg·kg-1 of dopamine is the most convenient means to elicit maximal renal hyperemia.