Volume 21 - Issue 5 - May, 2009

Metastatic Renal Cell Carcinoma Masquerading as ST-Segment Elevation Myocardial Infarction

Danai Kitkungvan, MD, *Sandeep Sharma, MD, *Luigi Pacifico, DO, *David H. Spodick, MD, DSc

From the Department of Medicine, and the *Division of Cardiology, Saint Vincent Hospital, Worcester, Massachusetts.
The authors report no conflicts of interest regarding the content herein.
Manuscript submitted December 16, 2008, provisional acceptance given February 5, 2009, and final version accepted February 11, 2009.
Address for correspondence: Danai Kitkungvan, MD, Department of Medicine, Saint Vincent Hospital, Worcester, MA 01608. E-mail: kitkungvan@hotmail.com

Case Presentation. A 60-year-old male presented to the emergency department with exertional dyspnea. His past medical history was significant for hypertension and renal cell carcinoma (RCC), which had been diagnosed 2 years previously. He underwent a left nephrectomy followed by combination chemotherapy. However, the cancer was resistant to the chemotherapy and had progressed. His case had been followed by an oncologist from outside the hospital. Therefore, the full details of his medical record were not available to us upon his arrival.

In the emergency department, his electrocardiogram (E...

Letter to the Editor



Fever after BioSTAR® Implantation: Is It a Systemic Reaction to the Collagen Matrix?

“The BioSTAR® septal repair implant for patent foramen ovale (PFO) closure is an exciting development, as it uses a bioabsorbable collagen matrix layer, which is thought to induce low host immune response and is absorbed and replaced by healthy host tissue. In the BEST study (first human trial with the implant), no major adverse events were reported and no evidence of a systematic inflammatory response was recorded.

We report 2 patients who developed fever within 24-hours of receiving a ...

Intravascular Ultrasound Guidance of Multiple Drug-Eluting Stent Implantation in Lesions Associated with Coronary Aneurysms

Godfrey Aleong, MD, Camino Bañuelos, MD, Fernando Alfonso, MD, PhD

From the Interventional Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain.

The authors report no conflicts of interest regarding the content herein.

Manuscript submitted December 8, 2008 provisional acceptance given January 13, 2009, and final version accepted February 9, 2009.

Address for correspondence: Fernando Alfonso, MD, Cardiología Intervencionista, Instituto Cardiovascular, Hospital Universitario Clínico “San Carlos”, Ciudad Universitaria, Plaza Cristo Rey, Madrid 28040, Spain. E-mail: falf@hotmail.com...

Feasibility and Safety of Ad Hoc Percutaneous Coronary Intervention in the Modern Era

Christopher W. Good, DO, James C. Blankenship, MD, Thomas D. Scott, DO, Kimberly A. Skelding, MD, Peter B. Berger, MD, *G. Craig Wood

From the Department of Cardiology, and the *Center for Health Research, Geisinger Medical Center, Danville, Pennsylvania.
The authors report no conflicts of interest regarding the content herein.
Manuscript submitted November 18, 2008, provisional acceptance given December 30, 2008, final version accepted February 9, 2009.
Address for correspondence: James Blankenship, MD, Department of Cardiology 21-60, Geisinger Medical Center, 100 North Academy Drive, Danville, PA 17822. E-mail: jblankenship@geisinger.edu

ABSTRACT: Background. The frequency of ad hoc percutaneous coronary intervention (PCI) varies among institutions and regions of the country. It is unclear what factors limit use of the ad hoc strategy. Objective. To define factors which limit the use of the ad hoc strategy. Methods. All patients who underwent PCI at our center in 2004 were reviewed. Patients who had emergent PCI for ST-elevation myocardial infarction (n = 188), those who had undergone diagnostic coronary angiography at a referring facility (n = 54), and those who had a repeat PCI after a previous ad hoc PCI (n = 19) were exclu...

Conservative Approach for Perforation and Early Pseudoaneurysm of Left Anterior Descending Artery during Overlapped Stenting

Mohammad Alidoosti, MD, Abbas Soleimani, MD, *Ali Abbasi, MD

From the Department of Interventional Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran, and the *Department of Epidemiology, University Medical Center Groningen, Groningen, the Netherlands.

The authors report no conflicts of interest regarding the content herein.

Manuscript submitted December 5, 2008, provisional acceptance given January 13, 2009, and final version accepted February 9. 2009.

Address for correspondence: Abbas Soleimani, MD, North Kargar Street, Tehran Heart Center, Postal code 1411713138, Tehran, Iran.,Tehran Heart Center...

Preprocedural White Blood Cell Count as a Predictor of Death and Major Adverse Cardiac Events (full title below)

Daniel L. Jurewitz, MD, Antonio Pessegueiro, MD, Raymond Zimmer, MD, Ravi Bhatia, MD, Jonathan Tobis, MD, Michael S. Lee, MD

From the David Geffen School of Medicine at University of California, Los Angeles (Division of Cardiology), Los Angeles, California.
Michael S. Lee is on the speaker’s bureau for Boston Scientific Corporation, Bristol Myer Squibb, and Schering-Plough; Jonathan Tobis is on the speaker’s bureau for Boston Scientific Corporation.
Manuscript submitted December 15, provisional acceptance given February 9, 2009, manuscript accepted February 25, 2009.
Address for correspondence: Michael S. Lee, MD, UCLA Medical Center, Adult Cardiac Catheterization Laboratory, 10833 Le Conte Avenue, Room BL-394 CHS, Los Angeles, CA 90095. E-mail: mslee@mednet.ucla.edu

Preprocedural White Blood Cell Count as a Predictor of Death and Major Adverse Cardiac Events in Patients Undergoing Percutaneous Coronary Intervention with Drug-Eluting Stents

ABSTRACT: Background. Patients with elevated white blood cell (WBC) counts who undergo percutaneous coronary intervention (PCI) are at increased risk for short- and long-term mortality as well as major adverse cardiac events (MACE). We assessed the relationship between elevated WBC counts and clinical events in patients who underwent PCI with drug-eluting stents (DES). Methods. Our retrospecti...

Percutaneous Revascularization of Chronic Total Occlusion of Left Anterior Descending Artery (full title below)

*Akio Kawamura, MD, §Masahiro Jinzaki, MD, §Sachio Kuribayashi, MD

Percutaneous Revascularization of Chronic Total Occlusion of Left Anterior Descending Artery Using Contralateral Injection via
Isolated Conus Artery

From the *Division of Cardiology, Department of Medicine, Keio University School of Medicine, Tokyo, and the §Division of Radiology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.

The authors report no conflicts of interest regarding the content herein.

Manuscript submitted December 15, 2008, and accepted January 5, 2009.

Address for correspondence: Akio Kawamura, MD, Division of Cardi...

Pre-PCI White Blood Cell Count: Should We Care?

David Lao, MD and Yerem Yeghiazarians, MD

From the University of California San Francisco, Division of Cardiology, San Francisco, California.
Address for correspondence: David Lao, MD, University of California San Francisco, Division of Cardiology, 505 Parnassus Avenue, Box 0103, San Francisco, CA 94143-0103. E-mail: david.lao@ucsf.edu

Numerous epidemiologic and clinical studies have shown leukocytosis to be an independent predictor of future cardiovascular events.1 While a causal mechanism has yet to be determined, the relationship remains consistent, temporal and dose-dependent in a wide array of patients, ranging from those free of coronary heart disease to those presenting with acute myocardial infarction (MI).2 In the era of percutaneous coronary intervention (PCI), an elevated preprocedural white blood cell (WBC) count has been associated with worse clinical outcomes in patients undergoing angioplasty with or without b...

IVUS-Guided Management of Late Stent Malaposition with Peri-Stent Restenosis with Coronary Artery Aneurysm (full title below)

*Charan P. Lanjewar, MD, DM, *Amit Sharma, MD, DM, §Tej Sheth, MD, FRCPC, FACC

From *Mumbai University, Seth G. S. Medical College and KEM Hospital, Mumbai, India, and §McMaster University, Hamilton Health Sciences, Hamilton General Hospital, Hamilton, Ontario, Canada.

The authors report no conflicts of interest regarding the content herein.

Manuscript submitted November 7, 2008, provisional acceptance given February 17, 2009, final version accepted February 20, 2009.

Address for correspondence: Charan Lanjewar, MD, DM, Associate Professor, Cardiology, Seth G.S.Medical College and KEM Hospital, Parel(E), Mumbai, India. E-mail: charanlanjewar@hotmai...

Impact of Thrombus Aspiration Use for the Treatment of Stent Thrombosis on Early Patient Outcomes

Gilles Lemesle, MD, Axel de Labriolle, MD, Laurent Bonello, MD, Tina L. Pinto Slottow, MD, Rebecca Torguson, MPH, Kimberly Kaneshige, BS, Daniel H. Steinberg, MD, Probal Roy, MD, Zhenyi Xue, MS, William O. Suddath, MD, Lowell F. Satler, MD, Kenneth M. Kent, MD, PhD, Joseph Lindsay, MD, Augusto D. Pichard, MD, Ron Waksman, MD

From the Washington Hospital Center, Washington, D.C.
Disclosures: Dr. Waksman has received speaker honoraria from Medtronic, Inc., is a consultant to that company, and has received research grants from the same.
Manuscript submitted November 19, 2008, provisional acceptance given December 30, 2008, final version accepted February 11, 2009.
Address for correspondence: Ron Waksman, MD, Washington Hospital Center, 110 Irving Street, N.W., Suite 4B-1, Washington, D.C. 20010. E-mail: ron.waksman@medstar.net

ABSTRACT: Background. Recent data suggest a clinical benefit with the systematic use of thrombus aspiration (TA) for the treatment of ST-elevation myocardial infarction (STEMI). Nevertheless, the impact of TA as a treatment strategy for stent thrombosis (ST) is unknown. This study aimed to analyze the impact of TA use for the treatment of ST on patient outcomes. Methods. From 2003 to 2008, 91 consecutive patients who presented with a definite ST were included in this analysis. We compared procedural success rates and the incidence of the composite criteria death-recurrent MI-recurrent ST at 30...

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