Clinical and laboratory predictors for plaque erosion in patients with acute coronary syndromes

Background-—Plaque erosion is responsible for 25% to 40% of patients with acute coronary syndromes (ACS). Recent studies suggest that anti-thrombotic therapy without stenting may be an option for this subset of patients. Currently, however, an invasive procedure is required to make a diagnosis of plaque erosion. The aim of this study was to identify clinical or laboratory predictors of plaque erosion in patients with ACS to enable a diagnosis of erosion without additional invasive procedures. Methods and Results-—Patients with ACS who underwent optical coherence tomography imaging were selected from 11 institutions in 6 countries. The patients were classified into plaque rupture, plaque erosion, or calcified plaque, and predictors were identified using multivariable logistic modeling. Among 1241 patients with ACS, 477 (38.4%) patients were found to have plaque erosion. Plaque erosion was more frequent in non–ST-segment elevation-ACS than in ST-segment–elevation myocardial infarction (47.9% versus 29.8%, P=0.0002). Multivariable logistic regression models showed 5 independent parameters associated with plaque erosion: age 15.0 g/dL, and normal renal function. When all 5 parameters are present in a patient with non–ST-segment elevation-ACS, the probability of plaque erosion increased to 73.1%. Conclusions-—Clinical and laboratory parameters associatedwith plaque erosion are explored in this retrospective registry study. These parametersmay be useful to identify the subset ofACS patients with plaque erosion and guide themto conservativemanagement without invasive procedures. The results of this exploratory analysis need to be confirmed in large scale prospective clinical studiesDr. Jang has received an educational grant from Abbott Vascular and Medicure. Dr. Adriaenssens has received grants and consulting fees from Abbott Vascula

Congenital Web-like Tracheal Stenosis Cured Surgically in Adult

A 60-year-old, Japanese woman, with congenital web-like tracheal stenosis surgically treated. Successful relief from tracheal stenosis was obstained. Detection in adulthood and chance of the treatment for congenital tracheal stenosis is very rare. As far as this case is concerned, delay in detection and treatment is discussed of congenital tracheal stenosis

Complement Activity in Carcinoma of the Digestive Tract

The function of the complement and its affection by operative insults were evaluated in patients with carcinoma of the digestive tract in comparison with 7 benign diseases and 4 critical patients. The C4 levels in the patients undergoing major operative insult and exposed prolonging operation time were significantly reduced. There was no tendency toward a certain alteration in C3, Factor B activity, CH50 and Factor H. whereas ACH50 was reduced until the 3rd day of operation. It was suggested of delayed recovery in alternativee pathway. Moreover, the protease inhibitor (α1-Antitrypsin, α2-Macrogloburin), which acts as an inhibitor of complement activity, and the ω-amino-acid (Arg, Lys) were markedly increased when a nutritional condition in cancer patient had been improved in help of TPN. It, however, was not statiscally significant. The complex release activity of the complement was increased according to advancing disease stage in gastric cancer. In contrast, it was much depressed in hepatic cancer in relation to liver function of C3 production. In conclusion, the complement activity related to surgery in carcinoma of the digestive tract was variably influenced by the degree of an operative insult and the staging of cancer disease including the nutritional status