rome and Hemorrhage

To compare the incidence of major adverse cardiac and cerebrovascular events (MACCE) and thrombolysis in myocardial infarction (TIMI) bleedings in primary percutaneous coronary intervention (pPCI) performed through transradial approach (TRA) or transfemoral approach (TFA) with systematic closure by FemoSeal™.. Although the risk of bleeding can be reduced using vascular closure devices (VCD), there are few data comparing TRA and TFA with VCD, particularly in the setting of pPCI.. we included in this retrospective registry 777 patients who underwent pPCI at two centers from years 2010 to 2013. Exclusion criteria were implantation of intra-aortic balloon pump and achievement of femoral hemostasis by other means than FemoSeal™. We performed propensity-score matching and multivariate analysis to adjust for clinical and procedural confounders.. We enrolled 511 patients in TRA group and 266 in TFA group. Both in the general population and in the propensity-matched population, the incidence of MACCE was comparable in TRA vs. TFA patients (3.5 vs. 3.4% and 4.4 vs. 2.6%, respectively; P = ns). On the contrary, we observed a higher incidence of TIMI bleedings in TFA vs. TRA patients (5.6 vs. 2.2% in the general population and 6.6 vs. 1.3% in the propensity-matched population; P < 0.05); this difference was mainly driven by TIMI major bleedings. TFA was an independent predictor of bleeding at multivariate analysis.. In pPCI the rate of TIMI major bleedings was higher in TFA with closure by FemoSeal™ as compared to TRA, whereas the rates of minor bleedings and of MACCE were similar.

Topics: Cardiac Catheterization; Catheterization, Peripheral; Cerebrovascular Disorders; Chi-Square Distribution; Equipment Design; Femoral Artery; Hemorrhage; Hemostatic Techniques; Humans; Logistic Models; Multivariate Analysis; Myocardial Infarction; Odds Ratio; Percutaneous Coronary Intervention; Propensity Score; Punctures; Radial Artery; Registries; Retrospective Studies; Risk Factors; Rome; Treatment Outcome; Vascular Closure Devices

Severe carotid stenosis is a frequent cause of stroke in both men and women. Whereas several sex-related comparisons are available on coronary atherosclerosis, there are few data appraising gender-specific features of carotid plaques. We aimed to systematically compare the pathology and inflammatory features of carotid plaques in men vs women.. Carotid plaque specimens were collected from patients undergoing surgical endarterectomy for asymptomatic or symptomatic carotid stenosis. Histologic analysis was performed, as well as measurements of plaque composition and inflammation.. A total of 457 patients were included (132 women, 325 men). Baseline analyses showed a greater prevalence of hypercholesterolemia, hypertension, and former smoking status in women, despite a higher Framingham Heart Score in men (all P < .05). Women had a lower prevalence of thrombotic plaques, smaller percentage area of necrotic core, and hemorrhage extension (all P < .05). Plaque inflammation analysis showed a lower concentration of inflammatory and, in particular, of macrophage foam cells in the plaque cap of women (both P < .05). These differences were, however, no longer significant at multivariable analysis, including several baseline features, such as symptom status and stenosis severity.. Carotid plaques seem significantly different in women and men, but the main drivers of such pathologic differences are baseline features, including stenosis severity and symptom status.

Topics: Aged; Asymptomatic Diseases; Carotid Arteries; Carotid Stenosis; Chi-Square Distribution; Endarterectomy, Carotid; Female; Foam Cells; Hemorrhage; Humans; Hypercholesterolemia; Hypertension; Inflammation; Linear Models; Male; Middle Aged; Multivariate Analysis; Necrosis; Plaque, Atherosclerotic; Prevalence; Risk Assessment; Risk Factors; Rome; Severity of Illness Index; Sex Factors; Smoking; Thrombosis

The description of Pyramus' suicide in the Metamorphoses has been commented on by many scholars. There has been particular criticism of the comparison between the unfortunate lover's wound, squirting out blood, and a burst water-main. This has been supposed to show yet again how Ovid, in spite of his undoubtedly great talent, is capable of ruining a story by exaggeration. Nevertheless, a medical look at his wording leads to quite a different judgement. In his simile of the burst water-main Ovid obviously had in mind the haemorrhage from a damaged femoral artery, which can shoot blood to a considerable distance, sometimes over several yards. Only in this way can the fruits of the mulberry tree, hanging high over the wounded Pyramus, be moistened with blood and painted dark. This is, after all, the metamorphosis which justifies the inclusion of the story in the whole corpus. As it is possible for a person fatally wounded in this way to survive for some hours, the poet has to guarantee that Pyramus dies within minutes of turning his sword against himself. Only so can Thisbe, returning quickly, confess her love for Pyramus in such a heartfelt way and follow him at once. The haemorrhage from a femoral artery my indeed kill a person within a few minutes. Therefore Ovid's description is neither gruesome nor tasteless but simply natural and dramatically conclusive. The comparison with the water-main is one which would easily have occurred to the poet. From Ovid' point of view and that of his contemporaries, who had no knowledge of the circulation of the blood, no better comparison can be imagined than that between the blood vessels of the human body and urban water-pipes, a technical achievement of which the Romans were particularly proud.

Topics: Blood Circulation; Femoral Artery; Hemorrhage; History, Ancient; Humans; Medicine in Literature; Metaphor; Poetry as Topic; Rome; Wounds and Injuries

Topics: Acute Disease; Adenoviridae Infections; Adenovirus Infections, Human; Adult; Conjunctivitis; Disease Outbreaks; Hemorrhage; Humans; Middle Aged; Rome