Jimmy Lim

Ocular manifestations and complications of Stevens–Johnson syndrome and toxic epidermal necrolysis: an Asian series*

Background:  To describe the acute and late ocular manifestations and complications in toxic epidermal necrosis (TEN) and Stevens–Johnson syndrome (SJS), and identify predictors for development of late complications.

Endothelial progenitor cell capture stent implantation in patients with ST-segment elevation acute myocardial infarction: one year follow-up

AIMS The Genous endothelial progenitor cell (EPC) capture stent is a bioengineered R stent coated with immobilised antibodies on its stent struts to allow for the capture of circulating EPCs to promote rapid endothelisation. We assessed the impact of this stent in the primary percutaneous coronary intervention (PCI) of patients with acute ST-elevation myocardial infarction (STEMI) and examined its long term clinical outcomes. METHODS AND RESULTS All patients with acute STEMI without cardiogenic shock who underwent primary PCI between January 2005 and April 2007 and received the stent were enrolled in the study. The study endpoints were major adverse cardiac events (MACE) defined as death, MI and target vessel revascularisation (TVR) at 30 days, six months and one year. A total of 321 enrolled patients received 357 EPC capture stents during the study period. The cohort comprises 81.0% males with mean age of 54.6+/-11.6 years. The mean stent length used was 20.98+/-5.50 mm and mean stent size was 2.99+/-0.32 mm. Ninety-four percent of patients achieved Thrombolysis in Myocardial Infarction (TIMI) 3 flow post-procedurally. The cumulative MACE rate was 8.1% at 30 days, 10.0% at six months and 12.2% at one year. There was one patient who developed acute stent thrombosis and another two with subacute stent thromboses. No late thrombosis or late cardiac mortality was observed in our cohort. The need for TVR was 4.4% at one year. CONCLUSIONS The use of EPC capture stents in patients who underwent primary PCI for STEMI is safe and showed good clinical outcomes, with low rates of TVR and no late stent thrombosis.

Variation of the platelet glycoprotein IIIa PIA1/A2 allele frequencies in the three ethnic groups of Singapore

BACKGROUND Polymorphisms of the glycoprotein IIIa receptor have been shown to be associated with differences in platelet aggregability. The PI(A2) variant of the polymorphism has been reported to be an inherited risk factor for acute coronary events. Although the allele frequency of this polymorphism is well documented in Caucasian populations, studies involving Asian Indians, Malays and Chinese are lacking. We studied 706 random male individuals to determine the genotypic distribution of this polymorphism in Singapore. METHODS Male subjects included in this study were drawn from those undergoing routine annual medical examinations offered by their employers. Venous blood was obtained from these patients after an overnight fast and from which genomic DNA was extracted. Genotyping was carried out by polymerase chain reaction (PCR) followed by digestion with restriction enzyme NciI. Personal and family medical history of the subjects were also taken. RESULTS The genotype distribution of the individuals studied was in accordance to a population at Hardy Weinberg equilibrium. The frequency of the PI(A2) allele was 0.1, 0.01 and 0.01 in the Indians, Malays and Chinese, respectively. The differences in frequencies of the PI(A2) variant are significant among different ethnic groups (P<0.001 for Indians vs. Chinese and Indians vs. Malays). CONCLUSIONS We observed a significantly higher frequency of the PI(A2) allele among Indians relative to the Chinese and Malays in Singapore. The effect of this genotype may partially explain the higher rate of ischaemic heart disease seen among Indians compared to the Chinese and Malay ethnic groups.

Comprehensive noninvasive evaluation of bypass grafts and native coronary arteries in patients after coronary bypass surgery: accuracy of 64-slice multidetector computed tomography compared to invasive coronary angiography.

Aims We assessed the accuracy of 64-slice multidetector computed tomography (MDCT) compared with that of invasive coronary angiography (ICA) in the evaluation of symptomatic postcoronary artery bypass graft (post-CABG) patients. Methods MDCT and ICA were performed in 44 consecutive post-CABG patients with chest pain (mean age 66 ± 10 years, mean duration post-CABG 9 ± 5 years). MDCT findings were compared with the corresponding ICA, which was read by an interventional cardiologist blinded to the MDCT findings. Significant stenosis was defined as at least 50% luminal stenosis. Results One hundred and thirty-seven grafts (31 arterial and 106 venous), all evaluable by MDCT, were assessed. In a ‘per graft’ analysis, MDCT could detect significant disease in bypass grafts (graft occlusion or stenosis) with a sensitivity of 98% and specificity of 98%. In a ‘per segment’ analysis, MDCT could detect significant disease in all native coronary arteries with a sensitivity of 91% and specificity of 79% and in clinically relevant native coronary arteries with a sensitivity of 92% and specificity of 84%. In a ‘per vessel’ analysis, MDCT could differentiate native arterial occlusion from nonocclusive stenosis with a sensitivity of 68% and specificity of 70%. In a ‘per patient’ analysis, MDCT could detect significant disease in bypass grafts or clinically relevant native coronary arteries with a sensitivity of 100%, specificity of 40% and accuracy of 93%. Conclusion Sixty-four-slice MDCT allows evaluation of bypass grafts and native coronary arteries in post-CABG patients. Although accurate for detecting bypass graft disease, 64-slice MDCT has significant limitations when evaluating native arteries in post-CABG patients.

His-bundle pacing in a patient with persistent left superior vena cava.

The presence of a persistent left superior vena cava was encountered in a 53‐year‐old woman undergoing a dual‐chamber pacemaker implant for sick sinus syndrome. Active fixation leads were used and positioned in the right atrium and right ventricle via the left superior vena cava draining into the coronary sinus. The natural course of the right ventricular lead riding up the lateral atrial wall and curving backward toward the septum as it exits from the coronary sinus os was found to facilitate the positioning of the lead tip close to the His bundle without the use of a specially designed guiding catheter.