PTCA

Percutaneous transluminal coronary angioplasty (PTCA) is performed to open blocked coronary arteries caused by coronary artery disease (CAD) and to restore arterial blood flow to the heart tissue without open-heart surgery. A special catheter (long hollow tube) is inserted into the coronary artery to be treated. This catheter has a tiny balloon at its tip. The balloon is inflated once the catheter has been placed into the narrowed area of the coronary artery. The inflation of the balloon compresses the fatty tissue in the artery and makes a larger opening inside the artery for improved blood flow.

The use of fluoroscopy (a special type of x-ray, similar to an x-ray “movie”) assists the physician in the location of blockages in the coronary arteries as the contrast dye moves through the arteries. A small sample of heart tissue (called a biopsy) may be obtained during the procedure to be examined later under the microscope for abnormalities.

A technique called intravascular ultrasound (IVUS), a technique that uses a computer and a transducer that sends out ultrasonic sound waves to create images of the blood vessels, may be used during PTCA. The use of IVUS provides direct visualization and measurement of the inside of the blood vessels and may assist the physician in selecting the appropriate size of balloons and/or stents, to ensure that a stent, if used, is properly opened, or to evaluate the use of other angioplasty instruments.

The physician may determine that another type of procedure is necessary. This may include the use of atherectomy (removal of plaque) at the site of the narrowing of the artery. In atherectomy, there may be tiny blades on a balloon or a rotating tip at the end of the catheter. When the catheter reaches the narrowed spot in the artery, the plaque is broken up or cut away to open the artery. Atherectomy is used when the plaque is calcified, hardened, or if the vessel is completely closed. Another type of atherectomy procedure uses a laser, which opens the artery by "vaporizing" the plaque.

Osteomyelitis

Osteomyelitis is characterized as an acute or chronic inflammatory condition of bone due to secondary infection of bacterial organisms. There are basically two process of contracting osteomyelitis 1) hematogenous infection and 2) direct contiguous infection. Hematogenous osteomyelitis is a secondary bone infection caused by blood bacteriemia seeding infectious bacteria into the bone through the blood stream. This is a common cause of osteomyelitis in children. Over 85% of hematogenous osteomyelitis is reported in children. This infection is most commonly associated with vascular metaphyseal infection in the young, growing bone. Vessels can thrombose and bone will locally necrose from bacterial infection. Direct or contiguous osteomyelitis is the most common cause of bone infection caused by open ulceration in diabetes after a break in the skin barrier. The most common pathogen to cause this infection is staphylococcus aureus. However, ulcerative osteomyelitis is multibacterial in nature with common pathogens such as pseudomonas and streptococcus species as primary and secondary organisms.