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Sample records for abdominal angina due

  1. Clinical course of isolated stable angina due to coronary heart disease

    NARCIS (Netherlands)

    Poole-Wilson, Philip A.; Voko, Zoltan; Kirwan, Bridget-Anne; de Brouwer, Sophie; Dunselman, Peter H. J. M.; Lubsen, Jacobus

    2007-01-01

    Aims To describe the clinical course of patients with stable angina due to coronary heart disease without a history of cardiovascular (CV) events or revascutarization (isolated angina). Methods and results Of 7665 patients in a trial comparing long-acting nifedipine with placebo, 2170 (28%) had isol

  2. Abdominal Compartment Syndrome due to OHSS

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    Firoozeh Veisi

    2012-03-01

    Full Text Available Abdominal compartment syndrome is a dangerous clinical situation, usually following abdominal injuries&operations. It is seldom observed in patients with gynecologic and obstetric problems. Abdominalcompartment syndrome may be consequence ovarian hyperstimulation syndrome. A 28-year-old womanpresented as a sever ovarian hyperstimulation.The increased IAP indicated that OHSS may beconsidered a compartment syndrome. Abdominal compartment syndrome needs laparotomy orparacentesis for reduction of pressure.

  3. Inferior venacaval compression due to excessive abdominal packing

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    M.C.B. Santhosh

    2014-06-01

    Full Text Available Inferior venacaval compression is a common problem in late pregnancy. It can also occur due to compression of inferior venacava by abdominal or pelvic tumors. We report a case of acute iatrogenic inferior venacaval compression due to excessive abdominal packing during an intraabdominal surgery.

  4. Angina Pectoris (Stable Angina)

    Science.gov (United States)

    ... Peripheral Artery Disease Venous Thromboembolism Aortic Aneurysm More Angina Pectoris (Stable Angina) Updated:Sep 19,2016 You may have heard the term “angina pectoris” or “stable angina” in your doctor’s office, but ...

  5. Infected abdominal aortic aneurysm due to Morganella morganii: CT findings.

    Science.gov (United States)

    Kwon, Oh Young; Lee, Jong Seok; Choi, Han Sung; Hong, Hoon Pyo; Ko, Young Gwan

    2011-02-01

    An infected aortic aneurysm, or mycotic aneurysm, is a rare arterial dilatation due to destruction of the infected vessel wall. Common pathogens resulting in an infected aortic aneurysm are Salmonella and Clostridium species, as well as Staphylococcus aureus; Morganella morganii, on the other hand, is very rare. An infected abdominal aortic aneurysm has tendencies to grow rapidly and to rupture. The mortality rate is high in patients undergoing emergent surgical intervention. We report the case of a 65-year-old man who presented with an infected abdominal aortic aneurysm caused by M. morganii. A high index of suspicion and imaging tests are necessary in order to diagnose an infected aortic aneurysm.

  6. Biliary peritonitis due to "fallen" hydatid cyst after abdominal trauma.

    Science.gov (United States)

    Kara, Melih; Tihan, Deniz; Fersahoglu, Tuba; Cavda, Faruk; Titiz, Izzet

    2008-01-01

    Hepatic hydatid cysts may cause serious complications. Intraperitoneal rupture of hepatic hydatid cyst is rarely seen and the prognosis can be fatal. By experience, we know that it might be difficult to diagnose an unruptured cyst expulsed into the peritoneal cavity. In this report, we present the case of a 54-year-old man with an intraperitoneal cystic mass of 10 cm of diameter which had extruded out from the liver due to a blunt abdominal trauma.

  7. Isolated duodenal rupture due to blunt abdominal trauma

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    Celik Atilla

    2006-01-01

    Full Text Available Duodenal rupture following blunt abdominal trauma is rare and it usually seen with other abdominal organ injuries. It represents approximately 2% to 20% of patients with blunt abdominal injury and often occurs after blows to the upper abdomen, or abdominal compression from high-riding seat belts. Two cases of blunt duodenal rupture successfully treated surgically, are presented with their preoperative diagnosis and final out comes.

  8. Cervical Angina

    Science.gov (United States)

    Sussman, Walter I.; Makovitch, Steven A.; Merchant, Shabbir Hussain I.

    2015-01-01

    Cervical angina has been widely reported as a cause of chest pain but remains underrecognized. This series demonstrates the varied clinical presentation of patients with cervical angina, the delay in diagnosis, and the extensive cardiac examinations patients with this condition typically undergo prior to a definitive diagnosis. Recognition of this condition in patients with acute chest pain requires a high index of suspicion and an awareness of the common presenting features and clinical findings of cervical angina. PMID:25553225

  9. Case of angina pectoris at rest and during effort due to coronary spasm and myocardial bridging

    Institute of Scientific and Technical Information of China (English)

    Hiroki; Teragawa; Yuichi; Fujii; Tomohiro; Ueda; Daiki; Murata; Shuichi; Nomura

    2015-01-01

    We present a case of a 71-year-old male who hadchest symptoms at rest and during effort. He had felt chest oppression during effort for 1 year,and his chest symptoms had recently worsened. One month before admission he felt chest squeezing at rest in the early morning. He presented at our institution to evaluate his chest symptoms. Electrocardiography and echocardiography failed to show any specific changes. Because of the possibility that his chest symptoms were due to myocardial ischemia,he was admitted to our institution for coronary angiography(CAG). An initial CAG showed mild atherosclerotic changes in the proximal segment of the left anterior descending coronary artery(LAD) and mid-segment of the left circumflex coronary artery. Subsequent spasm provocation testing using acetylcholine revealed a bilateral coronary vasospasm,which was relieved after the intracoronary infusion of nitroglycerin. Finally,a CAG showed myocardial bridging(MB) of the mid-distal segments of the LAD. Fractional flow reserve using the intravenous administration of adenosine triphosphate was positive at 0.77,which jumped up to 0.90 through the myocardial bridging segments when the pressure wire was pulled back. Thus,coronary vasospasm and MB might have contributed to his chest symptoms at rest and during effort. Interventional cardiologists should consider the presence of MB as a potential cause of myocardial ischemia.

  10. [Ludwig's angina].

    Science.gov (United States)

    De Bast, Y; Appoloni, O; Firket, C; Capello, M; Rocmans, P; Vincent, J L

    2000-06-01

    Ludwig's angina is a rare infectious condition originating in the oropharyngeal region, most commonly from the teeth. The principal symptoms consist of cervical pain, dyspnea, dysphagia, symmetrical neck swelling and fever. Serious complications include respiratory collapses, mediastinitis, pleural empyema, pericarditis and pericardial tamponade, and may result in the death of the patient. The most useful investigations in patients with suspected Ludwig's angina are clinical assessment, a cervico-thoracic CT-scan to determine the extent of the lesions, microbiological examination and panoramic radiography to detect possible dental focuses of infection. Treatment consists of ensuring adequate ventilation by securing the upper airways, broad spectrum antibiotic therapy, eradication of the source of infection, and often early surgical decompression may be necessary. Rapid diagnosis and appropriate treatment can reduce the mortality rate to 10%.

  11. Vertebral Bone Erosions Due to Aortic Abdominal Aneurysm: A Case Report

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    Jamal Hossin

    2009-01-01

    Full Text Available   "nOsteolytic aortic abdominal aneurysm has rarely been reported as the cause of spinal lesions. Patients presenting with pain secondary to an abdominal aortic aneurysm demands prompt attention. Such cases could be encountered in a neurosurgical field such as a lumbar disc disease, spondylosis, or a cauda equina tumor. "nWe represent a 65-year-old male who was referred by a neurosurgeon for lumbosacral MRI due to new onset low back pain since a week ago with extension of the radiculer pain to the left lower extremity. MRI revealed erosions on the left anterior border with sclerotic changes in the body of L4 and the left psoas muscle appeared wider than the right psoas muscle with a non homogeneous signal intensity. Follow-up multi slice CT revealed a 6.5 cm diameter saccular abdominal aortic aneurysm 5.5 cm beneath the origin of the left renal artery and just before the bifurcation of the abdominal aorta with aortic wall calcifications and a large retroperitoneal hematoma.  

  12. Sixty-one Cases of Angina Pectoris due to Coronary Heart Disease Treated by External Use of the Paste of Nitrum and Realgar Powder on Zhiyang (GV 9)

    Institute of Scientific and Technical Information of China (English)

    刘新; 马鸿斌; 李朝平; 崔庆荣; 郭月季; 汪龙德; 李培杰; 骆力

    2002-01-01

    In order to inquire into the therapeutic effects of Xiao Shi Xiong Huang San (硝石雄黄散the Nitrum and Realgar Powder), one of the Dunhuang Prescription, on angina pectoris due to coronary heart disease (APCHD), the authors have treated 61 cases of APCHD by externally applying paste of the powder on Zhiyang (GV 9), with another 30 cases of APCHD treated with the nitroglycerin paste on Zhiyang as the controls. The results showed that the total effective rate was 82% and markedly effective rate 31.2% in the treatment group (the Paste of Nitrum and Realgar Powder), and the total effective rate was 46.6% and markedly effective rate 23.2% in the control group (the nitroglycerin paste). The difference in therapeutic effects between the two groups was very significant (P<0.01), indicating that the therapeutic effect of the former was significantly superior to that of the latter.

  13. Acute renal failure due to abdominal compartment syndrome: report on four cases and literature review

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    Cleva Roberto de

    2001-01-01

    Full Text Available We report on 4 cases of abdominal compartment syndrome complicated by acute renal failure that were promptly reversed by different abdominal decompression methods. Case 1: A 57-year-old obese woman in the post-operative period after giant incisional hernia correction with an intra-abdominal pressure of 24 mm Hg. She was sedated and curarized, and the intra-abdominal pressure fell to 15 mm Hg. Case 2: A 73-year-old woman with acute inflammatory abdomen was undergoing exploratory laparotomy when a hypertensive pneumoperitoneum was noticed. During the surgery, enhancement of urinary output was observed. Case 3: An 18-year-old man who underwent hepatectomy and developed coagulopathy and hepatic bleeding that required abdominal packing, developed oliguria with a transvesical intra-abdominal pressure of 22 mm Hg. During reoperation, the compresses were removed with a prompt improvement in urinary flow. Case 4: A 46-year-old man with hepatic cirrhosis was admitted after incisional hernia repair with intra-abdominal pressure of 16 mm Hg. After paracentesis, the intra-abdominal pressure fell to 11 mm Hg.

  14. Angina de Prinzmetal Angina de Prinzmetal Prinzmetal's angina

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    Eduardo Contreras Zuniga

    2009-08-01

    Full Text Available Essa síndrome é causada por um espasmo focal de uma artéria coronária epicárdica, levando a isquemia miocárdica grave. Embora freqüentemente acredite-se que o espasmo ocorra em artérias sem estenose, muitos pacientes com angina de Prinzmetal apresentam espasmo adjacente a placas ateromatosas. A causa exata do espasmo não está bem definida, mas pode estar relacionada à hipercontratilidade do músculo liso vascular devido a mitógenos vasoconstrictores, leucotrienos ou serotonina. Em alguns pacientes, é uma manifestação de distúrbio vasoespástico e está associado à migrânea, fenômeno de Raynaud ou asma induzida por aspirina. Apresentamos um caso associado com depressão transitória do segmento ST.Este síndrome es causado por un espasmo focal de una arteria coronaria epicárdica, llevando a isquemia miocárdica grave. Aunque frecuentemente se crea que el espasmo ocurra en arterias sin estenosis, muchos pacientes con angina de Prinzmetal presentan espasmo adyacente a placas ateromatosas. La causa exacta del espasmo no está bien definida, pero puede estar relacionada a la hipercontractilidad del músculo liso vascular debido a mitógenos vasoconstrictores, leucotrienos o serotonina. En algunos pacientes, es una manifestación de disturbio vasoespástico y está asociado a la migraña, fenómeno de Raynaud o asma inducida por aspirina. Presentamos un caso asociado con depresión transitoria del segmento ST.This syndrome is due to focal spasm of an epicardial coronary artery, leading to severe myocardial ischemia. Although it is frequently thought that the spasm occurs in arteries without stenosis, many Prinzmetal patients have spasm adjacent to atheromatous plaques. The exact cause of the spasm has not been well defined, but it may be related to the hypercontractility of the vascular smooth muscle due to vasoconstrictor mitogens, leukotrienes, or serotonin. In some patients, it is a manifestation of a vasospastic disorder and it

  15. An Intra-Abdominal Pseudocyst around a Ventriculoperitoneal Shunt due to Streptococcus Infection 7 Years after Shunt Surgery

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    Arata Tomiyama

    2014-01-01

    Full Text Available In 1999, a 50-year-old woman underwent ventriculoperitoneal (VP shunt surgery for hydrocephalus after subarachnoid hemorrhage. She was hospitalized for fever and recurrent systemic seizures in November 2006. Head computed tomography (CT showed only old changes. The seizures and fever were controlled by medicinal therapy. However, in December, her consciousness level suddenly decreased, and she showed progressive lower abdominal distension. Head CT showed marked ventriculomegaly, and abdominal CT showed a giant cystic mass at the shunt-tube tip in the lower abdominal cavity. Because thick pus was aspirated from the intra-abdominal mass, we diagnosed the patient with acute obstructive hydrocephalus due to an infected abdominal pseudocyst. Laparotomy and direct cyst drainage were performed, and antibiotic therapy against Streptococcus, the causative pathogen, was administered. The VP shunt tube was replaced. The postoperative course was uneventful, and postoperative CT showed hydrocephalus improvement and no pseudocyst recurrence. Abdominal pseudocysts, which are rare after VP shunt surgeries, usually occur after the subacute postoperative course in younger cerebral hemorrhagic cases. Our case was quite rare because the cyst developed in the chronic phase in an older patient and was caused by streptococcal infection. The cyst components should be examined before cyst drainage when choosing surgical strategies.

  16. Long-term effects of spinal cord stimulation on angina symptoms and quality of life in patients with refractory angina pectoris--results from the European Angina Registry Link Study (EARL)

    DEFF Research Database (Denmark)

    Andréll, P; Yu, W; Gersbach, P;

    2010-01-01

    To assess the long-term effect of spinal cord stimulation (SCS) on angina symptoms and quality of life in patients with refractory angina pectoris defined as severe angina due to coronary artery disease resistant to conventional pharmacological therapy and/or revascularisation.......To assess the long-term effect of spinal cord stimulation (SCS) on angina symptoms and quality of life in patients with refractory angina pectoris defined as severe angina due to coronary artery disease resistant to conventional pharmacological therapy and/or revascularisation....

  17. Effect of increased intra-abdominal pressure due to pneumoperitoneum on liver functions and liver histopathology in a rat model with intra-abdominal sepsis.

    Science.gov (United States)

    Youssef, Youssef Farouk; Noseer, Mona

    2008-04-01

    Intra-abdominal sepsis was induced by open cecal ligation and puncture (OCLP) technique. Sixty rats were randomly divided into three equal groups each of 20. G1 was used as a control. G2 were subjected to laparotomy and closure after 12 hours from (OCLP) via the same incision. In G3, pneumoperitoneum was induced 12 hours after OCLP and maintained at 12 mmHg for about 30 minutes. Blood samples were taken for liver functions after 12 & 24 hours from OCLP procedure, and Liver biopsies were taken for histopathological examination after 24 hours. The results showed that liver functions were markedly increased in G3 after pneumoperitoneum, compared to Gs 1 & 2. The histopathological changes in liver biopsies due to sepsis were more marked in cases exposed to pneumoperitoneum than that exposed to conventional laparotomy. The intra-abdominal sepsis affected liver functions and caused pathogenesis. The increased intra-abdominal pressure induced more liver insults, compared to that gained after open surgery.

  18. Role of F-18 FDG PET/CT in the management of infected abdominal aortic aneurysm due to salmonella

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Seung Jin; Lee, Jin Soo; Cheong, Moon Hyun; Byun, Sung Su; Hyun, In Young [Inha University College of Medicine, Incheon (Korea, Republic of)

    2007-12-15

    We present a case of infected abdominal aortic aneurysm due to salmonella enteritidis. F-18 FDG PET/CT was performed to diagnosis and during follow-up after antibiotic treatment. Computed tomography (CT) is considered to be the best diagnostic imaging modality in infected aortic lesions. In this case, a combination of CT and FDG PET/CT provided accurate information for the diagnosis of infected abdominal aortic aneurysm. Moreover, FDG PET/CT made an important contribution of monitoring disease activity during antibiotic treatment.

  19. Postoperative infection of an abdominal mesh due to methicillin resistant Staphylococcus Aureus - A case report

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    Ashok R

    2004-01-01

    Full Text Available Methicillin resistant Stephylococcus aureus (MRSA infection has now become a major problem in hospitals. We present a case of postoperative infection MRSA where the primary source of the infection was found to be an abdominal mesh that was used to reinforce the abdominal wall. After one year of surgery, the patient developed wound dehiscence and discharge. MRSA was isolated from the wound, mesh, external nares, throat and axilla. Initially she was started on clindamycin and discharged from the hospital. After 5 months, patient came back to the hospital with infection at the same site. The patient was then treated with vancomycin and MRSA clearance. She responded to the treatment with complete healing of the wound and clearance of MRSA.

  20. [Deviation of the abdominal aorta and common iliac arteries due to aging and kidney dystopia].

    Science.gov (United States)

    Zhelobtsov, P M

    1982-12-01

    A specific peculiarity in the relief changeability and position of the abdominal aorta, the common iliac arteries is a segmentary deformity occurring in aged persons as a result of atherosclerotic alterations in their walls. A congenital homolateral dystopia, horseshoe and double kidney are rather seldom developmental anomalies in mature persons. In newborns, however, they are found 6-7 times more often and together with other congenital defects of the kidneys make evidently an often cause of the fetal and infantile death.

  1. Immediate and long-term clinical outcome after spinal cord stimulation for refractory stable angina pectoris.

    Science.gov (United States)

    Di Pede, Francesco; Lanza, Gaetano Antonio; Zuin, Guerrino; Alfieri, Ottavio; Rapati, Massimo; Romanò, Massimo; Circo, Antonio; Cardano, Paola; Bellocci, Fulvio; Santini, Massimo; Maseri, Attilio

    2003-04-15

    The treatment of patients with angina pectoris refractory to medical therapy and unsuitable for revascularization procedures has yet not been well standardized. Previous retrospective studies and small prospective studies have suggested beneficial effects of spinal cord stimulation (SCS) in these patients. We created a Prospective Italian Registry of SCS to evaluate the short- and long-term clinical outcome of patients who underwent SCS device implantation because of severe refractory angina pectoris. Overall, 104 patients were enrolled in the registry (70 men, aged 68 +/- 17 years), most of whom (83%) had severe coronary artery disease. Average follow-up was 13.2 +/- 8 months. Overall, 17 patients (16%) died, 8 (8%) due to cardiac death. Among clinical variables, only age was found to be significantly associated both with total mortality (p = 0.04) and cardiac mortality (p = 0.02) on Cox regression analysis. A significant improvement of anginal symptoms (> or =50% reduction of weekly anginal episodes, compared with baseline) occurred in 73% of patients, and Canadian Cardiovascular Society angina class improved by > or =1 class in 80% and by > or =2 classes in 42% of patients, with a relevant reduction in the rate of hospital admission and days spent in the hospital because of angina (p <0.0001 for both). No life-threatening or clinically serious complications were observed. The most frequent side effect consisted of superficial infections, either at the site of puncture of electrode insertion or of the abdominal pocket, which occurred in 6 patients. In conclusion, our prospective data point out that SCS can be performed safely and is associated with a sustained improvement of anginal symptoms in a relevant number of patients with refractory stable angina pectoris.

  2. Intestinal perforation due to minor blunt abdominal trauma–a harbinger of underlying disease pathology

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    Chinwendu Onwubiko

    2015-01-01

    Full Text Available When a patient suffers a blunt intestinal injury after a low-energy mechanism, be prepared to find a pathologic area in the bowel. We present the case of a previously healthy 13-year-old female who presented complaining of abdominal pain hours after impact with the safety bar of an amusement park ride. Upon operative exploration, she was found to have extensive inflammation of the distal ileum including the ileocecal valve with creeping mesenteric fat and a full-thickness perforation of the inflamed segment. An ileocecectomy and primary anastomosis were performed. Pathology confirmed the presence of Crohn's disease. This case is the first reported incidence of a traumatic perforation leading to a diagnosis of pediatric Crohn's disease. Blunt perforation of the bowel following a low-impact mechanism should heighten the suspicion of an underlying disease process.

  3. Angina de Prinzmetal Angina de Prinzmetal Prinzmetal's angina

    OpenAIRE

    Eduardo Contreras Zuniga; Juan Esteban Gomez Mesa; Sandra Ximena Zuluaga Martinez; Vanesa Ocampo; Cristian Andres Urrea

    2009-01-01

    Essa síndrome é causada por um espasmo focal de uma artéria coronária epicárdica, levando a isquemia miocárdica grave. Embora freqüentemente acredite-se que o espasmo ocorra em artérias sem estenose, muitos pacientes com angina de Prinzmetal apresentam espasmo adjacente a placas ateromatosas. A causa exata do espasmo não está bem definida, mas pode estar relacionada à hipercontratilidade do músculo liso vascular devido a mitógenos vasoconstrictores, leucotrienos ou serotonina. Em alguns pacie...

  4. An abdominal aortic rupture due to seatbelt blunt injury: report of a case.

    Science.gov (United States)

    Sugimoto, Takaki; Omura, Atsushi; Kitade, Takashi; Takahashi, Hideyuki; Koyama, Takashi; Kurisu, Sigeru

    2007-01-01

    A 66-year-old man, who was a passenger in a car involved in a low-speed head-on motor vehicle accident, was rushed to our hospital. His abdomen was tender and distended. An enhanced computed tomography scan showed a massive retroperitoneal hematoma, and its three-dimensional imaging revealed an active leak of the contrast medium from the aortic bifurcation. He went into shock, and was immediately transferred to the operating theater. Through a median laparotomy, a ruptured site measuring 5 mm in diameter was found at the aortic bifurcation and it was closed with sutures under a proximal aortic control. The other organs showed no evidence of injury. Because of the remarkable edema of the bowel, mesentery, and retroperitoneum, the abdomen was temporarily closed with a mesh sheet to prevent the occurrence of abdominal compartment syndrome. A delayed closure was then successfully performed 4 days later, and he was discharged with no residual sequelae 17 days after the initial operation.

  5. Critical ventriculo-peritoneal shunt failure due to peritoneal tuberculosis: Case report and diagnostic suggestions for abdominal pseudocyst

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    Hajime Takase

    2014-01-01

    Full Text Available Background: Tuberculous peritonitis (TBP is a well-known complication of ventriculo-peritoneal (VP shunt treatment for hydrocephalus resulting from tuberculous meningitis (TBM. However, a case of hydrocephalus unrelated to TBM resulting from VP shunt malfunction due to TBP has not been reported. Case Description: A 21-year-old male presented with nausea, abdominal pain, and headache. VP and cysto-peritoneal (CP shunts had been inserted to treat hydrocephalus due to a suprasellar arachnoid cyst, replaced the VP and removed the CP in his childhood. Computed tomography demonstrated acute hydrocephalus and an abdominal pseudocyst surrounding the distal end of the peritoneal tube. Initial laboratory data showed elevated white blood cell count and C-reactive protein level, but no causative pathogen was identified. External drainage of cerebrospinal fluid (CSF and of the fluid in the peritoneal cyst was established, and empirical antibiotic therapy was initiated. Bacterial cultures eventually revealed Mycobacterium tuberculosis infection, and TBP was diagnosed. The patient responded well to antituberculosis (anti-TB agents and insertion of a ventriculo-pleural shunt. Conclusion: This case highlights the possibility of CSF shunt failure and concomitant neurological sequelae from TB infection even when the pathogen has not invaded the central nervous system, as in TBM. Moreover, TBP is rare in developed countries and therefore may be misdiagnosed because of nonspecific clinical features and low sensitivity of common TB screening methods.

  6. Decreased Risk of Ventilator-Associated Pneumonia in Sepsis Due to Intra-Abdominal Infection.

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    François Philippart

    Full Text Available Experimental studies suggest that intra-abdominal infection (IAI induces biological alterations that may affect the risk of lung infection.To investigate the potential effect of IAI at ICU admission on the subsequent occurrence of ventilator-associated pneumonia (VAP.We used data entered into the French prospective multicenter Outcomerea database in 1997-2011. Consecutive patients who had severe sepsis and/or septic shock at ICU admission and required mechanical ventilation for more than 3 days were included. Patients with acute pancreatitis were not included.Of 2623 database patients meeting the inclusion criteria, 290 (11.1% had IAI and 2333 (88.9% had other infections. The IAI group had fewer patients with VAP (56 [19.3%] vs. 806 [34.5%], P<0.01 and longer time to VAP (5.0 vs.10.5 days; P<0.01. After adjustment on independent risk factors for VAP and previous antimicrobial use, IAI was associated with a decreased risk of VAP (hazard ratio, 0.62; 95% confidence interval, 0.46-0.83; P<0.0017. The pathogens responsible for VAP were not different between the groups with and without IAI (Pseudomonas aeruginosa, 345 [42.8%] and 24 [42.8%]; Enterobacteriaceae, 264 [32.8%] and 19 [34.0%]; and Staphylococcus aureus, 215 [26.7%] and 17 [30.4%], respectively. Crude ICU mortality was not different between the groups with and without IAI (81 [27.9%] and 747 [32.0%], P = 0.16.In our observational study of mechanically ventilated ICU patients with severe sepsis and/or septic shock, VAP occurred less often and later in the group with IAIs compared to the group with infections at other sites.

  7. Late diagnosis of Takayasu's arteritis with repeated attacks of heart failure and uncontrolled hypertension due to abdominal aortic thrombosis: case report and review of the literature.

    Science.gov (United States)

    Wang, Huan; Lai, Baochun; Wu, Xiaoying; Han, Tao; Chen, Hui

    2015-01-01

    Takayasu's arteritis (TA) is a chronic, idiopathic, inflammatory disease affecting the aorta and its branches. To date, only one case involving abdominal aortic thrombosis due to TA has been reported. After bilateral artificial subclavian-iliac bypass, a case of abdominal aortic thrombosis due to TA received a delayed diagnosis in a 44-year-old Chinese male who experienced recurrent episodes of heart failure and uncontrolled hypertension with claudication of two extremities. Abdominal color Doppler sonography and computed tomography aortography (CTA) showed occlusion of the abdominal aorta and bilateral renal artery stenosis. After vascular bypass and during 1 year follow-up, his cardiac function improved and blood pressure was well controlled, with reduced serum creatinine. Postoperative CTA still showed abdominal aortic thrombosis resulting in arterial occlusion extending from the left renal artery initial segment level to the bilateral common iliac artery and the bifurcation of the renal artery, except for the vascular bypass. Abdominal aortic thrombosis due to TA is very rare and potentially life threatening, probably becoming an atherosclerosis risk factor. Doppler sonography and CTA results are important for diagnosis. Artificial vascular bypass can be used for TA in debilitated patients with diffuse aortic disease.

  8. Medical image of the week: abdominal compartment syndrome due to massive upper gastrointestinal hemorrhage

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    Truong VN

    2014-11-01

    Full Text Available No abstract available. Article truncated after 150 words. A 29 year old woman with history of a Whipple procedure for pancreatic cancer and nonalcoholic steatohepatitis cirrhosis presented with a massive upper gastrointestinal bleeding (UGIB likely from esophageal varices and developed hemorrhagic shock. Emergent upper endoscopy could not be performed due to hemodynamic instability. Therefore, a Minnesota Tube was placed emergently for balloon tamponade of the bleeding. A transjugular intrahepatic portosystemic shunt was also placed emergently to decrease bleeding by reducing portal pressure. By this time, the patient had received 4 liters of normal saline, 14 units of packed red blood cells, 6 units of platelets, and 4 units of fresh frozen plasma. The Minnesota tube did control the bleeding somewhat, however, there was continued bloody drainage from the stomach port of the Minnesota tube. The patient’s abdomen became remarkably distended and was dull to percussion throughout. A CT scan of the abdomen and pelvis revealed severe dilatation of ...

  9. Abdominal Wall Abscess due to Acute Perforated Sigmoid Diverticulitis: A Case Report with MDCT and US Findings

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    Rafailidis Vasileios

    2013-01-01

    Full Text Available Perforation of the inflamed diverticula is a common diverticulitis complication. It usually leads to the formation of a local abscess. In some rare cases, the inflammatory process may spread towards extra-abdominal sites like the anterior or posterior abdominal wall or the thigh and form an abscess in these sites. We present the case of a 73-year-old man with a history of pain at the lower left quadrant of the abdomen for 20 days and a visible mass in this site. Ultrasonography and computed tomography revealed this mass to be an abscess of the abdominal wall which had been formed by the spread of ruptured sigmoid diverticulitis by continuity of tissue through the lower left abdominal wall. Local drainage of the abscess was performed and the patient was discharged after alleviation of symptoms and an uneventful course. We also discuss causes of abdominal wall abscesses along with the possible pathways by which an intra-abdominal abscess could spread outside the abdominal cavity.

  10. Angina de Prinzmetal

    OpenAIRE

    Contreras Zuniga,Eduardo; Gomez Mesa,Juan Esteban; Zuluaga Martinez,Sandra Ximena; Ocampo,Vanesa; Andres Urrea,Cristian

    2009-01-01

    Essa síndrome é causada por um espasmo focal de uma artéria coronária epicárdica, levando a isquemia miocárdica grave. Embora freqüentemente acredite-se que o espasmo ocorra em artérias sem estenose, muitos pacientes com angina de Prinzmetal apresentam espasmo adjacente a placas ateromatosas. A causa exata do espasmo não está bem definida, mas pode estar relacionada à hipercontratilidade do músculo liso vascular devido a mitógenos vasoconstrictores, leucotrienos ou serotonina. Em alguns pacie...

  11. Severe angina pectoris in asthma attack: a case report.

    Science.gov (United States)

    Nabavizadeh, Seyed Hesamedin; Farahbakhsh, Nazanin; Fazel, Ali; Mosavat, Fereshteh; Anushiravani, Amir

    2016-06-01

    Asthma is a chronic inflammatory disorder of the airways related to the obstruction of reversible airflow. Asthma presents as recurrent attacks of cough and dyspnea. Poor control causes recurrent admissions to the ICU, and mortality is related to poor drug compliance and follow-up. Angina pectoris is a syndrome of recurrent chest discomfort related to myocardial ischemia. The presence of these two disorders rarely has been reported. We reported a 12-year-old boy who was referred with exacerbation of asthma and developed angina pectoris during hospitalization. He had labored breathing and diffuse wheezing. During treatment of the asthma, the patient developed severe chest pain due to shunt formation and coronary hypoxia, caused by the sole administration of ventolin, since oxygen had been disconnected. After receiving appropriate therapy, both his asthma and angina recovered, and, to date, he has not experienced angina pectoris again.

  12. Angina pectoris efter sumatriptan (Imigran)

    DEFF Research Database (Denmark)

    Abrahamsen, Bo; Christiansen, B D

    1992-01-01

    Developed for the treatment of migraine, sumatriptan is an agonist of 5-hydroxytryptamine-1-receptors. Though a pressure sensation is a common complaint, significant ECG changes have not been reported after subcutaneous administration of sumatriptan. A case history is given where angina pectoris...... after sumatriptan self-administration was experienced on two occasions by a 61-year old man with a history of minor myocardial infarction--without post-infarction angina--two years previously. The angina after sumatriptan was accompanied on both occasions by significant ST-segment depression on ECG...

  13. Double hazards of ischemia and reperfusion arrhythmias in a patient with variant angina pectoris.

    Science.gov (United States)

    Xu, Mingzhu; Yang, Xiangjun

    2015-01-01

    Variant angina pectoris, also called Prinzmetal's angina, is a syndrome caused by vasospasms of the coronary arteries. It can lead to myocardial infarction, ventricular arrhythmias, atrioventricular block and even sudden cardiac death. We report the case of a 53 year-old male patient with recurrent episodes of chest pain and arrhythmias in the course of related variant angina pectoris. It is likely that the reperfusion following myocardial ischemia was responsible for the ventricular fibrillation while the ST-segment returned to the baseline. This case showed that potential lethal arrhythmias could arise due to variant angina pectoris. It also indicated that ventricular fibrillation could be self-terminated.

  14. Bipedicled transverse abdominal flap for coverage of exposed iliac crest due to post traumatic tissue loss in left inguinal region

    Directory of Open Access Journals (Sweden)

    Narendra G. Naik

    2016-03-01

    Full Text Available It is a surgical challenge for any plastic surgeon to choose the type of flap in the case of large inguinal canal tissue loss with exposed crest of ilium. Most repair methods provide inadequate closure of the defect for the large tissue loss over the inguinal region with exposure of the iliac crest. There are very few cases reported in the literature about transverse bipedicled abdominal flap for tissue defect over the inguinal region with exposure of the iliac crest bone and upper part of the thigh. In this case, by taking advantage of the large, loose, and lax nature of the abdominal skin, systematic primary closure of the donor as well as recipient site has been successfully achieved. [Int J Res Med Sci 2016; 4(3.000: 963-965

  15. Renal infarction due to spontaneous dissection of the renal artery: an unusual cause of non-visceral type abdominal pain.

    Science.gov (United States)

    Kang, James H-E; Kang, Jin-Yong; Morgan, Robert

    2013-09-18

    A 44-year-old man presented with very severe right upper quadrant pain of sudden onset. This was exacerbated by movement but unaffected by food or defaecation. It was continuous-day and night -but resolved over a 1-week period. The physical examination was normal at presentation, by which time the pain had resolved. His white cell count, alanine transaminase and C reactive protein were elevated but normalised after 10 days. An abdominal CT showed low density lesions in the right kidney consistent with segmental infarcts. CT angiogram showed a dissection of the right renal artery. The patient remained asymptomatic and normotensive when reviewed 1 month later.

  16. Post trauma abdominal cocoon.

    Science.gov (United States)

    Kaur, Supreet; Doley, Rudra Prasad; Chabbhra, Mohinish; Kapoor, Rajeev; Wig, Jaidev

    2015-01-01

    Abdominal cocoon or sclerosing peritonitis refers to a rare cause of intestinal obstruction due to formation of a membrane encasing the bowel. We report a case of abdominal cocoon post blunt trauma abdomen. The patient presented with a history of subacute intestinal obstruction and a mobile abdomen lump. Abdominal cocoon was diagnosed on computed tomography. He underwent adhesiolysis with excision of membrane.

  17. Meningitis due to Enterobacter aerogenes subsequent to resection of an acoustic neuroma and abdominal fat graft to the mastoid

    Directory of Open Access Journals (Sweden)

    Fida A. Khan

    2004-10-01

    Full Text Available Meningitis is an uncommon complication of neurosurgical procedures, with an incidence of 1.1% to 2.5%. Although unusual, the frequency of nosocomial Gram-negative meningitis appears to be increasing. Gram-negative meningitis has been documented following disruption of the dura-arachnoid barrier secondary to trauma or surgery. The association of Gram-negative bacillary meningitis with neurosurgical procedures was first reported in the 1940's. Wolff et al. described the association between Enterobacter species and post-neurosurgical infection. More recently, risk factors for nosocomial Enterobacter meningitis have been characterized by Parodi et al. Adipose graft, as an independent risk factor has not yet been reported. A patient with acoustic neuroma resection, who developed bacterial meningitis from an abdominal fat pad graft to a mastoidectomy bed is described. A brief overview was made of post-neurosurgical Gram-negative meningitis.

  18. Living with heart disease and angina

    Science.gov (United States)

    ... medlineplus.gov/ency/patientinstructions/000576.htm Living with heart disease and angina To use the sharing features on ... pain and reduce your risks from heart disease. Heart Disease and Angina CHD is a narrowing of the ...

  19. Bradycardiac angina: haemodynamic aspects and treatment.

    Science.gov (United States)

    Fowler, P B; Ikram, H; Maini, R N; Makey, A R; Kirkham, J S

    1969-01-11

    A patient with a sinus bradycardia and angina is described who was unable to increase his heart rate on vigorous exercise by more than a few beats. His severe angina was attributed to the bradycardia. Atrial pacing of his heart abolished his angina and increased his exercise tolerance. Circulatory changes at rest, on exertion, and with atrial pacing are described. The cause of angina in this patient is discussed.

  20. Menstruation angina: a case report

    Directory of Open Access Journals (Sweden)

    Choo Wai Kah

    2009-03-01

    Full Text Available Abstract Introduction Menstruation is commonly associated with migraine and irritable bowel but is rarely correlated with angina or myocardial ischaemia. Only a small number of cases have been reported suggesting a link between menstruation and myocardial ischaemic events. Case presentation A case of menstruation angina is reported in order to raise awareness of this association. A 47-year-old South Asian woman presented with recurrent chest pains in a monthly fashion coinciding with her menstruations. Each presentation was associated with troponin elevation. Angioplasty failed to resolve her symptoms but she eventually responded to hormonal therapy. Conclusions The possibility of menstruation angina should always be taken into account in any female patients from puberty to menopause presenting with recurrent chest pains. This can allow an earlier introduction of hormonal therapy to arrest further myocardial damage.

  1. Statine bei instabiler Angina pectoris

    Directory of Open Access Journals (Sweden)

    Marschang G

    1999-01-01

    Full Text Available Die Statine stellen die derzeit wirksamsten cholesterinsenkenden Medikamente dar, deren Effektivität und Verträglichkeit bereits durch große Primär- und Sekundärpräventionsstudien an zahlreichen Patienten gesichert ist. Subanalysen einiger dieser Interventionsstudien (AFCAPS/TexCAPS, 4S, CARE, LIPID haben eine signifikante Reduktion von Episoden instabiler Angina pectoris und damit verbundener Krankenhausaufenthalte ergeben. In der LIPID-Studie wurde weiters gezeigt, daß Patienten mit einer Anamnese von instabiler Angina pectoris mindestens ebenso wie Postinfarktpatienten von einer Therapie mit einem Statin profitieren. Von zwei derzeit noch nicht publizierten Studien (AVERT, MIRACL wird die Klärung weiterer Fragestellungen (hochdosierte Statintherapie im Vergeich zu Angioplastie, aggressive Cholesterinsenkung als Akuttherapie der instabilen Angina pectoris erwartet.

  2. Klinik der instabilen Angina pectoris

    Directory of Open Access Journals (Sweden)

    Auer J

    1999-01-01

    Full Text Available Die instabile Angina pectoris wird zu den akuten Koronarsyndromen gerechnet und weist als pathophysiologisches Substrat ein thrombotisches Ereignis auf dem Boden einer koronaren Endothelläsion auf. Aufgrund der Anamnese und unter Zuhilfenahme von EKG und serologischen Markern kann eine Risikostratifizierung von Patienten mit instabiler Angina pectoris vorgenommen werden. Je nach Risikoeinstufung und der damit möglichen prognostischen Abschätzung der klinischen Situation kann das weitere therapeutische Management stratifiziert werden. Im Rahmen der folgenden Übersicht werden anamnestische Kriterien für Definition und Klassifikation der instabilen Angina pectoris abgehandelt und darüber hinaus versucht, den Stellenwert der klinischen Untersuchung, der Echokardiographie und serologischer Tests für Risikoabschätzung und Therapieplanung dieser Patienten anzugeben.

  3. How Can Angina Be Prevented?

    Science.gov (United States)

    ... can help prevent or delay angina and heart disease. To adopt a healthy lifestyle, you can: Quit smoking and avoid secondhand smoke ... a healthy diet Be physically active Maintain a healthy ... and controlling heart disease risk factors, visit the Diseases and Conditions Index ...

  4. Post trauma abdominal cocoon

    Directory of Open Access Journals (Sweden)

    Supreet Kaur

    2015-01-01

    Full Text Available Abdominal cocoon or sclerosing peritonitis refers to a rare cause of intestinal obstruction due to formation of a membrane encasing the bowel. We report a case of abdominal cocoon post blunt trauma abdomen. The patient presented with a history of subacute intestinal obstruction and a mobile abdomen lump. Abdominal cocoon was diagnosed on computed tomography. He underwent adhesiolysis with excision of membrane.

  5. [Exercise tests in unstable angina suspects].

    Science.gov (United States)

    2012-01-01

    The review is devoted to exercise tests (ET) potential in patients with different forms of coronary heart disease (CHD) exacerbation and suspected unstable angina. It is well known that unstable angina untreated pharmacologically is a contraindication for ET. Of interest in clinical practice is diagnosis, risk assessment and treatment policy in patients with chest pain. The main focus is on ET conduction in unstable angina suspects with low and intermediate risk, on safety and validity of ET conduction in these patients.

  6. Management policies and prognosis in unstable angina pectoris : use of coronary angiography in different practice settings

    OpenAIRE

    Miltenburg-van Zijl, Addy

    1992-01-01

    textabstractUnstable angina encompasses a wide range of clinical presentations of myocardial ischemia, usually caused by sudden deteriorations of coronary lesions. Sometimes, extracardiac conditions disturbing the oxygen balance, such as severe anaemia, fever or thyrotoxicosis, may cause myocardial ischemia. In this thesis unstable angina is referred to as myocardial ischemia due to obstructive atherosclerotic coronary artery disease. In the literature and in clinical practice a variety of de...

  7. Variant angina and coronary artery spasm: the clinical spectrum, pathophysiology, and management.

    Science.gov (United States)

    Kusama, Yoshiki; Kodani, Eitaro; Nakagomi, Akihiro; Otsuka, Toshiaki; Atarashi, Hirotsugu; Kishida, Hiroshi; Mizuno, Kyoichi

    2011-01-01

    Variant angina is a form of angina pectoris that shows transient ST-segment elevation on electrocardiogram during an attack of chest pain. Ischemic episodes of variant angina show circadian variation and often occur at rest from midnight to early morning. Ischemic episodes also occur during mild exercise in the early morning. However, they are not usually induced by strenuous exercise in the afternoon. Other important clinical features of variant angina include the high frequency of asymptomatic ischemic episodes and the syncope that sometimes occur during the ischemic episodes. Syncope is due to severe arrhythmias, including ventricular tachycardia, ventricular fibrillation, and high-degree atrioventricular block. Coronary artery spasm is the mechanism of ischemic episodes in variant angina. The incidence of coronary artery spasm shows a racial difference and is higher in Japanese than in Caucasians. Coronary arteriograms are normal or near-normal in most Japanese patients with variant angina. Deficient basal release of nitric oxide (NO) due to endothelial dysfunction, and enhanced vascular smooth muscle contractility with the involvement of the Rho/Rho-kinase pathway are reported to play important roles in the pathogenesis of coronary artery spasm. Other precipitating factors of coronary artery spasm include imbalance in autonomic nervous activity, increased oxidative stress, chronic low-grade inflammation, magnesium deficiency, and genetic susceptibility. The genetic risk factors associated with coronary artery spasm include gene polymorphisms of endothelial NO synthase (NOS), paraoxonase, and other genes. Calcium channel blockers are extremely effective in preventing coronary spasm. The long-acting nitrate, nicorandil, and Rho-kinase inhibitor are also useful for inhibiting coronary artery spasm. Because variant angina can lead to acute myocardial infarction, fatal arrhythmias, and sudden death, early treatment is important. The prognosis of patients with

  8. Distensión abdominal y edemas por quiste del cordón espermático Abdomina distention and edema due to spermatic cord cyst

    Directory of Open Access Journals (Sweden)

    Guillermo A. Keller

    2006-04-01

    Full Text Available La distensión abdominal es un síntoma común, siendo en general la presentación inicial de enfermedades sistémicas o desórdenes gastrointestinales. Otras causas son infrecuentes. Los quistes del cordón espermático son poco frecuentes, pero aún más su ubicación intraabdominal, su tamaño habitual es insuficiente para producir distensión. El paciente presentado en este caso es un varón con criptorquidia bilateral admitido por distensión abdominal, interpretada inicialmente como síndrome ascítico edematoso. La ecografía interpretó la distensión como ascitis tabicada, y la tomografía computada como debida a un gran quiste. En la exploración quirúrgica se diagnosticó un quiste gigante del cordón espermático de ubicación abdominal.Abdominal distention is a frequent symptom, being often the initial presentation of systemic diseases or gastrointestinal disorders. Other causes are uncommon. Spermatic cord cysts are infrequent, abdominal location is even rarer, and the size of the cysts is usually not enough to produce abdominal distention. In our case a man with bilateral cryptorchidism was admitted with abdominal distention and edema of the lower extremities initially interpreted as ascitic-edematous syndrome. Ultrasonography interpreted abdominal distention as septate ascites, computed tomography as a giant cyst. Exploratory surgery showed a giant spermatic cord cyst in the left spermatic cord.

  9. Angina

    Science.gov (United States)

    ... Mann DL, Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine . 10th ... Mann DL, Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of ...

  10. Update on ranolazine in the management of angina

    Science.gov (United States)

    Codolosa, J Nicolás; Acharjee, Subroto; Figueredo, Vincent M

    2014-01-01

    Mortality rates attributable to coronary heart disease have declined in recent years, possibly related to changes in clinical presentation patterns and use of proven secondary prevention strategies. Chronic stable angina (CSA) remains prevalent, and the goal of treatment is control of symptoms and reduction in cardiovascular events. Ranolazine is a selective inhibitor of the late sodium current in myocytes with anti-ischemic and metabolic properties. It was approved by the US Food and Drug Administration in 2006 for use in patients with CSA. Multiple, randomized, placebo-controlled trials have shown that ranolazine improves functional capacity and decreases anginal episodes in CSA patients, despite a lack of a significant hemodynamic effect. Ranolazine did not improve cardiovascular mortality or affect incidence of myocardial infarction in the MERLIN (Metabolic Efficiency with Ranolazine for Less Ischemia in Non-ST-Elevation Acute Coronary Syndrome)-TIMI (Thrombolysis In Myocardial Infarction) 36 trial, but significantly decreased the incidence of recurrent angina. More recently, ranolazine has been shown to have beneficial and potent antiarrhythmic effects, both on supraventricular and ventricular tachyarrhythmias, largely due to its inhibition of the late sodium current. Randomized controlled trials testing these effects are underway. Lastly, ranolazine appears to be cost-effective due to its ability to decrease angina-related hospitalizations and improve quality of life. PMID:25028555

  11. Interpreting angina: symptoms along a gender continuum

    Science.gov (United States)

    Crea-Arsenio, Mary; Shannon, Harry S; Velianou, James L; Giacomini, Mita

    2016-01-01

    Background ‘Typical’ angina is often used to describe symptoms common among men, while ‘atypical’ angina is used to describe symptoms common among women, despite a higher prevalence of angina among women. This discrepancy is a source of controversy in cardiac care among women. Objectives To redefine angina by (1) qualitatively comparing angina symptoms and experiences in women and men and (2) to propose a more meaningful construct of angina that integrates a more gender-centred approach. Methods Patients were recruited between July and December 2010 from a tertiary cardiac care centre and interviewed immediately prior to their first angiogram. Symptoms were explored through in-depth semi-structured interviews, transcribed verbatim and analysed concurrently using a modified grounded theory approach. Angiographically significant disease was assessed at ≥70% stenosis of a major epicardial vessel. Results Among 31 total patients, 13 men and 14 women had angiograpically significant CAD. Patients describe angina symptoms according to 6 symptomatic subthemes that array along a ‘gender continuum’. Gender-specific symptoms are anchored at each end of the continuum. At the centre of the continuum, are a remarkably large number of symptoms commonly expressed by both men and women. Conclusions The ‘gender continuum’ offers new insights into angina experiences of angiography candidates. Notably, there is more overlap of shared experiences between men and women than conventionally thought. The gender continuum can help researchers and clinicians contextualise patient symptom reports, avoiding the conventional ‘typical’ versus ‘atypical’ distinction that can misrepresent gendered angina experiences. PMID:27158523

  12. TREATMENT OPTIMIZATION IN PATIENTS WITH STABLE ANGINA PECTORIS: FOCUS ON VERAPAMIL SR

    Directory of Open Access Journals (Sweden)

    I. M. Sokolov

    2011-01-01

    Full Text Available Possibilities of angina pectoris pharmacotherapy are analyzed. Achievement of target heart rate (HR 55-60 beats per minute in these patients is possible due to three classes of antianginal medications that slow down HR: beta blockers (BB, If-channel inhibitors, nondihydropyridine calcium channel blockers (CCB. Nondihydropyridine CCB verapamil in slow release (SR formulation is focused. The main results of randomized clinical trials (APSIS, VHAS, CRIS, EVERESTH, VAMPHYRE, INVEST, VESPA, DAVIT-1, DAVIT-2, which have proven efficacy and safety, are presented. Verapamil SR is indicated for the treatment of angina pectoris in patients without history of myocardial infarction (MI; angina patients experienced MI without systolic heart failure and with contraindications to BB; angina with arterial hypertension; left ventricular diastolic dysfunction; peripheral arteries obliterating atherosclerosis; silent myocardial ischemia; vasospastic angina; angina associated with supraventricular cardiac arrhythmias (especially in permanent atrial fibrillation except Wolff-Parkinson-White and Lown-Ganong-Levine syndromes; after coronary angioplasty and the placement of bare metal stents.

  13. Update on ranolazine in the management of angina

    Directory of Open Access Journals (Sweden)

    Codolosa JN

    2014-06-01

    Full Text Available J Nicolás Codolosa,1 Subroto Acharjee,1 Vincent M Figueredo1,2 1Einstein Center for Heart and Vascular Health, Einstein Medical Center, 2Jefferson Medical College, Philadelphia, PA, USA Abstract: Mortality rates attributable to coronary heart disease have declined in recent years, possibly related to changes in clinical presentation patterns and use of proven secondary prevention strategies. Chronic stable angina (CSA remains prevalent, and the goal of treatment is control of symptoms and reduction in cardiovascular events. Ranolazine is a selective inhibitor of the late sodium current in myocytes with anti-ischemic and metabolic properties. It was approved by the US Food and Drug Administration in 2006 for use in patients with CSA. Multiple, randomized, placebo-controlled trials have shown that ranolazine improves functional capacity and decreases anginal episodes in CSA patients, despite a lack of a significant hemodynamic effect. Ranolazine did not improve cardiovascular mortality or affect incidence of myocardial infarction in the MERLIN (Metabolic Efficiency with Ranolazine for Less Ischemia in Non-ST-Elevation Acute Coronary Syndrome-TIMI (Thrombolysis In Myocardial Infarction 36 trial, but significantly decreased the incidence of recurrent angina. More recently, ranolazine has been shown to have beneficial and potent antiarrhythmic effects, both on supraventricular and ventricular tachyarrhythmias, largely due to its inhibition of the late sodium current. Randomized controlled trials testing these effects are underway. Lastly, ranolazine appears to be cost-effective due to its ability to decrease angina-related hospitalizations and improve quality of life. Keywords: ranolazine, chronic stable angina, coronary artery disease

  14. [Panic disorder and angina pectoris].

    Science.gov (United States)

    Prenninger, Markus; Giefing, Georg; Auer, Johann; Windhager, Elmar; Eber, Bernd

    2004-02-01

    Panic attacks are a frequently cited cause of noncardiac chest pain. A strict separation of the internist's job (i. e., ruling out an "organic" cause of the patient's complaints) from the psychiatrist's job (e. g., diagnosing and treating panic disorder if present) may not always be the most efficient way of diagnostic work-up. We present the case of a 56-year-old female referred to our institution for elective coronary arteriography. Significant cardiovascular risk factors and symptoms compatible with unstable angina illustrate the common problem of a high probability of cardiac pathology in a patient with possible psychiatric symptoms. A modified SCID-interview complementing the coronary angiography results finally led to the definite diagnosis in this patient after symptoms had been present for over 20 years.

  15. Chronic abdominal pain after ventral hernia due to mesh migration and erosion into the sigmoid colon from a distant site: a case report and review of literature.

    Science.gov (United States)

    Millas, S G; Mesar, T; Patel, R J

    2015-10-01

    Hernia repair is one of the most commonly performed procedures in general surgery. Use of mesh has been shown to decrease the overall recurrence rate. Mesh implantation, however, carries its own risks and complications. We report a case of a 41-year-old female who presented with nonspecific, chronic lower abdominal pain after ventral hernia repair with mesh implantation. The chronic pain was found to be the consequence of mesh migration and erosion into the sigmoid colon from a previous supraumbilical hernia repair. Hernia repair, use of mesh, and chronic abdominal pain are discussed.

  16. [Changes of fatty acids spectrum of plasma triglycerides and their pharmacological correction by statins in patients with unstable angina].

    Science.gov (United States)

    Lyzohub, V H; Artemchuk, O O; Dolynna, O V; Altunina, N V; Sharaieva, M L; Koniuk, T N

    2013-01-01

    The fatty acid composition of plasma triglycerides by gas chromatography, the dynamics of the segment ST, cardiac arrhythmia by daily monitoring of electrocardiogram in patients with unstable angina (progressive) and the effects of treatment with statins were studied. Revealed marked qualitative abnormalities of plasma triglycerides in patients with progressive angina manifest increase in the amount of saturated and reduction--of unsaturated fatty acids. High therapeutic effect of simvastatin and atorvastatin may be due to the identified strong correlation between the dynamics of the fatty acid components of plasma triglycerides and indicators of ischemia, ectopic activity in patients with progressive angina.

  17. Microvascular angina in postmenopausal women.

    Directory of Open Access Journals (Sweden)

    Alexander Valdés Martín

    2011-10-01

    Full Text Available Fundamento: la angina microvascular es frecuente en mujeres posmenopáusicas. La isquemia miocárdica ha sido inducida mediante pruebas de estrés, en las que se ha comprobado una relación entre la disfunción endotelial y los defectos de perfusión miocárdica. Objetivo: determinar si la isquemia miocárdica puede evidenciarse por anormalidades de la perfusión y de la función detectadas por gammagrafía miocárdica en mujeres con angina típica, angiografía coronaria normal y disfunción endotelial. Métodos: estudio descriptivo realizado en el Instituto de Cardiología y Cirugía Cardiovascular de La Habana que incluyó 59 mujeres. Se les realizó lipidograma, se les midió función endotelial de la arteria braquial mediante ultrasonido, y estudio electrocardiográfico de 24 horas (Holter. Se aplicó un protocolo de estrés-reposo durante la gammagrafía. Las pacientes fueron divididas en dos grupos, acorde a la presencia (grupo I o ausencia (grupo II de defectos de perfusión miocárdica. Resultados: mostraron defectos de la perfusión 21 pacientes. El 57 % de las pacientes del grupo I exhibió más disfunción endotelial. Sólo doce pacientes mostraron defectos reversibles de la perfusión y en el 75 % de los casos se asoció a una reducción de la fracción de eyección ventricular izquierda postestrés mayor de un 5 % y a anormalidades regionales de la motilidad de la pared. Tres pacientes en el grupo I mostraron evidencia de isquemia comparado con cuatro en el grupo II. Conclusiones: la isquemia inducida por estrés se asocia a una reducción de la fracción de eyección ventricular izquierda postestrés y a una vasodilatación anormal dependiente del endotelio.

  18. Activities of the Oxazolidinones Linezolid and Eperezolid in Experimental Intra-Abdominal Abscess Due to Enterococcus faecalis or Vancomycin-Resistant Enterococcus faecium

    OpenAIRE

    1999-01-01

    The in vivo effectiveness of oxazolidinones eperezolid (U-100592) and linezolid (U-100766) against one strain each of Enterococcus faecalis and vancomycin-resistant Enterococcus faecium was examined in a rat model of intra-abdominal abscess. MICs of both drugs were 2 μg/ml for each strain. At doses of 25 mg/kg of body weight twice daily intravenously or orally, linezolid produced small but statistically significant reductions in abscess bacterial density for E. faecalis. The reduction in viab...

  19. Comparison of results of intracoronary stenting in patients with unstable vs. stable angina.

    Science.gov (United States)

    Malosky, S A; Hirshfeld, J W; Herrmann, H C

    1994-02-01

    Percutaneous transluminal coronary angioplasty (PTCA) has higher complication and restenosis rates when performed in the setting of unstable angina. Balloon-expandable intracoronary stenting is a new technique with the potential to improve the results of PTCA. In order to determine whether stenting is associated with a poorer outcome in patients with unstable angina, we retrospectively examined our experience with the Palmaz-Schatz balloon-expandable intracoronary stent in 105 patients. Patients were divided into 2 groups on the basis of symptoms at the time of stent insertion: group I (n = 57) had stable angina pectoris, and group II (n = 48) had unstable angina defined as pain at rest despite antianginal therapy (Braunwald class II, III). Initial (30-d) and final (6-mo) success rates were defined as stent insertion without myocardial infarction, need for bypass surgery, death, and significant angina. Baseline characteristics were similar, although the patients with unstable symptoms were older, more likely to be female, and had a higher incidence of postinfarction angina. A total of 136 stents were successfully delivered to 97 target sites in 92% of patients. Major complications occurred in 4 patients (4%) and were due to subacute thrombosis in 3 of them. There were no differences in complication rates between patients receiving stents electively with stable vs. unstable symptoms (2% vs. 6%, p = NS). Six-mo. follow-up status was ascertained in 96% of patients and revealed overall clinical success in 83% with angiographic restenosis (> or = 50% stenosis) in 28% of patients. There were no significant differences between groups in rates of restenosis, follow-up angina class, or overall clinical success.(ABSTRACT TRUNCATED AT 250 WORDS)

  20. Abdominal pain

    Science.gov (United States)

    Stomach pain; Pain - abdomen; Belly ache; Abdominal cramps; Bellyache; Stomachache ... Almost everyone has pain in the abdomen at some point. Most of the time, it is not serious. How bad your pain is does not always reflect the seriousness ...

  1. Abdominal actinomycosis.

    Science.gov (United States)

    Wagenlehner, F M E; Mohren, B; Naber, K G; Männl, H F K

    2003-08-01

    Intra-abdominal and extraperitoneal actinomycosis are rare infections, caused by different Actinomyces species. However, they have been diagnosed more frequently in the last ten years. We report three cases of abdominal actinomycosis and a literature review of the last eight years. All three patients were diagnosed by means of histopathologic examination only. In one case, an intrauterine device (IUD) was associated with the infection. Therapy consisted of surgical resection of the inflammatory, infected tissue, and long-term antibiotic therapy. All patients are free of recurrence. Abdominal actinomycosis should be included in the differential diagnosis of an abdominal pathology of insidious onset, especially when an IUD is in place. Even when infection had spread extensively, combined operative and antibiotic therapy cured most of the cases.

  2. Instabile Angina pectoris: nichtinvasive und invasive Diagnostik

    Directory of Open Access Journals (Sweden)

    Benzer W

    1999-01-01

    Full Text Available Patienten mit instabiler Angina pectoris befinden sich grundsätzlich in einer lebensbedrohlichen Situation, die eine notfallmäßige sofortige Klinikeinweisung und Einleitung einer maximalen medikamentösen Therapie unter intensivmedizinischer Überwachung nötig macht. Trotz moderner diagnostischer Möglichkeiten ist der Nachweis einer tatsächlich instabilen Angina pectoris nicht immer einfach. In der Beurteilung des klinischen Schweregrades der Symptomatik und der daraus abzuleitenden Prognose einer instabilen Angina pectoris hat sich zuletzt hauptsächlich die Braunwald-Klassifikation durchgesetzt. Die leichteste Form der instabilen Angina pectoris ist die Klasse IA1, die schwerste Form die Klasse IIIC3. Wenn eine EKG-Registrierung während einer Episode von Angina pectoris eine akute ST- Streckenveränderung zeigt, muß mit einem höheren Schweregrad der Erkrankung gerechnet werden. Das EKG ist darüber hinaus ein wichtiger prognostischer Marker für den Langzeitverlauf der Patienten über 6 Monate bis 1 Jahr. Die Bestimmung der kardialen Troponine ist heute ein unerläßlicher Eckpfeiler der Diagnostik und Risikostratifizierung von Patienten mit instabiler Angina pectoris. Wie in großen Studien gezeigt wurde, haben Patienten mit instabiler Angina pectoris und positivem Troponin T eine schlechtere Prognose als jene ohne Anstieg. Ist das Troponin I bzw. das Troponin T 6 Stunden nach Schmerzbeginn negativ, haben die Patienten ein sehr geringes Risiko ( 1% für ein folgendes kardiales Ereignis in den nächsten 30 Tagen. Bei den Troponin-positiven Patienten liegt die ereignisfreie Überlebensrate hingegen bei lediglich etwa 80%. Das C-reaktive Protein ist kein Prädiktor für die Prognose, gerade wenn die kardialen Troponine normal sind. Deshalb sollte dieser Parameter nicht als alleinstehender prognostischer Marker zur Abklärung der instabilen Angina pectoris verwendet werden. Das prognostische Gesamtbild der instabilen Angina pectoris

  3. A case of reninoma with variant angina

    Directory of Open Access Journals (Sweden)

    Hyung Ah Jo

    2014-06-01

    Full Text Available Reninoma is a tumor of the renal juxtaglomerular cell apparatus that causes hypertension and hypokalemia because of hypersecretion of renin. We present a case of a 29-year-old female patient with reninoma and concomitant variant angina. The patient had uncontrolled hypertension and elevated plasma renin activity and aldosterone levels. Imaging studies revealed a mass in the left kidney, which was further confirmed as a renin-producing lesion via selective venous catheterization. During the evaluation, the patient had acute-onset chest pain that was diagnosed as variant angina after a provocation test. After partial nephrectomy, the plasma renin activity and plasma aldosterone levels decreased and blood pressure normalized. We report a case of reninoma with variant angina.

  4. Bypass surgery versus stenting for the treatment of multivessel disease in patients with unstable angina compared with stable angina

    OpenAIRE

    de Feyter, Pim; Heuvel, P.; Unger, Felix; Beyar, R; Lindeboom, Wietze; de Valk, Vincent; Milo, S; Simon, Rudiger; Tyers, Frank; Regensburger, D.; Crean, Peter; Penn, Ian; McGovern, E; Cauwelaert, C.; Serruys, Patrick

    2002-01-01

    textabstractBACKGROUND: Earlier reports have shown that the outcome of balloon angioplasty or bypass surgery in unstable angina is less favorable than in stable angina. Recent improvements in percutaneous treatment (stent implantation) and bypass surgery (arterial grafts) warrant reevaluation of the relative merits of either technique in treatment of unstable angina. Methods and Results- Seven hundred fifty-five patients with stable angina were randomly assigned to coronary stenting (374) or ...

  5. Abdominal Sepsis.

    Science.gov (United States)

    De Waele, Jan J

    2016-08-01

    Abdominal infections are an important challenge for the intensive care physician. In an era of increasing antimicrobial resistance, selecting the appropriate regimen is important and, with new drugs coming to the market, correct use is important more than ever before and abdominal infections are an excellent target for antimicrobial stewardship programs. Biomarkers may be helpful, but their exact role in managing abdominal infections remains incompletely understood. Source control also remains an ongoing conundrum, and evidence is increasing that its importance supersedes the impact of antibiotic therapy. New strategies such as open abdomen management may offer added benefit in severely ill patients, but more data are needed to identify its exact role. The role of fungi and the need for antifungal coverage, on the other hand, have been investigated extensively in recent years, but at this point, it remains unclear who requires empirical as well as directed therapy.

  6. Activities of the oxazolidinones linezolid and eperezolid in experimental intra-abdominal abscess due to Enterococcus faecalis or vancomycin-resistant Enterococcus faecium.

    Science.gov (United States)

    Schülin, T; Thauvin-Eliopoulos, C; Moellering, R C; Eliopoulos, G M

    1999-12-01

    The in vivo effectiveness of oxazolidinones eperezolid (U-100592) and linezolid (U-100766) against one strain each of Enterococcus faecalis and vancomycin-resistant Enterococcus faecium was examined in a rat model of intra-abdominal abscess. MICs of both drugs were 2 microg/ml for each strain. At doses of 25 mg/kg of body weight twice daily intravenously or orally, linezolid produced small but statistically significant reductions in abscess bacterial density for E. faecalis. The reduction in viable cells observed would not likely be clinically relevant. Eperezolid was ineffective at this dose. At a dosage of 100 mg/kg/day, linezolid treatment led to an approximately 100-fold reduction in viable cells per gram of abscess. Against E. faecium infections, intravenous eperezolid and oral linezolid were effective, reducing densities approximately 2 log(10) CFU/g. Both oxazolidinones demonstrated activity against enterococci in this model. However, results were modest with the dosing regimens employed.

  7. Coronary angioplasty for early postinfarction unstable angina

    NARCIS (Netherlands)

    P.J. de Feyter (Pim); P.W.J.C. Serruys (Patrick); A. Soward; M.J.B.M. van den Brand (Marcel); E. Bos (Egbert); P.G. Hugenholtz (Paul)

    1986-01-01

    textabstractCoronary angioplasty was performed in 53 patients in whom unstable angina had reoccurred after 48 hr and within 30 days after sustained myocardial infarction. Single-vessel disease was present in 64% of the patients and multivessel disease in 36%. The preceding myocardial infarction had

  8. Abdominal Aortic Aneurysm (AAA)

    Science.gov (United States)

    ... News Physician Resources Professions Site Index A-Z Abdominal Aortic Aneurysm (AAA) Abdominal aortic aneurysm (AAA) occurs when atherosclerosis ... an abdominal aortic aneurysm treated? What is an abdominal aortic aneurysm? The aorta, the largest artery in the body, ...

  9. Stable and unstable angina: Identifying novel markers on circulating leukocytes.

    Science.gov (United States)

    Brown, Angus; Lattimore, Jo-Dee; McGrady, Michele; Sullivan, David; Dyer, Wayne; Braet, Filip; Dos Remedios, Cristobal

    2008-01-01

    There is currently no blood-based test that can rapidly and objectively distinguish between chest pain which is initiated by increased myocardial oxygen demand (stable angina pectoris (SAP)) and chest pain initiated due to decreased coronary blood flow (unstable angina pectoris (UAP)). Since leukocytes play an active role in the progression of coronary artery disease (CAD), we hypothesize these can provide novel markers of SAP and UAP. Here we use a microarray of 82 cluster of differentiation (CD) antibodies (plus controls) to selectively immobilize peripheral blood mononuclear cells. We find that the pattern of leukocyte immobilization from patients with CAD significantly differs from healthy donors. Within the CAD group, 15 SAP patients exhibited significant (p<0.05) changes in 8 of 82 CD antibody spots compared to 19 age-matched healthy blood donors. An additional ten CD antigens differed between healthy donors and patients with UAP (p<0.05). Furthermore, seven CD antibody spots are significantly different between SAP and UAP patients. These preliminary data suggest it is now appropriate to undertake a larger clinical trial to test the hypothesis that these antibody microarrays can monitor the progression from SAP to UAP.

  10. Association of interleukin-6 gene polymorphism with angina pectoris.

    Science.gov (United States)

    Amorim, Fernanda Gobbi; Campagnaro, Bianca Prandi; Tonini, Clarissa Loureiro; Norbim, Ana Paula Capua; Louro, Iuri Drummond; Vasquez, Elisardo Corral; Arruda, Jose Airton; Meyrelles, Silvana Santos

    2011-10-01

    In this study, we investigated the role of the -174G>C polymorphism of interleukin-6 (IL-6) as a predisposing factor to angina pectoris. Patients were separated into 2 groups: angina (N = 72) and nonangina (N = 71). There were no statistical differences between groups for all cardiovascular risk factors evaluated. The GG genotype frequency was 18% lower in the angina than in the non-angina group, whereas GC + CC was 18% higher in the angina group (P = .036). The frequency of G allele was 11% lower in the angina than in the nonangina group and C allele was 11% higher in the angina group (P = .043). Patients carrying the C allele showed a 2-fold increased risk for angina pectoris (P = .036). Our study demonstrates a high incidence of the -174G>C polymorphism of the IL-6 gene in patients with angina pectoris compared with those carrying the G allele, reinforcing the contribution of genetic factors to the symptoms of angina pectoris.

  11. Treating angina pectoris by acupuncture therapy.

    Science.gov (United States)

    Xu, Lixian; Xu, Hao; Gao, Wei; Wang, Wei; Zhang, Hui; Lu, Dominic P

    2013-01-01

    Acupuncture therapy on PC 6 (Neiguan) has a therapeutic effect on cardiac and chest ailments including angina pectoris. Additional beneficial acupuncture points are PC 4 (Ximen), HT 7 (Shenmen point), PC 7 (Daling point), PC 5 (Jianshi point), PC 3 (Quze point), CV 17 (Danzhong point), CV 6 (Qihai point), BL 15 (Xinshu point), L 20 (Pishu point), BL 17 (Geshu point), BL23 (Shenshu point), BL18 (Ganshu point), HT 5 (Tongli point), and ST36 (Zusanli point). Acupuncture not only quickly relieve the symptoms of acute angina pectoris, but also improve nitroglycerine's therapeutic effects. Therefore, it is an efficient simple therapeutic method used for emergency and for regular angina treatment. Review of studies on acupuncture therapy has shown effectiveness were between 80% to 96.2% that are almost as effective as conventional drug regimen. When compared with conventional medical treatment, the acupuncture therapy shows the obvious advantage of lacking, adverse side effects commonly associated with the Western anti-anginal drugs such as 1) Nitroglycerine (headache--63% with nitroglycerine patch and 50% with spray; syncope--4%; and dizziness--8% with patch; hypotension--4% with patch; and increased angina 2% with patch). 2) Isosorbide mononitrate (dizziness--3 to 5%; nausea/vomiting--2 to 4% and other reactions including hypotension, and syncope even with small doses). 3) Propranolol (bradycardia, chest pain, hypotension, worsening of AV conduction disturbance, Raynaud's syndrome, mental depression, hyperglycemia, etc.). Many conventional anti-anginal medications cause inter-drug reactions with other medications the patients taking for other diseases. Whereas, acupuncture therapy does not pose such an interference with patient's medications. Nevertheless, surgery is still the treatment of choice when acupuncture or conventional drug therapy fails. Combination of conventional drug therapy and acupuncture would considerably decrease the frequency and the required dosage

  12. Angina pectoris: current therapy and future treatment options.

    Science.gov (United States)

    Parikh, Raj; Kadowitz, Philip J

    2014-02-01

    Angina pectoris is the consequence of an inequality between the demand and supply of blood to the heart. Angina manifests itself as chest pain or discomfort and is a common complaint of patients in the hospital and in the clinic. There are, in fact, roughly half a million new cases of angina per year. Chest pain, while having many etiologies, is generally considered to be most lethal when related to a cardiac cause. In this review, the authors outline the current medical and surgical therapies that are used in the management of angina. Highlights of the various clinical trials that have assisted in the investigation of these therapies are summarized also. Then, the authors provide a focused review of the novel therapy options for angina that are currently being explored. From new medical treatments to revised surgical techniques to the discovery of stem cell therapy, many innovative options are being investigated for the treatment of angina.

  13. A rare cause of Ludwig's angina by Morganella morganii.

    Science.gov (United States)

    Ho, Min-Po; Tsai, Kuang-Chau; Yen, Szu-Lin; Lu, Cheng-Lin; Chen, Chia-Hung

    2006-10-01

    Ludwig's angina is a rapidly spreading and potentially lethal infection involving the floor of the mouth and neck. We present a rare case of Ludwig's angina caused by an unusual microorganism, Morganella morganii, and the group D alpha-hemolytic streptococcus. To our knowledge, this is the first case of Ludwig's angina and deep neck infection caused by Morganella morganii. Adequate airway maintenance, appropriate use of antibiotics and surgical drainage resulted in survival of the patient without complications.

  14. Resultados da cirurgia do aneurisma da aorta abdominal em pacientes jovens Outcomes after surgical repair of abdominal aortic aneurysms in young patients

    Directory of Open Access Journals (Sweden)

    Telmo P. Bonamigo

    2009-06-01

    Full Text Available CONTEXTO: A presença de aneurisma da aorta abdominal (AAA é rara em pacientes jovens. OBJETIVO: Avaliar os resultados da cirurgia do AAA em pacientes com idade BACKGROUND: Abdominal aortic aneurysms (AAA are rare in young patients. OBJECTIVE: To evaluate outcomes after AAA repair in patients aged < 50 years. METHODS: Between June 1979 and January 2008, 946 patients underwent elective repair for an infrarenal AAA performed by the first author. Of these, 13 patients (1.4% were < 50 years old at surgery. Demographic characteristics and surgical data were analyzed, as well as early and late outcomes after surgical intervention. RESULTS: Mean age was 46±3.4 years (ranging from 43 to 50 years. Most patients were men (76.9%, hypertensive (76.9% and smokers (61.5%. Perioperative morbidity and mortality rates were low (15.4% and 0%, respectively; one patient had respiratory infection and another patient had unstable angina. Median follow-up was 85.5 months, and two patients died due to ischemic cardiopathy and cerebrovascular accident during the follow-up period. CONCLUSION: AAA repair in young patients is a safe procedure, with good long-term results. In our study, there were no perioperative deaths, and a good long-term survival was observed.

  15. Use of ranolazine in patients with stable angina pectoris.

    Science.gov (United States)

    Khera, Sahil; Kolte, Dhaval; Aronow, Wilbert S

    2014-01-01

    The current American Heart Association/American College of Cardiology guidelines for patients with stable angina pectoris recommend β-blockers as the initial drug therapy for prevention of angina pectoris (class I B indication). Long-acting nitrates or calcium channel blockers should be prescribed for prevention of angina when β-blockers are contraindicated or not tolerated secondary to side effects (class I B indication). Long-acting nitrates or calcium channel blockers in combination with β-blockers should be prescribed for angina prevention when initial treatment with β-blockers is unsuccessful (class I B indication). Only sublingual nitroglycerin or nitroglycerin spray should be used for immediate relief of angina pectoris (class I B indication). Ranolazine with β-blockers can be used for prevention of angina when initial treatment with β-blockers is not successful (class IIa A indication). If angina persists despite treatment with β-blockers, long-acting nitrates and calcium channel blockers, we recommend the addition of ranolazine for prevention of stable angina pectoris. This editorial discusses the contemporary role of ranolazine in the management of patients with stable angina pectoris.

  16. Effectiveness of Ivabradine in Treating Stable Angina Pectoris.

    Science.gov (United States)

    Ye, Liwen; Ke, Dazhi; Chen, Qingwei; Li, Guiqiong; Deng, Wei; Wu, Zhiqin

    2016-04-01

    Many studies show that ivabradine is effective for stable angina.This meta-analysis was performed to determine the effect of treatment duration and control group type on ivabradine efficacy in stable angina pectoris.Relevant articles in the English language in the PUBMED and EMBASE databases and related websites were identified by using the search terms "ivabradine," "angina," "randomized controlled trials," and "Iva." The final search date was November 2, 2015.Articles were included if they were published randomized controlled trials that related to ivabradine treatment of stable angina pectoris.Patients with stable angina pectoris were included.The patients were classified according to treatment duration (ivabradine and control groups, respectively. The ivabradine group had significantly longer exercise duration when they had been treated for at least 3 months, but not when treatment time was less than 3 months. Ivabradine significantly improved time to angina onset regardless of treatment duration. Control group type did not influence the effect of exercise duration (significant) or time to angina onset (significant).Compared with beta-blocker and placebo, ivabradine improved exercise duration and time to onset of angina in patients with stable angina. However, its ability to improve exercise duration only became significant after at least 3 months of treatment.

  17. Pulmonary artery dilatation: an overlooked mechanism for angina pectoris.

    Science.gov (United States)

    Ginghina, Carmen; Popescu, Bogdan A; Enache, Roxana; Ungureanu, Catalina; Deleanu, Dan; Platon, Pavel

    2008-07-01

    Dilatation of the pulmonary artery may lead to the compression of adjacent structures. Of those, the extrinsic compression of the left main coronary artery is the most worrisome. We present the case of a 48-year-old woman who was diagnosed with pulmonary artery dilatation due to severe, thromboembolic pulmonary hypertension. She also had angina and coronary angiography revealed a 70% ostial stenosis of the left main coronary artery. The presence of this isolated lesion in a young woman without risk factors for atherosclerosis suggests extrinsic compression of the left main coronary artery by the dilated pulmonary artery as the likely mechanism. The patient underwent direct stenting of the left main coronary stenosis with a good result.

  18. An Unusual Case of Suspected Microvascular Angina in a Newborn

    Directory of Open Access Journals (Sweden)

    Stefania Cataldo

    2012-01-01

    Full Text Available Myocardial ischemia in pediatric population is uncommon and usually due to congenital heart disease or extracardiac conditions leading to poor coronary perfusion. A 6-day-old newborn presented with respiratory distress and signs of heart failure. ECG, echocardiography, and laboratory results were consistent with myocardial ischemia. Coronary angiography was performed to exclude anomalous origin of coronary arteries, showing normal coronary artery origin and course. Thrombophilia and extra-cardiac causes were ruled out. Clinical conditions improved with mechanical ventilation and diuretics, enzyme levels lowered, repolarisation and systolic function abnormalities regressed, but ischemic electrocardiographic and echocardiographic signs still presented during intense crying. Becaues of suspicion of microvascular angina, therapy with ASA and beta-blocker was started. At 5 month followup, the baby was in good clinical condition and no more episodes were recorded. We believe it is an interesting case, as no similar cases have been recorded till now.

  19. An Unusual Presentation of Ludwig’s Angina Complicated by Cervical Necrotizing Fasciitis: A Case Report and Review of the Literature

    OpenAIRE

    Kristelle Chueng; Clinkard, David J.; Danny Enepekides; Yousef Peerbaye; Lin, Vincent Y. W.

    2012-01-01

    Ludwig’s angina can seldom be complicated by necrotizing fasciitis. Due to the rapidly progressing nature of this infection and the potential for airway compromise and death, it is important to be aware of different ways in which this disease process can present in order to recognize and treat it emergently. We report here an unusual presentation of a case of Ludwig’s angina complicated by necrotizing fasciitis in an elderly patient. The clinical features, diagnosis, and treatment are discuss...

  20. Tratamento de angina mesentérica em pacientes com arterite de Takayasu Treatment of mesenteric angina in patients with Takayasu's arteritis

    Directory of Open Access Journals (Sweden)

    Luana Thayse Barros de Lima

    2011-04-01

    Full Text Available Aarterite de Takayasu (AT é uma doença inflamatória crônica do tecido conectivo, idiopática, que acomete preferencialmente a aorta e seus ramos. A terapêutica utilizada baseia-se sobretudo no uso de corticosteroides e imunossupressores. É relatado o caso de uma paciente, 33 anos, com mal-estar, febre, mialgia, cefaleia intensa, pulsátil, holocraniana, resistente a analgésicos, hipertensão arterial sistêmica de difícil controle, claudicação no membro inferior direito e dor abdominal de forte intensidade, a qual piorava após a alimentação. A angiotomografia revelou aneurisma da aorta ascendente, estenose da artéria ilíaca comum direita, estenose das artérias renais e estenose da artéria mesentérica superior, fato que embasou o diagnóstico de angina mesentérica e a conduta intervencionista através da angioplastia transluminal percutânea múltipla com a colocação de stents.Takayasu's arteritis (TA is an idiopathic chronic inflammatory disease of the connective tissue that affects mainly the aorta and its branches. Treatment is mainly based on corticosteroids and immunosuppressants. We report the case of a 33-year-old female complaining of malaise, fever, myalgia, severe pulsing holocranial headache resistant to analgesics, systemic arterial hypertension hard to control, right lower limb claudication, and severe abdominal pain that worsened after the meals. Angiotomography revealed aneurysm of the ascending aorta, and stenosis of the following vessels: right common iliac artery, renal arteries, and superior mesenteric artery. Those findings supported the diagnosis of mesenteric angina and the interventional approach by use of percutaneous transluminal angioplasty with stent placement.

  1. Xuesaitong Soft Capsule (Chinese Patent Medicine for the Treatment of Unstable Angina Pectoris: A Meta-Analysis and Systematic Review

    Directory of Open Access Journals (Sweden)

    Xiaochen Yang

    2013-01-01

    Full Text Available Objective. To provide a systematic review to evaluate the effectiveness and safety of Xuesaitong soft capsule (XST in treating unstable angina (UA. Methods. An extensive search of 6 medical databases was performed up to August 2013. Randomized controlled trials (RCTs involving XST alone or combined with conventional drugs versus conventional drugs were included. A meta-analysis of reduction of angina symptoms and electrocardiogram (ECG improvement was performed to evaluate the effects of XST on UA. Results. After researching, a total of 6 RCTs with 716 participants were included. Our review showed that XST combined with conventional drugs had significant effect on relieving angina symptoms (RR: 1.14 [1.07,1.22]; P=0.0001 and improving ECG (RR: 1.26 [1.12,1.42]; P=0.0001 compared with conventional drugs alone. Conclusions. XST appears to have beneficial effects on improvement of ECG, reduction of angina symptoms, and decreasing the frequency and duration of angina attack in participants with UA. However, the findings should be interpreted with caution due to the poor methodological quality of the included trials.

  2. Physicians' Abdominal Auscultation

    DEFF Research Database (Denmark)

    John, Gade; Peter, Kruse; Andersen, Ole Trier

    1998-01-01

    Background: Abdominal auscultation has an important position in the physical examination of the abdomen. Little is known about rater agreement. The aim of this study was to describe rater agreement and thus, indirectly, the value of the examination. Methods: In a semi-virtual setup 12 recordings...... of the intestinal sounds from 8 patients with acute abdominal pain and 4 healthy volunteers were presented to 100 physicians. The physicians were asked to characterize the intestinal sounds as normal or pathologic. Fisher's exact test was used for comparison between groups of physicians. Results: Overall, 72......% of the answers with regard to healthy volunteers concluded that the sounds were normal (equalling agreement), whereas 64% of answers with regard to intestinal obstruction concluded that the sounds were pathologic (but agreement was higher due to agreement on wrong diagnosis in one case). Bowel sounds from...

  3. Ludwig's angina after severe thrombocytopenic purpura associated with dengue fever

    Directory of Open Access Journals (Sweden)

    Maria Antonia Campos

    2014-01-01

    Full Text Available Here, we report a case of Ludwig's angina, which required surgery because of toothache. The patient had dengue and severe thrombocytopenia as confirmed by clinical and laboratory diagnoses. However, dengue is not included among the predisposing factors for Ludwig's angina.

  4. Necrotizing fasciitis in association with Ludwig's angina - A case report.

    Science.gov (United States)

    Kavarodi, A M

    2011-07-01

    A 28 year old male diabetic patient developed Ludwig's angina which subsequently evolved into cervicofacial necrotizing fasciitis. The differential characteristic of Ludwig's angina and cervicofacial necrotizing fasciitis, as it relates to this rare presentation is discussed. The clinical and radiological features, pathophysiology, diagnosis and the management that resulted in a successful outcome are presented.

  5. Angina de Ludwig. Reporte de 2 casos

    OpenAIRE

    Antonio Fabbio Gagliardi Lugo; María Gabriela Contreras Ravago; Ronar Alejandro Gudiño Martinez; Rafael José Zeballos Peltrini

    2014-01-01

    La angina de Ludwig (AL) es una entidad patológica, odontogénica e infecciosa que representa una situación de emergencia en la Cirugía Bucal y Maxilofacial por comprometer la vida del paciente debido a una progresiva oclusión de la vía aérea, producto del avance de la infección hacia los espacios submandibulares, sublinguales y submental, lo que trae como consecuencia el colapso de la misma. En el presente trabajo se hace una revisión de la literatura actualizada acerca de dicha entidad, orig...

  6. Preinfarction angina: old story initiates new attention

    Institute of Scientific and Technical Information of China (English)

    GE Jun-bo

    2012-01-01

    Since first report by Murry et al1 in 1986,the role of ischemia preconditioning before sustained coronary occlusion in protecting myocardium and reducing infarct size has been identified in animal studies.2-4 The mechanism underlying the endogenous cardioprotective effects of ischemia preconditioning is complex and may involve humoral,neural,or a combination of both,with different signaling pathwaysinvolving adenosine,bradykinin,protein kinases and K(ATP) channels.5,6 In humans,episodes of angina before acute myocardial infarction (AMI) may also confer a preconditioning or protective effect.

  7. Bypass surgery versus stenting for the treatment of multivessel disease in patients with unstable angina compared with stable angina

    NARCIS (Netherlands)

    P.J. de Feyter (Pim); P. van den Heuvel; F. Unger (Felix); R. Beyar; W.K. Lindeboom (Wietze); V. de Valk (Vincent); S. Milo; R. Simon (Rudiger); G.F.O. Tyers (Frank); D. Regensburger; P.A. Crean (Peter); I.M. Penn (Ian); E. McGovern; C. van Cauwelaert; P.W.J.C. Serruys (Patrick)

    2002-01-01

    textabstractBACKGROUND: Earlier reports have shown that the outcome of balloon angioplasty or bypass surgery in unstable angina is less favorable than in stable angina. Recent improvements in percutaneous treatment (stent implantation) and bypass surgery (arterial grafts) warrant reevaluation of the

  8. Effects of successful percutaneous transluminal coronary angioplasty on global and regional left ventricular function in unstable angina pectoris

    NARCIS (Netherlands)

    P.J. de Feyter (Pim); H. Suryapranata (Harry); P.W.J.C. Serruys (Patrick); K.J. Beatt (Kevin); M.J.B.M. van den Brand (Marcel); P.G. Hugenholtz (Paul)

    1987-01-01

    textabstractSixty-eight patients (58 men, 10 women, mean age 56.3 years, range 31 to 72) with unstable angina pectoris, either initially stabilized with or refractory to optimal pharmacologic treatment, were studied to determine whether regional dysfunction due to stunning of the myocardium caused b

  9. Burden of Hospital Admission and Repeat Angiography in Angina Pectoris Patients with and without Coronary Artery Disease

    DEFF Research Database (Denmark)

    Jespersen, Lasse; Abildstrom, Steen Z; Hvelplund, Anders

    2014-01-01

    AIMS: To evaluate risk of hospitalization due to cardiovascular disease (CVD) and repeat coronary angiography (CAG) in stable angina pectoris (SAP) with no obstructive coronary artery disease (CAD) versus obstructive CAD, and asymptomatic reference individuals. METHODS AND RESULTS: We followed 11...

  10. Frequency of Angina Pectoris After Percutaneous Coronary Intervention and the Effect of Metallic Stent Type.

    Science.gov (United States)

    Gaglia, Michael A; Torguson, Rebecca; Lipinski, Michael J; Gai, Jiaxiang; Koifman, Edward; Kiramijyan, Sarkis; Negi, Smita; Rogers, Toby; Steinvil, Arie; Suddath, William O; Satler, Lowell F; Pichard, Augusto D; Waksman, Ron

    2016-02-15

    Although metallic coronary stents significantly reduce angina pectoris compared with optimal medical therapy, angina after percutaneous coronary intervention (PCI) remains frequent. We, therefore, sought to compare the incidence of any angina during the 1 year after PCI among the spectrum of commercially available metallic stents. Metallic stent type was classified as bare metal stent, Cypher, Taxus Express, Xience V, Promus Element, and Resolute. The primary end point was patient-reported angina within 1 year of PCI. Multivariable logistic regression was performed to assess the independent association of stent type with any angina at 1 year. Overall, 8,804 patients were queried in regard to angina symptoms; 32.3% experienced angina at some point in the first year after PCI. Major adverse cardiovascular events, a composite of all-cause mortality, target vessel revascularization, and Q-wave myocardial infarction, increased with angina severity: 6.8% for patients without angina, 10.0% for patients with class 1 or 2 angina, and 19.7% for patients with class 3 or 4 angina (p angina at 1 year after PCI. Baseline Canadian Cardiovascular Society class 3 or 4 angina, history of coronary artery bypass grafting, and history of PCI were associated with a higher likelihood of angina at 1 year; increasing age, male gender, presentation with acute coronary syndrome, and higher stented length were associated with less angina. In conclusion, metallic stent type is not associated with the occurrence of angina at up to 1 year after PCI.

  11. Percutaneous Device to Narrow the Coronary Sinus: Shifting Paradigm in the Treatment of Refractory Angina?

    Directory of Open Access Journals (Sweden)

    Daniela Benedetto

    2016-10-01

    Full Text Available Refractory angina pectoris is defined as a chronic debilitating condition characterized by the presence of chronic anginal symptoms due to a severe obstructive and/or diffuse coronary artery disease that cannot be controlled by the combination of medical therapy and / or revascularization (percutaneous or surgical. In addition the presence of myocardial ischemia as a cause of the symptoms must have been documented. The coronary sinus Reducer (CSR is a recently introduced percutaneous device to treat patients with severe anginal symptoms refractory to optimal medical therapy and not amenable to conventional revascularization. The purpose of this review is to describe the current evidence from available studies measuring the clinical effect of the CSR implantation on the health and well-being of patients with refractory angina.

  12. Efficacy of Ligustrazine Injection as Adjunctive Therapy for Angina Pectoris: A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Shao, Huikai; Zhao, Lingguo; Chen, Fuchao; Zeng, Shengbo; Liu, Shengquan; Li, Jiajia

    2015-11-29

    BACKGROUND In the past decades, a large number of randomized controlled trials (RCTs) on the efficacy of ligustrazine injection combined with conventional antianginal drugs for angina pectoris have been reported. However, these RCTs have not been evaluated in accordance with PRISMA systematic review standards. The aim of this study was to evaluate the efficacy of ligustrazine injection as adjunctive therapy for angina pectoris. MATERIAL AND METHODS The databases PubMed, Medline, Cochrane Library, Embase, Sino-Med, Wanfang Databases, Chinese Scientific Journal Database, Google Scholar, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, and the Chinese Science Citation Database were searched for published RCTs. Meta-analysis was performed on the primary outcome measures, including the improvements of electrocardiography (ECG) and the reductions in angina symptoms. Sensitivity and subgroup analysis based on the M score (the refined Jadad scores) were also used to evaluate the effect of quality, sample size, and publication year of the included RCTs on the overall effect of ligustrazine injection. RESULTS Eleven RCTs involving 870 patients with angina pectoris were selected in this study. Compared with conventional antianginal drugs alone, ligustrazine injection combined with antianginal drugs significantly increased the efficacy in symptom improvement (odds ratio [OR], 3.59; 95% confidence interval [CI]: 2.39 to 5.40) and in ECG improvement (OR, 3.42; 95% CI: 2.33 to 5.01). Sensitivity and subgroup analysis also confirmed that ligustrazine injection had better effect in the treatment of angina pectoris as adjunctive therapy. CONCLUSIONS The 11 eligible RCTs indicated that ligustrazine injection as adjunctive therapy was more effective than antianginal drugs alone. However, due to the low quality of included RCTs, more rigorously designed RCTs were still needed to verify the effects of ligustrazine injection as adjunctive therapy for

  13. Selection of medical treatment in stable angina pectoris

    DEFF Research Database (Denmark)

    Ardissino, D; Savonitto, S; Egstrup, K

    1995-01-01

    pectoris. BACKGROUND: The characteristics of anginal symptoms and the results of exercise testing are considered of great importance for selecting medical treatment in patients with chronic stable angina pectoris. However, little information is available on how this first evaluation may be used to select...... the best pharmacologic approach in individual patients. METHODS: In this prospective multicenter study, 280 patients with stable angina pectoris were enrolled in 25 European centers. After baseline evaluation, consisting of an exercise test and a questionnaire investigating patients' anginal symptoms....... CONCLUSIONS: The results of a baseline exercise test, but not the characteristics of anginal symptoms, may offer useful information for selecting medical treatment in stable angina pectoris....

  14. Ranolazin--ny behandling af kronisk stabil angina pectoris

    DEFF Research Database (Denmark)

    Ahlehoff, Ole; Hansen, Peter Riis

    2009-01-01

    Ranolazine sustained-release tablets were recently approved in the EU for chronic stable angina as add-on therapy when symptoms are not controlled with first-line agents. The mechanism of action is thought to involve inhibition of late sodium influx in the heart, which can reduce abnormalities...... of contractility and repolarisation associated with ischaemia. Ranolazine increases the exercise capacity, reduces angina, and diminishes the use of nitroglycerine. The drug has an excellent safety profile and may be a valuable addition to the treatment of chronic stable angina....

  15. Anipamil prevents ST depression in patients with stable angina pectoris

    DEFF Research Database (Denmark)

    Larsen, C T; Sørum, C; Rasmussen, V

    1993-01-01

    . The patients received anipamil 80 mg once daily, anipamil 160 mg once daily, and placebo in a randomized order. At the end of each treatment period the patients underwent 24-hour ambulatory ECG recording. Nineteen patients were included, all with typical stable angina pectoris for at least 2 months, exercise...... test with > or = 0.10 mV horizontal or down-sloping ST-segment depression and limited by angina pectoris, and at least 10 attacks of angina pectoris in the initial single-blind placebo period. During the placebo period, a total duration of transient myocardial ischemia > or = 0.10 mV during the 24-hour...

  16. Angina bullosa hemorrhagica: report of 11 cases

    Directory of Open Access Journals (Sweden)

    Julieta Ruiz Beguerie

    2014-05-01

    Full Text Available Angina bullosa hemorrhagica is a rare and benign disorder, usually localized in the subepithelial layer of the oral, pharyngeal and esophageal mucosa. The lesions are characterized by their sudden onset. They appear as a painless, tense, dark red and blood-filled blister in the mouth that rapidly expand and rupture spontaneously in 24-48 hours. The underlying etiopathology remains ill defined, although it may be a multifactorial phenomenon including diabetes, and steroid inhalers. The condition is not attributable to blood dyscrasias, nor other vesicular-bullous disorders. In this study, eleven patients with such blisters are described. Physical examination of the patients revealed a single blister with hemorrhagic content localized in the oral mucosa. Biopsy of the lesions showed sub epithelial blisters with a mild infiltrate. In general practice, dermatologists could face a blood-filled bullous lesion of the oral mucosa. Recognition is, therefore, of great importance for dermatologists.

  17. Unstable angina of crescendo pattern vs new onset: a clinical, coronary arteriographic and hemodynamic study.

    Science.gov (United States)

    Hussain, K M; Gould, L; Bharathan, T; Abdelsayed, G; Karpov, Y

    1995-06-01

    Unstable angina includes a variety of clinical presentations with a different level of risk for an unfavorable outcome. In this study the authors investigated the prognostic significance of crescendo angina and new-onset angina to discuss management strategies, paying attention to the relevance of baseline clinical characteristics, coronary artery lesions, and left ventricular function, as well as their alterations during atrial pacing. Accordingly coronary arteriographic anatomy and changes in left ventricular volumes and ejection fraction before and during atrial pacing were studied by means of digital subtraction ventriculography in 18 patients with crescendo angina and in 18 patients with new-onset angina. Triple-vessel disease was more frequently observed in crescendo angina (56%; P crescendo angina. The angiographic evidence of intracoronary thrombi was found in 33% (P crescendo angina and in 4% patients with new-onset angina. Compared with the patients with new-onset angina, patients with crescendo angina had higher end-diastolic and end-systolic volumes and lower ejection fraction at rest. At peak pacing, ejection fraction was significantly (P crescendo angina (0.48 +/- 0.06) than in new-onset angina (0.66 +/- 0.04). In crescendo angina, during pacing, the magnitude of velocity of circumferential fiber shortening was significantly decreased as compared with new-onset angina.(ABSTRACT TRUNCATED AT 250 WORDS)

  18. [Abdominal pregnancy care. Case report].

    Science.gov (United States)

    Morales Hernández, Sara; Díaz Velázquez, Mary Flor; Puello Tamara, Edgardo; Morales Hernández, Jorge; Basavilvazo Rodríguez, Maria Antonia; Cruz Cruz, Polita del Rocío; Hernández Valencia, Marcelino

    2008-10-01

    Abdominal pregnancies are the implantation of gestation in some of the abdominal structures. This kind of pregnancies represents sevenfold maternal death risk than tubarian ectopic pregnancies, and 90-fold death risk than normal ones. Previous cases have erroneously reported as abscess in Douglas punch, and frequently result in obitus or postnatal deaths. We report a case of a patient with 27 years old, and diagnosis of 25.2 weeks of pregnancy, prior placenta and anhidramnios, referred due to difficult in uterine contour delimitation, easy palpation of fetal parts, cephalic pole in left hypochondrious and presence of mass in hypogastria, no delimitations, pain with mobilization, no transvaginal bleed and fetal movements. Interruption of pregnancy is decided by virtue of severe oligohidramnios, retardation in fetal intrabdominal growth, and recurrent maternal abdominal pain. Surgical intervention was carried out for resolution of the obstetrical event, in which was found ectopic abdominal pregnancy with bed placental in right uterine horn that corresponded to a pregnancy of 30 weeks of gestation. Abdominal pregnancy is still a challenge for obstetrics due to its diagnosis and treatment. Early diagnosis is oriented to prevent an intrabdominal hemorrhage that is the main maternal cause of mortality.

  19. Invaliderende angina pectoris behandlet med elektrisk rygmarvsstimulation (ERS)

    DEFF Research Database (Denmark)

    Andersen, C; Clemensen, S E; Henneberg, S W

    1992-01-01

    Thirty patients who had severe incapacitating angina pectoris which had not reacted to the conventional therapeutic measures and which required massive daily opioid consumption were treated with electrical spinal cord stimulation (SCS) by means of a completely implantable stimulation system...

  20. Neurostimulation bei refraktärer Angina pectoris

    Directory of Open Access Journals (Sweden)

    Theres H

    2005-01-01

    Full Text Available Trotz großer Fortschritte der katheterinterventionellen und operativen Versorgung der koronaren Herzkrankheit (KHK verbleiben Patienten, bei denen eine Revaskularisierung nicht möglich ist. Besteht eine ausgeprägte Angina pectoris (CCS III–IV, so sprechen wir von einer "refraktären Angina pectoris". Eine Arbeitsgruppe der Europäischen Gesellschaft für Kardiologie führt die Neurostimulation an erster Stelle der alternativen Therapiemöglichkeiten für diese Patienten an. Zahlreiche Studien belegen, daß es sich dabei um eine effiziente und sichere adjuvante Therapie handelt. Sie führt zu einer Abnahme der Angina pectoris-Symptomatik mit konsekutiver Zunahme der körperlichen Leistungsfähigkeit. Ingesamt wird eine entscheidende Verbesserung der Lebensqualität erzielt, die Angina pectoris als Warnsymptom bei Myokardinfarkt wird jedoch nicht maskiert.

  1. Phase changes caused by hyperventilation stress in spastic angina pectoris analyzed by first-pass radionuclide ventriculography

    Energy Technology Data Exchange (ETDEWEB)

    Wu, Jin; Takeda, Tohoru; Ajisaka, Ryuichi; Masuoka, Takeshi; Watanabe, Sigeyuki; Sato, Motohiro; Itai, Yuji [Tsukuba Univ., Ibaraki (Japan). Inst. of Clinical Medicine; Toyama, Hinako; Ishikawa, Nobuyoshi

    1999-02-01

    To understand the effect of hyperventilation (HV) stress in patients with spastic angina, left ventricular (LV) contraction was analyzed by quantitative phase analysis. The study was performed on 36 patients with spastic angina pectoris, including vasospastic angina pectoris (VspAP: 16 patients) and variant angina pectoris (VAP: 20 patients). First-pass radionuclide ventriculography (first-pass RNV) was performed at rest and after HV stress, and standard deviation of the LV phase distribution (SD) was analyzed. The SD was lower in patients with VspAP than in VAP(12.8{+-}1.4 degrees vs. 14.6{+-}2.2 degrees, p<0.005) at rest. After HV stress, the SD (HVSD) tended to increase in VspAP patients (62.5%), whereas the SD decreased in VAP patients (70%). Due to HV stress, the percentage change in SD (%SD) in VspAP patients was 8.9{+-}23.7% whereas that in VAP patients was -9.1{+-}17.3% (p<0.01). Moreover, phase histograms were divided into HVSD increase and HVSD decrease groups. The HVSD increase group had a decrease of HVEF, but the HVSD decrease group tended to have more decreased HVEF than the HVSD increase group. These results indicate that spastic angina pectoris patients show various responses to HV stress. The HVSD increase group might have additional myocardial ischemia due to regional coronary spasm. In contrast, in the HVSD decrease group severe LV dysfunction or diffuse wall motion abnormality might have been generated, and this caused a reduction in the SD value. Phase analysis would therefore add new information regarding electrocardiographically silent myocardial ischemia due to coronary spasm, and HV stress might increase sensitivity for the detection of abnormalities in quantitative phase analysis, especially in VspAP patients. (author)

  2. The Role of Ivabradine in the Management of Angina Pectoris.

    Science.gov (United States)

    Giavarini, Alessandra; de Silva, Ranil

    2016-08-01

    Stable angina pectoris affects 2-4 % of the population in Western countries and entails an annual risk of death and nonfatal myocardial infarction of 1-2 % and 3 %, respectively. Heart rate (HR) is linearly related to myocardial oxygen consumption and coronary blood flow, both at rest and during stress. HR reduction is a key target for the prevention of ischemia/angina and is an important mechanism of action of drugs which are recommended as first line therapy for the treatment of angina in clinical guidelines. However, many patients are often unable to tolerate the doses of beta blocker or non-dihydropyridine calcium antagonists required to achieve the desired symptom control. The selective pacemaker current inhibitor ivabradine was developed as a drug for the management of patients with angina pectoris, through its ability to reduce HR specifically. The available data suggest that ivabradine is a well-tolerated and effective anti-anginal agent and it is recommended as a second-line agent for relief of angina in guidelines. However, recent clinical trials of ivabradine have failed to show prognostic benefit and have raised potential concerns about safety. This article will review the available evidence base for the current role of ivabradine in the management of patients with symptomatic angina pectoris in the context of stable coronary artery disease.

  3. Abdominal radiation - discharge

    Science.gov (United States)

    Radiation - abdomen - discharge; Cancer - abdominal radiation; Lymphoma - abdominal radiation ... When you have radiation treatment for cancer, your body goes through changes. About 2 weeks after radiation treatment starts, you might notice changes ...

  4. Abdominal aortic aneurysm

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/000162.htm Abdominal aortic aneurysm To use the sharing features on this page, ... blood to the abdomen, pelvis, and legs. An abdominal aortic aneurysm occurs when an area of the aorta becomes ...

  5. Abdominal and Pelvic CT

    Medline Plus

    Full Text Available ... accurate. In emergency cases, it can reveal internal injuries and bleeding quickly enough to help save lives. ... kidney and bladder stones. abdominal aortic aneurysms (AAA), injuries to abdominal organs such as the spleen, liver, ...

  6. Renal artery stenosis presenting as crescendo angina pectoris.

    Science.gov (United States)

    Tami, L F; McElderry, M W; al-Adli, N M; Rubin, M; Condos, W R

    1995-07-01

    The coexistence of different clinical syndromes due to atherosclerosis in different organs is not rare and emphasizes the diffuse nature of this vascular process. Although renovascular disease may cause hypertension and/or renal insufficiency, it may also occur in the absence of the usual clinical markers that suggest renovascular hypertension. We report a patient with stable coronary anatomy who presented with crescendo angina pectoris. Diagnosis of renovascular hypertension was made by screening renal angiography at the time of the cardiac catheterization. Renal artery stenting resulted in stabilization of the coronary syndrome and obviated the need for further coronary intervention. To our knowledge, this is the first case of renovascular hypertension precipitating an unstable coronary syndrome in a patient with documented stable coronary anatomy. Review of the literature supports that patients undergoing cardiac catheterization are a high risk population for renovascular disease, particularly in the presence of other predictive factors such as documented coronary artery disease, older age, female gender, congestive heart failure, peripheral vascular disease, renal insufficiency, and smoking. Firm recommendations for routine screening renal angiography in patients undergoing peripheral or coronary angiography will need further studies.

  7. Performing stable angina pectoris: an ethnographic study.

    Science.gov (United States)

    Somerville, Claire; Featherstone, Katie; Hemingway, Harry; Timmis, Adam; Feder, Gene Solomon

    2008-04-01

    Symptoms play a crucial part in the formulation of medical diagnoses, yet the construction and interpretation of symptom narratives is not well understood. The diagnosis of angina is largely based on symptoms, but a substantial minority of patients diagnosed with "non-cardiac" chest pain go on to have a heart attack. In this ethnographic study our aims were to understand: (1) how the patients' accounts are performed or enacted in consultations with doctors; (2) the ways in which ambiguity in the symptom narrative is managed by doctors; and (3) how doctors reach or do not reach a diagnostic decision. We observed 59 consultations of patients in a UK teaching hospital with new onset chest pain who had been referred for a specialist opinion in ambulatory care. We found that patients rarely gave a history that, without further interrogation, satisfied the doctors, who actively restructured the complex narrative until it fitted a diagnostic canon, detaching it from the patient's interpretation and explanation. A minority of doctors asked about chest pain symptoms outside the canon. Re-structuring into the canonical classification was sometimes resisted by patients who contested key concepts, like exertion. Symptom narratives were sometimes unstable, with central features changing on interrogation and re-telling. When translation was required for South Asian patients, doctors considered the history less relevant to the diagnosis. Diagnosis and effective treatment could be enhanced by research on the diagnostic and prognostic value of the terms patients use to describe their symptoms.

  8. Angina de Ludwig. Reporte de 2 casos

    Directory of Open Access Journals (Sweden)

    Antonio Fabbio Gagliardi Lugo

    2014-10-01

    Full Text Available La angina de Ludwig (AL es una entidad patológica, odontogénica e infecciosa que representa una situación de emergencia en la Cirugía Bucal y Maxilofacial por comprometer la vida del paciente debido a una progresiva oclusión de la vía aérea, producto del avance de la infección hacia los espacios submandibulares, sublinguales y submental, lo que trae como consecuencia el colapso de la misma. En el presente trabajo se hace una revisión de la literatura actualizada acerca de dicha entidad, origen, vías de diseminación, manejo terapéutico y posibles complicaciones. Se reportan 2 casos que acuden a Emergencias del Hospital General del Oeste «Dr. José Gregorio Hernández» (HGO en Los Magallanes de Catia (Caracas, Venezuela con diagnóstico de AL. Se presenta el manejo clínico y la relevancia del rol que adquiere el cirujano maxilofacial en el diagnóstico en aras de la preservación de la vida del paciente.

  9. Analysis of Plasma Homocysteine Levels in Patients with Unstable Angina

    Directory of Open Access Journals (Sweden)

    José Roberto Tavares

    2002-08-01

    Full Text Available OBJECTIVE - To determine the prevalence of hyperhomocystinemia in patients with acute ischemic syndrome of the unstable angina type. METHODS - We prospectively studied 46 patients (24 females with unstable angina and 46 control patients (19 males, paired by sex and age, blinded to the laboratory data. Details of diets, smoking habits, medication used, body mass index, and the presence of hypertension and diabetes were recorded, as were plasma lipid and glucose levels, C-reactive protein, and lipoperoxidation in all participants. Patients with renal disease were excluded. Plasma homocysteine was estimated using high-pressure liquid chromatography. RESULTS - Plasma homocysteine levels were significantly higher in the group of patients with unstable angina (12.7±6.7 µmol/L than in the control group (8.7±4.4 µmol/L (p<0.05. Among males, homocystinemia was higher in the group with unstable angina than in the control group, but this difference was not statistically significant (14.1±5.9 µmol/L versus 11.9±4.2 µmol/L. Among females, however, a statistically significant difference was observed between the 2 groups: 11.0±7.4 µmol/L versus 6.4±2.9 µmol/L (p<0.05 in the unstable angina and control groups, respectively. Approximately 24% of the patients had unstable angina at homocysteine levels above 15 µmol/L. CONCLUSION - High homocysteine levels seem to be a relevant prevalent factor in the population with unstable angina, particularly among females.

  10. Pharmacological Management of Chronic Stable Angina: Focus on Ranolazine.

    Science.gov (United States)

    Rosano, Giuseppe M C; Vitale, Cristiana; Volterrani, Maurizio

    2016-08-01

    Percutaneous coronary intervention and anti-anginal medications have similar prognostic effectiveness in patients with chronic stable angina. The choice of optimal medical therapy for the management of chronic angina is of pivotal importance in patients with stable ischemic heart disease. The most commonly used anti-anginal agents have demonstrated equivalent efficacy in improving patient reported ischemic symptoms and quantitative exercise parameters. With regards to mortality, beta-blockers are beneficial only in the setting of depressed left ventricular systolic function after a recent myocardial infarction. Recent evidence suggests the lack of any benefit of beta-blockers in patients with preserved systolic function, even in the setting of prior myocardial infarction.Ranolazine is a non-haemodynamic anti-anginal agent. It is effective as adjunctive therapy in patients with chronic stable angina whose symptoms are un-adequately controlled by conventional treatment. The clinical development program of ranolazine has shown that the drug improves exercise performance, decreases angina and use of sublingual nitrates, compared to placebo. Ranolazine is well tolerated with neutral effect on haemodynamics. Besides its role in chronic stable angina, ranolazine has the potential for development in a number of other cardiovascular and non-cardiovascular conditions in the future.

  11. Incidence and follow-up of Braunwald subgroups in unstable angina pectoris

    NARCIS (Netherlands)

    A.J.M. van Miltenburg-van Zijl (Addy); M.L. Simoons (Maarten); R.J. Veerhoek (Rinus); P.M.M. Bossuyt (Patrick)

    1995-01-01

    textabstractObjectives. This study was performed to establish the prognosis of patients with unstable angina within the subgroups of the Braunwald classification. Background. Among many classifications of unstable angina, the Braunwald classification is frequently used. However, the incidence and

  12. ["Persistent" angina: rationale for a metabolic approach].

    Science.gov (United States)

    Marzilli, Mario

    2004-03-01

    Despite increasing pharmacological and mechanical treatment options, ischemic heart disease continues to be associated with considerable patient mortality and morbidity. The estimates of the direct and indirect costs associated with chronic stable angina amount to billions of dollars. Given the epidemiological and economic magnitude of the problem, the need for more effective therapies is self-evident. Based on current guidelines, the management of ischemic heart disease has progressively broadened to include risk factor modification, patient education, and pharmacological therapy. The latter includes i) classic antianginal agents such as beta-blockers, calcium antagonists, and nitrates, and ii) drugs for secondary prevention, such as aspirin, clopidogrel, statins, and angiotensin-converting enzyme inhibitors. Tailoring therapy to individual needs has become even more challenging because of the marked changes in the clinical profile of patients with chronic ischemic heart disease. Compared with the past, today's patients tend to be older, to have undergone revascularization procedures, and to frequently have associated illnesses, including heart failure and diabetes. Significant progress has been made in recent years in understanding the role of cardiac energy metabolism in the pathogenesis of myocardial ischemia. A better understanding of metabolic derangements associated with ischemia and reperfusion is translating into innovative therapeutic approaches. Optimization of cardiac energy metabolism is based on promoting cardiac glucose oxidation. This has been proved to enhance cardiac function and protect myocardial tissue against ischemia-reperfusion injury. A new class of metabolic agents, known as the 3-ketoacyl coenzyme A thiolase inhibitors (trimetazidine), is able to elicit an increase in glucose and lactate combustion secondary to partial inhibition of fatty acid oxidation, producing clinical benefits in patients with ischemic heart disease.

  13. Abdominal epilepsy in chronic recurrent abdominal pain

    Directory of Open Access Journals (Sweden)

    V Y Kshirsagar

    2012-01-01

    Full Text Available Background: Abdominal epilepsy (AE is an uncommon cause for chronic recurrent abdominal pain in children and adults. It is characterized by paroxysmal episode of abdominal pain, diverse abdominal complaints, definite electroencephalogram (EEG abnormalities and favorable response to the introduction of anti-epileptic drugs (AED. We studied 150 children with chronic recurrent abdominal pain and after exclusion of more common etiologies for the presenting complaints; workup proceeded with an EEG. We found 111 (74% children with an abnormal EEG and 39 (26% children with normal EEG. All children were subjected to AED (Oxcarbazepine and 139 (92% children responded to AED out of which 111 (74% children had an abnormal EEG and 27 (18% had a normal EEG. On further follow-up the patients were symptom free, which helped us to confirm the clinical diagnosis. Context: Recurrent chronic abdominal pain is a common problem encountered by pediatricians. Variety of investigations are done to come to a diagnosis but a cause is rarely found. In such children diagnosis of AE should be considered and an EEG will confirm the diagnosis and treated with AED. Aims: To find the incidence of AE in children presenting with chronic recurrent abdominal pain and to correlate EEG findings and their clinical response to empirical AEDs in both cases and control. Settings and Design: Krishna Institute of Medical Sciences University, Karad, Maharashtra, India. Prospective analytical study. Materials and Methods: A total of 150 children with chronic recurrent abdominal pain were studied by investigations to rule out common causes of abdominal pain and an EEG. All children were then started with AED oxycarbamezepine and their response to the treatment was noted. Results: 111 (74% of the total 150 children showed a positive EEG change suggestive of epileptogenic activity and of which 75 (67.56% were females and 36 (32.43% were male, majority of children were in the age of group of 9

  14. Gambaran Angiografi Koroner Pasien Angina Pektoris Tidak stabil Berjenis Kelamin Wanita di RSUP H. Malik Medan

    OpenAIRE

    Hutagalung, Adit Muhammad Prasetya

    2016-01-01

    Unstable angina pectoris are commonly diagnosis in women who have a heart attack with non spesific symptoms. Angina pectoris in women commonly show chest pain symptom but normal coronary arteries imaging. This study aims to determine the characteristics of the location of the blockage of the coronary arteries in patients with unstable angina pectoris in women and to determine the severity of coronary artery blockages in patients with unstable angina pectoris in women in RSUP. H...

  15. High probability of disease in angina pectoris patients

    DEFF Research Database (Denmark)

    Høilund-Carlsen, Poul F.; Johansen, Allan; Vach, Werner

    2007-01-01

    BACKGROUND: According to most current guidelines, stable angina pectoris patients with a high probability of having coronary artery disease can be reliably identified clinically. OBJECTIVES: To examine the reliability of clinical evaluation with or without an at-rest electrocardiogram (ECG......) in patients with a high probability of coronary artery disease. PATIENTS AND METHODS: A prospective series of 357 patients referred for coronary angiography (CA) for suspected stable angina pectoris were examined by a trained physician who judged their type of pain and Canadian Cardiovascular Society grade...... of pain. Pretest likelihood of disease was estimated, and all patients underwent myocardial perfusion scintigraphy (MPS) followed by CA an average of 78 days later. For analysis, the investigators focused on the approximate groups of patients with more severe disease, ie, typical angina (n=187), Canadian...

  16. Abdominal Decompression in Children

    Directory of Open Access Journals (Sweden)

    J. Chiaka Ejike

    2012-01-01

    Full Text Available Abdominal compartment syndrome (ACS increases the risk for mortality in critically ill children. It occurs in association with a wide variety of medical and surgical diagnoses. Management of ACS involves recognizing the development of intra-abdominal hypertension (IAH by intra-abdominal pressure (IAP monitoring, treating the underlying cause, and preventing progression to ACS by lowering IAP. When ACS is already present, supporting dysfunctional organs and decreasing IAP to prevent new organ involvement become an additional focus of therapy. Medical management strategies to achieve these goals should be employed but when medical management fails, timely abdominal decompression is essential to reduce the risk of mortality. A literature review was performed to understand the role and outcomes of abdominal decompression among children with ACS. Abdominal decompression appears to have a positive effect on patient survival. However, prospective randomized studies are needed to fully understand the indications and impact of these therapies on survival in children.

  17. Abdominal Compartment Syndrome

    OpenAIRE

    Ovchinnikov V.А.; Sokolov V.А.

    2013-01-01

    We considered one of the most complicated problems of surgery and intensive care — abdominal compartment syndrome. It is a severe, and in some cases lethal complication developing in major injuries and pathology of abdominal cavity and retroperitoneal space, as well as in extra-abdominal pathology. In addition, compartment syndrome can be the complication of a number of surgical procedures accompanied primarily by laparotomy wound closure with tissue tension. We demonstrated the classificatio...

  18. Abdominal Compartment Syndrome

    Directory of Open Access Journals (Sweden)

    Pınar Zeyneloğlu

    2015-04-01

    Full Text Available Intraabdominal hypertension and Abdominal compartment syndrome are causes of morbidity and mortality in critical care patients. Timely diagnosis and treatment may improve organ functions. Intra-abdominal pressure monitoring is vital during evaluation of the patients and in the management algorithms. The incidence, definition and risk factors, clinical presentation, diagnosis and management of intraabdominal hypertension and Abdominal compartment syndrome were reviewed here.

  19. Blood blisters of the oral mucosa (angina bullosa haemorrhagica).

    Science.gov (United States)

    Deblauwe, B M; van der Waal, I

    1994-08-01

    Angina bullosa haemorrhagica is a benign phenomenon that is characterized by the sudden appearance of a blood blister on the oral mucosa in the absence of an identifiable cause or systemic disorder; local trauma has been suggested to be the most likely contributory factor. No treatment is required. Angina bullosa haemorrhagica affects mainly middle-aged and elderly people. There is no strong predilection for either men or women. In this article nine patients with such blisters are described. Blood blisters apparently are more common than has been suggested in the literature.

  20. LUDWIG’S ANGINA AND ANAESTHETIC DIFFICULTIES: A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Sarda Devi

    2015-04-01

    Full Text Available Patients with deep neck infections present challenging airways for an anesthesiologist . Ludwig’s angina is potentially lethal, rapidly spreading cellulitis involving the floor of the mouth and neck. Without aggressive management it often results in life th reatening upper airway obstruction. Securing the airway remains the top priority in treatment of Ludwig’s angina. Although awake fibreoptic intubation remains the ideal method for securing the airway, but it is not available in every set up, so all feasibl e options of securing the airway should be prepared. We present a case successfully managed at our hospital with a brief review of airway management options.

  1. The sensitivity of the symptom angina pectoris as a marker of transient myocardial ischaemia in chronic stable angina pectoris

    DEFF Research Database (Denmark)

    Egstrup, K

    1987-01-01

    Therapeutic decisions in patients with angina pectoris are traditionally based on the history reported by the patient, since objective evidence of myocardial ischaemia during daily life is often not available. In this study, ambulatory ST segment monitoring was performed in 60 patients...... with a history of chronic stable angina pectoris, positive exercise test and/or positive coronary angiography, and a correlation was made between the episodes of chest pain and ST segment change. The patients were grouped according to the results of exercise testing and coronary arteriography, and one group...... was studied with and without antianginal medication. Overall, 195 episodes of angina were noted, only 94 of which (48%) were accompanied by ST segment depression. Pain and ST segment changes were best correlated in patients with a positive exercise test, positive angiography and who were not receiving...

  2. The prevalence and management of angina among patients with chronic coronary artery disease across US outpatient cardiology practices: insights from the Angina Prevalence and Provider Evaluation of Angina Relief (APPEAR) study.

    Science.gov (United States)

    Kureshi, Faraz; Shafiq, Ali; Arnold, Suzanne V; Gosch, Kensey; Breeding, Tracie; Kumar, Ashwath S; Jones, Philip G; Spertus, John A

    2017-01-01

    Although eliminating angina is a primary goal in treating patients with chronic coronary artery disease (CAD), few contemporary data quantify prevalence and severity of angina across US cardiology practices. The authors hypothesized that angina among outpatients with CAD managed by US cardiologists is low and its prevalence varies by site. Among 25 US outpatient cardiology clinics enrolled in the American College of Cardiology Practice Innovation and Clinical Excellence (PINNACLE) registry, we prospectively recruited a consecutive sample of patients with chronic CAD over a 1- to 2-week period at each site between April 2013 and July 2015, irrespective of the reason for their appointment. Eligible patients had documented history of CAD (prior acute coronary syndrome, prior coronary revascularization procedure, or diagnosis of stable angina) and ≥1 prior office visit at the practice site. Angina was assessed directly from patients using the Seattle Angina Questionnaire Angina Frequency score. Among 1257 patients from 25 sites, 7.6% (n = 96) reported daily/weekly, 25.1% (n = 315) monthly, and 67.3% (n = 846) no angina. The proportion of patients with daily/weekly angina at each site ranged from 2.0% to 24.0%, but just over half (56.3%) were on ≥2 antianginal medications, with wide variability across sites (0%-100%). One-third of outpatients with chronic CAD managed by cardiologists report having angina in the prior month, and 7.6% have frequent symptoms. Among those with frequent angina, just over half were on ≥2 antianginal medications, with wide variability across sites. These findings suggest an opportunity to improve symptom control.

  3. Recurrent Abdominal Pain

    Science.gov (United States)

    Banez, Gerard A.; Gallagher, Heather M.

    2006-01-01

    The purpose of this article is to provide an empirically informed but clinically oriented overview of behavioral treatment of recurrent abdominal pain. The epidemiology and scope of recurrent abdominal pain are presented. Referral process and procedures are discussed, and standardized approaches to assessment are summarized. Treatment protocols…

  4. [Abdominal pregnancy, institutional experience].

    Science.gov (United States)

    Bonfante Ramírez, E; Bolaños Ancona, R; Simón Pereyra, L; Juárez García, L; García-Benitez, C Q

    1998-07-01

    Abdominal pregnancy is a rare entity, which has been classified as primary or secondary by Studiford criteria. A retrospective study, between January 1989 and December 1994, realized at Instituto Nacional de Perinatología, found 35,080 pregnancies, from which 149 happened to be ectopic, and 6 of them were abdominal. All patients belonged to a low income society class, age between 24 and 35 years, and average of gestations in 2.6. Gestational age varied from 15 weeks to 32.2 weeks having only one delivery at term with satisfactory postnatal evolution. One patient had a recurrent abdominal pregnancy, with genital Tb as a conditional factor. Time of hospitalization varied from 4 to 5 days, and no further patient complications were reported. Fetal loss was estimated in 83.4%. Abdominal pregnancy is often the sequence of a tubarian ectopic pregnancy an when present, it has a very high maternal mortality reported in world literature, not found in this study. The stated frequency of abdominal pregnancy is from 1 of each 3372, up to 1 in every 10,200 deliveries, reporting in the study 1 abdominal pregnancy in 5846 deliveries. The study had two characteristic entities one, the recurrence and two, the delivery at term of one newborn. Abdominal pregnancy accounts for 4% of all ectopic pregnancies. Clinical findings in abdominal pregnancies are pain, transvaginal bleeding and amenorrea, being the cardinal signs of ectopic pregnancy.

  5. Breath markers of oxidative stress in patients with unstable angina.

    Science.gov (United States)

    Phillips, Michael; Cataneo, Renee N; Greenberg, Joel; Grodman, Richard; Salazar, Manuel

    2003-01-01

    Cardiac chest pain is accompanied by oxidative stress, which generates alkanes and other volatile organic compounds (VOCs). These VOCs are excreted in the breath and could potentially provide a rational diagnostic marker of disease. The breath methylated alkane contour (BMAC), a 3-dimensional surface plot of C4-C20 alkanes and monomethylated alkanes, provides a comprehensive set of markers of oxidative stress. In this pilot study, we compared BMACs in patients with unstable angina pectoris and in healthy volunteers. Breath VOCs were analyzed in 30 patients with unstable angina confirmed by coronary angiography and in 38 age-matched healthy volunteers with no known history of heart disease (mean age +/- SD, 62.7 +/- 12.3 years and 62.5 +/- 10.0, not significant). BMACs in both groups were compared to identify the combination of VOCs that provided the best discrimination between the 2 groups. Forward stepwise entry discriminant analysis selected 8 VOCs to construct a predictive model that correctly classified unstable angina patients with sensitivity of 90% (27 of 30) and specificity of 73.7% (28 of 38). On cross-validation, sensitivity was 83.3% (25 of 30) and specificity was 71.1% (27 of 38). We conclude that the breath test distinguished between patients with unstable angina and healthy control subjects.

  6. Angina pectoris in women: focus on microvascular disease.

    Science.gov (United States)

    Zuchi, Cinzia; Tritto, Isabella; Ambrosio, Giuseppe

    2013-02-20

    Ischemic heart disease (IHD) is the leading cause of death among women in Western countries, and it is associated with higher morbidity and mortality than in men. Nevertheless, IHD in women remains underdiagnosed and undertreated, and the misperception that females are "protected" against cardiovascular disease leads to underestimation of their cardiovascular risk; instead, women with chest pain have a high risk of cardiovascular events. Women suffering from angina pectoris tend to have different characteristics compared to men, with a high prevalence of non-significant coronary artery disease. Angina in women is more commonly microvascular in origin than in men, and therefore standard diagnostic algorithms may be suboptimal for women. This different pathophysiology impacts clinical management of IHD in women. While response to medical therapy may differ in women, they are scarcely represented in clinical trials. Therefore, solid data in terms of gender efficacy of antianginal drugs are lacking, and particularly when angina is microvascular in origin women often continue to be symptomatic despite maximal therapy with classical antianginal drugs. Recently, new molecules have shown promising results in women. In conclusion, women with angina are a group of patients in whom it seems appropriate to concentrate efforts aimed at reducing morbidity and improving quality of life.

  7. NEBIVOLOL IN TREATMENT OF STABLE EXERTIONAL ANGINA PECTORIS

    Directory of Open Access Journals (Sweden)

    Y. V. Gavrilov

    2015-12-01

    Full Text Available Aim. To evaluate antianginal and antiischemic efficiency of nebivolol in patients with stable angina pectoris.Material and methods. 100 patients with ischemic heart disease showing stable exertional angina pectoris and having no contraindications to beta-blockers were studied. After 5-7 days of control period 50 randomly selected patients began to take nebivolol in initial dose of 5mg once daily and 50 patients started to take metoprolol in initial dose of 50 mg twice daily. Duration of treatment was 8 weeks. Efficiency of treatment was assessed according to the results of control treadmill assessment and control daily ECG monitoring.Results. 56-day therapy with nebivolol at a dose of 7,5 mg per day results in increase in duration of treadmill test before angina or ST depression (p<0.05. Antianginal and antiischemic effect of nebivolol 7.5 mg once daily is rather similar with that of metoprolol in average daily dose of 175 mg. Nebivolol compared to metoprolol significantly (p<0.05 more effectively reduces the number of silent myocardial ischemia.Conclusion. Nebivolol is an efficient antianginal and antiischemic drug for patients with stable exertional angina pectoris.

  8. [Microvascular angina in women: a diagnostic and therapeutic challenge

    NARCIS (Netherlands)

    Elias-Smale, S.E.; Boer, M.J. de; Maas, A.H.E.M.

    2014-01-01

    Gender differences play an important role in coronary heart disease (CHD). Not only in the presentation of symptoms, but also in their underlying pathophysiology. Women with persistent angina without obstructive coronary artery disease (CAD) pose a diagnostic and therapeutic challenge. Half of these

  9. Unstable angina following intracavernous injection of alprostadil: a case study

    OpenAIRE

    Delongchamps, Nicolas Barry; Legrand, Guillaume; Zerbib, Marc; Peyromaure, Michael

    2009-01-01

    Intracavernous injection of alprostadil is the gold standard treatment for erectile dysfunction following radical prostatectomy. After surgery, low doses of alprostadil can be delivered for the sole purpose of penile rehabilitation. The only reported systemic side effects of such injections are arterial hypotension and headache. In the current report, a case of unstable angina immediately following an intracavernous injection of alprostadil is described.

  10. [Percutaneous myocardial laserrevascularization (PMR), a new therapy for patients with refractory angina pectoris].

    Science.gov (United States)

    Lauer, B; Stahl, F; Bratanow, S; Schuler, G

    2000-10-01

    In patients with severe angina pectoris due to coronary artery disease, who are not candidates for either percutaneous coronary angioplasty or coronary artery bypass surgery, transmyocardial laser revascularization (TMR) often leads to improvement of clinical symptoms and increased exercise capacity. One drawback of TMR is the need for surgical thoracotomy in order to gain access to the epicardial surface of the heart. Therefore, a catheter-based system has been developed, which allows creation of laser channels into the myocardium from the left ventricular cavity.Between January 1997 and November 1999, this "percutaneous myocardial laser-revascularization" (PMR) was performed in 85 patients at the Herzzentrum Leipzig. In 43 patients, only one region of the heart (anterior, lateral, inferior or septal) was treated with PMR; in 42 patients two or three regions were treated in one session. 12.3±4.3 (range 4-22) channels/region were created into the myocardium.Six months after PMR, the majority of patients reported significant improvement of clinical symptoms (CCS class at baseline: 3.3±0.4; after 6 months: 1.6±0.9) (p PMR treated regions.PMR seems to be a safe and feasible new therapeutic option for patients with refractory angina pectoris due to end-stage coronary artery disease. The first results indicate improvement of clinical symptoms and increased exercise capacity; evidence of increased perfusion in the laser-treated regions is still lacking.

  11. [Percutaneous myocardial laser revascularization (PMR), a new therapeutic procedure for patients with refractory angina pectoris].

    Science.gov (United States)

    Lauer, B; Stahl, F; Bratanow, S; Schuler, G

    2000-01-01

    In patients with severe angina pectoris due to coronary artery disease, who are not candidates for either percutaneous coronary angioplasty or coronary artery bypass surgery, transmyocardial laser revascularization (TMR) often leads to improvement of clinical symptoms and increased exercise capacity. One drawback of TMR is the need for surgical thoracotomy in order to gain access to the epicardial surface of the heart. Therefore, a catheter-based system has been developed, which allows creation of laser channels into the myocardium from the left ventricular cavity. Between January 1997 and November 1999, this "percutaneous myocardial laser-revascularization" (PMR) was performed in 85 patients at the Herzzentrum Leipzig. In 43 patients, only one region of the heart (anterior, lateral, inferior or septal) was treated with PMR; in 42 patients two or three regions were treated in one session. 12.3 +/- 4.3 (range 4-22) channels/region were created into the myocardium. Six months after PMR, the majority of patients reported significant improvement of clinical symptoms (CCS class at baseline: 3.3 +/- 0.4; after 6 months: 1.6 +/- 0.9) (p PMR treated regions. PMR seems to be a safe and feasible new therapeutic option for patients with refractory angina pectoris due to end-stage coronary artery disease. The first results indicate improvement of clinical symptoms and increased exercise capacity; evidence of increased perfusion in the laser-treated regions is still lacking.

  12. Cardiac catheterization in patients with unstable angina. Recent onset vs crescendo pattern.

    Science.gov (United States)

    Plotnik, G D; Fisher, M L; Carliner, N H; Becker, L C

    1980-08-01

    Among patients with unstable angina pectoris, those with crescendo angina seem to be at high risk for death and myocardial infarction. We reviewed the clinical, arteriographic, and hemodynamic findings in 218 consecutive catheterized patients with unstable angina. Unstable angina was defined as ischemic cardiac pain at rest associated with transient ECG changes but no evidence for acute myocardial infarction. Patients were divided into two groups according to the duration of symptoms: 134 patients with crescendo angina (new, or increasing, rest pain with previous ischemic symptoms present for more than three months) and 84 with recent onset angina (symptoms present for less than three months). Compared with patients with recent onset symptoms, patients with crescendo angina had more extensive coronary disease and lower ejection fractions, which may explain their poor prognosis.

  13. Traumatic abdominal hernia complicated by necrotizing fasciitis.

    Science.gov (United States)

    Martínez-Pérez, Aleix; Garrigós-Ortega, Gonzalo; Gómez-Abril, Segundo Ángel; Martí-Martínez, Eva; Torres-Sánchez, Teresa

    2014-11-01

    Necrotizing fasciitis is a critical illness involving skin and soft tissues, which may develop after blunt abdominal trauma causing abdominal wall hernia and representing a great challenge for physicians. A 52-year-old man was brought to the emergency department after a road accident, presenting blunt abdominal trauma with a large non-reducible mass in the lower-right abdomen. A first, CT showed abdominal hernia without signs of complication. Three hours after ICU admission, he developed hemodynamic instability. Therefore, a new CT scan was requested, showing signs of hernia complication. He was moved to the operating room where a complete transversal section of an ileal loop was identified. Five hours after surgery, he presented a new episode of hemodynamic instability with signs of skin and soft tissue infection. Due to the high clinical suspicion of necrotizing fasciitis development, wide debridement was performed. Following traumatic abdominal wall hernia (TAWH), patients can present unsuspected injuries in abdominal organs. Helical CT can be falsely negative in the early moments, leading to misdiagnosis. Necrotizing fasciitis is a potentially fatal infection and, consequently, resuscitation measures, wide-spectrum antibiotics, and early surgical debridement are required. This type of fasciitis can develop after blunt abdominal trauma following wall hernia without skin disruption.

  14. Gastrointestinal causes of abdominal pain.

    Science.gov (United States)

    Marsicano, Elizabeth; Vuong, Giao Michael; Prather, Charlene M

    2014-09-01

    Gastrointestinal causes of abdominal pain are numerous. These causes are reviewed in brief here, divided into 2 categories: acute abdominal pain and chronic abdominal pain. They are further subcategorized by location of pain as it pertains to the abdomen.

  15. Functional Abdominal Pain in Children

    Science.gov (United States)

    ... functional abdominal pain. Functional abdominal pain can be intermittent (recurrent abdominal pain or RAP) or continuous. Although ... tests are needed or whether a trial of diet changes, stress management or medication may be started. ...

  16. Emerging clinical role of ranolazine in the management of angina

    Directory of Open Access Journals (Sweden)

    David S Vadnais

    2010-10-01

    Full Text Available David S Vadnais, Nanette K WengerDivision of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USAAbstract: Chronic stable angina is an exceedingly prevalent condition with tremendous clinical, social, and financial implications. Traditional medical therapy for angina consists of beta-blockers, calcium channel blockers, and nitrates. These agents decrease myocardial oxygen demand and ischemia by reducing heart rate, lowering blood pressure, and/or optimizing ventricular loading characteristics. Unique in its mechanism of action, ranolazine is the first new antianginal agent approved for use in the US for chronic angina in over 25 years. By inhibiting the late inward sodium current (INa, ranolazine prevents pathologic intracellular calcium accumulation that leads to ischemia, myocardial dysfunction, and electrical instability. Ranolazine has been proven in multiple clinical trials to reduce the symptoms of angina safely and effectively and to improve exercise tolerance in patients with symptomatic coronary heart disease. These benefits occur without reduction in heart rate and blood pressure or increased mortality. Although ranolazine prolongs the QTc, experimental data indicate that ranolazine may actually be antiarrhythmic. In a large acute coronary syndrome clinical trial, ranolazine reduced the incidence of supraventricular tachycardia, ventricular tachycardia, new-onset atrial fibrillation, and bradycardic events. Additional benefits of ranolazine under investigation include reductions in glycosylated hemoglobin levels and improved left ventricular function. Ranolazine is a proven antianginal medication in patients with symptomatic coronary heart disease, and should be considered as an initial antianginal agent for those with hypotension or bradycardia.Keywords: chronic angina, myocardial ischemia, ranolazine, pharmacotherapy, antianginal, sodium current

  17. 口服莫西沙星致过敏伴腹痛和阴道出血%Allergy complicated with abdominal pain and colporrhagia due to oral moxifloxacin

    Institute of Scientific and Technical Information of China (English)

    姚丹林; 牟红梅

    2015-01-01

    1例45岁女性患者因急性支气管炎自行口服莫西沙星0.4 g。约5 min 后,患者出现周身瘙痒、全身皮肤发红、颜面水肿、声音嘶哑、呕吐、腹痛、腹泻;约25 min 后出现视物模糊、神志恍惚。遂静脉注射甲泼尼龙120 mg,快速静脉滴注0.9%氯化钠注射液1000 ml,但患者腹痛无缓解,服药后1 h 出现阴道出血。腹部超声检查未见明显异常。给予哌替啶100 mg 肌内注射,约30 min 后患者腹痛减轻,口服莫西沙星24 h 后阴道出血停止。患者1个月前有相同发病及诊治经历。%A 45 year-old woman with acute bronchitis took moxifloxacin 0. 4 g orally by herself. She developed pruritus and rubefaction on the whole body,edema in the face,hoarseness,vomiting,abdominal pain,and diarrhea 5 minutes after taking the medicine. About 25 minutes later,she developed clouded vision and became unconscious. She was given an intravenous injection of methylprednisolone 120 mg,and rapid intravenous drip of 0. 9% sodium chloride injection 1 000 ml. But the abdominal pain did not alleviate. She developed colporrhagia one hour after taking the medicine. The result of abdominal ultrasound examination showed no obvious abnormity. Then she was given an intramuscular injection of meperidine 100 mg. About 30 minutes later,her abdominal pain was relieved. Twenty-four hours after receiving moxifloxacin,her colporrhagia was stopped. The patient had a similar experience of morbidity,diagnosis and therapy one month ago.

  18. Effects of ovariohysterectomy on intra-abdominal pressure and abdominal perfusion pressure in cats.

    Science.gov (United States)

    Bosch, L; Rivera del Álamo, M M; Andaluz, A; Monreal, L; Torrente, C; García-Arnas, F; Fresno, L

    2012-12-15

    Intra-abdominal pressure (IAP) and abdominal perfusion pressure (APP) have shown clinical relevance in monitoring critically ill human beings submitted to abdominal surgery. Only a few studies have been performed in veterinary medicine. The aim of this study was to assess how pregnancy and abdominal surgery may affect IAP and APP in healthy cats. For this purpose, pregnant (n=10) and non-pregnant (n=11) queens undergoing elective spaying, and tomcats (n=20, used as controls) presented for neutering by scrotal orchidectomy were included in the study. IAP, mean arterial blood pressure (MAP), APP, heart rate and rectal temperature (RT) were determined before, immediately after, and four hours after surgery. IAP increased significantly immediately after abdominal surgery in both female groups when compared with baseline (PPregnancy did not seem to affect IAP in this population of cats, possibly due to subjects being in early stages of pregnancy.

  19. Decreased mortality of abdominal aortic aneurysms in a peripheral county

    DEFF Research Database (Denmark)

    Lindholt, Jes Sanddal; Henneberg, E W; Fasting, H

    1995-01-01

    To analyse the effect on the mortality associated with abdominal aortic aneurysms, due to the establishment of a decentralised vascular surgical unit in the county of Viborg.......To analyse the effect on the mortality associated with abdominal aortic aneurysms, due to the establishment of a decentralised vascular surgical unit in the county of Viborg....

  20. Predicting prognosis in stable angina--results from the Euro heart survey of stable angina: prospective observational study.

    NARCIS (Netherlands)

    Daly, C.A.; Stavola, B. De; Lopez Sendon, J.L.; Tavazzi, L.; Boersma, E.; Clemens, F.; Danchin, N.; Delahaye, F.; Gitt, A.; Julian, D.; Mulcahy, D.; Ruzyllo, W.; Thygesen, K.; Verheugt, F.W.A.; Fox, K.M.

    2006-01-01

    OBJECTIVES: To investigate the prognosis associated with stable angina in a contemporary population as seen in clinical practice, to identify the key prognostic features, and from this to construct a simple score to assist risk prediction. DESIGN: Prospective observational cohort study. SETTING: Pan

  1. [Inflammatory abdominal aortic aneurysm].

    Science.gov (United States)

    Ziaja, K; Sedlak, L; Urbanek, T; Kostyra, J; Ludyga, T

    2000-01-01

    The reported incidence of inflammatory abdominal aortic aneurysm (IAAA) is from 2% to 14% of patients with abdominal aortic aneurysm and the etiology of this disease is still discussed--according to the literature several pathogenic theories have been proposed. From 1992 to 1997 32 patients with IAAA were operated on. The patients were mostly symptomatic--abdominal pain was present in 68.75% cases, back pain in 31.25%, fever in 12.5% and weight loss in 6.25% of the operated patients. In all the patients ultrasound examination was performed, in 4 patients CT and in 3 cases urography. All the patients were operated on and characteristic signs of inflammatory abdominal aortic aneurysm like: thickened aortic wall, perianeurysmal infiltration or retroperitoneal fibrosis with involvement of retroperitoneal structures were found. In all cases surgery was performed using transperitoneal approach; in three cases intraoperatively contiguous abdominal organs were injured, which was connected with their involvement into periaortic inflammation. In 4 cases clamping of the aorta was done at the level of the diaphragmatic hiatus. 3 patients (9.37%) died (one patient with ruptured abdominal aortic aneurysm). Authors present diagnostic procedures and the differences in the surgical tactic, emphasizing the necessity of the surgical therapy in patients with inflammatory abdominal aortic aneurysm.

  2. Early and six-month outcome in patients with angina pectoris early after acute myocardial infarction (the GISSI-3 APPI [angina precoce post-infarto] study).

    Science.gov (United States)

    1996-12-01

    There is conflicting evidence whether or not early postinfarction angina implies an unfavorable prognosis. This prospective study assessed the significance and natural history of early angina in a broad population of patients conservatively managed after acute myocardial infarction (AMI) and enrolled in the third Gruppo Italiano per lo Studio della Sopravvivenza nel Infarto Miocardico (GISSI-3) trial. Out of 2,363 consecutive patients (age 63 +/- 11; first AMI in 86%; thrombolysis in 74%) admitted in 31 centers lacking on-site revascularization facilities, early angina associated with transient electrocardiographic (ECG) changes was documented in 332 (14%). At multivariate analysis, preinfarction angina, age > or = 70 years, female gender, and history of infarct were significant predictors of early angina. Though the in-hospital course was free from major cardiac events in 78% of patients after the first anginal episode, reinfarction was more common after early angina (7% vs 2% in patients without, RR 3.1, 95% confidence interval [CI] 1.9 to 5.6; p <0.001), and death occurred in 7% of patients with early angina (vs 5% of patients without, RR 1.4, CI 0.9 to 2.4, p = NS). No demographic or clinical characteristics identified patients who suffered nonfatal reinfarction after angina, and neither the ECG location (infarct zone or remote) nor patterns of ECG changes during angina proved significant predictors of in-hospital reinfarction or death. Early angina emerged as the sole independent predictor of 6-month cumulative reinfarction (12% vs 5% of patients without, RR 2.9, CI 2.0 to 4.4; p <0.0001) and an independent predictor of death (13% vs 7% of patients without early angina, RR 2.3, CI 1.6 to 3.3; p <0.0001). Early postinfarction angina is a powerful prognostic marker. Patients with early postinfarction angina had an unfavourable in-hospital outcome, but the prospective identification of patients at greater risk of major events after angina remains elusive

  3. Clinical Study on Abdominal Acupuncture plus Herbal Medicine for Chronic Pelvic Pain Due to Qi Stagnation and Blood Stasis%腹针配合中药治疗气滞血瘀型慢性盆腔痛的临床研究

    Institute of Scientific and Technical Information of China (English)

    宋玉娟; 张殿全; 苏丹萍

    2015-01-01

    Objective To observe the clinical efficacy of abdominal acupuncture plus herbal medicine in treating chronic pelvic pain due to qi stagnation and blood stasis after pelvic inflammatory diseases.Method Sixty patients with chronic pelvic pain due to qi stagnation and blood stasis after pelvic inflammatory diseases were randomized into a treatment group and a control group, 30 in each group. The treatment group was intervened by abdominal acupuncture plus herbal medicine, while the control group was by herbal medicine alone. After 3 menstrual cycles, the Visual Analogue Scale (VAS) for abdominal pain and McCormack scale were observed.Result After intervention, the abdominal VAS score and McCormack score were changed significantly in both groups (P<0.01,P<0.05). After intervention, there were significant differences in comparing the VAS score and McCormack score between the two groups (P<0.01).Conclusion Abdominal acupuncture plus herbal medicine can reduce chronic pelvic pain due to qi stagnation and blood stasis after pelvic inflammatory diseases.%目的:观察腹针配合中药治疗盆腔炎性疾病后气滞血瘀型慢性盆腔痛的临床疗效。方法将60例盆腔炎性疾病后气滞血瘀型慢性盆腔痛患者随机分为治疗组和对照组,每组30例。治疗组采用腹针配合中药治疗,对照组采用单纯中药治疗。治疗3个月经周期后,观察两组治疗前后腹痛VAS评分及McCormack量表评分变化。结果两组治疗后腹痛VAS评分及McCormack量表评分与同组治疗前比较,差异均具有统计学意义(P<0.01,P<0.05)。治疗组治疗后腹痛VAS评分及McCormack量表评分与对照组比较,差异均具有统计学意义(P<0.01)。结论腹针配合中药能够减轻盆腔炎性疾病后气滞血瘀型慢性盆腔痛。

  4. Abdominal wall endometriosis.

    Science.gov (United States)

    Upadhyaya, P; Karak, A K; Sinha, A K; Kumar, B; Karki, S; Agarwal, C S

    2010-01-01

    Endometriosis of abdominal wall scar following operation on uterus and tubes is extremely rare. The late onset of symptoms after surgery is the usual cause of misdiagnosis. Scar endometriosis is a rare disease which is difficult to diagnose and should always be considered as a differential diagnosis of painful abdominal masses in women. The diagnosis is made only after excision and histopathology of the lesion. Preoperative differentials include hernia, lipoma, suture granuloma or abscess. Hence an awareness of the entity avoids delay in diagnosis, helps clinicians to a more tailored treatment and also avoids unnecessary referrals. We report a case of abdominal endometriosis. The definitive diagnosis of which was established by histopathological studies.

  5. Congenital Abdominal Wall Defects

    DEFF Research Database (Denmark)

    Risby, Kirsten; Jakobsen, Marianne Skytte; Qvist, Niels

    2016-01-01

    complications were seen in five (15%) children: four had detachment of the mesh and one patient developed abdominal compartment syndrome. Mesh related clinical infection was observed in five children. In hospital mortality occurred in four cases (2 gastroschisis and 2 omphalocele) and was not procedure......OBJECTIVE: To evaluate the clinical utility of GORE® DUALMESH (GDM) in the staged closure of large congenital abdominal wall defects. MATERIALS AND METHODS: Data of patients with congenital abdominal wall defects managed with GDM was analyzed for outcome regarding complete fascial closure; mesh...

  6. An Overview of Meta-Analyses of Danhong Injection for Unstable Angina

    Directory of Open Access Journals (Sweden)

    Xiaoxia Zhang

    2015-01-01

    Full Text Available Objective. To systematically collect evidence and evaluate the effects of Danhong injection (DHI for unstable angina (UA. Methods. A comprehensive search was conducted in seven electronic databases up to January 2015. The methodological and reporting quality of included studies was assessed by using AMSTAR and PRISMA. Result. Five articles were included. The conclusions suggest that DHI plus conventional medicine treatment was effective for UA pectoris treatment, could alleviate symptoms of angina and ameliorate electrocardiograms. Flaws of the original studies and systematic reviews weaken the strength of evidence. Limitations of the methodology quality include performing an incomprehensive literature search, lacking detailed characteristics, ignoring clinical heterogeneity, and not assessing publication bias and other forms of bias. The flaws of reporting systematic reviews included the following: not providing a structured summary, no standardized search strategy. For the pooled findings, researchers took statistical heterogeneity into consideration, but clinical and methodology heterogeneity were ignored. Conclusion. DHI plus conventional medicine treatment generally appears to be effective for UA treatment. However, the evidence is not hard enough due to methodological flaws in original clinical trials and systematic reviews. Furthermore, rigorous designed randomized controlled trials are also needed. The methodology and reporting quality of systematic reviews should be improved.

  7. Abdominal tuberculosis: Imaging features

    Energy Technology Data Exchange (ETDEWEB)

    Pereira, Jose M. [Department of Radiology, Hospital de S. Joao, Porto (Portugal)]. E-mail: jmpjesus@yahoo.com; Madureira, Antonio J. [Department of Radiology, Hospital de S. Joao, Porto (Portugal); Vieira, Alberto [Department of Radiology, Hospital de S. Joao, Porto (Portugal); Ramos, Isabel [Department of Radiology, Hospital de S. Joao, Porto (Portugal)

    2005-08-01

    Radiological findings of abdominal tuberculosis can mimic those of many different diseases. A high level of suspicion is required, especially in high-risk population. In this article, we will describe barium studies, ultrasound (US) and computed tomography (CT) findings of abdominal tuberculosis (TB), with emphasis in the latest. We will illustrate CT findings that can help in the diagnosis of abdominal tuberculosis and describe imaging features that differentiate it from other inflammatory and neoplastic diseases, particularly lymphoma and Crohn's disease. As tuberculosis can affect any organ in the abdomen, emphasis is placed to ileocecal involvement, lymphadenopathy, peritonitis and solid organ disease (liver, spleen and pancreas). A positive culture or hystologic analysis of biopsy is still required in many patients for definitive diagnosis. Learning objectives:1.To review the relevant pathophysiology of abdominal tuberculosis. 2.Illustrate CT findings that can help in the diagnosis.

  8. Abdominal and Pelvic CT

    Medline Plus

    Full Text Available ... is done because a potential abnormality needs further evaluation with additional views or a special imaging technique. ... GI) contrast exams and ultrasound are preferred for evaluation of acute abdominal conditions in babies, such as ...

  9. [The abdominal catastrophe].

    Science.gov (United States)

    Seiler, Christian A

    2011-08-01

    Patients with an abdominal catastrophe are in urgent need of early, interdisciplinary medical help. The treatment plan should be based on medical priorities and clear leadership. First priority should be given to achieve optimal oxygenation of blood and stabilization of circulation during all treatment-phases. The sicker the patient, the less invasive the (surgical) treatment should to be, which means "damage control only". This short article describes 7 important, pragmatic rules that will help to increase the survival of a patient with an abdominal catastrophe. Preexisting morbidity and risk factors must be included in the overall risk-evaluation for every therapeutic intervention. The challenge in patients with an abdominal catastrophe is to carefully balance the therapeutic stress and the existing resistance of the individual patient. The best way to avoid abdominal disaster, however, is its prevention.

  10. Abdominal ultrasound (image)

    Science.gov (United States)

    Abdominal ultrasound is a scanning technique used to image the interior of the abdomen. Like the X-ray, MRI, ... it has its place as a diagnostic tool. Ultrasound scans use high frequency sound waves to produce ...

  11. Abdominal x-ray

    Science.gov (United States)

    ... are, or may be, pregnant. Alternative Names Abdominal film; X-ray - abdomen; Flat plate; KUB x-ray ... Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also ...

  12. The clinical characteristics and investigations planned in patients with stable angina presenting to cardiologists in Europe: from the Euro Heart Survey of Stable Angina.

    NARCIS (Netherlands)

    Daly, C.A.; Clemens, F.; Lopez-Sendon, J.; Tavazzi, L.; Boersma, E.; Danchin, N.; Delahaye, F.; Gitt, A.; Julian, D.; Mulcahy, D.; Ruzyllo, W.; Thygesen, K.; Verheugt, F.W.A.; Fox, K.M.

    2005-01-01

    AIMS: The Euro Heart Survey of Stable Angina set out to prospectively study the presentation and management of patients with stable angina as first seen by a cardiologist in Europe, with particular reference to adherence to existing guidelines and regional variability in patient presentation and ini

  13. Persistent angina: highly prevalent and associated with long-term anxiety, depression, low physical functioning, and quality of life in stable angina pectoris

    DEFF Research Database (Denmark)

    Jespersen, L.; Abildstrom, S. Z.; Hvelplund, Anders;

    2013-01-01

    To evaluate persistent angina in stable angina pectoris with no obstructive coronary artery disease (CAD) compared to obstructive CAD and its relation to long-term anxiety, depression, quality of life (QOL), and physical functioning. We invited 357 patients (men = 191; women = 166; response rate ...

  14. Linear abdominal trauma.

    Science.gov (United States)

    Danto, L A; Wolfman, E F

    1976-03-01

    Three cases of blunt abdominal trauma are presented to exemplify the mechanism of trauma and the problems of diagnosis associated with any linear blow to the abdomen. The mechanisms of visceral injury are reviewed, and special attention is directed to the abdominal wall injury that can be present in these patients. This injury has special implications in directing the operative approach and repair. An unusual aortic occlusion is described which is peculiar to this type of injury.

  15. Non-Linear Dynamics In Patients With Stable Angina Pectoris

    CERN Document Server

    Krstacic, G; Vargovic, E; Knezevic, A; Krstacic, A

    2001-01-01

    We investigate the clinical and prognostic significance of fractal dimension and detrended fluctuation analysis by comparing the group of patients with stable angina pectoris without previous myocardial infarction with the group of age-matched healthy controls. The fractal dimension of the R-R series was determined using the rescaled range (R/S) analysis technique. To quantify fractal longe-range-correlation properties of heart rate variability, the detrended fluctuation analysis (DFA) technique was used. The heart rate variability was characterized by a scaling exponent $\\alpha$, separately for short-term ($$ 11 beats) time scales. The results of data sets show the existence of crossover phenomena between short-time scales. The short-term fractal scaling exponent was significantly lower in patients with stable angina pectoris.

  16. Intravenous nitroglycerin for rest angina. Potential pathophysiologic mechanisms of action.

    Science.gov (United States)

    DePace, N L; Herling, I M; Kotler, M N; Hakki, A H; Spielman, S R; Segal, B L

    1982-10-01

    Twenty patients with refractory rest angina pectoris were treated with intravenously (IV) administered nitroglycerin (mean dosage, 72.4 micrograms/min; range, 15 to 226 micrograms/min). There was a considerable reduction or abolition in the number of ischemic episodes in 85% of patients without overall substantial changes in heart rate, mean arterial BP, pulmonary capillary wedge pressure (PCWP), and pulmonary arterial mean pressure. However, those patients with an initial PCWP of more than 12 mm Hg or a systolic pressure of more than 130 mm Hg had a substantial reduction in PCWP and systolic BP following IV nitroglycerin. We conclude that IV nitroglycerin may relieve rest angina by different pathophysiologic mechanisms. In some patients, IV nitroglycerin favorably altered the hemodynamic determinants of myocardial oxygen consumption. In others, however, no change in these determinants occurred, suggesting a direct effect on the coronary circulation.

  17. Treatment of Angina Pectoris Associated with Coronary Microvascular Dysfunction.

    Science.gov (United States)

    Ong, Peter; Athanasiadis, Anastasios; Sechtem, Udo

    2016-08-01

    Treatment of angina pectoris associated with coronary microvascular dysfunction is challenging as the underlying mechanisms are often diverse and overlapping. Patients with type 1 coronary microvascular dysfunction (i.e. absence of epicardial coronary artery disease and myocardial disease) should receive strict control of their cardiovascular risk factors and thus receive statins and ACE-inhibitors in most cases. Antianginal medication consists of ß-blockers and/or calcium channel blockers. Second line drugs are ranolazine and nicorandil with limited evidence. Despite individually titrated combinations of these drugs up to 30 % of patients have refractory angina. Rho-kinase inhibitors and endothelin-receptor antagonists represent potential drugs that may prove useful in these patients in the future.

  18. Update on ranolazine in the management of angina

    OpenAIRE

    Codolosa JN; Acharjee S; Figueredo VM

    2014-01-01

    J Nicolás Codolosa,1 Subroto Acharjee,1 Vincent M Figueredo1,2 1Einstein Center for Heart and Vascular Health, Einstein Medical Center, 2Jefferson Medical College, Philadelphia, PA, USA Abstract: Mortality rates attributable to coronary heart disease have declined in recent years, possibly related to changes in clinical presentation patterns and use of proven secondary prevention strategies. Chronic stable angina (CSA) remains prevalent, and the goal of treatment is control of sym...

  19. Ivabradine: the evidence of its therapeutic impact in angina

    Directory of Open Access Journals (Sweden)

    Guillaume Marquis-Gravel

    2008-12-01

    Full Text Available Guillaume Marquis-Gravel, Jean-Claude TardifMontreal Heart Institute, Université de Montréal, Montreal, Quebec, CanadaIntroduction: Stable angina pectoris (SAP is a widely prevalent disease affecting 30 000 to 40 000 per million people in Europe and the US. SAP is associated with reductions in quality of life and ability to work, and increased use of healthcare resources. Ivabradine is a drug with a unique therapeutic target, the If current of the sinus node, developed for the treatment of cardiovascular diseases including SAP. It has an exclusive heart rate reducing effect, without any negative effect on left ventricular function or coronary vasodilatation.Aims: The aim of this paper is to review the evidence concerning the use of ivabradine in the treatment of SAP.Evidence review: Ivabradine is an effective antianginal and antiischemic drug, not inferior to the beta blocker atenolol and the calcium channel antagonist (CCA amlodipine. It decreases the frequency of angina attacks and increases the time to anginal symptoms during exercise. Because of its exclusive chronotropic effect, ivabradine is not associated with the typical adverse reactions associated with beta blockers or other antianginal drugs.Clinical value: Clinical evidence shows that ivabradine is a very good antiischemic and antianginal agent, being as effective as beta blockade and CCA therapy in controlling myocardial ischemia and symptoms of stable angina. Ongoing studies will determine the potential of ivabradine to improve morbidity and mortality in coronary artery disease and heart failure.Key words: evidence, If current, ivabradine, outcomes, stable angina pectoris, treatment

  20. Angina treatments and prevention of cardiac events: an appraisal of the evidence.

    Science.gov (United States)

    Winchester, David E; Pepine, Carl J

    2015-12-01

    Angina pectoris is the symptomatic manifestation of transient myocardial ischaemia. At the most fundamental level, angina arises when myocardial oxygen demand exceeds the ability of the coronary circulation to provide adequate oxygen delivery to maintain normal myocardial metabolic function. In vivo, the balance of oxygen demand and delivery is a complex physiological process that can be altered by a variety of interventions. Lifestyle modification is a cornerstone of cardiovascular disease management, with or without angina. Additional pharmaceutical and physical interventions are usually applied to patients with angina. Mechanisms of action for these interventions include heart rate modulation, vascular smooth muscle relaxation, metabolic manipulation, revascularization, and others. A number of these interventions have overlapping mechanisms that target angina. Additionally, some interventions may directly or indirectly prevent or delay adverse outcomes such as myocardial infarction or death. This review summarizes current evidence for many applied ischaemia treatments documented to modify angina and comments on available evidence relating to improvement in cardiovascular outcomes.

  1. Selection of drug therapy in stable angina pectoris.

    Science.gov (United States)

    Savonitto, S; Ardissino, D

    1998-05-01

    Drug therapy in stable angina has two aims: the prevention of major cardiac events (such as unstable angina, myocardial infarction, or death) and the control of chest pain and transient myocardial ischemia. Given the low incidence of major cardiac events in patients with stable angina, primary preventive studies are scarce because they require a large sample size and long-term follow-up. Thus far, only aspirin and some lipid-lowering agents have been shown to be effective for this purpose. Antiischemic drugs reduce the imbalance between myocardial oxygen demand and supply, either by reducing oxygen consumption or by increasing coronary blood flow. The ideal approach would be to target drug therapy against the ischemia-inducing factor in each patient. The characteristics of anginal symptoms do not seem to help in selecting medical therapy, whereas a standard exercise test and a provocative test of coronary vasoconstriction may provide useful information in order to select patients who will preferentially respond to either a beta-blocker or a calcium antagonist. The combination of two or more anti-ischemic drugs does not seem to be any more effective than an adequately titrated monotherapy in reducing the occurrence of myocardial ischemia in individual patients. Combination therapy in stable coronary artery disease should include an individually selected and optimally titrated anti-ischemic agent and aspirin, with the addition of a lipid-lowering agent in patients with even mild hypercholesterolemia.

  2. Diurnal variation in exercise responses in angina pectoris.

    Science.gov (United States)

    Joy, M; Pollard, C M; Nunan, T O

    1982-01-01

    Thirty caucasian male patients with stable angina were investigated in two groups of nine and one group of 12. Nine normal subjects were also studied. Patients in the first group (on no treatment) underwent symptom-limited exercise electrocardiography at 0800, 1200, and 1600 hours on the same day. Their heart rates and ST segment displacements at 1600 hours were significantly greater than at 0800 hours and the same phenomenon was seen in the second group who had been receiving propranolol 40 mg four times a day. A similar effect was noted for ST segment displacement but not for heart rate in the third group (on no treatment) tested at 0800 hours and 1600 hours on separate days, two to three weeks apart. Normal control subjects showed no diurnal variation in heart rate and their heart rate responses at 1600 hours were reduced by propranolol. The observations show a circadian variation in the ST segment response to exercise in patients with angina and a possible training effect on heart rate with multiple exercise testing on the same day. This variation is associated with a reduction in vagal parasympathetic tone to the heart and should be taken into account in the assessment of patients with angina and in particular when comparing responses to treatment. PMID:7201319

  3. Sexual function in patients with chronic angina pectoris.

    Science.gov (United States)

    Kloner, Robert A; Henderson, Luana

    2013-06-01

    Drugs for erectile dysfunction (ED) may be contraindicated with nitrates commonly used to treat patients with angina pectoris, and certain antianginal therapies may worsen ED. The American Heart Association and the Princeton Consensus Conference panel of experts recommend that patients with coronary artery disease and ED who experience angina pectoris undergo full medical evaluations to assess the cardiovascular risks associated with resuming sexual activity before being prescribed therapy for ED. Current antianginal therapies include β blockers, calcium channel blockers, short- and long-acting nitrates, and ranolazine, a late sodium current inhibitor. Short- and long-acting nitrates remain a contraindication with phosphodiesterase-5 inhibitors commonly used to treat patients with ED, and the benefits of the other antianginal therapies must be weighed against their effects on cardiovascular health and erectile function. In conclusion, patients with coronary artery disease and ED who wish to initiate phosphodiesterase-5 inhibitor therapy and need to discontinue nitrate therapy need treatment options that manage their angina pectoris effectively, maintain their cardiovascular health, and provide the freedom to maintain their sexual function.

  4. ENHANCED PLATELET AGGREGABILITY UNDER HIGH SHEAR STRESS IN CORONARY CIRCULATION OF PATIENTS WITH UNSTABLE ANGINA

    OpenAIRE

    Doi, Naofumi

    2000-01-01

    Mechanical forces, including high shear stress, have been found to cause platelet aggregation. Although increased platelet aggregation is also associated with the pathophysiology of unstable angina, it is not known whether platelet aggregation induced by high shear stress occurs in the coronary circulation of patients with unstable angina. We assayed high shear stress induced platelet aggregation (h-SIPA) in each of 25 patients with unstable angina and a severe stenotic lesion of the left cor...

  5. Effect of Glucose - Insulin - Potassium (Gik) Solution on Short Term Prognosis of Unstable Angina

    OpenAIRE

    A Azimi; Azimi; M Motafakker; M Sadr-Bafghi; A Andishmand

    2007-01-01

    Introduction: Unstable angina as a clinical condition includes a major group of patients manifested with acute coronary syndrome. Misdiagnosis of this clinical syndrome causes myocardial infarction (MI) and death. Conventional and advanced forms of treatment are used with the aim of rapid stabilization of unstable angina. Although infusion of glucose - insulin - potassium (GIK) solution has had good results in acute MI, no major trial has studied its effect in unstable angina. The main goal o...

  6. Abdominal Wall Desmoid during Pregnancy: Diagnostic Challenges

    Directory of Open Access Journals (Sweden)

    Johnny Awwad

    2013-01-01

    Full Text Available Background. Desmoids are benign tumors, with local invasive features and no metastatic potential, which have rarely been described to be pregnancy associated. Case. We described the rapid growth of an anterior abdominal wall mass in a 40-year-old pregnant woman. Due to its close proximity to the enlarged uterus, it was misdiagnosed to be a uterine leiomyoma by ultrasound examination. Final tissue diagnosis and radical resection were done at the time of abdominal delivery. Conclusion. Due to the diagnostic limitations of imaging techniques, desmoids should always be considered when the following manifestations are observed in combination: progressive growth of a solitary abdominal wall mass during pregnancy and well-delineated smooth tumor margins demonstrated by imaging techniques. This case emphasizes the importance of entertaining uncommon medical conditions in the differential diagnosis of seemingly common clinical manifestations.

  7. Predicting prognosis in stable angina - results from the Euro heart survey of stable angina: prospective observational study

    DEFF Research Database (Denmark)

    Daly, Caroline A.; De Stavola, Bianca; Sendon, Jose L. Lopez

    2006-01-01

    -European survey in 156 outpatient cardiology clinics. Participants 3031 patients were included on the basis of a new clinical diagnosis by a cardiologist of stable angina with follow-up at one year. Main outcome measure Death or non-fatal myocardial infarction. Results The rate of death and non-fatal myocardial...... of outcome to estimate the probability of death or myocardial infarction within one year of presentation with stable angina. Conclusions A score based on the presence of simple, objective clinical and investigative variables makes it possible to discriminate effectively between very low risk and very high...... risk patients and to estimate the probability of death or non-fatal myocardial infarction over one year....

  8. Bisphosphonate-related osteonecrosis of the jaw complicated by Ludwig's angina.

    Science.gov (United States)

    Yang, Rong-Hsin; Shen, Shu-Huei; Li, Wing-Yin; Chu, Yum-Kung

    2015-01-01

    Ludwig's angina is a life-threatening cellulitis that involves the submandibular and sublingual spaces. It often occurs after an infection of the roots of the teeth. However, modern dental care and use of antibiotics for oral infections have made Ludwig's angina rare. We present here a cancer patient exhibiting the sequential features of bisphosphonate related osteonecrosis of the jaw on bone scan complicating with Ludwig's angina. This report highlights the need for medical practitioners to be alert to these rare combinations in the compromised patient after bisphosphonate therapy. To the best of our knowledge, no case of Ludwig's angina secondary to osteonecrosis of the jaw has been reported.

  9. A comparative study of dalteparin and unfractionated heparin in patients with unstable angina pectoris

    Directory of Open Access Journals (Sweden)

    Hanmant S Amane

    2011-01-01

    Conclusion : Dalteparin is as effective and safe as unfractionated heparin in the treatment of unstable angina. Dalteparin does not require routine laboratory monitoring as with unfractionated heparin.

  10. Abdominal emergencies in pediatrics.

    Science.gov (United States)

    Coca Robinot, D; Liébana de Rojas, C; Aguirre Pascual, E

    2016-05-01

    Abdominal symptoms are among the most common reasons for pediatric emergency department visits, and abdominal pain is the most frequently reported symptom. Thorough history taking and physical examination can often reach the correct diagnosis. Knowing the abdominal conditions that are most common in each age group can help radiologists narrow the differential diagnosis. When imaging tests are indicated, ultrasonography is usually the first-line technique, enabling the diagnosis or adding relevant information with the well-known advantages of this technique. Nowadays, plain-film X-ray studies are reserved for cases in which perforation, bowel obstruction, or foreign body ingestion is suspected. It is also important to remember that abdominal pain can also occur secondary to basal pneumonia. CT is reserved for specific indications and in individual cases, for example, in patients with high clinical suspicion of abdominal disease and inconclusive findings at ultrasonography. We review some of the most common conditions in pediatric emergencies, the different imaging tests indicated in each case, and the imaging signs in each condition.

  11. [Pain perception and peripheral pain localization in angina pectoris].

    Science.gov (United States)

    Droste, C

    1988-01-01

    Cardiac nociceptive afferences are mainly transmitted by sympathetic nervous tracts. After passing the ganglion stellatum and neighbouring ganglia, the nerves enter the dorsal horn of the spinal cord at C8-Th9 (especially Th2-Th6). Here the nerve synapses for the first time, mainly to neurons which run up to the thalamus contralaterally by the tractus spinothalamicus. Apart from atypically localised pain (jaw, head, neck), the nervus vagus is rarely involved in transmitting angina pectoris pain. There is no close relation between peripheral pain localisation and localisation of coronary stenosis or myocardial ischemia areas. The localisation of angina pectoris is decided by viscero-somatic summation (convergence-projection-theory). Almost all the ascending tracts of the tractus spinothalamicus with visceral inflow also receive inflow from somatic afferences, from skin areas of the dermatome from the same segment level, and especially from deep somatic structures such as muscle and ligaments (Head's zones). Additional reflex mechanisms, where the efferent part is probably sympathetic, explain transferred effects in the matching dermatome such as hypothermic skin zones, cutaneous hyperalgesia, higher pressure sensitivity of the muscles and occasionally even dystrophic changes. The amount of spinal visceral afferences is relatively small (only 1.5-2.5% of all somatic spinal afferences). The low amount, the pronounced divergence and, compared to converging somatic afferences, the larger receptive fields in the organ explain the diffuse, barely localisable character of angina pectoris pain. Cardiac afferences are tonically and phasically inhibited at spinal and supraspinal levels, especially by descending tracts. This explains why angina pectoris can be missing in spite of pronounced peripheral nociceptive impulse rates. Patients with silent myocardial ischemia have a higher central pain threshold than patients with symptomatic myocardial ischemia. Endogenous opioids

  12. Childhood abdominal cystic lymphangioma

    Energy Technology Data Exchange (ETDEWEB)

    Konen, Osnat; Rathaus, Valeria; Shapiro, Myra [Department of Diagnostic Imaging, Meir General Hospital, Sapir Medical Centre, Kfar Saba (Israel); Dlugy, Elena [Department of Paediatric Surgery, Schneider Medical Centre, Sackler School of Medicine, Tel-Aviv University (Israel); Freud, Enrique [Department of Paediatric Surgery, Sapir Medical Centre, Sackler School of Medicine, Tel-Aviv University (Israel); Kessler, Ada [Department of Diagnostic Imaging, Sourasky Medical Centre, Tel-Aviv (Israel); Horev, Gadi [Department of Diagnostic Imaging, Schneider Medical Centre, Tel-Aviv (Israel)

    2002-02-01

    Background: Abdominal lymphangioma is a rare benign congenital malformation of the mesenteric and/or retroperitoneal lymphatics. Clinical presentation is variable and may be misleading; therefore, complex imaging studies are necessary in the evaluation of this condition. US and CT have a major role in the correct preoperative diagnosis and provide important information regarding location, size, adjacent organ involvement, and expected complications. Objective: To evaluate the clinical and imaging findings of seven children with proven abdominal cystic lymphangioma. Materials and methods: Clinical and imaging files of seven children with pathologically proven abdominal lymphangioma, from three university hospitals, were retrospectively evaluated. Patient's ages ranged from 1 day to 6 years (mean, 2.2 years). Symptoms and signs included evidence of inflammation, abnormal prenatal US findings, chronic abdominal pain, haemorrhage following trauma, clinical signs of intestinal obstruction, and abdominal distension with lower extremities lymphoedema. Plain films of five patients, US of six patients and CT of five patients were reviewed. Sequential imaging examinations were available in two cases. Results: Abdominal plain films showed displacement of bowel loops by a soft tissue mass in five of six patients, two of them with dilatation of small bowel loops. US revealed an abdominal multiloculated septated cystic mass in five of six cases and a single pelvic cyst in one which changed in appearance over 2 months. Ascites was present in three cases. CT demonstrated a septated cystic mass of variable sizes in all available five cases. Sequential US and CT examinations in two patients showed progressive enlargement of the masses, increase of fluid echogenicity, and thickening of walls or septa in both cases, with multiplication of septa in one case. At surgery, mesenteric lymphangioma was found in five patients and retroperitoneal lymphangioma in the other two

  13. Abdominal paracentesis and thoracocentesis.

    Science.gov (United States)

    Lee, Ser Yee; Pormento, James G; Koong, Heng Nung

    2009-04-01

    Abdominal paracentesis and thoracocentesis are common bedside procedures with diagnostic, therapeutic and palliative roles. We describe a useful and familiar a useful and familiar technique with the use of a multiple lumen catheter commonly used for central venous line insertion for drainage of ascites or moderate to large pleural effusions. The use of a multiple lumen catheter allows easier and more rapid aspiration of fluid with a smaller probability of the side holes being blocked as compared to the standard needle or single catheter methods. This is particularly useful in situations where the dedicated commercial kits for thoracocentesis and abdominal paracentesis are not readily available.

  14. [Abdominal actinomycosis with IUD].

    Science.gov (United States)

    Kamprath, S; Merker, A; Kühne-Heid, R; Schneider, A

    1997-01-01

    We report a case of abdominal actinomycosis in a 54 year old woman using an intrauterine device for a period of 8 years. The most important finding was a tuboovarialabscess at the left pelvic side with involvement of the serosa of the jejunum, ileum, sigma, and omentum majus. Intraoperative exploration showed a solid retroperitoneal infiltration between the pelvic side wall and sigma. Another infiltration was found on the left side of the abdominal wall. The diagnosis was confirmed by histopathological examination and the patient was treated by a combination of Aminopenicillin and Metronidazol. After a period of three months we observed a complete regression of the clinical and the MRI findings.

  15. Unusual Differential Diagnosis of Upper Abdominal Pain

    Directory of Open Access Journals (Sweden)

    Lanthaler Monika

    2009-01-01

    The peculiarity of this case is the rarity of toothpick ingestion and gastric perforation in a young and healthy white Caucasian followed by development of a liver abscess after primary uneventful endoscopic removal. In light of this case, gastric perforation due to ingested foreign bodies such as toothpicks can be considered a rare cause of upper abdominal pain.

  16. Systemic lupus erythematosus : abdominal radiologic findings

    Energy Technology Data Exchange (ETDEWEB)

    Oh, Jae Cheon; Cho, On Koo; Lee, Yong Joo; Bae, Jae Ik; Kim, Yong Soo; Rhim, Hyun Chul; Ko, Byung Hee [Hanyang Univ. College of Medicine, Seoul (Korea, Republic of)

    1999-06-01

    Systemic lupus erythematosus(SLE) is a systemic disease of unknown etiology. Its main pathology is vasculitis and serositis, due to deposition of the immune complex or antibodies. Most findings are nonspecific ; abdominal manifestations include enteritis, hepatomegaly, pancreatic enlargement, serositis, lymphadenopathy, splenomegaly, nephritis, interstitial cystitis, and thrombophlebitis. We described radiologic findings of various organ involvement of SLE; digestive system, serosa, reticuloendothelial system, urinary system, and venous system. Diagnosis of SLE was done according to the criteria of American Rheumatism Association. Understanding of the variable imaging findings in SLE may be helpful for the early detection of abdominal involvement and complications.

  17. Pancreatic and biliary drainage for the treatment of bile leakage and severe intra-abdominal infection after pancreatiduodenectomy due to severe trauma%急诊胰十二指肠切除术后并发胆胰漏的处理

    Institute of Scientific and Technical Information of China (English)

    朱耀明

    2012-01-01

    目的 探讨因腹部外伤行急诊胰十二指肠切除术( pancreaticoduodenectomy,PD)后胆胰漏的发生及并发严重腹腔感染需再次手术时的处理策略.方法 回顾分析10年来因腹部外伤而急诊行PD手术病人共35例,术后发生胆胰漏12例,发生率为34.3%.经保守治疗、调整腹腔引流管或穿刺引流后治愈3例,另9例发生严重腹腔感染,再次手术行腹腔清洗和置管引流.结果 再手术者中8例未行胆胰管支撑引流,其中6例术后胆胰漏之积液区未有效局限,腹腔感染持续并加重,3例并发腹腔出血;均行第3次手术,于胰管和(或)胆管内置管外引流,感染区留置双套管术后冲洗腹腔并负压引流;6例均存活,6个月后行决定性手术.结论 胰十二指肠外伤行PD术后胆胰漏发生率高,再次手术时行胰管和(或)胆管内置支撑管外引流,可迅速有效地控制腹腔感染,降低死亡率.%Objective The objective of this study was to investigate the incidence and the operation strategy of biliary and pancreatic leakage and related severe intra-abdominal infection after pancre-aticoduodenectomy (PD) due to abdominal trauma. Methods A total of 35 patients who underwent e-mergent PD in our department due to severe abdominal trauma during past ten years were retrospectively analyzed. Results Postoperative biliary and pancreatic leakages developed in 12 cases with an incidence of 34.3 %, in which 3 patients were cured by non-operating treatment, including peritoneal drainage tube,and other 9 patients had severe abdominal infectious complications and needed re-operation. In these patients who required re-operations without biliary and pancreatic drainage, bile and pancreatic secreting fluid were not limited effectively, resulting in severe intraperitoneal infection in 6 cases, in which 3 patients needed to be re-operated for the third time due to a massive bleeding. Other 6 patients were treated with effectively drainage by

  18. Adult abdominal hernias.

    LENUS (Irish Health Repository)

    Murphy, Kevin P

    2014-06-01

    Educational Objectives and Key Points. 1. Given that abdominal hernias are a frequent imaging finding, radiologists not only are required to interpret the appearances of abdominal hernias but also should be comfortable with identifying associated complications and postrepair findings. 2. CT is the imaging modality of choice for the assessment of a known adult abdominal hernia in both elective and acute circumstances because of rapid acquisition, capability of multiplanar reconstruction, good spatial resolution, and anatomic depiction with excellent sensitivity for most complications. 3. Ultrasound is useful for adult groin assessment and is the imaging modality of choice for pediatric abdominal wall hernia assessment, whereas MRI is beneficial when there is reasonable concern that a patient\\'s symptoms could be attributable to a hernia or a musculoskeletal source. 4. Fluoroscopic herniography is a sensitive radiologic investigation for patients with groin pain in whom a hernia is suspected but in whom a hernia cannot be identified at physical examination. 5. The diagnosis of an internal hernia not only is a challenging clinical diagnosis but also can be difficult to diagnose with imaging: Closed-loop small-bowel obstruction and abnormally located bowel loops relative to normally located small bowel or colon should prompt assessment for an internal hernia.

  19. Screening for Abdominal Aortic Aneurysm

    Science.gov (United States)

    Understanding Task Force Recommendations Screening for Abdominal Aortic Aneurysm The U.S. Preventive Services Task Force (Task Force) has issued a final recommendation statement on Screening for Abdominal Aortic Aneurysm. This final ...

  20. Abdominal aortic aneurysm repair - open

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/007392.htm Abdominal aortic aneurysm repair - open To use the sharing features on this page, please enable JavaScript. Open abdominal aortic aneurysm repair is surgery to fix a widened part ...

  1. Abdominal Wall Endometrioma. Report of Two Cases

    Directory of Open Access Journals (Sweden)

    Tahiluma Santana Pedraza

    2014-08-01

    Full Text Available Abdominal wall endometrioma is a condition rarely seen by surgeons. It represents a diagnostic challenge due to its similarity with other tumors. This entity occurs in fertile women and often appears two to five years after gynecological and obstetric surgical procedures. It must be considered when dealing with a cyclically painful nodule located in a laparotomy scar. The diagnosis is established by histological examination; most imaging tests determine the characteristics of the lesion, concomitant lesions and the intra-abdominal origin or location in the abdominal wall. The cases of two patients treated at the General Surgery Department of the María Eugenia González Comprehensive Diagnostic Center in the Capital District, Venezuela, are presented. Wide excision of the tissue and histological examination were performed, confirming the diagnosis. The postoperative course was uneventful. This case is presented given the rarity of this condition.

  2. Plasma resistin is increased in patients with unstable angina

    Institute of Scientific and Technical Information of China (English)

    HU Wen-lan; QIAO Shu-bin; HOU Qing; YUAN Jian-song

    2007-01-01

    Background Resistin, a novel adipokine linked to insulin resistance and obesity in rodents, which is derived mainly from macrophages and identified in atheromas in human, has been shown to play a potential role in atherosclerosis.Resistin levels were reported to increase in coronary artery disease (CAD), while data concerning resistin in different stages of CAD in Chinese people are lacking. The aim of this study was to assess whether plasma concentrations of resistin differed between patients with unstable and stable angina pectoris.Methods Plasma resistin levels were determined by means of enzyme-linked immunosorbent assay (ELISA) in 46 patients with unstable angina (UAP), 37 with stable angina (SAP) and 31 control subjects.Results Plasma concentrations of resistin were significantly increased in UAP group (geometric mean (interquartile range) 12.09 ng/ml (8.40, 18.08)) in comparison with SAP (9.04 ng/ml (7.09, 11.44)) and control groups (8.71 ng/ml (6.58,11.56)). No differences in resistin levels were found between patients with SAP and controls. We also found that plasma resistin positively correlated with leukocyte counts (r=0.21, P=0.027), high sensitive C-reactive protein (hs-CRP) (r=0.25,P=0.008), and endothelin-1 (r=0.21, P=0.025) after adjustment for age, sex and BMI.Conclusion Resistin may be involved in the development of CAD by influencing systemic inflammation and endothelial activation.

  3. Gender differences in the management and clinical outcome of stable angina.

    NARCIS (Netherlands)

    Daly, C.A.; Clemens, F.; Lopez Sendon, J.L.; Tavazzi, L.; Boersma, E.; Danchin, N.; Delahaye, F.; Gitt, A.; Julian, D.; Mulcahy, D.; Ruzyllo, W.; Thygesen, K.; Verheugt, F.W.A.; Fox, K.M.

    2006-01-01

    BACKGROUND: We sought to examine the impact of gender on the investigation and subsequent management of stable angina and to assess gender differences in clinical outcome at 1 year. METHODS AND RESULTS: The Euro Heart Survey of Stable Angina enrolled patients with a clinical diagnosis of stable angi

  4. Muscle Fibre Types, Ubiquinone Content and Exercise Capacity in Hypertension and Effort Angina

    DEFF Research Database (Denmark)

    Karlsson, Jan; Diamant, Bertil; Folkers, Karl;

    1991-01-01

    Farmakologi, hypertension, IHD, skeletal muscle fibre composition, muscle coenzyme Q10, ischaemic heart disease, effort angina, muscle fibre lesion, muscle ubiquinone......Farmakologi, hypertension, IHD, skeletal muscle fibre composition, muscle coenzyme Q10, ischaemic heart disease, effort angina, muscle fibre lesion, muscle ubiquinone...

  5. Improving diagnosis and treatment of women with angina pectoris and microvascular disease

    DEFF Research Database (Denmark)

    Prescott, Eva; Abildstrøm, Steen Zabell; Aziz, Ahmed

    2014-01-01

    BACKGROUND: The iPOWER study aims at determining whether routine assessment of coronary microvascular dysfunction (CMD) in women with angina and no obstructive coronary artery disease is feasible and identifies women at risk. METHODS: All women with angina referred to invasive angiographic assess...

  6. Necrotizing fasciitis in association with Ludwig’s angina – A case report

    OpenAIRE

    Kavarodi, A.M.

    2011-01-01

    A 28 year old male diabetic patient developed Ludwig’s angina which subsequently evolved into cervicofacial necrotizing fasciitis. The differential characteristic of Ludwig’s angina and cervicofacial necrotizing fasciitis, as it relates to this rare presentation is discussed. The clinical and radiological features, pathophysiology, diagnosis and the management that resulted in a successful outcome are presented.

  7. Necrotizing fasciitis in association with Ludwig’s angina – A case report

    Science.gov (United States)

    Kavarodi, A.M.

    2011-01-01

    A 28 year old male diabetic patient developed Ludwig’s angina which subsequently evolved into cervicofacial necrotizing fasciitis. The differential characteristic of Ludwig’s angina and cervicofacial necrotizing fasciitis, as it relates to this rare presentation is discussed. The clinical and radiological features, pathophysiology, diagnosis and the management that resulted in a successful outcome are presented. PMID:24151421

  8. A STUDY OF HIGH SENSITIVITY C-REACTIVE PROTEIN IN UNSTABLE ANGINA

    Directory of Open Access Journals (Sweden)

    Satish

    2014-11-01

    Full Text Available BACKGROUND: Unstable angina has a wide variability in its natural history, changing concepts of Pathophysiology, and newer approaches to its management strategies. So, unstable angina still has importance and prime interest in research work. Various ongoing research works has provided newer insights in pathophysiology of unstable angina syndrome and helps in recognition of clinical variability and unpredictability of it. C - reactive protein being the most sensitive acute phase reactant currently held. A recent previous study has estimated the levels and values of high-sensitivity C - reactive protein in both stable and unstable angina pectoris. Data provided by the study indicated need for further studies in this field. With all these facts, the present study is carried out to estimated Hs CRP levels as a marker of inflammation in patient of unstable angina. AIMS AND OBJECTIVES: The present study was carried out with the following Aims and Objectives. To estimate Hs-CRP levels as a marker of inflammation in patients of unstable angina. To compare Hs-CRP levels in cases of unstable angina, with Hs-CRP levels in patients of stable angina and in healthy age and sex matched controls. MATERIAL AND METHODS: This study was carried out at Basaveshwar Teaching and General Hospital, Gulbarga, MRMC Gulbarga. Approximate duration of study was 1 ½ year from June-2008 to November, 2010. OBSERVATION: Following are the conclusions drawn from the present study.

  9. 灸法对肠易激综合征慢性内脏痛镇痛效应的研究与展望%Moxibustion therapy for chronic abdominal pain due to irritable bowel syndrome

    Institute of Scientific and Technical Information of China (English)

    包春辉; 吴焕淦; 黄任佳; 王硕硕; 周志刚; 胡智海; 赵继梦; 王思瑶; 谭琳蓥; 刘世敏

    2015-01-01

    BACKGROUND:Chronic visceral pain is one of major complaints of irritable bowel syndrome which seriously affects patient’s quality of life. Recent researches have shown that moxibustion therapy has positive effects on aleviating chronic visceral pain in irritable bowel syndrome patients. OBJECTIVE: To study the clinical utility of moxibustion in coping with chronic visceral pain of irritable bowel syndrome patients, and shed light on the theoretical basis of moxibustion analgesia, thereby to give insights into the further research and application on moxibustion. METHODS: With the key words of “moxibustion, irritable bowel syndrome, visceral pain, abdominal pain” in Chinese and in English, respectively, a computer-based search was performed in CNKI, VIP, Wanfang and PubMed databases for articles published from January 1990 to October 2014. After the initial screening, the remained articles went through further selection and categorization. RESULTS AND CONCLUSION:The result shows promising results of moxibustion on relieving chronic visceral pain for both two subtypes of irritable bowel syndrome patients, diarrhea type and constipation type. Moxibustion may exert an analgesic effect on chronic visceral pain in irritable bowel syndrome patients through regulation of visceral hypersensitivity, gastrointestinal motility disorders, brain-gut axis and neuroendocrine system disorders, immune dysfunction and low-grade inflammation in the gut, psychological abnormalities, and alteration of intestinal flora. However, to fuly understand the analgesia effect of moxibustion and elucidate its mechanism, more standardized randomized controled trials employing advanced scientific techniques and equipments wil stil be needed in the future.%背景:慢性内脏痛是肠易激综合征患者最主要的临床表现之一,患者的生活质量受到严重影响。近年研究表明,灸法对肠易激综合征患者慢性内脏痛的治疗取得了一定

  10. Total occlusion of left main coronary artery without angina pectoris.

    Science.gov (United States)

    DePace, N L; Kimbiris, D; Iskandrian, A S; Bemis, C E; Segal, B L

    1983-05-01

    A patient had total occlusion of the left main coronary artery that was proved by coronary arteriography. The patient was initially seen with clinical signs of congestive heart failure but without symptoms of angina pectoris or ECG evidence of myocardial infarction. The patient's extensive right-to-left coronary artery collaterals may have contributed to the absence of chest pain. Because of the severe left ventricular dysfunction and the absence of chest pain, the patient was treated with medical therapy. Six months after the cardiac catheterization, he was alive and well under New York Heart Association functional classification II.

  11. Changes in multifractal properties for stable angina pectoris

    Science.gov (United States)

    Knežević, Andrea; Martinis, Mladen; Krstačić, Goran; Vargović, Emil

    2005-12-01

    The multifractal approach has been applied to temporal fluctuations of heartbeat (RR) intervals, measured in various regimes of physical activity (ergometric data), taken from healthy subjects and those having stable angina pectoris (SAP). The problem we address here is whether SAP changes multifractality observed in healthy subjects. The G-moment method is used to analyse the multifractal spectrum. It is observed that both sets of data characterize multifractality, but a different trend in multifractal behaviour is found for SAP disease, under pronounced physical activity.

  12. Ivabradine: the evidence of its therapeutic impact in angina

    OpenAIRE

    Guillaume Marquis-Gravel; Jean-Claude Tardif

    2008-01-01

    Guillaume Marquis-Gravel, Jean-Claude TardifMontreal Heart Institute, Université de Montréal, Montreal, Quebec, CanadaIntroduction: Stable angina pectoris (SAP) is a widely prevalent disease affecting 30 000 to 40 000 per million people in Europe and the US. SAP is associated with reductions in quality of life and ability to work, and increased use of healthcare resources. Ivabradine is a drug with a unique therapeutic target, the If current of the sinus node, developed ...

  13. Angina pectoris during daily activities and exercise stress testing: The role of inducible myocardial ischemia and psychological distress.

    Science.gov (United States)

    Sullivan, Mark D; Ciechanowski, Paul S; Russo, Joan E; Spertus, John A; Soine, Laurie A; Jordan-Keith, Kier; Caldwell, James H

    2008-10-31

    Physicians often consider angina pectoris to be synonymous with myocardial ischemia. However, the relationship between angina and myocardial ischemia is highly variable and we have little insight into the sources of this variability. We investigated the relationship of inducible myocardial ischemia on SPECT stress perfusion imaging to angina reported with routine daily activities during the previous four weeks (N=788) and to angina reported during an exercise stress test (N=371) in individuals with confirmed or suspected coronary disease referred for clinical testing. We found that angina experienced during daily life is more strongly and consistently associated with psychological distress and the personal threat associated with angina than with inducible myocardial ischemia. In multivariable models, the presence of any angina during routine activities over the prior month was significantly associated with age, perceived risk of myocardial infarction, and anxiety when compared to those with no reported angina in the past month. Angina during daily life was not significantly associated with inducible myocardial ischemia on stress perfusion imaging in bivariate or multivariable models. In contrast, angina experienced during exercise stress testing was significantly related to image and ECG ischemia, though it was also significantly associated with anxiety. These results suggest that angina frequency over the previous four weeks is more strongly associated with personal threat and psychosocial distress than with inducible myocardial ischemia. These results lend support to angina treatment strategies that aim to reduce threat and distress as well as to reduce myocardial ischemia.

  14. Percutaneous drainage of abdominal abcess

    Energy Technology Data Exchange (ETDEWEB)

    Men, Sueleyman E-mail: suleyman.men@deu.edu.tr; Akhan, Okan; Koeroglu, Mert

    2002-09-01

    The mortality in undrained abdominal abscesses is high with a mortality rate ranging between 45 and 100%. The outcome in abdominal abscesses, however, has improved due to advances in image guided percutaneous interventional techniques. The main indications for the catheter drainage include treatment or palliation of sepsis associated with an infected fluid collection, and alleviation of the symptoms that may be caused by fluid collections by virtue of their size, like pancreatic pseudocele or lymphocele. The single liver abscesses may be drained with ultrasound guidance only, whereas the multiple abscesses usually require computed tomography (CT) guidance and placement of multiple catheters. The pancreatic abscesses are generally drained routinely and urgently. Non-infected pancreatic pseudocysts may be simply observed unless they are symptomatic or cause problems such as pain or obstruction of the biliary or the gastrointestinal tract. Percutaneous routes that have been described to drain pelvic abscesses include transrectal or transvaginal approach with sonographic guidance, a transgluteal, paracoccygeal-infragluteal, or perineal approach through the greater sciatic foramen with CT guidance. Both the renal and the perirenal abscesses are amenable to percutaneous drainage. Percutaneous drainage provides an effective and safe alternative to more invasive surgical drainage in most patients with psoas abscesses as well.

  15. Abdominal closed trauma in children. Trauma abdominal cerrado en el niño.

    Directory of Open Access Journals (Sweden)

    Rogelio Rodríguez Castillo

    Full Text Available Blunt abdominal trauma constitutes 90% approximately of the abdominal injuries in children. Due to the augmented size of the child trunk in relation to their extremities, the abdominal lesions are extremely frequents. The abdominal trauma is present in 20-30% of the patients with serious trauma. It's the second cause of death for accidents after the cranial traumatism in the pediatric patient. We presented the Good Clinical Practices Guideline for Blunt Abdominal Trauma, approved by consensus in the 2nd National Good Clinical Practices Workshop in Pediatric Surgery (Manzanillo, Cuba, September 31 - October 3, 2002.

    El trauma abdominal cerrado constituye aproximadamente el 90 % de los traumatismos abdominales en niños. Debido al tamaño aumentado del tronco del niño en relación con sus extremidades las lesiones abdominales son extremadamente frecuentes. El trauma abdominal está presente en el 20-30 % de los pacientes con trauma grave. Es la segunda causa de muerte por accidentes, después del traumatismo craneal, en el paciente pediátrico. Se presenta la Guía de Buenas Prácticas Clínicas para trauma abdominal cerrado, aprobada por consenso en el 2º Taller Nacional de Buenas Prácticas Clínicas en Cirugía Pediátrica (Manzanillo, 31 de septiembre al 3 de octubre del 2002.

  16. [Unstable angina pectoris in intermittent left bundle branch block].

    Science.gov (United States)

    Albert, S; Flury, G

    1997-11-19

    We present a case report of a 57 year old woman with recurrent chest pain, initially exclusively at exercise and later also at rest. This led to an emergency hospitalization for suspected myocardial infarction. As there were no enzymatic and electrocardiographic signs of acute infarction she was treated, as unstable angina pectoris. Coronary angiography revealed but a modest coronary atheromatosis without significant coronary stenosis. Therefore her symptoms were interpreted as primary manifestation of an intermittant Left Bundle Branch Block (LBBB) with changing heart-rate dependency. A majority of patients with LBBB and chest pain have a relevant Coronary Artery Disease (CAD). There is a small number of reports in literature about patients with intermittant LBBB without significant CAD but with both typical (exercise-induced) and atypical (at rest) chest pain. Special features of our case are presentation of LBBB as unstable angina, documentation of an intermittant LBBB with changing heart-rate dependency and heart-rate-dependent supranormal conduction in the left bundle branch. We review some important aspects of LBBB with regard to this case.

  17. Angina monocitica con sovrainfezione da Prevotella denticola: caso clinico

    Directory of Open Access Journals (Sweden)

    Maria Teresa Allù

    2005-06-01

    Full Text Available Monocytic angina with superinfection of Prevotella denticola: clinical case Monocytic angina is a clinical sindrome caused by Epstein-Barr virus characterized by fever, pharyngitis, exudative tonsillitis, swollen lymphoglands, splenomegaly and hepatomegaly.The inflamed pharynx and necrotic tonsils of infectious mononucleosis are subject to bacterial superinfection initially or during the course of the illness; the reduced PO2 tension and low oxidation-reduction potential that prevail in a vascular and necrotic tissues favour the growth of anaerobes. In this article we reported the clinical case of a ten years old children, who presented fever and tonsillopharyngitis; he was treated with cefotaxime and piperacillin, he did not improve in health. He was admitted to hospital (Department of Otorhinolaryngology. The patient was treated with aminoglycoside (tobramycin, piperacillin and cortisone; the clinical situation deteriorated. Pus sample was collected from the tonsils and cultured. Isolated strain from culture anaerobic was identified biochemically (Rapid-ID32ANA.The microorganism isolated was: Prevotella denticola (oral anaerobic gram-negative rods; β-lactamase production was tested by using the chromogenic cephalosporin disk test.The susceptibility to antibiotics was performed according to NCCLS recommendations. Prevotella denticola (β-lactamase production was resistant to penicillin, cefoxitin, cefotetan, piperacillin, clindamycin and metronidazole it was susceptible to piperacillin-tazobactam, amoxicillin-clavulanate, ticarcillin-clavulanate, imipenem and chloramphenicol. Children was treated with piperacillin-tazobactam, with rapid symptomatic relief.

  18. A case of relapsing polychondritis mimicking Ludwig’s angina

    Directory of Open Access Journals (Sweden)

    Adnan Agha

    2009-09-01

    Full Text Available Relapsing polychondritis (RP is a severe progressive inflammatory condition involving cartilaginous structures and caused by an autoimmune process, for which there is no confirmatory serological biomarker and which still is diagnosed on a mainly clinical basis. RP has been associated with many diseases like Sweet’s syndrome, Behcet’s disease, rheumatoid arthritis, and other autoimmune disorders. We attempt to describe here a unique case of a 38-year-old female with a high-grade fever, sore throat, difficulty in swallowing, hoarseness of the voice, and found to have signs of tongue swelling and inflammation of the oral cavity that mimicked Ludwig’s angina, necessitating antibiotic use. On careful re-evaluation the patient was diagnosed to have relapsing polychondritis based on auricular and respiratory tract chondritis and response to steroids. The purpose of this report is to emphasize the fact that careful clinical assessment is needed to diagnose RP, which may be misdiagnosed as Ludwig’s angina.

  19. [Significance of the fusospirillum complex (Plaut-Vincent angina)].

    Science.gov (United States)

    Van Cauwenberge, P

    1976-01-01

    The results are discussed of a retrospective study of 126 patients by whom an excess of the fusospirochaetal complex was found by direct microscopic examination of tonsillar material. These bacteria are not only found in unilateral ulcero-necrotic tonsillitis, but also in different other tonsillar and general diseases. Vincent's angina appears almost exclusively in young persons, aged from 16 to 25 years; in the adolescence (16-20 years) it forms about 40% of all cases of acute tonsillitis. The fusospirochaetal complex is also often found in chronic tonsillitis and even in morfologically normal tonsils, especially in patients with general diseases like rheumatic arthritis. In one third of the patients with infectious mononucleosis, the complex is present in the tonsillar lesions. The occurrence of Vincent's angina is double as high in women than in men. From our assessments we can conclude that the fusospirochaetal complex has a very low pathogenity, and that it only can grow in patients with a reduced local or general resistance, even without causing local lesions.

  20. Salvianolate injection in the treatment of unstable angina pectoris

    Science.gov (United States)

    Zhang, Dan; Wu, Jiarui; Liu, Shi; Zhang, Xiaomeng; Zhang, Bing

    2016-01-01

    Abstract Background: To systematically evaluate the clinical efficacy and safety of Salvianolate injection in the treatment of unstable angina pectoris (UAP). Methods: Using literature databases, we conducted a thorough and systematic retrieval of randomized controlled trials (RCTs) that using Salvianolate injection for treating UAP. The Cochrane Risk of Bias Assessment Tool was used to evaluate the methodological quality of the RCTs, and then the data were extracted and meta-analyzed by RevMan5.2 software. Results: A total of 22 RCTs with 2050 participants were included. The meta-analysis indicated that the combined use of Salvianolate injection and western medicine (WM) in the treatment of UAP can achieve a superior effect in angina pectoris total effective rate (risk ratio [RR] = 1.22, 95% confidence interval [CI] (1.17, 1.27), Z = 10.15, P Adverse drug reactions (ADRs) or adverse drug events (ADEs) were reported in 6 RCTs involving 15 cases; however, there were no serious ADRs/ADEs. Conclusion: Based on the systematic review, the combined use of Salvianolate injection and WM in the treatment of UAP can achieve a better effect; however, there was no definitive conclusion about its safety. More the large-sample and multicenter RCTs are needed to support its clinical usage. PMID:28002341

  1. Transcutaneous electrical nerve stimulation (TENS) in angina pectoris.

    Science.gov (United States)

    Mannheimer, C; Carlsson, C A; Vedin, A; Wilhelmsson, C

    1986-09-01

    The aim of this study was to determine the efficacy of transcutaneous electrical nerve stimulation (TENS) in the treatment of chronic stable severe angina pectoris. In a short-term study the effect of TENS was studied in 10 male patients with angina pectoris (functional class III and IV). All patients had previously been stabilized on long-term maximal oral treatment. The effects of the treatment were measured by means of repeated bicycle ergometer tests. All patients had an increased working capacity (16-85%), decreased ST segment depression and reduced recovery time during TENS. No adverse effects were observed. A long-term study of TENS on similarly selected patients showed beneficial effects in terms of pain reduction, reduced frequency of anginal attacks, increased physical activity and increased working capacity during bicycle ergometer tests. An invasive study was carried out with respect to systemic and coronary hemodynamics and myocardial metabolism during pacing provoked myocardial ischemia in 13 patients. The results showed that TENS led to an increased tolerance to pacing, improved lactate metabolism, less pronounced ST segment depression. A drop in systolic blood pressure during TENS treatment at identical pacing rates indicated a decreased afterload. An increased coronary flow to ischemic areas in the myocardium was supported by the fact that the rate pressure product during anginal pain increased during TENS.

  2. Angina crónica estable. Consideraciones actuales

    Directory of Open Access Journals (Sweden)

    Yanier Coll Muñoz

    2011-03-01

    Full Text Available La angina de pecho crónica estable es un síndrome clínico caracterizado por dolor o malestar precordial secundario a isquemia miocárdica y sin características clínicas de inestabilidad. El debate actual sobre esta entidad clínica incluye tres aspectos fundamentales: diagnóstico, prevalencia e impacto socioeconómico, y tratamiento médico frente a revascularización miocárdica. En los últimos cuatro años se han dado a conocer los resultados de varios estudios multicéntricos de gran importancia que compararon tratamiento médico con revascularización miocárdica y cirugía de revascularización frente a intervención coronaria percutánea; además, han mejorado las técnicas de revascularización y existe abundante información sobre la eficacia de nuevos fármacos antiisquémicos. El presente trabajo tiene como objetivo hacer una revisión de los aspectos actuales más importantes relacionados con la angina de pecho estable y su tratamiento, publicados en la literatura especializada.

  3. Ruptured abdominal aortic aneurysm.

    Science.gov (United States)

    Sachs, T; Schermerhorn, M

    2010-06-01

    Ruptured abdominal aortic aneurysm (AAA) continues to be one of the most lethal vascular pathologies we encounter. Its management demands prompt and efficient evaluation and repair. Open repair has traditionally been the mainstay of treatment. However, the introduction of endovascular techniques has altered the treatment algorithm for ruptured AAA in most major medical centers. We present recent literature and techniques for ruptured AAA and its surgical management.

  4. Abdominal aspergillosis: CT findings

    Energy Technology Data Exchange (ETDEWEB)

    Yeom, Suk Keu, E-mail: pagoda20@hanmail.net [Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap2-dong, Songpa-gu, Seoul, 138-736 (Korea, Republic of); Kim, Hye Jin, E-mail: kimhyejin@amc.seoul.kr [Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap2-dong, Songpa-gu, Seoul, 138-736 (Korea, Republic of); Byun, Jae Ho, E-mail: jhbyun@amc.seoul.kr [Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap2-dong, Songpa-gu, Seoul, 138-736 (Korea, Republic of); Kim, Ah Young, E-mail: aykim@amc.seoul.kr [Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap2-dong, Songpa-gu, Seoul, 138-736 (Korea, Republic of); Lee, Moon-Gyu, E-mail: mglee@amc.seoul.kr [Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap2-dong, Songpa-gu, Seoul, 138-736 (Korea, Republic of); Ha, Hyun Kwon, E-mail: hkha@amc.seoul.kr [Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap2-dong, Songpa-gu, Seoul, 138-736 (Korea, Republic of)

    2011-03-15

    Objective: In order to retrospectively evaluate the CT findings of abdominal aspergillosis in immunocompromised patients. Materials and methods: CT scans were reviewed with regard to the sites, number, morphologic appearance, attenuation, and the contrast enhancement patterns of the lesions in six patients (5 women, 1 man; mean age, 43.4 years; range, 23-59 years) with pathologically proved abdominal aspergillosis by two gastrointestinal radiologists in consensus. Medical records were also reviewed to determine each patient's clinical status and outcome. Results: All patients were immunocompromised state: 4 patients received immunosuppressive therapy for solid organ transplantation and 2 patients received chemotherapy for acute myeloid leukemia. Aspergillosis involved blood vessels (n = 3), liver (n = 2), spleen (n = 2), gastrointestinal tract (n = 2), native kidney (n = 1), transplanted kidney (n = 1), peritoneum (n = 1), and retroperitoneum (n = 1). CT demonstrated solid organ or bowel infarction or perforation secondary to vascular thrombosis or pseudoaneurysm, multiple low-attenuating lesions of solid organs presenting as abscesses, concentric bowel wall thickening mimicking typhlitis, or diffuse or nodular infiltration of the peritoneum and retroperitoneum. Conclusion: Familiarity with findings commonly presenting as angioinvasive features or abscesses on CT, may facilitate the diagnosis of rare and fatal abdominal aspergillosis.

  5. Effect of Glucose - Insulin - Potassium (Gik Solution on Short Term Prognosis of Unstable Angina

    Directory of Open Access Journals (Sweden)

    A Azimi

    2007-12-01

    Full Text Available Introduction: Unstable angina as a clinical condition includes a major group of patients manifested with acute coronary syndrome. Misdiagnosis of this clinical syndrome causes myocardial infarction (MI and death. Conventional and advanced forms of treatment are used with the aim of rapid stabilization of unstable angina. Although infusion of glucose - insulin - potassium (GIK solution has had good results in acute MI, no major trial has studied its effect in unstable angina. The main goal of this study was evaluation of the effectiveness of GIK solution on prognosis of hospitalized unstable angina patients. Methods: This randomized clinical trial included patients with class II and III unstable angina (two groups of 94 patients, each with a mean age of 62.47±13.20 years and Female /Male ratio of 1.35 admitted in the CCU’s of Yazd from September 2003 to May 2004 . Results: There was no significant difference between the study and control groups regarding mean age, sex ratio and unstable angina class (P=0.15, P=0.77 and P=0.76. The study group had significant reduction in recurrent chest pain and duration of hospitalization (P=0.001 and P=0.02. The most common adverse effect of GIK solution was pain at infusion site. Conclusion: Use of GIK solution causes early stabilization of unstable angina patients without any significant or life threatening adverse effect.

  6. Meta-analysis of acupuncture therapy for the treatment of stable angina pectoris.

    Science.gov (United States)

    Zhang, Ze; Chen, Min; Zhang, Li; Zhang, Zhe; Wu, Wensheng; Liu, Jun; Yan, Jun; Yang, Guanlin

    2015-01-01

    Angina pectoris is a common symptom imperiling patients' life quality. The aim of this study is to evaluate the efficacy and safety of acupuncture for stable angina pectoris. Clinical randomized-controlled trials (RCTs) comparing the efficacy of acupuncture to conventional drugs in patients with stable angina pectoris were searched using the following database of PubMed, Medline, Wanfang and CNKI. Overall odds ratio (ORs) and weighted mean difference (MD) with their 95% confidence intervals (CI) were calculated by using fixed- or random-effect models depending on the heterogeneity of the included trials. Total 8 RCTs, including 640 angina pectoris cases with 372 patients received acupuncture therapy and 268 patients received conventional drugs, were included. Overall, our result showed that acupuncture significantly increased the clinical curative effects in the relief of angina symptoms (OR=2.89, 95% CI=1.87-4.47, Pacupuncture therapy was superior to conventional drugs. Although there was no significant difference in overall effective rate relating reduction of nitroglycerin between two groups (OR=2.13, 95% CI=0.90-5.07, P=0.09), a significant reduction on nitroglycerin consumption in acupuncture group was found (MD=-0.44, 95% CI=-0.64, -0.24, Pacupuncture therapy than for traditional medicines (MD=2.44, 95% CI=1.64-3.24, Pacupuncture therapy were found. Acupuncture may be an effective therapy for stable angina pectoris. More clinical trials are needed to systematically assess the role of acupuncture in angina pectoris.

  7. Efficacy of anipamil, a phenylalkylamine calcium antagonist, in treatment of angina pectoris

    DEFF Research Database (Denmark)

    Sørum, C; Larsen, C T; Rasmussen, Verner

    1994-01-01

    with > or = 0.1-mV horizontal or downsloping ST-segment depression limited by angina, and (c) at least 10 attacks of angina pectoris in a single-blind 3-week run-in period. Nineteen patients were randomized to enter the study. In 3-week periods, they received either anipamil 80 mg once daily (o.d.), anipamil...... 160 mg o.d., or placebo. At the end of each period, an exercise test was performed. The number of angina pectoris attacks was significantly reduced during treatment with anipamil 80 mg (p ... reduced during treatment with anipamil 80 mg (p Heart rate (HR) at 0...

  8. Management of Stable Angina with Ivabradine as Safe Alternative to Patients with Myasthenia Gravis

    Directory of Open Access Journals (Sweden)

    Giuliano Ohde Dalledone

    2016-01-01

    Full Text Available Management of cardiac symptoms in myasthenia gravis (MG patients can be challenging. The aim of this report is to describe the safe use of ivabradine for stable angina in MG patients. A 48 y.o. woman, with MG diagnosis, presented stable angina. Therapies choices were reduced considering concomitant disease as well as previous and unsuccessful cardiologic managements. Ivabradine showed unexpected results. The patient presented an improvement of neurological and cardiac symptoms, bringing ivabradine as one more therapeutic option to similar patients. In this report we recommend ivabradine as an effective and safe drug for treatment of stable angina in MG patients.

  9. [Differential diagnosis of abdominal pain].

    Science.gov (United States)

    Frei, Pascal

    2015-09-02

    Despite the frequency of functional abdominal pain, potentially dangerous causes of abdominal pain need to be excluded. Medical history and clinical examination must focus on red flags and signs for imflammatory or malignant diseases. See the patient twice in the case of severe and acute abdominal pain if lab parameters or radiological examinations are normal. Avoid repeated and useless X-ray exposure whenever possible. In the case of subacute or chronic abdominal pain, lab tests such as fecal calprotectin, helicobacter stool antigen and serological tests for celiac disease are very useful. Elderly patients may show atypical or missing clinical signs. Take care of red herrings and be skeptical whether your initial diagnosis is really correct. Abdominal pain can frequently be an abdominal wall pain.

  10. Abdominal aortic aneurysm surgery

    DEFF Research Database (Denmark)

    Gefke, K; Schroeder, T V; Thisted, B

    1994-01-01

    The goal of this study was to identify patients who need longer care in the ICU (more than 48 hours) following abdominal aortic aneurysm (AAA) surgery and to evaluate the influence of perioperative complications on short- and long-term survival and quality of life. AAA surgery was performed in 553......, 78% stated that their quality of life had improved or was unchanged after surgery and had resumed working. These data justify a therapeutically aggressive approach, including ICU therapy following AAA surgery, despite failure of one or more organ systems....

  11. Lower Abdominal Pain.

    Science.gov (United States)

    Carlberg, David J; Lee, Stephen D; Dubin, Jeffrey S

    2016-05-01

    Although most frequently presenting with lower abdominal pain, appendicitis, colitis, and diverticulitis can cause pain throughout the abdomen and can cause peritoneal and retroperitoneal symptoms. Evaluation and management of lower intestinal disease requires a nuanced approach by the emergency physician, sometimes requiring computed tomography, ultrasonography, MRI, layered imaging, shared decision making, serial examination, and/or close follow-up. Once a presumed or confirmed diagnosis is made, appropriate treatment is initiated, and may include surgery, antibiotics, and/or steroids. Appendicitis patients should be admitted. Diverticulitis and inflammatory bowel disease can frequently be managed on an outpatient basis, but may require admission and surgical consultation.

  12. Dolor abdominal recurrente .

    Directory of Open Access Journals (Sweden)

    Rodrigo De Vivero

    2009-11-01

    Full Text Available El dolor abdominal recurrente (DAR es un problema frecuente en la consulta médica y en la subespecialidad médica y quirúrgica. El DAR es frecuentemente funcional, es decir, sin una causa orgánica aparente. El diagnóstico diferencial debe incluir pérdida de peso, sangrado gastrointestinal, fiebre persistente, diarrea crónica y vómito importante. En este artículo se revisa el diagnóstico y tratamiento, pruebas diagnósticas y manejo farmacológico y ambiental.

  13. Abdominal perfusion computed tomography.

    Science.gov (United States)

    Ogul, Hayri; Bayraktutan, Ummugulsum; Kizrak, Yesim; Pirimoglu, Berhan; Yuceler, Zeynep; Sagsoz, M Erdem; Yilmaz, Omer; Aydinli, Bulent; Ozturk, Gurkan; Kantarci, Mecit

    2013-02-01

    The purpose of this article is to provide an up to date review on the spectrum of applications of perfusion computed tomography (CT) in the abdomen. New imaging techniques have been developed with the objective of obtaining a structural and functional analysis of different organs. Recently, perfusion CT has aroused the interest of many researchers who are studying the applicability of imaging modalities in the evaluation of abdominal organs and diseases. Per-fusion CT enables fast, non-invasive imaging of the tumor vascular physiology. Moreover, it can act as an in vivo biomarker of tumor-related angiogenesis.

  14. Abdominal pregnancy- a case report.

    Science.gov (United States)

    Okafor, Ii; Ude, Ac; Aderibigbe, Aso; Amu, Oc; Udeh, Pe; Obianyo, Nen; Ani, Coc

    2011-01-01

    A case of abdominal pregnancy in a 39 year old female gravida 4, para 0(+3) is presented. Ultrasonography revealed a viable abdominal pregnancy at 15 weeks gestational age. She was initially managed conservatively. Surgical intervention became necessary at 20 weeks gestational age following Ultrasound detection of foetal demise. The maternal outcome was favourable. This case is presented to highlight the dilemma associated with diagnosis and management of abdominal pregnancy with a review of literature.

  15. [Myocardial infarct and unstable angina pectoris: diagnostics and therapy].

    Science.gov (United States)

    Weber, M; Hamm, C

    2007-04-01

    Acute coronary syndromes include ST-elevation and non-ST elevation myocardial infarction, and unstable angina pectoris. These are characterised by the acute onset of chest pain. For the diagnostic work up in the acute phase, ECG and the assessment of cardiac markers play a central role. For patients with ST-elevation, primary interventional therapy is the first choice. For patients with an acute coronary syndrome without ST-elevation, a risk adapted therapeutic strategy should be chosen. High risk patients (elevated troponins, clinical, rhythmological and hemodynamic instability, ST-depression and diabetes mellitus) should be treated by an early invasive approach with angiography performed within 48-72 h. Low risk patients should be treated conservatively. For all patients who are treated interventionally, the administration of an aggressive antiaggregatory therapy including aspirin, clopidogrel, glycoprotein IIb/IIIa inhibitors and heparin is indicated in the acute phase. In the chronic phase, the treatment of cardiovascular risk factors is of paramount importance.

  16. Effects of acupuncture in moderate, stable angina pectoris

    DEFF Research Database (Denmark)

    Ballegaard, Søren; Pedersen, F; Pietersen, A

    1990-01-01

    In order to evaluate the effects of acupuncture in moderate, stable angina pectoris, 49 patients were randomized to either genuine or sham acupuncture. In sham acupuncture needles were inserted into points within the same spinal segment as in genuine acupuncture, but outside the Chinese meridian...... system. The effect was evaluated from exercise tests, anginal attack rate and nitroglycerin consumption. There were no significant differences between the effects of genuine and sham acupuncture either on exercise test variables or on subjective variables. In patients receiving genuine acupuncture...... there was a significant increase in exercise tolerance (median 9%) and in delay of onset to pain (median 10%). No significant changes were observed in patients receiving sham acupuncture. Within both groups there was a median reduction of 50% in anginal attack rate and nitroglycerin consumption...

  17. Atypical presentations among Medicare beneficiaries with unstable angina pectoris.

    Science.gov (United States)

    Canto, John G; Fincher, Contessa; Kiefe, Catarina I; Allison, Jeroan J; Li, Qing; Funkhouser, Ellen; Centor, Robert M; Selker, Harry P; Weissman, Norman W

    2002-08-01

    Chest pain is a hallmark symptom in patients with unstable angina pectoris (UAP). However, little is known regarding the prevalence of an atypical presentation among these patients and its relation to subsequent care. We examined the medical records of 4,167 randomly sampled Medicare patients hospitalized with unstable angina at 22 Alabama hospitals between 1993 and 1999. We defined typical presentation as (1) chest pain located substernally in the left or right chest, or (2) chest pain characterized as squeezing, tightness, aching, crushing, arm discomfort, dullness, fullness, heaviness, pressure, or pain aggravated by exercise or relieved with rest or nitroglycerin. Atypical presentation was defined as confirmed UAP without typical presentation. Among patients with confirmed UAP, 51.7% had atypical presentations. The most frequent symptoms associated with atypical presentation were dyspnea (69.4%), nausea (37.7%), diaphoresis (25.2%), syncope (10.6%), or pain in the arms (11.5%), epigastrium (8.1%), shoulder (7.4%), or neck (5.9%). Independent predictors of atypical presentation for patients with UAP were older age (odds ratio 1.09, 95% confidence interval 1.01 to 1.17/decade), history of dementia (odds ratio 1.49, 95% confidence interval 1.10 to 2.03), and absence of prior myocardial infarction, hypercholesterolemia, or family history of heart disease. Patients with atypical presentation received aspirin, heparin, and beta-blocker therapy less aggressively, but there was no difference in mortality. Thus, over half of Medicare patients with confirmed UAP had "atypical" presentations. National educational initiatives may need to redefine the classic presentation of UAP to include atypical presentations to ensure appropriate quality of care.

  18. Serum cardiac troponin T in unstable angina pectoris patients.

    Science.gov (United States)

    Leowattana, W; Mahanonda, N; Bhuripanyo, K; Pokum, S; Kiartivich, S

    2000-11-01

    Cardiac troponin T (cTnT) is a regulatory contractile protein not normally found in blood. Its detection in the circulation has been shown to be a sensitive and specific marker for myocardial cell damage. In this study, we used a second-generation enzyme immunoassay for cTnT to determine whether its presence in the serum of patients with unstable angina was a prognostic indicator. Thirty patients with unstable angina pectoris (UAP) and 30 patients with Q-wave acute myocardial infarction (AMI) were screened for serum CK-MB activity and cTnT at 6, 12, 24 and 48 hours after the onset of chest pain, All of the mean concentrations of CK-MB activity determined in UAP patients were less than the upper limit of normal (25 U/L). Meanwhile, the mean concentration of cTnT at 6, 12, 24 and 48 hours after onset of chest pain were higher than the cutoff values (0.1 microg/L), We found that one third of UAP patients had serum cTnT at the time of admission more than 0.1 microg/L and that these groups of patients were associated with a high risk for cardiac events. Our results suggested that patients with elevated serum cTnT could be considered as high-risk patients for developing myocardial infarction, Patients with normal cTnT levels and a low or intermediate clinical risk could be stabilized and further stratified noninvasively.

  19. A case of lipoma of parietal peritoneum causing abdominal pain.

    Science.gov (United States)

    Bang, Chang Seok; Kim, Yeon Soo; Baik, Gwang Ho; Han, Sang Hak

    2014-06-01

    Lipomas are common benign tumors of mature adipose tissue, enclosed by thin fibrous capsules. They can occur on any part of the body; however, peritoneal lipoma is extremely rare. We encountered a case of a 75-year-old man presenting with intermittent abdominal pain, who had undergone right hemicolectomy due to colon cancer. Abdominal computerized tomography showed a well-defined heterogenous fatty mass measuring 4.5 × 3.5 cm in size, suggesting fat necrosis located in the abdominal wall. Laparotomy showed a very large soft mass of peritoneum. Pathologically, the tumor was diagnosed as lipoma containing fat necrosis located in parietal peritoneum not fixed to any organs, but with small bowel adhesion. Due to its rare etiologic origin and obscure cause of development, we report on a case of lipoma of parietal peritoneum causing abdominal pain.

  20. Nontraumatic abdominal emergencies: acute abdominal pain: diagnostic strategies

    Energy Technology Data Exchange (ETDEWEB)

    Marincek, B. [Institute of Diagnostic Radiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich (Switzerland)

    2002-09-01

    Common causes of acute abdominal pain include appendicitis, cholecystitis, bowel obstruction, urinary colic, perforated peptic ulcer, pancreatitis, diverticulitis, and nonspecific, nonsurgical abdominal pain. The topographic classification of acute abdominal pain (pain in one of the four abdominal quadrants, diffuse abdominal pain, flank or epigastric pain) facilitates the choice of the imaging technique. The initial radiological evaluation often consists of plain abdominal radiography, despite significant diagnostic limitations. The traditional indications for plain films - bowel obstruction, pneumoperitoneum, and the search of ureteral calculi - are questioned by helical computed tomography (CT). Although ultrasonography (US) is in many centers the modality of choice for imaging the gallbladder and the pelvis in children and women of reproductive age, CT is considered to be one of the most valued tools for triaging patients with acute abdominal pain. CT is particularly beneficial in patients with marked obesity, unclear US findings, bowel obstruction, and multiple lesions. The introduction of multidetector row CT (MDCT) has further enhanced the utility of CT in imaging patients with acute abdominal pain. (orig.)

  1. Impact of pre-infarction angina on angiographic and echocardiographic outcomes in patients with acute ante

    Directory of Open Access Journals (Sweden)

    Ahmed El Missiri

    2016-09-01

    Conclusions: For patients suffering from a first attack of acute anterior wall STEMI, pre-infarction angina is associated with a better Killip class at presentation, better TIMI flow grade after PPCI, less incidence of TMP 0 flow grade.

  2. [Clinical trial by perexiline maleate in treatment of angina pectoris (author's transl)].

    Science.gov (United States)

    Corsini, G; Correale, E; Oriani, G; Persico, S; Tritto, C

    1975-01-01

    A controlled double blind clinical trial has been conducted in 16 patients with "angina pectoris" in order to investigate the effect of Perexiline maleate as compared with prenilamine. Perexiline at the dose of 400 mg/die and prenilamine at the dose of 120 mg/die have been administered over a period of 4 weeks each. Between these periods placebo has been administered for two weeks. The number of attacks of angina and the number of tablets of nitroglycerine used per week by the patient during each period has been used for the evaluation. Furthermore ECG at rest and after exercise has been performed every two weeks. Our results statistically evaluated show a definite antianginal effect of Perexiline. According to our experience Perexiline should be considered the drug of choise in the treatment of angina complicated by bradicardia, left ventricular failure, bronchospasm, and in angina unresponsive to other drugs.

  3. Gender differences in the management and clinical outcome of stable angina

    DEFF Research Database (Denmark)

    Daly, Caroline; Clemens, Felicity; Sendon, Jose L. Lopez;

    2006-01-01

    Background- We sought to examine the impact of gender on the investigation and subsequent management of stable angina and to assess gender differences in clinical outcome at 1 year. Methods and Results- The Euro Heart Survey of Stable Angina enrolled patients with a clinical diagnosis of stable...... angina on initial assessment by a cardiologist. Baseline clinical details and cardiac investigations planned or performed within a 4-week period of the assessment were recorded, and follow-up data were collected at 1 year. A total of 3779 patients were included in the survey; 42% were female. Women were......, 1.13 to 3.85), even after multivariable adjustment for age, abnormal ventricular function, severity of coronary disease, and diabetes. Conclusions- Significant gender bias has been identified in the use of investigations and evidence-based medical therapy in stable angina. Women were also less...

  4. Benefit of abciximab in patients with refractory unstable angina in relation to serum troponin T levels.

    NARCIS (Netherlands)

    C.W. Hamm (Christian); C. Heeschen (Christopher); B. Goldmann (Britta); A. Vahanian (Alec); J. Adgey (Jennifer); C.M. Miguel (Carlos); W.R. Rutsch (Wolfgang); J. Berger (Jürgen); J.G. Kootstra (Jille); M.L. Simoons (Maarten)

    1999-01-01

    textabstractBACKGROUND: In patients with refractory unstable angina, the platelet glycoprotein IIb/IIIa-receptor antibody abciximab reduces the incidence of cardiac events before and during coronary angioplasty. We investigated whether serum troponin T levels identify patients most

  5. Structural and Functional Coronary Artery Abnormalities in Patients With Vasospastic Angina Pectoris

    DEFF Research Database (Denmark)

    Ong, Peter; Aziz, Ahmed; Hansen, Henrik Steen

    2015-01-01

    Coronary spasm is involved in many clinical scenarios, such as stable angina, acute coronary syndrome, sudden cardiac death, non-ischemic cardiomyopathy, arrhythmia and syncope. In recent years, imaging tools such as computerized tomographic angiography, intravascular ultrasound or optical cohere...

  6. Refractory angina pectoris in end-stage coronary artery disease : Evolving therapeutic concepts

    NARCIS (Netherlands)

    Schoebel, FC; Frazier, OH; Jessurun, GAJ; DeJongste, MJL; Kadipasaoglu, KA; Jax, TW; Heintzen, MP; Cooley, DA; Strauer, BE; Leschke, M

    1997-01-01

    Refractory angina pectoris in coronary artery disease is defined as the persistence of severe anginal symptoms despite maximal conventional antianginal combination therapy. Further, the option to use an invasive revascularization procedure such as percutaneous coronary balloon angioplasty or aortoco

  7. The prognostic significance of angina pectoris experienced during the first month following acute myocardial infarction

    DEFF Research Database (Denmark)

    Jespersen, C M

    1997-01-01

    BACKGROUND: Angina pectoris accompanied by transient ST-segment changes during the in-hospital phase of acute myocardial infarction (AMI) is a well established marker of subsequent cardiac death and reinfarction. HYPOTHESIS: This study was undertaken to record the prognostic significance of angina...... on study treatment 1 month after discharge. Of these patients, 311 (39%) reported chest pain during the first month following discharge. RESULTS: Patients with angina pectoris had a significantly increased risk of reinfarction [hazard 1.71; 95%-confidence limit (CL): 1.09, 2.69] and increased mortality...... risk which, however, only reached borderline statistical significance (hazard 1.52; 95%-CL: 0.96, 2.40). When patients were subdivided according to both angina pectoris and heart failure, those with one or both of these risk markers had significantly increased mortality (p 0.03) and reinfarction (p 0...

  8. Angina and exertional myocardial ischemia in diabetic and nondiabetic patients: assessment by exercise thallium scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Nesto, R.W.; Phillips, R.T.; Kett, K.G.; Hill, T.; Perper, E.; Young, E.; Leland, O.S. Jr.

    1988-02-01

    Patients with diabetes mellitus and coronary artery disease are thought to have painless myocardial ischemia more often than patients without diabetes. We studied 50 consecutive patients with diabetes and 50 consecutive patients without diabetes, all with ischemia, on exercise thallium scintigraphy to show the reliability of angina as a marker for exertional ischemia. The two groups had similar clinical characteristics, treadmill test results, and extent of infarction and ischemia, but only 7 patients with diabetes compared with 17 patients without diabetes had angina during exertional ischemia. In diabetic patients the extent of retinopathy, nephropathy, or peripheral neuropathy was similar in patients with and without angina. Angina is an unreliable index of myocardial ischemia in diabetic patients with coronary artery disease. Given the increased cardiac morbidity and mortality in such patients, periodic objective assessments of the extent of ischemia are warranted.

  9. Plasma endothelin in coronary venous blood from patients with either stable or unstable angina.

    OpenAIRE

    Stewart, J T; Nisbet, J A; Davies, M J

    1991-01-01

    STUDY OBJECTIVE--To test the hypothesis that the active coronary endothelial lesions in unstable angina raise the endothelin concentration in coronary venous blood. DESIGN--Systemic and coronary venous blood samples were obtained from unselected patients with the clinical syndromes of either stable or unstable angina at the time of cardiac catheterisation and coronary arteriography. Control venous blood samples were obtained from healthy laboratory workers and from patients with chronic renal...

  10. Angina-like chest pain: a joint medical and psychiatric investigation.

    OpenAIRE

    Colgan, S M; Schofield, P.M.; Whorwell, P. J.; Bennett, D.H.; Brooks, N H; Jones, P. E.

    1988-01-01

    Sixty three patients with chest pain typical of angina and who had normal coronary angiograms were investigated for left ventricular, oesophageal and psychiatric abnormalities. An additional 21 patients, age and sex matched, who had angina and significant coronary artery disease were also studied. Eighty six per cent of the 63 patients without evidence of coronary artery disease could be demonstrated to have a physical abnormality (left ventricular dysfunction in 35%, oesophageal disorder 51%...

  11. [Crescendo angina - an indication for surgery: A short literature survey and a discussion of three cases].

    Science.gov (United States)

    Meyer, J M; Kleynhans, P H; Hugo, J M; Verwoerd, C A; Steyn, J G

    1980-08-01

    A definition of crescendo angina is given, followed by a short discussion of the literature on this disease. A case of a patient treated surgically for crescendo angina is reported, and the angiograms of 2 other patients are reviewed to further illustrate the problem. The favourable postoperative course of the patients who underwent an operation for this life-threatening disease is a strong indication for this mode of treatment.

  12. Subtotal versus total abdominal hysterectomy

    DEFF Research Database (Denmark)

    Andersen, Lea Laird; Ottesen, Bent; Alling Møller, Lars Mikael

    2015-01-01

    a multiple imputation analysis, this difference disappeared (relative risk, 1.36; 95% confidence interval, 0.86-2.13; P = .19). No differences were seen in any of the secondary outcomes. CONCLUSION: Subtotal abdominal hysterectomy was not superior to total abdominal hysterectomy on any outcomes. More women...

  13. Abdominal Complications after Severe Burns

    Science.gov (United States)

    2009-05-01

    abdominal compartment syndrome, schemic bowel, biliary disease , peptic ulcer disease and astritis requiring laparotomy, small bowel obstruction, rimary fungal...complications in- luded trauma exploratory laparotomy, abdominal com- artment syndrome, ischemic bowel, biliary disease , peptic lcer disease and gastritis, large...because it was almost uniformly ssociated with serious lethal burns. This was in the period efore effective gastric acid control, explaining the high

  14. The prognostic significance of post-infarction angina pectoris and the effect of verapamil on the incidence of angina pectoris and prognosis. The Danish Study Group on Verapamil in Myocardial Infarction

    DEFF Research Database (Denmark)

    Jespersen, C M; Hansen, J F; Mortensen, L S

    1994-01-01

    The prognostic significance of angina pectoris and the effect of intervention with verapamil on the incidence of angina pectoris were studied in patients recovering from myocardial infarction and included in the Danish Verapamil Infarction Trial II. During the second week after admission patients...... were doubly-blindly randomized to treatment with verapamil 360 mg.day-1 or placebo. Treatment was continued for up to 18 months. At discharge angina pectoris was reported in 11% of 869 patients randomized to verapamil and in 12% of 888 randomized to placebo (ns). One month after discharge a significant...... increase in the prevalance of angina pectoris was reported in both the verapamil (33%) (P angina pectoris (P = 0.03) and the 18 months overall incidence of angina pectoris (P = 0.002) were both significantly lower...

  15. [Diltiazem versus intravenous nitroglycerin in the treatment of unstable angina pectoris. A randomized study].

    Science.gov (United States)

    Castro, P; Corbalán, R; Vergara, I; Kunstmann, S

    1995-07-01

    Prognosis of unstable angina pectoris is related to admission EKG changes and prompt symptom control. The aim of this study was to compare the clinical effects of intravenous diltiazem (DTZ) or nitroglycerin (NTG) in patients with unstable angina pectoris. We studied 43 patients admitted to the hospital with a history of rest angina within the last 48 hours, associated with EKG evidence of ischemia. All subjects received intravenous heparin and oral aspirin, 23 were randomly assigned to receive intravenous DTZ and 20 to receive intravenous NTG. Both groups had similar baseline features and the endpoints of treatment were recurrence of angina, myocardial infarction, death during hospitalization and secondary side effects. Treatment with DTZ, when compared to NTG, resulted in a significant reduction of recurrent angina (8.7 and 59% respectively; p bradicardia with DTZ (28% of patients). In each group, one patient had a myocardial infarction and one patient died. It is concluded that intravenous DTZ reduces myocardial ischemia to a greater extent than NTG and can be safely used in patients with unstable angina pectoris.

  16. Antianginal Efficacy of Ivabradine/Metoprolol Combination in Patients With Stable Angina.

    Science.gov (United States)

    Zarifis, John; Kallistratos, Manolis; Katsivas, Apostolos

    2016-12-01

    Medical treatment is the main clinical strategy for controlling patients with chronic stable angina and improving their quality of life (QoL). Ivabradine treatment on top of metoprolol decreases angina symptoms and improves QoL in patients with stable angina and coronary artery disease (CAD). This is a post hoc analysis (636 CAD patients given ivabradine/metoprolol free combination) of a prospective, noninterventional study that included 2403 patients with CAD and stable angina. Data were recorded at baseline at 1 and 4 months after inclusion. Patient QoL was assessed using the EQ-5D questionnaire. From baseline to study completion; ivabradine administration on top of metoprolol decreased heart rate (HR) from 80.8 ± 9.6 to 64.2 ± 6.2 bpm (P Ivabradine combined with metoprolol significantly decreased angina symptoms and use of nitroglycerin in patients with stable angina and CAD, leading to improved QoL. The benefits observed with this combination explain the high rate of adherence to treatment.

  17. Abdominal aortic aneurysms

    DEFF Research Database (Denmark)

    Lindholt, Jes Sanddal

    2010-01-01

    Although the number of elective operations for abdominal aortic aneurysms (AAA) is increasing, the sex- and age-standardised mortality rate of AAAs continues to rise, especially among men aged 65 years or more. The lethality of ruptured AAA continues to be 80-95%, compared with 5-7% by elective....... The acceptance rate was 77%, and 95% accept control scans. Furthermore, persons at the highest risk of having an AAA attend screening more frequently. We found that 97% of the interval cases developed from aortas that initially measured 2.5-2.9 cm - i.e. approx. only 5% attenders need re-screening at 5-year...... methods for measuring the degree of wall calcification must be developed and validated....

  18. Combination therapy with metoprolol and nifedipine versus monotherapy in patients with stable angina pectoris. Results of the International Multicenter Angina Exercise (IMAGE) Study

    DEFF Research Database (Denmark)

    Savonitto, S; Ardissiono, D; Egstrup, K

    1996-01-01

    10, the groups randomized to combination therapy had a further increase in time to 1-mm ST segment depression (p ...OBJECTIVES: This study was designed to investigate whether combination therapy with metoprolol and nifedipine provides a greater anti-ischemic effect than does monotherapy in individual patients with stable angina pectoris. BACKGROUND: Combination therapy with a beta-adrenergic blocking agent...... (which reduces myocardial oxygen consumption) and a dihydropyridine calcium antagonist (which increases coronary blood flow) is a logical approach to the treatment of stable angina pectoris. However, it is not clear whether, in individual patients, this combined therapy is more effective than monotherapy...

  19. Abdominal migraine in the differential diagnosis of acute abdominal pain.

    Science.gov (United States)

    Cervellin, Gianfranco; Lippi, Giuseppe

    2015-06-01

    Although traditionally regarded as a specific pediatric disease, abdominal migraine may also be observed in adults. Unfortunately, however, this condition is frequently overlooked in the differential diagnosis of abdominal pain in the emergency department (ED). A 30-year-old woman presented to our ED complaining of abdominal pain and vomiting, lasting for 12 hours. The pain was periumbilical, continuous, and not associated with fever or diarrhea. The physical examination and the results of conventional blood tests were normal. The patient was treated with intravenous ketoprofen, metoclopramide, and ranitidine, obtaining a prompt relief of symptoms. She had a history of similar episodes in the last 15 years, with several ED visits, blood test examinations, ultrasonography of the abdomen, and upper gastrointestinal endoscopies. Celiac disease, porphyry, sickle cell disease, and inflammatory bowel disease were all excluded. In July 2012, she became pregnant, and she delivered a healthy baby on April 2013. Until November 2014, she has remained asymptomatic. Based on the clinical characteristics of the abdominal pain episodes, the exclusion of any alternative diagnosis, and the relief of symptoms during and after pregnancy, a final diagnosis of abdominal migraine could be established. A skilled emergency physician should always consider abdominal migraine in the differential diagnosis of patients admitted to the ED with abdominal pain, especially when the attacks are recurrent and no alternative diagnosis can be clearly established.

  20. VACUUM THERAPY VERSUS ABDOMINAL EXERCISES ON ABDOMINAL OBESITY

    Directory of Open Access Journals (Sweden)

    Nevein Mohammed Mohammed Gharib

    2016-06-01

    Full Text Available Background: Obesity is a medical condition that may adversely affect wellbeing and leading to increased incidence of many health problems. Abdominal obesity tends to be associated with weight gain and obesity and it is significantly connected with different disorders like coronary heart disease and type II diabetes mellitus.This study was conducted to investigate the efficacy of vacuum therapy as compared to abdominal exercises on abdominal obesity in overweight and obese women. Methods: Thirtyoverweight and obese women participated in this study with body mass index > 25 kg/m2andwaist circumference ≥ 85 cm. Their ages ranged from 28 - 40 years old.The subjects were excluded if they have diabetes, abdominal infection diseases or any physical limitation restricting exercise ability. They were randomly allocated into two equal groups; group I and group II. Group I received vacuum therapy sessions (by the use of LPG device in addition to aerobic exercise training. Group II received abdominal exercises in addition to the same aerobic exercisesgiven to group I. This study was extended for successive 8 weeks (3 sessions/ week. All subjects were assessed for thickness ofnthe abdominal skin fold, waist circumference and body mass index. Results: The results of this study showeda significant difference between group I and group II post-interventionas regarding to the mean values of waist circumference and abdominal skin fold thickness (p<0.05. Conclusion: It can be concluded that aerobic exercises combined with vacuum therapy (for three sessions/week for successive 8 weeks have a positive effect on women with abdominal obesity in terms of reducing waist circumference and abdominal skin fold thickness.

  1. [Adrenal injury in blunt abdominal trauma].

    Science.gov (United States)

    Abakumov, M M; Smoliar, A N; Barmina, T G; Boĭko, A V; Shalimova, I G

    2009-01-01

    10 patients with adrenal damage were observed during 2.5 years. It amounted 0.93% of all patients with closed abdominal injuries. The right adrenal gland was traumatized in all cases evidently due to it's compression between right lobe of liver and vertebral column. Adrenal damage is observed quite often in combination with injuries of right liver lobe, right kidney and retroperitoneal hematoma formation. 5 patients underwent laparotomy on account of intra-abdominal bleeding, but adrenal damage was never revealed. Ultrasound and tomographic semiotics of adrenal damage was worked out, which allowed ascertaining diagnosis in 80% on application of ultrasound study and in 100% at computer tomography. Injury of one adrenal gland was not accompanied by adrenal failure and did not require hormonal replacement therapy.

  2. [Traumatic and iatrogenic lesions of abdominal vessels].

    Science.gov (United States)

    Farah, I; Tarabula, P; Voirin, L; Magne, J L; Delannoy, P; Gattaz, F; Guidicelli, H

    1997-01-01

    Gravity of abdominal vessels traumatisms is secondary to multiple factors. It depends on the type of injured vessels, aetiology and associated lesions. Between September 1984 and March 1995, 22 abdominal vessel traumatisms in 16 patients (mean age: 39 years) were treated. At surgical exploration, 4 aortic and 2 renal vein lesions, 7 iliac artery and 3 renal artery contusions, 2 superior mesenteric artery dissections; 3 infra-renal vena cava ruptures and 1 superior mesenteric vein dilaceration were found. All lesions were caused by penetrant wounds secondary to firearm or blade injury or secondary to injuries due to ski or traffic accidents. In 5 cases, lesions were iatrogenic. There was no mortality in the post-operative period, 14 patients out of the 16 patients operated on have been followed during a period from 1 to 120 months.

  3. Idiopathic sclerosing encapsulating peritonitis: Abdominal cocoon

    Institute of Scientific and Technical Information of China (English)

    Jenny N Tannoury; Bassam N Abboud

    2012-01-01

    Abdominal cocoon,the idiopathic form of sclerosing encapsulating peritonitis,is a rare condition of unknown etiology that results in an intestinal obstruction due to total or partial encapsulation of the small bowel by a fibrocollagenous membrane.Preoperative diagnosis re quires a high index of clinical suspicion.The early clinical features are nonspecific,are often not recognized and it is difficult to make a definite pre-operative diagnosis.Clinical suspicion may be generated by the recurrent episodes of small intestinal obstruction combined with relevant imaging findings and lack of other plausible etiologies.The radiological diagnosis of abdominal cocoon may now be confidently made on computed tomography scan.Surgery is important in the management of this disease.Careful dissection and excision of the thick sac with the release of the small intestine leads to complete recovery in the vast majority of cases.

  4. Estudio de eficacia y coste en la electroestimulación medular como tratamiento de la angina refractaria Cost-effectiveness study of medullary electrostimulation for the management of refractory angina

    Directory of Open Access Journals (Sweden)

    M. Mayo

    2004-07-01

    determine the costs associated to this treatment and its cost-benefit ratio. Material and methods: Retrospective study including 12 patients that were fol-lowed-up for 8 years with regular clinical exams in order to determine, both before and after the implant, the following variables: left ventricle ejection fraction (LVEF, NYHA functional stage, frequency of hospitalization, frequency of angina episodes and cafinitrina‚ administration, subjective perception of angina pain relief, exitus, hospital costs before and after the placement of EMS. Results: The MES electrode was implanted at the cervical level, being C2-C3 the most frequent location (58.3%. There were no intra-operative complications. In the early post-operative, there was only one complication due to the displacement of the electrode. Neither there were long-term complications. We found a decrease in the number of anginas per week (14 vs 4, p = 0.005 associated to a decrease in the number of fast-action nitroglycerin doses (15.7 vs 3.8, p=0.002 and a decrease in the number of hospital admissions per year (2.62 vs 0.84, p=0.003. Subjective improvement as perceived by the patient after the placement of the neuro-stimulator was 70%. The five-year hospital costs (considering only the hospitalization costs, without any other further tests was 37,921.85 € for patients with refractory angina without MES, compared to 15.150,25 e for patients with MES.

  5. Pylephlebitis: a rare complication of an intra-abdominal infection

    Directory of Open Access Journals (Sweden)

    Katherine Wong

    2013-07-01

    Full Text Available Pylephlebitis is defined as an inflamed thrombosis of the portal vein. It is a rare complication of an intra-abdominal infection, and the diagnosis is often missed due to its nonspecific clinical presentation. Symptoms may include abdominal pain, fever, chills, fatigue, nausea, and vomiting. It is important to consider this differential when a patient presents with signs of abdominal sepsis since it has a high mortality rate and is often diagnosed postmortem. Pylephlebitis can be diagnosed via abdominal ultrasound or CT demonstrating a thrombus in the portal vein, and it must be treated early and aggressively with broad-spectrum antibiotics. We are presenting a case of pylephlebitis as well as discussing the diagnosis and treatment of this potentially lethal condition.

  6. Abdominal actinomycosis associated with intrauterine device: CT features.

    Science.gov (United States)

    Laurent, T; de Grandi, P; Schnyder, P

    1996-01-01

    Abdominal actinomycosis is a severe and progressive peritoneal infection, due to an anerobic gram-positive bacterium, Actinomyces israelii. The presence of a long-standing intrauterine device (IUD) is a well-known risk factor in young women. We report two cases of pelviperitoneal actinomycosis appearing in two young women with acute low abdominal pain. Abdominal CT demonstrated multiple solid or encapsulated peritoneal masses with marked contrast enhancement and infiltration of the adjacent mesenteric fat. Laparoscopy confirmed the presence of intraperitoneal abscesses which contained Actinomyces israelii. High doses of amoxicillin and clavulanic acid (Augmentine) were given and following CT scan after 2 and 6 weeks showed a slow, but complete, resolution of the lesions. Although the radiologic presentation of actinomycosis is nonspecific, the diagnosis should be raised in the presence of pseudotumoral mesenteric infiltration, particularly in young women with an IUD. Abdominal CT is a useful method for diagnosis and for follow-up.

  7. Effect of anxiety and depression on endothelial function and inflammation degree of coronary heart disease patients with angina pectoris

    Institute of Scientific and Technical Information of China (English)

    Lin Ni; Xiang-Yang Xia; Ka Han; Yong-Xin Wu

    2016-01-01

    Objective:To study the effect of anxiety and depression on endothelial function and inflammation degree of coronary heart disease patients with angina pectoris.Methods: 80 cases of patients diagnosed with angina pectoris of coronary heart disease in our hospital from May 2012 to August 2014 were enrolled for study; anxiety and depression were judged by anxiety subscale (HADS-a) and depression subscale (HADS-d). Endothelial progenitor cell and endothelial microparticle contents in peripheral blood as well as serum ET-1, CGRP, IL-6, IL-6R, IL-18, ADAMTS-1 and NO contents were detected.Results:EPC, NO and CGRP contents of angina pectoris patients with anxiety were lower than those of angina pectoris patients without anxiety, and EMP, ET-1, IL-6, IL-6R, IL-18 and ADAMTS-1 contents were higher than those of angina pectoris patients without anxiety; EPC, NO and CGRP contents of angina pectoris patients with depression were lower than those of angina pectoris patients without depression, and EMP, ET-1, IL-6, IL-6R, IL-18 and ADAMTS-1 contents were higher than those of angina pectoris patients without depression.Conclusions:Angina pectoris of coronary heart disease patients complicated with anxiety and depression have endothelial dysfunction and inflammatory reaction activation; endothelial dysfunction and inflammatory reaction activation are possible pathways that anxiety and depression cause the progression of coronary heart disease.

  8. Deep Vein Thrombosis, Raynaud's Phenomenon, and Prinzmetal Angina in a Patient with Glanzmann Thrombasthenia.

    Science.gov (United States)

    Nurden, Alan; Mercié, Patrick; Zely, Pascal; Nurden, Paquita

    2012-01-01

    Patients with Glanzmann thrombasthenia fail to form large platelet thrombi due to mutations that affect the biosynthesis and/or function of the αIIbβ3 integrin. The result is a moderate to severe bleeding syndrome. We now report unusual vascular behaviour in a 55-year-old woman with classic type I disease (with no platelet αIIbβ3 expression) and a homozygous ITGA2B missense mutation (E324K) affecting the terminal β-propeller domain of αIIb. While exhibiting classic bleeding symptoms as a child, in later life this woman first developed deep vein thrombosis after a long air flight then showed vascular problems characteristic of Raynaud's phenomenon, and finally this year she presented with chest pains suggestive of coronary heart disease. Yet while coronary angiography first showed a stenosis, this was not seen on a second examination when she was diagnosed with coronary spastic angina and Prinzmetal phenomenon. It is significant that the absence of platelet aggregation with physiologic agonists had not prevented any of the above cardiovascular or vascular diseases.

  9. Deep Vein Thrombosis, Raynaud's Phenomenon, and Prinzmetal Angina in a Patient with Glanzmann Thrombasthenia

    Directory of Open Access Journals (Sweden)

    Alan Nurden

    2012-01-01

    Full Text Available Patients with Glanzmann thrombasthenia fail to form large platelet thrombi due to mutations that affect the biosynthesis and/or function of the αIIbβ3 integrin. The result is a moderate to severe bleeding syndrome. We now report unusual vascular behaviour in a 55-year-old woman with classic type I disease (with no platelet αIIbβ3 expression and a homozygous ITGA2B missense mutation (E324K affecting the terminal β-propeller domain of αIIb. While exhibiting classic bleeding symptoms as a child, in later life this woman first developed deep vein thrombosis after a long air flight then showed vascular problems characteristic of Raynaud’s phenomenon, and finally this year she presented with chest pains suggestive of coronary heart disease. Yet while coronary angiography first showed a stenosis, this was not seen on a second examination when she was diagnosed with coronary spastic angina and Prinzmetal phenomenon. It is significant that the absence of platelet aggregation with physiologic agonists had not prevented any of the above cardiovascular or vascular diseases.

  10. Economics of abdominal wall reconstruction.

    Science.gov (United States)

    Bower, Curtis; Roth, J Scott

    2013-10-01

    The economic aspects of abdominal wall reconstruction are frequently overlooked, although understandings of the financial implications are essential in providing cost-efficient health care. Ventral hernia repairs are frequently performed surgical procedures with significant economic ramifications for employers, insurers, providers, and patients because of the volume of procedures, complication rates, the significant rate of recurrence, and escalating costs. Because biological mesh materials add significant expense to the costs of treating complex abdominal wall hernias, the role of such costly materials needs to be better defined to ensure the most cost-efficient and effective treatments for ventral abdominal wall hernias.

  11. The impact of guideline compliant medical therapy on clinical outcome in patients with stable angina: findings from the Euro Heart Survey of stable angina.

    NARCIS (Netherlands)

    Daly, C.A.; Clemens, F.; Lopez-Sendon, J.L.; Tavazzi, L.; Boersma, E.; Danchin, N.; Delahaye, F.; Gitt, A.; Julian, D.; Mulcahy, D.; Ruzyllo, W.; Thygesen, K.; Verheugt, F.W.A.; Fox, K.M.

    2006-01-01

    AIMS: The European Society of Cardiology published guidelines for the management of stable angina in 1997, with the objective of promoting an evidence-based approach to the condition. This study focuses on the impact of guideline compliant medical treatment on clinical outcome in patients with stabl

  12. Ectasia coronaria, angina inestable e insuficiencia aórtica

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    Róger A Lanzas Rodríguez

    2009-12-01

    Full Text Available Se presenta el caso de una paciente femenina de 79 años, conocida portadora de cardiopatía hipertensiva, insuficiencia aórtica y dislipidemia, que se hospitalizó con un síndrome coronario agudo. Durante su evolución presentó cambios electrocardiográficos de isquemia subepicardica anterior extensa e inferior, por lo que se le realizó una coronariografia selectiva bilateral, detectándose ectasia de la arteria coronaria derecha, con flujo lento y retención del medio de contraste. Se refirió el caso para cirugía de reemplazo valvular.Coronary artery ectasia, unstable angina and aortic insufficiency The case of a 79 year old female patient, who was hospitalized with acute coronary syndrome (ACS, is presented. She had known hypertensive heart disease, aortic insufficiency and dyslipidemia. During the evolution of her ACS, she presented electrocardiographic changes of ischemia. Selective coronary angiography detected ectasia of the right coronary artery with slow flow and retention of contrast medium. The patient was referred for aortic valve replacement surgery.

  13. The Study of hemodynamics and coronary arteriography of Patients with Different Types of Unstable Angina Pectoris

    Institute of Scientific and Technical Information of China (English)

    谢小鲁; 王燕妮; 祝家庆; 袁祖贻

    2003-01-01

    Objectives To explore the basic heart functional state and cardiac reserve function of patients with different types of unstable angina pecto ris (UAP) and observe the relations between the heart function and severity of coronary arterial disease. Methods 70 eases with UAP were enrolled including 25 patients with angina decubitus (AD), 23 patients with mixed angina (MA) , and 22 patients with accelerated effort angina (AEA). All patients underwent a series of examination such as UCG, ECT, hemodynamics and volume-loading test. The patients were divided group. We assessed the basic heart function and cardiac reserve function of patients with different types of UAP and also observed the relations between coronary (48%). 43 percent of the patients with mixed angina had systolic dysfunction and other 43 percent of them had normal cardiac function. However, patients with nary capillary wedge pressure of positive patients rose,at the same time cardiac index fell to the extreme instantaneously after loading in volume-loading test and then they restored to the basic level until 60 minutes.However, both PCWP and CI of the negative patients arteriography show: there are 41% of patient with three-vessel disease, 50% with two-vessel disease,9% single vessel disease and left main narrowing 22.7% in AEA. There are separately 76%, 24%,were separately compared with AD, AEA/AD: P < 0. 05(P = 0.031); MA/AD: P < 0.01 (P = 0. 000313). Conclusions Most of patients with the above three types of unstable angina pectoris suffered from the basic heart dysfunction and cardiac reserve dysfunction which might participate in the occurrence and development of unstable angina pectoris. In angiography, there are the most three-vessel diseases in AD that are, therefore, the most severe UAP.

  14. Comparison of Results of Coronary Angioplasty in Patients with Unstable vs. Stable Angina

    Institute of Scientific and Technical Information of China (English)

    梅卫义; 杜志民; 罗初凡; 胡承恒; 李怡; 马虹

    2002-01-01

    Objectives To comparethe short and mid - term outcomes in cases of percuta-neous transluminal coronary angioplasty (PTCA) inpatients with unstable v stable angina. MethodsPatients selected for PTCA/stenting were divided into two groups, one with stable angina pectoris (SAgroup, n--92) and one with unstable angina pectoris(UA group, n = 112). The outcomes of coronary angiographies (CAG), initial (30-d) success of theprocedure, and follow- up status in the two groupswere compared. Results Baseline characteristicswere similar, although the patients with unstablesymptoms more females ( P< 0.05), and had a higheraverage CCS class ( P< 0.05) and a higher incidenceof postinfarction angina ( P< 0. 01 ). The frequency of"complex" stenosis in patients with unstable anginawas higher than that of patients with stable angina,33% v 20% (P<0.01). A total of 309 vessels accepted the procedure; including 210 stents were successfully delivered to 156 patients. 143 and 67 stentswere implanted in the UA and SA group, respectively(P< 0.01 ). No major complication occurred in thetwo groups, except 12 patients experienced reoccurring chest pain initially, 9 in UA group v 3 in SAgroup ( P< 0.05). The averaged six - month follow -up status was compared too. Only 3 cases developedmyocardial infarction, including 2 patients with unstable angina. 12 and 16 reoccurring chest pains werefound in the two groups, respectively (13% in SAgroup vs 14% in UA group). There were no significant differences between groups in rates of clinicalrestenosis, follow- up angina class, or overall clinicalsuccess. Conclusions Patients with unstable anginareceiving PTCA/stenting have similar complication,restenosis, and initial and midterm success rate ascompared to patients with stable symptoms with strictcases select and careful preparation.

  15. Micromanaging Abdominal Aortic Aneurysms

    Directory of Open Access Journals (Sweden)

    Lars Maegdefessel

    2013-07-01

    Full Text Available The contribution of abdominal aortic aneurysm (AAA disease to human morbidity and mortality has increased in the aging, industrialized world. In response, extraordinary efforts have been launched to determine the molecular and pathophysiological characteristics of the diseased aorta. This work aims to develop novel diagnostic and therapeutic strategies to limit AAA expansion and, ultimately, rupture. Contributions from multiple research groups have uncovered a complex transcriptional and post-transcriptional regulatory milieu, which is believed to be essential for maintaining aortic vascular homeostasis. Recently, novel small noncoding RNAs, called microRNAs, have been identified as important transcriptional and post-transcriptional inhibitors of gene expression. MicroRNAs are thought to “fine tune” the translational output of their target messenger RNAs (mRNAs by promoting mRNA degradation or inhibiting translation. With the discovery that microRNAs act as powerful regulators in the context of a wide variety of diseases, it is only logical that microRNAs be thoroughly explored as potential therapeutic entities. This current review summarizes interesting findings regarding the intriguing roles and benefits of microRNA expression modulation during AAA initiation and propagation. These studies utilize disease-relevant murine models, as well as human tissue from patients undergoing surgical aortic aneurysm repair. Furthermore, we critically examine future therapeutic strategies with regard to their clinical and translational feasibility.

  16. Abdominal aortic feminism.

    Science.gov (United States)

    Mortimer, Alice Emily

    2014-01-01

    A 79-year-old woman presented to a private medical practice 2 years previously for an elective ultrasound screening scan. This imaging provided the evidence for a diagnosis of an abdominal aortic aneurysm (AAA) to be made. Despite having a number of recognised risk factors for an AAA, her general practitioner at the time did not follow the guidance set out by the private medical professional, that is, to refer the patient to a vascular specialist to be entered into a surveillance programme and surgically evaluated. The patient became symptomatic with her AAA, was admitted to hospital and found to have a tender, symptomatic, 6 cm leaking AAA. She consented for an emergency open AAA repair within a few hours of being admitted to hospital, despite the 50% perioperative mortality risk. The patient spent 4 days in intensive care where she recovered well. She was discharged after a 12 day hospital stay but unfortunately passed away shortly after her discharge from a previously undiagnosed gastric cancer.

  17. Endovascular repair of ruptured abdominal aortic aneurysm

    Directory of Open Access Journals (Sweden)

    Šarac Momir

    2014-01-01

    Full Text Available Introduction. Rupture of an abdominal aortic aneurysm (AAA is a potentially lethal state. Only half of patients with ruptured AAA reach the hospital alive. The alternative for open reconstruction of this condition is endovascular repair (EVAR. We presented a successful endovascular reapir of ruptured AAA in a patient with a number of comorbidities. Case report. A 60-year-old man was admitted to our institution due to diffuse abdominal pain with flatulence and belching. Initial abdominal ultrasonography showed an AAA that was confirmed on multislice computed tomography scan angiography which revealed a large retroperitoneal haematoma. Because of patient’s comorbidites (previous surgery of laryngeal carcinoma and one-third laryngeal stenosis, arterial hypertension and cardiomyopathy with left ventricle ejection fraction of 30%, stenosis of the right internal carotid artery of 80% it was decided that endovascular repair of ruptured AAA in local anaesthesia and analgosedation would be treatment of choice. Endovascular grafting was achieved with aorto-bi-iliac bifurcated excluder endoprosthesis with complete exclusion of the aneurysmal sac, without further enlargment of haemathoma and no contrast leakage. The postoperative course of the patient was eventless, without complications. On recall examination 3 months after, the state of the patient was well. Conclusion. The alternative for open reconstruction of ruptured AAA in haemodynamically stable patients with suitable anatomy and comorbidities could be emergency EVAR in local anesthesia. This technique could provide greater chances for survival with lower intraoperative and postoperative morbidity and mortality, as shown in the presented patient.

  18. Intra-abdominal tuberculous peritonitis

    Energy Technology Data Exchange (ETDEWEB)

    Schneider, G.; Ahlhelm, F.; Altmeyer, K.; Kramann, B. [Dept. of Diagnostic Radiology, University Hospital, Homburg (Germany); Hennes, P. [Dept. of Pediatrics, University Hospital, Homburg (Germany); Pueschel, W. [Dept. of Pathology, University Hospital, Homburg (Germany); Karadiakos, N. [Dept. of Pediatric Surgery, University Hospital, Homburg (Germany)

    2001-07-01

    We report the case of a 15-year-old boy suffering from progressive dyspnea on exertion and painful abdominal protrusion. Final diagnosis of intra-abdominal tuberculosis (TB), including lymphadenopathy and abdominal abscess formation, was made following elective laparotomy. This type of disease is a rare manifestation of extrapulmonary tuberculosis. The imaging findings in unenhanced and contrast-enhanced MRI and laparoscopic images are presented. Differential diagnosis of abdominal abscess formation and other fungal or bacteriological infections, as well as the imaging findings of this type of lesion, are discussed. This case demonstrates that atypical manifestation of TB may remain unrecognized; thus, awareness of this kind of manifestation of tuberculosis may prevent patients from being subjected to inappropriate therapies. (orig.)

  19. Children's (Pediatric) Abdominal Ultrasound Imaging

    Medline Plus

    Full Text Available ... valuable for evaluating abdominal, pelvic or scrotal pain in children. Preparation will depend on the type of ... examinations do not use ionizing radiation (as used in x-rays ), thus there is no radiation exposure ...

  20. Children's (Pediatric) Abdominal Ultrasound Imaging

    Medline Plus

    Full Text Available ... children. Except for traumatic injury, appendicitis is the most common reason for emergency abdominal surgery. Ultrasound imaging ... of page How is the procedure performed? For most ultrasound exams, you will be positioned lying face- ...

  1. Children's (Pediatric) Abdominal Ultrasound Imaging

    Medline Plus

    Full Text Available ... of page What are some common uses of the procedure? Abdominal ultrasound imaging is performed to evaluate ... for ultrasound examinations. top of page What does the equipment look like? Ultrasound scanners consist of a ...

  2. Updates on abdominal desmoid tumors

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Desmoid tumor is a monoclonal, fibroblastic proliferation arising in musculoaponeurotic structures. This connective tissue hyperplasia infiltrates locally, recurs frequentiy after resection but does not metastasize. Abdominal desmoid occurs sporadically, in association with some familial syndromes and often represents a clinical dilemma for surgeons. The enigmatic biology and anatomical location of abdominal desmoids make treatment recommendations difficult. This distinct pathological entity is reviewed with a specific focus on aetiology and management.

  3. Critical evaluation of ivabradine for the management of chronic stable angina

    Directory of Open Access Journals (Sweden)

    Khan W

    2011-09-01

    Full Text Available Waqas Khan, Jeffrey S BorerDivision of Cardiovascular Medicine and the Department of Medicine, State University of New York Downstate Medical Center and College of Medicine, Brooklyn and New York, NY, USAAbstract: Angina pectoris is the most common symptom of coronary artery disease (CAD. Angina results from an imbalance between myocardial oxygen supply and demand. Heart rate (HR reduction can beneficially alter both elements of this imbalance by increasing diastolic filling time and reducing myocardial oxygen demand. Therefore, HR reduction is an accepted approach to angina prevention. ß-blockers, calcium-channel blockers, and long-acting nitrates are currently the cornerstones in prevention and management of stable angina. However, use of these treatments may be limited by adverse effects or development of tolerance. Thus, additional approaches to angina prevention may be useful for many patients with CAD. The discovery of the f-channel and the resulting current, If, that modulates the rate of spontaneous diastolic depolarization of sinoatrial nodal (SAN myocytes led to the study of these channels as targets for lowering HR. This resulted in the development of a novel agent, ivabradine, a selective and specific If inhibitor. Ivabradine slows the slope of diastolic depolarization of the action potential in the SAN cells, decreasing HR at rest and during exercise, but has no other cardiovascular effects. In different subpopulations with chronic stable angina, ivabradine markedly improves exercise capacity and significantly decreases the number of ambient angina attacks. In a post-hoc analysis of the BEAUTIFUL trial (morBidity-mortality EvAlUaTion of the If inhibitor ivabradine in patients with coronary disease and left-ventricULar dysfunction, ivabradine also reduced mortality, myocardial infarctions, and heart failure hospitalizations among patients with angina. To date, the drug has been well tolerated; transient visual disturbances and

  4. Common abdominal emergencies in children.

    Science.gov (United States)

    D'Agostino, James

    2002-02-01

    Because young children often present to EDs with abdominal complaints, emergency physicians must have a high index of suspicion for the common abdominal emergencies that have serious sequelae. At the same time, they must realize that less serious causes of abdominal symptoms (e.g., constipation or gastroenteritis) are also seen. A gentle yet thorough and complete history and physical examination are the most important diagnostic tools for the emergency physician. Repeated examinations and observation are useful tools. Physicians should listen carefully to parents and their children, respect their concerns, and honor their complaints. Ancillary tests are inconsistent in their value in assessing these complaints. Abdominal radiographs can be normal in children with intussusception and even malrotation and early volvulus. Unlike the classic symptoms seen in adults, young children can display only lethargy or poor feeding in cases of appendicitis or can appear happy and playful between paroxysmal bouts of intussusception. The emergency physician therefore, must maintain a high index of suspicion for serious pathology in pediatric patients with abdominal complaints. Eventually, all significant abdominal emergencies reveal their true nature, and if one can be patient with the child and repeat the examinations when the child is quiet, one will be rewarded with the correct diagnosis.

  5. Arterial embolization for traumatic lethal lateral abdomi-nal wall hemorrhage in a liver cirrhosis patient

    Institute of Scientific and Technical Information of China (English)

    Seiji Morita; Tomoatsu Tsuji; Takeshi Yamagiwa; Hiroyuki Otsuka; Sadaki Inokuchi

    2009-01-01

    @@ B lood loss due to abdominal wall hemorrhage is generally managed conservatively. Further, abdominal wall hemorrhage rarely develops into a life-threatening condition. However, it is difficult to sur-gically achieve hemostasis. We report the case of a liver cirrhosis patient with life-threatening abdominal wall hemorrhage that developed as a result of a minor trauma and was successfully treated with arterial embolization (AE).

  6. Value of iodine-123 metaiodobenzylguanidine scintigraphy in patients with vasospastic angina

    Energy Technology Data Exchange (ETDEWEB)

    Taki, Junichi; Nakajima, Kenichi; Matsunari, Ichiro; Takayama, Teruhiko; Tonami, Norihisa [Kanazawa Univ. School of Medicine (Japan). Dept. of Nuclear Medicine; Yasuhara, Shuichiro; Takamatsu, Tsuyoshi; Tatami, Ryozo; Ishise, Syozo [Maizuru Kyosai Hospital (Japan). Dept. of Internal Medicine

    1998-03-01

    To assess the presence and location of presynaptic myocardial sympathetic abnormality in patients with vasospastic angina, iodine-123 labelled metaiodobenzylguanidine (MIBG) single-photon emission tomography (SPET) was performed. Fifty patients suspected of having vasospastic angina pectoris were enrolled in the study. All patients underwent a provocative test with intracoronary ergonovine infusion during coronary angiography, in which 99%-100% obstructive spasm was defined as a positive result. Twenty-five patients were diagnosed as having vasospastic angina based on a positive provocative test. MIGB SPET was performed at 20 min and 3 h after administration of 111 MBq of MIBG. On early images, only 5 of 25 patients with vasospastic angina showed a mild reduction in MIBG uptake, whereas 3-h delayed images demonstrated MIBG abnormality in 20 patients (80%). The location of the MIBG abnormality was completely or partially consistent with the spastic coronary territory in 18 patients. On the other hand, only 4 of 25 patients (16%) with a negative provocative test demonstrated reduced MIBG uptake. Accordingly, positive and negative predictive values of MIBG SPET for the provocative test were 83% (20/24) and 81% (21/26) respectively. In conclusion, MIBG scintigraphy with SPET can permit the non-invasive detection and evaluation of suspected vasospastic angina. (orig.)

  7. The efficacy of trimetazidine on stable angina pectoris: a meta-analysis of randomized clinical trials.

    Science.gov (United States)

    Peng, Song; Zhao, Min; Wan, Jing; Fang, Qi; Fang, Dong; Li, Kaiyong

    2014-12-20

    This meta-analysis aimed to evaluate the efficacy of trimetazidine in combination with other anti-anginal drugs versus other anti-anginal drugs in the treatment of stable angina pectoris (SAP). Randomized controlled trials (RCTs) published in English and Chinese were retrieved from computerized databases: Embase, PubMed, and CNKI. Primary outcomes consist of clinical parameters (numbers of weekly angina attacks and nitroglycerin use) and ergometric parameters (time to 1mm ST-segment depression, and total work (in Mets) and exercise duration (in seconds) at peak exercise) in stable angina pectoris treated by trimetazidine or not. The quality of studies was evaluated using Jadad score. Data analysis of 13 studies was performed using Stata 12.0 software. Results showed that treatment of trimetazidine and other anti-anginal drugs was associated with a smaller weekly mean number of angina attacks (WMD=-0.95, 95%CI: -1.30 to -0.61, Z=5.39, Pangina pectoris. Sensitivity analysis was performed. Sub-group analysis showed that treatment duration was not a significant moderator and patients treated within 8 weeks and above 12 weeks had no difference in the outcomes addressed in this meta-analysis. No publish bias was detected. This meta-analysis confirms the efficacy of trimetazidine in the treatment of stable angina pectoris, in comparison with conventional antianginal agents, regardless of treatment duration.

  8. Narrowing of the Coronary Sinus: A Device-Based Therapy for Persistent Angina Pectoris.

    Science.gov (United States)

    Konigstein, Maayan; Verheye, Stefan; Jolicœur, E Marc; Banai, Shmuel

    2016-01-01

    Alongside the remarkable advances in medical and invasive therapies for the treatment of ischemic heart disease, an increasing number of patients with advanced coronary artery disease unsuitable for revascularization continue to suffer from angina pectoris despite optimal medical therapy. Patients with chronic angina have poor quality of life and increased levels of anxiety and depression. A considerable number of innovative therapeutic modalities for the treatment of chronic angina have been investigated over the years; however, none of these therapeutic options has become a standard of care, and none are widely utilized. Current treatment options for refractory angina focus on medical therapy and secondary risk factor modification. Interventions to create increased pressure in the coronary sinus may alleviate myocardial ischemia by forcing redistribution of coronary blood flow from the less ischemic subepicardium to the more ischemic subendocardium, thus relieving symptoms of ischemia. Percutaneous, transvenous implantation of a balloon expandable, hourglass-shaped, stainless steel mesh in the coronary sinus to create a fixed focal narrowing and to increase backwards pressure, may serve as a new device-based therapy destined for the treatment of refractory angina pectoris.

  9. A literature review to evaluate the economic value of ranolazine for the symptomatic treatment of chronic angina pectoris.

    Science.gov (United States)

    Vellopoulou, Katerina; Kourlaba, Georgia; Maniadakis, Nikos; Vardas, Panagiotis

    2016-05-15

    To conduct a systematic review of the evidence regarding the economic value of ranolazine relative to standard-of-care (SOC) for the treatment of symptomatic chronic stable angina (CSA). Electronic databases were searched using relevant keywords. The identified studies were independently reviewed by two investigators against pre-determined inclusion and exclusion criteria. Their data were extracted using a relevant form and consequently were synthesized. Studies were also evaluated using the Quality of Health Economic Studies scale. The main outcomes considered were the cost and effectiveness for each comparator and the incremental cost per quality-adjusted-life year (QALY) gained. Six studies were included in the review. Five of these assessed the cost-utility of ranolazine added to SOC, compared to SOC alone, using decision trees or Markov models whereas one was a retrospective cost evaluation study. The analysis was conducted from a payer perspective in five studies and from a societal perspective in one study with the time horizon varying between six months and a year. The incremental cost-effectiveness ratio (ICER), ranged from €4000 to €15,000 per QALY gained. Ranolazine appears to be dominant or cost-effective, mainly due to its ability to decrease angina-related hospitalizations and also due to a marginal improvement in quality of life. The acquisition cost of ranolazine was the variable with the greatest impact upon the ICER. The existing evidence, although limited, indicates that ranolazine may be a dominant or cost-effective therapy option, for the treatment of patients with symptomatic CSA. Further research is required to evaluate the cost-effectiveness of ranolazine.

  10. The initial management of stable angina in Europe, from the Euro Heart Survey: a description of pharmacological management and revascularization strategies initiated within the first month of presentation to a cardiologist in the Euro Heart Survey of Stable Angina.

    NARCIS (Netherlands)

    Daly, C.A.; Clemens, F.; Lopez-Sendon, J.; Tavazzi, L.; Boersma, E.; Danchin, N.; Delahaye, F.; Gitt, A.; Julian, D.; Mulcahy, D.; Ruzyllo, W.; Thygesen, K.; Verheugt, F.W.A.; Fox, K.M.

    2005-01-01

    AIMS: In order to assess adherence to guidelines and international variability in management, the Euro Heart Survey of Newly Presenting Angina prospectively studied medical therapy, percutaneous coronary intervention (PCI), and surgery in patients with new-onset stable angina in Europe. METHODS AND

  11. Impact of Clinical Presentation (Stable Angina Pectoris vs Unstable Angina Pectoris or Non-ST-Elevation Myocardial Infarction vs ST-Elevation Myocardial Infarction) on Long-Term Outcomes in Women Undergoing Percutaneous Coronary Intervention With Drug-Eluting Stents

    DEFF Research Database (Denmark)

    Giustino, Gennaro; Baber, Usman; Stefanini, Giulio Giuseppe

    2015-01-01

    ,577 women included in the pooled database, 10,133 with known clinical presentation received a DES. Of them, 5,760 (57%) had stable angina pectoris (SAP), 3,594 (35%) had unstable angina pectoris (UAP) or non-ST-segment-elevation myocardial infarction (NSTEMI), and 779 (8%) had ST...

  12. [Abdominal wall closure by incisional hernia and herniation after laparostoma].

    Science.gov (United States)

    Mischinger, H-J; Kornprat, P; Werkgartner, G; El Shabrawi, A; Spendel, S

    2010-03-01

    As hernias and abdominal wall defects have a variety of etiologies each with its own complications and comorbidities in various constellations, efficient treatment requires patient-oriented management. There is no recommended standard treatment and the very different clinical pictures demand an individualized interdisciplinary approach. Particularly in the case of complicated hernias, the planning of the operation should focus on the problems posed by the individual patient. Treatment mainly depends on the etiology of the hernia, immediate or long-term complications and the efficiency of individual repair techniques. Abdominal wall repair for recurrent herniation requires direct closure of the fascia generally using the sublay technique with a lightweight mesh. It is still unclear whether persistent inflammation, mesh dislocation, fistula formation or other long-term complications are due to certain materials or to the surgical technique. With mesh infections it has been shown to be advantageous to remove a polytetrafluoroethylene (PTFE) mesh, while the combination of systemic and local treatment appears to suffice for a polypropylene or polyester mesh. Heavier meshes in the sublay position or plastic reconstruction with autologous tissue are indicated as substitutes for the abdominal wall for giant hernias, repeated recurrences and large abdominal wall defects. A laparostoma is increasingly more often created to treat septic intra-abdominal processes but is very often responsible for a complicated hernia. If primary repair of the abdominal wall is not an option, resorbable material or split skin is used for coverage under the auspices of a planned hernia repair.

  13. Troca de gases prejudicada em pacientes com angina instável Deterioro del intercambio gaseoso en pacientes con angina inestable Impaired gas exchange in patients with unstable angina

    Directory of Open Access Journals (Sweden)

    Dayane Horta Rocha

    2009-09-01

    Full Text Available A identificação do diagnóstico de enfermagem "troca de gases prejudicada na assistência aos pacientes com angina" é visualizada rotineiramente, porém faz-se necessário um aprofundamento desta temática. Com o objetivo de analisar a ocorrência deste diagnóstico, realizamos um estudo transversal, de caráter descritivo-exploratório, com pacientes internados em um hospital especializado. Os dados foram obtidos por meio de entrevista, exame físico e consulta ao prontuário. O diagnóstico "troca de gases prejudicada" foi ausente em nossa amostra; entretanto, as variáveis profundidade da respiração, pressão arterial sistólica, sonolência e sódio sérico estiveram comprometidas, o que indica risco de agravamento. Visualizamos alguma relação entre os resultados obtidos e características do estilo de vida dos pacientes avaliados, o que reforça a importância de medidas preventivas para a obtenção de um melhor prognóstico na assistência aos pacientes com angina.La identificación del diagnóstico realizado por parte de la enfermería del Deterioro del intercambio gaseoso en el cuidado de pacientes con angina es comúnmente percibida, sin embargo es necesario profundizar esta temática. Con el objetivo de analizar la ocurrencia del diagnóstico del Deterioro del intercambio gaseoso en portadores de Angina Inestable desarrollamos un estudio transversal, de carácter descriptivo-exploratorio, con pacientes ingresados en un hospital especializado. Los datos fueron recolectados por medio de entrevistas, examenes físicos y consultas a los registros médicos. Este diagnóstico no fue identificado en nuestra muestra, sin embargo, las variables profundidad de la respiración, presión arterial sistólica, somnolencia y sodio sérico presentaron alteraciones , lo que indica riesgo de agravación del cuadro clínico. Se identificó una relación entre los resultados obtenidos y las características del estilo de vida de los pacientes

  14. Side effects of using nitrates to treat heart failure and the acute coronary syndromes, unstable angina and acute myocardial infarction.

    Science.gov (United States)

    Thadani, Udho; Ripley, Toni L

    2007-07-01

    Nitrates are potent venous dilators and anti-ischemic agents. They are widely used for the relief of chest pain and pulmonary congestion in patients with acute coronary syndromes and heart failure. Nitrates, however, do not reduce mortality in patients with acute coronary syndromes. Combination of nitrates and hydralazine when given in addition to beta-blockers and angiotensin-converting enzyme (ACE) inhibitors reduce mortality and heart failure hospitalizations in patients with heart failure due to left ventricular systolic dysfunction who are of African-American origin. Side effects during nitrate therapy are common but are less well described in the literature compared with the reported side effects in patients with stable angina pectoris. The reported incidence of side effects varies highly among different studies and among various disease states. Headache is the most commonly reported side effect with an incidence of 12% in acute heart failure, 41-73% in chronic heart failure, 3-19% in unstable angina and 2-26% in acute myocardial infarction. The reported incidence of hypotension also differs: 5-10% in acute heart failure, 20% in chronic heart failure, 9% in unstable angina and < 1-48% in acute myocardial infarction, with the incidence being much higher with concomitant nitrate therapy plus angiotensin-converting enzyme inhibitors. Reported incidence of dizziness is as low as 1% in patients with acute myocardial infarction to as high as 29% in patients with heart failure. Severe headaches and/or symptomatic hypotension may necessitate discontinuation of nitrate therapy. Severe life threatening hypotension or even death may occur when nitrates are used in patients with acute inferior myocardial infarction associated with right ventricular dysfunction or infarction, or with concomitant use of phosphodiesterase-5 inhibitors or N-acetylcysteine. Despite the disturbing observational reports in the literature that continuous and prolonged use of nitrates may lead to

  15. [Clinical presentation and coronary angiographic results in unstable angina pectoris].

    Science.gov (United States)

    Weber, T; Kirchgatterer, A; Auer, J; Wimmer, L; Lang, G; Mayr, H; Maurer, E; Punzengruber, C; Eber, B

    1999-01-01

    The syndrome "unstable angina" (UA) covers a broad spectrum of patients. In this study we tried to determine the relationship between the severity of UA and angiographic findings. We evaluated 1000 consecutive patients undergoing coronary angiography. Those with the clinical diagnosis "UA" were included in the study. In a retrospective analysis of their records we categorized them, using the Braunwald-classification for determination of the severity of the disease. 352 patients were include, 209 men and 143 women, the mean age was 65 years. 47% met Braunwald-Class I, 26% Class II and 27% Class III. Coronary single-vessel disease was present in 29%, two-vessel disease in 20%, three-vessel disease in 25%, normal coronaries in 13% and coronary atherosclerosis without critical narrowing in 13%. Left ventricular function was preserved in 72%, mild systolic dysfunction was found in 10%, moderate in 13% and severe in 5%. There was no overall correlation between clinical presentation (Braunwald-Classes) and angiographic findings. Women showed a similar distribution of Braunwald-Classes, but significantly more coronary arteries without critical obstruction. In patients with reduced systolic function the percentage of multi-vessel disease was significantly higher, the percentage without relevant coronary artery narrowing was significantly lower. 1) The lack of overall correlation between clinical presentation and angiographic findings supports the importance of coronary angiography in the evaluation of patients with UA. 2) The assessment of women with chest pain is more difficult than of men with regard to coronary heart disease. 3) UA in patients with impaired left ventricular function is a predictor of severe coronary artery disease.

  16. A new scoring system to stratify risk in unstable angina

    Directory of Open Access Journals (Sweden)

    Salzberg Simón

    2003-08-01

    Full Text Available Abstract Background We performed this study to develop a new scoring system to stratify different levels of risk in patients admitted to hospital with a diagnosis of unstable angina (UA, which is a complex syndrome that encompasses different outcomes. Many prognostic variables have been described but few efforts have been made to group them in order to enhance their individual predictive power. Methods In a first phase, 473 patients were prospectively analyzed to determine which factors were significantly associated with the in-hospital occurrence of refractory ischemia, acute myocardial infarction (AMI or death. A risk score ranging from 0 to 10 points was developed using a multivariate analysis. In a second phase, such score was validated in a new sample of 242 patients and it was finally applied to the entire population (n = 715. Results ST-segment deviation on the electrocardiogram, age ≥ 70 years, previous bypass surgery and troponin T ≥ 0.1 ng/mL were found as independent prognostic variables. A clear distinction was shown among categories of low, intermediate and high risk, defined according to the risk score. The incidence of the triple end-point was 6 %, 19.2 % and 44.7 % respectively, and the figures for AMI or death were 2 %, 11.4 % and 27.6 % respectively (p Conclusions This new scoring system is simple and easy to achieve. It allows a very good stratification of risk in patients having a clinical diagnosis of UA. They may be divided in three categories, which could be of help in the decision-making process.

  17. Mycobacterium fortuitum abdominal wall abscesses following liposuction

    Directory of Open Access Journals (Sweden)

    Al Soub Hussam

    2008-01-01

    Full Text Available We describe here a case of abdominal abscesses due to Mycobacterium fortuitum following liposuction. The abscesses developed three months after the procedure and diagnosis was delayed for five months. The clues for diagnosis were persistent pus discharge in spite of broad spectrum antibiotics and failure to grow any organisms on routine culture. This condition has been rarely reported; however, the increasing number of liposuction procedures done and awareness among physicians will probably result in the identification of more cases. Combination antibiotic therapy with surgical drainage in more extensive diseases is essential for cure.

  18. Myocardial oxygen supply/demand ratio in aortic stenosis: hemodynamic and echocardiographic evaluation of patients with and without angina pectoris.

    Science.gov (United States)

    Nadell, R; DePace, N L; Ren, J F; Hakki, A H; Iskandrian, A S; Morganroth, J

    1983-08-01

    Angina pectoris is a common symptom in patients with aortic stenosis without coronary artery disease. To investigate the correlates of angina pectoris, echocardiographic and hemodynamic data from 44 patients with aortic stenosis and no coronary artery disease (mean age 56 +/- 10 years) were analyzed. Twenty-three patients had no angina pectoris and 21 patients had angina pectoris. The ratio of the diastolic pressure-time index (area between the aortic and left ventricular pressure curves during diastole) to the systolic pressure-time index (area under the left ventricular pressure curve during systole), an index of the oxygen supply/demand ratio, was not different in patients with or without angina pectoris. There were no differences between patients with and without angina pectoris in echocardiographically determined wall thickness, chamber size, systolic and diastolic wall stress and left ventricular mass; in electrocardiographically defined voltage; and in hemodynamically defined aortic valve area, transaortic gradient and stroke work index. Thus, echocardiographic and hemodynamic measurements at rest are not significantly different in the presence or absence of angina pectoris in patients with aortic stenosis. Dynamic data appear to be essential for evaluation of the mechanisms of angina pectoris in patients with aortic stenosis.

  19. Abdominal Pain Syndrome

    Science.gov (United States)

    ... of the stomach) Pancreatitis (inflammation of the pancreas) Cholecystitis (inflammation of the gall bladder) Choledocholithiasis (passage of ... correct a problem. For example, pain due to cholecystitis (inflammation of the gall bladder) is usually treated ...

  20. Abdominal neurenteric cyst

    Institute of Scientific and Technical Information of China (English)

    Radoje (C)olovi(c); MarJan Micev; Miodrag Jovanovi(c); Slavko Mati(c); Nikica Grubor; Henry Dushan E Atkinson

    2008-01-01

    immunoexpression, and the respiratory epithelium revealed a CK8 and CK18 immunoprofile without CK 10/13 positive elements, though neither CEA or AFP positive cells were found. To our knowledge, this is the first reported case of an abdominally located neurenteric cyst with no associated spinal anomalies.

  1. Ludwig's angina and ketoacidosis as a first manifestation of diabetes mellitus.

    Science.gov (United States)

    Infante-Cossío, Pedro; Fernández-Hinojosa, Esteban; Mangas-Cruz, Miguel-Angel; González-Pérez, Luis-Miguel

    2010-07-01

    Ludwig's angina is a serious and rapidly progressive infectious process that spreads through the floor of the mouth and neck. In this paper we present an infrequent case of a patient who suffered an odontogenic infection with poor response to the previous treatment, which evolved towards a Ludwig's angina combined with ketoacidosis in the context of a diabetes mellitus not known before. According to the literature reviewed, this case report represents the first contribution of a Ludwig's angina and ketoacidosis as an initial manifestation of a diabetes mellitus. The airway management, the antibiotic prescription and the surgical drainage allowed the healing of the patient without medical complications. Factors of co-morbidity like the diabetes mellitus together with focus tooth of infection may eventually turn into serious medical complications as the diabetic ketoacidosis and develop potentially lethal cervical infections.

  2. Ventetid og omkostninger ved diagnostik og behandling af stabil angina pectoris

    DEFF Research Database (Denmark)

    Søgaard, Rikke; Sanchez, Ricardo

    Introduction: The objective of this pilot study was to examine possible consequences of a logistically non-optimal regimen, for the diagnosis and treatment of stable angina pectoris, on waiting time and costs to inform whether a larger study is warranted. Material and methods: Retrospective cohort...... study among 104 consecutive patients referred on suspected stable angina pectoris. Data on the diagnostic regimen was systematically collected from patient files and data on other resource use was collected using a questionnaire for self- reporting. Non-parametric bootstrapping was applied. Results...... of stable angina pectoris, which ceteris paribus would be associated with cost savings in the health care sector. However, these potentials should be examined in a larger- scale study....

  3. Aspiration Thrombectomy and Drug-Eluting Stent Implantation Decrease the Occurrence of Angina Pectoris One Year After Acute Myocardial Infarction.

    Science.gov (United States)

    Lee, Wei-Chieh; Fang, Chih-Yuan; Chen, Huang-Chung; Hsueh, Shu-Kai; Chen, Chien-Jen; Yang, Cheng-Hsu; Yip, Hon-Kan; Hang, Chi-Ling; Wu, Chiung-Jen; Fang, Hsiu-Yu

    2016-04-01

    Angina pectoris is a treatable symptom that is associated with mortality and decreased quality of life. Angina eradication is a primary care goal of care after an acute myocardial infarction (AMI). Our aim was to evaluate factors influencing angina pectoris 1 year after an AMI.From January 2005 to December 2013, 1547 patient received primary percutaneous intervention in our hospital for an acute ST-segment elevation myocardial infarction (MI). Of these patients, 1336 patients did not experience post-MI angina during a 1-year follow-up, and 211 patients did. Univariate and multivariate logistic regression analyses were performed to identify the factors influencing angina pectoris 1 year after an AMI. Propensity score matched analyses were performed for subgroups analyses.The average age of the patients was 61.08 ± 12.77 years, with a range of 25 to 97 years, and 82.9% of the patients were male. During 1-year follow-up, 13.6% of the patients experienced post-MI angina. There was a longer chest pain-to-reperfusion time in the post-MI angina group (P = 0.01), as well as a higher fasting sugar level, glycohemoglobin (HbA1C), serum creatinine, troponin-I and creatine kinase MB (CK-MB). The post-MI angina group also had a higher prevalence of multiple-vessel disease. Manual thrombectomy, and distal protective device and intracoronary glycoprotein IIb/IIIa inhibitor injection were used frequently in the no post-MI angina group. Antiplatelet agents and post-MI medication usage were similar between the 2 groups. Multivariate logistic regression analyses demonstrated that prior MI was a positive independent predictor of occurrence of post-MI angina. Manual thrombectomy use and drug-eluting stent implantation were negative independent predictors of post-MI angina. Higher troponin-I and longer chest pain-to-reperfusion time exhibited a trend toward predicting post-MI angina.Prior MIs were strong, independent predictors of post-MI angina. Manual thrombectomy and drug

  4. Abdominal lymphadenopathy:An atypical presentation of enteric fever

    Institute of Scientific and Technical Information of China (English)

    Nayla Ahmed; Zeb I Saeed; Muhammad Tariq

    2012-01-01

    This is a case report of a patient who presented to the Aga Khan University Hospital with generalized abdominal lymphadenopathy and high-grade fever. Due to ambiguous clinical findings, which were suggestive of either abdominal tuberculosis, or a lymphoma, the patient was started on empirical anti-tuberculous treatment due to the endemicity of tuberculosis in this region. The blood culture reports, however, were reported to grow colonies of Salmonellaparatyphi A; thus the diagnosis of the patient was changed to enteric fever, and the patient improved on the subsequently started therapy of ceftriaxone 2 000 mg bid. To the best of our knowledge, this is the first reported case of a patient suffering from enteric fever whose primary clinical findings were abdominal lymphadenopathy and fever.

  5. A clinical dilemma: abdominal tuberculosis

    Institute of Scientific and Technical Information of China (English)

    Oya Uygur-Bayramicli; G(u)l Dabak; Resat Dabak

    2003-01-01

    AIM: To evaluate the clinical, radiological and microbiological properties of abdominal tuberculosis (TB) and to discuss methods needed to get the diagnosis.METHODS: Thirty-one patients diagnosed as abdominal TB between March 1998 and December 2001 at the Gastroenterology Department of Kartal State Hospital,Istanbul, Turkey were evaluated prospectively. Complete physical examination, medical and family history, blood count erythrocyte sedimentation rate, routine biochemical tests,Mantoux skin test, chest X-ray and abdominal ultrasonography (USG) were performed in all cases, whereas microbiological examination of ascites, upper gastrointestinal endoscopy, colonoscopy or barium enema, abdominal tomography, mediastinoscopy, laparoscopy or laparotomy were done when needed.RESULTS: The median age of patients (14 females, 17males) was 34.2 years (range 15-65 years). The most frequent symptoms were abdominal pain and weight loss.Eleven patients had active pulmonary TB. The most common abdominal USG findings were ascites and hepatomegaly. Ascitic fluid analysis performed in 13 patients was found to be exudative and acid resistant bacilli were present in smear and cultured only in one patient with BacTec (3.2 %). Upper gastrointestinal endoscopy yielded nonspecific findings in 16 patients. Colonoscopy performed in 20 patients showed ulcers in 9 (45 %), nodules in 2 (10 %)and, stricture, polypoid lesions, granulomatous findings in terminal ileum and rectal fistula each in one patient (5 %).Laparoscopy on 4 patients showed dilated bowel loops,thickening in the mesentery, multiple ulcers and tubercles on the peritoneum. Patients with abdominal TB were divided into three groups according to the type of involvement.Fifteen patients (48 %) had intestinal TB, L1 patients (35.2 %) had tuberculous peritonitis and 5 (16.8 %)tuberculous lymphadenitis. The diagnosis of abdominal TB was confirmed microbiologically in 5 (16 %) and histopathologically in 19 patients (60.8 %). The

  6. Stellenwert des sympathischen Nervensystems und positiver Feedback-Mechanismen in der Pathophysiologie der instabilen Angina pectoris

    Directory of Open Access Journals (Sweden)

    Schauenstein K

    1999-01-01

    Full Text Available Die klinischen Begriffe "stabile" und "instabile" Angina beschreiben primär die Vorhersehbarkeit von pektanginösen Beschwerden. Dennoch weisen diese beiden Formen auch objektivierbare pathohistologische und pathophysiologische Unterschiede auf, die in der vorliegenden Einführung diskutiert werden. Besonders betont wird der Stellenwert des sympathischen Nervensystems sowie das Auftreten positiver Feedbackmechanismen im anginösen Anfallsgeschehen, die eine kritische Vertiefung des myokardialen Sauerstoffmangels bewirken können. Andererseits wird auf die Gefahr der häufigen asymptomatischen Koronarinsuffizienz ("stumme Angina" hingewiesen. Aus den skizzierten pathophysiologischen Überlegungen werden die Kriterien für eine effektive Therapie diskutiert.

  7. Transient myocardial ischaemia during ambulatory monitoring out of hospital in patients with chronic stable angina pectoris

    DEFF Research Database (Denmark)

    Egstrup, K

    1988-01-01

    Transient myocardial ischaemia during daily life, detected by ambulatory electrocardiographic monitoring, was investigated in 42 patients with chronic stable angina and documented coronary artery disease. Ambulatory monitoring was initiated for 36 hours after all prophylactic antianginal medication...... had been withdrawn for 5 days. There were 196 episodes of ST-segment depression, 145 (74%) of which were not accompanied by angina. As well, a tendency to more prolonged and greater ST-segment change with symptomatic ischaemic episodes was noted. A diurnal variation in transient ischaemia both...

  8. Endovascular repair for abdominal aortic aneurysm followed by type B dissection.

    Science.gov (United States)

    Shingaki, Masami; Kato, Masaaki; Motoki, Manabu; Kubo, Yoji; Isaji, Toshihiko; Okubo, Nobukazu

    2016-10-01

    An 86-year-old man with an abdominal aortic aneurysm was diagnosed with type B aortic dissection accompanied by a patent false lumen that started at the distal arch of the thoracic aorta and terminated at the left common iliac artery. Meticulous preoperative assessment detected 3 large intimal tears in the descending aorta, abdominal aortic aneurysm, and left common iliac artery. We performed single-stage thoracic and abdominal endovascular aneurysm repair and concomitant axillary-axillary bypass. The abdominal aortic aneurysm with type B aortic dissection was successfully treated using a single-stage endovascular stent graft, without any complications due to the careful preoperative examinations.

  9. Cardiac rehabilitation: a good measure to improve quality of life in peri- and postmenopausal women with microvascular angina

    Directory of Open Access Journals (Sweden)

    Wojciech Szot

    2015-05-01

    Full Text Available Cardiac Syndrome X (CSX was considered a stable coronary syndrome, yet due to its nature, CSX symptoms often have a great impact on patients’ Quality of Life (QoL. According to ESC 2013 stable coronary artery disease criteria, CSX was replaced by Microvascular Angina (MA.Unfortunately, most CSX or MA patients, after classical angina (involving main coronary vessels has been ruled out, often do not receive proper treatment. Indications for pharmacological treatment of MA patients were introduced only recently. Another problematic issue is that scientists describing the pathophysiology of both CSX and MA stress a lack of a deeper insight into the multifactorial etiology of the source of pain associated with this disease. In the presented article we have attempted to study the influence of cardiac rehabilitation (3 months programme on the QoL of patients recognized as suffering from MA, as well as to check if changes in myocardial perfusion in these patients at baseline and after completion of cardiac rehabilitation match changes in their QoL. Therefore, after screening 436 women for MA, we studied 55 of them who were confirmed as having MA and who agreed to participate in the study. Exercise tests, Myocardial Perfusion Imaging, and QoL questionnaires were studied at baseline and after completing 3 months period of cardiac rehabilitation. Results were subsequently compared, which showed a link between improved perfusion score in SPECT study and improved overall physical capacity, on one hand, and improved QoL score on the other. These results confirm that cardiac rehabilitation is a very useful treatment option for MA patients. It seems that training during cardiac rehabilitation is a very important factor (improved physical efficiency –> increase in self-belief, and that taking into consideration the multifactor pathophysiology of pain, it is connected with a better quality of life for MA patients.

  10. Clinical Practice Guidelines for Unstable Angina Treatment. Guía de práctica clínica para el tratamiento de la angina inestable.

    Directory of Open Access Journals (Sweden)

    Claudio Manuel González Rodríguez

    2009-03-01

    Full Text Available Clinical Practice Guidelines for Unstable Angina Treatment. It has been defined as the oppressive pain or uneasiness mainly thoracic, which is caused by a transitory myocardial ischemia. This document includes important aspects as classification, diagnosis, treatment (aimed at its principal strategies and risk stratification. It includes assessment guidelines focused on the most important aspects to be accomplished.Guía de práctica clínica para el tratamiento de la angina inestable. Definida como el dolor opresivo o malestar generalmente torácico atribuible a isquemia miocárdica transitoria. La guía enfoca aspectos principales como clasificación, diagnóstico, tratamiento dirigido a sus estrategias principales y estratificación de riesgos. Concluye con su guía de evaluación, enfocada en los aspectos más importantes a cumplir.

  11. Abdominal wall hernia and pregnancy

    DEFF Research Database (Denmark)

    Jensen, K K; Henriksen, N A; Jorgensen, L N

    2015-01-01

    PURPOSE: There is no consensus as to the treatment strategy for abdominal wall hernias in fertile women. This study was undertaken to review the current literature on treatment of abdominal wall hernias in fertile women before or during pregnancy. METHODS: A literature search was undertaken in Pub......Med and Embase in combination with a cross-reference search of eligible papers. RESULTS: We included 31 papers of which 23 were case reports. In fertile women undergoing sutured or mesh repair, pain was described in a few patients during the last trimester of a subsequent pregnancy. Emergency surgery...... of incarcerated hernias in pregnant women, as well as combined hernia repair and cesarean section appears as safe procedures. No major complications were reported following hernia repair before or during pregnancy. The combined procedure of elective cesarean section and abdominal wall hernia repair was reported...

  12. Abdominal actinomycosis mimicking acute appendicitis.

    Science.gov (United States)

    Conrad, Robert Joseph; Riela, Steven; Patel, Ravi; Misra, Subhasis

    2015-01-01

    A 52-year-old Hispanic woman presented to the emergency department, reporting worsening sharp lower right quadrant abdominal pain for 3 days. CT of the abdomen and pelvis showed evidence of inflammation in the peritoneal soft tissues adjacent to an enlarged and thick-walled appendix, an appendicolith, no abscess formation and a slightly thickened caecum consistent with acute appendicitis. During laparoscopic appendectomy, the caecum was noted to be firm, raising suspicion of malignancy. Surgical oncology team was consulted and open laparotomy with right hemicolectomy was performed. Pathology reported that the ileocaecal mass was not a malignancy but was, rather, actinomycosis. The patient was discharged after 10 days of intravenous antibiotics in the hospital, with the diagnosis of abdominal actinomycosis. Although the original clinical and radiological findings in this case were highly suggestive of acute appendicitis, abdominal actinomycosis should be in the differential for right lower quadrant pain as it may be treated non-operatively.

  13. Temporary abdominal closure with zipper-mesh device for management of intra-abdominal sepsis

    Directory of Open Access Journals (Sweden)

    Edivaldo Massazo Utiyama

    2015-02-01

    Full Text Available OBJECTIVE: to present our experience with scheduled reoperations in 15 patients with intra-abdominal sepsis. METHODS: we have applied a more effective technique consisting of temporary abdominal closure with a nylon mesh sheet containing a zipper. We performed reoperations in the operating room under general anesthesia at an average interval of 84 hours. The revision consisted of debridement of necrotic material and vigorous lavage of the involved peritoneal area. The mean age of patients was 38.7 years (range, 15 to 72 years; 11 patients were male, and four were female. RESULTS: forty percent of infections were due to necrotizing pancreatitis. Sixty percent were due to perforation of the intestinal viscus secondary to inflammation, vascular occlusion or trauma. We performed a total of 48 reoperations, an average of 3.2 surgeries per patient. The mesh-zipper device was left in place for an average of 13 days. An intestinal ostomy was present adjacent to the zipper in four patients and did not present a problem for patient management. Mortality was 26.6%. No fistulas resulted from this technique. When intra-abdominal disease was under control, the mesh-zipper device was removed, and the fascia was closed in all patients. In three patients, the wound was closed primarily, and in 12 it was allowed to close by secondary intent. Two patients developed hernia; one was incisional and one was in the drain incision. CONCLUSION: the planned reoperation for manual lavage and debridement of the abdomen through a nylon mesh-zipper combination was rapid, simple, and well-tolerated. It permitted effective management of severe septic peritonitis, easy wound care and primary closure of the abdominal wall.

  14. Blunt abdominal trauma in sports.

    Science.gov (United States)

    Rifat, Sami F; Gilvydis, Rimas P

    2003-04-01

    Abdominal injuries are rare in sports, but when they do occur it is important that the physician recognize the warning signs of potentially life-threatening injury to the liver, spleen, or hollow abdominal viscera. Though the sports medicine physician may not always provide definitive treatment of many of these conditions, he or she should be familiar with the preferred diagnostic modalities and latest treatment options. This information is not only essential to appropriately participate in treatment decisions, but is also important in order to make return-to-play determinations.

  15. [Gallstone ileus. Abdominal CT usefulness].

    Science.gov (United States)

    Sukkarieh, F; Brasseur, P; Bissen, L

    2004-06-01

    The authors report the case of a 93-year old woman referred to the emergency department and presenting with an intestinal obstruction. Abdominal CT reveals a biliary ileus caused by the migration and the impaction of a 3 cm gallstone in the small bowel. Surgical treatment by enterolithotomy was successful. In over 90% of cases, gallstone ileus is a complication of cholelithiasis and accounts for 25% of intestinal obstruction in patients over 65 years. To reduce morbidity and mortality, early diagnosis and prompt treatment are essential. Abdominal CT-scan is the gold standard technique.

  16. CT appearances of abdominal tuberculosis

    Energy Technology Data Exchange (ETDEWEB)

    Lee, W.-K., E-mail: leewk33@hotmail.com [Department of Medical Imaging, St Vincent' s Hospital, University of Melbourne, Fitzroy, Victoria (Australia); Van Tonder, F.; Tartaglia, C.J.; Dagia, C. [Department of Medical Imaging, St Vincent' s Hospital, University of Melbourne, Fitzroy, Victoria (Australia); Cazzato, R.L. [Department of Radiology, Universita Campus Bio-Medico di Roma, Rome (Italy); Duddalwar, V.A. [Department of Radiology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California (United States); Chang, S.D. [Department of Medical Imaging, Vancouver General Hospital, University of British Columbia, British Columbia (Canada)

    2012-06-15

    The purpose of this article is to review and illustrate the spectrum of computed tomography (CT) appearances of abdominal tuberculosis. Tuberculosis can affect any organ or tissue in the abdomen, and can be mistaken for other inflammatory or neoplastic conditions. The most common sites of tuberculosis in the abdomen include lymph nodes, genitourinary tract, peritoneal cavity and gastrointestinal tract. The liver, spleen, biliary tract, pancreas and adrenals are rarely affected, but are more likely in HIV-seropositive patients and in miliary tuberculosis. This article should alert the radiologist to consider abdominal tuberculosis in the correct clinical setting to ensure timely diagnosis and enable appropriate treatment.

  17. Diagnosis in acute abdominal pain and ongoing abdominal sepsis

    NARCIS (Netherlands)

    Kiewiet, J.J.S.

    2016-01-01

    Acute abdominal pain is a common reason for presentation at the emergency department. To establish a timely and adequate diagnosis, doctors use the pattern of complaints and physical examination as the basis for the evaluation of a patient. In this thesis we conducted a study that showed that surgeo

  18. Reprising Ramadan-Related Angina Pectoris: A Potential Strategy for Risk Reduction.

    Science.gov (United States)

    Siegel, Arthur J; Bhatti, Nasir A; Wasfy, Jason H

    2016-11-10

    BACKGROUND A preponderance of evidence supports short-term aspirin usage to reduce transiently increased cardiovascular risk in clinical conditions that promote acute myocardial ischemia. CASE REPORT We report on the case of a 69-year-old male of Muslim Indian heritage with multiple cardiovascular risk factors who experienced the onset of angina pectoris while fasting for Ramadan for more than 16 hours daily for 30 days in July 2015. While symptom free for 2 months on medical management after ending his fast, he underwent quadruple coronary artery bypass surgery for severe 4-vessel disease following an acute anterior myocardial infarction. A percutaneous coronary intervention with stent placement was subsequently required for persistent myocardial ischemia on stress-MIBI testing due to occlusion of the graft to left anterior descending artery. Presently asymptomatic, he decided to forgo fasting for Ramadan in June 2016. CONCLUSIONS Based on this case, measures for primary cardiovascular prevention among the 1.2 billion susceptible males at similar high short-term cardiac risk while fasting for Ramadan are proposed. The value of aspirin for attenuating high short-term cardiovascular risk in clinical conditions conferring transient inflammatory stress is considered. Low-dose aspirin usage at evening meals while fasting for Ramadan is prudent for primary cardiovascular protection of males who may have non-obstructive coronary atherosclerosis to mitigate the risk for rupture of potentially vulnerable plaques. Based in part on conclusive evidence for protection of middle-aged males from first myocardial infarction in a randomized prospective primary prevention trial, this measure is concordant with recommendations from sub-specialty societies for primary cardiovascular prevention for persons at above-average risk demonstrated by validated biomarkers and from the United States Preventive Services Task Force.

  19. Confiabilidade de sintomas sugestivos de angina em pacientes com doença pulmonar obstrutiva crônica Confiabilidad de síntomas sugestivos de angina en pacientes con enfermedad pulmonar obstructiva crónica Reliability of symptoms suggestive of angina in patients with chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    Yilmaz Gunes

    2009-05-01

    Full Text Available FUNDAMENTO: Devido à sobreposição de sintomas e inadequada capacidade de exercícios, o diagnóstico não-invasivo da doença arterial coronariana (DAC pode ser sub ou superestimado em pacientes com doença pulmonar obstrutiva crônica (DPOC. OBJETIVO: Avaliar os resultados de angiografias coronarianas em pacientes com DPOC dependendo das características clínicas basais. MÉTODOS: Os registros médicos de 157 pacientes com DPOC e 157 pacientes sem DPOC pareados por características clínicas basais, que haviam sido submetidos a angiografia coronariana diagnóstica pela primeira vez, foram revisados, retrospectivamente. RESULTADOS: A frequência de DAC era significantemente mais baixa em pacientes com DPOC do que no grupo controle (52,8% vs. 80,2%, pFUNDAMENTO: A causa de la superposición de síntomas e inadecuada capacidad de ejercicios, el diagnóstico no-invasivo de la enfermedad arterial coronaria (EAC se puede sub o superestimar en pacientes con enfermedad pulmonar obstructiva crónica (EPOC. OBJETIVO: Evaluar los resultados de angiografías coronarias en pacientes con EPOC dependiendo de las características clínicas basales. MÉTODOS: Se revisaron retrospectivamente los registros médicos de 157 pacientes con EPOC y 157 pacientes sin EPOC distribuidos en grupos según características clínicas basales, que se habían sometido a angiografía coronaria diagnóstica por primera vez. RESULTADOS: La frecuencia de EAC era significantemente más baja en pacientes con EPOC que en el grupo control (52,8% vs. 80,2%, pBACKGROUND: Due to overlapping symptoms and inadequate exercise capacity, noninvasive diagnosis of coronary artery disease (CAD may be under- or overestimated in patients with chronic obstructive pulmonary disease (COPD. OBJECTIVE: To assess outcomes of coronary angiography in COPD patients depending on baseline clinical characteristics. METHODS: Medical records of 157 patients with COPD and 157 patients without COPD matched for

  20. CT findings of benign omental lesions following abdominal cancer surgery

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Sang Yun; Kim, Dong Won; Cho, Jin Han; Kwon, Hee Jin; Ha, Dong Ho; Oh, Jong Young [Diagnostic Radiology, Dong-A University College of Medicine, Busan (Korea, Republic of)

    2016-07-15

    The greater omentum is the largest peritoneal fold and can be the origin of primary pathologic conditions, as well as a boundary and conduit for disease processes. Most diseases involving the omentum manifest with nonspecific and overlapping features on computed tomography (CT). In particular, varying benign disease processes of traumatic, inflammatory, vascular, or systemic origin can occur in the omentum during the follow-up period after surgery for intra-abdominal malignancy. It can be challenging for radiologists due to various spectrum of CT findings. Thus, we reviewed the CT findings of various benign omental lesions after surgery for intra-abdominal malignancy.

  1. Inadequate control of heart rate in patients with stable angina: results from the European heart survey.

    NARCIS (Netherlands)

    Daly, C.A.; Clemens, F.; Sendon, J.L.; Tavazzi, L.; Boersma, E.; Danchin, N.; Delahaye, F.; Gitt, A.; Julian, D.; Mulcahy, D.; Ruzyllo, W.; Thygesen, K.; Verheugt, F.W.A.; Fox, K.M.

    2010-01-01

    AIMS: To examine resting heart rate (HR) in a population presenting with stable angina in relation to prior and subsequent pharmacological treatment, comorbid conditions and clinical outcome. METHODS AND RESULTS: The European Heart Survey was a prospective, observational, cohort study of 3779 patien

  2. SAFETY AND EFFICACY OF BETA-BLOCKERS IN THE TREATMENT OF STABLE ANGINA-PECTORIS

    NARCIS (Netherlands)

    DEMUINCK, ED; LIE, KI

    1990-01-01

    In stable exercise-induced angina pectoris, beta-blockers exert their beneficial effects mainly through a reduction in heart rate, blood pressure, and contractility. Additional beneficial effects are an improvement in myocardial oxygen supply through a redistribution of coronary flow, a lengthening

  3. HEPARIN THERAPY IN PATIENT WITH NON-Q WAVE MYOCARDIAL INFARCTION AND UNSTABLE ANGINA

    Directory of Open Access Journals (Sweden)

    M.H EMAMI

    2000-03-01

    Full Text Available Introduction. This study was conducted to find that, is there any advantage from (5000 IU/6h in patient with non-Q wave MI and unastable angina. Methods. In a randomized clinical trial two group of patients with non-Q wave MI and unstable angina were compared about their prognosis and management outcomes. In interventional group (n= 145, heparin (5000 IU/6h was administered and in another group (n= 133 no treatment with heparin was used. Duration of chest pain, recurrent angina, intrahospital mortality were indices for patients outcome study. Findings. Anticoagulant complication was not report in any patient in interventional group. There is no significant difference between two groups about prognosis factors. Conclusion. Heparin administration (5000 IU/6h may have not any role in improving management outcome in patient with non-Q wave MI and unastable angina at least in acute phase. So, it is recommended that heparin have been administered to these patients in continuous regimen (1000-1500 U/hour continuously effusion.

  4. Spinal cord stimulation for refractory angina in a patient implanted with a cardioverter defibrillator.

    Science.gov (United States)

    Ferrero, Paolo; Grimaldi, Roberto; Massa, Riccardo; Chiribiri, Amedeo; De Luca, Anna; Castellano, Maddalena; Cardano, Paola; Trevi, Gian Paolo

    2007-01-01

    Spinal cord stimulation is currently used to treat refractory angina. Some concerns may arise about the possible interaction concerning the spinal cord stimulator in patients already implanted with a pacemaker or a cardioverter defibrillator. We are going to describe the successful implantation of a spinal cord stimulator in a patient previously implanted with a cardioverter defibrillator.

  5. Cardiologists' Use of clinical information for management decisions for patients with unstable angina: a policy analysis

    NARCIS (Netherlands)

    P.M.M. Bossuyt (Patrick); R.W. Nette (Robert); M.L. Simoons (Maarten); T.R. Taylor (Thomas); A.J.M. van Miltenburg-van Zijl (Addy)

    1997-01-01

    textabstractPrevious studies of management of unstable angina have revealed substantial differences in management between different hospitals, especially with respect to the use of coronary angiography. Physicians in a hospital with angiography facilities were more inclined to perform angiography th

  6. Invasive Evaluation of Patients with Angina in the Absence of Obstructive Coronary Artery Disease

    Science.gov (United States)

    Lee, Bong-Ki; Lim, Hong-Seok; Fearon, William F.; Yong, Andy; Yamada, Ryotaro; Tanaka, Shigemitsu; Lee, David P.; Yeung, Alan C.; Tremmel, Jennifer A.

    2017-01-01

    Background More than 20% of patients presenting to the cardiac catheterization laboratory with angina have no angiographic evidence of coronary artery disease (CAD). Despite a “normal” angiogram, these patients often have persistent symptoms, recurrent hospitalizations, a poor functional status, and adverse cardiovascular outcomes, without a clear diagnosis. Methods and Results In 139 patients with angina in the absence of obstructive CAD (no diameter stenosis >50%), endothelial function was assessed, the index of microcirculatory resistance (IMR), coronary flow reserve (CFR), and fractional flow reserve (FFR) were measured, and intravascular ultrasound (IVUS) was performed. There were no complications. The average age was 54.0±11.4 years and 107 (77%) were women. All patients had at least some evidence of atherosclerosis based on IVUS examination of the LAD. Endothelial dysfunction (a decrease in luminal diameter of >20% after intracoronary acetylcholine) was present in 61 patients (44%). Microvascular impairment (an IMR ≥25) was present in 29 patients (21%). Seven patients (5%) had an FFR ≤0.80. A myocardial bridge was present in 70 patients (58%). Overall, only 32 patients (23%) had no coronary explanation for their angina, with normal endothelial function, normal coronary physiologic assessment, and no myocardial bridging. Conclusions The majority of patients with angina in the absence of obstructive CAD have occult coronary abnormalities. A comprehensive invasive assessment of these patients at the time of coronary angiography can be performed safely and provides important diagnostic information which may affect treatment and outcomes. PMID:25712205

  7. Spinal cord stimulation in refractory angina pectoris - Clinical results and mechanisms

    NARCIS (Netherlands)

    Oosterga, M; tenVaarwerk, IAM; DeJongste, MJL; Staal, MJ

    1997-01-01

    Patients with therapeutically refractory angina pectoris do not respond to adequate anti-anginal medication and are not suitable anymore for revascularisation procedures. This group of patients has a poor quality of Life, since their exercise capacity is severely afflicted. A new additional therapy

  8. The significance of {sup 123}I-BMIPP myocardial SPECT on the evaluation of angina pectoris

    Energy Technology Data Exchange (ETDEWEB)

    Kurosawa, Kazuhiko; Ohtani, Hiroshi; Saitou, Tomiyoshi; Maruyama, Yukio [Fukushima Medical Coll. (Japan); Katohno, Eiichi; Ohwada, Kenji

    1998-06-01

    Some patients of ischemic heart disease have low uptake in {sup 123}I-labeled beta methyl-iodophenyl pentadecanoic acid (BMIPP) SPECT in spite of normal uptake in thallium-201 (Tl) SPECT. To investigate their clinical significance, we performed both Tl and BMIPP myocardial SPECT in 26 cases with stable angina (n=16) and unstable angina (n=10), and compared with clinical backgrounds electrocardiogram (ECG) and left ventriculography (LVG). In 11 patients of them, the uptake of BMIPP was moderately reduced. We divided 26 cases into two groups according to uptake of BMIPP (normal/reduced). The two groups had no differences in length of angina attack and duration of disease, but they had a significant difference in the abnormality of either ECG or LVG. Three to six months after PTCA, we examined LVG in 18 cases, 12 of 16 cases with the abnormality of LVG showed the improvement of wall motion. We concluded the reduced uptake of BMIPP with normal uptake of Tl was related to more severe ischemia in cases with unstable angina. (author)

  9. Emerging treatment options for refractory angina pectoris: ranolazine, shock wave treatment, and cell-based therapies.

    Science.gov (United States)

    Gennari, Marco; Gambini, Elisa; Bassetti, Beatrice; Capogrossi, Maurizio; Pompilio, Giulio

    2014-01-01

    A challenge of modern cardiovascular medicine is to find new, effective treatments for patients with refractory angina pectoris, a clinical condition characterized by severe angina despite optimal medical therapy. These patients are not candidates for surgical or percutaneous revascularization. Herein we review the most up-to-date information regarding the modern approach to the patient with refractory angina pectoris, from conventional medical management to new medications and shock wave therapy, focusing on the use of endothelial precursor cells (EPCs) in the treatment of this condition. Clinical limitations of the efficiency of conventional approaches justify the search for new therapeutic options. Regenerative medicine is considered the next step in the evolution of organ replacement therapy. It is driven largely by the same health needs as transplantation and replacement therapies, but it aims further than traditional approaches, such as cell-based therapy. Increasing knowledge of the role of circulating cells derived from bone marrow (EPCs) on cardiovascular homeostasis in physiologic and pathologic conditions has prompted the clinical use of these cells to relieve ischemia. The current state of therapeutic angiogenesis still leaves many questions unanswered. It is of paramount importance that the treatment is delivered safely. Direct intramyocardial and intracoronary administration has demonstrated acceptable safety profiles in early trials, and may represent a major advance over surgical thoracotomy. The combined efforts of bench and clinical researchers will ultimately answer the question of whether cell therapy is a suitable strategy for treatment of patients with refractory angina.

  10. Tissue Doppler echocardiography improves the diagnosis of coronary artery stenosis in stable angina pectoris

    DEFF Research Database (Denmark)

    Hoffmann, Soren; Jensen, Jan Skov; Iversen, Allan Zeeberg

    2012-01-01

    Aim To determine if colour tissue Doppler imaging (TDI) performed at rest in patients with suspected stable angina pectoris (SAP) is able to predict the presence of significant coronary artery disease (CAD). METHODS AND RESULTS: This study comprises 296 consecutive patients with clinically...

  11. [INTERVENTIONAL AND SURGICAL TREATMENT OF THE ANGINA PECTORIS RECURRENCE AFTER CORONARY SHUNTING OPERATION].

    Science.gov (United States)

    Fanta, S M

    2015-12-01

    There were examined 134 patients, in whom in the clinic in 2005-2014 yrs a coronary shunting operation was performed. In patients with the angina pectoris recurrence a reoperation is indicated. The data of repeated coronaroventriculography and shuntography were analyzed. Efficacy of the surgical and interventional methods application in the patients was proved.

  12. Mechanisms of angina pectoris in syndrome X assessed by myocardial perfusion dynamics and heart rate variability

    NARCIS (Netherlands)

    Meeder, JG; Blanksma, PK; Crijns, HJGM; Anthonio, RL; Pruim, J; Brouwer, J; DeJong, RM; VanderWall, EE; Vaalburg, W; Lie, KI

    1995-01-01

    The fundamental abnormality in syndrome X (angina pectoris, ischaemia-like stress ECG despite angiographically normal coronary arteries) might be patchily distributed increased tone in pre-arteriolar coronary vessels with compensatory release of adenosine. The aim of this study was to confirm this h

  13. Clinical management of abdominal trauma

    Institute of Scientific and Technical Information of China (English)

    FANG Guo-en; LUO Tian-hang; DU Cheng-hui; BI Jian-wei; XUE Xu-chao; WEI Guo; WENG Zhao-zhang; MA Li-ye; HUA Ji-de

    2008-01-01

    Objective: To improve the prognosis of patients with abdominal trauma. Methods: Between January 1993 and December 2005, 415 patients were enrolled in this research. The patients consisted of 347 males and 68 females with mean age of 36 years ranging from 3-82 years. All abdominal traumas consisted of closed traumas 360 cases, 86.7% and open traumas 55 cases, 13.3%. Results: Atotal of 407 cases 98.1% were fully recovered from trauma and the other 8 cases 1.9% died of multiple injuries. The mean injury severity score ISS of all patients was 22 while the mean ISS of the patients who died in hospital was 42. Postoperative complications were seen in 9 patients such as infection of incisional wounds 6 cases, pancreatic fistula 2 cases and intestinal fistula 1 case. All these postoperative complications were cured by the conservative treatment. Conclusion: Careful case history inquisition and physical examination are the basic methods to diagnose abdomi- nal trauma. Focused abdominal ultrasonography is always the initial imaging examination because it is non-invasive and can be performed repeatedly with high accuracy. The doctors should consider the severity of local injuries and the general status of patients during the assessment of abdominal trauma. The principle of treatment is to save lives at first, then to cure the injuries. Unnecessary laparotomy should be avoided to reduce additional surgical trauma.

  14. Chronic Abdominal Pain in Children

    NARCIS (Netherlands)

    C.F.M. Gijsbers (Carolien)

    2012-01-01

    textabstractRecurrent abdominal pain (RAP) was first defined in 1958 by Apley as “at least 3 bouts of pain, severe enough to affect activities, over a period of at least 3 months” (1). This was a landmark publication with great impact, showing, that emotional disturbances played a role in many patie

  15. Economic costs of abdominal obesity

    DEFF Research Database (Denmark)

    Højgaard, Betina; Olsen, Kim Rose; Søgaard, Jes

    2008-01-01

    BACKGROUND: To examine the relationship between waist circumference and future health care costs across a broad range of waist circumference values based on individual level data. METHOD: A prospective cohort of 31,840 subjects aged 50-64 years at baseline had health status, lifestyle and socio-e...... be a potential for significant resource savings through prevention of abdominal obesity....

  16. Abdominal aortic aneurysm repair - open - discharge

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000240.htm Abdominal aortic aneurysm repair - open - discharge To use the sharing features ... References Orandi BJ, Black JH. Open repair of abdominal aortic aneurysms. In: Cameron JL, Cameron AM, eds. Current Surgical ...

  17. Preoperative steroid in abdominal wall reconstruction

    DEFF Research Database (Denmark)

    Jensen, Kristian Kiim; Brøndum, Tina Lee; Belhage, Bo;

    2016-01-01

    INTRODUCTION: Preoperative administration of high-dose glucocorticoid leads to improved recovery and decreased length of stay after abdominal surgery. Even so, studies on administration of glucocorticoids for patients undergoing abdominal wall reconstruction (AWR) for giant ventral hernia repair ...

  18. A prospective study on geriatric abdominal surgical emergencies

    Directory of Open Access Journals (Sweden)

    Deepak R. Chavan

    2014-06-01

    Results: 128 patients aged 60 years or more who presented with abdominal emergency surgical conditions were studied. Most common cause for emergency abdominal surgery was perforated peptic ulcer (38% followed by intestinal obstruction (17%. The most common post-operative complication was surgical site infection (29%. Mortality rate was 17%. Most common cause of death was septic shock with multi organ dysfunction. Conclusion: Geriatric population is an important subgroup of population undergoing emergency abdominal surgeries. Most common cause is peptic ulcer perforation followed by intestinal obstruction due to adhesions. More than the age per say, the delay in presentation may be the cause for mortality in this age group. The therapeutic outcome in patients with co morbid factors like hypertension and diabetes mellitus in control, were similar to other patients. [Int J Res Med Sci 2014; 2(3.000: 963-971

  19. Abdominal Compartment Syndrome: pathophysiology and definitions

    OpenAIRE

    Cheatham Michael L

    2009-01-01

    Abstract "Intra-abdominal hypertension", the presence of elevated intra-abdominal pressure, and "abdominal compartment syndrome", the development of pressure-induced organ-dysfunction and failure, have been increasingly recognized over the past decade as causes of significant morbidity and mortality among critically ill surgical and medical patients. Elevated intra-abdominal pressure can cause significant impairment of cardiac, pulmonary, renal, gastrointestinal, hepatic, and central nervous ...

  20. Erhöhter oxidativer Streß bei Patienten mit instabiler Angina pectoris

    Directory of Open Access Journals (Sweden)

    Bodlaj G

    1998-01-01

    Full Text Available Die instabile Angina pectoris führt oft zum akuten Myokardinfarkt. Da die Lipid-Peroxidation im Verdacht steht, chronische und akute Ereignisse der Atherosklerose und der koronaren Herzkrankheit zu fördern, untersuchten wir die Lipid-Peroxidations-Parameter und alpha-Toco-pherol-Spiegel bei 100 KHK-Patienten und verglichen sie mit denen einer entprechenden Kontrollgruppe. 50 konsekutive Patienten mit stabiler Angina pectoris (SAP und 50 konsekutive Patienten mit instabiler Angina pectoris (IAP wurden untersucht und mit 100 klinisch gesunden Personen verglichen. Zusätzlich zur herkömmlichen Lipid- und Lipoprotein-Analyse wurden die Lipid-Peroxidations-Produkte als Hydroperoxide und Thiobarbituric acid reactive substances (TBARS gemessen. Die konjugierten Diene wurden nur bei den Patienten bestimmt. Da alpha-Tocopherol eines der wichtigsten Antioxidantien ist, wurde es ebenfalls quantifiziert. Wie erwartet hatten die Patienten wesentlich höhere Cholesterin-, Triglyzerid-, LDL-C- und Lp(a-Spiegel und niedrigere HDL-C-Spiegel als die Kontrollgruppe. Als die Patienten in Gruppen mit stabiler und instabiler Angina pectoris geteilt wurden, waren Peroxide und TBARS in der letzteren Gruppe wesentlich höher als bei den anderen Patienten und der Kontrollgruppe. Auch konjugierte Diene waren eindeutig höher bei den Patienten mit instabiler Angina pectoris. Der alpha-Tocopherol-Gesamtspiegel war in allen 3 Gruppen vergleichbar, aber der alpha-Tocopherol-Gehalt pro LDL-Partikel war bei den Patienten mit IAP am niedrigsten, gefolgt von denen mit SAP und der Kontrollgruppe. Wir schließen daraus, daß die Lipid-Peroxidations-Parameter bei Patienten mit IAP erhöht sind und SAP-Patienten von IAP-Patienten unterscheiden.

  1. Histopathological examination of specimens removed during directional coronary atherectomy in patients presenting with crescendo angina show mural thrombus.

    Science.gov (United States)

    Bellamy, C M; Grech, E D; Ashworth, M T; Ramsdale, D R

    1993-02-01

    Thrombus formation over a fissured coronary atheromatous plaque has been shown by post mortem histological examination to be the pathophysiological mechanism responsible for myocardial ischaemia in those patients who died following a crescendo pattern of angina. Histological examination of plaques responsible for a crescendo pattern of angina in patients who do not die has not been available until recently. We describe two patients who presented with a crescendo pattern of angina. A new technique of coronary revascularization, directional coronary atherectomy, produced symptomatic relief and resolution of myocardial ischaemia. Histological examination of material from the stenosis responsible for their myocardial ischaemia, obtained using this technique, confirmed thrombus formation overlying a fissured atheromatous plaque.

  2. Transient myocardial ischemia during daily life in rest and exertional angina pectoris and comparison of effectiveness of metoprolol versus nifedipine

    DEFF Research Database (Denmark)

    Ardissino, D; Savonitto, S; Egstrup, K

    1991-01-01

    The clinical characteristics of 65 patients with mixed angina were classified by means of (1) a questionnaire investigating the proportion of symptoms occurring at rest and on effort, (2) an exercise stress test, (3) 24-hour ambulatory Holter monitoring, and (4) coronary arteriography. According...... life (p less than 0.05) irrespective of the patients' clinical characteristics. Nifedipine was ineffective, particularly in patients with angina predominantly on effort and with a moderate to severe reduction in exercise tolerance. It is concluded that in patients with mixed angina, ischemic episodes...

  3. Rest delayed images on {sup 99m}Tc-MIBI myocardial SPECT as a noninvasive screen for the diagnosis of vasospastic angina pectoris

    Energy Technology Data Exchange (ETDEWEB)

    Ono, Soichi; Yamaguchi, Hiroyuki; Takayama, Shin [Yamagata Prefectural Shinjo Hospital (Japan); Kurabe, Atsushi; Heito, Takayuki [Yamagata Prefectural Nihonkai Hospital, Sakata (Japan)

    2002-05-01

    Diagnostic usefulness of {sup 99m}Tc-hexakis-2-methoxy isobutyl isonitrile (MIBI) myocardial SPECT at rest was examined in 39 cases of coronary vasospastic angina pectoris who were diagnosed by a positive reaction to ergonovine provocation. SPECT was performed 45 minutes (early image) and 3 hours (delayed image) after the intravenous injection of approximately 600 MBq of MIBI. Decrease in accumulation was ranked by four defect scores (0: normal; 1: slight decrease; 2: moderate decrease; 3: severe decrease) and the total defect score was evaluated semiquantitatively. The washout rate between the normal area and the spasm area was also evaluated quantitatively using bull's eye. As a result, 15 cases (15/39; 38.4%) showed decreased accumulation in the early image and 27 cases (27/39; 69.2%) showed decreased accumulation in the delayed image. All of the cases which showed decreased accumulation in the early image had decreased accumulation in the delayed image as well. In 6 cases (6/34; 17.6%) showed ST wave changes during exercise ECG and 16 cases (16/34: 47%) showed decreased accumulation in the exercise myocardial SPECT. The washout rate of MIBI in the decreased accumulation area was significantly higher than that of the normal area. Of 32 ergonovine induced vasospastic area, 23 areas (72%) exhibited decreased accumulation in the delayed image for the same area. Decreased accumulation in the delayed image in MIBI was due to the enhanced washout, which, in turn, indicated declined retention of MIBI by mitochondrial membrane. In coronary vasospastic angina pectoris, spasm induced ischemia was thought to have an effect on the mitochondria. This study suggested that even with a normal exercise ECG and exercise myocardial SPECT, there's a strong possibility of coronary vasospastic angina pectoris if a decreased accumulation was found in the delayed image in the MIBI myocardial SPECT at rest. Hence, in diagnosing coronary vasospastic angina pectoris, the delayed

  4. Superman play and pediatric blunt abdominal trauma.

    Science.gov (United States)

    Machi, J M; Gyuro, J; Losek, J D

    1996-01-01

    Two pediatric patients with life-threatening intra-abdominal injuries associated with Superman play are presented. The cases illustrate the importance of knowing the mechanism of injury in the assessment of children with blunt abdominal trauma. The diagnostic value of liver enzymes and the controversies surrounding the radiographic assessment of pediatric blunt abdominal trauma are presented.

  5. Peritoneal tuberculosis due to Mycobacterium caprae

    Directory of Open Access Journals (Sweden)

    T. Nebreda

    2016-01-01

    Full Text Available The incidence of tuberculosis in humans due to Mycobacterium caprae is very low and is almost confined to Europe. We report a case of a previously healthy 41-year-old Moroccan with a 6 month history of abdominal pain, weight loss, fatigue and diarrhea. A diagnosis of peritoneal tuberculosis due to M. caprae was made.

  6. Intra-Abdominal Actinomycosis Mimicking Malignant Abdominal Disease

    Directory of Open Access Journals (Sweden)

    Ali Ridha

    2017-01-01

    Full Text Available Abdominal actinomycosis is a rare infectious disease, caused by gram positive anaerobic bacteria, that may appear as an abdominal mass and/or abscess (Wagenlehner et al. 2003. This paper presents an unusual case of a hemodynamically stable 80-year-old man who presented to the emergency department with 4 weeks of worsening abdominal pain and swelling. He also complains of a 20-bound weight loss in 2 months. A large tender palpable mass in the right upper quadrant was noted on physical exam. Laboratory studies showed a normal white blood cell count, slightly decreased hemoglobin and hematocrit, and mildly elevated total bilirubin and alkaline phosphatase. A CT with contrast was done and showed a liver mass. Radiology and general surgery suspected malignancy and recommended CT guided biopsy. The sample revealed abundant neutrophils and gram positive rods. Cytology was negative for malignancy and cultures eventually grew actinomyces. High dose IV penicillin therapy was given for 4 weeks and with appropriate response transitioned to oral antibiotic for 9 months with complete resolution of symptoms.

  7. Intra-Abdominal Actinomycosis Mimicking Malignant Abdominal Disease

    Science.gov (United States)

    Oguejiofor, Njideka; Al-Abayechi, Sarah; Njoku, Emmanuel

    2017-01-01

    Abdominal actinomycosis is a rare infectious disease, caused by gram positive anaerobic bacteria, that may appear as an abdominal mass and/or abscess (Wagenlehner et al. 2003). This paper presents an unusual case of a hemodynamically stable 80-year-old man who presented to the emergency department with 4 weeks of worsening abdominal pain and swelling. He also complains of a 20-bound weight loss in 2 months. A large tender palpable mass in the right upper quadrant was noted on physical exam. Laboratory studies showed a normal white blood cell count, slightly decreased hemoglobin and hematocrit, and mildly elevated total bilirubin and alkaline phosphatase. A CT with contrast was done and showed a liver mass. Radiology and general surgery suspected malignancy and recommended CT guided biopsy. The sample revealed abundant neutrophils and gram positive rods. Cytology was negative for malignancy and cultures eventually grew actinomyces. High dose IV penicillin therapy was given for 4 weeks and with appropriate response transitioned to oral antibiotic for 9 months with complete resolution of symptoms. PMID:28299215

  8. Management of the open abdomen using negative pressure wound therapy with instillation in severe abdominal sepsis

    Directory of Open Access Journals (Sweden)

    Pablo Sibaja

    2017-01-01

    NPWT-I in patients with severe abdominal sepsis had promising results, since we obtained higher fascia closure rates, lower mortality and reduced hospital and ICU length of stay with no complications due to this therapeutic approach.

  9. The Diagnostic Value of Intra-abdominal Pressure in Patients with Blunt Acute Abdominal Trauma

    Directory of Open Access Journals (Sweden)

    Huseyin Narci

    2012-06-01

    Full Text Available Purpose:The objective of this study was to determine the diagnostic value of intra-abdominal pressure measurement in blunt abdominal trauma patients. Method: A prospective study was performed in 49 patients with blunt trauma in our university hospital for 1 years. Patients were randomly into two groups as intra-abdominal trauma (n=28 and extraabdominal trauma (n=21 groups. Intra-abdominal pressures was measured an classified as normal (10 cm H2O or less, elevated (more than 10 cm H2O determined indirectly. Results: No significant differences were found between abdominal trauma and extra-abdominal trauma groups from the point of intra-abdominal pressure (IAP. One the other hand, in abdominal trauma group; significant differences were observed between operated patients. Intra-abdominal bleeding was found in 10 patients and all of them elevated IAP values (exceeding 16 cm H2O. For determining the intra-abdominal injury, IAP had a sensitivity of 93%, specificity 38% in patients. Conclusion: IAP exceeding 16 cm H2O with blunt abdominal trauma patients abdominal trauma can be detected. It is thought that IAP, indirect monitoring of abdominal trauma patients is a reproducible, scientific guide and simple method.To determine the efficacy of the measurement of intra-abdominal pressure in blunt abdominal trauma patients, further studies should be done. [Cukurova Med J 2012; 37(3.000: 157-161

  10. Acupuncture Treatment of Abdominal Pain

    Institute of Scientific and Technical Information of China (English)

    胡金生

    2002-01-01

    @@ Case History Mr. Li, a university student aged 23 years, paid his first visit on July 16, 2001, with the chief complaint of abdominal pain for one day. The patient stated that one day before when it happened to be the weekend, he got abdominal pain after supper, which went worse gradually and caused him to roll all over in bed. The pain was slightly alleviated half an hour later after he had taken some pain killers. Upon inquiry, the patient said that because of their newly graduation from the university, he and his classmates were so excited that they went to have a sumptuous lunch with alcoholic drinks. And in the evening he ate again a delicious supper cooked for him by his mother, after which he continued to have some fruit and dessert.

  11. 腹部手术留置各类治疗导管导致患者痛苦程度的前瞻性评价%A prospective evaluation of postoperative pain due to various therapeutic catheters after abdominal surgery

    Institute of Scientific and Technical Information of China (English)

    刘鹏; 李磊; 金向辉; 付申凌; 门吉芳; 崔红元; 朱明炜

    2014-01-01

    目的 调查腹部术后各类治疗导管对患者引起的痛苦程度.方法 采用前瞻性研究设计,符合入选标准的患者进入本研究;记录一般资料,进行营养风险筛查;记录外科治疗需要留置的尿管、胃管、腹腔引流管、胆总管引流管、伤口引流管、中心静脉导管和经外周静脉置入中心静脉导管等,使用视觉模拟评分法,记录患者在置管后24、48和72 h的读数,评价不同导管对患者带来的痛苦程度.结果 共157例患者进入本研究,其中男性70例、女性87例;年龄(60.5±12.5)岁;体质量指数(23.8±3.2) kg/m2;总营养风险发生率为42.0%;根据视觉模拟尺读数,患者主观感觉痛苦程度依次为:胃管(4.9±1.7)、伤口引流管(3.6±0.9)、尿管(3.0±0.9)、中心静脉导管(2.6±0.9)、腹腔引流管(2.4±1.0)、胆总管引流管(1.9±0.7)和经外周静脉置入中心静脉导管(1.8±0.8);患者认为导管给其本次住院带来的痛苦占(44.9±14.1)%.结论 胃管、伤口引流管和尿管可增加患者痛苦,在不影响治疗前提下,及时拔除导管,有利于患者康复.%Objective To evaluate the postoperative pain induced by various therapeutic catheters after abdominal surgery.Methods A prospective study was conducted in patients selected based on the inclusion criteria.The general condition of the patients was recorded,and nutritional risk screening was performed.The indwelling of therapeutic catheters after abdominal surgery were recorded,including urinary catheter,nasogastric tube,peritoneal drainage tube,common bile duct drainage tube,wound drainage tube,central venous catheter and peripherally inserted central catheter.The pain caused by each type of catheters was evaluated using visual analog scale at 24,48 and 72 hours after tube/catheter insertion.Results A total of 157 patients were selected,including 70 males and 87 females,aged (60.5 ± 12.5) years,with a body mass index of (23.8 ± 3.2) kg/m2,and a total

  12. Direct evidence of endothelial injury in acute myocardial infarction and unstable angina by demonstration of circulating endothelial cells.

    Science.gov (United States)

    Mutin, M; Canavy, I; Blann, A; Bory, M; Sampol, J; Dignat-George, F

    1999-05-01

    Circulating endothelial cells (CECs) have been detected in association with endothelial injury and therefore represent proof of serious damage to the vascular tree. Our aim was to investigate, using the technique of immunomagnetic separation, whether the pathological events in unstable angina (UA) or acute myocardial infarction (AMI) could cause desquamation of endothelial cells in circulating blood compared with effort angina (EA) and noncoronary chest pain. A high CEC count was found in AMI (median, 7.5 cells/mL; interquartile range, 4.1 to 43.5, P chest pain as compared with controls (0; 0 to 0 cells/mL) and stable angina (0; 0 to 0 cells/mL). CEC levels in serial samples peaked at 15.5 (2.7 to 39) cells/mL 18 to 24 hours after AMI (P angina, confirming that these diseases have different etiopathogenic mechanisms.

  13. Case management does not decrease mortality of patients with myocardial infarction or unstable angina: Evidence from a systematic review

    Directory of Open Access Journals (Sweden)

    Li-Juan Yi

    2016-06-01

    Conclusion: Case management is not beneficial to all-cause mortality after myocardial infarction or unstable angina compared to routine care. Additional, prospective RCTs of high quality and large scale are warranted to verify these results.

  14. Effects of preinfarction angina on no-reflow phenomenon after percutaneous coronary intervention in patients with acute myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    王荣英

    2003-01-01

    Effects of preinfarction angina on no-reflow phenomenon after percutaneous coronary intervention in patients with acute myocardial infarction@王荣英$河北医科大学第二医院!石家庄050000 0311-70469016011

  15. Spinal cord stimulation for long-term treatment of severe angina pectoris: what does the evidence say?

    Science.gov (United States)

    Börjesson, Mats; Andréll, Paulin; Mannheimer, Clas

    2011-11-01

    Patients who continue to suffer from severe and disabling angina pectoris, despite optimum treatment in terms of conventional pharmacological therapy and/or revascularization procedures, have been termed as having refractory angina pectoris. The future group of patients with refractory angina pectoris will be different from today's patients and represent a 'moving target' as risk factors, efficacy of treatment and indications continue to change. Spinal cord stimulation (SCS) is today considered as first-line treatment of refractory angina pectoris, by the European Society of Cardiology, with an anti-ischemic effect. There is strong evidence for SCS giving symptomatic benefits (decrease in anginal attacks), improved quality of life and improvement of functional status. In addition, SCS seems to be cost effective with a 'break-even' after approximately 15-16 months.

  16. A risk score for predicting coronary artery disease in women with angina pectoris and abnormal stress test finding.

    Science.gov (United States)

    Lo, Monica Y; Bonthala, Nirupama; Holper, Elizabeth M; Banks, Kamakki; Murphy, Sabina A; McGuire, Darren K; de Lemos, James A; Khera, Amit

    2013-03-15

    Women with angina pectoris and abnormal stress test findings commonly have no epicardial coronary artery disease (CAD) at catheterization. The aim of the present study was to develop a risk score to predict obstructive CAD in such patients. Data were analyzed from 337 consecutive women with angina pectoris and abnormal stress test findings who underwent cardiac catheterization at our center from 2003 to 2007. Forward selection multivariate logistic regression analysis was used to identify the independent predictors of CAD, defined by ≥50% diameter stenosis in ≥1 epicardial coronary artery. The independent predictors included age ≥55 years (odds ratio 2.3, 95% confidence interval 1.3 to 4.0), body mass index angina pectoris and abnormal stress test findings. This tool, if validated, could help to guide testing strategies in women with angina pectoris.

  17. Latest progress of research on acute abdominal injuries

    Institute of Scientific and Technical Information of China (English)

    Ionut Negoi; Sorin Paun; Bogdan Stoica; Ioan Tanase; Mihaela Vartic; Ruxandra Irina Negoi; Sorin Hostiuc; Mircea Beuran

    2016-01-01

    Major abdominal trauma, both blunt and penetrating, is commonly seen nowadays, being particularly difficult to manage due to the frequent altered mental status of the patients and severity of associated injuries. The review article aims to make an uptodate study of the current strategies for therapeutic approach of abdominal injuries in polytrauma setting. Review of the medical literature is up to 2015, by using the PubMed/Medline, Science Direct, Cochrane Library and Web of Science databases. We have used different com-binations of the keywords of“abdominal trauma”,“liver”,“spleen”,“renal”, to review the reference list of retrieved articles for further relevant studies. Nowadays, we are facing a major change in abdominal trauma therapeutic approach, due to the continuous extending indications and very high successful rate of selective nonoperative management, completed or not with minimally invasive techniques like angiography and angiographic embolization. New imaging methods offer a high-quality characterization of solid organ injuries, being a secure support for decision algorithm in polytrauma patients. After a continuous decrease in number of laparotomies for trauma, new techniques should be developed for maintaining and developing the trauma surgeons' skills. According to the current standards, for a low morbidity and mortality, the trauma patients may be approached by a multidisciplinary and experienced trauma team. Even if nonoperative management is continuously expanding, this may be applied only by a trained and skillful trauma surgeon, who is able to perform difficult surgical techniques at any moments.

  18. Latest progress of research on acute abdominal injuries

    Directory of Open Access Journals (Sweden)

    Ionut Negoi

    2016-01-01

    Full Text Available Major abdominal trauma, both blunt and penetrating, is commonly seen nowadays, being particularly difficult to manage due to the frequent altered mental status of the patients and severity of associated injuries. The review article aims to make an uptodate study of the current strategies for therapeutic approach of abdominal injuries in polytrauma setting. Review of the medical literature is up to 2015, by using the PubMed/Medline, Science Direct, Cochrane Library and Web of Science databases. We have used different combinations of the keywords of “abdominal trauma”, “liver”, “spleen”, “renal”, to review the reference list of retrieved articles for further relevant studies. Nowadays, we are facing a major change in abdominal trauma therapeutic approach, due to the continuous extending indications and very high successful rate of selective nonoperative management, completed or not with minimally invasive techniques like angiography and angiographic embolization. New imaging methods offer a high-quality characterization of solid organ injuries, being a secure support for decision algorithm in polytrauma patients. After a continuous decrease in number of laparotomies for trauma, new techniques should be developed for maintaining and developing the trauma surgeons' skills. According to the current standards, for a low morbidity and mortality, the trauma patients may be approached by a multidisciplinary and experienced trauma team. Even if nonoperative management is continuously expanding, this may be applied only by a trained and skillful trauma surgeon, who is able to perform difficult surgical techniques at any moments.

  19. Abdominal wound closure: current perspectives

    Directory of Open Access Journals (Sweden)

    Williams ZF

    2015-12-01

    Full Text Available Zachary F Williams, William W Hope Department of Surgery, South East Area Health Education Center, New Hanover Regional Medical Center, Wilmington, NC, USA Abstract: This review examines both early and late wound complications following laparotomy closure, with particular emphasis on technical aspects that reduce hernia formation. Abdominal fascial closure is an area of considerable variation within the field of general surgery. The formation of hernias following abdominal wall incisions continues to be a challenging problem. Ventral hernia repairs are among the most common surgeries performed by general surgeons, and despite many technical advances in the field, incisional hernia rates remain high. Much attention and research has been directed to the surgical management of hernias. Less focus has been placed on prevention of hernia formation despite its obvious importance. This review examines the effects of factors such as the type of incision, suture type and size, closure method, patient risk factors, and the use of prophylactic mesh. Keywords: incisional, abdominal, hernia, prevention, wound closure techniques 

  20. TROMBO GIGANTE DE AURÍCULA DERECHA COMO CAUSA DE ANGINA Y SÍNCOPE / Giant thrombus in right atrium as a cause of angina and syncope

    OpenAIRE

    José L. Aparicio Suárez; Mario E. Nápoles Lizano; Roberto Bermúdez Yera; Jean L. Chao García; Roger Mirabal Rodríguez; Yuri Medrano Plana

    2012-01-01

    ResumenLas tumoraciones intracardíacas son poco frecuentes, y pueden ser de tipo neoplásicas y no neoplásicas. De estas últimas, los trombos, constituyen las masas más frecuentes. Se presenta un paciente joven, operado en el Cardiocentro "Ernesto Che Guevara" de Villa Clara, Cuba, con antecedentes de trastornos hematológicos desde la infancia, que comienza con episodios de disnea progresiva, angina y síncope; con diagnóstico preoperatorio de tumoración gigante en aurícula derecha que resultó ...

  1. Use of myocardial perfusion imaging to predict the effectiveness of coronary revascularisation in patients with stable angina pectoris

    Energy Technology Data Exchange (ETDEWEB)

    Johansen, Allan [Odense University Hospital, Department of Clinical Physiology and Nuclear Medicine, Odense (Denmark); Odense University Hospital, Department of Nuclear Medicine, Odense (Denmark); Hoeilund-Carlsen, Poul Flemming; Moeldrup, Mette [Odense University Hospital, Department of Clinical Physiology and Nuclear Medicine, Odense (Denmark); Christensen, Henrik Wulff [Nordic Institute of Chiropractic and Clinical Biomechanics, Odense (Denmark); Vach, Werner [University of Southern Denmark, Department of Statistics, Odense (Denmark); Haghfelt, Torben [Odense University Hospital, Department of Cardiology, Odense (Denmark)

    2005-12-01

    Coronary revascularisation is the treatment of choice in patients with stable angina who have significant stenoses. From a pathophysiological point of view, however, mitigation of angina is to be expected only in the presence of reversible ischaemia. Therefore it was the aim of this study to examine the effect of revascularisation on stable angina in relation to the myocardial perfusion imaging (MPI) pattern prior to intervention. Three hundred and eighty-four patients (58.0{+-}8.8 years) referred for angiography underwent MPI. Prior to MPI and at 2-year follow-up, patients were classified as having typical angina, atypical angina, non-cardiac chest pain or no pain, and the severity of chest pain was graded according to the Canadian Cardiovascular Society (CCS) criteria. The patients themselves estimated their pain on a visual analogue scale. Management was based on symptoms and angiographic findings, since the results of MPI were not communicated. Among the 240 patients who were not revascularised, 79% had typical or atypical angina at study entrance versus 40% at follow-up. In comparison, 93% of the 144 revascularised patients had typical or atypical angina before intervention versus only 36% at follow-up. This additional advantage of invasive therapy was present only in patients with reversible defects; revascularisation had no additional effect in patients with normal perfusion or irreversible defects. Similarly, additional, significant reductions in CCS class and visual analogue score were observed exclusively in patients with reversible defects. In patients referred for coronary angiography owing to known or suspected stable angina, revascularisation was significantly more effective than medical treatment exclusively in patients with reversible ischaemia. (orig.)

  2. Prognostic significance of myocardial imaging with iodine-123 beta-methyl-p-iodophenyl-pentadecanoic acid in patients with angina pectoris

    Energy Technology Data Exchange (ETDEWEB)

    Hatano, Tsuguhisa; Chikamori, Taishiro; Kamada, Tatsuya; Morishima, Takayuki; Hida, Satoshi; Yanagisawa, Hidefumi; Iino, Hitoshi; Yamashina, Akira [Tokyo Medical Coll. (Japan)

    2001-09-01

    To assess the clinical significance of iodine-123 beta-methyl-p-iodophenyl-pentadecanoic acid (BMIPP) single photon emission computed tomography (SPECT), the predictive value of BMIPP imaging in patients with angina pectoris was evaluated. One hundred seventy-four patients who underwent BMIPP imaging in our institution were aged 61.8{+-}11 years. One hundred thirty-five patients had stable angina and 39 had unstable angina at the time of examination. Patients with previous myocardial infarction or myocardial disorders were excluded. Early and delayed images were acquired in BMIPP SPECT, and the images were analyzed visually. Cardiac events were classified into hard and soft events: the former consisted of cardiac death and nonfatal myocardial infarction, and the latter included coronary revascularization and heart failure. The findings of BMIPP imaging were normal in 82 patients and abnormal in 92. During follow-up of 15.5{+-}9.5 months, hard events were observed in 4 patients and soft events in 53. In patients with normal BMIPP imaging, soft events were observed in nine patients, but no hard event was encountered. Furthermore, in patients with both normal BMIPP and stress thallium imagings, no cardiac event was observed during 2 years. In contrast, 4 hard events and 44 soft events occurred in patients with abnormal BMIPP imaging. Patients with abnormal BMIPP imaging had a higher incidence of soft events than those with normal BMIPP imaging, regardless of the type of angina (16/62 vs 3/73, p<0.0005 for stable angina; 28/30 vs 6/9, p<0.0001 for unstable angina). The finding of BMIPP imaging correlates well with the mid-term prognosis of patients with angina pectoris. Since BMIPP SPECT is performed without stress to the patient, this imaging modality is important in evaluating patients with stable or unstable angina. (author)

  3. Urgent Abdominal Re-Explorations

    Directory of Open Access Journals (Sweden)

    Peskersoy Mustafa

    2006-04-01

    Full Text Available Abstract Background Treatment of a number of complications that occur after abdominal surgeries may require that Urgent Abdominal Re-explorations (UARs, the life-saving and obligatory operations, are performed. The objectives of this study were to evaluate the reasons for performing UARs, outcomes of relaparotomies (RLs and factors that affect mortality. Methods Demographic characteristics; initial diagnoses; information from and complications of the first surgery received; durations and outcomes of UAR(s performed in patients who received early RLs because of complicated abdominal surgeries in our clinic between 01.01.2000 and 31.12.2004 were investigated retrospectively. Statistical analyses were done using the chi-square and Fisher exact tests. Results Early UAR was performed in 81 out of 4410 cases (1.8%. Average patient age was 50.46 (13–81 years with a male-to-female ratio of 60/21. Fifty one (62.96% patients had infection, 41 (50.61% of them had an accompanying serious disease, 24 (29.62% of them had various tumors and 57 (70.37% patients were operated under emergency conditions during first operation. Causes of urgent abdominal re-explorations were as follows: leakage from intestinal repair site or from anostomosis (n:34; 41.97%; hemorrhage (n:15; 18.51%; intestinal perforation (n:8; 9.87%; intraabdominal infection or abscess (n:8; 9.87%; progressive intestinal necrosis (n:7; 8.64%; stomal complications (n:5; 6.17%; and postoperative ileus (n:4; 4.93%. Two or more UARs were performed in 18 (22.22% cases, and overall mortality was 34.97% (n:30. Interval between the first laparotomy and UAR averaged as 6.95 (1–20 days, and average hospitalization period was 27.1 (3–78 days. Mortality rate was found to be higher among the patients who received multiple UARs. The most common (55.5% cause of mortality was sepsis/multiple organ failure (MOF. The rates for common mortality and sepsis/MOF-dependent mortality that occured following UAR were

  4. Bowel perforation by crumpled paper in a patient presenting with acute abdominal pain

    Directory of Open Access Journals (Sweden)

    Bakhshaeekia Alireza

    2009-01-01

    Full Text Available Many of the abdominal foreign bodies are due to accidental ingestion. Our objective in this case report is to emphasize the importance of the enquiry about the foreign body in the differential diagnosis of acute abdominal pain. According to our knowledge, this is the first report of bowel perforation caused by paper ingestion. A 14-year-old boy with abdominal pain underwent exploratory laparotomy and was found to have abdominal pus and ileal perforation. A crumpled paper was found at the site of perforation. Postoperative enquiry revealed that the patient had ingested 10 crumpled papers. We highlight that recording the history is an important aspect in the management of patients with acute abdominal pain and that foreign bodies should be included in its differential diagnosis.

  5. Terapia celular associada à revascularização transmiocárdica laser como proposta no tratamento da angina refratária Cell therapy plus transmyocardial laser revascularization: a proposed alternative procedure for refractory angina

    Directory of Open Access Journals (Sweden)

    Luís Alberto Oliveira Dallan

    2008-03-01

    Full Text Available OBJETIVO: É descrita uma proposição cirúrgica para o tratamento de pacientes com doença arterial coronária (DAC terminal, não mais passíveis de revascularização miocárdica convencional. Constitui-se na revascularização transmiocárdica com raios laser (RTML, associada ao emprego de células progenitoras hematopoiéticas autólogas (CPH. MÉTODOS: Nove pacientes (oito homens, 65±5 anos, com as características supracitadas foram submetidos ao procedimento combinado. Além da avaliação clínica, o protocolo incluiu o estudo da perfusão miocárdica através da ressonância cardíaca (RMC sob estresse farmacológico, antes e seis meses após a intervenção cirúrgica. Procedeuse à RMTL através de minitoracotomia esquerda e utilização de laser de CO2, com média de 11±3 tiros por paciente. As CPH foram obtidas por punção medular, seguindo-se sua injeção direta (1,9±0,3x10(8 células/paciente em múltiplas áreas do miocárdio isquêmico. RESULTADOS: Não ocorreram óbitos ou complicações imediatas decorrentes dos procedimentos. Um paciente faleceu no segundo ano de pós-operatório, de causa não cardíaca (choque séptico. O seguimento clínico pós-operatório desses pacientes revelou redução significativa da classe funcional de angina de 3,7±0,2 para 1,3±0,2 (pOBJECTIVE: We tested the hypothesis that TMLR combined with intramyocardial injection of BMC is safe, and may help increase the functional capacity of patient with refractory angina. METHODS: Nine patients (eight men, 65±5 years old, with refractory angina for multivessel disease and previous myocardial revascularization procedures (CABG/PCI, not candidates for another procedure due to the extension of the disease were enrolled. TMLR (11±3 laser drills was performed via a limited thoracotomy using a CO2 Heart Laser System. BMC were obtained immediately prior to surgery, and the lymphomonocytic fraction separated by density gradient centrifugation. During

  6. Visceral chest pain in unstable angina pectoris and effects of transcutaneous electrical nerve stimulation. (TENS). A review.

    Science.gov (United States)

    Börjesson, M

    1999-04-01

    A substantial proportion of patients with chest pain referred to hospital, show signs of coronary artery disease. Anginal pain could be conceptualized as a warning signal for coronary artery disease and impending death. But, for many reasons this theory is partly disputed. Firstly, not all ischemic episodes are accompanied by anginal pain (silent ischemia). Secondly, chest pain indistinguishable from true angina pectoris may be the result of other abnormalities of thoracic viscera. Nevertheless acute severe cardiac ischemia often gives rise to anginal chest pain. Unstable angina pectoris is carrying a higher risk for future events in spite of intensive medical treatment. A special problem are patients awaiting coronary intervention because of severe ischemia and maximum medical treatment, who experience ischemic pain. New treatment regimens are needed for these patients. This review discusses the symptom of visceral pain from the heart, angina pectoris, its relation to ischemia and unstable angina pectoris. It also addresses the role of afferent nerve stimulation (transcutaneous electrical nerve stimulation, TENS) in the treatment of severe angina pectoris as well as recent findings of TENS applicability in unstable angina.

  7. Asymptomatic myocardial ischemia as a predictor of cardiac events after coronary artery bypass grafting for stable angina pectoris

    DEFF Research Database (Denmark)

    Egstrup, K

    1988-01-01

    Thirty-six patients with chronic stable angina were studied before and after coronary artery bypass grafting (CABG) to assess the prevalence and prognostic implications of asymptomatic myocardial ischemia obtained by ambulatory monitoring. Ambulatory monitoring performed during medical therapy be...... for angina pectoris in some patients, whereas angina did not occur during the follow-up period in others. This study does not reveal whether or not these patients are at higher risk for cardiac events during long-term follow-up.......Thirty-six patients with chronic stable angina were studied before and after coronary artery bypass grafting (CABG) to assess the prevalence and prognostic implications of asymptomatic myocardial ischemia obtained by ambulatory monitoring. Ambulatory monitoring performed during medical therapy...... to 39 episodes after CABG (41%, p less than 0.05). During a follow-up of 9 months, 8 cardiac events occurred: 6 in group 1 comprising sudden death (1), revascularization (2), and angina (3) and 2 in group 2, including revascularization (1) and angina (1) (p = 0.005). Kaplan-Meier analysis demonstrated...

  8. Randomized double-blind comparison of metoprolol, nifedipine, and their combination in chronic stable angina

    DEFF Research Database (Denmark)

    Egstrup, K

    1988-01-01

    In a randomized double-blind study, treatment with either metoprolol, nifedipine, or their combination was compared for effects on ischemic variables and heart rate obtained during ambulatory monitoring in 42 patients with chronic stable angina. All patients had severe chronic stable angina...... of at least 6 months' duration despite medical treatment, and exhibited coronary artery stenosis of 75% in one or more coronary arteries. Metoprolol reduced the frequency of total (p less than 0.01) and asymptomatic ischemic episodes (p less than 0.05), the duration of ischemia (p less than 0.......05), and the ischemic burden (p less than 0.05), which contrasted to the lack of any similar significant effect during nifedipine monotherapy. During combination therapy, there was a tendency to further improvement, which did not reach statistical significance compared with metoprolol monotherapy. Heart rate...

  9. Treatment of Unstable Angina Pectoris with Modified Nuan Gan Jian - A Report of 33 Cases

    Institute of Scientific and Technical Information of China (English)

    贺敬波; 黄绵清; 张勤; 廖万柏; 王立军; 张玉英

    2004-01-01

    Objective: To observe the effectiveness of Modified Nuan Gan Jian Jiao Nang (MNGJ 加减暖肝煎胶囊Modified Liver-Warming Capsule) in treating unstable angina pectoris. Method: Sixty-six eligible cases were assigned randomly into a treatment group and a control group and treated for 3 weeks. Results:MNGJ produced an effect in reducing episodes, improving the abnormal findings in electro-cardiogram (ECG) (P<0.05) significantly, and decreasing myocardial oxygen consumption (P<0.05). In addition, it could decrease the plasma TXB2 level and increase 6-keto-prostaglandin F1α (6-Keto-PGF1α) level (P<0.01). Conclusion: MNGJ was quite effective in treating unstable angina pectoris, suggesting that the treatment of the disease could start from the liver.

  10. A Destabilized Case of Stable Effort Angina Pectoris Induced by Low-dose Adenosine Triphosphate

    Science.gov (United States)

    Sueta, Daisuke; Kojima, Sunao; Izumiya, Yasuhiro; Yamamuro, Megumi; Kaikita, Koichi; Hokimoto, Seiji; Ogawa, Hisao

    2016-01-01

    A 79-year-old man was diagnosed with sudden deafness. He had previously experienced a suspected episode of angina pectoris. At a local hospital, after 500 mg of hydrocortisone and 80 mg adenosine triphosphate (ATP) were administered, he became aware of chest discomfort. An electrocardiogram revealed serious ST-segment depressions. He was diagnosed with a non-ST elevated myocardial infarction (NSTEMI). Emergency coronary angiography revealed triple vessel disease, and the lesion was successfully stented. The mechanisms whereby the stable effort angina pectoris destabilized in this case were thought to include a reduction of the local blood flow because of an ATP product and probable thrombus formation in response to the administered steroids. PMID:27853071

  11. ONE CASE REPORT OF ANGINA TONSILLARIS INDUCED MEDIASTINAL ABSCESS AND THORACIC EMPYEMA

    Institute of Scientific and Technical Information of China (English)

    LI Qing-yun; WANG Xi; WAN Huan-ying; DENG Wei-wu

    2009-01-01

    A 27-year-old female patient with mediastinal abscess and thoracic empyema developed from angina tonsillaris was studied clinically on the manifestations, computed tomography (CT) scan, and the treatment process. The patient was admitted to hospital with a history of fever, sore throat, and chest and neck pain. CT showed air and air-fluid levels within mediastinal dense fatty planes that extended from the thoracic inlet to the sub-carinal region and left pleural empyema. She was cured by mediastinal drainage and extensive debridement of the necrotic tissue under operation and broad spectrum antibiotics treatment. Angina tonsillaris induced acute mediastitis and mediastinal abscess is a relatively rare inflammatory pathology but actually a fatal situation for its high mortality rate. CT scanning is extremely useful for early diagnosis and surgical treatment planning. The main treatment is aggressive and adequate surgical drainage of the abscess and intravenous effective antibiotic treatment.

  12. The Neuromatrix Theory of Pain and Angina during Exercise Stress Testing: Results from the PIMI Study

    Science.gov (United States)

    2011-05-27

    al., 1988; Glusman et al., 1996). In these individuals, the opioid reactivity would produce stronger analgesia of pain from most inputs, including...pain thresholds in silent ischemics might generalize to other areas as well. Pain tests in areas such as the toe, finger or dental pain thresholds...induced opioid Angina and the Neuromatrix 20 analgesia . Indeed, perhaps people who genetically have greater β-endorphin reactivity to stress

  13. Percutaneous transluminal coronary angioplasty in refractory unstable angina pectoris: are new devices useful?

    Science.gov (United States)

    Bertaglia, E; Ramondo, A; Cacciavillani, L; Isabella, G; Reimers, B; Marzari, A; Maddalena, F; Chioin, R

    1996-11-15

    This study was undertaken to assess if the introduction of new angioplasty devices (autoperfusion balloon catheters, stent and atherectomy) could ameliorate early and late results of prompt percutaneous transluminal coronary angioplasty (PTCA) in patients with refractory unstable angina. From January 1993 to June 1995, 59 of 278 patients (14 female, 45 male; mean age: 61 +/- 10 years; range: 38-78) admitted to our Coronary Care Unit with the diagnosis of unstable angina had more than one episode of chest pain at rest with dynamic electrocardiographic ST-T changes and without signs of cardiac necrosis while on medical therapy including oxygen, aspirin, heparin, nitroglycerin and either a beta-blocker or a calcium-antagonist. Coronary angiography was performed within 48 h from the last ischemic attack and a culprilesion technically suitable for PTCA was identified. PTCA was performed in 73 lesions. Elective stent implantation was considered for 16 type B or C lesions in 14 patients. The procedure was initially successful in 52/59 patients (88%), uncomplicated unsuccessful in 4/59 (7%) and complicated in 3/59 (5%). Elective stent insertions were all successful (16/16, 100%). All successfully treated patients were followed up for a mean of 12 +/- 7 months (range: 6-27): 2/52 patients (3.8%) suffered from non-transmural myocardial infarction, 14/52 (26.9%) had a recurrence of angina and 2/52 (3.8%), asymptomatic, had a positive stress test. We conclude that prompt PTCA in refractory unstable angina using 1990s 'state of the art' equipment compares favorably to previous study and that stent delivery might become the elective treatment of complex lesions in this subset of patients.

  14. Diagnosis of coronary vasospasm in patients with clinical presentation of unstable angina pectoris using ergonovine echocardiography.

    Science.gov (United States)

    Song, J K; Park, S W; Kang, D H; Lee, C W; Choi, K J; Hong, M K; Kim, J J; Kim, Y H; Park, S J

    1998-12-15

    Although coronary vasospasm can contribute to the development of unstable angina, the definite diagnostic method has not been established. The purpose of this study was to determine if ergonovine echocardiography (detection of regional wall motion abnormality during bedside ergonovine challenge) after angiographic confirmation of insignificant fixed disease would be useful and safe in detecting coronary vasospasm in patients with unstable angina. After control of chest pain with medications in patients admitted to the coronary care unit under the tentative diagnosis of unstable angina, diagnostic coronary angiography was performed. All patients with normal or insignificant fixed disease underwent ergonovine echocardiography after discontinuation of medications for 4+/-1 days. Among 208 consecutive patients enrolled for this study, 75% (156 of 208) showed significant fixed disease in the angiography. Ergonovine echocardiography was performed in 52 patients with insignificant disease, and coronary vasospasm was documented in 33 (63%, 33 of 52). No serious procedure-related arrhythmia or myocardial infarction occurred. Esophageal motility disorder and hypertrophic cardiomyopathy were diagnosed in 6 and 3 patients, respectively. Chest pain of undetermined etiology was the final diagnosis at discharge in 10 patients (5%, 10 of 208); among them chest pain redeveloped in 2 patients, and repeated ergonovine echocardiography revealed positive results. Our data suggest that among patients with the clinical presentation of unstable angina, coronary vasospasm is the main cause of myocardial ischemia in a considerable number of patients with a normal or near-normal angiogram, and ergonovine echocardiography after confirmation of absence of significant fixed disease is useful and safe for noninvasive diagnosis of coronary vasospasm in this setting.

  15. Optimal treatment of chronic angina in patients with type 2 diabetes mellitus

    Directory of Open Access Journals (Sweden)

    Kaur H

    2014-07-01

    Full Text Available Harjinder Kaur,1 Kully Sandhu,2 Awais Jabbar,3 Azfar G Zaman3,4 1City Hospitals Sunderland, Sunderland, UK; 2University Hospital of North Staffordshire, Stoke-on-Trent, UK; 3Freeman Hospital, Newcastle-upon-Tyne, UK; 4Institute of Cellular Medicine, Newcastle University, Newcastle, UK Abstract: Type 2 diabetes mellitus (T2DM trebles the risk of developing coronary artery disease (CAD; once CAD has developed, the risk of acute coronary syndromes (ACS and clinical risk associated with a coronary event, both double in diabetic patients. Patients with T2DM have more extensive CAD and present at a younger age; therefore, identification and management of chronic angina in these patients presents an opportunity to limit both cardiovascular symptoms and adverse outcomes. This article reviews the role of screening and treatment for chronic angina in patients with T2DM. There is a strong evidence base for modifying lifestyle as a way of reducing adverse cardiovascular outcomes in the diabetic population and this article reviews evidence of lifestyle modification as an important and necessary adjunct to pharmacologic intervention. Management of chronic stable angina is addressed by looking at treatments that reduce ischemic symptoms and those that reduce adverse cardiovascular outcomes. Trials specific to the diabetic population are limited, with information largely obtained from the diabetic subgroup analysis of large intervention trials. The growing diabetic population with increased propensity to cardiovascular disease mandates trials specifically in this patient population. Revascularization in patients with diabetes is associated with more complications than in the non-diabetic population. Recent trials specific to this population suggest surgical revascularization to be associated with better long-term outcomes and therefore, this article reviews the evidence for the optimal mode of revascularization in this population. Keywords: type 2 diabetes

  16. Chronic pseudo-angina left precordial chest pain caused by a thoracic meningioma

    OpenAIRE

    Azabou, Eric; Kumako, Vincent; Moussawi, Mahmoud; Berger, Colette; André-Obadia, Nathalie; Kocher, Laurence; Gonnaud, Pierre-Marie

    2013-01-01

    International audience; Left precordial chest pain (LPCP) evokes above all angina. Eliminating a cardiac origin is then always the first priority. When cardiac causes are eliminated, non-cardiac causes are sought in order to avoid leaving patients with undiagnosed or undifferentiated chest pain. There is a myriad of non-cardiac causes ranging from heartburn, panic attacks, pleurisy, pulmonary embolism, pneumothorax, Tietze syndrome, bruises and fractures of the ribs, to spine meningioma, neur...

  17. Acetylcholine test in patients with angina pectoris and normal coronary angiography

    Science.gov (United States)

    Barbieri, Enrico; Destro, Gianni; Oliva, Massimo; Zardini, Piero

    1994-02-01

    Angina pectoris with normal coronary artery on the coronary angiography is an intriguing issue. Intracoronary infusion of acetylcholine has recently been used to test the integrity of endothelial cells. We studied 16 patients with this syndrome. A relationship has been found between the acetylcholine test and the exercise stress test in normotensive patients. The presence of hypertension makes the evaluation of the test more unpredictable, probably because of the damage on the endothelial cells related to systemic hypertension.

  18. The efficacy and safety of dilevalol in patients with chronic stable angina pectoris.

    Science.gov (United States)

    Glasser, S P; Bittar, N; Kinhal, V; Bennett, W T; Koehn, D K

    1989-11-01

    This is the first reported large clinical trial of the antianginal and acute ischemic effectiveness and safety of dilevalol (the R, R-isomer of labetalol) in patients with chronic stable angina pectoris. This was a multicenter double blind fixed-dose parallel group placebo controlled trial. Patients with chronic stable angina and positive and reproducible exercise tests (+/- 20%) were included. If randomized, patients entered one of four fixed dose groups (twice a day placebo, 100 mgm, 200 mgm and 400 mgm bid for 2 weeks). Exercise testing was performed at 2 hours (peak) and 12 hours (trough) postdosing. This was followed by a 2-week once-a-day dosing regimen in which patients received the same total daily dose as the prior 2 weeks, with the full dose in the morning and a matched placebo in the evening. Exercise testing was performed at 2 hours (peak) and 24 hours (trough) postdosing. Anginal frequency and NTG consumption were significantly reduced, and equally so, by qd and bid regimens. The time of exercise to the onset of angina increased and the proportion of patients terminating exercise because of moderate angina decreased in a dose response fashion for both peak and trough tests and for both qd and bid regimens. There was also a dose related decrease in exercise induced ST segment depression and an increase in time to 1 mm ST depression. In 15 patients, 24-hour ambulatory monitoring also revealed a decrease in episodes of silent ischemia. No significant side effects related to the study drug occurred.(ABSTRACT TRUNCATED AT 250 WORDS)

  19. Angiotensin-converting enzyme in acute myocardial infarction and angina pectoris.

    Science.gov (United States)

    Rømer, F K; Kornerup, H J

    1981-06-01

    Serum activity of angiotensin-converting enzyme was measured by serial analysis in 19 patients with acute myocardial infarction and in eight patients with angina pectoris. As a rule no changes in enzyme activity occurred during 6 days observations. However, two patients with infarction exhibited a pronounced fall of enzyme activity which could not be related to clinical events. The analysis seems to have no place in the diagnosis and management of patients with myocardial infarction.

  20. Comparison of coronary artery specific leukocyte-platelet conjugate formation in unstable versus stable angina pectoris.

    Science.gov (United States)

    Patel, Parag B; Pfau, Steven E; Cleman, Michael W; Brennan, Joseph J; Howes, Christopher; Remetz, Michael; Cabin, Henry S; Setaro, John F; Rinder, Henry M

    2004-02-15

    This study evaluates transcoronary changes in neutrophil and platelet activation and conjugate formation in patients with angina pectoris secondary to coronary artery disease. We examined parameters of neutrophil and platelet activation as well as the neutrophil-platelet conjugate formation in patients who underwent diagnostic coronary angiography. Thirty-nine patients with chest pain referred for cardiac catheterization were studied (23 patients with unstable angina pectoris [UAP] and 16 with stable angina pectoris [SAP]). Before coronary angiography, blood samples were obtained simultaneously from the aortic root and coronary sinus to assess leukocyte (CD11b) and platelet (CD62P) activation and leukocyte-platelet conjugates. There was a 94% increase in CD62-expressing platelets from the aorta to the coronary sinus in patients with UAP compared with a 49% increase in patients with SAP. The percentage of neutrophil-platelet conjugates increased by 22% in patients with UAP compared with a 16% decrease in those with SAP (p <0.01). In contrast, monocyte-platelet binding across the coronary bed increased to a similar degree in both groups. This study demonstrates an increase in neutrophil-platelet conjugates across the coronary circulation in UAP, compatible with a higher activation state in both cell types.

  1. [The quality of life of the patient with unstable angina treated by spinal cord electrical stimulation].

    Science.gov (United States)

    González-Darder, J M; Vázquez, J L; Canela, P; González Martínez, V

    1990-12-01

    Quality of life was evaluated in patients with unstable angina before and after surgical therapy with spinal cord electrical stimulation (SCES). Overall 12 patients were evaluated, with quantification of the mean weekly number of anginal attacks, the degree of effort provoking them and the Nottingham Health Profile (NHP). The criteria of inclusion in the study were: angina grade IV, resistant to drug therapy and without indication of surgery. The mean follow-up period was 9.8 +/- 8.2 months. A significant reduction in the weekly number of anginal attacks (preoperative 30.9 +/- 14.5; postoperative 9.6 +/- 8.2; p less than 0.01); improvement in functional class (p less than 0.001), and significant improvement (p greater than 0.05) in the pain, energy, sleep, social isolation and emotional reactions areas of NHP were observed. It was concluded that SCES is a useful procedure in patients with unstable angina untreatable by other medical or surgical methods, as it reduces the number of anginal attacks and increases quality of life of the patients without additional risk.

  2. Efficacy evaluation of fluoxetine combined with conventional drug treatment on unstable angina patients complicated with depression

    Institute of Scientific and Technical Information of China (English)

    Chun-Hua Liao

    2015-01-01

    Objective:To study the efficacy of fluoxetine combined with conventional drug treatment on unstable angina patients complicated with depression. Methods:120 cases of unstable angina patients with depression were randomly divided into two groups. The anti-depression group received fluoxetine combined with conventional drug therapy; the conventional group received conventional drug therapy. Then contents of monoamine neurotransmitters and their metabolites, antioxidants and inflammatory mediators of both groups were compared. Results:Serum monoamine neurotransmitters NE, 5-HT and HA levels of the anti-depression group were higher than those of the conventional group and metabolites 5-HIAA and HVA contents were lower than those of the conventional group; serum SOD, CAT, GSH and HSP-70 contents of the anti-depression group were higher than those of the conventional group, and hs-CRP, MMP9, MCP1 and HMGB1 contents were lower than those of the conventional group. Conclusion:Fluoxetine combined with conventional drug therapy can increase the contents of monoamine neurotransmitters and antioxidants, and reduce oxidative stress response and inflammatory response; it is an ideal method for treating unstable angina complicated with depression.

  3. Terminalia arjuna in Chronic Stable Angina: Systematic Review and Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Navjot Kaur

    2014-01-01

    Full Text Available Background. Terminalia arjuna is a popular Indian medicinal plant with its bark been used for over centuries as cardiotonic. The bark has been found to contain several bioactive compounds including saponins and flavonoids. A number of experimental and clinical studies have been conducted to explore therapeutic potential of Terminalia arjuna in cardiovascular ailments specially in patients of coronary heart disease. A number of narrative reviews have been done but no systematic review has been conducted to date. Objective. To systematically review and conduct a meta-analysis on the available literature evaluating the efficacy of Terminalia arjuna in patients of chronic stable angina. Study selection. We included randomised, pseudo-randomized and before-after comparative studies which compared Terminalia arjuna/commercial preparation of Terminalia arjuna with current standard/ conventional treatment regimens in patients with chronic stable angina. Findings. Studies were found to be of poor methodological design. We found no significant difference in the Terminalia arjuna group as compared to control arm in the outcomes for which we were able to pool data and undertake meta-analysis. Conclusions. Currently, the evidence is insufficient to draw any definite conclusions in favour of or against Terminalia arjuna in patients of chronic stable angina. Further, well-controlled multicentric clinical trials need to be conducted in large number of patients to explore the therapeutic potential of Terminalia arjuna if any.

  4. Heart rate dynamics in patients with stable angina pectoris and utility of fractal and complexity measures

    Science.gov (United States)

    Makikallio, T. H.; Ristimae, T.; Airaksinen, K. E.; Peng, C. K.; Goldberger, A. L.; Huikuri, H. V.

    1998-01-01

    Dynamic analysis techniques may uncover abnormalities in heart rate (HR) behavior that are not easily detectable with conventional statistical measures. However, the applicability of these new methods for detecting possible abnormalities in HR behavior in various cardiovascular disorders is not well established. Conventional measures of HR variability were compared with short-term ( 11 beats, alpha2) fractal correlation properties and with approximate entropy of RR interval data in 38 patients with stable angina pectoris without previous myocardial infarction or cardiac medication at the time of the study and 38 age-matched healthy controls. The short- and long-term fractal scaling exponents (alpha1, alpha2) were significantly higher in the coronary patients than in the healthy controls (1.34 +/- 0.15 vs 1.11 +/- 0.12 [p angina pectoris have altered fractal properties and reduced complexity in their RR interval dynamics relative to age-matched healthy subjects. Dynamic analysis may complement traditional analyses in detecting altered HR behavior in patients with stable angina pectoris.

  5. Breviscapine Injection Improves the Therapeutic Effect of Western Medicine on Angina Pectoris Patients.

    Science.gov (United States)

    Wang, Chuan; Li, Yafeng; Gao, Shoucui; Cheng, Daxin; Zhao, Sihai; Liu, Enqi

    2015-01-01

    To evaluate the beneficial and adverse effects of breviscapine injection in combination with Western medicine on the treatment of patients with angina pectoris. The Cochrane Central Register of Controlled Trials, Medline, Science Citation Index, EMBASE, the China National Knowledge Infrastructure, the Wanfang Database, the Chongqing VIP Information Database and the China Biomedical Database were searched to identify randomized clinical trials (RCTs) that evaluated the effects of Western medicine compared to breviscapine injection plus Western medicine on angina pectoris patients. The included studies were analyzed using RevMan 5.1.0 software. The literature search yielded 460 studies, wherein 16 studies matched the selection criteria. The results showed that combined therapy using Breviscapine plus Western medicine was superior to Western medicine alone for improving angina pectoris symptoms (OR=3.77, 95% Cl: 2.76~5.15) and also resulted in increased electrocardiogram (ECG) improvement (OR=2.77, 95% Cl: 2.16~3.53). The current evidence suggests that Breviscapine plus Western medicine achieved a superior therapeutic effect compared to Western medicine alone.

  6. COMPARISON BETAXOLOL AND METOPROLOL TARTRATE THERAPIES IN PATIENTS WITH ARTERIAL HYPERTENSION ASSOCIATED WITH STABLE ANGINA

    Directory of Open Access Journals (Sweden)

    A. A. Anderzhanova

    2016-01-01

    Full Text Available Aim. To compare antihypertensive, antianginal and antiischemic efficacy of β1-selective adrenoblockers (betaxolol and metoprolol tartrate in patients with arterial hypertension (HT of 1-2 degree associated with stable angina class II.Material and methods. 100 patients (aged 23-66 y.o. with HT associated with stable angina or without angina were involved in the study. Patients were randomized into 2 groups (G1 and G2. G1 patients were treated with betaxolol, and G2 patients – with metoprolol tartrate. Ambulatory BP and electrocardiogram monitoring, exercise stress-test, echocardiography, evaluating of respiratory function, blood analysis was performed initially and in 30 and 90 days of treatment.Results. Target BP level was reached in 44 (88% patients treated with betaxolol (average daily dose 10±4 mg. 34 patients of G1 took 10 mg daily. Target BP level was reached in 41 (82% patients treated with metoprolol tartrate (average daily dose 150±27 mg. 30 patients of G2 took 150 mg daily. Exercise tolerance increased and a number of ischemic ST segment depressions reduced significantly in both groups. There were no significant differences in antihypertensive, antianginal, and antiischemic efficacy between groups.Conclusion. Betaxolol advantage is an ability to maintain target BP level more than 24 hours. A possibility to take betaxolol once a day raises patient’s compliance with therapy.

  7. ENDOTHELIAL DYSFUNCTION IN STABLE ANGINA AND MYOCARDIAL INFARCTION COMBINED WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE

    Directory of Open Access Journals (Sweden)

    M. A. Popova

    2015-01-01

    Full Text Available The research objective is to determine the state of endothelium-dependent and endothelium-independent vasodilatation in patients with coronary heart disease (CHD associated with chronic obstructive pulmonary disease (COPD.Material and methods. In the cross-sectional study included 122 patients with CHD associated with COPD: 68 people of them are patients with stable angina without acute coronary events in history and 54 patients with acute ST segment elevation myocardial infarction (STEMI. Comparison group comprised 53 patients with stable angina and 51 patients after STEMI without concomitant COPD. Patients were included if they met the following inclusion criteria: male, age <60 years, verified forms of CHD (stable angina, STEMI, documented with COPD without exacerbation and forced expiratory volume in 1 second > 30% in the groups with CHD and COPD. Arterial endothelial function was tested with high-resolution ultrasonography: brachial artery diameter was measured at rest, after flow increase (which causes endothelium-dependent dilatation, and after administration of sublingual nitroglycerin (an endothelium-independent dilator.Results. We found that endothelial dysfunction in patients with acute and chronic forms of CHD in combination with COPD are more pronounced than in isolated CHD.Conclusion. Expressed depression functional vascular reserve in patients with CHD associated with COPD, should be taken into account when conducting individualized therapy of these patients.

  8. Peritoneoscopy of the liver after abdominal surgery.

    Directory of Open Access Journals (Sweden)

    Kawaguchi,Kenji

    1983-02-01

    Full Text Available The incidence of intraperitoneal adhesion after abdominal surgery was studied. Peritoneoscopy was performed in 933 patients with liver diseases over the 6 year 5 month period from March 1974 to July 1980. Of the patients, 352 (37.7% had undergone an abdominal operation, and intraperitoneal adhesion was detected in 205 (58.2% of these patients. The liver was not observable in 5 out of 61 patients with adhesions after upper abdominal operations. Whereas, the liver was clearly observable in patients with lower abdominal operations in spite of adhesions. Out of the 581 patients without any abdominal operations, 30 patients (5.2% had adhesions in the abdominal cavity, and 6 of them had extensive adhesions that partially obscured the observation of liver surface. In all patients, peritoneoscopy was performed without complications by avoiding the surgical scar for puncture sites and ensuring a free air lumen before trocar puncture.

  9. Abdominal compartment syndrome. Interesting aspects.

    Directory of Open Access Journals (Sweden)

    Nicolás Rubio Silveira

    2004-04-01

    Full Text Available The management of the abdominal compartiment syndrome is still a controversial point nowadays. Its early diagnosis and treatment constitute a challenge for surgeons and physicians at the intensive care unit who have to face these cases . The physiopathologic changes that can occur can lead to the patients death, constituting pulmonary thromboembolism and multiorgan failure the principal causes of death. This paper presents the principal clinical parameters and technical procedures for its diagnosis and treatment with the aim of diminishing its morbi-mortality raits in our hospitals

  10. Successful emergency resection of a massiveintra-abdominal hemophilic pseudotumor

    Institute of Scientific and Technical Information of China (English)

    Julie Frezin; Lancelot Marique; Laurent Coubeau; Catherine Hubert; Catherine Lambert; Cédric Hermans; Nicolas Jabbour

    2015-01-01

    An intra-abdominal pseudotumor is a rare complicationof hemophilia. Surgical treatment is associated withhigh morbidity and mortality rates and reported casesare scarce. We present a 66-year-old Caucasian malesuffering from severe hemophilia type A treated for10 years with Factor Ⅷ. Major complications fromthe disease were chronic hepatitis B and C, cerebralhemorrhage and disabling arthropathy. Twenty-threeyears ago, retro-peritoneal bleeding led to the developmentof a large intra-abdominal pseudotumor, whichwas followed-up clinically due to the high surgical riskand the lack of clinical indication. The patient presentedto the emergency department with severe sepsis andumbilical discharge that had appeared over the past twodays. Abdominal computed tomography images werehighly suggestive of a bowel fistula. The patient wastaken to the operating room under continuous infusion offactor Ⅷ. Surgical exploration revealed a large infectedpseudotumor with severe intra-abdominal adhesionsand a left colonic fistula. The pseudotumor was partiallyresected en bloc with the left colon leaving the posteriorwall intact. The postoperative period was complicatedby septic shock and a small bowel fistula that requiredreoperation. He was discharged on the 73rd hospital dayand is well 8 mo after surgery. No bleeding complicationswere encountered and we consider surgery safe underfactor Ⅷ replacement therapy.

  11. [Internationalization and innovation of abdominal acupuncture].

    Science.gov (United States)

    Wang, Yong-Zhou

    2013-09-01

    Characteristics of abdominal acupuncture are analyzed through three aspects of inheriting and innovation, collaborated research as well as international visual field. It is pointed that abdominal acupuncture is based on clinical practice, focuses on enhancing the therapeutic effect and expending the clinical application. It also promots the thinking on how to recall the tradition and how to inherit tradition availably. The modern medical problems should be studied and innovation resolutions should be searched, which can help the internationalization and modernization of abdominal acupuncture.

  12. Clinical profile of abdominal tuberculosis in children

    OpenAIRE

    Ira Shah; Ramya Uppuluri

    2010-01-01

    Aim: A retrospective study was conducted in children, suffering from abdominal TB, attending Pediatric TB clinic from 2007 to 2009. Materials And Methods: Age-wise distribution and type of abdominal TB were analyzed with clinical features. Results : Out of 285 children with TB, 32 (11.2%) had abdominal tuberculosis. Male: Female ratio was 2.1:1. 7 (21.9%) children were 10 years of age. The most comm...

  13. Diagnostic accuracy of non-invasive 64-slice CT coronary angiography in patients with stable angina pectoris

    Energy Technology Data Exchange (ETDEWEB)

    Pugliese, Francesca; Krestin, Gabriel P. [Erasmus Medical Center, Department of Radiology, Rotterdam (Netherlands); Mollet, Nico R.A.; deFeyter, Pim J. [Erasmus Medical Center, Department of Radiology, Rotterdam (Netherlands); Erasmus Medical Center, Department of Cardiology, Rotterdam (Netherlands); Runza, Giuseppe [University of Palermo, Department of Radiology, Palermo (Italy); Azienda Ospedaliera di Parma, Department of Radiology, Parma (Italy); Mieghem, Carlos van; Meijboom, Willem B.; Baks, Timo [Erasmus Medical Center, Department of Cardiology, Rotterdam (Netherlands); Malagutti, Patrizia [Erasmus Medical Center, Department of Cardiology, Rotterdam (Netherlands); University of Ferrara, Department of Cardiology, Ferrara (Italy); Cademartiri, Filippo [Erasmus Medical Center, Department of Radiology, Rotterdam (Netherlands); Azienda Ospedaliera di Parma, Department of Radiology, Parma (Italy)

    2006-03-15

    Multislice computed tomography (CT) is an emerging technique for the non-invasive detection of coronary stenoses. While the diagnostic accuracy of 4-slice scanners was limited, 16-slice CT imagers showed promising results due to increased temporal and spatial resolution. These technical advances prompted us to evaluate the diagnostic performance of 64-slice CT coronary angiography in the detection of significant stenoses (defined as {>=} 50% luminal diameter reduction) versus invasive quantitative coronary angiography (QCA). Thirty-five patients with stable angina pectoris underwent CT coronary angiography performed with a 64-slice scanner (gantry rotation time 330 ms, individual detector width 0.6 mm) prior to conventional coronary angiography. Patients with heart rates >70 beats/min received 100 mg metoprolol orally. One hundred millilitres of contrast agent with an iodine concentration of 400 mgl/ml were injected at a rate of 5 ml/s into the antecubital vein. The CT scan was triggered with the bolus tracking technique. The sensitivity, specificity and the positive and negative predictive values of 64-slice CT were 99%, 96%, 78% and 99%, respectively, on a per-segment basis. The values obtained on a per-patient basis were 100%, 90%, 96% and 100%, respectively. When referral to catheterisation is questionable, CT coronary angiography may identify subjects with normal angiograms and consistently decrease the number of unnecessary invasive procedures. (orig.)

  14. Abdominal Pain in the Geriatric Patient.

    Science.gov (United States)

    Magidson, Phillip D; Martinez, Joseph P

    2016-08-01

    With an aging population, emergency department clinicians can expect an increase in geriatric patients presenting with abdominal pain. Compared with younger patients, this patient population is less likely to present with classic symptoms, physical examination findings, and laboratory values of abdominal disease. However, the morbidity and mortality associated with elderly patients presenting with abdominal pathologic conditions are significant. For this reason, the clinician must be familiar with some subtle and not so subtle differences when caring for the geriatric patient with abdominal pain to ensure timely diagnosis and appropriate treatment.

  15. Abdominal migraine in childhood: a review

    Directory of Open Access Journals (Sweden)

    Scicchitano B

    2014-08-01

    Full Text Available Beatrice Scicchitano,1 Gareth Humphreys,1 Sally G Mitton,2 Thiagarajan Jaiganesh1 1Children's Emergency Department, 2Department of Paediatric Gastroenterology, St Georges Hospital, St Georges Healthcare NHS Trust, Tooting, London, United Kingdom Abstract: The childhood condition of abdominal migraine has been described under many different synonyms, including "abdominal epilepsy", "recurrent abdominal pain", "cyclical vomiting syndrome", and "functional gastrointestinal disorder". In the early literature, abdominal migraine is included in the "childhood periodic syndrome", first described by Wyllie and Schlesinger in 1933. Abdominal migraine has emerged over the last century as a diagnostic entity in its own right thanks to the development of well defined diagnostic criteria and its recent inclusion in the International Headache Society's Classification of Headache disorders. Despite this progress, little is known about the pathophysiology of the condition, and the treatment options are poorly defined. Here we summarize the recent literature, with particular focus on establishing the diagnosis of abdominal migraine and its pathophysiology, and suggest an approach to management. Keywords: abdominal migraine, recurrent abdominal pain, abdominal epilepsy, cyclical vomiting

  16. Reported high salt intake is associated with increased prevalence of abdominal aortic aneurysm and larger aortic diameter in older men.

    Directory of Open Access Journals (Sweden)

    Jonathan Golledge

    Full Text Available Salt intake has been implicated in the pathogenesis of abdominal aortic aneurysm (AAA through studies in rodent models but not previously studied in humans. The aim of this study was to examine the association between reported addition of salt to food and the prevalence of AAA.A risk factor questionnaire which contained a question about salt intake was included as part of a population screening study for AAA in 11742 older men. AAA presence was assessed by abdominal ultrasound imaging using a reproducible protocol.The prevalence of AAA was 6.9, 8.5 and 8.6% in men who reported adding salt to food never, sometimes and always, respectively, p = 0.005. Addition of salt to food sometimes (odds ratio [OR]: 1.22, 95% confidence interval [CI]: 1.03-1.44 or always (OR: 1.23, 95% CI 1.04-1.47 was independently associated with AAA after adjustment for other risk factors including age, waist-hip ratio, blood pressure, history of hypertension, high cholesterol, angina, diabetes, myocardial infarction and stroke. Salt intake was also independently associated with aortic diameter (beta 0.023, p = 0.012. In men with no prior history of hypertension, high cholesterol, angina, myocardial infarction or stroke (n = 4185, the association between addition of salt to food sometimes (OR: 1.41, 95% CI 0.96-2.08 or always (OR: 1.52, 95% CI 1.04-2.22 and AAA remained evident.Reported salt intake is associated with AAA in older men. Additional studies are needed to determine whether reducing salt intake would protect against AAA.

  17. Chronic appendicitis as a cause of chronic rigth lower quadrant abdominal pain

    OpenAIRE

    Ramírez Chacón, Jorge Luis

    2013-01-01

    Abdominal pain is a frequent problem in the medical and surgical consult. There has been written a big number of causes  of chronic abdominal pain, of which there is an estimate of 10-30% that can be explained by a structural or biochemical problems, and in the cases left (70-90%), even though the advances of diagnostic methods, will not be found an organic cause, and it defines as a functional type of abdominal pain. The chronic appendicitis it is always a topic of discussion, due to is not ...

  18. MR angiography in abdominal neoplasms

    Energy Technology Data Exchange (ETDEWEB)

    Squillaci, E. [Dept. of Radiology, Rome-2 Univ., Hospital S. Eugenio, Rome (Italy); Crecco, M. [Dept. of Radiology, Cancer Research Inst. (Regina Elena), Rome (Italy); Grandinetti, M.L. [Dept. of Radiology, Cancer Research Inst. (Regina Elena), Rome (Italy); Maspes, F. [Dept. of Radiology, Rome-2 Univ., Hospital S. Eugenio, Rome (Italy); Lo Presti, G. [Dept. of Radiology, Rome-2 Univ., Hospital S. Eugenio, Rome (Italy); Squillaci, S. [Dept. of Radiology, Cancer Research Inst. (Regina Elena), Rome (Italy); Simonetti, G. [Dept. of Radiology, Rome-2 Univ., Hospital S. Eugenio, Rome (Italy)

    1994-10-01

    The role of magnetic resonance angiography (MRA) in the evaluation of vascular involvement was studied in 55 patients with abdominal neoplasms. A 2-D time-of-flight (TOF) technique was used in all patients. All patients underwent CT and MR examinations before MRA. Also, MR angiograms were compared with digital subtraction angiography in 22 cases, with Doppler US in 13 cases, and with surgical findings in 20 cases. In all patients with liver neoplasms (n=29) MRA demonstrated the absence of flow in the infiltrated segments. Pericapsular neovascularization was observed in 12 patients. Portal vein involvement was correctly detected in 27 patients. In all cases MRA demonstrated in relationship between the tumor and venous structures. Portosystemic shunts were visualized in 20 of 21 patients with portal hypertension. Vena cava thrombosis (3 cases), compression (5 cases), and displacement (2 cases) were correctly demonstrated. In renal (n=6) and adrenal gland (n=3) tumors renal vein compression was correctly detected in 2 cases, displacement in 1 case, and thrombosis in 3 cases, with only 1 false-positive finding. In 7 patients with pancreatic tumors MRA demonstrated splenic vein thrombosis in 2 cases and compression in 2 cases, with one false-positive finding. Our results indicate that MRA provides precise information regarding venous vascular involvement in abdominal neoplasms, but preoperative arterial mapping is still problematic. (orig.)

  19. Five year prognosis in patients with angina identified in primary care: incident cohort study.

    LENUS (Irish Health Repository)

    Buckley, Brian S

    2009-01-01

    OBJECTIVE: To ascertain the risk of acute myocardial infarction, invasive cardiac procedures, and mortality among patients with newly diagnosed angina over five years. DESIGN: Incident cohort study of patients with primary care data linked to secondary care and mortality data. SETTING: 40 primary care practices in Scotland. PARTICIPANTS: 1785 patients with a diagnosis of angina as their first manifestation of ischaemic heart disease, 1 January 1998 to 31 December 2001. MAIN OUTCOME MEASURES: Adjusted hazard ratios for acute myocardial infarction, coronary artery bypass grafting, percutaneous transluminal coronary angioplasty, death from ischaemic heart disease, and all cause mortality, adjusted for demographics, lifestyle risk factors, and comorbidity at cohort entry. RESULTS: Mean age was 62.3 (SD 11.3). Male sex was associated with an increased risk of acute myocardial infarction (hazard ratio 2.01, 95% confidence interval 1.35 to 2.97), death from ischaemic heart disease (2.80, 1.73 to 4.53), and all cause mortality (1.82, 1.33 to 2.49). Increasing age was associated with acute myocardial infarction (1.04, 1.02 to 1.06, per year of age increase), death from ischaemic heart disease (1.09, 1.06 to 1.11, per year of age increase), and all cause mortality (1.09, 1.07 to 1.11, per year of age increase). Smoking was associated with subsequent acute myocardial infarction (1.94, 1.31 to 2.89), death from ischaemic heart disease (2.12, 1.32 to 3.39), and all cause mortality (2.11, 1.52 to 2.95). Obesity was associated with death from ischaemic heart disease (2.01, 1.17 to 3.45) and all cause mortality (2.20, 1.52 to 3.19). Previous stroke was associated with all cause mortality (1.78, 1.13 to 2.80) and chronic kidney disease with death from ischaemic heart disease (5.72, 1.74 to 18.79). Men were more likely than women to have coronary artery bypass grafting or percutaneous transluminal coronary angioplasty after a diagnosis of angina; older people were less likely to

  20. The treatment of angina pectoris with nitroglycerin plasters. A multicenter study involving 6,986 patients.

    Science.gov (United States)

    Agabiti Rosei, E; Muiesan, M L; Pollavini, G; Bichisao, E; Muiesan, G

    1987-10-01

    A multicenter study was carried out in order to evaluate the efficacy and tolerability of 2 doses of a nitroglycerin transdermal system (TTS-NG 5 mg/24 h and TTS-NG 10 mg/24 h) on a large population of patients affected by angina pectoris. Nine hundred and seventy three cardiologists enrolled a total of 6,986 patients, 4,290 males and 2,696 females, mean age 61.7 years (range 26-95), 3,283 with effort-angina, 2,062 with mixed angina and 1,641 with angina at rest. Patients whose angina was not satisfactorily controlled by their previous therapy, were given TTS-NG 5 for 1 week in the morning, while continuing their antianginal treatment, with the exception of nitrates which were gradually withdrawn. At the end of this period, patients who responded to the treatment continued taking the same dose for a further 6 weeks, while poor responders were given a double dose of the study medication over the same period. Six thousand two hundred and sixty patients (90%) completed the study. TTS-NG 5 proved to be effective in 2,091 patients (33%) with a reduction in weekly anginal attacks after only 1 week of treatment (from 5.8 +/- 2.9 to 2.4 +/- 2.3). This reduction improved in the following 2 weeks (from 2.4 +/- 2.3 to 1.2 +/- 1.6) and subsequently remained virtually unchanged. Four thousand one hundred and sixty-nine patients (67%), whose angina was not sufficiently controlled by TTS-NG 5 (from 5.0 +/- 2.4 to 4.3 +/- 2.8), received double the dose at the end of the first week. TTS-NG 10 brought about a reduction in weekly anginal symptoms during the 2nd and the 3rd week (from 4.3 +/- 2.8 to 2.0 +/- 2.2), with a further decrease during the following 2 weeks (from 2.0 +/- 2.2 to 1.1 +/- 1.7). The reduction in anginal attacks was of the same extent both during the day and the night, thus suggesting that the drug is effective throughout 24 hours. A similar pattern was observed in the reduction of the number of anginal attacks weighted by their severity, the severity of attacks

  1. Uso da peritoneostomia na sepse abdominal Laparostomy in abdominal sepsis

    Directory of Open Access Journals (Sweden)

    Juvenal da Rocha Torres Neto

    2007-09-01

    Full Text Available Dentre as modalidades terapêuticas da sepse abdominal, a peritoneostomia tem papel decisivo permitindo explorações e lavagens da cavidade de forma facilitada. Observamos pacientes com diagnóstico clínico de sepse abdominal internados no Serviço de Coloproctologia do Hospital Universitário da Universidade Federal de Sergipe, e que foram submetidos a peritoneostomia de janeiro de 2004 a janeiro de 2006. Foram avaliados quanto ao diagnóstico primário e secundário, tipo de peritonite secundária, antibioticoterapia, esquema de lavagens, tempo de peritoneostomia, complicações e desfecho. Estudamos 12 pacientes, com idade de 15 a 57, média de 39,3 anos. Diagnóstico primário: abdome agudo inflamatório em 6(50%, abdome agudo obstrutivo em 2(16,7%, abdome agudo perfurativo em 2(16,7%, fístula enterocutânea em 1(8,3% e abscesso intra-cavitário em 1(8,3%. Diagnóstico secundário: perfuração de cólon em 4(33,3%, abscessos intra-cavitários em 3(25%, deiscências de anastomoses em 3(25%, 1(8,3% com tumor perfurado de sigmóide e 1(8,3% com necrose de cólon abaixado. Peritonite fecal em 10(83,3% e purulenta em 2(16,7%. A antibioticoterapia teve duração média de 19 dias. Lavagens de demanda em 6(50%, programadas em 4(33,3% e regime misto em 2(16,7%. O tempo médio de peritoneostomia foi de 10,9 dias (1-36. Como complicações: evisceração em 2(16,7% e fistulização em 1(8,3%. Quatro pacientes evoluíram com óbito.Among the therapeutics approach form of abdominal sepsis, the laparostomy has a decisive role allowing cavity explorations and lavages in an easier way. We study patients with abdominal sepsis diagnoses admitted to our surgical service of Coloproctology form Sergipe´s Federal University Hospital who underwent a Bogotá Bag laparostomy associated or not with polypropylene mesh from January 2004 to January 2006. These patients were assessed as: first and second diagnosis; secondary peritonitis type; antibiotic

  2. Mesh repair of hernias of the abdominal wall

    NARCIS (Netherlands)

    W.W. Vrijland (Wietske)

    2003-01-01

    textabstractA hernia of the abdominal wall is a permanent or intermittent protrusion of abdominal contents outside the abdominal cavity through a defect in the abdominal wall. Approximately 75% of all hernias occur in the inguinal region. Other types of hernias of the ventral abdominal wall are inci

  3. Duodenocolic fistula due to safety pin ingestion.

    Science.gov (United States)

    Cay, Ali; Imamoğlu, Mustafa; Sarihan, Haluk; Sayil, Ozgür

    2004-01-01

    The authors describe the case of a 16-month-old boy with benign duodenocolic fistula due to safety pin ingestion who presented with abdominal pain, diarrhea and weight loss. Etiology, symptomatology, diagnosis and management are discussed and the literature is reviewed. Early diagnosis and surgical management are necessary to avoid serious morbidity.

  4. McKusick-Kaufman syndrome: the diagnostic challenge of abdominal distension in the neonatal period.

    Science.gov (United States)

    Schaap, C; de Die-Smulders, C E; Kuijten, R H; Fryns, J P

    1992-08-01

    We report a newborn girl with McKusick-Kaufman syndrome who presented at birth with severe life-threatening abdominal distension due to hydrometrocolpos. In children with polydactyly and cystic masses in the lower abdomen should hydrometrocolpos be especially considered. Ultrasonography is of great value in the correct assignment of lower abdominal tumours, but should be completed by vagino(cysto)scopy when hydrometrocolpos is suspected.

  5. Comparative study on clinical and evolutionary aspects of children with abdominal trauma in intensive therapy unity

    OpenAIRE

    Sapolnik, Roberto; Vieira, Camilo; Rocha, Isa; Mota, Larissa; Chaves,Marta; Torreão,Lara de Araújo; Silva, Luciana Rodrigues

    2010-01-01

    p. 139-145 Abdominal trauma by accidents may induce life risk, because of the bleeding of solid organs or the development of sepsis due to perforation of empty viscera. Spleen and liver lesions in children are more frequent. The aim was to describe the epidemiological and clinical characteristics of children with abdominal trauma. A retrospective study was conducted in a general hospital in Salvador, Bahia, Brazil. This retrospective profile study with collected data describes the...

  6. The Potential Role of Kallistatin in the Development of Abdominal Aortic Aneurysm

    OpenAIRE

    Jiaze Li; Smriti Murali Krishna; Jonathan Golledge

    2016-01-01

    Abdominal aortic aneurysm (AAA) is a vascular condition that causes permanent dilation of the abdominal aorta, which can lead to death due to aortic rupture. The only treatment for AAA is surgical repair, and there is no current drug treatment for AAA. Aortic inflammation, vascular smooth muscle cell apoptosis, angiogenesis, oxidative stress and vascular remodeling are implicated in AAA pathogenesis. Kallistatin is a serine proteinase inhibitor, which has been shown to have a variety of funct...

  7. Postoperative intussusception in pediatric abdominal malignancies: early diagnosis and management

    Institute of Scientific and Technical Information of China (English)

    Maged M. Elshafiey; Gehad T. Meselhy; Amal Refaat; Alaa A. Younes

    2012-01-01

    Objective: The aim of this study was to review the incidence of postoperative intussusception (POI) in our patients with pediatric abdominal malignancies and the end result of management of these cases. Methods: From November2007 till the end of December 2011, a total of 538 patients with different abdominal malignancies were operated upon by laparotomies in our hospital. Reoperations were required in 12 patients for post operative intestinal obstruction developed in the 1st postoperative month. Review of the identified cases focused on patient's characteristics, the primary tumor type, the primary surgical procedure, clinical and imaging features of the intussusceptions, timing and findings at the 2nd laparotomy and the end result of subsequent interventions. Results: Early post operative intestinal obstruction (within 1 month) developed in 12 patients of whom 8 patients had POI. Five patients had adhesive intestinal obstruction (one patient developed POI then adhesive obstruction). The median duration between the primary surgery and the onset of intestinal obstruction symptoms was 5 days (range 4-12 days) in the POI group and 24 days (range 10-30 days) in the adhesion group. Abdominal CT was done in all cases and it could properly diagnose POI and detect its site in the POI group while in the adhesion group it showed evidence of complete obstruction. Plain radiograph failed to detect signs of intestinal obstruction in 3 cases (two in the POI group and one in the adhesion group). In POI group simple reduction was done in 7 cases while resection anastmosis was done in 1 case due to gangrene of the ileocecal region. Adhesiolysis was done in the 5 cases of intestinal adhesion group.Conclusion: Early POI in pediatric abdominal cancer is a rare complication; however it should be kept in mind with high index of suspicion. Early diagnosis and intervention is essential for successful management. Abdominal CT is very helpful as it can detect the level and possible cause of

  8. Well Leg Compartment Syndrome After Abdominal Surgery

    DEFF Research Database (Denmark)

    Christoffersen, Jens Krogh; Hove, Lars Dahlgaard; Mikkelsen, Kim Lyngby;

    2016-01-01

    BACKGROUND: Well leg compartment syndrome (WLCS) is a complication to abdominal surgery. We aimed to identify risk factors for and outcome of WLCS in Denmark and literature. METHODS: Prospectively collected claims to the Danish Patient Compensation Association (DPCA) concerning WLCS after abdominal...

  9. Actinomycosis mimicking abdominal neoplasm. Case report

    DEFF Research Database (Denmark)

    Waaddegaard, P; Dziegiel, Morten Hanefeld

    1988-01-01

    In a patient with a 6-month history of nonspecific abdominal complaints, preoperative examination indicated malignant disease involving the right ovary, rectum and sigmoid, but laparotomy revealed abdominal actinomycosis. Removal of the ovary and low anterior colonic resection followed by penicil...

  10. Thoraco-abdominal aortic aneurysm branched repair

    NARCIS (Netherlands)

    Verhoeven, E. L. G.; Tielliu, I. F. J.; Ferreira, M.; Zipfel, B.; Adam, D. J.

    2010-01-01

    Open thoraco-abdominal aortic aneurysm repair is a demanding procedure with high impact on the patient and the operating team. Results from expert centres show mortality rates between 3-21%, with extensive morbidity including renal failure and paraplegia. Endovascular repair of abdominal aortic aneu

  11. ABDOMINAL WALL DESMOID TUMOUR OVER APPENDICECTOMY SCAR

    OpenAIRE

    Vijaya; Sarbeshwar; Gogoi

    2015-01-01

    BACKGROUND: Desmoid tumors are slow growing deep fibromatoses with aggressive infiltration of adjacent tissue but without any metastatic potential . (1,2,3) CASE PRESENTATION: We report a female patient with desmoid tumor of the abdominal wall over appendicectomy scar w ho underwent primary resection. Preoperative evaluation incl uded abdominal ultrasound, and computed tomography. The histology of this cases revealed a desmoid tumor. CONCLUSION: ...

  12. Effect of Enhanced External Counterpulsation (EECP on Exercise Time Duration and Functional Capacity in Patients with Refractory Angina Pectoris

    Directory of Open Access Journals (Sweden)

    Ali Bozorgi

    2015-10-01

    Full Text Available Background: Enhanced external counterpulsation (EECP is a noninvasive technique used for patients with refractory angina pectoris. There are controversial data on the effectiveness of EECP in improving patients with refractory stable angina. The aim of the present study was to evaluate the effectiveness and safety of EECP for the treatment of patients with refractory angina pectoris.Methods: Twenty consecutive patients with refractory angina pectoris were treated with EECP, and their symptoms, echocardiographic measures, treadmill exercise test parameters, and Canadian Cardiovascular Society Class were evaluated before and immediately after EECP. The patients were followed up for 6months post treatment.Results: There were significant differences regarding total exercise time before and after treatment (p value < 0.001. The patients showed a significant reduction in angina classes III and IV immediately after EECP (p value < 0.001; for most of the patients, these beneficial effects were sustained for 6 months (p value = 0.010. There was no significant improvement in the echocardiographic parameters.Conclusion: EECP decreased symptoms and increased total exercise time in our study population. These beneficial effectswere sustained for 6 months.

  13. [Prognostic value of high-sensitivity C-reactive protein in assessing intrahospital outcome of unstable angina].

    Science.gov (United States)

    Ben Halima, Afef; Kammoun, Ikram; Sdiri, Wissem; Bachraoui, Kaouther; Chine, Samira; Zoaoui, Walid; Châabène, Olfa; Gargouri, Sami; Keskes, Hend; Lefi, Abdellatif; Ben Ammar, Slim; Boujnah, M Rachid; Kachboura, Salem

    2003-01-01

    Inflammation has been shown to play an important role in the pathogenesis of unstable angina. CRP has been demonstrated to be a reliable marker of prognosis is unstable angina. The aim of this study was to investigate the prognostic value of CRP in assessing short outcome of unstable angina. Our study is a prospective double blinded one. We measured CRP in 33 consecutive patients admitted for unstable angina at the 24th and 48th hour. The mean age is 60 years (30 to 84 years). There were 22 men and 11 women. 8 patients were included in class I of Braunwald classification, 5 were in class II and 20 in class III. 14 patients presented cardiac events. The CRP mean value was significantly higher among these patients (12 mg/l vs 5 mg/l, p or = 3 mg/l have a higher risk of developing complications (66% vs 13%, p = 0.002). Elevation of CRP predicted poor outcome of intrahospital evolution with a sensitivity of 86%, a specificity 68%, a positive and negative predictive values of 66% and 86%. The CRP in our preliminary study is an independent risk factor of early outcome of unstable angina. In association with clinical scores and other cardiac markers will lead to a better identification of high risk patients.

  14. Angina in a diabetic patient: a case of integrated approach

    Directory of Open Access Journals (Sweden)

    Eugenio Roberto Cosentino

    2008-09-01

    Full Text Available Diabetes mellitus, both of type 1 and 2, is an important risk factor for the development of atherosclerosis: in diabetic patients vascular atherosclerotic complications are responsible of approximately 80% of all the deaths. There is no doubt that patients affections originating from diabetes and coronaropathy remain at high risk. For this reason it is essential to adopt an aggressive strategy of secondary prevention. We report a case of a patient with multiple risk factors for cardiovascular diseases: the successful management was due to an integrated approach that involved the general practitioner and cardiologist.

  15. Acute spontaneous isolated dissection of abdominal aorta

    Directory of Open Access Journals (Sweden)

    Ali Akbar beigi

    2009-09-01

    Full Text Available

    • Aortic dissection occurs when the layers of the aorta separate as a result of extra luminal cavity of blood through an intimal tear. Dissection limited to the abdominal aorta is rare. Unfortunately, the appropriate management of dissecting aneurysm of abdominal aorta is not documented yet. A 43 years old man was admitted to Al-zahra hospital in Isfahan with sudden onset of periumbilical abdominal pain. CT scan confirmed infrarenal dissection of abdominal aorta. Performing laparotomy, aorta was repaired using bifurcate collagen-coated Dacron graft. Surgical intervention with synthetic graft is recommended in patients with dissecting aortic aneurysm of infrarenal segments where the extent of dissection is limited and accessible.
    • Keywords: Aneurysm, Aortic dissection, Aortic aneurysm abdominal surgery.

  16. Pulmonary complications of abdominal wall defects.

    Science.gov (United States)

    Panitch, Howard B

    2015-01-01

    The abdominal wall is an integral component of the chest wall. Defects in the ventral abdominal wall alter respiratory mechanics and can impair diaphragm function. Congenital abdominal wall defects also are associated with abnormalities in lung growth and development that lead to pulmonary hypoplasia, pulmonary hypertension, and alterations in thoracic cage formation. Although infants with ventral abdominal wall defects can experience life-threatening pulmonary complications, older children typically experience a more benign respiratory course. Studies of lung and chest wall function in older children and adolescents with congenital abdominal wall defects are few; such investigations could provide strategies for improved respiratory performance, avoidance of respiratory morbidity, and enhanced exercise ability for these children.

  17. Abdominal ultrasonography in the diagnostic work-up in children with recurrent abdominal pain

    DEFF Research Database (Denmark)

    Wewer, Anne Vibeke; Strandberg, C; Pærregaard, Anders;

    1997-01-01

    We report on our experience with routine abdominal ultrasonography in 120 children (aged 3-15 years) with recurrent abdominal pain, in order to determine the diagnostic value of this investigation. Eight children (7%) revealed sonographic abnormalities: gallbladder stone (n = 2), splenomegaly (n...... = 1) and urogenital abnormalities (n = 5). The recurrent abdominal pain could be explained by these findings in only two (may be three) cases. CONCLUSION: The diagnostic value of abdominal ultrasonography in unselected children with recurrent abdominal pain is low. However, the direct visualization...... of the abdominal structures as being normal may be helpful to the parents and the child in their understanding and acceptance of the benign nature of recurrent abdominal pain....

  18. Embolotherapy using N-butyl cyanoacrylate for abdominal wall bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Young Ho; Koh, Young Hwan; Han, Dae Hee; Kim, Ji Hoon; Cha, Joo Hee; Lee, Eun Hye; Song, Chi Sung [Seoul National University Boramae Hospital, Seoul (Korea, Republic of)

    2008-05-15

    We describe our experience with the use of N-butyl cyanoacrylate (NBCA) embolization of abdominal wall bleeding and we evaluate the clinical effectiveness of the procedure. Embolization was performed in nine patients with abdominal wall bleeding. The sites of embolization were the left first lumbar (n = 1), left second lumbar (n = 1), right inferior epigastric (n 2), left inferior epigastric (n = 3), right circumflex iliac (n = 1), and left circumflex iliac artery (n = 1). A coil was used with NBCA in one patient due to difficulty in selecting only a bleeding focus and anticipated reflux. NBCA was mixed with Lipiodol at the ratio of 1:1 to 1:4. Blood pressure and heart rate were measured before and after the embolization procedure, and the serial hemoglobin and hematocrit levels and transfusion requirements were reviewed to evaluate hemostasis and rebleeding. Hemostasis was obtained in six out of the nine patients and technical success was achieved in all patients. There were no procedure-related complications. Four out of the nine patients died due to rebleeding of a subarachnoid hemorrhage (n = 1), multiorgan failure (n = 1), and hepatic failure (n =2) that occurred two to nine days after the embolization procedure. One patient had rebleeding. The five surviving patients had no rebleeding, and the patients continue to visit the clinical on an outpatient basis. NBCA embolization is a clinically safe procedure and is effective for abdominal wall bleeding.

  19. Acute chylous peritonitis due to acute pancreatitis.

    Science.gov (United States)

    Georgiou, Georgios K; Harissis, Haralampos; Mitsis, Michalis; Batsis, Haralampos; Fatouros, Michalis

    2012-04-28

    We report a case of acute chylous ascites formation presenting as peritonitis (acute chylous peritonitis) in a patient suffering from acute pancreatitis due to hypertriglyceridemia and alcohol abuse. The development of chylous ascites is usually a chronic process mostly involving malignancy, trauma or surgery, and symptoms arise as a result of progressive abdominal distention. However, when accumulation of "chyle" occurs rapidly, the patient may present with signs of peritonitis. Preoperative diagnosis is difficult since the clinical picture usually suggests hollow organ perforation, appendicitis or visceral ischemia. Less than 100 cases of acute chylous peritonitis have been reported. Pancreatitis is a rare cause of chyloperitoneum and in almost all of the cases chylous ascites is discovered some days (or even weeks) after the onset of symptoms of pancreatitis. This is the second case in the literature where the patient presented with acute chylous peritonitis due to acute pancreatitis, and the presence of chyle within the abdominal cavity was discovered simultaneously with the establishment of the diagnosis of pancreatitis. The patient underwent an exploratory laparotomy for suspected perforated duodenal ulcer, since, due to hypertriglyceridemia, serum amylase values appeared within the normal range. Moreover, abdominal computed tomography imaging was not diagnostic for pancreatitis. Following abdominal lavage and drainage, the patient was successfully treated with total parenteral nutrition and octreotide.

  20. Acute chylous peritonitis due to acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Georgios K Georgiou; Haralampos Harissis; Michalis Mitsis; Haralampos Batsis; Michalis Fatouros

    2012-01-01

    We report a case of acute chylous ascites formation presenting as peritonitis (acute chylous peritonitis) in a patient suffering from acute pancreatitis due to hypertriglyceridemia and alcohol abuse.The development of chylous ascites is usually a chronic process mostly involving malignancy,trauma or surgery,and symptoms arise as a result of progressive abdominal distention.However,when accumulation of "chyle" occurs rapidly,the patient may present with signs of peritonitis.Preoperative diagnosis is difficult since the clinical picture usually suggests hollow organ perforation,appendicitis or visceral ischemia.Less than 100 cases of acute chylous peritonitis have been reported.Pancreatitis is a rare cause of chyloperitoneum and in almost all of the cases chylous ascites is discovered some days (or even weeks) after the onset of symptoms of pancreatitis.This is the second case in the literature where the patient presented with acute chylous peritonitis due to acute pancreatitis,and the presence of chyle within the abdominal cavity was discovered simultaneously with the establishment of the diagnosis of pancreatitis.The patient underwent an exploratory laparotomy for suspected perforated duodenal ulcer,since,due to hypertriglyceridemia,serum amylase values appeared within the normal range.Moreover,abdominal computed tomography imaging was not diagnostic for pancreatitis.Following abdominal lavage and drainage,the patient was successfully treated with total parenteral nutrition and octreotide.

  1. Mesh repair of hernias of the abdominal wall

    OpenAIRE

    2003-01-01

    textabstractA hernia of the abdominal wall is a permanent or intermittent protrusion of abdominal contents outside the abdominal cavity through a defect in the abdominal wall. Approximately 75% of all hernias occur in the inguinal region. Other types of hernias of the ventral abdominal wall are incisional, umbilical, epigastric and Spigelian hernia. In chapter 1 an overview of hernias of the abdominal wall is described. The incidence, clinical implications and treatment options and their comp...

  2. DIAGNÓSTICO DE ENFERMAGEM RISCO DE QUEDAS EM PACIENTES COM ANGINA INSTÁVEL

    Directory of Open Access Journals (Sweden)

    ALLYNE FORTES VITOR

    2010-01-01

    Full Text Available El riesgo de caídas puede ser considerado como fenómeno o diagnóstico de enfermería. Investigaciones han relacionado directamente isquemias de miocardio, como la angina inestable y el riesgo de caer. La meta de este estudio fue analizar el diagnóstico de enfermería Riesgo de caídas en casos de angina inestable a través de estudio transversal realizado en 57 individuos internados en un hospital académico, mediante examen físico y cuestionario. Para el análisis estadístico se utilizaron test de chi cuadrado, test exacto de Fisher, Mann-Whitney, test-t y Coeficiente Phi (p <0,05. El Riesgo de caídas fue el diagnóstico de enfermería más preponderante (87,71%, especialmente en los hombres, mayores, con menos años de estudio y renta inferior. Presencia de angina inestable, hipertensión arterial, remedios contra hipertensión, enfermedad vascular, dificultades visuales e insomnio presentaron asociación con el diagnóstico de enfermería Riesgo de caídas. Se concluye que es imprescindible el desarrollo de parámetros claros y objetivos para medir con más precisión el riesgo de caídas en el ámbito de un hospital.

  3. [The treatment of chronic stable angina with isradipine. A cooperative Latin American study].

    Science.gov (United States)

    Román, O; Alcocer, L; Espinoza, J; Arcos, R; Gómez, G; Mayorga, E; Buzzi, A; Tavella, N; Romero, C; Kuster, F

    1991-04-01

    In order to study the efficacy and tolerance of isradipine, a new Ca++ antagonist for the treatment of stable chronic angina, a multicentric cooperative study was carried out in eight Latin American countries (Argentine, Chile, Colombia, Ecuador, Mexico, Peru, Uruguay and Venezuela), which included 169 patients (60% men and 40% women), average age 62.6 +/- 9.7. Patients with more than 4 biweekly anginal crisis were accepted, with one or more of the following inclusion criteria: coronariographic evidence of obstruction greater than 60% in one or more vessels, IAM history, positive scintigraphy and positive effort test. The trial was single-blind, with placebo during the admission phase (2 weeks) and active treatment for 12 weeks. isradipine was administered in increasing doses of 2.5, 5, and 7 mg thrice a day, according to the presence or absence of anginal crisis. It was observed that the average frequency of weekly pains decreased from 8.2 +/- 7 under placebo to 6.3 +/- 7.5 under isradipine at low doses, and to 2.0 +/- 2.0 (p less than 0.001) under maximum doses. TNT intake decreased parallel also in a significant way. At the end of the trial, 37% of patients had become asymptomatic, and angina had reduced to less than two crisis a week in 33%. A clear relation doses-effect was observed. There was no alteration in laboratory exams neither in ECG. Seven patients had complications derived from the evolutional course of disease (2 IAM, 5 unstable angina and one sudden death). Adverse events were relatively frequent and the majority derived from vasodilator effect (tibial oedema 37%, flushing 17%, headache 23%).(ABSTRACT TRUNCATED AT 250 WORDS)

  4. Alteration in metabolic signature and lipid metabolism in patients with angina pectoris and myocardial infarction.

    Science.gov (United States)

    Park, Ju Yeon; Lee, Sang-Hak; Shin, Min-Jeong; Hwang, Geum-Sook

    2015-01-01

    Lipid metabolites are indispensable regulators of physiological and pathological processes, including atherosclerosis and coronary artery disease (CAD). However, the complex changes in lipid metabolites and metabolism that occur in patients with these conditions are incompletely understood. We performed lipid profiling to identify alterations in lipid metabolism in patients with angina and myocardial infarction (MI). Global lipid profiling was applied to serum samples from patients with CAD (angina and MI) and age-, sex-, and body mass index-matched healthy subjects using ultra-performance liquid chromatography/quadruple time-of-flight mass spectrometry and multivariate statistical analysis. A multivariate analysis showed a clear separation between the patients with CAD and normal controls. Lysophosphatidylcholine (lysoPC) and lysophosphatidylethanolamine (lysoPE) species containing unsaturated fatty acids and free fatty acids were associated with an increased risk of CAD, whereas species of lysoPC and lyso-alkyl PC containing saturated fatty acids were associated with a decreased risk. Additionally, PC species containing palmitic acid, diacylglycerol, sphingomyelin, and ceramide were associated with an increased risk of MI, whereas PE-plasmalogen and phosphatidylinositol species were associated with a decreased risk. In MI patients, we found strong positive correlation between lipid metabolites related to the sphingolipid pathway, sphingomyelin, and ceramide and acute inflammatory markers (high-sensitivity C-reactive protein). The results of this study demonstrate altered signatures in lipid metabolism in patients with angina or MI. Lipidomic profiling could provide the information to identity the specific lipid metabolites under the presence of disturbed metabolic pathways in patients with CAD.

  5. PHARMACOECONOMIC ASPECTS OF NICOTINE ADDICTION TREATMENT IN PATIENTS WITH ANGINA REQUIRING CARDIAC SURGERY

    Directory of Open Access Journals (Sweden)

    A. V. Rudakova

    2015-12-01

    Full Text Available Smoking is a major risk factor in patients with angina pectoris. Interventions that facilitate the rejection of it are an important part of the treatment. Aim. To analyze the cost effectiveness of the partial agonist of nicotinic receptors, varenicline, in patients with angina who require cardiac interventions. Material and methods. The estimation was conducted using a Markov model based on the results of clinical trials and epidemiological studies. The cost of treatment of complications were calculated on the basis of compulsory medical insurance rates for St. Petersburg in 2011. Results. The varenicline therapy in 70-year-old patients before cardiac surgery reduces hospital mortality at an extremely high cost-effectiveness (the cost of preventing one death - 148.8 thousand rubles. The cost/effectiveness ratio in the analysis for the period of survival of patients in this situation was 31.3 thousand rubles for 1 additional year of life. Life expectancy will be increased by an average of 0.147 years. Analysis for the period of survival of 50-year-old patients has shown that in patients after cardiac surgery cost-effectiveness of varenicline is extremely high (in the analysis from the perspective of the health care system the cost/effectiveness ratio was 36.0 thousand rubles for 1 additional year of life, in the analysis, taking into account the social perspective – 17.9 thousand rubles for 1 additional year of life. Increase in the life expectancy of 50 year-old patients will be 0.291 year in average. Conclusion. Varenicline therapy of patients with angina pectoris is the economy before cardiac surgery , and after their execution, and this applies not only young, but older patients. The desirability of varenicline including to federal and regional programs to reduce cardiovascular morbidity and mortality is shown.

  6. PHARMACOECONOMIC ASPECTS OF NICOTINE ADDICTION TREATMENT IN PATIENTS WITH ANGINA REQUIRING CARDIAC SURGERY

    Directory of Open Access Journals (Sweden)

    A. V. Rudakova

    2012-01-01

    Full Text Available Smoking is a major risk factor in patients with angina pectoris. Interventions that facilitate the rejection of it are an important part of the treatment. Aim. To analyze the cost effectiveness of the partial agonist of nicotinic receptors, varenicline, in patients with angina who require cardiac interventions. Material and methods. The estimation was conducted using a Markov model based on the results of clinical trials and epidemiological studies. The cost of treatment of complications were calculated on the basis of compulsory medical insurance rates for St. Petersburg in 2011. Results. The varenicline therapy in 70-year-old patients before cardiac surgery reduces hospital mortality at an extremely high cost-effectiveness (the cost of preventing one death - 148.8 thousand rubles. The cost/effectiveness ratio in the analysis for the period of survival of patients in this situation was 31.3 thousand rubles for 1 additional year of life. Life expectancy will be increased by an average of 0.147 years. Analysis for the period of survival of 50-year-old patients has shown that in patients after cardiac surgery cost-effectiveness of varenicline is extremely high (in the analysis from the perspective of the health care system the cost/effectiveness ratio was 36.0 thousand rubles for 1 additional year of life, in the analysis, taking into account the social perspective – 17.9 thousand rubles for 1 additional year of life. Increase in the life expectancy of 50 year-old patients will be 0.291 year in average. Conclusion. Varenicline therapy of patients with angina pectoris is the economy before cardiac surgery , and after their execution, and this applies not only young, but older patients. The desirability of varenicline including to federal and regional programs to reduce cardiovascular morbidity and mortality is shown.

  7. Study protocol: a randomised controlled trial investigating the effect of exercise training on peripheral blood gene expression in patients with stable angina

    Directory of Open Access Journals (Sweden)

    Crossman David C

    2010-10-01

    Full Text Available Abstract Background Exercise training has been shown to reduce angina and promote collateral vessel development in patients with coronary artery disease. However, the mechanism whereby exercise exerts these beneficial effects is unclear. There has been increasing interest in the use of whole genome peripheral blood gene expression in a wide range of conditions to attempt to identify both novel mechanisms of disease and transcriptional biomarkers. This protocol describes a study in which we will assess the effect of a structured exercise programme on peripheral blood gene expression in patients with stable angina, and correlate this with changes in angina level, anxiety, depression, and exercise capacity. Methods/Design Sixty patients with stable angina will be recruited and randomised 1:1 to exercise training or conventional care. Patients randomised to exercise training will attend an exercise physiology laboratory up to three times weekly for supervised aerobic interval training sessions of one hour in total duration. Patients will undergo assessments of angina, anxiety, depression, and peripheral blood gene expression at baseline, after six and twelve weeks of training, and twelve weeks after formal exercise training ceases. Discussion This study will provide comprehensive data on the effect of exercise training on peripheral blood gene expression in patients with angina. By correlating this with improvement in angina status we will identify candidate peripheral blood transcriptional markers predictive of improvements in angina level in response to exercise training. Trial Registration Clinicaltrials.gov identifier: NCT01147952

  8. Arteriosclerotic coronary arterial aneurysms in a 49-year-old man with crescendo angina: family history, natural course and prevalence.

    Science.gov (United States)

    Schneider, K W; Jesse, R; Deeg, P

    1977-01-01

    In a 49-year-old man with crescendo angina, elevated serum cholesterol level and an old posterior myocardial infarction, selective coronary arteriography showed multiple arteriosclerotic aneurysms of the right coronary artery associated with extensive and severe arteriosclerotic disease of the left coronary artery. The patient's mother and brother have both died of a myocardial infarction. Another brother suffers from angina and has documented arteriosclerotic coronary artery disease. Two sisters suffer from angina as well. The possibility of embolization of distal vessels from a friable clot of the aneurysms as a cause of the patient's infarction is discussed. To the best of our knowledge, this is the tenth patient with nonfistulous arteriosclerotic coronary artery aneurysm diagnosed and documented angiographically ante mortem. Including the present case and reviewing the literature, the prevalence of this condition among nonfistulous coronary aneurysms diagnosed ante mortem is 35 per cent and henceforth cannot be regarded as an incidental autopsy finding in cardiac asymptomatic patients.

  9. Diagnostic Value of Spiral on Kidney Angina%螺旋CT对肾绞痛的诊断价值

    Institute of Scientific and Technical Information of China (English)

    杨泽年; 张婷

    2003-01-01

    Objective Study the three methods' diacrisis value:X ray sheet of kidney angina cause of urinary calculus,vein renal pelvis contrast and spiral CT. Method Look back on and study 50 clinical kidney angina patients who have taken X ray sheet,or vein renal pelvis contrast, or spiral CT treatment. Compare those three methods and find the calculus positive rate and the areas of calculus frequently happening. Result X ray sheet finds that the calculus positive rate is 58%. Vein renal pelvis contrast finds that the calculus positive rate is 74%. Spiral CT finds that the calculus positive rate is 96% .All the calculus leans to appearing at the hypo - segment of ureter. And the Same - side kidney gets dropsy of different degree.Conclusion Urinary calculus, especially ureter hypo - segment calculus is the main cause of kidney angina. And spiral CT scanning is the best way to find calculus.

  10. Stable angina pectoris with no obstructive coronary artery disease is associated with increased risks of major adverse cardiovascular events

    DEFF Research Database (Denmark)

    Jespersen, Lasse; Hvelplund, Anders; Abildstrøm, Steen Z

    2012-01-01

    AimsPatients with chest pain and no obstructive coronary artery disease (CAD) are considered at low risk for cardiovascular events but evidence supporting this is scarce. We investigated the prognostic implications of stable angina pectoris in relation to the presence and degree of CAD...... with no obstructive CAD in focus.Methods and resultsWe identified 11 223 patients referred for coronary angiography (CAG) in 1998-2009 with stable angina pectoris as indication and 5705 participants from the Copenhagen City Heart Study for comparison. Main outcome measures were major adverse cardiovascular events.......ConclusionPatients with stable angina and normal coronary arteries or diffuse non-obstructive CAD have elevated risks of MACE and all-cause mortality compared with a reference population without ischaemic heart disease....

  11. Detection of culprit lesion in patients with unstable angina pectoris by using ATP thallium-201 myocardial SPECT

    Energy Technology Data Exchange (ETDEWEB)

    Kasai, Tokuo; Mori, Yutaka [Jikei Univ., Tokyo (Japan). School of Medicine; Yamashina, Akira; Kubo, Toru; Usui, Yasuhiro

    1999-10-01

    The purpose of this study is to determine the diagnostic accuracy for detection of culprit lesions in patients with unstable angina. Both ATP {sup 201}Tl SPECT and coronary angiography were performed in 51 patients with unstable angina pectoris within a week since the last attack. SPECT images were divided into 17 segments and the regional uptakes were scored semiquantitatively (0=normal to 3=no activity) and compared with the coronary angiographic findings. ATP {sup 201}Tl SPECT revealed decreased uptakes in 54 of 56 culprit lesions. The sensitivity, specificity and accuracy for detection of culprit lesions were 96.4%, 89.5% and 92.4%, respectively. Although adverse effects during ATP administration were complicated in 28 (54.9%) patients, all the complications were mild and resolved within two minutes. ATP {sup 201}Tl SPECT is sensitive and reliable method for detecting culprit lesions and can be performed safely even at acute phase in patients with unstable angina pectoris. (author)

  12. Angina-like chest pain and syncope as the clinical presentation of left ventricular endomyocardial fibrosis: a case report.

    Science.gov (United States)

    Bestetti, Reinaldo B; Corbucci, Helio A R; Fornitano, Luis D; Godoy, Moacyr F; Cury, Patricia M; Villafanha, Daniel; Santana, Domingos A; Soares, Marcelo J F; Braile, Domingo M

    2005-01-01

    A 47-year-old woman complained of angina-like chest pain, near-syncope, and syncopal episodes of 17 years' duration. Physical examination was unremarkable. A 12-lead resting ECG showed symmetrically inverted T waves in the inferior and anterolateral leads. A graded treadmill exercise stress test precipitated angina-like chest pain accompanied by a near-syncopal episode associated with a systemic arterial pressure of 60/40 mm Hg. Echocardiography disclosed left ventricular apical obliteration. Left ventriculogram showed a typical "ace of heart'' shadow as well as filling defects and apical obliteration. Endomyocardial biopsy of the left ventricle diagnosed left ventricular endomyocardial fibrosis. Thus, angina-like chest pain and near-syncopal episodes should be added to the list of clinical manifestations of pure left ventricular endomyocardial fibrosis.

  13. Comparing systems for costing hospital treatments. The case of stable angina pectoris.

    Science.gov (United States)

    Larsen, Jytte; Skjoldborg, Ulla Slothuus

    2004-03-01

    This paper demonstrates the basic properties in the systems most commonly considered for costing treatments in the Danish hospitals. The differences between the traditional charge system, the DRG system and the ABC system are analysed, and difficulties encountered in comparing these systems are discussed. A sample of patients diagnosed with stable angina pectoris (SAP) at Odense University Hospital was used to compare the three systems when costing an entire treatment path, costing single hospitalisations and studying the effects of length of stay. Furthermore, it is illustrated that the main idea behind each system is reflected in how the systems over- or underestimate costs. Implications when managing the hospitals, particularly reimbursement, are discussed.

  14. Unusual case of a large midoesophageal diverticulum mimicking unstable angina pectoris.

    Science.gov (United States)

    Hoffmann, J C; Pistorius, G; Müller, P; Zeitz, M

    2002-04-01

    We describe a 77-year-old lady who presented with progressive retrosternal pain radiating to the left arm and the back. After exclusion of cardiac causes a large midoesophageal diverticulum was found on oesophago-gastro-duodenoscopy. Importantly, the retrosternal pain completely disappeared after endoscopic removal of impacted food from the diverticulum. After the surgical resection the patient became fully asymptomatic. This is the first example of angina-like chest pain which definitively resulted from a midoesophageal diverticulum. Therefore, midoesophageal diverticula should be considered as a rare differential diagnosis of exercise-induced retrosternal pain.

  15. Late sodium current: A mechanism for angina, heart failure, and arrhythmia.

    Science.gov (United States)

    Makielski, Jonathan C

    2016-02-01

    The peak sodium current underlies excitability and conduction in heart muscle, but a late sodium current flowing after the peak contributes to maintaining and prolonging the action potential plateau, and also to intracellular sodium loading, which in turn increases intracellular calcium with consequent effects on arrhythmia and diastolic function. Late sodium current is pathologically increased in both genetic and acquired heart disease, making it an attractive target for therapy to treat arrhythmia, heart failure, and angina. This review provides an overview of the underlying bases for the clinical implications of late sodium current block.

  16. Insulin-resistant glucose metabolism in patients with microvascular angina--syndrome X

    DEFF Research Database (Denmark)

    Vestergaard, H; Skøtt, P; Steffensen, R;

    1995-01-01

    Studies in patients with microvascular angina (MA) or the cardiologic syndrome X have shown a hyperinsulinemic response to an oral glucose challenge, suggesting insulin resistance and a role for increased serum insulin in coronary microvascular dysfunction. The aim of the present study...... was to examine whether patients with MA are insulin-resistant. Nine patients with MA and seven control subjects were studied. All were sedentary and glucose-tolerant. Coronary arteriography was normal in all participants, and exercise-induced coronary ischemia was demonstrated in all MA patients. A euglycemic...

  17. Spinal cord stimulation for refractory angina in patients implanted with cardioverter defibrillators: five case reports

    DEFF Research Database (Denmark)

    Enggaard, Thomas P; Andersen, Claus; Scherer, Christian

    2010-01-01

    successful long-term treatment with SCS in five patients implanted with cardioverter defibrillators. The combined treatments with ICD and thoracic epidural electrical stimulation were used in five patients with refractory angina pectoris. During the procedure of the implantation, testing with the maximal...... tolerable level of stimulation was carried out to exclude inference with the ICD. The following treatment with SCS has in all cases been successful, with significant pain relief and improved quality of life. There were no incidences of inappropriate defibrillator shocks. Spinal cord stimulation...

  18. Association between thyroid dysfunction and incidence of atrial fibrillation in patients with stable angina pectoris

    Institute of Scientific and Technical Information of China (English)

    徐予

    2014-01-01

    Objective To explore the correlation between incidence of atrial fibrillation(AF)and thyroid dysfunction.Methods Patients with stable angina pectoris with thyroid function test results hospitalized at Fuwai Hospital from2011 Jan to 2011 Dec were included in this analysis(n=2 541).General clinical data and related biochemical parameters were analyzed.We divided patients into 5subgroups according to TSH levels:<0.55 mI U/L(n=105),0.55-2.49 mI U/L(n=1 599),2.50-4.77

  19. Percutaneous coronary intervention for poor coronary microcirculation reperfusion of patients with stable angina pectoris.

    Science.gov (United States)

    Li, J S; Zhao, X J; Ma, B X; Wang, Z

    2016-01-01

    Percutaneous coronary intervention (PCI) has been extensively applied to repair the forward flow of diseased coronary artery and can achieve significant curative results. However, some patients with acute myocardial infarction (AMI) develop non-perfusion or poor perfusion of cardiac muscle tissue after PCI, which increases the incidence of cardiovascular events and the death rate. PCI can dredge narrowed or infarct-related artery (IRA) and thus induce full reperfusion of ischemic myocardium. It is found in practice that some cases of AMI still have no perfusion or poor perfusion in myocardial tissue even though coronary angiography suggests opened coronary artery after PCI, which increases the incidence of vascular events and mortality. Therefore, to explore the detailed mechanism of PCI in treating coronary microcirculation of patients with stable angina pectoris, we selected 140 patients with stable angina pectoris for PCI, observing the index of microcirculatory resistance (IMR) of descending branch and changes of myocardial injury markers and left ventricular systolic function, and made a subgroup analysis based on the correlation between clinical indexes, IMR and other variables of diabetic and non-diabetic patients, PCI-related and non-PCI-related myocardial infarction patients. The results suggest that IMR of anterior descending branch after PCI was higher compared to that before PCI, and the difference was significant (P less than 0.05); creatine kinase-MB (CK-MB), myohemoglobin and high sensitive troponin T were all increased after PCI, and the difference was also significant (P less than 0.05); brain natriuretic peptide (BNP) level became higher after PCI, with significant difference (P less than 0.05); left ventricular ejection fraction (LVEF) declined after PCI, and the difference before and after PCI was statistically significant (P less than 0.05). Moreover, subgroup analysis results of the three groups all demonstrated statistically significant

  20. Problemas de adaptación fisiológica en personas con angina

    OpenAIRE

    Nóbrega Fortes, Allyne; Martins da Silva, Viviane; Lopes,Marcos Venícios de Oliveira

    2006-01-01

    En este artículo fueron identificados los problemas comunes de adaptación fisiológica presentados por pacientes con angina inestable teniendo como base el Modelo de la Adaptación de Callista Roy. Estudio descriptivo desarrollado en un hospital de servicio especializado en enfermedades cardíacas. La muestra para el estudio fue de 20 pacientes. Para caracterización y discusión, utilizamos las definiciones presentadas por Roy para cada problema de adaptación fisiológic...

  1. Brugada syndrome: a case report of an unusual association with vasospastic angina and coronary myocardial bridging.

    Science.gov (United States)

    Imazio, Massimo; Ghisio, Aldo; Coda, Luisella; Tidu, Massimo; Belli, Riccardo; Trinchero, Rita; Brusca, Antonio

    2002-04-01

    This report describes a case of an unusual association between vasospastic angina, coronary myocardial bridging, and Brugada syndrome. The patient complained of chest pain followed by rhythmic palpitation and syncope. Brugada syndrome ECG markers were documented with transient ST-segment elevation in lateral leads. A coronary angiogram showed a myocardial bridging in the left anterior descending artery and coronary vasospasm was reproduced after intracoronary ergonovine injection in the circumflex coronary artery. Ventricular fibrillation was induced by programmed electrical stimulation. The described association can be important because interaction between ischemia and Brugada syndrome electrophysiological substrate could modulate individual susceptibility to life-threatening ventricular tachyarrhythmias.

  2. A CASE OF LUDWiG ANGiNA ENDING WITH MORTALITY

    Directory of Open Access Journals (Sweden)

    Abdullah Onur Goksel

    2013-06-01

    Full Text Available Ludwig angina is a serious infection which is defines as edema, quickly progressing gangrenous sellulitis of soft tissues in neck and flor of the mouth. Airway obstruction is the most common cause of death. We present a case who applied to our outpatient clinic with a swelling under jaw and neck and was dignosed a a Ludwig Anjina. Broad spectrum antibiotherapy was given and followed without tracheotomy. He died because of cardiac arrest. [J Contemp Med 2013; 3(2.000: 112-115

  3. Radiologic findings of abdominal wall endometriosis

    Energy Technology Data Exchange (ETDEWEB)

    Seo, Jung Wook [Inje Univ. Ilsan Paik Hospital, Goyang (Korea, Republic of)

    2003-12-01

    To evaluate the imaging findings of abdominal wall endometriosis. In seven of 17 patients with surgically proven endometriosis of the abdominal wall, we retrospectively reviewed the findings of radiologic studies such as abdominal US (n=3), CT (n=4), and MRI (n=1). One patient under went more than one type of imaging, apparently. The surgical history of the seven, and their symptoms and preoperative diagnosis were reviewed, and the size, location, margin and nature of the mass, and the contrast enhancement patterns observed at radiologic studies, were assessed. The chief symptoms were palpable abdominal wall mass (n=5) and lower abdominal pain (n=2) around a surgical scar. Previous surgery included cesarean section (n=5), cesarean section with oophorectomy (n=1) and appendectomy (n=1). Masses were located in the subcutaneous fat layer (n=5) or rectus abdominis muscle (n=2), and their maximum diameter was 2.6 cm. Imaging findings, which correlated closely with the pathologic findings, included a well (n=5) or poorly marginated (n=2) solid mass, with a focal cystic area apparent in two cases. Although imaging findings of abdominal wall endometriosis may not be specific for diagnosis, the presence of a solid abdominal mass in female patients of reproductive age with a history of surgery is a diagnostic pointer.

  4. 9.1 cm abdominal aortic aneurysm in a 69-year-old male patient

    Institute of Scientific and Technical Information of China (English)

    Celine; Saade; Bhavi; Pandya; Muhammad; Raza; Mustafain; Meghani; Deepak; Asti; Foad; Ghavami

    2015-01-01

    We are presenting a case of one of the largest unruptured abdominal aortic aneurysm ever reported. Presented here is a rare case of a 69-year-old active smoker male with history of hypertension and incidental diagnosis of abdominal aortic aneurysm of 6.2 cm in 2003, who refused surgical intervention at the time of diagnosis with continued smoking habit and was managed medically. Patient was subsequently admitted in 2012 to the hospital due to unresponsiveness secondary to hypoglycemia along with diagnosis of massive symptomatic pulmonary embolism and nonST elevation myocardial infarction. With the further inpatient workup along with known history of abdominal aortic aneurysm, subsequent computed tomography scan of abdomen pelvis revealed increased in size of infrarenal abdominal aortic aneurysm to 9.1 cm of without any signs of rupture. Patient was unable to undergo any surgical intervention this time because of his medical instability and was eventually passed away under hospice care.

  5. Delayed presentation of a sigmoid colon injury following blunt abdominal trauma: a case report

    Directory of Open Access Journals (Sweden)

    Ertugrul Gokhan

    2012-08-01

    Full Text Available Abstract Introduction The low incidence of colon injury due to blunt abdominal trauma and the lack of a definitive diagnostic method for the same can lead to delays in diagnosis and treatment, subsequently resulting in high morbidity and mortality. Case presentation A 66-year-old woman with sigmoid colon injury was admitted to our emergency department after sustaining blunt abdominal trauma. Her physical examination findings and laboratory results led to a decision to perform a laparotomy; exploration revealed a sigmoid colon injury that was treated by sigmoid loop colostomy. Conclusions Surgical abdominal exploration revealed gross fecal contamination and a perforation site. Intra-abdominal irrigation and a sigmoid loop colostomy were performed. Our patient was discharged on post-operative day six without any problems. Closure of the sigmoid loop colostomy was performed three months after the initial surgery.

  6. The Impact of Upper Abdominal Pain During Pregnancy Following a Gastric Bypass

    DEFF Research Database (Denmark)

    Petersen, Liselotte; Lauenborg, Jeannet; Svare, Jens

    2016-01-01

    OBJECTIVE: The aim of the present study was to describe the risk of internal herniation (IH) and the obstetric outcome in pregnant women with Roux-en-Y gastric bypass (RYGB) and episodes of upper abdominal pain. METHODS: The cohort included 133 women with RYGB: 94 with 113 pregnancies, from...... the local area referred for routine antenatal care (local cohort) and 39 with 40 pregnancies referred from other hospitals for specialist consultation due to RYGB. RYGB was mainly performed without closure of the mesenteric defects. Data collected from medical records were episodes of upper abdominal pain......, pregestational and gestational abdominal surgery and pregnancy outcome. The risk of upper abdominal pain was estimated in the local cohort. Surgical intervention, IH and obstetric outcome according to pain were evaluated for 139 pregnancies with delivery of a singleton after 24 weeks of gestation (birth cohort...

  7. Ruptured Aneurysm of the Splenic Artery: A Rare Cause of Abdominal Pain after Blunt Trauma

    Directory of Open Access Journals (Sweden)

    Jalalludin Khoshnevis

    2013-01-01

    Full Text Available Introduction: Splenic artery aneurysms (SAAs are rare (0.2-10.4%; however, they are the most common form of visceral artery aneurysms. Splenic artery aneurysms are important to identify, because up to 25% of the cases are complicated by rupture. Post- rupture mortality rate is 25% -70% based on the underlying cause. Herein we present a young patient with abdominal pain after blunt abdominal trauma due to rupture of an SAA.Case Presentation: A 27-year-old male, without a remarkable medical history, who suffered from abdominal pain for 2 days after falling was admitted to the emergency department with hypovolemic shock. Upon performing emergency laparotomy a ruptured splenic artery aneurysm was found.Conclusions: It is important to consider rupture of a splenic artery aneurysm in patients with abdominal pain and hypovolemic shock.

  8. Anomalous Origin of a Stenosed Left Circumflex Coronary Artery in a Patient Presenting with Unstable Angina: A Case Report

    Directory of Open Access Journals (Sweden)

    Vakili Hossein

    2016-12-01

    Full Text Available 73 year-old man presented to our emergency department with complaint of retrosternal chest pain since 2 day and admitted with diagnosis of unstable angina. He underwent diagnostic coronary angiography in which left circumflex artery (LCX was not visualized during injection of the left coronary artery; indeed, it was originated, with common origin with RCA, from right coronary sinus of Valsalva. This case report is one of the uncommon cases with aberrant coronary arteries who presented with unstable angina. Moreover, coronary angiography with following coronary angioplasty was performed for him in a challenging course and angle for coronary intervention.

  9. Coronary Microvascular Function and Cardiovascular Risk Factors in Women With Angina Pectoris and No Obstructive Coronary Artery Disease

    DEFF Research Database (Denmark)

    Mygind, Naja Dam; Michelsen, Marie Mide; Pena, Adam;

    2016-01-01

    BACKGROUND: The majority of women with angina-like chest pain have no obstructive coronary artery disease when evaluated with coronary angiography. Coronary microvascular dysfunction is a possible explanation and associated with a poor prognosis. This study evaluated the prevalence of coronary.......01), hypertension (P=0.02), current smoking (Pheart rate (P.... CONCLUSION: Impaired CFVR was detected in a substantial proportion, which suggests that coronary microvascular dysfunction plays a role in the development of angina pectoris. CFVR was associated with few cardiovascular risk factors, suggesting that CFVR is an independent parameter in the risk evaluation...

  10. [Abdominal tuberculosis in childhood: the clinical manifestations].

    Science.gov (United States)

    Rivera Medina, J; Almendras, M; Devoto, G; Martinez, E; Gonzales, J; Alarcón, P; Muñoz, S

    1993-01-01

    The authors reviewed the histories of 133 patients with abdominal tuberculosis in Instituto Nacional de Salud del Niño (Children's Hospital), Lima, Perú, between 1989 and 1991. We found morbidity higher in scholars (67.4%). Weight lost were present in all cases and malaise in 95.3%, abdominal distension in 83.72% and abdominal pain in 79.06%. Anaemia in 76.06%, ratio albumin/globulin were altered in 74.41% leukocytosis in 67.44%. Evidence of tuberculosis on chest X-ray were detected only in 62.5%.

  11. [Churg-Strauss abdominal manifestation].

    Science.gov (United States)

    Suarez-Moreno, Roberto; Ponce-Pérez, Luis Virgilio; Margain-Paredes, Miguel Angel; Garza-de la Llave, Heriberto; Madrazo-Navarro, Mario; Espinosa-Álvarez, Arturo

    2014-01-01

    Antecedentes: la enfermedad de Churg-Strauss es poco común, idiopática, caracterizada por hipereosinofilia en sangre y tejidos, aunada a vasculitis sistémica en pacientes con antecedentes de asma o rinitis alérgica. Las manifestaciones gastrointestinales del síndrome de Churg Strauss se caracterizan por dolor abdominal, seguido de diarrea y hemorragia en 31-45% de los casos. Caso clínico: paciente masculino con antecedente de asma que acudió a consulta por abdomen agudo con probable apendicitis aguda; durante el protocolo de estudio se diagnosticó síndrome de Churg Strauss, con manifestaciones intestinales. Conclusión: el síndrome de Churg Strauss es una vasculitis poco frecuente que puede manifestarse con síntomas intestinales, como en este caso; es importante tenerlo en mente a la hora de los diagnósticos diferenciales. Existen pocos reportes con este síndrome asociado con abdomen agudo, todos ellos con mal pronóstico.

  12. Clinical evaluation of efonidipine hydrochloride in angina pectoris. Evaluation in exercise {sup 201}Tl myocardial scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Hori, Masatsugu; Nishimura, Tsunehiko [Osaka Univ., Suita (Japan). Medical School

    1996-12-01

    Clinical usefulness of once-daily administration of 20 to 60 mg of efonidipine hydrochloride and coronary hemodynamics during exercise {sup 201}Tl myocardial scintigraphy were investigated in patients with angina pectoris. Out of 11 patients enrolled in this study, 9 patients were included in the evaluation of patients` impression, in improvement rating in subjective symptoms, in the analysis of the exercise test, in the improvement rating of images on {sup 201}Tl myocardial scintigraphy, and in the global improvement rating, while 10 patients were included in the overall safety rating. Four patients in improvement rating in subjective symptoms, 2 in improving rating in the exercise test, and 5 in the global improvement rating were rated `improved` or better. In the improvement rating on the exercise {sup 201}Tl myocardial scintigraphy image, reduction of the image was observed in 5 patients, 3 out of which were evaluated as `improved` or better. A distinctive reduction of ischemic regions was observed in 2 patients out of the 3. A significant decrease in the number of angina pectoris events and a decreasing tendency in consumption of fast-acting nitrates were observed in spite of the low number of the patients studied. An adverse effect was observed in 1 patient and abnormal laboratory values were observed in 2 patients which were improved promptly after withdrawal of the drug. It was in 7 patients evaluated as `no problem`, while in 4 patients it was evaluated as `useful` or more. (author)

  13. RE-EVALUATION OF THE MECHANISM AND TREATMENT OF ANGINA DECUBITUS

    Institute of Scientific and Technical Information of China (English)

    陈纪林; 陈在嘉; 徐义枢; 高润霖; 寇文蓉; 姚康宝; 于全俊; 陶寿琪

    1996-01-01

    30 patients with angina decubittus(AD) were studied during hospitalization. These patients were found to have severe coronary artery obstructive lesions and an increase of myocardial oxygen consumption (MOC) before the onset to AD, indicating that AD belongs to the category of effort angina. 18 patients were investigated by continuous hemodynamic mordtoring. Three patients had significant increase in pulmonary artery diastolic pressure (PADP) before the onset. In the other 15 patients, PADP increased slightly in J2 and remained unchanged in 3 cases before the onset. Left ventriculography showed ejection fraction (EF))45% in 25 of the 27 patients. These results indicate that left ventricular (LV) systolic dysfunction is not a major factor in the pathogenesis of AD. The patients with LVEDP>12 mmHg constituted 60% of 25 patients with EF)45%, suggesting that these patients had obvious LV diastolic dysfunction, which may he the major factor in the pathogenesis of AD. According to the results of our treatment, Beta blockers may be used as the major form of treatment in the patients with AD.

  14. Abdominal binders may reduce pain and improve physical function after major abdominal surgery - a systematic review

    DEFF Research Database (Denmark)

    Rothman, Josephine Philip; Gunnarsson, Ulf; Bisgaard, Thue

    2014-01-01

    INTRODUCTION: Evidence for the effect of post-operative abdominal binders on post-operative pain, seroma formation, physical function, pulmonary function and increased intra-abdominal pressure among patients after surgery remains largely un-investigated. METHODS: A systematic review was conducted....... The PubMed, EMBASE and Cochrane databases were searched for studies on the use of abdominal binders after abdominal surgery or abdominoplasty. All types of clinical studies were included. Two independent assessors evaluated the scientific quality of the studies. The primary outcomes were pain, seroma...... to reduce seroma formation after laparoscopic ventral herniotomy and a non-significant reduction in pain. Physical function was improved, whereas evidence supports a beneficial effect on psychological distress after open abdominal surgery. Evidence also supports that intra-abdominal pressure increases...

  15. [Abdominal aortic aneurysm treated by endovascular surgery: a case report].

    Science.gov (United States)

    Alconero-Camarero, Ana Rosa; Cobo-Sánchez, José Luis; Casaus-Pérez, María; García-Campo, María Elena; García-Zarrabeitia, María José; Calvo-Diez, Marta; Mirones-Valdeolivas, Luz Elena

    2008-01-01

    An aneurysm is an abnormal dilation or irreversible convex of a portion of an artery. The most common site of aneurysms is the abdominal aorta and their appearance is often due to degeneration of the arterial wall, associated with atherosclerosis and favored by risk factors such as smoking and hypertension, among others. Left untreated, aneurysm of the abdominal aorta usually leads to rupture. Treatment is surgical, consisting of the introduction of a prosthesis, composed basically of a stent and an introducer, into the aorta. We report the case of a person diagnosed with abdominal aortic aneurysm in a routine examination who was admitted for ambulatory surgical treatment. We designed a nursing care plan, following Virginia Henderson's conceptual model. The care plan was divided into 2 parts, a first preoperative phase and a second postimplantation or monitoring phase. The care plan contained the principal nursing diagnoses, based on the taxonomies of the North American Nursing Diagnosis Association (NANDA), nursing interventions classification (NIC) and nursing outcomes classifications (NOC), and collaboration problems/potential complications. The patient was discharged to home after contact was made with his reference nurse in the primary health center, since during the hospital phase, some NOC indicators remained unresolved.

  16. Abdominal actinomycosis: barium enema and computed tomography findings.

    Science.gov (United States)

    Uchiyama, N; Ishikawa, T; Miyakawa, K; Iinuma, G; Nakajima, H; Ushio, K; Yokota, T; Akasu, T; Shimoda, T

    1997-02-01

    A case of abdominal actinomycosis is described in a woman with recurrent right lower abdominal pain and low-grade fever without history of appendectomy. Past history included the use of an intrauterine device (IUD) until 10 years before manifestation of these symptoms. We followed up the patient, via diagnostic imaging, for 7 months. On initial barium enema, a polypoid lesion was visualized at the bottom of the cecum and there was constriction of the sigmoid colon; the appendix was not seen. Seven months later, poor extension at the cecum, severe constriction in the sigmoid colon, and narrowing of the terminal ileum were also visualized. On computed tomography (CT), the lesion was initially localized only in the ileocecal region adjacent to the sigmoid colon. After 7 months, the lesion had infiltrated adjacent anatomic components and showed direct infiltration of the pelvic space. Differential diagnosis was difficult, as it was not obvious whether this was a pelvic abscess due to inflammation or appendiceal carcinoma. Laparotomy was performed. Macroscopically, the lesion was not limited to the ileocecal region, but involved the right ureter, tubes the Fallopian and ovary, bladder, psoas muscle, and abdominal wall. Pathology findings showed, chronic inflammatory tissue with evidence of actinomycosis. Although previous reports have described a lack of specific findings in this disease. When actinomycosis is suspected, CT is recommended to define its extent.

  17. [Inflammatory aneurysms of the abdominal aorta].

    Science.gov (United States)

    Tovar Martín, E; Acea Nebril, B

    1993-01-01

    Approximately 10 per cent of abdominal aneurysms have an excessively thick wall that sometimes involve duodenum, cava or colon by an inflammatory process. Between February 1986 and December 1992, 147 patients with abdominal aortic aneurysm (AAA) were treated surgically and in 13 (8.8%) the aneurysms were found to be inflammatory. Their mean age was 67.3 years (70.1 years in non inflammatory group) and all were symptomatics initially (abdominal pain in 53%, rupture in 23%, mass in 15%). The operative mortality for elective resection was 37% in patients with inflammatory abdominal aortic aneurysms (IAAA) decreasing to 9% in the AAA group without inflammatory involvement. We conclude that surgery is indicated in these patients to prevent rupture and to hasten the subsidense of inflammatory process ever with postoperative morbi-mortality increased.

  18. Abdominal pain - children under age 12

    Science.gov (United States)

    Stomach pain in children; Pain - abdomen - children; Abdominal cramps in children; Belly ache in children ... belly Has had a recent injury to the abdomen Is having trouble breathing Call your provider if ...

  19. Abdominal separation in an adult male patient with acute abdominal pain

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    We report a male patient with prolonged post-prandial abdominal distension and a sudden onset of epigastric pain initially diagnosed as acute abdomen. The patient had no history of surgery. Physical examination revealed peritonitis and abdominal computed tomography scan showed upper abdominal mesentery intorsion. The patient then underwent surgical intervention. It was found that the descending mesocolon dorsal root was connected to the ascending colon and formed a membrane encapsulating the small intestine...

  20. Abdominal Wall Hernias: Various Imaging Features Correlated with the Anatomy of Abdominal Wall at MDCT

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Shin Young; Shin, Hyeong Cheol; Kim, Sang Won; Kim, Il Young; Kim, Young Tong [Soonchunhyang University Cheonan Hospital, Cheonan (Korea, Republic of)

    2009-07-15

    Abdominal wall hernias are a common condition. However, they may develop acute complications and require surgical correction in most cases. Hence, the correct radiological examination is requisite for an accurate diagnosis. A multi-detector row CT (MDCT) provides an accurate identification of the anatomy of the abdominal wall, precise hernia type, and helps in the detection of early signs of complication. We report various imaging features of abdominal wall hernias via a MDCT.

  1. [Intestinal occlusion and abdominal compartment syndrome (ACS)].

    Science.gov (United States)

    Stagnitti, Franco

    2009-01-01

    Intestinal occlusion is defined as an independent predictive factor of intra-abdominal hypertension (IAH) which represents an independent predictor of mortality. Baggot in 1951 classified patients operated with intestinal occlusion as being at risk for IAH ("abdominal blow-out"), recommending them for open abdomen surgery proposed by Ogilvie. Abdominal surgery provokes IAH in 44.7% of cases with mortality which, in emergency, triples with respect to elective surgery (21.9% vs 6.8%). In particular, IAH is present in 61.2% of ileus and bowel distension and is responsible for 52% of mortality (54.8% in cases with intra-abdominal infection). These patients present with an increasing intra-abdominal pressure (IAP) which, over 20-25 mmHg, triggers an Abdominal Compartment Syndrome (ACS) with altered functions in some organs arriving at Multiple Organ Dysfunction Syndrome (MODS). The intestine normally covers 58% of abdominal volume but when there is ileus distension, intestinal pneumatosis develops (third space) which can occupy up to 90% of the entire cavity. At this moment, Gastro Intestinal Failure (GIF) can appear, which is a specific independent risk factor of mortality, motor of "Organ Failure". The pathophysiological evolution has many factors in 45% of cases: intestinal pneumatosis is associated with mucosal and serous edema, capillary leakage with an increase in extra-cellular volume and peritoneal fluid collections (fourth space). The successive loss of the mucous barrier permits a bacterial translocation which includes bacteria, toxins, pro-inflammatory factors and oxygen free radicals facilitating the passage from an intra-abdominal to inter-systemic vicious cyrcle. IAH provokes the raising of the diaphragm, and vascular and visceral compressions which induce hypertension in the various spaces with compartmental characteristics. These trigger hypertension in the renal, hepatic, pelvic, thoracic, cardiac, intracranial, orbital and lower extremity areas, giving

  2. Addition of felodipine to metoprolol vs replacement of metoprolol by felodipine in patients with angina pectoris despite adequate beta-blockade - Results of the felodipine ER and metoprolol CR in angina (FEMINA) study

    NARCIS (Netherlands)

    Dunselman, P; Liem, AH; Verdel, G; Kragten, H; Bosma, A; Bernink, P

    1997-01-01

    Aims The study aimed to compare the addition of felodipine to metoprolol, and of the replacement of metoprolol by felodipine, with continuation of metoprolol, in patients with angina pectoris despite optimal beta-blockade. Methods and results The study was double-blind, parallel, randomized and cont

  3. A focus on intra-abdominal infections

    Directory of Open Access Journals (Sweden)

    Sartelli Massimo

    2010-03-01

    Full Text Available Abstract Complicated intra-abdominal infections are an important cause of morbidity and are frequently associated with poor prognosis, particularly in higher risk patients. Well defined evidence-based recommendations for intra-abdominal infections treatment are partially lacking because of the limited number of randomized-controlled trials. Factors consistently associated with poor outcomes in patients with intra-abdominal infections include increased illness severity, failed source control, inadequate empiric antimicrobial therapy and healthcare-acquired infection. Early prognostic evaluation of complicated intra-abdominal infections is important to select high-risk patients for more aggressive therapeutic procedures. The cornerstones in the management of complicated intra-abdominal infections are both source control and antibiotic therapy. The timing and the adequacy of source control are the most important issues in the management of intra-abdominal infections, because inadequate and late control of septic source may have a negative effect on the outcomes. Recent advances in interventional and more aggressive techniques could significantly decrease the morbidity and mortality of physiologically severe complicated intra-abdominal infections, even if these are still being debated and are yet not validated by limited prospective trials. Empiric antimicrobial therapy is nevertheless important in the overall management of intra-abdominal infections. Inappropriate antibiotic therapy may result in poor patient outcomes and in the appearance of bacterial resistance. Antimicrobial management is generally standardised and many regimens, either with monotherapy or combination therapy, have proven their efficacy. Routine coverage especially against Enterococci and candida spp is not always recommended, but can be useful in particular clinical conditions. A de escalation approach may be recommended in patients with specific risk factors for multidrug

  4. [Late primary abdominal pregnancy. Case report].

    Science.gov (United States)

    Farías, Emigdio Torres; Gómez, Luis Guillermo Torres; Allegre, René Márquez; Higareda, Salvador Hernández

    2008-09-01

    Abdominal advanced pregnancy is an obstetric complication that put at risk maternal and fetal life. We report a case of advanced abdominal pregnancy with intact ovaries and fallopian tubes, without ureteroperitoneal fistulae and, late prenatal diagnosis, in a multiparous patient without risk factors, with alive newborn, and whose pregnancy was attended at Unidad Medica de Alta Especialidad, Hospital de Gineco-Obstetricia, Centro Medico Nacional de Occidente del IMSS, Guadalajara, Jalisco, México.

  5. Surveillance intervals for small abdominal aortic aneurysms

    DEFF Research Database (Denmark)

    Bown, Matthew J; Sweeting, Michael J; Brown, Louise C

    2013-01-01

    Small abdominal aortic aneurysms (AAAs [3.0 cm-5.4 cm in diameter]) are monitored by ultrasound surveillance. The intervals between surveillance scans should be chosen to detect an expanding aneurysm prior to rupture.......Small abdominal aortic aneurysms (AAAs [3.0 cm-5.4 cm in diameter]) are monitored by ultrasound surveillance. The intervals between surveillance scans should be chosen to detect an expanding aneurysm prior to rupture....

  6. Angina pectoris em paciente com hipertireoidismo e coronárias angiograficamente normais Angina pectoris in patient with hyperthyroidism and normal angiography coronary

    Directory of Open Access Journals (Sweden)

    Alessandra Ferri Casini

    2006-11-01

    Full Text Available A presença de angina pectoris em mulher pré-menopausa sem outros fatores de risco para doença arterial coronariana, obriga-nos a descartar outras causas de lesão coronariana não aterosclerótica. A relação entre o hipertireoidismo e as alterações no sistema cardiovascular está bem estabelecida, contudo o hipertireoidismo responde por menos de 5% dos casos de dor torácica. Apresenta-se um caso de uma mulher, 47 anos, com sintomas de precordialgia típica e eletrocardiograma (ECG sugestivo de isquemia coronariana, mas sem alteração laboratorial sugestiva de lesão miocárdica. Anamnese, exame físico e resultados laboratoriais permitiram firmar o diagnóstico de hipertireoidismo. Investigação subseqüente com o cateterismo cardíaco não demonstrou lesões obstrutivas. Após tratamento com iodo radioativo e retorno ao eutireoidismo, a paciente manteve-se assintomática e o ECG e a cintilografia miocárdica foram negativos para isquemia. Esses resultados sugerem uma interação entre hiperatividade tireoidiana e isquemia miocárdica, tendo o hipertireoidismo como provável etiologia dos achados clínicos e eletrocardiográficos.In the presence of angina pectoris in a premenopausal woman without significant risk factors for coronary disease, we have to rule out other causes of coronary lesion of non atherosclerotic origin. The relations between hyperthyroidism and the cardiovascular system are well known, but hyperthyroidism is responsable for less than 5% of all causes of chest pain. We present a clinical case of a 47 year old woman with typical chest pain and eletrocardiogram (EKG suggesting coronary ischemia but with normal laboratory data. Anamnesis, clinical and the laboratory data confirmed the diagnosis of hyperthyroidism. Further investigation showed a normal coronary angiography. After treatment with radioiodine and the establishment of euthyroidism, the patient remained asymptomatic and EKG and myocardial scintilography were

  7. Improving the efficiency of abdominal aortic aneurysm wall stress computations.

    Science.gov (United States)

    Zelaya, Jaime E; Goenezen, Sevan; Dargon, Phong T; Azarbal, Amir-Farzin; Rugonyi, Sandra

    2014-01-01

    An abdominal aortic aneurysm is a pathological dilation of the abdominal aorta, which carries a high mortality rate if ruptured. The most commonly used surrogate marker of rupture risk is the maximal transverse diameter of the aneurysm. More recent studies suggest that wall stress from models of patient-specific aneurysm geometries extracted, for instance, from computed tomography images may be a more accurate predictor of rupture risk and an important factor in AAA size progression. However, quantification of wall stress is typically computationally intensive and time-consuming, mainly due to the nonlinear mechanical behavior of the abdominal aortic aneurysm walls. These difficulties have limited the potential of computational models in clinical practice. To facilitate computation of wall stresses, we propose to use a linear approach that ensures equilibrium of wall stresses in the aneurysms. This proposed linear model approach is easy to implement and eliminates the burden of nonlinear computations. To assess the accuracy of our proposed approach to compute wall stresses, results from idealized and patient-specific model simulations were compared to those obtained using conventional approaches and to those of a hypothetical, reference abdominal aortic aneurysm model. For the reference model, wall mechanical properties and the initial unloaded and unstressed configuration were assumed to be known, and the resulting wall stresses were used as reference for comparison. Our proposed linear approach accurately approximates wall stresses for varying model geometries and wall material properties. Our findings suggest that the proposed linear approach could be used as an effective, efficient, easy-to-use clinical tool to estimate patient-specific wall stresses.

  8. Automatic segmentation of abdominal vessels for improved pancreas localization

    Science.gov (United States)

    Farag, Amal; Liu, Jiamin; Summers, Ronald M.

    2014-03-01

    Accurate automatic detection and segmentation of abdominal organs from CT images is important for quantitative and qualitative organ tissue analysis as well as computer-aided diagnosis. The large variability of organ locations, the spatial interaction between organs that appear similar in medical scans and orientation and size variations are among the major challenges making the task very difficult. The pancreas poses these challenges in addition to its flexibility which allows for the shape of the tissue to vastly change. Due to the close proximity of the pancreas to numerous surrounding organs within the abdominal cavity the organ shifts according to the conditions of the organs within the abdomen, as such the pancreas is constantly changing. Combining these challenges with typically found patient-to-patient variations and scanning conditions the pancreas becomes harder to localize. In this paper we focus on three abdominal vessels that almost always abut the pancreas tissue and as such useful landmarks to identify the relative location of the pancreas. The splenic and portal veins extend from the hila of the spleen and liver, respectively, travel through the abdominal cavity and join at a position close to the head of the pancreas known as the portal confluence. A third vein, the superior mesenteric vein, anastomoses with the other two veins at the portal confluence. An automatic segmentation framework for obtaining the splenic vein, portal confluence and superior mesenteric vein is proposed using 17 contrast enhanced computed-tomography datasets. The proposed method uses outputs from the multi-organ multi-atlas label fusion and Frangi vesselness filter to obtain automatic seed points for vessel tracking and generation of statistical models of the desired vessels. The approach shows ability to identify the vessels and improve localization of the pancreas within the abdomen.

  9. Hérnia traumática da parede abdominal Traumatic abdominal hernia

    Directory of Open Access Journals (Sweden)

    Alexandre Cruz Henriques

    1999-10-01

    Full Text Available A rare case of blunt traumatic abdominal hernia is presented in which jejunal loops herniated through the abdominal wall. The patient had a serious motor vehicle accident seven years ago, while wearing the seat belt. He developed a traumatic hernia in the anterior lateral abdominal wall, which was operated, and relapsed after some months. The patient was reoperated and we observed the unattachment of the anterior lateral abdominal musculature from the ilium crest. After the hernial sac treatment, the defect was solved with the use of a polypropylene mesh. The postoperative evolution was good and four months later there were no signs of recurrence. Traumatic abdominal hernia remains a rare clinical entity, despite the increase in blunt abdominal trauma. Traumatic abdominal wall hernia falls into two general categories: small lower quadrant abdominal defects, typically the result of blunt trauma with bicycle handlebars, and larger abdominal wall defects related to motor vehicle accidents. The diagnosis may be often established by the physical examination alone. Conventional radiology and computerized tomography usefulness have been proved. In the vast majority of cases, early repair is recommended. The appropriate treatment is the reduction of the herniated bowel into the abdomen, the debridment of nonviable tissues, and a primary tension free closure of the detect.

  10. Abdominal epilepsy and foreign body in the abdomen--dilemma in diagnosis of abdominal pain.

    Science.gov (United States)

    Topno, Noor; Gopasetty, Mahesh S; Kudva, Annappa; B, Lokesh

    2005-12-31

    There are many medical causes of abdominal pain; abdominal epilepsy is one of the rarer causes. It is a form of temporal lobe epilepsy presenting with abdominal aura. Temporal lobe epilepsy is often idiopathic, however it may be associated with mesial temporal lobe sclerosis, dysembryoplastic neuroepithelial tumors and other benign tumors, arterio-venous malformations, gliomas, neuronal migration defects or gliotic damage as a result of encephalitis. When associated with anatomical abnormality, abdominal epilepsy is difficult to control with medication alone. In such cases, appropriate neurosurgery can provide a cure or, at least, make this condition easier to treat with medication. Once all known intra-abdominal causes have been ruled out, many cases of abdominal pain are dubbed as functional. If clinicians are not aware of abdominal epilepsy, this diagnosis is easily missed, resulting in inappropriate treatment. We present a case report of a middle aged woman presenting with abdominal pain and episodes of unconsciousness. On evaluation she was found to have an intra-abdominal foreign body (needle). Nevertheless, the presence of this entity was insufficient to explain her episodes of unconsciousness. On detailed analysis of her medical history and after appropriate investigations, she was diagnosed with temporal lobe epilepsy which was treated with appropriate medications, and which resulted in her pain being relieved.

  11. Regional myocardial perfusion in patients with atherosclerotic coronary artery disease, at rest and during angina pectoris induced by tachycardia

    Energy Technology Data Exchange (ETDEWEB)

    Maseri, A.; L' Abbate, A.; Pesola, A.; Michelassi, C.; Marzilli, M.; De Nes, M.

    1977-03-01

    We studied regional myocardial perfusion by scintigraphic computer-assisted analysis of initial distribution, washout rates, and residual activity of /sup 133/Xe injected into the left coronary artery of four patients with normal arteriograms and 14 patients with coronary stenosis. At rest, residual activity in poststenotic regions was always greater than in control regions, but initial washout rates were not slower. During angina, following xenon injections, the amount of indicator distributed to the poststenotic regions was markedly reduced; the increase of the initial washout rates was smaller than in control regions relative to rest, and residual activity was higher. Initial washout rates did not differ as much as from those of normal myocardium because in severe ischemia too little indicator is deposited initially in these regions to produce a change of any magnitude. Indeed, when angina was induced immediately after the xenon injection, poststenotic washout rates became much slower during angina than at rest, a finding that implicates functional factors in impairing poststenotic myocardial perfusion during angina.

  12. Electrical neuromodulation improves myocardial perfusion and ameliorates refractory angina pectoris in patients with syndrome X : fad or future?

    NARCIS (Netherlands)

    Jessurun, G; Hautvast, RWM; Tio, RA; DeJongste, M

    2003-01-01

    At present, there is no reliable antianginal drug therapy for patients with cardiac syndrome X. Therefore, the effect of electrical neuromodulation on refractory angina pectoris and myocardial perfusion in cardiac syndrome X was assessed. Eight patients (aged 55 +/- 7 years) with heterogeneous myoca

  13. Modulation of intrinsic cardiac neurons by spinal cord stimulation : implications for its therapeutic use in angina pectoris

    NARCIS (Netherlands)

    Foreman, RD; Linderoth, B; Ardell, JL; Barron, KW; Chandler, MJ; Hull, SS; TerHorst, GJ; DeJongste, MJL; Armour, JA

    2000-01-01

    Objective: Electrical stimulation of the dorsal aspect of the upper thoracic spinal cord is used increasingly to treat patients with severe angina pectoris refractory to conventional therapeutic strategies. Clinical studies show that spinal cord stimulation (SCS) is a safe adjunct therapy for cardia

  14. Creatine kinase and creatine kinase subunit-B in coronary sinus blood in pacing-induced angina pectoris

    DEFF Research Database (Denmark)

    Bagger, J P; Ingerslev, J; Heinsvig, E M

    1982-01-01

    In nine out of 10 patients with angiographic documented coronary artery disease, pacing-induced angina pectoris provoked myocardial production of lactate, whereas no significant release of either creatine kinase or creatine kinase subunit-B to coronary sinus and peripheral venous blood could...

  15. Infuences of Previous Angina Pectoris on Coronary Collateral Circulation and Left Ventricular Function in Patients with Acute Myocardial Infarction

    Institute of Scientific and Technical Information of China (English)

    罗初凡; 杜志民; 胡承恒; 梅卫义; 伍贵富; 李怡; 马虹

    2001-01-01

    Objective To investigate the influences of previous angina pectoris on coronary collateral circulation and left ventricular function in patients with acute myocardial infarction. Methods 307 patients with a first episode acute myocardial infarction underwent selective coronary angiography and left ventriculography. The relation of previous angina pectoris to coronary collateral circulation, peak creatine kinase and left ventricular function were analyzed.Results ① In the 307 patients, there were 192(62.5 % ) with previous angina [PA ( + ) group] and 115 (37.5 % ) without [PA ( - ) group]. ②The peak creatine kinase (CK) and CK- MB were significantly higher in PA (-) group than in PA (+) group ( P < 0.05 for both comparisons) . ③ Collateral circulation to infarct- related artery was more likely to be present in PA (+) group than in PA (-) group ( P < 0.05) . ④ The left ventricular ejection fraction was significantly increased, and the left ventricular wall motion Cortina score decreased, in PA ( + ) group than in PA ( - ) group ( P < 0.01 for both comparisons) .Conclusion In patients with acute myocardial infarction, previous angina pectoris may have beneficial effects on coronary collateral circulation and left ventricular unction.

  16. Outcomes after revascularisation with everolimus- and sirolimus-eluting stents in patients with acute coronary syndromes and stable angina pectoris

    DEFF Research Database (Denmark)

    Antonsen, Lisbeth; Thayssen, Per; Hansen, Henrik S

    2014-01-01

    Aims: The aim of this substudy of the SORT OUT IV trial was to compare clinical outcomes among patients with acute coronary syndromes (ACS) and stable angina pectoris (SAP) treated with everolimus-eluting stents (EES) or sirolimus-eluting stents (SES). Methods and results: We performed a post hoc...

  17. Cardiac troponin T and CK-MB mass release after visually successful percutaneous transluminal coronary angioplasty in stable angina pectoris

    DEFF Research Database (Denmark)

    Ravkilde, J; Nissen, H; Mickley, H

    1994-01-01

    The incidence of cardiac troponin T (Tn-T) and creatine kinase (CK) isoenzyme MB mass release was studied in 23 patients with stable angina pectoris undergoing visually successful percutaneous transluminal coronary angioplasty (PTCA). Serial blood samples were drawn for measurement of serum Tn...

  18. The Changes of Vasoactive Substances Originated Endothelium in Patients with Unstable Angina Pectoris Treated by Improved Thrombolytic Therapy

    Institute of Scientific and Technical Information of China (English)

    Wang Congxia; Niu Xiaolin; Li Yongqin; Zhang MingJuan; Ding Kangning

    2004-01-01

    Objectives To analyze the changes of vasoactive substances originated from endothelium in patients with unstable angina pectoris treated by modified thrombolytic therapy and explore the mechanisms of the drug to treat unstable angina pectoris.Methods 120 patients with unstable angina pectoris who were not well responsed to common medication were studied. Their ECG stress tests were abnormal and there were ischemic changes in Holter. Urokinase 300,000 U was added in 100 ml normal saline and injected within 30 min once a day for 3 days. 300 mg aspirin was administrated a day before and during urokinase applications. Before and after urokinase treatments, endothelin-1, plasma tissue plasminogen activator and its inhibitor-1were determined. Results Compared with pretreatments, after treatments, the activities of tissue plasminogen activator increased, endothelin-1 and the inhibitor-1 decreased. The changes were significant. Conclusions Modified thrombolytic therapy can regulate the vasoactive substances originated endothelium in patients with unstable angina pectoris . The major substances include endothelin-1 ,plasma tissue plasminogen activator and inhibitor-1. This mechanism may suggest that urokinase can treat coronary heart disease effectively.

  19. EFFICACY OF SPINAL-CORD STIMULATION AS ADJUVANT THERAPY FOR INTRACTABLE ANGINA-PECTORIS - A PROSPECTIVE, RANDOMIZED CLINICAL-STUDY

    NARCIS (Netherlands)

    DEJONGSTE, MJL; HAUTVAST, RWM; HILLEGE, HL; LIE, KI

    1994-01-01

    Objectives. In a prospective, randomized study with an 8-week follow-up period, we evaluated the efficacy of spinal cord stimulation an exercise capacity and quality of life in patients with intractable angina. Background. Despite important achievements in therapy for ischemic heart disease, there r

  20. Effect of preoperative angina pectoris on cardiac outcomes in patients with previous myocardial infarction undergoing major noncardiac surgery (data from ACS-NSQIP).

    Science.gov (United States)

    Pandey, Ambarish; Sood, Akshay; Sammon, Jesse D; Abdollah, Firas; Gupta, Ena; Golwala, Harsh; Bardia, Amit; Kibel, Adam S; Menon, Mani; Trinh, Quoc-Dien

    2015-04-15

    The impact of preoperative stable angina pectoris on postoperative cardiovascular outcomes in patients with previous myocardial infarction (MI) who underwent major noncardiac surgery is not well studied. We studied patients with previous MI who underwent elective major noncardiac surgeries within the American College of Surgeons-National Surgical Quality Improvement Program (2005 to 2011). Primary outcome was occurrence of an adverse cardiac event (MI and/or cardiac arrest). Multivariable logistic regression models evaluated the impact of stable angina on outcomes. Of 1,568 patients (median age 70 years; 35% women) with previous MI who underwent major noncardiac surgery, 5.5% had postoperative MI and/or cardiac arrest. Patients with history of preoperative angina had significantly greater incidence of primary outcome compared to those without anginal symptoms (8.4% vs 5%, p = 0.035). In secondary outcomes, reintervention rates (22.5% vs 11%, p angina. In multivariable analyses, preoperative angina was a significant predictor for postoperative MI (odds ratio 2.49 [1.20 to 5.58]) and reintervention (odds ratio 2.40 [1.44 to 3.82]). In conclusion, our study indicates that preoperative angina is an independent predictor for adverse outcomes in patients with previous MI who underwent major noncardiac surgery, and cautions against overreliance on predictive tools, for example, the Revised Cardiac Risk Index, in these patients, which does not treat stable angina and previous MI as independent risk factors during risk prognostication.

  1. Importance of thrombosis and thrombolysis in silent ischaemia: comparison of patients with acute myocardial infarction and unstable angina.

    Science.gov (United States)

    Gurfinkel, E.; Altman, R.; Scazziota, A.; Rouvier, J.; Mautner, B.

    1994-01-01

    OBJECTIVE--To investigate whether plaque rupture and thrombosis have a role in silent ischaemia as well as in unstable angina. DESIGN--Prospective analysis of the results of haemostatic diagnostic tests at the moment of developing silent ischaemia at rest. SETTING--Coronary care unit. PATIENTS--22 patients with acute myocardial infarction, 12 patients with symptomatic angina (unstable angina), and 10 normal volunteers (control group). INTERVENTIONS--Continuous cardiac monitoring detected 15 asymptomatic episodes (silent ischaemia) in 6 patients with unstable angina. Blood samples were obtained at admission and when an asymptomatic alteration was detected and 10 minutes later. MAIN OUTCOME MEASURES--Comparisons of concentrations of tissue plasminogen activator, urokinase type plasminogen activator, tissue plasminogen activator inhibitor-1, cross-linked fibrin degradation products, von Willebrand factor, and thrombin-antithrombin III complexes in patients and controls at admission; same comparisons in patients with silent ischaemia at the start of an episode and 10 minutes later. RESULTS--Tissue plasminogen activator concentrations were raised at admission in patients with acute myocardial infarction (mean (SD) 14.2 (6) ng/ml) and in patients with unstable angina (10.1 (2.5) ng/ml) in comparison with controls (5.1 (2.7) ng/ml, p < 0.01 and < 0.05 respectively). There was no differences between the two groups of patients, however. Similar results were observed at the start of a silent ischaemic episode (9.8 (1.9) ng/ml) and 10 minutes later (10.5 (2.9) ng/ml) compared with controls (p < 0.05). Tissue plasminogen activator inhibitor-1 concentrations were raised in patients with acute myocardial infarction (45.1 (15) ng/ml) compared with volunteers (20.6 (16) ng/ml, p < 0.01). In patients with silent ischaemia tissue plasminogen activator inhibitor-1 concentrations were slightly but not significantly increased. Concentrations of cross-linked fibrin degradation products

  2. Inherited chromosomally integrated human herpesvirus 6 as a predisposing risk factor for the development of angina pectoris.

    Science.gov (United States)

    Gravel, Annie; Dubuc, Isabelle; Morissette, Guillaume; Sedlak, Ruth H; Jerome, Keith R; Flamand, Louis

    2015-06-30

    Inherited chromosomally integrated human herpesvirus-6 (iciHHV-6) results in the germ-line transmission of the HHV-6 genome. Every somatic cell of iciHHV-6+ individuals contains the HHV-6 genome integrated in the telomere of chromosomes. Whether having iciHHV-6 predisposes humans to diseases remains undefined. DNA from 19,597 participants between 40 and 69 years of age were analyzed by quantitative PCR (qPCR) for the presence of iciHHV-6. Telomere lengths were determined by qPCR. Medical records, hematological, biochemical, and anthropometric measurements and telomere lengths were compared between iciHHV-6+ and iciHHV-6- subjects. The prevalence of iciHHV-6 was 0.58%. Two-way ANOVA with a Holm-Bonferroni correction was used to determine the effects of iciHHV6, sex, and their interaction on continuous outcomes. Two-way logistic regression with a Holm-Bonferroni correction was used to determine the effects of iciHHV6, sex, and their interaction on disease prevalence. Of 50 diseases monitored, a single one, angina pectoris, is significantly elevated (3.3×) in iciHHV-6+ individuals relative to iciHHV-6- subjects (P = 0.017; 95% CI, 1.73-6.35). When adjusted for potential confounding factors (age, body mass index, percent body fat, and systolic blood pressure), the prevalence of angina remained three times greater in iciHHV-6+ subjects (P = 0.015; 95%CI, 1.23-7.15). Analyses of telomere lengths between iciHHV-6- without angina, iciHHV-6- with angina, and iciHHV-6+ with angina indicate that iciHHV-6+ with angina have shorter telomeres than age-matched iciHHV-6- subjects (P = 0.006). Our study represents, to our knowledge, the first large-scale analysis of disease association with iciHHV-6. Our results are consistent with iciHHV-6 representing a risk factor for the development of angina.

  3. Unstable angina

    Science.gov (United States)

    ... nih.gov/pubmed/25260718 . Giugliano RP, Cannon CP, Braunwald E. Non-ST elevation myocardial infarction. In: Mann DL, Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of ...

  4. Evaluation of the Add-On Effect of Chinese Patent Medicine for Patients with Stable or Unstable Angina: A Systematic Review and Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Chen Mao

    2013-01-01

    Full Text Available Chinese herbal medicine (CHM has been widely used as an adjunct to western medicine in treating angina in China. We carried out this systematic review to evaluate the effectiveness of CHM on top of western medicine for angina. This meta-analysis included 46 randomized control trials with 4212 patients. For trials that included stable angina patients, the CHM group had significant lower incidence of total heart events (relative risk (RR=0.50, 95% confidence interval (CI 0.33–0.78, myocardial infarction (RR=0.32, 95% CI 0.14–0.72, heart failure (RR=0.37, 95% CI 0.15–0.91, and angina (RR=0.46, 95% CI 0.30–0.71 than that of control group. For trials that included unstable angina patients, CHM led to significantly lower occurrence of total heart events (RR=0.46, 95% CI 0.32–0.66, myocardial infarction (RR=0.37, 95% CI 0.26–0.54, and angina (RR=0.36, 95%CI 0.26–0.51. Likewise, for trials that included stable or unstable angina patients, the rates of myocardial infarction (RR=0.34, 95% CI 0.17–0.68 and angina (RR=0.46, 95% CI 0.30–0.70 in CHM group were significantly lower than that in control group. In conclusion, CHM is very likely to be able to improve the survival of angina patients who are already receiving western medicine.

  5. Decreased Diagnostic Accuracy of Multislice Coronary Computed Tomographic Angiography in Women with Atypical Angina Symptoms

    Institute of Scientific and Technical Information of China (English)

    Wen-Ying Jin; Xiu-Juan Zhao; Hong Chen

    2016-01-01

    Background:Multislice computed tomography (MSCT) coronary angiography (CAG) is a noninvasive technique with a reported high diagnostic accuracy for coronary artery disease (CAD).Women,more frequently than men,are known to develop atypical angina symptoms.The purpose of this study was to investigate whether the diagnostic accuracy of MSCT in women with atypical presentation differs from that in men.Methods:We enrolled 396 in-hospital patients (141 women and 255 men) with suspected or proven CAD who successively underwent both MSCT and invasive CAG.CAD was defined as any coronary stenosis of≥50% on conventional invasive CAG,which was used as the reference standard.The patients were divided into typical and atypical groups based on their symptoms of angina pectoris.The diagnostic accuracy of MSCT,including its sensitivity,specificity,negative predictive value,and positive predictive value (PPV),was calculated to determine the usefulness of MSCT in assessing stenoses.The diagnostic performance of MSCT was also assessed by constructing receiver operating characteristic (ROC) curves.Results:The PPV (91% vs.97%,x2 =5.705,P < 0.05) and diagnostic accuracy (87% vs.93%,x2 =5.093,P < 0.05) of MSCT in detecting CAD were lower in women than in men.Atypical presentation was an independent influencing factor on the diagnostic accuracy of MSCT in women (odds ratio =4.94,95% confidence intervals:1.16-20.92,Walds =4.69,P < 0.05).Compared with those in the atypical group,women with typical angina pectoris had higher PPV (98% vs.74%,x2 =17.283.P < 0.001),diagnostic accuracy (93% vs.72%,x2 =9.571,P < 0.001),and area under the ROC curve (0.91 vs.0.64,Z =2.690,P < 0.01) in MSCT diagnosis.Conclusions:Although MSCT is a reliable diagnostic modality for the exclusion of significant coronary artery stenoses in all patients,gender and atypical symptoms might have some influence on its diagnostic accuracy.

  6. Bloqueo de Ganglio Estrellado en el tratamiento de angina de pecho refractaria: un posible tratamiento coadyuvante

    Directory of Open Access Journals (Sweden)

    Isaías Salas Herrera

    2002-04-01

    Full Text Available El presente trabajo corresponde una revisión bibliográfica de los estudios clínicos realizados en síndromes anginosos refractarios al tratamiento convencional, utilizando como tratamiento el bloqueo de ganglio estrellado. Se realizó una búsqueda de literatura publicada entre los años 1.900 al 2.000 en las bases de datos MDConsult, Medline y ProQuest. A su vez se revisaron las publicaciones en la Biblioteca del Hospital Rafael Ángel Calderón Guardia y en la Biblioteca del BINASSS (Biblioteca Nacional de Salud del Seguro Social. De acuerdo a los estudios analizados el bloqueo de ganglio estrellado se describe como posibilidad terapéutica para el control de dolor de la angina de pecho refractaria . La descripción clásica de la inervación cardíaca consiste en tres nervios simpáticos mayores originados de los ganglios cervicales superior, medio e inferior. Esta inervación simpática en conjunto con diversos nervios parasimpáticos, se describen como el plexo cardíaco. En contraste Jane et. al. (1986 en un estudio anatómico de 23 cadáveres describe que la inervación cardiopulmonar en el hombre se origina en el ganglio estrellado y las mitades caudales de las cadenas simpáticas cervicales junto con nervios que se originan del nervio recurrente laríngeo o del vago. De estas estructuras derivan los dos plexos cardiopulmonares. De estos plexos derivan tres nervios cardíacos mayores que se proyectan hacia el corazón. Se estima que determinado porcentaje de los pacientes diagnosticados con angina inestable progresará a desarrollar una angina refractaria al tratamiento. El bloqueo de ganglio estrellado podría ser un nuevo método terapéutico para controlar el dolor de dicha condición. Sin embargo se necesitan estudios clínicos randomizados a doble ciego para obtener resultados concluyentes.

  7. Evaluation of the Add-On Effect of Chinese Patent Medicine for Patients with Stable or Unstable Angina: A Systematic Review and Meta-Analysis

    OpenAIRE

    Chen Mao; Chung, Vincent C.H.; Jin-Qiu Yuan; Yuan-Yuan Yu; Zu-Yao Yang; Xin-Yin Wu; Jin-Ling Tang

    2013-01-01

    Chinese herbal medicine (CHM) has been widely used as an adjunct to western medicine in treating angina in China. We carried out this systematic review to evaluate the effectiveness of CHM on top of western medicine for angina. This meta-analysis included 46 randomized control trials with 4212 patients. For trials that included stable angina patients, the CHM group had significant lower incidence of total heart events (relative risk (RR) = 0.50, 95% confidence interval (CI) 0.33–0.78), myocar...

  8. Antianginal efficacy of the combination of felodipine-metoprolol 10/100 mg compared with each drug alone in patients with stable effort-induced angina pectoris

    DEFF Research Database (Denmark)

    Emanuelsson, H; Egstrup, K; Nikus, K

    1999-01-01

    -induced angina pectoris. The secondary objective was to compare the tolerability of the 3 treatments. METHODS: The main criteria for inclusion were stable effort-induced angina pectoris for at least 2 months before the enrollment and a positive bicycle exercise test result. Patients were allocated to once...... was significantly lower in the groups receiving felodipine-metoprolol and metoprolol than in the group receiving felodipine alone. The combination and metoprolol were better tolerated than felodipine alone. CONCLUSIONS: In stable angina pectoris, the combination felodipine-metoprolol 10/100 mg and felodipine 10 mg...

  9. Abdominal binders may reduce pain and improve physical function after major abdominal surgery - a systematic review

    DEFF Research Database (Denmark)

    Rothman, Josephine Philip; Gunnarsson, Ulf; Bisgaard, Thue

    2014-01-01

    INTRODUCTION: Evidence for the effect of post-operative abdominal binders on post-operative pain, seroma formation, physical function, pulmonary function and increased intra-abdominal pressure among patients after surgery remains largely un-investigated. METHODS: A systematic review was conducted...

  10. Childhood abdominal pain in primary care : design and patient selection of the HONEUR abdominal pain cohort

    NARCIS (Netherlands)

    Spee, Leo A A; van den Hurk, Arjan P J M; van Leeuwen, Yvonne; Benninga, Marc A; Bierma-Zeinstra, Sita M A; Passchier, Jan; Berger, Marjolein Y

    2010-01-01

    BACKGROUND: Abdominal pain in children is a common complaint presented to the GP. However, the prognosis and prognostic factors of childhood abdominal pain are almost exclusively studied in referred children. This cohort study aims at describing prognosis and prognostic factors of childhood abdomina

  11. General Considerations of Ruptured Abdominal Aortic Aneurysm: Ruptured Abdominal Aortic Aneurysm

    OpenAIRE

    Lee, Chung Won; Bae, Miju; Chung, Sung Woon

    2015-01-01

    Although development of surgical technique and critical care, ruptured abdominal aortic aneurysm still carries a high mortality. In order to obtain good results, various efforts have been attempted. This paper reviews initial management of ruptured abdominal aortic aneurysm and discuss the key point open surgical repair and endovascular aneurysm repair.

  12. Abdominal Compartment Syndrome and Intra-abdominal Ischemia in Patients with Severe Acute Pancreatitis

    NARCIS (Netherlands)

    Smit, M.; Buddingh, K. T.; Bosma, B; Nieuwenhuijs, V B; Hofker, H.S.; Zijlstra, J.G.

    2016-01-01

    INTRODUCTION: Severe acute pancreatitis may be complicated by intra-abdominal hypertension (IAH), abdominal compartment syndrome (ACS), and intestinal ischemia. The aim of this retrospective study is to describe the incidence, treatment, and outcome of patients with severe acute pancreatitis and ACS

  13. Abdominal Compartment Syndrome and Intra-abdominal Ischemia in Patients with Severe Acute Pancreatitis

    NARCIS (Netherlands)

    Smit, M.; Buddingh, K. T.; Bosma, B.; Nieuwenhuijs, V. B.; Hofker, H. S.; Zijlstra, J. G.

    2016-01-01

    Severe acute pancreatitis may be complicated by intra-abdominal hypertension (IAH), abdominal compartment syndrome (ACS), and intestinal ischemia. The aim of this retrospective study is to describe the incidence, treatment, and outcome of patients with severe acute pancreatitis and ACS, in particula

  14. Simulation of bifurcated stent grafts to treat abdominal aortic aneurysms (AAA)

    CERN Document Server

    Egger, Jan; Freisleben, Bernd

    2016-01-01

    In this paper a method is introduced, to visualize bifurcated stent grafts in CT-Data. The aim is to improve therapy planning for minimal invasive treatment of abdominal aortic aneurysms (AAA). Due to precise measurement of the abdominal aortic aneurysm and exact simulation of the bifurcated stent graft, physicians are supported in choosing a suitable stent prior to an intervention. The presented method can be used to measure the dimensions of the abdominal aortic aneurysm as well as simulate a bifurcated stent graft. Both of these procedures are based on a preceding segmentation and skeletonization of the aortic, right and left iliac. Using these centerlines (aortic, right and left iliac) a bifurcated initial stent is constructed. Through the implementation of an ACM method the initial stent is fit iteratively to the vessel walls - due to the influence of external forces (distance- as well as balloonforce). Following the fitting process, the crucial values for choosing a bifurcated stent graft are measured, ...

  15. Intra-abdominal pressure: an integrative review.

    Science.gov (United States)

    Milanesi, Rafaela; Caregnato, Rita Catalina Aquino

    2016-01-01

    There is a growing request for measuring intra-abdominal pressure in critically ill patients with acute abdominal pain to be clarified. Summarizing the research results on measurement of vesical intra-abdominal pressure and analyzing the level of evidence were the purposes of this integrative literature review, carried out based on the databases LILACS, MEDLINE and PubMed, from 2005 to July 2012. Twenty articles were identified, in that, 12 literature reviews, 4 descriptive and exploratory studies, 2 expert opinions, one prospective cohort study and one was an experience report. The vesical intra-abdominal pressure measurement was considered gold standard. There are variations in the technique however, but some common points were identified: complete supine position, in absence of abdominal contracture, in the end of expiration and expressed in mmHg. Most research results indicate keeping the transducer zeroed at the level of the mid-axillary line at the iliac crest level, and instill 25mL of sterile saline. Strong evidence must be developed. RESUMO Em pacientes críticos com quadros abdominais agudos a esclarecer é crescente a solicitação da aferição da pressão intra-abdominal. Sintetizar resultados de pesquisas sobre a mensuração da pressão intra-abdominal pela via vesical e analisar o nível de evidência foram os objetivos desta revisão integrativa da literatura, realizada nas bases LILACS, MEDLINE e PubMed, no período de 2005 a julho de 2012. Identificaram-se 20 artigos, sendo 12 revisões de literatura, 4 estudos exploratório-descritivos, 2 opiniões de especialistas, 1 estudo de coorte prospectivo e 1 relato de experiência. O método vesical para mensuração da pressão intra-abdominal foi considerado padrão-ouro. Existem variações na técnica, entretanto pontos em comum foram identificados: posição supina completa, na ausência de contratura abdominal, ao final da expiração e expressa em mmHg. A maioria indica posicionar o ponto zero do

  16. Diagnosis of Unstable Angina Pectoris Has Declined Markedly with the Advent of More Sensitive Troponin Assays

    DEFF Research Database (Denmark)

    D'Souza, Maria; Sarkisian, Laura; Saaby, Lotte

    2015-01-01

    in unselected hospital patients. METHODS: During 2010 we evaluated all patients in whom cardiac troponin I had been measured at a single university hospital. The diagnosis of acute myocardial infarction (ST-elevation myocardial infarction [STEMI] or non-ST-elevation myocardial infarction [NSTEMI......BACKGROUND: Since the arrival of the universal definition of myocardial infarction more sensitive troponin assays have been developed. How these occurrences have influenced the proportions and clinical features of the components of acute coronary syndrome have not been studied prospectively......]) was established in cases of a rise and/or fall of cardiac troponin I together with cardiac ischemic features. Patients with unstable chest discomfort and cardiac troponin I values below the decision limit of myocardial infarction were diagnosed as having unstable angina pectoris. The definition of acute coronary...

  17. A Becker myotonia patient with compound heterozygosity for CLCN1 mutations and Prinzmetal angina pectoris.

    Science.gov (United States)

    Zielonka, Daniel; Jurkat-Rott, Karin; Stachowiak, Paweł; Bryl, Anna; Marcinkowski, Jerzy T; Lehmann-Horn, Frank

    2012-04-01

    Becker myotonia is a recessive muscle disease with prevalence of > 1:50,000. It is caused by markedly reduced function of the chloride channel encoded by CLCN1. We describe a Polish patient with severe myotonia, transient weakness, and muscle cramps who only responds to lidocaine. In addition, the patient has Prinzmetal angina pectoris and multiple lipomatosis. He is compound heterozygeous for a novel p.W303X and a frequent p.R894X CLCN1 mutation. CLCN1 exon number variation was excluded by MLPA. His son with latent myotonia was heterozygeous for p.R894X. We discuss the potential relations of the three rare diseases and the inheritance of p.R894X.

  18. Psychophysical rehabilitation aspects of patient with coronary heart disease and Angina.

    Directory of Open Access Journals (Sweden)

    Mohammed Ali Khaleel.

    2012-03-01

    Full Text Available It is analyzed scientific and methodological literature, considered the views of scientists on the link of stress and cardiovascular diseases. It is determined causes of stress, with recommendations for combating stress and its prevention. A program of rehabilitation for patients with coronary artery disease after hospital discharge is shown. The experiment involved 88 patients of coronary heart disease and angina, II and III functional class at the age of 40-65 years. Participants were divided into two groups the main and control. The control group performed a program of physical rehabilitation, including breathing and physical exercises, in the program we have added to the main group autogenic exercises. At the end the experiment revealed that the health indicators of main group better than the control group in 23%.

  19. Effects on costs of frontline diagnostic evaluation in patients suspected of angina

    DEFF Research Database (Denmark)

    Nielsen, Lene H; Olsen, Jens; Markenvard, John;

    2012-01-01

    associated with downstream diagnostic utilization (DTU), treatment, ambulatory visits, and hospitalizations were registered. There was no difference between cohorts in demographic characteristics or the pre-test probability of significant CAD. The mean (SD) age was 56 (11) years; 52% were men; and 96% were......AIMS: The aim of this study was to investigate in patients with stable angina the effects on costs of frontline diagnostics by exercise-stress testing (ex-test) vs. coronary computed tomography angiography (CTA). METHODS AND RESULTS: In two coronary units at Lillebaelt Hospital, Denmark, 498...... patients were identified in whom either ex-test (n = 247) or CTA (n = 251) were applied as the frontline diagnostic strategy in symptomatic patients with a low-intermediate pre-test probability of coronary artery disease (CAD). During 12 months of follow-up, death, myocardial infarction and costs...

  20. Serum Adenosine deaminase activity and C-reactive protein levels in unstable angina

    Directory of Open Access Journals (Sweden)

    Rani Surekha

    2003-01-01

    Full Text Available In unstable angina (USA patients, immunological responses contributing to inflammation play a vital role in plaque rupture and thrombosis causing stroke. In the present study an attempt is made to estimate the levels of adenosine deaminase activity, an immunoenzyme marker and C-reactive protein, a marker of inflammation in USA patients. 45 patients presenting USA and 50 age and sex matched healthy controls were included in the study. Serum ADA activity was measured spectrophotometrically at 630nm and serum C-reactive protein was detected using Avitex CRP kit, which is a rapid latex agglutination test. The Mean ADA levels were 41.15 ± 11.04 in patients and 20.71±5.63 in controls and 66.6% of patients and none of the controls were positive to CRP. The present study observed the importance of ADA as a serum marker in addition to CRP for assessing the immune response in USA patients.

  1. Methods of patient warming during abdominal surgery.

    Directory of Open Access Journals (Sweden)

    Li Shao

    Full Text Available BACKGROUND: Keeping abdominal surgery patients warm is common and warming methods are needed in power outages during natural disasters. We aimed to evaluate the efficacy of low-cost, low-power warming methods for maintaining normothermia in abdominal surgery patients. METHODS: Patients (n = 160 scheduled for elective abdominal surgery were included in this prospective clinical study. Five warming methods were applied: heated blood transfusion/fluid infusion vs. unheated; wrapping patients vs. not wrapping; applying moist dressings, heated or not; surgical field rinse heated or not; and applying heating blankets or not. Patients' nasopharyngeal and rectal temperatures were recorded to evaluate warming efficacy. Significant differences were found in mean temperatures of warmed patients compared to those not warmed. RESULTS: When we compared temperatures of abdominal surgery patient groups receiving three specific warming methods with temperatures of control groups not receiving these methods, significant differences were revealed in temperatures maintained during the surgeries between the warmed groups and controls. DISCUSSION: The value of maintaining normothermia in patients undergoing abdominal surgery under general anesthesia is accepted. Three effective economical and practically applicable warming methods are combined body wrapping and heating blanket; combined body wrapping, heated moist dressings, and heating blanket; combined body wrapping, heated moist dressings, and warmed surgical rinse fluid, with or without heating blanket. These methods are practically applicable when low-cost method is indeed needed.

  2. Imaging the Abdominal Manifestations of Cystic Fibrosis

    Directory of Open Access Journals (Sweden)

    C. D. Gillespie

    2017-01-01

    Full Text Available Cystic fibrosis (CF is a multisystem disease with a range of abdominal manifestations including those involving the liver, pancreas, and kidneys. Recent advances in management of the respiratory complications of the disease has led to a greater life expectancy in patients with CF. Subsequently, there is increasing focus on the impact of abdominal disease on quality of life and survival. Liver cirrhosis is the most important extrapulmonary cause of death in CF, yet significant challenges remain in the diagnosis of CF related liver disease. The capacity to predict those patients at risk of developing cirrhosis remains a significant challenge. We review representative abdominal imaging findings in patients with CF selected from the records of two academic health centres, with a view to increasing familiarity with the abdominal manifestations of the disease. We review their presentation and expected imaging findings, with a focus on the challenges facing diagnosis of the hepatic manifestations of the disease. An increased familiarity with these abdominal manifestations will facilitate timely diagnosis and management, which is paramount to further improving outcomes for patients with cystic fibrosis.

  3. Abdominal aorta transplantation after programmed cryopreservation

    Institute of Scientific and Technical Information of China (English)

    Song Gu; Chang-Jian Liu; Tong Qiao; Xue-Mei Sun; Jun-Hao Chen

    2004-01-01

    AIM: To study the morphologic and cellular immunologic changes after homologous transplantation of the abdominal aorta in rats after programmed cryopreservation (-196°C).METHODS: Abdominal aorta was harvested from anesthetized Spraque Dawley (SD) rats for cryopreservation (group B) or immediate implantation (group A). The survival rates and apoptotic rates of aortic endothelial cells (ECs)were examined. The patency rates, histology and cellular immunologic changes of the abdominal aorta were examined on days 1, 3, 7, 14, 30, 60 after transplantation respectively.RESULTS: The survival rate of ECs after programmed cryopreservation was 90.1±1.79%, about 3.4% lower than that of uncryopreservation (93.5±1.96%). The apoptotic rates of ECs was increased after cryopreservation (7.15%vs 4.86%, P<0.05). The patency rate of group B was significantly higher than that of group A (91.6±12.9% vs 62.5±26.2%, P<0.01). CD4/CD8 ratio, TCR αβ and CD11b/CD18 ratio of group B were significantly lower than those of group A (P<0.05). Revivification of the cryopreserved abdominal aorta showed normal adventitia and intact smooth muscle cells.CONCLUSION: Cryopreservation can reduce homologous abdominal aortic antigenecity. Even if without administration of immunosuppressive agents, it is still feasible to implement homologous artery grafting in rats.

  4. Postoperative abdominal complications after cardiopulmonary bypass

    Directory of Open Access Journals (Sweden)

    Dong Guohua

    2012-10-01

    Full Text Available Abstract Background To summarize the diagnostic and therapeutic experiences on the patients who suffered abdominal complications after cardiovascular surgery with cardiopulmonary bypass(CPB. Methods A total of 2349 consecutive patients submitted to cardiovascular surgery with CPB in our hospital from Jan 2004 to Dec 2010 were involved. The clinical data of any abdominal complication, including its incidence, characters, relative risks, diagnostic measures, medical or surgical management and mortality, was retrospectively analyzed. Results Of all the patients, 33(1.4% developed abdominal complications postoperatively, including 11(33.3% cases of paralytic ileus, 9(27.3% of gastrointestinal haemorrhage, 2(6.1% of gastroduodenal ulcer perforation, 2(6.1% of acute calculus cholecystitis, 3(9.1% of acute acalculus cholecystitis, 4(12.1% of hepatic dysfunction and 2(6.1% of ischemia bowel diseases. Of the 33 patients, 26 (78.8% accepted medical treatment and 7 (21.2% underwent subsequent surgical intervention. There were 5(15.2% deaths in this series, which was significantly higher than the overall mortality (2.7%. Positive history of peptic ulcer, advanced ages, bad heart function, preoperative IABP support, prolonged CPB time, low cardiac output and prolonged mechanical ventilation are the risk factors of abdominal complications. Conclusions Abdominal complications after cardiovascular surgery with CPB have a low incidence but a higher mortality. Early detection and prompt appropriate intervention are essential for the outcome of the patients.

  5. Transverse abdominal plane neurostimulation for chronic abdominal pain: a novel technique.

    Science.gov (United States)

    Gupta, Mayank; Goodson, Robert

    2014-01-01

    Management of chronic abdominal pain can be challenging. Sometimes patients fail to get adequate response from multiple medications and nerve blocks. We present a patient case report of chronic abdominal pain with a history of multiple surgeries managed successfully by neuromodulation of the transverse abdominis plane (TAP). The TAP block is a procedure in which local anesthetic is injected into the abdominal fascial plane that carries sensory nerves to the abdominal wall in order to block pain sensation. It has been shown to reduce postoperative pain and analgesic dependence after abdominal and gynecological surgeries. A 60-year-old woman presented to us for chronic abdominal pain for which medications provided little relief. She had an extensive history of abdominal surgeries and was also treated for lower back pain with surgery and less invasive procedures in the past. Under our care, she underwent 2 TAP blocks with almost complete resolution of her abdominal pain. Her pain, however, came back within a few of weeks of the procedures. Since our patient found pain relief from the TAP blocks, we proceeded with neurostimulation of the TAP for long-term pain relief. We placed a dorsal column stimulator 16 contact lead for lower back and leg pain and 8 contact leads placed in the TAP under ultrasound guidance. She has had multiple follow-ups since her TAP lead placement procedure with continued and near complete resolution of her abdominal pain. The TAP lead stimulation was helping her abdominal pain and the dorsal column lead stimulation was helping her back and leg pain.

  6. Antenatal MR diagnosis of urinary hydrometrocolpos due to urogenital sinus

    Energy Technology Data Exchange (ETDEWEB)

    Subramanian, Subramanian; Sharma, Raju; Gamanagatti, Shivanand [All India Institute of Medical Sciences, Department of Radiodiagnosis, New Delhi (India); Agarwala, Sandeep [All India Institute of Medical Sciences, Department of Pediatric Surgery, New Delhi (India); Gupta, Prerna; Kumar, Sunesh [All India Institute of Medical Sciences, Department of Obstetrics and Gynaecology, New Delhi (India)

    2006-10-15

    Hydrometrocolpos is cystic dilatation of the vagina and uterus due to congenital vaginal obstruction. It may be secretory or urinary in character and manifests in the neonatal period with abdominal distension. Urinary hydrometrocolpos occurs in patients with urogenital sinus or cloacal anomaly. A rare case of antenatal MR diagnosis of urinary hydrometrocolpos due to urogenital sinus is presented. (orig.)

  7. Endotension: rupture of abdominal aortic aneurysm Endotensão: ruptura de aneurisma de aorta abdominal

    Directory of Open Access Journals (Sweden)

    Alexandre Campos Moraes Amato

    2012-06-01

    Full Text Available Aortic endovascular exclusion technique called 'chimney' consists of placing stents through abdominal aortic visceral branches and a prosthesis that excludes the thoraco-abdominal aneurysm. Stents and an aortic endoprosthesis are placed in the renal arteries. This method is primarily used when open surgery is too risky. The mechanism that provides aneurysm sac increase without the visible presence of endoleaks has not been fully elucidated. The expansion of the aneurysm sac, due to endotension, is difficult to diagnose, even with the use of advanced imaging tests. Its diagnosis is made by exclusion. We present a case of a late complication in a high-risk patient after a 'chimney' endovascular procedure. Following the surgery, the patient presented a ruptured aneurysm sac without a visible endoleak. A second intervention was not feasible due to the high risk of occluding all of the branches, and complicated by previous 'chimney'. Endotension is a possible cause of aneurysm rupture and death.A técnica de exclusão endovascular conhecida como 'chaminé' consiste na colocação de stent em ramos viscerais e de endoprótese excluindo o aneurisma toracoabdominal. São colocados stents revestidos nas artérias renais e uma endoprótese aórtica, que o método utilizado quando a cirurgia aberta tem risco muito alto. O mecanismo que causa a expansão aneurismática sem a presença detectável de vazamento pelos métodos de imagem não está completamente esclarecido. A expansão do saco aneurismático por endotensão é de difícil diagnóstico, mesmo com o uso de técnicas de imagem avançadas, como tomografia computadorizada e eco-Doppler, sendo o diagnóstico por exclusão. Apresenta-se um caso de complicação tardia após o tratamento endovascular pela técnica da 'chaminé'. Após a cirurgia, o paciente apresentou ruptura sem endoleak visível. Outro procedimento endovascular foi impossibilitado pela técnica da 'chaminé', que dificulta novos

  8. THE EFFECT OF LEFT VENTRICULAR DIASTOLIC DYSFUNCTION ON THE PATHOGENESIS OF ANGINA DECUBITUS

    Institute of Scientific and Technical Information of China (English)

    陈纪林; 高润霖; 姚康宝; 杨跃进; 秦学文; 乔树宾; 姚民

    2000-01-01

    Objective. To investigate the effect of left veraricular diastolic dysfunction on the pathogenesis of angina decubitus (AD).Methods. The study population consisted of three groups: 20 individuals without cardiovascular disease were studied as group Ⅰ . Group Ⅱ included 20 patents with coronary artery disease and without AD. Thirty-one patients with AD and ejection fraction(EF) > 50% were studied as group Ⅲ. Group Ⅱ and Ⅲ were matched for age, EF and extent of coronary artery disease.Results. Left ventricnlography (LVG) showed that left ventricnlar (LV) first 1/3 filling fraction (1/3FF) was significantly lower in group Ⅲ than in group Ⅱ and Ⅰ (both P <0.001),but LV late 1/3 FF was much higher in group Ⅲ than in group Ⅱ and Ⅰ (P < 0.05, P < 0.01). Left ventricular end-diastohc presstrre(LVEDP) was markedly inereased before and after LVGin group Ⅱ and Ⅲ as compared with group Ⅰ (beth P<0.05, beth P<0.001). The difference of LVEDP caused by left atrial contraction (left atrial contraction pressure difference, LACPD) before and after LVG was much higher in group Ⅲ than in group Ⅰ ( P < 0.01, P < 0.001). Howevere, there were significant differences in LVEDP and in LACPD between before and after LVG only in group Ⅲ (both P < 0.01).Conclusion. The patients with AD have LV diastolic dysfunction, which may be closely related to the pathogen-esis of angina decubitus.

  9. INFLUENCE OF MILDRONATE ON EFFICIENCY OF ANTIANGINAL THERAPY IN PATIENTS WITH STABLE BURDEN ANGINA

    Directory of Open Access Journals (Sweden)

    N. P. Kutishenko

    2005-01-01

    Full Text Available Aim. To study influence of mildronate (M on treatment efficiency of patients with ischemic heart disease (IHD, receiving standard antianginal therapy (AATMaterials and methods. Double-blind, randomized, placebo-controlled study was carried out in parallel groups. All patients continued the earlier prescribed AAT without changes. After control period (10-14 days was over, randomization of patients either to the treatment group (M 500mg twice per day, or to the control group (placebo (Pl twice per day was made for 6 weeks therapy. Criterion of treatment efficiency: increase in duration of trial with burden on treadmill (TB, decrease in angina attack frequency (AA and reduction in nitroglycerin taking (NTT. TB was carried out at the beginning (TB-1, at the end of the control period (TB-2, and at the end of the treatment (TB-3.Results. TB-1 and TB-2 had good reproducibility, their duration didn’t differ. At the end of the treatment additionally with M, growth in duration of TB-3 (p=0,002 was registered, while there was no growth of TB duration with the Pl treatment (p=0,07. During the treatment decrease in AA number both with M (p=0,002, and with Pl (p=0,02 was noted. With M treatment decrease in NTT treatment (p=0.02 was observed, while NTT with Pl didn’t change (p=0,7. Number of side effects, registered with M and Pl, didn’t differ.Conclusion. Mildronate provides additional benefits for patients with IHD with stable burden angina, when they do not reach desired effect with the prescribed AAT.

  10. Significance of silent ischemia in dipyridamole perfusion scintigraphy. Evaluation in patients with angina

    Energy Technology Data Exchange (ETDEWEB)

    Kitaoka, Hiroaki; Takata, Jun; Yamada, Mitsutoshi; Seo, Hiromi; Doi, Yoshinori [Kochi Medical School, Nankoku (Japan)

    1995-07-01

    The significance of silent myocardial ischemia detected by dipyridamole perfusion scintigraphy was evaluated in 80 patients with stable angina and reversible defects (RD) but no infarction. The patients consisted of 26 patients with silent RD and 54 patients with painful RD. There was no significant difference in the incidence of coronary risk factors between the two groups, except for hyperlipidemia which was less frequently observed in patients with silent RD than in those with painful RD (8% vs 41%), Coronary angiography revealed a higher prevalence of insignificant lesions or single vessel disease in patients with silent RD than in those with painful RD (73% vs 39%). Dipyridamole perfusion scintigraphy revealed a lower degree of RD in patients with silent RD than in those with painful RD (4.4{+-}3.3 vs 9.0{+-}4.1 segments), though there was no significant difference in the localization of RD between these two groups. Treadmill stress testing revealed a lower incidence of chest pain in patients with silent RD than in those with painful RD (26% vs 65%), despite the mean exercise-duration being significantly longer in the former than in the latter (5.5{+-}1.7 vs 3.9{+-}11.7 min). Although initial percutaneous transluminal coronary angioplasty (PTCA) and/or coronary artery bypass grafting (CABG) were less frequently performed in patients with silent RD than in those with painful RD (12% vs 31%), there was no significant difference in the cardiac event rate during the mean follow-up period of 24{+-}14 months between the two groups. Patients with stable angina and silent RD on dipyridamole perfusion scintigraphy may have less extensive coronary lesions and smaller amounts of ischemic myocardium than patients with painful RD. Dipyridamole perfusion scintigraphy is useful for detecting and evaluating silent myocardial ischemia, even in those patients who cannot exercise adequately. (J.P.N.).

  11. Relationship between resistin level in serum and acute coronary syndrome or stable angina pectoris

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Objective: To investigate the relationship between serum resistin level and acute coronary syndrome (ACS) or stable angina pectoris (SAP). Methods: Sixty-five patients, with coronary artery disease, were enrolled and divided into three subgroups:acute myocardial infarction (AMI), unstable angina pectoris (UAP) and SAP, and 26 healthy people were recruited as controls in the cross-sectional study. Serum resistin levels were determined by ELISA (enzyme-linked immunosorbent assay), and WBC (white blood cell count), hsCRP (high sensitive C-reaction protein), CKmax (maximum ofcreatinkinase), CK-MBmax (maximum of isozyme of creatinkinase) and cTnImax (maximum oftroponin) were measured by standard laboratory methods. Results: The serum resistin levels were 4 folds higher in AMI patients, 2.43 folds in UAP patients and 1.12 folds in SAP patients than in the healthy controls (P<0.05). The resistin levels were also significantly different between AMI [(8.16±0.79) ng/ml], UAP [(5.59±0.75) ng/ml]and SAP [(3.45±0.56) ng/ml] groups (P<0.01); WBC, hsCRP, CKmax, CK-MBmax and cTnImax were significantly increased in AMI patients over UAP and SAP patients. Spearman analysis showed that serum resistin levels were positively correlated with WBC (r=0.412, P=0.046), hsCRP (r=0.427, P=0.037), CKmax, CK-MBmax and cTnImax (r=0.731, 0.678, 0.656; P<0.01). Conclusion:Serum resistin levels increased with inflammatory factors and myocardial impairment. The results suggest that human resistin might play an important role in the pathogenesis of atherosclerosis and AMI as an inflammatory factor.

  12. SERUM LEVELS OF VASCULAR ENDOTHELIAL GROWTH FACTOR IN PATIENTS WITH ANGINA PECTORIS AND ACUTE MYOCARDIAL INFARCTION

    Institute of Scientific and Technical Information of China (English)

    尹瑞兴; 冯建章; 陈旦红; 乌汉东

    2000-01-01

    Objective. To determine whether serum vascular endothelial growth factor (VEGF) concontrafions are altered in several kinds of coronary heart disease patients. Materials and methods. Using a VEGF enzyme-linked immunosorbent assay (ELISA), serum VEGF concemra-tions were determined in anteotbital venous blood of 16 patients with stable angina pectoris(SAP), 16 with unstable angina pectoris(UAP) and 16 with acute myocardial infarcfion (AMI) before and after thrombolytic therapy, and d 16 age- and sex-matched healthy volunteers who used as controls. Results. The concentrations of serum VEGF in patients with SAP(98.60 ± 26.99pg/ml) and UAP ( 103.61 ± 24.89pg/ml) tended to be higher than those in control subjects(80.44 ± 24.57pg/ml), but the differences did notreach statistical significance ( P > 0.05 for each). Before thrombolyfie therapy, the concentrations of serum VEGF in patients with AM1 (285.92 ± 125.15pg/ml) were significantly higher than those in patients with SAP, UAP or control subjects ( P < 0.01 ,respectively), and correlated with synchronous serum ereafine kinase (CK) and its MB iscenzyme (CK-MB) contents( r = 0.866, P < 0.001 and r = 0.948, P < 0.001 ;respectively). Three hours after thrombolysis,the concentrations of VEGF had fallen to 111.57 ± 31.29pg/ml ( P < 0.01 vs. before thrombelytie therapy and P <0. 05 vs. control subjects). Condusion. The present study shows that serum concentrafiom of VEGF in patients with AMI are markedly ele-vated and that increased serum VEGF levels may be one of the most sensitive indexes in diagnosing AMI and judging reperfnsion.

  13. SERUM LEVELS OF VASCULAR ENDOTHELIAL GROWTH FACTOR IN PATIENTS WITH ANGINA PECTORIS AND ACUTE MYOCARDIAL INFARCTION

    Institute of Scientific and Technical Information of China (English)

    尹瑞兴; 冯建章; 陈旦红; 乌汉东

    2000-01-01

    Objective. To determine whether serum vascular endothelial growth factor(VEGF)concentrations are altered in several kinds of coronary heart disease patients. Materials and methods. Using a VEGF enzyme-linked immunosorbent assay(ELISA), serum VEGF concentra tions were determined in antecubital venous blood of 16 patients with stable angina pectoris(SAP), 16 with unstable angina pectoris(UAP) and 16 with acute myocardial infarction(AMI) before and after thrombolytic therapy, and of 16 age and sex-matched healthy volunteers who used as controls. Results. The concentrations of serum VEGF in patients with SAP(98.60 ± 26.99pg/ml) and UAP (103.61 ± 24.89pg/ml) tended to be higher than those in control subjects(80.44 ± 24.57pg/ml), but the differences did not reach statistical significance (P > 0.05 for each). Before throm bolytic therapy, the concentrations of serum VEGF in patients with AMI (285.92 ± 125.15pg/ml) were significantly higher than those in patients with SAP, UAP or control subjects ( P < 0.01 ,respectively), and correlated with synchronous serum creatine kinase (CK) and its MB isoenzyme (CK-MB) contents(r=0.866, P < 0.001 and r =0.948,P < 0.001;respectively). Three hours after thrombolysis, the concentrations of VEGF had fallen to 111.57 ± 31.29pg/ml ( P <0.01 vs. before thrombolytic therapy and P< 0.05 vs .control subjects). Conclusion. The present study shows that serum concentrations of VEGF in patients with AMI are markedly ele vated and that increased serum VEGF levels may be one of the most sensitive indexes in diagnosing AMI and judging reperfusion.

  14. [Correlation of heart rate variability with SYNTAX II on chronic angina].

    Science.gov (United States)

    Castro-de la Torre, Tatiana Chantal; Amador-Licona, Norma; Bernal-Ruíz, Enrique

    2017-01-01

    Introducción: la variabilidad de la frecuencia cardiaca (VFC) es un valor pronóstico de riesgo cardiovascular. Se desconoce su correlación con la severidad de la cardiopatía isquémica estable. El objetivo fue conocer la correlación de la VFC con la puntuación SYNTAX II en angina crónica. Métodos: estudio transversal en pacientes mayores de 18 años con angina estable e indicación de coronariografía diagnóstica que asistieron a un centro de tercer nivel. Mediante coronariografía se estableció la puntuación SYNTAX II y se obtuvo la VFC por Holter de 24 horas. La correlación de las mediciones se obtuvo con la prueba de Pearson. Un valor de SDNN valores de SDNN (73.77%) y solo 8 tenían disminución de los valores RMSSD (13.11%). No hubo correlación de ningún parámetro de VFC con SYNTAX II. Hubo mayor frecuencia de taquicardia ventricular en el grupo SDNN bajo en comparación con SDNN normal (15.5 frente a 0.0%; p = 0.04). Conclusiones: no identificamos correlación de parámetros de VFC con la severidad de cardiopatía isquémica crónica. Sin embargo, aquellos pacientes con menor VFC presentaron mayor proporción de taquicardia ventricular.

  15. THE EFFECT OF LEFT VENTRICULAR DIASTOLIC DYSFUNCTION ON THE PATHOGENESIS OF ANGINA DECUBITUS

    Institute of Scientific and Technical Information of China (English)

    陈纪林; 高润霖; 姚康宝; 杨跃进; 秦学文; 乔树宾; 姚民

    2000-01-01

    Objective. To investigate the effect of left ventricular diastohc dysfunction on the pathogenesis of angina decubitus (AD). Methods. The study population consisted of three groups: 20 individuals without cardiovascular disease were studied as group Ⅰ . Group Ⅱ included 20 patents with coronary artery disease and without AD. Thirty-one patients with AD and ejection fraction(EF) > 50% were studied as group Ⅲ. Group Ⅱ and Ⅲ were matched for age, EF and extent of coronary artery disease. Results. Left ventriculography (LVG) showed that left ventricular (LV) first 1/3 filling fraction(1/3FF) was significantly lower in group Ⅲ than in group Ⅱ and Ⅰ (both P < 0.001),but LV late 1/3 FF was much higher in group Ⅲ than in group Ⅱ and Ⅰ (P <0.05, P < 0.01). Left ventricular end-diastolic pressure(LVEDP)was markedly increased before and after LVG in group Ⅱ and Ⅲ as compared with group Ⅰ (bothP<0.05, both P< 0.001). The difference of LVEDP caused by left atrial contraction (left atrial contraction pressure difference, LACPD)before and after LVG was much higher in group Ⅲ than in group Ⅰ ( P <0.01, P < 0.001). Howevere,there were significant differences in LVEDP and in LACPD between before and after LVG only in group Ⅲ (both P < 0.01). Conclusion. The patients with AD have LV diastolic dysfunction, which may be closely related to the pathogen esis of angina decubitus.

  16. Impact of Abdominal Follow-Up Sonography in Trauma Patients Without Abdominal Parenchymal Organ Lesion or Free Intraabdominal Fluid in Whole-Body Computed Tomography.

    Science.gov (United States)

    Schneck, Emmanuel; Koch, Christian; Borgards, Mara; Reichert, Martin; Hecker, Andreas; Heiß, Christian; Padberg, Winfried; Alejandre-Lafont, Enrique; Röhrig, Rainer; Krombach, Gabriele Anja; Weigand, Markus; Bernhard, Michael; Roller, Fritz Christian

    2017-02-01

    Purpose Patients suffering from severe blunt abdominal trauma are challenging because of their need for accurate diagnostic imaging and fast therapeutic action. Whole-body computed tomography (WBCT) is highly sensitive and represents the gold standard in the trauma room diagnostic setting. The aim of our study was to investigate the impact and therapy relevance of abdominal follow-up sonography (AFS) as part of the tertiary trauma survey (TTS) in patients without abdominal parenchymal organ lesions or free abdominal fluid in initial WBCT. Materials and Methods All adult patients without abdominal parenchymal organ lesions or free intraabdominal fluid in the initial WBCT examination, who received AFS within 24 hours after trauma, were included in this retrospective analysis between January 2008 and December 2011. Results 316 patients were analyzed (ISS 10 ± 8, NISS 13 ± 11) according to the inclusion criteria. Overall, only small amounts of free intraabdominal fluid were detected in AFS in 3 patients (0.9 %) and remained without therapeutic consequence. None of the patients died due to intraabdominal bleeding. Conclusion AFS as part of the TTS did not show additional benefits and had no impact on further treatment in patients without abdominal parenchymal organ lesions or free intraabdominal fluid in the initial WBCT examination. We conclude that AFS is not routinely required but should be performed if indicated on a clinical or laboratory basis because of its fast and less invasive character. Key points  · Seriously injured patients are challenging for medical imaging and treatment.. · Whole-body computed tomography is known for its high accuracy in trauma patients.. · Nonetheless, missed injuries are a major challenge in trauma patients.. · Therefore, follow-up ultrasound is often performed within the tertiary trauma survey.. · Follow-up ultrasound in patients with an inconspicuous abdominal computed tomography scan did not show any

  17. Blunt abdominal injury with rupture of giant hepatic cavernous hemangioma and laceration of the spleen.

    Science.gov (United States)

    Kang, Lung-Yun; Huang, Fong-Dee; Liu, Yuan-Yuarn

    2015-02-01

    A 41-year-old woman with blunt abdominal trauma due to a motor vehicle accident presented to our emergency department. The patient had a history of a giant hepatic cavernous hemangioma. Emergency exploratory laparotomy was performed for suspected intra-abdominal bleeding with abdominal compartment syndrome, and more than 4 liters of blood and blood clots were removed. An active bleeding laceration (5 cm) of a hepatic cavernous hemangioma was detected in segment III of the liver. The bleeding was controlled by sutures, Teflon patches and tamponade. The abdomen was closed temporarily using the vacuum-assisted method. Because of the presence of persistent fresh blood through abdominal drainage at a rate of >1 L/h, splenectomy was performed to control the bleeding again by sutures and Teflon patches. Finally, the abdomen was closed using a biologic mesh. The patient was discharged home 30 days after trauma. Bleeding of trauma-caused hepatic hemangioma is rare, but splenic injury due to blunt abdominal trauma is common. An in-depth investigation is necessary to avoid second intervention.

  18. Electromyographic analysis of four popular abdominal exercises.

    Science.gov (United States)

    Piering, A W; Janowski, A P; Wehrenberg, W B; Moore, M T; Snyder, A C

    1993-01-01

    This study was designed to evaluate the effects of four specific sit-up exercises on muscular activity of the rectus abdominis. Pairs of surface electrodes were placed unilaterally on four quadrants of the rectus abdominis, delimited by tendinous inscriptions, in four male subjects. Electromyographic (EMG) recordings were taken while the subjects performed four different abdominal exercises. Each abdominal exercise was hypothesized to have a specific effect on one of the four quadrants of the rectus abdominis. The four exercises analyzed were: 1) long lying crunch, 2) bent knee crunch, 3) leg raise, and 4) vertical leg crunch. Analysis of the standardized EMG recordings demonstrated no significant differences in the mean muscle activity between the four different quadrants, in the mean muscle activity between the four different exercises, and in interactions between the exercises and the quadrants of the rectus abdominis. We conclude that none of the four abdominal exercises studied are specific for strengthening individual muscle quadrants of the rectus abdominis.

  19. Decompressive laparotomy for abdominal compartment syndrome

    Science.gov (United States)

    Kimball, E.; Malbrain, M.; Nesbitt, I.; Cohen, J.; Kaloiani, V.; Ivatury, R.; Mone, M.; Debergh, D.; Björck, M.

    2016-01-01

    Background The effect of decompressive laparotomy on outcomes in patients with abdominal compartment syndrome has been poorly investigated. The aim of this prospective cohort study was to describe the effect of decompressive laparotomy for abdominal compartment syndrome on organ function and outcomes. Methods This was a prospective cohort study in adult patients who underwent decompressive laparotomy for abdominal compartment syndrome. The primary endpoints were 28‐day and 1‐year all‐cause mortality. Changes in intra‐abdominal pressure (IAP) and organ function, and laparotomy‐related morbidity were secondary endpoints. Results Thirty‐three patients were included in the study (20 men). Twenty‐seven patients were surgical admissions treated for abdominal conditions. The median (i.q.r.) Acute Physiology And Chronic Health Evaluation (APACHE) II score was 26 (20–32). Median IAP was 23 (21–27) mmHg before decompressive laparotomy, decreasing to 12 (9–15), 13 (8–17), 12 (9–15) and 12 (9–14) mmHg after 2, 6, 24 and 72 h. Decompressive laparotomy significantly improved oxygenation and urinary output. Survivors showed improvement in organ function scores, but non‐survivors did not. Fourteen complications related to the procedure developed in eight of the 33 patients. The abdomen could be closed primarily in 18 patients. The overall 28‐day mortality rate was 36 per cent (12 of 33), which increased to 55 per cent (18 patients) at 1 year. Non‐survivors were no different from survivors, except that they tended to be older and on mechanical ventilation. Conclusion Decompressive laparotomy reduced IAP and had an immediate effect on organ function. It should be considered in patients with abdominal compartment syndrome. PMID:26891380

  20. Variation in the use of coronary angiography in patients with unstable angina is related to differences in patient population and availability of angiography facilities, without affecting prognosis

    NARCIS (Netherlands)

    A.J.M. van Miltenburg-van Zijl (Addy); M.L. Simoons (Maarten); P.M.M. Bossuyt (Patrick); T.R. Taylor (Thomas); M.J. Veerhoek

    1996-01-01

    textabstractOBJECTIVES: Examination of the difference in management strategies with respect to coronary angiography in patients with unstable angina pectoris, and the consequences of this difference on prognosis. DESIGN: Prospective registration of consecutive patients admitted to two different hosp