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Sample records for chronic total arterial

  1. Successful percutaneous coronary intervention for chronic total occlusion of right coronary artery in patient with dextrocardia.

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    Munawar, Muhammad; Hartono, Beny; Iskandarsyah, Kurniawan; Nguyen, Thach N

    2013-07-01

    Situs inversus with dextrocardia is rare congenital anomaly. Coronary artery disease in such patients is quite rare. We reported a 52-year-old man with dextrocardia and chronic total occlusion at the proximal right coronary artery just after conus branch and severe stenosis at the proximal left anterior descending artery. He underwent successful percutaneous coronary intervention with stenting of total occluded right coronary artery and simultaneously stenting of the proximal left anterior descending artery.

  2. Estimation of arterial and cardiopulmonary total peripheral resistance baroreflex gain values: validation by chronic arterial baroreceptor denervation.

    Science.gov (United States)

    Mukkamala, Ramakrishna; Kim, Jong-Kyung; Li, Ying; Sala-Mercado, Javier; Hammond, Robert L; Scislo, Tadeusz J; O'Leary, Donal S

    2006-05-01

    Feedback control of total peripheral resistance (TPR) by the arterial and cardiopulmonary baroreflex systems is an important mechanism for short-term blood pressure regulation. Existing methods for measuring this TPR baroreflex mechanism typically aim to quantify only the gain value of one baroreflex system as it operates in open-loop conditions. As a result, the normal, integrated functioning of the arterial and cardiopulmonary baroreflex control of TPR remains to be fully elucidated. To this end, the laboratory of Mukkamala et al. (Mukkamala R, Toska K, and Cohen RJ. Am J Physiol Heart Circ Physiol 284: H947-H959, 2003) previously proposed a potentially noninvasive technique for estimating the closed-loop (dimensionless) gain values of the arterial TPR baroreflex (GA) and the cardiopulmonary TPR baroreflex (GC) by mathematical analysis of the subtle, beat-to-beat fluctuations in arterial blood pressure, cardiac output, and stroke volume. Here, we review the technique with additional details and describe its experimental evaluation with respect to spontaneous hemodynamic variability measured from seven conscious dogs, before and after chronic arterial baroreceptor denervation. The technique was able to correctly predict the group-average changes in GA and GC that have previously been shown to occur following chronic arterial baroreceptor denervation. That is, reflex control by the arterial TPR baroreflex was virtually abolished (GA = -2.1 +/- 0.6 to 0.3 +/- 0.2; P TPR baroreflex more than doubled (GC = -0.7 +/- 0.4 to -1.8 +/- 0.2; P TPR baroreflex functioning in both humans and animals in health and disease.

  3. Differentiation of acute total occlusion of coronary artery from chronic total occlusion in coronary computed tomography angiography

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    Kwag, Hyon Joo [Sungkyunkwan Univ. School of Medicine, Seoul (Korea, Republic of)

    2012-08-15

    To compare the features of coronary computed tomography angiography (CCTA) imaging of the patients with acute total occlusion (ATO) of coronary artery with those of chronic total occlusion (CTO). CCTA of 26 patients with complete interruption of the coronary artery in CCTA and occlusion in conventional coronary angiography, were retrospectively analyzed. Discrimination between the ATO group (n = 11, patients with non ST elevation myocardial infarction or unstable angina) and the CTO group (n = 15, patients with stable angina or nonspecific symptom) was arbitrarily determined by clinical diagnosis. Lesion length, remodeling index (RI), plaque density measured by Hounsfield units (HU), plaque composition, percentage attenuation drop across the lesion, and presence of myocardial thinning were evaluated. Comparisons between the ATO and CTO groups revealed significantly shorter lesion length in the ATO group (0.40 cm vs. 1.87 cm, respectively; p = 0.001), and significantly higher RI (1.56 vs. 1.10, respectively; p = 0.004). Plaque density of the ATO group was lower (37.0 HU vs. 104.7 HU, respectively; p < 0.001) and non calcified plaque was frequently seen in the ATO group (72.7% vs. 26.7%, respectively; p = 0.02). Percentage attenuation drop across the lesion was lower for the ATO group (10.92% vs. 25.44%, respectively; p = 0.005). Myocardial thinning was exclusively observed in the CTO group (seven of 15 patients, p = 0.01). CCTA shows various statistically significant differences between the ATO and CTO groups.

  4. Prevalence and impact of a chronic total occlusion in a non-infarct-related artery on long-term mortality in diabetic patients with ST elevation myocardial infarction

    NARCIS (Netherlands)

    Claessen, B.E.P.M.; Hoebers, L.P.; van der Schaaf, R.J.; Kikkert, W.J.; Engstrom, A.E.; Vis, M.M.; Baan, J.,Jr; Koch, K.T.; Meuwissen, M.; van Royen, N.; de Winter, R.J.; Tijssen, J.G.P.; Piek, J.J.; Henriques, J.P.S.

    2010-01-01

    Background Recently, a chronic total occlusion (CTO) in a non-infarct-related artery (non-IRA) and not multivessel disease (MVD) alone was identified as an independent predictor of mortality after ST elevation myocardial infarction (STEMI). Patients with diabetes mellitus (DM) constitute a patient g

  5. Guidewires used in first intentional single wiring strategy for chronic total occlusions of the left anterior descending coronary artery

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    Yasser S Nassar

    2013-01-01

    Full Text Available Background: Percutaneous coronary intervention (PCI for chronic total occlusion (CTO of the left anterior descending (LAD specifically is associated with improved long-term 5 year survival as compared to PCI failure.The procedure is associated with usage of different types of dedicated guidewires by simple or complex techniques aiming to reopen the occluded artery. Aim: To describe types and outcome of guidewires used in LAD-CTO utilizing a first intentional single wiring simple strategy. Methods: A single center prospective registry for all consecutive patients with a PCI attempt to a native LAD CTO. The initial strategy for lesion crossing was Single wiring. Results: A total of 30 patients with LAD CTO lesions (100%, were recorded. Mean age was 71.6 + 15 years, 77% were Males, risk factors Hypertension in 63%, Diabetes 27%, Dyslipidemia 57%, smoking 40%, hereditary in 13% of patients. Isolated guidewire (GW success rate was very high 93%. Single wiring was the prevailing technique used in 97% of successfull lesions (83% of total cases while only 3% were by multiple wiring techniques. Successful single antegrade wiring represented 63% with a GW success rate of 92% of cases. Successful single retrograde wiring represented 13% with a GW success rate of 67%. Successful Crossing GW types in our patients were 44% Soft Tapered GWs; fielder XT (44%, 36% were Soft Non Tapered Pilot 50 (28%, whisper (8%, while 16% were Stiff Non tapered GWs; Miracle 12 (8%, Miracle 6 (4%, Miracle 3 (4%, and 4% were Stiff Tapered GWs; Progress 200 (4%. Conclusions: Single wiring as an initial strategy in PCI for LAD-CTO lesions has a high success rate and is associated with a 44% majority of Soft Tapered GWs, 36% Soft Non Tapered, 16% Stiff Non tapered GWs, and 4% Stiff Tapered GWs.

  6. 5-hydroxytryptamine (5-HT) reduces total peripheral resistance during chronic infusion: direct arterial mesenteric relaxation is not involved.

    Science.gov (United States)

    Davis, Robert Patrick; Pattison, Jill; Thompson, Janice M; Tiniakov, Ruslan; Scrogin, Karie E; Watts, Stephanie W

    2012-05-06

    Serotonin (5-hydroxytryptamine; 5-HT) delivered over 1 week results in a sustained fall in blood pressure in the sham and deoxycorticosterone acetate (DOCA)-salt rat. We hypothesized 5-HT lowers blood pressure through direct receptor-mediated vascular relaxation. In vivo, 5-HT reduced mean arterial pressure (MAP), increased heart rate, stroke volume, cardiac index, and reduced total peripheral resistance during a 1 week infusion of 5-HT (25 µg/kg/min) in the normotensive Sprague Dawley rat. The mesenteric vasculature was chosen as an ideal candidate for the site of 5-HT receptor mediated vascular relaxation given the high percentage of cardiac output the site receives. Real-time RT-PCR demonstrated that mRNA transcripts for the 5-HT2B, 5-HT1B, and 5-HT7 receptors are present in sham and DOCA-salt superior mesenteric arteries. Immunohistochemistry and Western blot validated the presence of the 5-HT2B, 5- HT1B and 5-HT7 receptor protein in sham and DOCA-salt superior mesenteric artery. Isometric contractile force was measured in endothelium-intact superior mesenteric artery and mesenteric resistance arteries in which the contractile 5- HT2A receptor was antagonized. Maximum concentrations of BW-723C86 (5- HT2B agonist), CP 93129 (5-HT1B agonist) or LP-44 (5-HT7 agonist) did not relax the superior mesenteric artery from DOCA-salt rats vs. vehicle. Additionally, 5-HT (10-9 M to 10-5 M) did not cause relaxation in either contracted mesenteric resistance arteries or superior mesenteric arteries from normotensive Sprague- Dawley rats. Thus, although 5-HT receptors known to mediate vascular relaxation are present in the superior mesenteric artery, they are not functional, and are therefore not likely involved in a 5-HT-induced fall in total peripheral resistance and MAP.

  7. OCLUSIÓN TOTAL CRÓNICA DEL TRONCO CORONARIO IZQUIERDO Y ESTENOSIS DE LA CORONARIA DERECHA / Chronic total occlusion of the left main coronary artery and right coronary artery stenosis

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    Roberto Bermúdez Yera

    2012-01-01

    Full Text Available ResumenLa estenosis del tronco coronario izquierdo se encuentra entre el 3-5 % de los pacientes a los que se les realiza una coronariografía, pero su oclusión total es rara (0,05-0,1 %. En este artículo presentamos el caso de un paciente de 42 años con oclusión total de este vaso, que presentaba además, una estenosis de 85 % en la arteria coronaria derecha y fue revascularizado quirúrgicamente de forma exitosa. Se implantaron 3 injertos, mamaria a la descendente anterior, y vena safena a una obtusa marginal y a la descendente posterior. Se presentan las imágenes angiográficas y de la cirugía, y se comentan las alternativas terapéuticas, donde lo más importante es individualizar el tratamiento, con el objetivo de brindar la mejor opción a cada paciente en particular. Para lograrlo es imprescindible una excelente relación del equipo de trabajo donde, como en este caso, el cardiólogo intervencionista y el cirujano cardiovascular se complementen, para el bien del paciente. AbstractThe left main coronary artery stenosis is found in 3-5 % of patients who undergo coronary angiography, but total occlusion is rare (0,05-0,1 %. In this article, the case of a 42-year-old patient with chronic total occlusion of the left main coronary artery is presented. This patient, who also had 85 % stenosis of the right coronary artery, was surgically and successfully revascularized. 3 grafts were implanted: mammary artery to the anterior descending artery and saphenous vein to the obtuse marginal and posterior descending artery. The angiographic and surgery images are shown, and treatment options are discussed, where the most important thing is to individualize treatment in order to provide the best option for each patient. It order to achieve this, an excellent team work is essential, in which, as in this case, the interventional cardiologist and cardiovascular surgeon complement each other for the good of the patient.

  8. Strategies for Successful Percutaneous Revascularization of Chronic Total Occlusion of the Femoropopliteal Arteries When the Antegrade Passage of a Guide Wire Fails

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    Lee, Hui Jin; Park, Sang Woo; Chang, So Il; Jeon, Hae Jeong; Park, Jeong Hee [Konkuk University Hospital, Konkuk University School of Medicine, Seoul (Korea, Republic of)

    2012-07-15

    To evaluate the efficacy of various strategies for revascularization of chronic total occlusion of femoropopliteal arteries when the guide wire does not pass in an anterograde direction. Twenty-four patients with totally occluded femoropopliteal arteries (mean occlusion length 13.75 cm; range, 6-22 cm) were treated by using a retrograde approach and two novel catheters. After successful recanalization or reentry, balloon angioplasty followed by stent placement was performed to complete the revascularization. In 16 cases in which to cross the occlusion via intraluminal or subintimal route was failed, we used Frontrunner catheters in five cases and Outback catheters in 11 cases. In eight cases in which to reenter after subintimal passage of the guide wire was failed, we used Outback catheters. Successful recanalization was achieved intraluminally or subintimally in all cases. One perforation occurred during subintimal passage of the guide wire that was controlled by recanalization of another subintimal tract. There were no cases of distal thromboembolism or other complications. A retrograde approach and using the Frontrunner and Outback catheters are safe and effective for successful revascularization of chronic total occlusion of femoropopliteal arteries. In particular, they are useful when the initial antegrade attempts at recanalization have failed.

  9. 5-hydroxytryptamine (5-HT) reduces total peripheral resistance during chronic infusion: direct arterial mesenteric relaxation is not involved

    OpenAIRE

    Davis, Robert Patrick; Pattison, Jill; Janice M Thompson; Tiniakov, Ruslan; Scrogin, Karie E.; Watts, Stephanie W.

    2012-01-01

    Serotonin (5-hydroxytryptamine; 5-HT) delivered over 1 week results in a sustained fall in blood pressure in the sham and deoxycorticosterone acetate (DOCA)-salt rat. We hypothesized 5-HT lowers blood pressure through direct receptor-mediated vascular relaxation. In vivo, 5-HT reduced mean arterial pressure (MAP), increased heart rate, stroke volume, cardiac index, and reduced total peripheral resistance during a 1 week infusion of 5-HT (25 µg/kg/min) in the normotensive Sprague Dawley rat. T...

  10. Comparison of drug eluting stent implantation with coronary artery bypass surgery in the treatment of patients with chronic total occlusion and multiple vessel disease

    Institute of Scientific and Technical Information of China (English)

    LIU Wei; ZHU Xiao-Ling; MA Chang-sheng; KANG Jun-ping; DU Xin; CHEN Fang; ZHOU Yu-jie; L(U) Shu-zheng; HUANG Fang-jiong; GU Cheng-xiong

    2011-01-01

    Background In patients with chronic total occlusion (CTO) and multivessel coronary artery disease, the comparison of surgical and the percutaneous revascularization strategies has rarely been conducted. The aim of this study was to compare long term clinical outcomes of drug eluting stent (DES) implantation with coronary artery bypass surgery (CABG)in the patients with CTO and multivessel disease.Methods From a prospective registry of 6000 patients in our institution, we included patients with CTO and multivessel coronary artery disease who underwent either CABG (n=679) or DES (n=267) treatment. Their propensity risk score was used for adjusting baseline differences.Results At a median follow-up of three years, propensity score adjusted Cox regression analysis showed that the rate of major adverse cardiac cerebrovascular events (MACCE) was lower in CABG group (12.7% vs. 24.3%, hazard ratio (HR) 1.969, 95% Cl 1.219-3.179, P=0.006) mainly due to lower rate of target vessel revascularization in CABG group than in DES group (3.1% vs. 17.2%, HR 16.14, 95% CI 5.739-45.391, P <0.001). The incidence of cardiac death or myocardial infarction (composite end point) was not significantly different between these two groups. On multivariate analysis, the significant predictors of MACCE were only the type of revascularization. Age, left ventricular ejection fraction (LVEF), and complete revascularization were identified as significant predictors of composite end points.Conclusions Our study shows that in patients with CTO and multivessel coronary disease, DES can offer comparable long term outcomes in cardiac death and myocardial infraction free survival in comparison with CABG. However, there is an increased rate of MACCE which results from more repeat revascularizations. Obtaining a complete revascularization is crucial for decreasing adverse cardiac events.

  11. Impact of Percutaneous Coronary Intervention for Chronic Total Occlusion in Non-Infarct-Related Arteries in Patients With Acute Myocardial Infarction (from the COREA-AMI Registry).

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    Choi, Ik Jun; Koh, Yoon-Seok; Lim, Sungmin; Choo, Eun Ho; Kim, Jin Jin; Hwang, Byung-Hee; Kim, Tae-Hoon; Seo, Suk Min; Kim, Chan Joon; Park, Mahn-Won; Shin, Dong Il; Choi, Yun-Seok; Park, Hun-Jun; Her, Sung-Ho; Kim, Dong-Bin; Park, Chul Soo; Lee, Jong-Min; Moon, Keon Woong; Chang, Kiyuk; Kim, Hee Yeol; Yoo, Ki-Dong; Jeon, Doo Soo; Chung, Wook-Sung; Ahn, Youngkeun; Jeong, Myung Ho; Seung, Ki-Bae; Kim, Pum-Joon

    2016-04-01

    Chronic total occlusion (CTO) in a non-infarct-related artery (IRA) is an independent predictor of clinical outcomes in patients with acute myocardial infarction (AMI). This study evaluated the impact of successful percutaneous coronary intervention (PCI) for CTO of a non-IRA on the long-term clinical outcomes in patients with AMI. A total of 4,748 patients with AMI were consecutively enrolled in the Convergent Registry of Catholic and Chonnam University for AMI registry from January 2004 to December 2009. We enrolled 324 patients with CTO in a non-IRA. To adjust for baseline differences, propensity matching (96 matched pairs) was used to compare successful PCI and occluded CTO for the treatment of CTO in non-IRA. The primary clinical end points were all-cause mortality and a composite of the major adverse cardiac events, including cardiac death, MI, stroke, and any revascularization during the 5-year follow-up. Patients who received successful PCI for CTO of non-IRA had lower rates of all-cause mortality (16.7% vs 32.3%, hazard ratio 0.459, 95% CI 0.251 to 0.841, p = 0.012) and major adverse cardiac events (21.9% vs 55.2%, hazard ratio 0.311, 95% CI 0.187 to 0.516, p <0.001) compared with occluded CTO group. Subgroup analyses revealed that successful PCI resulted in a better mortality rate in patients with normal renal function compared to patients with chronic kidney disease (p = 0.010). In conclusion, successful PCI for CTO of non-IRA is associated with improved long-term clinical outcomes in patients with AMI.

  12. Choice PTTM guidewire for recanalization of total occlusive coronary arteries

    Institute of Scientific and Technical Information of China (English)

    OUYANG Ping; HE Shi-hua; CHEN Wei-Kang; WOO Carrie

    2002-01-01

    Objective: To evaluate the therapeutic effects of 0. 014″Choice PTTM wire in chronic total occlusion angioplasty. Methods: Balloon angioplasty was attempted in 25 arteries with chronic total occlusion,with the mean time of occlusion of 17±13 months (ranging from 2 to 84 months) and mean length of 14±6mm (ranging from 5 to 25 mm). The morphology of the lesions included bridging collaterals (4 cases), calcification (3 cases) and major side branch at the lesion (4 cases) . Choice PTTM wire was used electively in all the cases. Results: Lesion was crossed successfully in 92% (23/25) cases, without incidences of dissection of the coronary artery with subintimal entry. Balloon angioplasy and stenting (n=21) were performed with good immediate angiograghic results. Acute myocardial infarction or death occurred in none of the patients.Conclusion Successful recanalization of chronic coronary total occlusions using Choice PTTM wire can be achieved with good safety.

  13. Arterial hypertension and chronic liver disease

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    Henriksen, Jens Henrik Sahl; Møller, S

    2005-01-01

    This review looks at the alterations in the systemic haemodynamics of patients with chronic liver disease (cirrhosis) in relation to essential hypertension and arterial hypertension of renal origin. Characteristic findings in patients with cirrhosis are vasodilatation with low overall systemic...... the development of chronic liver disease, and arterial hypertension is rarely manifested in patients with cirrhosis, even in those with renovascular disease and high circulating renin activity. There is much dispute as to the understanding of homoeostatic regulation in cirrhotic patients with manifest arterial...

  14. Pathology of Coronary Chronic Total Occlusion

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    Kenichi Sakakura

    2016-06-01

    Full Text Available There is an increasing need for percutaneous revascularization procedures of coronary Chronic Total Occlusion (CTO, because many patients with severe coronary artery disease have limited options for revascularization. Although the success rate of percutaneous revascularization of CTOs was unsatisfactory from the 1990s to the 2000s, recent technological advances in interventional strategies have improved the success rate to 85%. Detailed histological assessment of human autopsy studies of CTO has contributed significantly to the refinement in Percutaneous Coronary Intervention (PCI techniques and device development. We have recently reported the pathological findings and characteristics of CTOs that occur in different clinical scenarios. In this review, we discuss the pathology of CTOs to facilitate greater understanding of revascularization strategies for CTOs.

  15. Endovascular Treatment of Totally Occluded Superior Mesenteric Artery by Retrograde Crossing via the Villemin Arcade

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    Ferro, Carlo; Rossi, Umberto G., E-mail: urossi76@hotmail.com; Seitun, Sara; Bovio, Giulio [IRCCS San Martino University Hospital-IST-National Institute for Cancer Research, Department of Radiology and Interventional Radiology (Italy); Fornaro, Rosario [IRCCS San Martino University Hospital-IST-National Institute for Cancer Research, Department of Surgery (Italy)

    2013-06-15

    Chronic mesenteric ischemia (CMI) is a rare disorder that is commonly caused by progressive atherosclerotic stenosis or occlusion of one or more mesenteric arteries. Endovascular treatment for symptomatic CMI represents a viable option, especially in high-operative risk patients. We report a case of acute symptomatic CMI with chronic totally occlusion of the superior mesenteric artery (SMA) associated with significant stenosis of celiac trunk (CT) and inferior mesenteric artery (IMA) that underwent endovascular treatment of all the three mesenteric arteries: stenting of CT and IMA stenosis, and recanalization of the SMA occlusion by retrograde crossing via the Villemin arcade.

  16. Avanços nos materiais e no tratamento endovascular de oclusões arteriais crônicas totais: um relato de caso Advances in materials and endovascular treatment of chronic total arterial occlusions: a case report

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    Daniel Queiroz Neves

    2012-09-01

    Full Text Available As oclusões arteriais crônicas totais com forte componente cálcico são ainda nos dias atuais, um fator muitas vezes limitante para o tratamento endovascular devido à dificuldade em transpor estas lesões com fios-guia e cateteres habitualmente utilizados. Revisamos a literatura e descrevemos um caso de tratamento endovascular de uma oclusão total de artéria ilíaca externa, onde o uso de novos materiais desenvolvidos especificamente para o tratamento deste tipo de lesão foi determinante para o sucesso do caso.Chronic arterial occlusions with great calcium component are usually a factor of limitation to endovascular treatment to the difficulty to transpose these lesions with guidewires and catheters commonly used. We reviewed the literature and described a case of endovascular treatment of a total occlusion of external iliac artery, where the use of new materials developed specifically to the treatment of such injuries was critical to the success of the case.

  17. Total Arterial Revascularization with Internal Mammary Artery or Radial Artery Graft Configuration

    Institute of Scientific and Technical Information of China (English)

    2005-01-01

    To investigate the clinical use of π graft in total arterial revascularization and its outcomes, a retrospective analysis of 23 patients out of 1000 patients undergoing total arterial coronary bypass surgery with a π graft between September 1994 and December 2004 was performed. In the selected patients for the management of triple vessel disease with middle diagonal/intermediate ramus disease such that a skip with the left internal mammary artery (LIMA) or radial artery (RA),the main stem of π graft, to the left anterior descending coronary artery (LAD) will not work and the right internal mammary artery (RIMA) or right gastroepiploic artery (RGEA) cannot pick up the diagonal/intermediate ramus, hence the LAD and diagonal/intermediate ramus were grafted with a mini Y graft using the distal segment of LIMA, RIMA, RA or RGEA, together with the bilateral internal mammary artery (BIMA) or LIMA-RA T graft to compose π graft. Twenty-three patients (18 males, 5 females) underwent the π graft procedure. There were no deaths or episodes of myocardial infarction, stroke, and deep sternal wound infection. One patient required reopening for controlling bleeding. Until the end of 2004, during a mean follow-up of 81.0 ±28.4 months, no angina needing re-intervention or operative therapy or coronary related death occurred. In conclusion, in patients with specific coronary artery anatomy/stenosis, the BIMA (sometimes LIMA with RA or RGEA) π graft can be successfully performed for total arterial revascularization with good midterm outcomes.

  18. Alcohol septal ablation for hypertrophic obstructive cardiomyopathy in a patient with a chronic total occlusion of the right coronary artery: “beware of collateral damage”

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    de Hemptinne, Quentin; Picard, Fabien

    2017-01-01

    Alcohol septal ablation (ASA) is an effective semi-invasive alternative to surgical myectomy in selected patients for the management of severely symptomatic and drug-refractory hypertrophic obstructive cardiomyopathy (HOCM). One contraindication of this procedure is the presence of collateral flow originating from the target septal perforator to a remote myocardial territory. In such circumstances, ethanol injection could cause remote non-target myocardial necrosis in the collateralized territory. Percutaneous revascularization of the collateralized vessel prior to ASA might cope with this contraindication by restoring normal antegrade flow in the occluded artery. We report a case that illustrates the feasibility and efficacy of such strategy. PMID:28164017

  19. Totally thrombosed giant anterior communicating artery aneurysm

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    V R Roopesh Kumar

    2015-01-01

    Full Text Available Giant anterior communicating artery aneurysmsarerare. Apatient presented with visual dysfunction, gait ataxia and urinary incontinence. MRI showed a giant suprasellar mass.At surgery, the lesion was identified as being an aneurysm arising from the anterior communicating artery.The difficulty in preoperative diagnosis and relevant literature are reviewed.

  20. Comparison of five-year outcomes of patients with and without chronic total occlusion of noninfarct coronary artery after primary coronary intervention for ST-segment elevation acute myocardial infarction.

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    Tajstra, Mateusz; Gasior, Mariusz; Gierlotka, Marek; Pres, Damian; Hawranek, Michał; Trzeciak, Przemysław; Lekston, Andrzej; Polonski, Lech; Zembala, Marian

    2012-01-15

    The aim of the present study was to evaluate the effect of concurrent chronic total occlusion (CTO) in a noninfarct-related artery (IRA) on the long-term prognosis in patients with ST-segment elevation myocardial infarction and multivessel coronary disease. Of 1,658 consecutive patients with ST-segment elevation myocardial infarction, 666 with multivessel coronary disease who underwent percutaneous coronary intervention from 1999 to 2004 were included in the present analysis. The patients were divided into 2 groups: no CTO and CTO. The first group included 462 patients without CTO (69%) and the second group included 204 patients with CTO in a non-IRA (31%). The in-hospital mortality rate was 6.3% and 21.1% (p < 0.0001) and the 5-year mortality rate was 22.5% and 40.2% (p < 0.0001) for the no-CTO and CTO patients, respectively. Multivariate analysis revealed that after correction for baseline differences CTO in a non-IRA was a strong, independent predictor of 5-year mortality in patients undergoing percutaneous coronary intervention (hazard ratio 1.85; 95% confidence interval 1.35 to 2.53; p = 0.0001). In conclusion, the presence of CTO in a non-IRA in patients with ST-segment elevation myocardial infarction and multivessel coronary disease is a strong and independent risk factor for greater 5-year mortality.

  1. 腔内血管成形术治疗髂动脉长段慢性完全闭塞性病变%Endovascular angioplasty for the treatment of long iliac artery chronic total occlusions

    Institute of Scientific and Technical Information of China (English)

    叶开创; 施慧华; 刘光; 蒋米尔; 殷敏毅; 陆信武; 李维敏; 黄英; 黄新天; 陆民; 刘晓兵; 赵海光

    2011-01-01

    目的 评价腔内血管成形术治疗髂动脉长段慢性完全闭塞性病变(CTO)的可行性、有效性及安全性.方法 回顾性分析2006年1月至2010年12月经腔内血管成形术治疗的病变长度>5 cm的髂动脉CTO患者139例(157条患肢)的临床资料.其中男性93例(105条患肢),女性46例(52条患肢);年龄50 ~96岁,平均年龄(77±10)岁.TASCⅡ分型:B型18例,C型89例,D型32例.采用左肱动脉和(或)股动脉穿刺经内膜下或血管内行髂动脉闭塞的球囊血管成形联合支架植入术治疗.结果 技术成功率96.2% (151/157).踝肱指数由术前的0.42±0.19上升到术后的0.81±0.26.随访6~53个月,平均随访(30±7)个月,髂动脉支架畅通率94.1% (111/118),7例发生支架内再狭窄或闭塞,无髂动脉破裂、支架移位、穿刺动脉假性动脉瘤及动静脉瘘的发生.结论 腔内血管成形术治疗髂动脉长段CTO安全、有效,术后支架通畅率高,联合肱动脉和股动脉双向穿刺技术能够显著提高技术成功率.%Objective To evaluate the effectiveness,safety and feasibility of endovascular angioplasty in treating long iliac artery chronic total occlusions (CTO).Methods The clinical data from a consecutive series of patients with long ( > 5 cm) iliac artery CTO who treated by endovascular angioplasty from January 2006 to December 2010 was retrospectively analyzed.There were 139 patients ( 157 limbs) with long iliac artery CTO treated by endovascular angioplasty in this study [ male 93 and female 46,mean age (77 ± 10) years].According to TASC Ⅱ classification,there were 18 patients in type B,89 patients in type C and 32 patients in type D.Recanalization of the occluded lesions was attempted with the left brachial and/or femoral access.Results The ankle brachial index increased from 0.42 ± O.19 before treatment to 0.81 ±0.26 after treatment.The rate of technical success was 96.2% (151/157) and the patency rate of iliac artery was 94.1% (111

  2. The impact of a chronic total coronary occlusion on clinical outcome

    NARCIS (Netherlands)

    Hoebers, L.P.C.

    2016-01-01

    Ever since it was possible to view the status of the coronary arteries through angiography in 1958, it is known that mortality increases with the severity and extent of coronary artery disease (CAD). Multivessel disease (MVD) is present in more than half of the patients with CAD and a chronic total

  3. Hormones and arterial stiffness in patients with chronic kidney disease.

    Science.gov (United States)

    Gungor, Ozkan; Kircelli, Fatih; Voroneanu, Luminita; Covic, Adrian; Ok, Ercan

    2013-01-01

    Cardiovascular disease constitutes the major cause of mortality in patients with chronic kidney disease. Arterial stiffness is an important contributor to the occurrence and progression of cardiovascular disease. Various risk factors, including altered hormone levels, have been suggested to be associated with arterial stiffness. Based on the background that chronic kidney disease predisposes individuals to a wide range of hormonal changes, we herein review the available data on the association between arterial stiffness and hormones in patients with chronic kidney disease and summarize the data for the general population.

  4. Chronic hypoxia during gestation enhances uterine arterial myogenic tone via heightened oxidative stress.

    Directory of Open Access Journals (Sweden)

    Daliao Xiao

    Full Text Available Chronic hypoxia during gestation has profound adverse effects on the adaptation of uteroplacental circulation in pregnancy. Yet, the underlying mechanisms are not fully understood. The present study tested the hypothesis that enhanced production of reactive oxygen species (ROS in uterine arteries plays a critical role in the maladaptation of uterine circulation associated with chronic hypoxia. Uterine arteries were isolated from nonpregnant and near-term pregnant sheep maintained at sea level (~300 m or exposed to high-altitude (3801 m hypoxia for 110 days. Hypoxia significantly increased ROS production in uterine arteries of pregnant, but not nonpregnant, sheep. This was associated with a significant increase in NADPH oxidase (Nox 2, but not Nox1 or Nox4, protein abundance and total Nox activity in uterine arteries of pregnant animals. Chronic hypoxia significantly increased pressure-dependent uterine arterial myogenic tone in pregnant sheep, which was abrogated by a Nox inhibitor apocynin. Additionally, the hypoxia-induced increase in myogenic reactivity of uterine arteries to phorbol 12,13-dibutyrate in pregnant sheep was blocked by apocynin and tempol. In consistence with the myogenic responses, the hypoxia-mediated down-regulation of BKCa channel activity in uterine arteries of pregnant animals was reversed by apocynin. The findings suggest that heightened oxidative stress in uterine arteries plays a key role in suppressing the BKCa channel activity, resulting in increased myogenic reactivity and maladaptation of uteroplacental circulation caused by chronic hypoxia during gestation.

  5. Total Arterial Revascularization: Bypassing Antiquated Notions to Better Alternatives for Coronary Artery Disease

    Science.gov (United States)

    Samak, Mostafa; Fatullayev, Javid; Sabashnikov, Anton; Zeriouh, Mohamed; Schmack, Bastian; Ruhparwar, Arjang; Karck, Matthias; Popov, Aron-Frederik; Dohmen, Pascal M.; Weymann, Alexander

    2016-01-01

    Total arterial revascularization is the leading trend in coronary artery bypass grafting (CABG) for the treatment of coronary artery disease (CAD). Adding to its superiority to vein conduits, arteries allow for a high degree of versatility and long-term patency, while minimizing the need for reintervention. This is especially important for patients with multi-vessel coronary artery disease, as well as young patients. However, arterial revascularization has come a long way before being widely appreciated, with some yet unresolved debates, and advances that never cease to impress. In this review, we discuss the evolution of this surgical technique and its clinical success, as well as its most conspicuous limitations in light of accumulated published date from decades of experience. PMID:27698339

  6. ARTERIAL STIFFNESS AND CHRONIC KIDNEY DISEASE: CAUSES AND CONSEQUENCES

    Directory of Open Access Journals (Sweden)

    J. D. Kobalava

    2015-09-01

    Full Text Available Chronic kidney disease (CKD is associated with increased cardiovascular risk. CKD is characterized by accelerated aging of vessels in which the age-related arterial stiffness increase is exacerbated by a number of uremia-related processes. Increased arterial stiffness is associated with structural and functional disorders, as well as with the increase in cardiovascular mortality in patients with CKD. Increased arterial stiffness is diagnosed at an early stage of CKD. Modern understanding of the mechanisms of increased risk of cardiovascular complications in CKD, the factors contributing to the loss of elasticity of the arteries, arterial stiffness increase consequences are analyzed. Data illustrating the twoway interaction between CKD and arterial stiffness and mechanisms of accelerated progression of arterial stiffness in CKD are presented.

  7. 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.

  8. Chronic intestinal ischaemia: measurement of the total splanchnic blood flow.

    Science.gov (United States)

    Zacho, Helle D

    2013-04-01

    A redundant collateral network between the intestinal arteries is present at all times. In case of ischaemia in the gastrointestinal tract, the collateral blood supply can develop further, thus accommodating the demand for oxygen even in the presence of significant stenosis or occlusion of the intestinal arteries without clinical symptoms of intestinal ischaemia. Symptoms of ischemia develop when the genuine and collateral blood supply no longer can accommodate the need for oxygen. Atherosclerosis is the most common cause of obliteration in the intestinal arteries. In chronic intestinal ischaemia (CII), the fasting splanchnic blood flow (SBF) is sufficient, but the postprandial increase in SBF is inadequate and abdominal pain will therefore develop in relation to food intake causing the patient to eat smaller meals at larger intervals with a resulting weight loss. Traditionally, the CII-diagnosis has exclusively been based upon morphology (angiography) of the intestinal arteries; however, substantial discrepancies between CII-symptoms and the presence of atherosclerosis/stenosis in the intestinal arteries have been described repeatedly in the literature impeding the diagnosis of CII. This PhD thesis explores a method to determine the total SBF and its potential use as a diagnostic tool in patients suspected to suffer from CII. The SBF can be measured using a continuous infusion of a tracer and catheterisation of a hepatic vein and an artery. By measuring the SBF before and after a standard meal it is possible to assess the ability or inability to enhance the SBF and thereby diagnosing CII. In Study I, measurement of SBF was tested against angiography in a group of patients suspected to suffer from CII due to pain and weight loss. A very good agreement between the postprandial increase in SBF and angiography was found. The method was validated against a well-established method independent of the hepatic extraction of tracer using pAH in a porcine model (study II

  9. A PROSPECTIVE STUDY OF PULMONARY ARTERIAL HYPERTENSION IN CHRONIC OBSTRUCTIVE PULMONARY DISEASES

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    Saptanaga Kumar

    2015-04-01

    Full Text Available BACKGROUND : Chronic obstructive pulmonary disease (COPD is a heterogeneous, multisystem disease with complexities that extend far beyond airway obstruction. OBJECTIVES : The purpose of this prospective study is to determine pulmonary arterial hypertension in chronic obstructi ve pulmonary disease non - invasively. METHODS : In this descriptive, prospective, observational, cross sectional study, all patients who presented to the department of Medicine and Respiratory medicine, during this study period of 12 months from January 2013 - December 2014 in Chennai were included. RESULTS : Total number of males in the study is 90(90%, females in the study is 10 (10%. Number of patients in the age group 25 - 35years was 06 (6%, 36 - 45years was 38(38%, 46 - 55 years was 30(30, number of patie nts in 56 - 65 years was 14 (14 and number of patients in the age group 66 - 75 years was 12(12. total number of males smoking in the study is 55(61.11% and total number of non - smokers were 35(38.88, total number of female smoking in the study is 1(10% an d total number of non - smokers were 9(90%. Pulmonary arterial systolic pressure in present study, Mild pulmonary arterial hypertension was seen in 26(26%, Moderate pulmonary arterial hypertension was seen in 54(54%, Severe pulmonary arterial hypertension was seen in 20(20%. CONCLUSION : This study shows the prevalence of pulmonary arterial hypertension in COPD patients.

  10. Laser angioplasty of totally occluded arteries of the limb

    Science.gov (United States)

    Szopinski, Piotr; Hara, Marek; Noszczyk, Wojciech

    1996-03-01

    The authors summarize their experience in the use of Nd-YAG laser in chronic occlusion of lower limb arteries. Percutaneous transluminal laser angioplasty (PTLA) with laser-heated metal and sapphire tips were used as an adjuvant to conventional balloon angioplasty. In cases of reocclusions, endovascular stents were implanted. Laser recanalization was performed in 46 arteries (iliac, superficial femoral, and popliteal). Indications for the procedure were: limb salvage, claudication below 100 m, and temporal or rest pain. Initial clinical and hemodynamic improvement was observed in 37 (80%) patients. Four perforations occurred without clinical sequel. The one-year cumulative clinical patency was 27 (58%) of the 46 lesions. PTLA may be appropriate for high-risk patients, who are unsuitable for surgical reconstruction because of the concomitant diseases. The combination of laser recanalization and implantation of vascular stents may be a promising method in the management of limb ischemia.

  11. Internal iliac artery pseudoaneurysm in primary total hip arthroplasty

    Directory of Open Access Journals (Sweden)

    Sanjay Agarwala

    2016-01-01

    Full Text Available Vascular injury is one of the rare complications of primary total hip arthroplasty (THA. We report an unusual case of lobulated pseudoaneurysm arising from one of the branches of the left internal iliac artery during acetabulum preparation in THA, which was successfully treated with coil embolization and multidisciplinary care. After 6 years follow up, patient did not have any symptoms related to the hip replacement. We recommend that surgeons should be extremely cautious while drilling medial wall of the acetabulum for depth assessment. Aggressive multidisciplinary approach, including possible support from an interventional radiologist is required for the treatment of such vascular injuries.

  12. Acute effect of hydralazine administration on pulmonary artery hemodynamics in dogs with chronic heartworm disease.

    Science.gov (United States)

    Atkins, C E; Keene, B W; McGuirk, S M; Sato, T

    1994-02-01

    In an effort to better understand the role of vasodilators in the management of pulmonary hypertension associated with chronic heartworm disease (HWD), pulmonary hemodynamic measurements were obtained from 7 experimentally infected, anesthetized dogs before and after hydralazine administration (mean dose, 1.96 mg/kg of body weight). Five dogs were maintained on room air, while 2 were maintained on 100% oxygen during the hydralazine study. The hemodynamic effect of hydralazine in dogs with HWD was evaluated, using heart rate, cardiac index, mean pulmonary artery pressure, mean arterial pressure, total pulmonary resistance, total systemic resistance, total systemic resistance/total pulmonary resistance, left ventricular dP/dtmax, left ventricular end diastolic pressure, and left and right ventricular double products ([mean arterial pressure x heart rate] and [mean pulmonary artery pressure x heart rate], respectively). Responders were defined as those in which total pulmonary resistance decreased > or = 20% without an increase in mean pulmonary arterial pressure and in which heart rate increase was < or = 10%. Comparison was also made between maximal hemodynamic effect of hydralazine with that after 100% oxygen administration for 15 minutes to previously normoxemic dogs (n = 5). Significance was determined if P < 0.05, using the paired t-test. Hydralazine induced significant reductions in mean pulmonary and systemic arterial pressures and total pulmonary resistance, with no significant change in heart rate, cardiac index, total systemic resistance, left ventricular dP/dtmax, left ventricular end diastolic pressure, or right and left ventricular double products. Four (57%) of the 7 dogs studied were considered responders. Pretreatment cardiac index, mean pulmonary artery pressure, and total pulmonary resistance did not allow differentiation of responders from nonresponders.(ABSTRACT TRUNCATED AT 250 WORDS)

  13. Trombose arterial relacionada à artroplastia total de joelho: revisão de literatura Arterial thrombosis in total knee arthroplasty: a literature review

    Directory of Open Access Journals (Sweden)

    Ronald Fidelis Júnior

    2005-01-01

    Full Text Available As complicações arteriais após artroplastia total de joelho (ATJ são raras, no entanto a doença arterial oclusiva (DAO associada à osteoartrose crônica do joelho, pode representar um problema. Uma vez que as seqüelas podem ser desastrosas, a abordagem operatória da ATJ deveria ser diferente quando a DAO esteja presente. A maior parte dos casos referidos esteve atribuída aos seguintes fatores: uso de torniquete, manipulação operatória excessiva ou correção de contratura de flexão. A DAO é subestimada nos pacientes com osteoartrose e a maior parte dos casos ocorre em pacientes com evidências clínicas ou radiológicas de doença arterial. A avaliação vascular deveria ser considerada nestas situações. Alem disso, é difícil reconhecer e tratar prontamente um membro isquêmico no período pós-operatório de uma ATJ. Em que pese à pequena incidência da trombose arterial, é referido um alto risco de amputação. A revisão de literatura mostrou que a incidência referida de DAO em pacientes apresentando osteoartrose de joelho e aspectos da trombose arterial pós ATJ. Foram, ainda, identificados os fatores preditivos de complicações isquêmicas ateroscleróticas na ATJ. Lesões devidas ao trauma direto de artérias normais, levando aos pseudo-aneurismas, fístulas artério-venosas e sangramento não foram estudadas.Arterial complications after Total Knee Arthroplasty (TKA are quite rare, however, the arterial occlusive disease (AOD associated with chronic knee osteoarthrosis may represent a problem. Since the sequels can be disastrous, the surgical TKA approach should be different when AOD is present. Most of the cases reported have been attributed to the following factors: use of tourniquet; excessive intraop-erative manipulation; or the correction of a flexion contracture. AOD is underesti-mated among people with osteoarthrosis and most of cases occur among patients with previous clinical or radiological evidences of

  14. Role of radial artery in total arterial myocardial revascularization in coronary bypass surgery

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    Background Total arterial revascularization (TAR) was widely utilized in coronary artery bypass grafting (CABG) as a result of its better long-term effect compared with vein grafts.Of the arterial conduits,radial artery (RA) gained popularity for its easy availability and reported long-term patency.Thus,the objective of this study was to investigate the effect of RA in TAR in CABG.Methods From January 2000 to December 2006,85 patients (56 male and 29 female) at a mean age of 57.0±5.2 years,underwent TAR in CABG RA and left internal mammary artery (LIMA) with composite Y or T and seauential grafting techniques were used.Post-operative complications were recorded and follow-up was performed.Results Eighty-five LIMA and 149 RA grafts including 21 single and 64 bilateral RA were collected.A total of 87 distal anastomoses were done with the LIMA and another 152 were done with the RA,with the mean number of diStal anastOmosis per patient of 2.81±0.47.The proximal RA ends were anastomsed directly to the aorta in 140 grafts with Y or T graft off in situ LIMA in 9,Yor T graft off Rain 9.The distal end was anastomsed to right coronary artery system in 92,to Obtuse margma in 46,to diagonal in 19 and to ramous intermedius in 5.Nine sequential anastomoses were Derformed with RA.Nine composite Y or T grafts were constructed with RA and LIMA while another 9 were constructed with RA and RA.One (1.2%) patient died,3 patients (3.5%) experienced acute renal failure and 2 (2.4%) developed stroke.All patienfs were still alive and no patient had evidences of newly occurred myocardial infarction or angina after a mean tollow-up of 36.5±4.1 months (6-67 months).Postoperatively at 6 month,mean left ventricular ejective fraction was increased to 0.49±0.09,compared with that of 0.43±0.11 preoperatively (P=0.027).Postoperative mean New York Heart Association class was 2.5±0.5,compared with that of 3.0±0.4 preoperatively (P=0.003).Conclusions TAR with arterial conduits of which RA was

  15. Mechanism of arterial remodeling in chronic allograft vasculopathy

    Institute of Scientific and Technical Information of China (English)

    Qichang Zheng; Shanglong Liu; Zifang Song

    2011-01-01

    Chronic allograft vasculopathy (CAV) remains a major obstacle for long-term survival of grafts even though therapeutic strategies have improved considerably in recent years.CAV is characterized by concentric and diffuse neointimal formation,medial apoptosis,infiltration of lymphocyte or inflammatory cells,and deposition of extracellular matrix both in arteries and veins.Recent studies have shown that stem cells derived from the recipient contribute to neointimal formation under the regulation of chemokines and cytokines.Arterial remodeling in allografts eventually causes ischemic graft failure.The pathogenesis is multi-factorial with both immunologic and non-immunological factors being involved.The immunological factors have been discussed extensively in other articles.This review focuses mainly on the arterial remodeling that occurs in 3 layers of vessel walls including intimal injury,accumulation of smooth muscle-like cells in the neointimal,medial smooth muscle cell apoptosis,adventitial fibrosis,and deposition of extracellular matrix.

  16. [Intermittent thrombolytic treatment. Results during severe, chronic arterial diseases].

    Science.gov (United States)

    Fiessinger, J N; Aiach, M; Lagneau, P; Cormier, J M; Housset, E

    1975-04-20

    38 patients with severe chronic arteritis of the lower limbs were treated with streptokinase intermittently. All had been refused for surgical operation. One patient died, 4 others had early interruption of treatment. Eleven of the 38 patients had efficient thrombolysis confirmed by arteriography. The facts confirm the possibility of thrombolysis during chronic arterial disease. The fact that the aggravation was recent was favourable factor in prognosis. The eleven patients improved, had severe aggravation of symptomes for less than 2 months. Thus thrombolytic treatment has a place of choice in the treatment of severe arterial disease where surgery is impossible, or dangerous, owing to the uncertain state of the vascular bed below the lesion. Efficacious, it permits reconstructive surgery in cases where it had been at first refused. The use of intermittent treatment, apart from advantages of confort and cost, seems to increase the efficacy of treatment.

  17. Chronic total occlusions — Current techniques and future directions

    Directory of Open Access Journals (Sweden)

    George Touma

    2015-06-01

    Full Text Available Chronic total occlusions (CTOs of coronary arteries represent a common and significant challenge to interventional cardiology. Medical therapy is often regarded as an adequate long term strategy in the management of these lesions with surgical intervention for refractory symptoms. Extensive collateralisation is used as a marker of distal coronary perfusion, further reinforcing non-invasive strategies. This together with relatively low percutaneous success rates outside of specialised centres has meant that rates of percutaneous intervention have remained low. Increasing evidence suggests that CTOs are not a benign entity. Further, symptom control and quality of life improve significantly with successful percutaneous revascularisation. Both factors have reignited interest in percutaneous modalities. The Japanese have been pioneers in the field of CTO intervention although their success rates have been difficult to replicate. New techniques and equipment developed in North America offer an alternative to the Japanese approach. These techniques focus on time, radiation and contrast minimisation. This review will assess the histopathology of CTO and shifting paradigms in CTO treatment strategies.

  18. Acute arterial occlusion in the midpiece of femoral artery following total knee arthroplasty: Report of one case

    Institute of Scientific and Technical Information of China (English)

    Rui He; Liu Yang

    2016-01-01

    Acute arterial occlusion is a rare complication following total knee arthroplasty (TKA).The incidence as reported previously is from 0.03% to 0.17%;however,the sequelae can be disastrous because of its potential threat to limb loss.We report a case of acute arterial occlusion in the midpiece of femoral artery following TKA occurred 40 min postoperatively.The occlusion site existed at the midpiece of femoral artery is uncommon.Arterial circulation of the lower limb could not be restored by the thrombolysis and thrombectomy treatments performed within 11 h after TKA.In the end,amputation had to be carried out.In the treatment of acute arterial occlusion following TKA with a tourniquet,it is important to fully consider that arteriosclerosis may induce atheromatous plaque disruption,which might be the reason for acute arterial occlusion.

  19. Interventricular Septal Hematoma and Coronary-Ventricular Fistula: A Complication of Retrograde Chronic Total Occlusion Intervention

    Directory of Open Access Journals (Sweden)

    Abdul-rahman R. Abdel-karim

    2016-01-01

    Full Text Available Interventricular septal hematoma is a rare complication of retrograde chronic total occlusion (CTO percutaneous coronary interventions (PCI with a typically benign course. Here we report two cases of interventricular septal hematoma and coronary-cameral fistula development after right coronary artery (RCA CTO-PCI using a retrograde approach. Both were complicated by development of ST-segment elevation and chest pain. One case was managed actively and the other conservatively, both with a favorable outcome.

  20. Interventricular Septal Hematoma and Coronary-Ventricular Fistula: A Complication of Retrograde Chronic Total Occlusion Intervention

    Science.gov (United States)

    Abdel-karim, Abdul-rahman R.; Main, Michael L.

    2016-01-01

    Interventricular septal hematoma is a rare complication of retrograde chronic total occlusion (CTO) percutaneous coronary interventions (PCI) with a typically benign course. Here we report two cases of interventricular septal hematoma and coronary-cameral fistula development after right coronary artery (RCA) CTO-PCI using a retrograde approach. Both were complicated by development of ST-segment elevation and chest pain. One case was managed actively and the other conservatively, both with a favorable outcome. PMID:27668097

  1. The modified pulse-spray method using Urokinase in subacute and chronic thrombotic arterial occlusion

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Youn Kil; Hahn, Seong Tae; Baek, Jee Hee; Kim, Choon Yul; Shinn, Kyung Sub [The Catholic Univ. College of Medicine, Seoul (Korea, Republic of)

    1996-01-01

    To evaluate the effectiveness and safety of the modified pulse-spray method using Urokinase(UK) in subacute and chronic thrombotic arterial occlusion. Modified pulse-spray methods using UK were performed in seven patients with subacute (1 week-1month) to chronic (1month-5years) occlusive symptoms such as limb pain, claudication and impotence. Angiographic examination revealed thrombotic occlusion of the aorta, common iliac arteries, brachial arterio-venous hemodialysis graft and femoro-popliteal bypass graft. The patients underwent thrombolysis using modified pulse-spray and additional constant infusion of UK. In the presence of underlying stenosis or organized clots, balloon angioplasty or stent placement was performed. Complete lysis was obtained in five of seven patients. For initial lysis, the mean dose of UK was 420,000 units, and the mean modified pulse-spray time was 50 minutes. Mean total dose of UK and mean total time for complete lysis were 800,000 units and 161 minutes, respectively. Thrombolysis of the femoro-popliteal bypass graft failed due to severe occlusion of the distal anastomosis. Partial lysis was achieved in one patient with aorto-illac occlusion, but further thrombolysis was stopped due to bleeding at the puncture site. The modified pulse-spray method using UK is effective in treating subacute and chronic arterial thrombotic occlusion. It augments the speed, safety and efficacy of thrombolysis. When underlying stenosis or organized clots remain after thrombolysis, ballon angioplasty or stent placement would be helpful.

  2. N-acetylcysteine improves arterial vascular reactivity in patients with chronic kidney disease

    DEFF Research Database (Denmark)

    Wittstock, Antje; Burkert, Magdalena; Zidek, Walter;

    2009-01-01

    Patients with stage 5 chronic kidney disease show increased cardiovascular morbidity and mortality that are partly related to impaired arterial vascular reactivity. We investigated whether intravenous administration of the antioxidant acetylcysteine improves arterial vascular reactivity in these ......Patients with stage 5 chronic kidney disease show increased cardiovascular morbidity and mortality that are partly related to impaired arterial vascular reactivity. We investigated whether intravenous administration of the antioxidant acetylcysteine improves arterial vascular reactivity...

  3. Relationship of daily arterial blood pressure monitoring readings and arterial stiffness profile in male patients with chronic obstructive pulmonary disease combined with arterial hypertension

    Directory of Open Access Journals (Sweden)

    Karoli N.A.

    2013-06-01

    Full Text Available The aim of the study was to determine correlation between arterial blood pressure daily rhythm and daily profile of arterial stiffness in male patients with chronic obstructive pulmonary disease (COPD and arterial hypertension. Materials et methods: Prospective investigation comprised 45 male patients with COPD and arterial hypertension. Individuals of 40 years younger and 80 years elder, patients with diabetes, stroke, angina pectoris, or heart infarction, vascular diseases, and exacerbation of chronic disease, bronchial and pulmonary diseases of other etiology were excluded from the analyses. Comparison group included 47 patients with essential arterial hypertension and without chronic respiratory diseases closely similar on general parameters with patients from main clinical series. Twenty-four-hour arterial blood pressure monitoring (ABPM and daily arterial stiffness monitoring were performed using BPLab® MnSDP-2 apparatus (Petr Telegin, Russian Federation. Results: Patients with COPD combined with arterial hypertension with raised arterial stiffness measures prevail over individuals in essential hypertension group. There is pathological alteration of the ABPM circadian rhythm and raised «Pressure load» values in raised arterial stiffness group. Conclusion: We found ABPM raised parameters in patients with COPD and arterial hypertension. It confirms necessity of ABPM in daily arterial stiffness assessment in patients with COPD.

  4. Chronic pain following total hip arthroplasty: a nationwide questionnaire study

    DEFF Research Database (Denmark)

    Nikolajsen, Lone; Brandsborg, Birgitte; Lucht, Ulf;

    2006-01-01

    BACKGROUND: Chronic post-operative pain is a well-recognized problem after various types of surgery, but little is known about chronic pain after orthopedic surgery. Severe pre-operative pain is the primary indication for total hip arthroplasty (THA). Therefore, we examined the prevalence...... was 93.6%. Two hundred and ninety-four patients (28.1%) had chronic ipsilateral hip pain at the time of completion of the questionnaire, and pain limited daily activities to a moderate, severe or very severe degree in 12.1%. The chronic pain state was related to the recalled intensity of early post...

  5. Laser-driven short-duration heating angioplasty: chronic artery lumen patency and histology in porcine iliac artery

    Science.gov (United States)

    Shimazaki, Natsumi; Kunio, Mie; Naruse, Sho; Arai, Tsunenori; Sakurada, Masami

    2012-02-01

    We proposed a short-duration heating balloon angioplasty. We designed a prototype short-duration heating balloon catheter that can heat artery media to 60-70°C within 15-25 s with a combination of laser-driven heat generation and continuous fluid irrigation in the balloon. The purpose of this study was to investigate chronic artery lumen patency as well as histological alteration of artery wall after the short-duration heating balloon dilatation with porcine healthy iliac artery. The short-term heating balloon dilated sites were angiographically patent in acute (1 hour) and in chronic phases (1 and 4 weeks). One week after the dilatation, smooth muscle cells (SMCs) density in the artery media measured from H&E-stained specimens was approx. 20% lower than that in the reference artery. One and four weeks after the dilatations, normal structure of artery adventitia was maintained without any incidence of thermal injury. Normal lamellar structure of the artery media was also maintained. We found that the localized heating restricted to artery media by the short-duration heating could maintain adventitial function and artery normal structure in chronic phase.

  6. Vibrational angioplasty in recanalization of chronic femoropopliteal arterial occlusions: Single center experience

    Energy Technology Data Exchange (ETDEWEB)

    Kapralos, Ioannis, E-mail: jkapgr@yahoo.gr [251 Hellenic Air Force General Hospital, Athens (Greece); Kehagias, Elias, E-mail: eliaskmd@yahoo.gr [Interventional Radiology Unit, Department of Radiology, Faculty of Medicine, University of Crete, Heraklion, Crete (Greece); Ioannou, Christos, E-mail: ioannou@med.uoc.g [Faculty of Medicine, University of Crete, Heraklion, Crete (Greece); Bouloukaki, Izolde, E-mail: izolthi@gmail.com [Interventional Radiology Unit, Department of Radiology, Faculty of Medicine, University of Crete, Heraklion, Crete (Greece); Kostas, Theodoros, E-mail: kostasth@mailbox.gr [Faculty of Medicine, University of Crete, Heraklion, Crete (Greece); Katsamouris, Asterios, E-mail: asterios@med.uoc.gr [Faculty of Medicine, University of Crete, Heraklion, Crete (Greece); Tsetis, Dimitrios, E-mail: tsetis@med.uoc.gr [Interventional Radiology Unit, Department of Radiology, Faculty of Medicine, University of Crete, Heraklion, Crete (Greece)

    2014-01-15

    Purpose: This prospective study aims to present the overall success rate, safety and long-term outcome of vibrational angioplasty technique, in the treatment of chronic total femoropopliteal occlusions in our institute. Methods: Between October 2000 and December 2008, patients with chronic total femoropoliteal arterial occlusions, treated with vibrational angioplasty during the same session after a failed attempt with conventional recanalization technique, were included. Patient's follow up included serial ankle-brachial index measurements and arterial duplex ultrasound examinations at 1, 3, 6, 12, 24, 36 and 48 months. Results: Twenty-seven patients (16 males and 11 females) and twenty-eight lesions were included in our study. Twenty-five lesions (89.3%) were successfully recanalized. Pain relief was noticed in twenty-one cases. From ten lesions with tissue loss (ulcer or gangrene) in successfully recanalized occlusions, six healed without major, or minor amputation. One non-healing amputation stump was healed after recanalization, without further complications. Four limbs underwent amputation (one minor and three major) despite successful recanalization, however all had an excellent healing of the amputation stump without further complications. The Kaplan–Meier test demonstrated 90%, 85% and 70% amputation-free survival rate at 12, 24 and 36 months, respectively. No major or minor complications were encountered. Conclusions: Vibrational angioplasty is a safe, effective and durable endovascular technique for the treatment of chronic total occlusions in patients with limb ischemia that would be difficult to recanalize using conventional intraluminal techniques.

  7. The efficacy of hemodialysis in interventional therapy in coronary artery disease patients with chronic renal insufficiency.

    Science.gov (United States)

    Zhai, Hongxia; Li, Liang; Yin, Yaxin; Zhang, Jinjin; Chen, Haiwei; Liu, Runmei; Xia, Yun-feng

    2016-01-01

    The aim of this study was to explore the efficacy and safety of hemodialysis in interventional therapy for patients with coronary artery disease combined with chronic renal insufficiency. With the aging and social development, the number of coronary artery disease patients with chronic renal insufficiency gradually increased. Total 58 coronary heart disease patients with chronic renal dysfunction were selected. These patients were characterized with typical angina symptoms and typical electrocardiogram (ECG) changes of onset angina. Continuous oral administration of sodium bicarbonate tablets 1 g 3/day × 3 days and slow intravenous input sodium chloride 1000 ∼1500 mL 3-12 h before operation were given. By this way, all patients were treated by hydration and alkalization. After percutaneous coronary intervention (PCI) treatment, patients were immediately transferred to undergo 4 h of dialysis treatment without removing indwelling of femoral artery puncture sheath tube to protect renal function. Changes in renal function including serum creatinine, glomerular filtration rate, and urine were observed and recorded. All patients were successfully underwent PCI treatment. Within one month after PCI, there were no obvious complication and no stent thrombosis occurred. Among of 58 patients, 56 cases showed no significant increase in serum creatinine levels compared with those before operation. However, serum creatinine level of one patient increased to 251 umol/L and one patient still required permanent dialysis. Using hemodialysis in interventional therapy in coronary artery disease patients with chronic renal insufficiency could significantly improve the prognosis of the patients.

  8. Lysophospholipids in coronary artery and chronic ischemic heart disease

    Science.gov (United States)

    Abdel-Latif, Ahmed; Heron, Paula M.; Morris, Andrew J.; Smyth, Susan S.

    2015-01-01

    Purpose of review The bioactive lysophospholipids, lysophosphatidic acid (LPA) and sphingosine 1 phosphate (S1P) have potent effects on blood and vascular cells. This review focuses their potential contributions to the development of atherosclerosis, acute complications, such as acute myocardial infarction, and chronic ischemic cardiac damage. Recent findings Exciting recent developments have provided insight into the molecular underpinnings of LPA and S1P receptor signaling. New lines of evidence suggest roles for these pathways in the development of atherosclerosis. In experimental animal models, the production, signaling and metabolism of LPA may be influenced by environmental factors in the diet that synergize to promote the progression of atherosclerotic vascular disease. This is supported by observations of human polymorphisms in the lysophospholipid metabolizing enzyme, PPAP2B, that are associated with risk of coronary artery disease and myocardial infarction. S1P signaling protects from myocardial damage that follows acute and chronic ischemia both by direct effects on cardiomyocytes and through stem cell recruitment to ischemic tissue. Summary This review will suggest novel strategies to prevent the complications of coronary artery disease by targeting LPA production and signaling. Additionally, ways in which S1P signaling pathways may be harnessed to attenuate ischemia-induced cardiac dysfunction will be explored. PMID:26270808

  9. Arterial stiffness and enlargement in mild-to-moderate chronic kidney disease.

    Science.gov (United States)

    Briet, M; Bozec, E; Laurent, S; Fassot, C; London, G M; Jacquot, C; Froissart, M; Houillier, P; Boutouyrie, P

    2006-01-01

    Chronic kidney disease (CKD) is associated with an increased risk of cardiovascular morbidity and mortality. Arterial stiffness and remodeling have been well documented in patients with end-stage renal disease, but little is known about arterial phenotype in CKD patients with moderate reduction in glomerular filtration rate (GFR). In total, 95 patients (58+/-15 years, mean+/-s.d.) with CKD and GFR measured by renal clearance of (51)Cr-ethylenediaminetetraacetate were compared to 121 hypertensive patients without CKD (59+/-11 years), and 57 normotensive subjects (56+/-6 years). Common carotid artery diameter, intima-media thickness (IMT), distensibility, and Young's elastic modulus were noninvasively determined with a high-definition echotracking system. Patients with CKD had a significantly larger carotid internal diameter than in hypertensives and normotensives (6.32+/-1.05, 5.84+/-0.74, and 5.50+/-0.64 m x 10(-3), respectively; Pelastic modulus did not significantly differ between CKD and hypertensives; normotensives had significantly higher distensibility and lower elastic modulus than CKD and hypertensive patients. Carotid-femoral pulse wave velocity was significantly higher in CKD patients than in hypertensives and normotensives. In multivariate analyses either involving the entire population or restricted to CKD patients, GFR was independently and strongly related to carotid diameter and elastic modulus. Arterial enlargement and increased arterial stiffness occur in parallel with the decline in renal function in patients with mild-to-moderate CKD.

  10. Pulmonary artery rupture in a patient receiving an orthotopic heart transplant after total artificial heart explant.

    Science.gov (United States)

    Nomoto, Koichi; Weiner, Menachem M; Evans, Adam

    2014-02-01

    Our case illustrates a patient who suffered a pulmonary artery rupture despite previous total artificial heart implantation and replacement with orthotopic heart transplant. Pulmonary artery rupture during or following cardiac surgery has been reported to occur due to both pulmonary artery catheter use and surgical technique. Our case is the first to demonstrate the occurrence of this complication in the total artificial heart patient population.

  11. The renal arterial resistive index and stage of chronic kidney disease in patients with renal allograft

    DEFF Research Database (Denmark)

    Winther, Stine O; Thiesson, Helle C; Poulsen, Lene N;

    2012-01-01

    The study investigated the optimal threshold value of renal arterial resistive index as assessed by Doppler ultrasonography determining chronic kidney disease stage 4 or higher in patients with renal allograft.......The study investigated the optimal threshold value of renal arterial resistive index as assessed by Doppler ultrasonography determining chronic kidney disease stage 4 or higher in patients with renal allograft....

  12. Arterial stiffness & Sri Lankan chronic kidney disease of unknown origin

    Science.gov (United States)

    Gifford, Fiona; Kimmitt, Robert; Herath, Chula; Webb, David J.; Melville, Vanessa; Siribaddana, Sisira; Eddleston, Michael; Dhaun, Neeraj

    2016-09-01

    Chronic kidney disease (CKD) is common and independently associated with cardiovascular disease (CVD). Arterial stiffness contributes to CVD risk in CKD. In many developing countries a considerable proportion of CKD remains unexplained, termed CKDu. We assessed arterial stiffness in subjects with Sri Lankan CKDu, in matched controls without CKD and in those with defined CKD. Aortic blood pressure (BP), pulse wave velocity (PWV) and augmentation index (AIx) were assessed in 130 subjects (50 with CKDu, 45 with CKD and 35 without CKD) using the validated TensioMed™ Arteriograph monitor. Brachial and aortic BP was lower in controls than in CKDu and CKD subjects but no different between CKDu and CKD. Controls had a lower PWV compared to subjects with CKDu and CKD. Despite equivalent BP and renal dysfunction, CKDu subjects had a lower PWV than those with CKD (8.7 ± 1.5 vs. 9.9 ± 2.2 m/s, p groups (controls vs. CKDu vs. CKD: 6.7 ± 0.9 vs. 8.7 ± 1.5 vs. 10.4 ± 1.5 m/s, p < 0.001 for all). Sri Lankan CKDu is associated with less arterial stiffening than defined causes of CKD. Whether this translates to lower cardiovascular morbidity and mortality long term is unclear and should be the focus of future studies.

  13. Pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension: pathophysiology

    Directory of Open Access Journals (Sweden)

    M. Humbert

    2010-03-01

    Full Text Available Pulmonary arterial hypertension (PAH and chronic thromboembolic pulmonary hypertension (CTEPH are two of the key subgroups of pulmonary hypertension. They are characterised by different risk factors. PAH can be associated with mutations in the gene encoding bone morphogenetic protein receptor type II (BMPR2, HIV infection, congenital heart disease, connective tissue disease (such as systemic sclerosis, and exposure to particular drugs and toxins including fenfluramine derivatives. In contrast, CTEPH can be associated with anti-phospholipid antibodies, splenectomy and the presence of a ventriculo-atrial shunt or an infected pacemaker. The first-line therapies used to treat PAH and CTEPH also differ. While medical therapy tends to be used for patients with PAH, pulmonary endarterectomy is the treatment of choice for patients with CTEPH. However, there are possible common mechanisms behind the two diseases, including endothelial cell dysfunction and distal pulmonary artery remodelling. Further research into these similarities is needed to assist the development of targeted pharmacological therapies for patients with inoperable CTEPH and patients who have persistent pulmonary hypertension after endarterectomy.

  14. Body composition, fitness score and arterial stiffness assesment in a chronic hemodialysis population

    Directory of Open Access Journals (Sweden)

    Adelina Mihăescu

    2011-12-01

    Full Text Available Patients undergoing long-term hemodialysis have a high risk of cardiovascular disease. Arterial stiffness is highly prevalent in this type of patients. The aim of our study was to analyse the relationship between body composition, blood chemistries and arterial stiffness in a poorly fit population of chronic hemodialysed patients. Patients and methods involved measuring body composition and fitness score by multifrequence bioimpedance with the body composition analyzer InBody720 and arterial stiffness by the measurement of aortic Pulse Wave Velocity (PWVao and Aortic Augmentation Index (Aix using an oscillometric method on 65 HD patients; measurements were made before a midweek dialysis session. Results: PWVao correlated significantly with weight (p=0.01, r2=1.14, body fat mass (p=0.007, r2=0.14, abdominal circumference (p=0.01, r2=0.12 and with fitness score (p=0.01, r2=0.11. Aix correlated with weight (p<0.05, r2=0.25, intracellular, extracellular- and total body water (p<0.05, r2=0.24 with body protein, soft lean mass, minerals, fat free mass and skeletal muscle mass (p<0.05, r2= 0.3 and with serum calcium (p=0.005, r2=0.2. Conclusions: Arterial stiffness is a common feature of the hemodialysed patients, significantly related to the blood calcium, fitness score and the body composition, especially fat body mass.

  15. Total sleep deprivation, chronic sleep restriction and sleep disruption.

    Science.gov (United States)

    Reynolds, Amy C; Banks, Siobhan

    2010-01-01

    Sleep loss may result from total sleep deprivation (such as a shift worker might experience), chronic sleep restriction (due to work, medical conditions or lifestyle) or sleep disruption (which is common in sleep disorders such as sleep apnea or restless legs syndrome). Total sleep deprivation has been widely researched, and its effects have been well described. Chronic sleep restriction and sleep disruption (also known as sleep fragmentation) have received less experimental attention. Recently, there has been increasing interest in sleep restriction and disruption as it has been recognized that they have a similar impact on cognitive functioning as a period of total sleep deprivation. Sleep loss causes impairments in cognitive performance and simulated driving and induces sleepiness, fatigue and mood changes. This review examines recent research on the effects of sleep deprivation, restriction and disruption on cognition and neurophysiologic functioning in healthy adults, and contrasts the similarities and differences between these three modalities of sleep loss.

  16. RELAXANT EFFECTS OF VASOACTIVE INTESTINAL PEPTIDE ON PULMONARY ARTERY IN CHRONICALLY HYPOXIC RATS

    Institute of Scientific and Technical Information of China (English)

    陈玉玲; 罗慰慈; 蔡英年

    1996-01-01

    The object of this study is to investigate the effect of VIP on pulmonary artery of chronically hypoxic rats. It was shown that chronic hypoxla depressed significantly pulmnonary artery relaxation induced by VIP as compared with those of control (Parteries in rats was endotbelium-independent, and was not prevented by indomethaein or nordihydroguaiaretie acid, but was abolished completely by methylene blue. These results suggest that the lower relaxation of pulmonary artery in rats might not be due to the endothelial injury caused by chronic hypoxxia, and chronic hypoxiamay inhibit directly the soluble guanylate cyclase in vascular smooth muscle cells invioved in synthesis of cGMP and thus reduced the sensitivity and reactivity of pulmonary artery to VIP.

  17. Percutaneous Retrograde Recanalization of the Celiac Artery by Way of the Superior Mesenteric Artery for Chronic Mesenteric Ischemia

    Energy Technology Data Exchange (ETDEWEB)

    Joseph, George, E-mail: joseph59@gmail.com; Chacko, Sujith Thomas [Christian Medical College, Department of Cardiology (India)

    2013-02-15

    A 52-year-old man presented with recurrent postprandial abdominal pain, sitophobia, and progressive weight loss. Chronic mesenteric ischemia (CMI) due to subtotal occlusion of the superior mesenteric artery (SMA) and flush occlusion of the celiac artery (CA) was diagnosed. Retrograde recanalization of the CA by way of a collateral channel from the SMA was performed using contemporary recanalization equipment. The CA and SMA were then stented, resulting in sustained resolution of CMI-related symptoms.

  18. Effect of cuff ischemia training on myocardial ischemia and left ventricular function in patients with single coronary artery chronic total occlusion%袖带法缺血训练对单支冠状动脉慢性完全闭塞病变患者心肌缺血及左心室功能的影响

    Institute of Scientific and Technical Information of China (English)

    独磊; 项洁

    2016-01-01

    Objective To determine the effects of cuff ischemia training on myocardial ischemia and cardiac function in patients with chronic total occlusion of single-vessel coronary artery disease .Methods 52 patients with chronic total occlu-sion of single-vessel coronary artery disease were randomly divided into training group and control group ,each of 26 cases.All patients were treated with conventional medical treatment ,the patients in training group performed six-months training .Vascular endothealial growth factor(VEGF) were determined by enzyme linked immunosorbent assay (ELISA).Single-photon emission computed tomography ( SPECT) was used to evaluate myocardial perfusion ,ultrasonic cardiogram was used to evaluate left ven-tricular function .Results After six months of training ,the VEGF concentration of training group was significantly higher than that before training and control group ,the differences were statistically significant ( P0.05).The VEGF concentration and total resting SPECT score(SRS) had a high negative correlation .After six months of training,the SPECT SRS of training group was lower than the previous training and control group ,LVEF,6min walk test were higher than before training and control group ,the differences were statistically significant(P0.05).The heart rate and blood pressure before and after training in control group had no significant changes ,the difference was not statistically significant (P>0.05).Con-clusion Cuff ischemia training may promote myocardial perfusion and left ventricular function in patients with chronic total occlusion of single-vessel coronary artery disease .%目的:观察袖带法缺血训练对单支冠状动脉慢性完全闭塞病变患者心肌缺血及左心室功能的影响。方法将52例单支冠状动脉慢性完全闭塞病变患者随机分为训练组和对照组各26例,2组均给予药物治疗,在此基础上对训练组患者训练6个月。于训练前后抽取患者外周血,ELISA法检

  19. Pulmonary arterial hypertension secondary to chronic left-sided cardiac dysfunction in dogs.

    Science.gov (United States)

    Stepien, Rebecca L

    2009-09-01

    Pulmonary arterial hypertension is a description of a physiological finding rather than a diagnosis. Pulmonary arterial pressure is the result of interactions among pulmonary blood flow (right ventricular cardiac output), pulmonary vascular impedance and post-capillary pressure (typically reflecting left atrial pressure). When elevations in pulmonary arterial pressure (systolic/diastolic pulmonary arterial pressure > approximately 30/19 mmHg at rest) are accompanied by increased left atrial pressure, pulmonary arterial hypertension may be considered secondary to left-heart failure. Introduction of Doppler methods to diagnose pulmonary arterial hypertension has increased the awareness of the prevalence and importance of pulmonary arterial hypertension dogs with left-heart failure. Increasing understanding of the mechanism of development of pulmonary venous hypertension and reactive pulmonary arterial hypertension in dogs with left-heart disease has led to the development of successful additive therapies for progressive clinical signs in the setting of chronic therapy for congestive heart failure due to left-sided valvular and myocardial dysfunction. Because effective therapies for pulmonary arterial hypertension secondary to chronic left-sided cardiac dysfunction are now available, screening for pulmonary arterial hypertension should be a regular part of the Doppler echocardiographic examination in a clinical setting of chronic therapy for left-sided congestive heart failure due to valvular or myocardial disease.

  20. Association between chronic kidney dysfunction and the complexity of coronary artery disease in elderly patients

    Institute of Scientific and Technical Information of China (English)

    颜利求

    2013-01-01

    Objective To investigate the association between chronic kidney dysfunction and the complexity of coronary artery disease in elderly patients.Methods A prospective study was conducted on 1380 consecutive patients

  1. Direct Needle Puncture and Embolization of Splenic Artery Pseudoaneurysm in Case of Chronic Atrophic Calcific Pancreatitis

    Science.gov (United States)

    Shrivastava, Amit; Rampal, Jagadeesh Singh; Reddy, D. Nageshwar; Rao, Guduru Venkat

    2016-01-01

    Summary Background Gastro-Intestinal bleeding remains a frequent clinical dilemma and common cause of hospitalization, morbidity and mortality. Case Report We report a case of pseudo aneurysm of splenic artery developed after an episode of acute on chronic pancreatitis which was treated by direct percutaneous puncture of pseudoaneurysm and embolization by coils. Conclusions The aim was to preserve the main splenic artery and avoid the complications of splenic artery embolization like infarcts and abscess. PMID:27757174

  2. Control of drug treatment of chronic coronary artery disease: possibilities of a regional registry

    Directory of Open Access Journals (Sweden)

    Rachkova S.A.

    2016-03-01

    Full Text Available The article describes the results of the Register of hypertension, coronary artery disease, chronic heart failure (Register of AH, CAD, HF in the Ivanovo region in 2015. The frequency of prescribing of the main groups of drugs in patients with coronary artery disease was estimated.

  3. Initial clinical experience of CrossBoss catheter for in-stent chronic total occlusion lesions

    Science.gov (United States)

    Zhao, Lei; Li, Long-Bo; Wang, Zhi-Hui; Shi, Yong-Feng; Wu, Jun-Duo; Zhang, Ji-Chang; Liu, Bin

    2016-01-01

    Abstract Background: The CrossBoss coronary chronic total occlusion (CTO) crossing catheter has been demonstrated to have greatly improved the success rate of crossing CTO lesions, but there are no published data on its application for in-stent CTO lesions. Methods: In the current study, we retrospectively reviewed the clinical data of 8 patients with in-stent CTO lesions that were managed with the CrossBoss catheter and herein we report the efficacy and safety of the CrossBoss crossing and re-entry system for this clinically challenging condition. Results: The CrossBoss catheter was used for 8 patients with in-stent CTO lesions, which resulted in success in 6 cases and failure in 2 cases, with a 75% success rate. Of the 6 patients with successful treatment, 5 cases had the occlusive lesions crossed with the CrossBoss catheter through a proximal lumen-to-distal lumen approach, whereas the remaining case had his occlusive lesions penetrated by the CrossBoss catheter and the guidewire. Two cases failed in treatment as the CrossBoss catheter could not cross the occlusive lesions. The 6 cases with successful treatment included 3 cases with occlusive lesions in the left anterior descending artery, 1 case with occlusive lesions in the obtuse marginal branches, and 2 cases with occlusive lesions in the right coronary artery, and the 2 cases with failure in treatment had their occlusive lesions in the right coronary artery. In addition, patients with a higher Japan chronic total occlusion score were found to have a lower success rate of crossing the occlusive lesions. None of the patients developed complications. Conclusion: Our study demonstrates that the CrossBoss catheter has a high success rate and is safe for in-stent CTOs and can be recommended for this rather clinically challenging condition. PMID:27749568

  4. Effect of total lymphoid irradiation in chronic progressive multiple sclerosis

    Energy Technology Data Exchange (ETDEWEB)

    Cook, S.D.; Devereux, C.; Troiano, R.; Hafstein, M.P.; Zito, G.; Hernandez, E.; Lavenhar, M.; Vidaver, R.; Dowling, P.C.

    1986-06-21

    Total lymphoid irradiation (TLI; 1980 cGy) or sham irradiation was given to 40 patients with chronic progressive multiple sclerosis (MS) in a prospective, randomised, double-blind study. During mean follow-up of 21 months, MS patients treated with TLI has less functional decline than sham-irradiated MS patients (p<0.01). A significant relation was noted between absolute blood lymphocyte counts in the first year after TLI and subsequent course, patients with higher lymphocyte counts generally having a worse prognosis (p<0.01). TLI was well tolerated and associated with only mild short-term, and to date, long-term side-effects.

  5. Comparably improved health-related quality of life after total arterial revascularization versus conventional coronary surgery--Copenhagen arterial revascularization randomized patency and outcome trial

    DEFF Research Database (Denmark)

    Damgaard, Sune; Lund, Jens T; Lilleør, Nikolaj B

    2011-01-01

    OBJECTIVE: We compared health-related quality of life up to 11 months after coronary artery bypass grafting using total arterial revascularization versus conventional coronary surgery. METHODS: In this randomized single-center trial, 161 patients underwent total arterial revascularization using.......01). For total arterial revascularization, there were also not statistically significant improvements for 'physical component summary' (P=0.09), 'bodily pain' (P=0.07) and 'vitality' (P=0.08). CONCLUSION: Health-related quality of life up to 1 year after total arterial revascularization is equal or slightly...... of the general Danish population. On all scales of the SF-36, there was statistically significant improvement at 3 and 11 months in both groups. For 'social functioning', the improvement following total arterial revascularization was significantly higher than following conventional revascularization (P=0...

  6. Chronic total occlusion:To treat or not to treat

    Institute of Scientific and Technical Information of China (English)

    Alfredo; Bardají; Judit; Rodriguez-López; Mauricio; Torres-Sánchez

    2014-01-01

    Over the last two decades,there has been increasing interest in new techniques for the percutaneous treatment of coronary chronic total occlusions(CTO),which have a success rate that is much higher than that of a few years ago.The rise in percutaneous treatment for these lesions is due to its ability to improve the symptoms and prognosis of patients in the chronic and stable phase of coronary disease.Current data suggest that successful percutaneous coronary intervention for CTO is associated with improvement in patient symptoms,quality of life,left ventricular function,and survival,compared with those with unsuccessful CTO PCI.However,all the scientific evidence supporting this treatment comes from observational studies,and no randomized study comparing percutaneous treatment with medical treatment has yet been published.A major limitation of these studies is their observational design,with limited information with regard to potential baseline differences between the successful vs unsuccessful cohorts.Pending randomized studies,patients should be selected very carefully,especially if they are asymptomatic or very few symptoms,and the benefits obtained in terms of complications during the procedure,the quality of life obtained and further ischemic events avoided should be evaluated systematically.In this review,we will consider the available information supporting percutaneous treatment for chronic occlusions,as well as the areas of uncertainty where more research projects are required.

  7. Transcatheter arterial chemotherapy with miriplatin for hepatocellular carcinoma patients with chronic renal failure: report of three cases.

    Science.gov (United States)

    Imai, Norihiro; Ikeda, Kenji; Seko, Yuya; Kawamura, Yusuke; Sezaki, Hitomi; Hosaka, Tetsuya; Akuta, Norio; Kobayashi, Masahiro; Saitoh, Satoshi; Suzuki, Fumitaka; Suzuki, Yoshiyuki; Arase, Yasuji; Kumada, Hiromitsu

    2013-03-01

    Miriplatin is a novel lipophilic platinum complex that was developed to treat hepatocellular carcinoma (HCC). Although HCC patients frequently have coexisting chronic renal failure, little prospective data are available regarding the clinical toxicity of chemotherapeutic agents used to treat HCC patients with chronic renal failure. In a phase II study, the plasma concentration of total platinum in patients who received miriplatin was very low, and no severe renal toxicity caused by miriplatin injection was reported. Here, we present three cases of HCC with stage 4 chronic renal failure who received transcatheter arterial chemotherapy with miriplatin. All cases were male, ages 72, 84, and 83 years, and had serum creatinine levels of 2.3, 1.6, and 1.9 mg/dL, respectively. Their estimated glomerular filtration rates were 21.9, 20.3, and 22.2 mL/min, respectively. All cases were treated for unresectable HCC with transcatheter arterial chemotherapy with miriplatin. No serious adverse events were observed, and serum creatinine levels did not elevate, even in the patient who experienced renal failure caused by cisplatin administration. These results might suggest that transcatheter arterial chemotherapy with miriplatin can be safely used in HCC patients with chronic renal failure.

  8. Polyvinyl alcohol and gelatin sponge particle embolization of splenic artery pseudoaneurysm complicating chronic alcoholic pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Yong-Song Guan; Long Sun; Xiang-Ping Zhou; Xiao Li; Ze-Jun Fei; Xiao-Hua Zheng; Qing He

    2005-01-01

    AIM: To assess the effectiveness of and complications associated with polyvinyl alcohol (PVA) and gelatin sponge particles embolization of splenic artery pseudoaneurysm complicating chronic alcoholic pancreatitis.METHODS: A 42-year-old man with splenic artery pseudoaneurysm formation secondary to chronic alcoholic pancreatitis was admitted. We used PVA and gelatin sponge partides embo lization of splenic artery pseudoaneurysm by superselective embolization techniques.RESULTS: The splenic artery pseudoaneurysm was successfully controlled with splenic embolization. The patient was discharged in 9 d with complete recovery. CONCLUSION: This case confirms that superselective transcatheter embolization by PVA and gelatin sponge particles may represent an effective treatment for pseudoaneurysm caused by chronic alcoholic pancreatitis in the absence of other therapeutic alternatives.

  9. Developments in pulmonary arterial hypertension-targeted therapy for chronic thromboembolic pulmonary hypertension.

    Science.gov (United States)

    Hadinnapola, Charaka; Pepke-Zaba, Joanna

    2015-10-01

    Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare disease characterised by the presence of organised chronic thromboembolic material occluding the proximal pulmonary arteries and a vasculopathy in the distal pulmonary arterial tree. Pulmonary endarterectomy (PEA) is a potential cure for many patients with CTEPH. However, PEA is not suitable for patients with a significant distal distribution of chronic thromboembolic material or with significant comorbidities. Also, a proportion of patients are left with residual CTEPH post PEA. Until recently, pulmonary arterial hypertension-targeted therapies have been used off licence to treat patients with inoperable or residual CTEPH. The CHEST1 study investigated the use of riociguat and was the first randomised controlled trial to show efficacy in inoperable or residual CTEPH. In this review, we explore the pathophysiology of CTEPH and review the current trial evidence for pulmonary arterial hypertension-targeted therapies. We also include a discussion of physiological considerations that require further investigation.

  10. Prevalence of chronic obstructive pulmonary disease among patients with systemic arterial hypertension without respiratory symptoms

    Directory of Open Access Journals (Sweden)

    Rabahi MF

    2015-07-01

    Full Text Available Marcelo Fouad Rabahi,1,2 Sheila Alves Pereira,1 José Laerte Rodrigues Silva Júnior,1,2 Aline Pacheco de Rezende,1 Adeliane Castro da Costa,2 Krislainy de Sousa Corrêa,2,3 Marcus Barreto Conde4,5 1School of Medicine, Federal University of Goiás, Goiania, Brazil; 2Clínica do Aparelho Respiratório (CLARE, Goiania, Brazil; 3Pontifical Catholic University of Goiás, Goiania, Brazil; 4Faculdade de Medicina de Petrópolis/FASE, Petrópolis, Brazil; 5Instituto de Doenças do Tórax da Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil Background: The diagnosis of chronic obstructive pulmonary disease (COPD is often delayed until later stages of the disease. The purpose of the present study was to determine the prevalence of COPD among adults on treatment for systemic arterial hypertension independently of the presence of respiratory symptoms. Methods: This cross-sectional study included adults aged ≥40 years with tobacco/occupational exposure and systemic arterial hypertension diagnosed at three Primary Health Care facilities in Goiania, Brazil. Patients were evaluated using a standardized respiratory questionnaire and spirometry. COPD prevalence was measured considering the value of forced vital capacity and/or forced expiratory volume in 1 second <0.70. Results: Of a total of 570 subjects, 316 (55% met inclusion criteria and were invited to participate. Two hundred and thirty-three (73.7% patients with arterial hypertension reported at least one respiratory symptom, while 83 (26.3% reported no respiratory symptoms; 41 (17.6% patients with arterial hypertension and at least one respiratory symptom, and 10 (12% patients with arterial hypertension but no respiratory symptoms were diagnosed with COPD (P=0.24. The prevalence of COPD in people with no previous COPD diagnosis was greater among those with no respiratory symptoms (100% than among those with respiratory symptoms (56.1% (P=0.01. Conclusion: Our findings suggest that

  11. Is there a role for robotic totally endoscopic coronary artery bypass in patients with a colostomy?

    Science.gov (United States)

    Gibber, Marc; Lehr, Eric J; Kon, Zachary N; Wehman, P Brody; Griffith, Bartley P; Bonatti, Johannes

    2014-01-01

    Preoperative colostomy presents a significant risk of sternal wound complications, mediastinitis, and ostomy injury in patients requiring coronary artery bypass grafting. Less invasive procedures in coronary surgery have a potential to reduce the risk of sternal wound healing problems. Robotic totally endoscopic coronary artery bypass grafting in patients with a colostomy has not been reported. We describe a case of completely endoscopic coronary surgery using the da Vinci Si system in a patient with a transverse colostomy. Single left internal mammary artery grafting to the left anterior coronary artery was performed successfully on the beating heart. We regard this technique as the least invasive method of surgical coronary revascularization with a potential to reduce the risk of surgical site infection and mediastinitis in patients with a colostomy.

  12. Carotid angioplasty with stenting for chronic internal carotid artery occlusion: technical note

    Energy Technology Data Exchange (ETDEWEB)

    Kobayashi, Nozomu; Tanasawa, Toshihiko; Okada, Takeshi; Endo, Otone; Yamamoto, Naohito [Kainan Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives, Department of Neurosurgery, Aichi (Japan); Miyachi, Shigeru; Hattori, Kenichi [Nagoya University Graduate School of Medicine, Department of Neurosurgery, Nagoya (Japan)

    2006-11-15

    Carotid angioplasty with stenting (CAS) is becoming accepted as an effective and reliable treatment option for severe carotid artery stenosis. However, it is rarely applied for carotid occlusion, especially in its chronic stage. We report our experience of CAS for chronic internal carotid artery occlusion representing compromised cerebral blood flow using various protection methods. A 77-year-old woman, who was already diagnosed with severe left internal carotid artery stenosis, suddenly had right hemiparesis and aphasia. At that time, she was treated conservatively because her neurological status was quite good, in spite of left carotid artery occlusion. Her symptoms improved in the short term, except slight aphasia, but deteriorated again 18 days from the onset, and magnetic resonance imaging (MRI) showed new ischemic lesions. CAS was then performed for the occluded carotid artery on the 23rd day from the first onset. Using the proximal protection technique, the occluded lesion was crossed carefully with a microguidewire. Stents were also placed successfully with the distal protection technique. The occluded carotid artery was completely recanalized without any unfavorable events or neurological deterioration. In this patient, CAS was successfully to treat chronic carotid artery occlusion. These procedures and techniques are reviewed and discussed. (orig.)

  13. Acute Iliac and Femoral Arterial Thrombosis Secondary to Total Hip Arthroplasty

    Directory of Open Access Journals (Sweden)

    Nikola Fatic

    2014-12-01

    Full Text Available In the presented case report, we evaluated the mechanism of the external iliac, the common femoral and the superficial femoral arterial thrombosis secondary to total hip arthroplasty. A 75-year-old female sufferd from 5.5 cm shorter left lower limb and same sade coxarthritis. Next day after arthroplasty and eqalisation of the lower limbs, an acute ishemia of the treated leg was presented. Multyscan CT angiography revealed the presence of the external iliac, the common femoral and the superficial femoral arterial thrombosis. From the best of our knowledge, it seems to be the only case of this arterial segment thrombosis after total hip arthroplasty and equalistaion of the lower limbs reported.

  14. Percutaneous laser-assisted recanalization of long chronic iliac artery occlusions: primary and mid-term results

    Energy Technology Data Exchange (ETDEWEB)

    Balzer, Joern O.; Gastinger, Verena; Thalhammer, Axel; Vogl, Thomas J. [Johann Wolfgang Goethe University, Department of Diagnostic and Interventional Radiology, University Clinic, Frankfurt/Main (Germany); Ritter, Ralf G.; Schmitz-Rixen, Thomas [Johann Wolfgang Goethe University, Department of Vascular and Endovascular Surgery, University Clinic, Frankfurt/Main (Germany); Lindhoff-Last, Edelgard [Johann Wolfgang Goethe University, Center of Internal Medicine I, Division of Angiology, University Clinic, Frankfurt/Main (Germany)

    2006-02-01

    We report the primary and mid-term outcome of patients with long chronic iliac artery occlusions after percutaneous excimer-laser-assisted interventional recanalization. Between 2000 and 2001, 43 patients with 46 chronic occlusions of either the common iliac artery (n=27), the external iliac artery (n=13) or both (n=3) underwent laser-assisted percutaneous transluminal angioplasty and implantation of stents. The average length of the occlusion was 57.1{+-}26 mm. After laser-assisted angioplasty and implantation of a total of 60 stents, the patients were followed up for up to 4 years. Patency rates were analyzed by ankle-brachial index (ABI) measurement and duplex ultrasound. The primary technical success rate was 95.3%, with a major complication rate of 6.9%. Clinical improvement as categorized by the Rutherford guidelines could be observed in 97.6% of cases. The ABI of all patients improved from an average of 0.46{+-}0.08 before intervention to 0.97{+-}0.13 at the end of the follow-up period. The overall primary patency rate was 86.1%. Four reinterventions were successful (secondary patency rate 95.4%). The mid-term results of the percutaneous recanalization of iliac artery occlusions with primary and secondary patency rates of 86.1 and 95.4% are similar to those of the treatment of short stenoses. (orig.)

  15. Anatomy of the bovine ascending aorta and brachiocephalic artery found unfavorable for total artificial heart implant.

    Science.gov (United States)

    Karimov, Jamshid H; Sunagawa, Gengo; Such, Kimberly A; Sale, Shiva; Golding, Leonard A R; Moazami, Nader; Fukamachi, Kiyotaka

    2015-12-01

    The biocompatibility assessment of the Cleveland Clinic continuous-flow total artificial heart is an important part of the device developmental program. Surgical and postoperative management are key factors in achieving optimal outcomes. However, the presence of vascular anatomical abnormalities in experimental animal models is often unpredictable and may worsen the expected outcomes. We report a technical impediment encountered during total artificial heart implantation complicated by unfavorable bovine anatomy of the ascending aorta and brachiocephalic arterial trunk.

  16. Retrograde Percutaneous Coronary Intervention for Left Anterior Descending Chronic Total Occlusion Via an Ipsilateral Intraseptal Collateral Channel Using a Single Guiding Catheter.

    Science.gov (United States)

    Chon, Min Ku; Kim, Jeong Su; Chun, Kook Jin

    2016-06-01

    Successful recanalization of chronic total occlusion (CTO) of coronary arteries has improved symptoms and mortality. In CTO cases, retrograde approach from opposite coronary artery has a better chance of procedural success. But the retrograde approach from opposite site is not always suitable. In certain CTO cases, the distal left anterior descending (LAD) artery is supplied from the intraseptal collateral channel. Controlled antegrade and retrograde tracking (CART) strategy has been developed to improve guidewire crossing and successful recanalization. We report a case of the retrograde percutaneous coronary intervention for the LAD CTO lesion via an ipsilateral intraseptal collateral channel, which was successfully revascularized with reverse CARTtechnique using a single 8-French guiding catheter.

  17. Impact of Chronic Total Occlusions on Markers of Reperfusion, Infarct Size, and Long-Term Mortality : A Substudy from the TAPAS-Trial

    NARCIS (Netherlands)

    Lexis, Chris P. H.; van der Horst, Iwan C. C.; Rahel, Braim M.; Kampinga, Marthe A.; Gu, Youlan L.; de Smet, Bart J. G. L.; Zijlstra, Felix; Lexis, Chris

    2011-01-01

    Objectives: This study evaluated the impact of a chronic total occlusion (CTO) in a non-infarct related coronary artery (IRA) on markers of reperfusion, infarct size, and long-term cardiac mortality in patients with ST-elevation myocardial infarction (STEM!). Background: A concurrent CTO in STEMI pa

  18. Increased prevalence of coronary artery disease risk markers in patients with chronic hepatitis C

    DEFF Research Database (Denmark)

    Roed, Torsten; Kristoffersen, Ulrik Sloth; Knudsen, Andreas

    2014-01-01

    % confidence interval [CI] 0.9-2.7) and smoked more (53% versus 38%, PR 1.4; 95% CI 0.9-2.1). The two groups had similar body mass index (mean 25.0 versus 25.7 kg/m(2)), whereas those with chronic hepatitis C had less dyslipidemia (including significantly lower low-density lipoprotein and cholesterol...... of several coronary artery disease risk markers. These results may be important when evaluating the appropriateness of screening for coronary artery disease and its risk factors in chronic hepatitis C....

  19. Arterial distensibility as a possible compensatory mechanism in chronic aortic regurgitation

    Directory of Open Access Journals (Sweden)

    Kopel Liliane

    2001-01-01

    Full Text Available OBJECTIVE: To evaluate elastic properties of conduit arteries in asymptomatic patients who have severe chronic aortic regurgitation. METHODS: Twelve healthy volunteers aged 30±1 years (control group and 14 asymptomatic patients with severe aortic regurgitation aged 29±2 years and left ventricular ejection fraction of 0.61±0.02 (radioisotope ventriculography were studied. High-resolution ultrasonography was performed to measure the systolic and diastolic diameters of the common carotid artery. Simultaneous measurement of blood pressure enabled the calculation of arterial compliance and distensibility. RESULTS: No differences were observed between patients with aortic regurgitation and the control group concerning age, sex, body surface, and mean blood pressure. Pulse pressure was significantly higher in the aortic regurgitation group compared with that in the control group (78±3 versus 48±1mmHg, P<0.01. Arterial compliance and distensibility were significantly greater in the aortic regurgitation group compared with that in the control group (11.0±0.8 versus 8.1±0.7 10-10 N-1 m4, P=0.01 e and 39.3±2.6 versus 31.1±2.0 10-6 N-1 m², P=0.02, respectively. CONCLUSION: Patients with chronic aortic regurgitation have increased arterial distensibility. Greater vascular compliance, to lessen the impact of systolic volume ejected into conduit arteries, represents a compensatory mechanism in left ventricular and arterial system coupling.

  20. Embolization of the Middle Meningeal Artery Effectively Treats Refractory Chronic Subdural Hematoma: A Systematic Review

    Directory of Open Access Journals (Sweden)

    Gobran Alfotih

    2014-10-01

    Full Text Available Chronic subdural hematoma (CSDH formation mechanism is very complex, and has not entirely understood. It represents a frequent type of intracranial hemorrhage, and is very common disease in Neurosurgery practice, especially in older patients. Various surgical treatments have been proposed for the treatment of CSDH. The rate of recurrence in CSDH after surgery ranges from 5% to 30%, repeated surgery must be considered. But in some cases subdural collections are still persistent. Endovascular embolization of the middle meningeal artery (MMA is an option for treatment of refractory CSDH. We review all cases that were treated with embolization to assess the effect of this intervention. Our review revealed 6 papers with a total enrollment of 14 patients were treated with MMA embolization for refractory chronic subdural hematoma without any postoperative complication or recurrence. In this study we suggest MMA embolization as an alternative for treatment of non-curable CSDH, especially for old people with systematic diseases, who cannot tolerate repeat surgery.

  1. Estimation of cardiac output and total peripheral resistance in preterm infants by arterial waveform analysis.

    Science.gov (United States)

    Zhang, Ying; Chan, Gregory S H; Tracy, Mark B; Hinder, Murray; Redmond, Stephen J; Savkin, Andrey V; Lovell, Nigel H

    2013-01-01

    This study investigated whether arterial blood pressure waveform analysis could be useful for estimating left ventricular outflow (LVO) and total peripheral resistance (TPR) in preterm infants. A cohort of 27 infants were studied, with 89 measurements of left ventricular outflow (LVO) using Doppler echocardiography and arterial pressure using catheters, performed in 0, 12, 24 and 36 hours after birth. TPR was computed as mean arterial pressure divided by LVO. The diastolic decay rate (1/τ) was obtained via fitting an exponential function to the last one third of each arterial pulse, with the mean rate computed from 50 pulses selected from each infant. This decay rate was considered to be inversely related to TPR while positively related to LVO. The results of regression analysis have confirmed that the diastolic decay rate had significant positive and negative relationships with LVO and TPR respectively(r = 0.383, P = 0.0002 and r = -0.379, P = 0.0002 respectively). These preliminary results demonstrated the potential utility of arterial pressure waveform analysis for estimating LVO and TPR in preterm infants, but more advanced multi-parameter models may be needed to improve accuracy of the estimation.

  2. Total and free thyroid hormone levels in chronic renal failure.

    Directory of Open Access Journals (Sweden)

    Mehta H

    1991-04-01

    Full Text Available The levels of serum total thyroxine (TT4, triiodothyronine (TT3, free T3, (FT3 free T4 (FT4 and thyrotropin (TSH were measured in 127 clinically euthyroid patients with varying grades of chronic renal failure (CRF; and 97 healthy individuals. They were grouped as: Group I containing 93 patients on conservative management; Group II containing 34 patients on regular dialysis therapy; and Group III (normals. Group I patients showed significant decrease in TT3, TT4 and FT3 levels (p less than 0.001 as compared to Group III, whereas FT4 and TSH values in group I were not significantly altered. TT3, TT4 and FT3 levels reduced as the severity of renal damage increased. Variations in TT3, TT4, FT3, FT4 and TSH levels in Group II patients were similar to those in Group I, except for a decrease in TSH levels (p less than 0.05 as compared to normals. Several thyroid function tests are abnormal in CRF patients, however, finding of normal FT4 and TSH levels would indicate functional euthyroid status.

  3. [False arterial aneurysms of celiac trunk system in patients with chronic pancreatitis].

    Science.gov (United States)

    Kriger, A G; Kokov, L S; Karmazanovskiĭ, G G; Kuntsevich, G I; Fedorov, V D; Barbin, P B; Tarbaeva, N V

    2008-01-01

    20 patients with chronic pancreatitis complicated by development of false aneurysms of arteries in celiac trunk system were observed. Diagnostics utilities included ultrasound study, contrasted computed tomography and angiography. Two types of aneurysms are distinguished: parencchymal and pseudocysts. Radioendovascular operation is the method of choice for aneurism treatment. Surgical treatment is carried out in case of aneurism rupture with voluminous bleeding or on necessity of elimination other complications of chronic pancreatitis (pseudocyst, pancreatic hypertension, wirsungolithiasis).

  4. Increased arterial inflammation in individuals with stage 3 chronic kidney disease

    Energy Technology Data Exchange (ETDEWEB)

    Takx, Richard A.P. [Massachusetts General Hospital and Harvard Medical School, Cardiac MR PET CT Program, Boston, MA (United States); University Medical Center Utrecht, Department of Radiology, Utrecht (Netherlands); MacNabb, Megan H.; Emami, Hamed; Abdelbaky, Amr; Lavender, Zachary R. [Massachusetts General Hospital and Harvard Medical School, Cardiac MR PET CT Program, Boston, MA (United States); Singh, Parmanand [Massachusetts General Hospital and Harvard Medical School, Cardiac MR PET CT Program, Boston, MA (United States); New York Presbyterian Hospital, Weill Cornell Medical College, Division of Cardiology, New York, NY (United States); Di Carli, Marcelo; Taqueti, Viviany; Foster, Courtney [Brigham and Women' s Hospital and Harvard Medical School, Division of Radiology, Department of Medicine, Boston, MA (United States); Mann, Jessica; Comley, Robert A.; Weber, Chek Ing Kiu [F. Hoffmann-La Roche Ltd., Basel (Switzerland); Tawakol, Ahmed [Massachusetts General Hospital and Harvard Medical School, Cardiac MR PET CT Program, Boston, MA (United States); Massachusetts General Hospital and Harvard Medical School, Cardiology Division, Boston, MA (United States); Massachusetts General Hospital, Boston, MA (United States)

    2016-02-15

    While it is well known that patients with chronic kidney disease (CKD) are at increased risk for the development and progression of atherosclerosis, it is not known whether arterial inflammation is increased in mild CKD. The aim of this study was to compare arterial inflammation using {sup 18}F-FDG PET/CT in patients with CKD and in matched controls. This retrospective study included 128 patients undergoing FDG PET/CT imaging for clinical indications, comprising 64 patients with stage 3 CKD and 64 control patients matched by age, gender, and cancer history. CKD was defined according to guidelines using a calculated glomerular filtration rate (eGFR). Arterial inflammation was measured in the ascending aorta as FDG uptake on PET. Background FDG uptake (venous, subcutaneous fat and muscle) were recorded. Coronary artery calcification (CAC) was assessed using the CT images. The impact of CKD on arterial inflammation and CAC was then assessed. Arterial inflammation was higher in patients with CKD than in matched controls (standardized uptake value, SUV: 2.41 ± 0.49 vs. 2.16 ± 0.43; p = 0.002). Arterial SUV correlated inversely with eGFR (r = -0.299, p = 0.001). Venous SUV was also significantly elevated in patients with CKD, while subcutaneous fat and muscle tissue SUVs did not differ between groups. Moreover, arterial SUV remained significantly elevated in patients with CKD compared to controls after correcting for muscle and fat background, and also remained significant after adjusting for clinical risk factors. Further, CKD was associated with arterial inflammation (SUV) independent of the presence of subclinical atherosclerosis (CAC). Moderate CKD is associated with increased arterial inflammation beyond that of controls. Further, the increased arterial inflammation is independent of presence of subclinical atherosclerosis. Current risk stratification tools may underestimate the presence of atherosclerosis in patients with CKD and thereby the risk of

  5. Percutaneous stenting of the superior mesenteric artery for the treatment of chronic mesenteric ischemia

    Energy Technology Data Exchange (ETDEWEB)

    Gweon, Hye Mi; Suh, Sang Hyun; Won, Jong Yun [Yongdong Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of); Lee, Do Yun [Yonsei National College of Medicine, Seoul (Korea, Republic of); Kim, Sam Soo [Kangwon National University Hospital, Chuncheon (Korea, Republic of)

    2008-06-15

    We wanted to evaluate the effectiveness of stent placement on the superior mesenteric artery as a treatment for chronic mesenteric ischemia. Seven patients (mean age: 55 years, age range: 43-66 years) with chronic mesenteric ischemia were enrolled between March 2000 and September 2003. All the patients underwent pre-procedure contrast enhanced computerized tomography to evaluate for occlusion or stenosis of the mesenteric arteries and they then underwent an angiographic procedure. A balloon-expandable metal stent was placed in the superior mesenteric artery, and this was combined with balloon angioplasty and thrombolysis. We evaluated the angiographic and procedural success after the procedures. Angiographic and procedural success was obtained in 100% of the patients and the clinical symptoms improved in 100% of the patients. The patency at 6-months and 1-year was 85% and 71%, respectively. The mean follow-up period was 12 months (range: 1-25 months). During the follow-up period, ischemic symptoms recurred in 2 patients, and restenosis in a stent was confirmed with angiography; one patient was successfully treated by stent placement in the celiac artery and the other patient died due to extensive mesenteric thrombosis. For the treatment of chronic mesenteric ischemia, percutaneous stent placement on the superior mesenteric artery showed a favorable result and it was an effective alternative to surgery for the high-risk patients.

  6. Arterial hypertension in chronic glomerulonephritis. An analysis of 310 cases.

    Science.gov (United States)

    Danielsen, H; Kornerup, H J; Olsen, S; Posborg, V

    1983-06-01

    310 cases of glomerulonephritis classified morphologically according to the criteria of the WHO were analyzed retrospectively in order to determine the frequency of arterial hypertension. The overall prevalence of arterial hypertension was 61%. Hypertension was most frequent and severe in membranoproliferative and sclerotic glomerulonephritis, but often mild and transient in extracapillary glomerulonephritis. Hypertension usually developed during the early stages of the disease when kidney function was well preserved and in only 16% was hypertension first seen during the uremic stage. No correlation was found between hypertension and the presence of the nephrotic syndrome. During dialysis, hypertension was present in 78%; in 90% of these patients hypertension was "controllable" and in 10% it was "uncontrollable".

  7. Case Report: Chronic Recurrent Unilateral Pulmonary Infection: Result of Congenital Unilateral Agenesis of Pulmonary Artery.

    Science.gov (United States)

    Al Jabbari, Odeaa; Abu Saleh, Walid K; Ramchandani, Mahesh; Scheinin, Scott

    2016-01-01

    Unilateral agenesis of the pulmonary artery (UAPA) is a rare congenital anomaly. This report describes a 52-year-old female who gave a long history of chronic, recurrent, left-sided pulmonary infections related to UAPA. For many years, she was managed medically but the infection continued to recur. She eventually underwent left pneumonectomy and made a good recovery.

  8. Association between airway obstruction and peripheral arterial stiffness in elderly patients with chronic obstructive pulmonary disease

    Institute of Scientific and Technical Information of China (English)

    付志方

    2014-01-01

    Objective To evaluate the relationship between se-verity of airway obstruction and peripheral arterial stiffness in patients with chronic obstructive pulmonary disease(COPD).Methods 81 COPD patients[aged(78.32±6.98)yrs,73 males,8 females]from Jan2008 to Oct 2012 were enrolled in Geriatric Department

  9. Intravascular Ultrasound in Percutaneous Coronary Intervention for Chronic Total Occlusion

    Directory of Open Access Journals (Sweden)

    M Mohandes

    2010-09-01

    Full Text Available Background: Percutaneous coronary intervention (PCI of chronic total occlusion (CTO is one of the most challenging procedures in interventional cardiology. New techniques and devices have made possible to face these complex procedures. Intravascular ultrasound (IVUS reveals special features and contributes greatly to procedural success.Method: We analysed retrospectively IVUS contribution and findings in 23 cases of a total 46 CTOs PCI from February 2009 to August 2010 in our cath lab. Both true and functional CTO were included in this study. The procedure was considered successful when a TIMI III flow was reached in the occluded vessel after stent implantation with a residual stenosis less than 30%. IVUS features and contribution in CTO-PCI were analysed. All data were introduced in SPSS version 15 (SPSS Inc. Chicago, Illinois, USA. Continuous variables were described by mean ± SD and categorical variables were expressed as percentage. A P<0.05 was considered statistically significant.Results: 46 PCIs in 34 patients were performed during 19 months in our centre. The procedure was successful in 28 cases (60.9%.. IVUS was performed in 23 (82.1% of successful procedures. IVUS revealed calcium somewhere in 17 (73.9%. Despite wire angiographic verification in true lumen distally IVUS showed subintimal wire position in part of CTO segment in 6(26.1%. In 22(95.7% of cases IVUS allowed both the wire position verification in true lumen and the vessel measurement before stent implantation. In 1(4.3% case a second wire was introduced into true lumen guided by IVUS after realising that the first wire was in false lumen. We could not find significant relation between calcium presence and subintimal wire penetration in CTO segment (p: 0.14 Conclusions: IVUS showed calcium in CTO segment in a high percentage of cases. It is not unusual to find wire penetration in subintimal space in part of CTO segment. IVUS has a key contribution in the step by step

  10. Left ventricular, systemic arterial, and baroreflex responses to ketamine and TEE in chronically instrumented monkeys

    Science.gov (United States)

    Koenig, S. C.; Ludwig, D. A.; Reister, C.; Fanton, J. W.; Ewert, D.; Convertino, V. A.

    2001-01-01

    Effects of prescribed doses of ketamine five minutes after application and influences of transesophageal echocardiography (TEE) on left ventricular, systemic arterial, and baroreflex responses were investigated to test the hypothesis that ketamine and/or TEE probe insertion alter cardiovascular function. Seven rhesus monkeys were tested under each of four randomly selected experimental conditions: (1) intravenous bolus dose of ketamine (0.5 ml), (2) continuous infusion of ketamine (500 mg/kg/min), (3) continuous infusion of ketamine (500 mg/kg/min) with TEE, and (4) control (no ketamine or TEE). Monkeys were chronically instrumented with a high fidelity, dual-sensor micromanometer to measure left ventricular and aortic pressure and a transit-time ultrasound probe to measure aortic flow. These measures were used to calculate left ventricular function. A 4-element Windkessel lumped-parameter model was used to estimate total peripheral resistance and systemic arterial compliance. Baroreflex response was calculated as the change in R-R interval divided by the change in mean aortic pressure measured during administration of graded concentrations of nitroprusside. The results indicated that five minutes after ketamine application heart rate and left ventricular diastolic compliance decreased while TEE increased aortic systolic and diastolic pressure. We conclude that ketamine may be administered as either a bolus or continuous infusion without affecting cardiovascular function 5 minutes after application while the insertion of a TEE probe will increase aortic pressure. The results for both ketamine and TEE illustrate the classic "Hawthorne Effect," where the observed values are partly a function of the measurement process. Measures of aortic pressure, heart rate, and left ventricular diastolic pressure should be viewed as relative, as opposed to absolute, when organisms are sedated with ketamine or instrumented with a TEE probe.

  11. Novel Crossing System for Chronic Total Occlusion Recanalization: First-in-Man Experience With the SoundBite Crossing System.

    Science.gov (United States)

    Benko, Andrew; Bérubé, Simon; Buller, Christopher E; Dion, Steven; Riel, Louis-Philippe; Brouillette, Martin; Généreux, Philippe

    2017-02-01

    Chronic total occlusion (CTO) lesions are frequent in patients with peripheral and coronary artery disease, and are associated with a higher risk of adverse events, including mortality, decreased quality of life, and increased health-care costs. Percutaneous intervention of CTO lesions has been associated with a lower procedural success rate, and current dedicated CTO devices may be of limited use for non-CTO experts, and associated with increased intraprocedural complication rates. The SoundBite Crossing System (SoundBite Medical Solutions, Inc) is a newly-developed device using shockwaves (short-duration, high-amplitude pressure pulses) delivered to the tip of guidewire to facilitate penetration of the proximal cap and crossing of the occlusion. The current report describes the first-in-man use of the SoundBite Crossing System in the recanalization of two occluded lower-limb arteries.

  12. [CHARACTERISTIC OF ALTERATIONS OF ARTERIES IN PATIENTS WITH ISCHEMIC HEART DISEASE AND CHRONIC HEPATITIS C].

    Science.gov (United States)

    Guliaev, N I; Kuznetsov, V V; Poltareĭko, D S; Qleksiuk, I B; Gordienko, A V; Barsukov, A V

    2015-01-01

    The article presents an assessment of degree and type of atherosclerosis of coronary and non-coronary vessels in old patients with ischemic heart disease associated with chronic viral hepatitis C (VHC), the incidence of myocardial infarction and the possibility of participation chronic VHC in atherogenesis. Patients with ischemic heart disease have correlation of atherosclerosis of arteries with age, hypercholesterinemia. Patients without chronic VHC more often give a higher risk of myocardial infarction, especially in early period (1-1,5 years) of onset of ischemic heart disease clinical implications. Patients with ischemic heart disease associated with chronic viral hepatitis C more often have generalized alterations in vessels, multifocal type of alteration. So, participation of VHC in atherogenesis is most probably connected with maintenance of chronic immune inflammation in vascular endothelium.

  13. Mesenchymal stem cells and chronic renal artery stenosis.

    Science.gov (United States)

    Oliveira-Sales, Elizabeth B; Boim, Mirian A

    2016-01-01

    Renal artery stenosis is the main cause of renovascular hypertension and results in ischemic nephropathy characterized by inflammation, oxidative stress, microvascular loss, and fibrosis with consequent functional failure. Considering the limited number of strategies that effectively control renovascular hypertension and restore renal function, we propose that cell therapy may be a promising option based on the regenerative and immunosuppressive properties of stem cells. This review addresses the effects of mesenchymal stem cells (MSC) in an experimental animal model of renovascular hypertension known as 2 kidney-1 clip (2K-1C). Significant benefits of MSC treatment have been observed on blood pressure and renal structure of the stenotic kidney. The mechanisms involved are discussed.

  14. Life-threatening hemobilia caused by hepatic artery pseudoaneurysm:A rare complication of chronic cholangitis

    Institute of Scientific and Technical Information of China (English)

    Tsu-Te Liu; Ming-Chih Hou; Han-Chieh Lin; Full-Young Chang; Shou-Dong Lee

    2003-01-01

    Hemobilia is one of the causes of obscure gastrointestinal haemorrhage. Most cases of hemobilia are of iatrogenic or traumatic origin. Hemobilia caused by a hepatic artery pseudoaneurysm due to ascending cholangitis is very rare and its mechanism is undear. We report a 74-year-old woman with a history of surgery for choledocholithiasis 30 years ago, suffering from a protracted course of life-threatening gastrointestinal bleeding. A small intestines series and endoscopic retrograde cholangiopancreatography revealed a chronic cholangitis with marked contrast reflux into the biliary tree. Angiography confirmed the bleeding from a pseudoaneurysm of the middle hepatic artery. Coil embolization achieved successful hemostasis. We discussed the mechanism and reviewed the literature.

  15. Relationship between chronic obstructive pulmonary disease and subclinical coronary artery disease in long-term smokers

    DEFF Research Database (Denmark)

    Rasmussen, Thomas; Køber, Lars; Pedersen, Jesper Holst;

    2013-01-01

    Cardiovascular conditions are reported to be the most frequent cause of death in patients with chronic obstructive pulmonary disease (COPD). However, it remains unsettled whether severity of COPD per se is associated with coronary artery disease (CAD) independent of traditional cardiovascular risk...... factors. The aim of this study was to examine the relationship between the presence and severity of COPD and the amount of coronary artery calcium deposit, an indicator of CAD and cardiac risk, in a large population of current and former long-term smokers....

  16. Effects of statin treatment in patients with coronary artery disease and chronic kidney disease.

    Science.gov (United States)

    Kaneko, Hidehiro; Yajima, Junji; Oikawa, Yuji; Tanaka, Shingo; Fukamachi, Daisuke; Suzuki, Shinya; Sagara, Koichi; Otsuka, Takayuki; Matsuno, Shunsuke; Funada, Ryuichi; Kano, Hiroto; Uejima, Tokuhisa; Koike, Akira; Nagashima, Kazuyuki; Kirigaya, Hajime; Sawada, Hitoshi; Aizawa, Tadanori; Yamashita, Takeshi

    2014-01-01

    Statins reduce cardiovascular morbidity and mortality from coronary artery disease (CAD). However, the effects of statin therapy in patients with CAD and chronic kidney disease (CKD) remain unclear. Within a single hospital-based cohort in the Shinken Database 2004-2010 comprising all patients (n = 15,227) who visited the Cardiovascular Institute, we followed patients with CKD and CAD after percutaneous coronary intervention (PCI). A major adverse cardiovascular and cerebrovascular event (MACCE) was defined by composite end points, including death, myocardial infarction, cerebral infarction, cerebral hemorrhage, and target lesion revascularization. A total of 391 patients were included in this study (median follow-up time 905 ± 679 days). Of these, 209 patients used statins. Patients with statin therapy were younger than those without. Obesity and dyslipidemia were more common, and the glomerular filtration rate (GFR) was significantly higher, in patients undergoing statin treatment. MACCE and cardiac death tended to be less common, and all-cause death was significantly less common, in patients taking statins. Multivariate analysis showed that low estimated GFR, poor left ventricular ejection fraction, and the absence of statin therapy were independent predictors for all-cause death of CKD patients after PCI. Statin therapy was associated with reduced all-cause mortality in patients with CKD and CAD after PCI.

  17. Coronary artery disease in patients with chronic kidney disease: a brief literature review

    Directory of Open Access Journals (Sweden)

    Mostafa Dastani

    2015-09-01

    Full Text Available Cardiovascular is the major cause of death in chronic kidney disease and end-stage renal disease. The cardiovascular mortality rate of patients with renal impairment is evaluated to be higher than general population. Coronary artery disease seems to be an important type of cardiovascular complication among patients with chronic kidney disease and end-stage renal disease before the renal replacement therapy. Due to the strong association between chronic kidney disease and the incidence of coronary artery disease, accurate screening, diagnosis, and management of cardiovascular complications would be essential in patients at different stages of renal dysfunction. Despite the need for the comprehensive knowledge about different aspects of coronary artery disease in patients with renal failure, there is not sufficient evidence regarding the pathophysiology, ideal diagnosis, and treatment strategies for coronary heart disease in population with chronic kidney disease. In this study, we briefly reviewed the existing literatures about the possible screening, diagnosis, and the treatment approaches of risk of coronary heart disease in patients with kidney dysfunction.

  18. Upper limb artery segmental occlusions due to chronic use of ergotamine combined with itraconazole, treated by thrombolysis

    Directory of Open Access Journals (Sweden)

    Nodari Franco

    2011-08-01

    Full Text Available Abstract Background The ergotamine tartrate associated with certain categories of drugs can lead to critical ischemia of the extremities. Discontinuation of taking ergotamine is usually sufficient for the total regression of ischemia, but in some cases it could be necessary thrombolytic and anticoagulant therapy to avoid amputation. Case report A woman of 62 years presented with a severe pain left forearm appeared 10 days ago, with a worsening trend. The same symptoms appeared after 5 days also in the right forearm. Physical examination showed the right arm slightly hypothermic, with radial reduced pulse in presence of reduced sensitivity. The left arm was frankly hypothermic, pulse less on radial and with an ulnar humeral reduced pulse, associated to a decreased sensitivity and motility. Clinical history shows a chronic headache for which the patient took a daily basis for years Cafergot suppository (equivalent to 3.2 mg of ergotamine. From about ten days had begun therapy with itraconazole for vaginal candidiasis. The Color-Doppler ultrasound shown arterial thrombosis of the upper limbs (humeral and radial bilateral, with minimal residual flow to the right and no signal on the humeral and radial left artery. Results Angiography revealed progressive reduction in size of the axillary artery and right humeral artery stenosis with right segmental occlusions and multiple hypertrophic collateral circulations at the elbow joint. At the level of the right forearm was recognizable only the radial artery, decreased in size. Does not recognize the ulnar, interosseous artery was thin. To the left showed progressive reduction in size of the distal subclavian and humeral artery, determined by multiple segmental steno-occlusion with collateral vessels serving only a thin hypotrophic interosseous artery. Arteriographic findings were compatible with systemic drug-induced disease. The immediate implementation of thrombolysis, continued for 26 hours, with

  19. Total Bolus Extraction Method Improves Arterial Image Quality in Dynamic CTAs Derived from Whole-Brain CTP Data

    Directory of Open Access Journals (Sweden)

    Elyas Ghariq

    2014-01-01

    Full Text Available Background and Purposes. The 320-detector row CT scanner enables visualization of whole-brain hemodynamic information (dynamic CT angiography (CTA derived from CT perfusion scans. However, arterial image quality in dynamic CTA (dCTA is inferior to arterial image quality in standard CTA. This study evaluates whether the arterial image quality can be improved by using a total bolus extraction (ToBE method. Materials and Methods. DCTAs of 15 patients, who presented with signs of acute cerebral ischemia, were derived from 320-slice CT perfusion scans using both the standard subtraction method and the proposed ToBE method. Two neurointerventionalists blinded to the scan type scored the arterial image quality on a 5-point scale in the 4D dCTAs in consensus. Arteries were divided into four categories: (I large extradural, (II intradural (large, medium, and small, (III communicating arteries, and (IV cerebellar and ophthalmic arteries. Results. Quality of extradural and intradural arteries was significantly higher in the ToBE dCTAs than in the standard dCTAs (extradural P=0.001, large intradural P<0.001, medium intradural P<0.001, and small intradural P<0.001. Conclusion. The 4D dCTAs derived with the total bolus extraction (ToBE method provide hemodynamic information combined with improved arterial image quality as compared to standard 4D dCTAs.

  20. Total-body 3D magnetic resonance angiography influences the management of patients with peripheral arterial occlusive disease

    Energy Technology Data Exchange (ETDEWEB)

    Goyen, Mathias; Herborn, Christoph U.; Debatin, Joerg F. [University Medical Center Hamburg-Eppendorf, Hamburg (Germany); Kroeger, Knut [University Hospital Essen, Department of Angiology, Essen (Germany); Ruehm, Stefan G. [David Geffen School of Medicine at UCLA, Department of Radiology, Los Angeles, CA (United States)

    2006-03-15

    High-resolution total-body 3D MR angiography (MRA) has recently become available, revealing additional clinically relevant disease in patients with peripheral arterial occlusive disease (PAOD). However, the actual impact of total-body MRA on patient management in patients with PAOD has not been investigated so far. Two hundred forty-nine consecutive patients with angiographically proven PAOD were prospectively examined by means of contrast-enhanced total-body 3D MRA on a 1.5-T MR scanner. All correlative imaging studies performed within 60 days of total-body MRA were included in the efficacy analysis. Additional clinically relevant disease (luminal narrowing >50%, aneurysmal changes or dissections) was found in 73 segments (52 patients), including the renal arteries (36 segments), carotid arteries (28 segments), subclavian arteries (four segments) and abdominal aortic aneurysms (AAA) (five segments). Of the 73 segments, 36 were deemed necessary for further investigation by means of focused MRA examinations; the diagnosis was confirmed in all cases. Within the 60-day follow-up period, interventional or surgical therapy outside the peripheral arterial tree was performed in nine patients (11 segments), including carotid endatherectomy and renal artery angioplasty. The outlined total-body 3D MRA approach permits a comprehensive evaluation of the arterial system in patients with atherosclerosis and does indeed have an impact on patient management in patients with PAOD. (orig.)

  1. Total Flavone of Hawthorn Leaf inhibits neuronal apoptosis in brain tissue of rat models of chronic cerebral ischemia

    Institute of Scientific and Technical Information of China (English)

    Tan Rong-fang; Xia Ai-hua; Wu Xiao-guang; Cao Na-na; Li Meng-meng; Zhang Tian-ge; Wang Yi-ru; Yue Zhi-ling

    2014-01-01

    BACKGROUND: Cerebrovascular disease often causes dysfunction of the brain nerve, and nerve cel apoptosis is the important factor of cerebral nerve dysfunction. The excessive expression of c-fos can block the transduction of intracelular signal so that producing some apoptosis-promoting factors, which involve in nerve cel apoptosis process after ischemia injury of brain. Bcl-2 is an inhibited factor. It might to be the key to treat ischemic cerebrovascular disease by inhibiting or reducing the apoptosis of nerve cels after ischemia injury. OBJECTIVE: To investigate the therapeutic effect and mechanism of the Total Flavone of Hawthorn Leaf on chronic cerebral ischemia rats. METHODS: A total of 72 healthy male Sprague-Dawley rats were randomly divided into sham surgery group, model group, Total Flavone of Hawthorn Leaf group and ginkgo leaf group. Permanent bilateral carotid artery ligation was used to prepare chronic cerebral ischemia model in the model group, Total Flavone of Hawthorn Leaf group and ginkgo leaf group. Total Flavone of Hawthorn Leaf group and ginkgo leaf group respectively received 140 mg/kg Total Flavone of Hawthorn Leaf and 12.3 mg/kg ginkgo leaf intragastricaly for 36 days from 36 days after model induction. Model group and sham surgery group received 3.5 mL/kg physiological saline intragastricaly. RESULTS AND CONCLUSION: Compared with the model group, the expression of c-fos protein significantly deceased in the Total Flavone of Hawthorn Leaf group (P 0.05). These data indicated that the protective effect of Total Flavone of Hawthorn Leaf on chronic cerebral ischemia was associated with its inhibition of neuronal apoptosis. Its mechanism of anti-apoptosis might be associated with up-regulating expression of Bcl-2, down-regulating expression of c-fos and decreasing Ca2+ content in brain.

  2. Mild and moderate pre-dialysis chronic kidney disease is associated with increased coronary artery calcium

    Directory of Open Access Journals (Sweden)

    Budoff M

    2011-12-01

    Full Text Available Sion K Roy, Albert Cespedes, Dong Li, Tae-Young Choi, Matthew J BudoffDivision of Cardiology, Department of Medicine, Los Angeles Biomedical Research Center at Harbor-UCLA Medical Center, Torrance, California, USABackground: It is increasingly evident that patients with chronic kidney disease (CKD are more likely to die from heart disease than kidney failure. This study evaluated whether pre-dialysis CKD is an independent risk factor for coronary artery calcium (CAC.Methods: A total of 544 consecutive patients who underwent CAC scoring were analyzed. Eleven patients requiring hemodialysis were excluded. Patients were divided into three groups: normal glomerular filtration rate (GFR (GFR > 90 mL/min/1.73 m2, mild CKD (90 ≥ GFR > 60 mL/min/1.73 m2, and moderate CKD (60 ≥ GFR > 30 mL/min/1.73 m2. Continuous and categorical variables were compared using analysis of variance and the χ2 statistic. A multiple logistic regression model was used for detecting the association between total CAC score and GFR. An unadjusted model was used, followed by a second model adjusted for covariates known to be related to CAC. Another multivariable binary logistic model predicting the presence of CAC (>10 was performed and odds of incidence of CAC (>10 were calculated among the three GFR subgroups.Results: After adjustment for covariates, patients with mild CKD had mean CAC scores 175 points higher than those with the referent normal GFR (P = 0.048, while those with moderate CKD had mean CAC scores 693 points higher than the referent (P < 0.001. After adjustment for covariates, patients with mild CKD were found to be 2.2 times more likely (95% confidence interval 1.3–3.7, P = 0.004 and patients with moderate CKD were 6.4 times more likely (95% confidence interval 2.9–14.3, P < 0.001 to have incident CAC compared with the group with normal GFR.Conclusion: Mild and moderate pre-dialysis CKD are independent risk factors for increased mean and incident CAC

  3. Popliteal pseudoaneurysm after total knee arthroplasty secondary to intraoperative arterial injury with a surgical pin: review of the literature.

    Science.gov (United States)

    Sandoval, Enrique; Ortega, Francisco Javier; García-Rayo, Manuel Ramón; Resines, Carlos

    2008-12-01

    Pseudoaneurysms of the popliteal artery after total knee arthroplasty are rare. Although many possible explanations are proposed in the literature, no intimate mechanism of injury to the artery is previously described. We report on a case of popliteal pseudoaneurysm after a total knee arthroplasty that presented clinically on the second postoperative day. Open vascular surgery with resection of the pseudoaneurysm and end-to-end bypass of contralateral saphena vein graft was successfully performed. At the time of the surgery, a hole was clearly identified on the anterior wall of the popliteal artery due to a perforation with a pin used during the knee arthroplasty. The patient had no further complications.

  4. Stent-assisted mechanical recanalization for symptomatic subacute or chronic middle cerebral artery occlusion

    Science.gov (United States)

    Guo, Dong; Ma, Ji; Li, Teng-Fei; Zhu, Ming; Han, Xin-Wei; Shui, Shao-Feng

    2015-01-01

    To assess the feasibility and short-term effects of treating patients with subacute or chronic middle cerebral artery (M1) occlusion by stent-assisted mechanical recanalization. Six patients with cerebral arteries occlusion underwent surgery. Six cerebral arteries occlusion in 5 patients were successfully recanalized. On postoperative day 1, four patients’ symptoms were relieved and two patients’ symptoms were exacerbated, of which one was significantly improved after 3 days, the other one’s symptoms were recovered to preoperative levels in 2 weeks. No patients died after surgery. No stroke or transient ischemic attack occurred. The average follow-up of was 4.2 months, no worsening of condition, recurrence or death occurred. The results indicate that for patients with subacute or chronic middle cerebral artery (M1) occlusion, mechanical recanalization was technically feasible under the premise of strict case screening. Mechanical recanalization is able to improve ischemic symptoms and promote dysfunction restoration. But its long-term effect remains to be evaluated by further large samples, long-term follow-up studies. PMID:26885148

  5. Multimodality Imaging Evaluation of Functional and Clinical Benefits of Percutaneous Coronary Intervention in Patients with Chronic Total Occlusion Lesion

    Directory of Open Access Journals (Sweden)

    Dongdong Sun, Jing Wang, Yue Tian, Kazim Narsinh, Haichang Wang, Chengxiang Li, Xiaowei Ma, Yabing Wang, Dongjuan Wang, Chunhong Li, Joseph C Wu, Jie Tian, Feng Cao

    2012-01-01

    Full Text Available Aims: To determine the effects of percutaneous coronary intervention (PCI on cardiac perfusion, cardiac function, and quality of life in patients with chronic total occlusion (CTO lesion in left anterior descending (LAD coronary artery.Methods and Results: Patients (n=99 with CTO lesion in the LAD coronary artery who had successfully undergone PCI were divided into three groups based on the SPECT/CTCA fusion imaging: (a no severe cardiac perfusion defects (n=9; (b reversible cardiac perfusion defects (n=40; or (c fixed cardiac perfusion defects (n=50. No statistical difference of perfusion abnormality was observed at 6 months and 1 year after PCI in group (a. In group (b, SPECT/CTCA fusion imaging demonstrated that cardiac perfusion abnormality was significantly decreased 6 month and 1 year after PCI. Left ventricular ejection fraction (LVEF increased significantly at 6 months and 1 year follow up. Quality of life improved at 6 months and 1 year after PCI procedure. Moreover, patients in group (c also benefited from PCI therapy: a decrease in cardiac perfusion abnormality, an increase in LVEF, and an improvement in quality of life. PCI of coronary arteries in addition to LAD did not significantly affect cardiac function and quality of life improvement in each group.Conclusions: PCI exerts functional and clinical benefits in patients with CTO lesion in LAD coronary artery, particularly in patients with reversible cardiac perfusion defects. SPECT/CTCA fusion imaging may serve as a useful tool to evaluate the outcomes of patients with CTO lesion in LAD coronary artery.

  6. Does short-term whole-body vibration training affect arterial stiffness in chronic stroke? A preliminary study.

    Science.gov (United States)

    Yule, Christie E; Stoner, Lee; Hodges, Lynette D; Cochrane, Darryl J

    2016-03-01

    [Purpose] Previous studies have shown that stroke is associated with increased arterial stiffness that can be diminished by a program of physical activity. A novel exercise intervention, whole-body vibration (WBV), is reported to significantly improve arterial stiffness in healthy men and older sedentary adults. However, little is known about its efficacy in reducing arterial stiffness in chronic stroke. [Subjects and Methods] Six participants with chronic stroke were randomly assigned to 4 weeks of WBV training or control followed by cross-over after a 2-week washout period. WBV intervention consisted of 3 sessions of 5 min intermittent WBV per week for 4 weeks. Arterial stiffness (carotid arterial stiffness, pulse wave velocity [PWV], pulse and wave analysis [PWA]) were measured before/after each intervention. [Results] No significant improvements were reported with respect to carotid arterial stiffness, PWV, and PWA between WBV and control. However, carotid arterial stiffness showed a decrease over time following WBV compared to control, but this was not significant. [Conclusion] Three days/week for 4 weeks of WBV seems too short to elicit appropriate changes in arterial stiffness in chronic stroke. However, no adverse effects were reported, indicating that WBV is a safe and acceptable exercise modality for people with chronic stroke.

  7. The effects of direct renin inhibitor, aliskiren, on arterial hypertension, chronic kidney disease and cardiovascular disease: optimal pharmacotherapy.

    Science.gov (United States)

    Morishita, Yoshiyuki; Kusano, Eiji

    2013-03-01

    The renin-angiotensin-aldosterone system (RAAS) plays pivotal roles in the pathogenesis of progression of arterial hypertension, chronic kidney disease (CKD) and cardiovascular disease (CVD). Previous studies suggested that a direct renin inhibitor, aliskiren, may be effective for blood pressure lowering, renoprotection and cardiovascular protection. This review focuses on the effects of aliskiren for arterial hypertension, CKD and CVD.

  8. Clinical aspects of chronic gastritis in patients with concomitant arterial hypertension

    Directory of Open Access Journals (Sweden)

    Мар'яна Миколаївна Курбан

    2015-10-01

    Full Text Available Aim: The work deals with special features of chronic gastritis clinical course with comorbid arterial hypertension.Methods: 96 patients underwent complex examination: 62 patients with combined clinical course of arterial hypertension and chronic gastritis and 34 ones with isolated chronic gastritis. All patients underwent clinical, laboratory and instrumental examination.Result: At analysis of results it was established that in the 1 group of patients took place the more heavy clinical course and the main complaints were presented as pain syndrome (of an acute, nagging character especially in epigastric zone or without strict localization that took place after ingestion, dyspeptic syndrome (with predominant meteorism, spreading feeling in epigastrium and eructation and asthenoneurotic syndrome (with sleep disorders, general weakness and work disability as opposed to patients of the 11 group whose pain syndrome was predominantly stable or periodic of an acute character in epigastric zone. Among complaints that are specific for dyspeptic syndrome prevailed eructation, spreading feeling in epigastrium and nausea. At the same time the chronic gastritis duration and pain syndrome intensity correlated with helicobacterial infection and comorbidity.Conclusions: Combined pathology is characterized with more intense clinical symptomatology as a direct consequence of mutual influence of diseases. The researches aimed at the study of clinical features of comorbid states allow the grounded approach to its therapy with special attention to all aspects of interaction

  9. Chronic thromboembolic pulmonary arterial hypertension: a review of the literature and novel therapeutic approaches.

    Science.gov (United States)

    Androulakis, Emmanuel; Lioudaki, Eirini; Christophides, Theodoros; Ahmad, Mahmood; Fayed, Hossam; Laskar, Nabila; Schreiber, Benjamin

    2015-06-01

    Chronic thromboembolic pulmonary hypertension is defined as pulmonary hypertension (PH) caused by single or recurrent pulmonary emboli and is characterized by chronic obstruction of the pulmonary arteries leading to increased vascular resistance and PH. Also, progressive remodeling may occur in occluded and nonoccluded territories. Better understanding of the underlying mechanisms and risk factors could improve diagnosis and allow appropriate interventions. Pulmonary endarterectomy is an established approach and is considered the definitive treatment for chronic PH, resulting from thromboembolic disease. Furthermore, percutaneous transluminal pulmonary angioplasty is technically feasible, especially for those with peripheral-type of the disease. In addition, several agents, including prostanoids, endothelin receptor antagonists and phosphodiesterase type-5 inhibitors, have been tested in selected patients yielding promising results. Several novel agents are under investigation, and extensive research is currently in progress aiming to resolve uncertainties in the understanding and treatment of the disease.

  10. Variability of hemodynamic responses to acute digitalization in chronic cardiac failure due to cardiomyopathy and coronary artery disease.

    Science.gov (United States)

    Cohn, K; Selzer, A; Kersh, E S; Karpman, L S; Goldschlager, N

    1975-04-01

    Eight patients with chronic congestive heart failure (four with cardiomyopathy and four with ischemic heart disease) underwent hemodynamic studies during acute administration of digoxin, given intravenously in two 0-5 mg doses 2 hours apart. Observations were made before administration of digitalis (control period) and serially therafter for 4 hours after the first dose. Resting mean cardiac index and pulmonary arterial wedge pressure were as follows: 2.0 liters/min per m2 and 23 mm Hg (control period); 2.1 and 24 (at 1 hour); 2.0 and 23 (at 2 hours); 2.7 and 19 (at 3 hours); and 2.3 and 20 (at 4 hours). Exercise responses of mean cardiac index and pulmonary arterial wedge pressure in five patients were: 3.1 liters/min per m2 and 36 mm Hg (control period); 3.2 and 33 (at 1 hour); 3.2 and 28 (at 2 hours); 3.1 and 27 (at.3 hours); and 3.4 and 31 (at 4 hours). The pulmonary arterial wedge pressure remained elevated during exercise in all cases. Arrhythmias were seen in five patients after administration of 0.5 mg of digoxin. Hemodynamic improvement at 4 hours involving both reduced filling pressure and increased blood flow was observed in only two patients at rest and in one additional patient during exercise. Acute deterioration of cardiac function (elevated pulmonary arterial wedge pressure of decreased cardiac index) occurred 30 minutes after administration of digoxin in four patients, concomitantly with increased systemic resistance. In six patients, a peak hemodynamic effect appeared 1 to 1 1/2 hours after administration of digoxin, with partial or total loss of initial benefit by 2 and 4 hours. In previously performed studies observations have seldom exceeded 1 hour; the results of this 4 hour study suggest that, in patients with cardiomyopathy or coronary artery disease and chronic congestive heart failure, acute digitalization does not necessarily lead to consistent, marked or lasting hemodynamic improvement. Thus, current concepts of the use of digitalis is

  11. An improved strategy for evaluating the extent of chronic arterial baroreceptor denervation in conscious rats

    Directory of Open Access Journals (Sweden)

    M. Rodríguez-Martínez

    2010-11-01

    Full Text Available There is no index or criterion of aortic barodenervation, nor can we differentiate among rats that have suffered chronic sham, aortic or sino-aortic denervation. The objective of this study was to develop a procedure to generate at least one quantitative, reproducible and validated index that precisely evaluates the extent of chronic arterial barodenervation performed in conscious rats. Data from 79 conscious male Wistar rats of about 65-70 days of age with diverse extents of chronic arterial barodenervation and used in previous experiments were reanalyzed. The mean arterial pressure (MAP and the heart rate (HR of all rats were measured systematically before (over 1 h and after three consecutive iv bolus injections of phenylephrine (PHE and sodium nitroprusside (SNP. Four expressions of the effectiveness of barodenervation (MAP lability, PHE ratio, SNP ratio, and SNP-PHE slope were assessed with linear fixed models, three-level average variance, average separation among levels, outlier box plot analysis, and overlapping graphic analysis. The analysis indicated that a neither MAP lability nor SNP-PHE slope was affected by the level of chronic sodium intake; b even though the Box-Cox transformations of both MAP lability [transformed lability index (TLI] and SNP-PHE slope [transformed general sensitivity index (TGSI, {((3-(ΔHRSNP-ΔHRPHE/ΔMAPSNP-ΔMAPPHE-0.4-1/-0.04597}] could be two promising indexes, TGSI proved to be the best index; c TLI and TGSI were not freely interchangeable indexes for this purpose. TGSI ranges that permit differentiation between sham (10.09 to 11.46, aortic (8.40 to 9.94 and sino-aortic (7.68 to 8.24 barodenervated conscious rats were defined.

  12. Percutaneous laser thermal angioplasty: initial clinical results with a laser probe in total peripheral artery occlusions.

    Science.gov (United States)

    Cumberland, D C; Sanborn, T A; Tayler, D I; Moore, D J; Welsh, C L; Greenfield, A J; Guben, J K; Ryan, T J

    1986-06-28

    A metal-tipped laser fibre was used during percutaneous angioplasty of femoral/popliteal or iliac artery occlusions in 56 patients. Primary success was achieved in 50 (89%) of these total occlusions, providing a channel for subsequent balloon dilatation. Before the procedure, 18 lesions had been judged untreatable by conventional angioplasty and four of the six failures were in these. Complications directly attributable to the laser probe were one case of vessel perforation and two cases of entry into vessel walls; these had no sequelae. Other acute complications were a distal thrombosis in a non-heparinised patient, requiring local streptokinase treatment, and two reocclusions and one transient peripheral embolic episode in the first 24 hours. The laser probe technique has potential for increasing the proportion of patients suitable for angioplasty.

  13. Probe exchange catheter used for angioplasty of total coronary artery occlusions.

    Science.gov (United States)

    Kiemeneij, F; Suwarganda, J S; van der Wieken, L R

    1990-04-01

    Percutaneous transluminal coronary angioplasty (PTCA) for total occlusions frequently fails, because the guidewire fails to pass the occlusion. With the use of the Probe exchange catheter (PEC), however, stiffness of the guidewire is increased and a higher pushability is obtained in order to manipulate the guidewire beyond the lesion. Once the guidewire has passed, the PEC is advanced and a non-over-the-wire dilatation catheter can be introduced through the PEC. This paper describes the technique in a representative case. The results of this technique in 19 consecutive patients with class III-IV/IV(NYHA) angina due to an occluded coronary artery are presented. In 16 patients the PEC reached the lesion (84%) and in all these patients the guidewire could pass the occlusion. A successful PTCA was performed in 14 patients (74%).

  14. Atypical presentation of acute and chronic coronary artery disease in diabetics

    Institute of Scientific and Technical Information of China (English)

    Hadi; AR; Hadi; Khafaji; Jassim; M; Al; Suwaidi

    2014-01-01

    In patients with diabetes mellitus, cardiovascular disease is the principal cause of mortality and chest pain is the most frequent symptom in patients with stable and acute coronary artery disease. However, there is little knowledge concerning the pervasiveness of uncommon presentations in diabetics. The symptomatology of acute coronary syndrome, which comprises both pain and non-pain symptoms, may be affected by traditional risk factors such as age, gender, smoking, hypertension, diabetes, and dyslipidemia. Such atypical symptoms may range from silent myocardial ischemia to a wide spectrum of non-chest pain symptoms. Worldwide, few studies have highlighted this under-investigated subject, and this aspect of ischemic heart disease has also been under-evaluated in the major clinical trials. The results of these studies are highly diverse which makes definitive conclusions regarding the spectrum of atypical presentation of acute and even stable chronic coronay artery disease difficult to confirm. This may have a significant impact on the morbidity and mortality of coronary artery disease in diabetics. In this up-to-date review we will try to analyze the most recent studies on the atypical presentations in both acute and chronic ischemic heart disease which may give some emphasis to this under-investigated topic.

  15. Enhanced External Counterpulsation Inducing Arterial Hemodynamic Variations and Its Chronic Effect on Endothelial Function

    Institute of Scientific and Technical Information of China (English)

    DU Jian-hang; WU Gui-fu; ZHENG Zhen-sheng; DAI Gang; FENG Ming-zhe

    2014-01-01

    To make clear the precise hemodynamic mechanism underlying the anti-atherogenesis benefit of enhanced external couterpulsation(EECP) treatment, and to investigate the proper role of some important hemodynamic factors during the atherosclerotic progress, a comprehensive study combining long-term animal experiment and numerical solving was conducted in this paper. An experimentally induced hypercholesterolemic porcine model was developed and the chronic EECP intervention was subjected. Basic hemodynamic measurement was performed in vivo, as well as the arterial endothelial samples were extracted for physiological examination. Meanwhile, a numerical model was introduced to solve the complex hemodynamic factors such as WSS and OSI. The results show that EECP treatment resulted in significant increase of the instant levels of arterial WSS, blood pressure, and OSI. During EECP treatment, the instant OSI level of the common carotid arteries over cardiac cycles raised to a mean value of 8.58 ×10-2 ±2.13 ×10-2. Meanwhile, the chronic intervention of EECP treatment significantly reduced the atherosclerotic lesions in abdominal aortas and the endothelial cellular adherence. The present study suggests that the unique blood flow pattern induced by EECP treatment and the augmentation of WSS level in cardiac cycles may be the most important hemodynamic mechanism that contribute to its anti-atherogenesis effect. And as one of the indices that cause great concern in current hemodynamic study, OSI may not play a key role during the initiation of atherosclerosis.

  16. Color Doppler evaluation of the ocular arterial flow changes in chronic obstructive pulmonary disease

    Energy Technology Data Exchange (ETDEWEB)

    Ozer, Tulay [Department of Radiology, Karaelmas University, School of Medicine, Tip Fakueltesi, Radyoloji AD, 67600-Kozlu, Zonguldak (Turkey)]. E-mail: ozertulay@yahoo.com; Altin, Remzi [Department of Pulmonary Medicine, Karaelmas University, School of Medicine, Kozlu, Zonguldak (Turkey); Ugurbas, Suat Hayri [Department of Ophthalmology, Karaelmas University, School of Medicine, Kozlu, Zonguldak (Turkey); Ozer, Yetkin [Department of Anesthesiology and Reanimation, Karaelmas University, School of Medicine, Kozlu, Zonguldak (Turkey); Mahmutyazicioglu, Kamran [Department of Radiology, Karaelmas University, School of Medicine, Tip Fakueltesi, Radyoloji AD, 67600-Kozlu, Zonguldak (Turkey); Kart, Levent [Department of Pulmonary Medicine, Karaelmas University, School of Medicine, Kozlu, Zonguldak (Turkey)

    2006-01-15

    Purpose: To evaluate the hemodynamic changes in the extraocular orbital vessels of the patients with chronic obstructive pulmonary disease (COPD), using color Doppler ultrasonography (CDU) technique, and to compare the results with those of healthy control subjects. Methods: Forty-five patients with COPD and 17 healthy control subjects were included in this study. Patients with COPD were classified according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD). Fifteen patients of stage I COPD (mild airflow limitation), stage II COPD (worsening airflow limitation) or stage III COPD (severe airflow limitation) were enrolled into Group I, II and III, respectively. End tidal carbon dioxide (EtCO{sub 2}), peripheral oxygen saturation (SpO{sub 2}), pulse rate (PR) and respiratory rate (RR) were measured by using capnograph/pulse oximeter in all patients. Measurements were performed in only one randomly chosen eye of each participant. The peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistance index (RI) were measured in the ophthalmic artery (OA), central retinal artery (CRA), lateral short posterior ciliary artery (LPCA) and medial short posterior ciliary artery (MPCA), using CDU technique. Results: The PSV measurements of the OA were significantly higher in Groups II and III compared to control group (p < 0.01, p < 0.001, respectively). The RI values from OA and CRA were significantly higher in Group II and III than the control group (p < 0.05). The RI values of LPCA and MPCA were also significantly higher in Group II than the control subjects (p < 0.05). When RI values were compared, mean values of LPCA and MPCA were significantly lower in Group III than in Group II (p < 0.05). There were no significant differences between Group I and control patients about PSVs, EDVs and RI values of all arteries Statistically significant correlations were found for the EtCO{sub 2} with PSV (r = 0.53, p < 0.01) and EDV (r = 0.51, p < 0.01) of the

  17. Comparable three months' outcome of total arterial revascularization versus conventional coronary surgery: Copenhagen Arterial Revascularization Randomized Patency and Outcome trial

    DEFF Research Database (Denmark)

    Damgaard, S.; Lund, J.T.; Lilleor, N.B.;

    2008-01-01

    .9 in the conventional group (P = .004). Three months' follow-up for the arterial versus conventional groups showed the following: deaths: 1 (0.6%) versus 0; stroke: 3 (1.9%) versus 3 (1.8%); myocardial infarction: 6 (3.7%) versus 4 (2.4%); sternal wound reoperation: 4 (2.5%) versus 0 (P = .054); arm and leg wound...

  18. Effects of maturation, artery size, and chronic hypoxia on 5-HT receptor type in ovine cranial arteries.

    Science.gov (United States)

    Teng, G Q; Williams, J; Zhang, L; Purdy, R; Pearce, W J

    1998-09-01

    To test the hypothesis that variations in cerebrovascular reactivity to 5-HT among arteries of different size or type, during maturation, or during acclimatization to high altitude involve differences in serotonergic receptor subtype, we determined relative agonist potency orders and antagonist affinities in common carotid (Com), main branch middle cerebral (Main), and second branch middle cerebral (2BR) arteries from term fetal lambs and nonpregnant adult sheep acclimatized at sea level or at an altitude of 3,820 m for approximately 110 days. In normoxic adult Com segments, agonist potency order was 5-hydroxytryptamine (5-HT) > 5-carboxamidotryptamine (5-CT) >/= 8-hydroxy-2(di-n-propylamino)tetraline (8-OH-DPAT); sumatriptan (Suma) produced no contractile response; and antagonist dissociation constant (pKb) values were 9.4 and 9.5 for ketanserin against 5-HT and 5-CT, 7.5 for GR-127935 against 5-HT, and 7.2 for SB-206553 against 5-HT. In normoxic adult Main segments, agonist potency order was 5-HT > 5-CT >/= Suma >/= DPAT, and pKb values were 9.1 and 9.2 for ketanserin against 5-HT and 5-CT and 7.4 and 8.5 for GR-127935 against 5-HT and Suma, respectively. In the 2BR segments from normoxic adults, agonist potency order was 5-CT > 5-HT > Suma > DPAT and pKb values were 7.4 and 7.2 for ketanserin against 5-HT and 5-CT and 10.0 and 8.7 for GR-127935 against 5-HT and Suma, respectively. Compared with normoxic adults, none of these values were significantly different in hypoxic adults and in fetuses only the pKb values for ketanserin against 5-HT in the 2BR segments (8.8) were greater. From these results we propose that the ratio of 5-HT2 to 5-HT1 receptors is greatest in the Com and decreases progressively to its smallest values in 2BR or smaller segments. Because this gradient appears stable and relatively resistant to the effects of maturation and chronic hypoxia, changes in reactivity associated with these perturbations may involve alterations in receptor density

  19. INFLUENCE OF CHRONIC EXERCISE ON RED CELL ANTIOXIDANT DEFENSE, PLASMA MALONDIALDEHYDE AND TOTAL ANTIOXIDANT CAPACITY IN HYPERCHOLESTEROLEMIC RABBITS

    Directory of Open Access Journals (Sweden)

    Mohsen Alipour

    2006-12-01

    Full Text Available Despite the knowledge on the antiatherogenic effects of exercise, the mechanism by which exercise reduces atherogenic risk remains unknown. In this study, we investigated the hypothesis that chronic exercise-induced oxidative stress may increase plasma total antioxidant capacity and antioxidant defense in the red cells. For 8 weeks, 60 male Dutch rabbits were fed rabbit chow with or without the addition of 2% cholesterol. The animals were further divided into rest and exercise groups (n = 15 for each group. Animals in exercise groups ran on a rodent treadmill at 15 m/min for 10 to 60 minutes gradually for 5 days per week for a total of 8 weeks. At the end of experiments, blood samples were collected and glutathione peroxidase (GPX, superoxide dismutase (SOD, and catalase (CAT activities were determined in red blood cells. Total antioxidant capacity (TAC, malondialdehyde (MDA and total thiol (T-SH levels were measured in plasma. Thoracic aorta and carotid arteries were isolated for histological examination to evaluate atherosclerosis. Eight weeks of chronic exercise reduced atherogenic diet-induced atherosclerotic lesions in all the arteries studied, along with positive changes in cholesterol profile, especially increase of serum HDL-C level. Plasma MDA, TAC and T-SH concentrations were enhanced by exercise in both control and hypercholesterolemic diet groups. Erythrocyte catalase activity was significantly increased by chronic exercise (p < 0.05, whereas total SOD activity rose with exercise only in the control group. Surprisingly, GPX activity was significantly reduced (P < 0.05 in response to exercise in the control group and also in the high cholesterol diet group. Exercise is a useful tool for the prevention and regression of atherosclerosis which is evident by our findings of the enhancement of plasma TAC and positive change in serum cholesterol profile. However, the effect of exercise on red cell antioxidant activities is limited in the

  20. Red cell distribution width predicts totally occluded infarct-related artery in NSTEMI.

    Science.gov (United States)

    Açıkgöz, Sadık Kadri; Akboğa, Mehmet Kadri; Açıkgöz, Eser; Yayla, Çağrı; Şensoy, Barış; Aydoğdu, Sinan

    2016-08-01

    Objective Since non-ST segment elevation myocardial infarction (NSTEMI) patients with totally occluded infarct-related artery (TO-IRA) have worse prognosis, it is important to recognize TO-IRA in NSTEMI. Red cell distribution width (RDW) and mean platelet volume (MPV) are novel markers of inflammation and oxidative stress and were associated with poor clinical outcomes in acute coronary syndrome. In the present study, association of RDW and MPV with the presence of TO-IRA in NSTEMI was investigated. Methods Data of 201 consecutive patients who underwent coronary angiography with a diagnosis of NSTEMI were analyzed. Independent predictors of TO-IRA were investigated with logistic regression analysis. Results Sixty-six (32.8%) of the patients had TO-IRA. In patients with TO-IRA, RDW and troponin-T were significantly higher and left ventricular ejection fraction (LVEF) was lower. MPV did not differ between groups. Circumflex (CX) IRA was more common in TO-IRA group. The ROC curve analysis showed that the RDW at a cut-point of 13.95% has 76% sensitivity and 66% specificity in detecting TO-IRA. RDW, troponin-T, LVEF and CX-IRA were independent predictors of TO-IRA in NSTEMI, but MPV was not. Conclusion RDW is a cheap and readily available marker that may have a role to predict TO-IRA in NSTEMI.

  1. Characterization of proximal pulmonary arterial cells from chronic thromboembolic pulmonary hypertension patients

    Directory of Open Access Journals (Sweden)

    Quarck Rozenn

    2012-03-01

    Full Text Available Abstract Background Chronic thromboembolic pulmonary hypertension (CTEPH is associated with proximal pulmonary artery obstruction and vascular remodeling. We hypothesized that pulmonary arterial smooth muscle (PASMC and endothelial cells (PAEC may actively contribute to remodeling of the proximal pulmonary vascular wall in CTEPH. Our present objective was to characterize PASMC and PAEC from large arteries of CTEPH patients and investigate their potential involvement in vascular remodeling. Methods Primary cultures of proximal PAEC and PASMC from patients with CTEPH, with non-thromboembolic pulmonary hypertension (PH and lung donors have been established. PAEC and PASMC have been characterized by immunofluorescence using specific markers. Expression of smooth muscle specific markers within the pulmonary vascular wall has been studied by immunofluorescence and Western blotting. Mitogenic activity and migratory capacity of PASMC and PAEC have been investigated in vitro. Results PAEC express CD31 on their surface, von Willebrand factor in Weibel-Palade bodies and take up acetylated LDL. PASMC express various differentiation markers including α-smooth muscle actin (α-SMA, desmin and smooth muscle myosin heavy chain (SMMHC. In vascular tissue from CTEPH and non-thromboembolic PH patients, expression of α-SMA and desmin is down-regulated compared to lung donors; desmin expression is also down-regulated in vascular tissue from CTEPH compared to non-thromboembolic PH patients. A low proportion of α-SMA positive cells express desmin and SMMHC in the neointima of proximal pulmonary arteries from CTEPH patients. Serum-induced mitogenic activity of PAEC and PASMC, as well as migratory capacity of PASMC, were increased in CTEPH only. Conclusions Modified proliferative and/or migratory responses of PASMC and PAEC in vitro, associated to a proliferative phenotype of PASMC suggest that PASMC and PAEC could contribute to proximal vascular remodeling in CTEPH.

  2. The pulsatility index and the resistive index in renal arteries in patients with hypertension and chronic renal failure

    DEFF Research Database (Denmark)

    Petersen, L J; Petersen, J R; Ladefoged, S D

    1995-01-01

    The pulsatility index (PI) and the resistive index (RI) are used as pulsed-wave Doppler measurement of downstream renal artery resistance. Little information is available on their value in chronic renal failure and their correlation to parameters of renal function and haemodynamics. The aim...... was to compare PI and RI of renal arteries in healthy volunteers and in patients with hypertension and chronic renal failure, and furthermore to study the correlation of these indices to measurements of renal haemodynamics and function by standard methods in patients with renal failure and hypertension....

  3. Chronic heart failure model with sequential ligation of the homonymous artery and its diagonal branch in the sheep.

    Science.gov (United States)

    Kim, W G; Park, J J; Oh, S I

    2001-01-01

    We report a reliable chronic heart failure model in sheep using sequential ligation of the homonymous artery and its diagonal branch. After a left anterior thoracotomy in Corridale sheep, the homonymous artery was ligated at a point approximately 40% of the distance from the apex to the base of the heart, and after 1 hour, the diagonal vessel was ligated at a point at the same level. Hemodynamic measurements were done preligation, 30 minutes after the homonymous artery ligation, and 1 hour after diagonal branch ligation. The electrocardiograms were obtained as needed, and cardiac function was also evaluated with ultrasonography. After a predetermined interval (2 months for five animals and 3 months for two animals), the animals were reevaluated in the same way as before, and were killed for postmortem examination of their hearts. All seven animals survived the experimental procedures. Statistically significant decreases in systemic arterial blood pressure and cardiac output and increases in pulmonary artery capillary wedge pressure were observed 1 hour after sequential ligation of the homonymous artery and its diagonal branch. Untrasonographic analyses demonstrated variable degrees of anteroseptal dyskinesia and akinesia in all animals. The data from animals at 2 months after coronary artery ligation showed significant increases in central venous pressure, pulmonary artery pressure, and pulmonary artery capillary wedge pressure. Left ventricular enddiastolic dimension and left ventricular end-systolic dimension on ultrasonographic studies were also increased. Electrocardiography showed severe ST elevation immediately after the ligation and pathologic Q waves were found at 2 months after ligation. The thin walled infarcted areas with chamber enlargement were clearly seen in the hearts removed at 2 and 3 months after ligation. In conclusion, we could achieve a reliable ovine model of chronic heart failure using a simple concept of sequential ligation of the

  4. Development of chronic allograft rejection and arterial hypertension in Brown Norway rats after renal transplantation.

    Science.gov (United States)

    Vaskonen, T; Mervaala, E; Nevala, R; Soots, A; Krogerus, L; Lähteenmäki, T; Karppanen, H; Vapaatalo, H; Ahonen, J

    2000-01-01

    The cardiovascular and renal pathophysiology associated with chronic renal allograft rejection under triple drug immunosuppressive treatment was studied using a recently developed model (Brown Norway (BN) rats) in a 6-week experiment. Renal transplantation was performed to 10-week-old rats in a rat strain combination of Dark Agouti (DA) --> BN. The right kidney was removed from another group of BN rats (uninephrectomized). A triple drug treatment comprising cyclosporine (10 mg/kg subcutaneously, s.c.), azathioprine (2 mg/kg s.c.) and methylprednisolone (1.6 mg/kg s.c.) was given to each rat daily for 6 weeks. A control group underwent no operations nor drug treatment. After the transplantation, the systolic blood pressure in this group was increased from 116 +/- 2 to 166 +/- 2 mmHg, while in the uninephrectomized group the rise was from 115 +/- 4 to 146 +/- 4 mmHg, and no change was observed in the blood pressures of the control group. The vascular relaxation responses of mesenteric arterial rings in vitro to acetylcholine were inhibited in both the transplantation group and the uninephrectomized group as compared with the control group, but few significant differences were found in the contraction responses to noradrenaline and potassium chloride. Graft histology was examined after 6 weeks, quantified by using the chronic allograft damage index (CADI). Changes specific to a chronic rejection reaction were observed in the allografts (CADI mean 6.0) but no injuries were seen in the rats' own kidneys (CADI mean 1.2). Our findings show that allograft rejection in BN rats after renal transplantation is associated with the development of arterial hypertension. The combination of cyclosporine, methylprednisolone and azathioprine also rises blood pressure in uninephrectomized BN rats. The hypertensive effects of the drug treatment and graft rejection are associated with endothelial dysfunction.

  5. Endovascular Treatment of a Symptomatic Thoracoabdominal Aortic Aneurysm by Chimney and Periscope Techniques for Total Visceral and Renal Artery Revascularization

    Energy Technology Data Exchange (ETDEWEB)

    Cariati, Maurizio, E-mail: cariati.maurizio@sancarlo.mi.it [San Carlo Borromeo Hospital, Department of Diagnostic Sciences (Italy); Mingazzini, Pietro; Dallatana, Raffaello [San Carlo Borromeo Hospital, Department of Vascular Surgery (Italy); Rossi, Umberto G. [San Carlo Borromeo Hospital, Department of Diagnostic Sciences (Italy); Settembrini, Alberto [San Carlo Borromeo Hospital, Università degli Studi di Milano (Italy); Santuari, Davide [San Carlo Borromeo Hospital, Department of Vascular Surgery (Italy)

    2013-05-02

    Conventional endovascular therapy of thoracoabdominal aortic aneurysm with involving visceral and renal arteries is limited by the absence of a landing zone for the aortic endograft. Solutions have been proposed to overcome the problem of no landing zone; however, most of them are not feasible in urgent and high-risk patients. We describe a case that was successfully treated by total endovascular technique with a two-by-two chimney-and-periscope approach in a patient with acute symptomatic type IV thoracoabdominal aortic aneurysm with supra-anastomotic aneurysm formation involving the renal and visceral arteries and a pseduaneurismatic sac localized in the left ileopsoas muscle.

  6. Total aortic arch replacement: superior ventriculo-arterial coupling with decellularized allografts compared with conventional prostheses.

    Directory of Open Access Journals (Sweden)

    Alexander Weymann

    Full Text Available To date, no experimental or clinical study provides detailed analysis of vascular impedance changes after total aortic arch replacement. This study investigated ventriculoarterial coupling and vascular impedance after replacement of the aortic arch with conventional prostheses vs. decellularized allografts.After preparing decellularized aortic arch allografts, their mechanical, histological and biochemical properties were evaluated and compared to native aortic arches and conventional prostheses in vitro. In open-chest dogs, total aortic arch replacement was performed with conventional prostheses and compared to decellularized allografts (n = 5/group. Aortic flow and pressure were recorded continuously, left ventricular pressure-volume relations were measured by using a pressure-conductance catheter. From the hemodynamic variables end-systolic elastance (Ees, arterial elastance (Ea and ventriculoarterial coupling were calculated. Characteristic impedance (Z was assessed by Fourier analysis.While Ees did not differ between the groups and over time (4.1±1.19 vs. 4.58±1.39 mmHg/mL and 3.21±0.97 vs. 3.96±1.16 mmHg/mL, Ea showed a higher increase in the prosthesis group (4.01±0.67 vs. 6.18±0.20 mmHg/mL, P<0.05 in comparison to decellularized allografts (5.03±0.35 vs. 5.99±1.09 mmHg/mL. This led to impaired ventriculoarterial coupling in the prosthesis group, while it remained unchanged in the allograft group (62.5±50.9 vs. 3.9±23.4%. Z showed a strong increasing tendency in the prosthesis group and it was markedly higher after replacement when compared to decellularized allografts (44.6±8.3 dyn·sec·cm(-5 vs. 32.4±2.0 dyn·sec·cm(-5, P<0.05.Total aortic arch replacement leads to contractility-afterload mismatch by means of increased impedance and invert ventriculoarterial coupling ratio after implantation of conventional prostheses. Implantation of decellularized allografts preserves vascular impedance thereby improving

  7. 非梗死相关血管慢性完全闭塞对行急诊介入治疗的ST段抬高型心肌梗死患者预后的影响%Prognostic Impact of Chronic Total Occlusion on Non-infarct-related Artery in Patients of Acute ST-elevation Myocardial Infarction With Emergent Primary Percutaneous Coronary Intervention

    Institute of Scientific and Technical Information of China (English)

    张慧平; 艾虎; 李辉; 赵迎; 唐国栋; 郑耐心; 孙福成

    2016-01-01

    Objective: To study the prognostic impact of chronic total occlusion (CTO) on non-infarct-related artery (non-IRA) in patients of acute ST-elevation myocardial infarction (STEMI) with emergent primary percutaneous coronary intervention (PCI). Methods: In this prospective study, a total of 185 consecutive acute STEMI patients received early stage primary PCI in our hospital from 2010-01to 2011-06 were enrolled. The patients were divided into 2 groups:non-CTO group, n=160 and CTO group, n=25. The patients were followed-up for 1 year and the primary endpoint events included the hospitalization for angina, re-MI, heart failure or revascularization and cardiac death. Results: ①There were more patients with diabetes and three vessel disease in CTO group than those in non-CTO group (40.0%vs 20.0%, P=0.049) and (68.0%vs 36.3%, P=0.003);LVEF in CTO group was lower than non-CTO group (40.0 ± 20.1%vs 51.3 ± 15.3%, P Conclusion: Non-IRA combining CTO in STEMI patients with primary PCI are usually having poor prognosis.%目的:分析非梗死相关血管慢性完全闭塞(CTO)对接受直接经皮冠状动脉介入治疗(PCI)的急性ST段抬高型心肌梗死(STEMI)患者预后的影响。  方法:选择2010-01至2011-06连续在我院确诊急性STEMI并行早期直接PCI治疗的185例患者,分为非梗死相关血管无CTO组(无CTO组)和非梗死相关血管合并CTO组(CTO组),共150例患者完成了1年随访,主要终点为1年时因心绞痛、再次心肌梗死(MI)、心力衰竭而住院或再次血运重建以及心血管死亡。  结果:(1)无CTO组160例(86.5%),CTO组25例(13.5%),CTO组患者糖尿病及冠状动脉三支血管病变的比例均显著高于无CTO组(40.0%vs 20.0%,P=0.049;68.0%vs 36.3%,P=0.003);CTO组左心室射血分数显著低于无CTO组[(40.0±20.1)%vs(51.3±15.3)%,P  结论:非梗死相关血管存在CTO并接受直接PCI的急性STEMI患者多

  8. System identification of dynamic closed-loop control of total peripheral resistance by arterial and cardiopulmonary baroreceptors

    Science.gov (United States)

    Aljuri, A. N.; Bursac, N.; Marini, R.; Cohen, R. J.

    2001-01-01

    Prolonged exposure to microgravity in space flight missions (days) impairs the mechanisms responsible for defense of arterial blood pressure (ABP) and cardiac output (CO) against orthostatic stress in the post-flight period. The mechanisms responsible for the observed orthostatic intolerance are not yet completely understood. Additionally, effective counter measures to attenuate this pathophysiological response are not available. The aim of this study was to investigate the ability of our proposed system identification method to predict closed-loop dynamic changes in TPR induced by changes in mean arterial pressure (MAP) and right atrial pressure (RAP). For this purpose we designed and employed a novel experimental animal model for the examination of arterial and cardiopulmonary baroreceptors in the dynamic closed-loop control of total peripheral resistance (TPR), and applied system identification to the analysis of beat-to-beat fluctuations in the measured signals. Grant numbers: NAG5-4989. c 2001. Elsevier Science Ltd. All rights reserved.

  9. A 7-year, single-center research and long term follow-up of graft patency of robotic total arterial off-pump coronary artery bypass grafting

    Directory of Open Access Journals (Sweden)

    Guo-peng LIU

    2016-06-01

    Full Text Available Objective  The aim of the study was to explore the long-term benefits of coronary artery bypass grafting (CABG. Methods  From January 2007 to November 2014, 240 patients (187 males and 53 females, average age 59 years received robotic off-pump CABG assisted with da Vinci Surgical System (Intuitive Surgical, USA in our center. Totally endoscopic coronary artery bypass (totally robot-assisted TECAB, n=100 or mini-thoracotomy direct coronary artery bypass (free of internal mammary artery, IMA, by robot, MIDCAB, n=140 grafting was performed. Patients were followed-up regularly, and their graft patency was assessed every 6 months by coronary angiography or 64-multi-slide CT angiography. Results  All the procedures were completed successfully without conversion to median sternotomy or cardiopulmonary bypass , there was no operative mortality. 237 unilateral IMA grafts (98.7% and 3 bilateral IMA grafts (1.3% were used. Hybrid revascularization of non-left anterior descending vessels was performed in 24 patients (10%. In the follow-up of 41.1±12.9 months, no death, stroke or myocardial infarction occurred. All grafts were patent before discharge. The IMA graft patency was 97.1% in TECAB and 96.4 % in MIDCAB over 3 years (up to 91 months after surgery. Conclusions  Robotic off-pump CABG using IMA grafts is a safe and effective surgery method in selected patients. The long-term outcome and patency of IMA grafts are excellent. DOI: 10.11855/j.issn.0577-7402.2016.06.15

  10. Treatment with anti-gremlin 1 antibody ameliorates chronic hypoxia/SU5416-induced pulmonary arterial hypertension in mice.

    Science.gov (United States)

    Ciuclan, Loredana; Sheppard, Kellyann; Dong, Liqun; Sutton, Daniel; Duggan, Nicholas; Hussey, Martin; Simmons, Jenny; Morrell, Nicholas W; Jarai, Gabor; Edwards, Matthew; Dubois, Gerald; Thomas, Matthew; Van Heeke, Gino; England, Karen

    2013-11-01

    The expression of the bone morphogenetic protein antagonist, Gremlin 1, was recently shown to be increased in the lungs of pulmonary arterial hypertension patients, and in response to hypoxia. Gremlin 1 released from the vascular endothelium may inhibit endogenous bone morphogenetic protein signaling and contribute to the development of pulmonary arterial hypertension. Here, we investigate the impact of Gremlin 1 inhibition in disease after exposure to chronic hypoxia/SU5416 in mice. We investigated the effects of an anti-Gremlin 1 monoclonal antibody in the chronic hypoxia/SU5416 murine model of pulmonary arterial hypertension. Chronic hypoxic/SU5416 exposure of mice induced upregulation of Gremlin 1 mRNA in lung and right ventricle tissue compared with normoxic controls. Prophylactic treatment with an anti-Gremlin 1 neutralizing mAb reduced the hypoxic/SU5416-dependent increase in pulmonary vascular remodeling and right ventricular hypertrophy. Importantly, therapeutic treatment with an anti-Gremlin 1 antibody also reduced pulmonary vascular remodeling and right ventricular hypertrophy indicating a role for Gremlin 1 in the progression of the disease. We conclude that Gremlin 1 plays a role in the development and progression of pulmonary arterial hypertension in the murine hypoxia/SU5416 model, and that Gremlin 1 is a potential therapeutic target for pulmonary arterial hypertension.

  11. Comparison of transfemoral vs transbrachial approach for angioplastic reconstruction of chronic total aortoiliac occlusion.

    Science.gov (United States)

    Damera, Sheshagiri Rao; Barik, Ramachandra; Prasad, Akula Siva

    2016-09-01

    The angioplasty of chronic total aortoiliac occlusion using transfemoral is controversial. From March 2014 to December 2015, four consecutive patients (4 males; mean age 58.2±6.8 years; age of range 51-65 years) underwent angioplasty and stenting of TASC-D occlusion. In all the cases, we failed to cross from femoral approach. On switching over to left brachial access, angioplasty was done successfully in all. There was no procedural site complication or clinical evidence cerebral thromboembolism. Self-expandable stents were implanted in all with adequate pre and post dilation. Complete revascularisation was achieved in two cases and in other two cases, the angioplasty to the left aortoiliac carina was staged. Therefore, it is better to avoid femoral approach as initial step to cross chronic TASC 2007 type D (chronic total aortoiliac occlusion or called extensive aortoiliac disease) because of failure to cross retrogradely due to subintimal course of guide wire leading to retrograde aortic dissection.

  12. Successful management of hepatic artery pseudoaneurysm complicating chronic pancreatitis by stenting

    Institute of Scientific and Technical Information of China (English)

    Cynthia Sudar Singh; Kamini Giri; Renuka Gupta; Mohammed Aladdin; Harinder Sawhney

    2006-01-01

    A 41-year old alchoholic male with a history of chronic pancreatitis was admitted for nausea, vomiting and weight loss. Angiogram was performed and demonstrated an aneurysmal sac with a narrow neck originating from the inferior aspect of the distal portion of the proper hepatic artery. The origin of the pseudoaneurysm was covered with a 5 mm × 2.5 cm Viabahn cover stent (Gore). A repeat angiogram showed some leak and a second stent (6 mm × 2.3 cm)was deployed and overlapped with the first stent by 3 mm. Contrast was injected and a repeat angiogram demonstrated complete exclusion of the aneurysm. A repeat computerized axial tomography (CAT) scan of the abdomen after 24 h showed successful stenting. The patient had an uneventful post-operative course.

  13. Acute and chronic spectral domain optical coherence tomography features of branch retinal artery occlusion

    Science.gov (United States)

    Rodrigues, Ian Aureliano Stephen

    2013-01-01

    Branch retinal artery occlusion (BRAO) is a common vascular occlusive disorder. BRAO involving the posterior pole is usually symptomatic, but occasionally has very limited clinical features. We describe 2 cases where the underlying pathology was initially unclear and the diagnosis therefore not reached at presentation. Use of the latest retinal imaging, spectral domain optical coherence tomography (SD-OCT) enabled correct diagnosis of BRAO. The images demonstrate and contrast the fine changes that can be seen in the acute and chronic phases of this condition and illustrate how the pathogenesis of BRAO is confined to the outer retinal layers. We believe the subtle presentations of this common condition that we discuss highlight how diagnosis of BRAO can often be challenging, but may be facilitated by the use of SD-OCT retinal imaging. PMID:23661655

  14. Pulmonary arterial hypertension and cor pulmonale associated with chronic domestic woodsmoke inhalation

    Energy Technology Data Exchange (ETDEWEB)

    Sandoval, J.; Salas, J.; Martinez-Guerra, M.L.; Gomez, A.; Martinez, C.; Portales, A.; Palomar, A.; Villegas, M.; Barrios, R. (Instituto Nacional de Cardiologia, Ignacio Chavez, Mexico City (Mexico))

    1993-01-01

    We describe the clinical, radiologic, functional, and pulmonary hemodynamic characteristics of a group of 30 nonsmoking patients with a lung disease that may be related to intense, long-standing indoor wood-smoke exposure. The endoscopic and some of the pathologic findings are also presented. Intense and prolonged wood-smoke inhalation may produce a chronic pulmonary disease that is similar in many aspects to other forms of inorganic dust-exposure interstitial lung disease. It affects mostly country women in their 60s, and severe dyspnea and cough are the outstanding complaints. The chest roentgenograms show a diffuse, bilateral, reticulonodular pattern, combined with normalized or hyperinflated lungs, as well as indirect signs of pulmonary arterial hypertension (PAH). On the pulmonary function test the patients show a mixed restrictive-obstructive pattern with severe hypoxemia and variable degrees of hypercapnia. Endoscopic findings are those of acute and chronic bronchitis and intense anthracotic staining of the airways appears to be quite characteristic. Fibrous and inflammatory focal thickening of the alveolar septa as well as diffuse parenchymal anthracotic deposits are the most prominent pathologic findings, although inflammatory changes of the bronchial epithelium are also present. The patients had severe PAH in which, as in other chronic lung diseases, chronic alveolar hypoxia may play the main pathogenetic role. However, PAH in wood-smoke inhalation-associated lung disease (WSIALD) appears to be more severe than in other forms of interstitial lung disease and tobacco-related COPD. The patients we studied are a selected group and they may represent one end of the spectrum of the WSIALD.

  15. Phenylacetic acid and arterial vascular properties in patients with chronic kidney disease stage 5 on hemodialysis therapy

    DEFF Research Database (Denmark)

    Scholze, Alexandra; Jankowski, Vera; Henning, Lars;

    2007-01-01

    Phenylacetic acid (PAA) is a recently described uremic toxin that inhibits inducible nitric oxide synthase expression and plasma membrane calcium ATPase and may therefore also be involved in remodeling of arteries. Such vascular effects have not been evaluated yet in patients with chronic kidney...

  16. Comparison of mesenchymal stromal cells from young healthy donors and patients with severe chronic coronary artery disease

    DEFF Research Database (Denmark)

    Friis, Tina; Haack-Sørensen, Mandana; Hansen, Susanne Kofoed;

    2011-01-01

    It has been questioned whether bone marrow-derived mesenchymal stromal cells (MSCs) from patients with ischemic heart disease are suitable for use in regenerative stem cell therapy. We compared MSCs from patients with chronic coronary artery disease (CAD) and MSCs from young healthy donors...

  17. The pulsatility index and the resistive index in renal arteries. Associations with long-term progression in chronic renal failure

    DEFF Research Database (Denmark)

    Petersen, L J; Petersen, J R; Talleruphuus, U

    1997-01-01

    The pulsatility index (PI) and the resistive index (RI) are used as pulsed-wave Doppler measurements of downstream renal artery resistance. PI and RI have been found to correlate with renal vascular resistance, filtration fraction and effective renal plasma flow in chronic renal failure. The aim...

  18. Diabetes mellitus and chronic kidney disease amplify accumulation of tissue advanced glycation end products in patients with peripheral artery disease

    NARCIS (Netherlands)

    Lefrandt, J.D.; De Vos, L.C.; Mulder, D.J.; Dullaart, R.P.F.; Lutgers, H.L.; Lambers Heerspink, H.J.; Smit, A.J.; Kamphuisen, P.W.; Zeebregts, C.J.

    2013-01-01

    Backgrounds and aims: Diabetes mellitus (DM) and chronic kidney disease (CKD) are important risk factors for peripheral artery disease (PAD) and associated with a severely increased cardiovascular (CV) risk in these patients. DM increases production of AGEs and CKD decreases their clearance, while c

  19. Current trends in patients with chronic total occlusions undergoing coronary CT angiography

    NARCIS (Netherlands)

    M.P. Opolski (Maksymilian P.); B.T. Hartaigh (Bríain ó); D.S. Berman (Daniel); M.J. Budoff (Matthew J.); S. Achenbach (Stephan); M. Al-Mallah (Mouaz); D. Andreini (Daniele); F. Cademartiri (Filippo); H.-J. Chang (Hyuk-Jae); K. Chinnaiyan (Kavitha); B.J.W. Chow (Benjamin); M. Hadamitzky (Martin); J. Hausleiter (Jörg); G.M. Feuchtner (Gudrun); Y.-J. Kim (Yong-Jin); P.A. Kaufmann (Philipp A.); J. Leipsic (Jonathon); E. Maffei (Erica); G. Pontone (Gianluca); G.L. Raff (Gilbert); L.J. Shaw (Leslee J.); T.C. Villines (Todd); J.K. Min (James)

    2015-01-01

    textabstractObjective Data describing the prevalence, characteristics and management of coronary chronic total occlusions (CTOs) in patients undergoing coronary CT angiography (CCTA) have not been reported. The purpose of this study was to determine the prevalence, characteristics and treatment stra

  20. Current trends in patients with chronic total occlusions undergoing coronary CT angiography

    NARCIS (Netherlands)

    M.P. Opolski (Maksymilian P.); B.T. Hartaigh (Bríain ó); D.S. Berman (Daniel S.); M.J. Budoff (Matthew J.); S. Achenbach (Stephan); M. Al-Mallah (Mouaz); D. Andreini (Daniele); F. Cademartiri (Filippo); H.-J. Chang (Hyuk-Jae); K. Chinnaiyan (Kavitha); B.J.W. Chow (Benjamin); M. Hadamitzky (Martin); J. Hausleiter (Jörg); G. Feuchtner (Gudrun); Y.-J. Kim (Yong-Jin); P.A. Kaufmann (Philipp A.); J. Leipsic (Jonathon); E. Maffei (Erica); G. Pontone (Gianluca); G.L. Raff (Gilbert); L.J. Shaw (Leslee); T.C. Villines (Todd); J.K. Min (James)

    2015-01-01

    textabstractObjective: Data describing the prevalence, characteristics and management of coronary chronic total occlusions (CTOs) in patients undergoing coronary CT angiography (CCTA) have not been reported. The purpose of this study was to determine the prevalence, characteristics and treatment str

  1. Long-Term Outcome of Percutaneous Coronary Intervention for Chronic Total Occlusions

    NARCIS (Netherlands)

    R. Mehran; B.E. Claessen; C. Godino; G.D. Dangas; K. Obunai; S. Kanwal; M. Carlino; J.P.S. Henriques; C. di Mario; Y.H. Kim; S.J. Park; G.W. Stone; M.B. Leon; J.W. Moses; A. Colombo

    2011-01-01

    Objectives The aim of this study was to evaluate long-term clinical outcomes after percutaneous coronary intervention (PCI) for chronic total occlusions (CTO). Background Despite technical advancements, there is a paucity of data on long-term outcomes after PCI of CTO. Methods We evaluated long-term

  2. Chronic basilar artery dissection with an associated symptomatic aneurysm presenting with massive subarachnoid hemorrhage.

    Science.gov (United States)

    Cohen, José E; Moscovici, Samuel; Rajz, Gustavo; Vargas, Andres; Itshayek, Eyal

    2016-08-01

    Basilar artery dissection (BAD) is a rare condition with a worse prognosis than a dissection limited to the vertebral artery. We report a rare case of chronic BAD with an associated symptomatic aneurysm presenting with massive subarachnoid hemorrhage (SAH) in a 54-year-old woman. The diagnosis of acute BAD could only be made retrospectively, based on clinical and neuroradiological studies from a hospital admission 10months earlier. Angiography performed after her SAH showed unequivocal signs of imperfect healing; she was either post-recanalization of a complete occlusion or post-dissection. Residual multi-channel intraluminal defects led to the development of a small aneurysm, which was responsible for the massive hemorrhage. The occurrence of an associated aneurysm, and wall disease, but not an intraluminal process, reinforces the diagnosis of dissection. The patient was fully recovered at 90day follow-up. This case reinforces the need for long-term neuroradiological surveillance after non-hemorrhagic intracranial dissections to detect the development of de novo aneurysms.

  3. Dual-energy CT angiography of chronic thromboembolic disease: Can it help recognize links between the severity of pulmonary arterial obstruction and perfusion defects?

    Energy Technology Data Exchange (ETDEWEB)

    Renard, Benoit [Department of Thoracic Imaging, Hospital Calmette, University Centre of Lille (EA 2694), Boulevard Jules Leclercq, 59037 Lille cedex (France); Remy-Jardin, Martine, E-mail: mremy-jardin@chru-lille.fr [Department of Thoracic Imaging, Hospital Calmette, University Centre of Lille (EA 2694), Boulevard Jules Leclercq, 59037 Lille cedex (France); Santangelo, Teresa; Faivre, Jean-Baptiste; Tacelli, Nunzia; Remy, Jacques [Department of Thoracic Imaging, Hospital Calmette, University Centre of Lille (EA 2694), Boulevard Jules Leclercq, 59037 Lille cedex (France); Duhamel, Alain [Department of Biostatistics, University Centre of Lille (EA 2694), 59037 Lille cedex (France)

    2011-09-15

    Purpose: To evaluate whether dual-energy CT angiography (DE-CTA) could identify links between morphologic and functional abnormalities in chronic pulmonary thromboembolism (CPTE). Materials and methods: Seventeen consecutive patients with CPTE without underlying cardio-respiratory disease were investigated with DE-CTA. Two series of images were generated: (a) transverse diagnostic scans (i.e., contiguous 1-mm thick averaged images from both tubes), and (b) perfusion scans (i.e., images of the iodine content within the microcirculation; 4-mm thick MIPs). Two radiologists evaluated by consensus the presence of: (a) pulmonary vascular features of CPTE and abnormally dilated systemic arteries on diagnostic CT scans, and (b) perfusion defects of embolic type on perfusion scans. Results: Diagnostic examinations showed a total of 166 pulmonary arteries (166/833; 19.9%) with features of CPTE, more frequent at the level of peripheral than central arteries (8.94 vs 0.82; p < 0.0001), including severe stenosis with partial (97/166; 58.4%) or complete (20/166; 12.0%) obstruction, webs and bands (37/166; 22.3%), partial filling defects without stenosis (7/166; 4.2%), focal stenosis (4/166; 2.4%) and abrupt vessel narrowing (1/166; 0.6%). Perfusion examinations showed 39 perfusion defects in 8 patients (median number: 4.9; range: 1-11). The most severe pulmonary arterial features of CPTE were seen with a significantly higher frequency in segments with perfusion defects than in segments with normal perfusion (p < 0.0001). Enlarged systemic arteries were observed with a significantly higher frequency ipsilateral to lungs with perfusion defects (9/12; 75%) compared with lungs without perfusion defects (5/22; 22.7%) (p = 0.004). Conclusion: Dual-energy CTA demonstrates links between the severity of pulmonary arterial obstruction and perfusion impairment, influenced by the degree of development of the systemic collateral supply.

  4. Arterial baroreceptor reflex control of renal sympathetic nerve activity following chronic myocardial infarction in male, female, and ovariectomized female rats.

    Science.gov (United States)

    Pinkham, Maximilian I; Whalley, Gillian A; Guild, Sarah-Jane; Malpas, Simon C; Barrett, Carolyn J

    2015-07-15

    There is controversy regarding whether the arterial baroreflex control of renal sympathetic nerve activity (SNA) in heart failure is altered. We investigated the impact of sex and ovarian hormones on changes in the arterial baroreflex control of renal SNA following a chronic myocardial infarction (MI). Renal SNA and arterial pressure were recorded in chloralose-urethane anesthetized male, female, and ovariectomized female (OVX) Wistar rats 6-7 wk postsham or MI surgery. Animals were grouped according to MI size (sham, small and large MI). Ovary-intact females had a lower mortality rate post-MI (24%) compared with both males (38%) and OVX (50%) (P renal SNA. As a result, the male large MI group (49 ± 6 vs. 84 ± 5% in male sham group) and OVX large MI group (37 ± 3 vs. 75 ± 5% in OVX sham group) displayed significantly reduced arterial baroreflex range of control of normalized renal SNA (P renal SNA was unchanged regardless of MI size. In males and OVX there was a significant, positive correlation between left ventricle (LV) ejection fraction and arterial baroreflex range of control of normalized renal SNA, but not absolute renal SNA, that was not evident in ovary-intact females. The current findings demonstrate that the arterial baroreflex control of renal SNA post-MI is preserved in ovary-intact females, and the state of left ventricular dysfunction significantly impacts on the changes in the arterial baroreflex post-MI.

  5. Total Adiponectin and Risk of Symptomatic Lower Extremity Peripheral Artery Disease in Men

    NARCIS (Netherlands)

    Joosten, Michel M.; Joshipura, Kaumudi J.; Pai, Jennifer K.; Bertoia, Monica L.; Rimm, Eric B.; Mittleman, Murray A.; Mukamal, Kenneth J.

    2013-01-01

    Objective-Lower concentrations of adiponectin have been linked to subsequent risk of coronary heart disease in healthy individuals. Whether similar relationships exist for the development of systemic atherosclerosis, such as peripheral artery disease (PAD), is uncertain. We investigated the associat

  6. Total left main coronary artery occlusion after aortic aneurysm repair and valve replacement.

    Science.gov (United States)

    DePace, N L; Lemole, G M; Wolf, N W; Dowinsky, S; Untereker, W; Spagna, P M

    1991-02-01

    A 38-year-old woman with complete occlusion of the left main coronary artery secondary to cannulation during aortic valve replacement is presented. The clinical course was characterized by progressive left ventricular dysfunction and congestive heart failure. Recognition of this potential problem when it occurs is important as to institute therapeutic measures which may interrupt a patient's progressive clinical deterioration.

  7. Total knee arthroplasty with subvastus approach in patient with chronic post-traumatic patellar dislocation

    Directory of Open Access Journals (Sweden)

    Jader Joel Machado Junqueira

    Full Text Available ABSTRACT Chronic lateral dislocation of the patella is a rare condition and acquired causes are usually secondary to knee trauma. The neglected chronic dislocation leads to progressive genu valgum and external tibial torsion deformities with subsequent gonarthrosis, which becomes painful and debilitating. There is no consensus regarding treatment of these patients, but total knee arthroplasty (TKA is a useful therapy in cases of painful symptomatic gonarthrosis. Few reports have shown that subvastus approach and lateral release may be a valid option for TKA, since it allows the correction of valgus deformity and patellar tracking without interrupting vascular blood supply of patella. This article reports a case of TKA and extensor mechanism realignment without patellar resurfacing in a patient with genu valgum and chronic post-traumatic patellar dislocation with satisfactory results after two years of follow-up.

  8. Total knee arthroplasty with subvastus approach in patient with chronic post-traumatic patellar dislocation.

    Science.gov (United States)

    Junqueira, Jader Joel Machado; Helito, Camilo Partezani; Bonadio, Marcelo Batista; Pécora, Jose Ricardo; Demange, Marco Kawamura

    2016-01-01

    Chronic lateral dislocation of the patella is a rare condition and acquired causes are usually secondary to knee trauma. The neglected chronic dislocation leads to progressive genu valgum and external tibial torsion deformities with subsequent gonarthrosis, which becomes painful and debilitating. There is no consensus regarding treatment of these patients, but total knee arthroplasty (TKA) is a useful therapy in cases of painful symptomatic gonarthrosis. Few reports have shown that subvastus approach and lateral release may be a valid option for TKA, since it allows the correction of valgus deformity and patellar tracking without interrupting vascular blood supply of patella. This article reports a case of TKA and extensor mechanism realignment without patellar resurfacing in a patient with genu valgum and chronic post-traumatic patellar dislocation with satisfactory results after two years of follow-up.

  9. Chronic adventitial inflammation, vasa vasorum expansion, and 5-lipoxygenase up-regulation in irradiated arteries from cancer survivors

    Science.gov (United States)

    Halle, Martin; Christersdottir, Tinna; Bäck, Magnus

    2016-01-01

    Radiation-induced cardiovascular disease is an emerging problem in a steadily increasing population of survivors of cancer. However, the underlying biology is poorly described, and the late onset, which occurs several years after exposure, precludes adequate investigations in animal and cell culture models. We investigated the role of the 5-lipoxygenase (5-LO)/leukotriene pathway in radiation-induced vascular changes. Use of paired samples of irradiated arteries and nonirradiated internal control arteries from the same patient that were harvested during surgery for cancer reconstruction ≤10 yr after radiotherapy provides a unique human model of chronic radiation–induced vascular changes. Immunohistochemical stainings and perioperative inspection revealed an adventitial inflammatory response, with vasa vasorum expansion and chronic infiltration of CD68+ macrophages. These macrophages stained positive for the leukotriene-forming enzyme 5-LO. Messenger RNA levels of 5-LO and leukotriene B4 receptor 1 were increased in irradiated arterial segments compared with control vessels. These results point to targeting the 5-LO/leukotriene pathway as a therapeutic adjunct to prevent late adverse vascular effects of radiotherapy.—Halle, M., Christersdottir, T., Bäck, M. Chronic adventitial inflammation, vasa vasorum expansion, and 5-lipoxygenase up-regulation in irradiated arteries from cancer survivors. PMID:27530979

  10. Off-pump coronary artery bypass grafting versus on-pump coronary artery bypass grafting: which is better in patients with chronic obstructive pulmonary disease?

    Institute of Scientific and Technical Information of China (English)

    朱亚彬; 许建屏; 刘志勇; 杨丹宁; 李旭东; 李鸿雁

    2004-01-01

    To evaluate the clinic outcome of off-pump coronary bypass grafting (OPCABG) of patients with coronary heart disease and chronic obstructive pulmonary disease, we collected and analyzed 1998-2002 data on 28 patients with these two diseases who had received off-pump coronary bypass operation in our hospital, and compared with data on those who also had the same two diseases but received on-pump coronary artery bypass at same time. There were no operation-related death;one died of respiratory failure 14 days after operation while staying in hospital; there were more respiratory complications in the conventional coronary artery bypass grafting group (CCABG) than in the OPCABG group; and the PaO2/FiO2 in the CCABG group was higher than that in the OPCABG group during operation because of CPB, but lower than that in the OPCABG group 6-12 hours after operation. OPCABG seemed more suitable than CCABG for coronary artery disease patients with chronic obstructive pulmonary disease due to less damage to their oxygen-exchange capability and the fewer respiratory complications.

  11. Off-pump coronary artery bypass grafting versus on-pump coronary artery bypass grafting:which is better in patients with chronic obstructive pulmonary disease?

    Institute of Scientific and Technical Information of China (English)

    朱亚彬; 许建屏; 刘志勇; 杨丹宁; 李旭东; 李鸿雁

    2004-01-01

    To evaluate the clinic outcome of off-pump coronary bypass grafting (OPCABG) of patients with coronary heart disease and chronic obstructive pulmonary disease, we collected and analyzed 1998-2002 data on 28 patients with these two diseases who had received off-pump coronary bypass operation in our hospital, and compared with data on those who also had the same two diseases but received on-pump coronary artery bypass at same time. There were no operation-related death;one died of respiratory failure 14 days after operation while staying in hospital; there were more respiratory complications in the conventional coronary artery bypass grafting group (CCABG) than in the OPCABG group; and the PaO2/FiO2 in the CCABG group was higher than that in the OPCABG group during operation because of CPB, but lower than that in the OPCABG group 6-12 hours after operation. OPCABG seemed more suitable than CCABG for coronary artery disease patients with chronic obstructive pulmonary disease due to less damage to their oxygen-exchange capability and the fewer respiratory complications.

  12. The Effect of Race and Chronic Obstructive Pulmonary Disease on Long-Term Survival after Coronary Artery Bypass Grafting

    Directory of Open Access Journals (Sweden)

    Jimmy Thomas Efird

    2013-04-01

    Full Text Available Background: Chronic obstructive pulmonary disease (COPD is a known predictor of decreased long-term survival after coronary artery bypass grafting (CABG. Differences in survival by race have not been examined. Methods: A retrospective cohort study was conducted of CABG patients between 2002 and 2011. Long-term survival was compared in patients with and without COPD and stratified by race. Hazard ratios (HR and 95% confidence intervals (95%CI were computed using a Cox regression model. Results: A total of 984 (20% patients had COPD (black n=182; white n=802 at the time of CABG (N=4,801. The median follow-up for study participants was 4.4 years. White but not black race was observed to be a statistically significant predictor of decreased survival among COPD patients (no COPD: HR=1.0; white COPD: adjusted HR=1.5, 95%CI=1.3-1.7; black COPD: adjusted HR=1.2, 0.90-1.7. Conclusion: Contrary to the expected increased risk of mortality among black COPD patients in the general population, a similar survival disadvantage was not observed in our CABG population.

  13. Association between Density of Coronary Artery Calcification and Serum Magnesium Levels among Patients with Chronic Kidney Disease

    Science.gov (United States)

    Sakaguchi, Yusuke; Hamano, Takayuki; Nakano, Chikako; Obi, Yoshitsugu; Matsui, Isao; Kusunoki, Yasuo; Mori, Daisuke; Oka, Tatsufumi; Hashimoto, Nobuhiro; Takabatake, Yoshitsugu; Takahashi, Atsushi; Kaimori, Jun-Ya; Moriyama, Toshiki; Yamamoto, Ryohei; Horio, Masaru; Sugimoto, Ken; Yamamoto, Koichi; Rakugi, Hiromi; Isaka, Yoshitaka

    2016-01-01

    Background The Agatston score, commonly used to quantify coronary artery calcification (CAC), is determined by the plaque area and density. Despite an excellent predictability of the Agatston score for cardiovascular events, the density of CAC has never been studied in patients with pre-dialysis chronic kidney disease (CKD). This study aimed to analyze the CAC density and its association with serum mineral levels in CKD. Methods We enrolled patients with pre-dialysis CKD who had diabetes mellitus, prior cardiovascular disease history, elevated low-density lipoprotein cholesterol levels, or smoking history. The average CAC density was calculated by dividing the Agatston score by the total area of CAC. Results The mean estimated glomerular filtration rate (eGFR) of 109 enrolled patients was 35.7 mL/min/1.73 m2. The correlation of the Agatston score with density was much weaker than that with the total area (R2 = 0.19, P < 0.001; and R2 = 0.99, P < 0.001, respectively). Multivariate analyses showed that serum magnesium level was inversely associated with the density, but not with the total area, after adjustment for demographics and clinical factors related to malnutrition-inflammation-atherosclerosis syndrome and mineral and bone disorders including fibroblast growth factor 23 (P = 0.006). This inverse association was pronounced among patients with higher serum phosphate levels (P for interaction = 0.02). Conclusion CAC density was inversely associated with serum magnesium levels, particularly in patients with higher serum phosphate levels. PMID:27662624

  14. Pain catastrophizing as a risk factor for chronic pain after total knee arthroplasty: a systematic review

    Directory of Open Access Journals (Sweden)

    Burns LC

    2015-01-01

    Full Text Available Lindsay C Burns,1–3 Sarah E Ritvo,1 Meaghan K Ferguson,1 Hance Clarke,3–5 Ze’ev Seltzer,3,5 Joel Katz1,3–5 1Department of Psychology, York University, Toronto, ON, Canada; 2Arthritis Research Centre of Canada, Vancouver, BC, Canada; 3Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada; 4Department of Anesthesia, University of Toronto, Toronto, ON, Canada; 5Centre for the Study of Pain, Faculties of Dentistry and Medicine, University of Toronto, Toronto, ON, Canada Background: Total knee arthroplasty (TKA is a common and costly surgical procedure. Despite high success rates, many TKA patients develop chronic pain in the months and years following surgery, constituting a public health burden. Pain catastrophizing is a construct that reflects anxious preoccupation with pain, inability to inhibit pain-related fears, amplification of the significance of pain vis-à-vis health implications, and a sense of helplessness regarding pain. Recent research suggests that it may be an important risk factor for untoward TKA outcomes. To clarify this impact, we systematically reviewed the literature to date on pain catastrophizing as a prospective predictor of chronic pain following TKA. Methods: We searched MEDLINE, EMBASE, and PsycINFO databases to identify articles related to pain catastrophizing, TKA, risk models, and chronic pain. We reviewed titles and abstracts to identify original research articles that met our specified inclusion criteria. Included articles were then rated for methodological quality. including methodological quality. Due to heterogeneity in follow-up, analyses, and outcomes reported across studies, a quantitative meta-analysis could not be performed. Results: We identified six prospective longitudinal studies with small-to-mid-sized samples that met the inclusion criteria. Despite considerable variability in reported pain outcomes, pain catastrophizing was identified as a significant

  15. [Prediction of coronary artery stenosis by measurement of total plaque area and thickness versus intima media thickness of the carotid artery].

    Science.gov (United States)

    Adams, Ansgar; Bojara, Waldemar

    2015-08-01

    Total plaque area (TPA), maximum plaque thickness and intima media thickness (IMT) in the carotid arteries of 431 patients aged 27-88 years were measured 1 day before a planned coronary artery angiography without any clinical knowledge about the patient. Age-related cut-off values of the TPA for the presence of coronary stenosis were evaluated. Using ultrasound four types of carotid artery atherosclerosis were identified. The accuracy of detection of cardiovascular coronary stenosis was 87% for types III and IVb. No type I patient had coronary stenosis. The IMT was significantly less predictive: the area under the curve (AUC) for TPA by age and plaque thickness was 0.82 (95% CI: 0.78-0.85) versus IMT 0.59 (95% CI: 0.54-0.64, p = 0.001). Prediction with TPA measurement by age and plaque thickness was better than TPA alone: AUC 0.82 (95% CI: 0.78-0.85) versus 0.77 (95% CI: 0.73-0.81, p = 0.0028), respectively. In a second cohort of 2566 healthy men and 1216 healthy women aged between 20 and 64 years who were examined in an occupational screening program, 11.2% of the men and 3.4% of the women showed a type III or IVb result. In the mean follow-up of period of 23.4 ± 14.4 months, 14 heart attacks, 7 bypass operations and 3 stent implantations occurred and 6 subjects showed coronary stenosis between 50% and 95% in coronary angiography. In the baseline examination 26 out of 30 patients showed a type III or IVb result. In the case of men and women with types III and IVb diagnosis by ultrasound, pharmaceutical treatment could be indicated in order to reduce the risk of cardiovascular events. Type I patients do not need preventive medication or coronary catheterization.

  16. The pulsatility index and the resistive index in renal arteries. Associations with long-term progression in chronic renal failure

    DEFF Research Database (Denmark)

    Petersen, L J; Petersen, J R; Talleruphuus, U

    1997-01-01

    The pulsatility index (PI) and the resistive index (RI) are used as pulsed-wave Doppler measurements of downstream renal artery resistance. PI and RI have been found to correlate with renal vascular resistance, filtration fraction and effective renal plasma flow in chronic renal failure. The aim...... of the present study was to evaluate the potential relationship between these indices and the rate of decline in renal function, as reflected by changes in different parameters of renal function in patients with chronic renal failure....

  17. Inspiratory Muscle Training and Arterial Blood Oxygen Saturation in Patients With Chronic Obstructive Pulmonary Disease

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    Bakhshandeh Bavarsad

    2015-01-01

    Full Text Available Background One of the problems of the patients with chronic obstructive pulmonary disease (COPD is the weakness of the respiratory muscles that causes oxygen desaturation at rest and activity and decreases exercise tolerance. Objectives This study aimed to investigate the effect of inspiratory muscle training on arterial oxygen saturation (SPO2. Patients and Methods Forty patients with mild to very severe COPD were recruited for this study, which is a randomized control trail. The patients were randomized to IMT (inspiratory muscle training and control group. Training was performed with Respivol (a kind of inspiratory muscle trainer for 8 weeks (15 min/d for 6 d/week. SPSS software version 16 was used to analyze the data by performing independent t test, paired t test, and Fisher exact test. Results Results showed that, after 8 weeks of inspiratory muscle training, there was a little increase (but not statistically significant improvement in SPO2 (from 92.6 ± 8.71 % to 95.13 ± 7.08 %, with P = 0.06, whereas it remained unchanged in the control group (from 96.0 ± 3.46 % to 96.4 ± 3.35 % with P = 0.51. No statistically significant difference was seen between the two groups (P > 0.05. Conclusions Although inspiratory muscles training can prevent desaturation, which is caused by activity, it fails to improve it.

  18. Severe hypovitaminosis D in chronic kidney disease: association with blood pressure and coronary artery calcification.

    Science.gov (United States)

    Pillar, Roberta; G Lopes, Miriam Ghedini; Rocha, Lillian Andrade; Cuppari, Lilian; Carvalho, Aluízio B; Draibe, Sérgio A; Canziani, Maria Eugênia F

    2013-05-01

    Hypovitaminosis D occurs early in the course of chronic kidney disease (CKD), and its association with cardiovascular morbidity and mortality is well known. In this study, we aimed to evaluate whether the degree of hypovitaminosis D may differently affect blood pressure (BP) and coronary artery calcification (CAC) in nondialyzed CKD patients. This study included 80 CKD patients with a creatinine clearance between 15 and 60 ml/min/1.73 m(2) and serum 25 hydroxivitamin D [25(OH)D] level hypovitaminosis D, were defined according to the median 25(OH)D value. Patients with severe hypovitaminosis D [25(OH)D hypovitaminosis D [25(OH)D >17.2 ng/ml; M-group]. No differences were found between the S and M-group in terms of diastolic BP and the presence of coronary calcification. In the multiple linear regression analysis, severe hypovitaminosis D was a predictor of 24-h, daytime and nighttime BP after controlling for a number of confounders. The severity of hypovitaminosis D was associated with increased BP in nondialyzed CKD patients. The degree of hypovitaminosis D was not related to CAC, which was equally elevated in both the severe and mild hypovitaminosis D groups.

  19. Association between Urine Creatinine Excretion and Arterial Stiffness in Chronic Kidney Disease: Data from the KNOW-CKD Study

    Directory of Open Access Journals (Sweden)

    Young Youl Hyun

    2016-08-01

    Full Text Available Background/Aims: Previous studies have shown that low muscle mass is associated with arterial stiffness, as measured by pulse wave velocity (PWV, in a population without chronic kidney disease (CKD. This link between low muscle mass and arterial stiffness may explain why patients with CKD have poor cardiovascular outcomes. However, the association between muscle mass and arterial stiffness in CKD patients is not well known. Methods: Between 2011 and 2013, 1,529 CKD patients were enrolled in the prospective Korean Cohort Study for Outcome in Patients With Chronic Kidney Disease (KNOW-CKD. We analyzed 888 participants from this cohort who underwent measurements of 24-hr urinary creatinine excretion (UCr and brachial-ankle PWV (baPWV at baseline examination. The mean of the right and left baPWV (mPWV was used as a marker of arterial stiffness. Results: The baPWV values varied according to the UCr quartile (1,630±412, 1,544±387, 1,527±282 and 1,406±246 for the 1st to 4th quartiles of UCr, respectively, PConclusion: Low muscle mass estimated by low UCr was associated high baPWV in pre-dialysis CKD patients in Korea. Further studies are needed to confirm the causal relationship between UCR and baPWV, and the role of muscle mass in the development of cardiovascular disease in CKD.

  20. Myogenic constriction is increased in mesenteric resistance arteries from rats with chronic heart failure : instantaneous counteraction by acute AT(1) receptor blockade

    NARCIS (Netherlands)

    Gschwend, S; Henning, RH; Pinto, YM; de Zeeuw, D; van Gilst, WH; Buikema, H

    2003-01-01

    1 Increased vascular resistance in chronic heart failure (CHF) has been attributed to stimulated neurohumoral systems. However, local mechanisms may also importantly contribute to set arterial tone. Our aim, therefore, was to test whether pressure-induced myogenic constriction of resistance arteries

  1. Chronic fluoxetine treatment increases NO bioavailability and calcium-sensitive potassium channels activation in rat mesenteric resistance arteries.

    Science.gov (United States)

    Pereira, Camila A; Ferreira, Nathanne S; Mestriner, Fabiola L; Antunes-Rodrigues, José; Evora, Paulo R B; Resstel, Leonardo B M; Carneiro, Fernando S; Tostes, Rita C

    2015-10-15

    Fluoxetine, a selective serotonin reuptake inhibitor (SSRI), has effects beyond its antidepressant properties, altering, e.g., mechanisms involved in blood pressure and vasomotor tone control. Although many studies have addressed the acute impact of fluoxetine on the cardiovascular system, there is a paucity of information on the chronic vascular effects of this SSRI. We tested the hypothesis that chronic fluoxetine treatment enhances the vascular reactivity to vasodilator stimuli by increasing nitric oxide (NO) signaling and activation of potassium (K+) channels. Wistar rats were divided into two groups: (I) vehicle (water for 21 days) or (II) chronic fluoxetine (10 mg/kg/day in the drinking water for 21 days). Fluoxetine treatment increased endothelium-dependent and independent vasorelaxation (analyzed by mesenteric resistance arteries reactivity) as well as constitutive NO synthase (NOS) activity, phosphorylation of eNOS at Serine1177 and NO production, determined by western blot and fluorescence. On the other hand, fluoxetine treatment did not alter vascular expression of neuronal and inducible NOS or guanylyl cyclase (GC). Arteries from fluoxetine-treated rats exhibited increased relaxation to pinacidil. Increased acetylcholine vasorelaxation was abolished by a calcium-activated K+ channel (KCa) blocker, but not by an inhibitor of KATP channels. On the other hand, vascular responses to Bay 41-2272 and 8-bromo-cGMP were similar between the groups. In conclusion, chronic fluoxetine treatment increases endothelium-dependent and independent relaxation of mesenteric resistance arteries by mechanisms that involve increased eNOS activity, NO generation, and KCa channels activation. These effects may contribute to the cardiovascular effects associated with chronic fluoxetine treatment.

  2. Extracranial Vertebral Artery Aneurysm Presenting as a Chronic Cervical Mass Lesion

    Directory of Open Access Journals (Sweden)

    Lampis C. Stavrinou

    2010-01-01

    Full Text Available Background. Aneurysms of the extracranial vertebral artery are rare and can provide a diagnostic and therapeutic challenge. Methods. We reviewed the clinical history of a patient presenting with cervical radiculopathy, who harboured an extracranial vertebral artery aneurysm eroding the cervical spine. Results. CT Angiography and MR Angiography set the diagnosis, by revealing a left C5-C6 vertebral artery aneurysm with cervical root impingement. Bony reconstruction depicted enlargement of the C6 transverse foramen and a marked enlargement of the C6-C7 intravertebral foramen. The lesion was treated by intravascular proximal vertebral artery occlusion. Conclusions. Extracranial vertebral artery aneurysms require a high index of clinical suspicion. This is the first report of a vertebral artery pseudoaneurysm presenting with bony erosion, which supports a less minacious portrayal of vertebral artery aneurysms.

  3. Correlation between arterial and venous blood gas analysis parameters in patients with acute exacerbation of chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    Novović Miloš

    2012-01-01

    Full Text Available Introduction. Arterial blood gas (ABG analyses have an important role in the assessment and monitoring of the metabolic and oxygen status of patients with acute exacerbation of chronic obstructive pulmonary disease (COPD. Arterial puncture could have a lot of adverse effects, while sampling of venous blood is simpler and is not so invasive. Objective. The aim of this study was to evaluate whether venous blood gas (VBG values of pH, partial pressure of carbon dioxide (PCO2, partial oxygen pressure (PO2, bicarbonate (HCO3, and venous and arterial blood oxygen saturation (SO2 can reliably predict ABG levels in patients with acute exacerbation of COPD. Methods. Forty-seven patients with a prior diagnosis of COPD were included in this prospective study. The patients with acute exacerbation of this disease were examined at the General Hospital EMS Department in Prijepolje. ABG samples were taken immediately after venous sampling, and both were analyzed. Results. The Pearson correlation coefficients between arterial and venous parameters were 0.828, 0.877, 0.599, 0.896 and 0.312 for pH, PCO2, PO2, HCO3 and SO2, respectively. The statistically significant correlation between arterial and venous pH, PCO2 and HCO3, values was found in patients with acute exacerbation of COPD (p<0.001. Conclusion. When we cannot provide arterial blood for analysis, venous values of the pH, Pv,CO2 and HCO3 parameters can be an alternative to their arterial equivalents in the interpretation of the metabolic status in patients with acute exacerbation of COPD, while the values of venous Pv,O2 and Sv,O2 cannot be used as predictors in the assessment of oxygen status of such patients.

  4. Recanalization of Chronic Total Occlusion Lesions: A Critical Appraisal of Current Devices and Techniques

    Science.gov (United States)

    2016-01-01

    Chronic Total Occlusion (CTO) has been considered as one of the “final frontier” in interventional cardiology. Until recently, the patients with CTO are often managed surgically or medically due to lack of published evidence of clinical benefits and lower success rate of percutaneous recanalization of CTO. However, the introduction of enhanced guidewires, microcatheters combined with novel specialized devices and techniques reduce the number of unapproachable CTO. In this review article, current techniques and devices of percutaneous recanalization of CTO have been systematically summarized, which may help budding interventional cardiologists to theoretically understand these complex procedures and to deliver safe and effective percutaneous management of CTO to the patients. PMID:27790503

  5. Arterial microcalcification in atherosclerotic patients with and without chronic kidney disease: a comparative high-resolution scanning X-ray diffraction analysis.

    Science.gov (United States)

    Fischer, Dagmar-Christiane; Behets, Geert J; Hakenberg, Oliver W; Voigt, Mathias; Vervaet, Benjamin A; Robijn, Stef; Kundt, Günther; Schareck, Wolfgang; D'Haese, Patrick C; Haffner, Dieter

    2012-06-01

    Vascular calcification, albeit heterogeneous in terms of biological and physicochemical properties, has been associated with ageing, lifestyle, diabetes, and chronic kidney disease (CKD). It is unknown whether or not moderately impaired renal function (CKD stages 2-4) affects the physiochemical composition and/or the formation of magnesium-containing tricalcium phosphate ([Ca,Mg](3)[PO(4)](2), whitlockite) in arterial microcalcification. Therefore, a high-resolution scanning X-ray diffraction analysis (European Synchrotron Radiation Facility, Grenoble, France) utilizing histological sections of paraffin-embedded arterial specimens derived from atherosclerotic patients with normal renal function (n = 15) and CKD (stages 2-4, n = 13) was performed. This approach allowed us to spatially assess the contribution of calcium phosphate (apatite) and whitlockite to arterial microcalcification. Per group, the number of samples (13 vs. 12) with sufficient signal intensity and total lengths of regions (201 vs. 232 μm) giving rise to diffractograms ("informative regions") were comparable. Summarizing all informative regions per group into one composite sample revealed calcium phosphate/apatite as the leading mineral phase in CKD patients, whereas in patients with normal renal function the relative contribution of whitlockite and calcium phosphate/apatite was on the same order of magnitude (CKD, calcium phosphate/apatite 157 μm, whitlockite 38.7 μm; non-CKD, calcium phosphate/apatite 79.0 μm, whitlockite 94.1 μm; each p < 0.05). Our results, although based on a limited number of samples, indicate that chronic impairment of renal function affects local magnesium homeostasis and thus contributes to the physicochemical composition of microcalcification in atherosclerotic patients.

  6. [How to manage a patient with chronic arterial hypertension during pregnancy and the postpartum period].

    Science.gov (United States)

    Pourrat, O

    2015-03-01

    The management of chronic arterial hypertension during pregnancy and postpartum requires first to estimate the risk of the pregnancy, linked with the severity of hypertension, with cardiac and renal involvement, with its cause as well as with the background (obesity, diabetes, possible history of placental vascular pathology). On a very practical approach, antihypertensive drug has to be started or increased if systolic pressure reaches or exceeds 160 mmHg or if diastolic pressure reaches or exceeds 105 mmHg. Below this level, there are no evidence-based medicine data, but it seems reasonable to treat if pressure increases over 150/100 mmHg (140/90 mmHg in case of ambulatory monitoring). Excessive pressure figures control must be avoided as much as insufficient ones: in practice, it is necessary to decrease the treatment dose if figures are below 130/80 mmHg. Three antihypertensive drugs are consensually recommended today: alphametyldopa, calcium-channel blockers and labetalol. Monotherapy is most often sufficient; if needed, two of these drugs can easily be associated, and even three if necessary. Converting enzyme inhibitors and angiotensin receptor II antagonists should not be prescribed to pregnant women. Betablockers and diuretics are not recommended. Whatever is the antihypertensive drug used, it is necessary to detect the signs of bad placenta blood circulation with uterine Doppler ultrasound and regular controls of fetal growth, and to check for appearance of proteinuria, defining then over-imposed pre-eclampsia needing immediate admission to the maternity. After delivery, lacatation suppresion with bromocriptin should not be prescribed.

  7. Association Between Asymmetric Dimethylarginine and the Severity of Coronary Artery Disease in Patients with Chronic Kidney Disease

    Directory of Open Access Journals (Sweden)

    Yusuf SELCOKİ

    2011-01-01

    Full Text Available OBJECTIVE: Cardiovascular diseases are the most common cause of death in patients with endstage renal disease. Asymmetrical dimethylarginine (ADMA is increased in conditions associated with increased risk of atherosclerosis. We aimed to examine the association between severity of coronary stenosis and the ADMA levels in a group of chronic kidney disease (CKD stage 1 to 3. MATERIAL and METHODS: Eighty-eight (88 consecutive patients with decreased renal function (glomerular filtration rate (GFR between 90 and 30 ml/min, undergoing cardiac catheterization for proven or clinically suspected coronary artery disease were enrolled at the study. Serum levels of creatinine, ADMA, nitric oxide (NO, calcium, phosphate, total cholesterol, HDL and LDL fractions, triglycerides were determined using measurement techniques. The Gensini scoring system was used for the detection of the severity of coronary atherosclerosis. RESULTS: The mean serum values were 81.48 ± 13.8 micromol/l for ADMA and 3.7 ± 1.7 mmol/L for NO. The mean Gensini score in the study group was 30.4 ± 40.1. All patients were classified into tertiles of Gensini score level. Patients in the highest tertile had statistically significantly lower GFR values. The ADMA values increased statistically significantly in the third tertile compared with the first tertile. The Gensini score values significantly correlated in univariate analysis with the GFR, ADMA and presence of hypertension. In a multivariate regression model, ADMA was the only statistically significant independent predictor of Gensini score. CONCLUSION: ADMA appears to be one of the strongest risk markers for atherosclerosis in patients with mild and moderate CKD.

  8. Increased prevalence of coronary artery disease risk markers in patients with chronic hepatitis C – a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Roed T

    2014-01-01

    Full Text Available Torsten Roed,1 Ulrik Sloth Kristoffersen,2 Andreas Knudsen,1,2 Niels Wiinberg,3 Anne-Mette Lebech,1 Thomas Almdal,4 Reimar W Thomsen,5 Andreas Kjær,2 Nina Weis1,61Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark; 2Department of Clinical Physiology, Nuclear Medicine and PET and Cluster for Molecular Imaging, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; 3Department of Clinical Physiology, Frederiksberg Hospital, Copenhagen, Denmark; 4Steno Diabetes Center, Copenhagen, Denmark; 5Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; 6Faculty of Health Sciences, University of Copenhagen, Copenhagen, DenmarkObjective: Chronic hepatitis C is a global health problem and has been associated with coronary artery disease. Our aim was to examine the prevalence of coronary artery disease risk markers including endothelial biomarkers in patients with chronic hepatitis C and matched comparisons without manifest cardiovascular disease or diabetes in a cross-sectional design.Methods: Sixty patients with chronic hepatitis C (mean age 51 years were recruited from the Department of Infectious Diseases at Copenhagen University Hospital, and compared with 60 age-matched non-hepatitis C virus-infected individuals from a general population survey. We examined traditional coronary artery disease risk factors, metabolic syndrome, carotid intima media thickness, and a range of endothelial biomarkers.Results: Patients with chronic hepatitis C had more hypertension (40% versus 25%, prevalence ratio [PR] 1.6; 95% confidence interval [CI] 0.9–2.7 and smoked more (53% versus 38%, PR 1.4; 95% CI 0.9–2.1. The two groups had similar body mass index (mean 25.0 versus 25.7 kg/m2, whereas those with chronic hepatitis C had less dyslipidemia (including significantly lower low-density lipoprotein and cholesterol/high-density lipoprotein ratio, higher glycosylated hemoglobin level (mean 6.2 versus 5

  9. Relation of Aortic Valve and Coronary Artery Calcium in Patients With Chronic Kidney Disease to the Stage and Etiology of the Renal Disease

    NARCIS (Netherlands)

    Piers, Lieuwe H.; Touw, Hugo R. W.; Gansevoort, Ron; Franssen, Casper F. M.; Oudkerk, Matthijs; Zijlstra, Felix; Tio, Rene A.

    2009-01-01

    Patients with chronic renal failure have increased cardiac calcium loads. Previous studies have investigated the prevalence and quantitative extent of aortic valve calcium (AVC) and coronary artery calcium (CAC) in patients with various stages of chronic kidney disease (CKD). However, the impact of

  10. Intravascular ultrasound guidance of percutaneous coronary intervention in ostial chronic total occlusions: a description of the technique and procedural results.

    Science.gov (United States)

    Ryan, Nicola; Gonzalo, Nieves; Dingli, Philip; Cruz, Oscar Vedia; Jiménez-Quevedo, Pilar; Nombela-Franco, Luis; Nuñez-Gil, Ivan; Trigo, María Del; Salinas, Pablo; Macaya, Carlos; Fernandez-Ortiz, Antonio; Escaned, Javier

    2017-02-14

    Inability to cross the lesion with a guidewire is the most common reason for failure in percutaneous revascularization (PCI) of chronic total occlusions (CTOs). An ostial or stumpless CTO is an acknowledged challenge for CTO recanalization due to difficulty in successful wiring. IVUS imaging provides the opportunity to visualize the occluded vessel and to aid guidewire advancement. We review the value of this technique in a single-centre experience of CTO PCI. This series involves 22 patients who underwent CTO-PCI using IVUS guidance for stumpless CTO wiring at our institution. CTO operators with extensive IVUS experience in non-CTO cases carried out all procedures. Procedural and outcome data was prospectively entered into the institutional database and a retrospective analysis of clinical, angiographic and technical data performed. 17 (77%) of the 22 procedures were successful. The mean age was 59.8 ± 11.5 years, and 90.9% were male. The most commonly attempted lesions were located in the left anterior descending 36.4% (Soon et al. in J Intervent Cardiol 20(5):359-366, 2007) and Circumflex artery (LCx) 31.8% (Mollet et al. in Am J Cardiol 95(2):240-243, 2005). Mean JCTO score was 3.09 ± 0.75 (3.06 ± 0.68, 3.17 ± 0.98 in the successful and failed groups respectively p = 0.35). The mean contrast volume was 378.7 ml ± 114.7 (389.9 ml ± 130.5, 349.2 ml ± 52.2 p = 0.3 in the successful and failed groups respectively). There was no death, coronary artery bypass grafting or myocardial infarction requiring intervention in this series. When the success rates were analyzed taking into account the date of adoption of this technique, the learning curve had no significant impact on CTO-PCI success. This series describes a good success rate in IVUS guided stumpless wiring of CTOs in consecutive patients with this complex anatomical scenario.

  11. The occurrence of a pseudoaneurysm of the hepatic artery within the thrombosed portal vein of a patient with chronic pancreatitis: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Eun Soo; Jang, Kyung Mi; Kim, Min Jeong; Yoon, Hoi Soo; Lee, Hyun; Jeon, Eui Yong; Lee, Kwan Seop; Lee, Yul [College of Medicine, Hallym University, Anyang (Korea, Republic of)

    2008-04-15

    A pseudoaneurysm is an uncommon but important life threatening complication of chronic pancreatitis. The arteries most commonly affected by a pseudoaneurysm are (in decreasing percent occurrence), the splenic (40%), gastroduodenal (30%), pancreaticoduodenal (20%), gastric (5%), hepatic (2%), and others (superior mesenteric, jejunal, ileocecal, and aorta) (1-3%). Thrombosis of the splenic or portal vein is another important complication of chronic pancreatitis. In this case report, we present a rare complication in the form of a right hepatic artery pseudoaneurysm which developed within the thrombosed right portal vein of a 35-year-old woman afflicted with chronic pancreatitis.

  12. Use of the frozen elephant trunk technique in complicated chronic dissection with porcelain aorta and visceral arteries originating from different lumens.

    Science.gov (United States)

    Zembala, Michal O; Irimie, Vadim; Urbanski, Paul P

    2016-04-01

    A rare case of aortic arch aneurysm combined with chronic aortic dissection is reported. Because the visceral arteries originated from different, equivalently perfused lumens and the descending aorta was circumferentially calcified (porcelain aorta) limiting the possibilities of anastomosing, careful planning of the surgical strategy was of utmost importance. The complex surgery consisted of ascending and total arch replacement using the 'frozen elephant trunk' technique with Thoraflex™ Hybrid Prosthesis (Vascutek, Terumo, Inchinnan, Scotland); however, before insertion of the stent graft, an angioscopic resection of the dissection membrane in the proximal part of the descending aorta was carried out to ensure a complete expansion of the distal edge of the stent within the entire common lumen of the aorta and unimpaired distal flow in both lumens below the stent graft. The surgery and the postoperative course were uneventful.

  13. Oxidative Stress and Total Antioxidant Status During Internal Carotid Artery Clamping with or without Shunting: An Experimental Pilot Study.

    Science.gov (United States)

    Papapetrou, Anastasios; Moris, Demetrios; Patelis, Nikolaos; Kouvelos, George N; Bakogiannis, Chris; Klonaris, Chris; Georgopoulos, Sotiris

    2015-09-22

    BACKGROUND The exact role of shunting during carotid endarterectomy remains controversial and unclear. The aim of this experimental study was to investigate to what degree carotid clamping may induce changes in the cerebral oxidative status and to focus on the relation of these changes with shunt insertion. MATERIAL AND METHODS Forty New-Zealand rabbits were randomized into 4 groups: group 1 classifying animals with carotid shunt and patent contralateral carotid artery; group 2 shunt and occlusion of the contralateral carotid artery; group 3 no-shunt and patent contralateral carotid artery; and group 4 no-shunt and occlusion of the contralateral carotid artery. Blood samples were collected from the ipsilateral internal jugular vein, immediately after carotid clamping (time 0), and then at 5, 10, 15, 30, and 60 minutes afterwards. Evaluation of oxidative stress was accomplished by measuring the lag-time, representing the initial phase of oxidation, rate of accumulation (RA), showing concentration of free oxygen radical and total antioxidant status (TAS) representing antioxidant composition of serum. RESULTS Lag-time was significantly different in time points 0, 30 and 60 minutes within each different group. TAS was significantly different in time points 0, 15 and 60 min and RA in time points 0, 5, 10 and 60 min within each different group. 60 minutes after carotid clamping, the rate of accumulation as well as lag-time and TAS were increased in all groups, independently of using or not shunting or the presence of contralateral occlusion. After comparing groups 1, 2 and 3 regarding lag-time, TAS and RA, we did not find statistical difference among the groups at any time point. On the contrary, groups 1, 2 and 3 did show significantly different values comparing to group 4 after 60 min of occlusion. CONCLUSIONS Our experimental work based on cerebral metabolism found a significantly higher oxidative stress in models with contralateral carotid occlusion. The use of shunt

  14. Idiopathic infantile arterial calcification in a 12-year-old girl presenting as chronic mesenteric ischemia: imaging findings and angioplasty results

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, Edwin; Owen, Richard [University of Alberta, Department of Radiology and Diagnostic Imaging, Edmonton (Canada); Bruce, Garth [University of Saskatchewan, Department of Pediatrics, Royal University Hospital, Saskatoon (Canada); Wiebe, Sheldon [University of Saskatchewan, Department of Medical Imaging, Royal University Hospital, Saskatoon (Canada)

    2011-11-15

    We report an unusual case of chronic mesenteric ischemia presenting in a 12-year-old girl with idiopathic infantile arterial calcinosis (IIAC). This is the first reported case in the literature of chronic mesenteric ischemia in the setting of IIAC. The girl presented with a classical history of postprandial abdominal pain. Imaging demonstrated significant stenoses of the celiac axis, superior mesenteric artery (SMA) and inferior mesenteric artery (IMA). Angioplasty of the celiac axis and SMA was attempted, with successful dilation of the SMA only. At 3-, 6- and 12-month follow-ups, the child's symptoms had almost resolved. This case report has three important ramifications: chronic mesenteric ischemia is a possible clinical presentation in children with IACC, pre-angioplasty imaging is important in guiding treatment approach, and angioplasty was effective in this case of chronic mesenteric ischemia and offers hope for other similarly affected children. (orig.)

  15. The coronary artery disease quality dashboard: a chronic care disease management tool in an electronic health record.

    Science.gov (United States)

    Jung, Eunice; Schnipper, Jeffrey L; Li, Qi; Linder, Jeffrey A; Rose, Alan F; Li, Ruzhuo; Eskin, Michael S; Housman, Dan; Middleton, Blackford; Einbinder, Jonathan S

    2007-10-11

    Quality reporting tools, integrated with ambulatory electronic health records (EHRs), may help clinicians understand performance, manage populations, and improve quality. The Coronary Artery Disease Quality Dash board (CAD QD) is a secure web report for performance measurement of a chronic care condition delivered through a central data warehouse and custom-built reporting tool. Pilot evaluation of the CAD Quality Dash board indicates that clinicians prefer a quality report that combines not only structured data from EHRs but one that facilitates actions to be taken on individual patients or on a population, i.e., for case management.

  16. Stingray balloon used in slender percutaneous coronary intervention for chronic total occlusion.

    Science.gov (United States)

    Wu, Eugene B; Ikari, Yuji

    2013-07-01

    Slender chronic total occlusion (CTO) percutaneous coronary intervention (PCI) using 5 Fr radial Ikari catheter is possible in simple CTO cases. We report a case where we initially thought the LAD CTO was short and easy, but we found that the CTO had a considerable amount of calcium and also some tortuosity, making simple wire crossing impossible. We used a Stingray balloon to perform re-entry by tracking the balloon over an Ultimate Bros 3 gram wire using an extension wire. We successfully punctured into true lumen and completed stenting through a slender 5 Fr system. This case demonstrates the beauty of combining the advances in CTO PCI from the East and the West together and also demonstrates the possibility of using the Stingray system in a 5 Fr guiding catheter.

  17. A rapid decrease in pulmonary arterial pressure by noninvasive positive pressure ventilation in a patient with chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    Dursunoglu Nese

    2007-01-01

    Full Text Available The natural history of chronic obstructive pulmonary disease (COPD is characterized by progressive decrements in expiratory airflow, increments in end-expired pulmonary volume, hypoxaemia, hypercapnia and the progression of pulmonary arterial hypertension (PAH. Noninvasive positive pressure ventilation (NPPV treatment is increasingly used for the treatment of acute and chronic respiratory failure in patients with COPD. NPPV can increase PaO2 and decrease PaCO2 by correcting the gas exchange in such patients. The acute effect of NPPV on decreasing PAP is seen in patients with respiratory failure, probably due to the effect on cardiac output. Here, a case with COPD whose respiratory acidosis and PAH rapidly improved by NPPV was presented and therefore we suggested to perform an echocardiographic assessment to reveal an improvement of PAH as well as respiratory acidosis, hypercapnia and hypoxemia with that treatment.

  18. Reproducibility of arterial stiffness and wave reflections in chronic obstructive pulmonary disease: the contribution of lung hyperinflation and a comparison of techniques.

    Science.gov (United States)

    Stone, Ian S; John, Leonette; Petersen, Steffen E; Barnes, Neil C

    2013-11-01

    Significant cardiovascular morbidity and mortality exists in chronic obstructive pulmonary disease (COPD). Arterial stiffness is raised in COPD and may be a mechanistic link. Non-invasive assessment of arterial stiffness has the potential to be a surrogate outcome measure, although no reproducibility data exists in COPD patients. Two studies (23 and 33 COPD patients) were undertaken to 1) assess the Vicorder reproducibility of carotid-femoral pulse wave velocity and Augmentation index in COPD; 2) compare it to SphygmoCor; and 3) assess the contribution of lung hyperinflation to measurement variability. There were excellent correlations and good agreement between repeat Vicorder measurements for carotid-femoral pulse wave velocity (r = 0.96 (p lung hyperinflation (as measured by residual volume percent predicted, total lung capacity percent predicted or the ratio of inspiratory capacity to residual volume) and variability of measurements in either study. In COPD, measurement of carotid-femoral pulse wave velocity is highly reproducible, not affected by lung hyperinflation and suitable as a surrogate endpoint in research studies. Day-to-day variation in augmentation index highlights the importance of such studies prior to the planning and undertaking of clinical COPD research.

  19. Wire trapping technique combined with retrograde approach for recanalization of chronic total occlusion

    Institute of Scientific and Technical Information of China (English)

    GE Jun-bo; ZHANG Feng; GE Lei; QIAN Ju-ying; WANG Hao

    2008-01-01

    @@ Coronary chronic total occlusion (CTO),defined as a total occlusion of duration >3 months,remains a technical challenge for the interventional cardiologists.The major limitation in percutaneous coronary intervention (PCI) of CTO is the inability to penetrate and cross the occlusion with a guidewire.It was reported that the immediate angiographic success rate varied from 50%to 70% using the standard antegrade techniques,1 To improve this suboptimal success rate,the authors firstly introduced retrograde approach through the collateral channels as a novel technique2 and successfully recanalized a left main CTO using this technique when demonstrating the live cases in Transcatheter Cardiovascular Therapeutics (TCT) 2005.Recently,modified techniques based on the retrograde approach have demonstrated that this approach could provide a high success rate with PCI.3-5 In the present report,we described a new method,wire trapping technique combined with retrograde approach,which was applied successfully in three patients with CTO.

  20. Association between inflammatory factor, lipid peroxidation and total-antioxidant in non-diabetic patients of coronary artery disease

    Directory of Open Access Journals (Sweden)

    fatemeh khaki-khatibi

    2014-02-01

    Full Text Available Introduction: The oxidative stress and inflammation are cooperative events involved in atherosclerosis development. In the present study, we assessed the association ofmalondialdehyde (MDA, antioxidant markers, high sensitive C-reactive protein (HS-CRPand lipid status parameters in non-diabetic patients with coronary artery disease (CAD orvessel heart disease (VHD. Significant risk factors such as diabetes were excluded from thestudy. Methods: Oxidative stress parameters for example MDA, antioxidant markers including:erythrocyte superoxide dismutase (SOD, glutathione peroxidase (GPX, total antioxidant capacity (TAC, inflammation marker and serum lipid status parameters were measured in 120 subjects including 60 CAD patients (non-diabetic with angiographically diagnosed CADand 60 CAD-free subjects as a control group, also diabetic patients with malignancy, renal andliver disease, and other disease were excluded from the study. Results: The serum MDA and HS-CRP levels were increased significantly as compared to thecontrols. However, erythrocyte SOD, GPX activities and TAC level were reduced significantly in patients (non-diabetic (P < 0.05 in all cases. The levels of total cholesterol,triglyceride, and low-density lipoprotein cholesterol (LDL-c were significantly higher andthat of high-density lipoprotein cholesterol (HDL-c was significantly lower than those ofcontrols (P < 0.05 in all cases. Conclusion: The association between oxidative stress parameters, antioxidant markers, theinflammation index and lipid status parameters suggest their involvement in atherosclerosis development that may lead to CAD progression.

  1. Total pancreatectomy for the treatment of chronic pancreatitis: indications, outcomes, and recommendations.

    Science.gov (United States)

    Behrman, Stephen W; Mulloy, Matthew

    2006-04-01

    Total pancreatectomy (TP) for chronic pancreatitis (CP) has not gained widespread acceptance because of concerns regarding technical complexity, diabetic complications, and uncertainty with respect to long-term pain relief. Records of patients having TP from 1997 to 2005 were reviewed. Patient presentation, etiology of disease, and the indication for TP were examined. Operative results were analyzed. Long-term results were critically assessed, including narcotic usage and the need for re-admission. Postoperative quality of life (QOL) was assessed by the SF-36 health survey. During the study period, 7 patients with CP had TP, and 28 had other operations. The etiology of CP was alcohol in four and hereditary pancreatitis in three. The indication for surgery was pain and weight loss. Preoperatively, all patients used narcotics chronically and two had insulin-dependent diabetes. Four had TP after failed previous surgical procedures. Endoscopic retrograde cholangiopancreatography and computed tomography demonstrated small ducts and atrophic calcified glands. The mean length of the operation was 468 minutes, and only two patients required transfusion. There were no biliary anastomotic complications. The mean length of stay was 14 days. Major morbidity was limited to a single patient with a leak from the gastrojejunal anastomosis. Thirty-day mortality was zero, with one late death unrelated to the surgical procedure or diabetes. The mean length of follow-up was 46 months. All patients remained alcohol and narcotic free. No patient was readmitted with a diabetic complication. When compared with the general population, QOL scores were diminished but reasonable. We conclude that TP is indicated in hereditary pancreatitis and in those with an atrophic, calcified pancreas with small duct disease; that TP is technically arduous but can be completed with very low morbidity and mortality; and that on long-term follow-up, pain relief and abstinence from alcohol and narcotics was

  2. An unusual case of multiple aortic abnormalities: total occlusion of aortic arch, left external iliac artery, and bicuspid aortic valve in a 21-year-old man.

    Science.gov (United States)

    Tanindi, Asli; Tavil, Yusuf; Mutluay, Ruya; Taktak, Hacer; Cengel, Atiye

    2007-03-01

    An unusual case of total occlusion of aorta just distal to the left subclavian artery, bicuspid aortic valve, and occluded left external iliac artery in a 21-year-old man who was admitted with headache and severe hypertension is presented. We wish to report this case because so far there have been none reported with such multiple aortic abnormalities, although several documented cases of isolated total occlusion of aorta exist. Our patient underwent a successful surgical correction, i.e., patch plasty to the coarcted segment and end to side - end to side aortal-aortal bypass with Dacron graft.

  3. Multi-wire plaque crushing as a novel technique in treating chronic total occlusions

    Institute of Scientific and Technical Information of China (English)

    HAN Ya-ling; WANG Dong-mei; LI Yi; WANG Shou-li; JING Quan-min; MA Ying-yan; WANG Geng; LUAN Bo; WANG Bin; WANG Zhu-lu

    2008-01-01

    Background Failure of balloon catheter passing through the occluded segment accounts for 10%-15% of all procedures during percutaneous coronary intervention(PCI)for chronic total occlusion(CTO).We sought to investigate an original technique for facilitating balloon catheter passing by multi-wire plaque crushing.Methods Between July 2000 and October 2007,152 patients with 164 CTO lesions who had failed balloon passing were treated by multi-wire plaque crushing technique.The main process of this technique was to insert 1 or 2 wires along with the original wire located in the true lumen of CTO lesions after balloon failure for plaque crushing and then to withdraw the crushing wires to get an enlarged lumen inside of the occlusion segment,thus facilitating the balloon passing.Results Both overall lesion and technique success rates were 91.5%(150/164).A total of 211 crushing wires were used during PCI,including 1 crushing wire for 117(71.3%)lesions and 2 crushing wires for 47(28.7%)lesions.Approximately 57.3%(121/211)of all crushing wires were those already used in the same procedure.Technique failure occurred in 14 lesions(8.5%).Technique failure was due to crushing wires entering false lumen(92.9%,13/14)and coronary perforation(7.1%,1/14).Major procedural complications included coronary perforation(1 case)and severe coronary dissection(2 cases),all of which were successfully treated.Conclusions Multi-wire plaque crushing technique is effective in facilitating balloon catheter passing during CTO PCI.It is feasible,economical and relatively safe with a low rate of procedural complications.

  4. [Surgical treatment of secondary hyperparathyroidism in chronic kidney failure. Results of total parathyroidectomy with parathyroid autotransplantation].

    Science.gov (United States)

    Courant, O; Letessier, E; Moutel, M G; Hamy, A; Paineau, J; Visset, J

    1993-01-01

    Between 1978 and 1990, 68 patients, operated on for secondary hyperparathyroidism (HPT), received a forearm intramuscular free autologous parathyroid graft (37 women and 31 men--mean age: 43 +/- 16 years). The transplantation (Wells technique) was performed in the same time as the total parathyroidectomy and the remaining parathyroid material after surgical resection was cryopreserved. The results were evaluated in term of clinical and/or radiological and/or biological response respectively 3 or 5.5 years later, depending of the realisation of a renal transplantation (n = 27) or not. Four patients were lost to follow-up and 4 died post-operatively, including a wrong diagnosis (60 patients evaluated). Mortality rate was 12% (5 cases out of 7 related to chronic renal insufficiency). In 3 patients (5%) the transplanted gland had to be removed because of recurrent HPT (1 graft hyperplasia; 2 wrong diagnosis: 1 cervical gland left over and 1 aluminium intoxication). Second cervicotomy was performed in 3 cases (5%) for remaining cervical parathyroid gland (2 cases) and false-positive Tallium-Technetium scan (1 case). Overall results were good or very good in 51 cases (85%). A review of the literature indicate that subtotal parathyroidectomy in not superior to the Wells technique and the latter remain the landmark technique in the authors' hands in order to treat secondary HPT.

  5. Subadventitial techniques for chronic total occlusion percutaneous coronary intervention: The concept of "vessel architecture".

    Science.gov (United States)

    Azzalini, Lorenzo; Carlino, Mauro; Brilakis, Emmanouil S; Vo, Minh; Rinfret, Stéphane; Uretsky, Barry F; Karmpaliotis, Dimitri; Colombo, Antonio

    2017-03-17

    Despite improvements in guidewire technologies, the traditional antegrade wire escalation approach to chronic total occlusion (CTO) recanalization is successful in only 60-80% of selected cases. In particular, long, calcified, and tortuous occlusions are less successfully approached with a true-to-true lumen approach. Frequently, the guidewire tracks into the subadventitial space, with no guarantee of distal re-entry into the true lumen. The ability to manage the subadventitial space has been a key step in the tremendous improvement in success rates of contemporary CTO percutaneous coronary intervention (PCI), whether operating antegradely or retrogradely. A modern approach to CTO PCI involves understanding the concept of "vessel architecture," which is based on the distinction between coronary structures (occlusive plaque, comprising the disrupted intima and media, and the outer adventitia) and extravascular space. The vessel architecture represents a safe work environment for guidewire and device manipulation. This review provides an anatomy-based description of the concept of vessel architecture, along with a historical perspective of subadventitial techniques for CTO PCI, and outcome data of CTO PCI utilizing the subadventitial space. © 2017 Wiley Periodicals, Inc.

  6. Comparison of arterial and venous blood gases and the effects of analysis delay and air contamination on arterial samples in patients with chronic obstructive pulmonary disease and healthy controls.

    LENUS (Irish Health Repository)

    O'Connor, T M

    2012-01-31

    BACKGROUND: Arterial blood gases (ABGs) are often sampled incorrectly, leading to a \\'mixed\\' or venous sample. Delays in analysis and air contamination are common. OBJECTIVES: We measured the effects of these errors in patients with chronic obstructive pulmonary disease (COPD) exacerbations and controls. METHODS: Arterial and venous samples were analyzed from 30 patients with COPD exacerbation and 30 controls. Venous samples were analysed immediately and arterial samples separated into non-air-contaminated and air-contaminated specimens and analysed at 0, 30, 60, 90 and 180 min. RESULTS: Mean venous pH was 7.371 and arterial pH was 7.407 (p < 0.0001). There was a correlation between venous and arterial pH (r = 0.5347, p < 0.0001). The regression equation to predict arterial pH was: arterial pH = 4.2289 + 0.43113 . venous pH. There were no clinically significant differences in arterial PO associated with analysis delay. A statistically significant decline in pH was detected at 30 min in patients with COPD exacerbation (p = 0.0042) and 90 min in controls (p < 0.0001). A clinically significant decline in pH emerged at 73 min in patients with COPD exacerbation and 87 min in controls. Air contamination was associated with a clinically significant increase in PO in all samples, including those that were immediately analyzed. CONCLUSIONS: Arterial and venous pH differ significantly. Venous pH cannot accurately replace arterial pH. Temporal delays in ABG analysis result in a significant decline in measured pH. ABGs should be analysed within 30 min. Air contamination leads to an immediate increase in measured PO, indicating that air-contaminated ABGs should be discarded.

  7. No causal association between inflammation and Chlamydia pneumoniae in patients with chronic ischemic arterial disease.

    Science.gov (United States)

    Altman, Raúl; Rouvier, Jorge; Scazziota, Alejandra; Gonzalez, Claudio

    2002-02-01

    The C-reactive protein, Chlamydia-specific IgG antibody, and fibrinogen were assayed in the serum of 159 patients with arterial disease (the arterial group) and 203 patients with heart valve prostheses (the valvular group) and no demonstrable coronary disease. In the arterial group, the Chlamydia pneumoniae antibody was > or = 1:32 for 67.3% (107/159) of the patients, the C-reactive protein was elevated in 41.5% (66/159), and the fibrinogen was elevated in 27.7% (44/159). In the valvular group, the C. pneumoniae antibody was > or = 1:32 for 59.1% (120/203) of the patients; the C-reactive protein was elevated in 34.0% (69/203), and the fibrinogen was elevated in 17.2% (35/203). Of 107 patients in the arterial group with C. pneumoniae titers > or = 1:32, only 26 (24.3%) had elevated fibrinogen (426 +/- 29 mg/dL) and 44 (41.1%) had elevated C-reactive protein (1.06 +/- 0.52 mg/dL). Similarly, of the 120 patients in the valvular group with C. pneumoniae titers > or = 1:32, 17 (14.2%) had elevated fibrinogen (409 +/- 29 mg/dL) and 34 had elevated C-reactive protein (0.99 +/- 1.1 mg/dL). Correlated poorly was C. pneumoniae with C-reactive protein and fibrinogen levels. Only the fibrinogen level could be discriminated between the arterial and the valvular group. These results suggest that no causal association exists between inflammation and C. pneumoniae. A highly significant correlation between C-reactive protein and fibrinogen levels was found.

  8. A longitudinal study of arterial blood pressure in chronic haemodialysis patients with different levels of plasma renin concentration.

    Science.gov (United States)

    Kornerup, H J; Fredsted, B; Pedersen, R S

    1978-01-01

    The purpose of the study was to examine the value of regular measurements of plasma renin concentration (PRC) in selecting those chronic haemodialysis patients suitable for bilateral nephrectomy to prevent development of uncontrollable hypertension. Regular measurements of arterial blood pressure (BP) and PRC were performed during one year in 31 patients undergoing regular haemodialysis because of end-stage renal disease. Among 18 patients with PRC greater than or equal to 100 micro Goldblatt units per ml plasma (microGU/ml) systolic and/or diastolic hypertension persisted or developed in 12. In contrast, among 13 patients with PRC greater than 100microGU/ml, BP became normal in all but one, who had a slightly increased systolic BP. However, hypertension was mild and easily controlled by conventional therapy in all except one, who probably had an overlying volume-dependent hypertension. Therefore, bilateral nephrectomy was not necessary in any case. The results indicate that hypertension in the majority of chronic haemodialysis patients with high PRC can be adequately controlled without surgical intervention and that regular measurements of PRC have no practical value in forecasting the development of uncontrollable hypertension in chronic haemodialysis patients.

  9. Chronic myocardial infarction detection and characterization during coronary artery calcium scoring acquisitions.

    LENUS (Irish Health Repository)

    Rodríguez-Granillo, Gastón A

    2012-01-05

    Hypoenhanced regions on multidetector CT (MDCT) coronary angiography correlate with myocardial hyperperfusion. In addition to a limited capillary density, chronic myocardial infarction (MI) commonly contains a considerable amount of adipose tissue.

  10. Chronic wind and plant communities in dunes: Total biomass, inter-specific competition, and species abundance

    NARCIS (Netherlands)

    He, W.M.; Xi, W.M.; Anten, N.P.R.

    2013-01-01

    Chronic wind is an important ecological factor, but its direct roles in shaping plant communities remain poorly understood. We hypothesized that chronic wind can modulate community productivity, inter-specific competition, and species abundance in inland dunes. We conducted an experiment with three

  11. Impact of the Intracoronary Rendezvous technique on coronary angioplasty for chronic total occlusion.

    Science.gov (United States)

    Nihei, Taro; Yamamoto, Yoshito; Kudo, Shun; Hanawa, Kenichiro; Hasebe, Yuhi; Takagi, Yusuke; Minatoya, Yutaka; Sugi, Masafumi; Shimokawa, Hiroaki

    2016-08-30

    The Rendezvous technique, which requires bidirectional wiring, is one of the useful methods for improving the success rate of recanalization for chronic total occlusion (CTO) in the field of peripheral intervention. Recently, advanced new devices for percutaneous coronary intervention have enabled us to perform the Rendezvous technique for peripheral as well as for coronary CTO lesions. We used the Intracoronary Rendezvous technique to perform angioplasty for coronary CTO. "Intracoronary Rendezvous" means that Rendezvous was achieved within the CTO lesion. From March 2009 to November 2015, 189 patients underwent CTO angioplasty at our institute, and we treated 10 patients with the Intracoronary Rendezvous technique. This technique involves crossing the Gaia series guidewire to the contralateral Corsair microcatheter located inside the plaque of CTO lesions. The majority of the CTO sites examined were in the proximal RCA (60 %). Lesion length of the occlusion was relatively long (64.4 ± 12.2 mm). Using the biplane imaging system, we were able to control the Gaia guidewires in a specific direction. Furthermore, if the antegrade and retrograde wires can be advanced into contiguous space inside the CTO lesion, we intentionally entered either wire into the contralateral Corsair microcatheter, followed by successful CTO crossing. CTO recanalization was completed for all patients without controlled antegrade retrograde subintimal tracking (CART) or reverse CART. No major complications occurred during hospitalization. These results indicate that the Rendezvous technique, assisted by new devices and a biplane imaging system, represents one of the primary options to achieve successful coronary CTO recanalization. (249/250 words).

  12. Transcatheter pulmonary valve perforation using chronic total occlusion wire in pulmonary atresia with intact ventricular septum

    Science.gov (United States)

    Bakhru, Shweta; Marathe, Shilpa; Saxena, Manish; Verma, Sudeep; Saileela, Rajan; Dash, Tapan K; Koneti, Nageswara Rao

    2017-01-01

    Background: Perforation of pulmonary valve using radiofrequency ablation in pulmonary atresia with intact ventricular septum (PA IVS) is a treatment of choice. However, significant cost of the equipment limits its utility, especially in the developing economies. Objective: To assess the feasibility, safety, and efficacy of perforation of pulmonary valve using chronic total occlusion (CTO) wires in patients with PA IVS as an alternative to radiofrequency ablation. Methods: This is a single-center, nonrandomized, retrospective study conducted during June 2008 to September 2015. Twenty-four patients with PA IVS were selected for the procedure during the study period. The median age and weight of the study population were 8. days and 2.65 kg, respectively. Four patients were excluded after right ventricular angiogram as they showed right ventricular-dependent coronary circulation. The pulmonary valve perforation was attempted using various types of CTO wires based on the tip load with variable penetrating characteristics. Results: The procedure was successful in 16 of twenty patients using CTO wires: Shinobi in nine, Miracle in four, CROSS-IT in two, and Conquest Pro in one. Two patients had perforation of right ventricular outflow tract (RVOT). Pericardiocentesis was required in one patient to relieve cardiac tamponade. Later, the same patient underwent successful hybrid pulmonary valvotomy. The other patient underwent ductus arteriosus (DA) stenting. Balloon atrial septostomy was needed in three cases with systemic venous congestion. Desaturation was persistent in five cases necessitating DA or RVOT stenting to augment pulmonary blood flow. There were two early and two late deaths. The mean follow-up was 22.66 ± 16 months. Three patients underwent one and half ventricle repair and one Blalock–Taussig shunt during follow-up. Conclusion: Perforation of the pulmonary valve can be done successfully using CTO wires in selected cases of pulmonary atresia with intact

  13. Acute myocardial infarction in chronic Chagas' cardiomyopathy: report of two cases with no obstructive coronary artery lesions

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    Silvia G. Lage

    1986-04-01

    Full Text Available This report describes two patients with chronic Chagas' Heart Disease who developed clinical and laboratorial signs of myocardial infarction. Both patients presented sudden oppressive chest pain, without precipitating factor. In the first case, the highest MB-CK value was 65 IU, 22 hours after the beginning of the pain. On the second case, it was 77 IU at 18 hours after the beginning of the pain. In both cases ECG changes suggesting non-transmural infarction were present. The 99mTc PYP myocardial scintigram of the first case was positive. Coronary angiograms performed on the 18th and 9th day, respectively, after the acute infarction did not display obstructive lesions. Possible mechanisms causing myocardial infarction with normal coronary arteries in Chagas' Disease may include: embolic event's, particularly when there is associated congestive heart failure; coronary thrombosis and coronary spasms.

  14. Effects of chronic renal failure rat serum on histone acetyltransferase p300 and activation of activating transcription factor 4 of arterial smooth muscle cells cultured in vitro

    Institute of Scientific and Technical Information of China (English)

    张耀全

    2014-01-01

    Objective To investigate the effects of the rat serum with chronic renal failure(CRF)on ubiquitin-proteasome pathway,histone acetyltransferase p300 and activation of activating transcription factor 4(ATF4)of rat arterial vascular smooth muscle cells(VSMCs)cultured in vitro,and explore the possible mechanism.Methods Objective To establish the rat model of

  15. Renal Fractional Excretion of Sodium in Relation to Arterial Blood Gas and Spirometric Parameters in Chronic Obstructive Pulmonary Disease

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    Fariba Rezaeetalab

    2014-05-01

    Full Text Available Introduction: Arterial gas derangement could change urinary sodium excretion in Chronic Obstructive Pulmonary Disease (COPD patients.There are very few and conflicting data in regards to the measurement of fractional excretion of sodium in COPD patients. The main aim of this study was to assess the relationship between renal fractional excretion of sodium(FeNa with arterial blood gas and spirometric parameters in COPD. Materials and Methods: This study was a cross-sectional study performed on 40 consecutive stable COPD outpatients in 2 main general hospitals (Emam Reza, Ghaem in Mashhad/Iran between 2011 and 2012. We investigated the relationship of renal FeNa with arterial blood gas parameters including HCO3, PH, PaCO2 and PaO2, and spirometric parameters. Analysis was done by SPSS v16 with a statistically meaningful p value of less than 0.05. Results: Mean age was 65.97±10.77 SD years and female to male ratio was 0.26. A renal FeNa of less than 1% was presented in 27% patients. There was a significant, positive relationship between renal FeNa and PaO2 (P=0.005, r=0.456. The correlations between PaCO2, HCO3, PH and spirometric parameters were not seen (P>0.05, but there was a significant relationship between Urine Na and PaO2. Outstanding, it seems likely that kidneys of COPD patients are responsible for sodium retaining state particularly in the presence of hypoxemia. Conclusion: This study indicates that in COPD patients, PaO2 but not PaCO2 is related to renal FeNa which shows the probable role of hypoxemia on sodium output in COPD patients. However, some caution is needed for interpretation of the probable role of hypercapnia on sodium retention in COPD.

  16. Experimental stereotactic gamma knife radiosurgery. Vascular contractility studies of the rat middle cerebral artery after chronic survival.

    Science.gov (United States)

    Major, Otto; Szeifert, György Tamás; Radatz, Matthias W R; Walton, Lee; Kemeny, Andras Armand

    2002-03-01

    In vitro isometric small vessel myograph experiments and pathological investigations were performed on rat middle cerebral arteries. Thirty-four animals provided 68 normal vessels, six further rats had the endothelial layer mechanically removed from their 12 arteries. Eighteen animals received gamma knife irradiation to the middle cerebral arteries. Fifteen of these received 50 Gray, and three 25 Gray dose to the 50% isodose and the contralateral vessels offered 20 Gray and 15 Gray irradiated specimens. Survival times varied from 12 weeks to 18 months. In the acute stage, abolition of potassium-induced relaxation occurred as early as 24 h after irradiation whilst in one year this reaction seemed to recover and remained active to 18 months. The contraction response to prostaglandin F2 alpha was diminished at six weeks in the 50 Gray-irradiated vessels. However, from one year further reduction was seen and by 18 months this response was totally abolished. We demonstrated reduction of contractile capability of the irradiated normal vessels while the vessels remained patent. When using low irradiation dose there were no pathological changes even at 18 months, but marked physiological changes could be demonstrated. Different vessel wall functions appear to have different radiosensitivity, time course and capability for regeneration.

  17. Coronary artery calcium score using electron beam tomography in the patients with acute obstructive coronary arterial disease : comparative study within asymptomatic high-risk group of atherosclerosis and chronic obstructive coronary arterial disease group

    Energy Technology Data Exchange (ETDEWEB)

    Ryu, Seok Jong; Choi, Byoung Wook; Choe, Kyu Ok [Yonsei Univ. College of Medicine, Seoul (Korea, Republic of)

    2001-04-01

    To compare, through analysis of the coronary artery calcium (CAC) score and the risk factors for atherosclerosis, the characteristics of acute coronary syndrome between an asymptomatic high-risk group of atherosclerosis patients and a chronic coronary arterial obstructive disease(CAOD) group. The CAC scores of an asymptomatic high-risk group of atherosclerosis patients (group I, n=284), a chronic CAOD croup (group II, n=39) and an acute coronary syndrome group (group III, n=21) were measured by electron beam tomography. Forty-seven patients with CAOD from groups II and III underwent coronary angiography, and we scrutinized age, sex and risk factors including diabetes mellitus, hypertension, obesity, smoking, hypercholesterolemia and low high-density lipoproteinemia. The numbers of stenotic coronary arterial branches and degree of stenosis revealed by coronary angiography were also recorded. We determined the differences between the three groups in terms of CAC score and the risk factors, the relationship between CAC score and risk factors, and the characteristic features of each type of CAOD group. The mean CA score of group III (135.1) was not statistically different from that of group I (135.7) or group II (365.8). Among patients aged below 50, the mean CAC score of group III (127.4) was significantly higher than that of group I (6.2), (p=0.0006). The mean CAC score at the sixth decade was also significantly different between group I(81.5) and group II (266.9). The mean age of group III (54.2 years) was significantly lower than that of group I (58.1 years) (p=0.047) and of group II (60.1) (p=0.022). There was significant correlation between the number of stenotic coronary arterial branches and log(CAC +1) (p<.01). The square root of the CAC score and the maximal degree of stenosis was also well correlated (p<.01). There was no difference in the mean number of risk factors among the three groups, though the incidence of smoking in group III was significantly

  18. The laser driven short-term heating balloon catheter: Relation between the chronic neointimal hyperplasia formation and thermal damage to arterial smooth muscle cells.

    Science.gov (United States)

    Shimazaki, Natsumi; Hayashi, Tomoaki; Kunio, Mie; Igami, Yuka; Arai, Tsunenori; Sakurada, Masami

    2010-01-01

    We proposed a novel laser-driven short-term heating angioplasty to realize restenosis-suppressive angioplasty for peripheral artery disease. In this study, we investigated the chronic intimal hyperplasia formation after the short-term heating dilatation in vivo, as well as the thermal damage calculation on arterial smooth muscle cells (SMCs). The prototype short-term heating balloon catheter with 5.0, 5.5, 6.0 mm φ in balloon diameter and 25 mm in balloon length were employed. The short-term heating dilatation was performed in porcine iliac arteries with dilatation conditions of 75°C (N=4) and 65°C (N=5) as peak balloon temperature, 18 ± 4s as heating duration, 3.5 atm as balloon dilatation pressure. Four weeks after the balloon dilatation, the balloon-dilated artery segments were extracted and were stained with HE and picrosirius red for histological observation. In the case of 75°C as the peak balloon temperature, neointimal hyperplasia formation was significantly reduced. In this case, the SMCs density in the artery media measured from the HE-stained specimen was 20% lower than that in the reference artery. According to the thermal damage calculation, it was estimated that the SMCs lethality in artery media after the short-term heating angioplasty was 20% in the case of 75°C as the peak balloon temperature. We demonstrated that the short-term heating dilatation reduced the number of SMCs in artery media. We think this SMCs reduction might contribute to the suppression of chronic neointimal hyperplasia.

  19. Hemophilic Chronic Synovitis: Therapy of Hemarthrosis using Endovascular Embolization of Knee and Elbow Arteries

    Energy Technology Data Exchange (ETDEWEB)

    Galli, E., E-mail: emgalli1@yahoo.com.ar [CABA, Hospital de Agudos ' Juan A. Fernandez' (Argentina); Baques, A.; Moretti, N.; Candela, M. [CABA, Fundacion de la Hemofilia de Buenos Aires (Argentina); Caviglia, H. [CABA, Hospital de Agudos ' Juan A. Fernandez' (Argentina)

    2013-08-01

    PurposeCongenital hemophilia is a hereditary bleeding disorder that affects 1 in 5,000 males and is characterized by repetitive musculoskeletal bleeding episodes. Selective embolization of the knee and elbow arteries can prevent bleeding episodes. To evaluate the long-term efficacy of these procedures, we assessed the outcomes of 30 procedures performed in our center.MethodsWe performed 30 procedures in 27 hemophilic patients, including 23 knee, and 7 elbow procedures. To evaluate the efficacy of selective embolization of knee and elbow arteries in people with hemophilia, we analyzed the number of bleeding episodes during 12 months before the procedure compared with the amount of episodes that occurred 3, 6, and 12 months after embolization.ResultsTwenty-nine of 30 procedures were classified as successful. The median of 1.25 episodes per month (range 0-3) observed before the procedure was reduced to 0 (range 0-1.67; p < 0.001) at 3 months, 0.17 (range 0-1.67; p < 0.001) at 6 months, and 0.33 (range 0-1.67; p = 0.024) at 12 months. Three patients remained free of bleeding events for more than 6 months. Additionally, after the procedure there was a significant reduction in factor FVIII usage that sustained up to 12 months after the procedures. No serious adverse events were observed.ConclusionsSelective angiographic embolization of knee and elbow arteries is a feasible procedure that can prevent repetitive bleedings, which would translate in better joint outcomes for these patients.

  20. Vitamin K antagonism aggravates chronic kidney disease-induced neointimal hyperplasia and calcification in arterialized veins: role of vitamin K treatment?

    Science.gov (United States)

    Zaragatski, Emma; Grommes, Jochen; Schurgers, Leon J; Langer, Stephan; Kennes, Lieven; Tamm, Miriam; Koeppel, Thomas A; Kranz, Jennifer; Hackhofer, Tina; Arakelyan, Karen; Jacobs, Michael J; Kokozidou, Maria

    2016-03-01

    Arteriovenous fistula (AVF) is the common vascular access type for a hemodialysis patient. Its failure is due to neointimal hyperplasia. Vitamin K antagonists are given to lower thrombosis tendency, but have side effects that enhance arterial calcifications. Here, we investigated the effects of vitamin K antagonists and vitamin K2 (K2) treatment on neointimal hyperplasia development and calcification in rats and in arterialized human veins. AVF was generated in female rats while chronic kidney disease (CKD) was induced using an adenine-enriched diet. Arterialization, CKD, and vitamin K antagonists all significantly enhanced venous neointimal hyperplasia. K2 treatment, additional to vitamin K antagonists, significantly reduced neointimal hyperplasia in arterialized veins in healthy rats but not in rats with CKD. Arterialization, CKD, and vitamin K antagonism all significantly increased, whereas K2 supplementation attenuated calcification in healthy rats and rats with CKD. K2 significantly enhanced matrix Gla protein carboxylation in control rats and rats with CKD. Arterialized human vein samples contained inactive matrix Gla protein at calcification and neointimal hyperplasia sites, indicating local vitamin K deficiency. Thus, vitamin K antagonists have detrimental effects on AVF remodeling, whereas K2 reduced neointimal hyperplasia and calcification indicating vasoprotective effects. Hence, K2 administration may be useful to prevent neointimal hyperplasia and calcification in arterialized veins

  1. [Off-pump coronary artery bypass grafting for unstable angina pectoris combined with hypothyroidism and chronic renal failure; report of a case].

    Science.gov (United States)

    Hirano, Y; Matsumoto, Y; Endoh, M; Kasashima, F; Abe, Y; Sasaki, H

    2002-08-01

    Coronary artery bypass grafting for patients with ischemic heart disease and hypothyroidism contains many controversies, and chronic renal failure causes perioperative water-electrolyte balance disorders. We experienced a case of unstable angina pectoris combined with hypothyroidism and chronic renal failure successfully treated by off-pump coronary artery bypass grafting (OPCAB). A 68-year-old man with a history of hypothyroidism and chronic renal failure was hospitalized with chest pain. Cardiac catheterisation revealed a 90% stenosis of segment 3, 11 and right ventricular (RV) branch, 75% stenosis of segment 6 and 50% stenosis of segment 5. His thyroid function was normal with orally administered levothyroxine. OPCAB was performed safely with hemodialysis until a day before operation and hemofiltration from a day after operation, and postoperative course was uneventful.

  2. Mycotic aneurysm of the femoral artery resulting from mismanagement of a pathological femur fracture due to chronic osteomyelitis: a case report

    Directory of Open Access Journals (Sweden)

    Mwaka Erisa Sabakaki

    2013-01-01

    Full Text Available Abstract Introduction Mycotic aneurysms are rarely listed among the possible complications of osteomyelitis of the long bones. To the best of our knowledge this is the first case of chronic osteomyelitis associated with a pathological fracture of the femur and a mycotic aneurysm of the femoral artery. Case presentation We present the case of a 13-year-old Ugandan boy who was referred to our hospital with chronic osteomyelitis associated with a pathological fracture of the right femur and a mycotic aneurysm of the femoral artery. He underwent a successful above-knee amputation and is currently undergoing rehabilitation. Conclusions Aneurysms associated with chronic osteomyelitis of the long bones are very rare. However, in Africa, where people often still believe in crude traditional remedies, they should be considered among the possible diagnoses especially where acute injuries of the limbs are massaged and manipulated.

  3. Doppler assessment of brachial artery flow as a measure of endothelial dysfunction in pediatric chronic renal failure.

    Science.gov (United States)

    Hussein, Gehan; Bughdady, Yasser; Kandil, Manal E; Bazaraa, Hafez M; Taher, Heba

    2008-11-01

    Cardiovascular morbidity and mortality are highly prevalent among patients with chronic renal failure (CRF). Endothelial dysfunction is regarded as the initial reversible step in the development of atherosclerosis and has been demonstrated in all stages of renal failure. Non-invasive techniques to assess endothelial function have been recently developed and have been proven to predict future mortality in adults. We aimed to assess endothelial function in children with stage 4 chronic kidney disease (CKD 4) on conservative treatment, using a-non invasive, high-resolution, ultrasound Doppler study of the brachial artery flow, correlating it with other clinical and laboratory parameters. This study included 34 children with CKD 4 on conservative treatment who were compared with 30 healthy controls. Flow-mediated dilatation (FMD), nitroglycerin-mediated dilatation (NTG-MD) and FMD/NTG-MD ratio were estimated. FMD was abnormal (< 5%) in 24 patients (71%). FMD and FMD/NTG-MD ratio were significantly lower in patients than in controls (P = 0.001 and P = 0.01, respectively). FMD correlated positively with serum calcium and negatively with alkaline phosphatase. We concluded that endothelial dysfunction is present in children with CKD 4 on conservative treatment and may reflect increased atherogenic and thrombogenic properties of the endothelium, contributing to subsequent adverse cardiovascular outcome.

  4. Stent placement for chronic iliac arterial occlusive disease: the results of 10 years experience in a single institution

    Energy Technology Data Exchange (ETDEWEB)

    Park, Kwang Bo; Do, Young Soo; Kim, Dong Ik; Kim, Duk Kyung; Kim, Young Wook; Shin, Sung Wook; Cho, Sung Ki; Choo, Sung Wook; Choe, Yeon Heyon; Choo, In Wook [Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Kim, Jae Hyung; Han, Yoon Hee [Inje Univ., Kimhae (Korea, Republic of)

    2005-12-15

    We wanted to retrospectively evaluate the long-term therapeutic results of iliac arterial stent placement that was done in a single institution for 10 years. From May 1994 to April 2004, 206 patients who underwent iliac arterial stent placement (mean age; 64 {+-} 8.8) were followed up for evaluating the long term stent patency. Combined or subsequent bypass surgery was performed in 72 patients. The follow up period ranged from one month to 120 months (mean; 31 {+-} 25.2 months). The factors that were analyzed for their effect on the patency of stents were age, the stent type and diameter, the lesion site, lesion shape, lesion length, the Society of Cardiovascular and Interventinal Radiology criteria, the total run off scores, the Fontaine stage and the cardiovascular risk factors (diabetes mellitus, hypertension and smoking). Follow-up included angiography and/or CT angiography, color Doppler sonography and clinical evaluation with the ankle-brachial index. Two hundred and eighty-four stents were placed in 249 limbs of 203 patients. The technical success rate was 98% (203/206). The primary patency rates of the stents at 3, 5, 7 and 10 year were 87%, 83%, 61% and 49%, respectively. One hundred seventy-seven patients maintained the primary stent patency until the final follow up and 26 patients showed stenosis or obstruction during the follow up. Secondary intervention was performed in thirteen patients. Lesions in the external iliac artery (EIA) or lesions in both the common iliac artery (CIA) and EIA were a poor prognostic factor for stent patency. The run off score and stent diameter also showed statistically significant influence on stent patency. The overall complication rate was 6%. Iliac arterial stent placement is a safe treatment with favorable long term patency. Lesions in the EIA or lesions in both the EIA and CIA, poor run off vessels and a stent having the same or a larger diameter than 10 mm were the poor prognostic factors for long term stent patency.

  5. Utility of intra-operative capnogram to detect branch pulmonary artery obstruction following total correction of tetralogy of fallot

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    Garg Rajnish

    2011-01-01

    Full Text Available Branch pulmonary artery obstruction is one of the prime reasons for re-operation in patients who have undergone repair for tetralogy of Fallot. Branch pulmonary artery obstruction may develop over a period of time due to dilation of right ventricular outflow tract or it may be caused by residual stenosis after inadequate repair. This may lead to differential lung perfusion causing morbidity. Intra-operative capnogram monitoring reveals ventilation−perfusion relationship. We report two cases where the capnogram helped the diagnosis and management of branch pulmonary artery obstruction. We found a redundant patch in the first and an extra length of the homograft in second case which led to the obstruction. However, but for the changes in the intraoperative capnogram, this condition may by far remain undiagnosed considering the fact that it does not produce hemodynamic changes but can lead to postoperative morbidity.

  6. The effect of ACE inhibition on the pulmonary vasculature in combined model of chronic hypoxia and pulmonary arterial banding in Sprague Dawley rats

    Science.gov (United States)

    Clarke, Shanelle; Baumgardt, Shelley; Molthen, Robert

    2010-03-01

    Microfocal CT was used to image the pulmonary arterial (PA) tree in rodent models of pulmonary hypertension (PH). CT images were used to measure the arterial tree diameter along the main arterial trunk at several hydrostatic intravascular pressures and calculate distensibility. High-resolution planar angiographic imaging was also used to examine distal PA microstructure. Data on pulmonary artery tree morphology improves our understanding of vascular remodeling and response to treatments. Angiotensin II (ATII) has been identified as a mediator of vasoconstriction and proliferative mitotic function. ATII has been shown to promote vascular smooth muscle cell hypertrophy and hyperplasia as well as stimulate synthesis of extracellular matrix proteins. Available ATII is targeted through angiotensin converting enzyme inhibitors (ACEIs), a method that has been used in animal models of PH to attenuate vascular remodeling and decrease pulmonary vascular resistance. In this study, we used rat models of chronic hypoxia to induce PH combined with partial left pulmonary artery occlusion (arterial banding, PLPAO) to evaluate effects of the ACEI, captopril, on pulmonary vascular hemodynamic and morphology. Male Sprague Dawley rats were placed in hypoxia (FiO2 0.1), with one group having underwent PLPAO three days prior to the chronic hypoxia. After the twenty-first day of hypoxia exposure, treatment was started with captopril (20 mg/kg/day) for an additional twenty-one days. At the endpoint, lungs were excised and isolated to examine: pulmonary vascular resistance, ACE activity, pulmonary vessel morphology and biomechanics. Hematocrit and RV/LV+septum ratio was also measured. CT planar images showed less vessel dropout in rats treated with captopril versus the non-treatment lungs. Distensibility data shows no change in rats treated with captopril in both chronic hypoxia (CH) and CH with PLPAO (CH+PLPAO) models. Hemodynamic measurements also show no change in the pulmonary vascular

  7. Total Flavonoids Extracted from Xiaobuxin-Tang on the Hyperactivity of Hypothalamic-Pituitary-Adrenal Axis in Chronically Stressed Rats

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    Lei An

    2011-01-01

    Full Text Available Our previous studies have demonstrated that the total flavonoids (XBXT-2 isolated from the extract of Xiaobuxin-Tang (XBXT, a traditional Chinese herbal decoction, ameliorated behavioral alterations and hippocampal dysfunctions in chronically stressed rats. Studies over the last decades have suggested that the hyperactivity of hypothalamic-pituitary-adrenal (HPA axis is one of the most consistent findings in stress-related depression. Herein, we used the same chronic mild stress model of rats as before to further investigate the effect of XBXT-2 on the hyperactivity of HPA axis, including the stress hormones levels and glucocorticoid receptors (GRs expression. Our ELISA results showed that chronic administration of XBXT-2 (25, 50 mg kg−1, p.o., 28 days, the effective doses for behavioral responses significantly decreased serum corticosterone level and its upstream stress hormone adrenocorticotropic hormone (ACTH level in chronically stressed rats. Furthermore, western blotting result demonstrated XBXT-2 treatment ameliorated stress-induced decrease of GRs expression in hippocampus, an important target involved in the hyperactivity of HPA axis. These results were similar to that of classic antidepressant imipramine treatment (10 mg kg−1, p.o.. In conclusion, the modulation of HPA axis produced by XBXT-2, including the inhibition of stress hormones levels and up-regulation of hippocampal GRs expression, may be an important mechanism underlying its antidepressant-like effect in chronically stressed rats.

  8. Elevated Neutrophil-to-Lymphocyte Ratio Predicts Intermediate-Term Outcomes in Patients Who Have Advanced Chronic Kidney Disease with Peripheral Artery Disease Receiving Percutaneous Transluminal Angioplasty

    Science.gov (United States)

    Chen, I-Chih; Yu, Chao-Chin; Wu, Yi-Hsuan; Chao, Ting-Hsing

    2016-01-01

    Background Inflammation plays an important role in the pathogenesis of cardiovascular disease in patients with advanced chronic kidney disease (CKD). Neutrophil-to-lymphocyte ratio (NLR), an inflammatory biomarker, has not been evaluated in patients who have advanced CKD with peripheral artery disease (PAD) undergoing percutaneous transluminal angioplasty (PTA), especially in Taiwan. Methods We retrospectively evaluated 148 advanced CKD (creatinine clearance rate ≤ 30 mL/min/1.73 m2) identified from a prospective registry in our hospital (303 PTA cases in total). Kaplan-Meier analysis with log-rank test was used to study event-free survival, and all univariables (p value Rutherford grade 6, either NLR or NLR ≥ 3.76, and a history of hypertension had a positively prognostic impact on the occurrence of primary composite endpoint, whereas higher albumin level (≥ 3.0 mg/dL) and technical success had a significantly protective effect. History of hypertension, either NLR or NLR ≥ 3.76, and age were associated with all-cause mortality. In addition, Rutherford 6, higher albumin level (≥ 3.0 mg/dL), technical success, NLR, and age could predict the occurrence of major amputation. Conclusions NLR, but not C-reactive protein or platelet-lymphocyte ratio, is an important prognostic predictor of all major clinical outcomes in patients with advanced CKD and PAD receiving PTA. Further studies are warranted to establish a better strategy and healthcare program in this clinical setting. PMID:27713601

  9. Dipyridamole-dobutamine-stress-magnetic resonance imaging for the assessment of myocardial viability in patients with chronic coronary artery disease and comparison to positron emission tomography

    CERN Document Server

    Kaiser, B

    2000-01-01

    The purpose of this study was to evaluate the diagnostic value of (infra-low-dose)dipyridamole-(low-dose)-dobutamine-stress-MRI (DDS-MRI) for the assessment of myocardial viability by comparing the results to those of positron emission tomography (PET). Multisectional baseline- and stress-CINE-MRI as well as (18F)-fluorodeoxyglucose (18F-FDG)and (13N)-ammonia-PET were performed in 8 patients with chronic coronary artery disease and left ventricular dysfunction. MRI data analysis included the quantitative assessment of enddiastolic wall thickness (EDWT) and systolic wall thickening (SWT) for both baseline and stress examination in a total of 864 myocardial segments (6 slices, 18 seg./slice). MRI- and PET-results were compared in 128 corresponding myocardial regions following a 16-regions-model covering the entire left ventricle from apex to base. MRI viability criterions were a mean regional EDWT > 5.5 mm or a mean regional stress-induced SWT > 1.5 mm. PET defined regional myocardial viability either by a norm...

  10. Reference Renal Artery Diameter Is a Stronger Predictor of Contrast-Induced Nephropathy than Chronic Kidney Disease in Patients with High Cardiovascular Risk

    Directory of Open Access Journals (Sweden)

    Luca Zanoli

    2011-08-01

    Full Text Available Introduction: The incidence of contrast-induced nephropathy (CIN increases in high cardiovascular risk patients. Chronic kidney disease (CKD is a known risk factor for CIN development. In a previous report, we demonstrated that the mean reference renal artery diameter (RVD is an important determinant of CKD in patients undergoing coronary angiography for ischemic heart disease. However, RVD was never tested as a predictor of CIN. Aim: To look at the predictors of CIN. Methods: A total of 218 consecutive patients undergoing coronary and renal angiography were enrolled from the cohort of the RAS-CAD study (NCT 01173666. CIN was defined as a relative increase in baseline serum creatinine ≧25% within 1 week of contrast administration. Results: The incidence of CIN was 22%. In a fully adjusted model, contrast medium dose (20 ml increase, OR 1.12, 95% CI 1.06–1.19, p 2 increase, OR 0.59, 95% CI 0.41–0.86, p Conclusions: In patients undergoing coronary angiography for ischemic heart disease, RVD is a stronger predictor of CIN than CKD.

  11. The effect of protein kinase C on voltage-gated potassium channel in pulmonary artery smooth muscle cells from rats exposed to chronic hypoxia

    Institute of Scientific and Technical Information of China (English)

    张永昶; 倪望; 张珍祥; 徐永健

    2004-01-01

    Background Chronic hypoxia can cause pulmonary hypertension and pulmonary heart disease with high mortality.The signal transduction pathway of protein kinase C (PKC) plays an important role in chronic pulmonary hypertension. So it is necessary to investigate the effect of PKC on voltage-gated potassium (K+) channels in pulmonary artery smooth muscle cells of rats exposed to chronic hypoxia.Methods Male Wistar rats were randomly divided into a control group (group A) and a chronic hypoxia group (group B). Group B received hypoxia [oxygen concentration (10±1)%] eight hours per day for four consecutive weeks. Single pulmonary artery smooth muscle cells were obtained using an acute enzyme separation method. Conventional whole cell patch clamp technique was used to record resting membrane potential, membrane capacitance and voltage-gated K+ currents. The changes in voltage-gated K+ currents before and after applying paramethoxyamphetamine (PMA) (500 nmol/L), an agonist of PKC, and PMA plus carbohydrate mixture of glucose, fructose and xylitol (GFX) (30 nmol/L), an inhibitor of PKC, were compared between the two groups. Results The resting membrane potential in group B was significantly lower than that of group A: -(29.0±4.8) mV (n=18) vs -(42.5±4.6) mV (n=35) (P0.05). The voltage-gated K+ currents were significantly inhibited by PMA in group A, and this effect was reversed by GFX. However, the voltage-gated K+ currents in group B were not affected by PMA.Conclusions The resting membrane potential and voltage-gated K+ currents in pulmonary artery smooth muscle cells from rats exposed to chronic hypoxia decreased significantly. It seems that PKC has different effects on the voltage-gated K+ currents of pulmonary artery smooth muscle cells under different conditions.

  12. Chronic activation of plasma renin is log-linearly related to dietary sodium and eliminates natriuresis in response to a pulse change in total body sodium.

    Science.gov (United States)

    Kjolby, Mads; Bie, Peter

    2008-01-01

    Responses to acute sodium loading depend on the load and on the level of chronic sodium intake. To test the hypothesis that an acute step increase in total body sodium (TBS) elicits a natriuretic response, which is dependent on the chronic level of TBS, we measured the effects of a bolus of NaCl during different low-sodium diets spanning a 25-fold change in sodium intake on elements of the renin-angiotensin-aldosterone system (RAAS) and on natriuresis. To custom-made, low-sodium chow (0.003%), NaCl was added to provide four levels of intake, 0.03-0.75 mmol.kg(-1).day(-1) for 7 days. Acute NaCl administration increased PV (+6.3-8.9%) and plasma sodium concentration (~2%) and decreased plasma protein concentration (-6.4-8.1%). Plasma ANG II and aldosterone concentrations decreased transiently. Potassium excretion increased substantially. Sodium excretion, arterial blood pressure, glomerular filtration rate, urine flow, plasma potassium, and plasma renin activity did not change. The results indicate that sodium excretion is controlled by neurohumoral mechanisms that are quite resistant to acute changes in plasma volume and colloid osmotic pressure and are not down-regulated within 2 h. With previous data, we demonstrate that RAAS variables are log-linearly related to sodium intake over a >250-fold range in sodium intake, defining dietary sodium function lines that are simple measures of the sodium sensitivity of the RAAS. The dietary function line for plasma ANG II concentration increases from theoretical zero at a daily sodium intake of 17 mmol Na/kg (intercept) with a slope of 16 pM increase per decade of decrease in dietary sodium intake.

  13. Short-Term Left Ventricular Remodeling After Revascularization in Subacute Total and Subtotal Occlusion With the Infarct-Related Left Anterior Descending Artery

    Science.gov (United States)

    Celik, Ahmet; Kalay, Nihat; Korkmaz, Hasan; Dogdu, Orhan; Sahin, Omer; Elcik, Deniz; Karacavus, Seyhan; Dogan, Ali; Inanc, Tugrul; Ozdogru, Ibrahim; Oguzhan, Abdurrahman; Topsakal, Ramazan

    2011-01-01

    Background Large randomized studies revealed that percutaneous coronary intervention has no clinical benefit in patients with total occlusion. The purpose of this study is to evaluate left ventricular remodelling after PCI for total and subtotal infarct-related left anterior desending artery in stable patients who have not received trombolytic theraphy. Methods Sixty stable patients with subacute anterior myocardial infarction who have total or subtotal occlusion in the infarct-related left anterior descending artery were enrolled the study (20 patient in the total-medical group, 20 patient in the total-PCI group and 20 patient in the subtotal-PCI group). All patients’ left ventricular diameters, volumes and ejection fractions measured at admission and after a month. Results The necrotic segment number in scintigraphy were similar in three groups. In the total-PCI group, there were significant increases in left ventricular diastolic diameter, left ventricular end-diastolic volume and left ventricular end-systolic volume at first month. A borderline significant increase was observed in LVEDV in the total-medical group at first month. No significant difference was seen in all echocardiographic parameters in the subtotal-PCI group at a month after discharge. The percentage of increase in LVEDV was significantly higher and the percentage of increase in LVESV was borderline significantly higher in the total-PCI group than the other groups. Conclusions In stable patients, PCI for total occlusion in the subacute phase of anterior MI causes an increase in LV remodeling. Nevertheless PCI for subtotal occlusion in the subacute phase of anterior MI may prevent LV remodeling.

  14. Acute embolic occlusion of the right common iliac artery after revision total hip arthroplasty treated with catheter-directed thrombolysis and balloon angioplasty: A case report

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    Hongqi Yang

    2015-07-01

    Full Text Available Methods: A 63-year-old woman with atrial fibrillation presented clinical symptoms and signs of acute ischemia in the right lower extremity on the 17th postoperative day after revision total hip arthroplasty of the left hip for aseptic loosening of femoral component. Aspirin was discontinued 7 days before surgery. Both computed tomography angiography and digital subtraction angiography demonstrated complete occlusion of the right common iliac artery. An emergency catheter-directed thrombolysis with urokinase combined with balloon angioplasty was performed to obtain complete patency of the right common iliac artery. Results: The patient received anticoagulation and antiplatelet therapy postoperatively and was fine at the 2-year follow-up. Conclusions: This case demonstrated that catheter-directed thrombolysis combined with balloon angioplasty could be an efficacious, minimally invasive approach for the treatment of acute embolic occlusion of the common iliac artery. Preoperative anticoagulation for patients undergoing total hip arthroplasty with long-term use of aspirin for atrial fibrillation needs further investigation.

  15. CRosser As First choice for crossing Totally occluded coronary arteries (CRAFT Registry): Focus on conventional angiography and computed tomography angiography predictors of success

    NARCIS (Netherlands)

    H.M. Garcia-Garcia (Hector); S. Brugaletta (Salvatore); C.A.G. van Mieghem (Carlos); N. Gonzalo (Nieves); R. Diletti (Roberto); J. Gomez-Lara (Josep); F. Airoldi (Flavio); M. Carlino (Mauro); D. Tavano (Davide); A. Chieffo (Alaide); M. Montorfano (Matteo); I. Michev (Iassen); A. Colombo (Antonio); M. van der Ent (Martin); P.W.J.C. Serruys (Patrick)

    2011-01-01

    textabstractAims: We investigated the use of the CROSSER catheter, a CTO crossing device based upon high frequency mechanical vibration, as a first resort to treat patients with chronic total occlusions (CTO) while describing angiographic and computed tomography coronary angiography (CTCA) serving a

  16. Chronic hypoxia promotes pulmonary artery endothelial cell proliferation through H2O2-induced 5-lipoxygenase.

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    Kristi M Porter

    Full Text Available Pulmonary Hypertension (PH is a progressive disorder characterized by endothelial dysfunction and proliferation. Hypoxia induces PH by increasing vascular remodeling. A potential mediator in hypoxia-induced PH development is arachidonate 5-Lipoxygenase (ALOX5. While ALOX5 metabolites have been shown to promote pulmonary vasoconstriction and endothelial cell proliferation, the contribution of ALOX5 to hypoxia-induced proliferation remains unknown. We hypothesize that hypoxia exposure stimulates HPAEC proliferation by increasing ALOX5 expression and activity. To test this, human pulmonary artery endothelial cells (HPAEC were cultured under normoxic (21% O2 or hypoxic (1% O2 conditions for 24-, 48-, or 72 hours. In a subset of cells, the ALOX5 inhibitor, zileuton, or the 5-lipoxygenase activating protein inhibitor, MK-886, was administered during hypoxia exposure. ALOX5 expression was measured by qRT-PCR and western blot and HPAEC proliferation was assessed. Our results demonstrate that 24 and 48 hours of hypoxia exposure have no effect on HPAEC proliferation or ALOX5 expression. Seventy two hours of hypoxia significantly increases HPAEC ALOX5 expression, hydrogen peroxide (H2O2 release, and HPAEC proliferation. We also demonstrate that targeted ALOX5 gene silencing or inhibition of the ALOX5 pathway by pharmacological blockade attenuates hypoxia-induced HPAEC proliferation. Furthermore, our findings indicate that hypoxia-induced increases in cell proliferation and ALOX5 expression are dependent on H2O2 production, as administration of the antioxidant PEG-catalase blocks these effects and addition of H2O2 to HPAEC promotes proliferation. Overall, these studies indicate that hypoxia exposure induces HPAEC proliferation by activating the ALOX5 pathway via the generation of H2O2.

  17. Glutathione S-Transferase activity and total thiol status in chronic alcohol abusers before and 30 days after alcohol abstinence

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    Manjunatha S Muttigi

    2009-05-01

    Full Text Available Background: Glutathione S Transferase (GST has been involved in detoxification process in the liver and its activity has been shown to be increased in alcohol abusers. In the current work we measured the GST activity, total thiol status, AST, ALT, and direct bilirubin in chronic alcohol abusers before and 30 days after alcohol abstinence and lifestyle modification. Methods: Serum and urine GST activity and total thiol status were determined using spectrophotometric methods and serum transaminases were determined using clinical chemistry analyzer. Results: We found,significant increase in serum and urine GST (p<0.001, AST (p<0.001, ALT (p<0.001, and decrease in total thiol status (p<0.001 in chronic alcohol abusers. GST activity significantly decreased (p<0.001 and total thiol status were improved significantly (p<0.001 30 days after alcohol abstinence and lifestyle modification. Conclusion: This study provides preliminary data to suggest the role of GST as prognostic indicator of alcohol abstinence with possible trend towards an improvement in liver function.

  18. Use of Caval Subtraction 2D Phase-Contrast MR Imaging to Measure Total Liver and Hepatic Arterial Blood Flow: Preclinical Validation and Initial Clinical Translation.

    Science.gov (United States)

    Chouhan, Manil D; Mookerjee, Rajeshwar P; Bainbridge, Alan; Walker-Samuel, Simon; Davies, Nathan; Halligan, Steve; Lythgoe, Mark F; Taylor, Stuart A

    2016-09-01

    Purpose To validate caval subtraction two-dimensional (2D) phase-contrast magnetic resonance (MR) imaging measurements of total liver blood flow (TLBF) and hepatic arterial fraction in an animal model and evaluate consistency and reproducibility in humans. Materials and Methods Approval from the institutional ethical committee for animal care and research ethics was obtained. Fifteen Sprague-Dawley rats underwent 2D phase-contrast MR imaging of the portal vein (PV) and infrahepatic and suprahepatic inferior vena cava (IVC). TLBF and hepatic arterial flow were estimated by subtracting infrahepatic from suprahepatic IVC flow and PV flow from estimated TLBF, respectively. Direct PV transit-time ultrasonography (US) and fluorescent microsphere measurements of hepatic arterial fraction were the standards of reference. Thereafter, consistency of caval subtraction phase-contrast MR imaging-derived TLBF and hepatic arterial flow was assessed in 13 volunteers (mean age, 28.3 years ± 1.4) against directly measured phase-contrast MR imaging PV and proper hepatic arterial inflow; reproducibility was measured after 7 days. Bland-Altman analysis of agreement and coefficient of variation comparisons were undertaken. Results There was good agreement between PV flow measured with phase-contrast MR imaging and that measured with transit-time US (mean difference, -3.5 mL/min/100 g; 95% limits of agreement [LOA], ±61.3 mL/min/100 g). Hepatic arterial fraction obtained with caval subtraction agreed well with those with fluorescent microspheres (mean difference, 4.2%; 95% LOA, ±20.5%). Good consistency was demonstrated between TLBF in humans measured with caval subtraction and direct inflow phase-contrast MR imaging (mean difference, -1.3 mL/min/100 g; 95% LOA, ±23.1 mL/min/100 g). TLBF reproducibility at 7 days was similar between the two methods (95% LOA, ±31.6 mL/min/100 g vs ±29.6 mL/min/100 g). Conclusion Caval subtraction phase-contrast MR imaging is a simple and clinically

  19. [Mexidol preparation influence upon lipids peroxide oxidation and oral fluid antioxidant system activity in patients with chronic generalized parodontitis and arterial hypertension].

    Science.gov (United States)

    Kazarina, L N; Vdovina, L V; Dubrovskaia, E N

    2010-01-01

    Results of laboratory investigations of the estimation of peroxide oxidation of lipids and antioxidant protection in the oral fluid of the patients with chronic generalizating parodontitis and arterial hypertension with using mexidol. It was shown that the normalization of parameters of the primary and second products of peroxidation with mexidol action, antioxidant protection of oral liquid increased that was favorably reflected in structures and functions of cell.

  20. Low free to total PSA ratio is not a good discriminator of chronic prostatitis and prostate cancer: An Indian experience

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    V Thakur

    2014-01-01

    Full Text Available Aims: To find out the utility of free to total PSA ratio in discriminating chronic prostatitis and prostate cancer. Setting and design: The patients visited urology clinics at Batra Hospital and Medical Research Center, New Delhi. Background: The use of serum free to total PSA as a diagnostic tool for prostate cancer has led to early detection of prostate cancer; however, the effect of inflammation on f/t PSA ratio restricts its use in early detection of cancer. Materials and Methods: The study was conducted in age related 101 patients which include 27 carcinoma patients (group I, 34 BPH patients (group II and 40 chronic prostatitis patients (group III. Serum total PSA (tPSA and free PSA (fPSA were analyzed on Elecsys 2010. These were compared with histological reports of biopsy specimen. Other biochemistry tests were done on Randox Imola. P Value was calculated using one way ANOVA with posthoc Bonferroni analysis. Results: Serum total PSA levels were comparable in group I and III and were higher than group II (P < 0.049. Serum fPSA in group I was not significantly different from group II and III, However, group II has higher levels than group III (P < 0.035. Difference was significant for f/t PSA ratio in group I and II (P < 0.00 and group II and III (P < 0.000.Group I and III were with comparable levels (P < 0.807. Conclusions: f/t PSA ratio is not a good discriminator for malignancy and chronic prostatitis. This limitation of f/t PSA ratio must be taken into consideration while interpreting the results clinically.

  1. Significance of the percentage of cholesterol efflux capacity and total cholesterol efflux capacity in patients with or without coronary artery disease.

    Science.gov (United States)

    Norimatsu, Kenji; Kuwano, Takashi; Miura, Shin-Ichiro; Shimizu, Tomohiko; Shiga, Yuhei; Suematsu, Yasunori; Miyase, Yuiko; Adachi, Sen; Nakamura, Ayumi; Imaizumi, Satoshi; Iwata, Atsushi; Nishikawa, Hiroaki; Uehara, Yoshinari; Saku, Keijiro

    2017-01-01

    We hypothesized that cholesterol efflux capacity is more useful than the lipid profile as a marker of the presence and the severity of coronary artery disease (CAD). Therefore, we investigated the associations between the presence and the severity of CAD and both the percentage of cholesterol efflux capacity and total cholesterol efflux capacity and the lipid profile including the high-density lipoprotein cholesterol (HDL-C) level in patients who underwent coronary computed tomography angiography (CTA). The subjects consisted of 204 patients who were clinically suspected to have CAD and underwent CTA. We isolated HDL from plasma by ultracentrifugation and measured the percentage of cholesterol efflux capacity using (3)H-cholesterol-labeled J774 macrophage cells and calculated total cholesterol efflux capacity as follows: the percentage of cholesterol efflux capacity/100× HDL-C levels. While the percentage of cholesterol efflux capacity was not associated with the presence or the severity of CAD, total cholesterol efflux capacity and HDL-C in patients with CAD were significantly lower than those in patients without CAD. In addition, total cholesterol efflux capacity and HDL-C, but not the percentage of cholesterol efflux capacity, significantly decreased as the number of coronary arteries with significant stenosis increased. Total cholesterol efflux capacity was positively correlated with HDL-C, whereas the percentage of cholesterol efflux capacity showed only weak association. In a logistic regression analysis, the presence of CAD was independently associated with total cholesterol efflux capacity, in addition to age and gender. Finally, a receiver-operating characteristic curve analysis indicated that the areas under the curves for total cholesterol efflux capacity and HDL-C were similar. In conclusion, the percentage of cholesterol efflux capacity using the fixed amount of isolated HDL was not associated with CAD. On the other hand, the calculated total

  2. Moderate hypothermia technique for chronic implantation of a total artificial heart in calves.

    Science.gov (United States)

    Karimov, Jamshid H; Grady, Patrick; Sinkewich, Martin; Sunagawa, Gengo; Dessoffy, Raymond; Byram, Nicole; Moazami, Nader; Fukamachi, Kiyotaka

    2017-02-25

    The benefit of whole-body hypothermia in preventing ischemic injury during cardiac surgical operations is well documented. However, application of hypothermia during in vivo total artificial heart implantation has not become widespread because of limited understanding of the proper techniques and restrictions implied by constitutional and physiological characteristics specific to each animal model. Similarly, the literature on hypothermic set-up in total artificial heart implantation has also been limited. Herein we present our experience using hypothermia in bovine models implanted with the Cleveland Clinic continuous-flow total artificial heart.

  3. Correlation of angina pectoris and perfusion decrease by collateral circulation in single-vessel coronary chronic total occlusion using myocardial perfusion single-photon emssion computed tomography

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    Cho, Sang Geon; Park, Ki Seong; Kang, Sae Ryung [Chonnam National University Hospital, Gwangju (Korea, Republic of); and others

    2016-03-15

    To evaluate the perfusion decrease in donor myocardium by collateral circulation and its correlation with angina pectoris in patients with chronic total occlusion (CTO) using myocardial perfusion single-photon emission computed tomography (MPS). Thirty-six patients with single-vessel CTO without any other stenosis were included. All patients underwent MPS and coronary angiography (CAG) within 2 months. Total 72 donor arteries were evaluated for the grades of collaterals to the CTO artery using the Rentrop grading system on CAG. Perfusion defects and perfusion scores in donor and CTO territories were analyzed on MPS. Myocardial perfusion of donor and CTO territories were evaluated according to the presence of angina pectoris and the grades of collateral circulation. When the CTO territory was ischemic, symptomatic patients showed higher summed difference scores in the CTO territory compared to asymptomatic patients (3.5 ± 2.4 vs. 1.5 ± 0.8 for symptomatic and asymptomatic groups respectively; p = 0.034). However, when the CTO territory was nonischemic, symptomatic patients showed higher summed stress scores (SSS, 4.3 ± 2.9 vs. 1.6 ± 1.2; p = 0.032) and summed rest scores (SRS, 4.2 ± 2.5 vs. 1.5 ± 1.1; p = 0.003) in the donor territories. On the per-vessel analysis, perfusion defects in donor territories were more frequent (0 % vs. 53 % vs. 86 % for Rentrop 0, Rentrop 1–2 and Rentrop 3, respectively; p < 0.001) and showed higher SSS (0.0 ± 0.0, 1.3 ± 1.6 and 2.1 ± 1.1 for Rentrop 0, Rentrop 1–2 and Rentrop 3, respectively; p = 0.001) and SRS (0.0 ± 0.0, 1.0 ± 1.4 and 1.7 ± 1.2; p = 0.003) at higher Rentrop grades, but their patterns were variable. Angina pectoris was related to either ischemia of the myocardium beyond CTO or a perfusion decrease in the donor myocardium. The perfusion decrease in donor myocardium positively correlated with the collateral grades.

  4. Vascular Effects of Advanced Glycation End-Products: Content of Immunohistochemically Detected AGEs in Radial Artery Samples as a Predictor for Arterial Calcification and Cardiovascular Risk in Asymptomatic Patients with Chronic Kidney Disease

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    Katarzyna Janda

    2015-01-01

    Full Text Available Objectives. Our aim was to determine whether vascular deposition of advanced glycation end-products (AGEs is associated with arterial calcification and cardiovascular mortality in chronic kidney disease (CKD patients and to assess the relationships between vascular content of AGEs and selected clinical and biochemical parameters. Materials and Methods. The study comprised 54 CKD patients (33 hemodialyzed, 21 predialyzed. Examined parameters included BMI, incidence of diabetes, plasma fasting glucose, AGEs, soluble receptor for AGEs and 2,2-diphenyl-1-picrylhydrazyl (DPPH scavenging, serum C-reactive protein (hsCRP, plasminogen activator inhibitor-1 (PAI-1, and fetuin-A. Fragments of radial artery obtained during creation of hemodialysis access were stained for calcifications using alizarin red. AGEs deposits were identified immunohistochemically and their relative content was quantified. Results. Vascular content of AGEs was positively correlated with BMI, hsCRP, fetuin-A, PAI-1, and DPPH scavenging in simple regression; only fetuin-A was an independent predictor in multiple regression. There was a significant positive trend in the intensity of AGEs immunostaining among patients with grades 1, 2, and 3 calcifications. AGEs immunostaining intensity predicted 3-year cardiovascular mortality irrespective of patient’s age. Conclusions. The present study demonstrates an involvement of AGEs in the development of medial arterial calcification and the impact of arterial AGE deposition on cardiovascular mortality in CKD patients.

  5. Cardiac tamponade arising from a venous source following anterograde dissection re-entry coronary angioplasty to a chronic total occlusion.

    Science.gov (United States)

    Danson, E; Arena, F; Sapontis, J; Ward, M; Bhindi, R

    2016-10-01

    Cardiac tamponade is a rare complication of coronary intervention to chronic total occlusions (CTO PCI). We report a case of persistent bleeding from a venous source following successful anterograde dissection-reentry (ADR) CTO PCI. Pericardiocentesis was performed 1 h post-procedure for tamponade. Persistent bleeding was investigated with contrast transesophageal echocardiography, pericardial manometry and blood analysis. Coronary venography revealed subtle extravasation from a cardiac vein adjacent to the site of luminal re-entry. Coronary venous perforation using ADR CTO PCI has not previously been described; however, the volume of blood loss may be significant and surgical exploration may be appropriate.

  6. Chronic pre-operative opioid use and acute pain after fast-track total knee arthroplasty

    DEFF Research Database (Denmark)

    Aasvang, E K; Lunn, T H; Hansen, T B;

    2016-01-01

    BACKGROUND: Pre-operative opioid use has been suggested to increase post-operative pain and opioid consumption after total knee arthroplasty (TKA), but previous studies are either retrospective or inhomogeneous with regard to surgical procedures or control of analgesic regimes, or with few opioid...

  7. Chronic asymptomatic dislocation of a total hip replacement: a case report

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    Lidder Surjit

    2009-08-01

    Full Text Available Abstract Introduction Dislocation of a prosthetic hip is the second most common complication after thromboembolic disease in patients undergoing total hip arthroplasty, with an incidence reported as 0.5 to 20%. Although the period of greatest risk for dislocation has been reported to be within the first few months after surgery, late dislocation occurs more commonly then previously thought. Case presentation A 60-year-old man underwent a right Exeter cemented total hip replacement and was subsequently discharged after appropriate follow-up. He next presented 8 years later complaining of pain in the left groin. An anterioposterior radiograph of the pelvis revealed degenerative changes in the left hip and a dislocated right total hip replacement. The dislocated femoral component had formed a neoacetabulum within the ilium, in which it was freely articulating. He remained pain-free on this side, had 5 cm of true leg length shortening with a good range of movement and was very pleased with his hip replacement. He was later placed on the waiting list for a left total hip replacement. Conclusion This case illustrates that a dislocated total hip replacement may occasionally not cause symptoms that cause significant discomfort or reduction in range of movement. The prosthetic femoral head can form a neoacetabulum allowing a full range of pain-free movement. Furthermore it emphasises that with an increased trend to earlier hospital discharge and shorter follow-up, potential complications may be missed. We urge a low index of suspicion for potential complications and suggest that regular review with radiographic follow-up should be made.

  8. Renal arterial resistive index is associated with severe histological changes and poor renal outcome during chronic kidney disease

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    Bigé Naïke

    2012-10-01

    Full Text Available Abstract Background Chronic kidney disease (CKD is a growing public health problem and end stage renal disease (ESRD represents a large human and economic burden. It is important to identify patients at high risk of ESRD. In order to determine whether renal Doppler resistive index (RI may discriminate those patients, we analyzed whether RI was associated with identified prognosis factors of CKD, in particular histological findings, and with renal outcome. Methods RI was measured in the 48 hours before renal biopsy in 58 CKD patients. Clinical and biological data were collected prospectively at inclusion. Arteriosclerosis, interstitial fibrosis and glomerulosclerosis were quantitatively assessed on renal biopsy in a blinded fashion. MDRD eGFR at 18 months was collected for 35 (60% patients. Renal function decline was defined as a decrease in eGFR from baseline of at least 5 mL/min/ 1.73 m2/year or need for chronic renal replacement therapy. Pearson’s correlation, Mann–Whitney and Chi-square tests were used for analysis of quantitative and qualitative variables respectively. Kaplan Meier analysis was realized to determine renal survival according to RI value using the log-rank test. Multiple logistic regression was performed including variables with p Results Most patients had glomerulonephritis (82%. Median age was 46 years [21–87], eGFR 59 mL/min/ 1.73m2 [5–130], percentage of interstitial fibrosis 10% [0–90], glomerulosclerosis 13% [0–96] and RI 0.63 [0.31-1.00]. RI increased with age (r = 0.435, p = 0.0063, pulse pressure (r = 0.303, p = 0.022, renal atrophy (r = −0.275, p = 0.038 and renal dysfunction (r = −0.402, p = 0.0018. Patients with arterial intima/media ratio ≥ 1 (p = 0.032, interstitial fibrosis > 20% (p = 0.014 and renal function decline (p = 0.0023 had higher RI. Patients with baseline RI ≥ 0.65 had a poorer renal outcome than those with baseline RI Conclusions Our results suggest that RI ≥ 0.65 is associated

  9. Biphasic functional regulation in hippocampus of rat with chronic cerebral hypoperfusion induced by permanent occlusion of bilateral common carotid artery.

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    Jihye Bang

    Full Text Available BACKGROUND: Chronic cerebral hypoperfusion induced by permanent occlusion of the bilateral common carotid artery (BCCAO in rats has been commonly used for the study of Alzheimer's disease and vascular dementia. Despite the apparent cognitive dysfunction in rats with BCCAO, the molecular markers or pathways involved in the pathological alternation have not been clearly identified. METHODS: Temporal changes (sham, 21, 35, 45, 55 and 70 days in gene expression in the hippocampus of rats after BCCAO were measured using time-course microarray analysis. Gene Ontology (GO and pathway analyses were performed to identify the functional involvement of temporally regulated genes in BCCAO. RESULTS: Two major gene expression patterns were observed in the hippocampus of rats after BCCAO. One pattern, which was composed of 341 early up-regulated genes after the surgical procedure, was dominantly involved in immune-related biological functions (false discovery rate [FDR]<0.01. Another pattern composed of 182 temporally delayed down-regulated genes was involved in sensory perception such as olfactory and cognition functions (FDR<0.01. In addition to the two gene expression patterns, the temporal change of GO and the pathway activities using all differentially expressed genes also confirmed that an immune response was the main early change, whereas sensory functions were delayed responses. Moreover, we identified FADD and SOCS3 as possible core genes in the sensory function loss process using text-based mining and interaction network analysis. CONCLUSIONS: The biphasic regulatory mechanism first reported here could provide molecular evidence of BCCAO-induced impaired memory in rats as well as mechanism of the development of vascular dementia.

  10. Enhanced cellular responses and distinct gene profiles in human fetoplacental artery endothelial cells under chronic low oxygen.

    Science.gov (United States)

    Jiang, Yi-Zhou; Wang, Kai; Li, Yan; Dai, Cai-Feng; Wang, Ping; Kendziorski, Christina; Chen, Dong-Bao; Zheng, Jing

    2013-12-01

    Fetoplacental endothelial cells are exposed to oxygen levels ranging from 2% to 8% in vivo. However, little is known regarding endothelial function within this range of oxygen because most laboratories use ambient air (21% O2) as a standard culture condition (SCN). We asked whether human umbilical artery endothelial cells (HUAECs) that were steadily exposed to the physiological chronic normoxia (PCN, 3% O2) for ∼20-25 days differed in their proliferative and migratory responses to FGF2 and VEGFA as well as in their global gene expression compared with those in the SCN. We observed that PCN enhanced FGF2- and VEGFA-stimulated cell proliferation and migration. In oxygen reversal experiments (i.e., when PCN cells were exposed to SCN for 24 h and vice versa), we found that preexposure to 21% O2 decreased the migratory ability, but not the proliferative ability, of the PCN-HUAECs in response to FGF2 and VEGFA. These PCN-enhanced cellular responses were associated with increased protein levels of HIF1A and NOS3, but not FGFR1, VEGFR1, and VEGFR2. Microarray analysis demonstrated that PCN up-regulated 74 genes and down-regulated 86, 14 of which were directly regulated by hypoxia-inducible factors as evaluated using in silico analysis. Gene function analysis further indicated that the PCN-regulated genes were highly related to cell proliferation and migration, consistent with the results from our functional assays. Given that PCN significantly alters cellular responses to FGF2 and VEGFA as well as transcription in HUAECs, it is likely that we may need to reexamine the current cellular and molecular mechanisms controlling fetoplacental endothelial functions, which were largely derived from endothelial models established under ambient O2.

  11. Lipid peroxidation and total radical-trapping potential of the lungs of rats submitted to chronic and sub-chronic stress

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    Torres R.L.

    2004-01-01

    Full Text Available Exposure to stress induces a cluster of physiological and behavioral changes in an effort to maintain the homeostasis of the organism. Long-term exposure to stress, however, has detrimental effects on several cell functions such as the impairment of antioxidant defenses leading to oxidative damage. Oxidative stress is a central feature of many diseases. The lungs are particularly susceptible to lesions by free radicals and pulmonary antioxidant defenses are extensively distributed and include both enzymatic and non-enzymatic systems. The aim of the present study was to determine lipid peroxidation and total radical-trapping potential (TRAP changes in lungs of rats submitted to different models of chronic stress. Adult male Wistar rats weighing 180-230 g were submitted to different stressors (variable stress, N = 7 or repeated restraint stress for 15 (N = 10 or 40 days (N = 6 and compared to control groups (N = 10 each. Lipid peroxidation levels were assessed by thiobarbituric acid reactive substances (TBARS, and TRAP was measured by the decrease in luminescence using the 2-2'-azo-bis(2-amidinopropane-luminol system. Chronic variable stress induced a 51% increase in oxidative stress in lungs (control group: 0.037 ± 0.002; variable stress: 0.056 ± 0.007, P < 0.01. No difference in TBARS was observed after chronic restraint stress, but a significant 57% increase in TRAP was presented by the group repeatedly restrained for 15 days (control group: 2.48 ± 0.42; stressed: 3.65 ± 0.16, P < 0.05. We conclude that different stressors induce different effects on the oxidative status of the organism.

  12. Beneficial effects on arterial stiffness and pulse-wave reflection of combined enalapril and candesartan in chronic kidney disease--a randomized trial.

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    Marie Frimodt-Møller

    Full Text Available BACKGROUND: Cardiovascular disease (CVD is highly prevalent in patients with chronic kidney disease (CKD. Inhibition of the renin-angiotensinsystem (RAS in hypertension causes differential effects on central and brachial blood pressure (BP, which has been translated into improved outcome. The objective was to examine if a more complete inhibition of RAS by combining an angiotensin converting enzyme inhibitor (ACEI and an angiotensin receptor antagonist (ARB compared to monotherapy has an additive effect on central BP and pulse-wave velocity (PWV, which are known markers of CVD. METHODS: Sixty-seven CKD patients (mean GFR 30, range 13-59 ml/min/1.73 m(2 participated in an open randomized study of 16 weeks of monotherapy with either enalapril or candesartan followed by 8 weeks of dual blockade aiming at a total dose of 16 mg candesartan and 20 mg enalapril o.d. Pulse-wave measurements were performed at week 0, 8, 16 and 24 by the SphygmoCor device. RESULTS: Significant additive BP independent reductions were found after dual blockade in aortic PWV (-0.3 m/s, P<0.05 and in augmentation index (-2%, P<0.01 compared to monotherapy. Furthermore pulse pressure amplification was improved (P<0.05 and central systolic BP reduced (-6 mmHg, P<0.01. CONCLUSIONS: Dual blockade of the RAS resulted in an additive BP independent reduction in pulse-wave reflection and arterial stiffness compared to monotherapy in CKD patients. TRIAL REGISTRATION: Clinical trial.gov NCT00235287.

  13. A decreased level of serum soluble Klotho is an independent biomarker associated with arterial stiffness in patients with chronic kidney disease.

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    Masashi Kitagawa

    Full Text Available BACKGROUND: Klotho was originally identified in a mutant mouse strain unable to express the gene that consequently showed shortened life spans. In humans, low serum Klotho levels are related to the prevalence of cardiovascular diseases in community-dwelling adults. However, it is unclear whether the serum Klotho levels are associated with signs of vascular dysfunction such as arterial stiffness, a major determinant of prognosis, in human subjects with chronic kidney disease (CKD. METHODS: We determined the levels of serum soluble Klotho in 114 patients with CKD using ELISA and investigated the relationship between the level of Klotho and markers of CKD-mineral and bone disorder (CKD-MBD and various types of vascular dysfunction, including flow-mediated dilatation, a marker of endothelial dysfunction, ankle-brachial pulse wave velocity (baPWV, a marker of arterial stiffness, intima-media thickness (IMT, a marker of atherosclerosis, and the aortic calcification index (ACI, a marker of vascular calcification. RESULTS: The serum Klotho level significantly correlated with the 1,25-dihydroxyvitamin D level and inversely correlated with the parathyroid hormone level and the fractional excretion of phosphate. There were significant decreases in serum Klotho in patients with arterial stiffness defined as baPWV≥1400 cm/sec, atherosclerosis defined as maximum IMT≥1.1 mm and vascular calcification scores of ACI>0%. The serum Klotho level was a significant determinant of arterial stiffness, but not endothelial dysfunction, atherosclerosis or vascular calcification, in the multivariate analysis in either metabolic model, the CKD model or the CKD-MBD model. The adjusted odds ratio of serum Klotho for the baPWV was 0.60 (p = 0.0075. CONCLUSIONS: Decreases in the serum soluble Klotho levels are independently associated with signs of vascular dysfunction such as arterial stiffness in patients with CKD. Further research exploring whether therapeutic approaches

  14. The effects of long-acting bronchodilators on total mortality in patients with stable chronic obstructive pulmonary disease

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    Kliber Agnes

    2010-05-01

    Full Text Available Abstract Background Chronic obstructive pulmonary disease (COPD is the 4th leading cause of mortality worldwide. Long-acting bronchodilators are considered first line therapies for patients with COPD but their effects on mortality are not well known. We performed a comprehensive systematic review and meta-analysis to evaluate the effects of long-acting bronchodilators on total mortality in stable COPD. Methods Using MEDLINE, EMBASE and Cochrane Systematic Review databases, we identified high quality randomized controlled trials of tiotropium, formoterol, salmeterol, formoterol/budesonide or salmeterol/fluticasone in COPD that had a follow-up of 6 months or longer and reported on total mortality. Two reviewers independently abstracted data from the original trials and disagreements were resolved by iteration and consensus. Results Twenty-seven trials that included 30,495 patients were included in the review. Relative risk (RR for total mortality was calculated for each of the study and pooled together using a random-effects model. The combination of inhaled corticosteroid (ICS and long-acting beta-2 agonist (LABA therapy was associated with reduced total mortality compared with placebo (RR, 0.80; p = 0.005. Neither tiotropium (RR, 1.08; p = 0.61 nor LABA by itself (RR, 0.90; p = 0.21 was associated with mortality. Conclusions A combination of ICS and LABA reduced mortality by approximately 20%. Neither tiotropium nor LABA by itself modifies all-cause mortality in COPD.

  15. Evaluation of the Effect of Concurrent Chronic Total Occlusion and Successful Staged Revascularization on Long-Term Mortality in Patients with ST-Elevation Myocardial Infarction

    Directory of Open Access Journals (Sweden)

    Guoxiang Shi

    2014-01-01

    Full Text Available Aims. To investigate the impact of chronic total occlusion (CTO in non-infarct-related artery (IRA on the long-term prognosis and evaluate the clinical significance of staged revascularization in patients with ST-segment elevation myocardial infarction (STEMI. Methods. 1266 STEMI patients with primary percutaneous coronary intervention (PCI were categorized as single-vessel disease (SVD, multivessel disease (MVD without and with CTO. We study the clinical outcomes of patients after primary PCI in the following 3 years. Additionally, patients with CTO received staged revascularization, and major adverse cardiac events (MACE during 3-year follow-up were recorded. Results. Presence of CTO was a predictor of both early mortality [hazard ratio (HR 3.4, 95% confidence interval (CI 2.4–4.5, P<0.01] and late mortality (HR 1.9, 95% CI 1.4–3.6, P<0.01, whereas MVD without CTO was only a predictor of early mortality (HR 1.7, 95% CI 1.3–2.3, P<0.05. In CTO group, 100 patients had successful CTO recanalization, and 48 patients failed. During 3-year follow-up, patients with failed procedure had higher cardiac mortality (22.9% versus 9.0%, P=0.020 and lower MACE-free survival (50.0% versus 72.0%, P=0.009 compared to patients with successful procedure. Conclusion. The presence of CTO and not MVD alone is associated with long-term mortality. Successful revascularization of CTO in the non-IRA is associated with improved clinical outcomes in patients with STEMI undergoing primary PCI.

  16. Assessment of the physiologic contribution of right atrial function to total right heart function in patients with and without pulmonary arterial hypertension.

    Science.gov (United States)

    Sivak, Joseph A; Raina, Amresh; Forfia, Paul R

    2016-09-01

    Total right heart function requires normal function of both the right ventricle and the right atrium. However, the degree to which right atrial (RA) function and right ventricular (RV) function each contribute to total right heart function has not been quantified. In this study, we aimed to quantify the contribution of RA function to total right heart function in a group of pulmonary arterial hypertension (PAH) patients compared to a cohort of normal controls without cardiovascular disease. The normal cohort comprised 35 subjects with normal clinical echocardiograms, while the PAH cohort included 37 patients, of whom 31 had echocardiograms before and after initiation of PAH-specific therapy. Total right heart function was measured via tricuspid annular plane excursion (TAPSE). TAPSE was broken down into two components, the excursion occurring during RA contraction (TAPSERA) and that occurring before RA contraction (TAPSERV). RA fractional area change (RA-FAC) was also compared between the two groups. In the PAH cohort, more than half of the total TAPSE occurred during atrial systole, compared to less than one-third in the normal cohort (51.0% vs. 32.1%; P right heart function in patients with PAH than in normal subjects.

  17. Estimated aortic blood pressure based on radial artery tonometry underestimates directly measured aortic blood pressure in patients with advancing chronic kidney disease staging and increasing arterial stiffness

    DEFF Research Database (Denmark)

    Carlsen, Rasmus K; Peters, Christian D; Khatir, Dinah S;

    2016-01-01

    we compared invasive aortic systolic BP (SBP) with estimated central SBP obtained by radial artery tonometry and examined the influence of renal function and arterial stiffness on this relationship. We evaluated 83 patients with stage 3 to 5 CKD (mean estimated glomerular filtration rate [eGFR] 30 ml......% confidence interval -14.9 to -11.4) mm Hg. Arterial stiffness was evaluated by carotid-femoral pulse wave velocity (cf-PWV) and was significantly increased in CKD patients compared with (versus) control patients (mean 10.7 vs. 9.3 m/s). The difference in BP significantly increased 1.0 mm Hg for every 10 ml....../min decrease in eGFR and by 1.6 mm Hg per 1 m/s increase in cfPWV. Using multivariate regression analysis including both eGFR and cfPWV, the difference between estimated central and invasive aortic SBP was significantly increased by 0.7 mm Hg. For the entire cohort brachial SBP significantly better reflected...

  18. Endovascular treatment for aorto-bi-iliac artery total occlusive disease%主-双髂动脉全闭塞的介入治疗

    Institute of Scientific and Technical Information of China (English)

    王雪平; 叶炜; 马亮亮; 赫建平; 刘昌伟

    2015-01-01

    Objective To investigate the feasibility, safety and efficiency of endovascular treatment for patients with aorto-bilateral-iliac artery total occlusive disease.Methods A total of 35 patients with aorto-bi-iliac artery total occlusive disease treated with endovascular therapy in Peking Union Medical College Hospital and the First Hospital of Shijiazhuang between Jan 2012 and Dec 2013 were retrospectively analyzed.Results There were 33 males and 2 females, mean age (67 ± 6) years treated during the study period.Technical success rate was 100%.129 bare stents and 4 covered stents were implanted.There were no peri-operative death.Postoperative leg ankle brachial index (ABI) improved significantly (0.86 vs.0.28, P < 0.28).Postoperative complications occurred in 2 patients (5.7%), including brachial artery thrombosis and rupture of external iliac artery post-dilation.The mean follow-up period was 16.5 months (2-28 months).Two patients (5.7%) were lost to follow up.Re-intervention was performed in 3 patients (8.6%) due to reocclusion of the stents.Primary patency was 91% (30/33) Conclusions Endovascular treatment is effective for aorto-bi-iliac artery total occlusive disease with low complications and acceptable mid-term patent rate.%目的 探讨介入治疗主-双髂动脉全闭塞性病变的可行性、安全性及疗效.方法 回顾性分析2012年1月至2013年12月北京协和医院和石家庄市第一医院采用介入治疗主-双髂动脉全闭塞性疾病35例患者的临床资料,评价其治疗的可行性、安全性及近中期疗效.结果 本组35例,男33例,女2例,平均年龄(67 ±6)岁.手术成功率100%,共置入裸支架129枚,覆膜支架4枚.无围手术期死亡,术后下肢踝肱指数(ABI)0.86 ±0.18,较术前0.28 ±0.17明显改善(P<0.001).围手术期并发症2例,肱动脉血栓和髂动脉扩张后破裂各1例,发生率为5.7%.术后随访2 ~ 28个月,平均随访(16.5±2.3)个月,2例(5.7%)失访,3例(8.6%)

  19. Analysis of Arterial Blood Gas Report in Chronic Kidney Diseases – Comparison between Bedside and Multistep Systematic Method

    Science.gov (United States)

    Dhat, Vaishali; Tilak, Mona A; Roy, Indranath

    2016-01-01

    Introduction Acid Base Disorders (ABDs) are commonly encountered in critically ill Chronic Kidney Disease (CKD) patients. Timely and correct analysis of Arterial Blood Gases (ABG) is critical for the diagnosis, treatment and prediction of outcome of the patients. Aim The aim was to explore type and prevalence of ABDs in 31 critically ill CKD patients from a tertiary care hospital in Maharashtra, to compare two methods of analysis- bedside and systematic approaches and to clinically correlate the nature of ABDs in these patients. Materials and Methods The initial ABG reports of 31 consecutive CKD patients were analysed by two methods. Medica Easy stat analyser was the equipment for analysis with Principle of potentiometry and ion selective electrode for pH and pCO2 and amperometry for pO2. Serum albumin was also measured by Bromocresol green dye binding method using liquixx albumin kit in Erba XL 300 autoanalyser. Statistical Analysis Chi-square test was used for statistical analysis using Epi Info version 3.5.4 and SPSS 14.0 softwares. Results The systematic method showed a significantly higher prevalence of mixed disorders (50%) compared to bedside method (12.9%). Most prevalent disorder by bedside method was metabolic acidosis in 15 cases (48.39%). By the systematic method, 3 reports were invalid. As a single category, most prevalent type was both simple respiratory alkalosis and mixed metabolic acidosis with respiratory alkalosis- 6 of 31 cases in each type (19.36% each). As a whole, metabolic acidosis (including both High Anion Gap Metabolic Acidosis or HAGMA and Non Anion Gap Metabolic Acidosis or NAGMA with 4 in each type) was most prevalent- 8 of 31(25.8%). Conclusion Systematic approach was more effective in diagnosing mixed acid base disorders. By systematic method the findings of analysis in most cases could be correlated with the clinical condition and provisional diagnosis. Thus interpretation of ABDs by using stepwise approach could be useful to the

  20. EFFECTIVENESS OF NUTRITIONAL TREATMENT ASSESSED BY THE QUALITY OF THE DIET IN PATIENTS WITH CHRONIC CORONARY ARTERY DISEASE.

    Science.gov (United States)

    Cardoso, Dilui; Moraes, Glaucia; Rosa, Glorimar; Bello Moreira, Annie Seixas

    2015-09-01

    The effectiveness of nutritional treatment is important protective factor for the prevention of recurrences of cardiovascular diseases. The goal of this study was to assess the effectiveness of nutritional treatment and to know the eating pattern and the quality of an adjuvant diet for optimized clinical treatment in patients with chronic coronary artery disease (CCAD). This is a clinical trial with a three-month duration conducted with 116 patients of both sexes with (CCAD) in secondary prevention. The patients underwent nutritional treatment and blood pressure, anthropometric, biochemical and dietetic (24-hour recall) measures were collected. The Brazilian Healthy Eating Index (BHEI-R) was calculated for assessing diet quality. The average age was 62.5 ± 7.8 years. The nutritional treatment reduced: weight -1.5 ± 2.3 kg; p < 0.01; body mass index -0.5 ± 0.9 kg/m2; p < 0.01; waist circumference -2.0 ± 0.1cm; p < 0.01; neck circumference -0.8 ± 0.1; p < 0.01 cm; concentrations of plasma insulin -1.3 ± 0.5mU/ mL p < 0.03, glycated hemoglobin -0.4 ± 0.1 mg/dL; p < 0.01 (- 0,004 mmol/L), and HOMA-IR (-0.8 ± 3.9; p < 0.03); and increased insulin sensitivity 6.64 ± 23,9 x10-3; p < 0.01. The nutritional treatment increased HDL-cholesterol concentrations in patients who adhered to the diet after BHEI-R control 1.7 ± 1.4 mg/dL; p = 0.04 (0,04 mmol/L). Three-month nutritional treatment promoted reduction of saturated fats consumption (-1.9 ± 0.5%; p=<0.01), cholesterol (-67.7 ± 18.6 mg/d; p < 0.01), and sodium(815.2 ± 146.5 mg/d; p < 0.01); and 20.7% of the patients finished the study with a healthy diet. The intensive nutritional treatment was effective in reducing anthropometric measures and improving glycemic control.

  1. Estimated aortic blood pressure based on radial artery tonometry underestimates directly measured aortic blood pressure in patients with advancing chronic kidney disease staging and increasing arterial stiffness.

    Science.gov (United States)

    Carlsen, Rasmus K; Peters, Christian D; Khatir, Dinah S; Laugesen, Esben; Bøtker, Hans Erik; Winther, Simon; Buus, Niels H

    2016-10-01

    Central blood pressure (BP) can be assessed noninvasively based on radial tonometry and may potentially be a better predictor of clinical outcome than brachial BP. However, the validity of noninvasively obtained estimates has never been examined in patients with chronic kidney disease (CKD). Here we compared invasive aortic systolic BP (SBP) with estimated central SBP obtained by radial artery tonometry and examined the influence of renal function and arterial stiffness on this relationship. We evaluated 83 patients with stage 3 to 5 CKD (mean estimated glomerular filtration rate [eGFR] 30 ml/min/1.73 m(2)) and 41 controls without renal disease undergoing scheduled coronary angiography. BP in the ascending aorta was measured through the angiography catheter and simultaneously estimated using radial tonometry. The mean difference between estimated central and aortic SBP was -13.2 (95% confidence interval -14.9 to -11.4) mm Hg. Arterial stiffness was evaluated by carotid-femoral pulse wave velocity (cf-PWV) and was significantly increased in CKD patients compared with (versus) control patients (mean 10.7 vs. 9.3 m/s). The difference in BP significantly increased 1.0 mm Hg for every 10 ml/min decrease in eGFR and by 1.6 mm Hg per 1 m/s increase in cfPWV. Using multivariate regression analysis including both eGFR and cfPWV, the difference between estimated central and invasive aortic SBP was significantly increased by 0.7 mm Hg. For the entire cohort brachial SBP significantly better reflected invasive SBP than estimated SBP. Thus, tonometry-based estimates of central BP progressively underestimate invasive central SBP with decreasing renal function and increasing arterial stiffness in CKD patients.

  2. Central venous line complications with chronic ambulatory infusion of prostacyclin analogues in pediatric patients with pulmonary arterial hypertension.

    Science.gov (United States)

    Marr, Courtney R; McSweeney, Julia E; Mullen, Mary P; Kulik, Thomas J

    2015-06-01

    Chronic infusion of prostacyclin (PGI2) via a Broviac central venous line (CVL) is attended by risk of CVL-related complications, but we know of only one report regarding CVL-associated bloodstream infection (BSI) with PGI2 in children and none regarding other complications. We conducted a retrospective cohort study involving pediatric patients with pulmonary hypertension treated with chronic intravenous infusion of PGI2 at Boston Children's Hospital and determined the rate (per 1,000 line-days) of various CVL-related complications. We also determined how often complications necessitated line replacement and hospitalization, time to replacement of CVLs, and interpatient variability in the incidence of complications. From 1999 until 2014, 26 patients meeting follow-up criteria had PGI2 infusion, representing 43,855 line-days; mean follow-up was 56 months (range, 1.4-161 months). The CVL complication rates (per 1,000 line-days) were as follows: CVL-BSI, 0.25; superficial line infection, 0.48; impaired integrity, 0.59; occlusion, 0.09; and malposition, 0.32. The total complication rate was 1.73 cases per 1,000 line-days. All CVL-BSI and malposition cases were treated with CVL removal and replacement. Of CVLs with impaired integrity, 23 could be repaired and 3 required replacement. Six of 21 superficial CVL infections required replacement of the CVL. Three of 4 occluded CVLs were replaced. CVL complications occasioned 65 hospitalizations. There was marked interpatient variability in the rate of complications, much but not all of which appeared to be related to duration of CVL placement. We conclude that non-BSI complications are very significant and that efforts to teach and emphasize other aspects of line care are therefore very important.

  3. KCa3.1 channel downregulation and impaired EDH-type relaxation in pulmonary arteries from chronic hypoxic rats

    DEFF Research Database (Denmark)

    Kroigaard, Christel; Kudryavtseva, Olga; Dalsgaard, Thomas

    2013-01-01

    hypoxia-induced pulmonary hypertension in rats. For functional studies, pulmonary arteries were mounted in microvascular myographs for isometric tension recordings. The K(Ca) channel expression was evaluated by immunoblotting and quantitative PCR. Although ACh induced similar relaxations, the ACh......Calcium-activated potassium channels of small (K(Ca)2, SK) and intermediate (K(Ca)3.1, IK) conductance are involved in endothelium-dependent relaxation of pulmonary arteries. We hypothesized that the function and expression of K(Ca)2 and K(Ca)3.1 increase as a compensatory mechanism to counteract......-induced relaxations were abolished by the combined inhibition of nitric oxide synthase (by L-nitro-arginine, L-NOARG), cyclo-oxygenase (by indomethacin) and soluble guanylate cyclase (by ODQ) in pulmonary arteries from hypoxic rats, whereas 20 ± 6% (n = 8) maximal relaxation in response to ACh persisted in arteries...

  4. Myocardial protection during off pump coronary artery bypass surgery: A comparison of inhalational anesthesia with sevoflurane or desflurane and total intravenous anesthesia

    Directory of Open Access Journals (Sweden)

    Sharadaprasad Suryaprakash

    2013-01-01

    Full Text Available Aims and Objectives: The objective of the study was to evaluate the myocardial protective effect of volatile agents-sevoflurane and desflurane versus total intravenous anesthesia (TIVA with propofol in offpump coronary artery bypass surgery (OPCAB by measuring cardiac troponin-T (cTnT as a marker of myocardial cell death. Materials and Methods: The study was conducted on 139 patients scheduled to undergo elective OPCAB surgery. The patients were randomly allocated to receive anesthesia with sevoflurane, desflurane or TIVA with propofol. The cTnT levels were measured preoperatively, at arrival in postoperative intensive care unit, at 8, 24, 48 and 96 hours thereafter. Results: The changes in cTnT levels at all time intervals were comparable in the three groups. Conclusion: The study did not reveal any difference in myocardial protection after OPCAB with either sevoflurane or desflurane or TIVA using propofol as assessed by measuring serial cTnT values.

  5. Dual Arterial Access for Stenting of Aortic Coarctation in Patients with Near-Total Descending Aortic Interruption.

    Science.gov (United States)

    Hamid, Tahir; Jamallulail, Syed Ibrahim; Clarke, Bernard; Mahadevan, Vaikom S

    2015-12-01

    Endovascular stenting is a recognized treatment strategy for the treatment of coarctation of aorta (COA) in adults. The aortic coarctation is usually crossed retrogradely from the descending aorta via the femoral approach. We report three patients who had near-total descending aortic interruption and underwent successful stenting of severe COA using a combined radial/brachial and femoral approach due to difficulty in crossing the lesion retrogradely via a femoral approach. There were no procedural complications and no adverse events during 6 months of follow-up.

  6. Clinical, roentgenographic, and scintigraphic results after interruption of the superior lateral genicular artery during total knee arthroplasty

    Energy Technology Data Exchange (ETDEWEB)

    Ritter, M.A.; Keating, E.M.; Faris, P.M. (Center for Hip and Knee Surgery, Mooresville, IN (USA))

    1989-11-01

    Forty-eight patients treated by primary bilateral simultaneous total knee arthroplasty, in which one knee had a lateral release and the other did not, were evaluated clinically and roentgenographically from one to 12 years postoperatively. Thirty of these patients also had a technetium-99 bone scan. Mean clinical scores at the last follow-up examination were 90 for both groups. Roentgenographically, there were no subluxations, dislocations, or fractures in either group. There were two metal-backed patellae (one in each group) with signs of polyethylene wear and developed debris. Bone scans showed no difference between the two groups and no signs of osteonecrosis of the patella.

  7. The Prognostic Value of Residual Volume/Total Lung Capacity in Patients with Chronic Obstructive Pulmonary Disease.

    Science.gov (United States)

    Shin, Tae Rim; Oh, Yeon-Mok; Park, Joo Hun; Lee, Keu Sung; Oh, Sunghee; Kang, Dae Ryoung; Sheen, Seungsoo; Seo, Joon Beom; Yoo, Kwang Ha; Lee, Ji-Hyun; Kim, Tae-Hyung; Lim, Seong Yong; Yoon, Ho Il; Rhee, Chin Kook; Choe, Kang-Hyeon; Lee, Jae Seung; Lee, Sang-Do

    2015-10-01

    The prognostic role of resting pulmonary hyperinflation as measured by residual volume (RV)/total lung capacity (TLC) in chronic obstructive pulmonary disease (COPD) remains poorly understood. Therefore, this study aimed to identify the factors related to resting pulmonary hyperinflation in COPD and to determine whether resting pulmonary hyperinflation is a prognostic factor in COPD. In total, 353 patients with COPD in the Korean Obstructive Lung Disease cohort recruited from 16 hospitals were enrolled. Resting pulmonary hyperinflation was defined as RV/TLC ≥ 40%. Multivariate logistic regression analysis demonstrated that older age (P = 0.001), lower forced expiratory volume in 1 second (FEV1) (P hyperinflation. Multivariate Cox regression model that included age, gender, dyspnea scale, SGRQ, RV/TLC, and 6-min walking distance revealed that an older age (HR = 1.07, P = 0.027), a higher RV/TLC (HR = 1.04, P = 0.025), and a shorter 6-min walking distance (HR = 0.99, P hyperinflation in COPD. RV/TLC is an independent risk factor for all-cause mortality in COPD.

  8. Impact of diabetes on long term follow-up of elderly patients with chronic total occlusion post percutaneous coronary intervention

    Institute of Scientific and Technical Information of China (English)

    Wei Liu; Kenji Wagatsuma; Hideo Nii; Mikihito Toda; Hideo Amano; Yasuto Uchida

    2013-01-01

    Background The prognosis of elderly patients with chronic total occlusion (CTO) and diabetes mellitus (DM) treated with percutaneous coronary intervention (PCI) is not known. Objective To investigate the effect of diabetes on long-term follow-up of CTO after PCI in elderly patients. Methods A total of 153 elderly patients (age > 65 years old) with CTO lesions which were successfully treated with PCI were enrolled. Fifty one patients with diabetes and 102 without diabetes were compared for long-term outcomes (mean follow up: 36 ± 12 months). Major adverse cardiac events (MACE) which include death, myocardial infarction or target lesion revascularization (TLR) were considered as a combined endpoint. Results The combined endpoint occurred in 29.4% of diabetes patients, and 11.3% of the patients without diabetes (P < 0.05). The Cox proportional hazards model identified: drug eluting stent (DES) or bare metal stent (BMS) (HR: 0.13, follow-up. Conclusions The study demonstrates that DM is a predictive factor for MACE in elderly CTO patients treated with PCI, type of stent, final minimal lumen diameter and DM with renal impairment, and HBA1C level on admission are predictors of MACE.

  9. Ascending Aorta to Hepatic and Mesenteric Artery Bypassing, in Patients with Chronic Mesenteric Ischemia and Extensive Aortic Disease-A Case Report and Review of the Literature.

    Science.gov (United States)

    Barr, James; Kokotsakis, John; Tsipas, Pantelis; Papapavlou, Prodromos; Velissarios, Konstantinos; Kratimenos, Theodoros; Athanasiou, Thanos

    2017-02-01

    Chronic mesenteric ischemia (CMI) is a rare disorder caused by severe stenosis of the mesenteric arterial supply that results in postprandial pain and weight loss. Treatment options are surgical or endovascular. Surgical bypass can be performed in an antegrade fashion from the supraceliac abdominal aorta (AA) or the distal descending thoracic aorta or in a retrograde fashion from the infrarenal aorta or the common iliac artery. However, in some patients with disease of the descending thoracic aorta or the AA, another site for the proximal anastomosis needs to be found. In this article, we report the case of a 69-year-old man with a thoracoabdominal aortic aneurysm and CMI in whom we performed bypass grafts to the hepatic and superior mesenteric arteries using the ascending aorta as the site for the proximal anastomoses via a median sternolaparotomy. In addition, we performed a literature review of all similar cases and provide an analysis of this technique and an assessment of the success rates.

  10. Impact of chronic kidney disease on use of evidence-based therapy in stable coronary artery disease: a prospective analysis of 22,272 patients.

    Directory of Open Access Journals (Sweden)

    Paul R Kalra

    Full Text Available To assess the frequency of chronic kidney disease (CKD, define the associated demographics, and evaluate its association with use of evidence-based drug therapy in a contemporary global study of patients with stable coronary artery disease.22,272 patients from the ProspeCtive observational LongitudinAl RegIstry oF patients with stable coronary arterY disease (CLARIFY were included. Baseline estimated glomerular filtration rate (eGFR was calculated (CKD-Epidemiology Collaboration formula and patients categorised according to CKD stage: >89, 60-89, 45-59 and <45 mL/min/1.73 m2.Mean (SD age was 63.9±10.4 years, 77.3% were male, 61.8% had a history of myocardial infarction, 71.9% hypertension, 30.4% diabetes and 75.4% dyslipidaemia. Chronic kidney disease (eGFR<60 mL/min/1.73 m2 was seen in 22.1% of the cohort (6.9% with eGFR<45 mL/min/1.73 m2; lower eGFR was associated with increasing age, female sex, cardiovascular risk factors, overt vascular disease, other comorbidities and higher systolic but lower diastolic blood pressure. High use of secondary prevention was seen across all CKD stages (overall 93.4% lipid-lowering drugs, 95.3% antiplatelets, 75.9% beta-blockers. The proportion of patients taking statins was lower in patients with CKD. Antiplatelet use was significantly lower in patients with CKD whereas oral anticoagulant use was higher. Angiotensin-converting enzyme inhibitor use was lower (52.0% overall and inversely related to declining eGFR, whereas angiotensin-receptor blockers were more frequently prescribed in patients with reduced eGFR.Chronic kidney disease is common in patients with stable coronary artery disease and is associated with comorbidities. Whilst use of individual evidence-based medications for secondary prevention was high across all CKD categories, there remains an opportunity to improve the proportion who take all three classes of preventive therapies. Angiotensin-converting enzyme inhibitors were used less frequently

  11. Renin–angiotensin–aldosterone system related gene polymorphisms and urinary total arsenic is related to chronic kidney disease

    Energy Technology Data Exchange (ETDEWEB)

    Chen, Wei-Jen [School of Public Health, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan (China); Huang, Ya-Li [Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan (China); Shiue, Horng-Sheng [Department of Chinese Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan (China); Chen, Tzen-Wen [Division of Nephrology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan (China); Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan (China); Lin, Yuh-Feng [Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan (China); Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, New Taipei, Taiwan (China); Huang, Chao-Yuan [Department of Urology, National Taiwan University Hospital, College of Medicine National Taiwan University, Taipei, Taiwan (China); Lin, Ying-Chin [Department of Family Medicine, Shung Ho Hospital, Taipei Medical University, New Taipei, Taiwan (China); Department of Health Examination, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan (China); Division of Family Medicine, School of Medicine, Taipei Medical University, Taipei, Taiwan (China); Han, Bor-Cheng [School of Public Health, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan (China); Hsueh, Yu-Mei, E-mail: ymhsueh@tmu.edu.tw [School of Public Health, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan (China); Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan (China)

    2014-09-01

    A recent study demonstrated that an increased risk of chronic kidney disease (CKD) was associated with high urinary total arsenic levels. However, whether genomic instability is related to CKD remains unclear. An association between CKD and genetic polymorphisms of regulation enzymes of the renin–angiotensin–aldosterone system (RAAS), such as angiotensin-converting enzyme (ACE), angiotensinogen (AGT), angiotensin II type I receptor (AT1R), and aldosterone synthase (CYP11B2) has not been shown. The aim of the present study was to investigate the relationship between arsenic, genetic polymorphisms of RAAS enzymes and CKD. A total of 233 patients and 449 age- and gender-matched controls were recruited from the Taipei Medical University Hospital, Taipei Municipal Wan Fang Hospital and the Shin Kong Wu Ho-Su Memorial Hospital. Concentrations of urinary arsenic were determined by a high-performance liquid chromatography-linked hydride generator, and atomic absorption spectrometry. Polymorphisms of ACE(I/D), AGT(A[− 20]C), (T174M), (M235T), AT1R(A1166C) and CYP11B2(C[− 344]T) were examined by polymerase chain reaction and restriction fragment length polymorphism. Subjects carrying the CYP11B2 TT genotype had a higher odds ratio (OR), 1.39 (0.96–2.01), of CKD; while those with the AGT(A[− 20]C) CC genotype had an inverse OR of CKD (0.20 (0.05–0.81)), and a high-risk genotype was defined as A/A + A/C for AGT(A[− 20C]) and T/T for CYP11B2(C[− 344]T). The trend test showed a higher OR for CKD in patients who had either high urinary total arsenic levels or carried the high-risk genotype, or both, compared to patients with low urinary total arsenic levels, who carried the low-risk genotype, and could also be affected by the hypertension or diabetes status. - Highlights: • AGT(− 20 C) and CYP11B2(− 344 T) genotypes were significantly associated with CKD. • Combined effect of high-risk genotypes and high urinary total arsenic on OR of CKD. • Combined

  12. Diagnostic Value of Electrocardiographic T Wave Inversion in Lead aVL in Diagnosing Coronary Artery Disease in Patients with Chronic Stable Angina

    Directory of Open Access Journals (Sweden)

    Hatem L. Farhan

    2010-04-01

    Full Text Available Objectives: The clinical value of T wave inversion in lead aVL in diagnosing coronary artery disease (CAD remains unclear. This study aims to investigate the correlation between aVL T wave inversion and CAD in patients with chronic stable angina.Methods: Electrocardiograms (ECGs of 257 consecutive patients undergoing coronary angiography were analyzed. All patients had chronic stable angina. All patients with secondary T wave inversion had been excluded (66 patients. The remaining 191 patients constituted the study population. Detailed ECG interpretation and coronary angiographic findings were conducted by experienced cardiologists.Results: T wave inversion in aVL was identified in 89 ECGs (46.8% with definite ischemic Q-ST-T changes in different leads in 97 ECGs (50.8%. Stand alone aVL T wave inversion was found in 27 ECGs (14.1% while ischemic changes in other leads with normal aVL were identified in 36 ECGs (18.8%. The incidence of CAD was 86.3%. Single, two- and multi-vessel CAD were found in 38.8%, 28.5% and 32.7% of cases respectively. The prevalence of left main, left anterior descending, left circumflex and right coronary arteries were 4.7%, 61.2%, 29.3% and 44.5%, respectively. T wave inversion in aVL was found to be the only ECG variable significantly predicting mid segment left anterior descending artery (LAD lesions (Odds Ratio 2.93, 95% Confidence Interval 1.59-5.37, p=0.001.Conclusion: This study provides new information relating to T wave inversion in lead aVL to mid segment LAD lesions. Implication of this simple finding may help in bedside diagnosis of CAD typically mid LAD lesions. However, further studies are needed to corroborate this finding.

  13. Acute Total and Chronic Partial Sleep Deprivation: Effects on Neurobehavioral Functions, Waking EEG and Renin-Angiotensin System

    Science.gov (United States)

    Dijk, Derk-Jan

    1999-01-01

    protocol of the Quantitative EEG and Waking Neurobehavioral Function project. This will allow us to investigate two additional specific aims: 1) Test the hypothesis that chronic partial sleep deprivation during a 17 day bed rest experiment results in deterioration of neurobehavioral function during waking and increases in EEG power density in the theta frequencies, especially in frontal areas of the brain, as well as the nonREM- REM cycle dependent modulation of heart-rate variability. 2) Test the hypothesis that acute total sleep deprivation modifies the circadian rhythm of the renin-angiotensin system, changes the acute responsiveness of this system to posture beyond what a microgravity environment alone does and affects the nonREM-REM cycle dependent modulation of heart-rate variability.

  14. Does total body irradiation conditioning improve outcomes of myeloablative human leukocyte antigen-identical sibling transplantations for chronic lymphocytic leukemia?

    Science.gov (United States)

    Sabloff, Mitchell; Sobecks, Ronald M; Ahn, Kwang Woo; Zhu, Xiaochun; de Lima, Marcos; Brown, Jennifer R; Inamoto, Yoshihiro; Holland, H Kent; Aljurf, Mahmoud D; Laughlin, Mary J; Kamble, Rammurti T; Hsu, Jack W; Wirk, Baldeep M; Seftel, Matthew; Lewis, Ian D; Arora, Mukta; Alyea, Edwin P; Kalaycio, Matt E; Cortes, Jorge; Maziarz, Richard T; Gale, Robert Peter; Saber, Wael

    2014-03-01

    An allogeneic hematopoietic cell transplantation from an HLA-identical donor after high-dose (myeloablative) pretransplantation conditioning is an effective therapy for some people with chronic lymphocytic leukemia (CLL). Because CLL is a highly radiosensitive cancer, we hypothesized that total body irradiation (TBI) conditioning regimens may be associated with better outcomes than those without TBI. To answer this, we analyzed data from 180 subjects with CLL receiving myeloablative doses of TBI (n = 126) or not (n = 54), who received transplants from an HLA-identical sibling donor between 1995 and 2007 and reported to the Center for International Blood & Marrow Transplant Research. At 5 years, treatment-related mortality was 48% (95% confidence interval [CI], 39% to 57%) versus 50% (95% CI, 36% to 64%); P = NS. Relapse rates were 17% (95% CI, 11% to 25%) versus 22% (95% CI, 11% to 35%); P = NS. Five-year progression-free survival and overall survival were 34% (95% CI, 26% to 43%) versus 28% (95% CI, 15% to 42%); P = NS and 42% (95% CI, 33% to 51%) versus 33% (95% CI, 19% to 48%); P = NS, respectively. The single most common cause of death in both cohorts was recurrent/progressive CLL. No variable tested in the multivariate analysis was found to significantly affect these outcomes, including having failed fludarabine. Within the limitations of this study, we found no difference in HLA-identical sibling transplantation outcomes between myeloablative TBI and chemotherapy pretransplantation conditioning in persons with CLL.

  15. Arteriopatía periférica crónica inducida por cocaína Chronic peripheral arterial disease induced by cocaine

    Directory of Open Access Journals (Sweden)

    Sonia Pankl

    2012-02-01

    Full Text Available La trombosis periférica aguda inducida por cocaína ha sido descripta en la literatura, siendo una complicación poco común. Si bien existen comunicaciones que reflejan los efectos crónicos de la cocaína sobre el sistema arterial periférico, no hay casos publicados de tal complicación en ausencia de otros factores de riesgo. Se presenta el caso de una mujer de 22 años de edad con antecedentes de consumo de cocaína intranasal de 3 gramos por semana durante un año, que consultó por claudicación intermitente a los 200 metros asociada a dolor y parestesias en miembro inferior izquierdo de 2 meses de evolución. El ecodoppler arterial evidenció una estenosis mayor del 70% en la arteria femoral superficial izquierda. Se realizaron estudios complementarios descartando otras etiologías probables. Se inició tratamiento con ácido acetilsalicílico, cilostazol y ejercicio reglado, asociado a terapia de apoyo para mantenimiento del cese del consumo de cocaína, con buena respuesta. Se destaca la importancia de la difusión de información a los pacientes, dado que la mayoría de la población desconoce las complicaciones cardiovasculares de dicha adicción. Es indispensable indagar sobre el consumo de cocaína en pacientes jóvenes con arteriopatía sin factores de riesgo aparentes.Cocaine induced acute peripheral thrombosis, though a rare complication, has been described in the literature. Although there are reports describing the chronic effects of cocaine on the peripheral arterial system, there are no published cases of this complication when other risk factors are lacking. We report on a 22 year old female patient, with intranasal consumption of 3 grams of cocaine per week for a year, who consulted for intermittent claudication at 200 meters, associated to left lower limb pain and paresthesiae for the last two months. Arterial Doppler ultrasonography showed a stenosis greater than 70% in the superficial left femoral artery. Other

  16. 全机器人冠状动脉旁路移植术的护理%Nursing of totally robotic coronary artery byass grafting

    Institute of Scientific and Technical Information of China (English)

    刘喜梅; 于亚群; 陈玉红

    2012-01-01

    Objective To study the nursing of totally endoscopic coronary artery bypass grafting (TECAB)using da Vinci robot.Methods 60 patients who accepted TECAB from January 2007 to December 2010 were selected.All patients underwent coronary arteriography,which showed severe stenosis in left anterior descending artery(LAD).8 of them complicated with right coronary artery stenosis or left circumflex coronary (LCX)stenosis.All patients were given education and nursing care from admission to discharge.Results After operation,angina pectoris alleviated in all cases,no surgery-related complications occurred.The bridge vessel was all cleared.All patients were discharged after rehabilitation.Conclusions Totally robotic TECAB is a new minimally-invasive surgery.Perioperative education is important.In early postoperative course,nurses should pay attention to bleeding condition of drainage and pulmonary nursing.Early postoperative exercise is a must,which can promote the recovery of all systems.%目的 探讨使用“达芬奇”机器人系统完成不开胸、非体外循环下心脏不停跳冠状动脉旁路移植术的护理要点.方法 选取2007年1月至2010年12月使用“达芬奇S”(da Vinic S)全机器人系统,完成不开胸、心脏不停跳下冠状动脉旁路移植术患者60例.所有患者术前均经冠状动脉造影证实有严重的前降支病变,合并有回旋支或右冠状动脉的局限性狭窄8例.对患者实施了全程的教育和护理.结果 60例患者术后心绞痛症状缓解,无手术相关并发症发生.术后检查桥血管通畅率为100%,患者全部顺利康复出院.结论 机器人冠状动脉旁路移植术是一种全新的术式,围手术期健康教育对患者很重要,术后早期注意观察引流有无出血的发生,做好肺部护理,尽早让患者下床活动,可促进各系统的恢复.

  17. Three-year clinical outcome after treatment of chronic total occlusions with second-generation drug-eluting stents in the TWENTE trial

    NARCIS (Netherlands)

    Houwelingen, van K. Gert; Sen, Hanim; Lam, Ming Kai; Tandjung, Kenneth; Löwik, Marije M.; Man, de Frits H.A.F.; Louwerenburg, J. (Hans) W.; Stoel, Martin G.; Hartmann, Marc; Linssen, Gerard C.M.; Doggen, C.J.M.; Birgelen, von C.

    2015-01-01

    Objective To compare long-term outcome of patients treated for chronic total occlusion (CTO) lesions versus patients treated for non-CTO lesions only. Background Percutaneous coronary interventions (PCI) for CTO lesions generally have a higher adverse event risk than PCI for non-CTO lesions. Howeve

  18. Long-term follow-up evaluation of chronic pain after endoscopic total extraperitoneal repair of primary and recurrent inguinal hernia

    NARCIS (Netherlands)

    A.E.M. van der Pool (Anne); J.J. Harlaar (Jaap); P.Th. den Hoed (Pieter); W.F. Weidema (Wibo); R.N. van Veen (Ruben)

    2010-01-01

    textabstractBackground Long-term data on chronic pain after endoscopic total extraperitoneal (TEP) hernia repair are hardly available. Methods Between January 1997 and December 1998, 416 patients with consecutive primary and recurrent inguinal hernia underwent endoscopic TEP hernia repair. Long-term

  19. Development of chronic heart failure in a young woman with hypertension associated with renal artery stenosis with preserved renal function

    DEFF Research Database (Denmark)

    Byrne, Christina; Abdulla, Jawdat

    2014-01-01

    A 33-year-old woman with presumed essential hypertension and symptoms equivalent to New York Heart Association class II was suspected of heart failure and referred to echocardiography. The patient's ECG showed a left bundle branch block. Electrolytes, serum creatinine and estimated-glomerular fil......A 33-year-old woman with presumed essential hypertension and symptoms equivalent to New York Heart Association class II was suspected of heart failure and referred to echocardiography. The patient's ECG showed a left bundle branch block. Electrolytes, serum creatinine and estimated......-glomerular filtration rate as well as urine test for protein were all normal. The patient had no peripheral oedema. The transthoracic echocardiography confirmed systolic and diastolic dysfunction and an ejection fraction of 25% and left ventricular hypertrophy. Ultrasound of renal arteries and renal CT angiography...... (renal CTA) revealed a significant stenosis and an aneurysm corresponding to the right renal artery with challenges to traditional interventions....

  20. Outcome of Diabetic and Non-Diabetic Patients Undergoing Successful Percutaneous Coronary Intervention of Chronic Total Occlusion

    Directory of Open Access Journals (Sweden)

    Bahram Sohrabi

    2011-05-01

    Full Text Available Introduction: Diabetes mellitus is associated with an increased risk of adverse clinical outcomes after percutaneous coronary intervention (PCI. The prognosis of patients with diabetes mellitus and chronic total occlusion (CTO treated with PCI is poorly investigated. Current study evaluates outcome of successful PCI on CTO in patients with and without diabetes. Methods: One hundred and sixty three patients treated with successful PCI on CTO between January 2009 and March 2011 were prospectively identified from the PCI registry at the Madani Heart Center, Tabriz, Iran. Patients were followed for 15±3 months, were evaluated for the occurrence of major adverse cardiac events (MACE comprising death, acute myocardial infarction, and need for repeat revascularization.Results: No differences were found in baseline clinical and procedural variables between patients with (n=34 and without diabetes (n=129, unless for hypertension (p=0.03. Hospitalization period after PCI in diabetics (3.26±0.61 days and non-diabetics (2.86±0.52 days was similar. In-hospital MACE occurred in 8 (23.5% individuals of diabetics and 10 (7.8% individuals of non-diabetics (p=0.02, among them revascularization was significantly higher in diabetics (20.6% vs. 7%, p=0.04. Follow-up events in diabetic and non-diabetic groups were 12 (35.3% and 37 (28.5%, respectively (p was not significant. Conclusion: In patients undergoing successful PCI on CTO, diabetes is associated with higher in-hospital adverse events; however diabetes does not affect long term outcomes in these patients.

  1. Adipose inflammation initiates recruitment of leukocytes to mouse femoral artery: role of adipo-vascular axis in chronic inflammation.

    Directory of Open Access Journals (Sweden)

    Sumihiko Hagita

    Full Text Available BACKGROUND: Although inflammation within adipose tissues is known to play a role in metabolic syndrome, the causative connection between inflamed adipose tissue and atherosclerosis is not fully understood. In the present study, we examined the direct effects of adipose tissue on macro-vascular inflammation using intravital microscopic analysis of the femoral artery after adipose tissue transplantation. METHODS AND RESULTS: We obtained subcutaneous (SQ and visceral (VIS adipose tissues from C57BL/6 mice fed normal chow (NC or a high fat diet (HF, then transplanted the tissues into the perivascular area of the femoral artery of recipient C57/BL6 mice. Quantitative intravital microscopic analysis revealed an increase in adherent leukocytes after adipose tissue transplantation, with VIS found to induce significantly more leukocyte accumulation as compared to SQ. Moreover, adipose tissues from HF fed mice showed significantly more adhesion to the femoral artery. Simultaneous flow cytometry demonstrated upregulation of CD11b on peripheral granulocyte and monocytes after adipose tissue transplantation. We also observed dominant expressions of the inflammatory cytokine IL-6, and chemokines MCP-1 and MIP-1β in the stromal vascular fraction (SVF of these adipose tissues as well as sera of recipient mice after transplantation. Finally, massive accumulations of pro-inflammatory and dendritic cells were detected in mice with VIS transplantation as compared to SQ, as well as in HF mice as compared to those fed NC. CONCLUSION: Our in vivo findings indicate that adipose tissue stimulates leukocyte accumulation in the femoral artery. The underlying mechanisms involve upregulation of CD11b in leukocytes, induction of cytokines and chemokines, and accumulation of pro-inflammatory cells in the SVF.

  2. Chronic hypoxia increases arterial blood pressure and reduces adenosine and ATP induced vasodilatation in skeletal muscle in healthy humans

    DEFF Research Database (Denmark)

    Calbet, J A L; Boushel, Robert Christopher; Robach, P;

    2014-01-01

    into the femoral artery at sea level and then after 8-12 days of residence at 4559 m above sea level. At sea level, the infusions were carried out while the subjects breathed room air, acute hypoxia (FI O2 = 0.11) and hyperoxia (FI O2 = 1); and at altitude (FI O2 = 0.21 and 1). Skeletal muscle P2Y2 receptor...

  3. Vascular growth responses to chronic arterial occlusion are unaffected by myeloid specific focal adhesion kinase (FAK) deletion

    Science.gov (United States)

    Heuslein, Joshua L.; Murrell, Kelsey P.; Leiphart, Ryan J.; Llewellyn, Ryan A.; Meisner, Joshua K.; Price, Richard J.

    2016-05-01

    Arteriogenesis, or the lumenal expansion of pre-existing arterioles in the presence of an upstream occlusion, is a fundamental vascular growth response. Though alterations in shear stress stimulate arteriogenesis, the migration of monocytes into the perivascular space surrounding collateral arteries and their differentiation into macrophages is critical for this vascular growth response to occur. Focal adhesion kinase’s (FAK) role in regulating cell migration has recently been expanded to primary macrophages. We therefore investigated the effect of the myeloid-specific conditional deletion of FAK on vascular remodeling in the mouse femoral arterial ligation (FAL) model. Using laser Doppler perfusion imaging, whole mount imaging of vascular casted gracilis muscles, and immunostaining for CD31 in gastrocnemius muscles cross-sections, we found that there were no statistical differences in perfusion recovery, arteriogenesis, or angiogenesis 28 days after FAL. We therefore sought to determine FAK expression in different myeloid cell populations. We found that FAK is expressed at equally low levels in Ly6Chi and Ly6Clo blood monocytes, however expression is increased over 2-fold in bone marrow derived macrophages. Ultimately, these results suggest that FAK is not required for monocyte migration to the perivascular space and that vascular remodeling following arterial occlusion occurs independently of myeloid specific FAK.

  4. [Choice of the extent and the terms of sanifying procedures after vascular reconstructive surgeries in patients with stage IV chronic arterial lower limb insufficiency].

    Science.gov (United States)

    Zatevakhin, I I; Chadaev, A P; Lisin, S V; latonov, V V; Markov, A V; Priamikov, A D; Poliaev, A Iu

    2005-01-01

    Results of vascular reconstructions with the following sanifying procedures performed in 82 patients with stage IV chronic arterial lower limb insufficiency are analyzed. Based on complex evaluation of microcirculation three types of tissues ischemic lesion are revealed: irreversible, severe and mild. Patients with irreversible lesion of the tissues of a distal part of the lower extremity require vascular reconstruction with simultaneous amputation at the upper third of the shank. In a severe reversible ischemic lesion of the tissues radical sanifying surgery with preservation of limb support function is better to perform not earlier than one month after vascular reconstruction. Mild ischemia of tissues permits performing minimal sanifying procedure with primary closure of the wound simultaneously with vascular surgery.

  5. Oral azithromycin in extended dosage schedule for chronic, subclinical Chlamydia pneumoniae infection causing coronary artery disease: a probable cure in sight? Results of a controlled preliminary trial

    Directory of Open Access Journals (Sweden)

    Dogra J

    2012-06-01

    Full Text Available Jaideep DograPoly Clinic, Central Government Health Scheme, Jaipur, Rajasthan, IndiaPurpose: Two mega trials have raised the question as to whether the hypothesis that infection plays a role in atherosclerosis is still relevant. This controlled preliminary trial investigated an extended dose of azithromycin in the treatment of Chlamydia pneumoniae infection causing coronary artery disease (CAD.Patients and methods: Forty patients with documentary evidence of CAD were screened for immunoglobulin G titers against C. pneumoniae and grouped into either the study group (patients with positive titer, n = 32 or control group (patients with negative titer, n = 8. Cases who met inclusion criteria could not have had coronary artery bypass graft surgery or percutaneous coronary intervention in the preceding 6 months. Informed consent was obtained from every patient. Baseline blood samples were analyzed for red blood cell indices, serum creatinine, and liver function tests, and repeated every 2 months. A primary event was defined as the first occurrence of death by any cause, recurrent myocardial infarction, coronary revascularization procedure, or hospitalization for angina. Patients in the study group received 500 mg of oral azithromycin once daily for 5 days, which was then repeated after a gap of 10 days (total of 24 courses in the 1-year trial period. The control group did not have azithromycin added to their standard CAD treatment.Results: In the study group, 30 patients completed the trial. Two patients had to undergo percutaneous coronary intervention in the initial first quarter of the 1-year trial period. In the control group, one patient died during the trial, one had to undergo coronary artery bypass graft surgery, and one had percutaneous coronary intervention.Conclusion: The patients tolerated the therapy well and there was a positive correlation between azithromycin and secondary prevention of CAD.Keywords: azithromycin, Chlamydia pneumoniae

  6. Avaliação da circulação arterial pela medida do índice tornozelo/braço em doentes de úlcera venosa crônica Evaluation of arterial circulation using the ankle/brachial blood pressure index in patients with chronic venous ulcers

    Directory of Open Access Journals (Sweden)

    Fabiane Noronha Bergonse

    2006-03-01

    Full Text Available FUNDAMENTOS: As úlceras venosas dos membros inferiores são freqüentes e têm grande impacto na qualidade de vida e produtividade do indivíduo, além de alto custo para a saúde pública. OBJETIVOS: Detecção de alterações arteriais em pacientes de úlcera venosa crônica dos membros inferiores com emprego de método não invasivo, de modo a discriminar aqueles em que estaria contra-indicado o tratamento compressivo. MÉTODOS: Foram estudados 40 doentes portadores de úlcera venosa crônica, com o intuito de se avaliar a presença de doença arterial periférica pela medida do índice tornozelo/braço por doppler-ultra-som. RESULTADOS: O índice tornozelo/braço mostrou-se alterado (menor que 1 em 9/22 (40,9% doentes com úlcera venosa crônica e hipertensão arterial concomitante, e apenas em 1/13 (7,7% doentes de úlcera venosa crônica sem hipertensão arterial. CONCLUSÕES: Doentes de úlcera venosa crônica e hipertensão arterial concomitantes devem ser submetidos rotineiramente à medida do índice tornozelo/braço para detecção de possível insuficiência arterial periférica associada.BACKGROUND: Chronic venous ulcers are extremely frequent and have a significant impact on quality of life and work productivity of individuals, in addition to high costs to public health. OBJECTIVES: Detection of arterial circulation alterations in chronic venous ulcer legs using a non-invasive method to discriminate patients not indicated to have compressive treatment. METHODS: Forty patients with chronic venous ulcers were investigated for the presence of peripheral arterial disease with measurement of the ankle/brachial index by Doppler ultrasound. RESULTS: The resting ankle/brachial pressure index was abnormal (lower than 1 in 9/22 (40.9% patients with concomitant chronic venous ulcers and hypertension and only in one out of 13 (7.7% patients with chronic venous ulcers and no hypertension. CONCLUSIONS: Patients with concomitant chronic venous

  7. Arterial Stiffness by Aerobic Exercise Is Related with Aerobic Capacity, Physical Activity Energy Expenditure and Total Fat but not with Insulin Sensitivity in Obese Female Patients with Type 2 Diabetes

    OpenAIRE

    Ji Yeon Jung; Kyung Wan Min; Hee Jung Ahn; Hwi Ryun Kwon; Jae Hyuk Lee; Kang Seo Park; Kyung Ah Han

    2014-01-01

    Background Arterial stiffness is an important factor in atherosclerosis. Thus we examined whether aerobic exercise could reduce arterial stiffness in obese women with type 2 diabetes without diabetic complication. Methods A total of 35 women with type 2 diabetes (body mass index, 26.6±2.8 kg/m2; age, 56.4±1.9 years; duration of diabetes, 4.7±4.8 years) were assigned to aerobic exercise group (AEG) or control group (CG). AEG completed a 12-week exercise program (3.6 to 5.2 metabolic equivalent...

  8. Serum neutrophil gelatinase-associated lipocalin concentration reflects severity of coronary artery disease in patients without heart failure and chronic kidney disease.

    Science.gov (United States)

    Katagiri, Mikako; Takahashi, Masao; Doi, Kent; Myojo, Masahiro; Kiyosue, Arihiro; Ando, Jiro; Hirata, Yasunobu; Komuro, Issei

    2016-10-01

    Serum neutrophil gelatinase-associated lipocalin (NGAL) is recognized as a useful biomarker for acute kidney injury. Recently, elevated NGAL levels were reported in patients with heart failure and cardiac events, but the association between serum NGAL and severity of coronary artery disease (CAD) has not been investigated adequately. This study aimed to evaluate the association between serum NGAL concentration and CAD severity in patients without heart failure and chronic kidney disease. Two-hundred thirteen patients [mean age: 66.2 ± 9.2 (SD)] without heart failure and chronic kidney disease (estimated glomerular filtration rate >60 mL/min/1.73 m(2)) who underwent coronary angiography were retrospectively analyzed using the SYNTAX score. The mean concentration of serum NGAL was 134.3 ± 111.3 ng/mL. A statistically significant correlation was observed between serum NGAL levels and the SYNTAX score (R = 0.18, P = 0.0091). Multivariable analysis also showed elevated serum NGAL as an independent risk factor for a high SYNTAX score (P 100 ng/mL) and high levels of BNP (>25 pg/mL) had a higher SYNTAX score (low-low vs. high-high: 13.8 ± 13.4 vs. 20.8 ± 18.9, P heart failure. Serum NGAL might be a biomarker for CAD severity.

  9. Angiotensin II type 1a receptors in subfornical organ contribute towards chronic intermittent hypoxia-associated sustained increase in mean arterial pressure.

    Science.gov (United States)

    Saxena, Ashwini; Little, Joel T; Nedungadi, T Prashant; Cunningham, J Thomas

    2015-03-01

    Sleep apnea is associated with hypertension. The mechanisms contributing to a sustained increase in mean arterial pressure (MAP) even during normoxic awake-state remain unknown. Rats exposed to chronic intermittent hypoxia for 7 days, a model of the hypoxemia associated with sleep apnea, exhibit sustained increases in MAP even during the normoxic dark phase. Activation of the renin-angiotensin system (RAS) has been implicated in chronic intermittent hypoxia (CIH) hypertension. Since the subfornical organ (SFO) serves as a primary target for the central actions of circulating ANG II, we tested the effects of ANG II type 1a receptor (AT1aR) knockdown in the SFO on the sustained increase in MAP in this CIH model. Adeno-associated virus carrying green fluorescent protein (GFP) and small-hairpin RNA against either AT1aR or a scrambled control sequence (SCM) was stereotaxically injected in the SFO of rats. After recovery, MAP, heart rate, respiratory rate, and activity were continuously recorded using radiotelemetry. In the normoxic groups, the recorded variables did not deviate from the baseline values. Both CIH groups exhibited significant increases in MAP during CIH exposures (P SCM-injected group exhibited a sustained increase in MAP (P SCM-CIH group. Our data indicate that AT1aRs in the SFO are critical for the sustained elevation in MAP and increased FosB/ΔFosB expression in forebrain autonomic nuclei associated with CIH.

  10. [Diagnostics and therapy of chronic stable coronary artery disease : new guidelines of the European Society of Cardiology].

    Science.gov (United States)

    Athanasiadis, A; Sechtem, U

    2014-12-01

    The European Society of Cardiology (ESC) guidelines on the management of stable coronary artery disease published in 2013 give practical recommendations for diagnostics and therapy. The approach depends on the clinical picture and symptoms of the patient, the severity and extent of ischemia, the degree and location of coronary stenoses, additional cardiac findings and finally on non-cardiac comorbidities. The selection of suitable diagnostic tools is based on the tabulated pretest probability for the presence of coronary artery disease which plays an important and central role in the diagnostic algorithm. An invasive approach is recommended only in patients with severe angina, i.e. a Canadian Cardiovascular Society (CCS) angina grading scale of ≥ CCS3 or in patients who are at high risk for death or myocardial infarction based on the results of the test used for detection of ischemia. Detailed therapeutic recommendations are given for medicinal and interventional or surgical therapy. Medicinal therapy includes drugs both for relief of symptoms and prevention of cardiovascular events. Recommendations are also given for the use of new antianginal drugs. A PCI is only indicated in vessels causing ischemia which can be verified by using fractional flow reserve measurements. The indications for PCI now also include patients with a low SYNTAX score and multivessel disease or left main stenosis; however, the optimal strategy should be individually determined in heart team discussions.

  11. Quadruple-component superficial circumflex iliac artery perforator (SCIP) flap: A chimeric SCIP flap for complex ankle reconstruction of an exposed artificial joint after total ankle arthroplasty.

    Science.gov (United States)

    Yamamoto, Takumi; Saito, Takafumi; Ishiura, Ryohei; Iida, Takuya

    2016-09-01

    Total ankle arthroplasty (TAA) is becoming popular in patients with rheumatoid arthritis (RA)-associated ankle joint degeneration. However, ankle wound complications can occur after TAA, which sometimes requires challenging reconstruction due to anatomical complexity of the ankle. Superficial circumflex iliac artery (SCIA) perforator (SCIP) flap has been reported to be useful for various reconstructions, but no case has been reported regarding a chimeric SCIP flap for complex ankle reconstruction. We report a case of complex ankle defect successfully reconstructed with a free quadruple-component chimeric SCIP flap. A 73-year-old female patient with RA underwent TAA, and suffered from an extensive ankle soft tissue defect (13 × 5 cm) with exposure of the implanted artificial joint and the extensor tendons. A chimeric SCIP flap was raised based on the deep branch and the superficial branch of the SCIA, which included chimeric portions of the sartorius muscle, the deep fascia, the inguinal lymph node (ILN), and the skin/fat. The flap was transferred to the recipient ankle. The sartorius muscle was used to cover the artificial joint, the deep fascia to reconstruct the extensor retinaculum, the ILN to prevent postoperative lymphedema, and the adiposal tissue to put around the extensor tendons for prevention of postoperative adhesion. Postoperatively, the patient could walk by herself without persistent leg edema or bowstringing of the extensor tendons, and was satisfied with the concealable donor scar. Although further studies are required to confirm efficacy, multicomponent chimeric SCIP has a potential to be a useful option for complex defects of the ankle.

  12. Urinary metabonomics study of the hepatoprotective effects of total alkaloids from Corydalis saxicola Bunting on carbon tetrachloride-induced chronic hepatotoxicity in rats using (1)H NMR analysis.

    Science.gov (United States)

    Wu, Fang; Zheng, Hua; Yang, Zheng-Teng; Cheng, Bang; Wu, Jin-Xia; Liu, Xu-Wen; Tang, Chao-Ling; Lu, Shi-Yin; Chen, Zhao-Ni; Song, Fang-Ming; Ruan, Jun-Xiang; Zhang, Hong-Ye; Liang, Yong-Hong; Song, Hui; Su, Zhi-Heng

    2017-03-19

    Chronic liver injury has been shown to cause liver fibrosis due to the sustained pathophysiological wound healing response of the liver, and eventually progresses to cirrhosis. The total alkaloids of Corydalis saxicola Bunting (TACS), a collection of important bioactive ingredients derived from the traditional Chinese folk medicine Corydalis saxicola Bunting (CS), have been reported to have protective effects on the liver. However, the underlying molecular mechanisms need further elucidation. In this study, the urinary metabonomics and the biochemical changes in rats with carbon tetrachloride (CCl4)-induced chronic liver injury due to treatment TACS or administration of the positive control drug-bifendate were studied via proton nuclear magnetic resonance ((1)H NMR) analysis. Partial least squares-discriminate analysis (PLS-DA) suggested that metabolic perturbation caused by CCl4 damage was recovered with TACS and bifendate treatment. A total of seven metabolites including 2-oxoglutarate, citrate, dimethylamine, taurine, phenylacetylglycine, creatinine and hippurate were considered as potential biomarkers involved in the development of CCl4-induced chronic liver injury. According to pathway analysis using identified metabolites and correlation network construction, the tricarboxylic acid (TCA) cycle, gut microbiota metabolism and taurine and hypotaurine metabolism were recognized as the most affected metabolic pathways associated with CCl4 chronic hepatotoxicity. Notably, the changes in 2-oxoglutarate, citrate, taurine and hippurate during the process of CCl4-induced chronic liver injury were significantly restored by TACS treatment, which suggested that TACS synergistically mediated the regulation of multiple metabolic pathways including the TCA cycle, gut microbiota metabolism and taurine and hypotaurine metabolism. This study could bring valuable insight to evaluating the efficacy of TACS intervention therapy, help deepen the understanding of the

  13. Comparison between Total Parenteral Nutrition Vs. Partial Parenteral Nutrition on Serum Lipids Among Chronic Ventilator Dependent Patients; A Multi Center Study

    OpenAIRE

    Radpay, Rojan; Poor Zamany Nejat Kermany, Mahtab; Radpay, Badiozaman

    2016-01-01

    Background: Malnutrition is very common among chronically hospitalized patients, especially those in the intensive care unit (ICU). Identifying the patients at risk and providing suitable nutritional support can prevent and/or overcome malnutrition in them. Total parenteral nutrition (TPN) and partial parenteral nutrition (PPN) are two common routes to deliver nutrition to hospitalized patients. We conducted a multicenter, prospective double blind randomized controlled trial to evaluate the b...

  14. Near-infrared transillumination back scattering sounding--new method to assess brain microcirculation in patients with chronic carotid artery stenosis.

    Directory of Open Access Journals (Sweden)

    Andrzej F Frydrychowski

    Full Text Available PURPOSE: The purpose of the study was to assess the responses of pial artery pulsation (cc-TQ and subarachnoid width (sas-TQ to acetazolamide challenge in patients with chronic carotid artery stenosis and relate these responses to changes in peak systolic velocity (PSV, cerebral blood flow (CBF, cerebral blood volume (CBV, mean transit time (MTT and time to peak response (TTP. METHODS: Fifteen patients with carotid artery stenosis ≥ 90% on the ipsilateral side and <50% on the contralateral side were enrolled into the study. PSV was assessed using colour-coded duplex sonography, CBF, CBV, MTT and TTP with perfusion computed tomography, cc-TQ and sas-TQ with near-infrared transillumination/backscattering sounding (NIR-T/BSS. RESULTS: Based on the ipsilateral/contralateral cc-TQ ratio after acetazolamide challenge two groups of patients were distinguished: the first group with a ratio ≥ 1 and the second with a ratio <1. In the second group increases in CBF and CBV after the acetazolamide test were significantly higher in both hemispheres (ipsilateral: +33.0% ± 8.1% vs. +15.3% ± 4.4% and +26.3% ± 6.6% vs. +14.3% ± 5.1%; contralateral: +26.8% ± 7.0% vs. +17.6% ± 5.6% and +20.0% ± 7.3% vs. +10.0% ± 3.7%, respectively, cc-TQ was significantly higher only on the ipsilateral side (+37.3% ± 9.3% vs. +26.6% ± 8.6% and the decrease in sas-TQ was less pronounced on the ipsilateral side (-0.7% ± 1.5% vs. -10.2% ± 1.5%, in comparison with the first group. The changes in sas-TQ following the acetazolamide test were consistent with the changes in TTP. CONCLUSIONS: The ipsilateral/contralateral cc-TQ ratio following acetazolamide challenge may be used to distinguish patient groups characterized by different haemodynamic parameters. Further research on a larger group of patients is warranted.

  15. Effects of neuromuscular electrical stimulation and aerobic exercise training on arterial stiffness and autonomic functions in patients with chronic heart failure.

    Science.gov (United States)

    Dobšák, Petr; Tomandl, Josef; Spinarova, Lenka; Vitovec, Jiri; Dusek, Ladislav; Novakova, Marie; Jarkovsky, Jiri; Krejci, Jan; Hude, Petr; Honek, Tomáš; Siegelova, Jarmila; Homolka, Pavel

    2012-10-01

    Neuromuscular electrical stimulation (NMES) of leg muscles has been introduced in clinical practice as a rehabilitation (RHB) method in patients with chronic heart failure (CHF); however, the role of NMES on the reduction of arterial stiffness and autonomic disbalance in these patients has not yet been studied. Sixty-one patients with stable CHF (mean age 58.9 [2.1] years; mean ejection fraction 31 [4.2]%, New York Heart Association II-III) were randomly assigned into two groups. Patients in (i) exercise training group (ET; n = 30) underwent 12 weeks of bicycle ET (3 × 40 min/week); (ii) group NMES (n = 31) performed 12 weeks of NMES of quadriceps and calf muscles (frequency 10 Hz, mode "20 s on-20 s off," intensity 60 mA), 2 × 60 min/day. Noninvasive assessment of arterial stiffness was done using the cardio-ankle vascular index (CAVI). CAVI and heart rate variability (HRV) and ·VO(2peak) were evaluated before and after RHB program. Both types of RHB reduced significantly CAVI (ET from 9.6 [0.2] to 8.9 [0.2], P < 0.012; NMES from 9.3 [0.2] to 8.7 [0.2], P < 0.013), increased high frequency (HF) component of HRV (+65.6%; P = 0.001) and decreased ratio of low frequency (LF) component with HF component (LF/HF ratio) in group ET (-39.8%; P < 0.001). Changes of HRV parameters in group NMES were not significant; however, a marked tendency to autonomic stabilization was present. Both types of RHB led also to significant increase of ·VO(2peak) (ET from 18.7 [0.7] to 20.8 [0.7] mL/kg/min, P < 0.004; NMES from 17.3 [0.7] to 19.0 [0.7] mL/kg/min, P < 0.001). ET or NMES has been shown to improve significantly arterial stiffness and to stabilize autonomic balance.

  16. Noninvasive assessment of pulmonary arterial pressure by krypton-81m right cardiac ventriculography in patients with chronic obstructive pulmonary disease

    Energy Technology Data Exchange (ETDEWEB)

    Yamaoka, Shimpachi; Kuriyama, Takanobu; Hirai, Masashi; Nishimura, Kouichi; Kuno, Kenshi; Yonekura, Yoshiharu

    1987-10-01

    In twenty patients with COPD, the following pulmonary function test values were obtained (mean +- SD): FEV/sub 1.0/ = 1070 +- 490 ml;FEV/sub 1.0/ % = 47.7 +- 8.9 %;PaO/sub 2/ = 65.8 +- 8.4 torr;PaCO/sub 2/ = 39.7 +- 4.4 torr. All patients underwent right heart catheterization and pulmonary arterial mean pressures (PAMP) were obtained. The PAMP value was 20.2 +- 4.1 torr (range 12 - 28), RVEF was 52.2 +- 8.4 % (range 31 - 63) and RVRFR was 25.5 +- 4.7 %100 msec (range 18 - 34). The PAMP negatively correlated with the RVEF (r = -0.69, p < 0.001) and RVRFR (r = -0.82, p < 0.001). In ten healthy male subjects, the RVEF was 56.6 +- 5.1 % (range 50 - 64) and RVRFR was 37.7 +- 3.0 %100 msec (range 33 - 42). The lower limit of normal for the RVEF was regarded as 46.4 % and that of the RVRFR as 31.7 %100 msec;these are the values two standard deviations below the means. Nine of the twenty patients has a PAMP value of more than 20 torr (the sine qua non of cor pulmonale). Five of these nine patients had RVEF values less than 46.4 % and all of them had RVRFR values of less than 31.7 %100 msec. On the other hand, all of the remaining eleven patients (PAMP 20 torr or less) had RVEF values within the normal range, but ten of the eleven had RVRFR values of less than 31.7 %100 msec. Therefore, the RVRFR value, which showed excellent correlation with the PAMP, provided a noninvasive assessment of pulmonary arterial pressure with good sensitivity in detecting elevated pressure. The RVEF value supplemented the RVRFR with good specificity for detection of elevation of pressure;that is, it eliminated false positive results. (J.P.N.)

  17. Uso do Verapamil em Gestantes Hipertensas Crônicas: análise do Fluxo das Artérias Uterinas e Umbilical Use of Verapamil in Chronic Hypertensive Pregnant Women: flow Analysis of Uterine Arteries and Umbilical Artery

    Directory of Open Access Journals (Sweden)

    Marcus Jose do Amaral Vasconcellos

    2000-06-01

    patients were accompanied: study group (n = 61, submitted to verapamil 240 mg/day and control group (n = 62, submitted to placebo. These patients were randomized into groups of four women and treatment or placebo was given for thirty days. A flow examination of the uterine arteries and umbilical artery through doppler-velocimetry was recorded. The values of resistance (RI and pulsatility index (PI and of the systole/diastole ratio (S/D of the arteries were compared after the drug administration calculating means and standard deviations. Results: the verapamil group showed RI = 0.82 (0.28, PI = 1.06 (0.12 and S/D = 2.42 (0.51 in the uterine arteries. The placebo group showed RI = 0.75 (0.35, PI = 1.00 (0.18 and S/D = 2.30 (0.38. When we analyzed the umbilical artery, the verapamil group showed RI = 0.73 (0.12, PI = 1.04 (0.13 and S/D = 2.94 (0.32. The placebo group showed RI = 0.70 (0.14, PI = 1.03 (0.07 and S/D = 3.02 (0.78. The statistical analysis of the differences of the means by the F ratio showed that there was no difference between these two groups. Conclusion: this study indicates the use of verapamil for chronic hypertensive pregnants since it does not provoke damage to the uterine and fetal blood flow.

  18. Fludarabine Phosphate and Total-Body Irradiation Before Donor Peripheral Blood Stem Cell Transplant in Treating Patients With Chronic Lymphocytic Leukemia or Small Lymphocytic Leukemia

    Science.gov (United States)

    2016-07-18

    B-Cell Prolymphocytic Leukemia; Chronic Lymphocytic Leukemia; Prolymphocytic Leukemia; Recurrent Chronic Lymphocytic Leukemia; Recurrent Small Lymphocytic Lymphoma; Refractory Chronic Lymphocytic Leukemia; T-Cell Prolymphocytic Leukemia

  19. Vasomotor Effect of Salidroside on Mesenteric Artery in Rats with Chronic Cardiac Failure%红景天苷对慢性心力衰竭大鼠肠系膜动脉舒缩作用的影响

    Institute of Scientific and Technical Information of China (English)

    王晨阳; 孙卫卫; 徐鹏; 刘海燕; 曹雪滨

    2014-01-01

    目的:探讨红景天苷( Salidroside, SAL)对慢性心力衰竭(心衰)大鼠离体肠系膜动脉舒缩作用的影响。方法将20只大鼠随机分为心衰组、假手术组,每组10只。心衰组采用腹主动脉缩窄术制备压力超负荷心衰大鼠模型,假手术组制备方法同心衰组,但腹主动脉只穿过线而不进行缩窄。术后16周,取假手术组(n=8)和心衰组(n=5)大鼠处死后制备肠系膜动脉环,予去氧肾上腺素(PE)预收缩,以不同累积浓度的 SAL(10-8、10-7、10-6、10-5、10-4 mol/L)直接作用预收缩的肠系膜动脉环,应用DMT微血管张力测定仪测定比较两组肠系膜动脉环张力。结果SAL对PE预收缩的心衰组大鼠肠系膜动脉环产生浓度依赖性舒张作用,与假手术组比较,除10-8 mol/L之外各浓度作用下差异均有统计学意义(P<0.01);心衰组SAL诱导的最大舒张反应(Emax)和半数有效浓度(EC50)均高于假手术组(P<0.05,P<0.01)。结论 SAL对心衰大鼠动脉在具备血管收缩功能的同时还具有浓度依赖性舒张效应,这种调节能力对于临床休克状态下靶器官功能的保护有重要意义。%Objective To observe vasomotor effect of Salidroside ( SAL) on the mesenteric artery in rats with chronic heart failure in vitro. Methods A total of 20 SD rats were randomly divided into heart failure group ( HF group, n=10) and sham operation group (S group, n=10). Rat models of pressure overloading chronic heart failure were made by constriction of the abdominal aorta in HF group, while models in S group underwent aortic threading instead of con-striction. The superior mesenteric arterial circles were excised in HF group (n=5) and S group (n=8) in postoperative 16th week,and then based on Phenylephrine (PE) pre-vasoconstriction, and the different cumulative concentrations SAL (10 -8 , 10 -7 , 10 -6 , 10 -5 and 10 -4 mol/L) was given to mesenteric arterial circles. Tensions of mesenteric arterial cir-cles were

  20. 逆向技术在冠状动脉慢性完全闭塞病变介入治疗中的应用%The application of retrograde technique in the interventional treatment for chronic total coronary occlusion(CTO) lesions

    Institute of Scientific and Technical Information of China (English)

    左梅; 黎军德; 吴栋梁; 李阳; 王芝荣; 李新国

    2011-01-01

    Objectives: To evaluate the feasibility and security of applying retrograde technique in the interventional treatment for chronic total coronary occlusion(CTO) lesions. Methods:We elected 3 cases of chronic total coronary occlusion (CTO) patients confirmed by coronary angiography (CAG) via radial artery which all exist collateral circulations with another coronary artery at the distal portion whose coronary angiographies (CAG) suggested the images developed from distal to proximal portion . During the interventional operations, as the previously failed antegrade double guiding catheters, microcatheters and different special Guidings for chronic total coronary occlusion (CTO) and accuratelypercutaneous coronary intervention (PCI) , we tried to get through the occlusion lesions by the retrograde combined application of controlling directions of the guides wires, then performed balloon dilatation anchoring through antegrade guiding catheter and retrograde balloon dilatation, implanted and expanded sents successfully, when antegrade guide wire passed the lesion. Results:Percutaneous coronary intervention (PCI) have been performed successfully for 3 cases of chronic total coronary occlusion (CTO) patients, without coronary dissection and perforation. Conclusions:The retrograde technique is an ideal technique in the interventional treatment for chronic total coronary occlusion (CTO) lesions%目的:评价逆向技术在慢性冠状动脉完全闭塞病变(CTO)介入治疗中应用的可行性及安全性.方法:3例经造影证实的CTO,均有另一支冠状动脉向远端血管提供良好侧枝循环,造影时CTO血管由远及近逆向显影.正向技术失败后,使用双指引导管法,逆向联合应用微导管和不同CTO专用导丝,导丝通过CTO病变后,继续进入正向指引导管内进行球囊扩张锚定,行逆向球囊扩张,正向导丝通过病变,植入支架.结果:3例成功通过逆向技术植入支架,术中无冠状动脉夹层及穿孔并发

  1. The cumulative cost of additional wakefulness: dose-response effects on neurobehavioral functions and sleep physiology from chronic sleep restriction and total sleep deprivation

    Science.gov (United States)

    Van Dongen, Hans P A.; Maislin, Greg; Mullington, Janet M.; Dinges, David F.

    2003-01-01

    OBJECTIVES: To inform the debate over whether human sleep can be chronically reduced without consequences, we conducted a dose-response chronic sleep restriction experiment in which waking neurobehavioral and sleep physiological functions were monitored and compared to those for total sleep deprivation. DESIGN: The chronic sleep restriction experiment involved randomization to one of three sleep doses (4 h, 6 h, or 8 h time in bed per night), which were maintained for 14 consecutive days. The total sleep deprivation experiment involved 3 nights without sleep (0 h time in bed). Each study also involved 3 baseline (pre-deprivation) days and 3 recovery days. SETTING: Both experiments were conducted under standardized laboratory conditions with continuous behavioral, physiological and medical monitoring. PARTICIPANTS: A total of n = 48 healthy adults (ages 21-38) participated in the experiments. INTERVENTIONS: Noctumal sleep periods were restricted to 8 h, 6 h or 4 h per day for 14 days, or to 0 h for 3 days. All other sleep was prohibited. RESULTS: Chronic restriction of sleep periods to 4 h or 6 h per night over 14 consecutive days resulted in significant cumulative, dose-dependent deficits in cognitive performance on all tasks. Subjective sleepiness ratings showed an acute response to sleep restriction but only small further increases on subsequent days, and did not significantly differentiate the 6 h and 4 h conditions. Polysomnographic variables and delta power in the non-REM sleep EEG-a putative marker of sleep homeostasis--displayed an acute response to sleep restriction with negligible further changes across the 14 restricted nights. Comparison of chronic sleep restriction to total sleep deprivation showed that the latter resulted in disproportionately large waking neurobehavioral and sleep delta power responses relative to how much sleep was lost. A statistical model revealed that, regardless of the mode of sleep deprivation, lapses in behavioral alertness

  2. The effect of CTO recanalization on FFR of the donor artery.

    Science.gov (United States)

    Sachdeva, Rajesh; Uretsky, Barry F

    2011-02-15

    This case illustrates that fractional flow reserve (FFR) in addition to the severity and length of the coronary stenosis is critically dependent on the extent of viable myocardium perfused. In the presented case, the left anterior descending artery (LAD) that had modest angiographic stenosis supplied collaterals to the entire left ventricle. After recanalization of chronic total occlusions (CTO) of the right and circumflex arteries, FFR in the LAD had normalized.

  3. 下肢慢性静脉功能不全动脉铸型的三维重建及意义%Three-dimensional reconstruction and significance of arterial cast on chronic venous insufficiency of low extremity

    Institute of Scientific and Technical Information of China (English)

    黄海龙; 符伟平; 黄绍贤; 龚达聪

    2015-01-01

    Objective To evaluate the three-dimensional reconstruction and significance of arterial cast on chronic venous insufficiency of low extremity. Methods A set of specimen on chronic venous insufficiency of left lower extremity amputation residues was infused with epoxy resin-lead oxide through the femoral artery,and then casted. The CT data of the cast specimen was used to reconstruct 3D modal of ar-tery on chronic venous insufficiency of left lower extremity,using the volume rendering(VR) and maximum intensity projection(MIP). Re-sults The cast specimen and 3D reconstruction of chronic venous insufficiency of left lower extremity amputation residues could clearly dis-play distribution and run of lower extremity arteries,blood supply of lesion and local region embolism of small artery ( arteriole) . Conclusion The 3D modal of artery on chronic venous insufficiency of left lower extremity should provide morphological basis of exact etiology and perfect pathogenesis,also has a certain guiding significance of clinical diagnosis and treatment.%目的:探讨下肢慢性静脉功能不全动脉铸型的三维重建及意义。方法采用改良环氧树脂混合液-氧化铅填充剂对1例左侧下肢截肢残体慢性静脉功能不全( CVI)标本进行灌注并铸型,并在铸型基础上行64层螺旋CT薄层扫描,以容积再现法( VR)和最大密度投影法( MIP)重建三维数字化模型。结果血管铸型和CT三维重建的左侧下肢截肢残体CVI动脉模型均清晰地显示下肢动脉的分布及走行、内侧踝关节溃疡灶内踝网血供情况及局部区域性小动脉(微动脉)栓塞情况。结论下肢CVI动脉模型可为CVI确切病因和完善病理机制提供形态学基础,对临床诊断和治疗具有一定指导意义。

  4. Hyperbaric oxygenation effects determination in the therapy of chronic occlusive lower extremities arteries disease by the use of perfusion scintigraphy

    Directory of Open Access Journals (Sweden)

    Zoranović Uroš

    2010-01-01

    inoperable occlusive disease of the lower leg arteries significantly increases after the application of HBO treatment.

  5. Sarcoma intimal de artéria pulmonar: um diagnóstico diferencial do tromboembolismo pulmonar crônico Intimal sarcoma of the pulmonary artery: a differential diagnosis of chronic pulmonary thromboembolism

    Directory of Open Access Journals (Sweden)

    Ana Paula Alves Valle Dornas

    2009-08-01

    Full Text Available O sarcoma intimal de artéria pulmonar é um tumor raro e potencialmente letal, de diagnóstico difícil e, muitas vezes, tardio. Os sinais e sintomas clínicos são inespecíficos, simulando com frequência o tromboembolismo pulmonar crônico (TEPC. Apresentamos o caso de um homem de 45 anos em tratamento de TEPC associado com hipertensão arterial pulmonar e cor pulmonale crônico, sem resposta ao uso de anticoagulantes e sildenafil. Ressaltamos as dificuldades para o diagnóstico do sarcoma intimal de artéria pulmonar, a necessidade de se pesquisar essa neoplasia no diagnóstico diferencial do TEPC e a utilização sistemática de critérios para a adequada indicação dos novos medicamentos para a hipertensão arterial pulmonar.Intimal sarcoma of the pulmonary artery is a rare and potentially lethal tumor, the diagnosis of which is difficult and therefore frequently delayed. The clinical signs and symptoms are nonspecific, often mimicking chronic pulmonary thromboembolism (CPTE. We report the case of a 45-year-old male under treatment for CPTE associated with pulmonary arterial hypertension and chronic cor pulmonale. There was no response to treatment with anticoagulants and sildenafil. We emphasize the difficulties in diagnosing intimal sarcoma of the pulmonary artery, the need to investigate this neoplasm in the differential diagnosis of CPTE and the systematic use of criteria for the appropriate prescription of new medications for pulmonary artery hypertension.

  6. The predictive value of chronic kidney disease for assessing cardiovascular events under consideration of pretest probability for coronary artery disease in patients who underwent stress myocardial perfusion imaging.

    Science.gov (United States)

    Furuhashi, Tatsuhiko; Moroi, Masao; Joki, Nobuhiko; Hase, Hiroki; Masai, Hirofumi; Kunimasa, Taeko; Fukuda, Hiroshi; Sugi, Kaoru

    2013-02-01

    Pretest probability of coronary artery disease (CAD) facilitates diagnosis and risk stratification of CAD. Stress myocardial perfusion imaging (MPI) and chronic kidney disease (CKD) are established major predictors of cardiovascular events. However, the role of CKD to assess pretest probability of CAD has been unclear. This study evaluates the role of CKD to assess the predictive value of cardiovascular events under consideration of pretest probability in patients who underwent stress MPI. Patients with no history of CAD underwent stress MPI (n = 310; male = 166; age = 70; CKD = 111; low/intermediate/high pretest probability = 17/194/99) and were followed for 24 months. Cardiovascular events included cardiac death and nonfatal acute coronary syndrome. Cardiovascular events occurred in 15 of the 310 patients (4.8 %), but not in those with low pretest probability which included 2 CKD patients. In patients with intermediate to high pretest probability (n = 293), multivariate Cox regression analysis identified only CKD [hazard ratio (HR) = 4.88; P = 0.022) and summed stress score of stress MPI (HR = 1.50; P probability. In patients with intermediate to high pretest probability, CKD and stress MPI are independent predictors of cardiovascular events considering the pretest probability of CAD in patients with no history of CAD. In assessing pretest probability of CAD, CKD might be an important factor for assessing future cardiovascular prognosis.

  7. Differences of cardiac output measurements by open-circuit acetylene uptake in pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension: a cohort study

    Directory of Open Access Journals (Sweden)

    Schwaiblmair Martin

    2012-03-01

    Full Text Available Abstract Background As differences in gas exchange between pulmonary arterial hypertension (PAH and chronic thromboembolic pulmonary hypertension (CTEPH have been demonstrated, we asked if cardiac output measurements determined by acetylene (C2H2 uptake significantly differed in these diseases when compared to the thermodilution technique. Method Single-breath open-circuit C2H2 uptake, thermodilution, and cardiopulmonary exercise testing were performed in 72 PAH and 32 CTEPH patients. Results In PAH patients the results for cardiac output obtained by the two methods showed an acceptable agreement with a mean difference of -0.16 L/min (95% CI -2.64 to 2.32 L/min. In contrast, the agreement was poorer in the CTEPH group with the difference being -0.56 L/min (95% CI -4.96 to 3.84 L/min. Functional dead space ventilation (44.5 ± 1.6 vs. 32.2 ± 1.4%, p 2 gradient (9.9 ± 0.8 vs. 4.1 ± 0.5 mmHg, p Conclusion Cardiac output evaluation by the C2H2 technique should be interpreted with caution in CTEPH, as ventilation to perfusion mismatching might be more relevant than in PAH.

  8. The System of Neutrophil Elastase and the Plasma Level of MMP-7 in Children with Pulmonary Arterial Hypertension and Chronic Cor Pulmonale

    Directory of Open Access Journals (Sweden)

    Еlena M. Vasilyeva

    2014-03-01

    Full Text Available A significant increase in the activity of neutrophil elastase (NE and anti-NE-protection in the plasma were detected in children having bronchopulmonary dysplasia (BPD complicated by pulmonary arterial hypertension (PAH and chronic cor pulmonale (CCP. The changes revealed were more pronounced in patients with CCP. The plasma concentration of the NE was slightly reduced, which was probably associated with the activation of anti-NE and an increase in the α1-antitrypsin level. A gradual increase was noted in the plasma level of the matrix metalloproteinase-7 (MMP-7 in patients with an increase in the severity of the condition. In patients with cystic fibrosis (with and without CCP, the pronounced increase in the MMP-7 level was observed. In patients with cystic fibrosis (CF, even without the additional complication with PAH and CCP, the MMP-7 level was significantly higher than in those with congenital broncho-pulmonary malformations (CBPM. The difference was increased in those patients with PAH and reached a maximum in those with CCP.

  9. 慢性大脑中动脉狭窄或闭塞的CT灌注成像%CT perfusion imaging in patients with chronic middle cerebral artery stenosis or occlusion

    Institute of Scientific and Technical Information of China (English)

    苏凯燕; 刘增韬

    2012-01-01

    Objective To evaluate the blood perfusion character of chronic middle cerebral artery stenosis or occlusion with CT perfusion imaging. Methods The clinical and imaging dala of 11 cases with unilateral chronic middle cerebral artery stenosis or occlusion were collected. All cases were examined with CT perfusion and MR (MR1 and MKA). Results The CT perfusion character of chronic middle cerebral artery stenosis or occlusion included CBV elevated, CBF decreased, and MTI prolonged. Conclusion CT perfusion imaging can describe the blood perfusion character of chronic middle cerebral artery stenosis or occlusion, and provide theoretical basis for therapeutic plan.%目的 利用CT灌注成像技术研究慢性大动脉狭窄或闭塞患者的脑血流灌注特征.方法 搜集具有完整临床资料的单侧慢性大脑中动脉重度狭窄或闭寨患者11例,行CT灌注成像及磁共振(MRI及MRA)检查.结果 慢性大脑中动脉狭窄或闭塞患者的脑CT灌注特征是患侧脑血流量(CBF)降低,脑血容量(CBV)升高,平均通过时间(MTT)延长.结论 CT灌注成像能反映慢性大脑中动脉狭窄或闭塞患者的脑血流灌注特征,为临床治疗方案的制订提供理论依据.

  10. The total flavonoids extracted from Xiaobuxin Tang reverse the hyperactivity of hypothalamic-pituitary-adrenal axis in chronically stressed rats

    Institute of Scientific and Technical Information of China (English)

    AN Lei; ZHANG You-zhi

    2008-01-01

    Objective To investigate the effect of XBXT-2 on the activity of hypothalamic-pituitary-adrenal (HPA) axis in chronic mild stress (CMS) model of rats. Methods Using ELISA to test the serum corticos-terone, adrenocorticotropic hormone (ACTH) and corticotropin-releasing hormone (CRH) level in CMS rats; Using western blot to determine hippocampal glucocorticoids receptors (GR) expression in CMS rats. Results Co-administration of XBXT-2 (25, 50 mg·kg-1, p. o., 28 days, the effective doses for behavioral responses) significantly decreased the serum corticosterone and ACTH level in CMS rats, while the CRH level was not markedly affected by chronic stress or drugs. Moreover, XBXT-2 significantly increased the GR expression in the hippocampus of CMS rats. The same effects were observed in the positive control drug imipramine ( 10 mg·kg-1 p. o. ). Conclusions The decrease of serum corticosterone and ACTH level, as well as the increase of hippocampal GR expression may be the mechanisms underlying the antidepressant action of XBXT-2, which may associate with HPA axis.

  11. Transradial artery coronary angioplasty.

    Science.gov (United States)

    Kiemeneij, F; Laarman, G J; de Melker, E

    1995-01-01

    This study explored the feasibility and safety of percutaneous coronary balloon angioplasty (PTCA) with miniaturized PTCA equipment via the radial artery. Coronary angioplasty (PTCA) via the femoral or brachial arteries may be associated with rare vascular complications such as bleeding and damage to the artery and adjacent structures. It was postulated that PTCA via the radial artery with miniaturized angioplasty equipment is feasible and that no major puncture site-related complications occur because hemostasis is obtained easily and because no major structures are near the radial artery. With double blood supply to the hand, radial artery occlusion is well tolerated. In 100 patients with collateral blood supply to the right hand, PTCA was attempted with 6F guiding catheters and rapid-exchange balloon catheters for exertional angina (87 patients) or nonexertional angina (13 patients). Angioplasty was attempted in 122 lesions (type A n = 67 [55%], Type B n = 37 [30%], and type C n = 18 [15%]). Pre- and post-PTCA computerized quantitative coronary analysis was performed. Radial artery function and structure were assessed clinically and with Doppler and two-dimensional ultrasound on the day of discharge. Coronary catheterization via the radial artery was successful in 94 patients (94%). The 6 remaining patients had successful PTCA via the femoral artery (n = 5) or the brachial artery (n = 1). Procedural success (120 of 122 lesions) was achieved in 92 patients (98%) via the radial artery and in 98 patients of the total study population.(ABSTRACT TRUNCATED AT 250 WORDS)

  12. Changes of Serum Total and Free Testosterone Concentrations in Male Chronic Hemodialysis Patients with Secondary Hyperparathyroidism in Response to Cinacalcet Treatment

    Directory of Open Access Journals (Sweden)

    Piotr Kuczera

    2016-01-01

    Full Text Available Background/Aims: Calcium sensing receptor (CaSR is expressed, among others also in testis. Cinacalcet binds to the CaSR, increases sensitivity of CaSR to serum calcium and is used in the treatment of secondary hyperparathyroidism (sHPT in chronic hemodialysis patients (HDP. In most of male HDP, serum testosterone concentration is lower than in healthy males. The aim of this study was to assess the influence of six-month treatment with cinacalcet on the serum total and free testosterone concentration in male HDP with sHPT. Methods: 38 male, hemodialysed CKD patients with sHPT (PTH>300 pg/ml were enrolled into the study. In each patient serum PTH, total testosterone (TT and free testosterone (FT concentrations were assessed before the first dose of cinacalcet and then after 3 and 6 months of treatment. The results are presented as means with 95% confidence interval. Results: In 33 patients who completed the study cinacalcet treatment caused significant decrease of serum PTH from 1143 pg/ml (828 - 1458 pg/ml at the baseline, to 809 pg/ml (487 - 1132pg/ml after 3 month of treatment (p = 0.002, and to 607 pg/ml (281 - 934pg/ml; p Conclusion: Treatment with cinacalcet decreases serum total and free testosterone concentration in male hemodialysed patients with chronic kidney disease and secondary hyperparathyroidism.

  13. Correlation between total nitrite/nitrate concentrations and monoamine oxidase (types A and B) and semicarbazide-sensitive amine oxidase enzymatic activities in human mesenteric arteries from non-diabetic and type 2 diabetic patients

    Energy Technology Data Exchange (ETDEWEB)

    Nunes, S.F.; Figueiredo, I.V. [Laboratório de Farmacologia, Faculdade de Farmácia, Universidade de Coimbra, Coimbra (Portugal); Pereira, J.S. [Instituto Português de Oncologia de Coimbra, Coimbra (Portugal); Lopes, M.C.; Caramona, M.M. [Laboratório de Farmacologia, Faculdade de Farmácia, Universidade de Coimbra, Coimbra (Portugal)

    2011-11-25

    The aim of this study was to determine the correlation between total nitrite/nitrate concentrations (NOx) and the kinetic parameters of monoamine oxidase enzymes (MAO-A and MAO-B) and semicarbazide-sensitive amine oxidase (SSAO) in human mesenteric arteries. Arteries were from non-diabetic and type 2 diabetic patients with sigmoid or rectum carcinoma for whom surgery was the first option and who were not exposed to neo-adjuvant therapy. Segments of human inferior mesenteric arteries from non-diabetic (61.1 ± 8.9 years old, 7 males and 5 females, N = 12) and type 2 diabetic patients (65.8 ± 6.2 years old, 8 males and 4 females, N = 12) were used to determine NOx concentrations and the kinetic parameters of MAO-A, MAO-B and SSAO by the Griess reaction and by radiochemical assay, respectively. The NOx concentrations in arteries from diabetic patients did not differ significantly from those of the non-diabetic group (10.28 ± 4.61 vs 10.71 ± 4.32 nmol/mg protein, respectively). In the non-diabetic group, there was a positive correlation between NOx concentrations and MAO-B parameters: K{sub m} (r = 0.612, P = 0.034) and V{sub max} (r = 0.593, P = 0.042), and a negative correlation with the SSAO parameters: K{sub m} (r = -0.625, P = 0.029) and V{sub max} (r = -0.754, P = 0.005). However, in the diabetic group no correlation was found between NOx concentrations and the three kinetic parameters of the enzymes. These results suggest an important function of sympathetic nerves and vascular NOx concentrations in arteries of non-diabetic patients. Thus, these results confirm the importance of a balance between oxidants and antioxidants in the maintenance of vascular homeostasis to prevent oxidative stress.

  14. The Difficulties in Determining Time of the Operation in the Total Corrected Transposition of the Great Arteries with Severe Left AV Valve Regurgitation: Case Report

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    Erden İ et al.

    2010-03-01

    Full Text Available Congenitally corrected transposition of the great arteries (L-TGA is characterized by discordance between the atria and ventricles, as well as between the ventricles and the great arteries. As a result, the morphologic right ventricle lies to the left of the morphologic left ventricle and becomes the systemic ventricle. The morphologic right ventricle gives rise to the aorta, which is anterior of the pulmonary artery. As a result of discordance at both the atrioventricular (AV and the great vessel level, physiologic blood flow remains normal. It was shown that the decreased RV functions are related with increased mortality rates in long term follow up. Most of these patients have RV failure due to abnormal pressure load of systemic RV, imbalance between O2 supply and myocardial demand and development of systemic AV valvular regurgitation in most of the patients. Therefore, the most important and difficult point in the follow up of these patients is evaluation of RV functions and degree of systemic AV valve regurgitation. In this review, we discussed the difficulties in the diagnosis and treatment of these patients in the light of a typical TGA case.

  15. Transversal escharotomies: a new surgical technique adjuvant in the treatment of chronic ulcers with non-arterial etiology in the lower limbs Escarotomias transversais: uma nova opção cirúrgica adjuvante no tratamento de úlceras crônicas de etiologia não arterial em membros inferiores

    OpenAIRE

    2006-01-01

    PURPOSE: Propose a new and alternative surgical procedure in order to aid on treatments of chronic ulcers with non-arterial etiology in the lower limbs, especially those that reoccurs and accomplish of dermatosclerosis and skin contractures determining ankle and foot limits. METHODS: It describes a medical case regarding a female, 54 years old, with a pre-existing ulcer (sixteen years) on her left leg. Despite of conventional treatments such as curatives, compressive therapy and surgeries, th...

  16. Subintimal TRAnscatheter Withdrawal (STRAW) of hematomas compressing the distal true lumen: a novel technique to facilitate distal reentry during recanalization of chronic total occlusion (CTO).

    Science.gov (United States)

    Smith, Elliot J; Di Mario, Carlo; Spratt, James C; Hanratty, Colm G; de Silva, Ranil; Lindsay, Alistair C; Grantham, J Aaron

    2015-01-01

    The development of a large hematoma impairing visualization of the distal true lumen is a recognized complication of antegrade recanalization of chronic total occlusions, often forcing the operator to abort the procedure or switch to a retrograde approach. We describe a novel technique utilizing an over-the-wire balloon inflated in the proximal occluded vessel to block inflow and allow aspiration of the blood from the subintimal space. This decompressed the true lumen, restored distal visualization, and allowed successful reentry using a dedicated technology. Utilization of this novel technique may rescue antegrade recanalization attempts complicated by large subintimal hematomas.

  17. Bioresorbable vascular scaffold (BVS) for in-stent chronic total occlusion: Antegrade recanalization and IVUS-guided BVS implantation by radial access

    Energy Technology Data Exchange (ETDEWEB)

    Medda, Massimo [Interventional Cardiology Unit, Istituto Clinico Sant' Ambrogio, Milano (Italy); Casilli, Francesco, E-mail: frcasill@tin.it [Interventional Cardiology Unit, Istituto Clinico Sant' Ambrogio, Milano (Italy); Bande, Marta [Interventional Cardiology Unit, Istituto Clinico Sant' Ambrogio, Milano (Italy); Latini, Maria Giulia [Cardiologia Interventistica, IRCCS Policlinico San Donato, San Donato Milanese, Milano (Italy); Ghommidh, Mehdi [Interventional Cardiology Unit, Istituto Clinico Sant' Ambrogio, Milano (Italy); Del Furia, Francesca [Unità Operativa di Cardiologia, Azienda Ospedaliera di Melegnano, Milano (Italy); Inglese, Luigi [Interventistica Cardiovascolare, Gruppo Sanitario Policlinico di Monza, Milano (Italy)

    2016-01-15

    The completely absorbable stents represent one of the latest innovations in the field of interventional cardiology, prospecting the possibility of “vascular repair”. In the published trials (ABSORB Cohort A and B, ABSORB EXTEND, and ABSORB II, III and IV) chronic total occlusions (CTOs) were considered an exclusion criteria. More recently the CTO-ABSORB pilot study demonstrated the safety and feasibility of bioresorbable vascular scaffold (BVS) use in case of CTO recanalization. We present the first case, to our knowledge, of in-stent occlusion successfully treated with an everolimus-eluting BVS and discuss its potential advantages in such kind of lesions.

  18. Chronicity of Challenging Behaviours in People with Severe Intellectual Disabilities and/or Autism: A Total Population Sample

    Science.gov (United States)

    Murphy, Glynis H.; Beadle-Brown, Julie; Wing, Lorna; Gould, Judy; Shah, Amitta; Nan, Holmes

    2005-01-01

    The skills, social impairments and challenging behaviours of a total population of 166 children, with severe intellectual disabilities and/or autism, were assessed through interview with the main carers, when the children were under 15 years old (time 1). Twelve years later, 141 of these individuals were re-assessed, using the same measures (time…

  19. Comparison of outcomes of allogeneic transplantation for chronic myeloid leukemia with cyclophosphamide in combination with intravenous busulfan, oral busulfan, or total body irradiation.

    Science.gov (United States)

    Copelan, Edward A; Avalos, Belinda R; Ahn, Kwang Woo; Zhu, Xiaochun; Gale, Robert Peter; Grunwald, Michael R; Hamadani, Mehdi; Hamilton, Betty K; Hale, Gregory A; Marks, David I; Waller, Edmund K; Savani, Bipin N; Costa, Luciano J; Ramanathan, Muthalagu; Cahn, Jean-Yves; Khoury, H Jean; Weisdorf, Daniel J; Inamoto, Yoshihiro; Kamble, Rammurti T; Schouten, Harry C; Wirk, Baldeep; Litzow, Mark R; Aljurf, Mahmoud D; van Besien, Koen W; Ustun, Celalettin; Bolwell, Brian J; Bredeson, Christopher N; Fasan, Omotayo; Ghosh, Nilanjan; Horowitz, Mary M; Arora, Mukta; Szer, Jeffrey; Loren, Alison W; Alyea, Edwin P; Cortes, Jorge; Maziarz, Richard T; Kalaycio, Matt E; Saber, Wael

    2015-03-01

    Cyclophosphamide (Cy) in combination with busulfan (Bu) or total body irradiation (TBI) is the most commonly used myeloablative conditioning regimen in patients with chronic myeloid leukemia (CML). We used data from the Center for International Bone Marrow Transplantation Research to compare outcomes in adults who underwent hematopoietic cell transplantation for CML in first chronic phase after myeloablative conditioning with Cy in combination with TBI, oral Bu, or intravenous (i.v.) Bu. Four hundred thirty-eight adults received human leukocyte antigen (HLA)-matched sibling grafts and 235 received well-matched grafts from unrelated donors (URD) from 2000 through 2006. Important differences existed between the groups in distribution of donor relation, exposure to tyrosine kinase inhibitors, and year of transplantation. In multivariate analysis, relapse occurred less frequently among patients receiving i.v. Bu compared with TBI (relative risk [RR], .36; P = .022) or oral Bu (RR, .39; P = .028), but nonrelapse mortality and survival were similar. A significant interaction was detected between donor relation and the main effect in leukemia-free survival (LFS). Among recipients of HLA-identical sibling grafts, but not URD grafts, LFS was better in patients receiving i.v. Bu (RR, .53; P = .025) or oral Bu (RR, .64; P = .017) compared with TBI. In CML in first chronic phase, Cy in combination with i.v. Bu was associated with less relapse than TBI or oral Bu. LFS was better after i.v. or oral Bu compared with TBI.

  20. Detecting Carotid Artery and Radial Artery of Chronic Kidney Disease Patients by Echo-tracking Technique%血管回声跟踪技术检测慢性肾脏病患者颈总动脉及桡动脉弹性变化

    Institute of Scientific and Technical Information of China (English)

    郭卫东; 白亚玲; 张晓玲; 赵刚; 徐金生; 杨漪

    2011-01-01

    Objective To investigate the value of echo-tracking technique detecting carotid artery and radial artery elasticity of CKD patients. Methods Carotid artery and radial artery elasticity changes of 100 chronic kidney disease patients and normal control group were detected by ultrasound echo-tracking(ET) technique. The elasticity of different arteries and changing laws of chronic kidney patients were analyzed. Results (l)With the progression of disease course, Stiffness parameter (β) of ET technique, vascular pressure-strain elasticty modulus (Ep), one-point pulse wave velocity (PWVβ) gradually increased. Arterial compliance( AC) showed a decreasing tendency. (2)There were statistical differences (P<0. 05) in β, Ep, PWVβ, AC changes of RA in the mild group and moderate group. Only PWVβ of CCA in the moderate group and the mild group had statistical difference (P<0. 05). Β, Ep、 AC had, statistical differences (P<0. 05) only in the severe group. Conclusions ET technique can accurately detect early changes in arterial elasticity of CKD patients. RA have significant changes in the moderate group (CKD3), which occurs earlier than CCA parameters. It is indicated that muscular peripheral artery may be the sensitive indicators in reflecting the early changes of arterial elasticity.%目的 探讨血管回声跟踪技术检测慢性肾脏病(chronic kidney disease,CKD)患者颈总动脉(common carotid artery,CCA)和桡动脉(radial artery,RA)弹性的意义.方法 应用超声血管回声跟踪(echo-tracking,ET)技术检测100例各期CKD患者CCA及RA弹性的变化,并与正常对照组比较,分析不同部位动脉间弹性变化的差异,以及评价CKD患者的变化规律.结果 (1)随患者病程发展,参数僵硬度指数(stiffness parameter,β),血管压力-应变弹性系数(pressure-strain elastictymodulus,Ep),点脉搏波传导速度(one-point pulse wave velocity,PWVβ)呈逐渐增大变化,顺应性(arterial compliance,AC)呈逐渐减小趋势.(2)按照

  1. Isolated superior mesenteric artery dissection

    Directory of Open Access Journals (Sweden)

    Lalitha Palle

    2010-01-01

    Full Text Available Isolated superior mesenteric artery (SMA dissection without involvement of the aorta and the SMA origin is unusual. We present a case of an elderly gentleman who had chronic abdominal pain, worse after meals. CT angiography, performed on a 64-slice CT scanner, revealed SMA dissection with a thrombus. A large artery of Drummond was also seen. The patient was managed conservatively.

  2. Effect of Late Revascularization of a Totally Occluded Coronary Artery After Myocardial Infarction on Mortality Rates in Patients with Renal Impairment

    Science.gov (United States)

    Hastings, Ramin; Hochman, Judith S.; Dzavik, Vladimir; Lamas, Gervasio A.; Forman, Sandra A.; Schiele, Francois; Michalis, Lampros K.; Nikas, Dimitris; Jaroch, Joanna; Reynolds, Harmony R.

    2012-01-01

    Renal dysfunction is an independent predictor of cardiovascular events and a negative prognostic indicator after myocardial infarction (MI). Randomized data comparing percutaneous coronary intervention (PCI) to medical therapy in MI patients with renal insufficiency are needed. The Occluded Artery Trial (OAT) compared optimal medical therapy alone to PCI with optimal medical therapy in 2201 high risk patients with an occluded infarct artery >24 hours post-MI with serum creatinine ≤2.5 mg/dl. The primary endpoint was a composite of death, MI, and class IV heart failure (HF). Analyses were carried out utilizing estimated glomerular filtration rates (eGFR) as a continuous variable and by eGFR categories. Long term follow up data (maximum 9 years) were used for this analysis. Lower eGFR (ml/min/1.73m2) was associated with development of the primary outcome (6-year life-table rate 16.9% in eGFR>90; 19.2% in eGFR 60–89; 34.9% in eGFR<60; p-value <0.0001), death, and class IV HF, with no difference in rates of reinfarction. On multivariable analysis, eGFR was an independent predictor of death and HF. There was no effect of treatment assignment on the primary endpoint regardless of eGFR, and there was no significant interaction between eGFR and treatment assignment on any outcome. In conclusion, lower eGFR at enrollment was independently associated with death and HF in OAT participants. Despite this increased risk, the lack of benefit from PCI in the overall trial was also seen in patients with renal dysfunction and persistent occlusion of the infarct artery in the subacute phase post MI. PMID:22728005

  3. Assessment of myocardial perfusion and viability with technetium-99m methoxyisobutylisonitrile and thallium-201 rest redistribution in chronic coronary artery disease

    Energy Technology Data Exchange (ETDEWEB)

    Rosetti, C. [INB-CNR, University of Milan, Institute H San Raffaele (Italy); Landoni, C. [INB-CNR, University of Milan, Institute H San Raffaele (Italy); Lucignani, G. [INB-CNR, University of Milan, Institute H San Raffaele (Italy); Huang, G. [INB-CNR, University of Milan, Institute H San Raffaele (Italy); Bartorelli, A.L. [Institute of Cardiology, University of Milan, CNR, `I. Monzino` Foundation (Italy); Guazzi, M.D. [Institute of Cardiology, University of Milan, CNR, `I. Monzino` Foundation (Italy); Margonato, A. [INB-CNR, University of Milan, Institute H San Raffaele (Italy); Chierchia, S. [INB-CNR, University of Milan, Institute H San Raffaele (Italy); Galli, L. [INB-CNR, University of Milan, Institute H San Raffaele (Italy); Savi, A. [INB-CNR, University of Milan, Institute H San Raffaele (Italy); Fazio, F. [INB-CNR, University of Milan, Institute H San Raffaele (Italy)

    1995-11-01

    We compare thallium-201 rest redistribution and fluorine-18 fluorodeoxyglucose ([{sup 18}F]FDG) for the assessment of myocardial viability within technetium-99m methoxyisobutylisonitrile (MIBI) perfusion defects in 27 patients with chronic stable coronary artery disease. The following studies were performed: (1) stress {sup 99m}Tc-MIBI, (2) rest {sup 99m}Tc-MIBI, (3) {sup 201}Tl rest-redistribution single-photon emission tomography, (4) [{sup 18}F]FDG positron emission tomography. The left ventricle was devided into 11 segments on matched tomographic images. The segment with the highest activity at stress was taken as the reference (activity = 100%). Perfusion defects at {sup 99m}Tc-MIBI rest were classified as severe (activity < 50%), moderate (activity 50%-60%) or mild (activity 60%-85%). Uptakes of [{sup 18}F]FDG and rest-redistributed {sup 201}Tl were recognized as significant if they exceeded 50% of that in the reference segment. Among the 33 segments with severe {sup 99m}Tc-MIBI rest perfusion defects, 21 had significant [{sup 18}F]FDG and 10 significant rest-redistributed {sup 201}Tl uptake. As regards the 37 segments with moderate defects, [{sup 18}F]FDG was present in 29 and {sup 201}Tl in 31, while of the 134 segments with mild defects, 128 showed [{sup 18}F]FDG uptake, and 131, {sup 201}Tl uptake. In conclusion, there is an inverse relationship between the severity of {sup 99m}Tc-MIBI perfusion defects and the uptake of rest-redistributed {sup 201}Tl and [{sup 18}F]FDG. Both tracers are adequate markers of viability in mild and moderate defects; in severe defects {sup 201}Tl might underestimate the presence of viability as assessed by [{sup 18}F]FDG. (orig.)

  4. ASSESSMENT OF THE CHANGES IN BLOOD PRESSURE CIRCADIAN PROFILE AND VARIABILITY IN PATIENTS WITH CHRONIC HEART FAILURE AND ARTERIAL HYPERTENSION DURING COMBINED THERAPY INCLUDING IVABRADINE

    Directory of Open Access Journals (Sweden)

    M. V. Surovtseva

    2015-12-01

    Full Text Available Aim. To assess the changes in blood pressure (BP circadian profile and variability in patients with chronic heart failure (CHF of ischemic etiology and arterial hypertension (HT due to the complex therapy including ivabradine. Material and methods. Patients (n=90 with CHF class II–III NYHA associated with stable angina II-III class and HT were examined. The patients were randomized into 3 groups depending on received drugs: perindopril and ivabradine - group 1; perindopril, bisoprolol and ivabradine - group 2; perindopril and bisoprolol - group 3. The duration of therapy was 6 months. Ambulatory BP monitoring (ABPM was assessed at baseline and after treatment. Results. More significant reduction in average 24-hours systolic BP was found in groups 1 and 2 compared to group 3 (Δ%: -19.4±0,4; -21.1±0.4 and -11.8±0.6, respectively as well as diastolic BP (Δ%: -10.6±0.6; -12.9±0.4 and -4,3±0.3, respectively and other ABPM indicators. Improvement of BP circadian rhythm was found due to increase in the number of «Dipper» patients (p=0.016. More significant reduction in average daily and night systolic and diastolic BP (p=0.001, as well as daily and night BP variability (p=0.001 was also found in patients of group 2 compared to these of group 1. Conclusion. Moderate antihypertensive effect (in respect of both diastolic and systolic BP was shown when ivabradine was included into the complex therapy of patients with ischemic CHF and HT. The effect was more pronounced when ivabradine was combined with perindopril and bisoprolol. This was accompanied by reduction in high BP daily variability and improvement of the BP circadian rhythm. 

  5. ASSESSMENT OF THE CHANGES IN BLOOD PRESSURE CIRCADIAN PROFILE AND VARIABILITY IN PATIENTS WITH CHRONIC HEART FAILURE AND ARTERIAL HYPERTENSION DURING COMBINED THERAPY INCLUDING IVABRADINE

    Directory of Open Access Journals (Sweden)

    M. V. Surovtseva

    2012-01-01

    Full Text Available Aim. To assess the changes in blood pressure (BP circadian profile and variability in patients with chronic heart failure (CHF of ischemic etiology and arterial hypertension (HT due to the complex therapy including ivabradine. Material and methods. Patients (n=90 with CHF class II–III NYHA associated with stable angina II-III class and HT were examined. The patients were randomized into 3 groups depending on received drugs: perindopril and ivabradine - group 1; perindopril, bisoprolol and ivabradine - group 2; perindopril and bisoprolol - group 3. The duration of therapy was 6 months. Ambulatory BP monitoring (ABPM was assessed at baseline and after treatment. Results. More significant reduction in average 24-hours systolic BP was found in groups 1 and 2 compared to group 3 (Δ%: -19.4±0,4; -21.1±0.4 and -11.8±0.6, respectively as well as diastolic BP (Δ%: -10.6±0.6; -12.9±0.4 and -4,3±0.3, respectively and other ABPM indicators. Improvement of BP circadian rhythm was found due to increase in the number of «Dipper» patients (p=0.016. More significant reduction in average daily and night systolic and diastolic BP (p=0.001, as well as daily and night BP variability (p=0.001 was also found in patients of group 2 compared to these of group 1. Conclusion. Moderate antihypertensive effect (in respect of both diastolic and systolic BP was shown when ivabradine was included into the complex therapy of patients with ischemic CHF and HT. The effect was more pronounced when ivabradine was combined with perindopril and bisoprolol. This was accompanied by reduction in high BP daily variability and improvement of the BP circadian rhythm. 

  6. CART and Reverse CART Technique in the Retrograde Percutaneous Coronary Intervention of Chronic Total Occlusion%CART和反向CART技术在逆向PCI中的应用

    Institute of Scientific and Technical Information of China (English)

    孙党辉; 李悦

    2011-01-01

    控制性正向-逆向内膜下寻径(CART)和反向CART技术是近年来慢性完全闭塞病变介入治疗重要的技术进展,大大提高了慢性完全闭塞病变经皮冠状动脉介入治疗(PCI)成功率.CART和反向CART技术的开展要求术者具有较丰富的正向PCI操作经验,根据自身技术能力、设备条件和患者病变特点合理选择恰当的PCI治疗技术.在血管内超声指导下反向CART技术的应用进一步提高了手术的成功率和安全性.%CART and reverse CART technique are considered as the important current techniques in percutaneous coronary interven-tion for chronic total occlusion, and have great improved success rates of the recanalization of the chronic total occlusion. IVUS-guided re-verse CART could further elevate the success rate and safety of CTO recanalization. Because of the learning-carve, the operator should per-form antegrade recanalization well first, and choose best way according to the skill of the operator,and the facilities and the lesion condition.

  7. Preoperative proteinuria is associated with long-term progression to chronic dialysis and mortality after coronary artery bypass grafting surgery.

    Directory of Open Access Journals (Sweden)

    Vin-Cent Wu

    Full Text Available AIMS: Preoperative proteinuria is associated with post-operative acute kidney injury (AKI, but whether it is also associated with increased long-term mortality and end-stage renal disease (ESRD is unknown. METHODS AND RESULTS: We studied 925 consecutive patients undergoing CABG. Demographic and clinical data were collected prospectively, and patients were followed for a median of 4.71 years after surgery. Proteinuria, according to dipstick tests, was defined as mild (trace to 1+ or heavy (2+ to 4+ according to the results of the dipstick test. A total of 276 (29.8% patients had mild proteinuria before surgery and 119 (12.9% patients had heavy proteinuria. During the follow-up, the Cox proportional hazards model demonstrated that heavy proteinuria (hazard ratio [HR], 27.17 was an independent predictor of long-term ESRD. There was a progressive increased risk for mild proteinuria ([HR], 1.88 and heavy proteinuria ([HR], 2.28 to predict all-cause mortality compared to no proteinuria. Mild ([HR], 2.57 and heavy proteinuria ([HR], 2.70 exhibited a stepwise increased ratio compared to patients without proteinuria for long-term composite catastrophic outcomes (mortality and ESRD, which were independent of the baseline GFR and postoperative acute kidney injury (AKI. CONCLUSION: Our study demonstrated that proteinuria is a powerful independent risk factor of long-term all-cause mortality and ESRD after CABG in addition to preoperative GFR and postoperative AKI. Our study demonstrated that proteinuria should be integrated into clinical risk prediction models for long-term outcomes after CABG. These results provide a high priority for future renal protective strategies and methods for post-operative CABG patients.

  8. 慢性胰腺炎CT影像解剖学分型及其临床意义%CT imaging-anatomy type of total 213 chronic pancreatitis and its clinical significance

    Institute of Scientific and Technical Information of China (English)

    陈盛; 王卫东; 汪华侨

    2011-01-01

    Objective To explore CT imaging-anatomy type of chronic pancreatitis and their clinical significance based on the CT characteristics of chronic pancreatitis. Methods In total 213 cases of chronic pancreatitis patiernts , 156 males and 57 females, with an average age of 48.0±11.5 years old and an average hospital day of 18.4±9.2 days were enrolles in the study.History of bile duct disease and acute pancreatitis were positive in 68 patients (32%) and 36 patients (17%) respectively. Non contrast enhanced and contrast enhanced CT scans were performed (with range from liver to kidney artery level). Results 69 cases (32.4%) showed whole pancreas atrophic. Pancreatic pseudocyst was shown in 3lcases (14.5%). Pancreatic duct occlusion or dilated can be seen in 56 cases ( 26.3%). 18 cases (8.5%) for the mass type , showed local soft tissue samples of pancreatic tumors and 39 cases (18.3%) were mixed. appearance of dilated pancreatic duct or bile duct with pancreatic mass or pseudocyst etc.Conclusion The CT manifestations of chronic pancreatitis can be classified into 5 types: atrophy type, pancreatic pseudocyst type, pancreatic duct occlusion or dilatation type, mass type and mixed hybrid type. The classification had certain significance for the differential diagnosis and the etiological analysis of chronic pancreatitis.%目的 根据慢性胰腺炎CT表现的不同,探讨慢性胰腺炎的CT影像解剖学分型及分型的意义.方法收集1996年1月至2009年1月入住我院经临床或手术证实的213例慢性胰腺炎患者,其中男性156例,女性57例,平均年龄为(48.0±11.5)岁;平均住院天数(18.4±9.2)d;胆系疾病68例(32%),反复发作急性胰腺炎36例(17%).常规肝胆脾胰平扫加增强(肝至肾动脉水平).结果 213例慢性胰腺炎患者中,有69例(32.4%)表现为全胰腺萎缩型,31例(14.5%)表现为假性囊肿型,56例(26.3%)表现为胰管闭塞或扩张,18例(8.5%)表现局限性胰腺

  9. Dry Needling Combined With Physical Therapy in Patients With Chronic Postsurgical Pain Following Total Knee Arthroplasty: A Case Series.

    Science.gov (United States)

    Núñez-Cortés, Rodrigo; Cruz-Montecinos, Carlos; Vásquez-Rosel, Álvaro; Paredes-Molina, Orlando; Cuesta-Vargas, Antonio

    2017-03-01

    Study Design Case series. Background This case series describes a combined program of dry needling and therapeutic exercise in a small group of patients with persistent pain following total knee arthroplasty (TKA). Case Description Fourteen patients who underwent TKA had persistent postsurgical pain and myofascial trigger points that were nonresponsive to treatment with conventional physical therapy and/or medication. The patients received a weekly dry needling treatment in combination with therapeutic exercises for 4 weeks. Pain perception was assessed preintervention and postintervention with a visual analog scale and function was assessed with the Western Ontario and McMaster Universities Osteoarthritis Index, 6-minute walk test, timed up-and-go test, 30-second chair-stand test, and knee joint range of motion. Outcomes After TKA, the patients had a mean ± SD symptom duration of 6.3 ± 3.1 months. Subsequent to dry needling, patients reported a significant mean ± SD decrease in pain intensity from 55.6 ± 6.6 to 19.3 ± 5.6 (POsteoarthritis Index scores from 10.1 ± 0.8 to 4.9 ± 1.0 for pain (PTherapy, level 4. J Orthop Sports Phys Ther 2017;47(3):209-216. Epub 3 Feb 2017. doi:10.2519/jospt.2017.7089.

  10. The 'SAFARI' Technique Using Retrograde Access Via Peroneal Artery Access

    Energy Technology Data Exchange (ETDEWEB)

    Zhuang, Kun Da, E-mail: zkunda@gmail.com [Singapore General Hospital, Interventional Radiology Centre (Singapore); Tan, Seck Guan [Singapore General Hospital, Department of General Surgery (Singapore); Tay, Kiang Hiong [Singapore General Hospital, Interventional Radiology Centre (Singapore)

    2012-08-15

    The 'SAFARI' technique or subintimal arterial flossing with antegrade-retrograde intervention is a method for recanalisation of chronic total occlusions (CTOs) when subintimal angioplasty fails. Retrograde access is usually obtained via the popliteal, distal anterior tibial artery (ATA)/dorsalis pedis (DP), or distal posterior tibial artery (PTA). Distal access via the peroneal artery has not been described and has a risk of continued bleeding, leading to compartment syndrome due to its deep location. We describe our experience in two patients with retrograde access via the peroneal artery and the use of balloon-assisted hemostasis for these retrograde punctures. This approach may potentially give more options for endovascular interventions in lower limb CTOs.

  11. Intracoronary artery transplantation of cardiomyoblast-like cells from human adipose tissue-derived multi-lineage progenitor cells improve left ventricular dysfunction and survival in a swine model of chronic myocardial infarction

    Energy Technology Data Exchange (ETDEWEB)

    Okura, Hanayuki [The Center for Medical Engineering and Informatics, Osaka University, 2-2 Yamada-oka, Suita, Osaka 565-0879 (Japan); Department of Somatic Stem Cell Therapy and Health Policy, Institute of Biomedical Research and Innovation, Foundation for Biomedical Research and Innovation, 2-2 Minatojima-minamimachi, Chuo-ku, Kobe, Hyogo 650-0047 (Japan); Saga, Ayami; Soeda, Mayumi [Department of Somatic Stem Cell Therapy and Health Policy, Institute of Biomedical Research and Innovation, Foundation for Biomedical Research and Innovation, 2-2 Minatojima-minamimachi, Chuo-ku, Kobe, Hyogo 650-0047 (Japan); Miyagawa, Shigeru; Sawa, Yoshiki [Department of Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka 565-0879 (Japan); Daimon, Takashi [Division of Biostatistics, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501 (Japan); Ichinose, Akihiro [Department of Plastic Surgery, Kobe University Hospital, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo (Japan); Matsuyama, Akifumi, E-mail: akifumi-matsuyama@umin.ac.jp [The Center for Medical Engineering and Informatics, Osaka University, 2-2 Yamada-oka, Suita, Osaka 565-0879 (Japan); Department of Plastic Surgery, Kobe University Hospital, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo (Japan); RIKEN Program for Drug Discovery and Medical Technology Platforms, 1-7-22 Suehiro-cho, Tsurumi-ku, Yokohama, Kanagawa 230-0045 (Japan)

    2012-09-07

    Highlights: Black-Right-Pointing-Pointer We administered human CLCs in a swine model of MI via intracoronary artery. Black-Right-Pointing-Pointer Histological studies demonstrated engraftment of hCLCs into the scarred myocardium. Black-Right-Pointing-Pointer Echocardiography showed rescue of cardiac function in the hCLCs transplanted swine. Black-Right-Pointing-Pointer Transplantation of hCLCs is an effective therapeutics for cardiac regeneration. -- Abstract: Transplantation of human cardiomyoblast-like cells (hCLCs) from human adipose tissue-derived multi-lineage progenitor cells improved left ventricular function and survival of rats with myocardial infarction. Here we examined the effect of intracoronary artery transplantation of human CLCs in a swine model of chronic heart failure. Twenty-four pigs underwent balloon-occlusion of the first diagonal branch followed by reperfusion, with a second balloon-occlusion of the left ascending coronary artery 1 week later followed by reperfusion. Four weeks after the second occlusion/reperfusion, 17 of the 18 surviving animals with severe chronic MI (ejection fraction <35% by echocardiography) were immunosuppressed then randomly assigned to receive either intracoronary artery transplantation of hCLCs hADMPCs or placebo lactic Ringer's solution with heparin. Intracoronary artery transplantation was followed by the distribution of DiI-stained hCLCs into the scarred myocardial milieu. Echocardiography at post-transplant days 4 and 8 weeks showed rescue and maintenance of cardiac function in the hCLCs transplanted group, but not in the control animals, indicating myocardial functional recovery by hCLCs intracoronary transplantation. At 8 week post-transplantation, 7 of 8 hCLCs transplanted animals were still alive compared with only 1 of the 5 control (p = 0.0147). Histological studies at week 12 post-transplantation demonstrated engraftment of the pre DiI-stained hCLCs into the scarred myocardium and their expression of

  12. Artery by Neuropeptides

    Directory of Open Access Journals (Sweden)

    Esmeralda Sofia Costa Delgado

    2012-01-01

    Methods. Isolated rabbit eyes (n=12 were perfused in situ with tyrode through the external ophthalmic artery. Effects of intra-arterial injections of NPY 200 μg/ml (Group A; n=6 and VIP 200 μg/ml (Group B; n=6 on the recorded pressure were obtained. For statistical analysis, Student's paired t-test and Fast Fourier Transform were used. Results. Spontaneous oscillations were observed before any drug administration in the 12 rabbit models. NPY produced an increase in total vascular resistance and a higher frequency and amplitude of oscillations, while VIP evoked the opposite effects. Conclusions. This study provides evidence of vasomotion in basal conditions in rabbit external ophthalmic artery. Concerning drug effects, NPY increased arterial resistance and enhanced vasomotion while VIP produced opposite effects which demonstrates their profound influence in arterial vasomotion.

  13. Saudi experience in the management of pulmonary arterial hypertension; the outcome of PAH therapy with the exclusion of chronic parenteral prostacyclin

    Directory of Open Access Journals (Sweden)

    Majdy Idrees

    2015-01-01

    Full Text Available Aims: The purpose of this study is to present our center′s experience in managing patients with pulmonary arterial hypertension (PAH. The main objective is to describe patients′ management profile and treatment outcome. Methods: This study presents the results from a single pulmonary hypertension (PH specialized center in Saudi Arabia. Both incidence and prevalence cases are included. We have previously reported the clinical and physiological characteristics at the time of diagnosis for this cohort of patients. In this study, we describe the clinical management and the outcome of therapy in the same cohort, who were prospectively followed for a mean of 22 months. Results: A total of 107 patients were identified as having PAH. At the time of enrollment, 56.1% of patients were in modified New York Heart Association functional class (NYHA FC III and 16.8% were in IV. Phosphdiesterase-5 inhibitor was the most commonly used target therapy (82.2% followed by endothelin receptors antagonist (74.4%. Only five patients (4.7% were candidate to use calcium channel blockers. Seventy-nine patients (73.8 % received a combination nonparenteral target therapy. Thirty-one patients (28.9% died during the follow-up period. Modified NYHA FC III and IV patients, portopulmonary hypertension, heritable PAH, and PAH associated with connective tissue diseases had the highest mortality rate (P < 0.001. Conclusion: Our patients are detected at advanced stage of the disease, and thus the mortality is still unacceptably high. Advanced functional class at presentation and certain disease subgroups are associated with increased mortality.

  14. CT coronary angiography is feasible for the assessment of coronary artery disease in chronic dialysis patients, despite high average calcium scores.

    Directory of Open Access Journals (Sweden)

    Mihály K de Bie

    Full Text Available PURPOSE: Significant obstructive coronary artery disease (CAD is common in asymptomatic dialysis patients. Identifying these high risk patients is warranted and may improve the prognosis of this vulnerable patient group. Routine catheterization of incident dialysis patients has been proposed, but is considered too invasive. CT-angiography may therefore be more appropriate. However, extensive coronary calcification, often present in this patient group, might hamper adequate lumen evaluation. The objective of this study was to assess the feasibility of CT-angiography in this patient group. METHODS: For this analysis all patients currently participating in the ICD2 trial (ISRCTN20479861, with no history of PCI or CABG were included. The major epicardial vessels were evaluated on a segment basis (segment 1-3, 5-8, 11 and 13 by a team consisting of an interventional and an imaging specialist. Segments were scored as not significant, significant and not interpretable. RESULTS: A total of 70 dialysis patients, with a mean age of 66±8 yrs and predominantly male (70% were included. The median calcium score was 623 [79, 1619]. Over 90% of the analyzed segments were considered interpretable. The incidence of significant CAD on CT was 43% and was associated with cardiovascular events during follow-up. The incidence of cardiovascular events after 2-years follow-up: 36% vs. 0% in patients with no significant CAD (p<0.01. CONCLUSION: Despite the high calcium scores CT-angiography is feasible for the evaluation of the extent of CAD in dialysis patients. Moreover the presence of significant CAD on CT was associated with events during follow-up.

  15. Arterial Stiffness by Aerobic Exercise Is Related with Aerobic Capacity, Physical Activity Energy Expenditure and Total Fat but not with Insulin Sensitivity in Obese Female Patients with Type 2 Diabetes

    Directory of Open Access Journals (Sweden)

    Ji Yeon Jung

    2014-12-01

    Full Text Available BackgroundArterial stiffness is an important factor in atherosclerosis. Thus we examined whether aerobic exercise could reduce arterial stiffness in obese women with type 2 diabetes without diabetic complication.MethodsA total of 35 women with type 2 diabetes (body mass index, 26.6±2.8 kg/m2; age, 56.4±1.9 years; duration of diabetes, 4.7±4.8 years were assigned to aerobic exercise group (AEG or control group (CG. AEG completed a 12-week exercise program (3.6 to 5.2 metabolic equivalents, 3 day/week, 60 min/day, with their exercise activities monitored by accelerometers. We measured abdominal total fat area (TFA, visceral fat area (VFA, and subcutaneous fat area (SFA by computed tomography, insulin sensitivity by insulin tolerance test (KITT, and augmentation index (AIx by SphygmoCor at baseline and at the end of the 12-week program.ResultsThe AIx was improved in the AEG compared with the CG (P<0.001. The percent change of AIx had significant correlation with the improvement of physical activity energy expenditure (PAEE, aerobic capacity, TFA, and SFA (r=-0.416, P=0.013; r=0.560, P<0.001; r=0.489, P=0.003; r=0.531, P=0.001, respectively, but not with insulin sensitivity, energy intake, or VFA.ConclusionImprovement in aortic stiffness by aerobic exercise is related with the improvement of aerobic capacity, PAEE, and total fat but not with insulin sensitivity or energy intake in obese women with type 2 diabetes.

  16. Effect of total lymphoid irradiation on functional status in chronic multiple sclerosis: importance of lymphopenia early after treatment--the pros

    Energy Technology Data Exchange (ETDEWEB)

    Devereux, C.; Troiano, R.; Zito, G.; Devereux, R.B.; Kopecky, K.J.; Friedman, R.; Dowling, P.C.; Hafstein, M.P.; Rohowsky-Kochan, C.; Cook, S.D.

    1988-07-01

    To determine whether immunosuppression by total lymphoid irradiation (TLI) slowed deterioration of chronic progressive multiple sclerosis (MS), functional impairment score and blood lymphocyte counts were compared at 6-month intervals through 4 years following treatment of MS patients by either TLI (n = 27) or sham irradiation (n = 21). At each interval, 20 to 30% fewer TLI-treated patients had deteriorated (p less than 0.05 at 6, 12, and 18 months), and the difference in mean functional impairment score between groups became progressively greater (p less than 0.01 at 42 and 48 months). Benefit accrued principally to the 17 TLI-treated patients with absolute blood lymphocyte counts less than 900/mm3 3 months after treatment, whose mean functional impairment score remained within 0.6 units of baseline (p = NS), whereas the ten TLI patients with higher post-treatment lymphocyte counts had progressive deterioration (p less than 0.05 to p less than 0.001 versus TLI-treated patients with lower lymphocyte counts at all intervals except 30 months) and had deteriorated by more than 5 functional scale units by 42 and 48 months. Side effects were minor and complications rare in TLI-treated patients, but one TLI-treated patient developed staphylococcal sepsis. Thus, TLI slows deterioration of chronic progressive MS, with what appears to be enduring benefit through 4 years compartmented to patients with greater induced lymphopenia. Modification of lymphoid irradiation regimens to increase the proportion of MS patients who achieve a favorable degree of lymphopenia and to avert functional hyposplenism may further improve the benefit/risk ratio.

  17. Rituximab, fludarabine, and total body irradiation as conditioning regimen before allogeneic hematopoietic stem cell transplantation for advanced chronic lymphocytic leukemia: long-term prospective multicenter study.

    Science.gov (United States)

    Michallet, Mauricette; Socié, Gerard; Mohty, Mohamad; Sobh, Mohamad; Bay, Jacques-O; Morisset, Stéphane; Labussière-Wallet, Hélène; Tabrizi, Reza; Milpied, Noel; Bordigoni, Pierre; El-Cheikh, Jean; Blaise, Didier

    2013-02-01

    To evaluate the efficacy and toxicity of reduced-intensity conditioning (RIC) combining fludarabine, low-dose total body irradiation (TBI) and rituximab before allogeneic hematopoietic stem cell transplantation (allo-HSCT) from human leucocyte antigen (HLA) identical siblings, we conducted a prospective study in patients ≤65 years old with advanced chronic lymphocytic leukemia (CLL) stage B or C in response after a salvage treatment. Conditioning included rituximab (375 mg/m² on day 5), fludarabine (30 mg/m² from day 4 to day 2), TBI (2 Gy on day 0), and rituximab (500 mg/m² on days 1 and 8). Forty patients were included, 34 (85%) were male with a median age of 54 years (range, 35-65 years), 38 (95%) were in B stage, and 2 were in stage C; only 7 patients (17%) were in complete response. Seven (17%) patients did not receive rituximab. Thirty-nine (98%) patients engrafted, 17 patients developed acute graft-versus-host disease (GVHD) grade ≥II with a cumulative incidence at 3 months of 44% (36-52) with a significant protective effect of rituximab (p = 0.02). The cumulative incidence of chronic GVHD was 29% (21-36) at 12 months for both limited and extensive forms. The median overall survival was not reached with 5-years probability of 55% (41-74). The multivariate analysis showed a positive effect of rituximab on overall survival and event-free survival (hazard ratio [HR] = 0.1 [0-0.6], p = 0.02; and HR = 0.1 [0-0.4], p = 0.035, respectively). The association of fludarabine, TBI, and rituximab is feasible, well tolerated, and allows better outcomes in advanced CLL.

  18. Intestinal brucellosis associated with celiac artery and superior mesenteric artery stenosis and with ileum mucosa and submucosa thickening

    Science.gov (United States)

    Wang, Miaoqian; Zhu, Qingli; Yang, Qian; Li, Wenbo; Wang, Xinning; Liu, Wei; Zhou, Baotong; Li, Zhenghong; Yang, Hong

    2017-01-01

    Abstract Rationale: Brucellosis is a multisystem infection found worldwide that has a broad range of characteristics, which range from acute fever and hepatomegaly to chronic infections that most commonly affect the central nervous system, cardiovascular system, or skeletal system. Gastrointestinal and splanchnic artery involvements in brucellosis are relatively uncommon. Patient concerns: We report a case of brucellosis in an adolescent presenting as intermittent abdominal pain, diarrhea, and fever, with intestinal tract involvement. And stenosis of the celiac artery and the superior mesenteric artery was found after exposed to risk factors of Brucella infection. Splanchnic vessels stenosis and an endothelial lesion may exacerbate the prevalent symptom of abdominal pain, as a form of colic pain, occurring after eating. Diagnoses: The patient was diagnosed as brucellosis. The narrowing of the SMA and CA was suspected to be vasculitis secondary to the brucellosis. Interventions: The patient was treated with minocycline and rifampicin for 12 weeks totally. Outcomes: The gastrointestinal manifestations of brucellosis recovered rapidly under intensive treatment. However, follow-up imaging revealed that the superior mesenteric artery and celiac artery stenosis was unimproved. Lessons: In brucellosis, gastrointestinal manifestations may be the only observable features of the disease. Splanchnic arterial stenosis is a rare complication of brucellosis. Sonography and computed tomography may be useful for both diagnosis and follow-up. PMID:28079834

  19. Efectos crónicos de un programa de alargamiento pasivo sobre los valores de la presión arterial sanguinea y el estrés en adultos con hipertensión arterial. Chronics effects of a passive stretching program on the blood pressures and stress levels of hypertensions adults.

    Directory of Open Access Journals (Sweden)

    Bezerra da Silva, Elirez

    2007-07-01

    Full Text Available ResumenEl objetivo de este estudio fue analizar los efectos crónicos de un programa de alargamiento pasivo sobre la presión arterial sanguínea y estrés en adultos con hipertensión arterial. Participaron de este estudio, 12 personas de ambos sexos, con edad media de 52,12±5,5 años, sedentarios y con diagnóstico médico de hipertensión arterial. Las variables recolectadas para la realización de la investigación fueron la presión arterial sanguínea y el estrés de dichas personas. El tratamiento estadístico fue realizado por análisis descriptivos y análisis de inferencia. Los tests estadísticos de naturaleza comparativa fueron realizado a través de los análisis de variancia (ANOVA one-way yuxtapuesto con el test de Post hoc de Tukey, para identificar las posibles diferencias entre los datos de la presión arterial sanguínea. El test de Kruskal-Wallis fue usado para comparar las respuestas del cuestionario de estrés. Fue admitido el valor de pAbstractPurpose of this study was verifier the chronics effects of passive stretching programs on the stress and blood pressure levels of adults with arterial hypertension. 12 subjects of both gender, age average of 52,12 52,12±5,52 year, sedentary and with screening of arterial hypertension, volunteered to participate this study. The variables identified to the conduction of the respective study were the blood pressure, physical activity level and stress of the subjects. Statistic treatment was compost for descriptive and inferential analysis across of the variance analysis test (ANOVA two-way, concomitant with Post hoc test of Tukey, to estimate the differences in the average of the variables during the diverse moments of test. Kuskal-Wallis test was realized to compare the replies of the stress questionnaire. A value of p

  20. First reported revascularization of complex occlusion of the right coronary artery using the IVUS-guided reverse CART technique via a gastroepiploic artery graft.

    Science.gov (United States)

    Dai, Jian; Katoh, Osamu; Zhou, Hua; Kyo, Eisho

    2016-02-01

    When patients who have previously undergone coronary artery bypass graft surgery develop ischemia symptoms that cannot be controlled by optimal medical therapy, repeat revascularization is indicated. The revascularization strategy should be based on individual clinical and anatomical characteristics. We report here a challenging patient who presented with recurrent stable angina due to worsening of a proximal right coronary artery (RCA) stenosis to chronic total occlusion (CTO) after anastomosis of the right gastroepiploic artery (GEA) to the posterior descending artery. A soft guidewire was advanced through the right GEA collateral channel to the distal end of the CTO, but the dedicated CTO guidewires could not be advanced across the severely calcified CTO using the retrograde wire crossing or kissing wire techniques. The RCA was eventually revascularized by implantation of drug-eluting stents using the intravascular ultrasound-guided reverse controlled antegrade and retrograde subintimal tracking technique.

  1. Correlation of vitamin D deficiency and arterial stiffness in patients with chronic kidney disease%慢性肾脏病患者维生素D缺乏与动脉僵硬度的相关性

    Institute of Scientific and Technical Information of China (English)

    王来亮; 高燕红; 罗群

    2015-01-01

    目的 探讨慢性肾脏病患者维生素D缺乏与动脉僵硬度的相关性.方法 选取慢性肾脏病(CKD l~5期)患者300例,根据血25(OH)D3浓度分为维生素D缺乏组[25 (OH)D3<20 μg/L]和维生素D非缺乏组[25(OH)D3≥20 μg/L].采集临床资料数据,测定动脉僵硬度指标肱踝脉搏波传导速度(baPWV).对血25(OH)D3水平与baPWV间的关系进行单因素相关分析及多元线性回归分析. 结果 维生素D缺乏组188例(62.7%),维生素D非缺乏组112例(37.3%).全部CKD患者25(OH)D3平均浓度为(17.62±8.54) μg/L,维生素D缺乏组和非缺乏组分别为(12.38±4.55) μg/L与(26.44±6.05) μg/L(P<0.01).维生素D缺乏组baPWV值高于非缺乏组[(1 827.34±429.11) cm/s比(1 555.31±353.14) cm/s,P<0.01].单因素相关分析显示全体CKD患者(r=-0.38,P<0.01)以及CKD 2~5期患者[r=-0.30,P<0.05;r=-0.26,P<0.05;r=-0.46,P<0.01;r=-0.57,P<0.01]血25(OH)D3浓度与baPWV均呈负相关.多元线性回归分析显示血25 (OH)D3浓度下降与baPWV的增加独立相关(模型1:β=-0.18,P<0.01;模型2:β=-0.17,P=0.01),回归模型1与模型2均可解释baPWV变化的50%.结论 CKD患者普遍存在维生素D缺乏,维生素D缺乏与动脉僵硬度增加相关.维生素D替代治疗可能影响CKD患者的心血管预后,但有待未来研究的进一步明确.%Objective To evaluate the association between serum 25-hydroxyvitamin D3 [25 (OH)D3] and arterial stiffness in patients with chronic kidney disease (CKD).Methods Three hundred patients with CKD were included,and were divided into two groups based on serum 25(OH)D3 levels:vitamin D deficient [25(OH)D3 < 20 μg/L] and vitamin D non-deficient [25(OH)D3≥20 μg/L].Brachial ankle pulse wave velocity (baPWV),which reflected arterial stiffness,was calculated using the single-point method.Clinical data were collected in details.Correlation between serum 25(OH)D3 level and baPWV was assessed by the single factor correlation test and multiple

  2. A New Flow Control Technique Using Diluted Epinephrine in the N-butyl-2-cyanoacrylate Embolization of Visceral Artery Pseudoaneurysms Secondary to Chronic Pancreatitis

    Energy Technology Data Exchange (ETDEWEB)

    Morishita, Hiroyuki, E-mail: hmorif@koto.kpu-m.ac.jp [Japan Red Cross Kyoto Daiichi Hospital, Department of Diagnostic Radiology (Japan); Yamagami, Takuji [Kyoto Prefectural University of Medicine, Department of Radiology, Graduate School of Medical Science (Japan); Takeuchi, Yoshito [National Cancer Center, Division of Diagnostic Radiology (Japan); Matsumoto, Tomohiro; Asai, Shunsuke; Masui, Koji [Japan Red Cross Kyoto Daiichi Hospital, Department of Diagnostic Radiology (Japan); Sato, Hideki [Japan Red Cross Kyoto Daiichi Hospital, Department of Gastroenterology (Japan); Taniguchi, Fumihiro [Japan Red Cross Kyoto Daiichi Hospital, Department of Surgery (Japan); Sato, Osamu [Japan Red Cross Kyoto Daiichi Hospital, Department of Diagnostic Radiology (Japan); Nishimura, Tsunehiko [Kyoto Prefectural University of Medicine, Department of Radiology, Graduate School of Medical Science (Japan)

    2012-08-15

    Although n-butyl-2-cyanoacrylate (NBCA) has been used as an effective liquid embolization material, its indication for pseudoaneurysms has seemingly been limited because of the technical difficulties of using NBCA, such as reflux to the parent artery and causing significant infarction. Thus, considerable skill in using NBCA or a device to control blood flow during its polymerization is required to achieve embolization without severe complications. We report our new technique for controlling blood flow using diluted epinephrine in transcatheter arterial NBCA embolization of five pseudoaneurysms in four cases secondary to hemosuccus pancreaticus.

  3. Impact of lesion morphology on angiographic and clinical outcomes in patients with chronic total occlusion after recanalization with drug-eluting stents: a multislice computed tomography study

    Energy Technology Data Exchange (ETDEWEB)

    Ito, Tsuyoshi [Toyohashi Heart Center, Toyohashi (Japan); Nagoya City University Graduate School of Medical Sciences, Department of Cardio-Renal Medicine and Hypertension, Nagoya (Japan); Tsuchikane, Etsuo; Nasu, Kenya; Kimura, Masashi; Terashima, Mitsuyasu; Kinoshita, Yoshihisa; Habara, Maoto; Suzuki, Takahiko [Toyohashi Heart Center, Toyohashi (Japan); Suzuki, Yoriyasu; Ehara, Mariko [Nagoya Heart Center, Nagoya (Japan); Ohte, Nobuyuki [Nagoya City University Graduate School of Medical Sciences, Department of Cardio-Renal Medicine and Hypertension, Nagoya (Japan)

    2015-10-15

    The aim of this study was to investigate the multislice computed tomography (MSCT) parameters associated with adverse outcomes after chronic total occlusion percutaneous coronary intervention (CTO-PCI) with drug-eluting stents. A total of 285 patients who underwent MSCT before CTO-PCI were analyzed. Lesion morphology was assessed with MSCT. Angiographic restenosis, reocclusion, and MACE (a composite of cardiac death, myocardial infarction, stent thrombosis, and target lesion revascularization) were analyzed. MACE was observed in 36 patients (13.6 %). Occlusion length was greater (39.5 ± 19.9 mm vs. 22.3 ± 13.7 mm, p < 0.01), minimal vessel area smaller (11.2 ± 5.7 mm{sup 2} vs. 14.5 ± 5.6 mm{sup 2}, p < 0.01), and severe calcification more common (36 % vs. 12 %, p < 0.01) in the MACE group compared to the non-MACE group. We defined occluded length >25.4 mm, minimal vessel area <11.9 mm{sup 2}, which were identified by receiver operating characteristic analysis, and severe calcification as CT-derived risk factors. Angiographic restenosis (60 % vs. 12 % vs. 7 %, p < 0.01), reocclusion (29 % vs. 2 % vs. 2 %, p < 0.01), and MACE (43 % vs. 6 % vs. 3 %, p < 0.01) were more common in patients with 2 or more risk factors than in those with 1 or 0. MSCT characteristics associated with adverse outcomes after CTO-PCI were occlusion length, minimal vessel area, and severe calcification. (orig.)

  4. Platelet indices and platelet-to-lymphocyte ratio predict coronary chronic total occlusion in patients with acute ST-elevation myocardial infarction

    Directory of Open Access Journals (Sweden)

    Hadadi Laszlo

    2015-12-01

    Full Text Available Coronary chronic total occlusion (CTO is caused by organized thrombi or atherosclerotic plaque progression. The presence of a CTO is an independent predictor of mortality in patients presenting with ST-segment elevation myocardial infarction (STEMI. Platelets have a crucial role in the pathophysiology of atherosclerosis. The aim of this retrospective study was to investigate platelet indices as predictors of CTO in patients with STEMI treated with primary percutaneous coronary intervention (pPCI. A total number of 334 patients admitted for STEMI between January 2011 and December 2013 were included and divided in two groups based on the presence of CTO (48 patients in CTO+ group, 286 patients in CTO-group. Platelet count, mean platelet volume (MPV, platelet distribution width (PDW, platelet-large cell ratio (P-LCR, lymphocyte and neutrophil count determined on admission were analyzed. MPV was larger in patients with CTO compared with patients without CTO (p=0.02, as were PDW (p=0.03 and P-LCR (p=0.01. Platelet-to-lymphocyte ratio (PLT/LYM was lower in patients with CTO: 105.2 (75.86-159.1 compared to 137 (97-188.1, p<0.01. Receiver-operator characteristic curve analysis identified an area under the curve of 0.61 (95%CI=0.57-0.67, p< 0.01 for PLT/LYM in predicting the presence of a CTO, with a cut-off value at 97.73. Lower values than this were independent predictors of a CTO in multivariate logistic regression analysis, with an Odds Ratio of 2.2 (95%CI=1.15-4.20, p=0.02. Our results support the use of platelet indices and PLT/LYM as predictors of CTO in patients presenting with STEMI.

  5. Application of a snare technique in retrograde chronic total occlusion percutaneous coronary intervention - a step by step practical approach and an observational study.

    Science.gov (United States)

    Fang, Hsiu-Yu; Lee, Wei-Chieh; Fang, Chih-Yuan; Wu, Chiung-Jen

    2016-10-01

    Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) has recently become popular among interventional cardiologists. CTO originating from the ostium has been one of the most difficult CTO lesions to treat with PCI for a number of reasons. Our aim was to illustrate a specific technique during retrograde CTO PCI referred to as the "snare technique."We retrospectively examined the use of "snare technique" among 371 consecutive retrograde CTO PCIs performed at our institution between 2006 and 2015."Snare technique" was used in 10 patients among the 371 retrograde CTO PCIs. The baseline clinical and angiographic characteristics of patients with or without "snare technique" were similar. The "snare technique" group had significantly fewer side branches at occlusion (30.0% vs 71.2%, P = 0.01) and a higher incidence of externalization (90% vs 25.5%, P technique" group (285.0 ± 68.5 vs 379.2 ± 144.0, P = 0.04). The incidence of major complications, retrograde success, or final success did not differ between the groups.The "snare technique" is safe and feasible in retrograde CTO PCI, especially in cases of difficult coronary engagement in cases such as ostial occlusion, challenging coronary anatomy, or retrograde guidewire cannot get in antegrade guiding catheter.

  6. Application of a snare technique in retrograde chronic total occlusion percutaneous coronary intervention – a step by step practical approach and an observational study

    Science.gov (United States)

    Fang, Hsiu-Yu; Lee, Wei-Chieh; Fang, Chih-Yuan; Wu, Chiung-Jen

    2016-01-01

    Abstract Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) has recently become popular among interventional cardiologists. CTO originating from the ostium has been one of the most difficult CTO lesions to treat with PCI for a number of reasons. Our aim was to illustrate a specific technique during retrograde CTO PCI referred to as the “snare technique.” We retrospectively examined the use of “snare technique” among 371 consecutive retrograde CTO PCIs performed at our institution between 2006 and 2015. “Snare technique” was used in 10 patients among the 371 retrograde CTO PCIs. The baseline clinical and angiographic characteristics of patients with or without “snare technique” were similar. The “snare technique” group had significantly fewer side branches at occlusion (30.0% vs 71.2%, P = 0.01) and a higher incidence of externalization (90% vs 25.5%, P CTO PCI, especially in cases of difficult coronary engagement in cases such as ostial occlusion, challenging coronary anatomy, or retrograde guidewire cannot get in antegrade guiding catheter. PMID:27741138

  7. Acute arterial occlusion - kidney

    Science.gov (United States)

    Acute renal arterial thrombosis; Renal artery embolism; Acute renal artery occlusion; Embolism - renal artery ... kidney can often result in permanent kidney failure. Acute arterial occlusion of the renal artery can occur after injury or trauma to ...

  8. Lactate metabolism in chronic liver disease

    DEFF Research Database (Denmark)

    Jeppesen, Johanne B; Mortensen, Christian; Bendtsen, Flemming;

    2013-01-01

    Background. In the healthy liver there is a splanchnic net-uptake of lactate caused by gluconeogenesis. It has previously been shown that patients with acute liver failure in contrast have a splanchnic release of lactate caused by a combination of accelerated glycolysis in the splanchnic region...... and a reduction in hepatic gluconeogenesis. Aims. The aims of the present study were to investigate lactate metabolism and kinetics in patients with chronic liver disease compared with a control group with normal liver function. Methods. A total of 142 patients with chronic liver disease and 14 healthy controls...... underwent a liver vein catheterization. Blood samples from the femoral artery and the hepatic and renal veins were simultaneously collected before and after stimulation with galactose. Results. The fasting lactate levels, both in the hepatic vein and in the femoral artery, were higher in the patients than...

  9. Late reperfusion of a totally occluded infarct-related artery increases granulocyte-colony stimulation factor and reduces stroma-derived factor-1alpha blood levels in patients with ongoing ischemia after acute myocardial infarction.

    Science.gov (United States)

    Kuo, Li-Tang; Chen, Shih-Jen; Cherng, Wen-Jin; Yang, Ning-I; Lee, Chen-Chin; Cheng, Chi-Wen; Verma, Subodh; Wang, Chao-Hung

    2009-07-01

    After acute myocardial infarction (AMI), reopening of a totally occluded infarct-related artery (IRA) at a subacute stage is still controversial in symptom-free patients. However, in patients with persistent ischemic symptoms and inadequate collaterals to the infarct area, recanalization is thought to provide beneficial effects. In addition to augmenting myocardial perfusion, we hypothesized that the benefit of recanalization involves the manipulation of circulating stem cell-mobilizing cytokines. This study included 30 patients with a totally occluded IRA and ongoing ischemic symptoms (the study group) and 30 patients with a partially occluded IRA (the control group). All patients underwent successful angioplasty and/or stenting. Before and immediately after the coronary intervention, blood granulocyte-colony-stimulating factor (G-CSF), stem-cell factor (SCF), vascular endothelial growth factor (VEGF), and stroma-derived factor-1 (SDF-1alpha) were measured. After recanalization, G-CSF levels significantly increased in the study group compared to the control group (P=0.03). SDF-1alpha levels in the study group decreased relative to the controls (P=0.02). However, no significant changes in VEGF or SCF levels between the two groups were found. In the multivariate analysis, reopening of a totally occluded IRA was independently and significantly associated with changes in G-CSF and SDF-1alpha levels after recanalization. In conclusion, our data suggest that the benefits of late reperfusion of a totally occluded IRA in patients with ongoing myocardial ischemia may involve mechanisms associated with stem cell-mobilizing and plaque-stabilizing cytokines. This study provides the rationale to investigate serial changes in cytokines and the numbers of circulating progenitors after reperfusion in the future.

  10. Five-year outcomes of chronic total occlusion treatment with a biolimus A9-eluting biodegradable polymer stent versus a sirolimus-eluting permanent polymer stent in the LEADERS all-comers trial

    NARCIS (Netherlands)

    M. Ghione (Matteo); J.J. Wykrzykowska (Joanna); S. Windecker (Stephan); P.W.J.C. Serruys (Patrick); P.E. Buszman (Pawel); A. Linke (Axel); H.Y. Sohn (Hae Y); R. Corti (Roberto); M.L. Antoni (Louisa); W. Wijns (William); Estevez-Loureiro, R. (Rodrigo); M-C. Morice (Marie-Claude); G.A. van Es (Gerrit Anne); R.J.M. van Geuns (Robert Jan); P. Jùni (Peter); P. Eerdmans (Pedro); T. de Vries (Ton); Konik, S. (Stéphanie); C. di Mario (Carlo)

    2016-01-01

    textabstractBackground: Few data are available on long-term follow-up of drug-eluting stents in the treatment of chronic total occlusion (CTO). The LEADERS CTO sub-study compared the long-term results in CTO and non-CTO lesions of a Biolimus A9™-eluting stent (BES) with a sirolimus-eluting stent (SE

  11. Combining serum cystatin C with total bilirubin improves short-term mortality prediction in patients with HBV-related acute-on-chronic liver failure.

    Directory of Open Access Journals (Sweden)

    Zhihong Wan

    Full Text Available BACKGROUND & AIMS: HBV-related acute-on-chronic liver failure (HBV-ACLF is a severe liver disease which results in a high mortality in China. To early predict the prognosis of the patients may prevent the complications and improve the survival. This study was aimed to develop a new prognostic index to estimate the survival related to HBV-ACLF. METHODS: Consecutive patients with HBV-ACLF were included in a prospective observational study. Serum Cystatin C concentrations were measured by using the particle-enhanced immunonephelometry assay. All of the patients were followed for at least 3 months. Cox regression analysis was carried out to identify which factors were predictive of mortality. The area under the receiver operating characteristic curve (AUC was used to evaluate the efficacy of the variates for early predicting mortality. RESULTS: Seventy-two patients with HBV-ACLF were recruited between January 2012 and January 2013. Thirty patients died (41.7% during 3-months followed up. Cox multivariate regression analysis identified serum cystatin C (CysC and total bilirubin (TBil were independent factors significantly (P < 0.01 associated with survival. Our results further showed that new prognostic index (PI combining serum CysC with TBil was a good indicator for predicting the mortality of patients with HBV-ACLF. Specifically, the PI had a higher accuracy than the CTP, MELD, or MELD-Na scoring for early prediction short-term survival of HBV-ACLF patients with normal levels of serum creatinine (Cr. The survival rate in low risk group (PI < 3.91 was 94.3%, which was markedly higher than those in the high-risk group (PI ≥ 3.91 (17.4%, P < 0.001. CONCLUSION: We developed a new prognostic index combining serum CysC with TBil which early predicted the short-term mortality of HBV-ACLF patients.

  12. Inflammation Related MicroRNAs Are Modulated in Total Plasma and in Extracellular Vesicles from Rats with Chronic Ingestion of Sucrose

    Directory of Open Access Journals (Sweden)

    Malinalli Brianza-Padilla

    2016-01-01

    Full Text Available Circulating microRNAs (miRNAs and the functional implications of miRNAs contained in extracellular vesicles (EVs have gained attention in the last decade. Little is known about the regulation of the abundance of plasma miRNAs in response to chronic ingestion of carbohydrates. Therefore, we explored the circulating levels of miR-21, miR-146a, miR-155, and miR-223 in rats consuming sucrose in drinking water. Weanling Wistar rats were 25 weeks with 30% sucrose in drinking water, and miRNAs expression was determined in total plasma and in microvesicles, by RT-qPCR with TaqMan probe based assays for miR-21, miR-146a, miR-155, and miR-223, using cel-miR-39 (as spike in control and reference. Endotoxemia was also measured. Sucrose-fed animals showed higher body weight and retroperitoneal adipose tissue as well as higher glucose and triglyceride plasma levels than controls. Plasma endotoxin levels were low and not different among groups. Plasma miR-21 and miR-223 were higher in the sucrose group (p<0.05, whereas miR-155 tended to be lower (p=0.0661, and miR-146a did not show significant differences. In the plasma EVs the same trend was found except for miR-146a that showed significantly higher levels (p<0.05. Overall, our results show that high carbohydrate ingestion modulates circulating miRNAs levels related to an inflammatory response.

  13. First-Generation Versus Second-Generation Drug-Eluting Stents in Coronary Chronic Total Occlusions: Two-Year Results of a Multicenter Registry

    Science.gov (United States)

    Yu, Cheol Woong; Kim, Je Sang; Lee, Hyun Jong; Choi, Rak Kyeong; Kim, Tae Hoon; Jang, Ho Joon; Choi, Young Jin; Roh, Young Moo; Shim, Won-Heum; Song, Young Bin; Hahn, Joo-Yong; Choi, Jin-Ho; Lee, Sang Hoon; Gwon, Hyeon-Cheol; Choi, Seung-Hyuk

    2016-01-01

    Background Limited data are available regarding the long-term clinical outcomes of second-generation drug-eluting stents (DES) versus first-generation DES in patients with coronary chronic total occlusion (CTO) who undergo percutaneous coronary intervention (PCI). The aim of this study was to compare the clinical outcomes of second-generation DES with those of first-generation DES for the treatment of CTO. Methods and Results Between March 2003 and February 2012, 1,006 consecutive patients with CTO who underwent successful PCI using either first-generation DES (n = 557) or second-generation DES (n = 449) were enrolled in a multicenter, observational registry. Propensity-score matching was also performed. The primary outcome was cardiac death over a 2-year follow-up period. No significant differences were observed between the two groups regarding the incidence of cardiac death (first-generation DES versus second-generation DES; 2.5% vs 2.0%; hazard ratio [HR]: 0.86; 95% confidence interval [CI]: 0.37 to 1.98; p = 0.72) or major adverse cardiac events (MACE, 11.8% vs 11.4%; HR: 1.00; 95% CI: 0.67 to 1.50; p = 0.99). After propensity score matching, the incidences of cardiac death (HR: 0.86; 95% CI: 0.35 to 2.06; p = 0.86) and MACE (HR: 0.93; 95% CI: 0.63 to 1.37; p = 0.71) were still similar in both groups. Furthermore, no significant differences were observed between sirolimus-eluting, paclitaxel-eluting, zotarolimus-eluting, and everolimus-eluting stents regarding the incidence of cardiac death or MACE. Conclusion This study shows that the efficacy of second-generation DES is comparable to that of first-generation DES for treatment of CTO over 2 years of follow-up. PMID:27314589

  14. Inflammation Related MicroRNAs Are Modulated in Total Plasma and in Extracellular Vesicles from Rats with Chronic Ingestion of Sucrose

    Science.gov (United States)

    Brianza-Padilla, Malinalli; Carbó, Roxana; Arana, Julio C.; Vázquez-Palacios, Gonzalo; Ballinas-Verdugo, Martha A.; Cardoso-Saldaña, Guillermo C.; Palacio, Adán G.; Juárez-Vicuña, Yaneli; Sánchez, Fausto; Martínez-Martínez, Eduardo; Huang, Fengyang

    2016-01-01

    Circulating microRNAs (miRNAs) and the functional implications of miRNAs contained in extracellular vesicles (EVs) have gained attention in the last decade. Little is known about the regulation of the abundance of plasma miRNAs in response to chronic ingestion of carbohydrates. Therefore, we explored the circulating levels of miR-21, miR-146a, miR-155, and miR-223 in rats consuming sucrose in drinking water. Weanling Wistar rats were 25 weeks with 30% sucrose in drinking water, and miRNAs expression was determined in total plasma and in microvesicles, by RT-qPCR with TaqMan probe based assays for miR-21, miR-146a, miR-155, and miR-223, using cel-miR-39 (as spike in control and reference). Endotoxemia was also measured. Sucrose-fed animals showed higher body weight and retroperitoneal adipose tissue as well as higher glucose and triglyceride plasma levels than controls. Plasma endotoxin levels were low and not different among groups. Plasma miR-21 and miR-223 were higher in the sucrose group (p < 0.05), whereas miR-155 tended to be lower (p = 0.0661), and miR-146a did not show significant differences. In the plasma EVs the same trend was found except for miR-146a that showed significantly higher levels (p < 0.05). Overall, our results show that high carbohydrate ingestion modulates circulating miRNAs levels related to an inflammatory response. PMID:27999792

  15. Impact of Iodinated Contrast on Renal Function and Hemodynamics in Rats with Chronic Hyperglycemia and Chronic Kidney Disease.

    Science.gov (United States)

    Fernandes, Sheila Marques; Martins, Daniel Malisani; da Fonseca, Cassiane Dezoti; Watanabe, Mirian; Vattimo, Maria de Fátima Fernandes

    2016-01-01

    Iodinated contrast (IC) is clinically used in diagnostic and interventional procedures, but its use can result in contrast-induced acute kidney injury (CI-AKI). Chronic kidney disease (CKD) and chronic hyperglycemia (CH) are important predisposing factors to CI-AKI. The aim of this study was to investigate the impact of iodinated contrast on the renal function and hemodynamics in rats with chronic hyperglycemia and chronic kidney disease. A total of 30 rats were divided into six groups; Sham: control of chronic renal disease; Citrate: control of chronic hyperglycemia (CH); Nx5/6: rats with 5/6 nephrectomy; Chronic Hyperglycemia: rats receiving Streptozotocin 65 mg/kg; Nx5/6 + IC: rats Nx5/6 received 6 mL/kg of IC; CH + IC: Chronic hyperglycemia rats receiving 6 mL/kg of IC. Renal function (inulin clearance; urinary neutrophil gelatinase-associated lipocalin, NGAL) and hemodynamics (arterial blood pressure; renal blood flow; renal vascular resistance) were evaluated. Iodinated contrast significantly increased urinary NGAL and reduced inulin clearance, while the hemodynamics parameters showed changes in arterial blood pressure, renal blood flow, and renal vascular resistance in both CKD and CH groups. The results suggest that the iodinated contrast in risk factors models has important impact on renal function and hemodynamics. NGAL was confirmed to play a role of highlight in diagnosis of CI-AKI.

  16. Hepatitis C virus infection and risk of coronary artery disease

    DEFF Research Database (Denmark)

    Roed, Torsten; Lebech, Anne-Mette; Kjaer, Andreas;

    2012-01-01

    Several chronic infections have been associated with cardiovascular diseases, including Chlamydia pneumoniae, human immunodeficiency virus and viral hepatitis. This review evaluates the literature on the association between chronic hepatitis C virus (HCV) infection and the risk of coronary artery...

  17. Chronic deficit in nitric oxide elicits oxidative stress and augments T-type calcium-channel contribution to vascular tone of rodent arteries and arterioles

    DEFF Research Database (Denmark)

    Howitt, Lauren; Kuo, Ivana Y; Ellis, Anthie;

    2013-01-01

    AIMS: As cardiovascular disease is characterized by reduced nitric oxide bioavailability, our aim was to determine the impact of this change on the mechanism underlying vascular tone of pressurized arteries in vitro and in vivo. METHODS AND RESULTS: We used pressurized cerebral and mesenteric......, by regulating the bioavailability of reactive oxygen species produced by NADPH oxidase. Our data provide evidence for a novel causal link between nitric oxide deficit, oxidative stress, and T-type calcium channel function....

  18. Effectiveness of human atrial natriuretic peptide in patients with chronic kidney disease without dialysis undergoing coronary artery bypass grafting%人心房钠尿肽在患慢性肾病未经透析的患者冠状动脉移植术中的有效性

    Institute of Scientific and Technical Information of China (English)

    Isamu Yoshitake

    2010-01-01

    @@ Chronic kidney disease(CKD)is most important risk factors for cardiac surgery.In this study,the subjects were patients undergoing coronary artery bypass grafting(CABG)with CKD.Not only the early postoperative results but also the renal function including long-term prognosis were examined.

  19. Arterial Transit Time Mapping Obtained by Pulsed Continuous 3D ASL Imaging with Multiple Post-Label Delay Acquisitions: Comparative Study with PET-CBF in Patients with Chronic Occlusive Cerebrovascular Disease.

    Science.gov (United States)

    Tsujikawa, Tetsuya; Kimura, Hirohiko; Matsuda, Tsuyoshi; Fujiwara, Yasuhiro; Isozaki, Makoto; Kikuta, Ken-Ichiro; Okazawa, Hidehiko

    2016-01-01

    Arterial transit time (ATT) is most crucial for measuring absolute cerebral blood flow (CBF) by arterial spin labeling (ASL), a noninvasive magnetic resonance (MR) perfusion assessment technique, in patients with chronic occlusive cerebrovascular disease. We validated ASL-CBF and ASL-ATT maps calculated by pulsed continuous ASL (pCASL) with multiple post-label delay acquisitions in patients with occlusive cerebrovascular disease. Fifteen patients underwent MR scans, including pCASL, and positron emission tomography (PET) scans with 15O-water to obtain PET-CBF. MR acquisitions with different post-label delays (1.0, 1.5, 2.0, 2.5 and 3.0 sec) were also obtained for ATT correction. The theoretical framework of 2-compartmental model (2CM) was also used for the delay compensation. ASL-CBF and ASL-ATT were calculated based on the proposed 2CM, and the effect on the CBF values and the ATT correction characteristics were discussed. Linear regression analyses were performed both on pixel-by-pixel and region-of-interest bases in the middle cerebral artery (MCA) territory. There were significant correlations between ASL-CBF and PET-CBF both for voxel values (r = 0.74 ± 0.08, slope: 0.87 ± 0.22, intercept: 6.1 ± 4.9) and for the MCA territorial comparison in both affected (R2 = 0.67, y = 0.83x + 6.3) and contralateral sides (R2 = 0.66, y = 0.74x + 6.3). ASL-ATTs in the affected side were significantly longer than those in the contralateral side (1.51 ± 0.41 sec and 1.12 ± 0.30 sec, respectively, p <0.0005). CBF measurement using pCASL with delay compensation was feasible and fairly accurate even in altered hemodynamic states.

  20. 应用左向右分流建立大鼠慢性肺动脉高压模型及其特征%Establishment and characteristics of chronic pulmonary arterial hypertension rat models subjected to left-to-right shunting

    Institute of Scientific and Technical Information of China (English)

    汪健春; 钟前进

    2009-01-01

    was performed in Experimental Animal Center, Xinqiao Hospital, the Third Military Medical University of Chinese PLA from April 2008 to April 2009.MATERIALS: A total of 80 male inbred line healthy SD rats of specified-pathogens free class, 4 weeks old, weighing 95-110 g, were randomly assigned into control group (n=40) and shunt operation group (n=40). A shrinking polyethylene blood vessel connector (proximal part inner diameter was 0.6 mm and outer diameter was 0.8 mm, while distal part's was 0.8 mm and 1.0 mm, respectively, 1.6 mm long), was applied.METHODS: Shunt operation group underwent left-to-right shunting through right common carotid artery and external jugular vein connected by shrinking polyethylene blood vessel connector. Control group underwent sham operation. At 4, 8, 12 and 16 weeks postoperation, ten models were determined with a series in procedures: hemodynamics detection, pathological sample preparation, hematoxylin-eosin staining, imaging analysis and so on.MAIN OUTCOME MEASURES: Changes in right ventricular systolic pressure, right ventricular hypertrophy index of right ventricle to left ventricle plus interventricular septum, and relative medial wall thickness in moderate sized pulmonary arteries in rats of shunt group and control group.RESULTS: All animal were survived. The pulmonary blood flow in shunt group was significantly higher than control groups (P<0.01). Compared with control group, right ventricular systolic pressure elevated obviously and right ventricular hypertrophy index were significantly higher in shunt group at 12 and 16 weeks (P<0.01). Compared with control group, the relative medial wall thickness in pulmonary arteries also elevated obviously in shunt group at 12 and 16 weeks (P<0.01).CONCLUSION: Left-to-right continuous low-flow shunt in rats can induced right ventricle accommodated with the change of right ventricular systolic pressure and promote chronic pulmonary arterial remodeling continuously. The procedure of

  1. 慢性肺心病合并冠心病的临床诊治分析%Clinical diagnosis analysis on chronic pulmonary heart disease complicated with coronary artery disease

    Institute of Scientific and Technical Information of China (English)

    李顺辉; 涂颉洪; 张卫; 刘丽赟; 熊强珍

    2010-01-01

    目的 探讨慢性肺心病合并冠心病的临床特点和诊断依据,总结分析其治疗方法,从而提高临床诊断率、降低病死率.方法 回顾性分析98例慢性肺心病合并冠心病患者的临床特点、心电图、X线摄片、超声心电图以及治疗资料.结果 肺心病出现典型心绞痛、心肌梗死,心电图左心导联动态缺血性改变、左前半或完全性左束支传导阻滞,反复出现左心衰竭伴有左心扩大者,应考虑合并冠心病.处理时要在常规治疗的基础上区别对待.结论 肺心病合并冠心病引起的心力衰竭患者,要根据诊断结果,在常规基础治疗的同时,针对病因与并发症取有效的个体化治疗措施进行处理,可获得较满意的临床效果.%Objective To discuss the chronic pulmonary heart disease merge coronary artery disease's clinical characteristic and the diagnosis basis, then summarizes and analyzes its method of treatment,to improve the clinical diagnosis rates and reduce mortality. Methods Retrospective analyzing 98 cases of chronic pulmonary heart disease merge coronary artery disease patients' clinical characteristic, the electrocardiogram, X absorb the piece, the supersonic electrocardiogram and the treatment material. Results Pulmonary heart disease patients appear typical angina pectoris, myocardial infarction, 12-lead electrocardiography ischemic dynamic changes in ST-T segment, left anterior hemi block or CLBBB (Complete Left Bundle Branch Block), recurring the left heart failure with left heart amplification, we should consider merge coronary heart disease. When dealing with the disease, we must distinguish in the conventional treatment foundation. Conclusion Pulmonary heart disease merge coronary artery disease patients with heart failure, while taking conventional foundation treatment, aim at causes and complications to take effective measures to deal with individual treatment, can get a satisfactory clinical effect.

  2. Prediction of True Circulatory Decompensation in Chronic Heart Failure for Optimal Timing of Mechanical Circulatory Support: Non-Invasive Arterial-Ventricular Coupling

    Directory of Open Access Journals (Sweden)

    Roland Hetzer

    2012-02-01

    Full Text Available Background: Prospective comparative studies to predict the risk of hemodynamic deterioration in patients referred for transplantation were performed on the basis of standard invasive and non-invasive data and new wave intensity (WI parameters. Methods and results: Study Group 1 consisted of 151 consecutive outpatients (age 48.7 ± 12 years; 110 men with end-stage dilative cardiomyopathy. Group 2, consisting of 11 consecutive patients (age 50 ± 11 years; 6 men with sinus rhythm and “true” decompensation, was used to create “critical values” of WI. There were no demographic or somatic (weight and height differences between the groups. The follow-up period of ambulatory patients was 31 ± 8 months. Non-invasive WI was studied in the common carotid artery. Complete invasive and non-invasive data were also recorded on the day of investigation. During follow-up 44 pts were lost; there were 15 cardiac deaths (10%, life-saving ventricular assist device implantation in 10 (6.6% and transplantation in 19 (12.7%. For statistical purposes this group was named the “events” Group B (n = 44. A predisposing factor for events (death, “true” decompensation and “urgent” transplantation in ambulatory patients was low first peak (“cut-off value” assessed in Group 2 < 4100 mmHg*s³ (OR 45.6, CI 14.5–143.3, p < 0.001. Less powerful predictors of the risk of deterioration were pulmonary capillary pressure (PCP, diastolic pulmonary artery pressure (PAP and E/A mitral wave relation (p = 0.05. Conclusions: The new ventricular-arterial coupling parameter 1st peak of WI can potentially be used to distinguish patients at high risk for true deterioration and death. This parameter can be used to predict the need for assist device implantation.

  3. Beneficial effects on arterial stiffness and pulse-wave reflection of combined enalapril and candesartan in chronic kidney disease--a randomized trial

    DEFF Research Database (Denmark)

    Frimodt-Møller, Marie; Kamper, Anne-Lise; Strandgaard, Svend

    2012-01-01

    Cardiovascular disease (CVD) is highly prevalent in patients with chronic kidney disease (CKD). Inhibition of the renin-angiotensinsystem (RAS) in hypertension causes differential effects on central and brachial blood pressure (BP), which has been translated into improved outcome. The objective...

  4. Progress of Anesthetic Management of Robotic Totally Endoscopic Coronary Artery Bypass on Beating Heart%全机器人不停跳冠状动脉旁路移植术的麻醉管理进展

    Institute of Scientific and Technical Information of China (English)

    姚优修(综述); 孟秀丽(审校)

    2015-01-01

    [Summary] Robotic totally endoscopic coronary artery bypass on beating heart (BH-TECAB), a minimally invasive surgical approach with rapid postoperative recovery , is becoming the future trend of minimally invasive coronary surgery , which demands a higher standard for anesthetic management . It comprises pressured pneumothorax , unilateral lung ventilation , transesophageal echocardiography monitoring , hemodynamics maintaining , preparation for cardiopulmonary bypass and conversion to sternotomy , and ventricular fibrillation treatment , which require anesthesiologists to achieve more refined perioperative management and pathophysiological regulation .%全机器人不停跳冠状动脉旁路移植术创伤小,术后恢复快,是未来微创冠状动脉外科的趋势,对麻醉管理提出更高的要求,主要包括加压CO2气胸、单肺通气的应用、经食道超声心动图的监测、术中血流动力学的维持、体外循环及中转开胸手术的准备、室颤的处理等,要求麻醉医师对患者病理生理的调控及围术期的管理达到更精细化。

  5. Pulmonary Artery Intimal Sarcoma: A Case Report

    Directory of Open Access Journals (Sweden)

    Joseph P. Kriz

    2016-04-01

    Full Text Available Pulmonary artery intimal sarcomas are rare and lethal malignant tumors that typically affect larger vessels: the aorta, inferior vena cava, and pulmonary arteries. Since symptoms and imaging of pulmonary arterial intimal sarcomas mimic pulmonary thromboembolism, the differential diagnosis of a patient presenting with chest pain, dyspnea, and filling defect within the pulmonary arteries should include intimal sarcoma. Often right ventricular failure is observed due to pulmonary hypertension caused by the obstructive effect of the tumor and concomitant chronic thromboembolism. We report the case of a 72-year-old African-American male with arterial intimal sarcoma of the left and right pulmonary artery with extension through the right artery into the bronchus and right lung.

  6. 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.

  7. Fatal dissection of the pulmonary artery in pulmonary arterial hypertension

    Directory of Open Access Journals (Sweden)

    B. Degano

    2009-09-01

    Full Text Available A 41-yr-old patient with chronic stable idiopathic pulmonary arterial hypertension (PAH presented with sudden chest pain and unusual dyspnoea during physical exertion. The patient had been diagnosed with PAH at the age of 12 yrs and was in New York Heart Association functional class I/II. The patient was being treated with an anticoagulant regimen, low-dose diuretics and continuous intravenous epoprostenol therapy. A computed tomography scan showed ancient massive thrombi in dilated central pulmonary arteries, which were not haemodynamically significant (perfusion lung scans did not demonstrate segmental or larger defects, and extensive dissection of the right pulmonary artery starting from the intermediate branch. Due to the extensiveness of the dissection, the patient was immediately considered for heart–lung transplantation, but died 72 h after the onset of symptoms. Permission for post mortem examination was denied. Pulmonary artery dissection should be suspected in PAH patients presenting with chest pain and worsening dyspnoea. In the current case, the factors possibly associated with increased risk for dissection may include dilatation of the pulmonary artery, local inflammation favoured by in situ thrombosis, and acute increase of pulmonary pressure secondary to physical exertion. Extensive pulmonary artery dissection is a life-threatening complication of PAH, and urgent heart/lung transplantation might be the treatment of choice in eligible patients. In addition, better identification of the risk factors for pulmonary artery dissection may help in considering transplantation for selected patients at risk.

  8. The antioxidant n-acetylcysteine reduced necrosis, but exacerbated liver fibrosis induced by chronic alcohol in rats fed via total enteral nutrition

    Science.gov (United States)

    Despite many years of research, the molecular mechanisms underlying progression of alcoholic liver injury from simple steatosis through steatohepatitis and fibrosis remain in dispute. In the current study male Sprague-Dawley rats (350 g) were chronically fed a high unsaturated fat diet for 120 d usi...

  9. Robotics and coronary artery surgery.

    Science.gov (United States)

    Magee, Mitchell J; Mack, Michael J

    2002-11-01

    Significant progress in cardiac surgery, and specifically the surgical management of coronary artery disease, has been due in large part to enabling technology. Robotic systems have been recently developed and refined for use in cardiac surgery to facilitate, among other procedures, a totally endoscopic approach to coronary artery bypass surgery. These systems enhance precision through endoscopic approaches by specifically addressing the inherent limitations of conventional endoscopic coronary microsurgical instrumentation via computerized, digital interface, telemanipulation technology. With a combined experience of 125 patients, several groups have independently demonstrated the clinical feasibility of totally endoscopic coronary artery bypass with two commercially available robotic telemanipulation systems. Additional enabling technology is needed to overcome the challenges currently limiting development and widespread application of totally endoscopic off-pump multivessel coronary artery bypass surgery.

  10. Carotid artery surgery

    Science.gov (United States)

    Carotid endarterectomy; CAS surgery; Carotid artery stenosis - surgery; Endarterectomy - carotid artery ... through the catheter around the blocked area during surgery. Your carotid artery is opened. The surgeon removes ...

  11. Subclinical anaemia of chronic disease in adult patients with cystic fibrosis.

    LENUS (Irish Health Repository)

    O'connor, T M

    2012-02-03

    Patients with chronic hypoxaemia develop secondary polycythaemia that improves oxygen-carrying capacity. Therefore, normal haemoglobin and haematocrit values in the presence of chronic arterial hypoxaemia in cystic fibrosis constitute \\'relative anaemia\\'. We sought to determine the cause of this relative anaemia in patients with cystic fibrosis. We studied haematological indices and oxygen saturation in healthy volunteers (n=17) and in adult patients with cystic fibrosis (n=15). Patients with cystic fibrosis had lower resting arterial oxygen saturation when compared with normal volunteers (P<0.0001), and exercise led to a greater reduction in arterial oxygen saturation (P<0.0001). However, haemoglobin and haematocrit values in patients with cystic fibrosis did not significantly differ from normal volunteers. Serum iron (P=0.002), transferrin (P=0.02), and total iron-binding capacity (P=0.01) were lower in patients with cystic fibrosis. There were no significant differences in serum ferritin, percentage iron saturation, serum erythropoietin or red cell volume between the groups. The data presented demonstrate a characteristic picture of anaemia of chronic disease in adult patients with cystic fibrosis, except for normal haemoglobin and haematocrit values. Normal haemoglobin and haematocrit values in patients with cystic fibrosis appear to represent a combination of the effects of arterial hypoxaemia promoting polycythaemia, counterbalanced by chronic inflammation promoting anaemia of chronic disease.

  12. The impact of chronic kidney disease and albuminuria on coronary artery disease%慢性肾病及尿蛋白阳性对冠状动脉病变的影响

    Institute of Scientific and Technical Information of China (English)

    刘晶淼; 贾大林; 周维

    2010-01-01

    目的 研究慢性肾病患者冠状动脉病变特点及尿蛋白阳性对冠状动脉病变的影响.方法 根据基础肾小球滤过率(GFR)将连续299例接受冠状动脉造影患者分为三组:144例GFR>90ml/(min·1.73m~2)为肾功能正常组;97例GFR 60~90ml/(min·1.73m~2)为肾功能轻度减退组;58例GFR90 ml/(min·1.73m~2)],group Ⅱ[97 patients with mild renal impairment,GFR 60-90 ml/(min·1.73 m~2)]and group Ⅲ[58 patients with medium renal impairment,GFR < 60 ml/(min·1.73 m2~)].Then according to the albuminuria,patients were divided into 2 groups:the albuminuria negative group(171 patients)and albuminuria positive group(128 patients).Clinical features and coronary lesion characteristics were compared among the groups.Results In group Ⅰ,Ⅱ,Ⅲ,the incidence rate of coronary heart disease was 66.7%(96/144),70.1%(68/97),72.4%(42/58),the incidence rate of three-vessel coronary lesion was 9.7%(14/144),20.6%(20/97),22.4%(13/58),the incidence rate of left anterior descending artery lesion was 50.7%(73/144),56.7%(55/97),60.3%(35/58),and coronary jeopardy score was(15±15),(19+20),(22 ± 21)scores,respectively.There was significant difference among them(P <0.05).In albuminuria negative group and positive group,the incidence rate of coronary heart disease was 64.3%(110/171),75.0%(96/128),the incidence rate of three-vessd coronary lesion was 11.1%(19/171),21.9%(28/128),the incidence rate of left anterior descending artery lesion was 49.1%(84/171),61.7%(79/128),and coronary jeopardy score was(15 ±16),(20 ± 20)scores,respectively.There was significant difference between the two groups(P <0.05).Conclusions Chronic kidney dysfunction and albuminuria may be an important factor determining the occurrence and the severity of coronary artery disease.Especially it is more significant to inspect albuminuria at the early stage of kidney dysfunction.

  13. Chronic Supplementation of Paeonol Combined with Danshensu for the Improvement of Vascular Reactivity in the Cerebral Basilar Artery of Diabetic Rats

    Directory of Open Access Journals (Sweden)

    Peng-Cheng Qiu

    2012-11-01

    Full Text Available One of the leading causes of death in the world is cerebrovascular disease. Numerous Chinese traditional medicines, such as Cortex Moutan (root bark of Paeonia suffruticosa Andrew and Radix Salviae miltiorrhizae (root and rhizome of Salvia miltiorrhiza Bunge, protect against cerebrovascular diseases and exhibit anti-atherosclerotic effects. Traditional medicines have been routinely used for a long time in China. In addition, these two herbs are prescribed together in clinical practice. Therefore, the pharmacodynamic interactions between the active constituents of these two herbs, which are paeonol (Pae and danshensu (DSS, should be particularly studied. The study of Pae and DSS can provide substantial foundations in understanding their mechanisms and empirical evidence to support clinical practice. This study investigated the effects and possible mechanisms of the pharmacodynamic interaction between Pae and DSS on cerebrovascular malfunctioning in diabetes. Experimental diabetes was induced in rats, which was then treated with Pae, DSS, and Pae + DSS for eight weeks. Afterward, cerebral arteries from all groups were isolated and equilibrated in an organ bath with Krebs buffer and ring tension. Effects of Pae, DSS, and Pae + DSS were observed on vessel relaxation with or without endothelium as well as on the basal tonus of vessels from normal and diabetic rats. Indexes about oxidative stress were also determined. We report that the cerebral arteries from diabetic rats show decreased vascular reactivity to acetylcholine (ACh which was corrected in Pae, DSS, and Pae + DSS treated groups. Furthermore, phenylephrine (PE-induced contraction response decreased in the treated groups. Phenylephrine and CaCl2-induced vasoconstrictions are partially inhibited in the three treated groups under Ca2+-free medium. Pre-incubated with tetraethylammonium, a non-selective K+ channel blocker, the antagonized relaxation responses increased in DSS and Pae + DSS

  14. Ischemia as a potential etiologic factor in idiopathic unilateral sudden sensorineural hearing loss: Analysis of posterior circulation arteries.

    Science.gov (United States)

    Kim, Chulho; Sohn, Jong-Hee; Jang, Min Uk; Hong, Sung-Kwang; Lee, Joong-Seob; Kim, Hyung-Jong; Choi, Hui-Chul; Lee, Jun Ho

    2016-01-01

    The association between idiopathic sudden sensorineural hearing loss (ISSNHL) and the radiologic characteristics of the vertebrobasilar artery is unclear. We hypothesized that the degree and direction of vertebrobasilar artery curvature in the posterior circulation contribute to the occurrence of ISSNHL. We consecutively enrolled patients diagnosed with unilateral ISSNHL in two tertiary hospitals. Magnetic resonance images were performed in all patients to exclude specific causes of ISSNHL, such as vestibular schwannoma, chronic mastoiditis, and anterior inferior cerebellar artery infarct. We measured the following parameters of posterior circulation: vertebral and basilar artery diameter, the degree of basilar artery curvature (modified smoker criteria), and vertebral artery dominance. Pure tone audiometries were performed at admission and again 1 week and 3 months later. A total of 121 ISSNHL patients (mean age, 46.0 ± 17.3 years; 48.8% male) were included in these analyses. The proportion of patients with the left side hearing loss was larger than the proportion with the right side hearing loss (left, 57.9%; right, 42.1%). The majority of patients were characterized by a left dominant vertebral artery and right-sided basilar artery curvature. The direction of the basilar artery curvature was significantly associated with hearing loss lateralization (p = 0.036). Age and sex matched multivariable analyses revealed the absence of diabetes and right-sided basilar artery curvature as significant predictors for left sided hearing loss. There was no statistical difference between atherosclerotic cardiovascular risk score (high versus low) and hearing outcomes at 3 months. In ISSNHL, the laterality of hearing loss was inversely associated with the direction of basilar artery curvature. Our results, therefore, indicate the importance of vascular assessment when evaluating ISSNHL.

  15. Different reactivity to angiotensin II of peripheral and renal arteries in spontaneously hypertensive rats: effect of acute and chronic angiotensin converting enzyme inhibition

    Science.gov (United States)

    Guidi, E.; Hollenberg, N. K.

    1986-01-01

    We assessed renal blood flow and pressor responses to graded angiotensin II doses in spontaneously hypertensive (SHR) and Wistar-Kyoto (WKY) rats ingesting a diet containing 1.6% sodium basally and after acute and chronic angiotensin converting enzyme (ACE) inhibition with captopril. In the basal state the pressor response to angiotensin II was enhanced (Prenal vascular response was blunted (Pacute captopril administration the pressor response was enhanced in both strains, and the difference between them was maintained, while the renal vascular response was enhanced in both, but more in SHR, so that the renal vascular response in the SHR became larger than in WKY (Prenal responses in WKY rats, but only the pressor response in SHR. The renal vessels of SHR seem to be different from those of WKY rats in reaction to exogenous angiotensin II, and in response to both acute administration of captopril (probably acting through blockade of angiotensin II production) and chronic administration of captopril (probably acting mainly through accumulation of kinin or production of prostaglandins).

  16. Association between internal carotid artery dissection and arterial tortuosity

    Energy Technology Data Exchange (ETDEWEB)

    Saba, Luca; Piga, Mario [Azienda Ospedaliero Universitaria (A.O.U.), Department of Radiology, Monserrato, Cagliari (Italy); Argiolas, Giovanni Maria; Siotto, Paolo [Azienda Ospedaliero Brotzu (A.O.B.), Department of Radiology, di Cagliari (Italy); Sumer, Suna; Wintermark, Max [Neuroradiology Division, Neuroradiology, UVA Department of Radiology, Charlottesville, VA (United States); Raz, Eytan [New York University School of Medicine, Department of Radiology, New York, NY (United States); Sapienza University of Rome, Department of Neurology and Psychiatry, Rome (Italy); Sanfilippo, Roberto; Montisci, Roberto [Azienda Ospedaliero Universitaria (A.O.U.), Department of Vascular Surgery, di Cagliari (Italy)

    2014-10-18

    Carotid artery dissection is an important cause of ischemic stroke in all age groups, particularly in young patients. The purpose of this work was to assess whether there is an association between the presence of an internal carotid artery dissection (ICAD) and the arterial tortuosity. This study considered 124 patients (72 males and 52 females; median age 57 years) with CT/MR diagnosis of ICAD of the internal carotid artery were considered in this multi-centric retrospective study. The arterial tortuosity was evaluated and, when present, was categorized as elongation, kinking, or coiling. For each patient, both the right and left sides were considered for a total number of 248 arteries in order to have the same number of cases and controls. Fisher's exact test was applied to test the association between elongation, kinking, coiling, dissection, and the side affected by CAD. Fisher's exact test showed a statistically significant association between the ICAD and kinking (p = 0.0089) and coiling (p = 0.0251) whereas no statistically significant difference was found with arterial vessel elongation (p = 0.444). ICAD was more often seen on the left side compared to the right (p = 0.0001). These results were confirmed using both carotid arteries of the same patient as dependent parameter with p = 0.0012, 0.0129, and 0.3323 for kinking, coiling, and elongation, respectively. The presence of kinking and coiling is associated with ICAD. (orig.)

  17. 应用脾动脉结扎法行全腹腔镜巨脾切除术的临床研究%Clinical Research with Splenic Artery Ligation in Total Laparoscopic Massive Splenectomy

    Institute of Scientific and Technical Information of China (English)

    胡逸林; 曹庭加; 蔡逊; 李汉军; 刘颜良; 汪波

    2012-01-01

    目的:探讨应用脾动脉结扎法行全腹腔镜巨脾切除术的安全性、可行性及手术技巧.方法:将2010年1月1日至2012年1月1日因肝硬化门脉高压脾机能亢进巨脾患者随机分为腹腔镜脾切除(Laparoscopic Splenectomy,LS)组及开腹脾切除(Open Splenectomy,OS)组,比较两组的临床特征及围手术期差异.结果:LS组与OS组在性别组成、术前肝功能child分级、年龄组成及脾脏长径方面均无统计学意义.LS组手术时间比OS组略长,但无统计学意义,LS组术中出血量明显低于OS组(P<0.01),LS组术后进食、术后排气、引流管拔除及出院时间均明显早于OS组(P<0.01).结论:腹腔镜脾切除术为治疗门脉高压巨脾的一种有效、安全、可行的手术方式.%Objective: To investigate the safety, feasibility and surgical techniques with splenic artery ligation in total laparoscopic massive splenectomy. Methods: From January 1, 2010 to January 1, 2012, patients with hypertension due to cirrhosis of the liver spleen hyperfunction massive splenectomy were randomly assigned into laparoscopic splenectomy group and Open Splenectomy group. Compare the two groups in clinical characteristics and differences in the perioperative period. Results: Between the two groups, the differences in gender composition, age, child classification and the diameter in the spleen were not statistically significant. LS group operative time was slightly longer than that in the OS group, but the difference had no statistical significance. LS group blood loss was significantly lower than that in the OS group (P<0.01). The time of postoperative feeding, farting, postoperative tube remove, postopera- tive hospital stay in LS group were significantly earlier than that in the OS group (P<0.01). Conclusions: Total laparoscopic massive splenectomy is safe, feasible and effective to treatment portal hypertension.

  18. Endovascular repair for a huge vertebral artery pseudoaneurysm caused by Behcet's disease

    Institute of Scientific and Technical Information of China (English)

    DONG Zhi-hui; FU Wei-guo; GUO Da-qiao; XU Xin; CHEN Bin; JIANG Jun-hao; YANG Jue; SHI Zheng-yu; WANG Yu-qi

    2006-01-01

    @@ Behcet's disease (BD), a multisystem chronic autoimmune process of unknown etiology,usually leads to arterial impairment. Isolated case reports have described BD-related arterial dissections, pseudoaneurysms or aneurysms.1-4 Recently, we successfully treated a huge vertebral artery pseudoaneurysm (VAPA) in a patient with BD by stent-grafting with preservation of the affected vertebral artery.

  19. Deletion of Cyclooxygenase-2 in the mouse increases arterial blood pressure with no impairment in renal NO production in response to chronic high salt intake

    DEFF Research Database (Denmark)

    Staehr, Mette; Hansen, Pernille B L; Madsen, Kirsten

    2013-01-01

    Experiments were designed to test the hypothesis that COX-2 activity attenuates the blood pressure increase during high NaCl intake by stimulation of eNOS-mediated NO synthesis in the kidney medulla. COX-2(-/-) (C57BL6) and (+/+) mice were fed a diet with 0.004% (LS) or 4% (HS) NaCl for 18 days....... Arterial blood pressure was recorded continuously using indwelling catheters. Food and water intake and diuresis were measured in metabolic cages. Urine osmolality and excretion of electrolytes, cGMP, cAMP and NOx were determined, as well as plasma NOx and cGMP. There was a significant dependence of blood...... pressure on salt intake and genotype: COX-2(-/-) exhibited higher blood pressure than COX-2(+/+) both on HS and LS intake. COX-2(+/+) littermates displayed an increase in blood pressure on HS vs. LS (102.3±1.1 mmHg vs. 91.9±0.9 mmHg) day and night. The mice exhibited significant blood pressure increases...

  20. Transversal escharotomies: a new surgical technique adjuvant in the treatment of chronic ulcers with non-arterial etiology in the lower limbs Escarotomias transversais: uma nova opção cirúrgica adjuvante no tratamento de úlceras crônicas de etiologia não arterial em membros inferiores

    Directory of Open Access Journals (Sweden)

    Mário Augusto Silva Freitas

    2006-01-01

    Full Text Available PURPOSE: Propose a new and alternative surgical procedure in order to aid on treatments of chronic ulcers with non-arterial etiology in the lower limbs, especially those that reoccurs and accomplish of dermatosclerosis and skin contractures determining ankle and foot limits. METHODS: It describes a medical case regarding a female, 54 years old, with a pre-existing ulcer (sixteen years on her left leg. Despite of conventional treatments such as curatives, compressive therapy and surgeries, the ulcer on her leg was not cured for three years. The skin dermatosclerosis on her foot and ankle limited her mobility tremendously. The surgery involved the debridement of the ulcers, local phlebectomies and the correction of her scar contraction by a transversal escharotomies. Conventional procedures were applied in pre and post-surgery. RESULTS: After twelve weeks, the ulcer was completely healed by second intention. Despite the odds, she regained sustainable mobility in her foot and ankle, allowing this patient to wear medical elastic socks. Reoccurrences of the ulcer did not occur during the two years post-surgery. CONCLUSION: The transversal escharotomies may favor the healing of non-arterial chronic ulcers in the lower limbs, impeding perpetual mechanisms of this sort. For example, the ankle and foot limitation determinates in secondary scars, skin contractures, dermatosclerosis that produce the failure in the muscular calf-pump with deterioration in the ascending venous propulsion.OBJETIVO: Apresentar uma nova alternativa cirúrgica para auxiliar o tratamento de úlceras crônicas de etiologia não arterial em membros inferiores, especialmente aquelas com recidivas e complicadas por contraturas de pele, limitando movimentos do pé e tornozelo. MÉTODOS: Descrição de caso de uma paciente portadora de úlcera em perna esquerda com dezesseis anos de evolução, múltiplas recidivas, sem cicatrização há três anos apesar de curativos convencionais

  1. CT-guided thoracal sympathicolysis for the treatment of peripheral arterial occlusive disease and chronic thoracal pain syndromes in 6 patients; CT-gesteuerte thorakale Sympathikolyse zur Behandlung der peripheren arteriellen Verschlusskrankheit und thorakaler Schmerzen in 6 Faellen

    Energy Technology Data Exchange (ETDEWEB)

    Finkenzeller, T.; Techert, J.; Lenhart, M.; Link, J.; Feuerbach, S. [Klinikum der Univ. Regensburg (Germany). Abt. Roentgendiagnostik

    2001-10-01

    Purpose: Retrospective evaluation of the safety and effectivity of CT-guided percutaneous thoracal sympathicolysis (CT-TSL) in the treatment of patients with peripheral arterial occlusive disease (PAOD) of the upper limb and chronic thoracal pain syndromes. Comparison of our own experience with literature reports. Material and Methods: Between 6/96 and 12/99, 4 patients with PAOD of the upper limb and two with chronic thoracal pain syndromes caused by herpes zoster were treated by unilateral CT-TSL. Results: 18, 21 and 32 months after the intervention 3 out of 4 patients treated for PAOD reported subjective improvements, and one remained unchanged. Two patients treated for pain syndromes showed no long-term benefit of the procedure. There were no serious complications. Conclusion: The CT-TSL is an alternative method in the treatment of PAOD in patients who are unsuitable for treatment by revascularization. (orig.) [German] Ziel: Retrospektive Betrachtung der Sicherheit und Effektivitaet der CT-gesteuerten thorakalen Sympathikolyse (CT-TSL) bei der Behandlung von Patienten mit peripherer arterieller Verschlusskrankheit (AVK) der oberen Extremitaet oder chronischer thorakaler Schmerzsyndrome, und Vergleich der eigenen Erfahrungen mit der Literatur. Material und Methoden: Von 6/96 bis 12/99 wurden 4 Patienten mit AVK der oberen Extremitaet und zwei mit chronischen thorakalen Herpes-zoster-Neuralgien mittels jeweils unilateral durchgefuehrter CT-TSL behandelt. Ergebnisse: 3 von 4 der wegen AVK behandelten Patienten gaben im Verlauf nach 18, 21 und 32 Monaten eine subjektiv empfundene Besserung an, ein Patient hatte unveraendert Beschwerden. Beide Schmerzpatienten zeigten nur kurzfristig eine Verbesserung ihrer Beschwerdesymptomatik. Es traten keine relevanten Komplikationen auf. Schlussfolgerung: Die CT-TSL ist eine alternative Moeglichkeit zur Behandlung der AVK der oberen Extremitaet bei Patienten, die keinem revaskularisierenden Eingriff unterzogen werden koennen

  2. Clinical outcomes of totally endoscopic coronary artery bypass grafting: a system review and metaanalysis%全机器人腔镜下冠状动脉旁路移植术临床疗效荟萃分析

    Institute of Scientific and Technical Information of China (English)

    李波; 王粮山; 刘长城; 顾承雄

    2016-01-01

    Objective To assess the clinical outcomes of totally endoscopic coronary artery bypass grafting (TECABG).Methods A systematic review of studies reporting clinical outcomes of TECABG was performed.Twelve studies were included in the meta-analysis.R 3.2.3 was used to perform the statistical analysis.Results Length of hospital stay of TACABG patients ranged from 3.3 to 8.6 days.The rate of recent conversion to thoracotomy was 0-28.1% (from perioperative period to 2 years after surgery);the rate of anastomotic bleeding was 1.7%-8.5%;the case fatality rate of in-hospital or 30 days after surgery was 0-3.8%;the rate of myocardial infarction was 0-3.4%;the rate of stroke was 0-2.2%;the rate of revascularization was 0-6.8%;the patency rate of recent coronary artery bypass graft (CABG) was 89.5%-100%;the mid-time survival rate of TECABG patients (from 2 to 5 years after surgery) was 92.7%-100%;the rate of revascularization was 2.0%-12.2%;the patency rate of mid-time CABG was 71.4%-97.0%.Conclusions The current data suggests that TECABG is feasible,safe and effective when proper patients are selected.However,randomized controlled trials of TECABG versus conventional CABG are still required due to lack of long-term outcomes.%目的 系统评价全机器人腔镜下冠脉旁路移植术(TECABG)的临床疗效.方法 系统检索PubMed、Embase、Cochrane Library及相关文章的参考文献,检索自建库至2015年12月13日关于TECAB临床疗效的已发表文献.12项研究纳入最终分析.用R3.2.3软件进行单个率的荟萃分析.结果 TACAB患者住院时间为3.3~8.6 d.近期(围手术期~术后2年)中转开胸率为0~28.1%,吻合口出血率为1.7% ~8.5%,住院/术后30 d病死率为0~3.8%,心肌梗死发生率为0~3.4%,脑卒中发生率为0~2.2%;再次血运重建率为0 ~6.8%,近期桥血管通畅率为89.5% ~100%.TECAB患者中期(术后2~5年)生存率为92.7% ~ 100

  3. Chronic treatment with Vitamin D lowers arterial blood pressure and reduces endothelium-dependent contractions in the aorta of the SHR

    DEFF Research Database (Denmark)

    Wong, Michael S K; Delansorne, Remi; Svenningsen, Per;

    2010-01-01

    Vitamin D has cardiovascular protective effects besides regulating calcium homeostasis. To examine the chronic in vivo effect of a physiological dose 1,25-dihydroxyvitamin D3 on the occurrence of endothelium-dependent contractions, spontaneously hypertensive rats (SHR) and Wistar-Kyoto rats (WKY...... with or without endothelium were studied in conventional organ chambers for isometric force measurement. Confocal microscopy was used to measure the cytosolic-free calcium concentration (with the fluorescent dye Fluo-4) and reactive oxygen species (ROS; with dichlorodihydrofluorescein diacetate). Reverse...... transcription PCR and Western blotting were used to determine the mRNA and protein expression level of cyclooxygenase-1 (COX-1), prostacyclin synthase (PGIS) and thromboxane synthase (TBXS). The endothelium-dependent concentration-contraction curves to both acetylcholine- and A23187-induced contractions were...

  4. Coronary artery fistula

    Science.gov (United States)

    Congenital heart defect - coronary artery fistula; Birth defect heart - coronary artery fistula ... A coronary artery fistula is often congenital, meaning that it is present at birth. It generally occurs when one of the coronary arteries ...

  5. Minimally invasive direct coronary artery bypass plus coronary stent for acute coronary syndrome: a case report

    Institute of Scientific and Technical Information of China (English)

    Caiyi Lu; Gang Wang; Qi Zhou; Jinwen Tian; Lei Gao; Shenhua Zhou; Jinyue Zhai; Rui Chen; Zhongren Zhao; Cangqing Gao; Shiwen Wang; Yuxiao Zhang; Ming Yang; Qiao Xue; Cangsong Xiao; Wei Gao; Yang Wu

    2008-01-01

    A 69-year old female patient was admitted because of 3 days of worsened chest pain.Coronary angiography showed60% stenosis of distal left main stem,chronic total occlusion of left anterior descending (LAD),70% stenosis at the ostium of a smallleft circumflex,70-90%stenosis at the paroxysmal and middle part of a dominant fight coronary artery (RCA),and a normal left internalmammary artery (LIMA) with normal origination and orientation.Percutaneous intervention was attempted but failed on the occludedlesion of LAD.The patient received minimally invasive direct coronary artery bypass (MIDCAB) with left LIMA isolation by Davincirobot.Eleven days later,the RCA lesion was treated by Sirolimus Rapamicin eluting stents implantation percutaneously.Then thepatient was discharged uneventfully after 3 days hospitalization.Our experience suggests that two stop shops of hybrid technique befeasible and safe in the treatment of elderly patient with multiple coronary diseases.

  6. Association between the Gensini Score and Carotid Artery Stenosis

    Science.gov (United States)

    Fidan, Serdar; Tabakçı, Mehmet Mustafa; Toprak, Cuneyt; Alizade, Elnur; Acar, Emrah; Bayam, Emrah; Tellice, Muhammet; Naser, Abdurrahman; Kargın, Ramazan

    2016-01-01

    Background and Objectives The aim of this study was to evaluate the association between the extent of coronary artery disease assessed by the Gensini score and/or the SYNTAX score and the significant carotid stenosis in patients undergoing coronary artery bypass grafting (CABG). Subjects and Methods A total of 225 patients who had carotid doppler ultrasonography prior to CABG were included retrospectively. Significant coronary artery disease was assumed as a lumen diameter stenosis of ≥50% in any of the major epicardial coronary arteries. The severity of carotid stenosis was determined by B-mode and duplex ultrasonography. Clinically significant carotid stenosis was defined as peak systolic velocity greater than 125 cm/s. Results The mean value of SYNTAX score and Gensini score was highest in patients allocated to significant carotid stenosis (22.98±7.32, p<0.001 and 77.40±32.35, p<0.001, respectively). The other risk factors for significant carotid stenosis were found to be male gender (p=0.029), carotid bruit (p<0.001), diabetes (p=0.021), left main disease (p=0.002), 3-vessel disease (p=0.008), chronic total coronary occlusion (p=0.001), and coronary artery calcification (p=0.001) in univariate analysis. However, only the Gensini score (odds ratio[OR]=1.030, p=0.004), carotid bruit (OR=0.068, p<0.001), and male gender (OR=0.190, p=0.003) were the independent predictors. The Gensini score cut off value predicting significant carotid stenosis was 50.5 with 77% sensitivity (p<0.001). Conclusion The Gensini score may be used to identify patients at high risk for significant carotid stenosis prior to CABG. PMID:27721854

  7. Effects of hypoproteinemia on renal hemodynamics, arterial pressure, and fluid volume

    Energy Technology Data Exchange (ETDEWEB)

    Manning, R.D. Jr.

    1987-01-01

    The effects of long-term hypoproteinemia on renal hemodynamics, arterial pressure, and fluid volume were studied in eight conscious dogs over a 34-day period. Plasma protein concentration (PPC) was decreased by daily plasmapheresis, and the effects of decreasing and increasing sodium intake were measured. By the 12th day of plasmapheresis PPC had decreased to 2.5 g/dl from a control value of 7.2 g/dl, mean arterial pressure had decreased to 78% of control, glomerular filtration rate (GFR) was 75.2% of control, and urinary sodium excretion was decreased. By day 18 of plasmapheresis, estimated renal plasma flow (ERPF) was decreased to 60% of control due to the decreased arterial pressure and an increase in renal vascular resistance. GFR and ERPF were determined from the total clearance of (/sup 125/I)iothalamate and (/sup 131/I)iodohippurate. Also, plasma renin activity and plasma aldosterone concentration were both increased, and the relationship between mean arterial pressure and urinary sodium excretion was distinctly shifted to the left along the arterial pressure axis. In contradistinction to acute experiments, chronic hypoproteinemia results in decreases in GFR, ERPF, and urinary sodium excretion and has marked effects on both fluid volume and arterial pressure regulation.

  8. 老年患者慢性肾功能不全与冠状动脉钙化积分的相关性%Association between chronic kidney dysfunction and coronary artery calcification score in elderly patients

    Institute of Scientific and Technical Information of China (English)

    颜利求; 曹绪芬; 郑晔; 郭楠; 熊立新; 曹艳超; 赵世龙; 郭艳芬; 韩立宪

    2014-01-01

    Objective To investigate the association between chronic kidney dysfunction and coronary artery calcification score(CACS) in the elderly.Methods We prospectively studied 795 consecutive elderly patients with clinically suspected coronary artery disease who underwent 64-multidetector row computed tomography coronary angiography from January 2006 to December 2010.CACS was quantified using Agatston method.eGFR was calculated by the simplified modification of diet in renal disease(MDRD)equation.Patients were divided into four groups according to CACS as follows:No CACS(CACS =0),low CACS(0<CACS≤100),medium CACS(100<CACS≤400) and high CACS (CACS> 400).Ordinal logistic regression was used to analyze the association of chronic kidney dysfunction with CACS.Results Patients with higher CACS were older (F=4.99,P<0.01),had lower eGFR(F=10.16,P<0.001)and higher level of C-reactive protein(F=39.36,P <0.001),and were more likely to have a history of hypertension(x2 =18.59,P<0.001) and diabetes (x2=14.03,P<0.01)than patients without coronary artery calcification(CAC) or with lower CACS.Ordinal logistic regression showed that age,hypertension,diabetes,C-reactive protein and eGFR were independent risk factors for CAC.Conclusions Age,hypertension,diabetes mellitus,C-reactive protein and eGFR were independent risk factors for CAC in elderly patients.%目的 分析老年患者慢性肾功能不全与冠状动脉(冠脉)钙化积分(CACS)的相关性.方法 前瞻性连续性入选2006年1月至2010年12月因疑诊冠心病于我院行64层螺旋CT的老年患者795例,应用Agatston方法计算CACS,应用简化MDRD公式计算估算肾小球滤过率(eGFR).根据CACS将患者分为4组:无冠脉钙化组(CACS=0)、低冠脉钙化组(CACS 1~100)、中冠脉钙化组(CACS 101~400)以及高冠脉钙化组(CACS>400).通过有序Logistic回归分析慢性肾功能不全与冠状动脉钙化积分的相关性. 结果 高冠脉钙化组患者年龄大(F=4.99,P=0

  9. Frequency of hypertension in chronic Chagas' disease: retrospective clinical study Freqüência da hipertensão arterial na doença de Chagas crônica: estudo clínico retrospectivo

    Directory of Open Access Journals (Sweden)

    Cristina Brandt Friedrich Martin Gurgel

    2003-12-01

    Full Text Available OBJECTIVE: To assess the frequency of hypertension in chagasic patients, as well as its clinical behavior and cardiologic findings. METHODS: We carried out a retrospective study with 225 patients with chronic Chagas' disease and hypertension (104 males, mean age of 55.1 ± 11.8. These patients were being followed up in the outpatient care clinics from 1984 to 2000. The study assessed the clinical, electrocardiographic, and radiological viewpoints. RESULTS: Of the 225 hypertensive patients (prevalence = 33.3%, 78 (34.7% had mild hypertension, 108 (48% had moderate hypertension, and 39 (17.3% had severe hypertension. The association of left anterosuperior divisional block and right bundle-branch block occurred in 39 cases (17.3%, and enlargement of the cardiac area on radiological examination occurred in 93 (44.9% of the 207 cases studied. The undetermined form of Chagas' disease was the most prevalent, 30.2% of the cases, followed by the form associated with conduction disorders in 27.1%, and the isolated form of conduction disorders in 21.3%. CONCLUSION: Chagasic patients had a frequency of hypertension similar to that of the general population, and the clinical profile of the hypertensive chagasic patients seemed not to differ a lot from that of the chagasic patients.OBJETIVO: Verificar a freqüência da hipertensão arterial sistêmica em chagásicos e seu comportamento clínico e os achados cardiológicos. MÉTODOS: Estudo retrospectivo em 225 portadores de doença chagásica crônica e hipertensão arterial sistêmica (104 homens, idade média de 55,1±11,8 anos, acompanhados em ambulatório entre os anos de 1984 e 2000, avaliado do ponto de vista clínico, eletrocardiográfico e radiológico. RESULTADOS: Nos 225 hipertensos (prevalência = 33,3% a hipertensão arterial sistêmica leve ocorreu em 78 casos (34,7%, a moderada em 108 (48% e a grave em 39 (17,3%. A associação do bloqueio divisional ântero-superior do ramo esquerdo do feixe de

  10. Transcutaneous oximetry but not arterial toe blood pressure or ankle-brachial index is related to macular thickness in patients with chronic diabetic foot ulcers

    Directory of Open Access Journals (Sweden)

    Per Katzman

    2013-04-01

    Full Text Available Objectives: Diabetes related vascular complications of the lower extremity could be classified as micro- and macrovascular. Ankle-brachial index (ABI and toe blood pressure (TBP measurements evaluate macro-circulation, whereas transcutaneous oximetry (TcPO2 is considered to be a composite measure of vascular function, thereby also reflecting microcirculation. Microvascular disease in the eye involves abnormal capillary permeability and possibly thereby increased macular thickness. The aim of the present clinical study was to evaluate if microvascular disease in the eye was related to measures of foot ischemia in patients with diabetes mellitus. Methods: Twenty consecutive patients with diabetes and chronic full-thickness foot ulcers were included. Peripheral ischemia was diagnosed using TcPO2, TBP and ABI. Macular thickness was measured with optical coherence tomography technique. Results: Based on TcPO2, TBP and ABI measurements 14, 13 and 13 patients, respectively, were classified as ischemic. Patients with ischemic TcPO2 levels at the dorsum of the foot had significantly higher macular thicknesses. This was not the case in patients with ischemic TBP or ABI levels. Conclusion: TcPO2, unlike TBP and ABI, seems to be a clinically relevant measure of peripheral microvascular disease in patients with diabetes mellitus and may, if low, indicate an increased risk of macular edema. [J Exp Integr Med 2013; 3(2.000: 81-85

  11. Renal Artery Stent Outcomes

    Science.gov (United States)

    Murphy, Timothy P.; Cooper, Christopher J.; Matsumoto, Alan H.; Cutlip, Donald E.; Pencina, Karol M.; Jamerson, Kenneth; Tuttle, Katherine R.; Shapiro, Joseph I.; D’Agostino, Ralph; Massaro, Joseph; Henrich, William; Dworkin, Lance D.

    2016-01-01

    BACKGROUND Multiple randomized clinical trials comparing renal artery stent placement plus medical therapy with medical therapy alone have not shown any benefit of stent placement. However, debate continues whether patients with extreme pressure gradients, stenosis severity, or baseline blood pressure benefit from stent revascularization. OBJECTIVES The study sought to test the hypothesis that pressure gradients, stenosis severity, and/or baseline blood pressure affects outcomes after renal artery stent placement. METHODS Using data from 947 patients with a history of hypertension or chronic kidney disease from the largest randomized trial of renal artery stent placement, the CORAL (Cardiovascular Outcomes in Renal Atherosclerotic Lesions) study, we performed exploratory analyses to determine if subsets of patients experienced better outcomes after stent placement than the overall cohort. We examined baseline stenosis severity, systolic blood pressure, and translesion pressure gradient (peak systolic and mean) and performed interaction tests and Cox proportional hazards analyses for the occurrence of the primary endpoint through all follow-up, to examine the effect of these variables on outcomes by treatment group. RESULTS There were no statistically significant differences in outcomes based on the examined variables nor were there any consistent nonsignificant trends. CONCLUSIONS Based on data from the CORAL randomized trial, there is no evidence of a significant treatment effect of the renal artery stent procedure compared with medical therapy alone based on stenosis severity, level of systolic blood pressure elevation, or according to the magnitude of the transstenotic pressure gradient. (Benefits of Medical Therapy Plus Stenting for Renal Atherosclerotic Lesions [CORAL]; NCT00081731) PMID:26653621

  12. Pancreatic Pseudocyst Causing Celiac Artery Trunk Thrombosis

    Directory of Open Access Journals (Sweden)

    Christopher Challand

    2008-07-01

    Full Text Available Context Vascular complications of pancreatitis are more common in alcoholrather than gallstone-induced pancreatitis. Such complications are an important cause of mortality and morbidity, although peripancreatic vessel obstruction is a rare consequence. Patients with peripancreatic arterial obstruction can present with sudden and unexplained clinical deterioration requiring prompt diagnosis and intervention. Case report A 42-year-old woman with a proven pancreatic pseudocyst presented with acute abdominal pain. Initial investigations were non-diagnostic. A gastroscopy revealed patchy necrosis of the proximal stomach. Following sudden clinical deterioration, a contrast-enhanced CT scan was performed. The CT scan demonstrated a thickened gastric wall with intramural gas. The decision was taken to proceed to laparotomy, which revealed both gastric and splenic infarction. A total gastrectomy with Roux-en-Y reconstruction and splenectomy was performed. She made a successful recovery. Conclusion Arterial thrombosis should be considered in any patient with chronic pancreatitis who presents with an acute clinical deterioration. Successful outcomes can be achieved with prompt diagnosis using contrast-enhanced CT scanning and early surgical intervention.

  13. Mesenteric Ischemia:An unusual presentation of fistula between superior mesenteric artery and common hepatic artery

    Institute of Scientific and Technical Information of China (English)

    Ertugrul Kayacetin; Serdar Karak(o)se; Aydin Karabacakoglu; Dilek Emlik

    2004-01-01

    Chronic mesenteric ischemia is an uncommon condition associated with a high morbidity and mortality. We reported a 36-year old women with postprandial abdominal pain due to chronic mesenteric ischemia caused by a fistula between superior mesenteric and common hepatic artery.

  14. Robust and enduring atorvastatin-mediated memory recovery following the 4-vessel occlusion/internal carotid artery model of chronic cerebral hypoperfusion in middle-aged rats.

    Science.gov (United States)

    Zaghi, Gislene Gonçalves Dias; Godinho, Jacqueline; Ferreira, Emilene Dias Fiuza; Ribeiro, Matheus Henrique Dal Molin; Previdelli, Isolde Santos; de Oliveira, Rúbia Maria Weffort; Milani, Humberto

    2016-02-01

    Chronic cerebral hypoperfusion (CCH) is a common condition associated with the development and/or worsening of age-related dementia.We previously reported persistent memory loss and neurodegeneration after CCH in middle-aged rats. Statin-mediated neuroprotection has been reported after acute cerebral ischemia. Unknown, however, is whether statins can alleviate the outcome of CCH. The present study investigated whether atorvastatin attenuates the cognitive and neurohistological outcome of CCH. Rats (12–15 months old) were trained in a non-food-rewarded radial maze, and then subjected to CCH. Atorvastatin (10 mg/kg, p.o.) was administered for 42 days or 15 days, beginning 5 h after the first occlusion stage. Retrograde memory performance was assessed at 7, 14, 21, 28, and 35 days of CCH, and expressed by “latency,” “number of reference memory errors” and “number of working memory errors.” Neurodegeneration was then examined at the hippocampus and cerebral cortex. Compared to sham, CCH caused profound and persistent memory loss in the vehicle-treated groups, as indicated by increased latency (91.2% to 107.3%) and number of errors (123.5% to 2508.2%), effects from which the animals did not spontaneously recover across time. This CCH-induced retrograde amnesia was completely prevented by atorvastatin (latency: −4.3% to 3.3%; reference/working errors: −2.5% to 45.7%), regardless of the treatment duration. This effect was sustained during the entire behavioral testing period (5 weeks), even after discontinuing treatment. This robust and sustained memory-protective effect of atorvastatin occurred in the absence of neuronal rescue (39.58% to 56.45% cell loss). We suggest that atorvastatin may be promising for the treatment of cognitive sequelae associated with CCH.

  15. A randomized multicenter comparison of hybrid sirolimus-eluting stents with bioresorbable polymer versus everolimus-eluting stents with durable polymer in total coronary occlusion: rationale and design of the Primary Stenting of Occluded Native Coronary Arteries IV study

    Directory of Open Access Journals (Sweden)

    Teeuwen Koen

    2012-12-01

    Full Text Available Abstract Background Percutaneous recanalization of total coronary occlusion (TCO was historically hampered by high rates of restenosis and reocclusions. The PRISON II trial demonstrated a significant restenosis reduction in patients treated with sirolimus-eluting stents compared with bare metal stents for TCO. Similar reductions in restenosis were observed with the second-generation zotarolimus-eluting stent and everolimus-eluting stent. Despite favorable anti-restenotic efficacy, safety concerns evolved after identifying an increased rate of very late stent thrombosis (VLST with drug-eluting stents (DES for the treatment of TCO. Late malapposition caused by hypersensitivity reactions and chronic inflammation was suggested as a probable cause of these VLST. New DES with bioresorbable polymer coatings were developed to address these safety concerns. No randomized trials have evaluated the efficacy and safety of the new-generation DES with bioresorbable polymers in patients treated for TCO. Methods/Design The prospective, randomized, single-blinded, multicenter, non-inferiority PRISON IV trial was designed to evaluate the safety, efficacy, and angiographic outcome of hybrid sirolimus-eluting stents with bioresorbable polymers (Orsiro; Biotronik, Berlin, Germany compared with everolimus-eluting stents with durable polymers (Xience Prime/Xpedition; Abbott Vascular, Santa Clara, CA, USA in patients with successfully recanalized TCOs. In total, 330 patients have been randomly allocated to each treatment arm. Patients are eligible with estimated duration of TCO ≥4 weeks with evidence of ischemia in the supply area of the TCO. The primary endpoint is in-segment late luminal loss at 9-month follow-up angiography. Secondary angiographic endpoints include in-stent late luminal loss, minimal luminal diameter, percentage of diameter stenosis, in-stent and in-segment binary restenosis and reocclusions at 9-month follow-up. Additionally, optical coherence

  16. Lineage Analysis in Pulmonary Arterial Hypertension

    Science.gov (United States)

    2013-06-01

    endothelial cells 12, 13. At the level of small pulmonary arteries, the occlusion by neointimal formation significantly exceeds muscularization of the...pyrrole. A, B) Normal muscular pulmonary artery (PA) adjacent to bronchiole (Br) A) hematoxylin and eosin stain (H&E), B) elastin-van Gieson stain (EVG...Iyer NV, Huso DL, Sun X, McWilliams R, Beaty T, Sham JS, Wiener CM, Sylvester JT, Semenza GL. Impaired physiological responses to chronic hypoxia in

  17. 慢性肾脏病患者血清脂联素与冠状动脉钙化积分关系的研究%Study of the relation between serum adiponectin and coronary artery calcification score in patients with chronic kidney disease

    Institute of Scientific and Technical Information of China (English)

    王英; 孙懿; 程浩; 贾艳丽

    2015-01-01

    Objective To investigate the relation between serum adiponectin and coronary artery calcification score (CACS), and find the risk factors for CACS in patients with chronic kidney disease (CKD). Methods Twenty-nine patients with 3-5 stage CKD were selected. The serum adiponectin was measured by enzyme linked immunosorbent assay. The heart was scanned by 64-row spiral CT, and the CACS was calculated. The blood calcium, phosphorus, intact parathyroid hormone, total cholesterol, low density lipoprotein cholesterol, albumin, urea nitrogen, creatinine, uric acid and high sensitive C reactive protein levels were measured, and the calcium-phosphorus product and estimation glomerular filtration rate were calculated. Results In 29 patients with CKD, 24 cases (83%) had coronary artery calcification with different degree (CACS>0 score), and the average CACS was 508 (0-3 363) scores. There were statistical differences in systolic blood pressure, urea nitrogen and estimation glomerular filtration rate between CKD patients with CACS≥100 scores (15 cases) and CKD patients with CACS0分),CACS平均508(0~3 363)分.CACS≥100分(15例)与CACS<100分(14例)的慢性肾脏病患者的收缩压[(146.00±13.00)、(123.00±9.00)mmHg(1 mmHg=0.133 kPa)]、血尿素氮[(15.44±8.36)、(9.71±2.52)mmol/L]、估计肾小球滤过率[(21.77±11.81)、(38.71±11.56) ml/(min·1.73 m2)]比较差异有统计学意义(P<0.01或<0.05).Pearson相关分析显示,CACS与收缩压、肌酐和尿酸呈正相关,与白蛋白和估计肾小球滤过率呈负相关.多元逐步回归分析显示收缩压和估计肾小球滤过率是CACS的独立危险因素. 结论 慢性肾脏病3~5期患者冠状动脉钙化严重,收缩压和估计肾小球滤过率是冠状动脉钙化的独立危险因素.

  18. Incidence, risk factors, treatment and prognosis of popliteal artery embolization in the superficial femoral artery interventions.

    Directory of Open Access Journals (Sweden)

    Weiwei Wu

    Full Text Available OBJECTIVE: Percutaneous transluminal angioplasty and stenting (PTA + stent has gained acceptance as a primary treatment modality for the superficial femoral artery (SFA diseases. Popliteal artery embolization (PAE is a severe complication in SFA interventions. The purpose of this study was to evaluate the incidence, risk factors, treatment and prognosis of PAE in primary SFA PTA + stent. METHODS: Chronic SFA arteriosclerosis cases that underwent primary PTA + stent were reviewed from a retrospectively maintained database. Runoff vessels were evaluated in all cases before and after the interventions for PAE detection. The primary patency, secondary patency and limb salvage rates were calculated using Kaplan-Meier analysis and compared using log-rank analysis. Cox multivariate regression was performed to evaluate predictors of patency and limb salvage rates. RESULTS: There were 436 lesions treated in 388 patients with 10 PAE events (2.3% in total. PAE rate was significantly higher in Transatlantic Inter-Society Consensus (TASC C/D group compared with TASC A/B group (OR = 8.91, P = .002, in chronic total occlusion (CTO lesions compared with stenotic lesions (P<.0001, and in group with history of cerebral ischemic stroke (OR = 6.11, P = .007. PAE rates were not significantly affected by age, sex, smoking, hypertension, diabetes, hyperlipidemia and runoff status. The binary logistic regression showed that only the TASC C/D was an independent predictor of PAE (P = .031. The 12-month and 24-month primary patency, secondary patency and limb salvage rates in PAE group showed no significant differences comparing with non-PAE group. CONCLUSIONS: PAE is a rare event in primary SFA PTA + stent. TASC C/D lesion, CTO and cerebral ischemic stroke history are risk factors for PAE. PAE is typically reversible by comprehensive techniques. If the popliteal flow is restored in time, PAE has no significant effect on long-term patency and limb

  19. Does conduit artery diameter vary according to the anthropometric characteristics of children or men?

    Science.gov (United States)

    Hopkins, N D; Green, D J; Tinken, T M; Sutton, L; McWhannell, N; Thijssen, D H J; Cable, N T; Stratton, G; George, K

    2009-12-01

    Arterial measurements are commonly undertaken to assess acute and chronic adaptations to exercise. Despite the widespread adoption of scaling practices in cardiac research, the relevance of scaling for body size and/or composition has not been addressed for arterial measures. We therefore investigated the relationships between brachial artery diameter and body composition in 129 children aged 9 to 10 yr (75 girls and 54 boys), and 50 men aged 16-49 yr. Body composition variables (total, lean, and fat mass in the whole body, arm, and forearm) were assessed by dual-energy X-ray absorptiometry, and brachial artery diameter was measured using high-resolution ultrasound. Bivariate correlations were performed, and arterial diameter was then scaled using simple ratios (y/x) and allometric approaches after log-log least squares linear regression and production of allometric exponents (b) and construction of power function ratios (y/xb). Size independence was checked via bivariate correlations (x:y/x; x:y/xb). As a result, significant correlations existed between brachial artery diameter and measures of body mass and lean mass in both cohorts (r=0.21-0.48, P0.05). In conclusion, when between- or within-group comparisons are performed under circumstances where it is important to control for differences in body size or composition, allometric scaling of artery diameter should be adopted rather than ratio scaling. Our data also suggest that scaling for lean or total mass may be more appropriate than scaling for indexes of fat mass.

  20. Chronic pancreatitis

    Science.gov (United States)

    Chronic pancreatitis - chronic; Pancreatitis - chronic - discharge; Pancreatic insufficiency - chronic; Acute pancreatitis - chronic ... alcohol abuse over many years. Repeated episodes of acute ... chronic pancreatitis. Genetics may be a factor in some cases. ...

  1. Efectos crónicos de un programa regular de natación. Sobre la tensión arterial de adultos hipertensos. Swimming chronic effects on the blood pressure. In hypertensive adults.

    Directory of Open Access Journals (Sweden)

    Natali , Antônio José

    2006-07-01

    Full Text Available ResumenEl propósito de este trabajo fue verificar los efectos crónicos de un programa regular de natación sobre la tensión arterial de adultos hipertensos. La muestra ha sido compuesta por 28 personas con hipertensión leve y moderada separados en dos grupos: Grupo Experimental (GE 11 mujeres y 3 hombres y Grupo Control (GC 8 hombres y 6 mujeres con edades 42,29 ± 8,72, y 42,15 ± 9,72 años respectivamente. Aquellos pertenecientes al grupo experimental, participaron de un programa regular de natación durante 10 semanas, mientras el grupo control permaneció sin practicar actividad física en ese período. El procedimiento estadístico utilizado fue el Teste-t de Student, para verificar las diferencias entre los promedios antes y después de diez semanas del programa regular de natación. El estudio admitió el nivel de p AbstractThe purpose of this work was to verify the chronic effects of a regular swimming program on hypertensive adults’ pressoric levels. The sample was constituted of 28 individuals that presented light and moderated hypertension, who were divided into two groups: Experimental (11 women and 3 men and Control (8 men and 6 women, with 42,29 ± 8,72 and 42.15 ± 9.72 years old, respectively. The subjects of Experimental group have engaged into a regular swimming program for 10 weeks, while the Control group did not practice any physical activity for the period. It was used the Student t-Test as statistical procedure, in order to analyze the differences between the average indexes recorded before and after the 10-weeks regular swimming program. The study admitted a level of p

  2. Arterial calcification: A new perspective?

    Science.gov (United States)

    Nicoll, R; Henein, M

    2017-02-01

    Arterial calcification is commonly seen in atherosclerosis, chronic kidney disease (CKD) and diabetes and has long been considered a natural progression of atherosclerosis. Yet it is a systemic condition, occurring in a wide and diverse range of disease states and no medical treatment for cardiovascular disease has yet found a way to regress it; on the contrary, lipid-lowering therapy may worsen its progression. Although numerous studies have found associations between calcification and biomarkers, none has yet found a unifying mechanism that explains the calcification found in atherosclerosis, CKD or diabetes and many of the biomarkers are equally associated with atheroma development and cardiovascular events. Furthermore, both presence and absence of coronary artery calcification appear predictive of plaque rupture and cardiovascular events, indicating that the association is not causal. This suggests that we are no further forward in understanding the true nature of arterial calcification or its pathogenesis, other than noting that it is 'multifactorial'. This is because most researchers view arterial calcification as a progressive pathological condition which must be treated. Instead, we hypothesise that calcification develops as an immune response to endothelial injury, such as shear stress or oxidative stress in diabetics, and is consequently part of the body's natural defences. This would explain why it has been found to be protective of plaque rupture and why it is unresponsive to lipid-lowering agents. We propose that instead of attempting to treat arterial calcification, we should instead be attempting to prevent or treat all causes of endothelial injury.

  3. Computational modeling of hypertensive growth in the human carotid artery

    Science.gov (United States)

    Sáez, Pablo; Peña, Estefania; Martínez, Miguel Angel; Kuhl, Ellen

    2014-06-01

    Arterial hypertension is a chronic medical condition associated with an elevated blood pressure. Chronic arterial hypertension initiates a series of events, which are known to collectively initiate arterial wall thickening. However, the correlation between macrostructural mechanical loading, microstructural cellular changes, and macrostructural adaptation remains unclear. Here, we present a microstructurally motivated computational model for chronic arterial hypertension through smooth muscle cell growth. To model growth, we adopt a classical concept based on the multiplicative decomposition of the deformation gradient into an elastic part and a growth part. Motivated by clinical observations, we assume that the driving force for growth is the stretch sensed by the smooth muscle cells. We embed our model into a finite element framework, where growth is stored locally as an internal variable. First, to demonstrate the features of our model, we investigate the effects of hypertensive growth in a real human carotid artery. Our results agree nicely with experimental data reported in the literature both qualitatively and quantitatively.

  4. CLINICAL CO RELATION BETWEEN ARTERIAL VERSUS VENOUS AMMONIA LEVELS IN HEPATIC ENCEPHLOPATHY IN CIRRHOSIS OF LIVER

    Directory of Open Access Journals (Sweden)

    Manjunath

    2014-05-01

    Full Text Available : INTRODUCTION: Hepatic encephalopathy is a reversible neuropsychiatry state that complicates liver disease. Pathogenesis of Hepatic Encephalopathy in chronic liver is function is widely accepted to be due to failure of hepatic clearance of toxins products from gut exact toxin involved remains controversial but ammonia is thought to be an important factor. Ammonia levels help both in diagnosis and serve as a guide in treatment. Diagnosis of Hepatic Encephalopathy can be done based on clinical criteria and the severity of Hepatic Encephalopathy can be graded by West Haven Criteria. This criterion is the simplest grading of Hepatic Encephalopathy based on clinical findings. AIMS AND OBJECTIVES: To correlate between Ammonia levels and clinical severity of Hepatic Encephalopathy in Cirrhosis of liver and correlate between Arterial versus venous ammonia levels with severity of Hepatic Encephalopathy. RESULTS: Male patients had higher incidence than females. Severity of hepatic encephalopathy was graded by West Haven grading. Arterial total ammonia and venous ammonia was correlated with the clinical severity of HE. Of the 50 patients 3 had grade 1, 18 had grade 2, 22 had grade 3 and 7 had grade 4. Arterial and venous ammonia levels co related with severity of HE. The highest level of arterial ammonia was seen in grade 3 and grade 4.It was seen that other lab parameters also increased with severity of HE. But were not significant. Serum albumin was inversely co related with severity of HE. CONCLUSIONS: Arterial total ammonia correlated better with the severity of Hepatic Encephalopathy as compared to venous ammonia levels. Venous total ammonia did not correlate with severity of Hepatic Encephalopathy and with arterial ammonia levels.

  5. Total protein

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/article/003483.htm Total protein To use the sharing features on this page, please enable JavaScript. The total protein test measures the total amount of two classes ...

  6. Peripheral arterial line (image)

    Science.gov (United States)

    A peripheral arterial line is a small, short plastic catheter placed through the skin into an artery of the arm or leg. The purpose of a peripheral arterial line is to allow continuous monitoring of ...

  7. Effect of phentolamine and diltiazem on pulmonary artery hypertension in exacerbations of chronic obstructive pulmonary disease patients with chronic cor pulmonale%酚妥拉明联合地尔硫(卓)对慢性肺心病急性加重期肺动脉高压的疗效观察

    Institute of Scientific and Technical Information of China (English)

    付松泉; 王莉; 刘圳奋; 路婷; 王丽红

    2011-01-01

    Objective To evaluate the effects of phentolamine and diltiazem on pulmonary artery hypertension in exacerbations of patients with chronic cor pulmonale caused by chronic obstructive pulmonary disease(COPD). Methods One hundred and twenty-five patients with COPD compicated with cor pulmonale were randomly divided into routine group ( n = 35), phentolamine group( n = 30), diltiazem group( n = 30) and phentolamine+ diltiazem group( n = 30). Four groups were given routine treatment and phentolamine group was given phentolamine(10 mg) intravenous infusion by micro pump(0.4- 0.6 mg/h), diltiazem group was given oral diltiazem supplement (30 mg, three times a day),phentolamine+ diltiazem group was given phentolamine (10 mg) intravenous infusion by micro pump and oral diltiazem supplement (30 mg, three times a day). Change of brain natriuretic peptide(BNP) and mean artery pulmonary artery pressure(mPAP) after 14 days were measured. Results In treatment groups,BNP and mean pulmonary artery pressure decreased significantly after 14 days of treatment compared with those before treatment in the same group and routine group (all P <0.05). mPAP in routine group(55.2±6.5)mmHg vs (48.6±8. 2) mmHg( P <0. 05),BNP (602.9± 96. 6) pg/L vs (416.2 ± 43.7) pg/L( P <0.05) ; mPAP in phentolamine group(57. 3 ± 6.8) mmHg vs (42.1±9.6) mmHg( P <0. 05),BNP(628.2±89.1) pg/L vs (356.1±37.9) pg/L( P <0.01);mPAP in diltiazem group(56.2±6.1) mmHg vs (43.4±8. 9) mmHg( P <0.05) ,BNP(612. 7±87. 4) pg/L vs (382. 9±37.5) pg/L( P < 0.01) ; mPAP in phentolamine+diltiazem group(58.3±6.7) mmHg vs (30.5±7.7) mmHg( P<0.01) ,BNP(644. 6± 98.3) pg/L vs (286.5±33.4) pg/L( P <0.01). Further extremely significant downregulation of BNP expression and mean pulmonary artery pressure were observed in phentolamine and diltiazem group after the following 14 days'treatment. Conclusion Phentolamine and diltiazem can adjust the synthesis and secretion of BNP,and the treatment can

  8. Retrograde pedal access with a 20-gauge intravenous cannula after failed antegrade recanalization of a tibialis anterior artery in a diabetic patient: a case report

    Directory of Open Access Journals (Sweden)

    Yucel Colkesen

    2015-08-01

    Full Text Available Retrograde tibiopedal approach is being used frequently in below-the-knee vascular interventions. In patients with diabetic foot pathology, complex anatomy often requires a retrograde technique when the distal vascular anatomy and puncture site is suitable. The dorsalis pedis and posterior tibial arteries can be punctured because of their relatively superficial position. We report a retrograde puncturing technique in patients with chronic total occlusions. After failed antegrade recanalization, puncturing and cannulation of a tiny dorsalis pedis artery with a narrow bore [20-gauge (0.8 mm] intravenous cannula is described.

  9. O tratamento operatório da dissecção aórtica crônica tipo A em pacientes submetidos à revascularização cirúrgica do miocárdio Surgical treatment of chronic type A aortic dissection in patients undergoing coronary artery bypass grafting

    Directory of Open Access Journals (Sweden)

    João Carlos Leal

    2010-09-01

    Full Text Available O tratamento operatório da dissecção aórtica é um desafio para o cirurgião cardíaco, sobretudo nos pacientes submetidos a operação cardíaca prévia. Nosso objetivo neste relato de caso é demonstrar como tratamos a dissecção aórtica crônica tipo A em paciente revascularizado utilizando cânulas arterial e venosa percutâneas.Surgical treatment of aortic dissection is a challenge for the cardiac surgeon, especially in patients undergoing cardiac operations. Our objective in this case report is to demonstrate how we treat the chronic type A aortic dissection in patients revascularized using percutaneous arterial and venous cannulae.

  10. The inspiratory capacity/total lung capacity ratio as a predictor of survival in an emphysematous phenotype of chronic obstructive pulmonary disease

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    French A

    2015-07-01

    Full Text Available Aimee French, David Balfe, James M Mirocha, Jeremy A Falk, Zab Mosenifar Cedars-Sinai Medical Center, Division of Pulmonary and Critical Care Medicine, Los Angeles, CA, USA Background: Forced expiratory volume in 1 second (FEV1 grades severity of COPD and predicts survival. We hypothesize that the inspiratory capacity/total lung capacity (IC/TLC ratio, a sensitive measure of static lung hyperinflation, may have a significant association with survival in an emphysematous phenotype of COPD.Objectives: To access the association between IC/TLC and survival in an emphysematous phenotype of COPD. Methods: We performed a retrospective analysis of a large pulmonary function (PF database with 39,050 entries, from April 1978 to October 2009. Emphysematous COPD was defined as reduced FEV1/forced vital capacity (FVC, increased TLC, and reduced diffusing capacity of the lungs for carbon monoxide (DLCO; beyond 95% confidence intervals [CIs]. We evaluated the association between survival in emphysematous COPD patients and the IC/TLC ratio evaluated both as dichotomous (≤25% vs >25% and continuous predictors. Five hundred and ninety-six patients had reported death dates.Results: Univariate analysis revealed that IC/TLC ≤25% was a significant predictor of death (hazard ratio [HR]: 2.39, P<0.0001. Median survivals were respectively 4.3 (95% CI: 3.8–4.9 and 11.9 years (95% CI: 10.3–13.2. Multivariable analysis revealed age (HR: 1.19, 95% CI: 1.14–1.24, female sex (HR: 0.69, 95% CI: 0.60–0.83, and IC/TLC ≤25% (HR: 1.69, 95% CI: 1.34–2.13 were related to the risk of death. Univariate analysis showed that continuous IC/TLC was associated with death, with an HR of 1.66 (95% CI: 1.52–1.81 for a 10% decrease in IC/TLC.Conclusion: Adjusting for age and sex, IC/TLC ≤25% is related to increased risk of death, and IC/TLC as a continuum, is a significant predictor of mortality in emphysematous COPD patients.  Keywords: emphysema, pulmonary function

  11. Peripheral arterial embolism. Report of hospitalized cases

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    Antonio Carlos Pereira Barretto

    2000-04-01

    Full Text Available OBJECTIVE: We analyzed the frequency of peripheral embolisms, the underlying heart disease,triggering factors, the sites of the emboli, and evolution of the patients. METHODS: We analyzed 29 cases of peripheral arterial embolism out of a total of 20,211 hospitalizations in a cardiology center in the city of São Paulo. The age was 51.89±18.66 years, and 15 were males. RESULTS: Embolism in the right lower limb occurred in 18 patients (62.0%,in the left lower 11(37.9% and right upper 3 (10.3% limbs, and in the left arm (1. Four patients had embolism in two limbs. The heart disease, mitral valvar heart disease (9 patients - 31.0%; infective endocarditis (7- 24.1%; dilated cardiomyopathy (6 - 20.6%; ischemic coronary heart disease (6 patients - 20.6%; and one patient with cor pulmonale. Atrial fibrillation was observed in 20 patients (68.9%, chronic in 12 patients (41.3% and acute in 8 (27.5%. All patients with mitral valvar heart disease had atrial fibrillation, chronic in 8 patients (88.8%; patients with cardiomyopathy and coronary heart disease, 4 in each group had atrial fibrillation, acute in 60% of the patients.Patients with infective endocarditis, 3 had staphylococcus and 2 Gram-negative bacteria. In the follow-up, 2 patients (6.8% required limbs amputation, and 5 (17.2% died due to embolism. CONCLUSION: Most of the time, embolism does not cause permanent complications. Our data highlight the importance of anticoagulation for patients acute atrial fibrillation in myocardial dysfunction and for patients with chronic atrial fibrillation in cases of mitral valvar heart disease to prevent peripheral embolism.

  12. Recurrent hemarthrosis after total knee arthroplasty.

    Science.gov (United States)

    Rukavina, Alexander; Kerkhoffs, Gino M M J; Schneider, Philipp; Kuster, Markus S

    2010-07-01

    This report describes a case of spontaneous recurrent hemarthrosis of the knee that presented 4 weeks after total knee arthroplasty. Femoral arteriography showed a false aneurysm of a branch of the inferior lateral geniculate artery. Therapeutic embolization of the arterial branch was performed using three platinum coils with good clinical result and good knee joint function. Hemarthrosis has not recurred since embolization.

  13. Recurrent hemarthrosis after total knee arthroplasty

    OpenAIRE

    Rukavina, A.; Kerkhoffs, G. M. M. J.; Schneider, P.; Kuster, M S

    2010-01-01

    This report describes a case of spontaneous recurrent hemarthrosis of the knee that presented 4 weeks after total knee arthroplasty. Femoral arteriography showed a false aneurysm of a branch of the inferior lateral geniculate artery. Therapeutic embolization of the arterial branch was performed using three platinum coils with good clinical result and good knee joint function. Hemarthrosis has not recurred since embolization.

  14. Recurrent hemarthrosis after total knee arthroplasty

    NARCIS (Netherlands)

    Rukavina, A.; Kerkhoffs, G.M.M.J.; Schneider, P.; Kuster, M.S.

    2010-01-01

    This report describes a case of spontaneous recurrent hemarthrosis of the knee that presented 4 weeks after total knee arthroplasty. Femoral arteriography showed a false aneurysm of a branch of the inferior lateral geniculate artery. Therapeutic embolization of the arterial branch was performed usin

  15. Use of reactive hyperemia - peripheral arterial tonometry and circulating biological markers to predict outcomes in sepsis

    Science.gov (United States)

    Nobre, Vandack; Ataíde, Thiago Bragança; Brant, Luisa Caldeira; Oliveira, Clara Rodrigues; Rodrigues, Lucas Vieira; Ribeiro, Antonio Luiz Pinho; Lopes, Fernanda Barbosa; Saraiva, Ivan Euclides; Andrade, Marcus Vinícius

    2016-01-01

    Objective To evaluate the usefulness and prognostic value of reactive hyperemia - peripheral arterial tonometry in patients with sepsis. Moreover, we investigated the association of reactive hyperemia - peripheral arterial tonometry results with serum levels of certain inflammatory molecules. Methods Prospective study, conducted in an 18-bed mixed intensive care unit for adults. The exclusion criteria included severe immunosuppression or antibiotic therapy initiated more than 48 hours before assessment. We measured the reactive hyperemia - peripheral arterial tonometry on inclusion (day 1) and on day 3. Interleukin-6, interleukin-10, high-mobility group box 1 protein and soluble ST2 levels were measured in the blood obtained upon inclusion. Results Seventeen of the 79 patients (21.6%) enrolled were determined to have reactive hyperemia - peripheral arterial tonometry signals considered technically unreliable and were excluded from the study. Thus, 62 patients were included in the final analysis, and they underwent a total of 95 reactive hyperemia - peripheral arterial tonometry exams within the first 48 hours after inclusion. The mean age was 51.5 (SD: 18.9), and 49 (62%) of the patients were male. Reactive hyperemia indexes from days 1 and 3 were not associated with vasopressor need, Sequential Organ Failure Assessment score, Acute Physiology and Chronic Health Evaluation II score, or 28-day mortality. Among the patients who died, compared with survivors, there was a significant increase in the day 3 reactive hyperemia index compared with day 1 (p = 0.045). There was a weak negative correlation between the day 1 reactive hyperemia - peripheral arterial tonometry index and the levels of high-mobility group box 1 protein (r = -0.287). Conclusion Technical difficulties and the lack of clear associations between the exam results and clinical severity or outcomes strongly limits the utility of reactive hyperemia - peripheral arterial tonometry in septic patients

  16. ADVANCE: Study to Evaluate Cinacalcet Plus Low Dose Vitamin D on Vascular Calcification in Subjects With Chronic Kidney Disease Receiving Hemodialysis

    Science.gov (United States)

    2014-07-14

    Chronic Kidney Disease; End Stage Renal Disease; Coronary Artery Calcification; Vascular Calcification; Calcification; Cardiovascular Disease; Chronic Renal Failure; Hyperparathyroidism; Kidney Disease; Nephrology; Secondary Hyperparathyroidism

  17. Management of a chronic carotid artery pseudoaneurysm.

    Science.gov (United States)

    Baker, Aaron C; Arko, Frank R; Zarins, Christopher K; Lee, Eugene S

    2010-01-01

    An 82-year-old female with a history of right carotid endarterectomy with patch closure 12 years prior presents with a pulsatile right neck mass with skin erosion and bleeding. The patient had been previously evaluated but refused the surgical intervention because a median sternotomy was recommended to obtain adequate proximal control. Her aneurysm was successfully repaired using a combination of open and endovascular method. The repair was performed through a right-hand side anterior sternocleidomastoid neck incision, and proximal vascular control was obtained with an 8.5-mm balloon positioned under fluoroscopic guidance via a femoral puncture.

  18. Resting and Post-Exercise Ankle-Brachial Index Measurements to Diagnose Asymptomatic Peripheral Arterial Disease in Middle Aged and Elderly Chronic Obstructive Pulmonary Disease Patients: A Pilot Study

    Science.gov (United States)

    Alagiakrishnan, Kannayiram; Brokop, Michael; Cave, Andrew; Rowe, Brian H.; Wong, Eric; Senthilselvan, Ambikaipakan

    2016-01-01

    Background Chronic obstructive pulmonary disease (COPD) patients are at risk for asymptomatic peripheral arterial disease (PAD) because smoking is a risk factor for COPD and PAD. The objectives of this study were to determine the proportion of COPD patients with asymptomatic PAD and to investigate whether the estimated risk of asymptomatic PAD in subjects with COPD differs using resting and exercise ankle-brachial index (ABI) in smokers. Methods Using a cross-sectional study design, consecutive smokers > 50 years old were recruited over 2 months from the inpatient units and the outpatient clinics. Subjects previously diagnosed with PAD, unstable angina, recent (< 3 months) myocardial infarction or abdominal, intracranial, eye or lung surgery, and palliative care patients were excluded. Vascular risk factors, ABI (supine and post-3-minute walk supine), self-reported PAD symptoms, and spirometry were obtained. Two measurements of systolic blood pressure on all limbs were obtained using a sphygmomanometer and a Doppler ultrasound, and the ABI was calculated. Data were expressed as means ± standard deviation (SD). Dichotomous outcomes were assessed using Chi-square statistics; P-values of < 0.05 were considered significant. Results Thirty patients with no previous diagnosis of PAD were recruited. Mean age was 67.7 years (SD: 10.5). Overall, 21 subjects (70%) had spirometry-proven COPD. Significant ABI for PAD (< 0.9) was seen in 7/21 COPD (33.5%) and 0/9 non-COPD subjects in the supine resting position (P = 0.07), and in 9/21 COPD (42.9%) vs. 0/9 non-COPD subjects after exercise (P = 0.03). Conclusions A significant proportion of patients with spirometry-proven COPD screened positive for asymptomatic PAD after exercise. Resting ABI may not be very sensitive to diagnose asymptomatic PAD in COPD subjects. ABI may be a reliable, sensitive and practical screening tool to assess cardiovascular risk in COPD patients. Future large-scale studies are required to confirm this

  19. Detection of misery perfusion in the cerebral hemisphere with chronic unilateral major cerebral artery steno-occlusive disease using crossed cerebellar hypoperfusion: comparison of brain SPECT and PET imaging

    Energy Technology Data Exchange (ETDEWEB)

    Matsumoto, Yoshiyasu; Ogasawara, Kuniaki; Saito, Hideo; Takahashi, Yoshihiro; Ogasawara, Yasushi; Kobayashi, Masakazu; Ogawa, Akira [Iwate Medical University, Department of Neurosurgery, Morioka (Japan); Iwate Medical University, Cyclotron Research Center, Morioka (Japan); Terasaki, Kazunori [Iwate Medical University, Cyclotron Research Center, Morioka (Japan); Yoshida, Kenji; Beppu, Takaaki; Kubo, Yoshitaka; Fujiwara, Shunrou [Iwate Medical University, Department of Neurosurgery, Morioka (Japan); Tsushima, Eiki [Hirosaki University, Graduate School of Health Sciences, Hirosaki (Japan)

    2013-10-15

    In patients with unilateral internal carotid or middle cerebral artery (ICA or MCA) occlusive disease, the degree of crossed cerebellar hypoperfusion that is evident within a few months after the onset of stroke may reflect cerebral metabolic rate of oxygen in the affected cerebral hemisphere relative to that in the contralateral cerebral hemisphere. The aim of the present study was to determine whether the ratio of blood flow asymmetry in the cerebellar hemisphere to blood flow asymmetry in the cerebral hemisphere on positron emission tomography (PET) and single photon emission computed tomography (SPECT) correlates with oxygen extraction fraction (OEF) asymmetry in the cerebral hemisphere on PET in patients with chronic unilateral ICA or MCA occlusive disease and whether this blood flow ratio on SPECT detects misery perfusion in the affected cerebral hemisphere in such patients. Brain blood flow and OEF were assessed using {sup 15}O-PET and N-isopropyl-p-[{sup 123}I]iodoamphetamine ({sup 123}I-IMP) SPECT, respectively. All images were anatomically standardized using SPM2. A region of interest (ROI) was automatically placed in the bilateral MCA territories and in the bilateral cerebellar hemispheres using a three-dimensional stereotaxic ROI template, and affected-to-contralateral asymmetry in the MCA territory or contralateral-to-affected asymmetry in the cerebellar hemisphere was calculated. Sixty-three patients with reduced blood flow in the affected cerebral hemisphere on {sup 123}I-IMP SPECT were enrolled in this study. A significant correlation was observed between MCA ROI asymmetry of PET OEF and the ratio of cerebellar hemisphere asymmetry of blood flow to MCA ROI asymmetry of blood flow on PET (r = 0.381, p = 0.0019) or SPECT (r = 0.459, p = 0.0001). The correlation coefficient was higher when reanalyzed in a subgroup of 43 patients undergoing a PET study within 3 months after the last ischemic event (r = 0.541, p = 0.0001 for PET; r = 0.609, p < 0

  20. Prediction of improvement in global left ventricular function in patients with chronic coronary artery disease and impaired left ventricular function: rest thallium-201 SPET versus low-dose dobutamine echocardiography

    Energy Technology Data Exchange (ETDEWEB)

    Pace, L.; Salvatore, M. [Ist. di Scienze Biomorfologiche e Funzionali, Univ. Federico II, Napoli (Italy); Centro C.N.R. Medicina Nucleare, Napoli (Italy); Perrone-Filardi, P.; Dellegrottaglie, S.; Prastaro, M.; Crisci, T.; Ponticelli, M.P.; Piscione, F.; Chiariello, M. [Ist. di Medicina Interna, Cardiochirurgia e Cardiologia, Univ. Federico II, Napoli (Italy); Storto, G.; Della Morte, A.M. [Ist. di Scienze Biomorfologiche e Funzionali, Univ. Federico II, Napoli (Italy)

    2000-12-01

    Accurate assessment of myocardial viability permits selection of patients who would benefit from myocardial revascularization. Currently, rest-redistribution thallium-201 scintigraphy and low-dose dobutamine echocardiography are among the most used techniques for the identification of viable myocardium. Thirty-one consecutive patients (all men, mean age 60{+-}8 years) with chronic coronary artery disease and reduced left ventricular ejection fraction (31%{+-}7%) were studied. Rest {sup 201}Tl single-photon emission tomography (SPET), low-dose dobutamine echocardiography and radionuclide angiography were performed before revascularization. Radionuclide angiography and echocardiography were repeated after revascularization. An a/dyskinetic segment was considered viable on {sup 201}Tl SPET when tracer uptake was >65%, while improvement on low-dose dobutamine echocardiography was considered a marker of viability. Increase in global ejection fraction was considered significant at {>=}5%. In identifying viable segments, rest {sup 201}Tl SPET showed higher sensitivity than low-dose dobutamine echocardiography (72% vs 53%, P<0.05), while specificity was not significantly different (86% vs 88%). In 17 patients, global ejection fraction increased {>=}5% (group 1) while in 14 it did not (group 2). A higher number of a/dyskinetic segments were viable on {sup 201}Tl SPET in group 1 than in group 2 (2.6{+-}1.9 vs 0.6{+-}1.2, P<0.005), while no significant differences were observed on low-dose dobutamine echocardiography (1.7{+-}1.6 vs 1.1{+-}1.6). A significant correlation was found between the number of a/dyskinetic segments viable on {sup 201}Tl SPET and post-revascularization changes in ejection fraction (r=0.52, P<0.05), but such a correlation was not observed for low-dose dobutamine echocardiography. Using as the cut-off the presence of at least one viable a/dyskinetic segment, rest {sup 201}Tl SPET had a higher sensitivity (82% vs 53%, P=0.07) and showed a trend towards

  1. GIANT SPLENIC ARTERY PSEUDO ANEURYSM MASQUERADING AS BLEEDING PER RECTUM - A RARE CASE

    Directory of Open Access Journals (Sweden)

    Bhupesh

    2013-10-01

    Full Text Available ABSTRACT: Splenic artery aneurysm are rare entity, we report a c ase of 40 year old male presenting with hypovolemic shock and massive bleeding per rectum secondary to spleenic artery aneurysm rupture into the colon. Patient underwent exploratory laparotomy and definitive procedure was done KEY WORDS: Splenic artery an eurysm 1: shock 2 : bleeding per rectum 3: chronic pancreatitis;

  2. Pulmonary Artery Agenesis with Bronchial Asthma

    Directory of Open Access Journals (Sweden)

    Hassan Ghobadi

    2014-05-01

    Full Text Available Unilateral Pulmonary Artery Agenesis (UPAA is a rare congenital anomaly during the 4 th  week of gestational age. It is defined as an absence of pulmonary parenchyma and its supporting artery. A 9-year-old girl was admitted to our hospital because of chronic cough. Chest examination showed a decrement in lung sound of right hemi-thorax with expiratory wheeze. Chest radiography (CXR revealed a semi-opaque right hemi-thorax. Chest CT with intra-venous contrast demonstrated absence of the right pulmonary artery and lung parenchyma with hyper-inflated left lung and dextro-position of mediastinum. This case emphasizes that in patients with respiratory compliant and chronic cough CXR must be done to rule out similar diagnosis other than asthma.    

  3. Clinical significance of hepatic artery variations originating from the superior mesenteric artery in abdominal tumor surgery

    Institute of Scientific and Technical Information of China (English)

    HUANG Yuan; LIU Chao; LIN Jin-ling

    2013-01-01

    Background Hepatic artery variations are frequent clinical occurrences.The aim of this study was to investigate the characteristic course of variant hepatic arteries originating from the superior mesenteric artery for the purpose of providing instructions for abdominal tumor surgery.Methods The course of variant hepatic arteries originating from the superior mesenteric artery was studied in 400 patients with liver cancer confirmed by digital subtraction angiography (DSA) and multi-slice spiral computed tomography angiography (MSCTA),and 86 patients with gastric cancer confirmed by preoperative MSCTA between June 2008 and June 2010 in the First Affiliated Hospital of Guangxi Medical University.Results Hepatic artery variations originating from the superior mesenteric artery were noticed in 49 liver cancer patients and 14 gastric cancer patients (total 63 cases),with a variation rate of 12.96%,including two cases (3.17%) where the hepatic arteries ran along the anterior pancreas,and 61 cases (96.83%) where the hepatic arteries ran along the posterior pancreas.Conclusions Hepatic artery variations originating from the superior mesenteric artery present as two types:the pre-pancreas type and the post-pancreas type with the latter predominating.This finding is of clinical significance in abdominal tumor surgeries where clearance of portal lymph nodes is needed.

  4. [Ruptured pseudoaneurysm of the renal artery associated with segmental arterial mediolysis].

    Science.gov (United States)

    Mizutani, Kosuke; Kikuchii, Mina; Kondo, Hiroshi; Moriyama, Yoji; Tsuchiya, Tomohiro; Masahiro, Nakano; Hidetoshi, Ehara; Deguchii, Takashi; Shinoda, Ikuo

    2008-07-01

    We present a 71-year-old woman with spontaneous perinephric hematoma due to a rupture of pseudoaneurysm of the right renal artery on the fourth day after radical cystectomy and bilateral ureterocutaneostomy for bladder cancer. This patient received steroid therapy for chronic rheumatoid arthritis for several years. The digital subtraction angiography of the right renal artery showed two pseudoaneurysms in the anterior inferior segmental branch and the posterior inferior segmental branch. Transarterial coil embolization of the right renal artery proximally and distally to the two aneurysms was performed without complications. Moreover, the additional angiography showed typical string-of-beads appearance and small aneurysms in abdominal visceral arteries, suggesting segmental arterial mediolysis (SAM) as a possible etiology. Differential diagnoses of SAM are discussed.

  5. Total algorithms

    NARCIS (Netherlands)

    Tel, G.

    1993-01-01

    We define the notion of total algorithms for networks of processes. A total algorithm enforces that a "decision" is taken by a subset of the processes, and that participation of all processes is required to reach this decision. Total algorithms are an important building block in the design of distri

  6. Propeller liver acquisition with volume acceleration sequence in diagnosis of small enhancing nodular of chronic liver disease in arterial phase with contrast-enhanced dynamic MRI%Propeller肝脏三维容积内插快速序列诊断慢性肝病动脉期强化小结节

    Institute of Scientific and Technical Information of China (English)

    秦海燕; 王丹; 刘芳; 曹绍东; 薛美娜; 申宝忠; 方芳; 韩东; 刘学佳

    2011-01-01

    目的 评价Propeller LAVA序列MR动态增强对慢性肝病背景下动脉期强化小结节(≤3.0 cm)的诊断价值.方法 回顾分析132例经组织学和(或)临床实验室检查证实的慢性肝病者Propeller LAVA增强检查资料,观察动脉期强化小结节的血供特点、强化规律及程度.结果 所有患者中,89例153个结节(0.5~3.0 cm)符合本组纳入要求,其中<2.0 cm圆形或卵圆形结节62个,≥2.0 cm 55个,其他形状36个.90个肝细胞癌结节中,与邻近肝实质比较,62个在门静脉期和延迟期表现为低信号结节,21个略低于邻近肝实质,7个信号强度近似于邻近肝实质.肝血管瘤20个,15个T2WI信号强度类似于脑脊液,5个略低于脑脊液;动脉期10个边缘结节状强化,8个均匀强化,2个周边见楔状高信号;门静脉期和延迟期均表现为稍高于或等于邻近肝实质的强化结节.动脉门静脉分流40个,动脉期位于肝脏中心或周边部分的卵圆形、楔形或三角形强化影,随时间延迟与邻近肝实质信号强度一致.局灶结节增生3个,动脉期强化程度近似于同层面腹主动脉,门静脉期和延迟期与邻近肝实质信号强度近似.结论 Propeller LAVA序列可准确显示慢性肝病患者动脉期强化小结节的血供特点、形态、边缘及其组织学性质.%Objective To evaluate Propeller liver acquisition with volume acceleration(LAVA) dynamic enhanced MR in diagnosing small enhancing nodular of chronic liver disease. Methods Propeller LAVA examination data of 132 patients with chronic hepatic disease confirmed by histological and (or) laboratory were analyzed retrospectively. The features of small enhancing nodular, including blood supplying, contrast enhanced regulation and degree and lesions were observed.Results Totally 89 cases (153 nodulars 0. 5-3. 0 cm) were included, 117 (62 nodulars<2.0 cm and 55 nodulars≥2.0 cm) nodulars were round or oval, 36 were other shape. Compared with adjacent

  7. [Hypoparathyroid risk after total thyroidectomy].

    Science.gov (United States)

    Milone, Antonino; Carditello, Antonio; Stilo, Francesco; Paparo, Domenica; Paparo, Teresa

    2004-01-01

    From January 1970 to December 1999, 881 patients with thyroid pathology underwent surgery consisting in 551 subtotal thyroidectomies and 330 total thyroidectomies. Permanent hypocalcaemia was present in 32 patients (3.6%). The importance of accurate isolation and ultraligature of the branches of the inferior thyroid artery in the prevention of parathyroid damage is stressed.

  8. Experimental Study on Total Alkaloid of Stephania delavayi Diels for Treating Rat Chronic Atrophic Gastritis%金不换总生物碱治疗大鼠慢性萎缩性胃炎的实验研究

    Institute of Scientific and Technical Information of China (English)

    吴丽萌; 赖东梅; 陈娟; 周长华; 马仁强; 陈健文

    2011-01-01

    Objective To study the effects of total alkaloid of stephania delavayi diels on treating chronic atrophic gastritis(CAG) in rats.Methods 20 mmol/L sodium deoxycholate combined 30%, 60% alcohols were given to rats for 13 weeks to establish CAG model.The rats were randomly divided into six groups: normal control group, model control group, high, medium and low doses groups with total alkaloid of stephania delavayi diels, and Sanjiu Weitain group.The acidity of gastric juice, pepsase activities and volume of blood flow in gastric mucosa were detected, and the pathologic changes of the gastric mucosa were observed by microscope.Results In total alkaloid of stephania delavayi diels treated groups, the body weight was increased( P > 0.05) and the concentration of free acid was significantly increased, while pepsase activities and volume of blood flow in gastric mucosa were obviously higher than those in the control groups (P <0.05 or P <0.01 ).Chronic infiltration of inflammatory cells and atrophy of glands on gastric mucosa were observed less in JB groups than in model group( P <0.05 or P <0.01 ).Conclusion The total alkaloid of stephania delavayi diels has the satisfactory curative efficacy for chronic atrophic gastritis in rats, which provides the pharmacological basis for its clinical application.%目的 研究金不换总生物碱对慢性胃炎的作用.方法 饮用及灌胃给予20mmol/L去氧胆酸钠、30%及60%乙醇13周建立慢性萎缩性胃炎模型后,将大鼠随机分为正常对照组,模型对照组,金不换总生物碱高、中、低剂量组和三九胃泰组.观察其对胃酸酸度、胃蛋白酶活性、胃黏膜血流量和胃黏膜组织病理的影响.结果 与模型对照组比较,金不换总生物碱可改善慢性萎缩性胃炎大鼠体重,明显增加胃液游离酸浓度、胃蛋白酶活性和胃黏膜血流量(P<0.05或P<0.01),并能明显减轻胃黏膜的病理学损害.结论 金不换生物碱对慢性萎缩性

  9. Clinical characteristics among CABG or PCI which to treat chronic kidney disease with unprotected left main coronary artery disease%不同治疗策略在慢性肾疾病合并无保护左主干病变中的应用

    Institute of Scientific and Technical Information of China (English)

    潘昱; 仇琪; 张筠婷; 罗亚玮; 玉献鹏; 何继强; 李全

    2015-01-01

    Objective To explore the clinical characteristics and prognosis of patients with chronic kidney disease with unprotected left main (ULM) coronary artery disease undergoing coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI).Methods A total of 601 unprotected left main coronary artery disease patients were recruited.According to the values of endogenous creatinine clearance rate (Ccr),they were divided into three groups of <45 ml/min (n =40),45-59 ml/min (n =96) and ≥ 60 ml/min (n =465).Retrospective comparisons were made for the clinical parameters and prognosis of ULM patients in different Ccr groups with different therapies.Results In Ccr ≥ 60 ml/min group,the valves of left ventricular ejection fraction (LVEF) were lower in patients undergoing CABG.Patients with complete total occlusion (CTO) and complete revascularizations were much more than those undergoing PCI.In Ccr ≥60 ml/min and Ccr 45-59 ml/min groups,multivessel disease was frequent in CABG-treated patients.No significant difference existed among three groups in major adverse cardiac and cerebrovascular event (MACCE),overall mortality or cardiac mortality.Conclusion PCI is both safe and efficacious for chronic renal insufficiency patients with ULM.%目的 分析慢性肾疾病(CKD)患者合并无保护左主干(ULM)冠状动脉病变行经皮冠状动脉介入手术(PCI)和冠状动脉旁路移植术(CABG)的临床特点及预后.方法 回顾性分析2005年1月至2010年3月入住北京安贞医院ULM冠状动脉病变患者601例病例资料.按内生肌酐清除率(Ccr)分层,每层根据手术方式分为PCI组和CABG组.Ccr< 45 ml/min 40例(PCI术18例,CABG术22例);Ccr 45 ~ 59 ml/min 96例(PCI术37例,CABG术59例);Ccr≥60 ml/min 465例(PCI术211例,CABG术254例).分析各组患者临床特点,比较不同治疗策略的远期临床预后.结果 Ccr≥60 ml/min者,与CABG组比较,PCI组左心室射血分数(LVEF)较高[(64.28±8.29)%与(61.31±10

  10. 前列腺素 E1联合低分子肝素钙对慢性肺源性心脏病患者肺动脉压和相关生化指标的影响%Effects of PGE1 combined with low - molecular - weight heparin calcium on pulmonary artery pressure and related biochemical indexes in patients with chronic pulmonary heart disease

    Institute of Scientific and Technical Information of China (English)

    倪挺; 刘奇良

    2016-01-01

    was a week. To determine and compare the two groups of patients with pulmonary arterial pressure,plasma neurotransmitter endothelial(ET)and thromboxane B2(TXB2), 6 - keto - prostaglandin F1 alpha(6 - K - PGFL alpha),total bile red,aspartate aminotransferase and urea nitrogen concentration. Results Af-ter treatment,the mean pulmonary artery pressure( MPAP),pulmonary artery systolic blood pressure( PASP)and diastolic blood pressure (PADP)of the patients in the observation group were significantly lower than those in the control group( P ﹤ 0. 05). There was no significant difference between the control group and the observation group( P ﹥ 0. 05)(6 - K - PGFL). The observation group of patients with plasma ET, TXB2,total bilirubin,aspartate aminotransferase and urea nitrogen contents were lower than the control group( P ﹤ 0. 05). Conclusion Appli-cation of PGE1 combined with low molecular weight heparin calcium can effectively improve pulmonary artery pressure in patients with chronic pul-monary heart disease. They can adjust the concentration of plasma ET,TXB2,total bilirubin,aspartate aminotransferase and urea nitrogen.

  11. Arterial Stiffness and Dialysis Calcium Concentration

    Directory of Open Access Journals (Sweden)

    Fabrice Mac-Way

    2011-01-01

    Full Text Available Arterial stiffness is the major determinant of isolated systolic hypertension and increased pulse pressure. Aortic stiffness is also associated with increased cardiovascular morbidity and mortality in patients with chronic kidney disease, hypertension, and general population. Hemodynamically, arterial stiffness results in earlier aortic pulse wave reflection leading to increased cardiac workload and decreased myocardial perfusion. Although the clinical consequence of aortic stiffness has been clearly established, its pathophysiology in various clinical conditions still remains poorly understood. The aim of the present paper is to review the studies that have looked at the impact of dialysis calcium concentration on arterial stiffness. Overall, the results of small short-term studies suggest that higher dialysis calcium is associated with a transient but significant increase in arterial stiffness. This calcium dependant increase in arterial stiffness is potentially explained by increased vascular smooth muscle tone of the conduit arteries and is not solely explained by changes in mean blood pressure. However, the optimal DCa remains to be determined, and long term studies are required to evaluate its impact on the progression of arterial stiffness.

  12. Superior Mesenteric Artery Syndrome: An Infrequent Complication of Scoliosis Surgery

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    Metin Keskin

    2014-01-01

    Full Text Available Superior mesenteric artery syndrome is a rare condition that causes a proximal small intestinal obstruction due to contraction of the angle between the superior mesenteric artery and the aorta. Scoliosis surgery is one of the 15 reasons for superior mesenteric artery syndrome, which can present with acute or chronic manifestations. Although conservative treatment is usually possible, surgical treatment is required in certain cases that cannot be treated using conservative methods. In this paper, we describe a patient who developed superior mesenteric artery syndrome after scoliosis surgery and was treated with duodenojejunostomy due to failure and complications of conservative treatment.

  13. Diseases of the thoracic aorta and pulmonary arteries

    NARCIS (Netherlands)

    Salgado, R.; Habets, J.; Budde, R. P J; Leiner, T.

    2015-01-01

    Many acute and chronic clinical entities can affect the great thoracic arteries. As clinical findings are often unreliable, (mostly) noninvasive imaging plays a crucial role both in the initial assessment of critically ill patients, and in the follow-up of chronic conditions. Imaging also forms an i

  14. 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...

  15. Differences in superior thyroid artery and inferior thyroid artery blood flow spectrum parameters in subacute thyroiditis

    Institute of Scientific and Technical Information of China (English)

    Jin-Bo Li

    2016-01-01

    Objective:To study the differences in superior thyroid artery and inferior thyroid artery blood flow spectrum parameters in subacute thyroiditis. Methods:A Total of 40 cases of patients with subacute thyroiditis and 40 cases of healthy volunteers were selected for study and enrolled in pathology group and control group respectively, color Doppler ultrasonography was conducted to detect peak blood flow velocities (Vmax) of superior thyroid artery and inferior thyroid artery as well as resistance index (RI), and serum was collected to detect thyroid hormone contents, infection indexes and oxidative stress indexes. Results:Peak blood flow velocities Vmax of superior thyroid artery and inferior thyroid artery of pathology group were significantly higher than those of control group, and resistance index RI was not different from that of control group;FT3, FT4, TT3, TT4, ESR, CRP, PCT and MDA of pathology group were significantly higher than those of control group, and SOD and TAOC were significantly lower than those of control group;Vmax of superior thyroid artery and inferior thyroid artery were positively correlated with FT3, FT4, TT3, TT4, ESR, CRP, PCT and MDA, and negatively correlated with SOD and TAOC. Conclusion:Peak blood flow velocities (Vmax) of superior thyroid artery and inferior thyroid artery in subacute thyroiditis are significantly accelerated, Vmax has good consistency with thyroid hormone contents, infection indexes and oxidative stress indexes, and it can accurately assess the severity of the disease.

  16. Valve-Like and Protruding Calcified Intimal Flap Complicating Common Iliac Arteries Kissing Stenting

    Directory of Open Access Journals (Sweden)

    George S. Georgiadis

    2015-01-01

    Full Text Available Endovascular therapy for iliac artery chronic total occlusions is nowadays associated with low rates of procedure-related complications and improved clinical outcomes, and it is predominantly used as first-line therapy prior to aortobifemoral bypass grafting. Herein, we describe the case of a patient presenting with an ischemic left foot digit ulcer and suffering complex aortoiliac lesions, who received common iliac arteries kissing stents, illustrating at final antegrade and retrograde angiograms the early recognition of a blood flow obstructing valve-like calcified intimal flap protruding through the stent struts, which was obstructing antegrade but not retrograde unilateral iliac arterial axis blood flow. The problem was resolved by reconstructing the aortic bifurcation at a more proximal level. Completion angiogram verified normal patency of aorta and iliac vessels. Additionally, a severe left femoral bifurcation stenosis was also corrected by endarterectomy-arterioplasty with a bovine patch. Postintervention ankle brachial pressure indices were significantly improved. At the 6-month and 2-year follow-up, normal peripheral pulses were still reported without intermittent claudication suggesting the durability of the procedure. Through stent-protruding calcified intimal flap, is a very rare, but existing source of antegrade blood flow obstruction after common iliac arteries kissing stents.

  17. Mesenteric artery ischemia

    Science.gov (United States)

    ... medlineplus.gov/ency/article/001156.htm Mesenteric artery ischemia To use the sharing features on this page, please enable JavaScript. Mesenteric artery ischemia occurs when there is a narrowing or blockage ...

  18. Upper limb arterial thromboembolism

    DEFF Research Database (Denmark)

    Andersen, L V; Lip, Gregory Y.H.; Lindholt, J S;

    2013-01-01

    The aim of this review is to focus on risk factors, risk-modifying drugs and prognosis for upper limb arterial thromboembolism, and the relationship between upper limb arterial thromboembolism and atrial fibrillation (AF).......The aim of this review is to focus on risk factors, risk-modifying drugs and prognosis for upper limb arterial thromboembolism, and the relationship between upper limb arterial thromboembolism and atrial fibrillation (AF)....

  19. Humanized Chronic Graft-versus-Host Disease in NOD-SCID il2rγ-/- (NSG Mice with G-CSF-Mobilized Peripheral Blood Mononuclear Cells following Cyclophosphamide and Total Body Irradiation.

    Directory of Open Access Journals (Sweden)

    Hisaki Fujii

    Full Text Available Chronic graft-versus-host disease (cGvHD is the major source of late phase morbidity and mortality after allogeneic hematopoietic stem cell transplantation. Humanized acute GvHD (aGvHD in vivo models using NOD-SCID il2rγ-/- (NSG mice are well described and are important tools for investigating pathogenicity of human cells in vivo. However, there have been only few reported humanized cGvHD mouse models. We evaluated if prolonged inflammation driven by low dose G-CSF-mobilized human PBMCs (G-hPBMCs would lead to cGvHD following cyclophosphamide (CTX administration and total body irradiation (TBI in NSG mice. Engraftment was assessed in peripheral blood (PB and in specific target organs by either flow cytometry or immunohistochemistry (IHC. Tissue samples were harvested 56 days post transplantation and were evaluated by a pathologist. Some mice were kept for up to 84 days to evaluate the degree of fibrosis. Mice that received CTX at 20mg/kg did not show aGvHD with stable expansion of human CD45+ CD3+ T-cells in PB (mean; 5.8 to 23.2%. The pathology and fibrosis scores in the lung and the liver were significantly increased with aggregation of T-cells and hCD68+ macrophages. There was a correlation between liver pathology score and the percentage of hCD68+ cells, suggesting the role of macrophage in fibrogenesis in NSG mice. In order to study long-term survival, 6/9 mice who survived more than 56 days showed increased fibrosis in the lung and liver at the endpoint, which suggests the infiltrating hCD68+ macrophages may be pathogenic. It was shown that the combination of CTX and TBI with a low number of G-hPBMCs (1x106 leads to chronic lung and liver inflammation driven by a high infiltration of human macrophage and mature human T cells from the graft, resulting in fibrosis of lung and liver in NSG mice. In conclusion this model may serve as an important pre-clinical model to further current understanding of the roles of human macrophages in cGvHD.

  20. Humanized Chronic Graft-versus-Host Disease in NOD-SCID il2rγ-/- (NSG) Mice with G-CSF-Mobilized Peripheral Blood Mononuclear Cells following Cyclophosphamide and Total Body Irradiation.

    Science.gov (United States)

    Fujii, Hisaki; Luo, Zhi-Juan; Kim, Hye Jin; Newbigging, Susan; Gassas, Adam; Keating, Armand; Egeler, R Maarten

    2015-01-01

    Chronic graft-versus-host disease (cGvHD) is the major source of late phase morbidity and mortality after allogeneic hematopoietic stem cell transplantation. Humanized acute GvHD (aGvHD) in vivo models using NOD-SCID il2rγ-/- (NSG) mice are well described and are important tools for investigating pathogenicity of human cells in vivo. However, there have been only few reported humanized cGvHD mouse models. We evaluated if prolonged inflammation driven by low dose G-CSF-mobilized human PBMCs (G-hPBMCs) would lead to cGvHD following cyclophosphamide (CTX) administration and total body irradiation (TBI) in NSG mice. Engraftment was assessed in peripheral blood (PB) and in specific target organs by either flow cytometry or immunohistochemistry (IHC). Tissue samples were harvested 56 days post transplantation and were evaluated by a pathologist. Some mice were kept for up to 84 days to evaluate the degree of fibrosis. Mice that received CTX at 20mg/kg did not show aGvHD with stable expansion of human CD45+ CD3+ T-cells in PB (mean; 5.8 to 23.2%). The pathology and fibrosis scores in the lung and the liver were significantly increased with aggregation of T-cells and hCD68+ macrophages. There was a correlation between liver pathology score and the percentage of hCD68+ cells, suggesting the role of macrophage in fibrogenesis in NSG mice. In order to study long-term survival, 6/9 mice who survived more than 56 days showed increased fibrosis in the lung and liver at the endpoint, which suggests the infiltrating hCD68+ macrophages may be pathogenic. It was shown that the combination of CTX and TBI with a low number of G-hPBMCs (1x106) leads to chronic lung and liver inflammation driven by a high infiltration of human macrophage and mature human T cells from the graft, resulting in fibrosis of lung and liver in NSG mice. In conclusion this model may serve as an important pre-clinical model to further current understanding of the roles of human macrophages in cGvHD.

  1. Acute and chronic head-down tail suspension diminishes cerebral perfusion in rats

    Science.gov (United States)

    Wilkerson, M. Keith; Colleran, Patrick N.; Delp, Michael D.

    2002-01-01

    The purpose of this study was to test the hypothesis that regional brain blood flow and vascular resistance are altered by acute and chronic head-down tail suspension (HDT). Regional cerebral blood flow, arterial pressure, heart rate, and vascular resistance were measured in a group of control rats during normal standing and following 10 min of HDT and in two other groups of rats after 7 and 28 days of HDT. Heart rate was not different among conditions, whereas mean arterial pressure was elevated at 10 min of HDT relative to the other conditions. Total brain blood flow was reduced from that during standing by 48, 24, and 27% following 10 min and 7 and 28 days of HDT, respectively. Regional blood flows to all cerebral tissues and the eyes were reduced with 10 min of HDT and remained lower in the eye, olfactory bulbs, left and right cerebrum, thalamic region, and the midbrain with 7 and 28 days of HDT. Total brain vascular resistance was 116, 44, and 38% greater following 10 min and 7 and 28 days of HDT, respectively, relative to that during control standing. Vascular resistance was elevated in all cerebral regions with 10 min of HDT and remained higher than control levels in most brain regions. These results demonstrate that HDT results in chronic elevations in total and regional cerebral vascular resistance, and this may be the underlying stimulus for the HDT-induced smooth muscle hypertrophy of cerebral resistance arteries.

  2. Relationship Between Renin-Angiotensin System Gene Polymorphism and Ischemic Chronic Heart Failure in Aged Coronary Artery Disease Patient%肾素-血管紧张素系统双基因多态性与老年人冠心病慢性心力衰竭的关系

    Institute of Scientific and Technical Information of China (English)

    彭健; 罗礼云; 李铁; 梅啸; 牛云茜; 龚五星

    2011-01-01

    Objective :To investigate the relationship between angiotensin-converting enzyme (ACE)gene insertion/deletion (l/D) and angiotensinogen (AGT) gene M235T polymorphism with the onset of ischemic chronic heart failure (CHF) in aged coronary artery disease (CAD) patients in South China.Methods: A total of 396 consecutive CAD patients with the age of (60 ~ 91 ) years were divided into two groups, CHF group,n = 196 ,and Control group,n = 200 ,the patients had stable angina pectoris and with the left ventricular ejection fraction ≥ 45%.Genotype distributions, ACE gene I/D and AGT gene M235T polymorphisms were analyzed by PCR and restriction fragment length polymorphism (RFLP) methods in both groups.Results:①The frequencies of DD genotype of ACE gene and D allele of ACE gene were higher in CHF group than that in Control group respectively. ②The frequencies of TI genotype and T allele of AGT gene were higher in CHF group than that in Control group. ③In combined genotype analysis,the genotype of DD in ACE + TI in AGT was significantly higher in CHF group than that in Control group (28. 6% vs. 15.0% ).Conclusion: ACE gene I/D polymorphism and AGT gene M235T polymorphisms are related to the onset of ischemic chronic heart failure in aged CAD patients in South China,ACE and AGT gene have an interaction role in the onset of CHF.%目的:探讨中国南方部分汉族人群的老年冠心病患者中,肾素-血管紧张素系统中的关键成分即血管紧张素转换酶(ACE)及血管紧张素原(AGT)双基因多态性与慢性心力衰竭(心衰)发病的关系.方法:应用聚合酶链反应及限制性片断长度多态性技术,对396例老年冠心病患者的ACE基因插入/缺失(I/D)及AGT基因M235T多态性进行检测.将其中196例合并慢性心衰患者作为病例组,其余200例心功能正常者作为对照组.结果:①病例组DD基因型频率及D等位基因频率均高于对照组;②病例组TT基因型频率及T等位基因频率均高

  3. A Case Report: Balloon Occlusion Of Vertebral Artery In A Giant Vertebral Artery Aneurysm

    Directory of Open Access Journals (Sweden)

    K. Edraki

    2005-08-01

    Full Text Available Introduction & Background: True aneurysms of extra cranial vertebral arteries are rare. The usual pathogenesis of aneurysms in this location is either penetrating or blunt trauma with resultant pseudo- aneurysm formation. We report a patient with a presumed pseudo-aneurysm of the extra- cranial vertebral artery presenting with painful neck mass, without obvious history of trauma. Case description: A 59-year old man presented with painful left lateral neck mass from 3 month ago with a bruit over it on physical examination. Patient had a history of long term anticoagulant therapy because of chronic lower extremity DVT. Patient was referred to our DSA (Department for angiography. After color Doppler US, CT scan and MR-angiography were performed and a giant aneurysm in left vertebral artery was detected. The lesion was successfully treated by an endovascular technique of balloon occlusion of the verte-bral artery.

  4. Determinantes prognósticos de pacientes com insuficiência cardíaca sistólica crônica secundária à hipertensão arterial sistêmica Determinantes pronósticos de pacientes con insuficiencia cardíaca sistólica crónica secundaria a la hipertensión arterial sistémica Prognostic determinants of patients with chronic systolic heart failure secondary to systemic arterial hypertension

    Directory of Open Access Journals (Sweden)

    Dalva M.S. Rolande

    2012-01-01

    conocer los factores de predicción de mortalidad para pacientes con esa condición clínica para mejor tratamiento científico. OBJETIVO: Determinar los factores de riesgo de mortalidad general en pacientes con ICC secundaria a la HAS en la era moderna del tratamiento de la ICC por disfunción sistólica del ventrículo izquierdo MÉTODOS: Todos los pacientes rutinaria y prospectivamente tratados en la Clínica de Cardiomiopatía en nuestra institución de enero de 2000 a abril de 2008 con diagnóstico de ICC secundaria a la HAS fueron seleccionados para el estudio. El modelo de riesgos proporcionales de Cox fue utilizado para el establecimiento de factores de predicción independientes de mortalidad general. RESULTADOS: Ciento treinta pacientes fueron estudiados; 74 (57% eran hombres. Treinta y un (24% pacientes fallecieron; cinco (4% se sometieron a transplante cardíaco; y 94 (72% estaban vivos al final del estudio. La probabilidad de supervivencia a los 12, 24, 36, 48 y 60 meses fue de 96%, 93%, 84%, 79% y 76%, respectivamente. Edad (Razón de Riesgos = 1,05, Intervalo de Confianza 95% de 1,01 a 1,08, p = 0,01, dimensión diastólica del ventrículo izquierdo (Razón de Riesgos = 1,08; Intervalo de Confianza 95% de 1,02 a 1,09; p = 0,003 y terapia con betabloqueante (Razón de Riesgos = 0,41; Intervalo de Confianza 95% de 0,19 a 0,86; p = 0,02 fueron los factores de predicción independientes de mortalidad general. CONCLUSIÓN: Edad, dimensión diastólica del ventrículo izquierdo y no uso de betabloqueante son factores de predicción independientes de mortalidad general en pacientes con ICC sistólica secundaria a la HAS en la población estudiada.BACKGROUND: Systemic arterial hypertension (SAH is an important cause of chronic systolic heart failure (CHF in underdeveloped countries. It would be desirable to know predictors of mortality for patients with this condition in order to provide proper scientific treatment. OBJECTIVE: To determine risk factors for all

  5. [Upper extremity arterial diseases].

    Science.gov (United States)

    Becker, F

    2007-02-01

    Compared to lower limb arterial diseases, upper limb arterial diseases look rare, heterogeneous with various etiologies and a rather vague clinical picture, but with a negligible risk of amputation. Almost all types of arterial diseases can be present in the upper limb, but the anatomical and hemodynamic conditions particular to the upper limb often confuse the issue. Thus, atherosclerosis affects mainly the subclavian artery in its proximal segment where the potential of collateral pathway is high making the symptomatic forms not very frequent whereas the prevalence of subclavian artery stenosis or occlusion is relatively high. The clinical examination and the etiologies are discussed according to the clinical, anatomical and hemodynamic context.

  6. Arterial stiffness: pathophysiology and clinical impact.

    Science.gov (United States)

    London, Gérard M; Marchais, Sylvain J; Guerin, Alain P; Pannier, Bruno

    2004-01-01

    The ill effects of hypertension are usually attributed to a reduction in the caliber or the number of arterioles, resulting in an increase in total peripheral resistance (TPR). This definition does not take into account the fact that BP is a cyclic phenomenon with systolic and diastolic BP being the limits of these oscillations. The appropriate term to define the arterial factor(s) opposing LV ejection is aortic input impedance which depends on TPR, arterial distensibility (D), and wave reflections (WR). D defines the capacitive properties of arterial stiffness, whose role is to dampen pressure and flow oscillations and to transform pulsatile flow and pressure in arteries into a steady flow and pressure in peripheral tissues. Stiffness is the reciprocal value of D. These parameters are BP dependent, and arteries become stiffer at high pressure. In to D which provides information about the elasticity> of artery as a hollow structure, the elastic incremental modulus (Einc) characterizes the properties of the arterial wall biomaterials, independently of vessel geometry. As an alternative, arterial D can be evaluated by measuring the pulse wave velocity (PWV) which increases with the stiffening of arteries. Arterial stiffening increases left ventricular (LV) afterload and alters the coronary perfusion. With increased PWV, the WR impacts on the aorta during systole, increasing systolic pressures and myocardial oxygen consumption, and decreasing diastolic BP and coronary flow. The arterial stiffness is altered primarily in association with increased collagen content and alterations of extracellular matrix (arteriosclerosis) as classically observed during aging or in arterial hypertension. The arterial stiffening estimated by changes in aortic PWV and intensity of WR are independent predictors of survival in end stage renal disease (ESRD) and general population. Improvement of arterial stiffening could be obtained by antihypertensive treatmen as observed with the calcium

  7. Initial Experience and Feasibility of the New Low-Profile Stingray Catheter as Part of the Antegrade Dissection and Re-Entry Revascularization Strategy for Coronary Chronic Total Occlusions.

    Science.gov (United States)

    Maeremans, Joren; Palmers, Pieter-Jan; Dens, Joseph

    2017-01-31

    BACKGROUND During antegrade dissection re-entry (ADR) of chronic total occlusions (CTO), the first-generation Stingray catheter requires the use of large-bore guides (sheathless 7.5 Fr or 8 Fr), which increases the risk for access site-related complications and compromises radial approaches. Smaller guiding sizes necessitate long guidewires (e.g., 300 cm) or guidewire extensions for catheter advancement or removal. However, friction between guides and the Stingray catheter can result in unstable guidewire position or unintentional removal. Furthermore, failure to deliver the catheter at the distal re-entry zone is a common problem. To overcome issues of deliverability and reduce the need for pre-dilatations, with its inherent risk of creating subintimal hematomas, the Stingray low-profile (LP) balloon catheter was developed. CASE REPORT We describe 3 cases of successful application of the novel Stingray LP catheter during ADR. In all cases, 7 Fr guiding catheters were successfully used in combination with the device. The lower profile facilitated a good exchange and delivery of the device, without the need for balloon pre-dilatations in 2 cases. This resulted in a limited subintimal plane, enabling a smooth puncture into the true lumen. One case presented with extreme levels of calcification and tortuosity, resulting in a high degree of friction, despite the lower catheter profile. No in-hospital coronary or access site-related complications occurred. CONCLUSIONS This case report illustrates the feasibility of the Stingray LP catheter for the treatment of CTOs via the ADR technique. The lower profile of the catheter potentially increases the deliverability, safety, and exchangeability of the device.

  8. Acute occlusion of the left subclavian artery with artery dissection

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    @@ Subclavian steal syndrome is cerebral or brain stem ischemia resulting from diversion of blood flow from the basilar artery to the subclavian artery, which is caused by occlusive disease of either the subclavian artery or the innominate artery before they branch off at the vertebral artery. In the patients with subclavian steal syndrome the subclavian artery is fed by retrograde flow from the vertebral artery via the carotids and the circle of Willis.

  9. Superior mesenteric artery syndrome causing growth retardation

    Directory of Open Access Journals (Sweden)

    Halil İbrahim Taşcı

    2013-03-01

    Full Text Available Superior mesenteric artery syndrome is a rare and lifethreateningclinical condition caused by the compressionof the third portion of the duodenum between the aortaand the superior mesenteric artery’s proximal part. Thiscompression may lead to chronic intermittent, acute totalor partial obstruction. Sudden weight-loss and the relateddecrease in the fat tissue are considered to be the etiologicalreason of acute stenosis. Weight-loss accompaniedby nausea, vomiting, anorexia, epigastric pain, andbloating are the leading complaints. Barium radiographs,computerized tomography, conventional angiography,tomographic and magnetic resonance angiography areused in the diagnosis. There are medical and surgical approachesto treatment. We hereby present the case ofa patient with superior mesenteric artery syndrome withdelayed diagnosis.Key words: superior mesenteric artery syndrome, nausea-vomiting, anorexia

  10. Medical treatment update on pulmonary arterial hypertension.

    Science.gov (United States)

    Enderby, Cher Y; Burger, Charles

    2015-09-01

    Pulmonary arterial hypertension is a chronic, progressive disease of the pulmonary vasculature resulting in poor outcomes if left untreated. The management of group 1 pulmonary arterial hypertension has included the use of prostanoids, phosphodiesterase-5 inhibitors, and endothelin receptor antagonists targeting the prostacyclin, endothelin-1, and nitric oxide pathways. Three new medications have been approved by the US Food and Drug Administration over the past couple of years. Macitentan is the newest endothelin receptor antagonist, riociguat is a soluble guanylate cyclase stimulator, and treprostinil diolamine is the first oral prostanoid. This review will focus on the key trials leading to their approval, special considerations for each medication, and their potential place in therapy. The use of combination therapy as initial therapy in pulmonary arterial hypertension will also be discussed.

  11. Renal function after renal artery stenting

    Institute of Scientific and Technical Information of China (English)

    George S. Hanzel; Mark Downes; Peter A. McCullough

    2005-01-01

    @@ Atherosclerotic renal artery stenosis (ARAS), a common clinical finding, is increasing in prevalence as the population ages. ARAS is seen in ~ 7% of persons over 65 years of age1 and in ~ 20% of patients at the time of coronary angiography.2 It is an important cause of chronic kidney disease and may result in 11-14% of cases of end stage renal disease.3

  12. Reperfusion hemorrhage following superior mesenteric artery stenting.

    LENUS (Irish Health Repository)

    Moore, Michael

    2012-02-03

    Percutaneous transluminal angioplasty and stent placement is now an established treatment option for chronic mesenteric ischemia and is associated with low mortality and morbidity rates. We present a case of reperfusion hemorrhage complicating endovascular repair of superior mesenteric artery stenosis. Although a recognized complication following repair of carotid stenosis, hemorrhage has not previously been reported following mesenteric endovascular reperfusion. We describe both spontaneous cessation of bleeding and treatment with coil embolization.

  13. Bilateral accessory thoracodorsal artery.

    Science.gov (United States)

    Natsis, Konstantinos; Totlis, Trifon; Tsikaras, Prokopios; Skandalakis, Panagiotis

    2006-09-01

    The subscapular artery arises from the third part of the axillary artery and gives off the circumflex scapular and the thoracodorsal arteries. Although anatomical variations of the axillary artery are very common, the existence of a unilateral accessory thoracodorsal artery has been described in the literature only once. There are no reports of bilateral accessory thoracodorsal artery, in the literature. In the present study, a bilateral accessory thoracodorsal artery, originating on either side of the third part of the axillary artery, is described in a 68-year-old female cadaver. All the other branches of the axillary artery had a typical origin, course, distribution and termination. This extremely rare anatomical variation apart from the anatomical importance also has clinical significance for surgeons in this area. Especially, during the dissection or mobilization of the latissimus dorsi that is partly used for coverage problems in many regions of the body and also in dynamic cardiomyoplasty, any iatrogenic injury of this accessory artery may result in ischemia and functional loss of the graft.

  14. Hypertension following Therapeutic Arterial Embolization: A Rare Complication

    Directory of Open Access Journals (Sweden)

    Ghansham Biyani

    2014-05-01

    Full Text Available Accelerated hypertension following therapeutic arterial embolization is a rare phenomenon. A patient of left upper limb chronic lymphedema was posted for shoulder disarticulation under general anaesthesia. Coil embolization of the left subclavian artery was done prior to surgery. Following the intervention, patient’s blood pressure increased by more than 30% of the base line value and was managed with antihypertensives for the next 3 hours to get the blood pressure optimised prior to taking the patient for surgery.

  15. Arterial aging and arterial disease : interplay between central hemodynamics, cardiac work, and organ flow-implications for CKD and cardiovascular disease

    NARCIS (Netherlands)

    London, Gerard; Covic, Adrian; Goldsmith, David; Wiecek, Andrzej; Suleymanlar, Gultekin; Ortiz, Alberto; Massy, Ziad; Lindholm, Bengt; Martinez-Castelao, Alberto; Fliser, Danilo; Agarwal, Rajiv; Jager, Kitty J.; Dekker, Friedo W.; Blankestijn, Peter J.; Zoccali, Carmine

    2011-01-01

    Cardiovascular disease is an important cause of morbidity and mortality in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD). All epidemiological studies have clearly shown that accelerated arterial and cardiac aging is characteristic of these populations. Arterial premat

  16. Chronic myelogenous leukemia (CML)

    Science.gov (United States)

    CML; Chronic myeloid leukemia; Chronic granulocytic leukemia; Leukemia - chronic granulocytic ... Chronic myelogenous leukemia is grouped into phases: Chronic Accelerated Blast crisis The chronic phase can last for ...

  17. Arterial wave reflection decreases gradually from supine to upright

    DEFF Research Database (Denmark)

    van den Bogaard, Bas; Westerhof, Berend E; Best, Hendrik;

    2011-01-01

    BACKGROUND. An increase in total peripheral resistance (TPR) usually increases arterial wave reflection. During passive head-up tilt (HUT), however, arterial wave reflection decreases with increasing TPR. This study addressed whether arterial wave reflection gradually decreases during HUT. METHODS...... was quantified as the augmentation index (AIx) and the reflection magnitude (RM). RESULTS. During HUT, heart rate increased (p TPR increased...... represented as AIx and RM gradually decreases in the presence of increasing TPR....

  18. The arterial load in pulmonary hypertension

    Directory of Open Access Journals (Sweden)

    A. Vonk-Noordegraaf

    2010-09-01

    Full Text Available The anatomical differences between the pulmonary and systemic arterial system are the main cause of the difference in distribution of compliance. In the pulmonary arterial system compliance is distributed over the entire arterial system, and stands at the basis of the constancy of the RC-time. This distribution depends on the number of peripheral vessels, which is ∼8–10 times more in the pulmonary system than the systemic tree. In the systemic arterial tree the compliance is mainly located in the aorta (80% of total compliance in thoracic-abdominal aorta. The constant RC-time in the pulmonary bed results in proportionality of systolic and diastolic pressure with mean pressure and, in turn, in the constant ratio of oscillatory and mean power.

  19. TEVAR and covering the celiac artery. Is it safe or not?

    DEFF Research Database (Denmark)

    2010-01-01

    in these patients. If the distal sealing zone above the celiac axis is too short, several endovascular alternatives are possible; hybrid procedures with TEVAR and open by-pass to the celiac artery, custom made stent-grafts with scallop or fenestration for the celiac artery, or intentional coverage of the celiac...... artery. In the latter case, adequate collateral supply to the upper gastrointestinal tract is crucial. Collateral arteries joining the celiac and the superior mesenteric arteries are well characterized in patients with chronic celiac stenosis or occlusion. Are these collateral pathways sufficient also...... for sudden iatrogenic closure of the celiac artery? By performing a preoperative angiography of the superior mesenteric artery with temporary balloon occlusion of the celiac artery, collateral capacity between the two vessels can be tested in advance. Exact positioning of the distal end of a large thoracic...

  20. Medial arterial calcification in diabetes and its relationship to neuropathy

    DEFF Research Database (Denmark)

    Jeffcoate, W J; Rasmussen, Lars Melholt; Hofbauer, L C

    2009-01-01

    Calcification of the media of arterial walls is common in diabetes and is particularly associated with distal symmetrical neuropathy. Arterial calcification also complicates chronic kidney disease and is an independent risk factor for cardiovascular and all-cause mortality. The term calcification...... factor linked to the development of arterial calcification is distal symmetrical neuropathy; indeed, it has been suggested that neuropathy explains the distal distribution of arterial calcification in diabetes. It has also been suggested that the link with neuropathy results from loss of neuropeptides......, such as calcitonin gene-related peptide, which are inherently protective. The association between distal symmetrical neuropathy and calcification of the arterial wall highlights the fact that neuropathy may be an independent risk factor for cardiovascular mortality....

  1. Incidence and Clinical Features of Neovascularization of the Iris following Acute Central Retinal Artery Occlusion

    Science.gov (United States)

    Jung, Young Ho; Ahn, Seong Joon; Hong, Jeong-Ho; Park, Kyu Hyung; Han, Moon-Ku; Jung, Cheolkyu

    2016-01-01

    Purpose To investigate the incidence of neovascularization of the iris (NVI) and clinical features of patients with NVI following acute central retinal artery occlusion (CRAO). Methods A retrospective review of 214 consecutive CRAO patients who visited one tertiary hospital between January 2009 and January 2015 was conducted. In total, 110 patients were eligible for this study after excluding patients with arteritic CRAO, a lack of follow-up, iatrogenic CRAO secondary to cosmetic filler injection, or NVI detected before CRAO attack. Fluorescein angiography (FA) was applied until retinal arterial reperfusion was achieved, typically within 1 to 3 months. Results The incidence of NVI was 10.9% (12 out of 110 patients). Neovascular glaucoma was found in seven patients (6.4%). The mean time to NVI diagnosis after CRAO events was 3.0 months (range, 1 week to 15 months). The cumulative incidence was 5.5% at 3 months, 7.3% at 6 months, and 10.9% at 15 months. Severely narrowed ipsilateral carotid arteries were observed in only three patients (27.3%). The other nine patients (75.0%) showed no predisposing conditions for NVI, such as proliferative diabetic retinopathy or central retinal vein occlusion. Reperfusion rate and prevalence of diabetes were significantly different between patients with NVI and patients without NVI (reperfusion: 0% [NVI] vs. 94.7% [no NVI], p < 0.001; diabetes: 50.0% [NVI] vs. 17.3% [no NVI], p = 0.017). Conclusions CRAO may lead to NVI and neovascular glaucoma caused by chronic retinal ischemia from reperfusion failure. Our results indicate that follow-up fluorescein angiography is important to evaluate retinal artery reperfusion after acute CRAO events, and that prophylactic treatment such as panretinal photocoagulation should be considered if retinal arterial perfusion is not recovered. PMID:27729755

  2. Pulmonary oligemia maneuver can alleviate pulmonary artery injury during pulmonary thromboendarterectomy procedure

    Institute of Scientific and Technical Information of China (English)

    GAN Hui-li; ZHANG Jian-qun; LU Jia-kai; DONG Xiu-hua; HOU Xiao-tong; GAO Yuan-ming; ZHU Guang-fa

    2013-01-01

    Background Pulmonary thromboendarterectomy (PTE) has evolved as a treatment of choice for chronic thromboembolic pulmonary hypertension (CTEPH).This study aimed to characterize if pulmonary oligemia maneuver (POM) can alleviate pulmonary artery injury during PTE procedure.Methods A total of 112 cases of CTEPH admitted to Beijing Anzhen Hospital from March 2002 to August 2011 received PTE procedure.They were retrospectively classified as non-POM group (group A,n=55) or POM group (group B,n=57).Members from group B received POM during rewarming period,whereas members from group A did not.Results There were three (5.45%) early deaths in group A,no death in group B (0) (Fisher's exact test,P=-0.118).Six patients in group A needed extracorporeal membrane oxygenation (ECMO) as life support after the PTE procedure,no patients in group B needed ECMO (Fisher's exact test,P=0.013).The patients in group B had a shorter intubation and ICU stay,lower mean pulmonary arterial pressure (mPAP) and pulmonary vascular resistance (PVR),higher partial pressure of oxygen in artery (PaO2) and arterial oxygen saturation (SaO2) and less medical expenditure than patients in group A.With a mean follow-up time of (58.3 ± 30.6) months,two patients in group A and one patient in group B died.The difference of the actuarial survival after the procedure between the two groups did not reach statistical significance.Three months post the PTE procedure,the difference of residual occluded pulmonary segment between the two groups did not reach statistical significance (P=-0.393).Conclusion POM can alleviate pulmonary artery injury,shorten ICU stay and intubation time,and lower down the rate of ECMO after PTE procedure.

  3. [Intra-arterial thrombolysis of acute mesenteric ischemia].

    Science.gov (United States)

    Nathan, N; Wintringer, P; Bregeon, Y; Cassat, C; Le Blanche, A; Boulanger, J P; Feiss, P

    1995-01-01

    A 73-year-old man with pre-existing cardiac failure, coronary artery and chronic obstructive pulmonary disease was presented for an acute mesenteric ischaemia, resulting from an embolic obstruction of the superior mesenteric artery. An intra-arterial fibrinolysis with a bolus of 250 000 units of streptokinase, followed by an infusion of 150 mg rtPA with adequate heparin dosage was performed 10 hours after the first symptoms. An abdominal guarding occurred 24 hours later, despite radiological improvement, justifying emergency surgery which confirmed the partial efficiency of the medical therapy. Unfortunately, a cardiogenic shock occurred preoperatively and the patient died five days later from intractable cardiovascular failure.

  4. Celiac Artery Compression Syndrome

    Directory of Open Access Journals (Sweden)

    Mohammed Muqeetadnan

    2013-01-01

    Full Text Available Celiac artery compression syndrome is a rare disorder characterized by episodic abdominal pain and weight loss. It is the result of external compression of celiac artery by the median arcuate ligament. We present a case of celiac artery compression syndrome in a 57-year-old male with severe postprandial abdominal pain and 30-pound weight loss. The patient eventually responded well to surgical division of the median arcuate ligament by laparoscopy.

  5. Popliteal artery entrapment syndrome.

    LENUS (Irish Health Repository)

    O'Leary, D P

    2010-01-01

    Popliteal artery entrapment syndrome is a rare abnormality of the anatomical relationship between the popliteal artery and adjacent muscles or fibrous bands in the popliteal fossa. The following is a case report of a 19 year old female, in whom popliteal artery entrapment syndrome was diagnosed, and successfully treated surgically. A review of literature is also presented and provides details on how PAES is classified, diagnosed both clinically and radiologically, and treated surgically.

  6. Interesting Basis of Vertebrobasilar Arterial Territory

    Directory of Open Access Journals (Sweden)

    Kavian Ghandehari

    2012-07-01

    Full Text Available Background: Vertebrobasilar arterial territory nourishes one-quarter of human brain. It constitutes some vital and strategic parts of the central nervous system.Methods: A number of keywords (vertebral, basilar, artery, and territory were searched in MEDLINE (Ovid and PubMed as well as Google, ProQuest, Scopus, Cochrane Library, and Science Direct online electronic search engines. Only articles containing all keywords were included. The final search was performed on October, 1, 2012. We also reviewed archives of libraries in Mashhad University of Medical Sciences (Iran for all anatomy, embryology, neurology, and neuroscience books and journals about vertebrobasilar arterial territories.Results: The vertebrobasilar arterial (VA system has a high incidence of variations, anomalies, and persistent fetal vessels. Two important anatomic facts explain why VA origin lesions seldom cause chronic hemodynamically significant low flow to the vertebrobasilar system. First, the VAs are paired vessels that unite to form a single basilar artery. Second, the extracranial VA gives off numerous muscular and other branches as it ascends in the neck. Thus, in the VA system, there is much more potential for development of adequate collateral circulation. Even when there is bilateral occlusion of the VAs at their origins, patients do not often develop posterior circulation infarcts.Conclusion: VA origin disease is more benign than ICA origin disease from hemodynamic aspect. This important point could make influence in therapeutic interventional decisions in asymptomatic VA origin stenosis

  7. Efeito do tratamento convencional da constipação crônica funcional no tempo de trânsito orocecal e colônico total e segmentar Effects of conventional treatment of chronic functional constipation on total and segmental colonic and orocecal transit times

    Directory of Open Access Journals (Sweden)

    Ana Cristina Fontenele Soares

    2009-08-01

    Full Text Available OBJETIVO: Avaliar o efeito do tratamento convencional da constipação crônica funcional no tempo de trânsito colônico total e segmentar e no tempo de trânsito orocecal. MÉTODOS: Foram incluídos 34 pacientes com constipação funcional atendidos consecutivamente em ambulatório especializado. O tempo de trânsito colônico total e segmentar foi avaliado com marcadores radiopacos. O tempo de trânsito orocecal da lactulose e do feijão foi avaliado com teste do hidrogênio no ar expirado. O tratamento constou de desimpactação, orientações gerais e de consumo de dieta rica em fibra alimentar e administração de óleo mineral. RESULTADOS: Na admissão, dismotilidade colônica foi encontrada em 71,9% (23/32 dos pacientes. Todos os pacientes que realizaram corretamente o tratamento apresentaram melhora clínica na sexta semana do tratamento quando 82,6% (19/23 daqueles com dismotilidade na admissão apresentaram normalização ou diminuição da gravidade no padrão de trânsito colônico. Observou-se redução do tempo de trânsito (medianas entre a admissão e a oitava semana de tratamento: trânsito orocecal da lactulose (de 70 para 50 minutos, p = 0,002, orocecal do feijão (de 240 para 220 minutos, p = 0,002 e colônico total (de 69,5 para 37,0 horas, p = 0,001. A necessidade de uso de óleo mineral para controle da constipação aos 12 meses de tratamento associou-se com persistência de trânsito colônico total superior a 62 horas na oitava semana de tratamento (p = 0,014. CONCLUSÃO: O programa terapêutico convencional proporcionou bons resultados independentemente da presença ou não de dismotilidade colônica na admissão ao estudo. As anormalidades da motilidade digestiva na constipação funcional da criança podem apresentar reversibilidade e ser de natureza secundária.OBJECTIVE: To evaluate the effects of conventional treatment of chronic functional constipation on total and segmental colonic transit times and on orocecal

  8. Arterial waveform analysis.

    Science.gov (United States)

    Esper, Stephen A; Pinsky, Michael R

    2014-12-01

    The bedside measurement of continuous arterial pressure values from waveform analysis has been routinely available via indwelling arterial catheterization for >50 years. Invasive blood pressure monitoring has been utilized in critically ill patients, in both the operating room and critical care units, to facilitate rapid diagnoses of cardiovascular insufficiency and monitor response to treatments aimed at correcting abnormalities before the consequences of either hypo- or hypertension are seen. Minimally invasive techniques to estimate cardiac output (CO) have gained increased appeal. This has led to the increased interest in arterial waveform analysis to provide this important information, as it is measured continuously in many operating rooms and intensive care units. Arterial waveform analysis also allows for the calculation of many so-called derived parameters intrinsically created by this pulse pressure profile. These include estimates of left ventricular stroke volume (SV), CO, vascular resistance, and during positive-pressure breathing, SV variation, and pulse pressure variation. This article focuses on the principles of arterial waveform analysis and their determinants, components of the arterial system, and arterial pulse contour. It will also address the advantage of measuring real-time CO by the arterial waveform and the benefits to measuring SV variation. Arterial waveform analysis has gained a large interest in the overall assessment and management of the critically ill and those at a risk of hemodynamic deterioration.

  9. Effect of Total Flavonoids of Clerodendranthus spicatus on Chronic Abacterial Prostatitis in Rats%肾茶总黄酮对大鼠慢性非细菌性前列腺炎的影响

    Institute of Scientific and Technical Information of China (English)

    甘典辉; 唐爱存; 伍小燕; 李峰

    2013-01-01

    Objective: To study the therapeutic action and mechanism of total flavonoids of Clerodendranthus spicatus (TFC) on rats models of chronic abacterial prostatitis. Method: Sixty healthy adult male SD rats were randomly divided into six groups, 10 rats in each group; blank control group, model group, positive control group (250 mg·kg-1·d-1) , TFC low-dose, middle-dose and high-dose group (100, 200, 400 mg·kg-1) , respectively. Except for normal group, the rats models of Chronic abacterial prostatitis were builded by subcutaneous injection of oestradiol monobenzoate at the dose of 0. 25 mg · kg ~ after castration, and then treated with TFC at 100, 200, 400 mg 'kg'1 by oral administration whileblank and model group were given normal saline, once a day for 30 days. White blood cell ( WBC) count, lecithin corpuscle density and prostate index in prostatic fluid were examined, and the expressions of tumor necrosis factor (TNF-a) and interleukin-8 (IL-8) in the serum and prostate tissues of the rats were detected by ELISA. Result: Compared with model group, WBC count and prostate index were reduced and lecithin corpuscle density were increased in prostatic fluid by TFC, which showed significant statistical differences (P < 0. 01 or P < 0. 05) , and the levels of TNF-a and IL-8 in the serum and prostate tissues of the rats were reduced. Conclusion: TFC has therapeutic effects on chronic abacterial prostatitis inrats models, and the mechanism may be related to decreasing the levels of TNF-a and IL-8 in the serum and prostate tissues.%目的:研究肾茶总黄酮(TFC)对大鼠慢性非细菌性前列腺炎的治疗作用及机制.方法:将成年雄性SD大鼠随机分成6组,每组10只,即正常对照组、模型组、塞来昔布组(阳性组250 mg· kg-1)、肾茶总黄酮低、中、高剂量组(100,200,400mg·kg-1),除正常组外,大鼠去势后,皮下注射苯甲酸雌二醇0.25 mg·kg-1,建立大鼠慢性非细菌性前列腺炎模型,空白组和模型组

  10. Total Thyroidectomy

    Directory of Open Access Journals (Sweden)

    Lopez Moris E

    2016-06-01

    Full Text Available Total thyroidectomy is a surgery that removes all the thyroid tissue from the patient. The suspect of cancer in a thyroid nodule is the most frequent indication and it is presume when previous fine needle puncture is positive or a goiter has significant volume increase or symptomes. Less frequent indications are hyperthyroidism when it is refractory to treatment with Iodine 131 or it is contraindicated, and in cases of symptomatic thyroiditis. The thyroid gland has an important anatomic relation whith the inferior laryngeal nerve and the parathyroid glands, for this reason it is imperative to perform extremely meticulous dissection to recognize each one of these elements and ensure their preservation. It is also essential to maintain strict hemostasis, in order to avoid any postoperative bleeding that could lead to a suffocating neck hematoma, feared complication that represents a surgical emergency and endangers the patient’s life.It is essential to run a formal technique, without skipping steps, and maintain prudence and patience that should rule any surgical act.

  11. Treinamento resistido controla a pressão arterial de ratos hipertensos induzidos por l-NAME Resistance training controls arterial blood pressure in rats with L-NAME- induced hypertension

    Directory of Open Access Journals (Sweden)

    Ayslan Jorge Santos de Araujo

    2013-04-01

    Full Text Available FUNDAMENTO: A hipertensão arterial é uma síndrome multifatorial, crônica, causada tanto por fatores congênitos ou adquiridos. OBJETIVO: Avaliar os efeitos do treinamento físico resistido (TR sobre pressão arterial, reatividade e morfologia vascular de ratos hipertensos induzidos por L-NAME. MÉTODOS: Ratos Wistar machos (200-250 g foram divididos em 3 grupos: normotenso sedentário (NS, hipertenso sedentário (HS e hipertenso treinado (HT. A hipertensão foi induzida pela administração de L-NAME (40 mg/kg na água de beber por 4 semanas. A pressão arterial foi avaliada antes e após o TR. O TR foi realizado utilizando 50% de 1RM, em 3 séries de 10 repetições, 3 vezes por semana, durante quatro semanas. A reatividade vascular foi mensurada em artéria mesentérica superior por curvas concentração resposta ao nitroprussiato de sódio (NPS e fenilefrina (FEN. Além disso, foram realizadas análises histológicas e estereológicas. RESULTADOS: O TR inibiu o aumento das pressões arteriais média e diastólica. Foi observada uma redução significativa na resposta máxima e na potência da FEN entre os grupos HS e HT. A análise histológica evidenciou aspecto normal para as túnicas íntima, média e adventícia em todos os grupos. Não houve diferença significativa nas áreas do lúmen, da túnica média e total das artérias dos grupos HS e HT em relação ao NS. A razão parede/lúmen arterial do grupo HS apresentou diferença significativa em relação ao NS (p BACKGROUND: Arterial hypertension is a multifactorial chronic condition caused by either congenital or acquired factors. OBJECTIVE: To evaluate the effects of Resistance Training (RT on arterial pressure, and on vascular reactivity and morphology, of L-NAME-treated hypertensive rats. METHODS: Male Wistar rats (200 - 250 g were allocated into Sedentary Normotensive (SN, Sedentary Hypertensive (SH and Trained Hypertensive (TH groups. Hypertension was induced by adding L

  12. Anomalous origin of right coronary artery from pulmonary artery

    Directory of Open Access Journals (Sweden)

    Rajat Gupta

    2012-01-01

    Full Text Available Anomalous origin of coronary artery from the pulmonary artery is a rare anomaly that most frequently involves the left coronary artery and very rarely the right coronary artery. These lesions can be missed on echocardiography unless carefully looked for. We describe a case of isolated anomalous origin of right coronary artery from pulmonary artery diagnosed on echocardiography and confirmed by computed tomography (CT angiography.

  13. Influencing factors of carotid artery atheromatous plaque in patients with chronic kidney disease%慢性肾脏疾病患者颈动脉粥样斑块的相关因素分析

    Institute of Scientific and Technical Information of China (English)

    刘畅; 韩四萍; 袁军; 邹新蓉; 王小琴

    2014-01-01

    目的 分析慢性肾脏疾病(chronic kidney disease,CKD) 2~4期患者颈动脉粥样斑块发生情况及影响因素.方法 收集湖北省中医院门诊及住院的142例CKD 2~4期患者,根据颈动脉彩超检查结果是否有颈动脉斑块将其分为颈动脉斑块组(52例)及无颈动脉斑块组(90例),记录患者的一般资料包括性别、年龄、体质量指数(body mass index,BMI)、昼夜平均收缩压(24 h SBP)、昼夜平均舒张压(24 h DBP)、高血压病史及糖尿病病史,检测所有患者血肌酐(SCr)以及估算肾小球滤过率(estimated glomerular filtration rate,eGFR)、总胆固醇(total cholesterol,TC)、三酰甘油(triglyceride,TG)、高密度脂蛋白胆固醇(high density lipoprotein cholesterol,HDL-C)、低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-C)、糖化血红蛋白(glycosylated hemoglobin,HbA1c)、超敏C反应蛋白(high sensitive c-reactive protein,Hs-CRP)、空腹血糖的水平,评估颈动脉斑块的发病率及其相关影响因素.结果 颈动脉斑块组和无颈动脉斑块组2组间进行比较,其中年龄、HbA1c水平有显著统计学差异,eGFR、SBP、HDL-C水平、高血压、糖尿病有统计学差异,与性别、DBP、BMI及其余生化指标水平无关.以颈动脉斑块为因变量,将年龄、HbA1c、HDL-C、eGFR、糖尿病及高血压5项因素进行Logistic相关性分析,结果显示年龄与颈动脉斑块有统计学差异.结论 本研究中,HbA1c、HDL-C、糖尿病、高血压、CKD及收缩压是颈动脉斑块发生的危险因素,高龄患者发生颈动脉斑块的可能性更大.

  14. Postprandial lower limb pain: An unusual presentation of visceral arteries occlusion.

    Science.gov (United States)

    Patelis, Nikolaos; Papoutsis, Konstantinos; Liakopoulos, Dimitrios; Koutsoumpelis, Andreas; Bakogiannis, Christos; Georgopoulos, Sotirios

    2015-06-01

    This case report describes an atypical and unique presentation of mesenteric arteries occlusive disease. The patient presented with typical symptoms of chronic mesenteric ischemia, as well as with an atypical new symptom; postprandial buttock and lower limbs pain. Pain followed the time curve of the postprandial abdominal discomfort, starting 30 min after meals and gradually resolving within 2 h. The patient had been tolerating the signs of chronic mesenteric ischemia quite well by adjusting the quantity of food per meal to relieve symptoms. Angiography showed that the celiac artery, the superior mesenteric artery, and distal aorta were occluded, leaving the inferior mesenteric artery as the only feeding vessel of all abdominal viscera and both the lower limbs. Since an English medical literature search returned only one marginally similar case, we consider this case of iliac arteries' "steal syndrome" from the inferior mesenteric artery unique.

  15. Empirical description of bronchial and nonbronchial arteries with MDCT

    Energy Technology Data Exchange (ETDEWEB)

    Yu Hong, E-mail: yuhong.2002@hotmail.co [Department of Imageology, Changzheng hospital, Second Military Medical University, Shanghai 200003 (China); Liu Shiyuan, E-mail: cjr.liushiyuan@vip.163.co [Department of Imageology, Changzheng hospital, Second Military Medical University, Shanghai 200003 (China); Li Huimin, E-mail: yuhongphd@163.co [Department of Imageology, Changzheng hospital, Second Military Medical University, Shanghai 200003 (China); Xiao Xiangsheng, E-mail: cjr.xxsh@vip.163.co [Department of Imageology, Changzheng hospital, Second Military Medical University, Shanghai 200003 (China); Dong Weihua, E-mail: dongweihua2000@163.co [Department of Imageology, Changzheng hospital, Second Military Medical University, Shanghai 200003 (China)

    2010-08-15

    Purpose: We aimed to retrospectively evaluate bronchial and nonbronchial systemic arteries using multi-detector row helical computed tomographic (MDCT) angiography in patients with pulmonary disorders. Materials and Methods: Thirty-nine patients (24 men, 15 women; mean age, 63.4 years; range, 20-82 years) with congenital and acquired pulmonary disorders of the bronchial and nonbronchial systemic arteries underwent multi-detector row helical computed tomographic angiography of the thorax using a 16-detector row scanner. Each of these patients had experienced an episode of hemoptysis. Computed tomographic angiogram data, which included maximum intensity projections, multiplanar reconstruction, and three-dimensional volume-rendered images, were used to retrospectively analyse the characteristics of the bronchial and nonbronchial systemic arteries. Results: We identified a total of 128 bronchial arteries (76 on the right side and 52 on the left) in 39 patients. We detected 42 nonbronchial systemic artery branches, including 19 internal mammary artery branches, 8 subclavian artery branches, 8 inferior phrenic artery branches, 5 intercostal artery branches, 1 thyrocervical trunk branch, and 1 celiac trunk branch. Thirty-five dilated and tortuous nonbronchial systemic arteries entered into the lung parenchyma and extended down to the lesions. Every case, except the one case of sequestration, was associated with pleural thickening where the vascular structures passed through the extrapleural fat. Conclusions: The variations in both the bronchial artery anatomy and the location and type of the nonbronchial arteries were great. Nonbronchial arteries may be a significant source of hemoptysis. MDCT angiography can be used to detect detailed anatomical information about the origins and courses of bronchial and nonbronchial systemic arteries and their pathophysiologic features.

  16. New therapies for arterial hypertension.

    Science.gov (United States)

    Pagliaro, Beniamino; Santolamazza, Caterina; Rubattu, Speranza; Volpe, Massimo

    2016-03-01

    Arterial hypertension is the most common chronic disease in developed countries and it is the leading risk factor for stroke, ischemic heart disease, congestive heart failure, chronic renal failure and peripheral artery disease. Its prevalence appears to be about 30-45% of the general population. Recent European guidelines estimate that up to 15-20% of the hypertensive patients are not controlled on a dual antihypertensive combination and they require three or more different antihypertensive drug classes to achieve adequate blood pressure control. The guidelines confirmed that diuretics, beta-blockers, calcium-channel blockers, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers are suitable for the initiation and maintenance of antihypertensive treatment, either as monotherapy or in combination therapy. Very few antihypertensive agents have reached the market over the last few years, but no new therapeutic class has really emerged. The long-term adherence to cardiovascular drugs is still low in both primary and secondary prevention of cardiovascular diseases. In particular, the issue of compliance is persistently high in hypertension, despite the fixed-dose combination therapy. As a consequence, a cohort of high-risk hypertensive population, represented by patients affected by refractory and resistant hypertension, can be identified. Therefore, the need of controlling BP in high-risk patients may be addressed, in part, by the development of new drugs, devices and procedures that are designed to treat hypertension and comorbidities. In this review we will comprehensively discuss the current literature on recent therapeutic advances in hypertension, including both medical therapy and interventional procedures.

  17. Mammary artery harvesting using the Da Vinci Si robotic system

    Directory of Open Access Journals (Sweden)

    Leonardo Secchin Canale

    2014-03-01

    Full Text Available Internal mammary artery harvesting is an essential part of any coronary artery bypass operation. Totally endoscopic coronary artery bypass graft surgery has become reality in many centers as a safe and effective alternative to conventional surgery in selected patients. Internal mammary artery harvesting is the initial part of the procedure and should be performed equally safely if one wants to achieve excellence in patency rates for the bypass. We here describe the technique for mammary harvesting with the Da Vinci Si robotic system.

  18. Paraplegia after aortic and superior mesenteric artery stenting for occlusive disease.

    Science.gov (United States)

    Hans, Sachinder S; Ngo, William; McAllister, Michael

    2014-02-01

    Paraplegia after endovascular therapy for aortic and visceral artery occlusive disease is an extremely uncommon occurrence. Two cases of paraplegia after placement of an aortic covered stent for infrarenal aortic stenosis and a superior mesenteric artery stent for chronic visceral ischemia are presented. In both patients, embolization of the arterial supply to the spinal cord was the presumed cause. One patient had a slight recovery after intense physical therapy and rehabilitation. The second patient did not have any recovery from her paraplegia.

  19. Arterial hypoxaemia in cirrhosis

    DEFF Research Database (Denmark)

    Møller, S; Hillingsø, Jens; Christensen, E

    1998-01-01

    BACKGROUND: Although low arterial oxygen tension (Po2) has been claimed to occur in one to two thirds of patients with cirrhosis, hypoxaemia appears to be rare in clinical practice. AIMS: To assess the frequency of arterial hypoxaemia in cirrhosis in relation to clinical and haemodynamic......%, 96%, 96%, and 93% (NS). So2 was below the lower limit of 92% in 0%, 9%, 7%, and 24% (p arterial carbon dioxide tension, a low systemic vascular...... resistance, and a low indocyanine green clearance (p arterial hypoxaemia in cirrhosis is about 22% in patients without encephalopathy, but it varies from 10-40% depending on the degree of hepatic dysfunction. Arterial hypoxaemia in patients with cirrhosis of differing...

  20. [Transposition of Great Artery].

    Science.gov (United States)

    Konuma, Takeshi; Shimpo, Hideto

    2015-07-01

    Transposition of the great artery is one of common congenital cardiac disease resulting cyanosis. Death occurs easily in untreated patients with transposition and intact ventricular septal defect (VSD) in infancy at a few days of age when posterior descending coronary artery (PDA) closed. Since there are 2 parallel circulations, flow from pulmonary to systemic circulation is necessary for systemic oxygenation, and Balloon atrial septostomy or prostaglandin infusion should be performed especially if patient do not have VSD. Although the advent of fetal echocardiography, it is difficult to diagnose the transposition of the great arteries (TGA) as abnormality of great vessels is relatively undistinguishable. The diagnosis of transposition is in itself an indication for surgery, and arterial switch procedure is performed in the case the left ventricle pressure remains more than 2/3 of systemic pressure. Preoperative diagnosis is important as associated anomalies and coronary artery branching patterns are important to decide the operative indication and timing of surgery.

  1. Woven Coronary Artery Disease Successfully Managed with Percutaneous Coronary Intervention: A New Case Report

    Directory of Open Access Journals (Sweden)

    Yakup Alsancak

    2015-01-01

    Full Text Available Woven coronary artery is relatively rare and can be complicated in both acute and chronic phases. A few case reports have been published until now. Herein we report a case with right woven coronary artery managed with drug-eluted stent implantation without complication.

  2. Woven Coronary Artery Disease Successfully Managed with Percutaneous Coronary Intervention: A New Case Report

    OpenAIRE

    Yakup Alsancak; Burak Sezenoz; Sedat Turkoglu; Adnan Abacı

    2015-01-01

    Woven coronary artery is relatively rare and can be complicated in both acute and chronic phases. A few case reports have been published until now. Herein we report a case with right woven coronary artery managed with drug-eluted stent implantation without complication.

  3. Woven Coronary Artery Disease Successfully Managed with Percutaneous Coronary Intervention: A New Case Report.

    Science.gov (United States)

    Alsancak, Yakup; Sezenoz, Burak; Turkoglu, Sedat; Abacı, Adnan

    2015-01-01

    Woven coronary artery is relatively rare and can be complicated in both acute and chronic phases. A few case reports have been published until now. Herein we report a case with right woven coronary artery managed with drug-eluted stent implantation without complication.

  4. Does conduit artery diameter vary according to the anthropometric characteristics of children or men?

    NARCIS (Netherlands)

    Hopkins, N.D.; Green, D.J.; Tinken, T.M.; Sutton, L.; McWhannell, N.; Thijssen, D.H.J.; Cable, N.T.; Stratton, G.; George, K.

    2009-01-01

    Arterial measurements are commonly undertaken to assess acute and chronic adaptations to exercise. Despite the widespread adoption of scaling practices in cardiac research, the relevance of scaling for body size and/or composition has not been addressed for arterial measures. We therefore investigat

  5. Parameters of Blood Flow in Great Arteries in Hypertensive ISIAH Rats with Stress-Dependent Arterial Hypertension.

    Science.gov (United States)

    Seryapina, A A; Shevelev, O B; Moshkin, M P; Markel', A L

    2016-08-01

    Magnetic resonance angiography was used to examine blood flow in great arteries of hypertensive ISIAH and normotensive Wistar rats. In hypertensive ISIAH rats, increased vascular resistance in the basin of the abdominal aorta and renal arteries as well as reduced fraction of total renal blood flow were found. In contrast, blood flow through both carotid arteries in ISIAH rats was enhanced, which in suggests more intensive blood supply to brain regulatory centers providing enhanced stress reactivity of these rats characterized by stress-dependent arterial hypertension.

  6. A STUDY OF ARTERIAL SUPPLY OF VERMIFORM APPENDIX IN HUMANS

    Directory of Open Access Journals (Sweden)

    Hosmani

    2012-11-01

    Full Text Available ABSTRACT: The surgical procedures like appendicectomy, demands a precise knowledge of vascular anatomy of ileocolic region. The aim of th is study is to study the arterial supply of the appendix, findings of which may reveal more anatomica l facts about the arteries of appendix and their variations. Total 52 specimens of caecum a nd appendix with their arteries intact were collected, cleaned and dissected. The ileocolic art ery and its branches to the appendix were traced carefully and observations were recorded. Th e ileocolic artery arises independently from superior mesenteric artery in 96.88% of cases and en ds by dividing into superior and inferior division in 93.76% of cases. The appendicular artery arises from inferior division in 46.88%, ileal branch 28.13%, ileocolic