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.

Arterial hypertension and chronic liver disease

DEFF Research Database (Denmark)

Henriksen, Jens Henrik Sahl; Møller, S

2005-01-01

, calcitonin gene-related peptide, nitric oxide, and other vasodilators, and is most pronounced in the splanchnic area. This provides an effective (although relative) counterbalance to raised arterial blood pressure. Subjects with arterial hypertension (essential, secondary) may become normotensive during......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...... vascular resistance, high arterial compliance, increased cardiac output, secondary activation of counterregulatory systems (renin-angiotensin-aldosterone system, sympathetic nervous system, release of vasopressin), and resistance to vasopressors. The vasodilatory state is mediated through adrenomedullin...

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.

Percutaneous Intervention for Concurrent Chronic Total Occlusions in Patients With STEMI: The EXPLORE Trial

NARCIS (Netherlands)

Henriques, J.P.; Hoebers, L.P.; Ramunddal, T.; Laanmets, P.; Eriksen, E.; Bax, M.; Ioanes, D.; Suttorp, M.J.; Strauss, B.H.; Barbato, E.; Nijveldt, R.; Rossum, A.C. van; Marques, K.M.; Elias, J.; Dongen, I.M. van; Claessen, B.E.; Tijssen, J.G.; Schaaf, R.J. van der; Boer, M.J. de; et al.,

2016-01-01

BACKGROUND: In 10% to 15% of patients with ST-segment elevation myocardial infarction (STEMI), concurrent coronary chronic total occlusion (CTO) in a non-infarct-related artery is present and is associated with increased morbidity and mortality. OBJECTIVES: The EXPLORE (Evaluating Xience and Left

Collateral Circulation in Chronic Total Occlusions - An Interventional Perspective

Science.gov (United States)

Choo, Gim-Hooi

2015-01-01

Human coronary collaterals are inter-coronary communications that are believed to be present from birth. In the presence of chronic total occlusions, recruitment of flow via these collateral anastomoses to the arterial segment distal to occlusion provide an alternative source of blood flow to the myocardial segment at risk. This mitigates the ischemic injury. Clinical outcome of coronary occlusion ie. severity of myocardial infarction/ischemia, impairment of cardiac function and possibly survival depends not only on the acuity of the occlusion, extent of jeopardized myocardium, duration of ischemia but also to the adequacy of collateral circulation. Adequacy of collateral circulation can be assessed by various methods. These coronary collateral channels have been used successfully as a retrograde access route for percutaneous recanalization of chronic total occlusions. Factors that promote angiogenesis and further collateral remodeling ie. arteriogenesis have been identified. Promotion of collateral growth as a therapeutic target in patients with no suitable revascularization option is an exciting proposal.

Collateral Circulation in Chronic Total Occlusions - an interventional perspective.

Science.gov (United States)

Choo, Gim-Hooi

2015-09-09

Human coronary collaterals are inter-coronary communications that are believed to be present from birth. In the presence of chronic total occlusions, recruitment of flow via these collateral anastomoses to the arterial segment distal to occlusion provide an alternative source of blood flow to the myocardial segment at risk. This mitigates the ischemic injury. Clinical outcome of coronary occlusion ie. severity of myocardial infarction/ischemia, impairment of cardiac function and possibly survival depends not only on the acuity of the occlusion, extent of jeopardized myocardium, duration of ischemia but also to the adequacy of collateral circulation. Adequacy of collateral circulation can be assessed by various methods. These coronary collateral channels have been used successfully as a retrograde access route for percutaneous recanalization of chronic total occlusions. Factors that promote angiogenesis and further collateral remodeling ie. arteriogenesis have been identified. Promotion of collateral growth as a therapeutic target in patients with no suitable revascularization option is an exciting proposal.

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

International Nuclear Information System (INIS)

Kim, Youn Kil; Hahn, Seong Tae; Baek, Jee Hee; Kim, Choon Yul; Shinn, Kyung Sub

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

Morphological characteristics of chronic total occlusion. Predictors of different strategies for long-segment femoral arterial occlusions

Energy Technology Data Exchange (ETDEWEB)

Wei, Li-Ming; Zhu, Yue-Qi; Zhang, Pei-Lei; Lu, Hai-Tao; Zhao, Jun-Gong [Shanghai Jiaotong University Affiliated Sixth People' s Hospital, Department of Diagnostic and Interventional Radiology, Shanghai (China); Liu, Fang [Shanghai Jiaotong University Affiliated Sixth People' s Hospital, Department of Endocrinology, Shanghai (China)

2018-03-15

To investigate morphological characteristics used to predict recanalisation strategies in long-segment (>10 cm) femoral chronic total occlusion (LSF-CTO) angioplasty. We retrospectively evaluated a range of morphological CTA and DSA features in patients who underwent recanalisation of LSF-CTO. The stage of CTO was classified into early (3-12 months) and late (>12 months) according to estimated duration. Characteristics including stump morphology, lesion length and calcification, proximal side branches, collaterals circulation, runoff vessels and concomitant arterial occlusion were used as predictors, and multivariate logistic regression analysis was performed to identify variables associated with late-stage CTO and retrograde technique. A total of 119 patients with 137 CTOs in 137 limbs were enrolled. Overall, successful recanalisation was achieved in 122 CTOs (89.1%). Flush occlusion [odds ratio (OR) 2.958; 95% confidence interval (CI) 1.172-7.465; p = 0.022], large collateral (OR 2.778; 95% CI 1.201-6.427; p = 0.017) and TransAtlantic Inter-Society Consensus II class D (TASC D) lesion (OR 1.743; 95% CI 1.019-2.981; p = 0.042) were predictors for late-stage CTO. Flush occlusion (OR 75.278; 95% CI 10.664-531.384; p < 0.001) and large collateral (OR 23.213; 95% CI 3.236-166.523; p = 0.002) were associated with high likelihood for retrograde approach. Flush occlusion and large collateral were associated with a CTO at late-stage which may require retrograde recanalisation. (orig.)

Pulmonary arterial hypertension secondary to chronic thromboemboli

International Nuclear Information System (INIS)

Crysikopoulos, H.; Forrest, J.V.; Olson, L.K.; Roberts, A.C.

1989-01-01

The authors report their experience in 150 patients with pulmonary arterial hypertension secondary to chronic pulmonary embolism (CPE). Plain film findings are variable, commonly nonspecific. Occasionally nonuniformity of pulmonary perfusion or truncation of central pulmonary arteries suggest CPE. Multiple, large, unmatched perfusion defects are the most common scintigraphic observations. CT can exclude conditions mimicking CPE, particularly fibrosing mediastinitis. Pulmonary arteriography depicts the location and distribution of emboli. CPE is becoming an increasingly important entity to recognize because of available surgical treatment. Thromboendarterectomy may improve functional status and survival. The diagnosis should be considered in any patient with pulmonary arterial hypertension

Total Arterial Off‑pump Coronary Revascularization with a Bilateral ...

African Journals Online (AJOL)

Total Arterial Off‑pump Coronary Revascularization with a Bilateral Internal Mammary Artery Y Graft (208 cases). Jun-Feng Yang, Hong-Chao Zhang1, Cheng-Xiong Gu, Hua Wei. INTRODUCTION. AY graft is a graft formed by the left internal mammary artery (LIMA) connected to the left anterior descending (LAD) artery and ...

Chronic recurrent hemoptysis: effectiveness of bronchial artery embolization in 25 patients

Energy Technology Data Exchange (ETDEWEB)

Lee, Jong Ik; Shim, Hyung Jin; Wang, Chi Hyung; Hyun, Yu; Kim, Yang Soo; Kim, Young Goo; Kim, Kun Sang [Chungang University College of Medicine, Seoul (Korea, Republic of)

1994-09-15

Bronchial artery embolization has been effective in the treatment of massive hemoptysis. The purpose of this study was to report the effectiveness of bronchial artery embolization in patients with chronic recurrent hemoptysis intractable to medical treatment. This study included 25 patients who were admitted for treatment of chronic recurrent hemoptysis with bronchial artery embolization. Chronic recurrent hemoptysis was defined as condition in tractable to medical treatment persistently and occurring over two times per two months The target vessels for embolization were selected in consideration of the results of aortography as well as the finding of chest radiography and bronchoscopy. After selective arteriography for embolization by using 5-French Simmons catheter, embolic agents(mainly polyvinyl alcohol(PVA) and additionally gelfoam and coils) were released through the catheter. The results of the embolization were assessed with review of medical records. The cases of the hemoptysis were pulmonary tuberculosis(n=12.48%), bronchiectasis(n=6.24%), aspergilloma(n=3.12%), chronic obstructive pulmonary disease(n=2.8%), chronic bronchitis(n=1.4%) and lung abscess(n=1.4%). Selective embolization was carried out in 49 sites(42 in bronchial artery and 7 in nonbronchial systemic collaterals). Early success rate within 2 months was 96%. After long-term follow up study (6-30 months, average 15 months), complete remission was 72%, partial remission 12% and recurrence 12% respectively. During and after embolization, major complications such as spinal cord injury or bronchial wall necrosis was not found. Minor complications were chest pain, shoulder pain and chilling sense, which were relieved spontaneously within a few days. High success rate and relatively low recurrence with no significant complication were achieved with bronchial artery embolization in the patients complaining of chronic recurrent hemoptysis.

Missed Total Occlusion Due to the Occipital Artery Arising from the Internal Carotid Artery

International Nuclear Information System (INIS)

Ustunsoz, Bahri; Gumus, Burcak; Koksal, Ali; Koroglu, Mert; Akhan, Okan

2007-01-01

A 56-year-old man was referred for digital subtraction angiography (DSA) with an ultrasound diagnosis of right proximal internal carotid artery (ICA) stenosis for possible carotid artery stenting. DSA revealed total occlusion of the ICA and an occipital artery arising from the stump and simulating continuation of the ICA. An ascending pharyngeal artery also arose from the same occipital artery. This case is of interest because this is a rare variation besides being a cause of misdiagnosis at carotid ultrasound

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.)

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

International Nuclear Information System (INIS)

Kobayashi, Nozomu; Tanasawa, Toshihiko; Okada, Takeshi; Endo, Otone; Yamamoto, Naohito; Miyachi, Shigeru; Hattori, Kenichi

2006-01-01

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.)

Subintimal angioplasty for below-the-ankle arterial occlusion in diabetic patients with chronic critical limb ischemia

International Nuclear Information System (INIS)

Xu Ying; Zhu Yueqi; Zhao Jungong; Wang Jianbo; Tan Huaqiao; Cheng Yingsheng; Li Minghua; Wang Jue; Cheng Yongde

2011-01-01

Objective: To assess the feasibility and efficacy of subintimal angioplasty (SA) for the treatment of below-the-arterial occlusion in diabetic patients with chronic critical limb ischemia (CLI). Methods: SA was adopted for 57 diseased lower limbs in 37 diabetic patients with chronic CLI and occlusive disease of the dorsalis pedis artery (DPA) and/or planter artery (PA), who were not suitable candidates for intraluminal angioplasty or bypass surgery. Of the total 57 diseased lower limbs, tissue loss was seen in 31 (54.4%) and pain was reported in 51 (89.5%). SA was carried out to create continuous arterial flow to the foot for limb salvage. Both before and after the procedure the clinical symptoms, DPA or PA pulse volume scores and ankle-brachial indexes (ABI) were determined in all patients, the results were compared and statistically analysed. During the follow-up period, the healing of the wound, the salvage of the diseased limb and the re-stenosis occurrence of the target vessels were evaluated. Kaplan-Meier curves were constructed to evaluate limb salvage, survival rate and freedom from amputation. Results: A total of 66 below-the-ankle arterial lesions were detected in 57 affected limbs. Of the 66 lesions, SA was successfully performed in 55 (83.3%). Before SA the median pulse volume scores and ABIs were 0.33±0.54 and 0.31±0.19 respectively, which became 2.04±1.05 and 0.80±0.14 respectively after SA, the differences in both median pulse volume scores and ABI were statistically significant (P<0.01 for both). One patient (2.7%) died within 30 days after the procedure. Mild complications, such as bleeding, thrombosis or angiospasm etc. occurred in five patents (13.5%). Twelve months after SA. Kaplan-Meier analysis showed that the limb salvage rate was 94.6%, the freedom from amputation was 89.2% and the survival rate was 97.3%. Conclusion: SA of the dorsalis pedis artery and/or planter artery is an effective technique for lower limb salvage in diabetic

[Clinicofunctional features of arterial hypertension in chronic broncho-obstructive syndrome].

Science.gov (United States)

Zadionchenko, V S; Kuz'micheva, N V; Sviridov, A A; Ol'kha, R P; Kashcheeva, E V

2000-01-01

To describe clinicofunctional features of essential and pulmogenic hypertension in chronic bronchoobstructive syndrome, 24-h profile of arterial pressure (AP), intracardiac hemodynamics and to propose differential diagnostic criteria for these hypertension forms. 24-h monitoring of arterial pressure (MAP), cardiohemodynamics, external respiration function (ERF) and blood gases examinations were made in 100 hypertensive subjects with chronic obstructive bronchitis and bronchial asthma. Significant differences were found between the groups of essential and pulmogenic hypertension by major values of MAP, echo-CG and ERF. Early disturbances in diastolic function of both the ventricles in essential and pulmonary hypertension in chronic bronchial obstruction arise long before clinical, x-ray and ECG signs of chronic pulmonary heart. The findings enable formulation of criteria of differential diagnosis of essential and pulmogenic hypertension and identify the latter as an independent nosological entity.

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.

Multidetector CT findings of splenic artery aneurysm in children with chronic liver disease

International Nuclear Information System (INIS)

Ulu, Esra Meltem Kayahan; Kirbas, Ismail; Emiroglu, Feride Kural; Cakir, Banu; Harman, Ali; Coskun, Mehmet; Bakar, Coskun

2008-01-01

Splenic artery aneurysm (SAA) is a well-known complication of chronic liver disease and portal hypertension in adults. The incidence of SAA in children undergoing selective hepatic angiography prior to liver transplantation is reported as 4%, but there are few systematic studies. To investigate the SAAs detected by multidetector CT angiography (MDCTA) among children with chronic liver disease. A total of 124 children (71 girls, 53 boys; mean age 118 months; age range 5 days to 204 months) with chronic liver disease underwent MDCTA to display the vascular anatomy and any vascular complications during the pretransplantation period. Of these children, 23 also underwent coeliac angiography. The digital subtraction angiography (DSA) and MDCTA findings were compared. SAAs were detected in 13 children (10.4%); none was detectable by US. All patients had more than one aneurysm; ten patients had more than three. In all except one patient, the SAAs were located only in the intraparenchymal branches of the splenic artery; in one patient they were located in the intraparenchymal segment and in the distal third of the splenic artery. The mean size of the aneurysms was 6.5 mm (range 2.5-18 mm). All patients with aneurysms had splenomegaly and vascular collaterals. Nine of the children with SAAs had portal vein pathologies (two occlusions, two stenoses, five dilatations). A statistically significant difference existed with regard to the size of spleen (P < 0.05) and patient age (P < 0.05) between children with SAAs and children without SAAs. There was an increased risk of SAAs in patients with portal vein pathologies. In 19 patients without SAAs on MDCTA, no SAAs were seen on DSA. It is likely that the incidence of SAA in children with chronic liver disease will increase with improved survival of children with long-standing portal hypertension and chronic liver disease. MDCTA with multiplanar reconstruction is a noninvasive and effective means of imaging paediatric patients with

Multidetector CT findings of splenic artery aneurysm in children with chronic liver disease

Energy Technology Data Exchange (ETDEWEB)

Ulu, Esra Meltem Kayahan; Kirbas, Ismail; Emiroglu, Feride Kural; Cakir, Banu; Harman, Ali; Coskun, Mehmet [Baskent University Faculty of Medicine, Department of Radiology, Ankara (Turkey); Bakar, Coskun [Baskent University Faculty of Medicine, Department of Public Health, Ankara (Turkey)

2008-10-15

Splenic artery aneurysm (SAA) is a well-known complication of chronic liver disease and portal hypertension in adults. The incidence of SAA in children undergoing selective hepatic angiography prior to liver transplantation is reported as 4%, but there are few systematic studies. To investigate the SAAs detected by multidetector CT angiography (MDCTA) among children with chronic liver disease. A total of 124 children (71 girls, 53 boys; mean age 118 months; age range 5 days to 204 months) with chronic liver disease underwent MDCTA to display the vascular anatomy and any vascular complications during the pretransplantation period. Of these children, 23 also underwent coeliac angiography. The digital subtraction angiography (DSA) and MDCTA findings were compared. SAAs were detected in 13 children (10.4%); none was detectable by US. All patients had more than one aneurysm; ten patients had more than three. In all except one patient, the SAAs were located only in the intraparenchymal branches of the splenic artery; in one patient they were located in the intraparenchymal segment and in the distal third of the splenic artery. The mean size of the aneurysms was 6.5 mm (range 2.5-18 mm). All patients with aneurysms had splenomegaly and vascular collaterals. Nine of the children with SAAs had portal vein pathologies (two occlusions, two stenoses, five dilatations). A statistically significant difference existed with regard to the size of spleen (P < 0.05) and patient age (P < 0.05) between children with SAAs and children without SAAs. There was an increased risk of SAAs in patients with portal vein pathologies. In 19 patients without SAAs on MDCTA, no SAAs were seen on DSA. It is likely that the incidence of SAA in children with chronic liver disease will increase with improved survival of children with long-standing portal hypertension and chronic liver disease. MDCTA with multiplanar reconstruction is a noninvasive and effective means of imaging paediatric patients with

Hydration Status Is Associated with Aortic Stiffness, but Not with Peripheral Arterial Stiffness, in Chronically Hemodialysed Patients

Directory of Open Access Journals (Sweden)

Daniel Bia

2015-01-01

Full Text Available Background. Adequate fluid management could be essential to minimize high arterial stiffness observed in chronically hemodialyzed patients (CHP. Aim. To determine the association between body fluid status and central and peripheral arterial stiffness levels. Methods. Arterial stiffness was assessed in 65 CHP by measuring the pulse wave velocity (PWV in a central arterial pathway (carotid-femoral and in a peripheral pathway (carotid-brachial. A blood pressure-independent regional arterial stiffness index was calculated using PWV. Volume status was assessed by whole-body multiple-frequency bioimpedance. Patients were first observed as an entire group and then divided into three different fluid status-related groups: normal, overhydration, and dehydration groups. Results. Only carotid-femoral stiffness was positively associated (P<0.05 with the hydration status evaluated through extracellular/intracellular fluid, extracellular/Total Body Fluid, and absolute and relative overhydration. Conclusion. Volume status and overload are associated with central, but not peripheral, arterial stiffness levels with independence of the blood pressure level, in CHP.

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 ...

Color Doppler Indices of Orbital Arterial Flow in End-Stage Renal Disease Patients; Are the Changes Related to Chronic Hemodialysis or Chronic Renal Failure?

International Nuclear Information System (INIS)

Rokni Yazdi, Hadi; Faraji, Safoura; Ahmadi, Farokhlegha; Shahmirzae, Reza

2012-01-01

Endothelial injury is a well-known complication in chronic kidney disease (CKD) and hemodialysis. One of the sites in which early vascular changes may be detected is the retina. Of course, these flow changes may not be detected in ophthalmologic exams, but it seems that color Doppler sonography of retinal arteries may be helpful in these cases. In previous studies on CKD patients who underwent chronic hemodialysis,hemodynamic changes were noted in retinal arteries, but no study has been performed to determine which of the two processes (CKD or chronic hemodialysis) can produce these changes. In this study, we tried to answer this question. Doppler ultrasonography of the orbital vasculature including the ophthalmic artery and the central retinal artery was carried out in 17 patients (34 eyes) with chronic renal failure (CRF) who underwent hemodialysis, 17 patients (34 eyes)with CRF without a history of hemodialysis and 17 normal patients (34 eyes). The peak systolic velocity (PSV), end diastolic velocity (EDV) and resistance index were measured excluding hypertensive, diabetic patients and patients with cardiovascular disease. The mean PSV and EDV were lower only in the ophthalmic artery of CRF patients irrespective of the history of hemodialysis (PSV was 35.2 in hemodialysis, 38.8 in CRF and 51.6 in normal patients, P value = 0.001 and EDV was 7.4, 9.4, 11.8, respectively, P value =0.001) with no significant difference in the resistance index of the ophthalmic artery and other parameters [EDV, PSV, Resistance Index (RI)] in the central retinal artery. The mean PSV and DSV in the ophthalmic artery were lower only in the ophthalmic artery of CRF patients regardless of the history of hemodialysis. No significant difference in the resistance index of the ophthalmic artery and other parameters (EDV, PSV) of the central retinal artery were noted between different groups. These findings suggest that microvascular disease and endothelial cell dysfunction of the orbital

“Transcollateral” Renal Angioplasty for a Completely Occluded Renal Artery

International Nuclear Information System (INIS)

Chandra, Subash; Chadha, Davinder S.; Swamy, Ajay

2011-01-01

Percutaneous transluminal renal angioplasty with stenting has been effective in the control of hypertension, renal function, and pulmonary edema caused by atherosclerotic renal artery stenosis. However, the role of the procedure has not been fully established in the context of chronic total occlusion of renal artery. We report the successful use of this procedure in 57-year-old male patient who reported for evaluation of a recent episode of accelerated hypertension. A renal angiogram in this patient showed ostial stenosis of the right renal artery, which was filling by way of the collateral artery. Renal angioplasty for chronic total occlusion of right renal artery was successfully performed in a retrograde fashion through a collateral artery, thereby leading to improvement of renal function and blood pressure control.

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

OpenAIRE

Abdul-rahman R. Abdel-karim; Minh Vo; Michael L. Main; J. Aaron Grantham

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 f...

Optical coherence tomography findings after chronic total occlusion interventions: Insights from the “AngiographiC evaluation of the everolimus-eluting stent in chronic Total occlusions” (ACE-CTO) study (NCT01012869)

Energy Technology Data Exchange (ETDEWEB)

Sherbet, Daniel P.; Christopoulos, Georgios; Karatasakis, Aris; Danek, Barbara Anna; Kotsia, Anna; Navara, Rachita; Michael, Tesfaldet T.; Roesle, Michele; Rangan, Bavana V.; Haagen, Donald [VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, TX (United States); Garcia, Santiago [Minneapolis VA Healthcare System and University of Minnesota, Minneapolis, MN (United States); Maniu, Calin [Bon Secours Health System, Suffolk, VA (United States); Pershad, Ashish [Banner Good Samaritan Medical Center, Phoenix, AZ (United States); Abdullah, Shuaib M.; Hastings, Jeffrey L.; Kumbhani, Dharam J.; Luna, Michael; Addo, Tayo; Banerjee, Subhash [VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, TX (United States); Brilakis, Emmanouil S., E-mail: esbrilakis@gmail.com [VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, TX (United States)

2016-10-15

Background: There is limited information on optical coherence tomography (OCT) findings after percutaneous coronary intervention (PCI) of chronic total occlusions (CTOs). OCT allows high resolution imaging that can enhance understanding of the vascular response after stenting of chronically occluded vessels. Methods: The Angiographic Evaluation of the Everolimus-Eluting Stent in Chronic Total Occlusions (ACE-CTO) study collected angiographic and clinical outcomes from 100 patients undergoing CTO PCI with the everolimus-eluting stent (EES). OCT was performed 8-months post stenting in 62 patients. Every third frame was analyzed throughout the course of the stented arterial segment. Lumen contours were semi-automatically traced and stent struts were manually delineated, with automatic measurement of the strut to lumen distance. Struts on the luminal side of the lumen contour were classified as malapposed if the distance to the lumen contour exceeded 0.108 mm. Results: A total of 44,450 struts in 6047 frames were analyzed, of which 4113 9.3%, 95% confidence intervals [CI] 9.0% to 9.5%) were malapposed and 1230 (2.8%, 95% CI 2.6% to 2.9%) were uncovered. Fifty-five of 62 patients (88.7%, 95% CI 78.5% to 98.4%) had at least one malapposed stent strut and 50 patients (80.7%, 95% CI 69.2% to 88.6%) had at least one uncovered stent strut. Mean strut-intimal thickness of the apposed and malapposed struts was 0.126 ± 0.140 mm and − 0.491 ± 0.440 mm, respectively. Conclusion: High rates of stent strut malapposition and incomplete stent strut coverage were observed after CTO PCI using EES, highlighting unique challenges associated with stent implantation in CTOs. - Highlights: • Percutaneous coronary intervention with drug-eluting stents for chronic total occlusion is associated with a 40% rate of binary in-stent restenosis at 8 months • Of patients who receive a drug eluting stent for a chronic total occlusion 88.7% will have stent strut malapposition and 80.7% will

The feasibility of transradial laser atherectomy for chronic total occlusion using the 5 Fr sheath system

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Khaled Sherif

2016-05-01

Full Text Available Objective. We present a case of chronic total occlusion (CTO approached with LASER endovascular intervention by radial artery approach using a 5 French sheath. Case report. A 57-year-old man presented to our hospital having had retrosternal chest pain for two days. Physical examination was normal at the time of presentation. The laboratory tests were within normal limits, including cardiac enzymes except the lipid panel which showed hypertriglyceridemia. The patient underwent a myocardial perfusion scintigraphy stress test that revealed inferior wall ischemia, with normal left ventricular ejection fraction. A 5-French vascular sheath was placed in the right radial artery. Selective coronary artery angiography was performed, which showed right coronary artery (RCA CTO. A 5-French JR4 guide catheter successfully engaged the RCA and Laser angioplasty was performed across the CTO into the RCA. A marked improvement of flow was evident thereafter. Conclusion. To best of our knowledge this is the first case report showing the feasibility of laser atherectomy using the 5 French sheath system in a coronary arterial CTO.

The feasibility of transradial laser atherectomy for chronic total occlusion using the 5 Fr sheath system.

Science.gov (United States)

Sherif, Khaled; Yaqub, Yasir; Suarez, Jose A

2016-05-01

We present a case of chronic total occlusion (CTO) approached with LASER endovascular intervention by radial artery approach using a 5 French sheath. A 57-year-old man presented to our hospital having had retrosternal chest pain for two days. Physical examination was normal at the time of presentation. The laboratory tests were within normal limits, including cardiac enzymes except the lipid panel which showed hypertriglyceridemia. The patient underwent a myocardial perfusion scintigraphy stress test that revealed inferior wall ischemia, with normal left ventricular ejection fraction. A 5-French vascular sheath was placed in the right radial artery. Selective coronary artery angiography was performed, which showed right coronary artery (RCA) CTO. A 5-French JR4 guide catheter successfully engaged the RCA and Laser angioplasty was performed across the CTO into the RCA. A marked improvement of flow was evident thereafter. To best of our knowledge this is the first case report showing the feasibility of laser atherectomy using the 5 French sheath system in a coronary arterial CTO. Copyright © 2016 by Academy of Sciences and Arts of Bosnia and Herzegovina.

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...

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.

Conservative Management of an Epicardial Collateral Perforation During Retrograde Chronic Total Occlusion Percutaneous Coronary Intervention.

Science.gov (United States)

Ngo, Christian; Christopoulos, George; Brilakis, Emmanouil S

2016-01-01

Coronary artery perforation is a highly feared complication of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) and can lead to pericardial effusion, tamponade, and, rarely, emergent cardiac surgery. Perforation of epicardial collaterals during retrograde CTO-PCI may be particularly challenging to treat, as embolization from both sides of the perforation may be required to control the bleeding. However, conservative measures can occasionally be effective. We present a case of epicardial collateral vessel perforation that was managed conservatively with anticoagulation reversal.

Management of Infrapopliteal Arterial Disease: Critical Limb Ischemia.

Science.gov (United States)

Mustapha, Jihad A; Diaz-Sandoval, Larry J

2014-10-01

According to the TransAtlantic Inter-Society Consensus Document on Management of Peripheral Arterial Disease, "there is increasing evidence to support a recommendation for angioplasty in patients with critical limb ischemia and infrapopliteal artery occlusion." Management of infrapopliteal artery disease starts with diagnosis using modern preprocedural noninvasive and invasive imaging. Interventionalists need to learn the role of chronic total occlusion cap analysis and collateral zone recognition in angiosome-directed interventions for management of critical limb ischemia and be familiar with equipment and device selection and a stepwise approach for endovascular interventions. Interventionalists need to know which crossing tools to use to successfully cross-complex chronic total occlusion caps. Copyright © 2014 Elsevier Inc. All rights reserved.

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

International Nuclear Information System (INIS)

Joseph, George; Chacko, Sujith Thomas

2013-01-01

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.

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

International Nuclear Information System (INIS)

Gweon, Hye Mi; Suh, Sang Hyun; Won, Jong Yun; Lee, Do Yun; Kim, Sam Soo

2008-01-01

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

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....

Impact of diabetes mellitus on acute outcomes of percutaneous coronary intervention in chronic total occlusions: insights from a US multicentre registry.

Science.gov (United States)

Martinez-Parachini, J R; Karatasakis, A; Karmpaliotis, D; Alaswad, K; Jaffer, F A; Yeh, R W; Patel, M; Bahadorani, J; Doing, A; Nguyen-Trong, P-K; Danek, B A; Karacsonyi, J; Alame, A; Rangan, B V; Thompson, C A; Banerjee, S; Brilakis, E S

2017-04-01

To examine the impact of diabetes mellitus on procedural outcomes of patients who underwent percutaneous coronary intervention for chronic total occlusion. We assessed the impact of diabetes mellitus on the outcomes of percutaneous coronary intervention for chronic total occlusion among 1308 people who underwent such procedures at 11 US centres between 2012 and 2015. The participants' mean ± sd age was 66 ± 10 years, 84% of the participants were men and 44.6% had diabetes. As compared with participants without diabetes, participants with diabetes were more likely to have undergone coronary artery bypass graft surgery (38 vs 31%; P = 0.006), and to have had previous heart failure (35 vs 22%; P = 0.0001) and peripheral arterial disease (19 vs 13%; P = 0.002). They also had a higher BMI (31 ± 6 kg/m 2 vs 29 ± 6 kg/m 2 ; P = 0.001), similar Japanese chronic total occlusion scores (2.6 ± 1.2 vs 2.5 ± 1.2; P = 0.82) and similar final successful crossing technique: antegrade wire escalation (46 vs 47%; P = 0.66), retrograde (30 vs 28%; P = 0.66) and antegrade dissection re-entry (24 vs 25%; P = 0.66). Technical (91 vs 90%; P = 0.80) and procedural (89 vs 89%; P = 0.93) success was similar in the two groups, as was the incidence of major adverse cardiac events (2.2 vs 2.5%; P = 0.61). In a contemporary cohort of people undergoing percutaneous coronary intervention for chronic total occlusion, nearly one in two (45%) had diabetes mellitus. Procedural success and complication rates were similar in people with and without diabetes. © 2016 Diabetes UK.

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.

Frequency and clinical predictors of coronary artery disease in chronic renal failure renal transplant candidates.

Science.gov (United States)

de Albuquerque Seixas, Emerson; Carmello, Beatriz Leone; Kojima, Christiane Akemi; Contti, Mariana Moraes; Modeli de Andrade, Luiz Gustavo; Maiello, José Roberto; Almeida, Fernando Antonio; Martin, Luis Cuadrado

2015-05-01

Cardiovascular diseases are major causes of mortality in chronic renal failure patients before and after renal transplantation. Among them, coronary disease presents a particular risk; however, risk predictors have been used to diagnose coronary heart disease. This study evaluated the frequency and importance of clinical predictors of coronary artery disease in chronic renal failure patients undergoing dialysis who were renal transplant candidates, and assessed a previously developed scoring system. Coronary angiographies conducted between March 2008 and April 2013 from 99 candidates for renal transplantation from two transplant centers in São Paulo state were analyzed for associations between significant coronary artery diseases (≥70% stenosis in one or more epicardial coronary arteries or ≥50% in the left main coronary artery) and clinical parameters. Univariate logistic regression analysis identified diabetes, angina, and/or previous infarction, clinical peripheral arterial disease and dyslipidemia as predictors of coronary artery disease. Multiple logistic regression analysis identified only diabetes and angina and/or previous infarction as independent predictors. The results corroborate previous studies demonstrating the importance of these factors when selecting patients for coronary angiography in clinical pretransplant evaluation.

Intravascular stenting in the superior mesenteric artery for chronic abdominal angina.

Science.gov (United States)

Busquet, J

1997-11-01

Abdominal angina is an early clinical expression of occlusive mesenteric arterial insufficiency, a condition that requires aggressive treatment to prevent intestinal infarction. We report a case of chronic mesenteric ischemia in a young polyvascular man who had symptoms of abdominal angina. An aortic angiogram revealed a significant ostial stenosis of the superior mesenteric artery (SMA) associated with an occlusion of the inferior mesenteric artery. After predilation of the ostial portion of the SMA, significant residual stenosis remained. A balloon-expandable Palmaz P154 stent was deployed, restoring adequate luminal dimensions and blood flow. The patient was discharged after 2 days and remains asymptomatic at 5 months. Intraluminal stenting for treatment of mesenteric ischemia represents a viable alternative to surgical revascularization in selected cases.

Evaluation of arterial stiffness in nondiabetic chronic kidney disease patients

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Bodanapu Mastanvalli

2017-01-01

Full Text Available Chronic kidney disease (CKD is a growing problem worldwide. Clinical and epidemiologic studies have shown that structural and functional changes that occur in major arteries are a major contributing factor to the high mortality in uremic patients. Recent studies have shown a stepwise increase of the carotid-femoral pulse wave velocity (cfPWV from CKD Stage 1 to Stage 5. We evaluated the cfPWV and augmentation index (AIx, as indirect markers of arterial stiffness in patients with nondiabetic CKD and compared the values with normal population; we also evaluated the relationship between various stages of CKD and arterial stiffness markers. This cross-sectional study was carried out in the Department of Nephrology for a duration of two years from January 15, 2012, to January 14, 2014. Fifty patients with nondiabetic CKD were studied along with 50 healthy volunteers who did not have CKD, who served as controls. Assessment of arterial stiffness (blood pressure, PWV, heart rate, aortic augmentation pressure, and AIx was performed using the PeriScope device. PWV positively correlated with systolic and diastolic blood pressure, mean aortic arterial pressure, serum creatinine, and serum uric acid and negatively correlated with estimated glomerular filtration rate. Arterial stiffness increased as CKD stage increased and was higher in nondiabetic CKD group than in the general population. Arterial stiffness progressed gradually from CKD Stage 2 to 5, and then abruptly, in dialysis patients. Measures to decrease the arterial stiffness and its influence on decreasing cardiovascular events need further evaluation.

Evaluation of Blood Hemodynamics in Vascular Grafts after Total Arterial Coronary Revascularization

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Ahmad Ali Amirghofran

2016-07-01

Full Text Available Arterial grafting has increasingly been advocated for the treatment of coronary artery disease in an attempt to improve the long-term results. In the quest to perform routine total arterial revascularization, composite Y graft methods are gaining popularity. The aim of our study was to evaluate whether blood flow in the left internal thoracic artery can provide sufficient perfusion to the entire cardiac muscle per se. Twenty patients with severe coronary artery stenosis who underwent complete arterial coronary revascularization using a composite graft entered our study. Blood flow in thoracic trunk was evaluated in three phases: cross-clamp on, cross-clamp off, and after weaning the patient from cardiopulmonary bypass. Mean arterial blood pressure in the thoracic trunk in these various positions was 62.7±3.7. left internal thora cic artery can provide sufficient blood flow to the cardiac muscles for both rest and exercise conditions.

Coronary collateral circulation in patients with chronic coronary total occlusion; its relationship with cardiac risk markers and SYNTAX score.

Science.gov (United States)

Börekçi, A; Gür, M; Şeker, T; Baykan, A O; Özaltun, B; Karakoyun, S; Karakurt, A; Türkoğlu, C; Makça, I; Çaylı, M

2015-09-01

Compared to patients without a collateral supply, long-term cardiac mortality is reduced in patients with well-developed coronary collateral circulation (CCC). Cardiovascular risk markers, such as N-terminal pro-brain natriuretic peptide (NT-proBNP), high-sensitive C-reactive protein (hs-CRP) and high-sensitive cardiac troponin T (hs-cTnT) are independent predictors for cardiovascular mortality. The main goal of this study was to examine the relationship between CCC and cardiovascular risk markers. We prospectively enrolled 427 stable coronary artery disease patients with chronic total occlusion (mean age: 57.5±11.1 years). The patients were divided into two groups, according to their Rentrop scores: (a) poorly developed CCC group (Rentrop 0 and 1) and (b) well-developed CCC group (Rentrop 2 and 3). NT-proBNP, hs-CRP, hs-cTnT, uric acid and other biochemical markers were also measured. The SYNTAX score was calculated for all patients. The patients in the poorly developed CCC group had higher frequencies of diabetes and hypertension (prisk markers, such as NT-proBNP, hs-cTnT and hs-CRP are independently associated with CCC in stable coronary artery disease with chronic total occlusion. © The Author(s) 2014.

Acute and chronic dissection of pulmonary artery: new challenges in pulmonary arterial hypertension?

Science.gov (United States)

Florczyk, Michał; Wieteska, Maria; Kurzyna, Marcin; Gościniak, Piotr; Pepke-Żaba, Joanna; Biederman, Andrzej; Torbicki, Adam

2018-01-01

Right ventricular failure is a leading cause of mortality in patients with pulmonary arterial hypertension (PAH). However, up to 25% of such patients die unexpectedly, without warning signs of hemodynamical decompensation. We previously documented that pulmonary artery (PA) dilatation significantly increases the risk of those deaths. Some of them may be due to dissection of PA resulting in cardiac tamponade. However, direct confirmation of this mechanism is difficult as most of such deaths occur outside hospitals. We present 4 patients with severe PAH and PA dilatation in whom PA dissection has been confirmed. Three patients had IPAH, one had PAH associated with congenital heart disease. All patients had mean pulmonary artery pressure (PAP) > 50 mmHg at diagnosis and dissection occurred late in the course of apparently well controlled disease (6 to 14 years). Several clinical elements were common to our patients - high systolic PAP, long lasting PH, progressive dilatation of PA to more than 50 mm with chest pain prior to dissection. However, clinical course followed three different patterns: sudden death due to cardiac tamponade, hemopericarditis caused by blood leaking from dissected aneurysm with imminent but not immediate cardiac tamponade, or chronic asymptomatic PA dissection. Indeed, two of our patients are alive and on lung transplantation waiting list for more than 2 years now. Further research is needed to suggest optimal management strategies for patients with stable PAH but significantly dilated proximal pulmonary arteries or confirmed PA dissection depending on the clinical presentation and expected outcome.

Embolization of gastroduodenal artery pseudoaneurysm caused by chronic pancreatitis: a case report

International Nuclear Information System (INIS)

Kim, Se Jong; Ko, Kang Seok; Park, Byung Lan; Kim, Byong Geun; Kim, Jae Kyu

1993-01-01

Pseudoaneurysm due to chronic pancreatitis is uncommon, but it can cause recurrent and massive hemorrhage. Because of high morbidity and mortality associated with the pseudoaneurysm, early detection and treatment is essential. Surgical ligation or resection of the aneurysm has a high mortality and therefore, transcatheter embolization is preferably carried out. We report a case in which gastroduodenal artery pseudoaneurysm caused by chronic pancreatitis was successfully treated by transcatheter embolization using Gelfoam and Gianturco spring coils

Embolization of gastroduodenal artery pseudoaneurysm caused by chronic pancreatitis: a case report

Energy Technology Data Exchange (ETDEWEB)

Kim, Se Jong; Ko, Kang Seok; Park, Byung Lan; Kim, Byong Geun [Kwangju Christian Hospital, Gwangju (Korea, Republic of); Kim, Jae Kyu [College of Medicine, Chonnam National Univrsity, Gwangju (Korea, Republic of)

1993-01-15

Pseudoaneurysm due to chronic pancreatitis is uncommon, but it can cause recurrent and massive hemorrhage. Because of high morbidity and mortality associated with the pseudoaneurysm, early detection and treatment is essential. Surgical ligation or resection of the aneurysm has a high mortality and therefore, transcatheter embolization is preferably carried out. We report a case in which gastroduodenal artery pseudoaneurysm caused by chronic pancreatitis was successfully treated by transcatheter embolization using Gelfoam and Gianturco spring coils.

The relationship between total arterial revascularization and blood transfusion following coronary artery bypass grafting.

Science.gov (United States)

Djordjevic, Jasmina; Ngaage, Dumbor L

2015-05-01

Blood transfusion adversely affects the outcome of coronary artery bypass grafting (CABG), yet blood transfusion after CABG is still common. Total arterial revascularisation (TAR) is increasingly used in current practice but its impact on postoperative blood transfusion is not known. We reviewed the cardiothoracic and blood bank databases and collected data for isolated primary CABG patients from July 2007 to June 2012, excluding patients who had a single graft (n = 148). Perioperative variables of TAR patients (n = 745) were compared with patients who had one or more venous grafts (SVG, n = 1,761) for first-time isolated CABG. The conduits used in TAR patients were predominantly left internal thoracic and radial arteries. Matched group comparison of TAR and SVG patients was performed. The association of TAR with blood transfusion was investigated using multivariate and matched analysis. Of 2,506 patients, the 745 (29.7 %) that had TAR were generally younger, with less complex coronary artery disease and less often diabetic. After correcting for these by 1:1 matching, the mean chest tube drainage and rates of blood transfusion remained significantly lower (p transfused in TAR patients. By multivariate analysis, TAR had an independent effect on reducing blood transfusion after CABG [odds ratio (OR) 0.67, 95 % confidence interval (CI) 0.47-0.97, p = .03]. TAR achieved predominantly with left internal thoracic and radial arteries substantially reduced blood transfusion rates after primary CABG. Further studies are warranted.

CHRONIC OBSTRUCTIVE PULMONARY DISEASE AND ARTERIAL HYPERTENSION: VASCULAR WALL AS THE TARGET ORGAN IN COMORBID PATIENTS

OpenAIRE

N. A. Karoli; A. P. Rebrov

2017-01-01

Studies of endothelial dysfunction in patients with respiratory diseases have become relevant in recent years. Perhaps endothelial dysfunction and high arterial stiffness bind bronchopulmonary and cardiovascular diseases.Aim. To reveal features of disturbances of arterial wall vasoregulatory function in patients with chronic obstructive pulmonary disease (COPD) in the presence and absence of arterial hypertension (HT).Material and methods. The study included 50 patients with COPD with normal ...

Pulmonary artery hypertension in chronic obstructive lung disease. The validity of morphometric tests in radiodiagnosis of the thorax

Energy Technology Data Exchange (ETDEWEB)

Dinkel, E; Mundinger, A; Reinbold, W D; Wuertemberger, G

1989-06-01

Standard biplane chest X-rays were tested for the validity of morphometric criteria in the diagnosis of pulmonary artery hypertension. Twenty-seven patients suffering from chronic obstructive lung disease were examined and compared with a control group without cardiopulmonary disease. The diameter of the right and left pulmonary artery, pulmonary conus and the hilar-to-thoracic ratio were significantly increased in patients with chronic obstructive lung disease (p<0.0001). Measurement of the right pulmonary artery was 19.7+-3.9 mm compared to 13.6+-1.2 mm of the control group; mean hilar thoracic index was 0.35 compared to 0.31. Thus if the width of the descending branch of the right pulmonary artery was above 16 mm, pulmonary arterial hypertension was suggested, with a specificity of almost 100%, although the sensitivity of the diagnosis was only 59%. The mean pulmonary arterial pressure obtained by right heart catheterization correlated poorly with the morphometric criteria obtained. (orig.).

Increased arterial inflammation in individuals with stage 3 chronic kidney disease

International Nuclear Information System (INIS)

Takx, Richard A.P.; MacNabb, Megan H.; Emami, Hamed; Abdelbaky, Amr; Lavender, Zachary R.; Singh, Parmanand; Di Carli, Marcelo; Taqueti, Viviany; Foster, Courtney; Mann, Jessica; Comley, Robert A.; Weber, Chek Ing Kiu; Tawakol, Ahmed

2016-01-01

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 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 cardiovascular

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

The Use of a Re-Entry Catheter in Recanalization of Chronic Inflow Occlusions of the Common Iliac Artery

International Nuclear Information System (INIS)

Ramjas, Greg; Thurley, Peter; Habib, Said

2008-01-01

Endovascular treatment of iliac artery occlusions can be unsuccessful due to a failure to break back into the true lumen, and lesions without a proximal stump can be particularly problematic. True lumen re-entry catheters have not been previously used for this type of lesion. The authors report eight patients, five males and three females, with lifestyle-limiting intermittent claudication referred for endovascular treatment. Imaging demonstrated unilateral chronic total occlusion of the common iliac artery in six patients and two patients with short patent stumps at the origin of the occluded common iliac artery. Endovascular therapy was initially unsuccessful due to an inability to re-enter the true lumen after crossing the occlusion in the subintimal plane. With the assistance of the Outback LTD catheter it was possible to achieve continuity of the dissecting tract with the true lumen, thus facilitating successful primary stenting in all eight patients. To our knowledge this is the first report of the use of the Outback LTD catheter in this type of lesion

Endovascular diagnostics and treatment of stenosis, acute thrombosis and chronic occlusion of arteries and upper limbs

International Nuclear Information System (INIS)

Tonev, I.; Zechirov, B.; Stanoev, D.; Velikov, C.; Smilkova, D.

2015-01-01

Full text: Diseases of the upper limb arteries are significantly rarer than those of the lower limbs but they are not causes and due to the lack of diagnostic algorithms are often missed. the symptoms are not typical except for those in acute thrombosis. The complaints in acute thrombosis is strong, sudden pain in the limb or part of it, bruising or paleness of the ischemic area and a lack of pulsation. Diagnosis is fairly easy – clinical events, difference in blood pressure or a lack of blood pressure in the affected limb, a total lack of blood pressure or a difference in the pressure in the left and right arm. Then complaints in stenosis and chronic occlusions is significantly less pronounced and is expressed as weakness in the affected limb, heaviness, bluish or paleness. If the proximal segments are affected Still’s syndrome is often observed. The complaints is not decisive for diagnosis. A difference in blood pressure of more than 20 mm Hg and an echodoppler examination of the arteries are the main criteria for directing the patients for angiography. Contrast CT and MRT are not used often. treatment is vascular surgery and endovascular. In acute thrombosis priority takes vascular surgery through extraction of the thrombi with Fogerty catheters, and in chronical stenosis and occlusions – dilation and stenting. Clinical cases: Case 1 – Revascularization of artery brachialis, radialis and ulnaris after acute occlusion L.Y., 77 years old. Complains of sharp pain and bruising of right forearm since two hours before hospitalization. A lack of blood flow was identified using palpation and echodoppler. After a diagnostic angiography , thrombaspiration was undertaken, through a leading catheter, recovering blood flow in both arteries and stenting of the proximal segment of artery radialis. Case 2: Revascularization of Trunkus brachiocefalicus K.P., 65 years old. Suffering from bradypsychia for several months. Bradypsychia becomes worse after manual labor

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

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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.)

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

International Nuclear Information System (INIS)

Zhang, Edwin; Owen, Richard; Bruce, Garth; Wiebe, Sheldon

2011-01-01

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.)

[Clinical, functional and biochemical characteristics of arterial hypertension in military men under chronic stress].

Science.gov (United States)

Shpagina, L A; Ermakova, M A; Volkova, E A; Iakovleva, S A

2008-01-01

Peculiarities of military occupational activities are repeated stress and high degree of psychoemotional strain. The article deals with results of momentary study covering a select from military men cohort, with thyroid tests, renal functional tests, diurnal monitoring of blood pressure and psychologic state assessment. Course of arterial hypertension in military men subjected to chronic stress presents prevailing systolic-diastolic and diastolic variants with excessive decrease of blood pressure at night, with high values of albuminuria. Psychologic state of the military men examined, whe were subjects to chronic stress, was mostly mixed reactivity type with general overstrain and somatization of inner conflict (psychosomatic variant of dysadaptation). The authors demonstrated close correlation between intrinsic emotional strain degree with arterial hypertension type according to "hyper-dipper" variant and free T3 level.

Chronic hindlimb ischemia impairs functional vasodilation and vascular reactivity in mouse feed arteries

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Trevor R Cardinal

2011-12-01

Full Text Available Vasodilation of lower leg arterioles is impaired in animal models of chronic peripheral ischemia. In addition to arterioles, feed arteries are a critical component of the vascular resistance network, accounting for as much as 50% of the pressure drop across the arterial circulation. Despite the critical importance of feed arteries in blood flow control, the impact of ischemia on feed artery vascular reactivity is unknown. At 14 days following unilateral resection of the femoral-saphenous artery-vein pair, functional vasodilation of the profunda femoris artery was severely impaired, 11 ± 9% versus 152 ± 22%. Although endothelial and smooth muscle-dependent vasodilation were both impaired in ischemic arteries compared to control arteries (Ach: 40 ± 14% vs 81 ± 11%, SNP: 43 ± 12% vs and 85 ± 11%, the responses to acetylcholine and sodium nitroprusside were similar, implicating impaired smooth muscle-dependent vasodilation. Conversely, vasoconstriction responses to norepinephrine were not different between ischemic and control arteries, -68 ± 3% versus -66 ± 3%, indicating that smooth muscle cells were functional following the ischemic insult. Finally, maximal dilation responses to acetylcholine, in vitro, were significantly impaired in the ischemic artery compared to control, 71 ± 9% versus 97 ± 2%, despite a similar generation of myogenic tone to the same intravascular pressure (80 mmHg. These data indicate that ischemia impairs feed artery vasodilation by impairing the vascular wall’s responsiveness to vasodilating stimuli. Future studies to examine the mechanistic basis for these observations or treatment strategies to improve feed artery vasodilation following ischemia could provide the foundation for an alternative therapeutic paradigm for peripheral arterial occlusive disease.

Total retinal detachments due to retinoblastoma: Outcomes following intra-arterial chemotherapy/ophthalmic artery chemosurgery.

Directory of Open Access Journals (Sweden)

Megan A Rowlands

Full Text Available To report on the rate and timing of retinal reattachment and outcomes for retinoblastoma children who have total retinal detachments at presentation to our center and were treated with intra-arterial chemotherapy (ophthalmic artery chemosurgery, OAC.Single-center retrospective review of retinoblastoma patients who presented with total retinal detachments and were subsequently treated with OAC at MSKCC between May 2006 and July 2016. Endpoints were retinal detachment resolution, visual function, ERG amplitude, ocular survival, and patient survival from metastases.87 eyes of 84 retinoblastoma patients were included. Using a survival multistate model, by 36 months of follow-up, there was a 54% cumulative probability of complete retinal reattachment and a 76% probability of partial reattachment. 24% of eyes that completely reattached received only OAC without any prior or adjuvant treatments. Eyes that completely reattached were significantly more likely to have been diagnosed at a younger age (p<0.0001 and to have greater initial ERG values (p = 0.006. At final follow-up, 14% of eyes had gained at least 25 μV of ERG activity, and 8.0% had achieved hand motion vision or better, including one to 20/60. 13% of eyes were enucleated. No patient died from metastatic disease, and only one developed metastases.OAC can successfully treat previously considered "non-salvageable" retinoblastoma eyes with total retinal detachments, promote retinal reattachment in the majority of eyes, and preserve ocular and patient survival.

Evaluation of chronic kidney disease in chronic heart failure: From biomarkers to arterial renal resistances

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Iacoviello, Massimo; Leone, Marta; Antoncecchi, Valeria; Ciccone, Marco Matteo

2015-01-01

Chronic kidney disease and its worsening are recurring conditions in chronic heart failure (CHF) which are independently associated with poor patient outcome. The heart and kidney share many pathophysiological mechanisms which can determine dysfunction in each organ. Cardiorenal syndrome is the condition in which these two organs negatively affect each other, therefore an accurate evaluation of renal function in the clinical setting of CHF is essential. This review aims to revise the parameters currently used to evaluate renal dysfunction in CHF with particular reference to the usefulness and the limitations of biomarkers in evaluating glomerular dysfunction and tubular damage. Moreover, it is reported the possible utility of renal arterial resistance index (a parameter associated with abnormalities in renal vascular bed) for a better assesment of kidney disfunction. PMID:25610846

Frequency of undiagnosed chronic obstructive pulmonary disease in patients with coronary artery disease

International Nuclear Information System (INIS)

Ullah, R.; Ghaffar, T.; Khan, I.; Muhammad, R.; Salman, S.

2017-01-01

Chronic obstructive airway disease (COPD) is considered as risk factor for coronary artery disease (CAD) along with other risk factors. This study was conducted to determine the frequency of undiagnosed chronic obstructive pulmonary disease in patients with coronary artery disease. Methods: This cross-sectional study was conducted in the Pulmonology and Cardiology wards/OPD's of Khyber Teaching Hospital Peshawar. Patients more than 35 years of age, diagnosed with CAD of either gender were included. Patients already diagnosed with COPD, recent myocardial infarction (within 7 days), left ventricular impairment, pneumothorax, bronchiectasis, comatose patient, asthmatic and those with chest trauma were excluded. All the patients underwent spirometry examination before and after administration of salbutamol (5 mg for 5 minutes) via nebulizer. FEV1/FVC less than 70% confirmed the presence of COPD. Results: Out of 151 patients, 57 (37.7%) were found to have COPD. Among them, 39 (68.42%) were male and 18 (31.57%) were female. Among male patients with COPD, 82.05% (n=32) were smokers and 17.94% (n=7) were nonsmokers while in females with COPD no one was smoker. Conclusion: COPD is an under-diagnosed progressive disease in patients with high risk patients with coronary artery disease. (author)

Etiology of chronic skin lesions in subjects with peripheral arterial disease.

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Chisari, G; Chisari, E M; Borzì, A M; Grasso, A; Chisari, C G

2018-01-01

Skin lesions can be defined as lesions that result in loss of tissues and their joints, and often this cutaneous skin process is a primary or secondary consequence of the structural changes in the skin itself. Subjects with peripheral arteripathies that develop chronic skin lesions in the lower extremities of the Western world are constantly increasing. We conducted a study on the etiologic incidence of chronic skin lesions in peripheral arterial disease CSLpa subjects in the lower limbs compared to subjects with chronic skin lesions CSL (controls). 30 subjects with peripheral atheropathies PA (22 F - 8 M mean age 74,5 ± 4,9) and with chronic skin lesions (CSLpa) in the lower limbs "A" group were admitted to our study according to a randomized and compared to 30 no peripheral atheropathies subjects (19 F-11 M, mean age 81,5 ± 7,3 - controls) group B with chronic skin lesions (CSL). These two groups "A" and "B" have been studied and compared on the basis of infectious etiology responsible for the infectious skin process. In the subjects of the "A" group we found a 12 positive assay of 40.0% of the examinations, while in the group "B" we achieved a total cultured positivity of 9 cases corresponding to 30.0% of the examinations . For the number of bacterial species identified for "A" group we obtained 3 mono microbial and 6 poly microbial bacteriological tests and for group "B" we observed 7 mono microbial and 2 poly microbial tests. All bacteriological isolates showed "in vitro" sensitivity to satisfactory ciprofloxacin with MICs range of 0.78-1.56mg/L. The data observed after 4 weeks after the amniotic membrane (MA) in the two study groups A and B were respectively the following: and for group A 50% scarring, 46.6% partial resolution and in one case worsening for the B-healing group in 63.3%, the partial resolution in the remaining 36.6. The data from this study show a different etiology between subjects with CSLpa than subjects with CSL. This phenomenon confirms

Reliable porcine coronary model of chronic total occlusion using copper wire stents and bioabsorbable levo-polylactic acid polymer.

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Sim, Doo Sun; Jeong, Myung Ho; Cha, Kyoung Rae; Park, Suk Ho; Park, Jong Oh; Shin, Young Min; Shin, Heungsoo; Hong, Young Joon; Ahn, Youngkeun; Schwartz, Robert S; Kang, Jung Chaee

2012-12-01

Chronic total occlusion (CTO) remains a challenge in interventional cardiology. We investigated the feasibility and reliability of copper wire stents and levo-polylactic acid (l-PLA) as a means of CTO induction in a porcine model. In one group of 20 swine, copper stents were crimped on a 3.0mm angioplasty balloon and inserted into the mid-left anterior descending coronary artery (LAD). In the other group of 20 swine, l-PLA was wrapped on a guidewire and pushed into the distal LAD with a 3.0mm balloon catheter to induce embolization. Of 20 swine which underwent copper stent implantation, 13 died of stent thrombosis. In the remaining 7 swine, total or near total occlusion with collateral circulation was observed at 5 weeks. Of 20 swine which underwent l-PLA embolization, 4 died of ventricular fibrillation during or shortly after the procedure. Serial histopathologic studies showed complete absorption of the polymer with replacement by fibrotic tissue approximately 4 weeks following the polymer implantation. CTO could be reliably induced in porcine coronary arteries by copper stents and l-PLA. These models may support investigation of new percutaneous devices to facilitate CTO interventions. Copyright © 2012 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

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

International Nuclear Information System (INIS)

Ozer, Tulay; Altin, Remzi; Ugurbas, Suat Hayri; Ozer, Yetkin; Mahmutyazicioglu, Kamran; Kart, Levent

2006-01-01

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 2 ), peripheral oxygen saturation (SpO 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 2 with PSV (r = 0.53, p < 0.01) and EDV (r = 0.51, p < 0.01) of the OA. Statistically significant correlations were also found for the SpO2 with RI (r = -0.34, p < 0.05) in the OA. Conclusion: We concluded that COPD is associated with impaired retrobulbar hemodynamics, especially in the ophthalmic artery. Moreover, central retinal and posterior ciliary arteries with increased resistance are also found to be affected when compared with healthy control eyes

Measures of chronic kidney disease and risk of incident peripheral artery disease: a collaborative meta-analysis of individual participant data.

Science.gov (United States)

Matsushita, Kunihiro; Ballew, Shoshana H; Coresh, Josef; Arima, Hisatomi; Ärnlöv, Johan; Cirillo, Massimo; Ebert, Natalie; Hiramoto, Jade S; Kimm, Heejin; Shlipak, Michael G; Visseren, Frank L J; Gansevoort, Ron T; Kovesdy, Csaba P; Shalev, Varda; Woodward, Mark; Kronenberg, Florian

2017-09-01

Some evidence suggests that chronic kidney disease is a risk factor for lower-extremity peripheral artery disease. We aimed to quantify the independent and joint associations of two measures of chronic kidney disease (estimated glomerular filtration rate [eGFR] and albuminuria) with the incidence of peripheral artery disease. In this collaborative meta-analysis of international cohorts included in the Chronic Kidney Disease Prognosis Consortium (baseline measurements obtained between 1972 and 2014) with baseline measurements of eGFR and albuminuria, at least 1000 participants (this criterion not applied to cohorts exclusively enrolling patients with chronic kidney disease), and at least 50 peripheral artery disease events, we analysed adult participants without peripheral artery disease at baseline at the individual patient level with Cox proportional hazards models to quantify associations of creatinine-based eGFR, urine albumin-to-creatinine ratio (ACR), and dipstick proteinuria with the incidence of peripheral artery disease (including hospitalisation with a diagnosis of peripheral artery disease, intermittent claudication, leg revascularisation, and leg amputation). We assessed discrimination improvement through c-statistics. We analysed 817 084 individuals without a history of peripheral artery disease at baseline from 21 cohorts. 18 261 cases of peripheral artery disease were recorded during follow-up across cohorts (median follow-up was 7·4 years [IQR 5·7-8·9], range 2·0-15·8 years across cohorts). Both chronic kidney disease measures were independently associated with the incidence of peripheral artery disease. Compared with an eGFR of 95 mL/min per 1·73 m 2 , adjusted hazard ratios (HRs) for incident study-specific peripheral artery disease was 1·22 (95% CI 1·14-1·30) at an eGFR of 45 mL/min per 1·73 m 2 and 2·06 (1·70-2·48) at an eGFR of 15 mL/min per 1·73 m 2 . Compared with an ACR of 5 mg/g, the adjusted HR for incident study

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....

Identification of differential gene expression patterns in human arteries from patients with chronic kidney disease

DEFF Research Database (Denmark)

Stubbe, Jane; Skov, Vibe; Thiesson, Helle Charlotte

2018-01-01

BACKGROUND: Uremia accelerates atherosclerosis but little is known about affected pathways in human vasculature. This study aimed to identify differentially expressed arterial transcripts in patients with chronic kidney disease (CKD) Methods: Global mRNA expression was estimated by microarray...... hybridization in iliac arteries (n=14) from renal transplant recipients and compared with renal arteries from healthy living kidney donors (n=19) in study 1. Study 2 compared non-atherosclerotic internal mammary arteries (IMA) from five patients with elevated plasma creatinine levels and age and gender matched...... controls with normal levels. Western blotting and immunohistochemistry for selected proteins was performed on a subset of study 1 samples. RESULTS: 15 gene transcripts with fold changes (FC)>1.05 were significantly different between the two groups in study 1, with false discovery rates (FDR) of

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

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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.

Knowledge of chronic total occlusion among Polish interventional cardiologists.

Science.gov (United States)

Bryniarski, Krzysztof L; Zabojszcz, Michał; Dębski, Grzegorz; Marchewka, Jakub; Legutko, Jacek; Surowiec, Sławomir; Siudak, Zbigniew; Żmudka, Krzysztof; Dudek, Dariusz; Bryniarski, Leszek

2015-01-01

Chronic total occlusion (CTO) recanalization is indicated in patients with symptoms and evidence of ischemia, but in most cases those types of lesions are still treated medically. In the last few years CTO angioplasty technique has changed dramatically due to considerable advances in techniques and dedicated equipment. An attempt to assess the state of knowledge of technical aspects of CTO angioplasty of coronary arteries among Polish interventional cardiologists. Questionnaire survey performed during two major Polish invasive cardiology workshops. In the study there participated 113 physicians with an average length of work experience of 13 years, most of them cardiologists certified as independent primary operators. The majority of respondents recognized the need of prevention of thrombotic complications through control of activated coagulation time during the CTO procedures. Prevention of renal complications and X-ray protection are also recognized as a significant part of the procedures. The benefits from the use of over-the-wire microcatheters and balloons, the proper choice of dedicated guidewires, contralateral injections and retrograde technique are underestimated. Despite satisfactory knowledge about indications and qualification for the CTO procedure, the awareness of procedural aspects (particularly the retrograde technique) as well as the dedicated CTO equipment among Polish interventional cardiologists is still insufficient.

Central arterial characteristics of gout patients with chronic kidney diseases.

Science.gov (United States)

Celik, Gulperi; Yilmaz, Sema; Kebapcilar, Levent; Gundogdu, Ali

2017-05-01

The aim of this study was to investigate the relationship between central blood pressure, arterial stiffness parameters and renal function parameters in gout patients with chronic kidney disease (CKD) and without CKD. The study enrolled 48 gout patients and 32 control subjects. Central blood pressure, arterial stiffness parameters and renal function parameters in gout patients were investigated. The vascular measurements were performed with an arteriograph. Of the gout patients, 40.1% had CKD. The 24-h pulse pressure (PP) (P < 0.001), central systolic blood pressure (SBP) (P < 0.001), central diastolic blood pressure (DBP) (P < 0.001), cardiac output (CO) (P < 0.001) and peripheral resistance (P = 0.004) were significantly higher in the all patients with gout compared to healthy control subjects. Moreover, when the gout patients with and without CKD were compared, the gout patients with CKD had higher 24-h PP (P = 0.009), 24-h augmentation index standardized to a heart rate of 75 beats per min (AIx@75) (P < 0.023), daytime PP (P = 0.001), daytime AIx@75 (P = 0.027), and nighttime PP (P = 0.035) than the gout patients without CKD. In our study, gout patients with CKD had worse and more emphasized evidence of arterial stiffness than gout patients without CKD. Further investigations with large sample sizes are needed to evaluate the effect of CKD on the arterial stiffness of gout patients. © 2015 Asia Pacific League of Associations for Rheumatology and Wiley Publishing Asia Pty Ltd.

Pulmonary artery pulse pressure and wave reflection in chronic pulmonary thromboembolism and primary pulmonary hypertension.

Science.gov (United States)

Castelain, V; Hervé, P; Lecarpentier, Y; Duroux, P; Simonneau, G; Chemla, D

2001-03-15

The purpose of this time-domain study was to compare pulmonary artery (PA) pulse pressure and wave reflection in chronic pulmonary thromboembolism (CPTE) and primary pulmonary hypertension (PPH). Pulmonary artery pressure waveform analysis provides a simple and accurate estimation of right ventricular afterload in the time-domain. Chronic pulmonary thromboembolism and PPH are both responsible for severe pulmonary hypertension. Chronic pulmonary thromboembolism and PPH predominantly involve proximal and distal arteries, respectively, and may lead to differences in PA pressure waveform. High-fidelity PA pressure was recorded in 14 patients (7 men/7 women, 46 +/- 14 years) with CPTE (n = 7) and PPH (n = 7). We measured thermodilution cardiac output, mean PA pressure (MPAP), PA pulse pressure (PAPP = systolic - diastolic PAP) and normalized PAPP (nPAPP = PPAP/MPAP). Wave reflection was quantified by measuring Ti, that is, the time between pressure upstroke and the systolic inflection point (Pi), deltaP, that is, the systolic PAP minus Pi difference, and the augmentation index (deltaP/PPAP). At baseline, CPTE and PPH had similar cardiac index (2.4 +/- 0.4 vs. 2.5 +/- 0.5 l/min/m2), mean PAP (59 +/- 9 vs. 59 +/- 10 mm Hg), PPAP (57 +/- 13 vs. 53 +/- 13 mm Hg) and nPPAP (0.97 +/- 0.16 vs. 0.89 +/- 0.13). Chronic pulmonary thromboembolism had shorter Ti (90 +/- 17 vs. 126 +/- 16 ms, p PPAP (0.26 +/- 0.01 vs. 0.09 +/- 0.07, p < 0.01). Our study indicated that: 1) CPTE and PPH with severe pulmonary hypertension had similar PA pulse pressure, and 2) wave reflection is elevated in both groups, and CPTE had increased and anticipated wave reflection as compared with PPH, thus suggesting differences in the pulsatile component of right ventricular afterload.

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....

Rare associations of tetralogy of Fallot with anomalous left coronary artery from pulmonary artery and totally anomalous pulmonary venous connection.

Science.gov (United States)

Sen, Supratim; Rao, Suresh G; Kulkarni, Snehal

2016-06-01

We describe the cases of two patients with tetralogy of Fallot, aged 4 years and 8 months, who were incidentally detected to have concomitant anomalous left coronary artery from pulmonary artery and total anomalous pulmonary venous connection, respectively, on preoperative imaging. They underwent surgical correction with good mid-term outcomes. In this study, we discuss the embryological basis, physiological effects, and review the literature of these two unusual associations. Awareness of these rare associations will avoid missed diagnoses and consequent surgical surprises.

Total parathyroidectomy with forearm auto-transplantation improves the quality of life and reduces the recurrence of secondary hyperparathyroidism in chronic kidney disease patients.

Science.gov (United States)

Li, Jia-Gen; Xiao, Zhang-Sheng; Hu, Xian-Jie; Li, Yun; Zhang, Xing; Zhang, Song-Ze; Shan, Ai-Qin

2017-12-01

Our study aims to explore the effect of total parathyroidectomy (PTX) with forearm autotransplantation (FAT) on the quality of life and recurrence of secondary hyperparathyroidism (SHPT) in chronic kidney disease patients. A total of 104 chronic kidney disease patients with SHPT were enrolled and divided into the PTX (n = 62) and PTX + FAT (n = 42) groups. The operation efficacy was evaluated by analyzing preoperative and postoperative values, including levels of intact parathyroid hormone (iPTH), serum phosphorus, serum calcium, alkaline phosphatase (ALP), calcium-phosphorus product, signs and symptoms, and MOS 36-item short-form health survey (SF-36) scores. Moreover, complications and recurrences were followed up for 12 months after the operation. Binary logistic regression was to present the risk factors for the recurrence of chronic kidney disease patients with SHPT. Compared with the preoperative values, the PTX and PTX + FAT groups showed decrease postoperative levels of iPTH, serum phosphorus, serum calcium, calcium-phosphorus product, bone pain, and skin pruritus at all time periods. The PTX and PTX + FAT groups demonstrated decreased ALP, fracture or deformity, and coronary artery calcification at 1 month, decreased short stature at 3 months after the operation but increased SF-36 score after operation. Compared with the PTX group, the level of iPTH decreased and the levels of serum calcium, calcium-phosphorus product increased at 3, 6, and 12 months after the operation in the PTX + FAT group. The levels of ALP, fracture or deformity, short stature, and SF-36 decreased separately at 1 week and 6 and 12 months after the operation, along with the decrease of coronary artery calcification and the recurrence rate, respectively, at 6 and 12 months after the operation in the PTX + FAT group when compared with those in the PTX group. Logistic regression analysis evidenced that the preoperative iPTH level, SF-36 score, and operation

Transcatheter arterial embolization of a pseudoaneurysm of gastroduodenal artery: a case report

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Han, Young Min; Kang, Sung Soo; Lee, Jeong Min; Chung, Jin Young; Lee, Sang Yong; Chung, Gyung Ho; Kim, Chong Soo; Sohn, Myung Hee; Choi, Ki Chul [Chonbuk National University School of Medicine, Chonju (Korea, Republic of)

1997-01-01

Gastroduodenal artery pseudoaneurysm is a relatively rare and potentionally life-threatening complication of chronic pancreatitis, which is thought to occur because of autodigestion of arterial walls by pancreatic enzymes. Embolotherapy should probably be the first method of treatment, since surgical treatment carries a high risk of mortality and morbidity. We report the case of 30-year-old male with gastroduodenal artery pseudoaneurysm caused by chronic pancreatitis which was successfully treated by transcatheter embolization using Gianturco spring coils.

Transcatheter arterial embolization of a pseudoaneurysm of gastroduodenal artery: a case report

International Nuclear Information System (INIS)

Han, Young Min; Kang, Sung Soo; Lee, Jeong Min; Chung, Jin Young; Lee, Sang Yong; Chung, Gyung Ho; Kim, Chong Soo; Sohn, Myung Hee; Choi, Ki Chul

1997-01-01

Gastroduodenal artery pseudoaneurysm is a relatively rare and potentionally life-threatening complication of chronic pancreatitis, which is thought to occur because of autodigestion of arterial walls by pancreatic enzymes. Embolotherapy should probably be the first method of treatment, since surgical treatment carries a high risk of mortality and morbidity. We report the case of 30-year-old male with gastroduodenal artery pseudoaneurysm caused by chronic pancreatitis which was successfully treated by transcatheter embolization using Gianturco spring coils

Ambulatory arterial stiffness index in chronic kidney disease stage 2-5. Reproducibility and relationship with pulse wave parameters and kidney function

DEFF Research Database (Denmark)

Boesby, Lene; Thijs, Lutgarde; Elung-Jensen, Thomas

2012-01-01

Arterial stiffness contributes to the increased cardiovascular risk in patients with chronic kidney disease (CKD). Reproducible and easily obtainable indices of arterial stiffness are needed in order to monitor therapeutic strategies. The ambulatory arterial stiffness index (AASI) has been propos...... as such a marker. The present study investigated the day-to-day reproducibility of AASI in CKD stage 2-5 and its relationship with other markers of arterial stiffness as well as with kidney function....

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

2016-09-02

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 CKDu vs. CKD: 6.7 ± 0.9 vs. 8.7 ± 1.5 vs. 10.4 ± 1.5 m/s, p 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.

Real-time fusion of coronary CT angiography with X-ray fluoroscopy during chronic total occlusion PCI

Energy Technology Data Exchange (ETDEWEB)

Ghoshhajra, Brian B.; Takx, Richard A.P. [Harvard Medical School, Cardiac MR PET CT Program, Massachusetts General Hospital, Department of Radiology and Division of Cardiology, Boston, MA (United States); Stone, Luke L.; Yeh, Robert W.; Jaffer, Farouc A. [Harvard Medical School, Cardiac Cathetrization Laboratory, Cardiology Division, Massachusetts General Hospital, Boston, MA (United States); Girard, Erin E. [Siemens Healthcare, Princeton, NJ (United States); Brilakis, Emmanouil S. [Cardiology Division, Dallas VA Medical Center and UT Southwestern Medical Center, Dallas, TX (United States); Lombardi, William L. [University of Washington, Cardiology Division, Seattle, WA (United States)

2017-06-15

The purpose of this study was to demonstrate the feasibility of real-time fusion of coronary computed tomography angiography (CTA) centreline and arterial wall calcification with X-ray fluoroscopy during chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Patients undergoing CTO PCI were prospectively enrolled. Pre-procedural CT scans were integrated with conventional coronary fluoroscopy using prototype software. We enrolled 24 patients who underwent CTO PCI using the prototype CT fusion software, and 24 consecutive CTO PCI patients without CT guidance served as a control group. Mean age was 66 ± 11 years, and 43/48 patients were men. Real-time CTA fusion during CTO PCI provided additional information regarding coronary arterial calcification and tortuosity that generated new insights into antegrade wiring, antegrade dissection/reentry, and retrograde wiring during CTO PCI. Overall CTO success rates and procedural outcomes remained similar between the two groups, despite a trend toward higher complexity in the fusion CTA group. This study demonstrates that real-time automated co-registration of coronary CTA centreline and calcification onto live fluoroscopic images is feasible and provides new insights into CTO PCI, and in particular, antegrade dissection reentry-based CTO PCI. (orig.)

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

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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

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.

The “SAFARI” Technique Using Retrograde Access Via Peroneal Artery Access

International Nuclear Information System (INIS)

Zhuang, Kun Da; Tan, Seck Guan; Tay, Kiang Hiong

2012-01-01

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.

Total embolization of the main splenic artery as a supplemental treatment modality for hypersplenism

OpenAIRE

He, Xin-Hong; Li, Wen-Tao; Peng, Wei-Jun; Li, Guo-Dong; Wang, Sheng-Ping; Xu, Li-Chao

2011-01-01

AIM: To study the safety and feasibility of total embolization of the main splenic artery as a supplemental treatment modality for hypersplenism with thrombocytopenia or leukocytopenia accompanying liver cirrhosis.

Arterial Stiffness in Children: Pediatric Measurement and Considerations

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Savant, Jonathan D.; Furth, Susan L.; Meyers, Kevin E.C.

2014-01-01

Background Arterial stiffness is a natural consequence of aging, accelerated in certain chronic conditions, and predictive of cardiovascular events in adults. Emerging research suggests the importance of arterial stiffness in pediatric populations. Methods There are different indices of arterial stiffness. The present manuscript focuses on carotid-femoral pulse wave velocity and pulse wave analysis, although other methodologies are discussed. Also reviewed are specific measurement considerations for pediatric populations and the literature describing arterial stiffness in children with certain chronic conditions (primary hypertension, obesity, diabetes, chronic kidney disease, hypercholesterolemia, genetic syndromes involving vasculopathy, and solid organ transplant recipients). Conclusions The measurement of arterial stiffness in children is feasible and, under controlled conditions, can give accurate information about the underlying state of the arteries. This potentially adds valuable information about the functionality of the cardiovascular system in children with a variety of chronic diseases well beyond that of the brachial artery blood pressure. PMID:26587447

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...

The GuideLiner catheter: A supportive tool in percutaneous coronary intervention of chronic total occlusion

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Jan-Erik Guelker

2018-04-01

Full Text Available Background: Failure of delivering a stent or a balloon across the target lesion during percutaneous coronary intervention (PCI of chronic total occlusion (CTO, especially in arteries with calcified tortuous anatomy, is often due to insufficient backup support from the guiding catheter. The purpose of this study was to assess the feasibility of the GuideLiner (GL catheter use. Methods: We examined 18 patients and used the GL catheter to overcome poor support and excessive friction in standardized antegrade and retrograde CTO procedures. The GL is a coaxial, monorail guiding catheter extension delivered through a standard guiding catheter and is available in different sizes. Results: Almost all lesions were classified as severely calcified (94.4 ± 0.24%. The Japanese CTO score reflecting lesion complexity was 3.56 ± 0.78. All procedures were performed femorally; the retrograde approach was used in 27.8 ± 0.46% of cases. The overall success rate was 88.9 ± 0.32%; there were no relevant complications. Conclusions: The GL catheter is an adjunctive interventional device which enhances and amplifies CTO-PCI. Its use is indicated in cases in which back-up force needs to be strengthened to pass a CTO despite advanced calcification. It can be recommended as an important additional tool in advanced interventional cardiology such as antegrade and retrograde CTO-PCI if other techniques like anchor balloon or anchor wire are not possible. Keywords: Chronic total occlusion, GuideLiner catheter, Percutaneous coronary intervention, Severe calcification

The dilatation of main pulmonary artery and right ventricle observed by enhanced chest computed tomography predict poor outcome in inoperable chronic thromboembolic pulmonary hypertension.

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Ema, Ryogo; Sugiura, Toshihiko; Kawata, Naoko; Tanabe, Nobuhiro; Kasai, Hajime; Nishimura, Rintaro; Jujo, Takayuki; Shigeta, Ayako; Sakao, Seiichiro; Tatsumi, Koichiro

2017-09-01

Dilatation of the pulmonary artery and right ventricle on chest computed tomography images is often observed in patients with pulmonary hypertension. The clinical significance of these image findings has not been defined in chronic thromboembolic pulmonary hypertension. We investigated whether the pulmonary arterial and right ventricle dilatation was associated with poor outcome in chronic thromboembolic pulmonary hypertension. This was a retrospective cohort investigation in 60 subjects with inoperable chronic thromboembolic pulmonary hypertension diagnosed consecutively between 1997 and 2010 at Chiba University Hospital. Digital scout multi-detector chest computed tomography images were obtained. The main pulmonary arterial to ascending aortic diameter ratio and the right ventricular to left ventricular diameter ratio were calculated. Main pulmonary arterial to ascending aortic diameter ratio ranged from 0.85 to 1.84, and right ventricular to left ventricular diameter ratio ranged from 0.71 to 2.88. During the observation period of 1284.5days (range, 21-4550days), 13 patients required hospitalization due to worsening; 6 of them died. Kaplan-Meier analysis showed significant differences in hospitalization between the patients with main pulmonary arterial to ascending aortic diameter ratio of ≥1.1 and pulmonary hypertension. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

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

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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.

Prevalence of chronic kidney disease among patients undergoing transradial percutaneous coronary interventions.

Science.gov (United States)

Hossain, Mohammad A; Quinlan, Amy; Heck-Kanellidis, Jennifer; Calderon, Dawn; Patel, Tejas; Gandhi, Bhavika; Patel, Shrinil; Hetavi, Mahida; Costanzo, Eric J; Cosentino, James; Patel, Chirag; Dewan, Asa; Kuo, Yen-Hong; Salman, Loay; Vachharajani, Tushar J

2018-03-01

While transradial approach to conduct percutaneous coronary interventions offers multiple advantages, the procedure can cause radial artery damage and occlusion. Because radial artery is the preferred site for the creation of an arteriovenous fistula to provide dialysis, patients with chronic kidney disease are particularly dependent on radial artery for their long-term survival. In this retrospective study, we investigated the prevalence of chronic kidney disease in patients undergoing coronary interventions via radial artery. Stage of chronic kidney disease was based on estimated glomerular filtration rate and National Kidney Foundation - Kidney Disease Outcomes Quality Initiative guidelines. A total of 497 patients undergoing transradial percutaneous coronary interventions were included. Over 70.4% (350/497) of the patients had chronic kidney disease. Stage II chronic kidney disease was observed in 243 (69%) patients (estimated glomerular filtration rate = 76.0 ± 8.4 mL/min). Stage III was observed in 93 (27%) patients (estimated glomerular filtration rate = 49 ± 7.5 mL/min). Stage IV chronic kidney disease was observed in 5 (1%) patients (estimated glomerular filtration rate = 25.6 ± 4.3 mL/min) and Stage V chronic kidney disease was observed in 9 (3%) patients (estimated glomerular filtration rate = 9.3 ± 3.5 mL/min). Overall, 107 of 350 patients (30%) had advanced chronic kidney disease, that is, stage III-V chronic kidney disease. Importantly, 14 of the 107 (13%) patients had either stage IV or V chronic kidney disease. This study finds that nearly one-third of the patients undergoing transradial percutaneous coronary interventions have advanced chronic kidney disease. Because many of these patients may require dialysis, the use of radial artery to conduct percutaneous coronary interventions must be carefully considered in chronic kidney disease population.

Dasatinib-induced pulmonary arterial hypertension - A rare late complication.

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Ibrahim, Uroosa; Saqib, Amina; Dhar, Vidhya; Odaimi, Marcel

2018-01-01

Dasatinib is a dual Src/Abl tyrosine kinase inhibitor approved for frontline and second line treatment of chronic phase chronic myelogenous leukemia. Pulmonary arterial hypertension is defined by an increase in mean pulmonary arterial pressure >25 mmHg at rest. Dasatinib-induced pulmonary hypertension has been reported in less than 1% of patients on chronic dasatinib treatment for chronic myelogenous leukemia. The pulmonary arterial hypertension from dasatinib may be categorized as either group 1 (drug-induced) or group 5 based on various mechanisms that may be involved including the pathogenesis of the disease process of chronic myelogenous leukemia. There have been reports of dasatinib-induced pulmonary arterial hypertension being reversible. We report a case of pulmonary arterial hypertension in a 46-year-old female patient with chronic phase chronic myelogenous leukemia on dasatinib treatment for over 10 years. She had significant improvement in symptoms after discontinuation of dasatinib and initiation of vasodilators. Several clinical questions arise once patients experience significant adverse effects as discussed in our case.

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

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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.

Relationship of femoral artery ultrasound measures of atherosclerosis with chronic kidney disease.

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Hsu, Simon; Rifkin, Dena E; Criqui, Michael H; Suder, Natalie C; Garimella, Pranav; Ginsberg, Charles; Marasco, Antoinette M; McQuaide, Belinda J; Barinas-Mitchell, Emma J; Allison, Matthew A; Wassel, Christina L; Ix, Joachim H

2017-12-22

Chronic kidney disease (CKD) is strongly associated with peripheral artery disease (PAD). Detection of subclinical PAD may allow early interventions for or prevention of PAD in persons with CKD. Whether the presence of atherosclerotic plaque and femoral intima-media thickness (IMT) are associated with kidney function is unknown. We performed a cross-sectional observational study of 1029 community-living adults. We measured superficial and common femoral artery IMT and atherosclerotic plaque presence by ultrasound. Estimated glomerular filtration rate (eGFR; continuous) and eGFR <60 mL/min/1.73 m 2 (binary) were evaluated as outcomes. Mean age was 70 ± 10 years, mean eGFR was 78 ± 17 mL/min/1.73 m 2 , and 156 (15%) individuals had eGFR <60 mL/min/1.73 m 2 ; 260 (25%) had femoral artery plaque. In models adjusted for demographics and cardiovascular risk factors, individuals with femoral artery plaque had mean eGFR approximately 3.0 (95% confidence interval, -5.3 to -0.8) mL/min/1.73 m 2 lower than those without plaque (P < .01). The presence of plaque was also associated with a 1.7-fold higher odds of eGFR <60 mL/min/1.73 m 2 (95% confidence interval, 1.1-2.8; P < .02). Associations were similar in persons with normal ankle-brachial index. The directions of associations were similar for femoral IMT measures with eGFR and CKD but were rendered no longer statistically significant with adjustment for demographic variables and cardiovascular disease risk factors. Femoral artery plaque is significantly associated with CKD prevalence in community-living individuals, even among those with normal ankle-brachial index. Femoral artery ultrasound may allow evaluation of relationships and risk factors linking PAD and kidney disease earlier in its course. Copyright © 2017 Society for Vascular Surgery. All rights reserved.

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

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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.

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...

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.

Science.gov (United States)

O'Connor, T M; Barry, P J; Jahangir, A; Finn, C; Buckley, B M; El-Gammal, A

2011-01-01

Arterial blood gases (ABGs) are often sampled incorrectly, leading to a 'mixed' or venous sample. Delays in analysis and air contamination are common. We measured the effects of these errors in patients with chronic obstructive pulmonary disease (COPD) exacerbations and controls. 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. Mean venous pH was 7.371 and arterial pH was 7.407 (p Air contamination was associated with a clinically significant increase in PO₂ in all samples, including those that were immediately analyzed. 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 PO₂, indicating that air-contaminated ABGs should be discarded. Copyright © 2010 S. Karger AG, Basel.

Chronic total coronary occlusion: treatment results.

Science.gov (United States)

Kirk Christensen, Martin; Freeman, Phillip Fischer; Rasmussen, Jeppe Groendal; Villadsen, Anton Boel; Raungaard, Bent; Eggert Jensen, Svend; Thuesen, Leif

2017-08-01

To describe the clinical and procedural coronary chronic total occlusion (CTO) treatment results in a Nordic PCI centre during the implementation of a CTO treatment program. In a retrospective registry study, we assessed; (1) indication for the procedure, (2) Canadian Cardiovascular Society angina pectoris score (CCS)/New York Heart Association (NYHA) heart failure score, (3) lesion complexity and (4) adverse events during hospital stay and three months following the index procedure. The study cohort included 503 patients (594 lesions). From 2010 to 2013 96% of procedures were performed with antegrade wire-escalation technique and 4% performed using retrograde techniques, from 2013-2016 the corresponding numbers were 83% and 17.0%. The procedural success rate was 69%, increasing from 64% before to 72% (p = .06) after routinely using the retrograde approach. No individual patient characteristic, lesion variable or score was strongly associated with procedural success or failure. There were 4% serious procedure related complications. In patients with PCI of a CTO lesion only, 87% were in CCS or NYHA functional class ≥2 before the index procedure vs. 22% at follow-up. Routine use of retrograde techniques tended to increase the procedural success rate. Clinical results after three months were acceptable, but the complication rate was higher than for non-CTO PCI. Individual patient and lesion characteristics had a low predictability for procedural success. Therefore, clinical symptoms, objective signs of myocardial ischemia and procedural risk should be focus points in coronary chronic total occlusion treatment strategies.

Assessment and management of chronic pain in patients with stable total hip arthroplasty

OpenAIRE

Classen, Tim; Zaps, Daniela; Landgraeber, Stefan; Li, Xinning; Jäger, Marcus

2012-01-01

Total hip arthroplasty (THA) is one of the most successful operations that can restore function and relieve pain. Although a majority of the patients achieve significant pain relief after THA, there are a number of patients that develop chronic pain for unknown reasons. A literature search was performed looking for chronic pain after total hip arthroplasty and stable THA. Major causes of chronic pain include aseptic loosening or infection. However, there is a subset of patients with a stable ...

Chronic renal failure due to unilateral renal agenesis and total renal dysplasia (=aplasia)

International Nuclear Information System (INIS)

Kroepelin, T.; Ziupa, J.; Wimmer, B.

1983-01-01

Three adult patients with unilateral renal agenesis/total dysplasia (= aplasia) and with an early chronic renal failure are presented. One patient had renal agenesis without ureter bud and ureteric ostium on one side, and reflux pyelonephritis on the other; one had small compact total renal dysplasia (= aplasia) on one side, while chronic uric acid nephropathy (chronic renal disease as a cause of gout) was diagnosed on the other; the third patient had a total large multicystic dysplasia on one side, and on the other a segmental large multicystic dysplasia. Radiological steps and radiodiagnostic criteria are discussed and the combination of urogenital and extraurogenital anomalies is referred to. (orig.)

Preparatory catheter-directed thrombolysis together with assisted endovascular angioplasty for the treatment of chronic occlusive arterial disorders of lower extremities

International Nuclear Information System (INIS)

Zhang Fuxian; Zhang Changming; Hu Lu; Feng Yaping; Liang Gangzhu; Zhang Huan

2010-01-01

Objective: To evaluate the safety and efficacy of preparatory catheter-directed thrombolysis together with assisted endovascular angioplasty in treating chronic occlusive arterial disorders of lower extremities. Methods: From January 2008 to December 2009, preparatory catheter-directed thrombolysis together with assisted endovascular angioplasty was performed in 12 patients with chronic occlusive arterial disorders of lower extremities, including 8 males and 4 females with an average age of 56.3 years (within a range of 38-71 years). All 12 patients had a history of chronic ischemia of lower limb,the mean ill duration was 19.3 months (3-48 months). All patients complained of intermittent claudication with a mean distance of 125 m (50-200 m). Rest pain occurred in 5 patients (42%), toe necrosis was seen in 3 patients (25%) and critically ischemic limb in 4 patients (33%). Ankle-brachial index (ABI) was 0.00 0.65 with a mean of 0.33. In all 12 patients catheter-directed thrombolysis with rt-PA or urokinase was initially carried out, which was followed by endovascular angioplasty (balloon dilatation or stent placement) in two days. The clinical data and the therapeutic results were analyzed. Results: Technical success was achieved in all 12 patients. The mean time of thrombolysis was 48 hours. Of 12 patients, rt-PA was employed in 4 and urokinase in 8. The occluded length of the diseased arteries before the treatment was 60-150 mm, with a mean of 80 mm. After catheter-directed thrombolysis,the occluded length decreased to 10-50 mm (mean of 30 mm). Endovascular angioplasty was successfully completed in all patients after thrombolysis therapy. Postoperative ABI was 0.64-1.0 (mean of 0.86), which was increased by 0.53 when compared to the preoperative figure. During the perioperative period neither complications needed to be surgically treated nor death occurred. All patients were followed up, and the arteries remained open after one year in all cases. Conclusion

Left Circumflexus Coronary Artery Total Occlusion with Clinical Presentation as NSTEMI and Acute Pulmonary Oedema

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Budi Yuli Setianto

2017-04-01

Full Text Available Current guidelines for the management of patients with acute coronary syndromes (ACSs focus on the electrocardiogram to divide patients into ST-elevation acute myocardial infarction (STEMI or non-ST-elevation acute myocardial infarction (NSTEMI/unstable angina (UA. Patients with STEMI in the earliest time will receive reperfusion therapy to destruct occlusive thrombus. An ST segment elevation is the ‘sine qua non’ for diagnosing acute total coronary occlusion causing transmural myocardial infarction. Left circumflex coronary artery (LCx occlusion is often categorized as NSTEMI because of the absence of significant ST-elevation on the 12 lead standard electrocardiogram. An ST segment elevation is presented in fewer than 50% of patients with LCx total occlusion, such that the reperfusion therapy is delayed. We reported a 77 years old woman whom being diagnosed with NSTEMI because a 12 lead electrocardiogram showed ST segment depression in lead V2-V5. On coronary angiography, we found a total occlusion in the LCx artery as the culprit lession.

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

Distinguishing Chronic Thromboembolic Pulmonary Hypertension From Other Causes of Pulmonary Hypertension Using CT.

Science.gov (United States)

Grosse, Alexandra; Grosse, Claudia; Lang, Irene M

2017-12-01

The purpose of this study was to discern imaging findings that separate chronic thromboembolic pulmonary hypertension (CTEPH) from other causes of pulmonary hypertension (PH). A total of 143 patients with proven PH (group 1, pulmonary arterial hypertension; group 2, PH due to left heart disease; group 3, PH due to lung disease; group 4, CTEPH; and group 5, PH due to unclear or multifactorial mechanisms) underwent MDCT angiography. The CT images were assessed for the presence of chronic pulmonary embolism (PE), disparity in segmental vessel size, mosaic perfusion, parenchymal densities, bronchial dilatation, and collateral arteries. The frequencies of vascular signs of chronic PE, disparity in segmental vessel size, mosaic perfusion, parenchymal densities, bronchial collateral arteries, and bronchial dilatation were statistically significantly higher in patients with CTEPH than in patients with nonthromboembolic PH. Vascular signs of chronic PE, mosaic perfusion, parenchymal densities, and bronchial dilatation without bronchial wall thickening were significantly more frequent in patients with CTEPH than in patients in groups 1, 2, 3, and 5. There was no significant difference in the frequencies of bronchial collateral arteries between patients with CTEPH and patients in groups 3 and 5. Most patients with CTEPH have direct vascular signs of chronic PE. Secondary signs include disparity in segmental vessel size, mosaic perfusion pattern, parenchymal densities, collateral bronchial arteries, and bronchial dilatation, which help distinguish CTEPH from other causes of PH.

Rare Presentation of Left Lower Lobe Pulmonary Artery Dissection

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René Hako

2017-01-01

Full Text Available Background. Pulmonary arterial dissection with chronic pulmonary arterial hypertension as its major cause is a very rare but life-threatening condition. In most cases the main pulmonary trunk is the affected site usually without involvement of its branches. Segmental or lobar pulmonary artery dissection is extremely rare. Case Presentation. We report a unique case of left lower lobe pulmonary artery dissection in a 70-year-old male, with confirmed chronic pulmonary hypertension. To confirm dissection MDCT pulmonary angiography was used. Multiplanar reformation (MPR images in sagittal, coronal, oblique sagittal, and curved projections were generated. This case report presents morphologic CT features of rare chronic left lobar pulmonary artery dissection associated with chronic pulmonary hypertension at a place of localised pulmonary artery calcification. CT pulmonary angiography excluded signs of thromboembolism and potential motion or flow artefacts. Conclusion. To the best of our knowledge, no case of lower lobe pulmonary artery dissection with flap calcification has been reported yet. CT imaging of the chest is a key diagnostic tool that is able to detect an intimal flap and a false lumen within the pulmonary arterial tree and is preferred in differential diagnosis of rare complications of sustained pulmonary arterial hypertension.

The Use of Below-Knee Percutaneous Transluminal Angioplasty in Arterial Occlusive Disease Causing Chronic Critical Limb Ischemia

International Nuclear Information System (INIS)

Loefberg, Ann-Marie; Loerelius, Lars-Erik; Karacagil, Sadettin; Westman, Bo; Almgren, Bo; Berqgvist, David

1996-01-01

Purpose: To determine the efficacy, safety and long-term results of crural artery percutaneous transluminal angioplasty (PTA) in limbs with chronic critical limb ischemia (CLI). Methods: Patients undergoing crural artery PTA due to CLI were followed at regular clinic visits with ankle brachial pressure index (ABPI) measurements. PTA of the crural arteries was attempted either alone (n= 39) or in combination with PTA of the superficial and/or popliteal artery (n= 55) in 86 limbs (82 patients and 94 procedures) presenting with CLI. The ages of patients ranged from 37 to 94 years (mean 72 years). The indications for PTA were rest pain in 10 and ulcer/gangrene in 84 limbs.Results: A technically successful PTA with at least one crural level was achieved in 88% of cases (n= 83). Cumulative primary clinical success rates at 6, 12, 24, and 36 months were 55%, 51%, 36%, and 36%, respectively. Cumulative secondary clinical success and limb salvage rates at 36 months were 44% and 72%, respectively. Conclusion: PTA of the crural arteries might be considered the primary choice of treatment in patients with CLI and distal lesions with localized stenosis or segmental short occlusions

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.

Recanalisation of Chronically Occluded Remote Superficial Femoral Artery Endarterectomy Through Angioplasty for Limb Salvage

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Husainy, Mohammad Ali, E-mail: m.husainy@nhs.net [King’s College Hospital, Department of Radiology (United Kingdom); Slim, Hani; Rashid, Hisham [King’s College Hospital, Department of Vascular Surgery (United Kingdom); Huang, Dean Y. [King’s College Hospital, Department of Radiology (United Kingdom)

2017-02-15

We report a novel application of balloon angioplasty to recanalise a chronically occluded remote endarterectomy superficial femoral artery. This patient previously had two occluded surgical bypass grafts in an attempt to revascularise the limb and presented with critical limb ischaemia and necrotic foot ulcerations. Following the angioplasty, the patient showed significant improvement in rest pain and healing of the ulcerations. This technique may be useful for limb salvage in patients where surgical options have been exhausted.

Prevalence of pulmonary artery hypertension in patients of chronic obstructive pulmonary disease and its correlation with stages of chronic obstructive pulmonary disease, exercising capacity, and quality of life.

Science.gov (United States)

Gupta, Kamlesh Kumar; Roy, Bidyut; Chaudhary, Shyam Chand; Mishra, Arvind; Patel, M L; Singh, Jitendra; Kumar, Vivek

2018-01-01

Pulmonary arterial hypertension (PAH) is a complication of chronic obstructive pulmonary disease (COPD) in advance stages, and its presence indicates poor prognosis. The present study was design to know the prevalence of PAH in patients with COPD and its correlation with stages of COPD, exercising capacity, and quality of life. It is a cross-sectional prevalence study over a period of 1 year from August 2015 to July 2016. The study included 109 COPD patients, diagnosed by spirometry, and severity was determined according Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification criteria. Screening two-dimensional echocardiography was done to determine pulmonary arterial hypertension and exercising capacity assessed by 6 min walk test (6MWT) while the quality of life was assessed by St George respiratory Questionnaire for COPD (SGRQ-C) Questionnaires. Out of 109 patients, PAH was present in 68 (62.4%) cases consisting of mild grade 41 (37.6%), moderate grade 11 (10.1%), and severe grade 16 (14.7%). In GOLD A stage, there were 20 cases of mild PAH and Stage B included 18 cases of mild and 3 cases of moderate PAH. Stage C had 3 cases of mild and 8 cases of moderate PAH while Stage D had 16 cases of severe PAH. In 6MWT, patients with severe grade PAH fail to perform the test while patients with mild to moderate PAH walked short distance. In SGRQ-C Questionnaires symptom, activity, impact, and total score were high with the severity of PAH. The prevalence of PAH in COPD was significant. Therefore, every COPD patient should be evaluated for PAH.

The Renal Arterial Resistance Index Predicts Worsening Renal Function in Chronic Heart Failure Patients

Science.gov (United States)

Iacoviello, Massimo; Monitillo, Francesco; Leone, Marta; Citarelli, Gaetano; Doronzo, Annalisa; Antoncecchi, Valeria; Puzzovivo, Agata; Rizzo, Caterina; Lattarulo, Maria Silvia; Massari, Francesco; Caldarola, Pasquale; Ciccone, Marco Matteo

2016-01-01

Background/Aim The renal arterial resistance index (RRI) is a Doppler measure, which reflects abnormalities in the renal blood flow. The aim of this study was to verify the value of RRI as a predictor of worsening renal function (WRF) in a group of chronic heart failure (CHF) outpatients. Methods We enrolled 266 patients in stable clinical conditions and on conventional therapy. Peak systolic velocity and end diastolic velocity of a segmental renal artery were obtained by pulsed Doppler flow, and RRI was calculated. Creatinine serum levels were evaluated at baseline and at 1 year, and the changes were used to assess WRF occurrence. Results During follow-up, 34 (13%) patients showed WRF. RRI was associated with WRF at univariate (OR: 1.13; 95% CI: 1.07–1.20) as well as at a forward stepwise multivariate logistic regression analysis (OR: 1.09; 95% CI: 1.03–1.16; p = 0.005) including the other univariate predictors. Conclusions Quantification of arterial renal perfusion provides a new parameter that independently predicts the WRF in CHF outpatients. Its possible role in current clinical practice to better define the risk of cardiorenal syndrome progression is strengthened. PMID:27994601

Effects of combined aerobic and resistance exercise on central arterial stiffness and gait velocity in patients with chronic poststroke hemiparesis.

Science.gov (United States)

Lee, Yong Hee; Park, Soo Hyun; Yoon, Eun Sun; Lee, Chong-Do; Wee, Sang Ouk; Fernhall, Bo; Jae, Sae Young

2015-09-01

The effects of combined aerobic and resistance exercise training on central arterial stiffness and gait velocity in patients with chronic poststroke hemiparesis were investigated. Twenty-six patients with chronic poststroke hemiparesis were randomly assigned to either the combined aerobic and resistance exercise group (n = 14) or the control group (n = 12). The exercise intervention group received a combined aerobic and resistance exercise training (1 hr/day, three times/week for 16 wks), whereas the control group received usual care. Central arterial stiffness was determined by pulse wave velocity and augmentation index. Gait velocity was assessed using the 6-min walk test, 10-m walk test, and the Timed Up-and-Go test. Patients in the exercise intervention group had greater improvement of mean pulse wave velocity (P hemiparesis.

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. PMID:27034930

Impact of Iodinated Contrast on Renal Function and Hemodynamics in Rats with Chronic Hyperglycemia and Chronic Kidney Disease

Directory of Open Access Journals (Sweden)

Sheila Marques Fernandes

2016-01-01

Full Text Available 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.

Acute and chronic effects of flavanol-rich cocoa on vascular function in subjects with coronary artery disease: a randomized double-blind placebo-controlled study.

Science.gov (United States)

Farouque, H M Omar; Leung, Michael; Hope, Sarah A; Baldi, Mauro; Schechter, Clyde; Cameron, James D; Meredith, Ian T

2006-07-01

Evidence suggests that flavonoid-containing diets reduce cardiovascular risk, but the mechanisms responsible are unclear. In the present study, we sought to determine the effect of flavanol-rich cocoa on vascular function in individuals with CAD (coronary artery disease). Forty subjects (61+/-8 years; 30 male) with CAD were recruited to a 6-week randomized double-blind placebo-controlled study. Subjects consumed either a flavanol-rich chocolate bar and cocoa beverage daily (total flavanols, 444 mg/day) or matching isocaloric placebos daily (total flavanols, 19.6 mg/day) for 6 weeks. Brachial artery FMD (flow-mediated dilation) and SAC (systemic arterial compliance) were assessed at baseline, 90 min following the first beverage and after 3 and 6 weeks of daily consumption. Soluble cellular adhesion molecules and FBF (forearm blood flow) responses to ACh (acetylcholine chloride; 3-30 microg/min) and SNP (sodium nitroprusside; 0.3-3 microg/min) infusions, forearm ischaemia and isotonic forearm exercise were assessed at baseline and after 6 weeks. FMD, SAC and FBF responses did not differ between groups at baseline. No acute or chronic changes in FMD or SAC were seen in either group. No difference in soluble cellular adhesion molecules, FBF responses to ischaemia, exercise, SNP or ACh was seen in the group receiving flavanol-rich cocoa between baseline and 6 weeks. These data suggest that over a 6-week period, flavanol-rich cocoa does not modify vascular function in patients with established CAD.

Decrease of total antioxidant capacity during coronary artery bypass surgery.

Science.gov (United States)

Kunt, Alper Sami; Selek, Sahbettin; Celik, Hakim; Demir, Deniz; Erel, Ozcan; Andac, Mehmet Halit

2006-09-01

Cardiac surgery induces an oxidative stress, which may lead to impairment of cardiac function. In this study, we aimed to measure the changes of oxidative and antioxidative status of patients undergoing coronary artery bypass surgery (CABG). We studied 79 patients who underwent CABG with and without cardiopulmonary bypass (CPB). Of the 79 patients, 39 had CPB and 40 did not. Blood samples were drawn before, during, and after the surgery. Antioxidant status was evaluated by measuring total antioxidant capacity (TAC), and oxidative status was evaluated by measuring total peroxide (TP) levels and oxidative stress index (OSI). TP and OSI levels increased, while TAC decreased progressively after the beginning of surgery, for all patients. There were negative correlations between TAC levels and aortic cross-clamping period and anastomosis time ( r = -0.553, p antioxidant vitamins such as vitamins C and E may be beneficial for patients undergoing CABG.

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.

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...

Real-time fusion of coronary CT angiography with x-ray fluoroscopy during chronic total occlusion PCI.

Science.gov (United States)

Ghoshhajra, Brian B; Takx, Richard A P; Stone, Luke L; Girard, Erin E; Brilakis, Emmanouil S; Lombardi, William L; Yeh, Robert W; Jaffer, Farouc A

2017-06-01

The purpose of this study was to demonstrate the feasibility of real-time fusion of coronary computed tomography angiography (CTA) centreline and arterial wall calcification with x-ray fluoroscopy during chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Patients undergoing CTO PCI were prospectively enrolled. Pre-procedural CT scans were integrated with conventional coronary fluoroscopy using prototype software. We enrolled 24 patients who underwent CTO PCI using the prototype CT fusion software, and 24 consecutive CTO PCI patients without CT guidance served as a control group. Mean age was 66 ± 11 years, and 43/48 patients were men. Real-time CTA fusion during CTO PCI provided additional information regarding coronary arterial calcification and tortuosity that generated new insights into antegrade wiring, antegrade dissection/reentry, and retrograde wiring during CTO PCI. Overall CTO success rates and procedural outcomes remained similar between the two groups, despite a trend toward higher complexity in the fusion CTA group. This study demonstrates that real-time automated co-registration of coronary CTA centreline and calcification onto live fluoroscopic images is feasible and provides new insights into CTO PCI, and in particular, antegrade dissection reentry-based CTO PCI. • Real-time semi-automated fusion of CTA/fluoroscopy is feasible during CTO PCI. • CTA fusion data can be toggled on/off as desired during CTO PCI • Real-time CT calcium and centreline overlay could benefit antegrade dissection/reentry-based CTO PCI.

Chronic dissection of the superior mesenteric artery: case report

International Nuclear Information System (INIS)

Common, A.A.; Pressacco, J.

1999-01-01

Acute dissection of the thoracic aorta is a well-recognized, often fatal condition that frequently extends to involve the abdominal aorta and iliac vessels. The ostia of the renal and mesenteric vessels may be compromised, and the resulting visceral ischemia may necessitate surgical intervention. However, visceral perfusion may be restored if blood flow from true to false lumen is re-established or if the false lumen is obliterated, either spontaneously or by surgical or interventional techniques. Isolated dissections of mesenteric, renal, and carotid vessels are rarely reported. These may be spontaneous, related to high blood pressure and underlying disease of the vessel wall, or caused by abdominal trauma or medical intervention, including angiographic procedures. They are usually associated with pain and other signs and symptoms of ischemia in the appropriate territory. We present a case of chronic superior mesenteric artery (SMA) dissection, an incidental angiographic finding, in an asymptomatic patient being evaluated for resection of an abdominal aortic aneurysm (AAA). (author)

Chronic dissection of the superior mesenteric artery: case report

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Common, A.A.; Pressacco, J. [Univ. of Toronto, St. Michael' s Hospital, Dept. of Medical Imaging, Toronto, Ontario (Canada)

1999-02-01

Acute dissection of the thoracic aorta is a well-recognized, often fatal condition that frequently extends to involve the abdominal aorta and iliac vessels. The ostia of the renal and mesenteric vessels may be compromised, and the resulting visceral ischemia may necessitate surgical intervention. However, visceral perfusion may be restored if blood flow from true to false lumen is re-established or if the false lumen is obliterated, either spontaneously or by surgical or interventional techniques. Isolated dissections of mesenteric, renal, and carotid vessels are rarely reported. These may be spontaneous, related to high blood pressure and underlying disease of the vessel wall, or caused by abdominal trauma or medical intervention, including angiographic procedures. They are usually associated with pain and other signs and symptoms of ischemia in the appropriate territory. We present a case of chronic superior mesenteric artery (SMA) dissection, an incidental angiographic finding, in an asymptomatic patient being evaluated for resection of an abdominal aortic aneurysm (AAA). (author)

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....

Is total abolishment of great saphenous reflux in the invasive treatment of superficial chronic venous insufficiency always necessary?

Science.gov (United States)

Navarro, T P; Nunes, T A; Ribeiro, A L; Castro-Silva, M

2009-02-01

Chronic venous insufficiency ranges from mild telangiectasias to skin ulceration with poor prognosis regarding healing and quality of life. Varicose veins are the most frequent clinical presentation, affecting 75% of such patients and 71% are due to primary reflux of great saphenous vein, which is the most compromised vein in chronic venous insufficiency. However, about 75% of these veins are not dilated. The standard treatment has been stripping of the saphenous vein, because it has 85% of good results at long term. However, saphenous vein is the main arterial substitute and should be spared whenever possible. The development of non-invasive diagnostic methods showed that hemodynamic worsening correlates with clinical severity and that the majority of patients did not have a dilated saphenous vein. Thus, several selective operations proposed to spare the saphenous vein have reported good results. Minimally invasive techniques (eco-guided foam, radiofrequency and laser) have also emerged aiming to obliterate the vein and abolishing reflux and have also reported good results, but they do not spare the vessel. Measurement of saphenous diameter has been shown to correlate with clinical and hemodynamic worsening, thus allowing planning the invasive treatment of chronic venous insufficiency. Dilated diameters (>7.2 mm) correlate with severe disease and poor prognosis, being an indication for total abolishment of saphenous vein reflux. All other presentations must be individualized, sparing saphenous vein whenever possible and and a standardized approach is not indicated for all patients.

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.

Correlation of Deviance in Arterial Oxygenation with Severity of Chronic Liver Disease

International Nuclear Information System (INIS)

Shaukat, A. A.; Zuhaid, M.

2016-01-01

Background: Hepatitis B and C related chronic liver diseases have led to development of a serious threat to the people of South Asia. The main aim of this study was to evaluate the correlation of magnitude of arterial deoxygention to the severity of liver disease. Methods: It was a hospital based cross sectional descriptive study, carried out in the Medical Department of Khyber Teaching Hospital Peshawar. All in all 115 patients were assessed for the severity of the liver diseases and were correlated with arterial deoxygenation using linear regression models. Results: Male to female ratio was 1.5:1. Males infected with hepatitis B, hepatitis C and both were 9, 60 and 1, while females suffered from hepatitis B, Hepatitis C and both were 2, 42 and 1 respectively. The linear relationship between A-a DO2 with severity of liver disease showed positive correlation while PO2 showed negative correlation with severity of liver disease. Conclusion: There was a positive correlation between A-a DO2 and severity of liver diseases while PO2 and severity of liver diseases showed negative correlation. (author)

Combined stent placement and high dose PGE1 drip infusion for chronic occlusion of the superficial femoral artery as a modality to salvage chronic critical limb ischemia

Energy Technology Data Exchange (ETDEWEB)

Ikushima, Ichiro [Department of Radiology, Miyakonojo Medical Association Hospital, 5822-3 Oiwadacho, Miyakonojo 885-0062 (Japan)], E-mail: iku-i@fk.enjoy.ne.jp; Hirai, Toshinori [Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University (Japan); Ishii, Akihiko [Department of Radiology, Miyakonojo Medical Association Hospital, 5822-3 Oiwadacho, Miyakonojo 885-0062 (Japan); Yamashita, Yasuyuki [Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University (Japan)

2008-04-15

Purpose: To assess the initial effect, short-term patency, and limb salvage rates of combined stent placement and high-dose prostaglandin E-1 (PGE1) drip infusion for chronic occlusion of the superficial femoral artery (SFA). Materials and methods: A total of 15 arteriosclerotic occlusive lesions of the SFA were treated in 11 consecutive patients (mean age: 78.4 years old). All cases were of category 4 or 5, based on the criteria of the Society of Vascular Surgery and Intermittent Society for Cardiovascular Surgery (SVC/ISCVS). In all cases a self-expandable stainless steel stent was implanted. PGE1 treatment was started 3-5 days before stent placement and continued for 7-10 days after the intervention. The technical success, limb salvage outcomes, patency rates, and complications were examined. Results: In all cases, the technical success rate of the procedure was 100%. After stent implantation, the clinical status of all cases was improved by at least +2, and major amputation was not required in any cases. The 12-month primary, secondary patency rates, and limb salvage rate were 57%, 100%, and 100%, respectively. Conclusion: Combined stent placement and high-dose PGE1 drip infusion is a treatment of choice for salvaging the lower limb of a patient with chronic critical ischemia.

Retrograde approach for the recanalization of coronary chronic total occlusion: collateral selection and collateral related complication.

Science.gov (United States)

Ma, Jian-Ying; Qian, Ju-Ying; Ge, Lei; Fan, Bing; Wang, Qi-Bing; Yan, Yan; Zhang, Feng; Yao, Kang; Huang, Dong; Ge, Jun-Bo

2013-03-01

The retrograde approach through collaterals has been applied in the treatment of chronic total occlusion (CTO) lesions during percutaneous recanalization of coronary arteries. This study was to investigate the success rate of recanalization and collateral related complications in patients when using the retrograde approach. Eighty-four cases subjected to retrograde approach identified from July 2005 to July 2012 were included in this study. Patient characteristics, procedural outcomes and in-hospital clinical events were evaluated. Mean age of the patient was (59.6 ± 11.2) years old and 91.7% were men. The target CTO lesions were distributed among the left anterior descending artery in 45 cases (53.5%), left circumflex artery in one case (1.2%), right coronary artery in 34 cases (40.5%), and left main in four cases (4.8%). The overall success rate of recanalization was 79.8%. The septal collateral was three times more frequently used for retrograde access than the epicardial collateral, 68/84 (81%) vs. 16/84 (19%). Successful wire passage through the collateral channel was achieved in 58 (72.6%) patients. The success rate of recanalization was 93.1% (54/58) in patients with and 50% (13/26) in patients without successful retrograde wire passage of the collateral channel (P collaterals was achieved in 49 of 68 septal collaterals (72.1%) and in 9 of 16 epicardial collaterals (56.3%) (P = NS). There was no significant difference between the septal collateral group and the epicardial group in the success rate of recanalization after retrograde wire crossing the collaterals (91.8% vs. 100%, P > 0.05). CART or reverse CART technique was used in 15 patients, and 14 patients (93.3%) were recanalized successfully. Collateral related perforation occurred in three (18.8%) cases with the epicardial collateral as the first choice (compared with the septal collateral group (0), P collaterals. The retrograde approach is an effective technique to recanalize CTO lesions, the septal

Systemic Arterial-to-Pulmonary Artery Shunt Utilization

African Journals Online (AJOL)

multiruka1

In certain circumstances, such as cyanotic neonates with tetralogy of Fallot (4) or cyanotic patients with. Tetralogy of Fallot and hypoplastic pulmonary arteries. (5), better outcomes are obtained if definitive surgery. (total correction or palliation) is preceded by creation of a systemic arterial-to-pulmonary artery shunt (SAPAS).

Stenting of the Superior Mesenteric Artery as a Preoperative Treatment for Total Pancreatectomy

International Nuclear Information System (INIS)

Tanigawa, Noboru; Kariya, Shuji; Komemushi, Atsushi; Satoi, Sohei; Kamiyama, Yasuo; Sawada, Satoshi; Kojima, Hiroyuki; Sougawa, Mitsuharu; Takai, Yuichirou

2004-01-01

The patient was a 58-year-old male with mucinous cyst adenocarcinoma of the pancreas. Prior to total pancreatectomy, preoperative CT and angiography showed a high-grade arteriosclerotic stenosis of about 1.0 cm in length in the ostium of the superior mesenteric artery (SMA), as well as the development of collateral vessels in the area around the head of the pancreas. A stent was placed in the SMA stenosis to preserve the intestinal blood flow in the SMA region after total pancreatectomy, which was performed 25 days after stent placement. The postoperative SMA blood flow was favorable, with no postoperative intestinal ischemia, and the patient had an uneventful postoperative course

Vasodilative effects of prostaglandin E1 derivate on arteries of nerve roots in a canine model of a chronically compressed cauda equina

Directory of Open Access Journals (Sweden)

Konno Shin-ichi

2008-04-01

Full Text Available Abstract Background Reduction of blood flow is important in the induction of neurogenic intermittent claudication (NIC in lumbar spinal canal stenosis. PGE1 improves the mean walking distance in patients with NIC type cauda equina compression. PGE1 derivate might be effective in dilating blood vessels and improving blood flow in nerve roots with chronically compressed cauda equina. The aim of this study was to assess whether PGE1 derivate has vasodilatory effects on both arteries and veins in a canine model of chronic cauda equina compression. Methods Fourteen dogs were used in this study. A plastic balloon inflated to 10 mmHg was placed under the lamina of the 7th lumbar vertebra for 1 week. OP-1206-cyclodextrin clathrate (OP-1206-CD: prostaglandin E1 derivate was administered orally. The blood vessels of the second or third sacral nerve root were identified using a specially designed surgical microscope equipped with a video camera. The diameter of the blood vessels was measured on video-recordings every 15 minutes until 90 minutes after the administration of the PGE1 derivate. Results We observed seven arteries and seven veins. The diameter and blood flow of the arteries was significantly increased compared with the veins at both 60 and 75 minutes after administration of the PGE1 derivate (p Discussion The PGE1 derivate improved blood flow in the arteries but did not induce blood stasis in the veins. Our results suggest that the PGE1 derivate might be a potential therapeutic agent, as it improved blood flow in the nerve roots in a canine model of chronic cauda equina compression.

Estimation of the Arterial Fraction of Total Hepatic Flow from Radionuclide Angiogram Using 99mTc-DISIDA

International Nuclear Information System (INIS)

Lee, Hae Gin; Lim, Gye Yeon; Yang, Il Kwon; Kim, Hack Hee; Lim, Jung Ik; Bahk, Yong Whee; Han, Sok Won; Han, Nam Ik; Lee, Young Sok

1991-01-01

Arterial fraction of total hepatic blood flow was estimated by a new method, slope method, on radionuclide angiogram using 99m Tc-DISIDA and was compared with that from 99m Tc-Phytate radionuclide angiogram. This study included 11 of normal subjects, 37 of intermediate group with various liver diseases, and 25 patients with liver cirrhosis. We analyzed the data with slope method from radionuclide angiograms and the results were compared with hepatic arterial fractions from uptake method, introduced by Lee et al. at 1986. The hepatic arterial fractions from radionuclide angiograms using 99m Tc-DISIDA and 99m Tc- Phytate were 0.32 ± 0.09 and 0.31 ± 0.11 respectively in normal subjects, and 0.75 ± 0.18 and 0.77 ± 0.21 respectively in patients with liver cirrhosis. The hepatic arterial fractions by the slope method was well correlated with those of the uptake method on 99m Tc-DISIDA scan. There was high correlation between the hepatic arterial fractions from 99m Tc-DISIDA and 99m Tc-Phytate scans. Hepatic arterial fraction estimated by the slope method is a useful index for the diagnosis of liver cirrhosis and the evaluation of status of portal hypertension.

Impact on adenosine stress cardiac magnetic resonance for recanalisation and follow up of chronic total coronary occlusions

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Heyne, J.P. [Institute of Diagnostic and Interventional Radiology, Friedrich Schiller University Jena, Erlanger Allee 101, D-07740 Jena (Germany)], E-mail: Jens-Peter.Heyne@med.uni-jena.de; Goernig, M. [Clinic for Internal Medicine I, Friedrich Schiller University Jena, Erlanger Allee 101, D-07740 Jena (Germany)], E-mail: Matthias.Goernig@med.uni-jena.de; Feger, J. [Institute of Diagnostic and Interventional Radiology, Friedrich Schiller University Jena, Erlanger Allee 101, D-07740 Jena (Germany)], E-mail: Joachim.Feger@email.de; Kurrat, C. [Institute of Diagnostic and Interventional Radiology, Friedrich Schiller University Jena, Erlanger Allee 101, D-07740 Jena (Germany)], E-mail: Claudia.Kurrat@med.uni-jena.de; Werner, G.S. [Clinic for Internal Medicine I, Friedrich Schiller University Jena, Erlanger Allee 101, D-07740 Jena (Germany)], E-mail: Gerald.Werner@Klinikum-Darmstadt.de; Figulla, H.R. [Clinic for Internal Medicine I, Friedrich Schiller University Jena, Erlanger Allee 101, D-07740 Jena (Germany)], E-mail: Hans.Figulla@med.uni-jena.de; Kaiser, W.A. [Institute of Diagnostic and Interventional Radiology, Friedrich Schiller University Jena, Erlanger Allee 101, D-07740 Jena (Germany)], E-mail: Werner.Kaiser@med.uni-jena.de

2007-09-15

Objective: To evaluate the impact on cardiac magnetic resonance imaging (CMRI) with adenosine stress and delayed enhancement for indication and follow up after interventional recanalisation of chronic total coronary occlusions (CTOs). Material and methods: Twenty consecutive patients (15 males; 5 females; mean age 65 years) with CTO verified by cardiac catheterisation referred to CMRI. Sixteen of them got CMRI before and after coronary recanalisation. Wall motion abnormalities (WMAs), first pass perfusion with adenosine and viability were assessed using a 1.5 T MR scanner (Sonata; Siemens). CMRI results were compared with clinical classifications, the results of cardiac catheterisation and follow up angiography. Results: Sixteen patients had a successful recanalisation, 15 of the occluded coronary artery and one of collateral donor artery stenosis. After recanalisation all stress-induced progressive or new wall motion abnormalities (WMAs) of the corresponding segments and in the collateral donor territory (5 patients) and all adenosine induced perfusion defects (PD) or delay (12 patients) were regredient. 13/16 patients showed no transmural and one patient transmural delayed enhancement (DE) indicating myocardial scar. In 10/16 patients CSS grading of angina improved after recanalisation. Conclusion: After successful recanalisation of CTOs, patients with preinterventional stress-induced PDs and WMAs in viable myocardium did not display any signs of stress-induced ischemia postinterventionally. A comprehensive CMRI approach, including assessment of rest and stress WMAs, first pass perfusion and myocardial viability represents an important tool for the pre-interventional decision to recanalise CTOs and follow up.

One-year results of total arterial revascularization vs. conventional coronary surgery: CARRPO trial

DEFF Research Database (Denmark)

Damgaard, Sune; Wetterslev, Jørn; Lund, Jens T

2009-01-01

+/- 18% in the conventional group (P = 0.52). In 72% of TAR patients and 67% of the conventional group, all grafts were patent (P = 0.45). Multiple imputation of missing angiographic data did not influence on results. Within 1 year, 37 (23%) TAR patients and 43 (25%) conventional group patients suffered...... cardiac events (HR 1.09, 95% CI 0.70-1.69, P = 0.70). One patient (0.6%) in the TAR group and two (1.2%) in the conventional group died (P = 1.00). CONCLUSION: Within 1 year post-operatively, TAR seems at least as safe and effective as CR. Prolonged follow-up will reveal whether this is sustained......AIMS: To investigate clinical and angiographic outcomes after coronary surgery using total arterial revascularization (TAR). METHODS AND RESULTS: We randomized 331 patients with multivessel or isolated left main disease to TAR [internal thoracic (ITA) and radial arteries] vs. conventional...

[Indices of 24-hour monitoring of arterial blood pressure in patients with neurogenic syncope and patients with chronic constitution- dependent hypotension].

Science.gov (United States)

Musaeva, Z A; Khapaev, B A; Fedotova, A V; Oknin, V Iu

1999-01-01

Clinical-psychologic study, spectral analysis of heart rate variability, 24-h monitoring of arterial pressure (AP) were performed in 20 patients with chronic constitutional arterial hypotension and in 18 patients with neurogenic syncopal states. Both groups were characterised by considerable manifestations of the syndrome of autonomic dystonia, by emotional-personal disorders that correlated with elevated level of slow-waves of the second order in heart rhythms' spectrum. That testified activation of supersegmental sympathetic-adrenal systems. Disorders in sympathetic-parasympathetic correlations were specific in each group. In patients with arterial hypotension disorder of circadian rhythm was observed in the form of superfluous decrease of diastolic AP during sleep. Circadian rhythms in patients with neurogenic syncopes have parameters characteristic for normals showing a preverved chronobiologic AP regulation. A role of the alterations revealed in pathogenesis of arterial hypotensionis discussed.

Traumatic Distal Ulnar Artery Thrombosis

Directory of Open Access Journals (Sweden)

Ahmet A. Karaarslan

2014-01-01

Full Text Available This paper is about a posttraumatic distal ulnar artery thrombosis case that has occurred after a single blunt trauma. The ulnar artery thrombosis because of chronic trauma is a frequent condition (hypothenar hammer syndrome but an ulnar artery thrombosis because of a single direct blunt trauma is rare. Our patient who has been affected by a single blunt trauma to his hand and developed ulnar artery thrombosis has been treated by resection of the thrombosed ulnar artery segment. This report shows that a single blunt trauma can cause distal ulnar artery thrombosis in the hand and it can be treated merely by thrombosed segment resection in suitable cases.

Intestinal brucellosis associated with celiac artery and superior mesenteric artery stenosis and with ileum mucosa and submucosa thickening: A case report.

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

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. 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. The patient was diagnosed as brucellosis. The narrowing of the SMA and CA was suspected to be vasculitis secondary to the brucellosis. The patient was treated with minocycline and rifampicin for 12 weeks totally. 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. 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.

Total pancreatectomy for recurrent acute and chronic pancreatitis: a critical review of patient selection criteria

Science.gov (United States)

Faghih, Mahya; Gonzalez, Francisco Garcia; Makary, Martin A.; Singh, Vikesh K.

2018-01-01

Purpose of review Critical review of the indications for total pancreatectomy and highlight limitations in current diagnostic criteria for chronic pancreatitis. Recent findings The diagnosis of noncalcific chronic pancreatitis remains controversial because of an overreliance on nonspecific imaging and laboratories findings. Endoscopic ultrasound, s-magnetic resonance cholangiopancreatography, and/or endoscopic pancreatic function testing are often used to diagnose noncalcific chronic pancreatitis despite the fact that there is no gold standard for this condition. Abdominal pain is not specific for chronic pancreatitis and is more likely to be encountered in patients with functional gastrointestinal disorders based on the high incidence of these conditions. The duration of pain and opioid analgesic use results in central sensitization that adversely affects pain outcomes after total pancreatectomy. An alcoholic cause is associated with poorer pain outcomes after total pancreatectomy. Summary The lack of a gold standard for noncalcific chronic pancreatitis limits the diagnostic accuracy of imaging and laboratory tests. The pain of chronic pancreatitis is nonspecific and is affected by duration, preoperative opioid use, and cause. These factors will need to be considered in the development of future selection criteria for this morbid surgery. PMID:28700371

Endovascular recanalization of native chronic total occlusions in patients with failed lower-extremity bypass grafts.

Science.gov (United States)

Wrigley, Clinton W; Vance, Ansar; Niesen, Timothy; Grilli, Christopher; Velez, J Daniel; Agriantonis, Demetrios J; Kimbiris, George; Garcia, Mark J; Leung, Daniel A

2014-09-01

To investigate the feasibility, safety, and outcome of endovascular recanalization of native chronic total occlusions (CTOs) in patients with failed lower-extremity bypass grafts. Retrospective review of 19 limbs in 18 patients with failed lower-extremity bypass grafts that underwent recanalization of native arterial occlusions between February 2009 and April 2013 was performed. Nine of the limbs presented with acute ischemia and 10 presented with chronic ischemia, including eight with critical limb ischemia and two with disabling claudication. The mean patency of the failed bypass grafts (63% venous) was 27 months. All limbs had Transatlantic Inter-Society Consensus class D lesions involving the native circulation. Technical success of the endovascular recanalization procedure was achieved in all but one limb (95%). The mean ankle brachial indices before and after treatment were 0.34 and 0.73, respectively. There were no major complications or emergency amputations. Mean patient follow-up was 64 weeks, and two patients were lost to follow-up. Primary patency rates at 3, 6, and 12 months were 87%, 48%, and 16%, respectively. Successful secondary procedures were performed in seven patients, with secondary patency rates at 3, 6, and 12 months of 88%, 73%, and 44%, respectively. Limb salvage rates at 12 and 24 months were 94% and 65%, and amputation-free survival rates at 12 and 24 months were 87% and 60%, respectively. Endovascular recanalization of native CTOs in patients with failed lower-extremity bypass grafts is technically feasible and safe and results in acceptable limb salvage. Copyright © 2014 SIR. Published by Elsevier Inc. All rights reserved.

Effect of hemodialysis on total antioxidant status of chronic renal ...

African Journals Online (AJOL)

Background: Renal failure is accompanied by oxidative stress, which is caused by enhanced production of reactive oxygen species and impaired antioxidant defense. Aim: To assess the effect of hemodialysis (by cellulose membrane dialyzer) on plasma total antioxidant status and lipid peroxidation of patients in chronic ...

Tips and tricks for antegrade recanalization of chronic total occlusions using the CrossBoss catheter.

Science.gov (United States)

Kwan, Tak W; Diwan, Ravi; Ratcliffe, Justin A; Huang, Yili; Patri, Rahul; James, David; Liou, Michael; Fallahi, Arzhang; Young, Bruce; Nanjundappa, Aravinda; Daggubati, Ramesh

2015-02-01

To provide new strategies and techniques for the successful recanalization of chronic total occlusions (CTOs) with the sole use of the CrossBoss catheter. In addition, some common CTO scenarios are illustrated in detail. CTOs are one of the most challenging complex coronary lesion subsets to intervene upon. Even with the innovation of specialized catheters, the success rate of antegrade recanalization remains low. Between June and December 2013, a retrospective analysis of 50 consecutive patients who presented with a planned percutaneous intervention (PCI) of a CTO was performed. In all patients, the CrossBoss catheter was used. No additional reentry devices were necessary. Procedural success was defined as failure. The average fluoroscopy time was 45.9 minutes and the average amount of contrast use was 273.8 mL. No patient suffered a coronary perforation from the CrossBoss catheter. With increased experience using the CrossBoss catheter, the antegrade success rate of CTOs can be improved. Some tips include identifying the likely course of the artery with the aid of retrograde injection, proper guidewire selection and manipulation, and redirecting the CrossBoss catheter if there is substantial deviation from the original path.

Diabetes mellitus and female gender are the strongest predictors of poor collateral vessel development in patients with severe coronary artery stenosis.

Science.gov (United States)

Yetkin, Ertan; Topal, Ergun; Erguzel, Nuri; Senen, Kubilay; Heper, Gulumser; Waltenberger, Johannes

2015-04-01

Coronary collateral vessel development (CVD), i.e., arteriogenesis, is regarded as one of the most important mechanisms—along with angiogenesis—to result in protection of the myocardium. Coronary CVD is associated with a reduction in infarct size, future cardiovascular events and improved survival in patients with occlusive coronary artery disease by enhancing regional perfusion in the chronically ischemic myocardium. In the present study, we aimed to investigate the relation of cardiovascular risk factors and hematological parameters with collateral development in patients with severely stenotic (≥95%) and totally occluded coronary artery disease including at least one major coronary artery. The study population was selected from the patients who underwent coronary angiography between January 2008 and March 2009. Five hundred and two patients who had at least one coronary artery stenosis ≥95% (368 men; mean age 59 ± 10 years) comprised the study population. Of the 502 patients, 228 had total occlusion in at least one major epicardial coronary artery. Collateral artery grading was performed by using Cohen-Rentrop method to the vessel with coronary artery stenosis of ≥95% and patients with chronic total occlusions (CTO). Patients with grade 0-1 collateral development were regarded as the poor collateral group, and patients with grade 2-3 collateral development were regarded as the good collateral group. Two hundred and fifty-eight (51%) of 502 patients had poor collateral development, and 244 (49%) had good collateral development. Logistic regression analysis revealed that DM was independently associated with poor CVD in patients with ≥95% stenosis (p risk factor for poor CVD in addition to DM in patients with CTO.

Bronchial arteries: anatomy, function, hypertrophy, and anomalies.

Science.gov (United States)

Walker, Christopher M; Rosado-de-Christenson, Melissa L; Martínez-Jiménez, Santiago; Kunin, Jeffrey R; Wible, Brandt C

2015-01-01

The two main sources of blood supply to the lungs and their supporting structures are the pulmonary and bronchial arteries. The bronchial arteries account for 1% of the cardiac output but can be recruited to provide additional systemic circulation to the lungs in various acquired and congenital thoracic disorders. An understanding of bronchial artery anatomy and function is important in the identification of bronchial artery dilatation and anomalies and the formulation of an appropriate differential diagnosis. Visualization of dilated bronchial arteries at imaging should alert the radiologist to obstructive disorders that affect the pulmonary circulation and prompt the exclusion of diseases that produce or are associated with pulmonary artery obstruction, including chronic infectious and/or inflammatory processes, chronic thromboembolic disease, and congenital anomalies of the thorax (eg, proximal interruption of the pulmonary artery). Conotruncal abnormalities, such as pulmonary atresia with ventricular septal defect, are associated with systemic pulmonary supply provided by aortic branches known as major aortopulmonary collaterals, which originate in the region of the bronchial arteries. Bronchial artery malformation is a rare left-to-right or left-to-left shunt characterized by an anomalous connection between a bronchial artery and a pulmonary artery or a pulmonary vein, respectively. Bronchial artery interventions can be used successfully in the treatment of hemoptysis, with a low risk of adverse events. Multidetector computed tomography helps provide a vascular road map for the interventional radiologist before bronchial artery embolization. RSNA, 2015

Pleural subxyphoid drain confers better pulmonary function and clinical outcomes in chronic obstructive pulmonary disease after off-pump coronary artery bypass grafting: a randomized controlled trial.

Science.gov (United States)

Guizilini, Solange; Viceconte, Marcela; Esperança, Gabriel Tavares da M; Bolzan, Douglas W; Vidotto, Milena; Moreira, Rita Simone L; Câncio, Andréia Azevedo; Gomes, Walter J

2014-01-01

To evaluate the lung function and clinical outcome in severe chronic obstructive pulmonary disease in patients undergoing off-pump coronary artery bypass grafting with left internal thoracic artery graft, comparing the pleural drain insertion in the intercostal versus subxyphoid region. A randomized controlled trial. Chronic obstructive pulmonary disease patients were randomized into two groups according pleural drain site: II group (n=27) - pleural drain in intercostal space; SI group (n=29) - pleural drain in the subxyphoid region. Spirometry values (Forced Vital Capacity - and Forced expiratory volume in 1 second) were obtained on preoperative and 1, 3 and 5 postoperative days. Chest x-ray from preoperative until postoperative day 5 (POD5) was performed for monitoring respiratory events, such as atelectasis and pleural effusion. Pulmonary shunt fraction and pain score was evaluate preoperatively and on postoperative day 1. In both groups there was a significant decrease of the spirometry values (Forced Vital Capacity and Forced expiratory volume in 1 second) until POD5 (Ppleural drainage in severe Chronic obstructive pulmonary disease patients determined better preservation and recovery of pulmonary capacity and volumes with lower pulmonary shunt fraction and better clinical outcomes on early postoperative off-pump coronary artery bypass grafting.

Carotid artery thickness is associated with chronic use of highly active antiretroviral therapy in patients infected with human immunodeficiency virus: A 3.0 Tesla magnetic resonance imaging study.

Science.gov (United States)

LaBounty, T M; Hardy, W D; Fan, Z; Yumul, R; Li, D; Dharmakumar, R; Conte, A Hernandez

2016-08-01

While patients with HIV infection have an elevated stroke risk, ultrasound studies of carotid artery wall thickness have reported variable results. We hypothesized that subjects with HIV infection on chronic highly active antiretroviral therapy (HAART) would have increased carotid artery wall thickness by magnetic resonance imaging (MRI). This cross-sectional study compared carotid artery wall thickness between 26 individuals infected with HIV on chronic HAART and 20 controls, without HIV infection but with similar cardiovascular risk factors, using 3.0-T noncontrast MRI. Inclusion criteria included male gender, age 35-55 years, and chronic HAART (≥ 3 years) among HIV-seropositive subjects; those with known cardiovascular disease or diabetes were excluded. Between subjects with HIV infection and controls, there were no differences in mean (±SD) age (47.8 ± 5.0 vs. 47.8 ± 4.7 years, respectively; P = 0.19) or cardiovascular risk factors (P > 0.05 for each). Mean (±SD) wall thickness was increased in those with HIV infection vs. controls for the left (0.88 ± 0.08 vs. 0.83 ± 0.08 mm, respectively; P = 0.03) and right (0.90 ± 0.10 vs. 0.85 ± 0.07 mm, respectively; P = 0.046) common carotid arteries. Among individuals with HIV infection, variables associated with increased mean carotid artery wall thickness included lipoaccumulation [+0.09 mm; 95% confidence interval (CI) 0.03-0.14 mm; P = 0.003], Framingham risk score ≥ 5% (+0.07 mm; 95% CI 0.01-0.12; P = 0.02 mm), and increased duration of protease inhibitor therapy (+0.03 mm per 5 years; 95% CI 0.01-0.06 mm; P = 0.02). Individuals with HIV infection on chronic HAART had increased carotid artery wall thickness as compared to similar controls. In subjects with HIV infection, the presence of lipoaccumulation and longer duration of protease inhibitor therapy were associated with greater wall thickness. © 2015 British HIV Association.

Association of serum adiponectin concentration with aortic arterial stiffness in chronic kidney disease: from the KNOW-CKD study.

Science.gov (United States)

Kim, Chang Seong; Bae, Eun Hui; Ma, Seong Kwon; Park, Sue K; Lee, Ju Yeon; Chung, Wookyung; Lee, Kyubeck; Kim, Yeong Hoon; Oh, Kook-Hwan; Ahn, Curie; Kim, Soo Wan

2017-08-01

High serum adiponectin levels predict all-cause and cardiovascular mortality in chronic kidney disease (CKD). However, the relationship between serum adiponectin concentration and arterial stiffness in CKD is not well established. The aim of this study was to assess this relationship by measuring pulse wave velocity (PWV) in CKD patients. Serum adiponectin concentration was measured in 716 CKD patients in the prospective KoreaN cohort study for Outcome in patients With Chronic Kidney Disease. The study group consisted of 415 men and 301 women; mean age was 53.1 years, and baseline estimated glomerular filtration rate (eGFR) was 51 ± 29 ml/min per 1.73 m 2 . Heart to femoral PWV (hfPWV) and mean brachial to ankle PWV (baPWV) served as indicators of aortic artery stiffness and arterial stiffness, respectively. Increasing quartiles of serum adiponectin levels were associated with women, lower eGFRs and body mass indices, and higher urinary albumin-creatinine ratios. Serum adiponectin concentration also correlated with hfPWV and mean baPWV, even after adjusting for age and sex. It independently associated with hfPWV (B 0.028; 95 % confidence interval, 0.004-0.051; P = 0.020) but not mean baPWV in a multivariable linear regression analysis. In a multivariable logistic regression analysis, it correlated significantly with the highest quartile of hfPWVs but not mean baPWVs. The independent and significant correlation of serum adiponectin concentration with hfPWV in CKD patients implicates adiponectin in CKD-associated aortic stiffness.

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.

Perceptions of Received Information, Social Support, and Coping in Patients with Pulmonary Arterial Hypertension or Chronic Thromboembolic Pulmonary Hypertension

Directory of Open Access Journals (Sweden)

Bodil Ivarsson

2014-01-01

Full Text Available Patients with a life-limiting diagnosis of pulmonary arterial hypertension (PAH or chronic thromboembolic pulmonary hypertension (CTEPH need disease-specific information, ability to cope, and functioning social networks. This cohort study investigated the experiences of PAH and CTEPH patients who received information about their diagnosis, treatment, and management, in addition to coping and social support. Sixty-eight adult patients (mean ∓ SD, age 67 ∓ 14; 66% women were included. A total of 54% of the patients wanted more information. Patients received information mostly in areas concerning medical test procedures, the diagnosis, disease severity, possible disease causes, and how to manage their disease. Coping ability was significantly better in patients who were satisfied with the received information (P= 0.0045. The information given to PAH or CTEPH patients and their communication with healthcare professionals can be greatly improved. Gaps in information and misunderstandings can be avoided by working in cooperation with the patients, their relatives, and within the PAH team.

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

International Nuclear Information System (INIS)

Ryu, Seok Jong; Choi, Byoung Wook; Choe, Kyu Ok

2001-01-01

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

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

Process review of a departmental change from conventional coronary artery bypass grafting to totally arterial coronary artery bypass and its effects on the incidence and severity of postoperative stroke.

Science.gov (United States)

Albert, Alexander; Sergeant, Paul; Florath, Ines; Ismael, Mohammed; Rosendahl, Ulrich; Ennker, Jürgen

2011-04-01

We evaluated the process of changing from conventional coronary artery bypass grafting (CABG) to totally arterial off-pump coronary artery bypass (TOPCAB) at a single heart center in Germany. We (1) used multivariate statistical methods to assess real-time monitoring of OPCAB effects, (2) conducted a case review to assess preventable deaths and identify areas of improvement, (3) conducted a team survey, and (4) evaluated benchmarking results. All surgeons and assistants (n = 18) at this center were involved and were guided by the department head and one of the consultants, who was trained in this procedure in 2004 at the Leuven OPCAB school. The frequency of OPCAB operations increased abruptly in 2005 from 5% to 43% and then increased gradually to 67% (n = 546) by 2008 (total, 1781 OPCAB cases and 1563 on-pump cases). The in-hospital and 30-day mortality rates for OPCAB surgeries (n = 10 [0.6%] and 21 [1.2%], respectively) were lower than for on-pump surgeries (n = 27 [1.7%] and 26 [1.7%], respectively). Stroke rates were also lower for OPCAB surgeries (7 cases [0.4%] versus 15 cases [1%]). The lower risk of stroke in the OPCAB group was significant (P popularity, and a top national rank). The change from conventional CABG to TOPCAB was effective in decreasing the incidence and severity of stroke, in developing a team routine and a positive team attitude, and in producing excellent benchmarking results. The presence of a training and communication deficiency at the beginning of the study suggested an area for further improvement. After 6 years TOPCAB had largely replaced conventional CABG.

Use of i.v. radionuclide total body arteriography to evaluate arterial bypass shunts--a new method--a review of several cases

International Nuclear Information System (INIS)

Yang, D.C.; Jain, C.U.; Patel, D.; Gould, L.; Schaefer, H.; Maghazeh, P.; Giovanniello, J.

1990-01-01

Currently, Doppler ultrasound and contrast angiography are the main imaging procedures being used to evaluate arterial bypass shunts. IV radionuclide total body arteriography (TBA) is another useful imaging procedure for evaluation of bypass shunts. The authors reviewed 33 patients, 19 women and 14 men, ranging in age from forty-three to eighty-five, who had TBA done after arterial bypass surgery. Ten patients had multiple shunts and 5 had multiple follow-up studies. In total there were 80 shunts, including 43 femoropopliteal, 16 axillofemoral, 1 axillopopliteal, 13 crossover femorofemoral, and 7 aortofemoral shunts. Sixty-two of the 80 shunts were patent, 14 were occluded, and 4 had partial occlusion. The results were confirmed by Doppler studies, contrast angiograms, and/or surgical exploration without false positives or false negatives. Since the radiotracer used was 99mTc-labeled red blood cells, a MUGA study can also be performed immediately following TBA in the same injection. Twenty-eight patients had gated cardiac blood pool studies (MUGA) done; 16 had abnormal wall motion and diminished ventricular function. TBA requires only a single IV injection of radiotracer (less than 1 cc) in the upper limb. The imaging times for total body arterial and perfusion images are seventy seconds and five minutes respectively. Both total body arterial and perfusion images clearly demonstrated the entire course of shunts (single or multiple); underlying and coexisting arterial abnormalities, e g, occlusive disease (27 patients), or aneurysm (3 patients); and related perfusion changes in the extremities. TBA has unique features. It permits a complete, excellent visualization of the bypass graft without the hazard of contrast media injection. It is a simple and a virtually noninvasive procedure, particularly useful for preoperative workups and postoperative follow-ups

Is chronic obstructive pulmonary disease associated with increased arterial stiffness?

DEFF Research Database (Denmark)

Janner, Julie H; McAllister, David A; Godtfredsen, Nina S

2012-01-01

We hypothesize that airflow limitation is associated with increasing arterial stiffness and that having COPD increases a non-invasive measure of arterial stiffness - the aortic augmentation index (AIx) - independently of other CVD risk factors.......We hypothesize that airflow limitation is associated with increasing arterial stiffness and that having COPD increases a non-invasive measure of arterial stiffness - the aortic augmentation index (AIx) - independently of other CVD risk factors....

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......, 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.......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...

Impact of Proximal Cap Ambiguity on Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From a Multicenter US Registry.

Science.gov (United States)

Karatasakis, Aris; Danek, Barbara A; Karmpaliotis, Dimitri; Alaswad, Khaldoon; Jaffer, Farouc A; Yeh, Robert W; Patel, Mitul P; Bahadorani, John N; Wyman, R Michael; Lombardi, William L; Grantham, J Aaron; Kandzari, David E; Lembo, Nicholas J; Doing, Anthony H; Moses, Jeffrey W; Kirtane, Ajay J; Garcia, Santiago; Parikh, Manish A; Ali, Ziad A; Karacsonyi, Judit; Kalra, Sanjog; Rangan, Bavana V; Kalsaria, Pratik; Thompson, Craig A; Banerjee, Subhash; Brilakis, Emmanouil S

2016-10-01

We sought to determine the impact of proximal cap ambiguity on procedural techniques and outcomes for coronary chronic total occlusion (CTO) percutaneous coronary intervention (PCI). We examined the clinical and angiographic characteristics and outcomes of 1021 CTO-PCIs performed between 2012 and 2015 at 11 United States centers. Proximal cap ambiguity was present in 31% of target lesions and was associated with increased clinical and angiographic complexity (prior coronary artery bypass graft surgery: 43% vs 33%; P=.01; moderate/severe calcification 66% vs 51%; Pambiguity (68% vs 33%; Pambiguity was associated with increased use of intravascular ultrasound (49% vs 36%; P=.01) and contrast (281 mL vs 250 mL; Pambiguity is present in one-third of CTO-PCI target lesions and is associated with lower success rates, higher utilization of the retrograde approach, and lower procedural efficiency, but no significant difference in the incidence of major adverse cardiac events.

The associations of cardiorespiratory fitness, adiposity and sports participation with arterial stiffness in youth with chronic diseases or physical disabilities.

Science.gov (United States)

Haapala, Eero A; Lankhorst, Kristel; de Groot, Janke; Zwinkels, Maremka; Verschuren, Olaf; Wittink, Harriet; Backx, Frank Jg; Visser-Meily, Anne; Takken, Tim

2017-07-01

Background The evidence on the associations of cardiorespiratory fitness, body adiposity and sports participation with arterial stiffness in children and adolescents with chronic diseases or physical disabilities is limited. Methods Altogether 140 children and adolescents with chronic diseases or physical disabilities participated in this cross-sectional study. Cardiorespiratory fitness was assessed using maximal exercise test with respiratory gas analyses either using shuttle run, shuttle ride, or cycle ergometer test. Cardiorespiratory fitness was defined as peak oxygen uptake by body weight or fat-free mass. Body adiposity was assessed using waist circumference, body mass index standard deviation score and body fat percentage. Sports participation was assessed by a questionnaire. Aortic pulse wave velocity and augmentation index were assessed by a non-invasive oscillometric tonometry device. Results Peak oxygen uptake/body weight (standardised regression coefficient β -0.222, 95% confidence interval (CI) -0.386 to -0.059, P = 0.002) and peak oxygen uptake/fat-free mass (β -0.173, 95% CI -0.329 to -0.017, P = 0.030) were inversely and waist circumference directly (β 0.245, 95% CI 0.093 to 0.414, P = 0.002) associated with aortic pulse wave velocity. However, the associations of the measures of cardiorespiratory fitness with aortic pulse wave velocity were attenuated after further adjustment for waist circumference. A higher waist circumference (β -0.215, 95% CI -0.381 to -0.049, P = 0.012) and a higher body mass index standard deviation score (β 0.218, 95% CI -0.382 to -0.054, P = 0.010) were related to lower augmentation index. Conclusions Poor cardiorespiratory fitness and higher waist circumference were associated with increased arterial stiffness in children and adolescents with chronic diseases and physical disabilities. The association between cardiorespiratory fitness and arterial stiffness was partly explained by waist

Contrast-induced nephropathy in patients with chronic kidney disease and peripheral arterial disease

International Nuclear Information System (INIS)

Kroneberger, Christian; Enzweiler, Christian N; Schmidt-Lucke, Andre; Rückert, Ralph-Ingo; Teichgräber, Ulf; Franiel, Tobias

2015-01-01

The risk for contrast-induced nephropathy (CIN) after intra-arterial application of an iodine-based contrast material is unknown for patients with chronic kidney disease (CKD) and peripheral arterial disease (PAD). To investigate the incidence of CIN in patients with CKD and PAD. This retrospective study was approved by the local ethics committee. One hundred and twenty patients with 128 procedures (73 with baseline eGFR in the range of 45–60 mL/min/1.73m 2 , 55 with eGFR < 45 mL/min/1.73m 2 ) were evaluated. All patients received intra-arterially an iodine-based low-osmolar contrast material (CM) after adequate intravenous hydration with isotonic NaCl 0.9% solution. CIN was defined as an increase in serum creatinine of more than 44 μmol/L within 4 days. The influence of patient-related risk factors (age, weight, body mass index, eGFR, serum creatinine, hypertension, diabetes mellitus, coronary heart disease, heart failure) and therapy-related risk factors (amount of CM, nephrotoxic drugs, number of CM applications) on CIN were examined. CIN developed in 0% (0/73) of procedures in patients with PAD and an eGFR in the range of 45–60 mL/min/1.73m 2 and in 10.9% (6/55) of procedures in patients with an eGFR <45 mL/min/1.73m 2 . No risk factor significantly influenced the development of CIN, although baseline serum creatinine (P = 0.06) and baseline eGFR (P = 0.10) showed a considerable dependency. Patients with an eGFR in the range of 45–60 mL/min/1.73m 2 and PAD seem not at risk for CIN after intra-arterial CM application and adequate hydration. Whereas, an eGFR < 45 mL/min/1.73m 2 correlated with a risk of 10.9% for a CIN

[Association between collateral circulation and myocardial viability evaluated by cardiac magnetic resonance imaging in patients with coronary artery chronic total occlusion].

Science.gov (United States)

Li, J N; Zhang, L J; He, Y; Chen, Y L; Huang, R C; Lyu, S Z; Song, X T

2017-07-24

Objective: Late gadolinium enhancement(LGE) cardiac magnetic resonance imaging(CMR) was used to evaluate the myocardial viability of chronic total occlusion(CTO) in patients with coronary heart disease and to observe the relationship between collateral circulation and myocardium viability in these patients. Methods: This retrospective study included 40 patients with CTO diagnosed by invasive coronary angiography (CAG) from September 2015 to June 2016 in our department, all patients performed CMR examination within one week after CAG.The collateral circulation of CTO was graded with Rentrop classification as follows: poor or no collateral circulation group, moderate collateral circulation group and good collateral circulation group.According to CMR images, the delayed enhancement transmural extent of myocardial segments were scored, the ventricular wall motion of the myocardial segment were graded, and the wall motion score index (WMSI) was calculated.Spearman correlation analysis was used to analyze the relationship between the delayed enhancement transmural extent of myocardial segments and WMSI. Results: In the no or poor collateral group of 6 myocardial regions, 1 myocardial region had viable myocardium and 3 myocardial regions had no viable myocardium; in the moderate collateral group of 16 myocardial regions, 11 myocardial regions had viable myocardium and 5 myocardial regions had no viable myocardium; in the good collateral group of 24 myocardial regions, 21 myocardial regions had viable myocardium and 3 myocardial regions had no viable myocardium, there was significant difference between the groups ( P =0.002). The WMSI of poor or no collateral circulation group, moderate collateral circulation group and good collateral circulation group were 1.54±0.50, 1.21±0.34 and 1.26±0.40, respectively, there was no significant difference between the groups ( P =0.063). Spearman correlation analysis showed that the extent of delayed enhancement transmural extent of

The assessment of chronic health conditions on work performance, absence, and total economic impact for employers.

Science.gov (United States)

Collins, James J; Baase, Catherine M; Sharda, Claire E; Ozminkowski, Ronald J; Nicholson, Sean; Billotti, Gary M; Turpin, Robin S; Olson, Michael; Berger, Marc L

2005-06-01

The objective of this study was to determine the prevalence and estimate total costs for chronic health conditions in the U.S. workforce for the Dow Chemical Company (Dow). Using the Stanford Presenteeism Scale, information was collected from workers at five locations on work impairment and absenteeism based on self-reported "primary" chronic health conditions. Survey data were merged with employee demographics, medical and pharmaceutical claims, smoking status, biometric health risk factors, payroll records, and job type. Almost 65% of respondents reported having one or more of the surveyed chronic conditions. The most common were allergies, arthritis/joint pain or stiffness, and back or neck disorders. The associated absenteeism by chronic condition ranged from 0.9 to 5.9 hours in a 4-week period, and on-the-job work impairment ranged from a 17.8% to 36.4% decrement in ability to function at work. The presence of a chronic condition was the most important determinant of the reported levels of work impairment and absence after adjusting for other factors (P < 0.000). The total cost of chronic conditions was estimated to be 10.7% of the total labor costs for Dow in the United States; 6.8% was attributable to work impairment alone. For all chronic conditions studied, the cost associated with performance based work loss or "presenteeism" greatly exceeded the combined costs of absenteeism and medical treatment combined.

Versatility of the Distally-Based Sural Artery Fasciocutaneous Flap on the Lower Leg and Foot in Patients with Chronic Disease

Directory of Open Access Journals (Sweden)

Jin-Su Park

2013-05-01

Full Text Available Background  A recent advancement in microsurgery, the free flap is widely used in the re­construction ofthe lowerleg and foot. The simple and effective methods oflocal flaps, inclu­ding transposition and advancement flaps, have been considered for patients with chronicdebilitationwho are unable to endure long surgical procedures or general anesthesia.However,the location and size of the wound may restrict the clinical application of a local flap. Underthese circumstances, a sural flap can be an excellent alternative, rendering satisfying clinicaloutcomesin chronically debilitated patients.Methods  Between 2008 and 2012, 39 patients underwent soft tissue defect treatment bysural artery flap as a final method. All ofthe patients had atleast one chronic disease or more(diabetes, hypertension, vascular disease, etc.. Also, all ofthe patients had a history of chroniclower extremity ulceration, which revealed no response to several months of conservativetreatment.Results  The results of the 39 cases had a successrate of 100% with 39 complete recoveries.Nine casessuffered complications: partial necrosis(n= 4,wound dehiscencewithout necrosis(n= 3, hematoma (n= 1, and infection (n= 1.Conclusions  The sural artery flap is not only usefulforthe lowerleg but also forthe heel, andother various parts. Furthermore, itis a relatively simple surgicaltechnique forreconstructingthe defect area for patients with various chronic conditions with a high surgical risk or con­traindicationsto surgery

Chronic intestinal ischemia and splanchnic blood-flow

DEFF Research Database (Denmark)

Zacho, Helle Damgaard; Henriksen, Jens Henrik; Abrahamsen, Jan

2013-01-01

AIM: To determine the splanchnic blood flow and oxygen uptake in healthy-subjects and patients and to relate the findings to body-composition. METHODS: The total splanchnic blood flow (SBF) and oxygen uptake (SO₂U) were measured in 20 healthy volunteers (10 women) and 29 patients with suspected...... arteries was performed during the same investigation. A whole-body dual-energy x-ray absorptiometry scan was performed in healthy volunteers to determine body composition. RESULTS: Angiography revealed no atherosclerotic lesions in the intestinal arteries. The mean baseline SBF was 1087 mL/min (731...... chronic intestinal ischemia (15 women), age 40-85 years, prior to and after a standard meal. The method is based on the Fick principle using the continuous infusion of an indicator (99mTechnetium-labelled mebrofenin) and catheterization of an artery and the hepatic vein. An angiography of the intestinal...

The metabolic syndrome and risk of coronary artery disease in patients with chronic schizophrenia or schizoaffective disorder in a chronic mental institute

Directory of Open Access Journals (Sweden)

Ping-Tao Tseng

2014-11-01

Full Text Available The prevalence rate of metabolic syndrome (MS and coronary artery disease (CAD has been found to be high in patients with chronic schizophrenia. Current evidence shows that CAD is underdiagnosed in this group. Our study evaluated the prevalence of MS and the risk of CAD in patients with chronic schizophrenia in a chronic care mental hospital in southern Taiwan. We included all patients with the diagnosis of schizophrenia or schizoaffective disorder. We collected all laboratory, physical examination, psychiatric interview, and chart review data. We also evaluated the risk of CAD in these patients using the Framingham point system. There was no significant age difference in the MS prevalence rate in these patients. The young patients with schizophrenia in our study tended to have a higher prevalence of MS than the general population. In addition, female patients had a higher prevalence rate of MS than males. Based on the Framingham point system, we found the 10-year risk of CAD to be higher among the patients with schizophrenia than in the general population. Our study highlights the importance of the high risk of MS in both younger and older patients with schizophrenia, without a significant relationship to the use of antipsychotics. More complete cohort studies are needed to confirm these findings. Psychiatrists may want to establish more specific and detailed clinical guidelines for patients with chronic schizophrenia with comorbid physical diseases, especially MS and CAD.

Risks of on-pump coronary artery bypass grafting surgery in patients with chronic obstructive pulmonary disease due to sulfur mustard.

Science.gov (United States)

Firoozabadi, Mehdi Dehghani; Sheikhi, Mohammad Ali; Rahmani, Hossein; Ebadi, Ahmad; Heidari, Amanollah; Gholizadeh, Behnam; Sharifi, Khosrow

2017-10-01

Sulfur mustard (SM) is a toxic chemical agent that belongs to a class of vesicant compounds. In the 1980s it was used by the Iraqi army against Iranian forces. Sulfur mustard severely irritates the skin, eyes and lungs. The highest side effects seen in patients affected by this gas are pulmonary complications including different types of lung diseases such as bronchiolitis. It has also led to a certain type of chronic obstructive pulmonary disease called mustard lung. Similar extra-pulmonary, molecular and hormonal effects can be observed in these patients and patients with chronic obstructive pulmonary disease. Here cardiovascular complications may be one of the most dangerous visible effects. And atherosclerosis is probable following the direct effects or consequential long-term effects of SM. The development of atherosclerosis in these patients is associated with an increased risk of cardiovascular and coronary artery disease. Coronary artery bypass grafting surgery is the treatment of coronary artery disease. Doing this surgery by bypass pump has its own morbidity and due to local and systemic inflammation changes in patients with SM pulmonary disorders it may have more side effects. Therefore, detailed knowledge of inflammatory diseases as well as the serum level or even the local lung fluid of the inflammatory factors in these patients before surgery are needed so that it would be possible to reduce the rate of morbidity and mortality by normalizing the inflammatory conditions of the patients before cardiac surgery.

Pulmonary arterial lesions in explanted lungs after transplantation correlate with severity of pulmonary hypertension in chronic obstructive pulmonary disease

DEFF Research Database (Denmark)

Carlsen, Jørn; Andersen, Kasper Hasseriis; Boesgaard, Søren

2013-01-01

BACKGROUND: Pulmonary vascular findings are largely unreported in end-stage chronic obstructive pulmonary disease (COPD). METHODS: Pulmonary vascular lesions in explanted lungs from 70 patients with COPD/emphysema or α-1-antitrypsin deficiency were analyzed retrospectively. Patients were stratified...... of pulmonary vascular lesions in COPD correlate with the severity of PH. Morphologic lesions similar to those characteristic of IPAH can be observed as PH in COPD progresses to levels characteristic of IPAH....... by the presence and severity of pulmonary hypertension (PH) assessed by right-heart catheterization in 3 hemodynamically distinct groups: (1) non-PH (mean pulmonary arterial pressure [mPAP]50 mm Hg; median HE Grade 4 (range 3-6), with generalized arterial dilatation and plexiform lesions. CONCLUSIONS: The extent...

The success of opening single chronic total occlusion lesions to improve myocardialviabilitytrial (SOS-COMEDY)

Science.gov (United States)

Huang, Rongchong; Song, Xiantao; Zhang, Haishan; Tian, Wen; Huang, Zheng; Zhang, Xingwei; Yang, Junqing; Zhang, Dongfeng; Wu, Jian; Zhong, Lei; Ting, Henry H.

2018-01-01

Abstract Aims: Success of opening single (SOS)-comedy is a prospective multicenter study to compare the improvement in the decrease of myocardial viability by percutaneous coronary intervention (PCI) with that by optimal medical therapy (OMT) alone in patients with chronic total occlusion (CTO) of a single coronary artery. Methods and results: The risks and the benefits of both options (PCI and OMT) were listed in a CTO decision aid (DA). Eligible participants detected by invasive coronary angiography (ICA) or coronary computed tomography angiography (CCTA) were divided into PCI or OMT groups according to patients’ choice after shared-decision making process with DA. Participants will undergo positron emission tomography/computed tomography (PET/CT), cardiac magnetic resonance (CMR) and transthoracic echocardiography (TTE), and proceed to ICA and revascularization if possible. Blinded core laboratory interpretation will be performed for ICA, CCTA, PET/CT, CMR, and TTE. All participants will be followed up for 12 months. The primary endpoint is the improvement to the decrease of myocardial viability from baseline assessed with the use of PET/CT after 12-month follow-up. Conclusions: All of the patients are appropriately consented before enrolling in this study, which has been approved by the Ethics Committee. Results of SOS-COMEDY will be helpful to develop a strategy for single CTO patients. PMID:29668609

Arterial hypertension in women at different ages

OpenAIRE

Pacheco-Romero, José

2011-01-01

Hypertension is associated to co-morbidities such as diabetes mellitus, coronary artery disease, stroke, peripheral vascular disease, chronic renal failure, entities that decrease life span. Peruvians suffer from arterial hypertension with characteristics similar to those of the general population. Early detection and treatment of hypertension should benefit them with years of quality of life. The occurrence of arterial hypertension in women from childhood through menopause, including reprodu...

Efficacy and safety of novel multi-lumen catheter for chronic total occlusions: from preclinical study to first-in-man experience.

Science.gov (United States)

Mitsutake, Yoshiaki; Ebner, Adrian; Yeung, Alan C; Taber, Mark D; Davidson, Charles J; Ikeno, Fumiaki

2015-02-15

To report our initial animal and human experience with a new multi-lumen catheter called MultiCross™ (Roxwood Medical, Inc.) in a porcine coronary model and patients with a chronic total occlusion (CTO). Preclinical safety study was done in the coronary vasculature of a porcine model. In a clinical setting, patients with a CTO of a coronary artery (n = 5) were enrolled. After an initial unsuccessful attempt using a conventional guidewire, operators could use the MultiCross system. The primary efficacy endpoint was successful recanalization (technical success) and the primary safety endpoint was serious adverse events through 30 days post-procedure. The MultiCross catheter was used for all patients after failure of the initial attempt with a guidewire. Successful recanalization was achieved in all CTOs attempted (100%). No patients reported any adverse events at 30 days post-procedure. In this first-in-man experience, the MultiCross catheter has the potential to enhance crossing of CTOs. © 2014 Wiley Periodicals, Inc.

Contribution of reactive oxygen species to the pathogenesis of pulmonary arterial hypertension

Science.gov (United States)

Naik, Jay S.; Weise-Cross, Laura; Detweiler, Neil D.; Herbert, Lindsay M.; Yellowhair, Tracylyn R.; Resta, Thomas C.

2017-01-01

Pulmonary arterial hypertension is associated with a decreased antioxidant capacity. However, neither the contribution of reactive oxygen species to pulmonary vasoconstrictor sensitivity, nor the therapeutic efficacy of antioxidant strategies in this setting are known. We hypothesized that reactive oxygen species play a central role in mediating both vasoconstrictor and arterial remodeling components of severe pulmonary arterial hypertension. We examined the effect of the chemical antioxidant, TEMPOL, on right ventricular systolic pressure, vascular remodeling, and enhanced vasoconstrictor reactivity in both chronic hypoxia and hypoxia/SU5416 rat models of pulmonary hypertension. SU5416 is a vascular endothelial growth factor receptor antagonist and the combination of chronic hypoxia/SU5416 produces a model of severe pulmonary arterial hypertension with vascular plexiform lesions/fibrosis that is not present with chronic hypoxia alone. The major findings from this study are: 1) compared to hypoxia alone, hypoxia/SU5416 exposure caused more severe pulmonary hypertension, right ventricular hypertrophy, adventitial lesion formation, and greater vasoconstrictor sensitivity through a superoxide and Rho kinase-dependent Ca2+ sensitization mechanism. 2) Chronic hypoxia increased medial muscularization and superoxide levels, however there was no effect of SU5416 to augment these responses. 3) Treatment with TEMPOL decreased right ventricular systolic pressure in both hypoxia and hypoxia/SU5416 groups. 4) This effect of TEMPOL was associated with normalization of vasoconstrictor responses, but not arterial remodeling. Rather, medial hypertrophy and adventitial fibrotic lesion formation were more pronounced following chronic TEMPOL treatment in hypoxia/SU5416 rats. Our findings support a major role for reactive oxygen species in mediating enhanced vasoconstrictor reactivity and pulmonary hypertension in both chronic hypoxia and hypoxia/SU5416 rat models, despite a

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

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

Outcomes of the Endovascular Treatment of Stenotic Lesions versus Chronic Total Occlusions in the Iliac Sector.

Science.gov (United States)

Revuelta Suero, Sergio; Martínez López, Isaac; Hernández Mateo, Manuela; Marqués de Marino, Pablo; Cernuda Artero, Iñaki; Cabrero Fernández, Maday; Serrano Hernando, Francisco Javier

2016-07-01

This study compares outcomes of the endovascular treatment (EVT) of iliac artery occlusive disease according to whether the treated lesion is a stenosis or a chronic total occlusion (CTO). Patients undergoing EVT from 2003 to 2013 for iliac artery occlusive disease were identified and the lesions treated stratified into stenotic (Group 1, n = 375) or CTO (Group 2, n = 87). Patients were followed clinically and hemodynamically (thigh-brachial index, TBI). Comorbidities, procedural factors, and outcomes were compared between the 2 groups using Kaplan-Meier, Breslow, and Cox models. Four hundred sixty-two iliac endovascular procedures in 378 patients were included in a retrospective study. The 2 groups only differed in preprocedural TBI [0.77 (Group 1) vs. 0.67 (Group 2), P P2) patency rates [P1 93.0% and 85.8% vs. 83.1% and 74.7%, hazard ratio (HR) 1.90 (1.15-3.14), P = 0.018; P2 97.8% and 96.8% vs. 93.0% and 87.4%, HR 2.86 (1.39-5.90), P = 0.007] and freedom from reintervention (FFR) rates [91.6% and 83.5% vs. 84.1% and 78.9%, HR 1.51 (0.90-2.53), P = 0.132]. In a multivariate analysis, CTO showed a worse P2 than stenotic lesions [HR 2.81 (1.17-6.76), P = 0.021], yet no differences emerged in P1 [HR 1.41 (0.76-2.63), P = 0.277] or FFR [HR 1.43 (0.79-2.57), P = 0.237]. A lower preprocedural TBI was correlated with a greater risk of EVT failure in terms of patency and FFR (P 40 mm were related to a worse stent patency. Copyright © 2016 Elsevier Inc. All rights reserved.

Effects of cranberry juice consumption on vascular function in patients with coronary artery disease.

Science.gov (United States)

Dohadwala, Mustali M; Holbrook, Monika; Hamburg, Naomi M; Shenouda, Sherene M; Chung, William B; Titas, Megan; Kluge, Matthew A; Wang, Na; Palmisano, Joseph; Milbury, Paul E; Blumberg, Jeffrey B; Vita, Joseph A

2011-05-01

Cranberry juice contains polyphenolic compounds that could improve endothelial function and reduce cardiovascular disease risk. The objective was to examine the effects of cranberry juice on vascular function in subjects with coronary artery disease. We completed an acute pilot study with no placebo (n = 15) and a chronic placebo-controlled crossover study (n = 44) that examined the effects of cranberry juice on vascular function in subjects with coronary artery disease. In the chronic crossover study, subjects with coronary heart disease consumed a research preparation of double-strength cranberry juice (54% juice, 835 mg total polyphenols, and 94 mg anthocyanins) or a matched placebo beverage (480 mL/d) for 4 wk each with a 2-wk rest period between beverages. Beverage order was randomly assigned, and participants refrained from consuming other flavonoid-containing beverages during the study. Vascular function was measured before and after each beverage, with follow-up testing ≥12 h after consumption of the last beverage. Mean (±SD) carotid-femoral pulse wave velocity, a measure of central aortic stiffness, decreased after cranberry juice (8.3 ± 2.3 to 7.8 ± 2.2 m/s) in contrast with an increase after placebo (8.0 ± 2.0 to 8.4 ± 2.8 m/s) (P = 0.003). Brachial artery flow-mediated dilation, digital pulse amplitude tonometry, blood pressure, and carotid-radial pulse wave velocity did not change. In the uncontrolled pilot study, we observed improved brachial artery flow-mediated dilation (7.7 ± 2.9% to 8.7 ± 3.1%, P = 0.01) and digital pulse amplitude tonometry ratio (0.10 ± 0.12 to 0.23 ± 0.16, P = 0.001) 4 h after consumption of a single 480-mL portion of cranberry juice. Chronic cranberry juice consumption reduced carotid femoral pulse wave velocity-a clinically relevant measure of arterial stiffness. The uncontrolled pilot study suggested an acute benefit; however, no chronic effect on measures of endothelial vasodilator function was found. This trial

Nuclear magnetic resonance imaging with cardiac synchronization in chronic thrombosis of main pulmonary arteries. A case review with CT scan imaging correlation

International Nuclear Information System (INIS)

Coulomb, M.; Wolf, J.E.; Rose-Pittet, L.; Le Bas, J.F.; Dalsoglio, S.; Paramelle, B.

1986-01-01

Results of nuclear magnetic resonance exploration in a patient with chronic thrombosis of main pulmonary arteries are used to outline an elementary semiology in agreement with current documented data. Signs observed relate to the thrombosis and showing of flow due to associated pulmonary artery hypertension. Cardiac synchronization is essential: obtaining 2 echos by the spin-echo technique allows differentiation of circulatory slowing phenomena, which provoke increased strength of 2nd echo, from the thrombus itself. Correlations established with V/Q scintigraphy, angiography and CT scan findings in this case provided preliminary evaluation of use of this imaging technique in this affection [fr

Pulmonary Arterial Hypertension

Science.gov (United States)

... heart). This type of pulmonary hypertension was called “secondary pulmonary hypertension” but is now referred to as PH, because the cause is known to be from lung disease, heart disease, or chronic thromboemboli (blood clots). Pulmonary Arterial Hypertension (PAH) used to be ...

Nonbronchial systemic arteries: incidence and endovascular interventional management for hemoptysis

International Nuclear Information System (INIS)

Jiang Sen; Zhu Xiaohua; Sun Xiwen; You Zhengqian; Ma Jun; Yu Dong; Peng Gang; Jie Bing; Sun Chunyi

2009-01-01

Objective: To investigate the incidence and relation to primary diseases of the nonbronchial systemic arteries (NBSA) supply to the pulmonary lesions, and to evaluate the clinical value of transcatheter arterial embolization (TAE) of the responsibly NBSA for hemoptysis. Methods: The aortography and subclavian artery angiography were performed in 139 patients with hemoptysis, including pulmonary tuberculosis in 66 cases (2 cases with post-thoracoplasty, 1 case with post-lobectomy, and 1 case with ventricular septal defect), bronchiectasis in 41 (1 case with post-lobectomy and 1 case with post-ligation of patent ductus arteriosus), bronchiogenic carcinoma in 15, unknown hemoptysis in 7, silicosis in 3, broncholithiasis in 3, bronchial cysts in 1, empyema in 1, postoperative lung cancer in 1, and chronic pulmonary embolism in 1, respectively. TAE was performed in patients with the discoverable responsible NBSA. The frequency, distribution and relation to primary diseases of the responsible NBSA were evaluated and the clinical results and complications were observed. Follow-up time ranged from 6 months to 5 years. Results: Seventy-three patients (52.5%) had nonbronchial systemic contributions, including 5 cases of post-thoracotomy with pulmonary lesions, 1 case complicating with ventricular septal defect, 1 case with post-ligation of patent ductus arteriosus, and 1 case of chronic pulmonary embolism. The total number of NBSA were 181 including posterior intercostal arteries (n=88), internal thoracic arteries (n=27), inferior phrenic arteries (n=21), proper esophageal arteries (n=20), lateral thoracic arteries (n=9), subscapular arteries (n=7), costocervical trunks (n=5) and thyrocervical trunks (n=4). Main responsible NBSA were posterior intercostal arteries (n=75) and branches of subclavian and axillary artery (n=44) in patients with pulmonary tuberculosis, and proper esophageal arteries (n=16) and inferior phrenic arteries (n=17) in bronchiectasis. The clinical

Chronic intersticial lung disease in the horse- Findings in arterial bloodgas analysis, tracheobronchial mucus cytology and radiological examination of the thorax; Chronisch interstitielle Lungenerkrankung beim Pferd - Blutgasanalytische, sekretzytolytische und röntgenologische Befunde

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Dieckmann, M. [Klinik fuer Pferde, Tieraerztliche Hochschule Hannover (Germany); Klein, H. J.; Deegen, E.

1990-07-01

In 12 horses chronic interstitial lung disease was diagnosed. All horses were referrred because of unexplained loss of performance. In general there was no history of respiratory problems; 4 horses showed nasal discharge and 2 horses coughed. Results of arterial bloodgas analysis, tracheobronchial mucus cytology and radiological examination of the lungs were found in a typical combination, and they were different from results found generally in horses suffering from chronic obstructive pulmonary disease. Mean value of arterial partial pressure of oxygen was 100,6 mm Hg, arterial partial pressure of carbon dioxide was 45,1 mm Hg and alveolo-arterial difference in oxygen 5,1 mm Hg, respectively. In tracheobronchial aspirates pulmonary alveolar macrophages and neutrophil granulocytes were found in a relation of 2,6 : 1. Chest radiographs of all horses showed diffuse interstitial pattern throughout the lung.

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

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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.

Risk score for predicting long-term mortality after coronary artery bypass graft surgery.

Science.gov (United States)

Wu, Chuntao; Camacho, Fabian T; Wechsler, Andrew S; Lahey, Stephen; Culliford, Alfred T; Jordan, Desmond; Gold, Jeffrey P; Higgins, Robert S D; Smith, Craig R; Hannan, Edward L

2012-05-22

No simplified bedside risk scores have been created to predict long-term mortality after coronary artery bypass graft surgery. The New York State Cardiac Surgery Reporting System was used to identify 8597 patients who underwent isolated coronary artery bypass graft surgery in July through December 2000. The National Death Index was used to ascertain patients' vital statuses through December 31, 2007. A Cox proportional hazards model was fit to predict death after CABG surgery using preprocedural risk factors. Then, points were assigned to significant predictors of death on the basis of the values of their regression coefficients. For each possible point total, the predicted risks of death at years 1, 3, 5, and 7 were calculated. It was found that the 7-year mortality rate was 24.2 in the study population. Significant predictors of death included age, body mass index, ejection fraction, unstable hemodynamic state or shock, left main coronary artery disease, cerebrovascular disease, peripheral arterial disease, congestive heart failure, malignant ventricular arrhythmia, chronic obstructive pulmonary disease, diabetes mellitus, renal failure, and history of open heart surgery. The points assigned to these risk factors ranged from 1 to 7; possible point totals for each patient ranged from 0 to 28. The observed and predicted risks of death at years 1, 3, 5, and 7 across patient groups stratified by point totals were highly correlated. The simplified risk score accurately predicted the risk of mortality after coronary artery bypass graft surgery and can be used for informed consent and as an aid in determining treatment choice.

Arterial spin labelling shows functional depression of non-lesion tissue in chronic Wernicke's aphasia.

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Robson, Holly; Specht, Karsten; Beaumont, Helen; Parkes, Laura M; Sage, Karen; Lambon Ralph, Matthew A; Zahn, Roland

2017-07-01

Behavioural impairment post-stroke is a consequence of structural damage and altered functional network dynamics. Hypoperfusion of intact neural tissue is frequently observed in acute stroke, indicating reduced functional capacity of regions outside the lesion. However, cerebral blood flow (CBF) is rarely investigated in chronic stroke. This study investigated CBF in individuals with chronic Wernicke's aphasia (WA) and examined the relationship between lesion, CBF and neuropsychological impairment. Arterial spin labelling CBF imaging and structural MRIs were collected in 12 individuals with chronic WA and 13 age-matched control participants. Joint independent component analysis (jICA) investigated the relationship between structural lesion and hypoperfusion. Partial correlations explored the relationship between lesion, hypoperfusion and language measures. Joint ICA revealed significant differences between the control and WA groups reflecting a large area of structural lesion in the left posterior hemisphere and an associated area of hypoperfusion extending into grey matter surrounding the lesion. Small regions of remote cortical hypoperfusion were observed, ipsilateral and contralateral to the lesion. Significant correlations were observed between the neuropsychological measures (naming, repetition, reading and semantic association) and the jICA component of interest in the WA group. Additional ROI analyses found a relationship between perfusion surrounding the core lesion and the same neuropsychological measures. This study found that core language impairments in chronic WA are associated with a combination of structural lesion and abnormal perfusion in non-lesioned tissue. This indicates that post-stroke impairments are due to a wider disruption of neural function than observable on structural T1w MRI. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Aldosterone glucuronidation inhibition as a potential mechanism for arterial dysfunction associated with chronic celecoxib and diclofenac use in patients with rheumatoid arthritis.

Science.gov (United States)

Crilly, Michael A; Mangoni, Arduino A; Knights, Kathleen M

2013-01-01

Adverse cardiovascular (CV) effects of non-steroidal anti-inflammatory drugs (NSAIDs) are largely independent of their cyclooxygenase (COX) enzyme selectivity, but could be a consequence of aldosterone 18ß-glucuronidation inhibition (AGI), which varies between NSAIDS. This study assesses the chronic effects of celecoxib (selective COX-2 inhibitor) versus diclofenac (non-selective NSAID) therapy on arterial dysfunction in patients with rheumatoid arthritis (RA). AGI was assessed in vitro using human kidney cortical microsomes. Arterial function was measured clinically as the extent (augmentation index, AIX%) and timing (reflected wave transit time, RWTT, msec) of arterial wave reflection using radial applanation pulse wave analysis (SphygmoCor PWA device) in 39 RA patients without overt CV disease aged 40-65. A higher AIX% (and lower RWTT) indicates arterial dysfunction. Clinical assessment on a single occasion included a fasting blood sample, patient questionnaire and medical record review. Multivariable analysis was used to adjust for sex, mean blood pressure, arthritis duration, cumulative ESR-years and current DMARD therapy. The inhibition constant (Ki) for celecoxib was lower than that of diclofenac (Ki, 3.5 vs. 8.4 μM). Chronic celecoxib use was associated with a higher AIX% (34.8 vs. 32.3) and lower RWTT (130.1 vs. 132.7 msec) compared with diclofenac. Adjusted mean differences were AIX% 4.7 (95%CI 0.6 to 8.9; p=0.03) and RWTT -3.6 (95%CI -10.0 to 2.7; p=0.26). Celecoxib has a greater potency for AGI than diclofenac and its use is associated with a significantly higher AIX%. Our findings support AGI as a plausible mechanism for the CV toxicity of NSAIDs.

Relationship between arterial hypertension and renal damage in chronic kidney disease: insights from ABPM.

Science.gov (United States)

Paoletti, Ernesto; Bellino, Diego; Amidone, Marco; Rolla, Davide; Cannella, Giuseppe

2006-01-01

To date, few studies have used ambulatory pressure monitoring (ABPM) in patients with chronic kidney disease (CKD) before the start of dialysis treatment. The aim of this study was therefore to ascertain the correlates of arterial hypertension assessed by ABPM in CKD patients at their first referral to a nephrologist. We studied 244 (164 men; mean age 63 years) nondiabetic patients with CKD. Each patient had blood pres-sure (BP) measured by 24-hour ABPM, creatinine clearance (CrCl) estimated according to the Cockcroft-Gault formula, and Hgb concentration, serum lipids, iPTH, daily urinary protein (Uprot) and sodium (UNa) excretion assessed using routine methods. According to ABPM data analysis, 81 patients were normotensives, 78 were stable hypertensives, 26 had day-time hypertension and 59 had nocturnal hypertension. ANOVA showed both lower CrCl (p=0.0033), and higher Uprot (p nighttime SBP > 24-hour PP > daytime PP > daytime SBP > 24-hour SBP. In CKD patients, proteinuria is the strongest correlate of arterial hypertension and particularly of increased nocturnal PP, possibly as an expression of vascular damage. On the basis of these results, ABPM appears to be the most reliable tool for detecting the associations between raised BP (particularly nighttime hypertension) and renal damage in CKD patients not yet on renal replacement therapy (RRT).

Endovascular Treatment of a Gastroduodenal Artery Pseudoaneurysm Rupture after a Car Accident

Directory of Open Access Journals (Sweden)

Sofia Dutra

2017-09-01

Full Text Available The authors present a case of a 39-year-old man with alcoholic chronic pancreatitis that was admitted in the emergency department after a car accident, complaining of abdominal pain and looking pale. The patient was hemodinamically unstable, requiring blood transfusions. He underwent computed tomography angiogram of the abdomen and pelvis, showing a pseudoaneurysm of the gastroduodenal artery and a hemoperitoneum. He was referred to our interventional radiology unit and submitted to endovascular treatment, consisting of ‘backdoor’ and ‘frontdoor’ embolization of the gastroduodenal artery and pseudoaneurysm neck with coils, with total exclusion in control angiography. With this case description we intend to highlight the rarity of the pseudoaneurysm rupture of the gastroduodenal artery and to emphasize the importance of an interventional radiology response that had a fundamental role in the endovascular treatment, in an emergency context.

Contribution of noninvasive imaging methods and angiography to diagnosis of chronic viscero-visceral arterial colateral circulations in stenosis of truncus coeliacus

International Nuclear Information System (INIS)

Lanyi, A.; Kasuba, J.; Mistina, L.; Darmo, V.; Benko, M.; Pokorny, D.

1989-01-01

Stenosis and occlusion of truncus coeliacus represent the most frequent causes in the development of collateral blood circulation with caudiocranial flow through extended pancreatic-duodenal arcades. In a group of 32 patients with such mesenteric-coeliacal collateral circulation the arteriographic picture was evaluated. The differences and specific diagnostic contribution were evaluated of individual visualization methods for the demonstration of arteries. The noninvasive visualization methods are of exceptional significance in the examination of the abdominoretroperitoneal region by considerably decreasing the needs of invasive angiographic examination by the catheterization technique. This leads to a decrease in the number of diagnosed chronically developed viscerovisceral arterial collateral circulations of various etiologies. Ultrasonography and computerized tomography well depict morphological changes in the aorta diameter as well as of the unpaired viscelar arteries in the segment of their branching. The viscerovisceral arterial colateral circulations, however, may not be detected or at least not to a sufficient degree. They are represented in detail in the whole course only by selective arteriography. Attention is drawn to the supplementary role of arteriography within the framework of noninvasive visualization methods. (author). 4 figs., 14 refs

A case of reocclusion of the renal artery diagnosed by the color Doppler method with evaluation of blood flow direction in the collateral circulation of the kidney in addition to the non-detectable blood signal in the renal artery.

Science.gov (United States)

Hirano, Megumi; Ohta, Tomoyuki; Nakata, Norio; Kawakami, Reina; Takamura, Kimihiro; Matsuda, Tosiharu; Nishioka, Makiko; Sakurai, Tomoo; Matsuo, Kouichi; Miyamoto, Yukio

2014-10-01

A 23-year-old woman was referred to our hospital for an interventional procedure for chronic total occlusion of the right renal artery, probably due to fibromuscular dysplasia (FMD), and for control of renal vascular hypertension. Before percutaneous transluminal renal angioplasty (PTRA), aortography revealed collateral circulation to the right kidney from the lower lumbar artery. After PTRA, however, blood flow in the renal side of the collateral circulation flowed outside from the right renal parenchyma. 4 months later, we could not find a blood flow signal in the right renal artery, and there was a contrary flow signal in the right kidney parenchyma continuously from the extrahilar vessel, possibly a collateral artery. These findings indicated reocclusion of the right artery. We confirmed reocclusion of the renal artery and collateral feeding by contrast dynamic computed tomography (CT), and PTRA was performed again without any complications or reocclusion for 5 months. This is the first case report showing that a back-flowing signal in the right renal parenchyma from the extrahilar artery is useful as an indirect finding suggesting reocclusion.

Endovascular Treatment of Unusual Multiple Aneurysms of the Internal Carotid Artery-Posterior Communicating Artery Complex

OpenAIRE

Kubo, Michiya; Kuwayama, Naoya; Hirashima, Yutaka; Ohi, Masayoshi; Takami, Masaaki; Endo, Shunro

2000-01-01

A 79-year-old female presented with subarachnoid hemorrhage due to rupture of a rare true posterior communicating artery(PCoA)aneurysm and with poor general condition. Endovascular therapy was performed in the chronic stage. Right carotid angiography just before embolization demonstrated unusual multiple aneurysms of the internal carotid artery(ICA)-PCoA complex. Superselective an-giography and aneurysmography using microcatheter revealed two separate aneurysms arising from the PCoA and the I...

First Report of 90-Day Support of Two Calves with a Continuous-Flow Total Artificial Heart

Science.gov (United States)

Karimov, Jamshid H.; Moazami, Nader; Kobayashi, Mariko; Sale, Shiva; Such, Kimberly; Byram, Nicole; Sunagawa, Gengo; Horvath, David; Gao, Shengqiang; Kuban, Barry; Golding, Leonard A.; Fukamachi, Kiyotaka

2015-01-01

Objective The Cleveland Clinic continuous-flow total artificial heart (CFTAH) is a compact, single-piece, valveless, pulsatile pump providing self-regulated hemodynamic output to left/right circulation. We evaluated chronic in vivo pump performance, physiologic and hemodynamic parameters, and biocompatibility of the CFTAH in a well-established calf model. Methods CFTAH pumps have been implanted in 17 calves total. Hemodynamics, pump performance, and device-related adverse events were evaluated during studies and at necropsy. Results In vivo experiments demonstrated good hemodynamic performance (pump flow, 7.3 ± 0.7 L/min; left atrial pressure [LAP], 16 ± 3 mm Hg; right atrial pressure [RAP], 17 ± 3 mm Hg; RAP-LAP difference, 1 ± 2 mm Hg; mean arterial pressure, 103 ± 7 mm Hg; arterial pulse pressure, 30 ± 11 mm Hg; pulmonary arterial pressure, 34 ± 5 mm Hg). The CFTAH has operated within design specifications and never failed. With ever-improving pump design, the implants have shown no chronic hemolysis. Three recent animals with the CFTAH recovered well, with no postoperative anticoagulation, during planned in vivo durations of 30, 90, and 90 days (last two were intended to be 90-day studies). All these longest-surviving cases showed good biocompatibility, with no thromboembolism in organs. Conclusions The current CFTAH has demonstrated reliable self-regulation of hemodynamic output and acceptable biocompatibility without anticoagulation throughout 90 days of chronic implantation in calves. Meeting these milestones is in accord with our strategy to achieve transfer of this unique technology to surgical practice, thus filling the urgent need for cardiac replacement devices as destination therapy. PMID:26173607

Calcified Plaque of Coronary Artery: Factors Influencing Overestimation of Coronary Artery Stenosis on Coronary CT Angiography

International Nuclear Information System (INIS)

Kim, Mok Hee; Kim, Yun Hyeon; Choi, Song; Seon, Hyun Ju; Jeong, Gwang Woo; Park, Jin Gyoon; Kang, Heoung Keun; Ko, Joon Seok

2010-01-01

To assess the influence of calcified plaque characteristics on the overestimation of coronary arterial stenosis on a coronary CT angiography (CCTA). The study included 271 coronary arteries with calcified plaques identified by CCTA, and based on 928 coronary arteries from 232 patients who underwent both CCTA and invasive coronary angiography (ICA). Individual coronary arteries were classified into two groups by agreement based on the degree of stenosis from each CCTA and ICA: 1) group A includes patients with concordant CCTA and ICA results and, 2) group B includes patients with an overestimation of CCTA compared to ICA. Parameters including total calcium score, calcium score of an individual coronary artery, calcium burden number of an individual coronary artery, and the density of each calcified plaque (calcium score / number of calcium burden) for each individual coronary artery were compared between the two groups. Of the 271 coronary arteries, 164 (60.5%) were overestimated on CCTA. The left anterior descending artery (LAD) had a significantly low rate of overestimation (47.1%) compared to the other coronary arteries (p=0.001). No significant differences for total calcium score, calcium score of individual coronary artery, and the density of each calcified plaque from individual coronary arteries between two groups was observed. However, a decreasing tendency for the rate of overestimation on CCTA was observed with an increase in calcium burden of individual coronary arteries (p<0.05). The evaluation of coronary arteries suggests that the degree of coronary arterial stenosis had a tendency to be overestimated by calcified plaques on CCTA. However, the rate of overestimation for the degree of coronary arterial stenosis by calcified plaques was not significantly influenced by total calcium score, calcium score of individual coronary artery, and density of each calcified plaque

Losartan attenuates chronic cigarette smoke exposure-induced pulmonary arterial hypertension in rats: Possible involvement of angiotensin-converting enzyme-2

International Nuclear Information System (INIS)

Han Suxia; He Guangming; Wang Tao; Chen Lei; Ning Yunye; Luo Feng; An Jin; Yang Ting; Dong Jiajia; Liao Zenglin; Xu Dan; Wen Fuqiang

2010-01-01

Chronic cigarette smoking induces pulmonary arterial hypertension (PAH) by largely unknown mechanisms. Renin-angiotensin system (RAS) is known to function in the development of PAH. Losartan, a specific angiotensin II receptor antagonist, is a well-known antihypertensive drug with a potential role in regulating angiotensin-converting enzyme-2 (ACE2), a recently found regulator of RAS. To determine the effect of losartan on smoke-induced PAH and its possible mechanism, rats were daily exposed to cigarette smoke for 6 months in the absence and in the presence of losartan. Elevated right ventricular systolic pressure (RVSP), thickened wall of pulmonary arteries with apparent medial hypertrophy along with increased angiotensin II (Ang II) and decreased ACE2 levels were observed in smoke-exposed-only rats. Losartan administration ameliorated pulmonary vascular remodeling, inhibited the smoke-induced RVSP and Ang II elevation and partially reversed the ACE2 decrease in rat lungs. In cultured primary pulmonary artery smooth muscle cells (PASMCs) from 3- and 6-month smoke-exposed rats, ACE2 levels were significantly lower than in those from the control rats. Moreover, PASMCs from 6-month exposed rats proliferated more rapidly than those from 3-month exposed or control rats, and cells grew even more rapidly in the presence of DX600, an ACE2 inhibitor. Consistent with the in vivo study, in vitro losartan pretreatment also inhibited cigarette smoke extract (CSE)-induced cell proliferation and ACE2 reduction in rat PASMCs. The results suggest that losartan may be therapeutically useful in the chronic smoking-induced pulmonary vascular remodeling and PAH and ACE2 may be involved as part of its mechanism. Our study might provide insight into the development of new therapeutic interventions for PAH smokers.

Medical therapy, percutaneous coronary intervention and prognosis in patients with chronic total occlusions.

Science.gov (United States)

Ladwiniec, Andrew; Allgar, Victoria; Thackray, Simon; Alamgir, Farquad; Hoye, Angela

2015-12-01

There is little published data reporting outcomes for those found to have a chronic total coronary occlusion (CTO) that is electively treated medically versus those treated by percutaneous coronary intervention (PCI). We sought to compare long-term clinical outcomes between patients treated by PCI and elective medical therapy in a consecutive cohort of patients with an identified CTO. Patients found to have a CTO on angiography between January 2002 and December 2007 in a single tertiary centre were identified using a dedicated database. Those undergoing CTO PCI and elective medical therapy to the CTO were propensity matched to adjust for baseline clinical and angiographic differences. In total, 1957 patients were identified, a CTO was treated by PCI in 405 (20.7%) and medical therapy in 667 (34.1%), 885 (45.2%) patients underwent coronary artery bypass graft surgery. Of those treated by PCI or medical therapy, propensity score matching identified 294 pairs of patients, PCI was successful in 177 patients (60.2%). All-cause mortality at 5 years was 11.6% for CTO PCI and 16.7% for medical therapy HR 0.63 (0.40 to 1.00, p=0.052). The composite of 5-year death or myocardial infarction occurred in 13.9% of the CTO PCI group and 19.6% in the medical therapy group, HR 0.64 (0.42 to 0.99, p=0.043). Among the CTO PCI group, if the CTO was revascularised by any means during the study period, 5-year mortality was 10.6% compared with 18.3% in those not revascularised in the medical therapy group, HR 0.50 (0.28-0.88, p=0.016). Revascularisation, but not necessarily PCI of a CTO, is associated with improved long-term survival relative to medical therapy alone. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Thrombosis of digital arteries associated with tamoxifen use: case report.

Science.gov (United States)

Hutchison, Richard L; Rayan, Ghazi M

2012-02-01

Arterial thrombosis in the upper extremity occurs often at the wrist. We report a unique case of thrombosis that involved multiple digital arteries, without radial or ulnar artery involvement, which developed only after using tamoxifen despite chronic occupational blunt percussive hand use. Revascularization was achieved after thrombectomy. Multiple digital arterial thromboses may complicate the use of tamoxifen. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The ability of NT-proBNP to detect chronic heart failure and predict all-cause mortality is higher in elderly Chinese coronary artery disease patients with chronic kidney disease

OpenAIRE

Fu, Shihui; Yi,Shuangyan; Liu,Yuan; Zhu,Bing; Wang,Liang; Tiehui Xiao,; Bai,Yongyi; Ye,Ping; Luo,Leiming

2013-01-01

Shihui Fu, Leiming Luo, Ping Ye, Shuangyan Yi, Yuan Liu, Bing Zhu, Liang Wang, Tiehui Xiao, Yongyi Bai Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, People's Republic of China Objective: To analyze the relationship between N-terminal pro-brain natriuretic peptide (NT-proBNP) and renal function, and compare the ability and cut-off thresholds of NT-proBNP to detect chronic heart failure (CHF) and predict mortality in elderly Chinese coronary artery disease ...

Interventions for the prediction and management of chronic postsurgical pain after total knee replacement: systematic review of randomised controlled trials.

Science.gov (United States)

Beswick, Andrew D; Wylde, Vikki; Gooberman-Hill, Rachael

2015-05-12

Total knee replacement can be a successful operation for pain relief. However, 10-34% of patients experience chronic postsurgical pain. Our aim was to synthesise evidence on the effectiveness of applying predictive models to guide preventive treatment, and for interventions in the management of chronic pain after total knee replacement. We conducted a systematic review of randomised controlled trials using appropriate search strategies in the Cochrane Library, MEDLINE and EMBASE from inception to October 2014. No language restrictions were applied. Adult patients receiving total knee replacement. Predictive models to guide treatment for prevention of chronic pain. Interventions for management of chronic pain. Reporting of specific outcomes was not an eligibility criterion but we sought outcomes relating to pain severity. No studies evaluated the effectiveness of predictive models in guiding treatment and improving outcomes after total knee replacement. One study evaluated an intervention for the management of chronic pain. The trial evaluated the use of a botulinum toxin A injection with antinociceptive and anticholinergic activity in 49 patients with chronic postsurgical pain after knee replacement. A single injection provided meaningful pain relief for about 40 days and the authors acknowledged the need for a large trial with repeated injections. No trials of multidisciplinary interventions or individualised treatments were identified. Our systematic review highlights a lack of evidence about the effectiveness of prediction and management strategies for chronic postsurgical pain after total knee replacement. As a large number of people are affected by chronic pain after total knee replacement, development of an evidence base about care for these patients should be a research priority. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Total pancreatectomy and autoislet transplant for chronic recurrent pancreatitis in a 5-year-old boy

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Shaheed Merani

2016-10-01

Full Text Available Childhood chronic pancreatitis is a rare disorder, which can lead to a chronically debilitating condition. The etiology of recurrent hereditary pancreatitis, which previously was classified as idiopathic, has now been attributed in certain cases to specific genetic mutations including abnormalities in the PRSS gene. We describe here the use of total pancreatectomy and autoislet transplant in a 5-year-old with chronic pancreatitis. This represents the youngest patient undergoing the procedure at our institution. The early successful outcomes for this patient, both of symptom relief and glycemic control are detailed.

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. Copyright © 2016 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

Total Arterial Off‑pump Coronary Revascularization with a Bilateral ...

African Journals Online (AJOL)

2012-10-10

surgery for the patients. ... Y graft under OPCABG for the selected patients. We ... October 10, 2012, IP: 41.185.99.174] || Click here to download free Android application for this journal ..... did pay more attention to treat first the intercostal artery.

Arterial scan versus radiographic angiography in detection of shallow arterial ulcers

International Nuclear Information System (INIS)

Pollak, E.W.; Webber, M.M.; Cragin, M.D.; Wolfman, E.F. Jr.

1977-01-01

A comparison of 99m-technetium albumin aggregated arterial scan and radiographic angiography for detection of shallow intimal carotid artery ulcerations was made in a series of 12 anesthetized dogs, having a total of 16 acute arterial ulcerations. Radiographic angiography showed positive findings related to presence of stenosis or mural thrombosis in 12 instances. Direct visualization of ulceration was only exceptionally encountered. Arterial scan detected 14 of 16 intimal ulcers. The radionuclide method was reliable even in absence of stenosis or when only minimal mural thrombosis was present. Moreover, autopsy scan of the isolated arterial segments detected all 16 intimal lesions. These results indicate that the arterial scan was a more reliable method for detection of shallow arterial ulcers in this experimental model than radiographic angiography, especially when arterial lumen stenosis or mural thrombosis was minimal or absent

Impact of Duplex arterial mapping on decision making in non-acute ischemic limb patients.

Science.gov (United States)

Elbadawy, A; Aly, H; Ibrahim, M; Bakr, H

2015-12-01

The aim of this study was to demonstrate the impact of Duplex arterial mapping on decision making in non-acute ischemic limb patient group reporting pain onset between 15 days and 3 months. We prospectively evaluated patients presented with critical limb ischemia who reported pain onset of duration between 15 days and 3 months in one-year period. Our series included thirty cases (mean age=61.3 years old), as Duplex arterial mapping was the sole preoperative imaging tool performed in all of them. All patients, in whom duplex indicated thrombosis in long occluded segments, were candidates for fluoroscopically guided thrombectomy. When Duplex defined chronic arterial occlusions, patients underwent endovascular or bypass revascularisation procedures. Impact of Duplex wall interrogation on decision-making between the two groups (subacute and chronic) was measured. Duplex arterial mapping categorized correctly all 30 patients into either subacute ischemia with removable clot (N.=14) or chronic ischemia (N.=16). Fluoroscopic guided thrombectomy was performed in 14 cases when Duplex advised long occluded arterial segments as indicted by intact intima with echogenic thrombus inside. Bypass surgery was performed in 8 patients. Percutaneous transluminal angioplasty (PTA) was done in 7 cases and thrombendartrectomy of common femoral artery in a single case. One-year patency rate in our series was 86.6%. It was 71.4% in thrombosis group. Limb salvage rate was 93.3%. Duplex arterial mapping could be used to differentiate the subacute ischemia with removable thrombus and chronic arterial occlusions guiding for the best revascularization procedure accordingly.

Identification of viable myocardium in patients with chronic coronary artery disease and left ventricular dysfunction. Comparison of thallium scintigraphy with reinjection and PET imaging with 18F-fluorodeoxyglucose

International Nuclear Information System (INIS)

Bonow, R.O.; Dilsizian, V.; Cuocolo, A.; Bacharach, S.L.

1991-01-01

In patients with chronic coronary artery disease and left ventricular dysfunction, the distinction between ventricular dysfunction arising from myocardial fibrosis and ischemic, but viable, myocardium has important clinical implications. By positron emission tomography (PET), enhanced fluorine-18-labeled fluorodeoxyglucose (FDG) uptake in myocardial segments with impaired function and reduced blood flow is evidence of myocardial viability. Reinjection of thallium-201 at rest immediately after stress-redistribution imaging may also provide evidence of myocardial viability by demonstrating thallium uptake in regions with apparently irreversible defects. To compare these two methods, we studied 16 patients with chronic coronary artery disease and left ventricular dysfunction, all of whom had irreversible defects on standard exercise-redistribution thallium single-photon emission computed tomography (SPECT) imaging. Thallium was reinjected immediately after the redistribution study, and SPECT images were reacquired. The patients also underwent PET imaging with FDG and oxygen-15-labeled water. A total of 432 myocardial segments were analyzed from comparable transaxial tomograms, of which 166 (38%) had irreversible thallium defects on redistribution images before reinjection. FDG uptake was demonstrated in 121 (73%) of these irreversible defects. Irreversible defects were then subgrouped according to the degree of thallium activity, relative to peak activity in normal regions. Irreversible defects with only mild (60-85% of peak activity) or moderate (50-59% of peak) reduction in thallium activity were considered viable on the basis of FDG uptake in 91% and 84% of these segments, respectively. In contrast, in irreversible defects with severe reduction in thallium activity (less than 50% of peak), FDG uptake was present in 51% of segments

Efficacy of total lymphoid irradiation for chronic allograft rejection following double lung transplantation

International Nuclear Information System (INIS)

Diamond, David A.; Michalski, Jeff M.; Trulock, Elbert M.; Lynch, John P.

1997-01-01

Purpose: The purpose of this study was to assess the safety and efficacy of total lymphoid irradiation in a series of patients experiencing chronic rejection following bilateral lung transplantation. Patients and Materials: Eleven patients (10 males, 1 female) received total lymphoid irradiation for chronic allograft rejection (bronchiolitis obliterans syndrome) refractory to conventional treatment modalities. Treatment was delivered between March, 1995, and September, 1996. Mean patient age was 33 years (range 15-51). Indications for transplantation included cystic fibrosis (7 patients), alpha 1 anti-trypsin deficiency (2 patients), primary pulmonary hypertension (1 patient), and emphysema (1 patient). Radiation therapy was prescribed as 800 cGy delivered in ten 80 cGy fractions, 2 fractions per week, via AP/PA mantle and inverted-Y fields. Radiation was withheld for total wbc count 3 , absolute neutrophil count 3 , or platelets 3 . Serial pre- and post-radiation therapy pulmonary function values, complete blood counts, and immunosuppressive augmentation requirements (use of methylprednisolone, azathioprine, mycophenolate mofetil, OKT3, and FK506) were monitored. Results: In the 3 months preceding total lymphoid irradiation, the average decrease in FEV 1 was 34% (range 0-75%) and the median number of immunosuppression augmentations was 3 (range 0-5). At initiation of radiation therapy, the average FEV 1 was 1.4 liters (range 0.77-2.28). Only (4(11)) patients completed all 10 treatment fractions. Reasons for discontinuation included unabated rejection (4 patients), worsening pulmonary infection (2 patients), and persistent thrombocytopenia (1 patient). No treatment course was discontinued because of persistent neutropenia or leukopenia. Seven of the 11 patients failed within 8 weeks of treatment cessation. One patient had unabated rejection and received bilateral living related donor transplants. He is alive and well. Six patients died. Two of these deaths were due

Pleural subxyphoid drain confers better pulmonary function and clinical outcomes in chronic obstructive pulmonary disease after off-pump coronary artery bypass grafting: a randomized controlled trial

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Solange Guizilini

2014-12-01

Full Text Available Objective: To evaluate the lung function and clinical outcome in severe chronic obstructive pulmonary disease in patients undergoing off-pump coronary artery bypass grafting with left internal thoracic artery graft, comparing the pleural drain insertion in the intercostal versus subxyphoid region. Methods: A randomized controlled trial. Chronic obstructive pulmonary disease patients were randomized into two groups according pleural drain site: II group (n=27 - pleural drain in intercostal space; SI group (n=29 - pleural drain in the subxyphoid region. Spirometry values (Forced Vital Capacity - and Forced expiratory volume in 1 second were obtained on preoperative and 1, 3 and 5 postoperative days. Chest x-ray from preoperative until postoperative day 5 (POD5 was performed for monitoring respiratory events, such as atelectasis and pleural effusion. Pulmonary shunt fraction and pain score was evaluate preoperatively and on postoperative day 1. Results: In both groups there was a significant decrease of the spirometry values (Forced Vital Capacity and Forced expiratory volume in 1 second until POD5 (P<0.05. However, when compared, SI group presented less decrease in these parameters (P<0.05. Pulmonary shunt fraction was significantly lower in SI group (P<0.05. Respiratory events, pain score, orotracheal intubation time and postoperative length of hospital stay were lower in the SI group (P<0.05. Conclusion: Subxyphoid pleural drainage in severe Chronic obstructive pulmonary disease patients determined better preservation and recovery of pulmonary capacity and volumes with lower pulmonary shunt fraction and better clinical outcomes on early postoperative off-pump coronary artery bypass grafting.

Myocardial perfusion SPECT in diabetic patients for detection of coronary artery disease

International Nuclear Information System (INIS)

Saeed, M.A.; Fatima, S.; Fatmi, S.; Kureshi, S.

2003-01-01

The aim of this study was to evaluate the efficacy of myocardial SPECT perfusion scan in the diagnosis of coronary artery disease in diabetic patients. A total number of thirty diabetic patients (21 males, 9 females) were included in the study. All the patients had strong risk-factors for coronary artery disease (strong family history, chronic smokers, hyperlipidemia, history of chest pain). All patients underwent coronary angiography and stress/rest myocardial perfusion SPECT scans with Tc-99m MIBI (two days protocol). Twenty two patients had significant coronary artery stenosis and 8 had normal coronary arteries. Myocardial perfusion scintigraphy (MPS) was positive in 19 subjects out of the 22 patients with significant stenosis (Sensitivity 86.4%) and negative (false negative) in only three. Out of 8 patients with normal angiography 7 had normal MPS (Specificity 87.5%) whereas only one patient revealed abnormality in the myocardial perfusion study. When compared with coronary angiography the positive predictive value and negative predictive value for Tc-99m MIBI myocardial perfusion scan was 86.4% and 87.5% respectively. In conclusion, Tc-99m MIBI myocardial perfusion scintigraphy is a useful screening modality for the detection of coronary artery disease in diabetic patients. (author)

Effects of cranberry juice consumption on vascular function in patients with coronary artery disease123

Science.gov (United States)

Dohadwala, Mustali M; Holbrook, Monika; Hamburg, Naomi M; Shenouda, Sherene M; Chung, William B; Titas, Megan; Kluge, Matthew A; Wang, Na; Palmisano, Joseph; Milbury, Paul E; Blumberg, Jeffrey B; Vita, Joseph A

2011-01-01

Background: Cranberry juice contains polyphenolic compounds that could improve endothelial function and reduce cardiovascular disease risk. Objective: The objective was to examine the effects of cranberry juice on vascular function in subjects with coronary artery disease. Design: We completed an acute pilot study with no placebo (n = 15) and a chronic placebo-controlled crossover study (n = 44) that examined the effects of cranberry juice on vascular function in subjects with coronary artery disease. Results: In the chronic crossover study, subjects with coronary heart disease consumed a research preparation of double-strength cranberry juice (54% juice, 835 mg total polyphenols, and 94 mg anthocyanins) or a matched placebo beverage (480 mL/d) for 4 wk each with a 2-wk rest period between beverages. Beverage order was randomly assigned, and participants refrained from consuming other flavonoid-containing beverages during the study. Vascular function was measured before and after each beverage, with follow-up testing ≥12 h after consumption of the last beverage. Mean (±SD) carotid-femoral pulse wave velocity, a measure of central aortic stiffness, decreased after cranberry juice (8.3 ± 2.3 to 7.8 ± 2.2 m/s) in contrast with an increase after placebo (8.0 ± 2.0 to 8.4 ± 2.8 m/s) (P = 0.003). Brachial artery flow-mediated dilation, digital pulse amplitude tonometry, blood pressure, and carotid-radial pulse wave velocity did not change. In the uncontrolled pilot study, we observed improved brachial artery flow-mediated dilation (7.7 ± 2.9% to 8.7 ± 3.1%, P = 0.01) and digital pulse amplitude tonometry ratio (0.10 ± 0.12 to 0.23 ± 0.16, P = 0.001) 4 h after consumption of a single 480-mL portion of cranberry juice. Conclusions: Chronic cranberry juice consumption reduced carotid femoral pulse wave velocity—a clinically relevant measure of arterial stiffness. The uncontrolled pilot study suggested an acute benefit; however, no chronic effect on measures of

Lack of exercise is a major cause of chronic diseases

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Booth, Frank W.; Roberts, Christian K.; Laye, Matthew J.

2014-01-01

Chronic diseases are major killers in the modern era. Physical inactivity is a primary cause of most chronic diseases. The initial third of the article considers: activity and prevention definitions; historical evidence showing physical inactivity is detrimental to health and normal organ functional capacities; cause vs. treatment; physical activity and inactivity mechanisms differ; gene-environment interaction [including aerobic training adaptations, personalized medicine, and co-twin physical activity]; and specificity of adaptations to type of training. Next, physical activity/exercise is examined as primary prevention against 35 chronic conditions [Accelerated biological aging/premature death, low cardiorespiratory fitness (VO2max), sarcopenia, metabolic syndrome, obesity, insulin resistance, prediabetes, type 2 diabetes, non-alcoholic fatty liver disease, coronary heart disease, peripheral artery disease, hypertension, stroke, congestive heart failure, endothelial dysfunction, arterial dyslipidemia, hemostasis, deep vein thrombosis, cognitive dysfunction, depression and anxiety, osteoporosis, osteoarthritis, balance, bone fracture/falls, rheumatoid arthritis, colon cancer, breast cancer, endometrial cancer, gestational diabetes, preeclampsia, polycystic ovary syndrome, erectile dysfunction, pain, diverticulitis, constipation, and gallbladder diseases]. The article ends with consideration of deterioration of risk factors in longer-term sedentary groups; clinical consequences of inactive childhood/adolescence; and public policy. In summary, the body rapidly maladapts to insufficient physical activity, and if continued, results in substantial decreases in both total and quality years of life. Taken together, conclusive evidence exists that physical inactivity is one important cause of most chronic diseases. In addition, physical activity primarily prevents, or delays, chronic diseases, implying that chronic disease need not be an inevitable outcome during life

Relationship between collateral circulation and myocardial viability of 18F-FDG PET/CT subtended by chronic total occluded coronary arteries.

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Dong, Wei; Li, Jianan; Mi, Hongzhi; Song, Xiantao; Jiao, Jian; Li, Quan

2018-04-01

To analyze the relationship between the collateral flow of coronary chronic total occlusion (CTO) and myocardial viability detected by 18 F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) imaging. A prospective analysis of 104 patients diagnosed by coronary angiography. All patients underwent resting myocardial perfusion imaging and PET/CT within 1 week. The collateral circulation was graded with Rentrop classification as no or poor collateral circulation in 16 CTO vessels, moderate collateral circulation in 34 CTO vessels, and good collateral circulation in 69 CTO vessels. Myocardial viability was determined with myocardial perfusion imaging and PET. The patterns were interpreted as mismatch, match and normal perfusion and 18 F-FDG uptake. There was no significant correlation between the severity and extent of perfusion defect, myocardial viability and collateral circulation grade. The myocardial viability was normal in mild and moderate hypokinetic regions and decreased in severe hypokinetic and akinesis-dyskinesis regions. The presence of collateral circulation was a sensitive (89%) but not a specific (31%) sign of myocardial viability. In patients with CTO, collateral circulation does not seem to be an effective way for predicting myocardial viability. Further analysis of PET patterns of viable myocardium is needed to guide further revascularization and predict functional improvement and survival benefit.

First report of 90-day support of 2 calves with a continuous-flow total artificial heart.

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Karimov, Jamshid H; Moazami, Nader; Kobayashi, Mariko; Sale, Shiva; Such, Kimberly; Byram, Nicole; Sunagawa, Gengo; Horvath, David; Gao, Shengqiang; Kuban, Barry; Golding, Leonard A R; Fukamachi, Kiyotaka

2015-09-01

The Cleveland Clinic continuous-flow total artificial heart (CFTAH) is a compact, single-piece, valveless, pulsatile pump providing self-regulated hemodynamic output to left/right circulation. We evaluated chronic in vivo pump performance, physiologic and hemodynamic parameters, and biocompatibility of the CFTAH in a well-established calf model. CFTAH pumps have been implanted in 17 calves total. Hemodynamic parameters, pump performance, and device-related adverse events were evaluated during studies and at necropsy. In vivo experiments demonstrated good hemodynamic performance (pump flow, 7.3 ± 0.7 L/min; left atrial pressure, 16 ± 3 mm Hg; right atrial pressure, 17 ± 3 mm Hg; right atrial pressure-left atrial pressure difference, 1 ± 2 mm Hg; mean arterial pressure, 103 ± 7 mm Hg; arterial pulse pressure, 30 ± 11 mm Hg; and pulmonary arterial pressure, 34 ± 5 mm Hg). The CFTAH has operated within design specifications and never failed. With ever-improving pump design, the implants have shown no chronic hemolysis. Three animals with recent CFTAH implantation recovered well, with no postoperative anticoagulation, during planned in vivo durations of 30, 90, and 90 days (last 2 were intended to be 90-day studies). All these longest-surviving cases showed good biocompatibility, with no thromboembolism in organs. The current CFTAH has demonstrated reliable self-regulation of hemodynamic output and acceptable biocompatibility without anticoagulation throughout 90 days of chronic implantation in calves. Meeting these milestones is in accord with our strategy to achieve transfer of this unique technology to human surgical practice, thus filling the urgent need for cardiac replacement devices as destination therapy. Copyright © 2015 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

A case of gastrointestinal bleeding due to right hepatic artery pseudoaneurysm following total remnant pancreatectomy: A case report

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Atsushi Fujio

Full Text Available Introduction: Pseudoaneurysm is a serious complication after pancreatic surgery, which mainly depends on the presence of a preceding pancreatic fistula. Postpancreatectomy hemorrhage following total pancreatectomy is a rare complication due to the absence of a pancreatic fistula. Here we report an unusual case of massive gastrointestinal bleeding due to right hepatic artery (RHA pseudoaneurysm following total remnant pancreatectomy. Presentation of case: A 75-year-old man was diagnosed with intraductal papillary mucinous carcinoma recurrence following distal pancreatectomy and underwent total remnant pancreatectomy. After discharge, he was readmitted to our hospital with melena because of the diagnosis of gastrointestinal bleeding. Gastrointestinal endoscopy was performed to detect the origin of bleeding, but an obvious bleeding point could not be detected. Abdominal computed tomography demonstrated an expansive growth, which indicated RHA pseudoaneurysm. Emergency angiography revealed gastrointestinal bleeding into the jejunum from the ruptured RHA pseudoaneurysm. Transcatheter arterial embolization was performed; subsequently, bleeding was successfully stopped for a short duration. Because of improvements in his general condition, the patient was discharged. Discussion: To date, very few cases have described postpancreatectomy hemorrhage following total remnant pancreatectomy. We suspect that the aneurysm ruptured into the jejunum, possibly because of the scarring and inflammation associated with his two complex surgeries. Conclusion: Pseudoaneurysm should be considered when the fragility of blood vessels is suspected, despite no history of anastomotic leak and intra-abdominal abscess. Our case also highlighted that detecting gastrointestinal bleeding is necessary to recognize sentinel bleeding if the origin of bleeding is undetectable. Abbreviations: PPH, RHA, CT, IPMC, RCCs, POD, LHA, GIE, TAE, Keywords: Case report, Pseudoaneurysm, Total

24-HOUR ARTERIAL STIFFNESS VALUES IN MEN WITH DIFFERENT PHENOTYPES OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE CONCURRENT WITH HYPERTENSION

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N. A. Karoli

2015-01-01

Full Text Available Objective: to study the specific features of the daily arterial stiffness (AS profile in men with different phenotypes of chronic obstructive pulmonary disease (COPD concurrent with hypertension. Subjects and methods. The investigation enrolled 78 male patients with COPD and hypertension. The patients were divided according to COPD phenotypes into 2 groups: 1 COPD patients with emphysema; 2 those with bronchitis. The exclusion criteria were less than 40 years and more than 80 years of age; diabetes mellitus; coronary heart disease; vascular diseases; an exacerbation of chronic diseases; bronchial and pulmonary diseases of another etiology. The patients underwent 24-hour blood pressure and AS monitoring, external respiratory function testing: spirography with a short-acting β2-agonist test, a six-minute walk test at baseline and after a hemoglobin oxygen saturation test, and a CAT test. Results. The patients of both groups were observed to have a statistically significant increase in (dP/dtmax as compared to those of the control group (p < 0.05; p < 0.01 in both the daytime and nighttime. In these periods, the COPD patients with emphysema had a higher AIx than those with bronchitis (p < 0.001. There was a statistically significantly (p < 0.001 higher AIx in the nighttime than in the daytime in Groups 1 and 2 patients. Conclusion. The patients with different COPD phenotypes were noted to have impaired arterial elastic properties, circadian AS changes with predominantly nocturnal impaired vascular stiffness. Relationships were found between 24-hour AS values and clinicoanamnestic findings. 

Studies on arterial stiffness and wave reflections in hypertension.

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Safar, Michel E; Levy, Bernard I

2015-01-01

Patho-physiological and pharmacological studies have consistently noticed that, with the exception of subjects with end-stage renal disease, total intravascular blood volume is not increased in patients with chronic hypertension. Because the mean circulatory pressure is enhanced in such subjects, it was postulated that the compliance of the cardiovascular system could be abnormally low in this particular population. This simple observation has influenced a great part of our experimental and clinical research directed toward subjects with hypertension and their relationship with the compliance of the vascular system. These works started between 1970 and 1980 by methodological investigations and validations followed by analysis of clinical situations that showed that venous and mostly arterial stiffness were significantly increased in hypertensive patients independently of blood pressure level. During the same time, we assessed the role of endothelium on the large arterial wall mechanical properties in normotensive and hypertensive rats. Thereafter more specific directions have been developed, affecting large arteries structure and function and arterial wall remodeling, including their consequences on central and peripheral hemodynamics. In parallel, epidemiological studies identified the pulsatile hemodynamic parameters as major independent predictors of cardiovascular risks. The consequences of these alterations on clinical pharmacology and therapeutics in hypertension are analyzed in detail. © American Journal of Hypertension, Ltd 2014. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Endovascular crossing of Chronic Total Occlusions using an impulse : An explorative design study

NARCIS (Netherlands)

Sakes, A.; van der Wiel (student), Marleen; Dodou, D.; Breedveld, P.

2017-01-01

In this study we investigated whether exerting an impulse on a Chronic Total Occlusion (CTO) improves the success rate of CTO crossing as compared to the currently used method of statically pushing the guidewire against the CTO. A prototype (Ø2 mm) was developed that generates translational

A computational analysis of the long-term regulation of arterial pressure.

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Beard, Daniel A; Pettersen, Klas H; Carlson, Brian E; Omholt, Stig W; Bugenhagen, Scott M

2013-01-01

The asserted dominant role of the kidneys in the chronic regulation of blood pressure and in the etiology of hypertension has been debated since the 1970s. At the center of the theory is the observation that the acute relationships between arterial pressure and urine production-the acute pressure-diuresis and pressure-natriuresis curves-physiologically adapt to perturbations in pressure and/or changes in the rate of salt and volume intake. These adaptations, modulated by various interacting neurohumoral mechanisms, result in chronic relationships between water and salt excretion and pressure that are much steeper than the acute relationships. While the view that renal function is the dominant controller of arterial pressure has been supported by computer models of the cardiovascular system known as the "Guyton-Coleman model", no unambiguous description of a computer model capturing chronic adaptation of acute renal function in blood pressure control has been presented. Here, such a model is developed with the goals of: 1. representing the relevant mechanisms in an identifiable mathematical model; 2. identifying model parameters using appropriate data; 3. validating model predictions in comparison to data; and 4. probing hypotheses regarding the long-term control of arterial pressure and the etiology of primary hypertension. The developed model reveals: long-term control of arterial blood pressure is primarily through the baroreflex arc and the renin-angiotensin system; and arterial stiffening provides a sufficient explanation for the etiology of primary hypertension associated with ageing. Furthermore, the model provides the first consistent explanation of the physiological response to chronic stimulation of the baroreflex.

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

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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.

Resistance training controls arterial blood pressure in rats with L-NAME- induced hypertension.

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Araujo, Ayslan Jorge Santos de; Santos, Anne Carolline Veríssimo dos; Souza, Karine dos Santos; Aires, Marlúcia Bastos; Santana-Filho, Valter Joviniano; Fioretto, Emerson Ticona; Mota, Marcelo Mendonça; Santos, Márcio Roberto Viana

2013-04-01

Arterial hypertension is a multifactorial chronic condition caused by either congenital or acquired factors. To evaluate the effects of Resistance Training (RT) on arterial pressure, and on vascular reactivity and morphology, of L-NAME-treated hypertensive rats. 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-NAME (40 mg/Kg) to the drinking water for four weeks. Arterial pressure was evaluated before and after RT. RT was performed using 50% of 1RM, 3 sets of 10 repetitions, 3 times per week for four weeks. Vascular reactivity was measured in rat mesenteric artery rings by concentration-response curves to sodium nitroprusside (SNP); phenylephrine (PHE) was also used for histological and stereological analysis. Resistance training inhibited the increase in mean and diastolic arterial pressures. Significant reduction was observed in Rmax (maximal response) and pD2 (potency) of PHE between SH and TH groups. Arteries demonstrated normal intima, media and adventitia layers in all groups. Stereological analysis demonstrated no significant difference in luminal, tunica media, and total areas of arteries in the SH and TH groups when compared to the SN group. Wall-to-lumen ratio of SH arteries was significantly different compared to SN arteries (parteries. RT was able to prevent an increase in blood pressure under the conditions in this study. This appears to involve a vasoconstrictor regulation mechanism and maintenance of luminal diameter in L-NAME induced hypertensive rats.

Incidence, risk factors, treatment and prognosis of popliteal artery embolization in the superficial femoral artery interventions.

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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

Daily concurrent chemoradiotherapy using superselective intra-arterial infusion via superficial temporal artery. Preoperative therapy for stage III, IV oral cancer

International Nuclear Information System (INIS)

Tohnai, Iwai; Mitsudo, Kenji; Nishiguchi, Hiroaki; Fukui, Takafumi; Yamamoto, Noriyuki; Ueda, Minoru; Fuwa, Nobukazu

2005-01-01

Recently, daily concurrent chemoradiotherapy using new superselective intra-arterial infusion via superficial temporal arterial artery is attracting attention. The catheter with curved tip is inserted superselectively to the feeding artery of the tumor via the superficial temporal artery, allowing long-term catheterization. Forty-one patients with stage III, IV oral cancer were treated. Radiotherapy (total dose: 40 Gy/4 weeks) and superselective intra-arterial infusion chemotherapy using docetaxel (total dose: 60 mg/m 2 , 15 mg/m 2 /week) and cisplatin (total dose: 100 mg/m 2 , 5 mg/m 2 /day) were concurrently performed daily, followed by surgery. In 35 patients, intra-arterial infusion was successful (success rate: 85.4%) and no major complication was observed. The clinical effects were complete response (CR) in 29 patients (82.9%), and pathological effects of resected tumor after surgery were pathological CR in 31 (88.6%). This method promises to be a new strategy of choice for the treatment of oral cancer. (author)

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...

The treatment of chronic intestinal ischemia.

Science.gov (United States)

Illuminati, G; Caliò, F G; D'Urso, A; Papaspyropoulos, V; Mancini, P; Ceccanei, G; Vietri, F

2004-01-01

Due to the rarity of the condition, large and prospective series defining the optimal method of digestive arteries revascularization, for the treatment of chronic intestinal ischemia, are lacking. The aim of this consecutive sample clinical study was to test the hypothesis that flexible application of different revascularization methods, according to individual cases, will yield the best results in the management of chronic intestinal ischemia. Eleven patients, of a mean age of 57 years, underwent revascularization of 11 digestive arteries for symptomatic chronic mesenteric occlusive disease. Eleven superior mesenteric arteries and one celiac axis were revascularized. The revascularization techniques included retrograde bypass grafting in 7 cases, antegrade bypass grafting in 2, percutaneous arterial angioplasty in 1, and arterial reimplantation in one case. The donor axis for either reimplantation or bypass grafting was the infrarenal aorta in 4 cases, an infrarenal Dacron graft in 4, and the celiac aorta in one case. Grafting materials included 5 polytetrafluoroethylene (PTFE) and 3 Dacron grafts. Concomitant procedures included 3 aorto-ilio-femoral grafts and one renal artery revascularization. Mean follow-up length was 31 months. There was no operative mortality. Cumulative survival rate was 88.9% at 36 months (SE 12.1%). Primary patency rate was 90% at 36 months (SE 11.6%). The symptom free rate was 90% at 36 months (SE 11.6%). Direct reimplantation, antegrade and retrograde bypass grafting, all allow good mid-term results: the choice of the optimal method depends on the anatomic and general patients status. Associated infrarenal and renal arterial lesions can be safely treated in the same time of digestive revascularization. Angioplasty alone yields poor results and should be limited to patients at poor risk for surgery.

Hepatic Falciform Ligament Artery in Patients with Chronic Liver Diseases: Detection on Computed Tomography Hepatic Arteriography

International Nuclear Information System (INIS)

Tajima, T.; Yoshimitsu, K.; Irie, H.; Nishie, A.; Hirakawa, M.; Ishigami, K.; Ushijima, Y.; Okamoto, D.; Honda, H.

2009-01-01

Background: The detection rate of hepatic falciform ligament artery (FLA) has been reported as ranging from 2-25%. The rate of FLA on laparotomy, however, is reported to be higher, at 68%. Purpose: To compare the detection rate of FLA on computed tomography hepatic arteriography (CTHA) with that on angiography and dynamic CT, and to clarify the clinical significance of FLA in patients with chronic liver disease. Material and Methods: 126 consecutive patients underwent CTHA angiography and dynamic CT to evaluate suspected liver tumors. Liver function was classified as follows: normal, n=5; Child-Pugh class A, n=94; B, n=21; and C, n=6. All CT images were obtained using multidetector (MDCT) scanners (Aquilion; Toshiba, Tokyo (JP)). For CTHA, CT images were obtained during contrast material injection through the left hepatic, proper, or common hepatic artery. On CT, FLAs were retrospectively identified within the hepatic falciform ligament and the hepatic round ligament by the paging method on a workstation (TWS-5000; Toshiba, Tokyo (JP)). The detection rates were compared among the three modalities (hepatic arterial phase of dynamic CT, CTHA, and angiography). The calibers of FLA were also correlated with the hepatic function of the patients. Results: The detection rates of FLA by angiography, dynamic CT, and CTHA were 37% (47/126), 10% (13/126), and 77% (97/126), respectively. The calibers of FLA increased as the hepatic function deteriorated (P=0.001). Conclusion: The detection rates of FLA with CTHA are far higher than those with angiography and dynamic CT. Careful interpretation with recognition of FLA on CTHA images is important, as inadvertent embolization or chemotherapeutic infusion of the FLA may result in supraumbilical skin rash

Coil Embolization of Pancreaticoduodenal Artery Aneurysms Associated with Celiac Artery Stenosis: Report of Three Cases

International Nuclear Information System (INIS)

Ikeda, Osamu; Tamura, Yoshitaka; Nakasone, Yutaka; Kawanaka, Kohichi; Yamashita, Yasuyuki

2007-01-01

Aneurysms of the pancreaticoduodenal artery are rare. Degeneration of pancreaticoduodenal arcade vessels due to these aneurysms is associated with celiac artery stenosis or occlusion. Untreated lesions enlarge progressively and may rupture spontaneously. As the location of aneurysms of pancreaticoduodenal arcade vessels renders their surgical extirpation a challenge, we examined whether endovascular techniques offer a treatment alternative. We report on 3 patients with aneurysms of the pancreaticoduodenal arcade vessels and concomitant celiac artery stenosis/occlusion due to compression by the median arcuate ligament or chronic pancreatitis. All patients were treated by percutaneous coil embolization of the aneurysm. The aneurysmal sac was successfully excluded and the native circulation was preserved. Endovascular surgery can be used to treat these aneurysms safely and permits retention of the native circulation

The role of atherectomy in the treatment of lower extremity peripheral artery disease

Science.gov (United States)

2012-01-01

Background The incidence of lower extremity peripheral artery disease (LE-PAD) continues to increase and associated morbidity remains high. Despite the significant development of percutaneous revascularization strategies, over the past decade, LE-PAD still represents a unique challenge for interventional cardiologists and vascular surgeons. Method Typical features of atherosclerosis that affects peripheral vascular bed (diffuse nature, poor distal runoff, critical limb ischemia, chronic total occlusion) contribute to the disappointing results of traditional percutaneous transluminal angioplasty (PTA). New technologies have been developed in attempt to improve the safety and effectiveness of percutaneous revascularization. Among these, atherectomy, debulking and removing atherosclerotic plaque, offers the potential advantage of eliminating stretch on arterial walls and reducing rates of restenosis. Conclusions This review summarizes the features and the current applications of new debulking devices. PMID:23173800

Coronary artery disease in Brazil: contemporary management and future perspectives.

Science.gov (United States)

Polanczyk, C A; Ribeiro, J P

2009-06-01

Cardiovascular diseases are responsible for 32% of total mortality in Brazil, mostly due to cerebrovascular and coronary artery disease. Epidemiological and socio-economical factors play a pivotal role on the distribution, severity and management of coronary artery disease, and the burden is greater in the southeast and south regions of the country, with a higher mortality in low-income populations. The Brazilian healthcare structure is divided into two complementary systems-public and private-but 75% of the population is covered exclusively by the public system. Some Brazilian institutions offer state-of-the-art care to patients with acute and chronic coronary artery disease, but regional inequalities in medical care are still significant. National policies will have to be implemented to fight risk factors, to ensure primary prevention strategies, including assistance on drugs with known protective effects, areas to be tackled by both the private and the public health sectors. Finally, large investments will have to be made to improve tertiary care, to reorganise systems of care for acute patients and mainly to ensure prompt access and continuity of cardiac care and secondary prevention strategies for the whole population.

Effect of total lymphoid irradiation in chronic progressive multiple sclerosis

International Nuclear Information System (INIS)

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

1986-01-01

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. (author)

Rendezvous technique for recanalization of long-segmental chronic total occlusion above the knee following unsuccessful standard angioplasty.

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Cao, Jun; Lu, Hai-Tao; Wei, Li-Ming; Zhao, Jun-Gong; Zhu, Yue-Qi

2016-04-01

To assess the technical feasibility and efficacy of the rendezvous technique, a type of subintimal retrograde wiring, for the treatment of long-segmental chronic total occlusions above the knee following unsuccessful standard angioplasty. The rendezvous technique was attempted in eight limbs of eight patients with chronic total occlusions above the knee after standard angioplasty failed. The clinical symptoms and ankle-brachial index were compared before and after the procedure. At follow-up, pain relief, wound healing, limb salvage, and the presence of restenosis of the target vessels were evaluated. The rendezvous technique was performed successfully in seven patients (87.5%) and failed in one patient (12.5%). Foot pain improved in all seven patients who underwent successful treatment, with ankle-brachial indexes improving from 0.23 ± 0.13 before to 0.71 ± 0.09 after the procedure (P rendezvous technique is a feasible and effective treatment for chronic total occlusions above the knee when standard angioplasty fails. © The Author(s) 2015.

The impact of occupational stress factors on temporary work disability related to arterial hypertension and its complications.

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Lazaridis, Konstantinos; Jovanović, Jovica; Jovanović, Jovana; Šarac, Ivana; Jovanović, Stefan

2017-06-01

To determine which specific groups of occupational stress factors influence the duration of temporary work disability related to arterial hypertension and joint complications/co-morbidities. Workers (n = 1398; 1009 in the exposed group, 389 in the control group) with arterial hypertension who worked at one workplace for a minimum of 10 years were divided into 10 subgroups, depending on the presence of joint complications/co-morbidities. The intensity of seven groups of occupational stress factors, the total score of Occupational Stress Index (OSI) and the average number of lost working days during 1 year were analysed. The number of lost working days due to arterial hypertension and joint complications/co-morbidities was significantly higher in the exposed group. In all subgroups of the exposed group there was a high correlation between the number of lost working days and the total OSI score. Specific occupational stress factors were associated with specific complications: High Demands with chronic myocardial infarction, Strictness with cerebral haemorrhage, Conflict/Uncertainty with cerebral infarction, Extrinsic Time Pressure with acute myocardial infarction, and Avoidance/Symbolic Aversiveness with non-insulin-dependent diabetes. There are specific groups of occupational stress factors which can influence the duration of work disability associated with certain complications and co-morbidities of arterial hypertension.

Routine one-stage exchange for chronic infection after total hip replacement.

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Jenny, Jean-Yves; Lengert, Régis; Diesinger, Yann; Gaudias, Jeannot; Boeri, Cyril; Kempf, Jean-François

2014-12-01

We hypothesized that a routine one-stage exchange for treatment of chronically infected total hip replacement (THR) will lead to (1) a higher rate of infection recurrence and (2) a poorer hip outcome than the published rates after two-stage exchange. Sixty-five cases have been treated consecutively with one-stage exchange. All patients have been followed for a period of three to six years or until death or infection recurrence. The five-year rate for infection recurrence was 16%. The five-year survival rate for recurrence of the index infection was 8%. Forty-two percent of the hips had a good or excellent PMA score, and 46% a good or excellent OH score. Routine one-stage exchange was not associated with a higher recurrence rate and a poorer hip function than previously published series of two-stage exchange. Therefore, there is little support to choose two-stage exchange as the routine treatment for management of chronically infected THR.

Influence of angiographic collateral circulation on myocardial perfusion in patients with chronic total occlusion of a single coronary artery and no prior myocardial infarction.

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Aboul-Enein, Fatma; Kar, Saibal; Hayes, Sean W; Sciammarella, Maria; Abidov, Aiden; Makkar, Raj; Friedman, John D; Eigler, Neal; Berman, Daniel S

2004-06-01

The functional role of various angiographic grades for coronary collaterals remains controversial. The aim of this study was to assess the influence of the Rentrop angiographic grading of coronary collaterals on myocardial perfusion in patients with single-vessel chronic total occlusion (CTO) and no prior myocardial infarction (MI). The study included 56 patients with single-vessel CTO and no prior MI who underwent rest-stress myocardial perfusion SPECT and coronary angiography within 6 mo. All patients had angiographic evidence of coronary collaterals. Patients were divided according to the Rentrop classification: Group I had grade 1 or 2 (n = 25) and group II had grade 3 collaterals (n = 31). Group I had a higher frequency of resting regional wall motion abnormalities on left ventriculography (52.6% vs. 19.2% [P = 0.019]). The mean perfusion scores of the overall population showed severe and extensive stress perfusion defects (summed stress score of 14.1 +/- 7.1 and summed difference score of 12.9 +/- 6.9) but minimal resting perfusion defects (summed rest score of 1.0 +/- 2.7). No perfusion scores differed between the 2 groups. The perfusion findings suggested that chronic stunning rather than hibernation is the principal cause of regional wall motion abnormalities in these patients. In the setting of single-vessel CTO and no prior MI, coronary collaterals appear to protect against resting perfusion defects. Excellent angiographic collaterals may prevent resting regional wall motion abnormalities but do not appear to protect against stress-induced perfusion defects.

Autofluorescence and high-definition optical coherence tomography of retinal artery occlusions

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Raeba Mathew

2010-10-01

Full Text Available Raeba Mathew, Evangelia Papavasileiou, Sobha SivaprasadLaser and Retinal Research Unit, Department of Ophthalmology, King’s College Hospital, Denmark Hill, London, UKBackground: The purpose of this study is to illustrate the fundus autofluorescence and high-definition optical coherence tomography (HD-OCT features of acute and long-standing retinal artery occlusions.Design: Retrospective case series.Participants: Patients with acute and chronic retinal and cilioretinal artery occlusions are included in this series.Methods: A detailed clinical examination, color fundus photographs, autofluorescence, and HD-OCT of the subjects were performed.Results: HD-OCT demonstrates the localized and well-demarcated thickening of the inner retina in the acute phase of arterial occlusions that correlates with the areas of blocked autofluorescence caused by the cloudy swelling of the retina. The areas of blocked autofluorescence disappear with chronicity of the disease and this corresponds to the thinning of the inner retinal layers on HD-OCT.Conclusion: Heidelberg OCT and autofluorescence are useful tools to assess retinal arterial occlusions especially in subjects with unexplained visual field loss.Keywords: autofluorescence, high definition OCT, retinal artery occlusion

The association of ABO blood groups with extent of coronary atherosclerosis in Croatian patients suffering from chronic coronary artery disease.

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Karabuva, Svjetlana; Carević, Vedran; Radić, Mislav; Fabijanić, Damir

2013-01-01

The aim of study was to: 1) examine the relationship between ABO blood groups and extent of coronary atherosclerosis in patients with chronic coronary artery disease (CAD), 2) compare ABO blood groups distribution in CAD patients and general population, 3) examine possible differences in traditional risk factors frequency in CAD patients with different ABO blood groups. In the 646 chronic CAD patients (72.4% males) coronary angiograms were scored by quantitative assessment using multiple angiographic scoring system, Traditional risk factors were self reported or measured by standard methods. ABO blood distribution of patients was compared with group of 651 healthy blood donors (74.6% males). Among all ABO blood group patients there was no significant difference between the extent of coronary atherosclerosis with regard to all the three scoring systems: number of affected coronary arteries (P = 0.857), Gensini score (P = 0.818), and number of segments narrowed > 50% (P = 0.781). There was no significant difference in ABO blood group distribution between CAD patients and healthy blood donors. Among CAD patients, men with blood group AB were significantly younger than their pairs with non-AB blood groups (P = 0.008). Among CAD patients with AB blood group, males groups (P = 0.003). No association between ABO blood groups and the extent of coronary atherosclerosis in Croatian CAD patients is observed. Observation that AB blood group might possibly identify Croatian males at risk to develop the premature CAD has to be tested in larger cohort of patients.

Effects of chronic portal hypertension on small heat-shock proteins in mesenteric arteries.

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Chen, Xuesong; Zhang, Hai-Ying; Pavlish, Kristin; Benoit, Joseph N

2005-04-01

Previous studies have shown that impaired vasoconstrictor function in chronic portal hypertension is mediated via cAMP-dependent events. Recent data have implicated two small heat-shock proteins (HSP), namely HSP20 and HSP27, in the regulation of vascular tone. Phosphorylation of HSP20 is associated with vasorelaxation, whereas phosphorylation of HSP27 is associated with vasoconstriction. We hypothesized that alterations in the expression and/or phosphorylation of small HSPs may play a role in impaired vasoconstriction in portal hypertension. A rat model of prehepatic chronic portal hypertension was used. Studies were conducted in small mesenteric arteries isolated from normal and portal hypertensive rats. Protein levels of HSP20 and HSP27 were detected by Western blot analysis. Protein phosphorylation was analyzed by isoelectric focusing. HSP20 mRNA expression was determined by RT-PCR. To examine the role of cAMP in the regulation of small HSP phosphorylation and expression, we treated both normal and portal hypertensive vessels with a PKA inhibitor Rp-cAMPS. We found both an increased HSP20 phosphorylation and a decreased HPS20 protein level in portal hypertension, both of which were restored to normal by PKA inhibition. However, PKA did not change HSP20 mRNA expression. We conclude that decreased HSP20 protein level is mediated by cAMP-dependent pathway and that impaired vasoconstrictor function in portal hypertension may be partially explained by decreased expression of HSP20. We also suggest that the phosphorylation of HSP20 by PKA may alter HSP20 turnover.

Systemic arterial hypertension secondary to chronic kidney disease in two captive-born large felids.

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Leclerc, A; Trehiou-Sechi, E; Greunz, E M; Damoiseaux, C; Bouvard, J; Chetboul, V

2017-06-01

Systemic arterial hypertension (SHT) has been widely described in the domestic cat (Felis catus). In these feline patients, SHT is considered as the most common vascular disorder of middle-aged to older animals, and secondary SHT related to chronic kidney disease (CKD) represents the most common form of the disease. We describe here the first two cases of spontaneous SHT in large felids, i.e. one 18-year old, 34.4 kg, male North-Chinese leopard (Panthera pardus japonensis, case #1) and one 20-year old, 28.7 kg, female snow leopard (Panthera uncia, case #2), both captive-bred and previously diagnosed with CKD. Both animals underwent complete echocardiographic examination under general anesthesia due to abnormal cardiac auscultation (heart murmur and/or gallop sound), and recurrent lethargy in case #1. The combination of left ventricular remodeling with moderate aortic regurgitation of high velocity was highly suggestive of SHT, which was confirmed by indirect blood pressure measurement (systolic arterial blood pressure of 183 mmHg for case #1 and 180 mmHg for case #2). Amlodipine was prescribed (0.35-0.70 mg/kg/day orally) for 31 and 6 months respectively after the initial diagnosis. In case #1, concurrent amlodipine and benazepril treatment was associated with decreased heart murmur grade and reduced aortic insufficiency severity. These reports illustrate that, similarly to domestic cats, SHT should be suspected in old large felids with CKD and that amlodipine is a well-tolerated antihypertensive drug in these species. Copyright © 2017 Elsevier B.V. All rights reserved.

Clinical worsening in Chronic Thromboembolic Pulmonary Hypertension

NARCIS (Netherlands)

Schölzel, B.E.

2015-01-01

Chronic thromboembolic pulmonary hypertension (CTEPH) is defined as a raised mean pulmonary artery pressure (of at least 25 mmHg at rest) caused by persistent obstruction of pulmonary arteries after pulmonary embolism that has not resolved despite at least 3 months of therapeutic anticoagulation.

Transcatheter Arterial Chemoembolization of Liver Tumors: Effects of Embolization Protocol on Injectable Volume of Chemotherapy and Subsequent Arterial Patency

International Nuclear Information System (INIS)

Geschwind, Jean-Francois H.; Ramsey, Douglas E.; Wal, B.C.H. van der; Kobeiter, Hicham; Juluru, Krishna; Hartnell, George G.; Choti, Michael A.

2003-01-01

The purpose of this study was to determine whether transcatheter arterial chemoembolization (TACE) protocol affects the total volume of chemotherapy injected into the liver as well as subsequent arterial patency. A total of 160 patients with primary or secondary liver cancer were treated with 3 different chemoembolization protocols at a single institution. Data were analyzed retrospectively.Group 1 (n = 36) consisted of slurry of chemotherapy,oil and polyvinyl alcohol particles (PVA), group 2 (n =91), chemotherapy and oil followed by PVA, and group 3(n = 33), chemotherapy and oil followed by Gelfoampledgets. The total volume of chemotherapy injected into the liver was recorded. Arterial patency was determined during subsequent chemoembolizations. The mean percentage of total intended chemotherapydose administered was 54.6% for group 1, 75.3% for group 2, and 80.6% for group 3. Arterial patency at follow-up angiography was 56% for group 1, 74% for group 2, and 81% for group 3. The slurry protocol (group 1) significantly reduced arterial patency and injectable volume of chemotherapy during TACE

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

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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.

CHRONIC OBSTRUCTIVE PULMONARY DISEASE AND ARTERIAL HYPERTENSION: VASCULAR WALL AS THE TARGET ORGAN IN COMORBID PATIENTS

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N. A. Karoli

2017-01-01

Full Text Available Studies of endothelial dysfunction in patients with respiratory diseases have become relevant in recent years. Perhaps endothelial dysfunction and high arterial stiffness bind bronchopulmonary and cardiovascular diseases.Aim. To reveal features of disturbances of arterial wall vasoregulatory function in patients with chronic obstructive pulmonary disease (COPD in the presence and absence of arterial hypertension (HT.Material and methods. The study included 50 patients with COPD with normal blood pressure (BP and 85 patients with COPD and HT. Control group was presented by 20 practically healthy men comparable in age with COPD patients. Tests with reactive hyperemia (endothelium-dependent dilation and nitroglycerin (endothelium-independent dilation were performed in order to evaluate endothelium function. The number of desquamated endotheliocytes in the blood was determined.Results. In patients with COPD and HT in comparison with COPD patients without HT and healthy individuals more pronounced damages of the vascular wall, endothelium vasoregulatory function disturbances and a tendency to the reduction in endothelium-dependent vasodilation were determined both during COPD exacerbation and remission. These differences were most pronounced during the COPD exacerbation. In patients with COPD and HT in comparison with COPD patients without HT the damage of the vascular wall was more pronounced during the remission and endothelium-dependent dilatation disorder – during the exacerbation. The revealed disorders in patients with COPD and HT were associated with smoking status (r=0.61, p<0.01, severity of bronchial obstruction (r=-0.49, p<0.05, and hypoxemia (r=-0.76, p<0.01. We noted relationships between the parameters of 24-hour BP monitoring and remodeling of the brachial artery (r=0.34, p<0.05, endothelium lesion (r=0.25, p<0.05, and impairment of its vasoregulating function (r=-0.58, p<0.05. At that, the following parameters were important: the

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

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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.

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.

Divergent effects of laughter and mental stress on arterial stiffness and central hemodynamics.

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Vlachopoulos, Charalambos; Xaplanteris, Panagiotis; Alexopoulos, Nikolaos; Aznaouridis, Konstantinos; Vasiliadou, Carmen; Baou, Katerina; Stefanadi, Elli; Stefanadis, Christodoulos

2009-05-01

To investigate the effect of laughter and mental stress on arterial stiffness and central hemodynamics. Arterial stiffness and wave reflections are independent predictors of cardiovascular risk. Chronic psychological stress is an independent risk factor for cardiovascular events, whereas acute stress deteriorates vascular function. Eighteen healthy individuals were studied on three occasions, according to a randomized, single-blind, crossover, sham procedure-controlled design. The effects of viewing a 30-minute segment of two films inducing laughter or stress were assessed. Carotid-femoral pulse wave velocity was used as an index of arterial stiffness; augmentation index was used as a measure of wave reflections. Laughter decreased pulse wave velocity (by 0.30 m/sec, p = .01), and augmentation index (by 2.72%, p = .05). Conversely, stress increased pulse wave velocity (by 0.29 m/sec, p = .05) and augmentation index (by 5.1%, p = .005). Laughter decreased cortisol levels by 1.67 microg/dl (p = .02), soluble P-selectin by 26 ng/ml (p = .02) and marginally von Willebrand factor (by 2.4%, p = .07) and increased total oxidative status (by 61 micromol/L, p laughter) and negative (stress) behavioral interventions have divergent acute effects on arterial stiffness and wave reflections. These findings have important clinical implications extending the spectrum of lifestyle modifications that can ameliorate arterial function.

Automated assessment of aortic and main pulmonary arterial diameters using model-based blood vessel segmentation for predicting chronic thromboembolic pulmonary hypertension in low-dose CT lung screening

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Suzuki, Hidenobu; Kawata, Yoshiki; Niki, Noboru; Sugiura, Toshihiko; Tanabe, Nobuhiro; Kusumoto, Masahiko; Eguchi, Kenji; Kaneko, Masahiro

2018-02-01

Chronic thromboembolic pulmonary hypertension (CTEPH) is characterized by obstruction of the pulmonary vasculature by residual organized thrombi. A morphological abnormality inside mediastinum of CTEPH patient is enlargement of pulmonary artery. This paper presents an automated assessment of aortic and main pulmonary arterial diameters for predicting CTEPH in low-dose CT lung screening. The distinctive feature of our method is to segment aorta and main pulmonary artery using both of prior probability and vascular direction which were estimated from mediastinal vascular region using principal curvatures of four-dimensional hyper surface. The method was applied to two datasets, 64 lowdose CT scans of lung cancer screening and 19 normal-dose CT scans of CTEPH patients through the training phase with 121 low-dose CT scans. This paper demonstrates effectiveness of our method for predicting CTEPH in low-dose CT screening.

Surgical treatment of chronic occlusive in peripheral arteries (Review of 100 cases

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H. AHRARI

1977-01-01

Full Text Available The purpose of this article is to diseuse the philosophy of our approch to the severely ischemic extremity and ourcurrent methods of treatment. 1 - The natural history of artheriosclerotic arterial obstruction should always be borne in mind. There is no doubt that many people have some degree of arterial stenosis or obstrcction and never suffer symptoms, either because of the reduced demand due to senility or because they are prepared to tolerate minor inconveniences which do not significantly interfere with their lives or livelihood. It should also be remembered that a proportion of patients with claudication improve spontaneously ever a time scale extending to many months or years. Taylor and Cale (1962, in a long term follow up of patients with untreated intermittent claudication, found spontaneous relief of symptoms in 39 per cent of the cases, no change in 45% and 16% worsening. Because of this it is impossible to lay down precise rules concerning the treatment of patients with intermittent claudication. It would be wrong to advise major arterial surgery in an elderly patient with extensive main' vessel disease and relatively mild claudication, and equally wrong to deny surgical treatment to an active younger patient with a we 11 localized arterial lesion. It is superfuous to add that anyhow, the surgery must not make the patient worse. 2- In a survey of a decade of experience, the arterioplastie treatment of occlusive disease seems to fall int three groups based on the anatomic distribution of the lesion. (Ref, 13. A - These in whom the obstructive disease is limited to the aortoiliac segments of the arterial tree supplying the leg. B - Those with both aort-iliao and femoral arterial disease. C - These with only femoropopliteal or proximal part of the popliteal arteries. Results in both the aorto-iliac and femoral arterial disease operations were in general satisfactory. The good early results of aorto-iliac operations showed only a

TEVAR and covering the celiac artery. Is it safe or not?

DEFF Research Database (Denmark)

Falkenberg, Morten; Lönn, Lars Birger; Schroeder, Torben Veith

2010-01-01

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...... together, in the large majority of patients, it appears that intentional celiac coverage can be done safely provided that sufficient collateral function have been demonstrated in advance....

[Treatment for patients who have arterial ulcers].

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Antolínez de Abia, Noelia

2009-01-01

Arterial ulcers are produced due to chronic ischemia in lower limbs. This causes a progressive, slow decrease in blood flow and oxygen supply to lower limbs. The main symptom consists of an intermittent claudication, or muscle pain while walking which ceases upon resting, but, when these symptoms appear; this wound usually is advanced and medical professionals basically use surgical, pharmaceutical and local treatments to cure this ulcer. In this article, the author presents a guide to diagnosis, treatment and prevention of arterial ulcers.

Association between internal carotid artery dissection and arterial tortuosity

International Nuclear Information System (INIS)

Saba, Luca; Piga, Mario; Argiolas, Giovanni Maria; Siotto, Paolo; Sumer, Suna; Wintermark, Max; Raz, Eytan; Sanfilippo, Roberto; Montisci, Roberto

2015-01-01

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.)

Association between internal carotid artery dissection and arterial tortuosity

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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.)

Coronary artery calcification scores improve contrast-induced nephropathy risk assessment in chronic kidney disease patients.

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Osugi, Naohiro; Suzuki, Susumu; Shibata, Yohei; Tatami, Yosuke; Harata, Shingo; Ota, Tomoyuki; Hayashi, Mutsuharu; Yasuda, Yoshinari; Ishii, Hideki; Shimizu, Atsuya; Murohara, Toyoaki

2017-06-01

Coronary artery calcification (CAC) is an independent predictor of cardiovascular morbidity and mortality in chronic kidney disease (CKD) patients. The aim of the present study was to evaluate the predictive value of CAC scores for the incidence of contrast-induced nephropathy (CIN) after cardiac catheterization in non-dialyzed CKD patients. The present study evaluated a total of 140 CKD patients who underwent cardiac catheterization. Patients were stratified into two groups based on the optimal cut-off value of the CAC score, which was graded by a non-triggered, routine diagnostic chest computed tomography scan: CAC score ≥8 (high CAC group); and CAC score 10 % in the baseline serum cystatin C level at 24 h after contrast administration. The mean estimated glomerular filtration rate levels were 41.1 mL/min/1.73 m 2 , and the mean contrast dose administered was 37.5 mL. Patients with high CAC scores exhibited a higher incidence of CIN than patients with low CAC scores (25.5 vs. 3.2 %, p < 0.001). After multivariate adjustment for confounders, the CAC score predicted CIN (odds ratio 1.68, 95 % confidence interval 1.28-2.21, p < 0.001). Moreover, the C-index for CIN prediction significantly increased when the CAC scores were added to the Mehran risk score (0.855 vs. 0.760, p = 0.023). CAC scores, as evaluated using semi-quantitative methods, are a simple and powerful predictor of CIN. Incorporating the CAC score in the Mehran risk score significantly improved the predictive ability to predict CIN incidence.

Chronic Prenatal Hypoxia Down-Regulated BK Channel Β1 Subunits in Mesenteric Artery Smooth Muscle Cells of the Offspring

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Bailin Liu

2018-02-01

Full Text Available Background/Aims: Chronic hypoxia in utero could impair vascular functions in the offspring, underlying mechanisms are unclear. This study investigated functional alteration in large-conductance Ca2+-activated K+ (BK channels in offspring mesenteric arteries following prenatal hypoxia. Methods: Pregnant rats were exposed to normoxic control (21% O2, Con or hypoxic (10.5% O2, Hy conditions from gestational day 5 to 21, their 7-month-old adult male offspring were tested for blood pressure, vascular BK channel functions and expression using patch clamp and wire myograh technique, western blotting, and qRT-PCR. Results: Prenatal hypoxia increased pressor responses and vasoconstrictions to phenylephrine in the offspring. Whole-cell currents density of BK channels and amplitude of spontaneous transient outward currents (STOCs, not the frequency, were significantly reduced in Hy vascular myocytes. The sensitivity of BK channels to voltage, Ca2+, and tamoxifen were reduced in Hy myocytes, whereas the number of channels per patch and the single-channel conductance were unchanged. Prenatal hypoxia impaired NS1102- and tamoxifen-mediated relaxation in mesenteric arteries precontracted with phenylephrine in the presence of Nω-nitro-L-arginine methyl ester. The mRNA and protein expression of BK channel β1, not the α-subunit, was decreased in Hy mesenteric arteries. Conclusions: Impaired BK channel β1-subunits in vascular smooth muscle cells contributed to vascular dysfunction in the offspring exposed to prenatal hypoxia.

Excimer laser coronary atherectomy in septal collaterals during retrograde recanalization of a chronic total occlusion

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Bernward Lauer

2011-09-01

Full Text Available Management of chronic total occlusions has been refined through the development of a retrograde approach via collateral pathways. We describe the use of Excimer Laser Coronary Atherectomy in the septal collaterals. This appraoch was not yet described in the literature.

Total Body Irradiation for Allogeneic Bone Marrow Transplantation in Chronic Myelogenous Leukemia

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Chung, Su Mi; Choi, Ihl Bohng; Kang, Ki Mun; Kim, In Ah; Shinn, Kyung Sub; Kim, Choon Choo; Kim, Dong Jip [Catholic University College of Medicine, Seoul (Korea, Republic of)

1994-06-15

Between July 1987 and December 1992, we treated 22 patients with chromic myelogenous leukemia; 14 in the chronic phase and 8 with more advanced disease. All were received with allogeneic bone marrow transplantation from HLA-identical sibling donors after a total body irradiation (TBI) cyclophosphamide conditioning regimen. Patients were non-randomly assigned to either 1200 cGy/6 fractions/3 days (6 patients) or 1320 cGy/8 fractions/4 days (16 patients) by dose of TBI. Of the 22 patients, 8 were prepared with cyclophosphamide alone, 14 were conditioned with additional adriamycin or daunorubicin. To prevent graft versus host disease, cyclosporine was given either alone or in conjunction with methotrexate. The actuarial survival and leukemic-free survival at four years were 58.5% and 41.2%, respectively, and the relapse rate was 36% among 22 patients. There was a statistically significant difference in survival between the patients in chronic phase and more advanced phase (76% vs 33%, p=0.05). The relapse rate of patients receiving splenectomy was higher than that of patients receiving splenic irradiation (50% vs 0%, p=0.04). We conclude that the probability of cure is highest if transplantation is performed while the patient remains in the chronic phase.

Total Body Irradiation for Allogeneic Bone Marrow Transplantation in Chronic Myelogenous Leukemia

International Nuclear Information System (INIS)

Chung, Su Mi; Choi, Ihl Bohng; Kang, Ki Mun; Kim, In Ah; Shinn, Kyung Sub; Kim, Choon Choo; Kim, Dong Jip

1994-01-01

Between July 1987 and December 1992, we treated 22 patients with chromic myelogenous leukemia; 14 in the chronic phase and 8 with more advanced disease. All were received with allogeneic bone marrow transplantation from HLA-identical sibling donors after a total body irradiation (TBI) cyclophosphamide conditioning regimen. Patients were non-randomly assigned to either 1200 cGy/6 fractions/3 days (6 patients) or 1320 cGy/8 fractions/4 days (16 patients) by dose of TBI. Of the 22 patients, 8 were prepared with cyclophosphamide alone, 14 were conditioned with additional adriamycin or daunorubicin. To prevent graft versus host disease, cyclosporine was given either alone or in conjunction with methotrexate. The actuarial survival and leukemic-free survival at four years were 58.5% and 41.2%, respectively, and the relapse rate was 36% among 22 patients. There was a statistically significant difference in survival between the patients in chronic phase and more advanced phase (76% vs 33%, p=0.05). The relapse rate of patients receiving splenectomy was higher than that of patients receiving splenic irradiation (50% vs 0%, p=0.04). We conclude that the probability of cure is highest if transplantation is performed while the patient remains in the chronic phase

[Cognitive disturbances in patients with arterial hypertension].

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Starchina, Iu A; Parfenov, V A; Chazova, I E; Pustovitova, T S; Iakhno, N N

2008-01-01

Memory impairment, headaches and vertigo are considered as initial appearances of chronic cerebral vascular disorder in patients with arterial hypertension (AH). The complex analysis of complaints, cognitive functioning, emotional state and MRI data was conducted in 60 patients with AH, mean age 58,4+/-7,8 years, without a history of stroke and 30 controls matched for age, sex and education. Impairment of cognitive functioning was assessed by the Psychiatric Status Scale (a short version), the Clock Drawing Test, tests of auditory and verbal memory, attention concentration, speed of test performance, speech fluency and spatial orientation. The deterioration effect of systolic arterial pressure on cognitive functioning was found. The lesions of white matter (subcortical and/or periventricular leucoaraiosis) were observed in 76% of patients and single asymptomatic lacunar infarctions--in 20%. Cerebral vascular lesions were correlated with cognitive impairment. Anxiety and anxiety-depressive disorders which were not associated with the cerebral vascular lesion but related in large to the patient's complaints on headaches and vertigo were revealed in 62% of cases. The results of the study suggest that cognitive dysfunction proves to be the early and reliable predictor of chronic cerebral vascular disorder in patients with arterial hypertension.

Utility of adjunctive modalities in Coronary chronic total occlusion intervention

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Hemal Bhatt

2017-05-01

Full Text Available Coronary chronic total occlusion (CTO intervention remains one of the most challenging domains in interventional cardiology. Due to the technical challenges involved and potential procedural complications, CTO percutaneous coronary intervention (PCI attempt and success rates remain less than standard PCI. However, the use of several adjunctive tools such as intravascular ultrasound, optical coherence tomography, rotational atherectomy, orbital atherectomy, excimer laser coronary atherectomy and percutaneous left ventricular assist device may contribute to improved CTO PCI success rates or provide better hemodynamic assessment of CTO lesion (i.e., using fractional flow reserve. In this review we present the current literature describing the utility and efficacy of these adjunctive modalities in CTO intervention.

Valve-Like and Protruding Calcified Intimal Flap Complicating Common Iliac Arteries Kissing Stenting

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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.

Value of electrocardiogram in predialytic chronic kidney disease patient without known coronary artery disease

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Dutta PK, Das S

2014-11-01

Full Text Available Chronic Kidney disease (CKD is a pressing public health burden occurring in about 10% of the population. The majority of them die before reaching End Stage Renal Disease (ESRD due to cardiovascular disease (CVD. Hypertension (HTN and anaemia are two reversible factors for progression of CKD. Besides asymptomatic coronary artery disease, the electrolyte abnormalities such as hyperkalaemia and hypocalcaemia also subject these patients to sudden cardiac death. This study is aimed at to see the changes in electrocardiogram (ECG in hospitalized predialytic CKD patients due to these abnormalities. Methods: This is a 6 months cross-sectional study carried out at Chittagong Medical College Hospital in Chittagong, Bangladesh. 50 patients with stages 3, 4 and 5 CKD were recruited from the Nephrology and Medicine wards. Patients with prior history of coronary artery disease, cardiomyopathy, valvular heart disease and dialysis were excluded. All had their standard 12–lead electrocardiogram (ECG recorded and various findings were critically studied and interpreted independently by two consultant physicians including a cardiologist. Data analysis was done using SPSS version 19. Results: LVH (left ventricular hypertrophy (66%, LAE (left atrial enlargement (30% and unrecognized myocardial infarction (28% were very common ECG abnormalities in our predialytic CKD patients. HTN, anaemia, late presentation, and male gender appear to be associated with ECG abnormalities. Though 28 patients (56% were hyperkalaemic only 9 patients (38% of them had tall tented T wave in ECG. Conclusion: Detection of HTN and anaemia in male predialytic CKD patients will arouse suspicion which will help in early detection of cardiac outcome by ECG abnormality which will help in taking treatment strategy in resource limited country.

Total parenteral alimentation via indwelling umbilical catheters in the newborn period.

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Hall, R T; Rhodes, P G

1976-01-01

Total parenteral alimentation (TPA) was delivered to 80 infants via indwelling umbilical artery and to 9 via indwelling umbilical venous catheters. The primary indication for catheter placement and maintenance was monitoring of arterial blood gases (umbilical venous catheter tip in left atrium) in a group of sick neonates requiring increased inspired oxygen or assisted ventilation. Results were compared with those from 23 infants who had tunnelled jugular catheters for a variety of chronic medical and surgical problems preventing gastric or intestinal feeding. A mean weight gain was achieved in both groups. Mortality and morbidity rates were similar in both groups. The most common complications were infection and thrombotic phenomena. Metabolic complications were few. It is concluded that infusing TPA solutions via indwelling umbilical catheters presents no greater risk than infusion via tunnelled jugular catheters, and provides a method for supplying adequate caloric intake for growth during the acute stage of illness. PMID:827978

Extrahepatic Arteries Originating from Hepatic Arteries: Analysis Using CT During Hepatic Arteriography and Visualization on Digital Subtraction Angiography

International Nuclear Information System (INIS)

Ozaki, Kumi; Kobayashi, Satoshi; Matsui, Osamu; Minami, Tetsuya; Koda, Wataru; Gabata, Toshifumi

2017-01-01

PurposeTo investigate the prevalence and site of origin of extrahepatic arteries originating from hepatic arteries on early phase CT during hepatic arteriography (CTHA) was accessed. Visualization of these elements on digital subtraction hepatic angiography (DSHA) was assessed using CTHA images as a gold standard.Materials and MethodsA total of 943 patients (mean age 66.9 ± 10.3 years; male/female, 619/324) underwent CTHA and DSHA. The prevalence and site of origin of extrahepatic arteries were accessed using CTHA and visualized using DSHA.ResultsIn 924 (98.0%) patients, a total of 1555 extrahepatic branches, representing eight types, were found to originate from hepatic arteries on CTHA. CTHA indicated the following extrahepatic branch prevalence rates: right gastric artery, 890 (94.4%); falciform artery, 386 (40.9%); accessory left gastric artery, 161 (17.1%); left inferior phrenic artery (IPA), 43 (4.6%); posterior superior pancreaticoduodenal artery, 33 (3.5%); dorsal pancreatic artery, 26 (2.8%); duodenal artery, 12 (1.3%); and right IPA, 4 (0.4%). In addition, 383 patients (40.6%) had at least one undetectable branch on DSHA. The sensitivity, specificity, and accuracy of visualization on DSHA were as follows: RGA, 80.0, 86.8, and 80.4%; falciform artery, 53.9, 97.7, and 80.0%; accessory LGA, 64.6, 98.6, and 92.3%; left IPA, 76.7, 99.8, and 98.7%; PSPDA, 100, 99.7, and 99.9%; dorsal pancreatic artery, 57.7, 100, and 98.8%; duodenal artery, 8.3, 99.9, and 98.7%; and right IPA, 0, 100, and 99.6%, respectively.ConclusionExtrahepatic arteries originating from hepatic arteries were frequently identified on CTHA images. These arteries were frequently overlooked on DSHA.

Extrahepatic Arteries Originating from Hepatic Arteries: Analysis Using CT During Hepatic Arteriography and Visualization on Digital Subtraction Angiography

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Ozaki, Kumi, E-mail: ozakik-rad@umin.org [Kanazawa University Graduate School of Medical Science, Department of Radiology (Japan); Kobayashi, Satoshi [Kanazawa University Graduate School of Medical Science, Department of Quantum Medicine Technology (Japan); Matsui, Osamu; Minami, Tetsuya; Koda, Wataru; Gabata, Toshifumi [Kanazawa University Graduate School of Medical Science, Department of Radiology (Japan)

2017-06-15

PurposeTo investigate the prevalence and site of origin of extrahepatic arteries originating from hepatic arteries on early phase CT during hepatic arteriography (CTHA) was accessed. Visualization of these elements on digital subtraction hepatic angiography (DSHA) was assessed using CTHA images as a gold standard.Materials and MethodsA total of 943 patients (mean age 66.9 ± 10.3 years; male/female, 619/324) underwent CTHA and DSHA. The prevalence and site of origin of extrahepatic arteries were accessed using CTHA and visualized using DSHA.ResultsIn 924 (98.0%) patients, a total of 1555 extrahepatic branches, representing eight types, were found to originate from hepatic arteries on CTHA. CTHA indicated the following extrahepatic branch prevalence rates: right gastric artery, 890 (94.4%); falciform artery, 386 (40.9%); accessory left gastric artery, 161 (17.1%); left inferior phrenic artery (IPA), 43 (4.6%); posterior superior pancreaticoduodenal artery, 33 (3.5%); dorsal pancreatic artery, 26 (2.8%); duodenal artery, 12 (1.3%); and right IPA, 4 (0.4%). In addition, 383 patients (40.6%) had at least one undetectable branch on DSHA. The sensitivity, specificity, and accuracy of visualization on DSHA were as follows: RGA, 80.0, 86.8, and 80.4%; falciform artery, 53.9, 97.7, and 80.0%; accessory LGA, 64.6, 98.6, and 92.3%; left IPA, 76.7, 99.8, and 98.7%; PSPDA, 100, 99.7, and 99.9%; dorsal pancreatic artery, 57.7, 100, and 98.8%; duodenal artery, 8.3, 99.9, and 98.7%; and right IPA, 0, 100, and 99.6%, respectively.ConclusionExtrahepatic arteries originating from hepatic arteries were frequently identified on CTHA images. These arteries were frequently overlooked on DSHA.

Relationship between chronic intermittent hypoxia and intraoperative mean arterial pressure in obstructive sleep apnea patients having laparoscopic bariatric surgery.

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Turan, Alparslan; You, Jing; Egan, Cameron; Fu, Alex; Gazmuri, Ignazia; Khanna, Ashish; Eshraghi, Yashar; Ghosh, Raktim; Bose, Somnath; Qavi, Shahbaz; Arora, Lovkesh; Sessler, Daniel I; Doufas, Anthony G

2015-01-01

Recurrent nocturnal hypoxemia in obstructive sleep apnea enhances sympathetic function, decreases baroreceptor sensitivity, and weakens peripheral vascular responses to adrenergic signals. The authors hypothesized that the percentage of total sleep time spent at oxyhemoglobin saturation (SaO2) less than 90% and minimum nocturnal SaO2 on preoperative polysomnography are associated with decreased intraoperative mean arterial pressure. The authors examined the records of all patients who had laparoscopic bariatric surgery at Cleveland Clinic between 2005 and 2009 and an available polysomnography study. The authors assessed the relationships between the percentage of total sleep time spent at SaO2 less than 90% and minimum nocturnal SaO2, and the time-weighted average of mean arterial pressure. The authors used multivariable regression models to adjust for prespecified clinical confounders. Two hundred eighty-one patients were included in the analysis. The average change in the time-weighted average of mean arterial pressure was -0.02 (97.5% CI, -0.08, 0.04) mmHg for each 1% absolute increase in the percentage of sleep time spent at SaO2 less than 90% (P = 0.50). The average change was -0.13 (97.5% CI, -0.27, 0.01) mmHg, for each 1% absolute decrease in the minimum SaO2 (P = 0.04 > significance criterion of 0.025, Bonferroni correction). An unplanned analysis estimated 1% absolute decrease in minimum SaO2 was associated with -0.22 (98.75% CI, -0.39, -0.04) mmHg, change in mean arterial pressure (P = 0.002) in the time period between endotracheal intubation and trocar insertion. Recurrent nocturnal hypoxemia in obstructive sleep apnea is not a risk marker for intraoperative hypotension.

Laparoscopic management of superior mesentric artery syndrome: A case report and review of literature

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Makam Ramesh

2008-01-01

Full Text Available Superior mesentric artery syndrome is a rare cause of high small bowel obstruction, caused by compression of the transverse part of the duodenum in between the superior mesentric artery and aorta. Patients present with chronic abdominal pain, vomiting and weight loss. We report a case of superior mesenteric artery syndrome, managed laparoscopically with laparoscopic duodenojejunostomy.

Embolization of a large, symptomatic splenic artery pseudoaneurysm

International Nuclear Information System (INIS)

Kukliński, Adam; Batycki, Krzysztof; Matuszewski, Wiesław; Ostrach, Andrzej; Kupis, Zbigniew; Łęgowik, Tomasz

2014-01-01

Splenic artery aneurysm is the third most common abdominal aneurysm. Most often it is due to pancreatitis. There were only 19 cases of aneurysms larger than 5 cm in diameter described in the literature. Management of splenic artery aneurysms depends on the size and symptoms. Invasive treatment modalities involve open procedures and interventional radiology methods (endovascular). A 44-years-old male with chronic pancreatitis, in a gradually worsening general condition due to a large splenic artery aneurysm, was subjected to the procedure. Blood flow through the aneurysm was cut-off by implanting a covered stent between celiac trunk and common hepatic artery. Patient’s general condition rapidly improved, allowing discharge home in good state soon after the procedure. Percutaneous embolization appears to be the best method of treatment of large splenic artery aneurysms. Complications of such treatment are significantly less dangerous than those associated with surgery

Elevated arterial compliance in patients with cirrhosis is not related to arterial endothelin-1

DEFF Research Database (Denmark)

Møller, Søren; Gülberg, V; Becker, U

2002-01-01

study was to investigate a potential relation between altered arterial compliance and arterial ET-1 in patients with cirrhosis. As ET-1 may be manipulated by somastostatin, the study includes infusion of octreotide in a subset of patients. METHODS: A total of 67 patients with cirrhosis and 27 controls...

Two cases of upper gingival cancer with a new superselective intra-arterial chemotherapy method from superficial temporal artery. Combined with arterial redistribution and preoperative embolization

International Nuclear Information System (INIS)

Tange, Kazuhisa; Fukuta, Kohta; Higa, Teruo

2007-01-01

We have begun to apply arterial redistribution and preoperative embolization in superselective intra-arterial chemotherapy from the superficial temporal artery. This study examines two typical cases of upper gingival cancer. Case 1 was a male, age 61, with T4N0M0 upper gingival cancer. Drug dosage began with 50-100 mg/m 2 /day of 5-fluorouracil (FU), while 15 mg/m 2 /hour of Docetaxel was also given once a week for three weeks. At the same time, radiation therapy with a total of 30 Gy (2 Gy at a time) was given. Immediately before the operation, embolization in the internal maxillary artery was performed in order to limit bleeding. Case 2 was a female, age 73, with T3N0M0 upper gingival cancer. This patient was also given 5-FU and Docetaxel for four weeks respectively with a total of 40 Gy radiation therapy. No operation was performed. Both cases gained complete response (CR) with a sole side effect of grade 3 mucositis. Superselective intra-arterial chemotherapy with arterial redistribution in the oral area is highly effective due to local, concentrated dosage of anticancer drug and reduced side effects. It is a promising method to replace surgical operation especially in cases of upper gingival cancer, whose tumor is often limited to the internal maxillary artery alone. (author)

Iron Deficiency in COPD Associates with Increased Pulmonary Artery Pressure Estimated by Echocardiography

DEFF Research Database (Denmark)

Plesner, Louis L; Schoos, Mikkel M; Dalsgaard, Morten

2017-01-01

OBJECTIVES: Iron deficiency (ID) might augment chronic pulmonary hypertension in chronic obstructive pulmonary disease (COPD). This observational study investigates the association between ID and systolic pulmonary artery pressure estimated by echocardiography in non-anaemic COPD outpatients...

ROCK2 mediates the proliferation of pulmonary arterial endothelial cells induced by hypoxia in the development of pulmonary arterial hypertension

OpenAIRE

QIAO, FENG; ZOU, ZHITIAN; LIU, CHUNHUI; ZHU, XIAOFENG; WANG, XIAOQIANG; YANG, CHENGPENG; JIANG, TENGJIAO; CHEN, YING

2016-01-01

It has been reported that RhoA activation and Rho-kinase (ROCK) expression are increased in chronic hypoxic lungs, and the long-term inhibition of ROCK markedly improves the survival of patients with pulmonary arterial hypertension (PAH). However, whether Rho-kinase α (ROCK2) participates in regulation of the growth of pulmonary arterial endothelial cells (PAECs) remains unknown. The aim of the present study was to investigate the effect of hypoxia on the proliferation of PAECs and the role o...

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

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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

Stenting in the treatment of chronic mesenteric ischemia. Technical and clinical success rates

International Nuclear Information System (INIS)

Heiss, P.; Zorger, N.; Kaempfe, I.; Jung, E.M.; Paetzel, C.; Feuerbach, S.; Herold, T.; Pfister, K.

2008-01-01

Purpose: to evaluate the technical and clinical success rates of percutaneous stent revascularization in the treatment of chronic mesenteric ischemia (CMI). Patients and methods: 17 patients (12 female) with typical symptoms of CMI were treated by percutaneous stent placement for stenoses of the splanchnic arteries (celiac trunk; superior mesenteric artery, SMA; inferior mesenteric artery, IMA). The primary and secondary technical success, primary and secondary clinical success, and the long-term clinical outcome were determined. Results: a total of 24 stents were implanted in 21 splanchnic arteries (12 stents in the celiac trunk, 11 in the SMA and 1 in the IMA). The primary technical success rate was 91% (19/21 arteries), the secondary technical success rate was 95% (21/22 arteries). Clinical follow-up was available for 16 patients. The primary clinical success rate was 81% (13/16 patients). Following two secondary interventions, the secondary clinical success rate was 94% (15/16 patients). Long-term clinical success was achieved in 15 of 16 patients (94%) with a mean follow-up of 26 months. One patient died within 30 days of the intervention and two patients demonstrated major complications (1 dissection, 1 stent dislocation). None of the patients required surgical revascularization and none of the patients died due to recurrent mesenteric ischemia. (orig.)

Definition, classification, and epidemiology of pulmonary arterial hypertension.

Science.gov (United States)

Hoeper, Marius M

2009-08-01

Pulmonary arterial hypertension (PAH) is a distinct subgroup of pulmonary hypertension that comprises idiopathic PAH, familial/heritable forms, and PAH associated with connective tissue disease, congenital heart disease, portal hypertension, human immunodeficiency virus (HIV) infection, and some other conditions. The hemodynamic definition of PAH was recently revised: PAH is now defined by a mean pulmonary artery pressure at rest > or =25 mm Hg in the presence of a pulmonary capillary wedge pressure or =30 mm Hg during exercise) that was used in the old definition of PAH has been removed because there are no robust data that would allow defining an upper limit of normal for the pulmonary pressure during exercise. The revised classification of pulmonary hypertension still consists of five major groups: (1) PAH, (2) pulmonary hypertension due to left heart disease, (3) pulmonary hypertension due to chronic lung disease and/or hypoxia, (4) chronic thromboembolic pulmonary hypertension, and (5) miscellaneous forms. Modifications have been made in some of these groups, such as the addition of schistosomiasis-related pulmonary hypertension and pulmonary hypertension in patients with chronic hemolytic anemia to group 1.

Combined evaluation of rest-redistribution thallium-201 tomography and low-dose dobutamine echocardiography enhances the identification of viable myocardium in patients with chronic coronary artery disease

International Nuclear Information System (INIS)

Pace, L.; Cuocolo, A.; Salvatore, M.; Perrone-Filardi, P.; Prastaro, M.; Vezzuto, P.; Crisci, T.; Dellegrottaglie, S.; Piscione, F.; Chiariello, M.; Mainenti, P.P.; Varrone, A.

1998-01-01

The purpose of this study was to evaluate whether combined evaluation by discriminant analysis of rest-redistribution thallium-201 tomography and low-dose dobutamine echocardiography enhances the accuracy in identifying viable myocardium in patients with chronic coronary artery disease. Rest-redistribution 201 Tl has high sensitivity but low specificity in identifying viable myocardium, while the opposite is true for low-dose dobutamine echocardiography. Forty-six patients underwent low-dose dobutamine echocardiography and rest-redistribution 201 Tl tomography on the same day. Rest echocardiography was repeated at least 30 days (mean 40±20) after myocardial revascularization. Discriminant analysis was applied to the results of 201 Tl tomography and dobutamine echocardiography to classify a/dyskinetic segments as viable or non-viable. In 92 a/dyskinetic segments that were revascularized, rest-redistribution 201 Tl tomography yielded an accuracy of 75%, while the accuracy of dobutamine echocardiography was 70% (P 201 Tl imaging are useful and complementary techniques for identifying viable myocardium in patients with chronic coronary artery disease. Combined evaluation by discriminant analysis significantly improves accuracy, although the cost-effectiveness of such an approach remains to be determined. (orig.)

Parameters of Blood Flow in Great Arteries in Hypertensive ISIAH Rats with Stress-Dependent Arterial Hypertension.

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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.

Spatial differences of cellular origins and in vivo hypoxia modify contractile properties of pulmonary artery smooth muscle cells: lessons for arterial tissue engineering.

Science.gov (United States)

Hall, S M; Soueid, A; Smith, T; Brown, R A; Haworth, S G; Mudera, V

2007-01-01

Tissue engineering of functional arteries is challenging. Within the pulmonary artery wall, smooth muscle cells (PASMCs) have site-specific developmental and functional phenotypes, reflecting differing contractile roles. The force generated by PASMCs isolated from the inner 25% and outer 50% of the media of intrapulmonary elastic arteries from five normal and eight chronically hypoxic (hypertensive) 14 day-old piglets was quantified in a three-dimensional (3D) collagen construct, using a culture force monitor. Outer medial PASMCs from normal piglets exerted more force (528 +/- 50 dynes) than those of hypoxic piglets (177 +/- 42 dynes; p engineering of major blood vessels.

The Benefits of Internal Thoracic Artery Catheterization in Patients With Chronic Abdominal Aortic Occlusion

International Nuclear Information System (INIS)

Ilic, Nikola; Davidovic, Lazar; Koncar, Igor; Dragas, Marko; Markovic, Miroslav; Colic, Momcilo; Cinara, Ilijas

2011-01-01

Occlusion of the abdominal aorta may be caused by an embolic lesion, but more commonly by thrombotic disease at the aortoiliac area, progressing retrograde. However, the visualization of the distal run-off via internal thoracic-epigastric inferior artery collateral channel may be a very important diagnostic tool, especially in countries with poor technical equipment. This study was designed to show the benefit of the selective internal thoracic angiography in cases with complete aortic occlusion. We present 30 patients with chronic aortic abdominal occlusion who were submitted to the transaxillary aortography and selective ITA angiography with purpose of distal run off evaluation. Angiographic evaluation was performed by two independent radiologists according to previously defined classification. Good angiographic score via internal thoracic angiography by first observer was achieved in 19 (63.3%) patients and in 18 (60%) by a second observer. Transaxillary aortography showed inferior results: good angiographic score by the first observer in six (20%) patients and by the second observer in three (3%) patients. Low extremity run-off is better visualized during internal thoracic angiography than during transaxillary aortography.

Usefulness of interventional embolization of the middle meningeal artery for recurrent chronic subdural hematoma: Five cases and a review of the literature

Science.gov (United States)

Yamauchi, Shigeru; Ikeda, Hidetoshi; Tsubota, Nobuyuki; Furukawa, Hironori; Maeda, Daisuke; Kondo, Kimito; Nishio, Akimasa

2015-01-01

Purpose Although several strategies against recurrent chronic subdural hematoma (CSDH) have been proposed, no consensus has been established. Recently, middle meningeal artery (MMA) embolization has been proposed as radical treatment for recurrent CSDH. We wanted to estimate the usefulness of MMA embolization for recurrent CSDH. Methods From February 2012 to June 2013, 110 patients with CSDH underwent single burr-hole surgery with irrigation and drainage. Among these patients, 13 showed recurrent hematoma formation and were retreated surgically. Furthermore, repeated recurrence of CSDH was observed in six patients. Five of these six patients underwent middle meningeal artery (MMA) embolization with polyvinyl alcohol particles. All five patients with interventional treatment were observed for four to 60 weeks. Results No more recurrence of CSDH was observed in any of the patients. During the follow-up period, no patients suffered from any side effects or complications from the interventional treatment. Conclusion MMA embolization with careful attention paid to the procedure might be a treatment of choice for recurrent CSDH. PMID:26015518

Superior mesenteric artery syndrome causing growth retardation

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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

Training-induced increase in nitric oxide metabolites in chronic heart failure and coronary artery disease: an extra benefit of water-based exercises?

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Laurent, Mourot; Daline, Teffaha; Malika, Bouhaddi; Fawzi, Ounissi; Philippe, Vernochet; Benoit, Dugue; Catherine, Monpère; Jacques, Regnard

2009-04-01

Rehabilitation programs involving immersed exercises are more and more frequently used, with severe cardiac patients as well. This study investigated whether a rehabilitation program including water-based exercises has additional effects on the cardiovascular system compared with a traditional land-based training in heart disease patients. Twenty-four male stable chronic heart failure patients and 24 male coronary artery disease patients with preserved left ventricular function participated in the study. Patients took part in the rehabilitation program performing cycle endurance exercises on land. They also performed gymnastic exercises either on land (first half of the participants) or in water (second half). Resting plasma concentration of nitric oxide metabolites (nitrate and nitrite) and catecholamine were evaluated, and a symptom-limited exercise test on a cycle ergometer was performed before and after the rehabilitation program. In the groups performing water-based exercises, the plasma concentration of nitrates was significantly increased (P = 0.035 for chronic heart failure and P = 0.042 for coronary artery disease), whereas it did not significantly change in the groups performing gymnastic exercise on land. No changes in plasma catecholamine concentration occurred. In every group, the cardiorespiratory capacity of patients was significantly increased after rehabilitation. The water-based exercises seemed to effectively increase the basal level of plasma nitrates. Such changes may be related to an enhancement of endothelial function and may be of importance for the health of the patients.

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

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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

Infrarenal aorta as the donor site for bypasses to the superior mesenteric artery for chronic mesenteric ischemia: A prospective clinical series of 24 patients.

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Illuminati, Giulio; Pizzardi, Giulia; Calio', Francesco G; Pasqua, Rocco; Masci, Federica; Vietri, Francesco

2017-11-01

Treatment of symptomatic, chronic mesenteric ischemia is indicated to relieve symptoms and prevent acute ischemia and death. Current therapeutic options include endovascular and open surgery. The purpose of this prospective study was to evaluate the results of bypasses to the superior mesenteric artery arising from the infrarenal aorta or infrarenal aortic grafts. From January 1999 to December 2016, 24 consecutive patients with a mean age of 61 years underwent a prosthetic bypass to the superior mesenteric artery. Nine patients (37%) presented with an associated clinically important stenosis of the celiac artery and 10 (42%) of the inferior mesenteric artery. Five patients (21%) received preoperative parenteral nutrition. Four patients (17%) underwent dual antiplatelet treatment. The donor site was the infrarenal aorta in 19 patients (79%) and an infrarenal, Dacron graft was used in 5 (21%). The origin of the bypass was from the distal infrarenal aorta or Dacron graft in 19 patients (79%) and from the proximal infrarenal aorta in 5 patients (21%). The graft material consisted of 7 mm polytetrafluoroethylene in 19 cases (79%) and 7 mm Dacron in 5 cases (21%). A concomitant bypass to the inferior mesenteric artery was performed in 4 patients (17%). The primary end points were postoperative mortality, morbidity, graft infection, late survival, primary patency, and symptom-free rate. The secondary end point was postoperative hemorrhagic complications. No postoperative mortality occurred. Postoperative morbidity included a prolonged postoperative ileus in 4 patients (17%), transitory postoperative increases in serum creatinine concentrations in 3 patients (12%), and myocardial ischemia in 2 patients (8%). No postoperative hemorrhagic complications or graft infection were observed. Overall, the cumulative survival rate was 77% at 60 months. The overall late-patency rate and freedom from recurrence of symptoms were both 87% at 60 months. Infrarenal aorta and

Calciphylaxis: Temporal Artery Calcification Preceding Widespread Skin Lesions and Penile Necrosis

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Manzoor A. Shah

2012-01-01

Full Text Available Temporal artery calciphylaxis has rarely been described in chronic kidney disease patients on dialysis. We report a case of 72-year-old Caucasian man with multiple comorbidities and end-stage renal disease on dialysis who presented with temporal artery calcification leading to bilateral loss of vision followed by extensive skin lesions including one on glans penis. While on peritoneal dialysis, he developed anterior ischemic optic neuropathy, had no improvement on high dose steroids, and temporal artery biopsy showed marked calcification without any evidence of vasculitis. Few weeks later on hemodialysis, he developed widespread cutaneous lesions on extremities and penile necrosis with skin biopsy revealing calciphylaxis. On literature review of calciphylaxis in chronic kidney disease, we found only four cases of temporal artery calciphylaxis leading to anterior ischemic optic neuropathy and blindness. We believe this is the first case in which the rare temporal artery calciphylaxis and the uncommon penile necrosis are being described together. The objective is to emphasize the need to recognize this condition early in the CKD patients on dialysis presenting with visual symptoms as the different treatment strategies may help prevent complete loss of vision and also modify or prevent a full blown calciphylaxis.

Chronic kidney disease and bleeding risk in patients at high cardiovascular risk: a cohort study.

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Ocak, G; Rookmaaker, M B; Algra, A; de Borst, G J; Doevendans, P A; Kappelle, L J; Verhaar, M C; Visseren, F L

2018-01-01

Essentials The association between chronic kidney disease and bleeding is unknown. We followed 10 347 subjects at high cardiovascular risk for bleeding events. Chronic kidney disease was associated with a 1.5-fold increased bleeding risk. Especially albuminuria rather than decreased kidney function was associated with bleeding events. Background There are indications that patients with chronic kidney disease have an increased bleeding risk. Objectives To investigate the association between chronic kidney disease and bleeding in patients at high cardiovascular risk. Methods We included 10 347 subjects referred to the University Medical Center Utrecht (the Netherlands) from September 1996 to February 2015 for an outpatient visit with classic risk factors for arterial disease or with symptomatic arterial disease (Second Manifestation of Arterial disease [SMART] cohort). Patients were staged according to the KDIGO guidelines, on the basis of estimated glomerular filtration rate (eGFR) and albuminuria, and were followed for the occurrence of major hemorrhagic events until March 2015. Hazard ratios (HRs) with 95% confidence intervals (CIs) for bleeding were calculated with Cox proportional hazards analyses. Results The incidence rate for bleeding in subjects with chronic kidney disease was 8.0 per 1000 person-years and that for subjects without chronic kidney disease was 3.5 per 1000 person-years. Patients with chronic kidney disease (n = 2443) had a 1.5-fold (95% CI 1.2-1.9) increased risk of bleeding as compared with subjects without chronic kidney disease (n = 7904) after adjustment. Subjects with an eGFR of Chronic kidney disease is a risk factor for bleeding in patients with classic risk factors for arterial disease or with symptomatic arterial disease, especially in the presence of albuminuria. © 2017 University Medical Center Utrecht. Journal of Thrombosis and Haemostasis © 2017 International Society on Thrombosis and Haemostasis.

Smoking associated with malignancy, hypertension, chronic obstructive pulmonary disease and concurrent coronary artery disease: report of nine cases.

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Dwivedi, S; Srivastava, S; Dwivedi, G

2006-01-01

Tobacco smoking in any form is a major risk factor for coronary artery disease (CAD), hypertension (HTN), chronic obstructive pulmonary disease (COPD), oral, nasopharyngeal, bronchial and other visceral malignancies. Cessation of smoking exerts considerable beneficial effect on development, recurrence and prognosis of these diseases. Present communication is based on the study of nine cases who had concurrent CAD, HTN, COPD and mitotic and/or pre malignant lesions due to unabated smoking. The youngest patient was a 35-year-old male having a smoking index of 300, presenting with acute coronary syndrome, COPD, HTN and buccal leukoplakia. Associated genitourinary malignancies in two cases and osteosarcoma in one case was an unusual presentation. These cases highlight the prognosis and public health implications of continuous smoking.

Embolic Protection using the WIRION Embolic Protection System with JetStream Atherectomy in a Patient with Superficial Femoral Artery Chronic total Occlusion.

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Shammas, Nicolas W

2017-06-01

Distal embolization is a common occurrence with peripheral arterial interventions and is more frequent with the use of atherectomy devices. We report the first case of JetStream atherectomy (Boston Scientific, Maple Grove, MN) with the use of the novel WIRION embolic protection system filter. The procedure was performed successfully with no distal embolizations beyond the filter and with no complications in the delivery or retrieval of the filter. The pros and cons of the off label use of this filter with JetStream atherectomy are discussed.

Epigallocatechin gallate attenuates ET-1-induced contraction in carotid artery from type 2 diabetic OLETF rat at chronic stage of disease.

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Matsumoto, Takayuki; Watanabe, Shun; Kawamura, Ryusuke; Taguchi, Kumiko; Kobayashi, Tsuneo

2014-11-24

There is a growing body of evidence suggesting that epigallocatechin gallate (EGCG), a major catechin isolated from green tea, has several beneficial effects, such as anti-oxidant and anti-inflammatory activities. However, whether treatment with EGCG can suppress the endothelin-1 (ET-1)-induced contraction in carotid arteries from type 2 diabetic rats is unknown, especially at the chronic stage of the disease. We hypothesized that long-term treatment with EGCG would attenuate ET-1-induced contractions in type 2 diabetic arteries. Otsuka Long-Evans Tokushima fatty (OLETF) rats (43 weeks old) were treated with EGCG (200 mg/kg/day for 2 months, p.o.), and the responsiveness to ET-1, phenylephrine (PE), acetylcholine (ACh) and sodium nitroprusside (SNP) was measured in common carotid artery (CA) from EGCG-treated and -untreated OLETF rats and control Long-Evans Tokushima Otsuka (LETO) rats. In OLETF rats, EGCG attenuated responsiveness to ET-1 in CA compared to untreated groups. However, EGCG did not alter PE-induced contractions in CA from OLETF rats. In endothelium-denuded arteries, EGCG did not affect ET-1-induced contractions in either the OLETF or LETO group. Acetylcholine-induced relaxation was increased by EGCG treatment in CA from the OLETF group. The expressions of ET receptors, endothelial nitric oxide synthase, superoxide dismutases, and gp91(phox) [an NAD(P)H oxidase component] in CA were not altered by EGCG treatment in either group. Our data suggest that, within the timescale investigated here, EGCG attenuates ET-1-induced contractions in CA from type 2 diabetic rats, and one of the mechanisms may involve normalizing endothelial function. Copyright © 2013 The Authors. Published by Elsevier Inc. All rights reserved.

Does conduit artery diameter vary according to the anthropometric characteristics of children or men?

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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

Coronary Artery Bypass Graft Surgery Cost Coverage by the Brazilian Unified Health System (SUS

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Gilmara Silveira da Silva

Full Text Available Abstract Introduction: Cost management has been identified as an essential tool for the general control and evaluation of health organizations. Objectives: To identify the coverage percentage of transferred funds from the Unified Health System for coronary artery bypass grafts in a philanthropic hospital having a consolidated costing system in the municipality of São Paulo. Methods: A quantitative, descriptive and cross-sectional research with information provided from a database composed of 1913 patients undergoing coronary artery bypass graft from March 13 to September 30, 2012, including isolated elective coronary artery bypass graft with the use of extracorporeal circulation. It excluded 551 (28.8% patients, among them 76 (4.0% deaths and 8 hospitalized patients, since the cost was compared according to the length of hospital stay. Therefore, the sample consisted of 1362 patients. Results: The average total cost per patient was $7,992.55. The average fund transfer by the Unified Health System was $3,450.73 (48.66%, resulting in a deficit of $4,541.82 (51.34%. Conclusion: The Unified Health System transfers covered 48.66% of the average total cost of hospitalization. Although the amount transferred increased with increasing costs, it was not proportional to the total cost, resulting in a percentage difference in revenue that was increasingly negative for each increase in cost and hospital stay. Those hospitalized for longer than seven days presented higher costs, older age, higher percentage of diabetics and chronic kidney disease patients and more postoperative complications.

Daily concurrent preoperative chemoradiotherapy using superselective intra-arterial infusion via superficial temporal artery for advanced oral cancer. Histological evaluation of metastatic cervical lymph nodes

International Nuclear Information System (INIS)

Mitsudo, Kenji; Yamamoto, Noriyuki; Shigetomi, Toshio

2010-01-01

Superselective intra-arterial chemotherapy via a superficial temporal artery has become feasible for daily concurrent radiotherapy and chemotherapy in patients with oral cancer. In this study, histopathological effects on metastatic cervical lymph nodes in cases of advanced oral cancer using superselective intra-arterial chemoradiotherapy were evaluated. Thirty-seven oral cancer patients with cervical lymph node metastasis were treated with preoperative chemoradiotherapy using superselective intra-arterial infusion via the superficial temporal artery. The treatment consisted of superselective intra-arterial infusions (docetaxel, total 60 mg/m 2 ; cisplatin, total 100-150 mg/m 2 ) and concurrent radiotherapy (total 40-60 Gy) for 4-6 weeks, followed by surgery. In cases in which the catheter was inserted into the facial artery, grade III or IV (Oboshi-Shimosato classification) in the cervical lymph node metastasis was obtained in 20 (83.3%) of 24 patients. And, forty-six (88.5%) of 52 metastatic lymph nodes showed grade III or IV. This method was an effective regimen for oral cancer with cervical lymph node metastasis. (author)

Minimum concentrations of NO/sub 2/ causing acute effects on the respiratory gas exchange and airway-resistance in patients with chronic bronchitis

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von Nieding, G; Wagner, M; Krekeler, H; Smidt, U; Muysers, K

1971-01-01

Nitrogen dioxide-air mixtures containing 0.5 to 5.0 ppM NO/sub 2/ were inhaled by 88 patients with chronic bronchitis over a 15-minute period for a total of 30 breaths during studies investigating the effects of the gas on airway resistance and respiratory gas exchange. End-expiratory oxygen pressures remained nearly constant during inhalation of 4 or 5 ppM NO/sub 2/, though significant decreases in arterial oxygen pressure accompanied by increases in end-expiratory-arterial oxygen pressure difference occurred. Inhalation of 2 ppM NO/sub 2/ did not decrease arterial oxygen pressure. Airway resistances increased significantly down to 1.5 ppM NO/sub 2/ concentrations. Lower concentrations caused no significant effects.

The success of opening single chronic total occlusion lesions to improve myocardialviabilitytrial (SOS-COMEDY): Study protocol of a prospective multicenter study.

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Huang, Rongchong; Song, Xiantao; Zhang, Haishan; Tian, Wen; Huang, Zheng; Zhang, Xingwei; Yang, Junqing; Zhang, Dongfeng; Wu, Jian; Zhong, Lei; Ting, Henry H

2018-04-01

Success of opening single (SOS)-comedy is a prospective multicenter study to compare the improvement in the decrease of myocardial viability by percutaneous coronary intervention (PCI) with that by optimal medical therapy (OMT) alone in patients with chronic total occlusion (CTO) of a single coronary artery. The risks and the benefits of both options (PCI and OMT) were listed in a CTO decision aid (DA). Eligible participants detected by invasive coronary angiography (ICA) or coronary computed tomography angiography (CCTA) were divided into PCI or OMT groups according to patients' choice after shared-decision making process with DA. Participants will undergo positron emission tomography/computed tomography (PET/CT), cardiac magnetic resonance (CMR) and transthoracic echocardiography (TTE), and proceed to ICA and revascularization if possible. Blinded core laboratory interpretation will be performed for ICA, CCTA, PET/CT, CMR, and TTE. All participants will be followed up for 12 months. The primary endpoint is the improvement to the decrease of myocardial viability from baseline assessed with the use of PET/CT after 12-month follow-up. All of the patients are appropriately consented before enrolling in this study, which has been approved by the Ethics Committee. Results of SOS-COMEDY will be helpful to develop a strategy for single CTO patients.

Relationship of myocardial hibernation, scar, and angiographic collateral flow in ischemic cardiomyopathy with coronary chronic total occlusion.

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Wang, Li; Lu, Min-Jie; Feng, Lei; Wang, Juan; Fang, Wei; He, Zuo-Xiang; Dou, Ke-Fei; Zhao, Shi-Hua; Yang, Min-Fu

2018-03-07

The relationship between myocardial viability and angiographic collateral flow is not fully elucidated in ischemic cardiomyopathy (ICM) with coronary artery chronic total occlusion (CTO). We aimed to clarify the relationship between myocardial hibernation, myocardial scar, and angiographic collateral flow in these patients. Seventy-one consecutive ICM patients with 122 CTOs and 652 dysfunctional segments within CTO territories were retrospectively analyzed. Myocardial hibernation (perfusion-metabolism mismatch) and the extent of 18 F-fluorodeoxyglucose (FDG) abnormalities were assessed using 99m Tc-sestamibi and 18 F-FDG imaging. Myocardial scar was evaluated by late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) imaging. Collateral flow observed on coronary angiography was assessed using Rentrop classification. In these patients, neither the extent nor frequency of myocardial hibernation or scar was related to the status of collateral flow. Moreover, the matching rate in determining myocardial viability was poor between any 2 imaging indices. The extent of 18 F-FDG abnormalities was linearly related to the extent of LGE rather than myocardial hibernation. Of note, nearly one-third (30.4%) of segments with transmural scar still had hibernating tissue. Hibernation and non-transmural scar had higher sensitivity (63.0% and 66.7%) than collateral flow (37.0%) in predicting global functional improvement. Angiographic collateral cannot accurately predict myocardial viability, and has lower sensitivity in prediction of functional improvement in CTO territories in ICM patients. Hence, assessment of myocardial viability with non-invasive imaging modalities is of importance. Moreover, due to the lack of correlation between myocardial hibernation and scar, these two indices are complementary but not interchangeable.

Constriction of collateral arteries induced by "head-up tilt" in patients with occlusive arterial disease of the legs

DEFF Research Database (Denmark)

Agerskov, K; Henriksen, O; Tønnesen, K H

1981-01-01

The effect of head-up tilt on leg blood flow and segmental arterial blood pressures was studied in 21 patients with occlusion or severe stenosis of the common or superficial femoral artery. Arterial pressure was measured directly in the brachial artery, common femoral artery and popliteal artery....... Relative change in blood flow in the leg during tilt was estimated by changes in arterio-venous oxygen differences and by the indicator dilution technique in nine patients. Head-up tilt caused a decrease in leg blood flow of 36% corresponding to an increase in total vascular resistance of 57%. Tilt did...... not change the pressure gradient from femoral to popliteal artery in the patients with occlusion of the superficial femoral artery, indicating that the flow resistance offered by the collateral arteries had increased. In a bilateral sympathectomised patient the increase in collateral resistance was almost...

Bronchial arterial infusion versus bronchial combined pulmonary arterial infusion for pulmonary metastatic tumors

International Nuclear Information System (INIS)

Dong Sheng; Dong Weihua; Jia Ningyang; Zhang Dianbo; Xiao Xiangsheng

2008-01-01

Objective: To evaluate the pulmonary metastatic tumor response to different ways of transcatheter arterial infusion. Methods: Thirty-five patients with pulmonary metastatic tumors were randomized divided into two groups: 15 patients with 49 lesions treated with bronchial arterial infusion (BAI) and 20 patients with 65 lesions treated with bronchial arterial infusion (BM)combined with pulmonary arterial infusion (PAI). The therapeutic response was assessed by the WHO evaluation criteria. Results: The total effective rate(CR + PR) of BAI was 65.3% (32/49), PAI + BAI was 61.5%(40/65) showing no statistical difference. The median survival time of BAI was 9 mo, BAI + PAI was 11.5 mo, demonstrating no statistical significance. Conclusions: BAI should be the primary treatment for pulmonary metastatic tumor. (authors)

Percutaneous transluminal angioplasty combining intraarterial drug perfusion for the treatment of chronic lower limb ischemia

International Nuclear Information System (INIS)

Liu Yuan; He Chunshui; Liao Huaqiang; Zeng Wei; Zhang Hongwei; Liu Yang; Mu Yan; Liao Huaqiang; Guan Yongsong

2008-01-01

Objective: To evaluate the clinical effects of balloon angioplasty in combination with intraarterial perfusion of vasoactive drugs in the treatment of chronic lower limb ischemia. Methods: A total of 21 patients were treated with percutaneous transfemoral or transaxillary approach of balloon dilatation of the occlusive arterial segments, and then followed by perfusion of urokinase, Lipo prostaglandin E 1 and ginkgo leaf injection, respectively, into the responsible arteries via the catheter. Postoperatively, some of the patients with tibioperoneal arteries occlusion were perfused with the same drugs into their diseased arterial segments, one time per day altogether 5-7 times, through the ipsilateral femoral arterial sheath reserved temporarily, and then followed by observation for improvement of ischemia, superficial ulceration and gangrenous change. Results: Of the 21 patients, 20 were successfully treated with percutaneous transluminal balloon dilation and arterial perfusion with a technical successful rate of 95.2% (20/21). Five of the total 20 were additionally treated with the same drugs perfusion 5-7 days through the retained sheath, showing well patency. No serious complications occurred and ischemic symptoms of limbs improved, such as rest pain, claudication and dermo temperature. During 2-7 months follow-up, healing of skin ulcer occurred in 4 patients and breakoff of necrotic digits in 2 with the surface wound healed. Necrotic toes in all patients were dehydrated with stopping of necrosis and without any amputation. Conclusions: Percutaneous transluminal angioplasty combining intraarterial drug perfusion is safe and effective for promoting blood circulation with healing of ulceration and ceasing the development of lesions; with furthermore of maintaining the arterial patency through the retained vascular sheath for sustaining the drug plerfusion. (authors)

How do high cost-sharing policies for physician care affect total care costs among people with chronic disease?

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Xin, Haichang; Harman, Jeffrey S; Yang, Zhou

2014-01-01

This study examines whether high cost-sharing in physician care is associated with a differential impact on total care costs by health status. Total care includes physician care, emergency room (ER) visits and inpatient care. Since high cost-sharing policies can reduce needed care as well as unneeded care use, it raises the concern whether these policies are a good strategy for controlling costs among chronically ill patients. This study used the 2007 Medical Expenditure Panel Survey data with a cross-sectional study design. Difference in difference (DID), instrumental variable technique, two-part model, and bootstrap technique were employed to analyze cost data. Chronically ill individuals' probability of reducing any overall care costs was significantly less than healthier individuals (beta = 2.18, p = 0.04), while the integrated DID estimator from split results indicated that going from low cost-sharing to high cost-sharing significantly reduced costs by $12,853.23 more for sick people than for healthy people (95% CI: -$17,582.86, -$8,123.60). This greater cost reduction in total care among sick people likely resulted from greater cost reduction in physician care, and may have come at the expense of jeopardizing health outcomes by depriving patients of needed care. Thus, these policies would be inappropriate in the short run, and unlikely in the long run to control health plans costs among chronically ill individuals. A generous benefit design with low cost-sharing policies in physician care or primary care is recommended for both health plans and chronically ill individuals, to save costs and protect these enrollees' health status.

Daily concurrent preoperative chemoradiotherapy using new superselective intra-arterial infusion via superficial temporal artery for oral cancer. Cervical lymph node metastasis

International Nuclear Information System (INIS)

Yamamoto, Noriyuki; Mitsudo, Kenji; Tohnai, Iwai

2007-01-01

Seventeen oral cancer patients with cervical lymph node metastasis were treated by preoperative chemoradiotherapy using superselective intra-arterial infusion via the superficial temporal artery. Radiotherapy (total dose: 40 Gy/4 weeks) and superselective intra-arterial infusion chemotherapy using docetaxel (DOC) (total dose: 60 mg/m 2 , 15 mg/m 2 /week) and cisplatin (CDDP) (total dose: 100 mg/m 2 , 5 mg/m 2 /day) were performed, followed by surgery. The pathological effects of resected lymph node metastasis after surgery were grade III, IV (Oboshi-Shimosato classification) in level I, II. This method is a promising strategy for oral cancer with cervical lymph node metastasis. (author)

PECULIARITIES OF THE CLINICAL COURSE OF NON-ALCOHOLIC STEATOHEPATITIS AGAINST THE BACKGROUND OF THE CHRONIC KIDNEY DISEASE OF THE I-III STAGE WITH SECONDARY ARTERIAL HYPERTENSION.

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Hukhlina, O; Antoniv, A; Dudka, I; Dudka, T; Mandryk, O

2017-09-01

The article addresses the theoretical generalization of the clinical study of non-alcoholic steatohepatitis peculiarities in comorbidity with obesity and chronic kidney disease of the І-ІІІ stage, characterized by higher frequency and intensity of clinical and biochemical syndromes, the manifestation of which is likely to increase the occurrence of secondary arterial hypertension (portal hypertension syndromes, cholestasis, mesenchymal inflammation). Comorbid course of non-alcoholic steatohepatitis with chronic kidney disease is characterized by higher degree of liver steatosis compared to the patients with only non-alcoholic steatohepatitis (p<0.05), and a higher diagnostic threshold of the hepatorenal index values, which correlates with the Steato-test index (p<0.001) with strong interdependence.

Balloon angioplasty of popliteal and crural arteries in elderly with critical chronic limb ischemia

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Atar, Eli; Siegel, Yoel; Avrahami, Ram; Bartal, Gabriel; Bachar, Gil N.; Belenky, Alexander

2005-02-01

Objective: Elderly patients with extensive infrainguinal peripheral vascular disease and critical chronic limb ischemia (CCLI) are poor surgical candidates. Our purpose was to evaluate angiographic and clinical results of popliteal, infrapopliteal, and multi-level disease percutaneous transluminal angioplasty (PTA) in such patients. Design: Retrospective study of angiographic and clinical files in selected group. Materials and methods: Between 1996 and 2002, 38 elderly patients aged 80-94 years old (mean age 83.3) with critical leg ischemia were treated with PTA. All patients were at high surgical risk. 31/38 (81.5%) patients had chronic non-healing wounds, and 14/38 (37%) had multi-level disease of superficial femoral, popliteal and crural arteries. One hundred and two lesions were treated by angioplasty. Immediate angiographic and 1 year clinical results were retrospectively analyzed. Results: The overall procedural success rate was 32/38 (84.2%). There were three major complications (7.9%), but no deaths, and three technical failures, all were of infrapopliteal lesions. After 1 year, 27 patients could be followed, five patients died during the first year of unrelated causes. Twenty-three patients (85.2%), were clinically re-occluded within 1 year, but complete and partial wound healing was achieved in 80% (16/20) and rest pain improvement in 57% (4/7), so that overall limb salvage was 74% (20/27). Conclusions: Elderly patients with multi-level CCLI have a short patency term following angioplasty of 14.8% after 1 year. Nevertheless, this temporary vascular patency enables wound healing or improvement in 74% of these patients, thus such endovascular interventions are recommended in this age group.

Balloon angioplasty of popliteal and crural arteries in elderly with critical chronic limb ischemia

International Nuclear Information System (INIS)

Atar, Eli; Siegel, Yoel; Avrahami, Ram; Bartal, Gabriel; Bachar, Gil N.; Belenky, Alexander

2005-01-01

Objective: Elderly patients with extensive infrainguinal peripheral vascular disease and critical chronic limb ischemia (CCLI) are poor surgical candidates. Our purpose was to evaluate angiographic and clinical results of popliteal, infrapopliteal, and multi-level disease percutaneous transluminal angioplasty (PTA) in such patients. Design: Retrospective study of angiographic and clinical files in selected group. Materials and methods: Between 1996 and 2002, 38 elderly patients aged 80-94 years old (mean age 83.3) with critical leg ischemia were treated with PTA. All patients were at high surgical risk. 31/38 (81.5%) patients had chronic non-healing wounds, and 14/38 (37%) had multi-level disease of superficial femoral, popliteal and crural arteries. One hundred and two lesions were treated by angioplasty. Immediate angiographic and 1 year clinical results were retrospectively analyzed. Results: The overall procedural success rate was 32/38 (84.2%). There were three major complications (7.9%), but no deaths, and three technical failures, all were of infrapopliteal lesions. After 1 year, 27 patients could be followed, five patients died during the first year of unrelated causes. Twenty-three patients (85.2%), were clinically re-occluded within 1 year, but complete and partial wound healing was achieved in 80% (16/20) and rest pain improvement in 57% (4/7), so that overall limb salvage was 74% (20/27). Conclusions: Elderly patients with multi-level CCLI have a short patency term following angioplasty of 14.8% after 1 year. Nevertheless, this temporary vascular patency enables wound healing or improvement in 74% of these patients, thus such endovascular interventions are recommended in this age group

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.

Carotid artery revascularization : Surgical and endovascular developments

NARCIS (Netherlands)

Borst, G.J. de

2007-01-01

Carotid artery revascularization. Surgical and endovascular developments. Stroke is among the most disabling chronic diseases and the third major cause of death in the Western world. In the Netherlands around 12 per 1000 inhabitants suffers a stroke, and in 2005 over 10.000 people died as a result

Woven Coronary Artery Disease Successfully Managed with Percutaneous Coronary Intervention: A New Case Report

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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.

Splenic artery pseudoaneurysm as a complication of pancreatic pseudocyst

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Micković Saša

2011-01-01

Full Text Available Introduction. Pancreatic pseudocyst presented as pseudoaneurysm of the splenic artery is a potential serious complication in patients with chronic pancreatitis. Case report. A 42-year-old male patient with a long-standing evolution of chronic pancreatitis and 8-year long evolution of pancreas pseudocyst was referred to the Military Medical Academy, Belgrade due to worsening of the general condition. At admission, the patient was cachectic, febrile, and had the increased values of amylases in urine and sedimentation (SE. After clinical and diagnostic examination: laboratory assessment, esophagogastroduodenoscopy (EGDS, ultrasonography (US, endoscopic ultrasonography (EUS, multislice computed scanner (MSCT angiography, pseudoaneurysm was found caused by the conversion of pseudocyst on the basis of chronic pancreatitis. The patient was operated on after founding pancreatic pseudocyst, which caused erosion of the splenic artery and their mutual communication. Postoperative course was duly preceded without complications with one year follow-up. Conclusion. Angiography is the most reliable and the safest method for diagnosing hemorrhagic pseudocysts when they clinically present as pseudoaneurysms. A potentially dangerous complication in the presented case was treated surgically with excellent postoperative results.

Frequency and predictors of renal artery stenosis in patients with coronary artery disease

International Nuclear Information System (INIS)

Shah, S.S.; Hafeezullah, M.

2010-01-01

Background: Renal artery stenosis (RAS) is a common finding in patients undergoing coronary angiography. We designed this study to look for the frequency and any predictors of renal artery stenosis in patients with coronary artery disease (CAD). Methods: A total of 201 consecutive patients with CAD confirmed by coronary angiography underwent an abdominal aortogram in the same sitting to screen for RAS. Patient demographics and co-morbidities were analysed for any association with RAS. Results: Forty-one of the patients were female (20.4%); ninety patients were hypertensive (44.8%); 49 patients (24.4%) were smokers; 19 patients (9.5%) had renal insufficiency; 88 patients (43.8%) had high cholesterol levels; 44 patients (21.9%) were diabetic. Thirty-two patients (15.9%) had single coronary artery disease, 59 patients (29.4%) had two vessel disease, and 110 patients (54.7%) had three vessel disease. Significant renal artery stenosis (less or equal to 50% stenosis) was present in 26 patients (12.9%). Among the variables studied, only female gender was found to be associated with a higher frequency of renal artery stenosis (24.39% vs 10.0%, p=0.01). Conclusions: The frequency of renal artery stenosis in patients with coronary artery disease is 12.9%. Female gender is associated with a higher frequency of renal artery stenosis in patients with CAD. (author)

Retrograde CTO-PCI of Native Coronary Arteries Via Left Internal Mammary Artery Grafts: Insights From a Multicenter U.S. Registry.

Science.gov (United States)

Tajti, Peter; Karatasakis, Aris; Karmpaliotis, Dimitri; Alaswad, Khaldoon; Jaffer, Farouc A; Yeh, Robert W; Patel, Mitul; Mahmud, Ehtisham; Choi, James W; Doing, Anthony H; Toma, Catalin; Uretsky, Barry; Garcia, Santiago; Moses, Jeffrey W; Parikh, Manish; Kirtane, Ajay; Ali, Ziad A; Hatem, Raja; Karacsonyi, Judit; Danek, Barbara A; Rangan, Bavana V; Banerjee, Subhash; Ungi, Imre; Brilakis, Emmanouil S

2018-03-01

Retrograde percutaneous coronary intervention (PCI) of native coronary artery chronic total occlusion (CTO) via left internal mammary artery (LIMA) graft has received limited study. We compared the clinical and procedural characteristics and outcomes of retrograde CTO-PCI through LIMA grafts vs other conduits in a contemporary multicenter CTO registry. The LIMA was used as the collateral channel in 20 of 990 retrograde CTO-PCIs (2.02%) performed at 18 United States centers. The mean age of the study patients was 69 ± 7 years and 95% were men. The most common CTO target vessel was the right coronary artery (55%). The mean J-CTO score in the LIMA group was high (3.45 ± 0.76). The technical success rates were 70% for retrograde PCI via LIMA graft vs 81.05% for retrograde via other conduits (P=.25), while procedural success rates were 70% for retrograde PCI via LIMA graft and 78.19% for retrograde via other conduits (P=.41). The incidence of major in-hospital complications was also similar between the LIMA and non-LIMA retrograde groups (5% vs 6%; P>.99). Use of guide-catheter extensions (40% vs 28%; P=.22), intravascular ultrasound (45% vs 31%; P=.20), and left ventricular assist devices (24% vs 10%; P=.08) was numerically higher in retrograde CTO-PCIs via LIMA grafts. Retrograde CTO-PCI is infrequently performed via LIMA grafts and is associated with similar success and major in-hospital complication rates as retrograde CTO-PCI performed via other conduits.

[Vascular calcifications in subjects with and without chronic renal failure: types, sites and risk factors].

Science.gov (United States)

Marinelli, Annibale; Di Napoli, Anteo

2017-04-01

Vascular calcifications worse outcomes in the general population and in patients on dialysis. We investigated 146 patients on chronic hemodialysis and 63 healthy controls with normal renal function under 65 years of age. All subjects underwent B-mode ultrasonography of common and internal carotid artery, abdominal aorta, common and superficial femoral artery and posterior tibial artery to assess the presence of intimal and medial calcifications. Intimal and media calcifications were present at the level of the carotid vessel, the abdominal aorta, the common femoral artery, the superficial femoral artery and the posterior tibial artery, respectively in 45%, 50%, 45%, 50%, 42% of patients on dialysis and in 5%, 15%, 24%, 5%, 2% of controls (p chronic hemodialysis. Ultrasonography currently available in Nephrology, is a sensitive, reproducible, inexpensive imaging technique to identify arterial intimal and medial calcification in high-risk cardiovascular subjects. Copyright by Società Italiana di Nefrologia SIN, Rome, Italy.

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

Autofluorescence and high-definition optical coherence tomography of retinal artery occlusions

OpenAIRE

Mathew, Raeba; Papavasileiou, Evangelia; Sivaprasad, Sobha

2010-01-01

Raeba Mathew, Evangelia Papavasileiou, Sobha SivaprasadLaser and Retinal Research Unit, Department of Ophthalmology, King’s College Hospital, Denmark Hill, London, UKBackground: The purpose of this study is to illustrate the fundus autofluorescence and high-definition optical coherence tomography (HD-OCT) features of acute and long-standing retinal artery occlusions.Design: Retrospective case series.Participants: Patients with acute and chronic retinal and cilioretinal artery occlus...

Role of proopiomelanocortin neuron Stat3 in regulating arterial pressure and mediating the chronic effects of leptin.

Science.gov (United States)

Dubinion, John H; do Carmo, Jussara M; Adi, Ahmad; Hamza, Shereen; da Silva, Alexandre A; Hall, John E

2013-05-01

Although signal transducer and activator of transcription 3 (Stat3) is a key second messenger by which leptin regulates appetite and body weight, its role in specific neuronal populations in metabolic regulation and in mediating the chronic effects of leptin on blood pressure is unknown. The current study tested the hypothesis that Stat3 signaling in proopiomelanocortin (POMC) neurons mediates the chronic effects of leptin on mean arterial pressure (MAP), as well as on glucose regulation, energy expenditure, and food intake. Stat3(flox/flox) mice were crossed with POMC-Cre mice to generate mice with Stat3 deletion specifically in POMC neurons (Stat3(flox/flox)/POMC-Cre). Oxygen consumption (Vo2), carbon dioxide respiration (Vco2), motor activity, heat production, food intake, and MAP were measured 24 hours/d. After baseline measurements, leptin was infused (4 μg/kg per min, IP) for 7 days. Stat3(flox/flox)/POMC-Cre mice were hyperphagic, heavier, and had increased respiratory quotients compared with control Stat3(flox/flox) mice. Baseline MAP was not different between the groups, and chronic leptin infusion reduced food intake similarly in both groups (27 versus 29%). Vo2, Vco2, and heat production responses to leptin were not significantly different in control and Stat3(flox/flox)/POMC-Cre mice. However, leptin-mediated increases in MAP were completely abolished, and blood pressure responses to acute air-jet stress were attenuated in male Stat3(flox/flox)/POMC-Cre mice. These results indicate that Stat3 signaling in POMC neurons is essential for leptin-mediated increases in MAP, but not for anorexic or thermogenic effects of leptin.

Total lymphoid irradiation preceding bone marrow transplantation for chronic myeloid leukaemia

Energy Technology Data Exchange (ETDEWEB)

James, N D; Apperley, J F; Kam, K C; Mackinnon, S; Goldman, J M; Goolden, A W.G.; Sikora, K [Royal Postgraduate Medical School, London (UK)

1989-03-01

Between August 1985 and October 1987 35 patients with chronic myeloid leukaemia (CML) were treated by high dose chemotherapy, total body irradiation (TBI) (1000 or 1200 cGy, n=31) and total lymphoid irradiation (TLI) (800 or 600 cGy, n=35) preceding allogeneic bone marrow transplantation (BMT). Both TBI and TLI were given at 200 cGy/fraction. Twenty-three patients had HLA-identical sibling donors, nine patients had HLA-matched but unrelated donors, and three partially HLA-mismatched donors. Twenty-two patients received T-cell depleted marrow. TLI did not add greatly to the toxicity. Four patients had recurrent leukaemia before engraftment was evaluable. The other 31 patients engrafted and no graft failed. Twenty-two patients survive at a median time from transplant of 305 days (range 81-586 days). Fourteen have no evidence of disease; eight have or had only cytogenetic evidence of leukaemia. It is concluded that addition of TLI to pretransplant immunosuppression increases the probability of reliable engraftment in patients receiving T-cell depleted marrow. This is not associated with significantly increased toxicity. (author).

Total lymphoid irradiation preceding bone marrow transplantation for chronic myeloid leukaemia

International Nuclear Information System (INIS)

James, N.D.; Apperley, J.F.; Kam, K.C.; Mackinnon, S.; Goldman, J.M.; Goolden, A.W.G.; Sikora, K.

1989-01-01

Between August 1985 and October 1987 35 patients with chronic myeloid leukaemia (CML) were treated by high dose chemotherapy, total body irradiation (TBI) (1000 or 1200 cGy, n=31) and total lymphoid irradiation (TLI) (800 or 600 cGy, n=35) preceding allogeneic bone marrow transplantation (BMT). Both TBI and TLI were given at 200 cGy/fraction. Twenty-three patients had HLA-identical sibling donors, nine patients had HLA-matched but unrelated donors, and three partially HLA-mismatched donors. Twenty-two patients received T-cell depleted marrow. TLI did not add greatly to the toxicity. Four patients had recurrent leukaemia before engraftment was evaluable. The other 31 patients engrafted and no graft failed. Twenty-two patients survive at a median time from transplant of 305 days (range 81-586 days). Fourteen have no evidence of disease; eight have or had only cytogenetic evidence of leukaemia. It is concluded that addition of TLI to pretransplant immunosuppression increases the probability of reliable engraftment in patients receiving T-cell depleted marrow. This is not associated with significantly increased toxicity. (author)

Practical importance and modern methods of the evaluation of skin microcirculation during chronic lower limb ischemia in patients with peripheral arterial occlusive disease and/or diabetes.

Science.gov (United States)

Kluz, J; Małecki, R; Adamiec, R

2013-02-01

Skin ischemia is one of the crucial phenomena during chronic lower limb ischemia in patients with peripheral arterial occlusive disease and/or diabetes. However, risk stratification for development of ischemic ulceration and/or skin necrosis in those patients is not easy, mostly due to the complex structure of the dermal vascular bed and limited possibilities for studying the skin capillaries in everyday practice. All definitions of critical limb ischemia thus far have considered mostly the clinical symptoms and the degree of macrocirculatory impairment. Despite the fact that the reduction of absolute dermal perfusion and improper distribution of perfusion in ischemic feet, primarily diminished perfusion or even a complete loss of blood flow in nutritional capillaries, rather than arterial occlusion per se, is the eventual reason for critical limb ischemia symptoms, the vessels of the microcirculation are not routinely assessed in clinical practice. Monitoring of microcirculatory parameters, as a part of integrated diagnostic approach, may have a considerable value in the evaluation of risk, progression of the disease and the effectiveness of therapeutic intervention in individual patients. Relative simplicity and availability of different non-invasive methods, including video capillaroscopy and laser Doppler fluxmetry, should constitute a premise to their wider application in clinical management of chronic limb ischemia.

Popliteal Arterial Aneurysms

African Journals Online (AJOL)

plication was acute arterial occlusion caused by thrombo- embolism. The reasons for ... Total. 43. 55. TABLE 11. CONCOMITANT DISEASE IN 38 PATIENTS .... Dacron prosthesis in 4. .... genous saphenous vein and the type of anastomosis.

Comparison of arterial and venous blood biomarker levels in chronic obstructive pulmonary disease [v1; ref status: indexed, http://f1000r.es/9x

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Emer Kelly

2013-04-01

Full Text Available Purpose: The development of novel biomarkers is an unmet need in chronic obstructive pulmonary disease (COPD. Arterial blood comes directly from the lung and venous blood drains capillary beds of the organ or tissue supplied. We hypothesized that there would be a difference in levels of the biomarkers metalloproteinase 9 (MMP-9, vascular endothelial growth factor A (VEGF-A and interleukin 6 (IL-6 in arterial compared with venous blood.  Methods: Radial artery and brachial vein blood samples were taken simultaneously in each of 12 patients with COPD and seven controls with normal lung function. Circulating immunoreactive MMP-9, VEGF-A and IL-6 levels in serum were measured using quantitative enzyme-linked immunosorbent assays. Results were compared using a Student’s paired t test. The study was powered to determine whether significant differences in cytokine levels were present between paired arterial and venous blood samples.   Results: In the 12 patients with COPD, four were female, and age ranged 53-85 years, mean age 69 years. Three patients in the control group were female, with age range 46-84 years, mean age 64.7 years. In the COPD group, three patients had mild, five moderate and four severe COPD. No significant difference was found between arterial and venous levels of MMP-9, VEGF-A or IL-6.  Conclusions: In this pilot study, levels of the measured biomarkers in arterial compared with venous blood in both COPD patients and healthy controls did not differ. This suggests that as we continue to chase the elusive biomarker in COPD as a potential tool to measure disease activity, we should focus on venous blood for this purpose.

Effects of carbonated mineral water treatment in Băile Tuşnad on chronic arterial occlusive disease – a case report

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Gabriela Dogaru

2017-05-01

Full Text Available Introduction. Băile Tușnad spa is recognized for its role in the prevention and rehabilitation treatment of cardiovascular diseases, including chronic arterial occlusive disease, due to the presence of natural therapeutic factors: carbonated mineral waters through their peripheral vasodilator effects, natural mofettes, stimulating bioclimate. Aim. The current study aimed to assess the clinical efficiency of natural therapeutic factors in Băile Tuşnad for the continuation of rehabilitation treatment in a patient with chronic arterial occlusive disease, in order to encourage walking, reduce cardiovascular risk and improve quality of life. Material and method. Patient N.M., aged 75, with multiple cardiovascular risk factors. In 2013, he was diagnosed with lower limb peripheral ischemia syndrome stage II B Fontaine, predominantly left claudication at about 100 m, for which balloon angioplasty was performed. He attended rehabilitation treatment for 3 years in Baile Tuşnad, consisting of carbonated mineral water baths for 15 minutes, aerotherapy for 30 minutes daily for the stimulation of walking, massotherapy, kinesiotherapy, performed daily for 16 days, and in 2016, at the Rehabilitation Hospital Cluj-Napoca. He was clinically evaluated before and at the end of treatment by the Visual Analogue Scale, the 10-m walking test, adverse reactions, Doppler ultrasound. Results. At the end of treatment, an increase in the walking distance and speed, a significant improvement in the quality of gait was found; claudication occurred after 250 m, pain in the lower limbs was improved. There were no side reactions. Conclusions. Rehabilitation treatment with natural therapeutic factors influenced the clinical and functional picture, determining a significant improvement in the quality of gait and quality of life.

Fractional Flow Reserve Assessment of a Coronary Artery Fistula

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Joseph Petit

2015-01-01

Full Text Available A 63 y/o male with a past medical history of hypertension, chronic obstructive pulmonary disease, and obesity was admitted to an outside hospital for an abdominal incisional hernia repair and cholecystectomy. Post-operatively he developed shortness of breath (SOB and multiple runs of paroxysmal atrial fibrillation. A CT scan was negative for pulmonary embolism, but showed a left anterior descending (LAD coronary artery to main pulmonary artery (MPA fistula. He was transferred to our facility for further management.

Screening of Chronic Obstructive Pulmonary Disease Patients for Pulmonary Arterial Hypertension Using Two-Dimensional Transthoracic Doppler Echocardiography in Tertiary Care Hospital in India

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Vinay Mahishale

2015-01-01

Full Text Available Background: Chronic obstructive pulmonary disease (COPD and pulmonary arterial hypertension (PAH are common and underdiagnosed medical conditions in India. Prevalence of these chronic diseases is high both in rural and urban areas. However, the exact prevalence of PAH in Indian COPD patients is unclear. Comorbid conditions like PAH have a great impact on the outcome of COPD in the form of severity, exacerbations, morbidity, and mortality. Right heart catheterization remains the gold standard test for diagnosis of PAH, but it is invasive and practically not feasible. Aims and objectives: The present study objective was to screen COPD patients for PAH using two-dimensional transthoracic Doppler echocardiography (ECHO in Tertiary Care Hospital. Results: A total of 2040 patients with a confirmed diagnosis of COPD were enrolled in the study. Among these patients, 1509 were males (73.9%, 531 were females (23.06%, and 1428 were known or ex-smokers (70%. None of the females were smokers, but there was a history of biomass fuel exposure for >10 years. As per global initiative for chronic obstructive lung disease criteria, mild, moderate, severe, and very severe COPD was noted in 525,629,511, and 375 patients, respectively. When they were screened using ECHO, prevalence of PAH was 41.96% as 856 subjects had PAH. Prevalence of PAH among mild, moderate, severe, and very severe COPD was 23.8%, 34.81%, 48.53%, and 70.4%, respectively. There was a linear relationship between PAH and severity of COPD. Conclusion: PAH is very common in COPD patients in India. As the severity of COPD increased, the frequency and degree of PAH also increased. ECHO is an excellent tool for detection of PAH in COPD patients. All patients with severe to very severe COPD should be routinely screened by ECHO for PAH and with mild to moderate COPD, who have dyspnea out of proportion to their clinical condition should also be screened for PAH.

Insulin resistance and associated dysfunction of resistance vessels and arterial hypertension

DEFF Research Database (Denmark)

Henriksen, Jens Henrik; Møller, Søren

2005-01-01

, calcitonin gene-related peptide, nitric oxide, and other vasodilators, and is most pronounced in the splanchnic area. This provides an effective (although relative) counterbalance to raised arterial blood pressure. Subjects with arterial hypertension (essential, secondary) may become normotensive during......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...... vascular resistance, high arterial compliance, increased cardiac output, secondary activation of counterregulatory systems (renin-angiotensin-aldosterone system, sympathetic nervous system, release of vasopressin), and resistance to vasopressors. The vasodilatory state is mediated through adrenomedullin...

Long-term survival benefit of revascularization compared with medical therapy in patients with coronary chronic total occlusion and well-developed collateral circulation.

Science.gov (United States)

Jang, Woo Jin; Yang, Jeong Hoon; Choi, Seung-Hyuk; Song, Young Bin; Hahn, Joo-Yong; Choi, Jin-Ho; Kim, Wook Sung; Lee, Young Tak; Gwon, Hyeon-Cheol

2015-02-01

The purpose of this study was to compare the long-term clinical outcomes of patients with chronic total occlusion (CTO) and well-developed collateral circulation treated with revascularization versus medical therapy. Little is known about the clinical outcomes and optimal treatment strategies of CTO with well-developed collateral circulation. We screened 2,024 consecutive patients with at least 1 CTO detected on coronary angiogram. Of these, we analyzed data from 738 patients with Rentrop 3 grade collateral circulation who were treated with medical therapy alone (n = 236), coronary artery bypass grafting (n = 170) or percutaneous coronary intervention (n = 332; 80.1% successful). Patients who underwent revascularization and medical therapy (revascularization group, n = 502) were compared with those who underwent medical therapy alone (medication group, n = 236) in terms of cardiac death and major adverse cardiac events (MACE), defined as the composite of cardiac death, myocardial infarction, and repeat revascularization. During a median follow-up duration of 42 months, multivariate analysis revealed a significantly lower incidence of cardiac death (hazard ratio [HR]: 0.29; 95% confidence interval [CI]: 0.15 to 0.58; p collateral circulation, aggressive revascularization may reduce the risk of cardiac mortality and MACE. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Nuclear medicine in acute and chronic renal failure

Energy Technology Data Exchange (ETDEWEB)

Sherman, R.A.; Byun, K.J.

1982-07-01

The diagnostic value of renal scintiscans in patients with acute or chronic renal failure has not been emphasized other than for the estimation of renal size. /sup 131/I OIH, /sup 67/gallium, /sup 99m/TcDTPA, glucoheptonate and DMSA all may be valuable in a variety of specific settings. Acute renal failure due to acute tubular necrosis, hepatorenal syndrome, acute interstitial nephritis, cortical necrosis, renal artery embolism, or acute pyelonephritis may be recognized. Data useful in the diagnosis and management of the patient with obstructive or reflux nephropathy may be obtained. Radionuclide studies in patients with chronic renal failure may help make apparent such causes as renal artery stenosis, chronic pyelonephritis or lymphomatous kidney infiltration. Future correlation of scanning results with renal pathology promises to further expand nuclear medicine's utility in the noninvasive diagnosis of renal disease.

Nuclear medicine in acute and chronic renal failure

International Nuclear Information System (INIS)

Sherman, R.A.; Byun, K.J.

1982-01-01

The diagnostic value of renal scintiscans in patients with acute or chronic renal failure has not been emphasized other than for the estimation of renal size. 131 I OIH, 67 gallium, /sup 99m/TcDTPA, glucoheptonate and DMSA all may be valuable in a variety of specific settings. Acute renal failure due to acute tubular necrosis, hepatorenal syndrome, acute interstitial nephritis, cortical necrosis, renal artery embolism, or acute pyelonephritis may be recognized. Data useful in the diagnosis and management of the patient with obstructive or reflux nephropathy may be obtained. Radionuclide studies in patients with chronic renal failure may help make apparent such causes as renal artery stenosis, chronic pyelonephritis or lymphomatous kidney infiltration. Future correlation of scanning results with renal pathology promises to further expand nuclear medicine's utility in the noninvasive diagnosis of renal disease

Spironolactone Therapy in Chronic Stable Right HF Trial

Science.gov (United States)

2018-04-12

Chronic Right-Sided Heart Failure; Pulmonary Arterial Hypertension; Pulmonary Hypertension, Primary, 2; Pulmonary Hypertension, Primary, 3; Pulmonary Hypertension, Primary, 4; Cardiomyopathy Right Ventricular

Arteries of the falciform ligament on C-arm CT hepatic arteriography: The hepatic falciform artery and the Sappey's superior artery

Energy Technology Data Exchange (ETDEWEB)

Hur, Saebeom; Chung, Jin Wook; Lee, Jae Hwan; Cho, SooBeum; Kim, Minuk; Lee, Myungsu; Kim, Hyo-Cheol; Jae, Hwan Jun [Seoul National University Hospital, Department of Radiology, Seoul (Korea, Republic of); Zhou, Chun Gao [First Affiliated Hospital of Nanjing Medical University, Department of Interventional Radiology, Nanjing, Jangsu (China)

2017-04-15

To investigate the prevalence, anatomy and distribution of the hepatic falciform artery (HFA) and Sappey's superior artery (SSA) using C-arm CT hepatic arteriography (C-arm CTHA). From January 2011 to December 2012, 220 patients who underwent C-arm CTHA during initial transarterial treatment for hepatocellular carcinoma were included in this retrospective study. The HFAs and SSAs prevalence and origin were evaluated using axial images of C-arm CTHA. A 5-point scale for HFAs and a 4-point scale for SSAs were used to designate the radiologically conspicuous arteries. The prevalences of the total HFAs and SSAs were 95 % (n=209) and 22 % (n=49), while those of radiologically conspicuous HFAs and SSAs were 62 % (n=137) and 10 % (n=22), respectively. Thirty HFAs (22 % of radiologically conspicuous HFAs and 14 % of the total study population) were distributed in the subcutaneous layer of the anterior abdominal wall, while the majority of SSAs ran through the superior part of the falciform ligament in the left-anterior direction and anastomosed with left inferior phrenic artery. Our study using C-arm CTHA revealed that the prevalence of the HFA is higher than the existing knowledge and proved the existence of the SSA radiologically for the first time. (orig.)

Arteries of the falciform ligament on C-arm CT hepatic arteriography: The hepatic falciform artery and the Sappey's superior artery

International Nuclear Information System (INIS)

Hur, Saebeom; Chung, Jin Wook; Lee, Jae Hwan; Cho, SooBeum; Kim, Minuk; Lee, Myungsu; Kim, Hyo-Cheol; Jae, Hwan Jun; Zhou, Chun Gao

2017-01-01

To investigate the prevalence, anatomy and distribution of the hepatic falciform artery (HFA) and Sappey's superior artery (SSA) using C-arm CT hepatic arteriography (C-arm CTHA). From January 2011 to December 2012, 220 patients who underwent C-arm CTHA during initial transarterial treatment for hepatocellular carcinoma were included in this retrospective study. The HFAs and SSAs prevalence and origin were evaluated using axial images of C-arm CTHA. A 5-point scale for HFAs and a 4-point scale for SSAs were used to designate the radiologically conspicuous arteries. The prevalences of the total HFAs and SSAs were 95 % (n=209) and 22 % (n=49), while those of radiologically conspicuous HFAs and SSAs were 62 % (n=137) and 10 % (n=22), respectively. Thirty HFAs (22 % of radiologically conspicuous HFAs and 14 % of the total study population) were distributed in the subcutaneous layer of the anterior abdominal wall, while the majority of SSAs ran through the superior part of the falciform ligament in the left-anterior direction and anastomosed with left inferior phrenic artery. Our study using C-arm CTHA revealed that the prevalence of the HFA is higher than the existing knowledge and proved the existence of the SSA radiologically for the first time. (orig.)

Efficacy of total lymphoid irradiation for chronic allograft rejection following bilateral lung transplantation

International Nuclear Information System (INIS)

Diamond, David A.; Michalski, Jeff M.; Lynch, John P.; Trulock, Elbert P.

1998-01-01

Purpose: To assess the safety and efficacy of total lymphoid irradiation (TLI) in patients experiencing chronic rejection following bilateral lung transplantation (BLT). Patients and Materials: Eleven patients received TLI for chronic allograft rejection (bronchiolitis obliterans syndrome) refractory to conventional treatment modalities. Radiation therapy (RT) was prescribed as 8 Gy delivered in 10 0.8-Gy fractions, 2 fractions/week, via mantle, paraaortic, and inverted-Y fields. Serial pre- and post-RT pulmonary function values, complete blood counts, and immunosuppressive augmentation requirements [use of methylprednisolone, murine anti-human mature T-cell monoclonal antibody (OKT3), polyclonal antithymocyte globulin (ATG), and tacrolimus] were monitored. Results: In the 3 months preceding TLI, the average decrease in forced expiratory volume in 1 s (FEV 1 ) was 34% (range 0-75%) and the median number of immunosuppression augmentations was 3 (range 0-5). Only 4 of 11 patients completed all 10 TLI treatment fractions. Reasons for discontinuation included progressive pulmonary decline (four patients), worsening pulmonary infection (two patients), and persistent thrombocytopenia (one patient). Seven of the 11 patients failed within 8 weeks of treatment cessation. One patient had unabated rejection and received bilateral living related-donor transplants; he is alive and well. Six patients died. Two of these deaths were due to pulmonary infection from organisms isolated prior to the start of RT; the other four deaths were from progressive pulmonary decline. The four remaining patients had durable positive responses to TLI (mean follow-up of 47 weeks; range 24-72). Comparing the 3 months preceding RT to the 3 months following treatment, these four patients had improvements in average FEV 1 (40% decline vs. 1% improvement) and fewer median number of immunosuppressive augmentations (3.5 vs. 0). None of these patients has developed lymphoproliferative disease or has died

Isolated Unilateral Absent Branch Pulmonary Artery with Peripheral Pulmonary Stenosis and Coronary Artery Disease

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Sunil Abhishek B

2017-09-01

Full Text Available Isolated Unilateral Absent Pulmonary Artery (UAPA is a rare congenital anomaly. It is usually associated with congenital heart defects. A 45 year old male patient presented with complaints of fever with cough and expectoration for 15 days and retrosternal chest discomfort for the previous 2 days. ECG showed diffuse ST segment depression with T wave inversion in the inferior and lateral leads. Coronary Angiogram done through the right femoral approach revealed diffusely diseased Left Anterior Descending (LAD artery that was totally cut off at the mid segment. The Left Circumflex (LCx artery was providing blood supply to the right middle and lower lung areas. There was another collateral arising from the Left Subclavian Artery supplying the right middle and lower lung areas. The left pulmonary artery was normal, but branches supplying the middle and lower lobes of the right lung were absent and the upper lobe branch had pulmonary stenosis. UAPA is a rare clinical entity; collaterals from coronaries are extremely rare in this condition and till now there has not been any case report of unilateral absent branch pulmonary artery with peripheral stenosis of other branches, on the affected side and associated coronary artery disease.

First-in-Man Computed Tomography-Guided Percutaneous Revascularization of Coronary Chronic Total Occlusion Using a Wearable Computer: Proof of Concept.

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Opolski, Maksymilian P; Debski, Artur; Borucki, Bartosz A; Szpak, Marcin; Staruch, Adam D; Kepka, Cezary; Witkowski, Adam

2016-06-01

We report a case of successful computed tomography-guided percutaneous revascularization of a chronically occluded right coronary artery using a wearable, hands-free computer with a head-mounted display worn by interventional cardiologists in the catheterization laboratory. The projection of 3-dimensional computed tomographic reconstructions onto the screen of virtual reality glass allowed the operators to clearly visualize the distal coronary vessel, and verify the direction of the guide wire advancement relative to the course of the occluded vessel segment. This case provides proof of concept that wearable computers can improve operator comfort and procedure efficiency in interventional cardiology. Copyright © 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

A case of atherosclerotic inferior mesenteric artery aneurysm secondary to high flow state.

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Troisi, Nicola; Esposito, Giovanni; Cefalì, Pietro; Setti, Marco

2011-07-01

Inferior mesenteric artery aneurysms are very rare and they are among the rarest of visceral artery aneurysms. Sometimes, the distribution of the blood flow due to chronic atherosclerotic occlusion of some arteries can establish an increased flow into a particular supplying district (high flow state). A high flow state in a stenotic inferior mesenteric artery in compensation for a mesenteric occlusive disease can produce a rare form of aneurysm. We report the case of an atherosclerotic inferior mesenteric aneurysm secondary to high flow state (association with occlusion of the celiac trunk and severe stenosis of the superior mesenteric artery), treated by open surgical approach. Copyright © 2011 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

Chronic binge alcohol consumption during pregnancy alters rat maternal uterine artery pressure response.

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Naik, Vishal D; Lunde-Young, Emilie R; Davis-Anderson, Katie L; Orzabal, Marcus; Ivanov, Ivan; Ramadoss, Jayanth

2016-11-01

We aimed to investigate pressure-dependent maternal uterine artery responses and vessel remodeling following gestational binge alcohol exposure. Two groups of pregnant rats were used: the alcohol group (28.5% wt/v, 6.0 g/kg, once-daily orogastric gavage in a binge paradigm between gestational day (GD) 5-19) and pair-fed controls (isocalorically matched). On GD20, excised, pressurized primary uterine arteries were studied following equilibration (60 mm Hg) using dual chamber arteriograph. The uterine artery diameter stabilized at 20 mm Hg, showed passive distension at 40 mm Hg, and redeveloped tone at 60 mm Hg. An alcohol effect (P = 0.0025) was observed on the percent constriction of vessel diameter with greater pressure-dependent myogenic constriction. Similar alcohol effect was noted with lumen diameter response (P = 0.0020). The percent change in media:lumen ratio was higher in the alcohol group (P alcohol affects pressure-induced uterine artery reactivity, inward-hypotrophic remodeling, and adaptations critical for nutrient delivery to the fetus. Copyright © 2016 Elsevier Inc. All rights reserved.

Management and outcome of bleeding pseudoaneurysm associated with chronic pancreatitis

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Jan Yi-Yin

2006-01-01

Full Text Available Abstract Background A bleeding pseudoaneurysm in patients with chronic pancreatitis is a rare and potentially lethal complication. Optimal treatment of bleeding peripancreatic pseudoaneurysm remains controversial. This study reports on experience at Chang Gung Memorial Hospital (CGMH in managing of bleeding pseudoaneurysms associated with chronic pancreatitis. Methods The medical records of 9 patients (8 males and 1 female; age range, 28 – 71 years; median, 36 years with bleeding pseudoaneurysms associated with chronic pancreatitis treated at CGMH between Aug. 1992 and Sep. 2004 were retrospectively reviewed. Alcohol abuse (n = 7;78% was the predominant predisposing factor. Diagnoses of bleeding pseudoaneurysms were based on angiographic (7/7, computed tomographic (4/7, ultrasound (2/5, and surgical (2/2 findings. Whether surgery or angiographic embolization was performed was primarily based on patient clinical condition. Median follow-up was 38 months (range, 4 – 87 months. Results Abdominal computed tomography revealed bleeding pseudoaneurysms in 4 of 7 patients (57%. Angiography determined correct diagnosis in 7 patients (7/7, 100%. The splenic artery was involved in 5 cases, the pancreaticoduodenal artery in 2, the gastroduodenal artery in 1, and the middle colic artery in 1. Initial treatment was emergency (n = 4 or elective (n = 3 surgery in 7 patients and arterial embolization in 2. Rebleeding was detected after initial treatment in 3 patients. Overall, 5 arterial embolizations and 9 surgical interventions were performed; the respective rates of success of these treatments were 20% (1/5 and 89% (8/9. Five patients developed pseudocysts before treatment (n = 3 or following intervention (n = 2. Pseudocyst formation was identified in 2 of the 3 rebleeding patients. Five patients underwent surgical treatment for associated pseudocysts and bleeding did not recur. One patient died from angiography-related complications. Overall mortality

Arterial grafts balance survival between incomplete and complete revascularization: a series of 1000 consecutive coronary artery bypass graft patients with 98% arterial grafts.

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Kieser, Teresa M; Curran, Helen J; Rose, M Sarah; Norris, Colleen M; Graham, Michelle M

2014-01-01

Coronary artery bypass grafting (CABG) with incomplete revascularization (ICR) is thought to decrease survival. We studied the survival of patients with ICR undergoing total arterial grafting. In a consecutive series of all-comer 1000 patients with isolated CABG, operative and midterm survival were assessed for patients undergoing complete versus ICR, with odds ratios and hazard ratios, adjusted for European System for Cardiac Operative Risk Evaluation category, CABG urgency, age, and comorbidities. In this series of 1000 patients with 98% arterial grafts (2922 arterial, 59 vein grafts), 73% of patients with multivessel disease received bilateral internal mammary artery grafts. ICR occurred in 140 patients (14%). Operative mortality was 3.8% overall, 8.6% for patients with ICR, and 3.2% for patients with complete revascularization (P = .008). For operative mortality using multivariable logistic regression, after controlling for European System for Cardiac Operative Risk Evaluation category (P System for Cardiac Operative Risk Evaluation category (P reserved.

Association of pentraxin and high-sensitive C-reactive protein as inflammatory biomarkers in patients with chronic periodontitis and peripheral arterial disease.

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Boyapati, Ramanarayana; Chinthalapani, Srikanth; Ramisetti, Arpita; Salavadhi, Shyam Sunder; Ramachandran, Radhika

2018-01-01

Inflammation is a common feature of both peripheral artery disease (PAD) and periodontal disease. The aim of this study is to evaluate the relationship between PAD and periodontal disease by examining the levels of inflammatory cytokines, pentraxin-3 (PTX-3), and high-sensitive C-reactive protein from serum. A total of 50 patients were included in this cross-sectional study. Patients were divided into two groups: those with PAD (test group) and those with the non-PAD group (control group) based on ankle-brachial index values. Periodontal examinations and biochemical analysis for PTX-3 and high-sensitive C-reactive protein were performed to compare the two groups. All the obtained data were sent for statistical analyses using SPSS version 18. In the clinical parameters, there is statistically significant difference present between plaque index, clinical attachment loss, and periodontal inflammatory surface area with higher mean values in patients with PAD having periodontitis. There is statistical significant ( P C-reactive protein (hs-CRP), and PTX-3. PTX-3 and acute-phase cytokine such as hs-CRP can be regarded as one of the best indicators to show the association between the PAD and periodontitis followed by hs-CRP, TC, very LDL (VLDL), and LDL. However, high-density lipoprotein (HDL) is a poor indicator for its association with chronic periodontitis and PAD.

Sequential change of hemodynamic reserve in patients with major cerebral artery occlusion of severe stenosis

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Hasegawa, Y.; Yamaguchi, T.; Tsuchiya, T. (National Cardiovascular Center, Osaka (Japan). Cerebrovascular Div.); Minematsu, K. (National Cardiovascular Center, Osaka (Japan). Research Inst.); Nishimura, T. (National Cardiovascular Inst., Osaka (Japan). Dept. of Diagnostic Radiology)

1992-02-01

To identify regional vasodilatory capacity and its sequential change, we evaluated prospectively a total of 78 acetazolamide tests in 51 patients with occlusion or greater than 75% stenosis of the carotid or middle cerebral arteries. The relative distribution of cerebral blood flow was determined by single photon emission computed tomography using N-isopropyl-p-({sup 123}I)-iodoamphetamine before and after intravenous injection of acetazolamide. Reduced vasodilatory capacity was demonstrated in 20 patients (38%), including 5 patients with hemodynamic transient ischemic attacks or infarction. Follow-up acetazolamide tests revealed asymptomatic progression of the arterial lesion (from stenosis to occlusion) in 1 patient and almost complete improvement of vasodilatory capacity in 5 patients, including 3 without surgical intervention. During an average follow-up period of 18.5 months, 4 patients died from cardiac causes or neoplasm; no neurovascular events occurred. Much larger numbers of patients with longer observation periods will be necessary to clarify the contribution of chronic hemodynamic failure to subsequent stroke. However, the present data indicate that the acetazolamide test is useful for assessing the course of high grade stenosis or occlusion of major cerebral arteries. (orig.).

Biomarkers of coronary endothelial health: correlation with invasive measures of collateral function, flow and resistance in chronically occluded coronary arteries and the effect of recanalization.

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Ladwiniec, Andrew; Ettelaie, Camille; Cunnington, Michael S; Rossington, Jennifer; Thackray, Simon; Alamgir, Farquad; Hoye, Angela

2016-06-01

In the presence of a chronically occluded coronary artery, the collateral circulation matures by a process of arteriogenesis; however, there is considerable variation between individuals in the functional capacity of that collateral network. This could be explained by differences in endothelial health and function. We aimed to examine the relationship between the functional extent of collateralization and levels of biomarkers that have been shown to relate to endothelial health. We measured four potential biomarkers of endothelial health in 34 patients with mature collateral networks who underwent a successful percutaneous coronary intervention (PCI) for a chronic total coronary occlusion (CTO) before PCI and 6-8 weeks after PCI, and examined the relationship of biomarker levels with physiological measures of collateralization. We did not find a significant change in the systemic levels of sICAM-1, sE-selectin, microparticles or tissue factor 6-8 weeks after PCI. We did find an association between estimated retrograde collateral flow before CTO recanalization and lower levels of sICAM-1 (r=0.39, P=0.026), sE-selectin (r=0.48, P=0.005) and microparticles (r=0.38, P=0.03). Recanalization of a CTO and resultant regression of a mature collateral circulation do not alter systemic levels of sICAM-1, sE-selectin, microparticles or tissue factor. The identified relationship of retrograde collateral flow with sICAM-1, sE-selectin and microparticles is likely to represent an association with an ability to develop collaterals rather than their presence and extent.

Coronary artery bypass grafts: assessment of graft patency and native coronary artery lesions using 16-slice MDCT

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Stauder, Norbert I.; Drosch, Tanja; Claussen, Claus D.; Kopp, Andreas F. [Eberhard-Karls-University, Department of Diagnostic Radiology, Tuebingen (Germany); Kuettner, Axel [Friedrich-Alexander-University, Department of Diagnostic Radiology, Erlangen (Germany); Schroeder, Stephen; Beck, Torsten [Eberhard-Karls-University, Department of Internal Medicine, Division Cardiology, Tuebingen (Germany); Stauder, Heidrun [Eberhard-Karls-University, Department of Thoracic and Cardiovascular Surgery, Tuebingen (Germany); Blumenstock, Gunnar [Eberhard-Karls-University, Department of Medical Information Processing, Tuebingen (Germany)

2006-11-15

The objective of this study was to evaluate the accuracy of electrocardiography (ECG)-gated 16-slice multidetector-row computed tomography (MDCT) in detection of stenosis of bypass grafts and native coronary arteries in patients who have undergone coronary artery bypass grafting (CABG). ECG-gated contrast-enhanced MDCT using 12 x 0.75-mm collimation was performed in 20 patients with recurrent angina 4.75 years after undergoing CABG. A total of 50 grafts, 16 arterial and 34 venous, were examined. All graft and coronary segments were evaluated for stenosis in comparison with conventional coronary angiography (CCA). Among the 80 arterial graft segments, 62 could be assessed (77.5%). Sensitivity, specificity, and positive and negative predictive values for stenosis were 96.2%, 97.2%, 96.2%, and 97.2%, respectively. In a total of 180 venous graft segments, 167 could be assessed. Sensitivity, specificity, and positive and negative predictive values for stenosis were 98.5%, 93.9%, 91.8%, and 98.9%, respectively. MDCT could assess 179 of 260 native coronary artery segments (68.8%).Sensitivity, specificity, and positive and negative predictive values for stenosis were 92.1%, 76.9%, 87.5%, and 84.7%, respectively. Sixteen-slice MDCT provides excellent image quality and diagnostic accuracy in detection of graft and coronary artery lesions in patients with suspected graft dysfunction. (orig.)

[Chronic wounds as a public health problem].

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Situm, Mirna; Kolić, Maja; Redzepi, Gzim; Antolić, Slavko

2014-10-01

Chronic wounds represent a significant burden to patients, health care professionals and the entire health care system. Regarding the healing process, wounds can be classified as acute or chronic wounds. A wound is considered chronic if healing does not occur within the expected period according to the wound etiology and localization. Chronic wounds can be classified as typical and atypical. The majority of wounds (95 percent) are typical ones, which include ischemic, neurotrophic and hypostatic ulcers and two separate entities: diabetic foot and decubital ulcers. Eighty percent of chronic wounds localized on lower leg are the result of chronic venous insufficiency, in 5-10 percent the cause is of arterial etiology, whereas the rest are mostly neuropathic ulcers. Chronic wounds significantly decrease the quality of life of patients by requiring continuous topical treatment, causing immobility and pain in a high percentage of patients. Chronic wounds affect elderly population. Chronic leg ulcers affect 0.6-3 percent of those aged over 60, increasing to over 5 percent of those aged over 80. Emergence of chronic wounds is a substantial socioeconomic problem as 1-2 percent of western population will suffer from it. This estimate is expected to rise due to the increasing proportion of elderly population along with the diabetic and obesity epidemic. It has been proved that chronic wounds account for the large proportion of costs in the health care system, even in rich societies. Socioeconomically, the management of chronic wounds reaches a total of 2-4 percent of the health budget in western countries. Treatment costs for some other diseases are not irrelevant, nor are the method and materials used for treating these wounds. Considering etiologic factors, a chronic wound demands a multidisciplinary approach with great efforts of health care professionals to treat it more efficiently, more simply and more painlessly for the patient, as well as more inexpensively for

The ability of NT-proBNP to detect chronic heart failure and predict all-cause mortality is higher in elderly Chinese coronary artery disease patients with chronic kidney disease

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Fu S

2013-04-01

Full Text Available Shihui Fu, Leiming Luo, Ping Ye, Shuangyan Yi, Yuan Liu, Bing Zhu, Liang Wang, Tiehui Xiao, Yongyi Bai Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, People's Republic of China Objective: To analyze the relationship between N-terminal pro-brain natriuretic peptide (NT-proBNP and renal function, and compare the ability and cut-off thresholds of NT-proBNP to detect chronic heart failure (CHF and predict mortality in elderly Chinese coronary artery disease (CAD patients with and without chronic kidney disease (CKD. Methods: The study included 999 CAD patients older than 60 years. The endpoint was all-cause mortality over a mean follow-up period of 417 days. Results: The median age was 86 years (range: 60–104 years, and the median NT-proBNP level was 409.8 pg/mL. CKD was present in 358 patients. Three hundred and six patients were positive for CHF. One hundred and ten CKD patients and 105 non-CKD patients died. Not only CKD, but also estimated glomerular filtration rate independently affected NT-proBNP. NT-proBNP detected CHF with a cut-off value of 298.4 pg/mL in non-CKD patients and a cut-off value of 435.7 pg/mL in CKD patients. NT-proBNP predicted death with a cut-off value of 369.5 pg/mL in non-CKD patients and a cut-off value of 2584.1 pg/mL in CKD patients. The NT-proBNP level was significantly related to the prevalence of CHF and all-cause mortality in CAD patients with and without CKD; this effect persisted after adjustment. The crude and multiple adjusted hazard ratios of NT-proBNP to detect CHF and predict mortality were significantly higher in patients with CKD compared with the remainder of the population. The addition of NT-proBNP to the three-variable and six-variable models generated a significant increase in the C-statistic. Conclusion: Amongst elderly Chinese CAD patients, there was an independently inverse association between NT-proBNP and renal function. With the higher cutoff points, NT

Ankle-brachial index as indicator of chronic arterial insufficiency of the lower extremities and renal artery stenosis CT/DS angiography

International Nuclear Information System (INIS)

Georgiev, A.; Chervenkov, L.; Karadon, S.

2015-01-01

Full text: The aim is to validate the measurements of ankle -brachial index (ABI), as part of routine examination algorithm in conducting CTA/DSA of the extremities in patients suffering from PAD. Correlations between ABI values and renal artery stenosis. The present study includes 200 patients (138 men and 62 women, aged between 60 and 75 years). 130 of them were examined by a computer- tomography angiography - 95 men and 32 women. 70 patients were examined by digital subtraction angiography - 50 men and 20 women. Measurements of ankle-brachial index (ABI) were performed on all patients by measuring the systolic blood pressure on both brachial arteries and determine the peak pressure in both aa. dorsalis pedis. Statistical data processing. There are no patients in the study with ABI values above 0.7 that have established renal artery stenosis. All patients with severe atherosclerotic changes have values of the ABI below 0.7, and those with the most severe changes below 0.5. This fully corresponds to global data showing that values below 0.9 ABI show mild engagement, below 0.7 average, and below 0.5 severe involvement. According to the results of this survey sensitivity of ABI for renal arteries below 0.7 equals 100% and its specificity = 67.5%. For values of ABI below 0.5: Sensitivity =100%; Specificity = 83.85%. By determining ABI values both symptomatic and asymptomatic form of a PAD can be diagnosed. the method is fast, non-invasive, inexpensive and applicable everywhere. No special preparation of the patient is needed. The method can be used not only to assess the degree of commitment of the vessels of the lower limbs, but also as an indicator for the state of renal arteries in those patients

Functional dilatation and medial remodeling of the renal artery in response to chronic increased blood flow.

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Roan, Jun-Neng; Yeh, Chin-Yi; Chiu, Wen-Cheng; Lee, Chou-Hwei; Chang, Shih-Wei; Jiangshieh, Ya-Fen; Tsai, Yu-Chuan; Lam, Chen-Fuh

2011-01-01

Renal blood flow (RBF) is tightly regulated by several intrinsic pathways in maintaining optimal kidney blood supply. Using a rat model of aortocaval (AC) fistula, we investigated remodeling of the renal artery following prolonged increased blood flow. An AC fistula was created in the infrarenal aorta of anesthetized rats, and changes of blood flow in the renal artery were assessed using an ultrasonic flow probe. Morphological changes and expression of endothelial nitric oxide synthase and matrix metalloproteinase-2 in the remodeled renal artery were analyzed. Blood flow in the renal artery increased immediately after creation of AC fistula, but normal RBF was restored 8 weeks later. The renal artery dilated significantly 8 weeks after operation. Expression of endothelial nitric oxide synthase and matrix metalloproteinase-2 was upregulated shortly after blood flow increase, and returned to baseline levels after 3 weeks. Histological sections showed luminal dilatation with medial thickening and endothelial cell-to-smooth muscle cell attachments in the remodeled renal artery. Increased RBF was accommodated by functional dilatation and remodeling in the medial layer of the renal artery in order to restore normal blood flow. Our results provide important mechanistic insight into the intrinsic regulation of the renal artery in response to increased RBF. Copyright © 2011 S. Karger AG, Basel.

Chronic pulmonary embolism - radiological imaging and differential diagnosis; Chronische Lungenembolie - Radiologische Bildmorphologie und Differenzialdiagnose

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Coppenrath, E.; Herzog, P.; Attenberger, U.; Reiser, M. [Klinikum Innenstadt der Ludwig-Maximilians-Universitaet Muenchen, Institut fuer Klinische Radiologie, Muenchen (Germany)

2007-08-15

In chronic pulmonary embolism branches of the pulmonary arterial tree remain partially or totally occluded. This may lead to pulmonary hypertension with the development of right ventricular hypertrophy as well as structural changes of pulmonary arteries. Imaging of chronic pulmonary embolism should prove vessel occlusions (pulmonary angiography, MSCT, MRI) and reduction of regional lung perfusion (lung scanning, MSCT, MRI). According to current guidelines ventilation-perfusion lung scanning and pulmonary angiography are still recommended as the methods of choice. MSCT and MRI provide technical alternatives which are helpful in differential diagnosis versus other types of pulmonary hypertension. In spite of medical and surgical measures (in rare cases pulmonary thromboendarterectomy) the prognosis of chronic pulmonary embolism remains unfavourable. (orig.) [German] Bei der chronischen Lungenembolie sind Abschnitte der arteriellen Lungenstrombahn dauerhaft verschlossen. Dies kann zu einer Erhoehung des pulmonal-arteriellen Drucks mit den Folgen einer Rechtsherzbelastung und strukturellen Veraenderungen der Pulmonalarterien fuehren. Bildmorphologisch nachzuweisen sind Gefaessverschluesse (Pulmonalisangiographie, MSCT, MRT) und die Minderperfusion des Lungenparenchyms (Szintigraphie, MSCT, MRT). Nach den bisherigen Empfehlungen gelten fuer die Diagnostik der chronischen Lungenembolie die Lungenszintigraphie (Ventilation/Perfusion) und die Pulmonalisangiographie als Methoden der ersten Wahl. Die MSCT und MRT (Angiographie/Perfusion) stellen technische Alternativen dar. Differenzialdiagnostisch sind andere Formen der pulmonalen Hypertonie abzugrenzen. Trotz medikamentoeser und chirurgischer Therapiemassnahmen (z. B. pulmonale Thrombendarterektomie) bleibt die Prognose der chronischen Lungenembolie unguenstig. (orig.)

Hipertensión arterial en la mujer

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Juan K. Urrea

2018-01-01

Full Text Available Resumen: La hipertensión arterial es la condición médica crónica más común en el cuidado primario y uno de los factores de riesgo cardiovascular modificable más transcendental en hombres y mujeres. Es la principal causa de muerte; por tanto, reducir la presión arterial en ambos sexos previene la morbi-mortalidad. Aunque el sexo masculino tiene mayores cifras de presión arterial en todos los rangos de edad en comparación con el femenino, las mujeres añosas tienen una prevalencia ligeramente mayor de hipertensión arterial y casi siempre menos controlada. Además de la edad, hay factores de riesgo específicos y del estilo de vida que contribuyen al desarrollo de la hipertensión en mujeres; estos incluyen obesidad, raza, diabetes y enfermedad renal crónica. Se requiere el uso de estrategias de reducción del riesgo para disminuir la hipertensión; mantener un cuerpo saludable a través de la dieta y el ejercicio, reducir la ingesta de sal y alcohol, son solo algunas aproximaciones. Por tanto, deben enfrentarse estos problemas y generar esfuerzos para resolver situaciones que rodean el tratamiento y control de la hipertensión en mujeres. Abstract: Arterial hypertension is the most commonly encountered chronic medical condition in primary care, and one of the most important modifiable cardiovascular risk factors for women and men. It is the leading cause of death; therefore, lowering blood pressure prevents mortality and morbidity in both sexes. Although men have higher blood pressures compared with women at all ages, older women have a slightly higher prevalence of hypertension, and it is almost always less controlled. In addition to age, there are specific risk factors and lifestyle contributors for the development of hypertension in women, including obesity, ethnicity, diabetes, and chronic kidney disease. Risk reduction strategies are needed to help reduce hypertension; healthy body weight maintenance through diet and exercise

A Novel External Carotid Arterial Sheath System for Intra-arterial Infusion Chemotherapy of Head and Neck Cancer.

Science.gov (United States)

Ii, Noriko; Fuwa, Nobukazu; Toyomasu, Yutaka; Takada, Akinori; Nomura, Miwako; Kawamura, Tomoko; Sakuma, Hajime; Nomoto, Yoshihito

2017-07-01

The purpose of this study was to describe a novel system for treating advanced head and neck cancer consisting of an external carotid arterial sheath (ECAS) and a microcatheter to inject drugs retrogradely into multiple feeding arteries through the superficial temporal artery (STA). Four consecutive patients with head and neck cancer that had more than one feeding artery were enrolled in this study. The ECAS was made of polyurethane and surface-coated with heparin resin to prevent thrombus formation, allowing it to remain in place for a prolonged period of time. The ECAS was inserted through the STA, and its tip was placed between the maxillary artery and facial artery. The tumor-feeding arteries were selected using a hooked-shaped microcatheter through the ECAS. A total of 13 target arteries were selected in the four patients. The microcatheter inserted via the ECAS was used to catheterize ten arteries (five lingual arteries and five facial arteries). The remaining three lingual arteries were directly selected by the catheter without ECAS. All of the target arteries were able to be catheterized superselectively. The technical success rate was 100%. Vascular occlusion, which might have been caused by the ECAS, was observed in one patient. No neurologic toxicities occurred. This ECAS system is a new approach for retrograde superselective intra-arterial chemotherapy that covers the entire tumor with anticancer drugs. It has the potential to increase the effectiveness of therapy for advanced head and neck cancer. Level 4, Case Series.

Symptoms of anxiety and depression: A comparison among patients with different chronic conditions.

Science.gov (United States)

Bayat, Noushin; Alishiri, Gholam Hossein; Salimzadeh, Ahmad; Izadi, Morteza; Saleh, Davoud Kazemi; Lankarani, Maryam Moghani; Assari, Shervin

2011-11-01

Although patients with chronic diseases are at high-risk for symptoms of anxiety and depression, few studies have compared patients with different chronic conditions in this regard. This study aimed to compare patients with different chronic medical conditions in terms of anxiety and depression symptoms after controlling for the effects of socio-demographic and clinical data. This cross-sectional study enrolled 2234 adults, either healthy (n = 362) or patients with chronic medical conditions (n = 1872). Participants were recruited from the outpatient clinic of Baqiyatallah Hospital, Tehran, Iran. Patients had one of the following five medical conditions: coronary artery disease (n = 675), renal transplantation (n = 383), chronic hemodialysis (n = 68), rheumatoid conditions (rheumatoid arthritis, osteoarthritis, systemic lupus erythematosus and ankylosing spondylitis) (n = 666) and viral hepatitis (n = 80). Independent factors included socio-demographic data, pain disability, and somatic comorbidities (Ifudu index). Outcomes included symptoms of anxiety and depression through Hospital Anxiety and Depression Scale (HADS). Two multinomial regression models were used to determine the predictors of anxiety and depression symptoms. After controlling the effect of age, sex, educational level, comorbidities, disability and pain, rheumatoid arthritis and hepatitis were predictors of higher anxiety symptoms, while coronary artery disease and chronic hemodialysis were predictors of depression symptoms. Although all chronic conditions may require psychological consideration; be that as it may, different chronic diseases are dissimilar in terms of their mental health need. Anxiety for rheumatoid arthritis and hepatitis as well as depression for coronary artery disease and chronic hemodialysis is more important.

Takayasu Arteritis of the Coronary Arteries Presenting as Sudden Death in a White Teenager.

Science.gov (United States)

Hlavaty, Leigh; Diaz, Francisco; Sung, LokMan

2015-09-01

Takayasu arteritis is a rare disease that expresses chronic, large vessel inflammation. The etiology remains unclear and its presentation depends on the affected arteries. With coronary artery involvement, manifestations range from chest pain and shortness of breath to sudden death. We report a case of a 15-year-old white girl who presented with syncope immediately before passing. On autopsy, all 3 major coronary arteries grossly contained multiple proximal lesions that were consistent with Takayasu arteritis, microscopically. Takayasu arteritis solely affecting multiple coronary arteries is exceedingly rare. This report discusses the significance of coronary involvement in Takayasu arteritis at autopsy and sudden death.

Successful penetration and bougie dilatation with Brockenbrough needle for severely calcified occlusion in superficial femoral artery.

Science.gov (United States)

Makita, Toshio; Suzuki, Kenji; Takizawa, Kaname; Ootomo, Tatsushi; Inoue, Naoto; Meguro, Taiichirou

2014-04-01

A 75-year-old hemodialysis patient with right critical limb ischemia received endovascular therapy for a chronic total occlusion (CTO) in a diffusely calcified superficial femoral artery (SFA). During a retrograde approach, a Brockenbrough needle (BN) was able to penetrate the calcified hard plaque formed in the middle segment of the CTO. Moreover, bougie dilatation with the BN allowed balloon crossing and stent deployment, even after failure to pass a 2.0-mm monorail balloon across the plaque. These results suggest that the BN offers a new therapeutic option in the penetration and modification of severely calcified CTO in SFA.

Segmental embolization of the gastroduodenal artery in a case of a perforated pseudoaneurysm and gastrointestinal bleeding

International Nuclear Information System (INIS)

Schmitt, R.; Cavallaro, A.; Bautz, W.

2004-01-01

We present the history of a woman suffering from an extensive gastrointestinal bleeding due to liver cirrhosis and chronic pancreatitis. Selective angiogram of the celiac artery revealed a pseudoaneurysm of the gastroduodenal artery caused by inflammatory wall penetration. The life-threatening hemorrhage was completely stopped by embolization with three stainless steel coils after microcatheter engagement of the gastroduodenal artery. The particularity of this case is the restricted embolization of the aneurysm vessel segment, so the collateral circulation of the gastroduodenal and pancreaticoduodenal artery could be preserved. (orig.)

Three-dimensional segmentation of pulmonary artery volume from thoracic computed tomography imaging

Science.gov (United States)

Lindenmaier, Tamas J.; Sheikh, Khadija; Bluemke, Emma; Gyacskov, Igor; Mura, Marco; Licskai, Christopher; Mielniczuk, Lisa; Fenster, Aaron; Cunningham, Ian A.; Parraga, Grace

2015-03-01

Chronic obstructive pulmonary disease (COPD), is a major contributor to hospitalization and healthcare costs in North America. While the hallmark of COPD is airflow limitation, it is also associated with abnormalities of the cardiovascular system. Enlargement of the pulmonary artery (PA) is a morphological marker of pulmonary hypertension, and was previously shown to predict acute exacerbations using a one-dimensional diameter measurement of the main PA. We hypothesized that a three-dimensional (3D) quantification of PA size would be more sensitive than 1D methods and encompass morphological changes along the entire central pulmonary artery. Hence, we developed a 3D measurement of the main (MPA), left (LPA) and right (RPA) pulmonary arteries as well as total PA volume (TPAV) from thoracic CT images. This approach incorporates segmentation of pulmonary vessels in cross-section for the MPA, LPA and RPA to provide an estimate of their volumes. Three observers performed five repeated measurements for 15 ex-smokers with ≥10 pack-years, and randomly identified from a larger dataset of 199 patients. There was a strong agreement (r2=0.76) for PA volume and PA diameter measurements, which was used as a gold standard. Observer measurements were strongly correlated and coefficients of variation for observer 1 (MPA:2%, LPA:3%, RPA:2%, TPA:2%) were not significantly different from observer 2 and 3 results. In conclusion, we generated manual 3D pulmonary artery volume measurements from thoracic CT images that can be performed with high reproducibility. Future work will involve automation for implementation in clinical workflows.

Anatomical variations of hepatic arterial system, coeliac trunk and renal arteries: an analysis with multidetector CT angiography.

Science.gov (United States)

Ugurel, M S; Battal, B; Bozlar, U; Nural, M S; Tasar, M; Ors, F; Saglam, M; Karademir, I

2010-08-01

The purpose of our investigation was to determine the anatomical variations in the coeliac trunk-hepatic arterial system and the renal arteries in patients who underwent multidetector CT (MDCT) angiography of the abdominal aorta for various reasons. A total of 100 patients were analysed retrospectively. The coeliac trunk, hepatic arterial system and renal arteries were analysed individually and anatomical variations were recorded. Statistical analysis of the relationship between hepatocoeliac variations and renal artery variations was performed using a chi(2) test. There was a coeliac trunk trifurcation in 89% and bifurcation in 8% of the cases. Coeliac trunk was absent in 1%, a hepatosplenomesenteric trunk was seen in 1% and a splenomesenteric trunk was present in 1%. Hepatic artery variation was present in 48% of patients. Coeliac trunk and/or hepatic arterial variation was present in 23 (39.7%) of the 58 patients with normal renal arteries, and in 27 (64.3%) of the 42 patients with accessory renal arteries. There was a statistically significant correlation between renal artery variations and coeliac trunk-hepatic arterial system variations (p = 0.015). MDCT angiography permits a correct and detailed evaluation of hepatic and renal vascular anatomy. The prevalence of variations in the coeliac trunk and/or hepatic arteries is increased in people with accessory renal arteries. For that reason, when undertaking angiographic examinations directed towards any single organ, the possibility of variations in the vascular structure of other organs should be kept in mind.

Bronchial arteries: an arteriosclerosis-resistant circulation.

Science.gov (United States)

Kotoulas, Christophoros; Melachrinou, Maria; Konstantinou, George N; Alexopoulos, Dimitrios; Dougenis, Dimitrios

2010-01-01

Until now, it is unknown whether and to what extent arteriosclerotic disease affects the bronchial arteries. We conducted this pilot study to estimate the prevalence of arteriosclerosis of the bronchial arteries, to correlate it with certain clinicolaboratory arteriosclerotic parameters or any coexistent coronary artery disease (CAD) and to validate the clinical significance. Bronchial arteries 10-15 mm long were obtained from 40 patients with a mean age of 62.3 years who underwent major thoracic procedures. Their medical history and detailed clinical and laboratory arteriosclerotic risk factors were documented. The mean diameter of bronchial artery specimens was 0.97 mm. Histology revealed medial calcific sclerosis only in 1 patient (2.5%) without simultaneous, established atherosclerotic lesions or narrowing of the lumen. Furthermore, the vessel diameter was significantly correlated not only with the advanced stage of the disease (p = 0.031), but also with the proximal occlusion of the bronchial tree (p = 0.042). We noted a marginally not significant correlation between arteriosclerosis and metabolic syndrome (p = 0.075), independent from a history of CAD (p = 0.84). Bronchial arteries exhibit only medial calcific sclerosis. CAD and chronic obstructive pulmonary disease do not seem to affect them in terms of atherosclerotic alteration findings or vessel diameter changes. The bronchial resistance to arteriosclerosis might support the mediastinal status quo through their anastomoses, contributing to all its structures, and might be indirect evidence of a different physiological function of the bronchial endothelium, which needs to be further investigated. Copyright 2009 S. Karger AG, Basel.

Hemopoiesis in monkeys in the course of and after total chronic irradiation

International Nuclear Information System (INIS)

Dzhikikidze, Eh.E.; Kosichenko, L.P.; Kuksova, M.I.

1992-01-01

Morphological and cytogenetic changes in blood-formation system of 2 types of monkeys were studied following chronic prolonged irradiation with low daily doses and considerable integral radiation load. Peak decrease of total leukocyte number of 1 mkl in both groups of monkeys at the expense of neutrophils was observed at integral dose of 10.78 Gy and was caused by decrease of index of neutrophil maturation. Violations of hereditary structures of bone marrow cells and peripheric blood lymphocytes were stable. Structural chromosomal aberrations remained in monkeys of both groups up to natural animal death. Quantitative and qualitative violations were less pronounced in macaca rhesus than in hamadryas baboons. This fact revealed high radiosensitivity of the baboons

A Novel Risk Score in Predicting Failure or Success for Antegrade Approach to Percutaneous Coronary Intervention of Chronic Total Occlusion: Antegrade CTO Score.

Science.gov (United States)

Namazi, Mohammad Hasan; Serati, Ali Reza; Vakili, Hosein; Safi, Morteza; Parsa, Saeed Ali Pour; Saadat, Habibollah; Taherkhani, Maryam; Emami, Sepideh; Pedari, Shamseddin; Vatanparast, Masoomeh; Movahed, Mohammad Reza

2017-06-01

Total occlusion of a coronary artery for more than 3 months is defined as chronic total occlusion (CTO). The goal of this study was to develop a risk score in predicting failure or success during attempted percutaneous coronary intervention (PCI) of CTO lesions using antegrade approach. This study was based on retrospective analyses of clinical and angiographic characteristics of CTO lesions that were assessed between February 2012 and February 2014. Success rate was defined as passing through occlusion with successful stent deployment using an antegrade approach. A total of 188 patients were studied. Mean ± SD age was 59 ± 9 years. Failure rate was 33%. In a stepwise multivariate regression analysis, bridging collaterals (OR = 6.7, CI = 1.97-23.17, score = 2), absence of stump (OR = 5.8, CI = 1.95-17.9, score = 2), presence of calcification (OR = 3.21, CI = 1.46-7.07, score = 1), presence of bending (OR = 2.8, CI = 1.28-6.10, score = 1), presence of near side branch (OR = 2.7, CI = 1.08-6.57, score = 1), and absence of retrograde filling (OR = 2.5, CI = 1.03-6.17, score = 1) were independent predictors of PCI failure. A score of 7 or more was associated with 100% failure rate whereas a score of 2 or less was associated with over 80% success rate. Most factors associated with failure of CTO-PCI are related to lesion characteristics. A new risk score (range 0-8) is developed to predict CTO-PCI success or failure rate during antegrade approach as a guide before attempting PCI of CTO lesions.

Pulmonary arterial stent implantation in an adult with Williams syndrome

NARCIS (Netherlands)

Reesink, Herre J.; Henneman, Onno D. F.; van Delden, Otto M.; Biervliet, Jules D.; Kloek, Jaap J.; Reekers, Jim A.; Bresser, Paul

2007-01-01

We report a 38-year-old patient who presented with pulmonary hypertension and right ventricular dysfunction due to pulmonary artery stenoses as a manifestation of Williams syndrome, mimicking chronic thromboembolic pulmonary hypertension. The patient was treated with balloon angioplasty and stent

Investigation Of Arterial Blood Pressure Level And Metabolic Indices In Patients With Arterial Hypertension At Pharmacotherapy With Antihypertensive Medicines Of Various Chemical Structure

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G.Kh. Glybochko

2009-12-01

Full Text Available The research goal is to carry on the comparative analysis of medicines of various chemical structure, Telmisar-tan and Bisoprolol, and to reveal their effect on the arterial blood pressure level and the indices of various metabolic processes in patients with arterial hypertension. 60 out-patients with arterial hypertension (stage II risk III both males and females aged 33-55 have been under study taking Telmisartan and Bisoprolol for 3 months. While treating the patients the arterial blood pressure level control and biochemical investigations for determination the indices of metabolic processes have been carried out. The investigated medications have provided the decrease of systolic and diastolic arterial pressure parameters, the increase of concentration of total and ionized calcium, chlorine ions, urea and total bilirubin in blood plasma. Therapy with Telmisartan has shown more significant increase of potassium level in erythro-cytes, decrease of levels of natrium, glucose, glycolized hemoglobin and triglycerides and increased contents of alani-naminotransferase and aspartataminotransferase. The course of therapy with Bisoprolol has restored the normal level of magnesium in blood plasma, has not have any influence on carbohydrate and lipid metabolism, increased the level of alaninaminotransferase and significantly increased the contents of total and ionized calcium, urea and creatinine. 3-months therapy with Telmisartan and Bisoprolol has proved the decrease of systolic and diastolic arterial pressure in patients with arterial hypertension. The medications under study have had active and variable effects on metabolic indices

Symptoms of anxiety and depression: A comparison among patients with different chronic conditions

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Noushin Bayat

2011-01-01

Conclusions: Although all chronic conditions may require psychological consideration; be that as it may, different chronic diseases are dissimilar in terms of their mental health need. Anxiety for rheumatoid arthritis and hepatitis as well as depression for coronary artery disease and chronic hemodialysis is more important.

Correlation of total body potassium and leukemic cell mass in patients with chronic lymphocytic leukemia

International Nuclear Information System (INIS)

Chandra, P.; Sawitsky, A.; Chanana, A.D.; Chikkappa, G.; Cohn, S.H.; Rai, K.R.; Cronkity, E.P.

1979-01-01

Total body leukemic mass in patients with chronic lymphocytic leukemia (CLL) was measured by quantitation of total body potassium (TBK) with a whole-body counter. In addition, the predicted normal total body potassium (Kp) for each patient was calculated from an empirically derived relationship involving height, weight age, and sex. Both the absolute TBK and the relative excess of total body potassium (TBK/Kp) were related to the stage of disease. Patients in the early stages of CLL were found to have lower TBK and TBK/Kp than patients in the late stages of disease. Both of these parameters increased with the successively advanced stages of the disease. The clinically monitored reduction of leukemic cell mass following therapy was accompanied by reductions in TBK and TBK/Kp. Data presented support the notion that TBK/Kp is a useful indicator of the total body leukemic mass. Futhermore, the results of these studies quantitatively validate the proposed clinical staging system for CLL. Quantitation of TBK by a whole-body counter is an accurate and noninvasive procedure and does not require administration of isotopes

Peripheral Artery Disease and Its Clinical Relevance in Patients with Chronic Obstructive Pulmonary Disease in the COPD and Systemic Consequences-Comorbidities Network Study.

Science.gov (United States)

Houben-Wilke, Sarah; Jörres, Rudolf A; Bals, Robert; Franssen, Frits M E; Gläser, Sven; Holle, Rolf; Karch, Annika; Koch, Armin; Magnussen, Helgo; Obst, Anne; Schulz, Holger; Spruit, Martijn A; Wacker, Margarethe E; Welte, Tobias; Wouters, Emiel F M; Vogelmeier, Claus; Watz, Henrik

2017-01-15

Knowledge about the prevalence of objectively assessed peripheral artery disease (PAD) and its clinical relevance in patients with chronic obstructive pulmonary disease (COPD) is scarce. We aimed to: (1) assess the prevalence of PAD in COPD compared with distinct control groups; and (2) study the association between PAD and functional capacity as well as health status. The ankle-brachial index was used to diagnose PAD (ankle-brachial index ≤ 0.9). The 6-minute-walk distance, health status (St. George's Respiratory Questionnaire), COPD Assessment Test, and EuroQol-5-Dimensions were assessed in patients enrolled in the German COPD and Systemic Consequences-Comorbidities Network cohort study. Control groups were derived from the Study of Health in Pomerania. A total of 2,088 patients with COPD (61.1% male; mean [SD] age, 65.3 [8.2] years, GOLD (Global Initiative for Chronic Obstructive Lung Disease) stages I-IV: 9.4, 42.5, 37.5, and 10.5%, respectively) were included, of which 184 patients (8.8%; GOLD stage I-IV: 5.1, 7.4, 11.1, and 9.5%, respectively, vs. 5.9% in patients with GOLD stage 0 in the COPD and Systemic Consequences-Comorbidities Network) had PAD. In the Study of Health in Pomerania, PAD ranged from 1.8 to 4.2%. Patients with COPD with PAD had a significantly shorter 6-minute-walk distance (356 [108] vs. 422 [103] m, P COPD Assessment Test: 19.6 [7.4] vs. 17.9 [7.4] points, P = 0.004; EuroQol-5-Dimensions visual analog scale: 51.2 [19.0] vs. 57.2 [19.6], P COPD, 8.8% were diagnosed with PAD, which is higher than the prevalence in control subjects without COPD. PAD was associated with a clinically relevant reduction in functional capacity and health status.

Changes in CT angiographic opacification of porcine coronary artery wall with patchy altered flow in vasa vasorum.

Science.gov (United States)

Moritz, Regina; Anderson, Jill L; Vercnocke, Andrew J; Wentz, Robert J; Ritman, Erik L

2013-08-01

To evaluate the potential of whole-body CT to detect localized areas of decreased or increased vascularity in coronary arterial walls. We used both microsphere embolization of coronary artery vasa vasorum to generate small areas of hypoperfusion and surrounding hyperperfusion of the arterial wall and diet-induced hypercholesterolemia. As a stimulus for localized angiogenesis, such as occurs in early plaque formation in the coronary arterial wall, microspheres were injected selectively into the LAD coronary artery lumens of anesthetized pigs. Fourteen pigs (acute) then had a segment of their LAD harvested during injection of contrast medium and snap-frozen for subsequent cryo-static micro-CT. An additional thirteen pigs (chronic) were allowed to recover, fed a high cholesterol diet and 3 months later were again anesthetized and a segment of the LAD artery harvested and scanned. The spatial distribution of the contrast agent within the arterial wall was measured in contiguous micro-CT images at right angles to the lumen axis with the area of wall in each cross-sectional image being approximately (0.1 mm)(3) in size. In the acute animals there were no localized areas of increased contrast around the hypoperfused embolized perfusion territories in the arterial wall, but in the chronic animals the hypoperfused areas were surrounded by increased contrast. These results suggest that CT might be able to detect localized regions of increased vascularity in the arterial wall as an indicator of early atherosclerotic stimulation of vasa vasorum proliferation.

Impact of Chronic Renal Failure on Safety and Effectiveness of Paclitaxel-Eluting Stents for Femoropopliteal Artery Disease: Subgroup Analysis from Zilver PTX Post-Market Surveillance Study in Japan.

Science.gov (United States)

Ogawa, Yukihisa; Yokoi, Hiroyoshi; Ohki, Takao; Kichikawa, Kimihiko; Nakamura, Masato; Komori, Kimihiro; Nanto, Shinsuke; O'Leary, Erin E; Lottes, Aaron E; Saunders, Alan T; Dake, Michael D

2017-11-01

Favorable long-term outcomes of the Zilver PTX drug-eluting stent (DES) in femoropopliteal lesions have been demonstrated. Chronic renal failure (CRF) has been shown to be a risk factor for restenosis and decreased limb salvage. The results of the DES in patients with CRF have not previously been reported. This study compares the results with the DES in patients with CRF and those without CRF. This retrospective analysis from the Zilver PTX Japan Post-Market Surveillance Study included 321 patients with CRF and 584 patients without CRF. Outcomes included freedom from target lesion revascularization (TLR) and patency. Of the patients included in this subgroup analysis, 2-year data were available for 209 patients in the CRF group and 453 patients in the non-CRF group. The two groups were similar in terms of lesion length and the frequency of in-stent restenosis. Critical limb ischemia, severe calcification, and diabetes were more common in patients with CRF, whereas total occlusion was more common in patients without CRF. Freedom from TLR rates were 81.4 versus 84.9% (p = 0.24), and patency rates were 70.7 versus 70.3% (p = 0.95) in patients with and without CRF at 2 years, respectively. This is the first comparative study of the DES in femoropopliteal artery lesions in patients with and without CRF. These results indicate that the DES placed in femoropopliteal artery lesions of CRF patients is safe and effective with similar patency and TLR rates to patients without CRF. Level 3, Post-Market Surveillance Study.

Impact of Short-Term Treatment with Telmisartan on Cerebral Arterial Remodeling in SHR

OpenAIRE

Foulquier , Sébastien; Lartaud , Isabelle; Dupuis , François

2014-01-01

International audience; Background and Purpose: Chronic hypertension decreases internal diameter of cerebral arteries and arterioles. We recently showed that short-term treatment with the angiotensin II receptor blocker telmisartan restored baseline internal diameter of small cerebral arterioles in spontaneously hypertensive rats (SHR), via reversal of structural remodeling and inhibition of the angiotensin II vasoconstrictor response. As larger arteries also participate in the regulation of ...

Edward F. Adolph Distinguished Lecture: The remarkable anti-aging effects of aerobic exercise on systemic arteries

Science.gov (United States)

2014-01-01

Cardiovascular diseases (CVD) remain the leading cause of morbidity and mortality in modern societies, and advancing age is the major risk factor for CVD. Arterial dysfunction, characterized by large elastic artery stiffening and endothelial dysfunction, is the key event leading to age-associated CVD. Our work shows that regular aerobic exercise inhibits large elastic artery stiffening with aging (optimizes arterial compliance) and preserves endothelial function. Importantly, among previously sedentary late middle-aged and older adults, aerobic exercise improves arterial stiffness and enhances endothelial function in most groups and, therefore, also can be considered a treatment for age-associated arterial dysfunction. The mechanisms by which regular aerobic exercise destiffens large elastic arteries are incompletely understood, but existing evidence suggests that reductions in oxidative stress associated with decreases in both adventitial collagen (fibrosis) and advanced glycation end-products (structural protein cross-linking molecules), play a key role. Aerobic exercise preserves endothelial function with aging by maintaining nitric oxide bioavailability via suppression of excessive superoxide-associated oxidative stress, and by inhibiting the development of chronic low-grade vascular inflammation. Recent work from our laboratory supports the novel hypothesis that aerobic exercise may exert these beneficial effects by directly inducing protection to aging arteries against multiple adverse factors to which they are chronically exposed. Regular aerobic exercise should be viewed as a “first line” strategy for prevention and treatment of arterial aging and a vital component of a contemporary public health approach for reducing the projected increase in population CVD burden. PMID:24855137

Edward F. Adolph Distinguished Lecture: The remarkable anti-aging effects of aerobic exercise on systemic arteries.

Science.gov (United States)

Seals, Douglas R

2014-09-01

Cardiovascular diseases (CVD) remain the leading cause of morbidity and mortality in modern societies, and advancing age is the major risk factor for CVD. Arterial dysfunction, characterized by large elastic artery stiffening and endothelial dysfunction, is the key event leading to age-associated CVD. Our work shows that regular aerobic exercise inhibits large elastic artery stiffening with aging (optimizes arterial compliance) and preserves endothelial function. Importantly, among previously sedentary late middle-aged and older adults, aerobic exercise improves arterial stiffness and enhances endothelial function in most groups and, therefore, also can be considered a treatment for age-associated arterial dysfunction. The mechanisms by which regular aerobic exercise destiffens large elastic arteries are incompletely understood, but existing evidence suggests that reductions in oxidative stress associated with decreases in both adventitial collagen (fibrosis) and advanced glycation end-products (structural protein cross-linking molecules), play a key role. Aerobic exercise preserves endothelial function with aging by maintaining nitric oxide bioavailability via suppression of excessive superoxide-associated oxidative stress, and by inhibiting the development of chronic low-grade vascular inflammation. Recent work from our laboratory supports the novel hypothesis that aerobic exercise may exert these beneficial effects by directly inducing protection to aging arteries against multiple adverse factors to which they are chronically exposed. Regular aerobic exercise should be viewed as a "first line" strategy for prevention and treatment of arterial aging and a vital component of a contemporary public health approach for reducing the projected increase in population CVD burden. Copyright © 2014 the American Physiological Society.

Lower limb revascularisation preceding surgical wound coverage - an interdisciplinary algorithm for chronic wound closure.

Science.gov (United States)

Aust, M C; Spies, M; Guggenheim, M; Gohritz, A; Kall, S; Rosenthal, H; Pichlmaier, M; Oehlert, G; Vogt, P M

2008-08-01

Chronic wounds may occur or persist due to arterial insufficiency. Despite the high prevalence of arterial occlusive disease, a search of the literature has yielded a paucity of data on the benefit of interventions to recanalise lower extremity arteries prior to surgical closure of chronic wounds. To investigate the correlation of simple clinical examinations and apparative diagnostics for the detection of arterial occlusive disease of the lower extremity in patients with chronic wounds, and to evaluate the benefit of vascular procedures to optimise wound perfusion before surgical closure. During a 6-year period, 150 patients with chronic lower extremity wounds (no healing for more than 30 days) were included into this prospective study. All patients underwent palpation of foot pulses, Doppler sonography and measurement of occlusive pressures. Positive clinical findings were re-evaluated by angiography. All patients with peripheral extremity vessel occlusions underwent vascular interventions (percutaneous transluminal angioplasty with stenting, open thrombectomy or vascular bypass surgery) prior to surgical wound closure. In all 34 patients (21%) with missing foot pulses, suspicious Doppler signals or pathological occlusive pressure measurements, the clinical diagnosis of arterial occlusion was confirmed by angiography. An arterial pathology had previously been diagnosed in merely two of those patients. Nineteen patients underwent percutaneous transluminal angioplasty and 21 stents were implanted; in 10 cases, open thrombectomy or vascular bypasses were performed. In all 34 patients, sufficient peripheral recanalisation and improved wound perfusion were successfully achieved. For definitive wound closure, microsurgical tissue transplantation was performed in 15 patients. Angiography was performed prior to surgery. In 11 patients, regional or local flaps were used. Six patients received split skin grafting only; two wounds healed conservatively following vascular

A unique case of bifid left testicular artery having its anomalous high origin from renal artery

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Ashwini P Aithal

2016-01-01

Full Text Available The testicular arteries are known to originate from the ventrolateral aspect of the abdominal aorta and descend obliquely to the pelvic cavity and supply the testis. An anatomical description of an uncommon variation of the left testicular artery is presented in this case report, highlighting its clinical implications. During routine dissection of a male cadaver, we found that the left testicular artery was bifid and it was arising from the left renal artery. After its origin, it then coursed behind the left renal vein, passed between the left testicular vein and left ureter and at the lower pole of the left kidney, this bifid testicular artery joined to form a single testicular artery which thereafter presented a normal course. Anatomy of the testicular artery has been studied in detail because of its importance in testicular physiology, as well as its significance in testicular and renal surgery. This vascular variation shows a major significance in renal surgery, partial or total nephrectomy, and renal transplant. In addition, this anatomical variation enhances the importance of arteriography or the Doppler ultrasound examination of the renal hilum before surgeries.

Bone metabolism and arterial stiffness after renal transplantation.

Science.gov (United States)

Cseprekál, Orsolya; Kis, Eva; Dégi, Arianna A; Kerti, Andrea; Szabó, Attila J; Reusz, György S

2014-01-01

To assess the relationship between bone and vascular disease and its changes over time after renal transplantation. Metabolic bone disease (MBD) is common in chronic kidney disease (CKD) and is associated with cardiovascular (CV) disease. Following transplantation (Tx), improvement in CV disease has been reported; however, data regarding changes in bone disease remain controversial. Bone turnover and arterial stiffness (pulse wave velocity (PWV)) were assessed in 47 Tx patients (38 (3-191) months after Tx). Bone alkaline phosphatase (BALP), osteocalcin (OC) and beta-crosslaps were significantly higher in Tx patients, and decreased significantly after one year. There was a negative correlation between BALP, OC and steroid administered (r = -0.35; r = -0.36 respectively). PWV increased in the Tx group (1.15 SD). In patients with a follow up of bone turnover and arterial stiffness are present following kidney transplantation. While bone turnover decreases with time, arterial stiffness correlates initially with bone turnover, after which the influence of cholesterol becomes significant. Non-invasive estimation of bone metabolism and arterial stiffness may help to assess CKD-MBD following renal transplantation.

Angiographic visualization of a spurious aneurism of the common hepatic artery

Energy Technology Data Exchange (ETDEWEB)

Fobbe, F.; Wolf, K.J.

1987-01-01

Pseudoaneurisms of the artery in chronic pancreatitis are rare complications that are not detected by conventional ultrasonography. The article reports a case where an aneurisma spurium of the A. gastroduodenalis has been detected by means of angiodynography.

The surgical treatment of chronic intestinal ischemia: results of a recent series.

Science.gov (United States)

Illuminati, G; Caliò, F G; D'Urso, A; Papaspiropoulos, V; Mancini, P; Ceccanei, G

2004-04-01

Due to the rarity of the condition, large and prospective series defining the optimal method of digestive arteries revascularization, for the treatment of chronic intestinal ischemia, are lacking. The aim of this consecutive sample clinical study was to test the hypothesis that flexible application of different revascularization methods, according to individual cases, will yield the best results in the management of chronic intestinal ischemia. Eleven patients, of a mean age of 56 years, underwent revascularization of 11 digestive arteries for symptomatic chronic mesenteric occlusive disease. Eleven superior mesenteric arteries and one celiac axis were revascularized. The revascularization techniques included retrograde bypass grafting in 7 cases, antegrade bypass grafting in 2, percutaneous arterial angioplasty in 1, and arterial reimplantation in one case. The donor axis for either reimplantation or bypass grafting was the infrarenal aorta in 4 cases, an infrarenal Dacron graft in 4, and the celiac aorta in one case. Grafting materials included 5 polytetrafluoroethylene (PTFE) and 3 Dacron grafts. Concomitant procedures included 3 aorto-ilio-femoral grafts and one renal artery revascularization. Mean follow-up duration was 31 months. There was no operative mortality. Cumulative survival rate was 88.9% at 36 months (SE 12.1%). Primary patency rate was 90% at 36 months (SE 11.6%). The symptom free rate was 90% at 36 months (SE 11.6%). Direct reimplantation, antegrade and retrograde bypass grafting, all allow good mid-term results: the choice of the optimal method depends on the anatomic and general patient's status. Associated infrarenal and renal arterial lesions can be safely treated in the same time of digestive revascularization. Angioplasty alone yields poor results and should be limited to patients at poor risk for surgery.

Influence of oxidative stress on cardiovascular parameters in patients with combined flow of chronic obstructive pulmonary disease and arterial hypertension

Directory of Open Access Journals (Sweden)

V. G. Deinega

2013-04-01

Full Text Available Introduction. It is well known that active forms of oxygen, such as hydrogen peroxide, superoxide anion, hydroxyl radical and others are involved in different pathological conditions, such as cell necrosis, senescence, apoptosis, autophagy, inflammatory responses, remodeling of extracellular matrix and blood vessels, endothelial dysfunction, inactivation of antiproteases, and impaired tissue repair. The pathological increased production of mentioned active forms is called “oxidative stress”. From the literature data, we know that oxidative stress is involved in pathogenesis of arterial hypertension (AH, chronic obstructive pulmonary disease (COPD, atherosclerosis and others. The influence of oxidative stress on cardiovascular disorders in patients with combined flow of COPD and AH is not clearly known. Objective. To study peculiarities and links between parameters of oxidative stress and lesions of heart and vessels in patients with combined flow of COPD and AH. Materials and methods. A total of 101 patients with COPD, AH and with combined flow of COPD and AH were examined. The patients were divided into 3 groups. The first group was formed by patients with AH (n=29 the second group was formed by patients with COPD (n=29, the third group was formed by patients with combined flow of COPD and AH (n=57. Control group was formed from healthy persons of the same age and sex (n=22.All patients underwent spirography, echocardiography, ultrasound measurement of common carotid artery intimal-medial thickness and estimation of endhothelium-dependent vasodilatation. As oxidative stress markers, the levels of oxidative protein modification, spontaneous and iron induced aldehydephenylhydrazone’s (APH, ketondinitrophenylhydrazone’s (KPH and medium size molecules (MSM were measured. Results. Patients with combined flow of COPD and AH had higher levels of spontaneous APH (p<0,01 comparing with first and second group. The levels of spontaneous KPH were

Osseous changes in the foot bones in patients with arterial occlusion and simultaneous polyneuropathy

International Nuclear Information System (INIS)

Langer, R.; Langer, M.

1981-01-01

The present article evaluates 26 cases with arterial occlusion and additional polyneuropathy in diabetes mellitus or chronic alcohol addiction. For comparison, a group of 30 patients with arterial occlusion without neutrologically detectable polyneuropathy were also evaluated. It is pointed out that the osseous changes in the foot bone region are due to the additionally existing polyneuropathy and cannot be explained alone by an avascular bone necrosis in arterial vascular occlusion. Changes in the sense of an arthropathy occur in our group of patients even in case of unilateral arterial occlusion, these changes occurring bilaterally in the foot bones; after reconstruction measures in the arterial vascular system, these arthropathic changes in the foot bones continue to advance in case of persisting polyneuropathy. (orig.) [de

Osseous changes in the foot bones in patients with arterial occlusion and simultaneous polyneuropathy

Energy Technology Data Exchange (ETDEWEB)

Langer, R; Langer, M

1981-09-01

The present article evaluates 26 cases with arterial occlusion and additional polyneuropathy in diabetes mellitus or chronic alcohol addiction. For comparison, a group of 30 patients with arterial occlusion without neutrologically detectable polyneuropathy were also evaluated. It is pointed out that the osseous changes in the foot bone region are due to the additionally existing polyneuropathy and cannot be explained alone by an avascular bone necrosis in arterial vascular occlusion. Changes in the sense of an arthropathy occur in our group of patients even in case of unilateral arterial occlusion, these changes occurring bilaterally in the foot bones; after reconstruction measures in the arterial vascular system, these arthropathic changes in the foot bones continue to advance in case of persisting polyneuropathy.

Marked Increase in Flow Velocities During Deep Expiration: A Duplex Doppler Sign of Celiac Artery Compression Syndrome

International Nuclear Information System (INIS)

Erden, Ayse; Yurdakul, Mehmet; Cumhur, Turhan

1999-01-01

Symptoms of chronic mesenteric ischemia develop when the celiac artery is constricted by the median arcuate ligament of the diaphragm. Lateral aortography is the primary modality for diagnosing ligamentous compression of the celiac artery. However, duplex Doppler sonography performed during deep expiration can cause a marked increase in flow velocities at the compressed region of the celiac artery and suggest the diagnosis of celiac arterial constriction due to the diaphragmatic ligament. RID='''' ID='''' Correspondence to: A. Erden, M.D., Hafta sokak. 23/6, Gaziosmanpasa, 06700 Ankara, Turkey

Complications of operative treatment of injuries of peripheral arteries.

Science.gov (United States)

Velinovic, M M; Davidovic, B L; Lotina, I S; Vranes, R M; Djukic, L P; Arsov, J V; Ristic, V M; Kocica, J M; Petrovic, L P

2000-06-01

In 1991 and 1992, a total of 97 patients with 106 peripherial arterial injuries underwent surgery at the Institute for Cardiovascular Diseases, Clinical Centre of Serbia. Civilian injuries accounted for 53 (54.6%) patients (94.3% males, age range: 16-63 yr, mean: 35.2), and 44 patients had war injuries (93.2% males, age range: 19-61 yr, mean: 34.8). The injuries affected the superfitial femoral artery in 31 (29.24%); the popliteal artery in 28 (26.41%); the brachial artery in 17 (16.04%); the posterior tibial artery in 6 (5.66%); the axillary artery in 5 (4.72%); the anterior tibial artery in 5 (4.72%); the tibioperoneal trunk in 4 (3. 77%); the common femoral artery in 4 (3.77%); the external iliac artery in 2 (1.89%); the profound femoral artery in 2 (1.89%); the radial artery in 1 (0.94%); and ulnar artery in 1 (0.94%).A total of 98 reconstructive procedures were used to treat these patients. Graft interposition carried out in 50 (51.02%); by pass in 25 (25. 51%); end-to-end anastomosis in 9 (9.18%); suture in 8 (8.16%); ligation in 4 (4.08%); and patch-angioplasty in 2 (2.04%). Primary reconstruction of injured arteries was performed in 72.2% and secondary repair in 27.8% cases. Infection developed in 51 (52.57%) patients, and it was significantly (P<0.05) more common in the war injuries (70.45%) and in secondary repairs (88.89%). The presence of associated lesions (69.56%) was also correlated with a greater rate of infection. Amputation was necessary in 21 (21.65%) of our patients, and was significantly (P<0.05) more often performed after secondary (44.44%) than primary operations (12.86%) and in the presence of associated injuries (32.61%).

Balloon angioplasty of infrapopliteal artery in chronic lower limb ischemia with diabetes

International Nuclear Information System (INIS)

Wang Jianbo; Zhao Jungong; Zhu Yueqi; Li Minghua; Cheng Yingsheng; Cheng Yongde; Wang Jue

2008-01-01

Objective: To evaluate the technique, successful rate and perioperative complications together with the therapy and prevention of using PTA in treating diabetic patients with infrapopliteal arterial diseases. Methods: Angiographic and clinical data of 27 patients with diabetic lower limb ischemia treated by PTA from January 2006 to May 2007 were retrospectively reviewed. Rutherf0rd-Becker categories and ankle- brachial index(ABI)were evaluated before and after the treatment. The effects were compared between different lesion types (stenosis or occlusion)and between different ways of balloon technique. The complications were also analyzed, together with the primary, discussion of the therapy and prevention. Results: 24 patients showed improvement of ischemic symptoms, and 3 cases fell in failure. The intra-procedural main complications included acute thrombosis, vascular wall perforation, distal emboli resulting from plaque falling off and dissection. There were statistically significant differences between the effects of two type lesions and between different balloon methods. Conclusions: 1. The condition of lower limb arteries should be assessed carefully before operation. 2. PTA shows safe and good clinical result and ought to be recommended in treating diabetic patients with peripheral arterial diseases, especially the lower extremity ischemia. (authors)

A Modified Method for Reconstruction of Chronic Rupture of the Quadriceps Tendon after Total Knee Replacement

Directory of Open Access Journals (Sweden)

S Singh

2008-11-01

Full Text Available We describe herein a modified technique for reconstruction of chronic rupture of the quadriceps tendon in a patient with bilateral total knee replacement and distal realignment of the patella. The surgery involved the application of a Dacron graft and the ‘double eights’ technique. The patient achieved satisfactory results after surgery and we believe that this technique of reconstruction offers advantages over other methods.

Renal resistive index and mortality in chronic kidney disease.

Science.gov (United States)

Toledo, Clarisse; Thomas, George; Schold, Jesse D; Arrigain, Susana; Gornik, Heather L; Nally, Joseph V; Navaneethan, Sankar D

2015-08-01

Renal resistive index (RRI) measured by Doppler ultrasonography is associated with cardiovascular events and mortality in hypertensive, diabetic, and elderly patients. We studied the factors associated with high RRI (≥0.70) and its associations with mortality in chronic kidney disease patients without renal artery stenosis. We included 1962 patients with an estimated glomerular filtration rate of 15 to 59 mL/min per 1.73 m(2) who also had RRI measured (January 1, 2005, to October 2011) from an existing chronic kidney disease registry. Participants with renal artery stenosis (60%-99% or renal artery occlusion) were excluded. Multivariable logistic regression model was used to study factors associated with high RRI (≥0.70), and its association with mortality was studied using Kaplan-Meier plots and Cox proportional hazards model. Hypertension was prevalent in >90% of the patients. In the multivariable logistic regression, older age, female sex, diabetes mellitus, coronary artery disease, peripheral vascular disease, higher systolic blood pressure, and the use of β blockers were associated with higher odds of having RRI≥0.70. During a median follow-up of 2.2 years, 428 patients died. After adjusting for covariates, RRI≥0.70 was associated with increased mortality (adjusted hazard ratio, 1.29; 95% confidence interval, 1.02-1.65; Pchronic kidney disease. Noncardiovascular/non-malignancy-related deaths were higher in those with RRI≥0.70. RRI≥0.70 is associated with higher mortality in hypertensive chronic kidney disease patients without clinically significant renal artery stenosis after accounting for other significant risk factors. Its evaluation may allow early identification of those who are at risk thereby potentially preventing or delaying adverse outcomes. © 2015 American Heart Association, Inc.

Patient-Reported Outcomes Assessed by the CAMPHOR Questionnaire Predict Clinical Deterioration in Idiopathic Pulmonary Arterial Hypertension and Chronic Thromboembolic Pulmonary Hypertension

Science.gov (United States)

McCabe, Colm; Bennett, Maxine; Doughty, Natalie; MacKenzie Ross, Robert; Sharples, Linda

2013-01-01

Background: The Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR) is a disease-specific assessment tool used for the evaluation and follow-up of patients with pulmonary hypertension (PH). We describe a novel use for this questionnaire in its potential to predict clinical deterioration (CD) in two patient cohorts with subtypes of PH, idiopathic pulmonary arterial hypertension (IPAH), and chronic thromboembolic pulmonary hypertension (CTEPH) during an 8-year period. Methods: We retrospectively analyzed CAMPHOR scores obtained at baseline and at follow-up visits in patients under the care of our unit over an 8-year period to assess CD and survival, as well as 6-min walk distance (6MWD) and New York Heart Association (NYHA) class. Results: Using Cox regression, we demonstrated a significant predictive effect of CD from total CAMPHOR scores at study enrollment in IPAH and CTEPH (hazard ratios, 1.03 [95% CI, 1.01-1.05] and 1.04 [95% CI, 1.02-1.06] per unit score increase, respectively), as well as from CAMPHOR subscales as independent predictors. This predictive effect is diluted after adjusting for the prognostic effect of 6MWD and NYHA class. Repeated CAMPHOR assessment over time appears not to add predictive value of CD to that obtained at diagnosis, although it still informs physicians of important changes in self-reported symptoms. Conclusions: When emphasis is placed on the evaluation of patient perceptions, CAMPHOR may represent an alternative method of estimating the likelihood of CD. PMID:23430021

Comparison of partial and complete arterial occlusion models for studying intestinal ischemia

International Nuclear Information System (INIS)

Parks, D.A.; Grogaard, B.; Granger, D.N.

1982-01-01

Mucosal albumin clearance was measured in jejunal segments of dogs under control conditions and following complete or partial arterial occlusion of varying durations (1, 2, 3, or 4 hours). The rate of albumin clearance was estimated from the luminal perfusion rate and the activity of protein bound 125 I in the perfusate and plasma. Partial and total arterial occlusions of 60 minutes to 4 hours' duration produced significant increases in mucosal albumin clearance. The magnitude of the rise in albumin clearance was directly related to the duration of ischemia in both total and partial arterial occlusion models. However, the magnitude of the increase in albumin clearance was significantly greater with total arterial occlusion for any given duration of ischemia. The albumin clearance results obtained in the present study compare favorably with previously reported morphologic changes in the intestinal mucosa produced by both total and partial occlusion of the superior mesenteric artery. The agreement between morphologic and physiologic measurements indicates that mucosal albumin clearance may be a useful tool for studying the pathophysiology of intestinal ischemia

Early results of coronary artery bypass grafting with coronary endarterectomy for severe coronary artery disease

Directory of Open Access Journals (Sweden)

Toischer Karl

2009-09-01

Full Text Available Abstract Background Despite the existence of controversial debates on the efficiency of coronary endarterectomy (CE, it is still used as an adjunct to coronary artery bypass grafting (CABG. This is particularly true in patients with endstage coronary artery disease. Given the improvements in cardiac surgery and postoperative care, as well as the rising number of elderly patient with numerous co-morbidities, re-evaluating the pros and cons of this technique is needed. Methods Patient demographic information, operative details and outcome data of 104 patients with diffuse calcified coronary artery disease were retrospectively analyzed with respect to functional capacity (NYHA, angina pectoris (CCS and mortality. Actuarial survival was reported using a Kaplan-Meyer analysis. Results Between August 2001 and March 2005, 104 patients underwent coronary artery bypass grafting (CABG with adjunctive coronary endarterectomy (CE in the Department of Thoracic-, Cardiac- and Vascular Surgery, University of Goettingen. Four patients were lost during follow-up. Data were gained from 88 male and 12 female patients; mean age was 65.5 ± 9 years. A total of 396 vessels were bypassed (4 ± 0.9 vessels per patient. In 98% left internal thoracic artery (LITA was used as arterial bypass graft and a total of 114 vessels were endarterectomized. CE was performed on right coronary artery (RCA (n = 55, on left anterior descending artery (LAD (n = 52 and circumflex artery (RCX (n = 7. Ninety-five patients suffered from 3-vessel-disease, 3 from 2-vessel- and 2 from 1-vessel-disease. Closed technique was used in 18%, open technique in 79% and in 3% a combination of both. The most frequent endarterectomized localization was right coronary artery (RCA = 55%. Despite the severity of endstage atherosclerosis, hospital mortality was only 5% (n = 5. During follow-up (24.5 ± 13.4 months, which is 96% complete (4 patients were lost caused by unknown address 8 patients died (cardiac

Impaired flow-induced arterial remodeling in DOCA-salt hypertensive rats

DEFF Research Database (Denmark)

Lemkens, Pieter; Nelissen, Jelly; Meens, Merlijn J P M T

2012-01-01

Arteries from young healthy animals respond to chronic changes in blood flow and blood pressure by structural remodeling. We tested whether the ability to respond to decreased (-90%) or increased (+100%) blood flow is impaired during the development of deoxycorticosterone acetate (DOCA)-salt hype...

[The method and result analyses of pathogenic bacteria culture on chronic periprosthetic joint infection after total knee arthroplasty and total hip arthroplasty].

Science.gov (United States)

Ji, Baochao; Xu, Enjie; Cao, Li; Yang, Desheng; Xu, Boyong; Guo, Wentao; Aili, Rehei

2015-02-01

To analyze the results of pathogenic bacteria culture on chronic periprosthetic joint infection after total knee arthroplasty (TKA) and total hip arthroplasty (THA). The medical data of 23 patients with chronic periprosthetic joint infection after TKA or THA from September 2010 to March 2014 were reviewed. Fifteen cases of TKA and 8 cases of THA were included in this study. There were 12 male and 11 female patients with the mean age of 62 years (range from 32 to 79 years), and among them 9 patients with sinus. All patients discontinued antibiotic therapy for a minimum of 2 weeks before arthrocentesis, taking pathogenic bacteria culture and antimicrobial susceptibility test by using synovial fluid taken preoperatively and intraoperatively of revision. Common pathogenic bacteria culture and pathological biopsy were taken on tissues intraoperatively of revision. Culture-negative specimens were prolonged the period of incubation for 2 weeks. The overall culture-positive rate of all 23 patients for 1 week before revision was 30.4% (7/23), and the positive rate of culture-negative samples which prolonged for 2 weeks was 39.1% (9/23). The overall culture-positive rate of patients for 1 week intraoperatively of revision was 60.9% (14/23), and the positive rate of culture-negative samples which prolonged for 2 weeks was 82.6% (19/23). The incubation results of 7 cases (30.4%) preoperatively conformed to that of intraoperation. The culture-positive rate of pathogenic bacteria culture can be increased evidently by discontinuing antimicrobial therapy for a minimum of 2 weeks prior to the definite diagnosis.

Exercise through a cardiac rehabilitation program attenuates oxidative stress in patients submitted to coronary artery bypass grafting.

Science.gov (United States)

Taty Zau, José Francisco; Costa Zeferino, Rodrigo; Sandrine Mota, Nádia; Fernandes Martins, Gerez; Manoel Serra, Salvador; Bonates da Cunha, Therezil; Medeiros Lima, Daniel; Bragança Pereira, Basilio de; Matos do Nascimento, Emília; Filho, Danilo Wilhelm; Curi Pedrosa, Rozangela; Pedrosa, Roberto Coury

2018-12-01

Cardiovascular disease is the main cause of morbidity and mortality in the world and oxidative stress has been implicated in the pathogenesis. Cardiac rehabilitation in patients with coronary artery disease submitted to coronary artery bypass grafting may prevent cardiovascular events probably through the attenuation of oxidative stress. The aim of this study was to evaluate the benefits of a cardiac rehabilitation program in the control of the systemic oxidative stress. The studied population consisted of 40 patients, with chronic stable coronary artery disease submitted to coronary artery bypass grafting, who attended a cardiac rehabilitation program. Biomarkers of oxidative stress were evaluated in the blood of these patients at different moments. After the onset of cardiac rehabilitation, there was a significant and progressive decrease in thiobarbituric acid reactive substances levels and protein carbonyls, an initial increase and subsequent decrease in superoxide dismutase, catalase and glutathione peroxidase activities. Also, a progressive increase of uric acid, while ferric reducing antioxidant power levels increased only at the end of the cardiac rehabilitation and a tendency to increase of glutathione contents. The results suggest that regular exercise through a cardiac rehabilitation program can attenuate oxidative stress in chronic coronary artery disease patients submitted to coronary artery bypass grafting.

Predictive role of arterial carboxyhemoglobin concentrations in ovine burn and smoke inhalation-induced lung injury.

Science.gov (United States)

Lange, Matthias; Cox, Robert A; Enkhbaatar, Perenlei; Whorton, Elbert B; Nakano, Yoshimitsu; Hamahata, Atsumori; Jonkam, Collette; Esechie, Aimalohi; von Borzyskowski, Sanna; Traber, Lillian D; Traber, Daniel L

2011-05-01

Inhalation injury frequently occurs in burn patients and contributes to the morbidity and mortality of these injuries. Arterial carboxyhemoglobin has been proposed as an indicator of the severity of inhalation injury; however, the interrelation between arterial carboxyhemoglobin and histological alterations has not yet been investigated. Chronically instrumented sheep were subjected to a third degree burn of 40% of the total body surface area and inhalation of 48 breaths of cotton smoke. Carboxyhemoglobin was measured immediately after injury and correlated to clinical parameters of pulmonary function as well as histopathology scores from lung tissue harvested 24 hours after the injury. The injury was associated with a significant decline in pulmonary oxygenation and increases in pulmonary shunting, lung lymph flow, wet/dry weight ratio, congestion score, edema score, inflammation score, and airway obstruction scores. Carboxyhemoglobin was negatively correlated to pulmonary oxygenation and positively correlated to pulmonary shunting, lung lymph flow, and lung wet/dry weight ratio. No significant correlations could be detected between carboxyhemoglobin and histopathology scores and airway obstruction scores. Arterial carboxyhemoglobin in sheep with combined burn and inhalation injury are correlated with the degree of pulmonary failure and edema formation, but not with certain histological alterations including airway obstruction scores.

Resting technetium-99m methoxyisobutylisonitrile cardiac imaging in chronic coronary artery disease: comparison with rest-redistribution thallium-201 scintigraphy

International Nuclear Information System (INIS)

Cuocolo, A.; Maurea, S.; Pace, L.; Nicolai, E.; Nappi, A.; Imbriaco, M.; Trimarco, B.; Salvatore, M.

1993-01-01

We studied 19 patients with angiographically proven coronary artery disease and left ventricular dysfunction (ejection fraction 33%±8%) by resting technetium-99m methoxyisobutylisonitrile ( 99m Tc-MIBI) and rest-redistribution thallium-201 cardiac imaging. Thallium and 99m Tc-MIBI studies were visually analysed. Of 285 segments, 203 (71%) had normal thallium uptake, 48 (17%) showed reversible thallium defects and 34 (12%) showed irreversible thallium defects. Of these 34 irreversible thallium defects, 19 (56%) were moderate and 15 (44%) were severe. Of the corresponding 285 segments, 200 (70%) had normal 99m Tc-MIBI uptake, while 37 (13%) showed moderate and 48 (17%) showed severe reduction of MIBI uptake. Myocardial segmental agreement for regional uptake score between initial thallium and resting 99m Tc-MIBI images was 90% (κ=0.78). Segmental agreement between delayed thallium and resting 99m Tc-MIBI images was 77% (κ=0.44). In particular, in 26 (9%) segments 99m Tc-MIBI uptake was severely reduced while delayed thallium uptake was normal or only moderately reduced. These data suggest that although rest-redistribution thallium and resting 99m Tc-MIBI cardiac imaging provide concordant results in the majority of myocardial segments, some segments with severely reduced resting 99m Tc-MIBI uptake may contain viable but hypoperfused myocardium. Thus, conclusions on myocardial viability based on 99m Tc-MIBI uptake should be made with caution in chronic coronary artery disease. (orig.)

Treatment of blastic transformation of chronic granulocytic leukemia by chemotherapy, total body irradiation and infusion of cryopreserved autologous marrow

Energy Technology Data Exchange (ETDEWEB)

Buckner, C D; Stewart, P; Clift, R A; Fefer, A; Neiman, P E; Singer, J; Storb, R; Thomas, E D [Washington Univ., Seattle (USA). School of Medicine; The United States Public Health Service Hospital; Providence Medical Center, and the Fred Hutchinson Cancer Research Center, Seattle, Washington, USA)

1978-01-01

We have previously reported attempts to reestablish the chronic phase of chronic granulocytic leukemia (CGL), in two patients with blastic transrormation, utilizing intensive therapy followed by the infusion of cryopreserved autologous marrow. This approach has now been attempted in a total of seven patients. Marrow was harvested on single or multiple occasions during the chronic phase of CGL and cryopreserved in 10% dimethylsulfoxide. All patients were treated with cyclophosphamide, 120 mg/kg, plus 1,000 rad of total body irradiation followed by infusion of stored marrow. Two patients failed to achieve marrow repopulation and died of infection after 29 and 48 days. Three patients had partial marrow recovery. Two of these achieved repopulation of myeloid, erythroid, and lymphoid elements but did not recover platelet function; one died of hemorrhage on day 55, and one died of cytomegalovirus interstitial pneumonitis on day 58. A third patient had delayed engraftment of all cell elements, most prominently lymphocytes, and died after 84 days of an iodopathic interstitial pneumonitis. Two patients achieved prompt and complete reestablishment of the chronic phase of CGL. One died on day 72 with a fungal pheumonitis and one developed blastic transformation within 4 months. These preliminary results indicate that this approach to the treatment of blastic transformation of CGL is feasible but difficult. Improvements in results may be achieved by more frequent storage of marrow and pheripheral blood stem cells and lymphocytes and further advances in pretransplant therapy.

Isolated unilateral pulmonary artery hypoplasia with accompanying pulmonary parenchymal findings on CT: A case report

Energy Technology Data Exchange (ETDEWEB)

Park, Surin; Cha, Yoon Ki; Kim, Jeung Sook; Kwon, Jae Hyun; Jeong, Yun Jeong [Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang (Korea, Republic of); Kim, Seon Jeong [Dept. of Radiology, Myongji Hospital, Goyang (Korea, Republic of)

2017-05-15

Unilateral pulmonary artery hypoplasia or agenesis without congenital cardiovascular anomalies is rare in adults. We report a case of a 36-year-old man with isolated left unilateral pulmonary artery hypoplasia with recurrent hemoptysis. On computed tomography (CT), the left pulmonary artery showed hypoplasia with multiple collateral vessels seen in the mediastinum and the left hemithorax. Also, parenchymal bands and peripheral linear opacities were seen in the affected lung, which were probably due to chronic infarction induced by unilateral pulmonary artery hypoplasia. There are only a few reports focusing on the radiologic findings in the pulmonary parenchyma induced by unilateral pulmonary artery hypoplasia, such as parenchymal bands and peripheral linear opacities. Therefore we report this case, which focused on the CT findings in the pulmonary parenchyma due to isolated unilateral pulmonary artery hypoplasia.

Isolated unilateral pulmonary artery hypoplasia with accompanying pulmonary parenchymal findings on CT: A case report

International Nuclear Information System (INIS)

Park, Surin; Cha, Yoon Ki; Kim, Jeung Sook; Kwon, Jae Hyun; Jeong, Yun Jeong; Kim, Seon Jeong

2017-01-01

Unilateral pulmonary artery hypoplasia or agenesis without congenital cardiovascular anomalies is rare in adults. We report a case of a 36-year-old man with isolated left unilateral pulmonary artery hypoplasia with recurrent hemoptysis. On computed tomography (CT), the left pulmonary artery showed hypoplasia with multiple collateral vessels seen in the mediastinum and the left hemithorax. Also, parenchymal bands and peripheral linear opacities were seen in the affected lung, which were probably due to chronic infarction induced by unilateral pulmonary artery hypoplasia. There are only a few reports focusing on the radiologic findings in the pulmonary parenchyma induced by unilateral pulmonary artery hypoplasia, such as parenchymal bands and peripheral linear opacities. Therefore we report this case, which focused on the CT findings in the pulmonary parenchyma due to isolated unilateral pulmonary artery hypoplasia

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

Energy Technology Data Exchange (ETDEWEB)

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.

Posterior cerebral artery involvement in moyamoya disease: initial infarction and angle between PCA and basilar artery.

Science.gov (United States)

Lee, Ji Yeoun; Kim, Seung-Ki; Cheon, Jung-Eun; Choi, Jung Won; Phi, Ji Hoon; Kim, In-One; Cho, Byung-Kyu; Wang, Kyu-Chang

2013-12-01

Moyamoya disease (MMD) is a chronic cerebrovascular occlusive disease, and progressive involvement of the posterior cerebral artery (PCA) has been reported. However, majority of MMD articles are presenting classic anterior circulation related issues. This study investigates the preoperative factors related to the long-term outcome of posterior circulation in MMD. Retrospective review of 88 MMD patients (166 PCAs in either hemisphere) without symptomatic disease involvement of PCA at initial diagnosis was done. Data at initial diagnosis regarding age, presence of infarction, status of the PCA, type of posterior communicating artery, and the angle between PCA and basilar artery were reviewed. Progressive stenosis of PCA was evaluated by symptom or radiological imaging during follow up. During an average follow up of 8.3 years, 29 out of 166 (18 %) evaluated PCAs showed progressive disease involvement. The average time of progression from the initial operation was 4.9 years, with the latest onset at 10.8 years. The patients who showed progressive stenosis of the PCA tended to be younger, present with infarction, have smaller angle between PCA and basilar artery, and have asymptomatic stenosis of the PCA at initial presentation. However, multivariate analysis confirmed only the presence of initial infarction and a smaller angle between PCA and basilar artery to be significantly associated with progressive stenosis of PCA. Involvement of PCA in MMD may occur in a delayed fashion, years after the completion of revascularization of anterior circulation. Persistent long-term follow-up regarding the posterior circulation is recommended.

Popliteal versus tibial retrograde access for subintimal arterial flossing with antegrade-retrograde intervention (SAFARI) technique.

Science.gov (United States)

Hua, W R; Yi, M Q; Min, T L; Feng, S N; Xuan, L Z; Xing, J

2013-08-01

This study aimed to ascertain differences in benefit and effectiveness of popliteal versus tibial retrograde access in subintimal arterial flossing with the antegrade-retrograde intervention (SAFARI) technique. This was a retrospective study of SAFARI-assisted stenting for long chronic total occlusion (CTO) of TASC C and D superficial femoral lesions. 38 cases had superficial femoral artery lesions (23 TASC C and 15 TASC D). All 38 cases underwent SAFARI-assisted stenting. The ipsilateral popliteal artery was retrogradely punctured in 17 patients. A distal posterior tibial (PT) or dorsalis pedis (DP) artery was retrogradely punctured in 21 patients, and 16 of them were punctured after open surgical exposure. SAFARI technical success was achieved in all cases. There was no significant difference in 1-year primary patency (75% vs. 78.9%, p = .86), secondary patency (81.2% vs. 84.2%, p = .91) and access complications (p = 1.00) between popliteal and tibial retrograde access. There was statistical difference in operation time between popliteal (140.1 ± 28.4 min) and tibial retrograde access with PT/DP punctures after surgical vessel exposure (120.4 ± 23.0 min, p = .04). The SAFARI technique is a safe and feasible option for patients with infrainguinal CTO (TASC II C and D). The PT or DP as the retrograde access after surgical vessel exposure is a good choice when using the SAFARI technique. Copyright © 2013 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

A Comparison of Po2, Pco2, Ph and Bicarbonate in Blood from the Carotid and Coccygeal Arteries of Calves

OpenAIRE

Gustin, Pascal; de Groote, A.; Dhem, A. R.; Bakima, M.; Lomba; Lekeux, Pierre

1988-01-01

A technique is described for the subcutaneous deviation of the carotid artery into the jugular groove of calves weighing between 90 and 200 kg. This makes sampling arterial blood or chronic cannulation for further experimentation very easy. Values of oxygen tension, carbon dioxide tension, pH and bicarbonate concentration in blood sampled from the ventral coccygeal artery were compared with the values obtained in blood from carotid artery puncture. The high correlations observed indicate that...

Pulmonary venous remodeling in COPD-pulmonary hypertension and idiopathic pulmonary arterial hypertension

DEFF Research Database (Denmark)

Andersen, Kasper Hasseriis; Andersen, Claus Bøgelund; Gustafsson, Finn

2017-01-01

Pulmonary vascular arterial remodeling is an integral and well-understood component of pulmonary hypertension (PH). In contrast, morphological alterations of pulmonary veins in PH are scarcely described. Explanted lungs (n = 101) from transplant recipients with advanced chronic obstructive...... pulmonary disease (COPD) and idiopathic pulmonary arterial hypertension (IPAH) were analyzed for venous vascular involvement according to a pre-specified, semi-quantitative grading scheme, which categorizes the intensity of venous remodeling in three groups of incremental severity: venous hypertensive (VH......) grade 0 = characterized by an absence of venous vascular remodeling; VH grade 1 = defined by a dominance of either arterialization or intimal fibrosis; and VH grade 2 = a substantial composite of arterialization and intimal fibrosis. Patients were grouped according to clinical and hemodynamic...

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.

In vivo evidence for long-term vascular remodeling resulting from chronic cerebral hypoperfusion in mice

OpenAIRE

Struys, Tom; Govaerts, Kristof; Oosterlinck, Wouter; Casteels, Cindy; Bronckaers, Annelies; Koole, Michel; Van Laere, Koen; Herijgers, Paul; Lambrichts, Ivo; Himmelreich, Uwe; Dresselaers, Tom

2016-01-01

We have characterized both acute and long-term vascular and metabolic effects of unilateral common carotid artery occlusion in mice by in vivo magnetic resonance imaging and positron emission tomography. This common carotid artery occlusion model induces chronic cerebral hypoperfusion and is therefore relevant to both preclinical stroke studies, where it serves as a control condition for a commonly used mouse model of ischemic stroke, and neurodegeneration, as chronic hypoperfusion is causati...

Plasma levels of acylated and total ghrelin in pediatric patients with chronic kidney disease.

Science.gov (United States)

Naufel, Maria Fernanda Soares; Bordon, Milena; de Aquino, Talita Marques; Ribeiro, Eliane Beraldi; de Abreu Carvalhaes, João Tomás

2010-12-01

This cross-sectional study set out to compare total and acyl ghrelin levels in children with mild chronic kidney disease (CKD) undergoing conservative treatment (n = 19) with children with end-stage renal disease (ESRD) undergoing hemodialysis (n = 24), and with healthy controls (n = 20). The relationship between ghrelin levels and parameters of renal function, nutritional status, and selective hormones were investigated. ESRD patients had higher total ghrelin levels than those with mild CKD or control individuals. However, acyl ghrelin did not differ between groups, indicating that the excess circulating ghrelin was desacylated. Since desacyl ghrelin has been shown to inhibit appetite, increased levels might contribute to protein-energy wasting in pediatric renal patients. When all 43 renal patients were combined, multiple regression analysis found age and glomerular filtration rate (GFR) to be significant negative predictors of total ghrelin. Acyl ghrelin was influenced negatively by age and positively by energy intake. Acyl to total ghrelin ratio related positively to GFR and energy intake. The results indicate that total but not acyl ghrelin is influenced by low GFR in children with CKD and suggests that ghrelin activation may be impaired in these patients. Since energy intake is a positive predictor of acyl ghrelin, the physiological control of ghrelin secretion appears to be altered in pediatric renal patients.

Daily concurrent chemoradiotherapy with docetaxel (DOC) and cisplatin (CDDP) using superselective intra-arterial infusion via superficial temporal artery for advanced oral cancer

International Nuclear Information System (INIS)

Mitsudo, Kenji; Fukui, Takafumi; Shigetomi, Toshio

2007-01-01

Superselective intra-arterial chemotherapy via superficial temporal artery (HFT method) is feasible for daily concurrent radiotherapy and chemotherapy for oral cancer. The possibility of organ preservation in cases of advanced oral cancer was evaluated. Treatment consisted of superselective intra-arterial infusions (docetaxel (DOC) total 60 mg/m 2 , cisplatin (CDDP) total 100 mg/m 2 ) and concurrent radiotherapy (total 40 Gy) for four weeks. Patients with T3 and T4 oral cancer were treated with four-week daily concurrent chemoradiotherapy, and the clinical response was evaluated after treatment. Clinical complete response (CR) of primary sites was obtained in 23 patients, and the same treatment was continued for one or two weeks. Local recurrence was observed in four patients (17.4%), all of whom all patients underwent salvage operation, and the final local control rate was 95.6% (22 of 23 cases). One patient died of neck metastasis, and one died of local recurrence. One-year and 3-year survival rates were estimated by Kaplan-Meier's method to be 95.5% and 79.5%, respectively. In this treatment, it is important to identify the tumor's feeding artery and deliver a sufficient amount of anticancer drug to the tumor. Superselective intra-arterial chemotherapy for oral cancer has the advantage of delivering a high concentration of chemotherapeutic agents into the tumor bed with fewer systemic toxic effects than seen with systemic chemotherapy. Superselective intra-arterial chemotherapy using the HFT method can preserve organs and minimize functional disturbance, thus contributing to patients' quality of life (QOL). (author)

Balloon pulmonary angioplasty: a treatment option for inoperable patients with chronic thromboembolic pulmonary hypertension

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Aiko eOgawa

2015-02-01

Full Text Available In chronic thromboembolic pulmonary hypertension, stenoses or obstructions of the pulmonary arteries due to organized thrombi can cause an elevation in pulmonary artery resistance, which in turn can result in pulmonary hypertension. Chronic thromboembolic pulmonary hypertension can be cured surgically by pulmonary endarterectomy; however, patients deemed unsuitable for pulmonary endarterectomy due to lesion, advanced age, or comorbidities have a poor prognosis and limited treatment options. Recently, advances have been made in balloon pulmonary angioplasty for these patients, and this review highlights this recent progress.

Percutaneous recanalization of chronic total occlusions: wherein lies the body of proof?

Science.gov (United States)

Tamburino, Corrado; Capranzano, Piera; Capodanno, Davide; Dangas, George; Zimarino, Marco; Bass, Theodore A; Mehran, Roxana; Antoniucci, David; Colombo, Antonio; La Manna, Alessio; Di Salvo, Maria E; Stone, Gregg W

2013-02-01

Although interventional technology and skills have markedly advanced, percutaneous coronary intervention (PCI) for coronary chronic total occlusion (CTO) lesions remains challenging. Indeed, CTO PCI is technically complex, carries the potential for a relatively high likelihood of failure and acute complications, and requires specifically skilled operators and a demanding use of resources. In addition, controversy persists surrounding appropriate indications for attempting CTO revascularization. Finally, there is a wide uncertainty on the actual benefits achieved with successful CTO recanalization. A growing number of studies have reported procedural results and/or assessed functional effects and long-term clinical outcomes of CTO PCI. We therefore sought to review and critically appraise the evidence base for procedural outcomes and potential clinical benefits of CTO PCI. Copyright © 2013 Mosby, Inc. All rights reserved.

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

Clinical factors useful for the differentiation of acute arterial embolism from acute arterial thrombosis of the lower extremities

International Nuclear Information System (INIS)

Xia Caifeng; Gu Jianping; Lou Wensheng; He Xu; Chen Liang; Chen Guoping; Su Haobo; Song Jinhua; Wang Tao

2012-01-01

Objective: To assess the clinical factors useful for the differentiation of acute arterial embolism from acute arterial thrombosis in patients with acute lower extremity ischemia. Methods: A total of 73 patients with acute arterial embolism or acute arterial thrombosis of lower extremity, who were admitted to the hospital during the period from May 2005 to June 2010, were enrolled in the study. Depending on the DSA findings, the patients were divided into arterial embolism group (n=52) and arterial thrombosis group (n=21). The clinical data, including general information, the onset of the disease, the obstructed sites, the condition of the diseased limb, the clinical manifestations and the severity of ischemia, were retrospectively analyzed and compared between the two groups. Results: The acute arterial embolism occurred usually on the iliofemoral artery (χ 2 =5.44, P 2 =4.15, P 2 =9.42, P 2 =18.10, P 2 =10.01, P 2 =5.44, P 2 =12.37, P 2 =7.96, P = 8.18, P 2 =14.00, P 2 =4.24, P<0.05) was only seen in patients with acute arterial embolism. Conclusion: The clinical factors helpful for differentiating acute arterial embolism from acute arterial thrombosis include: clinical manifestations (dyskinesia, impaired sensation and peripheral pulse condition of the healthy limb), the obstructed sites, the history of intermittent claudication and previous arterial embolism, the severity of ischemia, and the high-risk factors of the peripheral vascular disease (atrial fibrillation, hypertension, diabetes mellitus and smoking habit). (authors)

Central Blood Pressure and Chronic Kidney Disease Progression

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Debbie L. Cohen

2011-01-01

Full Text Available Hypertension, diabetes, and proteinuria are well-recognized risk factors for progressive kidney function loss. However, despite excellent antihypertensive and antidiabetic drug therapies, which also often lower urinary protein excretion, there remains a significant reservoir of patients with chronic kidney disease who are at high risk for progression to end-stage kidney disease. This has led to the search for less traditional cardiovascular risk factors that will help stratify patients at risk for more rapid kidney disease progression. Among these are noninvasive estimates of vascular structure and function. Arterial stiffness, manifested by the pulse wave velocity in the aorta, has been established in a number of studies as a significant risk factor for kidney disease progression and cardiovascular endpoints. Much less well studied in chronic kidney disease are measures of central arterial pressures. In this paper we cover the physiology behind the generation of the central pulse wave contour and the studies available using these approaches and conclude with some speculations on the rationale for why measurements of central pressure may be informative for the study of chronic kidney disease progression.

Right hemithoracic pseudocyst with splenic artery aneurysm: two rare complications of uncommon disease

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John Freels

2006-06-01

Full Text Available Pleural involvement is an uncommon but well recognized complication of chronic pancreatitis, mainly in the form of pleural effusion affecting the left hemithorax. Pancreatic pseudocyst extending to the posterior mediastinum with or without communication with the pleural space is another rare form of this involvement.The treatment of chronic pancreatic pleural effusions and pancreatic pseudocysts generally starts with a conservative approach including bowel rest, drainage of the pleural effusion by repeated thoracentesis or a chest tube, and total parenteral nutrition (TPN for a period of time determined by the clinical course. Other treatment modalities including percutaneous drainage, endoscopic retrograde cholangiopancreatogram (ERCP with stenting of the pancreatic duct and surgical drainage are used if conservative approaches fail.We report a patient with a complicated pancreatic pseudocyst who showed an involvement of the posterior mediastinum and right pleural space, with conspectus sparing of the left hemithorax. The patient had a prolonged and complicated course that included recurrence of the pseudocyst with oral feedings and the development of a splenic artery aneurysm. Some of the above findings have been reported separately as uncommon complications of chronic pancreatitis and pancreatic pseudcyst, but to our knowledge a single case with all these complications was not published in the English literature.

Cephalic pancreaticoduodenectomy with preservation of a right coronary artery bypass graft using the right gastro-epiploic artery: a case report.

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Homsy, K; Paquay, J-L; Farghadani, H

2018-02-20

Pancreatic cancer is a rare disease with a high mortality rate, for which complete surgical resection, when possible, is the preferred therapeutic. Pancreaticoduodenectomy represents the surgical technique of choice. Abdominal surgeons can be faced with the challenge of patients with a history of coronary artery bypass graft in which the right gastro-epiploic artery is used. We report the case of a patient with an adenocarcinoma of the pancreatic head, stage IIA, having previously undergone a triple coronary artery bypass, one of which being a right gastro-epiploic graft. Our challenge was underlined by the necessity of a complete oncological resection through a cephalic pancreaticoduodenectomy while preserving the necessary cardiac perfusion via the right gastro-epiploic artery. We have been able to preserve a right gastro-epiploic artery as a coronary bypass during a cephalic pancreaticoduodenectomy for a cephalic pancreatic adenocarcinoma. We have successfully been able to preserve and re-implant the right gastro-epiploic artery to the origin of the gastroduodenal artery while insuring R0 resection of the tumor. A coronary artery bypass using the right gastro-epiploic artery should therefore not be considered as an obstacle to a Whipple's procedure if total oncological resection is obtainable.

Preliminary Experience of Endovascular Embolization Using N-Butyl Cyanoacrylate for Hemoptysis due to Infectious Pulmonary Artery Pseudoaneurysms via Systemic Arterial Approach.

Science.gov (United States)

Torikai, Hideyuki; Hasegawa, Ichiro; Jinzaki, Masahiro; Narimatsu, Yoshiaki

2017-10-01

We report 5 patients with hemoptysis due to infectious pulmonary artery pseudoaneurysm (PAP) treated with endovascular embolization using N-butyl cyanoacrylate (NBCA) injected via bronchial and nonbronchial systemic arterial approaches. Infectious diseases included inactive tuberculosis (n = 3), nontuberculous mycobacteriosis (n = 1), and chronic infection of unknown origin (n = 1). Seven PAPs were detected on selective systemic angiography, and injection of NBCA was performed. Disappearance of all PAPs was confirmed on systemic arteriography after the intervention. In all patients, hemoptysis was stopped without major complications, and it did not recur during the follow-up period (mean, 351 d; range, 285-427 d). Copyright © 2016 SIR. Published by Elsevier Inc. All rights reserved.

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.

Total Artificial Heart and Chronic Haemodialysis: A Possible Bridge to Transplantation?

Science.gov (United States)

Demiselle, Julien; Besson, Virginie; Sayegh, Johnny; Subra, Jean-François; Augusto, Jean-François

2016-01-01

Total artificial heart (TAH) device is sometimes necessary to treat end stage heart failure (HF). After surgery, renal impairment can occur with the need of renal replacement therapy. We report the case of a 51-year-old man who was treated with conventional hemodialysis (HD) while on support with TAH. The patient underwent HD while on TAH support during 14 months. He benefited from conventional HD, 6 sessions per week. HD sessions were well tolerated, and patient's condition and quality of life improved significantly. The main difficulty was to maintain red blood cell level because of chronic hemolysis due to TAH, which required repetitive blood transfusions, resulting in a high rate of human leukocyte antigen sensitization. Unfortunately, the patient died of mesenteric ischemia due to anticoagulation under dosing. We conclude that HD treatment is possible despite TAH and should be considered in patients with both end stage renal and HF. © 2016 S. Karger AG, Basel.

Genetics in arterial calcification: pieces of a puzzle and cogs in a wheel.

Science.gov (United States)

Rutsch, Frank; Nitschke, Yvonne; Terkeltaub, Robert

2011-08-19

Artery calcification reflects an admixture of factors such as ectopic osteochondral differentiation with primary host pathological conditions. We review how genetic factors, as identified by human genome-wide association studies, and incomplete correlations with various mouse studies, including knockout and strain analyses, fit into "pieces of the puzzle" in intimal calcification in human atherosclerosis, and artery tunica media calcification in aging, diabetes mellitus, and chronic kidney disease. We also describe in sharp contrast how ENPP1, CD73, and ABCC6 serve as "cogs in a wheel" of arterial calcification. Specifically, each is a minor component in the function of a much larger network of factors that exert balanced effects to promote and suppress arterial calcification. For the network to normally suppress spontaneous arterial calcification, the "cogs" ENPP1, CD73, and ABCC6 must be present and in working order. Monogenic ENPP1, CD73, and ABCC6 deficiencies each drive a molecular pathophysiology of closely related but phenotypically different diseases (generalized arterial calcification of infancy (GACI), pseudoxanthoma elasticum (PXE) and arterial calcification caused by CD73 deficiency (ACDC)), in which premature onset arterial calcification is a prominent but not the sole feature.

Epidemiology, etiology, and treatment of chronic leg ulcer ...

African Journals Online (AJOL)

Background: Chronic leg ulcer (CLU) is reported to have an impact on virtually all ... Conclusion: Most patients benefited from debridement with or without split thickness skin graft or flap. .... low incidence of arterial and venous diseases in.

Effect of angiotensin II on voltage-gated sodium currents in aortic baroreceptor neurons and arterial baroreflex sensitivity in heart failure rats.

Science.gov (United States)

Zhang, Dongze; Liu, Jinxu; Zheng, Hong; Tu, Huiyin; Muelleman, Robert L; Li, Yu-Long

2015-07-01

Impairment of arterial baroreflex sensitivity is associated with mortality in patients with chronic heart failure (CHF). Elevation of plasma angiotension II (Ang II) contributes to arterial baroreflex dysfunction in CHF. A reduced number of voltage-gated sodium (Nav) channels in aortic baroreceptor neurons are involved in CHF-blunted arterial baroreflex. In this study, we investigated acute effect of Ang II on Nav currents in the aortic baroreceptor neuron and on arterial baroreflex in sham and coronary artery ligation-induced CHF rats. Using Ang II I radioimmunoassay, real-time reverse transcription-PCR and western blot, we found that Ang II levels, and mRNA and protein expression of angiotension II type 1 receptor in nodose ganglia from CHF rats were higher than that from sham rats. Local microinjection of Ang II (0.2  nmol) into the nodose ganglia decreased the arterial baroreflex sensitivity in sham rats, whereas losartan (1  nmol, an angiotension II type 1 receptor antagonist) improved the arterial baroreflex sensitivity in CHF rats. Data from patch-clamp recording showed that Ang II (100  nmol/l) acutely inhibited Nav currents in the aortic baroreceptor neurons from sham and CHF rats. In particular, inhibitory effect of Ang II on Nav currents in the aortic baroreceptor neurons was larger in CHF rats than that in sham rats. Losartan (1  μmol/l) totally abolished the inhibitory effect of Ang II on Nav currents in sham and CHF aortic baroreceptor neurons. These results suggest that elevation of endogenous Ang II in the nodose ganglia contributes to impairment of the arterial baroreflex function in CHF rats through inhibiting Nav channels.

Total hip arthroplasty in chronic dialysis patients in the United States.

Science.gov (United States)

Abbott, Kevin C; Bucci, Jay R; Agodoa, Lawrence Y

2003-01-01

The national incidence of and factors associated with total hip arthroplasty (THA) in chronic dialysis patients has never been reported. We therefore performed an historical cohort study of 375,857 chronic dialysis patients listed in the 2000 United States Renal Data System between 1 April 1995 and 31 December 1999 and followed-up until 14 May 2000. Primary outcomes were associations with hospitalizations for a primary discharge code of THA (ICD9 procedure code 81.51x) after initiation of dialysis. Dialysis patients had a cumulative incidence of THA of 35 episodes/10,000 person-years, compared to 5.3/10,000 in the general population. The leading indication for THA was osteoarthritis of the hip and pelvis (58% of cases). However, the strongest risk factor for THA in dialysis patients was end-stage renal disease (ESRD) due to systemic lupus erythematosus (SLE, adjusted rate ratio (ARR), 6.80, 95% CI 4.62-10.03, in whom avascular necrosis of the hip was the most common indication, 68.4%). The database did not include information on use of corticosteroids. Diabetic recipients were significantly less likely to receive THA, as were males, and African Americans. Mortality after THA was 0.25% at thirty days and 30% at three years, not significantly different from the expected mortality of dialysis, adjusted for comorbidity. The most common indication for THA in dialysis patients is osteoarthritis of the hip, similar to the general population. Patients with SLE are more likely to receive THA which is well tolerated and not associated with increased mortality in this population, perhaps reflecting selection bias due to appropriate screening for this elective procedure.

Massive Hematemesis from a Splenic Artery Pseudoaneurysm Presenting Two Years after Penetrating Trauma

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Geraldine Abbey-Mensah

2018-01-01

Full Text Available Splenic artery pseudoaneurysms (PSA are rare entities and far less common than true aneurysms of the splenic artery. The most common etiology is pancreatitis, recurrent either in the setting of chronic pancreatitis or as an episode of acute pancreatitis. Less common causes include trauma, peptic ulcer disease, or iatrogenic causes. Almost all of the trauma-related case reports have been due to blunt trauma. We believe this to be the first reported case of a splenic artery PSA presenting with massive hematemesis at a significant time frame after penetrating trauma. Successful transcatheter treatment was performed and alternative techniques are also discussed.

Histomorphometric study of brachiocephalic artery of Japanese quail.

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Shariati, Sarah; Rahmanifar, Farhad; Tamadon, Amin

2015-01-01

Brachiocephalic arteries in quails are large arteries which are arising separately from the aortic arch. The aim of the present study was to determine the histomorphometric aspects of brachiocephalic arteries in the Japanese quail. The different layers of the brachiocephalic artery were studied quantitatively in 10, 20 and 60 days-old Japanese quail; (n = 6) and both sexes. Luminal diameter, thickness of the intima, media and adventitia, the percentage of the intima, media and adventitia, as compared with the total wall thickness were determined. It was found that luminal diameter and whole artery thickness increased by age (p < 0.05). In addition, the tunica media was the thickest layer, then tunica intima and at last tunica adventitia (p < 0.05). The muscularity of the right brachiocephalic artery was more than that of the left one (p < 0.05). Histomorphometric study of brachiocephalic arteries of Japanese quails showed that increasing of age causes increase of internal and external diameters of the artery and this increase in females was more than males.

Computerized analysis of coronary artery disease: Performance evaluation of segmentation and tracking of coronary arteries in CT angiograms

Energy Technology Data Exchange (ETDEWEB)

Zhou, Chuan, E-mail: chuan@umich.edu; Chan, Heang-Ping; Chughtai, Aamer; Kuriakose, Jean; Agarwal, Prachi; Kazerooni, Ella A.; Hadjiiski, Lubomir M.; Patel, Smita; Wei, Jun [Department of Radiology, University of Michigan, Ann Arbor, Michigan 48109 (United States)

2014-08-15

Purpose: The authors are developing a computer-aided detection system to assist radiologists in analysis of coronary artery disease in coronary CT angiograms (cCTA). This study evaluated the accuracy of the authors’ coronary artery segmentation and tracking method which are the essential steps to define the search space for the detection of atherosclerotic plaques. Methods: The heart region in cCTA is segmented and the vascular structures are enhanced using the authors’ multiscale coronary artery response (MSCAR) method that performed 3D multiscale filtering and analysis of the eigenvalues of Hessian matrices. Starting from seed points at the origins of the left and right coronary arteries, a 3D rolling balloon region growing (RBG) method that adapts to the local vessel size segmented and tracked each of the coronary arteries and identifies the branches along the tracked vessels. The branches are queued and subsequently tracked until the queue is exhausted. With Institutional Review Board approval, 62 cCTA were collected retrospectively from the authors’ patient files. Three experienced cardiothoracic radiologists manually tracked and marked center points of the coronary arteries as reference standard following the 17-segment model that includes clinically significant coronary arteries. Two radiologists visually examined the computer-segmented vessels and marked the mistakenly tracked veins and noisy structures as false positives (FPs). For the 62 cases, the radiologists marked a total of 10191 center points on 865 visible coronary artery segments. Results: The computer-segmented vessels overlapped with 83.6% (8520/10191) of the center points. Relative to the 865 radiologist-marked segments, the sensitivity reached 91.9% (795/865) if a true positive is defined as a computer-segmented vessel that overlapped with at least 10% of the reference center points marked on the segment. When the overlap threshold is increased to 50% and 100%, the sensitivities were 86

Radial artery approach for coronary intervention - early experience

International Nuclear Information System (INIS)

Jan, H.; Hadi, A.; Fahim, M.; Gul, A.M.; Irfan, M.; Khan, S.B.; Hafizullah, M.

2012-01-01

Objective: To see the clinical outcome of patients undergoing Transradial Coronary Angioplasty with stable Angina. Methodology: This was a single center observational study with prospective data collection of 338 patients who underwent transradial coronary angioplasty from September 2009 to August 2011, at Post Graduate Medical Institute, Lady Reading Hospital, Peshawar. Patients of both genders and all ages who had transradial coronary angioplasty for chronic stable angina were included in the study. Patients were clinically examined in out patients department on first month of hospital discharge and clinical outcome data was recorded. Results: A total of 338 patients were included in the study. Male were 58.8% and 41.2% were female with mean age of 52+-7 years. All the patients had coronary intervention through right radial artery. Baseline characteristics of the patients were; 48.2% diabetic, 43.2% hypertensive, 30.5% smokers, dyslipidemia was 45.7% and mean values of serum creatinine and Hemoglobin were 1.1+-0.3 and 11.5+-1.5, respectively. The frequency of various complications were as follow; hematoma 1.3%, nausea and vomiting 2.2%, pain in hand 11.2%, re admission to hospital for chest pain 6.5%, need for revascularization 2.2%, hand ischemia 1.8%, minor bleeding 0.9%, no major bleeding and 1.9% mortality. Conclusion: The radial artery approach for coronary intervention is useful with low degree of access site vascular complications and an early mobilization. (author)

Radial artery approach for coronary intervention - early experience

Energy Technology Data Exchange (ETDEWEB)

Jan, H; Hadi, A; Fahim, M; Gul, A M; Irfan, M; Khan, S B; Hafizullah, M [Lady Reading Hospital and Khyber Medical University, Peshawar (Pakistan). Dept. of Cardiology

2012-01-15

Objective: To see the clinical outcome of patients undergoing Transradial Coronary Angioplasty with stable Angina. Methodology: This was a single center observational study with prospective data collection of 338 patients who underwent transradial coronary angioplasty from September 2009 to August 2011, at Post Graduate Medical Institute, Lady Reading Hospital, Peshawar. Patients of both genders and all ages who had transradial coronary angioplasty for chronic stable angina were included in the study. Patients were clinically examined in out patients department on first month of hospital discharge and clinical outcome data was recorded. Results: A total of 338 patients were included in the study. Male were 58.8% and 41.2% were female with mean age of 52+-7 years. All the patients had coronary intervention through right radial artery. Baseline characteristics of the patients were; 48.2% diabetic, 43.2% hypertensive, 30.5% smokers, dyslipidemia was 45.7% and mean values of serum creatinine and Hemoglobin were 1.1+-0.3 and 11.5+-1.5, respectively. The frequency of various complications were as follow; hematoma 1.3%, nausea and vomiting 2.2%, pain in hand 11.2%, re admission to hospital for chest pain 6.5%, need for revascularization 2.2%, hand ischemia 1.8%, minor bleeding 0.9%, no major bleeding and 1.9% mortality. Conclusion: The radial artery approach for coronary intervention is useful with low degree of access site vascular complications and an early mobilization. (author)

Ultrasonographic study of common carotid arteries in adolescents with type 1 diabetes mellitus

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Viktoriya Nikolaevna Panfilova

2009-03-01

Full Text Available Aim. To elucidate sonographic characteristics of common carotid arteries in adolescents with type1 diabetes mellitus (DM1 depending on the duration of the disease and thepresence of chronic complications. Materials and methods. A total of 56 adolescents having DM1 of different duration were examined to evaluate conditions of common carotid arteries (CA in the systole anddiastole during at least 3 cardiac cycles. The following parameters were measured: CA diameter, intima-media thickness (IMT, estimated stretch and stiffness coefficients, Youngsmodulus. The control group comprised 16 healthy adolescents. Results. Bilateral increase of IMT was recorded in patients with DM duration over 5 years. Youngs modulus, stretch and stiffness coefficients were virtually unrelated to diseaseduration. In patients having DM for more than 10 years, stretch coefficient was 5.38 (95% DI 4.82-5.8 compared with 5.82 (95% DI 5.63-7.38 in those with DM for less than 3years (p = 0.04. The level of albuminuria correlated with IMT (r=0.32, p=0.03, stiffness coefficient (r = 0.43, p=0.001, stretch coefficient (r= -0.48, p

The Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery (ALCAPA: a Case Series and Brief Review

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Aliasghar Moeinipour

2016-02-01

Full Text Available Background Anomalous left coronary artery from the pulmonary artery (ALCAPA is a rare congenital cardiovascular defect that occurs in approximately 1/300 000 live births or 0.5% of children with congenital heart disease. There are two types of ALCAPA syndrome: the infant type and the adult type. The most infants experience myocardial infarction and congestive heart failure, and approximately 90% die within the first year of life; also, without early surgical intervention they have a dismal prognosis. Materials and Methods We report 3- year experiences from January 2013 to January 2016 of Imam Reza Hospital center (a tertiary referral hospital North East of Iran that consist of all patients with ALCAPA syndrome. Results The Takeuchi procedure, were successfully performed in five children with anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA. There was no death and significant mitral regurgitation postoperative (n=0 in this short study. All of patients (n=5 had evidence of improving ischemic myocardium status by increasing of ejection fraction and regional wall motion of left ventricular in follow up echocardiography. Conclusion The only cure treatment for ALCAPA syndrome is surgical intervention that needs to be performed immediately after diagnosis to prevent myocardial infarction and chronic heart failure. Today, establishing a system with two coronary arteries is the goal in definitive surgical repair. The Takeuchi procedure is a prefer method to establish a two-coronary repair for ALCAPA.

Vena Cava Filter Retrieval with Aorto-Iliac Arterial Strut Penetration.

Science.gov (United States)

Holly, Brian P; Gaba, Ron C; Lessne, Mark L; Lewandowski, Robert J; Ryu, Robert K; Desai, Kush R; Sing, Ronald F

2018-05-03

To evaluate the safety and technical success of inferior vena cava (IVC) filter retrieval in the setting of aorto-iliac arterial strut penetration. IVC filter registries from six large United States IVC filter retrieval practices were retrospectively reviewed to identify patients who underwent IVC filter retrieval in the setting of filter strut penetration into the adjacent aorta or iliac artery. Patient demographics, implant duration, indication for placement, IVC filter type, retrieval technique and technical success, adverse events, and post procedural clinical outcomes were identified. Arterial penetration was determined based on pre-procedure CT imaging in all cases. The IVC filter retrieval technique used was at the discretion of the operating physician. Seventeen patients from six US centers who underwent retrieval of an IVC filter with at least one strut penetrating either the aorta or iliac artery were identified. Retrieval technical success rate was 100% (17/17), without any major adverse events. Post-retrieval follow-up ranging from 10 days to 2 years (mean 4.6 months) was available in 12/17 (71%) patients; no delayed adverse events were encountered. Findings from this series suggest that chronically indwelling IVC filters with aorto-iliac arterial strut penetration may be safely retrieved.

Safety analysis of urban arterials at the meso level.

Science.gov (United States)

Li, Jia; Wang, Xuesong

2017-11-01

Urban arterials form the main structure of street networks. They typically have multiple lanes, high traffic volume, and high crash frequency. Classical crash prediction models investigate the relationship between arterial characteristics and traffic safety by treating road segments and intersections as isolated units. This micro-level analysis does not work when examining urban arterial crashes because signal spacing is typically short for urban arterials, and there are interactions between intersections and road segments that classical models do not accommodate. Signal spacing also has safety effects on both intersections and road segments that classical models cannot fully account for because they allocate crashes separately to intersections and road segments. In addition, classical models do not consider the impact on arterial safety of the immediately surrounding street network pattern. This study proposes a new modeling methodology that will offer an integrated treatment of intersections and road segments by combining signalized intersections and their adjacent road segments into a single unit based on road geometric design characteristics and operational conditions. These are called meso-level units because they offer an analytical approach between micro and macro. The safety effects of signal spacing and street network pattern were estimated for this study based on 118 meso-level units obtained from 21 urban arterials in Shanghai, and were examined using CAR (conditional auto regressive) models that corrected for spatial correlation among the units within individual arterials. Results showed shorter arterial signal spacing was associated with higher total and PDO (property damage only) crashes, while arterials with a greater number of parallel roads were associated with lower total, PDO, and injury crashes. The findings from this study can be used in the traffic safety planning, design, and management of urban arterials. Copyright © 2017 Elsevier Ltd. All

Pulmonary artery perfusion versus no pulmonary perfusion during cardiopulmonary bypass in patients with COPD

DEFF Research Database (Denmark)