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Sample records for infarction require full

  1. Hemorrhagic infarction at 33 days after birth in a healthy full-term neonate

    Directory of Open Access Journals (Sweden)

    Kubo Y

    2011-11-01

    Full Text Available Yoshitaka Kubo1, Kuniaki Ogasawara1, Akira Kurose2, Hiroshi Kashimura1, Takahiro Koji1, Yasunari Otawara1, Jun Kamei3, Manami Akasaka3, Makoto Sasaki4, Akira Ogawa1 1Department of Neurosurgery, 2Department of Pathology, 3Department of Pediatrics, 4Department of Radiology, Iwate Medical University, Morioka, Japan Abstract: Intraparenchymal hemorrhage in the full-term neonate rarely occurs more than 2 weeks after birth, and its definitive cause remains unclear. In the present report, a case of a patient with intraparenchymal hemorrhage occurring 33 days after birth is described. Histological examination of the brain tissue obtained during hematoma evacuation through craniotomy showed hemorrhagic infarction. Patent foramen ovale may have been present and this may have led to spontaneous paradoxical cerebral embolism followed by hemorrhagic infarction. Keywords: full-term neonate, hemorrhagic cerebral infarction, patent foramen ovale, surgery

  2. Massive Myocardial Infarction in a Full-Term Newborn: A Case Report

    Directory of Open Access Journals (Sweden)

    Vlasta Fesslova

    2010-01-01

    Full Text Available A full-term female newborn with neonatal asphyxia and severe anemia (Hb 2.5 g/dL with normal heart developed a massive myocardial infarction. No examinations were performed during pregnancy for parental nomadism. The baby had immediate external cardiac massage, ventilatory assistance, and blood transfusion. Cardiomegaly was evident at chest X-ray and marked signs of ischemia-lesion at ECG. Echocardiography showed dilated, hypertrophic, and hypocontractile left ventricle (LV, mitral and tricuspid regurgitation, and moderate pericardial effusion. Rh isoimmunization and infective agents were excluded at laboratory tests. Despite the treatment with inotropes, hydrocortisone, and furosemide, the baby worsened and died at 45 hours of life. Postmortem examination showed diffuse subendocardial infarction of LV and diffuse parenchymal hemorrhages and myocardial hypertrophy, increase of eosinophilia, and polymorphonucleated cells at histology. Our patient suffered apparently from longstanding fetal anemia of unknown etiology that led to perinatal distress, severe hypoxia, and massive myocardial infarction, unresponsive to the therapy.

  3. 75 FR 43107 - Revocation of Requirements for Full-Size Baby Cribs and Non-Full-Size Baby Cribs

    Science.gov (United States)

    2010-07-23

    ... COMMISSION 16 CFR Parts 1508 and 1509 Revocation of Requirements for Full-Size Baby Cribs and Non-Full- Size Baby Cribs AGENCY: Consumer Product Safety Commission. ACTION: Proposed rule. SUMMARY: Section 104(b.../Hand delivery/Courier (for paper, disk, or CD-ROM submissions), preferably in five copies, to: Office...

  4. Full-term newborns with normal birth weight requiring special care in ...

    African Journals Online (AJOL)

    Full-term newborns with normal birth weight requiring special care in a ... weight compared with preterm/low birth weight newborns that require special care at ... with normal birth weight and are associated with modifiable risk factors that can ...

  5. 42 CFR 84.118 - Half-mask facepieces, full facepieces, and mouthpieces; fit; minimum requirements.

    Science.gov (United States)

    2010-10-01

    ... mouthpieces; fit; minimum requirements. 84.118 Section 84.118 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT... mouthpieces; fit; minimum requirements. (a) Half-mask facepieces and full facepieces shall be designed and constructed to fit persons with various facial shapes and sizes either: (1) By providing more than...

  6. 42 CFR 84.75 - Half-mask facepieces, full facepieces, mouthpieces; fit; minimum requirements.

    Science.gov (United States)

    2010-10-01

    ...; fit; minimum requirements. 84.75 Section 84.75 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF... facepieces, mouthpieces; fit; minimum requirements. (a) Half-mask facepieces and full facepieces shall be designed and constructed to fit persons with various facial shapes and sizes, either: (1) By providing...

  7. 14 CFR 60.35 - Specific full flight simulator compliance requirements.

    Science.gov (United States)

    2010-01-01

    ... 14 Aeronautics and Space 2 2010-01-01 2010-01-01 false Specific full flight simulator compliance... TRANSPORTATION (CONTINUED) AIRMEN FLIGHT SIMULATION TRAINING DEVICE INITIAL AND CONTINUING QUALIFICATION AND USE § 60.35 Specific full flight simulator compliance requirements. (a) No device will be eligible for...

  8. Reduced chronotropic reserve to the metabolic requirement during exercise in advanced heart failure with old myocardial infarction.

    Science.gov (United States)

    Yamabe, H; Kobayashi, K; Takata, T; Fukuzaki, H

    1987-03-01

    We studied the metabolic and cardiac responses to exercise by expiratory gas analysis in 40 patients with old myocardial infarction and 33 normal sedentary males. On the basis of exercise energy metabolism, the elevation of the respiratory quotient (RQ; RQ = VCO2/VO2) during exercise is caused by the increase of blood lactate due to the augmented anaerobic metabolism. Functional aerobic impairment (FAI) in our study was significantly advanced in the control group and the NYHA functional class I, class II and class III groups, that is, -2.3 +/- 11.2%, +14.8 +/- 10.4%, +27.8 +/- 13.8% and +49.4 +/- 2.8%, respectively. The delta RQ values were similar among all groups; 0.29 respectively. The delta RQ values were similar among all groups; 0.29 +/- 0.06, 0.28 +/- 0.07, 0.27 +/- 0.07 and 0.29 +/- 0.09, respectively. Functional chronotropic impairment (FCI) for the same groups was -0.9 +/- 7.0%, +1.4 6.1%, +3.8 +/- 4.8% and +8.7 +/- 6.0%, and that of the class III group was significantly larger than that of the control group. Thus, in the class III congestive heart failure group, the chronotropic response to the metabolic requirement was impaired in comparison to the control group. It was concluded that the reduced chronotropic reserve was present in NYHA class III patients with old myocardial infarction, and that this mechanism might contribute to a decrease in the pump reserve of the heart, resulting in further impairment of physical capacity in these patients.

  9. Marine reserves: long-term protection is required for full recovery of predatory fish populations.

    Science.gov (United States)

    Russ, Garry R; Alcala, Angel C

    2004-03-01

    No-take marine reserves are advocated widely as a potential solution to the loss of marine biodiversity and ecosystem structure, and to over-fishing. We assess the duration of protection required for unfished populations of large predatory reef fish to attain natural states. We have monitored two marine reserves at Sumilon and Apo Islands, Philippines, regularly for 17 years (1983-2000). The biomass of large predatory fish was still increasing exponentially after 9 and 18 years of protection at Sumilon and Apo reserves, respectively. There was little evidence that the rate of accumulation of biomass inside the reserves was slowing down even after so many years of protection. This suggests that the length of time to full recovery will be considerable. We made two assumptions in order to estimate this period. Firstly, that biomass growth will follow the logistic model. Secondly, the conservative assumption that biomass had already attained 90% of the local carrying capacity of the environments in the reserves. We conclude that the time required for full recovery will be 15 and 40 years at Sumilon and Apo reserves, respectively. Such durations of recovery appear consistent with known life history characteristics of these fish, and with empirical data on recovery rates of heavily exploited fish stocks. By the time the full fisheries or ecosystem benefits from such reserves are apparent, human populations and impacts will have doubled in much of the developing world. Thus, networks of such reserves need to be implemented immediately. Furthermore, the management mechanisms for the reserves need to be successful over timescales of human generations.

  10. Splenic infarction

    Science.gov (United States)

    Splenic infarction is the death of tissue (necrosis) in the spleen due to a blockage in blood flow. ... Common causes of splenic infarction include: Blood clots Blood diseases such as sickle cell anemia Infections such as endocarditis

  11. Detoxification of α-tomatine by Cladosporium fulvum is required for full virulence on tomato.

    Science.gov (United States)

    Ökmen, Bilal; Etalo, Desalegn W; Joosten, Matthieu H A J; Bouwmeester, Harro J; de Vos, Ric C H; Collemare, Jérôme; de Wit, Pierre J G M

    2013-06-01

    · α-Tomatine is an antifungal glycoalkaloid that provides basal defense to tomato (Solanum lycopersicum). However, tomato pathogens overcome this basal defense barrier by the secretion of tomatinases that degrade α-tomatine into the less fungitoxic compounds β-tomatine and tomatidine. Although pathogenic on tomato, it has been reported that the biotrophic fungus Cladosporium fulvum is unable to detoxify α-tomatine. · Here, we present a functional analysis of the glycosyl hydrolase (GH10), CfTom1, which is orthologous to fungal tomatinases. · We show that C. fulvum hydrolyzes α-tomatine into tomatidine in vitro and during the infection of tomato, which is fully attributed to the activity of CfTom1, as shown by the heterologous expression of this enzyme in tomato. Accordingly, ∆cftom1 mutants of C. fulvum are more sensitive to α-tomatine and are less virulent than the wild-type fungus on tomato. · Although α-tomatine is thought to be localized in the vacuole, we show that it is also present in the apoplast, where it is hydrolyzed by CfTom1 on infection. The accumulation of tomatidine during infection appears to be toxic to tomato cells and does not suppress defense responses, as suggested previously. Altogether, our results show that CfTom1 is responsible for the detoxification of α-tomatine by C. fulvum, and is required for full virulence of this fungus on tomato.

  12. The type VI secretion system gene cluster of Salmonella typhimurium: required for full virulence in mice.

    Science.gov (United States)

    Liu, Ji; Guo, Ji-Tao; Li, Yong-Guo; Johnston, Randal N; Liu, Gui-Rong; Liu, Shu-Lin

    2013-07-01

    Type VI secretion system (T6SS) has increasingly been believed to participate in the infection process for many bacterial pathogens, but its role in the virulence of Salmonella typhimurium remains unclear. To look into this, we deleted the T6SS cluster from the genome of S. typhimurium 14028s and analyzed the phenotype of the resulting T6SS knockout mutant (T6SSKO mutant) in vitro and in vivo. We found that the T6SSKO mutant exhibited reduced capability in colonizing the spleen and liver in an in vivo colonization competition model in BALB/c mice infected by the oral route. Additionally, infection via intraperitoneal administration also showed that the T6SSKO mutant was less capable of colonizing the mouse spleen and liver than the wild-type strain. We did not detect significant differences between the T6SSKO and wild-type strains in epithelial cell invasion tests. However, in the macrophage RAW264.7 cell line, the T6SSKO mutant survived and proliferated significantly more poorly than the wild-type strain. These findings indicate that T6SS gene cluster is required for full virulence of S. typhimurium 14028s in BALB/c mice, possibly due to its roles in bacterial survival and proliferation in macrophages.

  13. Dietary supplement labeling and advertising claims: are clinical studies on the full product required?

    Science.gov (United States)

    Villafranco, John E; Bond, Katie

    2009-01-01

    Whether labeling and advertising claims for multi-ingredient dietary supplements may be based on the testing of individual, key ingredients--rather than the actual product--has caused a good deal of confusion. This confusion stems from the dearth of case law and the open-endedness of Federal Trade Commission (FTC) and Food and Drug Administration (FDA) guidance on this issue. Nevertheless, the relevant regulatory guidance, case law and self-regulatory case law--when assessed together--indicate that the law allows and even protects "key ingredient claims" (i.e., claims based on efficacy testing of key ingredients in the absence of full product testing). This article provides an overview of the relevant substantiation requirements for dietary supplement claims and then reviews FTC's and FDA's guidance on key ingredient claims; relevant case law; use of key ingredient claims in the advertising of other consumer products; and the National Advertising Division of the Better Business Bureau, Inc.'s (NAD's) approach to evaluating key ingredient claims for dietary supplements. This article concludes that key ingredient claims--provided they are presented in a truthful and non-deceptive manner--are permissible, and should be upheld in litigation and cases subject to industry self-regulation. This article further concludes that the NAD's approach to key ingredient claims provides practical guidance for crafting and substantiating dietary supplement key ingredient claims.

  14. 76 FR 82115 - Enhancing Airline Passenger Protections: Full Fare Price Advertising Requirements

    Science.gov (United States)

    2011-12-30

    ... Price Advertising Requirements AGENCY: Office of the Secretary (OST), Department of Transportation (DOT... advertising requirements in 14 CFR 399.84 from January 24, 2012, to January 26, 2012. DATES: The effective... fare and other advertising requirements from January 24, 2012, to January 26, 2012, to...

  15. Infarct healing is a dynamic process following acute myocardial infarction

    Directory of Open Access Journals (Sweden)

    Pokorney Sean D

    2012-09-01

    Full Text Available Abstract Background The role of infarct size on left ventricular (LV remodeling in heart failure after an acute ST-segment elevation myocardial infarction (STEMI is well recognized. Infarct size, as determined by cardiovascular magnetic resonance (CMR, decreases over time. The amount, rate, and duration of infarct healing are unknown. Methods A total of 66 patients were prospectively enrolled after reperfusion for an acute STEMI. Patients underwent a CMR evaluation within 1 week, 4 months, and 14 months after STEMI. Results Mean infarct sizes for the 66 patients at baseline (acute necrosis, early follow-up (early scar, and late follow-up (late scar were 25 ± 17 g, 17 ± 12 g, and 15 ± 11 g, respectively. Patients were stratified in tertiles, based on infarct size, with the largest infarcts having the greatest absolute decrease in mass at early and late scar. The percent reduction of infarct mass was independent of initial infarct size. There was an 8 g or 32% decrease in infarct mass between acute necrosis and early scar (p  Conclusions Infarct healing is a continuous process after reperfusion for STEMI, with greatest reduction in infarct size in the first few months. The dynamic nature of infarct healing through the first year after STEMI indicates that decisions based on infarct size, and interventions to reduce infarct size, must take into consideration the time frame of measurement.

  16. 42 CFR 84.175 - Half-mask facepieces, full facepieces, hoods, helmets, and mouthpieces; fit; minimum requirements.

    Science.gov (United States)

    2010-10-01

    ..., helmets, and mouthpieces; fit; minimum requirements. 84.175 Section 84.175 Public Health PUBLIC HEALTH....175 Half-mask facepieces, full facepieces, hoods, helmets, and mouthpieces; fit; minimum requirements. (a) Half-mask facepieces and full facepieces shall be designed and constructed to fit persons...

  17. 42 CFR 84.198 - Half-mask facepieces, full facepieces, mouthpieces, hoods, and helmets; fit; minimum requirements.

    Science.gov (United States)

    2010-10-01

    ..., hoods, and helmets; fit; minimum requirements. 84.198 Section 84.198 Public Health PUBLIC HEALTH SERVICE..., full facepieces, mouthpieces, hoods, and helmets; fit; minimum requirements. (a) Half-mask facepieces and full facepieces shall be designed and constructed to fit persons with various facial shapes...

  18. 42 CFR 84.1135 - Half-mask facepieces, full facepieces, hoods, helmets, and mouthpieces; fit; minimum requirements.

    Science.gov (United States)

    2010-10-01

    ..., helmets, and mouthpieces; fit; minimum requirements. 84.1135 Section 84.1135 Public Health PUBLIC HEALTH..., full facepieces, hoods, helmets, and mouthpieces; fit; minimum requirements. (a) Half-mask facepieces and full facepieces shall be designed and constructed to fit persons with various facial shapes...

  19. Omental Infarction Mimicking Cholecystitis

    Directory of Open Access Journals (Sweden)

    David Smolilo

    2015-01-01

    Full Text Available Omental infarction can be difficult to diagnose preoperatively as imaging may be inconclusive and patients often present in a way that suggests a more common surgical pathology such as appendicitis. Here, a 40-year-old Caucasian man presented to casualty with shortness of breath and progressive right upper abdominal pain, accompanied with right shoulder and neck pain. Exploratory laparoscopy was eventually utilised to diagnose an atypical form of omental infarction that mimics cholecystitis. The vascular supply along the long axis of the segment was occluded initiating necrosis. In this case, the necrotic segment was adherent with the abdominal wall, a pathology not commonly reported in cases of omental infarction.

  20. 77 FR 63771 - Implementation of Full-Service Intelligent Mail Requirements for Automation Prices

    Science.gov (United States)

    2012-10-17

    ... be fully captured. Full-service Intelligent Mail would also enable simplification of the current mail... worked closely with mailers, software providers, and mail service providers to simplify, refine, and evolve full-service offerings. Thousands of mailers, software providers, and mail service providers have...

  1. Formation of a full complement of cranial proprioceptors requires multiple neurotrophins

    NARCIS (Netherlands)

    Fan, GP; Copray, S; Huang, EJ; Jones, K; Yan, Q; Walro, J; Jaenisch, R; Kucera, J

    2000-01-01

    Inactivation of neurotrophin-3 (NT3) completely blocks the development of limb proprioceptive neurons and their end organs, the muscle spindles. We examined whether cranial proprioceptive neurons of the trigeminal mesencephalic nucleus (TMN) require NT3, brain-derived neurotrophic factor (BDNF) or n

  2. TroA of Streptococcus suis is required for manganese acquisition and full virulence

    NARCIS (Netherlands)

    Wichgers Schreur, P.J.; Rebel, J.M.J.; Smits, M.A.; Putten, van J.P.M.; Smith, H.E.

    2011-01-01

    Streptococcus suis causes infections in pigs and occasionally in humans resulting in 23 manifestations as meningitis, sepsis, arthritis and septic shock. For survival within the 24 host, S. suis requires numerous nutrients including trace metals. Little is known about 25 the specific proteins involv

  3. ESD full chip simulation: HBM and CDM requirements and simulation approach

    Directory of Open Access Journals (Sweden)

    E. Franell

    2008-05-01

    Full Text Available Verification of ESD safety on full chip level is a major challenge for IC design. Especially phenomena with their origin in the overall product setup are posing a hurdle on the way to ESD safe products. For stress according to the Charged Device Model (CDM, a stumbling stone for a simulation based analysis is the complex current distribution among a huge number of internal nodes leading to hardly predictable voltage drops inside the circuits.

    This paper describes an methodology for Human Body Model (HBM simulations with an improved ESD-failure coverage and a novel methodology to replace capacitive nodes within a resistive network by current sources for CDM simulation. This enables a highly efficient DC simulation clearly marking CDM relevant design weaknesses allowing for application of this software both during product development and for product verification.

  4. 42 CFR 84.135 - Half-mask facepieces, full facepieces, hoods, and helmets; fit; minimum requirements.

    Science.gov (United States)

    2010-10-01

    ... helmets; fit; minimum requirements. 84.135 Section 84.135 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT... facepieces, hoods, and helmets; fit; minimum requirements. (a) Half-mask facepieces and full facepieces shall be designed and constructed to fit persons with various facial shapes and sizes either: (1)...

  5. 77 FR 23643 - Advance Notice of Implementation of Full-Service Intelligent Mail Required for Automation Prices

    Science.gov (United States)

    2012-04-20

    ... Intelligent Mail meets this information need. Full-Service Intelligent Mail also enables simplification of... processing operations. ] The Postal Service has worked closely with mailers, software providers, and mail... Full-Service requirements were introduced. Thousands of mailers, software providers and mail service...

  6. Migrainous infarction

    DEFF Research Database (Denmark)

    Laurell, K; Artto, V; Bendtsen, L

    2011-01-01

    Migrainous infarction (MI), i.e. an ischemic stroke developing during an attack of migraine with aura is rare and the knowledge of its clinical characteristics is limited. Previous case series using the International Classification of Headache Disorders (ICHD) included......Migrainous infarction (MI), i.e. an ischemic stroke developing during an attack of migraine with aura is rare and the knowledge of its clinical characteristics is limited. Previous case series using the International Classification of Headache Disorders (ICHD) included...

  7. Occipital lobe infarctions are different

    Directory of Open Access Journals (Sweden)

    Halvor Naess

    2007-09-01

    Full Text Available Halvor Naess, Ulrikke Waje-Andreassen, Lars ThomassenDepartment of Neurology, Haukeland University Hospital, University of Bergen, N-5021 Bergen, NorwayObjectives: We hypothesized that occipital lobe infarctions differ from infarctions in other locations as to etiology, risk factors and prognosis among young adults.Methods: Location, etiology, risk factors and long-term outcome were evaluated among all young adults 15–49 years suffering from cerebral infarction in Hordaland County, Norway between 1988 and 1997.Results: The following variables were more frequent among patients with occipital lobe infarction compared with patients with infarctions located elsewhere: younger age (P < 0.001, female sex (P = 0.016, prothrombotic state (P = 0.005 and lack of hypertension (P = 0.001. There was no difference as to long-term mortality or recurrence of cerebral infarction. Conclusion: Occipital lobe infarctions differ from infarctions in other locations among young adults. This may have important etiologic and therapeutical implications that need further studies.Keywords: cerebral infarction, occipital lobe, young adults

  8. Pseudo-dissection of ascending aorta in inferior myocardial infarction.

    Directory of Open Access Journals (Sweden)

    Grahame K. Goode

    2011-06-01

    Full Text Available Acute aortic dissection is a cardiac emergency which can present as inferior myocardial infarction. It has high morbidity and mortality requiring prompt diagnosis and treatment. Rapid advances in noninvasive imaging modalities have facilitated the early diagnosis of this condition and in ruling out this potentially catastrophic illness. We report an interesting case of a 57 year- old -man who presented with inferior myocardial infarction requiring thrombolysis and temporary pacing wire for complete heart block. An echocardiogram was highly suspicious of aortic dissection. CT scan confirmed that the malposition of the temporary pacing wire through the aorta mimicked aortic dissection.

  9. Determination of Dietary Iron Requirements by Full Expression of Iron-Containing Enzymes in Various Tissues of Broilers.

    Science.gov (United States)

    Ma, Xinyan; Liao, Xiudong; Lu, Lin; Li, Sufen; Zhang, Liyang; Luo, Xugang

    2016-11-01

    The current dietary iron requirement (80 mg/kg) of broilers is mainly based on growth, hemoglobin concentration, or hematocrit data obtained in a few early studies; however, expressions of iron-containing enzymes might be more sensitive novel criteria to evaluate dietary iron requirements. The objective of this study was to determine dietary iron requirements of broilers for the full expression of succinate dehydrogenase (SDH), catalase, and cytochrome c oxidase (COX) in various tissues. A total of 336 1-d-old Arbor Acres male chicks were randomly assigned to 1 of 7 treatments with 6 replicates and fed a basal corn and soybean-meal diet (control, containing 67 mg Fe/kg) and the basal diet supplemented with 20, 40, 60, 80, 100, or 120 mg Fe/kg from FeSO4 ⋅ 7H2O for 21 d. Regression analysis was performed to estimate the optimal dietary iron concentration with the use of broken-line or quadratic models. SDH activity in the liver and heart, COX and catalase activity in the liver, Sdh mRNA levels in the liver, and Cox mRNA levels in the liver and heart of broilers were affected (P requirements estimated on the basis of fitted broken-line or quadratic-curve models (P requirements of broilers, and the dietary iron requirements would be 97-136 mg/kg to support the full expression of the above iron-containing enzymes in various tissues of broiler chicks from 1 to 21 d of age, which are higher than the current NRC iron requirement. © 2016 American Society for Nutrition.

  10. Migraine Infarction. Case Report

    Directory of Open Access Journals (Sweden)

    Yoany Mesa Barrera

    2015-03-01

    Full Text Available Migraine is considered like a risk factor for ischemic ictus in adult young people. In spite of the criteria established for the treatment of the migraine infarct, they are not always fulfilled strictly, permitting certain flexibility in the aforementioned treatment. The case of a patient with a background of migraine with auras, who suffers an ischemic cerebral migraine infarct at the course of a migraine crisis, is presented. The ictus was manifested like an especial right hemiparesis of the female sex in fertile age. The prognosis is good with low risk of recurrence, with unstable disorders and dysarthria. The laboratories studies were normal and the cerebral infarct was detected in the magnetic resonance, at the half left cerebral artery's territory. The patient had favorable evolution without sequel.

  11. Repetitive Myocardial Infarctions Secondary to Delirium Tremens

    Directory of Open Access Journals (Sweden)

    David Schwartzberg

    2014-01-01

    Full Text Available Delirium tremens develops in a minority of patients undergoing acute alcohol withdrawal; however, that minority is vulnerable to significant morbidity and mortality. Historically, benzodiazepines are given intravenously to control withdrawal symptoms, although occasionally a more substantial medication is needed to prevent the devastating effects of delirium tremens, that is, propofol. We report a trauma patient who required propofol sedation for delirium tremens that was refractory to benzodiazepine treatment. Extubed prematurely, he suffered a non-ST segment myocardial infarction followed by an ST segment myocardial infarction requiring multiple interventions by cardiology. We hypothesize that his myocardial ischemia was secondary to an increased myocardial oxygen demand that occurred during his stress-induced catecholamine surge during the time he was undertreated for delirium tremens. This advocates for the use of propofol for refractory benzodiazepine treatment of delirium tremens and adds to the literature on the instability patients experience during withdrawal.

  12. Endothelial progenitor cell-dependent angiogenesis requires localization of the full-length form of uPAR in caveolae.

    Science.gov (United States)

    Margheri, Francesca; Chillà, Anastasia; Laurenzana, Anna; Serratì, Simona; Mazzanti, Benedetta; Saccardi, Riccardo; Santosuosso, Michela; Danza, Giovanna; Sturli, Niccolò; Rosati, Fabiana; Magnelli, Lucia; Papucci, Laura; Calorini, Lido; Bianchini, Francesca; Del Rosso, Mario; Fibbi, Gabriella

    2011-09-29

    Endothelial urokinase-type plasminogen activator receptor (uPAR) is thought to provide a regulatory mechanism in angiogenesis. Here we studied the proangiogenic role of uPAR in endothelial colony-forming cells (ECFCs), a cell population identified in human umbilical blood that embodies all of the properties of an endothelial progenitor cell matched with a high proliferative rate. By using caveolae-disrupting agents and by caveolin-1 silencing, we have shown that the angiogenic properties of ECFCs depend on caveolae integrity and on the presence of full-length uPAR in such specialized membrane invaginations. Inhibition of uPAR expression by antisense oligonucleotides promoted caveolae disruption, suggesting that uPAR is an inducer of caveolae organization. Vascular endothelial growth factor (VEGF) promoted accumulation of uPAR in ECFC caveolae in its undegraded form. We also demonstrated that VEGF-dependent ERK phosphorylation required integrity of caveolae as well as caveolar uPAR expression. VEGF activity depends on inhibition of ECFC MMP12 production, which results in impairment of MMP12-dependent uPAR truncation. Further, MMP12 overexpression in ECFC inhibited vascularization in vitro and in vivo. Our data suggest that intratumor homing of ECFCs suitably engineered to overexpress MMP12 could have the chance to control uPAR-dependent activities required for tumor angiogenesis and malignant cells spreading.

  13. Convulsive Movements in Bilateral Paramedian Thalamic and Midbrain Infarction

    Directory of Open Access Journals (Sweden)

    Kazuo Yamashiro

    2011-11-01

    Full Text Available Although some previous reports have described convulsive movements in bilateral paramedian thalamic and midbrain infarction, little is known about their nature. A 71-year-old man presented with impaired consciousness and clonic movements of both arms. Each series of movements lasted 10 to 20 s and occurred at 2- to 3-min intervals, which disappeared after intravenous administration of diazepam and phenytoin. Magnetic resonance imaging showed acute bilateral paramedian thalamic and midbrain infarction. A review of the literature revealed that convulsive movements were observed mostly at the onset of infarction. Clonic movements appeared frequently in the limbs, particularly in both arms. Clinical observations and results of animal experiments suggest that these seizures might originate from the mesencephalic reticular formation. Physicians should recognize this condition, because not only seizure control but also early management of ischemic stroke is required.

  14. Lipoprotein biosynthesis by prolipoprotein diacylglyceryl transferase is required for efficient spore germination and full virulence of Bacillus anthracis

    Science.gov (United States)

    Okugawa, Shu; Moayeri, Mahtab; Pomerantsev, Andrei P.; Sastalla, Inka; Crown, Devorah; Gupta, Pradeep K.; Leppla, Stephen H.

    2011-01-01

    Bacterial lipoproteins play a crucial role in virulence in some Gram-positive bacteria. However, the role of lipoprotein biosynthesis in Bacillus anthracis is unknown. We created a B. anthracis mutant strain altered in lipoproteins by deleting the lgt gene encoding the enzyme prolipoprotein diacylglyceryl transferase, which attaches the lipid anchor to prolipoproteins. 14C-palmitate labeling confirmed that the mutant strain lacked lipoproteins, and hydrocarbon partitioning showed it to have decreased surface hydrophobicity. The anthrax toxin proteins were secreted from the mutant strain at nearly the same levels as from the wild-type strain. The TLR2-dependent TNF-α response of macrophages to heat-killed lgt mutant bacteria was reduced. Spores of the lgt mutant germinated inefficiently in vitro and in mouse skin. As a result, in a murine subcutaneous infection model, lgt mutant spores had markedly attenuated virulence. In contrast, vegetative cells of the lgt mutant were as virulent as those of the wild-type strain. Thus, lipoprotein biosynthesis in B. anthracis is required for full virulence in a murine infection model. PMID:22103323

  15. Glyceraldehyde-3-phosphate dehydrogenase of Xanthomonas campestris pv. campestris is required for extracellular polysaccharide production and full virulence.

    Science.gov (United States)

    Lu, Guang-Tao; Xie, Jia-Ri; Chen, Lei; Hu, Jiang-Ru; An, Shi-Qi; Su, Hui-Zhao; Feng, Jia-Xun; He, Yong-Qiang; Jiang, Bo-Le; Tang, Dong-Jie; Tang, Ji-Liang

    2009-05-01

    Glyceraldehyde-3-phosphate dehydrogenase (GAPDH) plays an important role in glucose catabolism, converting glyceraldehyde 3-phosphates to 1,3-bisphosphoglycerates. Open reading frame (ORF) XC_0972 in the genome of Xanthomonas campestris pv. campestris (Xcc) strain 8004 is the only ORF in this strain annotated to encode a GAPDH. In this work, we have demonstrated genetically that this ORF encodes a unique GAPDH in Xcc strain 8004, which seems to be constitutively expressed. A GAPDH-deficient mutant could still grow in medium with glucose or other sugars as the sole carbon source, and no phosphofructokinase activity was detectable in strain 8004. These facts suggest that Xcc may employ the Entner-Doudoroff pathway, but not glycolysis, to utilize glucose. The mutant could not utilize pyruvate as sole carbon source, whereas the wild-type could, implying that the GAPDH of Xcc is involved in gluconeogenesis. Furthermore, inactivation of the Xcc GAPDH resulted in impairment of bacterial growth and virulence in the host plant, and reduction of intracellular ATP and extracellular polysaccharide (EPS). This reveals that GAPDH is required for EPS production and full pathogenicity of Xcc.

  16. The rgg0182 gene encodes a transcriptional regulator required for the full Streptococcus thermophilus LMG18311 thermal adaptation

    Directory of Open Access Journals (Sweden)

    Bertin Stéphane

    2011-10-01

    Full Text Available Abstract Background Streptococcus thermophilus is an important starter strain for the production of yogurt and cheeses. The analysis of sequenced genomes of four strains of S. thermophilus indicates that they contain several genes of the rgg familly potentially encoding transcriptional regulators. Some of the Rgg proteins are known to be involved in bacterial stress adaptation. Results In this study, we demonstrated that Streptococcus thermophilus thermal stress adaptation required the rgg0182 gene which transcription depends on the culture medium and the growth temperature. This gene encoded a protein showing similarity with members of the Rgg family transcriptional regulator. Our data confirmed that Rgg0182 is a transcriptional regulator controlling the expression of its neighboring genes as well as chaperones and proteases encoding genes. Therefore, analysis of a Δrgg0182 mutant revealed that this protein played a role in the heat shock adaptation of Streptococcus thermophilus LMG18311. Conclusions These data showed the importance of the Rgg0182 transcriptional regulator on the survival of S. thermophilus during dairy processes and more specifically during changes in temperature.

  17. The type IV pilin, PilA, is required for full virulence of Francisella tularensis subspecies tularensis

    Directory of Open Access Journals (Sweden)

    Forslund Anna-Lena

    2010-08-01

    Full Text Available Abstract Background All four Francisella tularensis subspecies possess gene clusters with potential to express type IV pili (Tfp. These clusters include putative pilin genes, as well as pilB, pilC and pilQ, required for secretion and assembly of Tfp. A hallmark of Tfp is the ability to retract the pilus upon surface contact, a property mediated by the ATPase PilT. Interestingly, out of the two major human pathogenic subspecies only the highly virulent type A strains have a functional pilT gene. Results In a previous study, we were able to show that one pilin gene, pilA, was essential for virulence of a type B strain in a mouse infection model. In this work we have examined the role of several Tfp genes in the virulence of the pathogenic type A strain SCHU S4. pilA, pilC, pilQ, and pilT were mutated by in-frame deletion mutagenesis. Interestingly, when mice were infected with a mixture of each mutant strain and the wild-type strain, the pilA, pilC and pilQ mutants were out-competed, while the pilT mutant was equally competitive as the wild-type. Conclusions This suggests that expression and surface localisation of PilA contribute to virulence in the highly virulent type A strain, while PilT was dispensable for virulence in the mouse infection model.

  18. The Adh1 gene of the fungus Metarhizium anisopliae is expressed during insect colonization and required for full virulence.

    Science.gov (United States)

    Callejas-Negrete, Olga Alicia; Torres-Guzmán, Juan Carlos; Padilla-Guerrero, Israel Enrique; Esquivel-Naranjo, Ulises; Padilla-Ballesteros, Maria Fernanda; García-Tapia, Adriana; Schrank, Augusto; Salazar-Solís, Eduardo; Gutiérrez-Corona, Félix; González-Hernández, Gloria Angélica

    2015-03-01

    Zymography of alcohol dehydrogenase (ADH) activity in the entomopathogenic fungus Metarhizium anisopliae grown under various conditions revealed that micro-aerobic growth was associated with increased ADH activity. The major ADH protein, AdhIp, was purified to homogeneity by affinity chromatography and has an estimated molecular weight of 41kDa and an isoelectric point (pI) of 6.4. Peptide mass fingerprint analysis allowed the identification and cloning of the gene that encodes this protein, Adh1, as annotated in the M. anisopliae genome database. AdhIp is related to the medium-chain dehydrogenase/reductase (MDR)/zinc-dependent alcohol dehydrogenase-like family and contains conserved ADH sequence motifs, such as the zinc-containing ADH signature, the FAD/NAD binding domain and amino acid residues that are conserved in most microbial ADHs. Semi-quantitative RT-PCR analysis revealed that Adh1 gene expression occurs at low levels during early Plutella xylostella infection and that the Adh1 gene was primarily expressed at larval death and as mycelia emerge from the insect cuticle before conidiation. Antisense-RNA experiments indicated that NAD(+)-dependent ADH activity was diminished by 20-75% in the transformants, and the transformants that had lower ADH activity showed allyl alcohol resistance, which indicates that reduction in ADH activity also occurs in vivo. Bioassays performed using antisense adh1 transformants, which have lower ADH activity, showed that LC50 values were two to five times higher than the wild-type, indicating that AdhIp is required for full capability of the fungus to penetrate and/or colonize the insect.

  19. Automatic infarct planimetry by means of swarm-based clustering

    OpenAIRE

    Van Vuuren, Pieter A.; Van Vuuren, Derick

    2014-01-01

    Infarct planimetry is an important tool in cardiology research. At present this technique entails that infarct size is manually determined from scanned images of prepared heart sections. Existing attempts at automating infarct planimetry are limited in that they require user input in the form of starting points for region growing algorithms or template values for classification algorithms. In this paper a new automatic infarct planimetry (AIP) algorithm is presented. The ...

  20. Successful Thrombolytic Therapy for Bilateral Renal Infarction: A Case Report

    Directory of Open Access Journals (Sweden)

    Han-Ching Lin

    2006-08-01

    Full Text Available Acute renal infarction is a rarely reported disease in the medical literature. Angiography, renal scintigraphy, intravenous pyelography, sonography, and enhanced computed tomography may be useful in diagnosing acute renal infarction antemortem. Therapeutic guidelines for the treatment of renal infarction have not been established. We report a case of bilateral renal infarction in an elderly woman with atrial fibrillation, which was successfully treated by thrombolytic therapy.

  1. Estrogen Receptor Alpha Binding to ERE is Required for Full Tlr7- and Tlr9-Induced Inflammation.

    Science.gov (United States)

    Cunningham, Melissa A; Wirth, Jena R; Naga, Osama; Eudaly, Jackie; Gilkeson, Gary S

    2014-01-20

    We previously found that a maximum innate inflammatory response induced by stimulation of Toll-like receptors (TLRs) 3, 7 and 9 requires ERα, but does not require estrogen in multiple cell types from both control and lupus-prone mice. Given the estrogen-independence, we hypothesized that ERα mediates TLR signaling by tethering to, and enhancing, the activity of downstream transcription factors such as NFκB, rather than acting classically by binding EREs on target genes. To investigate the mechanism of ERα impact on TLR signaling, we utilized mice with a knock-in ERα mutant that is unable to bind ERE. After stimulation with TLR ligands, both ex vivo spleen cells and bone marrow-derived dendritic cells (BM-DCs) isolated from mutant ERα ("KIKO") mice produced significantly less IL-6 compared with cells from wild-type (WT) littermates. These results suggest that ERα modulation of TLR signaling does indeed require ERE binding for its effect on the innate immune response.

  2. The 'silence' of silent brain infarctions may be related to chronic ischemic preconditioning and nonstrategic locations rather than to a small infarction size

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    Chao Feng

    2013-01-01

    Full Text Available OBJECTIVE: Silent brain infarctions are the silent cerebrovascular events that are distinguished from symptomatic lacunar infarctions by their 'silence'; the origin of these infarctions is still unclear. This study analyzed the characteristics of silent and symptomatic lacunar infarctions and sought to explore the mechanism of this 'silence'. METHODS: In total, 156 patients with only silent brain infarctions, 90 with only symptomatic lacunar infarctions, 160 with both silent and symptomatic lacunar infarctions, and 115 without any infarctions were recruited. Vascular risk factors, leukoaraiosis, and vascular assessment results were compared. The National Institutes of Health Stroke Scale scores were compared between patients with only symptomatic lacunar infarctions and patients with two types of infarctions. The locations of all of the infarctions were evaluated. The evolution of the two types of infarctions was retrospectively studied by comparing the infarcts on the magnetic resonance images of 63 patients obtained at different times. RESULTS: The main risk factors for silent brain infarctions were hypertension, age, and advanced leukoaraiosis; the main factors for symptomatic lacunar infarctions were hypertension, atrial fibrillation, and atherosclerosis of relevant arteries. The neurological deficits of patients with only symptomatic lacunar infarctions were more severe than those of patients with both types of infarctions. More silent brain infarctions were located in the corona radiata and basal ganglia; these locations were different from those of the symptomatic lacunar infarctions. The initial sizes of the symptomatic lacunar infarctions were larger than the silent brain infarctions, whereas the final sizes were almost equal between the two groups. CONCLUSIONS: Chronic ischemic preconditioning and nonstrategic locations may be the main reasons for the 'silence' of silent brain infarctions.

  3. Intestinal ischemia and infarction

    Science.gov (United States)

    ... medlineplus.gov/ency/article/001151.htm Small intestinal ischemia and infarction To use the sharing features on this page, please enable JavaScript. Intestinal ischemia and infarction occurs when there is a narrowing ...

  4. Classification of myocardial infarction

    DEFF Research Database (Denmark)

    Saaby, Lotte; Poulsen, Tina Svenstrup; Hosbond, Susanne Elisabeth

    2013-01-01

    The classification of myocardial infarction into 5 types was introduced in 2007 as an important component of the universal definition. In contrast to the plaque rupture-related type 1 myocardial infarction, type 2 myocardial infarction is considered to be caused by an imbalance between demand...... and supply of oxygen in the myocardium. However, no specific criteria for type 2 myocardial infarction have been established....

  5. Severe Spasm of the Renal Artery after Blunt Abdominal Trauma Simulating End-Organ Infarction

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    Adem Ucar

    2010-01-01

    Full Text Available Traumatic occlusion of the renal artery is a serious injury. Management differs according to the grade of injury. In most circumstances, emergency surgical revascularization or endovascular intervention is required. We describe the case of a child with multiorgan injuries and spasm of the main renal artery after blunt trauma simulating arterial occlusion or end-organ infarction.

  6. Quorum Sensing in Bacillus thuringiensis Is Required for Completion of a Full Infectious Cycle in the Insect

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    Leyla Slamti

    2014-07-01

    Full Text Available Bacterial cell-cell communication or quorum sensing (QS is a biological process commonly described as allowing bacteria belonging to a same pherotype to coordinate gene expression to cell density. In Gram-positive bacteria, cell-cell communication mainly relies on cytoplasmic sensors regulated by secreted and re-imported signaling peptides. The Bacillus quorum sensors Rap, NprR, and PlcR were previously identified as the first members of a new protein family called RNPP. Except for the Rap proteins, these RNPP regulators are transcription factors that directly regulate gene expression. QS regulates important biological functions in bacteria of the Bacillus cereus group. PlcR was first characterized as the main regulator of virulence in B. thuringiensis and B. cereus. More recently, the PlcR-like regulator PlcRa was characterized for its role in cysteine metabolism and in resistance to oxidative stress. The NprR regulator controls the necrotrophic properties allowing the bacteria to survive in the infected host. The Rap proteins negatively affect sporulation via their interaction with a phosphorelay protein involved in the activation of Spo0A, the master regulator of this differentiation pathway. In this review we aim at providing a complete picture of the QS systems that are sequentially activated during the lifecycle of B. cereus and B. thuringiensis in an insect model of infection.

  7. The histone acetyltransferase PsGcn5 mediates oxidative stress responses and is required for full virulence of Phytophthora sojae.

    Science.gov (United States)

    Zhao, Wei; Wang, Tao; Liu, Shusen; Chen, Qingqing; Qi, Rende

    2015-10-01

    In eukaryotic organisms, histone acetyltransferase complexes are coactivators that are important for transcriptional activation by modifying chromatin. In this study, a gene (PsGcn5) from Phytophthora sojae encoding a histone acetyltransferase was identified as a homolog of one component of the histone acetyltransferase complex from yeasts to mammals. PsGcn5 was constitutively expressed in each stage tested, but had a slightly higher expression in sporulating hyphae and 3 h after infection. PsGcn5-silenced mutants were generated using polyethylene glycol-mediated protoplast stable transformation. These mutants had normal development, but compared to wild type strains they had higher sensitivity to hydrogen peroxide (H2O2) and significantly reduced virulence in soybean. Diaminobenzidine staining revealed an accumulation of H2O2 around the infection sites of PsGcn5-silenced mutants but not for wild type strains. Inhibition of the plant NADPH oxidase by diphenyleneiodonium prevented host-derived H2O2 accumulation in soybean cells and restored infectious hyphal growth of the mutants. Thus, we concluded that PsGcn5 is important for growth under conditions of oxidative stress and contributes to the full virulence of P. sojae by suppressing the host-derived reactive oxygen species.

  8. Requirement of the Pseudomonas aeruginosa CbrA Sensor Kinase for Full Virulence in a Murine Acute Lung Infection Model

    Science.gov (United States)

    Yeung, Amy T. Y.; Janot, Laure; Pena, Olga M.; Neidig, Anke; Kukavica-Ibrulj, Irena; Hilchie, Ashley; Levesque, Roger C.; Overhage, Joerg

    2014-01-01

    Pseudomonas aeruginosa is an opportunistic pathogen that is a major cause of respiratory tract and other nosocomial infections. The sensor kinase CbrA is a central regulator of carbon and nitrogen metabolism and in vitro also regulates virulence-related processes in P. aeruginosa. Here, we investigated the role of CbrA in two murine models of infection. In both peritoneal infections in leukopenic mice and lung infection models, the cbrA mutant was less virulent since substantially larger numbers of cbrA mutant bacteria were required to cause the same level of infection as wild-type or complemented bacteria. In contrast, in the chronic rat lung model the cbrA mutant grew and persisted as well as the wild type, indicating that the decrease of in vivo virulence of the cbrA mutant did not result from growth deficiencies on particular carbon substrates observed in vitro. In addition, a mutant in the cognate response regulator CbrB showed no defect in virulence in the peritoneal infection model, ruling out the involvement of certain alterations of virulence properties in the cbrA mutant including defective swarming motility, increased biofilm formation, and cytotoxicity, since these alterations are controlled through CbrB. Further investigations indicated that the mutant was more susceptible to uptake by phagocytes in vitro, resulting in greater overall bacterial killing. Consistent with the virulence defect, it took a smaller number of Dictyostelium discoideum amoebae to kill the cbrA mutant than to kill the wild type. Transcriptional analysis of the cbrA mutant during D. discoideum infection led to the conclusion that CbrA played an important role in the iron metabolism, protection of P. aeruginosa against oxidative stress, and the regulation of certain virulence factors. PMID:24379284

  9. Requirement of the Pseudomonas aeruginosa CbrA sensor kinase for full virulence in a murine acute lung infection model.

    Science.gov (United States)

    Yeung, Amy T Y; Janot, Laure; Pena, Olga M; Neidig, Anke; Kukavica-Ibrulj, Irena; Hilchie, Ashley; Levesque, Roger C; Overhage, Joerg; Hancock, Robert E W

    2014-03-01

    Pseudomonas aeruginosa is an opportunistic pathogen that is a major cause of respiratory tract and other nosocomial infections. The sensor kinase CbrA is a central regulator of carbon and nitrogen metabolism and in vitro also regulates virulence-related processes in P. aeruginosa. Here, we investigated the role of CbrA in two murine models of infection. In both peritoneal infections in leukopenic mice and lung infection models, the cbrA mutant was less virulent since substantially larger numbers of cbrA mutant bacteria were required to cause the same level of infection as wild-type or complemented bacteria. In contrast, in the chronic rat lung model the cbrA mutant grew and persisted as well as the wild type, indicating that the decrease of in vivo virulence of the cbrA mutant did not result from growth deficiencies on particular carbon substrates observed in vitro. In addition, a mutant in the cognate response regulator CbrB showed no defect in virulence in the peritoneal infection model, ruling out the involvement of certain alterations of virulence properties in the cbrA mutant including defective swarming motility, increased biofilm formation, and cytotoxicity, since these alterations are controlled through CbrB. Further investigations indicated that the mutant was more susceptible to uptake by phagocytes in vitro, resulting in greater overall bacterial killing. Consistent with the virulence defect, it took a smaller number of Dictyostelium discoideum amoebae to kill the cbrA mutant than to kill the wild type. Transcriptional analysis of the cbrA mutant during D. discoideum infection led to the conclusion that CbrA played an important role in the iron metabolism, protection of P. aeruginosa against oxidative stress, and the regulation of certain virulence factors.

  10. The monofunctional catalase KatE of Xanthomonas axonopodis pv. citri is required for full virulence in citrus plants.

    Directory of Open Access Journals (Sweden)

    María Laura Tondo

    Full Text Available BACKGROUND: Xanthomonas axonopodis pv. citri (Xac is an obligate aerobic phytopathogen constantly exposed to hydrogen peroxide produced by normal aerobic respiration and by the plant defense response during plant-pathogen interactions. Four putative catalase genes have been identified in silico in the Xac genome, designated as katE, catB, srpA (monofunctional catalases and katG (bifunctional catalase. METHODOLOGY/PRINCIPAL FINDINGS: Xac catalase activity was analyzed using native gel electrophoresis and semi-quantitative RT-PCR. We demonstrated that the catalase activity pattern was regulated in different growth stages displaying the highest levels during the stationary phase. KatE was the most active catalase in this phase of growth. At this stage cells were more resistant to hydrogen peroxide as was determined by the analysis of CFU after the exposition to different H(2O(2 concentrations. In addition, Xac exhibited an adaptive response to hydrogen peroxide, displaying higher levels of catalase activity and H(2O(2 resistance after treatment with sub-lethal concentrations of the oxidant. In the plant-like medium XVM2 the expression of KatE was strongly induced and in this medium Xac was more resistant to H(2O(2. A XackatE mutant strain was constructed by insertional mutagenesis. We observed that catalase induction in stationary phase was lost meanwhile the adaptive response to peroxide was maintained in this mutant. Finally, the XackatE strain was assayed in planta during host plant interaction rendering a less aggressive phenotype with a minor canker formation. CONCLUSIONS: Our results confirmed that in contrast to other Xanthomonas species, Xac catalase-specific activity is induced during the stationary phase of growth in parallel with the bacterial resistance to peroxide challenge. Moreover, Xac catalases expression pattern is modified in response to any stimuli associated with the plant or the microenvironment it provides. The catalase Kat

  11. Depression following myocardial infarction

    DEFF Research Database (Denmark)

    Larsen, Karen Kjær

    2013-01-01

    Myocardial infarction (MI) is a severe life event that is accompanied by an increased risk of depression. Mounting evidence suggests that post-MI depression is associated with adverse outcomes, but the underlying mechanisms of this association remain unclear, and no previous studies have examined...... whether the mental burden of MI is so heavy that it increases the risk of suicide. Although post-MI depression is common and burdensome, the condition remains under-recognised and under-treated. The development of new strategies to improve the quality of care for people with post-MI depression requires...... thorough understanding of the mechanisms that influence the prognosis as well as knowledge of the present care provided. The purpose of this PhD thesis is accordingly subdivided into four specific aims: 1. To estimate the prevalence of depression in people with MI after three months, and to estimate...

  12. Recurrent Postmyocardial Infarction Ventricular Tachycardia: An Unusual Culprit

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    Akhil Kumar Sharma

    2015-01-01

    Full Text Available Although temporary transvenous pacing is life-saving in patients with myocardial infarction who develop bradyarrhythmias, the electrical complications resulting from it can be fatal and are rarely reported. We report here a patient with acute inferior wall myocardial infarction who required temporary transvenous pacing due to second-degree atrioventricular block accompanied with hypotension. Following coronary angiography and successful revascularisation, the patient developed multiple episodes of monomorphic and polymorphic ventricular tachycardia as well as ventricular fibrillation which on careful inspection were found to be initiated by fusion of the intrinsic and paced complexes. The problem of malignant ventricular tachycardia was solved by simple removal of the pacing lead. To the best of our knowledge, malignant ventricular tachycardia of both monomorphic and polymorphic types initiated by fusion complexes in a paced patient has not been reported in literature.

  13. Echocardiography diagnosis of myocardial infarction complications

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    N.D. Oryshchyn

    2016-03-01

    Full Text Available Diagnosis and management of myocardial infarction complications are discussed in this article. These complications are associated with high level of mortality and surgery is a main treatment method. High level of suspicion and early diagnosis are essential for appropriate treatment and improvement of prognosis. Echocardiography is a main diagnostic method. Analysis of literature about contemporary management of mechanical complications of myocardial infarction has been performed, case reports are presented.

  14. Myocardial infarction and subsequent pregnancy

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    Tedoldi Citânia Lúcia

    2000-01-01

    Full Text Available We report the case of a 40-year-old woman with 2 previous myocardial infarctions, revascularization surgery, and an ongoing pregnancy complicated with preeclampsia and fetal hypoxia. Her follow-up performed by a multidisciplinary team made possible the birth through cesarean section of a premature infant of the female sex with a very low birth weight, but without severe respiratory distress of the hyaline membrane disease type. Three months after the delivery, mother and daughter were healthy.

  15. The value of exercise tests after acute myocardial infarction

    DEFF Research Database (Denmark)

    Nielsen, F E; Nielsen, S L; Knudsen, F

    1992-01-01

    The aim of the present study was to relate the clinical course in patients after a first acute myocardial infarction with the response to exercise-tests performed one month after discharge. 90 consecutive patients who suffered an acute myocardial infarction for the first time were followed-up after...... (W) were predictive with respect to mortality, heart failure, and angina pectoris requiring drug treatment. Exercise tests following acute myocardial infarction could not predict the chances of returning to work....

  16. Biventricular Mechanical Circulatory Support Does Not Prevent Delayed Myocardial Ventricular Rupture following Myocardial Infarction

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    Yazhini Ravi

    2013-01-01

    Full Text Available Cardiogenic shock and myocardial rupture can complicate an acute myocardial infarction (AMI. A case is reported in which a 58-year-old male with an acute inferior myocardial infarction required placement of biventricular assist device for hemodynamic support eight days after the onset of his AMI; eleven days after his AMI, the patient developed abrupt onset of hemodynamic instability with massive bleeding from his chest tube due to delayed free wall myocardial rupture that was discovered when he was taking emergently to the operating room. Myocardial rupture in patients with a ventricular assist device should be considered in the differential diagnosis in the event of acute hemodynamic compromise. A high level of suspicion for such a complication should prompt aggressive and emergent actions including surgery. We present a case of delayed free wall myocardial rupture following an acute inferior wall myocardial infarction in a patient with biventricular mechanical circulatory support.

  17. infarction in rats

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    Keyvan Yousefi

    2014-03-01

    Full Text Available Introduction: Nowadays, finding new therapeutic compounds from natural products for treatment and prevention of a variety of diseases including cardiovascular disorders is getting a great deal of attention. This approach would result in finding new drugs which are more effective and have fewer side effects than the conventional medicines. The present study was designed to investigate the anti-inflammatory effect of the methanolic extract of Marrubium vulgare, a popular traditional medicinal herb, on isoproterenol-induced myocardial infarction (MI in rat model. Methods: Male Wistar rats were assigned to 6 groups of control, sham, isoproterenol, and treatment with 10, 20, and 40 mg/kg/12h of the extract given orally concurrent with MI induction. A subcutaneous injection of isoproterenol (100 mg/kg/day for two consecutive days was used to induce MI. Then, histopathological changes and inflammatory markers were evaluated. Results: Isoproterenol injection increased inflammatory response, as shown by a significant increase in peripheral neutrophil count, myocardial myeloperoxidase (MPO activity and serum levels of creatinine kinase-MB (CK-MB and TNF-α (pM.vulgare extract serum CK-MB was subsided by 55.4%, 52.2% and 69%, respectively. Also treatment with the extract (40 mg/kg significantly reduced (p<0.001 MPO activity in MI group. The levels of TNF-α was also considerably declined in the serums of MI group (p<0.001. In addition, peripheral neutrophil count, was significantly lowered by all doses of the extract (p<0.001. Interstitial fibrosis significantly was attenuated in treated groups compared with control MI group.Conclusion:The results of study demonstrate that the M. vulgare extract has strong protective effects against isoproterenol-induced myocardial infarction and it seems possible that this protection is due to its anti-inflammatory effects.

  18. [Spinal cord infarction].

    Science.gov (United States)

    Naumann, N; Shariat, K; Ulmer, S; Stippich, C; Ahlhelm, F J

    2012-05-01

    Infarction of the spinal cord can cause a variety of symptoms and neurological deficits because of the complex vascular supply of the myelon. The most common leading symptom is distal paresis ranging from paraparesis to tetraplegia caused by arterial ischemia or infarction of the myelon. Venous infarction, however, cannot always be distinguished from arterial infarction based on the symptoms alone.Modern imaging techniques, such as computed tomography angiography (CTA) and magnetic resonance angiography (MRA) assist in preoperative planning of aortic operations to reliably identify not only the most important vascular structure supplying the spinal cord, the artery of Adamkiewicz, but also other pathologies such as tumors or infectious disorders. In contrast to CT, MRI can reliably depict infarction of the spinal cord.

  19. The tole of ischemic preconditioning in acute myocardial infarction

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    Ristić Anđelka

    2005-01-01

    Full Text Available Introduction Ischemic preconditioning is a phenomenon in which brief episodes of ischemia and reperfusion increase myocardial tolerance and substantially reduce the infarction size. Case report Two patients with acute left anterior descending artery occlusion received fibrinolytic therapy within 6 hours of symptom onset, but nevertheless developed myocardial infarctions of different size. The first patient, without a history of preinfarction angina, developed a large anterior infarction, because there was no time for ischemic preconditioning or development of coronary collateral vessels. The second patient, with a 4-day history of preinfarction angina, had a more favorable outcome-he developed apical necrosis, with greater myocardial viability in the infarct-related area. Conclusion The beneficial effects of angina occurring 24-48h before infarction are resulting from ischemic preconditioning, which reduces cardiac mortality, infarct size and occurrence of life-threatening ventricular arrhythmias. .

  20. Unexpected Coexisting Myocardial Infarction Detected by Delayed Enhancement MRI

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    Edouard Gerbaud

    2009-01-01

    Full Text Available We report a case of an unexpected coexisting anterior myocardial infarction detected by delayed enhancement MRI in a 41-year-old man following a presentation with a first episode of chest pain during inferior acute myocardial infarction. This second necrotic area was not initially suspected because there were no ECG changes in the anterior leads and the left descending coronary artery did not present any significant stenoses on emergency coronary angiography. Unrecognised myocardial infarction may carry important prognostic implications. CMR is currently the best imaging technique to detect unexpected infarcts.

  1. Recurrent Bilateral Occipital Infarct with Cortical Blindness and Anton Syndrome

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    Kiu Kwong Yew

    2014-01-01

    Full Text Available Bilateral cortical blindness and Anton syndrome, are most commonly caused by ischaemic stroke. In this condition, patients have loss of vision but deny their blindness despite objective evidence of visual loss. We report a case of a patient with multiple cardiovascular risk factors who developed recurrent bilateral occipital lobe infarct with Anton syndrome. A suspicion of this condition should be raised when the patient has denial of blindness in the presence of clinical and radiological evidence of occipital lobe injury. Management of this condition should focus on the underlying cause, in which our patient requires secondary stroke prevention and rehabilitation.

  2. Factors associated with the implementation of quality and safety requirements for cross-border care in acute myocardial infarction: Results from 315 hospitals in four countries.

    Science.gov (United States)

    Groene, Oliver; Suñol, Rosa

    2010-12-01

    Cross-border patients have specific quality and safety requirements for hospital care. Little is known to what extent hospitals meet these requirements. We aim to assess their current level, and the factors associated with their implementation. A cross-sectional survey of 315 hospitals and cardiology departments in the Czech Republic, France, Poland and Spain. Employing bi-variate statistics and logistic regression analysis, we assess quality and safety requirements for cross-border patients and their association with hospital characteristics, cross-border care arrangements, proximity to EU borders, the hospital's quality improvement system, and country. Certain quality and safety requirements are frequently met (administrative support or informed consent using forms in various EU languages) while others are widely absent (case-managers, contacts to patients' general practitioners). Due to communication problems, it is often not possible to inform patients about their condition and treatment. Discharge summaries are rarely available in other than the vernacular languages, and medication upon discharge and arranging back-transfer occur occasionally only. Logistic regression analysis suggests a strong effect of country-level covariates (followed by type of hospital, hospital size and hospital's quality improvement system), but covariates are not consistently associated with higher rates of implementation. Hospitals with existing cross-border care collaboration do not differ substantially from hospitals without such arrangements. Cross-border patients have specific quality and safety requirements that are not always met. Various factors are associated with these requirements; however, the trend is not systematic and the underlying mechanisms need to be studied further to inform policy decisions. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

  3. Postoperative omental infarction following colonic resection

    Energy Technology Data Exchange (ETDEWEB)

    Kerr, S.F., E-mail: skerr44@doctors.org.uk [Department of Radiology, Leeds General Infirmary, Leeds (United Kingdom); Hyland, R.; Rowbotham, E.; Chalmers, A.G. [Department of Radiology, Leeds General Infirmary, Leeds (United Kingdom)

    2012-02-15

    Aim: To illustrate the computed tomography (CT) appearances and natural history of postoperative omental infarction following colonic resection and to highlight the important clinical implications of this radiological diagnosis. Materials and methods: Over a 3 year period, 15 patients with a history of colonic resection were identified as having a CT diagnosis of postoperative omental infarction. Relevant clinical and pathological data were retrospectively collected from the institution's electronic patient records system and all relevant imaging was reviewed, including serial CT images in 10 patients. Results: A diagnosis of postoperative omental infarction was made in symptomatic and asymptomatic patients who had undergone open or laparoscopic colonic resection for benign or malignant disease. CT appearances ranged from diffuse omental stranding to discrete masses, which typically appeared within weeks of surgery and could persist for years. In four (36%) of the patients with colorectal cancer, the CT appearances raised concern for recurrent malignancy, but percutaneous biopsy and/or serial CT allowed a confident diagnosis of omental infarction to be made. Although most cases were self-limiting, three (20%) cases were complicated by secondary infection and required radiological or surgical intervention. Conclusion: Postoperative omental infarction is an under-recognized complication of colonic resection. It has the potential to mimic recurrent malignancy and may require radiological or surgical intervention for secondary infection.

  4. Spinal Cord Infarction

    Science.gov (United States)

    ... arteries that supply it. It is caused by arteriosclerosis or a thickening or closing of the major ... infarction is caused by a specific form of arteriosclerosis called atheromatosis, in which a deposit or accumulation ...

  5. Medically Relevant Acinetobacter Species Require a Type II Secretion System and Specific Membrane-Associated Chaperones for the Export of Multiple Substrates and Full Virulence.

    Science.gov (United States)

    Harding, Christian M; Kinsella, Rachel L; Palmer, Lauren D; Skaar, Eric P; Feldman, Mario F

    2016-01-01

    Acinetobacter baumannii, A. nosocomialis, and A. pittii have recently emerged as opportunistic human pathogens capable of causing severe human disease; however, the molecular mechanisms employed by Acinetobacter to cause disease remain poorly understood. Many pathogenic members of the genus Acinetobacter contain genes predicted to encode proteins required for the biogenesis of a type II secretion system (T2SS), which have been shown to mediate virulence in many Gram-negative organisms. Here we demonstrate that Acinetobacter nosocomialis strain M2 produces a functional T2SS, which is required for full virulence in both the Galleria mellonella and murine pulmonary infection models. Importantly, this is the first bona fide secretion system shown to be required for virulence in Acinetobacter. Using bioinformatics, proteomics, and mutational analyses, we show that Acinetobacter employs its T2SS to export multiple substrates, including the lipases LipA and LipH as well as the protease CpaA. Furthermore, the Acinetobacter T2SS, which is found scattered amongst five distinct loci, does not contain a dedicated pseudopilin peptidase, but instead relies on the type IV prepilin peptidase, reinforcing the common ancestry of these two systems. Lastly, two of the three secreted proteins characterized in this study require specific chaperones for secretion. These chaperones contain an N-terminal transmembrane domain, are encoded adjacently to their cognate effector, and their disruption abolishes type II secretion of their cognate effector. Bioinformatic analysis identified putative chaperones located adjacent to multiple previously known type II effectors from several Gram-negative bacteria, which suggests that T2SS chaperones constitute a separate class of membrane-associated chaperones mediating type II secretion.

  6. Depression after myocardial infarction.

    Science.gov (United States)

    Ziegelstein, R C

    2001-01-01

    Depression is an independent risk factor for increased postmyocardial infarction morbidity and mortality, even after controlling for the extent of coronary artery disease, infarct size, and the severity of left ventricular dysfunction. This risk factor takes on added significance when one considers that almost half of patients recovering from a myocardial infarction have major or minor depression and that major depression alone occurs in about one in five of these individuals. Despite the well-documented risk of depression, questions remain about the mechanism of the relationship between mood disturbance and adverse outcome. The link may be explained by an association with lower levels of social support, poor adherence to recommended medical therapy and lifestyle changes intended to reduce the risk of subsequent cardiac events, disturbances in autonomic tone, enhanced platelet activation and aggregation, and systemic immune activation. Unfortunately, questions about the pathophysiologic mechanism of depression in this setting are paralleled by uncertainties about the optimal treatment of depression for patients recovering from a myocardial infarction and by a lack of knowledge about whether treating depression lowers the associated increased mortality risk. Ongoing research studies will help to determine the benefits of psychosocial interventions and of antidepressant therapy for patients soon after myocardial infarction. Although the identification of depression as a risk factor may by itself be a reason to incorporate a comprehensive psychological evaluation into the routine care of patients with myocardial infarction, this practice should certainly become standard if studies show that treating depression reduces the increased mortality risk of these patients.

  7. PsAAT3, an oomycete-specific aspartate aminotransferase, is required for full pathogenicity of the oomycete pathogen Phytophthora sojae.

    Science.gov (United States)

    Wang, Rongbo; Zhang, Meixiang; Liu, Hong; Xu, Jing; Yu, Jia; He, Feng; Zhang, Xiong; Dong, Suomeng; Dou, Daolong

    2016-04-01

    Pathogen nutrient acquisition and metabolism are critical for successful infection and colonization. However, the nutrient requirements and metabolic pathways related to pathogenesis in oomycete pathogens are unknown. In this study, we bioinformatically identified Phytophthora sojae aspartate aminotransferases (AATs), which are key enzymes that coordinate carbon and nitrogen metabolism. We demonstrated that P. sojae encodes more AATs than the analysed fungi. Some of the AATs contained additional prephenate dehydratase and/or prephenate dehydrogenase domains in their N-termini, which are unique to oomycetes. Silencing of PsAAT3, an infection-inducible expression gene, reduced P. sojae pathogenicity on soybean plants and affected the growth under N-starving condition, suggesting that PsAAT3 is involved in pathogen pathogenicity and nitrogen utilisation during infection. Our results suggest that P. sojae and other oomycete pathogens may have distinct amino acid metabolism pathways and that PsAAT3 is important for its full pathogenicity.

  8. Diabetes patients requiring glucose-lowering therapy and nondiabetics with a prior myocardial infarction carry the same cardiovascular risk: a population study of 3.3 million people

    DEFF Research Database (Denmark)

    Schramm, Tina Ken; Gislason, Gunnar H; Køber, Lars

    2008-01-01

    BACKGROUND: Previous studies reveal major differences in the estimated cardiovascular risk in diabetes mellitus, including uncertainty about the risk in young patients. Therefore, large studies of well-defined populations are needed. METHODS AND RESULTS: All residents in Denmark > or = 30 years...... diabetes types. Analyses with adjustments for comorbidity, socioeconomic status, and prophylactic medical treatment showed similar results, and propensity score-based matched-pair analyses supported these findings. CONCLUSIONS: Patients requiring glucose-lowering therapy who were > or = 30 years of age...

  9. STUDY ON PSYCHOSOCIAL STRESSORS AND PSYCHIATRY MORBIDITY IN ACUTE MYOCARDIAL INFARCTION: A QUANTITATIVE STUDY

    Directory of Open Access Journals (Sweden)

    Mohamed Ilyas Rahamathulla

    2016-06-01

    Full Text Available BACKGROUND Numerous biological, environmental, behavioural, and sociocultural variables interact in its aetiology and pathogenesis of Coronary Heart Disease. It can be seen as a disorder of lifestyle and many of its aetiologic agents are potentially modifiable particularly life stressors. AIM We aimed 1. To compare the occurrence of stressful life events among myocardial infarction patients with non-myocardial infarction patients with diabetes mellitus as control group who are with same age and sex. 2. To assess the level of psychiatric morbidity in the post myocardial infarction period. MATERIALS AND METHODS The study was conducted in the intermediate care unit, Department of Cardiology, of tertiary care hospital. Thirty consecutive patients admitted who satisfied the inclusion criteria were included in the study. Thirty randomly selected patients were taken as controls. Both the patients and controls were administered the following tools: Presumptive Stressful Life Events Scale (PSLES, Socio-Economic Status scale (SES, Hospital anxiety and depression scale and ICD 10 criteria for depressive episode. RESULTS The clinical variable, blood pressure, and blood glucose level showed statistically significant level in myocardial infarction group. Alcohol drinking and smoking did not have any statistical significance. Presumptive stressful life events in the past 12 months are statistically significant. CONCLUSION Patients who developed myocardial infarction have more stressful life events in the preceding 12 months. Both depression and anxiety were significantly more in myocardial infarction than the controls. Further research requires samples representing all socioeconomic status to have a clear picture of the association of the biological and socioeconomic risk factors in coronary heart disease.

  10. Bone infarction - A rare complication of pancreatitis

    Energy Technology Data Exchange (ETDEWEB)

    Lundberg, T.M.; Jesspo, J.F.; Wong, J.C.H. [Royal Brisbane Hospital, Herston, QLD (Australia). Department of Nuclear Medicine

    1997-09-01

    Full text: In this study a combination of a {sup 99m}Tc MDP Bone scan and {sup 67}Ga scan was used to help in the diagnosis of bone infarction, in a patient with known pancreatitis. A 40-year-old male patient presented to hospital with a history of abdominal epigastric pain and generalised joint pains especially in his left knee and foot. He was recovering after a diagnosis four months earlier of hypertension and pancreatitis. On examination, he was febrile, and had scattered erythematous nodules on both legs. There were joint effusions involving his elbows, knees and ankles. (A series of tests, seemed to suggest either an inflammatory process or osteomyelitis.) At this stage, a two phase bone scan was performed which showed several areas of marked hyperaemia on the blood pools and intense abnormal uptake in the delayed images. Differential diagnosis was bone infarcts or multifocal osteomyelitis. A gallium scan was performed. The combined bone and gallium studies were more in keeping with bone infarcts. Conservative treatment was instituted and a repeat bone scan one year later showed marked improvement. Since pancreatitis is rarely complicated by bone infarction, the diagnosis is often delayed. In this case, nuclear medicine imaging played a very decisive role in excluding osteomyelitis and diagnosing the presence of widespread bone infarction-a rare sequela of pancreatitis.

  11. Hepatic infarction following abdominal interventional procedures.

    Directory of Open Access Journals (Sweden)

    Fujiwara H

    2004-04-01

    Full Text Available To clarify the incidence, background, and progress of hepatic infarction following interventional procedures, cases of hepatic infarction following interventional procedures at our department during the last decade were identified by reviewing the clinical records of 1982 abdominal angiography and interventional procedures and records of abdominal CT. Nine episodes (0.5% in 8 patients were identified as hepatic infarction following an interventional procedure. Five episodes were preceded by embolization of the hepatic or celiac artery at emergency angiography for postoperative bleeding with hemorrhagic shock. Three episodes followed the elected interventional procedure for hepatocellular carcinoma, and the remaining episode occurred after 12 months of chemoinfusion through an indwelling catheter in the hepatic artery and portal vein. Hepatic arterial occlusion in all episodes and portal venous flow abnormality in 5 episodes were observed on angiography. Four patients whose liver function was initially impaired died of hepatic infarction, although the extent of the disease on CT did not appear to be related to the mortality. Multiple risk factors, including arterial insufficiency, were observed in each patient. The incidence of hepatic infarction following interventional procedures in this series was low but sometimes fatal, and occurred most frequently in emergency embolization in hemorrhagic shock.

  12. Experimental Myocardial Infarction: The quest for novel therapeutics

    NARCIS (Netherlands)

    Hout, G.P.J. van

    2015-01-01

    Myocardial infarction (MI) and its consequences are associated with high mortality rates and considerable health care costs. Novel therapeutics that protect the heart after MI are therefore required. To assess safety and efficacy before exposing patients to experimental compounds, thorough

  13. Anterograde and Retrograde Amnesia following Bitemporal Infarction

    Directory of Open Access Journals (Sweden)

    A. Schnider

    1994-01-01

    Full Text Available A patient suffered very severe anterograde and retrograde amnesia following infarction of both medial temporal lobes (hippocampus and adjacent cortex and the left inferior temporo-occipital area. The temporal stem and the amygdala were intact; these structures do not appear to be critical for new learning in humans. Extension of the left-sided infarct into the inferior temporo-occipital lobe, an area critically involved in visual processing, appears to be responsible for our patient's loss of remote memories.

  14. Silent Infarcts with Sickle Cell Anemia

    Directory of Open Access Journals (Sweden)

    J Gordon Millichap

    2002-01-01

    Full Text Available The effect of transfusion therapy on the risk for new silent infarct or stroke in children with sickle cell anemia and abnormal transcranial Doppler (TCD ultrasonography was determined at the University of Miami, FL, and other centers in the STOP trial (Stroke Prevention in Sickle Cell Anemia.

  15. Acute Thrombo-embolic Renal Infarction

    Directory of Open Access Journals (Sweden)

    Haijiang Zhou

    2016-07-01

    Full Text Available A 65-year-old woman was admitted for acute onset of right lower abdominal pain. She was taking anticoagulant medication regularly for rheumatic valvular disease and atrial fibrillation. Physical examination revealed no obvious abdominal or flank tenderness. Right thrombo-embolic renal infarction was diagnosed after performing computed tomography angiography (CTA.

  16. [Case of infective endocarditis diagnosed with renal infarction].

    Science.gov (United States)

    Nakayama, Takayuki; Yokoyama, Minato; Saito, Kazutaka; Takenaka, Shunsuke; Kubo, Yuichi; Iimura, Yasumasa; Numao, Noboru; Sakai, Yasuyuki; Koga, Fumitaka; Fujii, Yasuhisa; Kobayashi, Tsuyoshi; Kawakami, Satoru; Kihara, Kazunori

    2009-03-01

    A 46-year-old woman with sudden on set strong right flank pain was transferred to our hospital with the diagnosis of right renal infarction. Cardiac ultrasonography revealed a vegetation on the posterior cusp of the mitral valve, and the renal infarction was thought to be caused by renal artery embolism from infective endocarditis. Since the vegetation remained after antimicrobial therapy as conservative management, the patient was surgically treated by mitral annuloplasty. It has been known that infective endocarditis can cause renal infarction. Infective endocarditis requires immediate and adequate treatment because of high mortality. Therefore, the appropriate diagnosis of infective endocarditis is needed for patients with renal infarction without any other disorder causing renal infarction.

  17. Siderophore-mediated iron acquisition influences motility and is required for full virulence of the xylem-dwelling bacterial phytopathogen Pantoea stewartii subsp. stewartii.

    Science.gov (United States)

    Burbank, Lindsey; Mohammadi, Mojtaba; Roper, M Caroline

    2015-01-01

    Iron is a key micronutrient for microbial growth but is often present in low concentrations or in biologically unavailable forms. Many microorganisms overcome this challenge by producing siderophores, which are ferric-iron chelating compounds that enable the solubilization and acquisition of iron in a bioactive form. Pantoea stewartii subsp. stewartii, the causal agent of Stewart's wilt of sweet corn, produces a siderophore under iron-limiting conditions. The proteins involved in the biosynthesis and export of this siderophore are encoded by the iucABCD-iutA operon, which is homologous to the aerobactin biosynthetic gene cluster found in a number of enteric pathogens. Mutations in iucA and iutA resulted in a decrease in surface-based motility that P. stewartii utilizes during the early stages of biofilm formation, indicating that active iron acquisition impacts surface motility for P. stewartii. Furthermore, bacterial movement in planta is also dependent on a functional siderophore biosynthesis and uptake pathway. Most notably, siderophore-mediated iron acquisition is required for full virulence in the sweet corn host, indicating that active iron acquisition is essential for pathogenic fitness for this important xylem-dwelling bacterial pathogen. Copyright © 2015, American Society for Microbiology. All Rights Reserved.

  18. A Genetic Screen Reveals that Synthesis of 1,4-Dihydroxy-2-Naphthoate (DHNA, but Not Full-Length Menaquinone, Is Required for Listeria monocytogenes Cytosolic Survival

    Directory of Open Access Journals (Sweden)

    Grischa Y. Chen

    2017-03-01

    Full Text Available Through unknown mechanisms, the host cytosol restricts bacterial colonization; therefore, only professional cytosolic pathogens are adapted to colonize this host environment. Listeria monocytogenes is a Gram-positive intracellular pathogen that is highly adapted to colonize the cytosol of both phagocytic and nonphagocytic cells. To identify L. monocytogenes determinants of cytosolic survival, we designed and executed a novel screen to isolate L. monocytogenes mutants with cytosolic survival defects. Multiple mutants identified in the screen were defective for synthesis of menaquinone (MK, an essential molecule in the electron transport chain. Analysis of an extensive set of MK biosynthesis and respiratory chain mutants revealed that cellular respiration was not required for cytosolic survival of L. monocytogenes but that, instead, synthesis of 1,4-dihydroxy-2-naphthoate (DHNA, an MK biosynthesis intermediate, was essential. Recent discoveries showed that modulation of the central metabolism of both host and pathogen can influence the outcome of host-pathogen interactions. Our results identify a potentially novel function of the MK biosynthetic intermediate DHNA and specifically highlight how L. monocytogenes metabolic adaptations promote cytosolic survival and evasion of host immunity.

  19. Occipital lobe infarctions are different

    OpenAIRE

    Naess, Halvor; Waje-Andreassen, Ulrikke; Thomassen, Lars

    2007-01-01

    Objectives We hypothesized that occipital lobe infarctions differ from infarctions in other locations as to etiology, risk factors and prognosis among young adults. Methods Location, etiology, risk factors and long-term outcome were evaluated among all young adults 15–49 years suffering from cerebral infarction in Hordaland County, Norway between 1988 and 1997. Results The following variables were more frequent among patients with occipital lobe infarction compared with patients with infarcti...

  20. Omental infarction in an obese 10-year-old boy

    Directory of Open Access Journals (Sweden)

    Katerina Kambouri

    2011-09-01

    Full Text Available Primary omental infarction (POI has a low incidence worldwide, with most cases occurring in adults. This condition is rarely considered in the differential diagnosis of acute abdominal pain in childhood. Herein, we present a case of omental infarction in an obese 10-year-old boy who presented with acute abdominal pain in the right lower abdomen. The ultrasound (US examination did not reveal the appendix but showed secondary signs suggesting acute appendicitis. The child was thus operated on under the preoperative diagnosis of acute appendicitis but the intraoperative finding was omental infarct. Since the omental infarct as etiology of acute abdominal pain is uncommon, we highlight some of the possible etiologies and emphasize the importance of accurate diagnosis and appropriate treatment of omental infarction.

  1. EVOLUTION OF THROMBOLYTIC THERAPY IN THE TREATMENT OF MYOCARDIAL INFARCTION

    Directory of Open Access Journals (Sweden)

    P. G. Kesov

    2014-01-01

    Full Text Available History of thrombolytic therapy is shortly reflected, main trials of various thrombolytics in acute ST-segment elevation myocardial infarction (STEMI are analyzed. Perspectives of modern thrombolytic therapy in patients with STEMI are discussed.

  2. Prophylactic lidocaine for myocardial infarction.

    Science.gov (United States)

    Martí-Carvajal, Arturo J; Simancas-Racines, Daniel; Anand, Vidhu; Bangdiwala, Shrikant

    2015-08-21

    2.29 to 6.47; participants = 2533; studies = 6; I(2) = 0%; low-quality evidence). Overall, safety data were poorly reported and adverse events may have been underestimated. Trial sequential analyses suggest that additional trials may not be needed for reliable conclusions to be drawn regarding these outcomes. This Cochrane review found evidence of low quality to suggest that prophylactic lidocaine has very little or no effect on mortality or ventricular fibrillation in people with acute myocardial infarction. The safety profile is unclear. This conclusion is based on randomised controlled trials with high risk of bias. However (disregarding the risk of bias), trial sequential analysis suggests that additional trials may not be needed to disprove an intervention effect of 20% relative risk reduction. Smaller risk reductions might require additional higher trials.

  3. 脑梗死恢复期患者家属需求及相关因素分析%Requirements of recovery cerebral infarction panients' family and the related factors

    Institute of Scientific and Technical Information of China (English)

    张春燕; 林可可; 王攀峰

    2011-01-01

    目的 了解脑梗死患者及家属在恢复期的需求,并分析其相关因素。方法 采用自行设计的需求调查表,对81名住院患者家属进行调查。结果 81名患者家属需求得分85 ~ 230分,平均(150.84±32.40)分,在7个维度中用药护理的需求最高,需求前10项中有6项是用药护理的需求,需求后10项中日常生活护理有6项,其中管道护理需求最低只占14.8%。男性家属和女性家属在日常生活护理方面的需求差异有统计学意义[(21.70±6.11)分比(17.63±5.50)分;t=3.13,P<0.01];有、无照护经历的家属需求总分差异有统计学意义[(164.90±30.28)分比(142.12±30.81)分;t=-3.26,P<0.01];患者家属需求的其他相关因素有护工协助照护、家属与患者的关系、家属的文化程度(P<0.05)。结论 恢复期脑梗死患者家属对用药护理、患者心理护理、家属自身需求、家庭安全环境、康复护理及预防并发症护理存在不同程度的需,护士应针对性地对家属进行宣教。%Objective To explore the requirements of patients with recovery cerebral infarction and their family and the related factors. Methods 81 patients in hospital were investigated by a self-designed questionnaire. Results Needs score of 81 patients was 85 -230, and the average was (150.84 ±32.40).Medication care was the most needs of all the seven dimensions. 6 medication cares were in the top 10 needs,and 6 ordinary nursing in the last 10 items and pipeline nursing was the lowest and accounted for 14.8%. Male family members were different from the female in the nursing requirements [(21.70 ± 6. 11 ) vs ( 17.63 ±5.50) ; t =3.13, P <0. 01] ; Family members with and without care vigorous were also different [( 164.90 ±30.28) vs ( 142. 12 ± 30.81 ) ; t =- 3. 26, P < 0. 01]. Other related needs of family members were care workers, relationship between the patients and the family members, and education status of

  4. Meta-Analysis of the Clinical Effectiveness and Safety of Ligustrazine in Cerebral Infarction

    Directory of Open Access Journals (Sweden)

    Tian Yu

    2016-01-01

    Full Text Available Objectives. To evaluate the efficacy and safety of ligustrazine in the treatment of cerebral infarction. Methods. A systematic literature search was conducted in 6 databases until 30 June 2016 to identify randomized controlled trials (RCTs of ligustrazine in the treatment of cerebral infarction. The quality of all the included studies was evaluated. All data were analyzed by Review Manager 5.1 Software. Results. 19 RCTs totally involving 1969 patients were included. The primary outcome measures were Neurological Deficit Score (NDS and clinical effective rate. The secondary outcome measure was adverse events. Meta-analysis showed that ligustrazine could improve clinical efficacy and NDS of cerebral infarction with [OR = 3.60, 95% CI (2.72, 4.78, P<0.00001] and [WMD = −3.87, 95% CI (−4.78, −2.95, P<0.00001]. Moreover, ligustrazine in treatment group exerted better clinical effects in improving the Blood Rheology Index (BRI in patients compared with control group. Ten trials contained safety assessments and stated that no obvious side effects were found. Conclusions. Ligustrazine demonstrated definite clinical efficacy for cerebral infarction, and it can also improve NDS in patients without obvious adverse events. However, due to the existing low-quality research, more large-scale and multicentric RCTs are required to provide clear evidence for its clinical efficacy in the near future.

  5. The gpsX gene encoding a glycosyltransferase is important for polysaccharide production and required for full virulence in Xanthomonas citri subsp. citri

    Directory of Open Access Journals (Sweden)

    Li Jinyun

    2012-03-01

    . Conclusions Taken together, our data confirm that the gpsX gene is involved in EPS and LPS synthesis and biofilm formation in Xac and suggest that the gpsX gene contributes to the adaptation of Xac to the host microenvironments at early stage of infection and thus is required for full virulence on host plants.

  6. Infection structure-specific reductive iron assimilation is required for cell wall integrity and full virulence of the maize pathogen Colletotrichum graminicola.

    Science.gov (United States)

    Albarouki, Emad; Deising, Holger B

    2013-06-01

    Ferroxidases are essential components of the high-affinity reductive iron assimilation pathway in fungi. Two ferroxidase genes, FET3-1 and FET3-2, have been identified in the genome of the maize anthracnose fungus Colletotrichum graminicola. Complementation of growth defects of the ferroxidase-deficient Saccharomyces cerevisiae strain Δfet3fet4 showed that both Fet3-1 and Fet3-2 of C. graminicola represent functional ferroxidases. Expression of enhanced green fluorescent protein fusions in yeast and C. graminicola indicated that both ferroxidase proteins localize to the plasma membrane. Transcript abundance of FET3-1 increased dramatically under iron-limiting conditions but those of FET3-2 were hardly detectable. Δfet3-1 and Δfet3-2 single as well as Δfet3-1/2 double-deletion strains were generated. Under iron-sufficient or deficient conditions, vegetative growth rates of these strains did not significantly differ from that of the wild type but Δfet3-1 and Δfet3-1/2 strains showed increased sensitivity to reactive oxygen species. Furthermore, under iron-limiting conditions, appressoria of Δfet3-1 and Δfet3-1/2 strains showed significantly reduced transcript abundance of a class V chitin synthase and exhibited severe cell wall defects. Infection assays on intact and wounded maize leaves, quantitative data of infection structure differentiation, and infection stage-specific expression of FET3-1 showed that reductive iron assimilation is required for appressorial penetration, biotrophic development, and full virulence.

  7. [Segmental testicular infarction].

    Science.gov (United States)

    Ripa Saldías, L; Guarch Troyas, R; Hualde Alfaro, A; de Pablo Cárdenas, A; Ruiz Ramo, M; Pinós Paul, M

    2006-02-01

    We report the case of a 47 years old man previously diagnosed of left hidrocele. After having a recent mild left testicular pain, an ultrasonografic study revealed a solid hipoecoic testicular lesion rounded by a big hidrocele, suggesting a testicular neoplasm. Radical inguinal orchiectomy was made and pathologic study showed segmental testicular infarction. No malignancy was found. We review the literature of the topic.

  8. CT features of renal infarction

    Energy Technology Data Exchange (ETDEWEB)

    Suzer, Okan; Shirkhoda, Ali; Jafri, S. Zafar; Madrazo, Beatrice L.; Bis, Kostaki G.; Mastromatteo, James F

    2002-10-01

    Purpose: To demonstrate the different patterns of renal infarction to avoid pitfalls. To present 'flip-flop enhancement' pattern in renal infarction. Materials and methods: Retrospective review of a total of 41 renal infarction in 37 patients were done. These patients underwent initial CT and the diagnosis of renal infarction was confirmed with either follow up CT or at surgery. Results: Twenty-three patients had wedge-shaped focal infarcts, nine patients had global and five patients had multifocal infarcts of the kidneys. Cortical rim sign was seen predominantly with global infarcts. In five patients, a 'flip-flop enhancement' pattern was observed. In two patients, planned renal biopsies due to tumefactive renal lesions were cancelled because of 'flip-flop enhancement' pattern on follow up CTs. Conclusion: Although most of our cases were straightforward for the diagnosis of renal infarction, cases with tumefactive lesions and global infarctions without the well-known cortical rim sign were particularly challenging. We describe a new sign, flip-flop enhancement pattern, which we believe solidified the diagnosis of renal infarction in five of our cases. The authors recommend further investigations for association of flip-flop enhancement and renal infarction.

  9. Computed tomography of splenic infarcts

    Energy Technology Data Exchange (ETDEWEB)

    Triller, J.; Bona, E.; Barbier, P.

    1985-04-01

    Splenic infarcts are represented by wedge-shaped, oval or linear areas. Haemorrhagic infarcts are characterised by being hyperdense. Disseminated infarction occurs predominantly in myeloproliferative diseases. During the early stages, the infarct appears as an ill-defined hypodense defect, with non-homogeneous contrast enhancement. During the acute and sub-acute stage, the density of the infarct is low and there is no contrast enhancement. During the chronic stage, its density increases and there is slight contrast enhancement. Complications following splenic infarcts, such as abscesses, bleeding and rupture can be demonstrated by CT with great accuracy. Problems in differential diagnosis may occur if there are atypical manifestations of the infarct, with respect to abscess or leukaemic infiltrations.

  10. Transferability of decompression wave speed measured by a small-diameter shock tube to full size pipelines and implications for determining required fracture propagation resistance

    Energy Technology Data Exchange (ETDEWEB)

    Botros, K.K., E-mail: botrosk@novachem.co [NOVA Research and Technology Center, 2928 - 16 Street N.E., Calgary, Alberta T2E 7K7 (Canada); Geerligs, J. [NOVA Research and Technology Center, 2928 - 16 Street N.E., Calgary, Alberta T2E 7K7 (Canada); Rothwell, Brian [Brian Rothwell Consulting Inc., 100 Hamptons Link Northwest, Calgary, Alberta T3A 5V9 (Canada); Carlson, Lorne [Alliance Pipeline Ltd., Calgary, Alberta (Canada); Fletcher, Leigh [Welding and Pipeline Integrity, Bright, Victoria (Australia); Venton, Philip [Venton and Associates Pty Ltd, Bundanoon, NSW (Australia)

    2010-12-15

    The control of propagating ductile (or tearing) fracture is a fundamental requirement in the fracture control design of pipelines. The Battelle two-curve method developed in the early 1970s still forms the basis of the analytical framework used throughout the industry. GASDECOM is typically used for calculating decompression speed, and idealizes the decompression process as isentropic and one-dimensional, taking no account of frictional effects. While this approximation appears not to have been a major issue for large-diameter pipes and for moderate pressures (up to 12 MPa), there have been several recent full-scale burst tests at higher pressures and smaller diameters for which the measured decompression velocity has deviated progressively from the predicted values, in general towards lower velocities. The present research was focused on determining whether pipe diameter was a major factor that could limit the applicability of frictionless models such as GASDECOM. Since potential diameter effects are primarily related to wall friction, which in turn is related to the ratio of surface roughness-to-diameter, an experimental approach was developed based on keeping the diameter constant, at a sufficiently small value to allow for an economical experimental arrangement, and varying the internal roughness. A series of tests covering a range of nominal initial pressures from 10 to 21 MPa, and involving a very lean gas and three progressively richer compositions, were conducted using two specialized high-pressure shock tubes (42 m long, I.D. = 38.1 mm). The first is honed to an extremely smooth surface finish, in order to minimize frictional effects and better simulate the behaviour of larger-diameter pipelines, while the second has a higher internal surface roughness. The results show that decompression wave speeds in the rough tube are consistently slower than those in the smooth tube under the same conditions of mixture composition and initial pressure and temperature

  11. Human cord blood cells and myocardial infarction: effect of dose and route of administration on infarct size.

    Science.gov (United States)

    Henning, Robert J; Burgos, Jose D; Vasko, Mark; Alvarado, Felipe; Sanberg, Cyndy D; Sanberg, Paul R; Morgan, Michael B

    2007-01-01

    There is no consensus regarding the optimal dose of stem cells or the optimal route of administration for the treatment of acute myocardial infarction. Bone marrow cells, containing hematopoietic and mesenchymal stem cells, in doses of 0.5 x 10(6) to >30 x 10(6) have been directly injected into the myocardium or into coronary arteries or infused intravenously in subjects with myocardial infarctions to reduce infarct size and improve heart function. Therefore, we determined the specific effects of different doses of human umbilical cord blood mononuclear cells (HUCBC), which contain hematopoietic and mesenchymal stem cells, on infarct size. In order to determine the optimal technique for stem cell administration, HUCBC were injected directly into the myocardium (IM), or into the LV cavity with the ascending aorta transiently clamped to facilitate coronary artery perfusion (IA), or injected intravenously (IV) in rats 1-2 h after the left anterior coronary artery was permanently ligated. Immune suppressive therapy was not given to any rat. One month later, the infarct size in control rat hearts treated with only Isolyte averaged 23.7 +/- 1.7% of the LV muscle area. Intramyocardial injection of HUCBC reduced the infarct size by 71% with 0.5 x 10(6) HUCBC and by 93% with 4 x 10(6) HUCBC in comparison with the controls (p p p p < 0.05). Nevertheless, IM, IA, and IV HUCBC all produced significant reductions in infarct size in comparison with Isolyte-treated infarcted hearts without requirements for host immune suppression. The present experiments demonstrate that the optimal dose of HUCBC for reduction of infarct size in the rat is 4 x 10(6) IM, 4 x 10(6) IA, and 16 x 10(6) IV, and that the IM injection of HUCBC is the most effective technique for reduction in infarct size.

  12. Does FXIII deficiency impair wound healing after myocardial infarction?

    Directory of Open Access Journals (Sweden)

    Matthias Nahrendorf

    Full Text Available Inadequate healing of myocardial infarction may contribute to local expansion of the infarct, frequently leading to chamber dilation, heart failure, or myocardial rupture. Experimental evidence in mouse models suggests that Factor XIII might play a key role in wound healing, and low persistent values lead to increased incidence of cardiac rupture following myocardial infarction. Here we would like to share our initial clinical experiences with strikingly similar observations in patients with this grave disease, and compare these observations to experimental findings.

  13. Inferior ST-Elevation Myocardial Infarction Associated with Takotsubo Cardiomyopathy

    Directory of Open Access Journals (Sweden)

    Oliver Koeth

    2010-01-01

    Full Text Available Takotsubo cardiomyopathy (TCM is usually characterized by transient left ventricular apical ballooning. Due to the clinical symptoms which include chest pain, electrocardiographic changes, and elevated myocardial markers, Takotsubo cardiomyopathy is frequently mimicking ST-elevation myocardial infarction in the absence of a significant coronary artery disease. Otherwise an acute occlusion of the left anterior descending coronary artery can produce a typical Takotsubo contraction pattern. ST-elevation myocardial infarction (STEMI is frequently associated with emotional stress, but to date no cases of STEMI triggering TCM have been reported. We describe a case of a female patient with inferior ST-elevation myocardial infarction complicated by TCM.

  14. Renal infarct: a rare disease due to a rare etiology

    Directory of Open Access Journals (Sweden)

    Divya Akshintala

    2015-06-01

    Full Text Available Renal infarction is caused by profound hypoperfusion secondary to embolic/thrombotic occlusion of the renal artery or vasospasm of the renal artery. We present a case of a 54-year-old patient who presented with nausea, vomiting, and vague abdominal pain. He had frequent episodes of migraine headaches and he treated himself with as needed rizatriptan. CT scan of the abdomen showed renal cortical infarction. After extensive investigations, etiology of his renal infarct was deemed to be due to rizatriptan.

  15. Multiorgan with renal infarction following treatment of cerebral infarction.

    Science.gov (United States)

    Kim, Ji Hee; Kang, Chung; Moon, Hyo Jeong; Joo, Min Cheol

    2013-08-01

    Acute renal infarction is a rare disease and it is often difficult to make a clinical diagnosis due to the non-specific clinical presentations and lack of the physicians' awarenesses. We experienced a case of a 72-year-old man who was diagnosed as multiorgan with renal infarction during the bridge therapy of cerebral infarction with atrial fibrillation. Computed tomogram (CT) with intravenous contrast of the abdomen and pelvis revealed left renal infarction with renal artery occlusion, multifocal splenic infarction, and ischemic colitis on rectum and sigmoid colon. The patient was treated with low molecular weight heparin for 10 days, his symptoms were improved and laboratory findings were normalized. Follow-up CT was performed on the 43th day, there were persisted left renal infarction with atrophic change shown and the splenic perfusion was improved.

  16. Anti-CCL21 Antibody Attenuates Infarct Size and Improves Cardiac Remodeling After Myocardial Infarction

    Directory of Open Access Journals (Sweden)

    Yi Jiang

    2015-09-01

    Full Text Available Background/Aims: Over-activation of cellular inflammatory effectors adversely affects myocardial function after acute myocardial infarction (AMI. The CC-chemokine CCL21 is, via its receptor CCR7, one of the key regulators of inflammation and immune cell recruitment, participates in various inflammatory disorders, including cardiovascular ones. This study explored the therapeutic effect of an anti-CCL21 antibody in cardiac remodeling after myocardial infarction. Methods and Results: An animal model of AMI generated by left anterior descending coronary artery ligation in C57BL/6 mice resulted in higher levels of circulating CCL21 and cardiac CCR7. Neutralization of CCL21 by intravenous injection of anti-CCL21 monoclonal antibody reduced infarct size after AMI, decreased serum levels of neutrophil and monocyte chemo attractants post AMI, diminished neutrophil and macrophage recruitment in infarcted myocardium, and suppressed MMP-9 and total collagen content in myocardium. Anti-CCL21 treatment also limited cardiac enlargement and improved left ventricular function. Conclusions: Our study indicated that CCL21 was involved in cardiac remodeling post infarction and anti-CCL21 strategies might be useful in the treatment of AMI.

  17. Lingual Haematoma due to Tenecteplase in a Patient with Acute Myocardial Infarction

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    Muhlis Bal

    2013-01-01

    Full Text Available The use of intravenous thrombolytic agents has revolutionised the treatment of acute myocardial infarction. However, the improvement in mortality rate achieved with these drugs is tempered by the risk of serious bleeding complications, including intracranial haemorrhage. Tenecteplase is a genetically engineered mutant tissue plasminogen activator. Haemorrhagic complications of tissue plasminogen activator (tPA are well known. Compared to other tPAs, tenecteplase use leads to lower rates of bleeding complications. Here, we report a case of unusual site of spontaneous bleeding, intralingual haematoma during tenecteplase therapy following acute myocardial infarction, which caused significant upper airway obstruction and required tracheotomy to maintain the patient’s airway. Clinical dilemmas related to securing the airway or reversing the effects of tissue plasminogen activator are discussed.

  18. Malignant Hemispheric Cerebral Infarction Associated with Idiopathic Systemic Capillary Leak Syndrome

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    Kei Miyata

    2013-10-01

    Full Text Available Idiopathic systemic capillary leak syndrome (ISCLS is a rare condition that is characterized by unexplained episodic capillary hyperpermeability due to a shift of fluid and protein from the intravascular to the interstitial space. This results in diffuse general swelling, fetal hypovolemic shock, hypoalbuminemia, and hemoconcentration. Although ISCLS rarely induces cerebral infarction, we experienced a patient who deteriorated and was comatose as a result of massive cerebral infarction associated with ISCLS. In this case, severe hypotensive shock, general edema, hemiparesis, and aphasia appeared after serious antecedent gastrointestinal symptoms. Progressive life-threatening ischemic cerebral edema required decompressive hemicraniectomy. The patient experienced another episode of severe hypotension and limb edema that resulted in multiple extremity compartment syndrome. Treatment entailed forearm and calf fasciotomies. Cerebral edema in the ischemic brain progresses rapidly in patients suffering from ISCLS. Strict control of fluid volume resuscitation and aggressive diuretic therapy may be needed during the post-leak phase of fluid remobilization.

  19. Myocardial infarction in the young

    Directory of Open Access Journals (Sweden)

    Cengel A

    2009-01-01

    Full Text Available An increasing number of patients under 40 years of age are being hospitalized with the diagnosis of acute myocardial infarction. This is partly due to the increased prevalance of risk factors for atherosclerosis in the younger age group; especially increased incidence of impaired fasting glucose, high triglyceride, low high-density lipoprotein levels and increased waist to hip ratio. However, non-atherosclerotic coronary artery disease or hypercoagulability should also be investigated or at least suspected in the younger patients. The pathophysiology of different clinical conditions and disease states which cause acute coronary syndromes in the young patients are reviewed, and the diagnostic modalities and therapatic options for these conditions are briefly discussed by searching for "premature atherosclerosis", "hypercoagulable states", "risk factors for atherosclerosis in youth", "novel risk factors for atherosclerosis", "non-atherosclerotic coronary artery diseases" in PubMed.

  20. Obsessive-Compulsive Behavior Disappearing after Left Capsular Genu Infarction

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    Ji-Hyang Oh

    2011-01-01

    Full Text Available This case report describes a 74-year-old woman with obsessive-compulsive behaviors that disappeared following a left capsular genu infarction. The patient’s capsular genu infarction likely resulted in thalamocortical disconnection in the cortico-basal ganglia-thalamocortical loop, which may have caused the disappearance of her obsessive-compulsive symptoms. The fact that anterior capsulotomy has been demonstrated to be effective for treating refractory obsessive-compulsive disorder further supports this hypothesis.

  1. Occipital lobe infarctions are different

    OpenAIRE

    Halvor Naess; Ulrikke Waje-Andreassen; Lars Thomassen

    2007-01-01

    Halvor Naess, Ulrikke Waje-Andreassen, Lars ThomassenDepartment of Neurology, Haukeland University Hospital, University of Bergen, N-5021 Bergen, NorwayObjectives: We hypothesized that occipital lobe infarctions differ from infarctions in other locations as to etiology, risk factors and prognosis among young adults.Methods: Location, etiology, risk factors and long-term outcome were evaluated among all young adults 15–49 years suffering from cerebral infarction in Hordaland County, Norw...

  2. Full Scan MS in Comprehensive Qualitative and Quantitative Residue Analysis in Food and Feed Matrices: How Much Resolving Power is Required?

    NARCIS (Netherlands)

    Kellmann, M.; Muenster, H.; Zomer, P.; Mol, J.G.J.

    2009-01-01

    In LC full scan based MS screening methods correct mass assignment is essential. Parameters affecting the accuracy of mass assignment, i.e., analyte concentration, complexity of the matrix, and resolving power, were studied using typical examples from the field of residue and contaminant analysis in

  3. Spontaneous resolution of splenic infarcts after distal splenorenal shunt in children with extra hepatic portal venous obstruction: Our experience

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    Arbinder Kumar

    2014-01-01

    Full Text Available Background: In cases of portal hypertension with splenic infarcts, splenectomy with proximal splenorenal shunt has been recommended. We are sharing our experience with distal splenorenal shunt in these cases contrary to the popular belief. Materials and Methods: Splenic infarcts were graded as mild, moderate and severe according to the pre-operative CT portogram. Mild, moderate and severe infarcts were defined as an infarct involving 50% area of the spleen, respectively. Mild and moderate infarcts were managed by spleen-preserving distal splenorenal shunt while those with extensive infarcts were subjected to splenectomy and proximal splenorenal shunt. Those with spleen-preserving shunts were closely followed in the post-operative period according to a uniform protocol. Clinical examination was regularly done to assess the size of the spleen and note the presence of pain, tenderness in the left intercostal space. An ultrasound Doppler was done after 7 days to assess shunt patency while CT portogram was repeated at 6 monthly intervals. Results: Fourteen cases with splenic infarcts formed the study group. Eight cases had mild infarcts, 3 had moderate infarcts and 3 had severe infarcts. Four underwent proximal splenorenal shunt, and 10 underwent warren′s shunt (8 with mild and 2 with moderate infarcts. In 9/10 (90%, spleen could eventually be retained. Spleen completely regressed in them and so did the infarct. Conclusions:Spleen-preserving distal splenorenal shunt can be considered as a viable option in the management of cases with mild and carefully selected moderate splenic infarcts.

  4. Acute arterial infarcts in patients with severe head injuries

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    Deepak Agrawal

    2012-01-01

    Full Text Available Aims and Objectives: To study the incidence, demographic profile, and outcome of patients with severe closed head injuries who develop acute arterial infarcts. Materials and Methods: Patients with severe head injury (Glasgow coma score (GCS ≤8 presenting within 8 h of injury in the Department of Neurosurgery over a period of 5 months were enrolled in the study. Patients with penetrating head injury, infarct due to herniation and iatrogenic arterial injuries were excluded from the study. Only arterial infarcts developing within 8 h of injury were included in the study. A computed tomography (CT head was done on all patients within 8 h of injury and repeated if necessary. Arterial infarct was defined as well-demarcated wedge-shaped hypodensity corresponding to an arterial territory on plain CT of the head. Outcome was assessed using Glasgow outcome score (GOS at 1 month post-injury or at death (whichever came earlier. Results: Forty-four patients of severe head injury were included in the study during the above period. Of these, four patients (9.1% had arterial infarcts on the initial CT scan. The male:female ratio was 1:3. The mean age was 54 years (range 3-85 years. Two patients had infarcts in the middle cerebral artery distribution and two in the superior cerebellar artery distribution. Poor outcome (GOS 1-3 was seen in 100% of the patients with arterial infarct compared to 52.5% (n=21 in patients with severe head injury without arterial infarct. Conclusions: A significant percentage of patients with severe head injury have arterial infarcts on admission, which may imply arterial injury. Our study shows that these patients have a poorer prognosis vis-a-vis patient without these findings.

  5. Silent myocardial infarction during hypoglycemic coma

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    Varun Vijay Mahajan

    2012-01-01

    Full Text Available Hypoglycemia is a common complication of treatment of diabetes mellitus. The potential neurological complications of hypoglycemia as seizures and coma are well-recognized entities. A hypoglycemic episode is a risk factor for a patient with diabetes to have cardiovascular complications. Myocardial ischemia and infarction are known to occur in the setting of hypoglycemia. In view of the potential association of the two, the diabetic patients should undergo a routine ECG in such circumstances.

  6. The 3' region of the chicken hypersensitive site-4 insulator has properties similar to its core and is required for full insulator activity.

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    Paritha I Arumugam

    Full Text Available Chromatin insulators separate active transcriptional domains and block the spread of heterochromatin in the genome. Studies on the chicken hypersensitive site-4 (cHS4 element, a prototypic insulator, have identified CTCF and USF-1/2 motifs in the proximal 250 bp of cHS4, termed the "core", which provide enhancer blocking activity and reduce position effects. However, the core alone does not insulate viral vectors effectively. The full-length cHS4 has excellent insulating properties, but its large size severely compromises vector titers. We performed a structure-function analysis of cHS4 flanking lentivirus-vectors and analyzed transgene expression in the clonal progeny of hematopoietic stem cells and epigenetic changes in cHS4 and the transgene promoter. We found that the core only reduced the clonal variegation in expression. Unique insulator activity resided in the distal 400 bp cHS4 sequences, which when combined with the core, restored full insulator activity and open chromatin marks over the transgene promoter and the insulator. These data consolidate the known insulating activity of the canonical 5' core with a novel 3' 400 bp element with properties similar to the core. Together, they have excellent insulating properties and viral titers. Our data have important implications in understanding the molecular basis of insulator function and design of gene therapy vectors.

  7. Myocardial infarction and cerebral infarction in a Danish suburban community

    DEFF Research Database (Denmark)

    Lyngborg, K; Marquardsen, J; Trautner, F

    1985-01-01

    A comparison was made of 485 cases of cerebral infarction (CI), registered prospectively in Frederiksberg, Copenhagen, with 495 cases of myocardial infarction (AMI), recorded retrospectively in the same population. The overall annual incidence of AMI was 6.5 per 1,000 population for males, 3...

  8. Assessment of Myocardial Infarction by Cardiac Magnetic Resonance Imaging and Long-Term Mortality

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    João Luiz Fernandes Petriz

    2015-02-01

    Full Text Available Background: Cardiac magnetic resonance imaging provides detailed anatomical information on infarction. However, few studies have investigated the association of these data with mortality after acute myocardial infarction. Objective: To study the association between data regarding infarct size and anatomy, as obtained from cardiac magnetic resonance imaging after acute myocardial infarction, and long-term mortality. Methods: A total of 1959 reports of “infarct size” were identified in 7119 cardiac magnetic resonance imaging studies, of which 420 had clinical and laboratory confirmation of previous myocardial infarction. The variables studied were the classic risk factors – left ventricular ejection fraction, categorized ventricular function, and location of acute myocardial infarction. Infarct size and acute myocardial infarction extent and transmurality were analyzed alone and together, using the variable named “MET-AMI”. The statistical analysis was carried out using the elastic net regularization, with the Cox model and survival trees. Results: The mean age was 62.3 ± 12 years, and 77.3% were males. During the mean follow-up of 6.4 ± 2.9 years, there were 76 deaths (18.1%. Serum creatinine, diabetes mellitus and previous myocardial infarction were independently associated with mortality. Age was the main explanatory factor. The cardiac magnetic resonance imaging variables independently associated with mortality were transmurality of acute myocardial infarction (p = 0.047, ventricular dysfunction (p = 0.0005 and infarcted size (p = 0.0005; the latter was the main explanatory variable for ischemic heart disease death. The MET-AMI variable was the most strongly associated with risk of ischemic heart disease death (HR: 16.04; 95%CI: 2.64-97.5; p = 0.003. Conclusion: The anatomical data of infarction, obtained from cardiac magnetic resonance imaging after acute myocardial infarction, were independently associated with long

  9. Acute myocardial infarction and infarct size: do circadian variations play a role?

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    Ibáñez B

    2012-08-01

    Full Text Available Aída Suárez-Barrientos,1 Borja Ibáñez1,21Cardiovascular Institute, Hospital Clínico San Carlos, 2Centro Nacional de Investigaciones Cardiovasculares, Madrid, SpainAbstract: The circadian rhythm influences cardiovascular system physiology, inducing diurnal variations in blood pressure, heart rate, cardiac output, endothelial functions, platelet aggregation, and coronary arterial flow, among other physiological parameters. Indeed, an internal circadian network modulates cardiovascular physiology by regulating heart rate, metabolism, and even myocyte growth and repair ability. Consequently, cardiovascular pathology is also controlled by circadian oscillations, with increased morning incidence of cardiovascular events. The potential circadian influence on the human tolerance to ischemia/reperfusion has not been systematically scrutinized until recently. It has since been proven, in both animals and humans, that infarct size varies during the day depending on the symptom onset time, while circadian fluctuations in spontaneous cardioprotection in humans with ST-segment elevation myocardial infarction (STEMI have also been demonstrated. Furthermore, several studies have proposed that the time of day at which revascularization occurs in patients with STEMI may also influence infarct size and reperfusion outcomes. The potential association of the circadian clock with infarct size advocates the acknowledgment of time of day as a new prognostic factor in patients suffering acute myocardial infarction, which would open up a new field for chronotherapeutic targets and lead to the inclusion of time of day as a variable in clinical trials that test novel cardioprotective strategies.Keywords: cardioprotection, circadian rhythm, reperfusion injury, ST-segment elevation myocardial infarction

  10. Orbital Infarction due to Sickle Cell Disease without Orbital Pain

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    Cameron L. McBride

    2016-01-01

    Full Text Available Sickle cell disease is a hemoglobinopathy that results in paroxysmal arteriolar occlusion and tissue infarction that can manifest in a plurality of tissues. Rarely, these infarcted crises manifest in the bony orbit. Orbital infarction usually presents with acute onset of periorbital tenderness, swelling, erythema, and pain. Soft tissue swelling can result in proptosis and attenuation of extraocular movements. Expedient diagnosis of sickle cell orbital infarction is crucial because this is a potentially sight-threatening entity. Diagnosis can be delayed since the presentation has physical and radiographic findings mimicking various infectious and traumatic processes. We describe a patient who presented with sickle cell orbital crisis without pain. This case highlights the importance of maintaining a high index of suspicion in patients with known sickle cell disease or of African descent born outside the United States in a region where screening for hemoglobinopathy is not routine, even when the presentation is not classic.

  11. National registry of myocardial infarction

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    Amin Daemi

    2016-07-01

    Full Text Available The Registry of Myocardial Infarctions (MI Registry is a national registry in Iran that collects and reports the data on myocardial infarctions. Its main advantage is that it covers the whole country and is mandatory for hospitals to register the MI cases in it. Then, the qualified individuals at the provincial and national levels can get intended reports and make appropriate decisions. Such reports, further to the policy makers and managers, can be very valuable for researchers. The registry is a unique and comprehensive source of data that can provide priceless reports which can be used in management, policy making, resource allocation, and for research purposes. The data of MI patients from all around the country are entered into the registry by the hospitals in which the MI patients are admitted. The data include the demographic information (name, gender, date of birth, literacy, nationality, health insurance, city, and province, admission data (date and time of the first signs of the attack, date and time of admission in the hospital emergency department, date and time of admission in cardiac care unit-CCU, name of the doctor, and the number of patient’s medical record, medical history (coronary heart disease, hypertension, diabetes, high cholesterol, number of cigarettes if smoking, history of CABG and/or PCI and its date, clinical condition (the patient’s condition in terms of rhythm and heart block according to the diagnosis of the doctor, interventions (thrombolytic therapy, CABG, PCI, and date and time of each intervention if applied, laboratory results (positive or negative Troponin T and Troponin I, amount of CPKMB, maximum Troponin T and Troponin I, and date and time of each laboratory test, and the discharge information (the patient’s status when discharged from CCU-stable or dead, prescribed drugs, final diagnosis, and date and time of discharge.

  12. Myocardial infarction and nocturnal hypoxaemia

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    Penčić Biljana

    2007-01-01

    Full Text Available Introduction: There is an increased risk of cardiovascular morbidity and mortality in patients with nocturnal intermittent hypoxaemia. Objecive. The aim of this study was to evalute the influence of nocturnal hypoxaemia on ventricular arrhythmias and myocardial ischaemia in patients with myocardial infarction (MI. Method. We studied 77 patients (55.8±7.9 years with MI free of complications, chronic pulmonary diseases, abnormal awake blood gases tension. All patients underwent overnight pulse oximetry and 24-hour electrocardiography. Patients were divided into two groups according to nocturnal hypoxaemia. Total number of ventricular premature complex (VPC; maximal VPC/h; incidence of VPC Lown class>2 and occurrence of ST-segment depression were analyzed for nocturnal (10 PM to 6 AM, daytime (6 AM to 22 PM periods and for the entire 24 hours. Results. Both groups were similar in age, gender, standard risk factors, myocardial infarction size and did not differ in VPC during the analyzed periods. The number of nocturnal maximal VPC/h was insignificantly greater in group 1 (with hypoxaemia compared to group 2 (without hypoxaemia, (p=0.084. Maximal VPC/h did not differ significantly either for daytime or for 24 hours among the groups. Nocturnal VPC Lown>2 were significantly more frequent in group 1 (25% vs 0%, p=0.002. The incidence of VPC Lown>2 was similar during the daytime, and during 24 hrs in both groups. Occurrence of ST-segment depression did not differ between groups 1 and 2. Conclusion. Nocturnal hypoxaemia was associated with complex nocturnal ventricular arrhythmias in patients with MI. .

  13. Emergency clinical path of ST Elevation Acute Myocardial Infarction

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    Tiziano Lenzi

    2007-08-01

    Full Text Available ST Elevation Acute Myocardial Infarction (STEMI represents a clinical condition that witnessed a new therapeutic progress in the last years, from thrombolysis era to primary percutaneous coronary intervention (PPCI era. New European and North American guidelines and the Consensus document produced from Italian Cardiologist Federation (FIC with Emergency Physicians (SIMEU and Territorial System of Emergency 118 (SIS 118 require clinical and organized pathway with the involvement of Cardiologist, in and out hospital Emergency Physicians and 118. Main aim is to develop a network able to give to all patients the best treatment in the shortest time. The efficiency and functionality of these pathways must be verified through evaluation systems. The Imola’s experience confirms as the network can be put into practice and that it’s possible to analyse and to develop models of improvement.

  14. Clinical predictors of lacunar syndrome not due to lacunar infarction

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    Comes Emili

    2010-05-01

    Full Text Available Background Lacunar syndrome not due to lacunar infarct is poorly characterised. This single centre, retrospective study was conducted to describe the clinical characteristics of patients with lacunar syndrome not due to lacunar infarct and to identify clinical predictors of this variant of lacunar stroke. Methods A total of 146 patients with lacunar syndrome not due to lacunar infarction were included in the "Sagrat Cor Hospital of Barcelona Stroke Registry" during a period of 19 years (1986-2004. Data from stroke patients are entered in the stroke registry following a standardized protocol with 161 items regarding demographics, risk factors, clinical features, laboratory and neuroimaging data, complications and outcome. The characteristics of these 146 patients with lacunar syndrome not due to lacunar infarct were compared with those of the 733 patients with lacunar infarction. Results Lacunar syndrome not due to lacunar infarct accounted for 16.6% (146/879 of all cases of lacunar stroke. Subtypes of lacunar syndromes included pure motor stroke in 63 patients, sensorimotor stroke in 51, pure sensory stroke in 14, atypical lacunar syndrome in 9, ataxic hemiparesis in 5 and dysarthria-clumsy hand in 4. Valvular heart disease, atrial fibrillation, sudden onset, limb weakness and sensory symptoms were significantly more frequent among patients with lacunar syndrome not due to lacunar infarct than in those with lacunar infarction, whereas diabetes was less frequent. In the multivariate analysis, atrial fibrillation (OR = 4.62, sensorimotor stroke (OR = 4.05, limb weakness (OR = 2.09, sudden onset (OR = 2.06 and age (OR = 0.96 were independent predictors of lacunar syndrome not due to lacunar infarct. Conclusions Although lacunar syndromes are highly suggestive of small deep cerebral infarctions, lacunar syndromes not due to lacunar infarcts are found in 16.6% of cases. The presence of sensorimotor stroke, limb weakness and sudden onset in a patient

  15. Multimodality imaging of pulmonary infarction

    Energy Technology Data Exchange (ETDEWEB)

    Bray, T.J.P., E-mail: timothyjpbray@gmail.com [Department of Radiology, Papworth Hospital NHS Foundation Trust, Ermine Street, Papworth Everard, Cambridge CB23 3RE (United Kingdom); Mortensen, K.H., E-mail: mortensen@doctors.org.uk [Department of Radiology, Papworth Hospital NHS Foundation Trust, Ermine Street, Papworth Everard, Cambridge CB23 3RE (United Kingdom); University Department of Radiology, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Box 318, Cambridge CB2 0QQ (United Kingdom); Gopalan, D., E-mail: deepa.gopalan@btopenworld.com [Department of Radiology, Papworth Hospital NHS Foundation Trust, Ermine Street, Papworth Everard, Cambridge CB23 3RE (United Kingdom)

    2014-12-15

    Highlights: • A plethora of pulmonary and systemic disorders, often associated with grave outcomes, may cause pulmonary infarction. • A stereotypical infarct is a peripheral wedge shaped pleurally based opacity but imaging findings can be highly variable. • Multimodality imaging is key to diagnosing the presence, aetiology and complications of pulmonary infarction. • Multimodality imaging of pulmonary infarction together with any ancillary features often guide to early targeted treatment. • CT remains the principal imaging modality with MRI increasingly used alongside nuclear medicine studies and ultrasound. - Abstract: The impact of absent pulmonary arterial and venous flow on the pulmonary parenchyma depends on a host of factors. These include location of the occlusive insult, the speed at which the occlusion develops and the ability of the normal dual arterial supply to compensate through increased bronchial arterial flow. Pulmonary infarction occurs when oxygenation is cut off secondary to sudden occlusion with lack of recruitment of the dual supply arterial system. Thromboembolic disease is the commonest cause of such an insult but a whole range of disease processes intrinsic and extrinsic to the pulmonary arterial and venous lumen may also result in infarcts. Recognition of the presence of infarction can be challenging as imaging manifestations often differ from the classically described wedge shaped defect and a number of weighty causes need consideration. This review highlights aetiologies and imaging appearances of pulmonary infarction, utilising cases to illustrate the essential role of a multimodality imaging approach in order to arrive at the appropriate diagnosis.

  16. [Streptokinase in impending heart infarct].

    Science.gov (United States)

    Kiemeneij, F; Schuilenburg, R M

    1989-02-18

    A patient is described with an impending myocardial infarction due to presence of an intracoronary thrombus in an otherwise normal left anterior descending artery. This case illustrates that intracoronary and intravenous administration of streptokinase can be of value in the treatment of impending myocardial infarction.

  17. FDA & digital mammography: why has FDA required full field digital mammography systems to be regulated as potentially dangerous devices for more than 10 years?

    Science.gov (United States)

    Nields, Morgan W

    2010-05-01

    Digital mammography is routinely used in the US to screen asymptomatic women for breast cancer and currently over 50% of US screening centers employ the technology. In spite of FDAs knowledge that digital mammography requires less radiation than film mammography and that its equivalence has been proven in a prospective randomized trial, the agency has failed to allow the technology market access via the 510(k) pre market clearance pathway. As a result of the restrictive Pre Market Approval process, only four suppliers have received FDA approval. The resulting lack of a competitive market has kept costs high, restricted technological innovation, and impeded product improvements as a result of PMA requirements. Meanwhile, at least twelve companies are on the market in the EU and the resulting competitive market has lowered costs and provided increased technological choice. A cultural change with new leadership occurred in the early 90's at FDA. The historical culture at the Center for Devices and Radiological Health of collaboration and education gave way to one characterized by a lack of reliance on outside scientific expertise, tolerance of decision making by unqualified reviewers, and an emphasis on enforcement and punishment. Digital mammography fell victim to this cultural change and as a result major innovations like breast CT and computer aided detection technologies are also withheld from the market. The medical device law, currently under review by the Institute of Medicine, should be amended by the Congress so that new technologies can be appropriately classified in accordance with the risk based assessment classification system detailed in Chapter V of the Federal Food, Drug, and Cosmetic Act. A panel of scientific experts chartered by the NIH or IOM should determine the classification appropriate for new technologies that have no historical regulatory framework. This would be binding on FDA. Unless the law is changed we will likely again experience

  18. Patent Foramen Ovale in Patients with Cerebral Infarction: A Transesophageal Echocradigraphy Study

    Science.gov (United States)

    Petty, George W.; Khandheria, Bijoy K.; Chu, Chu-Pin; Sicks, JoRean D.; Whisnant, Jack P.

    1997-01-01

    Patent foramen ovale was detected in 37 patients (32%). Mean age was similar in those with (60 years) and those without (64 years) PFO. Patent foramen ovale was more frequent among men (39%) than women (20%, P=.03). Patients with PFO had a lower frequency of atrial fibrillation, diabetes me!litus, hypertension, and peripheral vascular disease compared with those without PFO. There was no difference in frequency of the following characteristics in patients with PFO compared with those without PFO: pulmonary embolus, chronic obstructive pulmonary disease, pulmonary hypertension, peripheral embolism, prior cerebral infarction, nosocomial cerebral infarction, Valsalva maneuver at the time of cerebral infarction, recent surgery, or hemorrhagic transformation of cerebral infarction. Patent foramen ovale was found in 22 (40%) of 55 patients with infarcts of uncertain cause and in 15 (25%) of 61 with infarcts of known cause (cardioembolic, 21%; large vessel atherostenosis, 25%; lacune, 40%) (P=.08). When the analysis was restricted to patients who underwent Valsalva maneuver, PFO with right to left or bidirectional shunt was found in 19 (50%) of 38 patients with infarcts of uncertain cause and in 6 (20%) of 30 with infarcts of known cause (P=.Ol). Conclusion: Although PFO was over-represented in patients with infarcts of uncertain cause in our and other studies, it has a high frequency among patients with cerebral infarction of all types. The relation between PFO and stroke requires further study.

  19. The Mycobacterium avium ssp. paratuberculosis specific mptD gene is required for maintenance of the metabolic homeostasis necessary for full virulence in mouse infections.

    Science.gov (United States)

    Meißner, Thorsten; Eckelt, Elke; Basler, Tina; Meens, Jochen; Heinzmann, Julia; Suwandi, Abdulhadi; Oelemann, Walter M R; Trenkamp, Sandra; Holst, Otto; Weiss, Siegfried; Bunk, Boyke; Spröer, Cathrin; Gerlach, Gerald-F; Goethe, Ralph

    2014-01-01

    Mycobacterium avium subspecies paratuberculosis (MAP) causes Johne's disease, a chronic granulomatous enteritis in ruminants. Furthermore, infections of humans with MAP have been reported and a possible association with Crohn's disease and diabetes type I is currently discussed. MAP owns large sequence polymorphisms (LSPs) that were exclusively found in this mycobacteria species. The relevance of these LSPs in the pathobiology of MAP is still unclear. The mptD gene (MAP3733c) of MAP belongs to a small group of functionally uncharacterized genes, which are not present in any other sequenced mycobacteria species. mptD is part of a predicted operon (mptABCDEF), encoding a putative ATP binding cassette-transporter, located on the MAP-specific LSP14. In the present study, we generated an mptD knockout strain (MAPΔmptD) by specialized transduction. In order to investigate the potential role of mptD in the host, we performed infection experiments with macrophages. By this, we observed a significantly reduced cell number of MAPΔmptD early after infection, indicating that the mutant was hampered with respect to adaptation to the early macrophage environment. This important role of mptD was supported in mouse infection experiments where MAPΔmptD was significantly attenuated after peritoneal challenge. Metabolic profiling was performed to determine the cause for the reduced virulence and identified profound metabolic disorders especially in the lipid metabolism of MAPΔmptD. Overall our data revealed the mptD gene to be an important factor for the metabolic adaptation of MAP required for persistence in the host.

  20. A Genetic Screen Reveals that Synthesis of 1,4-Dihydroxy-2-Naphthoate (DHNA), but Not Full-Length Menaquinone, Is Required for Listeria monocytogenes Cytosolic Survival.

    Science.gov (United States)

    Chen, Grischa Y; McDougal, Courtney E; D'Antonio, Marc A; Portman, Jonathan L; Sauer, John-Demian

    2017-03-21

    Through unknown mechanisms, the host cytosol restricts bacterial colonization; therefore, only professional cytosolic pathogens are adapted to colonize this host environment. Listeria monocytogenes is a Gram-positive intracellular pathogen that is highly adapted to colonize the cytosol of both phagocytic and nonphagocytic cells. To identify L. monocytogenes determinants of cytosolic survival, we designed and executed a novel screen to isolate L. monocytogenes mutants with cytosolic survival defects. Multiple mutants identified in the screen were defective for synthesis of menaquinone (MK), an essential molecule in the electron transport chain. Analysis of an extensive set of MK biosynthesis and respiratory chain mutants revealed that cellular respiration was not required for cytosolic survival of L. monocytogenes but that, instead, synthesis of 1,4-dihydroxy-2-naphthoate (DHNA), an MK biosynthesis intermediate, was essential. Recent discoveries showed that modulation of the central metabolism of both host and pathogen can influence the outcome of host-pathogen interactions. Our results identify a potentially novel function of the MK biosynthetic intermediate DHNA and specifically highlight how L. monocytogenes metabolic adaptations promote cytosolic survival and evasion of host immunity.IMPORTANCE Cytosolic bacterial pathogens, such as Listeria monocytogenes and Francisella tularensis, are exquisitely evolved to colonize the host cytosol in a variety of cell types. Establishing an intracellular niche shields these pathogens from effectors of humoral immunity, grants access to host nutrients, and is essential for pathogenesis. Through yet-to-be-defined mechanisms, the host cytosol restricts replication of non-cytosol-adapted bacteria, likely through a combination of cell autonomous defenses (CADs) and nutritional immunity. Utilizing a novel genetic screen, we identified determinants of L. monocytogenes cytosolic survival and virulence and identified a role for

  1. Amphetamine Abuse Related Acute Myocardial Infarction

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    Archana Sinha

    2016-01-01

    Full Text Available Amphetamine abuse is a global problem. The cardiotoxic manifestations like acute myocardial infarction (AMI, heart failure, or arrhythmia related to misuse of amphetamine and its synthetic derivatives have been documented but are rather rare. Amphetamine-related AMI is even rarer. We report two cases of men who came to emergency department (ED with chest pain, palpitation, or seizure and were subsequently found to have myocardial infarction associated with the use of amphetamines. It is crucial that, with increase in amphetamine abuse, clinicians are aware of this potentially dire complication. Patients with low to intermediate risk for coronary artery disease with atypical presentation may benefit from obtaining detailed substance abuse history and urine drug screen if deemed necessary.

  2. Bumblebees require visual pollen stimuli to initiate and multimodal stimuli to complete a full behavioral sequence in close-range flower orientation.

    Science.gov (United States)

    Wilmsen, Saskia; Gottlieb, Robin; Junker, Robert R; Lunau, Klaus

    2017-03-01

    Flower visits are complex encounters, in which animals are attracted by floral signals, guided toward the site of the first physical contact with a flower, land, and finally take up floral rewards. At close range, signals of stamens and pollen play an important role to facilitate flower handling in bees, yet the pollen stimuli eliciting behavioral responses are poorly known. In this study, we test the response of flower-naive bumblebees (Bombus terrestris) toward single and multimodal pollen stimuli as compared to natural dandelion pollen. As artificial pollen stimuli, we used the yellow flavonoid pigment quercetin, the scent compound eugenol, the amino acid proline, the monosaccharide glucose, and the texture of pollen-grain-sized glass pellets as a tactile stimulus. Three test stimuli, dandelion pollen, one out of various uni- and multimodal stimulus combinations, and a solvent control were presented simultaneously to individual bumblebees, whose response was recorded. The results indicate that bumblebees respond in an irreversible sequence of behavioral reactions. Bumblebees approached the visual stimulus quercetin as often as natural dandelion pollen. An additional olfactory stimulus resulted in slightly more frequent landings. The multimodal stimulus combinations including visual, olfactory, gustatory, and tactile stimuli elicited approaches, antennal contacts, and landings as often as natural pollen. Subsequent reactions like proboscis extension, mandible biting, and buzzing were more often but not regularly observed at dandelion pollen. Our study shows that visual signals of pollen are sufficient to trigger initial responses of bumblebees, whereas multimodal pollen stimuli elicit full behavioral response as compared to natural pollen. Our results suggest a major role of pollen cues for the attraction of bees toward flowers and also explain, why many floral guides mimic the visual signals of pollen and anthers, that is, the yellow and UV-absorbing color, to

  3. Delta receptors are required for full inhibitory coupling of mu-receptors to voltage-dependent Ca(2+) channels in dorsal root ganglion neurons.

    Science.gov (United States)

    Walwyn, Wendy; John, Scott; Maga, Matthew; Evans, Christopher J; Hales, Tim G

    2009-07-01

    Recombinant micro and delta opioid receptors expressed in cell lines can form heterodimers with distinctive properties and trafficking. However, a role for opioid receptor heterodimerization in neurons has yet to be identified. The inhibitory coupling of opioid receptors to voltage-dependent Ca(2+) channels (VDCCs) is a relatively inefficient process and therefore provides a sensitive assay of altered opioid receptor function and expression. We examined micro-receptor coupling to VDCCs in dorsal root ganglion neurons of delta(+/+), delta(+/-), and delta(-/-) mice. Neurons deficient in delta receptors exhibited reduced inhibition of VDCCs by morphine and [D-Ala(2),Phe(4),Gly(5)-ol]-enkephalin (DAMGO). An absence of delta receptors caused reduced efficacy of DAMGO without affecting potency. An absence of delta receptors reduced neither the density of VDCCs nor their inhibition by either the GABA(B) receptor agonist baclofen or intracellular guanosine 5'-O-(3-thio)triphosphate. Flow cytometry revealed a reduction in micro-receptor surface expression in delta(-/-) neurons without altered DAMGO-induced internalization. There was no change in micro-receptor mRNA levels. D-Phe-Cys-Tyr-D-Trp-Arg-Thr-Pen-Thr-NH(2)-sensitive mu-receptor-coupling efficacy was fully restored to delta(+/+) levels in delta(-/-) neurons by expression of recombinant delta receptors. However, the dimerization-deficient delta-15 construct expressed in delta(-/-) neurons failed to fully restore the inhibitory coupling of micro-receptors compared with that seen in delta(+/+) neurons, suggesting that, although not essential for micro-receptor function, micro-delta receptor dimerization contributes to full micro-agonist efficacy. Because DAMGO exhibited a similar potency in delta(+/+) and delta(-/-) neurons and caused similar levels of internalization, the role for heterodimerization is probably at the level of receptor biosynthesis.

  4. The Arabidopsis thaliana lectin receptor kinase LecRK-I.9 is required for full resistance to Pseudomonas syringae and affects jasmonate signalling.

    Science.gov (United States)

    Balagué, Claudine; Gouget, Anne; Bouchez, Olivier; Souriac, Camille; Haget, Nathalie; Boutet-Mercey, Stéphanie; Govers, Francine; Roby, Dominique; Canut, Hervé

    2016-07-11

    On microbial attack, plants can detect invaders and activate plant innate immunity. For the detection of pathogen molecules or cell wall damage, plants employ receptors that trigger the activation of defence responses. Cell surface proteins that belong to large families of lectin receptor kinases are candidates to function as immune receptors. Here, the function of LecRK-I.9 (At5g60300), a legume-type lectin receptor kinase involved in cell wall-plasma membrane contacts and in extracellular ATP (eATP) perception, was studied through biochemical, gene expression and reverse genetics approaches. In Arabidopsis thaliana, LecRK-I.9 expression is rapidly, highly and locally induced on inoculation with avirulent strains of Pseudomonas syringae pv. tomato (Pst). Two allelic lecrk-I.9 knock-out mutants showed decreased resistance to Pst. Conversely, over-expression of LecRK-I.9 led to increased resistance to Pst. The analysis of defence gene expression suggests an alteration of both the salicylic acid (SA) and jasmonic acid (JA) signalling pathways. In particular, LecRK-I.9 expression during plant-pathogen interaction was dependent on COI1 (CORONATINE INSENSITIVE 1) and JAR1 (JASMONATE RESISTANT 1) components, and JA-responsive transcription factors (TFs) showed altered levels of expression in plants over-expressing LecRK-I.9. A similar misregulation of these TFs was obtained by JA treatment. This study identified LecRK-I.9 as necessary for full resistance to Pst and demonstrated its involvement in the control of defence against pathogens through a regulation of JA signalling components. The role of LecRK-I.9 is discussed with regard to the potential molecular mechanisms linking JA signalling to cell wall damage and/or eATP perception.

  5. Effects of lisinopril on experimental ischemia in rats. Influence of infarct size

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    Leonardo A. M. Zornoff

    1999-10-01

    Full Text Available OBJECTIVE - Angiotensin-converting enzyme inhibitors (ACEIs have gained importance in preventing or attenuating the process of ventricular remodeling after myocardial infarction. The significance of infarct size in regard to the response to ACEIs, however, is controversial. This study aimed to analyze the effects of lisinopril on mortality rate, cardiac function, degree of cardiac hypertrophy and fibrosis in rats with different infarct sizes. METHODS - Lisinopril (20 mg/kg/day dissolved in drinking water was administered to rats immediately after coronary artery occlusion. After being sacrificed, the infarcted animals were divided into two groups: one group of animals with small infarcts ( 40% of the left ventricle. RESULTS - The mortality rate was 31.7% in treated rats and 47% in the untreated rats. There was no statistical difference between the groups with small and large infarcts in regard to myocardial concentration of hydroxyproline. In small infarcts, the treatment attenuated the heart dysfunction characterized by lower levels of blood pressure and lower values of the first derivative of pressure and of the negative derivative of pressure. The degree of hypertrophy was also attenuated in small infarcts. In regard to large infarcts, no differences between the groups were observed. CONCLUSION - Treatment with the ACEIs had no effect on mortality rate and on the amount of fibrosis. The protective effect of lisinopril on heart function and on the degree of hypertrophy could only be detected in small infarcts

  6. Treatment of municipal wastewater in full-scale on-site sand filter reduces BOD efficiently but does not reach requirements for nitrogen and phosphorus removal.

    Science.gov (United States)

    Laaksonen, Petteri; Sinkkonen, Aki; Zaitsev, Gennadi; Mäkinen, Esa; Grönroos, Timo; Romantschuk, Martin

    2017-04-01

    A traditional sand filter for treatment of household wastewater was constructed in the fall of 2012 at Biolinja 12, Turku, Finland. Construction work was led and monitored by an authorized wastewater treatment consultant. The filter was placed on a field bordered by open ditches from all sides in order to collect excess rain and snowmelt waters. The filter was constructed and insulated from the environment so that all outflowing water was accounted for. Untreated, mainly municipal, wastewater from Varissuo suburb was pumped from a sewer separately via three septic tanks (volume = 1 m(3) each) into the filters. Normally, wastewater was distributed to ground filters automatically according to pre-programmed schedule. Initially, the daily flow was 1200 L day(-1) to reflect the average organic load of a household of five persons (load: ca 237 g day(-1) BOD; 73 g day(-1) total N; and 10.4 g day(-1) total P). Later in the test, the flow rate was decreased first to 900 and then to 600 L day(-1) to better reflect the average volume produced by five persons. Volumes of inlet wastewater as well as treated water were monitored by magnetic flow meters. Samples were withdrawn from the inlet water, from the water entering the filters after the third septic tank, and from the outflowing water. After an initial adaption time, the reductions in BOD and chemical oxygen demand were constantly between 92 and 98%, showing that the biological degradation process in the filters functioned optimally and clearly comply with the national and EU standards. The reduction in total nitrogen and total phosphorus, however, reached required levels only during the first months of testing, apparently when buildup of microbial biomass was still ongoing. After this initial period of 3 months showing satisfactory reduction levels, the reduction of total nitrogen varied between 5 and 25% and total phosphorus mostly between 50 and 65%. Nitrification was efficient in the filter, but as

  7. Hyperintense Acute Reperfusion Marker on FLAIR in Posterior Circulation Infarction.

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    Alex Förster

    Full Text Available In the present study, we aimed to investigate the frequency of blood brain barrier injury in posterior circulation infarction as demonstrated by the hyperintense acute reperfusion marker (HARM on fluid attenuated inversion recovery images (FLAIR.From a MRI report database we identified patients with posterior circulation infarction who underwent MRI, including perfusion-weighted images (PWI, within 12 hours after onset and follow-up MRI within 24 hours and analyzed diffusion-weighted images (DWI, PWI, FLAIR, and MR angiography (MRA. On FLAIR images, the presence of HARM was noted by using pre-specified criteria (focal enhancement in the subarachnoid space and/or the ventricles.Overall 16 patients (median age of patients 68.5 (IQR 55.5-82.75 years with posterior circulation infarction were included. Of these, 13 (81.3% demonstrated PCA occlusion, and 3 (18.7% patients BA occlusion on MRA. Initial DWI demonstrated ischemic lesions in the thalamus (68.8%, splenium (18.8%, hippocampus (75%, occipital lobe (81.3%, mesencephalon (18.8%, pons (18.8%, and cerebellum (50%. On follow-up MRA recanalization was noted in 10 (62.5% patients. On follow-up FLAIR images, HARM was observed in 8 (50% patients. In all of these, HARM was detected remote from the acute ischemic lesion. HARM was more frequently observed in patients with vessel recanalization (p = 0.04, minor infarction growth (p = 0.01, and smaller ischemic lesions on follow-up DWI (p = 0.05.HARM is a frequent finding in posterior circulation infarction and associated with vessel recanalization, minor infarction growth as well as smaller infarction volumes in the course. Neuroradiologists should be cognizant of the fact that HARM may be present on short interval follow-up FLAIR images in patients with acute ischemic infarction who initially underwent MRI and received intravenous gadolinium-based contrast agents.

  8. Evaluation of Cognitive Impairment After Posterior Cerebral Artery Infarction

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    Nilgün Çınar

    2013-02-01

    Full Text Available OBJECTIVE: The assessment of cognitive impairment after posterior cerebral artery (PCA ischemic infarction has not been well documanted. MATERIAL and METHODS: Twenty-six oriented, cooperated and non-aphasic consecutive patients with right or left (10/16 PCA infarction who were hospitalized between the years 2010-2012 were enrolled to the study. The branches of PSA were dealt as cortical and subcortical infarct under two groups. Short mental state examination test and cognitive test battery (CTB created from Wechsler memory scale (WMS, word-catogory association test and similarity test parameters were applied to the patients at the first week and third month follow-up visits and the groups were compared with each other. RESULTS: There was a significant improvement in catogory association test and total score of cognitive test battery (CTB in right PCA group, also there was a significant improvement in catogory association test in left PCA group at the first and 3th month evaluations. At the first month evaluations, total score of CTB of the subcortical segment PCA infarcts are lower than the cortical segment PCA infarcts. At the 3th month evaluations the scores increased in the both groups; but the scores in the subcortical PCA infarcts were lower than the cortical PCA infarcts. CONCLUSION: Our findings suggest that there was a cognitive impairment in patients with PCA infarction. The impairment in verbal fluency which was showed by catogory association test was found more prominent in the second evaluation. Further studies including functional imaging methods and cortical function tests are needed.

  9. MYOCARDIAL INFARCTION TYPE 2. MYTH OR REALITY?

    OpenAIRE

    V. V. Zhelnov; N. V. Dyatlov; L. I. Dvoretsky

    2016-01-01

    According to The Third Definition of Myocardial Infarction there are five types of myocardial infarction depending on pathogenesis. This review provides actual data about myocardial infarction type 2 mechanism including diagnosis management, epidemiological characteristic and patient prognosis. Previously published data shows discordant information about myocardial infarction type 2 frequency, treatment and diagnostic options. Our clinical observation illustrates these severities in diagnosis...

  10. Omental infarction in the postpartum period: a case report and a review of the literature

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    Izbicki Jakob R

    2010-11-01

    Full Text Available Abstract Introduction Omental infarction is a rare and often misdiagnosed clinical event with unspecific symptoms. It affects predominantly young and middle aged women. Case presentation This is a case report of a 26-year-old Caucasian woman with spontaneous omental infarction two weeks after normal vaginal delivery. Conclusion Omental infarction is a differential diagnosis in the postpartum acute abdomen. As some cases of omental infarction, which are caused by torsion, can be adequately diagnosed via computed tomography, a conservative treatment strategy for patients without complications should be considered in order to avoid any unnecessary surgical intervention.

  11. What drives progressive motor deficits in patients with acute pontine infarction?

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    Jue-bao Li

    2015-01-01

    Full Text Available Progressive motor deficits are relatively common in acute pontine infarction and frequently associated with increased functional disability. However, the factors that affect the progression of clinical motor weakness are largely unknown. Previous studies have suggested that pontine infarctions are caused mainly by basilar artery stenosis and penetrating artery disease. Recently, lower pons lesions in patients with acute pontine infarctions have been reported to be related to progressive motor deficits, and ensuing that damage to the corticospinal tracts may be responsible for the worsening of neurological symptoms. Here, we review studies on motor weakness progression in pontine infarction and discuss the mechanisms that may underlie the neurologic worsening.

  12. Acute capsular infarction

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    Kashihara, M.; Matsumoto, K.

    1985-05-01

    Sixty-three patients with lacunar-type of acute capsular infarction were treated in our service during the last 2 years. Their lesions were identified by computed tomography (CT) and classified into six types according to their locations: anterior, lateral, posterior, superior, inferior and multiple. The lesions were thought to be in the watershed areas of the regional arterial supplies, and the areas were considered to be prone to ischemia. The clinical course of each type showed characteristic features of ischemic strokes. In the majority of the patients with the lateral type, reversible ischemic neurological deficit (RIND) was seen as the predominant symptom, transient ischemic attack (TIA) was noted in the patients with the superior type, and major completed stroke was observed in those with posterior type.

  13. Atorvastatin therapy during the peri-infarct period attenuates left ventricular dysfunction and remodeling after myocardial infarction.

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    Xian-Liang Tang

    Full Text Available Although statins impart a number of cardiovascular benefits, whether statin therapy during the peri-infarct period improves subsequent myocardial structure and function remains unclear. Thus, we evaluated the effects of atorvastatin on cardiac function, remodeling, fibrosis, and apoptosis after myocardial infarction (MI. Two groups of rats were subjected to permanent coronary occlusion. Group II (n = 14 received oral atorvastatin (10 mg/kg/d daily for 3 wk before and 4 wk after MI, while group I (n = 12 received equivalent doses of vehicle. Infarct size (Masson's trichrome-stained sections was similar in both groups. Compared with group I, echocardiographic left ventricular ejection fraction (LVEF and fractional area change (FAC were higher while LV end-diastolic volume (LVEDV and LV end-systolic and end-diastolic diameters (LVESD and LVEDD were lower in treated rats. Hemodynamically, atorvastatin-treated rats exhibited significantly higher dP/dt(max, end-systolic elastance (Ees, and preload recruitable stroke work (PRSW and lower LV end-diastolic pressure (LVEDP. Morphometrically, infarct wall thickness was greater in treated rats. The improvement of LV function by atorvastatin was associated with a decrease in hydroxyproline content and in the number of apoptotic cardiomyocyte nuclei. We conclude that atorvastatin therapy during the peri-infarct period significantly improves LV function and limits adverse LV remodeling following MI independent of a reduction in infarct size. These salubrious effects may be due in part to a decrease in myocardial fibrosis and apoptosis.

  14. Midterm renal functions following acute renal infarction

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    Sakir Ongun

    2015-10-01

    Full Text Available The aim of this study was to explore clinical features of renal infarction (RI that may have a role in diagnosis and treatment in our patient cohort and provide data on midterm renal functions. Medical records of patients with diagnosis of acute RI, established by contrast enhanced computed tomography (CT and at least 1 year follow-up data, who were hospitalized in our clinic between 1998 and 2012 were retrospectively reviewed; including descriptive data, clinical signs and symptoms, etiologic factors, laboratory findings, and prescribed treatments. Patients with solitary infarct were treated with acetylsalicylic acid (ASA only, whereas patients with atrial fibrillation (AF or multiple or global infarct were treated with anticoagulants. Estimated Glomerular Filtration Rate (eGFR referring to renal functions was determined by the Modification of Diet in Renal Disease (MDRD formula. Twenty-seven renal units of 23 patients with acute RI were identified. The mean age was 59.7 ± 15.7 years. Fourteen patients (60.8% with RI had atrial fibrillation (AF as an etiologic factor of which four had concomitant mesenteric ischemia at diagnosis. At presentation, 20 patients (86.9% had elevated serum lactate dehydrogenase (LDH, 18 patients (78.2% had leukocytosis, and 16 patients (69.5% had microscopic hematuria. Two patients with concomitant mesenteric ischemia and AF passed away during follow up. Mean eGFR was 70.8 ± 23.2 mL/min/1.73 m2 at admission and increased to 82.3 ± 23.4 mL/min/1.73 m2 at 1 year follow up. RI should be considered in patients with persistent flank or abdominal pain, particularly if they are at high risk of thromboembolism. Antiplatelet and/or anticoagulant drugs are both effective treatment options according to the amplitude of the infarct for preserving kidney functions.

  15. Paradoxical embolism in acute myocardial infarction in a patient with congenital heart disease

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    Abdelrahman Jamiel

    2012-01-01

    Full Text Available We present a case of a young male with severe pulmonary stenosis, hypoplastic right ventricle, and atrial septal defect. Acute embolic myocardial infarction, followed by cardiac arrest, occurred during hospitalization after Glenn operation. The therapeutic challenges are discussed. Insufficient anticoagulation therapy during the postoperative period was a possible contributing factor leading to embolic myocardial infarction.

  16. Is the time between onset of pain and restoration of patency of infarct-related artery shortened in patients with myocardial infarction? The effects of the Kielce Region System for Optimal Management of Acute Myocardial Infarction

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    Marcin Sadowski

    2014-09-01

    Full Text Available Introduction : The importance of delay in the restoration of infarct-related artery patency in patients with myocardial infarction was discussed, and actions were undertaken in the Kielce Region aimed at shortening this time within the System for Optimal Management of Acute Myocardial Infarction. Aim of the research: To evaluate the effectiveness of shortening time delays during transport of patients and diagnostics of myocardial infarction in the Kielce Region. Material and methods: Time delays were analysed in 5,934 patients with ST-segment elevation myocardial infarction (STEMI, hospitalised in cardiology wards with interventional cardiology on 24-hour duty, during the period 2008–2012. Time delays were analysed between the onset of myocardial infarction pain and undertaking treatment – T1 and T2 time – within which a patient with myocardial infarction, after admission to hospital, has intervention performed on infarct-related coronary artery. Results : During the period 2008–2012, the median T1 time was successfully shortened from 355 to 203 min, and the T2 time from 101 to 48 min. Conclusions: The effectiveness of the system was confirmed, and the necessity for further improvement of the system indicated.

  17. Examining the subcortical infarcts in the era of acute multimodality CT imaging

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    Mindy Tan

    2016-12-01

    Full Text Available Background: Lacunar infarcts have been characterized as small subcortical infarcts, resulting from in situ microatheroma or lipohyalinosis in small vessels. Based on this hypothesis, such infarcts should not be associated with large areas of perfusion deficits extending beyond subcortical regions to involve cortical regions. By contrast, selected small subcortical infarcts, as defined by MR imaging in the subacute or chronic stage, may initially have large perfusion deficits or related large vessel occlusions. These infarcts with ‘lacunar’ phenotype may also be caused by disease in the parent vessel and may have very different stroke mechanisms from small vessel disease. Our aim was to describe differences in imaging characteristics between patients with small subcortical infarction with ‘lacunar phenotype’ from those with lacunar mechanism. Methods: Patients undergoing acute CT Perfusion/angiography (CTP/CTA within 6 hours of symptom onset and follow-up magnetic resonance imaging (MRI for ischaemic stroke were included (2009-2013. A lacunar infarct was defined as a single subcortical infarct (SSI ≤20 mm on follow-up MRI. Presence of perfusion deficits, vessel occlusion and infarct dimensions were compared between lacunar infarcts and other topographical infarct types. Results: Overall, 182 patients (mean age 66.4±15.3 years, 66% male were included. SSI occurred in 31 (17% patients. Of these, 12 (39% patients had a perfusion deficit compared with those with any cortical infarction (120/142, 67%, and the smallest SSI with a perfusion deficit had a diameter of <5mm. The majority of patients with SSI (8/12, 66.7% had a relevant vessel occlusion. A quarter of SSIs had a large-artery stroke mechanism evident on acute CTP/CTA. Lacunar mechanism was present in 3/8 patients with corona radiata, 5/10 lentiform nucleus, 5/6 posterior limb of internal capsule PLIC, 3/5 thalamic infarcts and 1/2 miscellaneous locations. There was a trend toward

  18. A new non-human primate model of photochemically induced cerebral infarction.

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    Satoshi Ikeda

    Full Text Available BACKGROUND AND PURPOSE: Rat models of photochemically induced cerebral infarction have been readily studied, but to date there are no reports of transcranial photochemically induced infarctions in the marmoset. In this report, we used this non-human primate as a model of cerebral thrombosis and observed the recovery process. METHODS: Five common marmosets were used. Cerebral ischemia was produced via intravascular thrombosis induced by an intravenous injection of Rose Bengal and irradiation with green light. After inducing cerebral infarction, we observed the behavior of marmosets via a continuous video recording. We evaluated maximum speed, mean speed, and distance traveled in 1 min. In addition, we evaluated scores for feeding behavior, upper limb grip, and lower limb grip. We confirmed the infarct area after cerebral infarction using 2,3,5-triphenyltetrazolium chloride staining in a separate marmoset. RESULTS: We found functional decreases 2 days after creating the cerebral infarction in all measurements. Total distance traveled, average speed, upper limb score, and feeding behavior score did not recover to pre-infarction levels within 28 days. Maximum speed in 1 min and lower limb score recovered 28 days after infarction as compared to pre-infarction levels. We confirmed the infarct area of 11.4 mm × 6.8 mm as stained with 2,3,5-triphenyltetrazolium chloride. CONCLUSION: We were able to create a primate photothrombosis-induced cerebral infarction model using marmosets and observe functional recovery. We suggest that this is a useful model for basic research of cerebral infarction.

  19. Exercise training prior to myocardial infarction attenuates cardiac deterioration and cardiomyocyte dysfunction in rats

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    Luiz Henrique Marchesi Bozi

    2013-04-01

    Full Text Available OBJECTIVES: The present study was performed to investigate 1 whether aerobic exercise training prior to myocardial infarction would prevent cardiac dysfunction and structural deterioration and 2 whether the potential cardiac benefits of aerobic exercise training would be associated with preserved morphological and contractile properties of cardiomyocytes in post-infarct remodeled myocardium. METHODS: Male Wistar rats underwent an aerobic exercise training protocol for eight weeks. The rats were then assigned to sham surgery (SHAM, sedentary lifestyle and myocardial infarction or exercise training and myocardial infarction groups and were evaluated 15 days after the surgery. Left ventricular tissue was analyzed histologically, and the contractile function of isolated myocytes was measured. Student's t-test was used to analyze infarct size and ventricular wall thickness, and the other parameters were analyzed by the Kruskal-Wallis test followed by Dunn's test or a one-way analysis of variance followed by Tukey's test (p<0.05. RESULTS: Myocardial infarctions in exercise-trained animals resulted in a smaller myocardial infarction extension, a thicker infarcted wall and less collagen accumulation as compared to myocardial infarctions in sedentary animals. Myocardial infarction-induced left ventricular dilation and cardiac dysfunction, as evaluated by +dP/dt and -dP/dt, were both prevented by previous aerobic exercise training. Moreover, aerobic exercise training preserved cardiac myocyte shortening, improved the maximum shortening and relengthening velocities in infarcted hearts and enhanced responsiveness to calcium. CONCLUSION: Previous aerobic exercise training attenuated the cardiac dysfunction and structural deterioration promoted by myocardial infarction, and such benefits were associated with preserved cardiomyocyte morphological and contractile properties.

  20. Surgery-related thrombosis critically affects the brain infarct volume in mice following transient middle cerebral artery occlusion.

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    Xiaojie Lin

    Full Text Available Transient middle cerebral artery occlusion (tMCAO model is widely used to mimic human focal ischemic stroke in order to study ischemia/reperfusion brain injury in rodents. In tMCAO model, intraluminal suture technique is widely used to achieve ischemia and reperfusion. However, variation of infarct volume in this model often requires large sample size, which hinders the progress of preclinical research. Our previous study demonstrated that infarct volume was related to the success of reperfusion although the reason remained unclear. The aim of present study is to explore the relationship between focal thrombus formation and model reproducibility with respect to infarct volume. We hypothesize that suture-induced thrombosis causes infarct volume variability due to insufficient reperfusion after suture withdrawal. Seventy-two adult male CD-1 mice underwent 90 minutes of tMCAO with or without intraperitoneal administration of heparin. Dynamic synchrotron radiation microangiography (SRA and laser speckle contrast imaging (LSCI were performed before and after tMCAO to observe the cerebral vascular morphology and to measure the cerebral blood flow in vivo. Infarct volume and neurological score were examined to evaluate severity of ischemic brain injury. We found that the rate of successful reperfusion was much higher in heparin-treated mice compared to that in heparin-free mice according to the result of SRA and LSCI at 1 and 3 hours after suture withdrawal (p<0.05. Pathological features and SRA revealed that thrombus formed in the internal carotid artery, middle cerebral artery or anterior cerebral artery, which blocked reperfusion following tMCAO. LSCI showed that cortical collateral circulation could be disturbed by thrombi. Our results demonstrated that suture-induced thrombosis was a critical element, which affects the success of reperfusion. Appropriate heparin management provides a useful approach for improving reproducibility of reperfusion

  1. Case report: Renal infarction by paradoxical embolism through the patent foramen ovale as an unusual cause of post-operative abdominal pain after sleeve gastrectomy

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    Oleksandr Khoma, Dr

    2016-01-01

    Full Text Available 50-year-old female presented with abdominal pain 9 days post sleeve gastrectomy and was found to have acute renal infarction caused by paradoxical emboli through patent foramen ovale (PFO as a cause of the renal infarction. Renal infarctions caused by paradoxical embolism are rare and have not been previously reported following surgery, bariatric surgery in particular. This report describes presentation, work up and management of a patient with renal infarct following bariatric surgery.

  2. Can pulsed ultrasound increase tissue damage during ischemia? A study of the effects of ultrasound on infarcted and non-infarcted myocardium in anesthetized pigs

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    Grins Edgars

    2005-04-01

    Full Text Available Abstract Background The same mechanisms by which ultrasound enhances thrombolysis are described in connection with non-beneficial effects of ultrasound. The present safety study was therefore designed to explore effects of beneficial ultrasound characteristics on the infarcted and non-infarcted myocardium. Methods In an open chest porcine model (n = 17, myocardial infarction was induced by ligating a coronary diagonal branch. Pulsed ultrasound of frequency 1 MHz and intensity 0.1 W/cm2 (ISATA was applied during one hour to both infarcted and non-infarcted myocardial tissue. These ultrasound characteristics are similar to those used in studies of ultrasound enhanced thrombolysis. Using blinded assessment technique, myocardial damage was rated according to histopathological criteria. Results Infarcted myocardium exhibited a significant increase in damage score compared to non-infarcted myocardium: 6.2 ± 2.0 vs. 4.3 ± 1.5 (mean ± standard deviation, (p = 0.004. In the infarcted myocardium, ultrasound exposure yielded a further significant increase of damage scores: 8.1 ± 1.7 vs. 6.2 ± 2.0 (p = 0.027. Conclusion Our results suggest an instantaneous additive effect on the ischemic damage in myocardial tissue when exposed to ultrasound of stated characteristics. The ultimate damage degree remains to be clarified.

  3. Neuroimaging diagnosis for cerebral infarction An 8-year bibliometric analysis

    Institute of Scientific and Technical Information of China (English)

    Yan Du; Xiaoxia Yang; Hong Song; Bo Chen; Lin Li; Yue Pan; Qiong Wu; Jia Li

    2012-01-01

    OBJECTIVE:To identify global research trends in neuroimaging diagnosis for cerebral infarction using a bibliometric analysis of the Web of Science.DATA RETRIEVAL:We performed a bibliometric analysis of data retrieval for neuroimaging diagnosis for cerebral infarction containing the key words "CT,magnetic resonance imaging,MRI,transcranial Doppler,transvaginal color Doppler,digital subtraction angiography,and cerebral infarction" using the Web of Science.SELECTION CRITERIA:Inclusion criteria were:(a) peer-reviewed articles on neuroimaging diagnosis for cerebral infarction which were published and indexed in the Web of Science; (b) original research articles and reviews; and (c) publication between 2004-2011.Exclusion criteria were:(a) articles that required manual searching or telephone access; and (b) corrected papers or book chapters.MAIN OUTCOME MEASURES:(1)Annual publication output; (2) distribution according to country;(3) distribution according to institution; (4) top cited publications; (5) distribution according to journals; and (6) comparison of study results on neuroimaging diagnosis for cerebral infarction.RESULTS:Imaging has become the predominant method used in diagnosing cerebral infarction.The most frequently used clinical imaging methods were digital subtraction angiography,CT,MRI,and transcranial color Doppler examination.Digital subtraction angiography is used as the gold standard.However,it is a costly and time-consuming invasive diagnosis that requires some radiation exposure,and is poorly accepted by patients.As such,it is mostly adopted in interventional therapy in the clinic.CT is now accepted as a rapid,simple,and reliable non-invasive method for use in diagnosis of cerebrovascular disease and preoperative appraisal.Ultrasonic Doppler can be used to reflect the hardness of the vascular wall and the nature of the plaque more clearly than CT and MRI.CONCLUSION:At present,there is no unified standard of classification of cerebral infarction

  4. Stem Cell Therapy for Myocardial Infarction: Are We Missing Time?

    NARCIS (Netherlands)

    K.W. ter Horst

    2010-01-01

    The success of stem cell therapy in myocardial infarction (MI) is modest, and for stem cell therapy to be clinically effective fine-tuning in regard to timing, dosing, and the route of administration is required. Experimental studies suggest the existence of a temporal window of opportunity bound by

  5. Acute renal infarction: an unusual cause of abdominal pain.

    Science.gov (United States)

    Javaid, Muhammad M; Butt, Mohammed A; Syed, Yadullah; Carr, Patrick

    2009-01-01

    Acute renal infarction is an uncommon and under-diagnosed disease. Its clinical presentation is nonspecific and often mimics other more common disease entities. The diagnosis is usually missed or delayed, which frequently results in irreversible renal parenchyma damage. High index of suspicion is required for early diagnosis, as timely intervention may prevent loss of kidney function. We report a case of acute renal infarction following coronary angiography in a patient with paroxysmal atrial fibrillation who initially presented with acute abdominal pain mimicking appendicitis.

  6. Cell tracking and therapy evaluation of bone marrow monocytes and stromal cells using SPECT and CMR in a canine model of myocardial infarction

    Directory of Open Access Journals (Sweden)

    Merrifield Peter

    2009-04-01

    Full Text Available Abstract Background The clinical application of stem cell therapy for myocardial infarction will require the development of methods to monitor treatment and pre-clinical assessment in a large animal model, to determine its effectiveness and the optimum cell population, route of delivery, timing, and flow milieu. Objectives To establish a model for a in vivo tracking to monitor cell engraftment after autologous transplantation and b concurrent measurement of infarct evolution and remodeling. Methods We evaluated 22 dogs (8 sham controls, 7 treated with autologous bone marrow monocytes, and 7 with stromal cells using both imaging of 111Indium-tropolone labeled cells and late gadolinium enhancement CMR for up to12 weeks after a 3 hour coronary occlusion. Hearts were also examined using immunohistochemistry for capillary density and presence of PKH26 labeled cells. Results In vivo Indium imaging demonstrated an effective biological clearance half-life from the injection site of ~5 days. CMR demonstrated a pattern of progressive infarct shrinkage over 12 weeks, ranging from 67–88% of baseline values with monocytes producing a significant treatment effect. Relative infarct shrinkage was similar through to 6 weeks in all groups, following which the treatment effect was manifest. There was a trend towards an increase in capillary density with cell treatment. Conclusion This multi-modality approach will allow determination of the success and persistence of engraftment, and a correlation of this with infarct size shrinkage, regional function, and left ventricular remodeling. There were overall no major treatment effects with this particular model of transplantation immediately post-infarct.

  7. Warfarin dose and INR related to genotypes of CYP2C9 and VKORC1 in patients with myocardial infarction

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    Seljeflot Ingebjørg

    2008-06-01

    Full Text Available Abstract Background Warfarin treatment has a narrow therapeutic range, requiring meticulous monitoring and dosage titration. Individual dosage requirement has recently partly been explained by genetic variation of the warfarin metabolizing enzyme CYP2C9 and the Vitamin K-activating enzyme VKORC1. In the WARIS-II study, comparing three different antithrombotic regimens after myocardial infarction, warfarin treatment reduced thrombotic events, but was associated with more frequent bleeding than use of acetylsalisylic acid (ASA alone. Aims The primary aim of the present study was to investigate the relation between genotypes of CYP2C9 and VKORC1 and warfarin maintenance dose in myocardial infarction. The secondary aim was to relate the genotypes to international normalized ratio (INR. Methods Genotyping was performed in 212 myocardial infarction patients from the WARIS-II study by robotic isolation of DNA from EDTA whole blood (MagNa Pure LC before PCR amplification (LightCycler and melting point analysis. Results The 420 C>T substitution of CYP2C9*2, the 1075 A>C substitution of CYP2C9*3 and the 1173 C>T substitution of VKORC1 had minor allele frequencies of, 11.3%, 5.7% and 36.6% respectively. Warfarin weekly dose varied between 17 mg and 74 mg among the patients. INR did not vary between genotypes. Warfarin dosage requirement was significantly associated with CYP2C9 and VKORC1 genotypes, treatment group and age. The VKORC1 genotype contributed 24.5% to the interindividual variation in warfarin dosage, whereas the combined CYP2C9 genotypes were only responsible for 7.2% of the dose variation. Conclusion CYP2C9 and VKORC1 genotype frequencies in myocardial infarction patients appear similar to other patient groups and have similar impact on warfarin maintenance dose.

  8. Performance of two-dimensional Doppler echocardiography for the assessment of infarct size and left ventricular function in rats

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    Nozawa E.

    2006-01-01

    Full Text Available Although echocardiography has been used in rats, few studies have determined its efficacy for estimating myocardial infarct size. Our objective was to estimate the myocardial infarct size, and to evaluate anatomic and functional variables of the left ventricle. Myocardial infarction was produced in 43 female Wistar rats by ligature of the left coronary artery. Echocardiography was performed 5 weeks later to measure left ventricular diameter and transverse area (mean of 3 transverse planes, infarct size (percentage of the arc with infarct on 3 transverse planes, systolic function by the change in fractional area, and diastolic function by mitral inflow parameters. The histologic measurement of myocardial infarction size was similar to the echocardiographic method. Myocardial infarct size ranged from 4.8 to 66.6% when determined by histology and from 5 to 69.8% when determined by echocardiography, with good correlation (r = 0.88; P < 0.05; Pearson correlation coefficient. Left ventricular diameter and mean diastolic transverse area correlated with myocardial infarct size by histology (r = 0.57 and r = 0.78; P < 0.0005. The fractional area change ranged from 28.5 ± 5.6 (large-size myocardial infarction to 53.1 ± 1.5% (control and correlated with myocardial infarct size by echocardiography (r = -0.87; P < 0.00001 and histology (r = -0.78; P < 00001. The E/A wave ratio of mitral inflow velocity for animals with large-size myocardial infarction (5.6 ± 2.7 was significantly higher than for all others (control: 1.9 ± 0.1; small-size myocardial infarction: 1.9 ± 0.4; moderate-size myocardial infarction: 2.8 ± 2.3. There was good agreement between echocardiographic and histologic estimates of myocardial infarct size in rats.

  9. Incidence of heart failure in infarcted rats that die spontaneously

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    R.L.G. Flumignan

    2006-10-01

    Full Text Available The present study reports for the first time the incidence of congestive heart failure (CHF in previously infarcted rats that died spontaneously. Previously, pulmonary (PWC and hepatic (HWC water contents were determined in normal rats: 14 control animals were evaluated immediately after sacrifice, 8 placed in a refrigerator for 24 h, and 10 left at room temperature for 24 h. In the infarcted group, 9 rats died before (acute and 28 died 48 h after (chronic myocardial infarction. Thirteen chronic animals were submitted only to autopsy (N = 13, whereas PWC and HWC were also determined in the others (N = 15. Seven rats survived 48 h and died during anesthesia. Notably, PWC differed in normal rats: ambient (75.7 ± 1.3% < control (77.5 ± 0.7% < refrigerator (79.1 ± 1.4% and there were no differences with respect to HWC. No clinical signs of CHF (dyspnea, lethargy or foot edema were observed in infarcted rats before death. PWC was elevated in all chronic and anesthetized rats. HWC was increased in 48% of chronic and in all anesthetized rats. Our data showed that PWC needs to be evaluated before 24 h post mortem and that CHF is the rule in chronic infarcted rats suffering natural death. The congestive syndrome cannot be diagnosed correctly in rats by clinical signs alone, as previously proposed.

  10. Segmental Infarction of Omentum –A Case Report

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    SA Jalali

    2001-09-01

    Full Text Available Idiopathic or spontaneous segmental infarction of omentum is a rare disease producing acute abdominal emergency. This rare entity is in a small group of abdominal emergencies with circulatory compromise. Infarction could be caused by omental torsion which could be due to adhesion of a previouse surgery or it could be spontaneous. Less than 150 cases of idiopathic segmental infarction of omentum has been reported since it was first reported about hundred years ago. The importance of this abdominal emergency lies ion differential diagnosis of acute appendecitis because its defenitive diagnosis is made only after laparotomy. In these cases the appendix is normal and besides an amount of serosanguinous fluid in the peritoneal cavity, a segment of omentum is infarcted. A case of idiopathic segmental infarction is reported in a 37-year-old heavy weigh male. The suggested procedure is appendectomy and segmental resection of the necrotic piece of omentum. In this case no adhesion or torsion of omentum was present.

  11. A case of serpentine coronaries and acute myocardial infarction

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    Shivashankara TH

    2015-06-01

    Full Text Available Microvascular disease is a prominent feature of systemic sclerosis (SSc and leads to Raynaud's phenomenon, pulmonary arterial hypertension, and scleroderma renal crisis. The presence of macrovascular disease is less well established, and, in particular, it is not known whether the prevalence of coronary heart disease in SSc is increased. We report a case of SSc who presented with evolved myocardial infarction whose angiogram revealed tortuous coronaries and peripheral arteries. Regional wall motion abnormality was not demonstrated on echocardiography. The microvascular dysfunction and vasospasm of coronaries were responsible for the myocardial infarction. [Int J Res Med Sci 2015; 3(6.000: 1511-1513

  12. Myocardial infarction and cerebral infarction in a Danish suburban community

    DEFF Research Database (Denmark)

    Lyngborg, K; Marquardsen, J; Trautner, F

    1985-01-01

    A comparison was made of 485 cases of cerebral infarction (CI), registered prospectively in Frederiksberg, Copenhagen, with 495 cases of myocardial infarction (AMI), recorded retrospectively in the same population. The overall annual incidence of AMI was 6.5 per 1,000 population for males, 3...... with advancing age; for each sex and diagnosis the relationship can thus be expressed as a simple mathematical formula, which may facilitate comparisons of incidence patterns in different communities. Theories explaining the similarities and differences of the age-incidence curves for AMI and CI are discussed....

  13. CMR of microvascular obstruction and hemorrhage in myocardial infarction

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    Wu Katherine C

    2012-09-01

    Full Text Available Abstract Microvascular obstruction (MO or no-reflow phenomenon is an established complication of coronary reperfusion therapy for acute myocardial infarction. It is increasingly recognized as a poor prognostic indicator and marker of subsequent adverse LV remodeling. Although MO can be assessed using various imaging modalities including electrocardiography, myocardial contrast echocardiography, nuclear scintigraphy, and coronary angiography, evaluation by cardiovascular magnetic resonance (CMR is particularly useful in enhancing its detection, diagnosis, and quantification, as well as following its subsequent effects on infarct evolution and healing. MO assessment has become a routine component of the CMR evaluation of acute myocardial infarction and will increasingly play a role in clinical trials of adjunctive reperfusion agents and strategies. This review will summarize the pathophysiology of MO, current CMR approaches to diagnosis, clinical implications, and future directions needed for improving our understanding of this common clinical problem.

  14. A schizophrenic patient with cerebral infarctions after hemorrhagic shock

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    Youichi Yanagawa

    2013-01-01

    Full Text Available We herein report the fourth case of cerebral infarction, concomitant with hemorrhagic shock, in English literature. A 33-year-old male, who had been diagnosed with schizophrenia and given a prescription for Olanzapine, was discovered with multiple self-inflicted bleeding cuts on his wrist. On arrival, he was in hemorrhagic shock without verbal responsiveness, but his vital signs were normalized following infusion of Lactate Ringer′s solution. The neuroradiological studies revealed multiple cerebral ischemic lesions without any vascular abnormality. He was diagnosed with speech apraxia, motor aphasia, and dysgraphia, due to multiple cerebral infarctions. As there was no obvious causative factor with regard to the occurrence of cerebral infarction in the patient, the hypoperfusion due to hemorrhagic shock, and the thromboembolic tendency due to Olanzapine, might have acted together to lead to the patient′s cerebral ischemia.

  15. Severe Hyperthyroidism Presenting with Acute ST Segment Elevation Myocardial Infarction

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    Dayan Zhou

    2015-01-01

    Full Text Available Introduction. Acute myocardial infarction is life-threatening. A cardiac troponin rise accompanied by typical symptoms, ST elevation or depression is diagnostic of acute myocardial infarction. Here, we report an unusual case of a female who was admitted with chest pain. However, she did not present with a typical profile of an acute myocardial infarction patient. Case Presentation. A 66-year-old Han nationality female presented with chest pain. The electrocardiogram (ECG revealed arched ST segment elevations and troponin was elevated. However, the coronary angiography showed a normal coronary arterial system. Thyroid function tests showed that this patient had severe hyperthyroidism. Conclusion. Our case highlights the possibility that hyperthyroidism may cause a large area of myocardium injury and ECG ST segment elevation. We suggest routine thyroid function testing in patients with chest pain.

  16. Air Pollution Exposure—A Trigger for Myocardial Infarction?

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    Niklas Berglind

    2010-03-01

    Full Text Available The association between ambient air pollution exposure and hospitalization for cardiovascular events has been reported in several studies with conflicting results. A case-crossover design was used to investigate the effects of air pollution in 660 first-time myocardial infarction cases in Stockholm in 1993–1994, interviewed shortly after diagnosis using a standard protocol. Air pollution data came from central urban background monitors. No associations were observed between the risk for onset of myocardial infarction and two-hour or 24-hour air pollution exposure. No evidence of susceptible subgroups was found. This study provides no support that moderately elevated air pollution levels trigger first-time myocardial infarction.

  17. PCA Infarction With Its Cognitive Findings: More Than Hemianopia

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    Zehra Bozdoğan

    2013-12-01

    Full Text Available Posterior cerebral artery infarctions constitute 5-10 % of all ischemic strokes.In this case report, a 62 year-old man presenting with right hemiparesia and dysarthria is going to be discussed. The patient had acute onset- demential symptoms and difficulty in reading, and acute infarction in the territory of left posterior cerebral artery was detected in cranial magnetic resonance imaging. The patient who had acute ischemic lesions in left parahippocampus, splenium of corpus callosum, left fusiform gyrus and left thalamus was evaluated with detailed neuropsychological tests. Cognitive deficits severe enough to affect daily living were detected. Pure alexia, anterograde amnesia and anomia, being often neglected manifestations of unilateral posterior cerebral artery infarction, are going to be reviewed with corresponding radiological findings.

  18. Pharmacological effects of Salvia miltiorrhiza (Danshen on cerebral infarction

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    Hsieh Ching-Liang

    2010-06-01

    Full Text Available Abstract Danshen, the dried root of Salvia miltiorrhiza, is a Chinese medicine used to promote blood flow and treat vascular disease. The present article reviews the pharmacological effects of Danshen on cerebral infarction and possible interactions between Danshen and Western drugs. Danshen may reduce or prolong the development of atherosclerosis and may have anti-hypertensive and anti-platelet aggregation effects, which prevent cerebral infarction. Danshen may enhance endogenous anti-oxidative enzyme activities such as the expression of endothelial nitric oxide synthase and may scavenge oxygen free radicals. Prevention and treatment of cerebral infarction by Danshen involves multiple pathways, including anti-atherosclerosis, anti-hypertension, anti-platelet aggregation, anti-inflammatory and anti-oxidative effects.

  19. Watershed Cerebral Infarction in a Patient with Acute Renal Failure

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    Ruya Ozelsancak

    2016-02-01

    Full Text Available Acute renal failure can cause neurologic manifestations such as mood swings, impaired concentration, tremor, stupor, coma, asterixis, dysarthria. Those findings can also be a sign of cerebral infarct. Here, we report a case of watershed cerebral infarction in a 70-year-old female patient with acute renal failure secondary to contrast administration and use of angiotensin converting enzyme inhibitor. Patient was evaluated with magnetic resonance imaging because of dysarthria. Magnetic resonance imaging revealed milimmetric acute ischemic lesion in the frontal and parietal deep white matter region of both cerebral hemisphere which clearly demonstrated watershed cerebral infarction affecting internal border zone. Her renal function returned to normal levels on fifth day of admission (BUN 32 mg/dl, creatinine 1.36 mg/dl and she was discharged. Dysarthria continued for 20 days.

  20. Copeptin Testing in Acute Myocardial Infarction: Ready for Routine Use?

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    Sebastian Johannes Reinstadler

    2015-01-01

    Full Text Available Suspected acute myocardial infarction is one of the leading causes of admission to emergency departments. In the last decade, biomarkers revolutionized the management of patients with suspected acute coronary syndromes. Besides their pivotal assistance in timely diagnosis, biomarkers provide additional information for risk stratification. Cardiac troponins I and T are the most sensitive and specific markers of acute myocardial injury. Nonetheless, in order to overcome the remaining limitations of these markers, novel candidate biomarkers sensitive to early stage of disease are being extensively investigated. Among them, copeptin, a stable peptide derived from the precursor of vasopressin, emerged as a promising biomarker for the evaluation of suspected acute myocardial infarction. In this review, we summarize the currently available evidence for the usefulness of copeptin in the diagnosis and risk stratification of patients with suspected acute myocardial infarction in comparison with routine biomarkers.

  1. Hemiballismus, Hyperphagia, and Behavioral Changes following Subthalamic Infarct

    Directory of Open Access Journals (Sweden)

    Masoud Etemadifar

    2012-01-01

    Full Text Available The function of subthalamic nucleus (STN which is a part of the basal ganglia system is not clear, but it is hypothesized that this component might be involved in action selection. Unilateral damage to STN, which can commonly occur due to the small vessel stroke mainly, causes hemiballismus and sometimes hemichorea-hemiballismus. This paper deals with a 60-year-old patient with sudden onset of abnormal movements in his right limbs. He had increased appetite and hyperphagia and also developed mood and behavioral changes (aggressiveness, irritability, anxiety, and sometimes obscene speech. The magnetic resonance imaging revealed infarct area in left subthalamus. In our case, hemiballismus is caused by infarction in left subthalamic area. Occurrence of irritability, anxiety, and some behavioral changes such as aggressiveness and obscene speech can be explained by impairment of STN role in nonmotor behavior and cognitive function as a result of infarct.

  2. The immune system in atherosclerosis and in acute myocardial infarction

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    Antonio Barsotti

    2006-12-01

    Full Text Available Acute myocardial infarction (AMI occurs when the atheromatous process prevents total blood flow through the coronary artery. It was previously thought that progressive luminal narrowing from the continued growth of smooth muscle cells (SMCs in the plaque was the main cause of infarction, however, angiographic studies, have identified culprit lesions that do not cause marked stenosis. Is now evident that plaque activation, rather than stenosis, precipitates ischemia and infarction. Coronary spasm could be involved to some extent, but most cases of AMI are due to the formation of an occluding thrombus on the surface of the plaque; the two major causes of coronary thrombosis are plaque rupture and endothelial erosion. Plaque rupture is detectable in 60- 70% of cases and preferentially occurs when the fibrous cap is thin and partly destroyed. One of the major challenges in modern cardiology is the knowledge of the factors that induce a silent atherosclerotic plaque shifting from a stable to a vulnerable form.

  3. Is enhanced MRI helpful in brainstem infarction?

    Energy Technology Data Exchange (ETDEWEB)

    Jeong, Y. M.; Shin, G. H.; Choi, W. S. [Kyung Hee University Hospital, Seoul (Korea, Republic of)

    1994-12-15

    To determine the role of MR contrast enhancement in evaluating time course of brainstem infarction. MR imaging with IV administration of gadopentetate dimeglumine was retrospectively reviewed in 43 patients with clinically and radiologically documented brainstem infarctions. The pattern of infarction was classified into spotty and patchy. Presence of parenchymal enhancement in infarction was evaluated. By location, there were 34 pontine, 3 midbrain, 6 medullary infarctions. The age of the infarctions ranged from 1 day to 9 months, with 5 patients scanned within 3 days and 10 scanned within 2 weeks of clinical ictus. Abnormalities on T2-weighted images were encountered in every case, with spotty pattern in 14 cases and patchy pattern in 29 cases. Parenchymal contrast enhancement was seen in 9 cases(20%), primarily occurring between days 8 and 20. MR contrast enhancement in brainstem infarction was infrequent that it may not be useful in the estimation of the age of infarction.

  4. [Myocardial infarction caused by exertion].

    Science.gov (United States)

    Bernard, F; Weber, S

    1997-01-01

    Myocardial infarction is the main cause of sudden death during physical exercise, particularly in subjects over 40 and may even occur in high-performance young athletes. Sports and physical activity have a beneficial effect in preventing cardiovascular diseases, but certain rules of prudence must be followed to avoid the risk of a severe coronary event. Myocardial infarction always occurs in particularly susceptible subjects with several risk factors, predominantly smoking, hypercholesterolemia, family history of atherosclerosis. Dietary factors, either before, during or after the exercise, are always found. Distribution of coronary lesions differs with age. Before 40 years, the coronary network is normal in 40% of the cases. The infarction is partially explained by platelet hyperaggregahility and coronary spasms at exercise or in the post-exercise period.

  5. Idiopathic Renal Infarction Mimicking Appendicitis

    Science.gov (United States)

    Lisanti, Francesco; Scarano, Enrico

    2017-01-01

    Renal infarction is a rare cause of referral to the emergency department, with very low estimated incidence (0.004%–0.007%). Usually, it manifests in patients aged 60–70 with risk factors for thromboembolism, mostly related to heart disease, atrial fibrillation in particular. We report a case of idiopathic segmental renal infarction in a 38-year-old patient, presenting with acute abdominal pain with no previous known history or risk factors for thromboembolic diseases. Because of its aspecific clinical presentation, this condition can mimic more frequent pathologies including pyelonephritis, nephrolithiasis, or as in our case appendicitis. Here we highlight the extremely ambiguous presentation of renal infarct and the importance for clinicians to be aware of this condition, particularly in patients without clear risk factors, as it usually has a good prognosis after appropriate anticoagulant therapy. PMID:28203466

  6. Renal infarction complicating fibromuscular dysplasia.

    Science.gov (United States)

    Gavalas, M; Meisner, R; Labropoulos, N; Gasparis, A; Tassiopoulos, A

    2014-01-01

    Fibromuscular dysplasia (FMD) is a nonatherosclerotic, noninflammatory vascular disease that most commonly affects the renal and extracranial carotid arteries. We present 3 cases of renal infarction complicating renal artery FMD in 42-, 43-, and 46-year-old females and provide a comprehensive review of the literature on this topic. In our patients, oral anticoagulation therapy was used to treat all cases of infarction, and percutaneous angioplasty was used nonemergently in one case to treat refractory hypertension. All patients remained stable at 1-year follow-up. This is consistent with outcomes in previously published reports where conservative medical management was comparable to surgical and interventional therapies. Demographic differences may also exist in patients with renal infarction and FMD. A higher prevalence of males and a younger age at presentation have been found in these patients when compared to the general population with FMD.

  7. Cerebral Infarction Arising from Takotsubo Cardiomyopathy: Case Report and Literature Review.

    Science.gov (United States)

    Otani, Yoshihiro; Tokunaga, Koji; Kawauchi, Satoshi; Inoue, Satoshi; Watanabe, Kyoichi; Kiriyama, Hideki; Sakane, Kosuke; Maekawa, Kiyoaki; Date, Isao; Matsumoto, Kengo

    2016-10-01

    Although most patients with takotsubo cardiomyopathy have a favorable outcome, complications are not uncommon. Recent studies have reported an increase in incidence of cardioembolic complications; however, the association between takotsubo cardiomyopathy and stroke, in particular thromboembolic cerebral infarction, remains unclear. We reported a 44-year-old woman who had a cerebral infarction resulting from takotsubo cardiomyopathy. She had felt chest discomfort a few days prior to infarction, and later developed left hemiparesis. Head magnetic resonance imaging (MRI) revealed acute infarction in the right insular cortex and occlusion of the right middle cerebral artery at the M2 segment. Echocardiogram revealed a takotsubo-like shape in the motion of the left ventricular wall, and coronary angiography showed neither coronary stenosis nor occlusion. Cerebral infarction resulting from takotsubo cardiomyopathy was diagnosed and treatment with anticoagulant was started. MRI on the eighth day after hospitalization showed recanalization of the right middle cerebral artery and no new ischemic lesions. The findings of the 19 previously published cases who had cerebral infarction resulting from takotsubo cardiomyopathy were also reviewed and showed the median interval between takotsubo cardiomyopathy and cerebral infarction was approximately 1 week and cardiac thrombus was detected in 9 of 19 patients. We revealed that thromboembolic events occurred later than other complications of takotsubo cardiomyopathy and longer observation might be required due to possible cardiogenic cerebral infarction. Anticoagulant therapy is recommended for patients with takotsubo cardiomyopathy with cardiac thrombus or a large area of akinetic left ventricle.

  8. Post-traumatic cerebellar infarction due to vertebral artery foramina fracture: case report

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    Moscote-Salazar Luis Rafael

    2016-03-01

    Full Text Available Posttraumatic cerebral infarction is an uncommon cause of morbidity and mortality and many studies have highlighted that trauma needs to considered as causative factor for cerebellar infarction. We present a case of cerebellar infarction in a 35 year old young patient secondary to vertebral fracture involving the vertebral foramen and vertebral artery injury. CT scan cervical spine showed C2-3 fracture on left side with fracture extending into the left vertebral foramen. A CT scan angiogram could not be performed because of poor neurological status. Possibly the infarction was due to left vertebral artery injury. Without surgical intervention prognosis of these patients remain poor. Prognosis of patients with traumatic cerebellar infarction depends on the neurological status of the patient, intrinsic parenchymal damage and more importantly extrinsic compression of the brainstem by the edematous cerebellar hemispheres.

  9. SIGNIFICANCE OF LIPID PROFILE ESTIMATION IN PATIENT WITH ACUTE MYOCARDIAL INFARCTION

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    Santhosh Kumar .N

    2013-06-01

    Full Text Available Acute myocardial infarction is one of the important reasons of death and unhealthiness in the world. The present study was undertaken to investigate the changes in serum lipids and lipoproteins in patients with acute myocardial infarction. The levels of lipid profile were significantly changed in the acute myocardial infarction patients. Acute myocardial infarction patients had significantly higher levels of total cholesterol, LDL-cholesterol, TG, Lipoprotein and lower level of HDL-cholesterol, as compared to the control subjects. We found a significant association of lipid profiles with acute myocardial infarction. Reduced serum HDL-cholesterol and increased Serum LDL, Serum TG, Lipoprotein (a, in our study subjects may be the effective reasonable lipid disorders in AMI patients.

  10. Orbital infarction in sickle cell disease.

    Science.gov (United States)

    Blank, J P; Gill, F M

    1981-06-01

    Bone infarction is a common occurrence in sickle cell disease. Described are three cases in which frontal headache, proptosis, and lid edema were seen with infarction of the orbital bone. Radionuclide scanning was useful in distinguished bone infarction from orbital infection in one case.

  11. Oxygen therapy for acute myocardial infarction.

    Science.gov (United States)

    Cabello, Juan B; Burls, Amanda; Emparanza, José I; Bayliss, Susan E; Quinn, Tom

    2016-12-19

    import data from Review Manager 5 and create 'Summary of findings' tables. The updated search yielded one new trial, for a total of five included studies involving 1173 participants, 32 of whom died. The pooled risk ratio (RR) of all-cause mortality in the intention-to-treat analysis was 0.99 (95% CI 0.50 to 1.95; 4 studies, N = 1123; I(2) = 46%; quality of evidence: very low) and 1.02 (95% CI 0.52 to 1.98; 4 studies, N = 871; I(2) = 49%; quality of evidence: very low) when only analysing participants with confirmed AMI. One trial measured pain directly, and two others measured it by opiate usage. The trial showed no effect, with a pooled RR of 0.97 for the use of opiates (95% CI 0.78 to 1.20; 2 studies, N = 250). The result on mortality and pain are inconclusive. There is no clear effect for oxygen on infarct size (the evidence is inconsistent and low quality). There is no evidence from randomised controlled trials to support the routine use of inhaled oxygen in people with AMI, and we cannot rule out a harmful effect. Given the uncertainty surrounding the effect of oxygen therapy on all-cause mortality and on other outcomes critical for clinical decision, well-conducted, high quality randomised controlled trials are urgently required to inform guidelines in order to give definitive recommendations about the routine use of oxygen in AMI.

  12. Renal infarction secondary to ketamine abuse.

    Science.gov (United States)

    Chen, Chin-Li; Chen, Jin-Li; Cha, Tai-Lung; Wu, Sheng-Tang; Tang, Shou-Hung; Tsao, Chih-Wei; Meng, En

    2013-07-01

    Renal infarction is an uncommon condition that resulted from inadequate perfusion of the kidney and is easily missed diagnosed due to its nonspecific clinical presentations. Major risk factors for renal infarction are atrial fibrillation, previous embolism, and ischemic and valvular heart disease. Progressive decrease in renal function or even death can occur if renal infarction is not diagnosed accurately and promptly. Ketamine abuse may cause variable urinary tract injury. However, renal infarction caused by ketamine abuse has never been reported. To our knowledge, this is the first documented case of renal infarction following nasal insufflation of ketamine.

  13. Neonatal Myocardial Infarction or Myocarditis?

    NARCIS (Netherlands)

    de Vetten, Leanne; Bergman, Klasien A.; Elzenga, Nynke J.; van Melle, Joost P.; Timmer, Albertus; Bartelds, Beatrijs

    2011-01-01

    We report a 29 week-gestation preterm infant who presented during his second week of life with cardiogenic shock. Clinical presentation and first diagnostics suggested myocardial infarction, but echocardiographic features during follow-up pointed to a diagnosis of enteroviral myocarditis. The child

  14. Spousal Adjustment to Myocardial Infarction.

    Science.gov (United States)

    Ziglar, Elisa J.

    This paper reviews the literature on the stresses and coping strategies of spouses of patients with myocardial infarction (MI). It attempts to identify specific problem areas of adjustment for the spouse and to explore the effects of spousal adjustment on patient recovery. Chapter one provides an overview of the importance in examining the…

  15. Pregnancy-related myocardial infarction

    NARCIS (Netherlands)

    Lameijer, H.; Lont, M. C.; Buter, H.; van Boven, A. J.; Boonstra, P. W.; Pieper, P. G.

    Introduction The risk of acute myocardial infarction in young women is low, but increases during pregnancy due to the physiological changes in pregnancy, including hypercoagulability. Ischaemic heart disease during pregnancy is not only associated with increased maternal morbidity and mortality, but

  16. A plant-derived remedy for repair of infarcted heart.

    Directory of Open Access Journals (Sweden)

    Lei Cheng

    Full Text Available BACKGROUND: Myocardial infarction (MI due to coronary artery disease remains one of the leading causes of premature death. Replacement of infarcted heart tissue with regenerating myocardium from endogenous progenitor pools or exogenously introduced stem cells remains a therapeutic ideal. Their impracticality mainly lies in their low efficiency in cardiogenic differentiation (CD. Our recent studies with an acute MI animal model have already demonstrated the therapeutic effect of the MeOH extract of Geum japonicum (EGJ, providing clear evidence of myocardial regeneration. METHODS AND FINDINGS: The present study further isolated the active component contained in EGJ using bioassay-guided isolation and investigated its efficacy in the treatment of infarcted heart in animal MI models. We demonstrated that substantial repair of infarcted heart in animal MI models by EGJ can be mimicked by the isolated candidate compound (cardiogenin in MI animal models. Clear evidence of newly regenerated endogenous mesenchymal stem cells (MSCs derived cardiomyocytes was observed throughout the infarct zone, accompanied by significantly improved functional performance of the heart. Transplantation of MSCs pretreated with EGJ or cardiogenin into a MI animal model also resulted in substantial regeneration of functional myocardium, implying that the activated MSCs carry all the necessary blueprints for myocardial regeneration. Signaling pathways specific to cell survival, CD identified in embryonic heart induction and angiogenesis were activated in both cardiogenin-treated MSCs and cardiogenin-induced regenerating myocardium. CONCLUSIONS: This study has demonstrated the therapeutic effects of cardiogenin in infarcted heart repair, and identified the associated signalling pathways for effective cardiogenic differentiation of MSCs, cell survival and angiogenesis. These findings should enable new treatment strategies for MI to be developed immediately.

  17. The management of impending myocardial infarction using coronary artery by-pass grafting and an intra-aortic balloon pump.

    Science.gov (United States)

    Harris, P L; Woollard, K; Bartoli, A; Makey, A R

    1980-01-01

    Of 33 patients with impending myocardial infarction 25 were treated using a combination of coronary artery by-pass grafting and intra-aortic balloon pumping. Eight patients were treated with coronary artery by-pass grafting alone. Twenty-two of the 25 patients who were treated with the combined technique made a full recovery. Three patients sustained definite myocardial infarctions and one of these died. Five of the 8 patients treated by grafting alone suffered infarction and of these 3 died. The value of intra-aortic balloon pumping in combination with coronary artery by-pass grafting in the management of impending myocardial infarction is discussed.

  18. Acute inferior myocardial infarction with right ventricular infarction is more prone to develop cardiogenic shock.

    Science.gov (United States)

    Bari, M A; Roy, A K; Islam, M Z; Aditya, G; Bhuiyan, A S

    2015-01-01

    Cardiogenic shock is rare in isolated acute inferior myocardial infarction but there is relationship of cardiogenic shock with inferior myocardial infarction if associated with right ventricular infarction. A prospective study was carried out to see the association of cardiogenic shock with inferior myocardial infarction if associated with right ventricular infarction. This study was conducted from January 2011 to November 2011. A total of 100 cases were selected as study population which was taken from the Department of Cardiology, Mymensingh Medical College Hospital, Mymensingh, Bangladesh. Among them 50 were in Group A and 50 were in Group B. Group A was the patients of acute myocardial infarction with right ventricular infarction. Group B was the patients of acute myocardial infarction without right ventricular infarction. It revealed that 9(18%) in Group A and 3(6%) in Group B developed cardiogenic shock which is statistically significant (pcardiogenic shock.

  19. AN INTERESTING CASE OF DIABETIC MUSCLE INFARCTION

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    Srichandhanreddy

    2014-08-01

    Full Text Available Diabetic muscle infarction is rare complications of diabetes that occurs in patients with type 1 diabetes (70% of total cases or in patients with poorly controlled type 2 diabetes. Here is a 55 year old male patient was admitted with diabetic ketoacidosis and coma. Two days later following recovery he gave history of pain in the right thigh since 10 days. There was no history of trauma, fever, weight loss. On examination vitals are stable, systemic examination: clinically normal. Examination of right thigh lower one third, showed a tender mass of about 3.4 x8.2 cms, FNAC of which showed muscle fibres with hemorrhagic back ground. MRI scan suggesting of myositis involving vastus group of muscles. This patient had normal renal functions and normal fundus. This patient responded to conservative management and antibiotics. CONCLUSION: A high index of suspicion is needed to make a timely diagnosis of diabetic muscle Infarction, and avoid the use of steroids or surgical intervention.

  20. Medical image of the week: splenic infarction

    Directory of Open Access Journals (Sweden)

    Casey DJ

    2016-08-01

    Full Text Available No abstract available. Article truncated after 150 words. A 52-year-old Hispanic woman with a past medical history significant for Type 1 Diabetes Mellitus, hypertension, and rheumatoid arthritis presented with left upper quadrant pain for one day. Her review of systems was positive for bloating, severe epigastric and left upper quadrant tenderness that radiated to the back and left shoulder, nausea with non-bilious emesis, and diarrhea for one day prior to admission. Physical exam only revealed epigastric and left upper quadrant tenderness to light palpation without rebound or guarding. Abdominal computed tomography of the abdomen demonstrated a new acute or subacute splenic infarct with no clear evidence of an embolic source in the abdomen or pelvis (Figure 1. Echocardiogram with bubble study and contrast did not demonstrate valve abnormalities, cardiac mass, vegetation, valve or wall motion abnormalities and no evidence of patent foramen ovale. Splenic infarction should be suspected when patients present with sharp, acute left upper quadrant pain ...

  1. Full tree harvesting update

    Energy Technology Data Exchange (ETDEWEB)

    Kelly, K.; White, K.

    1981-03-01

    An important harvesting alternative in North America is the Full Tree Method, in which trees are felled and transported to roadside, intermediate or primary landings with limbs and branches intact. The acceptance of Full Tree Systems is due to many factors including: labour productivity and increased demands on the forest for ''new products''. These conditions are shaping the future look for forest Harvesting Systems, but must not be the sole determinants. All harvesting implications, such as those affecting Productivity and silviculture, should be thoroughly understood. This paper does not try to discuss every implication, nor any particular one in depth; its purpose is to highlight those areas requiring consideration and to review several current North American Full Tree Systems. (Refs. 5).

  2. Association between exposure to environmental tobacco smoke and biomarkers of oxidative stress among patients hospitalised with acute myocardial infarction.

    Directory of Open Access Journals (Sweden)

    Ian L Megson

    Full Text Available OBJECTIVE: To determine whether exposure to environmental tobacco smoke was associated with oxidative stress among patients hospitalised for acute myocardial infarction. DESIGN: An existing cohort study of 1,261 patients hospitalised for acute myocardial infarction. SETTING: Nine acute hospitals in Scotland. PARTICIPANTS: Sixty never smokers who had been exposed to environmental tobacco smoke (admission serum cotinine ≥3.0 ng/mL were compared with 60 never smokers who had not (admission serum cotinine ≤0.1 ng/mL. INTERVENTION: None. MAIN OUTCOME MEASURES: Three biomarkers of oxidative stress (protein carbonyl, malondialdehyde (MDA and oxidised low-density lipoprotein (ox-LDL were measured on admission blood samples and adjusted for potential confounders. RESULTS: After adjusting for baseline differences in age, sex and socioeconomic status, exposure to environmental tobacco smoke was associated with serum concentrations of both protein carbonyl (beta coefficient 7.96, 95% CI 0.76, 15.17, p = 0.031 and MDA (beta coefficient 10.57, 95% CI 4.32, 16.81, p = 0.001 but not ox-LDL (beta coefficient 2.14, 95% CI -8.94, 13.21, p = 0.703. CONCLUSIONS: Exposure to environmental tobacco smoke was associated with increased oxidative stress. Further studies are requires to explore the role of oxidative stress in the association between environmental tobacco smoke and myocardial infarction.

  3. Apolipoprotein D is elevated in oligodendrocytes in the peri-infarct region after experimental stroke

    DEFF Research Database (Denmark)

    Rickhag, Karl Mattias; Deierborg, Tomas; Patel, Shutish

    2008-01-01

    Injury to the brain (e.g., stroke) results in a disruption of neuronal connectivity and loss of fundamental sensori-motor functions. The subsequent recovery of certain functions involves structural rearrangements in areas adjacent to the infarct. This remodeling of the injured brain requires...... experimental stroke in the rat brain. In the core of the brain infarct, apoD immunoreactivity but not mRNA increased in dying pyramidal neurons, indicative of cellular redistribution of lipids. During 2 to 7 days of recovery after stroke, the apoD levels increased in the peri-infarct and white matter areas...

  4. Interrater reliability of a national acute myocardial infarction register

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    Govatsmark RES

    2016-08-01

    Full Text Available Ragna Elise Støre Govatsmark,1,2 Sylvi Sneeggen,2 Hanne Karlsaune,2 Stig Arild Slørdahl,2 Kaare Harald Bønaa,1–3 1Department of Public Health and General Practice, Norwegian University of Science and Technology, 2Department of Medical Quality Registries, 3Clinic for Heart Disease, St. Olav’s University Hospital, Trondheim, Norway Background: Disease-specific registers may be used for measuring and improving healthcare and patient outcomes, and for disease surveillance and research, provided they contain valid and reliable data. The aim of this study was to assess the interrater reliability of all variables in a national myocardial infarction register.Methods: We randomly selected 280 patients who had been enrolled from 14 hospitals to the Norwegian Myocardial Infarction Register during the year 2013. Experienced audit nurses, who were blinded to the data about the 280 patients already in the register, completed the Norwegian Myocardial Infarction paper forms for 240 patients by review of medical records. We then extracted all registered data on the same patients from the Norwegian Myocardial Infarction Register. To compare the interrater reliability between the register and the audit nurses, we calculated intraclass correlations coefficient for continuous variables, Cohen’s kappa and Gwet’s first agreement coefficient (AC1 for nominal variables, and quadratic weighted Cohen’s kappa and Gwet’s second AC for ordinal variables.Results: We found excellent (AC1 >0.80 or good (AC1 0.61–0.80 agreement for most variables, including date and time variables, medical history, investigations and treatments during hospitalization, medication at discharge, and ST-segment elevation or non-ST-segment elevation acute myocardial infarction. However, only moderate agreement (AC1 0.41–0.60 was found for family history of coronary heart disease, diagnostic electrocardiography, and complications during hospitalization, whereas fair agreement (AC1

  5. Spontaneous Splenic Infarcts in a Cirrhotic Patient with Primary Biliary Cirrhosis

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    Fredy Nehme

    2017-01-01

    Full Text Available Spontaneous splenic infarction has been rarely reported as a complication of cirrhosis and portal hypertension. We describe the case of a 67-year-old female with past medical history of primary biliary cirrhosis presenting for a 1-day history of left upper quadrant pain. Investigations were in favor of splenic infarcts secondary to portal hypertension. The patient improved with conservative management and no recurrence was noted on further follow-up. Splenic infarction must be kept in mind when a patient with cirrhosis presents with left upper quadrant abdominal pain without a clear source.

  6. Effects of donepezil on behavioural manifestations of thalamic infarction: a single case observation

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    Rodrigo eRiveros

    2011-03-01

    Full Text Available Objective: To examine the effect of donepezil for the treatment of cognitive and behavioural disorders associated with thalamic lesions in a 45 years old male who suffered an infarct in the left thalamus. Background: Recent studies suggest that donepezil may improve executive functions impairments due to subcortical ischemic lesionsMethod: The crossover effects of donepezil were analyzed in a single case of thalamic infarction with cognitive and behavioural alterations. Results: Significant behavioural modifications related to improved performances in executive functions were observed with the treatment. Conclusions: The results suggest that donepezil may have significant effect on executive functions that can alter behavioural outcomes after thalamic infarctions

  7. Stepwise optimization of the procedure for assessment of circulating progenitor cells in patients with myocardial infarction.

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    Yu-Xin Cui

    Full Text Available BACKGROUND: The number and functional activity of circulating progenitor cells (CPCs is altered in diabetic patients. Furthermore, reduced CPC count has been shown to independently predict cardiovascular events. Validation of CPCs as a biomarker for cardiovascular risk stratification requires rigorous methodology. Before a standard operation protocol (SOP can be designed for such a trial, a variety of technical issues have to be addressed fundamentally, which include the appropriate type of red blood cell lysis buffer, FMO or isotype controls to identify rare cell populations from background noise, optimal antibody dilutions and conditions of sample storage. We herein propose improvements in critical steps of CPC isolation, antigenic characterization and determination of functional competence for final application in a prospective investigation of CPCs as a biomarker of outcome following acute myocardial infarction. METHODS AND FINDINGS: In this validation study, we refined the standard operating procedure (SOP for flow cytometry characterisation and functional analysis of CPCs from the first 18 patients of the Progenitor Cell Response after Myocardial Infarction Study (ProMIS. ProMIS aims to verify the prognostic value of CPCs in patients with either ST elevation or non-ST elevation myocardial infarction with or without diabetes mellitus, using cardiac magnetic resonance imaging (MRI for assessment of ventricular function as a primary endpoint. Results indicate crucial steps for SOP implementation, namely timely cell isolation after sampling, use of appropriate lysis buffer to separate blood cell types and minimize the acquisition events during flow cytometry, adoption of proper fluorophore combination and antibody titration for multiple antigenic detection and introduction of counting beads for precise quantification of functional CPC activity in migration assay. CONCLUSION AND SIGNIFICANCE: With systematic specification of factors influencing

  8. Experiences with surgical treatment of ventricle septal defect as a post infarction complication

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    Stich Kathrin

    2009-01-01

    Full Text Available Abstract Background Complications of acute myocardial infarction (AMI with mechanical defects are associated with poor prognosis. Surgical intervention is indicated for a majority of these patients. The goal of surgical intervention is to improve the systolic cardiac function and to achieve a hemodynamic stability. In this present study we reviewed the outcome of patients with post infarction ventricular septal defect (PVSD who underwent cardiac surgery. Methods We analysed retrospectively the hospital records of 41 patients, whose ages range from 48 to 81, and underwent a surgical treatment between 1990 and 2005 because of PVSD. Results In 22 patients concomitant coronary artery bypass grafting (CAGB was performed. In 15 patients a residual shunt was found, this required re-op in seven of them. The time interval from infarct to rupture was 8.7 days and from rupture to surgery was 23.1 days. Hospital mortality in PVSD group was 32%. The mortality of urgent repair within 3 days of intractable cardiogenic shock was 100%. The mortality of patients with an anterior VSD and a posterior VSD was 29.6% vs 42.8%, respectively. All patients who underwent the surgical repair later than day 36 survived. Conclusion Surgical intervention is indicated for a majority of patients with mechanical complications. Cardiogenic shock remains the most important factor that affects the early results. The surgical repair of PVSD should be performed 4–5 weeks after AMI. To improve surgical outcome and hemodynamics the choice of surgical technique and surgical timing as well as preoperative management should be tailored for each patient individually.

  9. Moringa Oleifera Lam Mitigates Oxidative Damage and Brain Infarct Volume in Focal Cerebral Ischemia

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    Woranan Kirisattayakul

    2012-01-01

    Full Text Available Problem statement: At present, the therapeutic outcome of cerebral ischemia is still not in the satisfaction level. Therefore, the preventive strategy is considered. Based on the protective effect against oxidative damage of Moringa oleifera Lam. Leaves extract, we hypothesized that this plant extract might protect against cerebral ischemia, one of the challenge problems nowadays. In order to test this hypothesis, we aimed to determine the protective effect of M.oleifera leaves extract in animal model of focal cerebral ischemia induced by permanent occlusion of right middle cerebral artery. Approach: Male Wistar rats, weighing 300-350 g, were orally given the extract once daily at doses of 100, 200 and 400 mg kg-1 BW at a period of 2 weeks, then, they were permanently occluded the right Middle Cerebral Artery (MCAO. The animals were assessed the cerebral infarction volume and oxidative damage markers including MDA level and the activities of SOD, CAT and GSHPx enzymes at 24 h after occlusion. Results: Rats subjected to M.oleifera extract at all doses used in this study significantly decreased brain infarct volume both at cortical and subcortical structures in accompany with the elevation of SOD activity in both hippocampus and striatum while only the rats exposed to the extract at doses of 100 and 400 mg kg-1 BW showed the increased GSHPx activity in hippocampus. No the changes were observed. Therefore, our results demonstrates the potential benefit of M.oleifera leaves to decrease oxidative stress damage and brain infarct volume. Conclusion: This study is the first study to demonstrate the neuroprotective effect against focal cerebral ischemia of M.oleifera leaves. It suggests that M.oleifera may be served as natural resource for developing neuroprotectant against focal cerebral ischemia. However, the precise underlying mechanism and possible active ingredient are still required further study.

  10. Comparison between primary angioplasty and thrombolytic therapy on erectile dysfunction after acute ST elevation myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    Ramazan Akdemir; Ekrem Yeter; (O)zlem Karakurt; Salih Orcan; Nihat Karakoyunlu; Mustafa Mucahit Balci; Levent Sa(g)nak; Hamit Ersoy; Mehmet Bulent Vatan; Harun Kilic

    2012-01-01

    Acute ST elevation myocarclial infarction has high mortality and morbidity rates.The majority of patients with this condition face erectile dysfunction in addition to other health problems,In this study,we aimed to investigate the effects of two different reperfusion strategies,primary angioplasty and thrombolytic therapy,on the prevalence of erectile dysfunction after acute myocardial infarction.Of the 71 patients matching the selection criteria,45 were treated with primary coronary angioplasty with stenting,and 26 were treated with thrombolytic agents.Erectile function was evaluated using the International Index of Erectile Function in the hospital to characterize each patient's sexual function before the acute myocardial infarction and 6 months after the event.The time required to restore blood flow to the artery affected by the infarct was found to be associated with the occurrence of erectile dysfunction after acute myocardial infarction.The increase in the prevalence of erectile dysfunction after acute myocardial infarction was 44.4% in the angioplasty group and 76.9% in the thrombolytic therapy group (P=0.008).In conclusion,this study has shown that reducing the time of reperfusion decreases the erectile dysfunction prevalence,and primary angioplasty is superior to thrombolytic therapy for decreasing the prevalence of erectile dysfunction after acute myocardial infarction.

  11. Strategies for recruitment of stem cells to treat myocardial infarction.

    Science.gov (United States)

    Shafiq, Muhammad; Lee, Sang-Hoon; Jung, Youngmee; Kim, Soo Hyun

    2015-01-01

    Heart failure is one of the most prominent causes of morbidity and mortality worldwide. According to the World Health Organization, coronary artery disease and myocardial infarction (MI) are responsible for 29% of deaths worldwide. MI results in obstruction of the blood supply to the heart and scar formation, and causes substantial death of cardiomyocytes in the infarct zone followed by an inflammatory response. Current treatment methodologies of MI and heart failure include organ transplantation, coronary artery bypass grafting, ventricular remodeling, cardiomyoplasty, and cellular therapy. Each of these methodologies has associated risks and benefits. Cellular cardiomyoplasty is a viable option to decrease the fibrosis of infarct scars, adverse post-ischemic remodeling, and improve heart function. However, the low rate of cell survival, shortage of cell sources and donors, tumorigenesis, and ethical issues hamper full exploitation of cell therapy for MI treatment. Consequently, the mobilization and recruitment of endogenous stem/progenitor cells from bone marrow, peripheral circulation, and cardiac tissues has immense potential through harnessing the host's own reparative capacities that result from interplay among cytokines, chemokines, and adhesion molecules. Therapeutic treatments to enhance the mobilization and homing of stem cells are under development. In this review, we present state-of-the-art approaches that are being pursued for stem cell mobilization and recruitment to regenerate infarcted myocardium. Potential therapeutic interventions and delivery strategies are discussed in detail.

  12. Cytopathologic Diagnosis of Spontaneous Infarction of Fibroadenoma of the Breast

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    Neelam WADHWA

    2014-09-01

    Full Text Available Infarction is an uncommon event in a fibroadenoma, which is the commonest benign tumor of the breast. Most often it occurs in pregnancy, lactation or is secondary to fine needle aspiration. Spontaneous infarction of a fibroadenoma in the absence of a predisposing condition is very rare. The cytopathologic features of infarction are necrosis and worrisome nuclear features, which are often misinterpreted as either inflammation or malignancy. We detail a report of accurate cytopathologic diagnosis of spontaneous infarction of fibroadenoma in a 17-year-old adolescent non pregnant girl. Careful attention to the cytopathologic clues like uniform thickness of the necrotic epithelial fragments, branching pattern reminiscent of the staghorn pattern despite atypical nuclear features and clinical details like young age of the patient and recent onset pain in a pre-existing lump helped arrive at the correct diagnosis and spared the patient of a radical excision. To the best of our knowledge, there are no earlier reports of correct cytopathologic diagnosis.

  13. Association of Mycoplasma pneumoniae Infection with Myocardial Infarction

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    Abdolreza Sotoodeh Jahromy

    2009-01-01

    Full Text Available Problem statement: In addition to the major risk factors for atherosclerosis such as high plasma level of low density lipoprotein, low plasma level of high density lipoprotein, cigarette smoking, hypertension and diabetes mellitus, some studies introduce other agents such as Mycoplasma pneumoniae as risk factors for atherodclerosis and coronary artery diseases. Aim of this study was to clarify the risk of Mycoplasma pneumoniae for myocardial infarction in Iranian population. Approach: This was a case-control study, in which 90 patients studied. (March 2005-2007. First group (or case group include 45 units who had been admitted in hospital with diagnosis of myocardial infarction and second group include 45 units, who were healthy individuals without any positive history of ischemic heart disease. IgG antibodies was assessed by ELISA technique in both groups. Results: There was significant statistic difference in antimycoplasma antibody level. In the groups (p = 0.028 and the relative risk of mycoplasma infection for myocardial infarction estimated to be 2.7. Conclusion: Mycoplasma pneumoniae infection seems to be a risk factor for myocardial infarctin, in Iranian population. It is better to design other studies to evaluate the risk of coinfection of Mycoplasma pneumoniae and Chlamydia pneumoniae and also the risk of these infection plus conventional risk factors for myocardial infarction in this country.

  14. Myocardial infarction in young adults

    OpenAIRE

    Egred, M; Viswanathan, G; Davis, G.

    2005-01-01

    Although myocardial infarction (MI) mainly occurs in patients older than 45, young men or women can suffer MI. Fortunately, its incidence is not common in patients younger than 45 years. However, the disease carries a significant morbidity, psychological effects, and financial constraints for the person and the family when it occurs at a young age. The causes of MI among patients aged less than 45 can be divided into four groups: (1) atheromatous coronary artery disease; (2) non-atheromatous ...

  15. 朱氏头皮针留针配合肢体训练对急性脑梗死后痉挛性瘫痪神经功能缺损的影响%Effect on the Neurological Deficits of Spastic Hemiplegia after Acute Cerebral Infarction Exerted by the Practice of Zhu Scalp Acupuncture (needle retention required) Coordinated with Limbs Training

    Institute of Scientific and Technical Information of China (English)

    王京军; 金章安; 梁頔; 崔译心

    2013-01-01

    Objective: To observe the effect of the neurological deficits of spastic hemiplegia after acute cerebral infarction treated by the practice of Zhu scalp acupuncture (needle retention required) coordinated with limbs training. Methods: 72 patients were randomly divided into the trial group and the control group. Each group was administered basic treatment for the sake of stable blood pressure and the protection of cerebral cells. Meanwhile, the 2 groups were provided with intravenous injection of Shuxietong Injection,6 ml every time,once a day. Moreover, the trial group was given additional Zhu scalp acupunctural treatment once a day together with limbs training over 4 courses of treatment (5 days for each course,2 days interval). Results: It was revealed that the trial group demonstrated greater effectiveness in relieving muscle tension and stimulating the recovery of neurological deficits. Conclusion: The practice of Zhu scalp acupuncture (needle retention required ), coordinated with limbs training, at the early stage of spastic hemiplegia after acute cerebral infarction, improves hypermyotonia and the recovery of neurological deficits, as well as reduces the incidence of spastic hemiplegia.%目的 观察应用朱氏头皮针留针配合肢体训练对急性脑梗死后痉挛性瘫痪神经功能缺损的影响.方法 将72例患者随机分为治疗组和对照组,两组均给予稳定血压、脑细胞保护剂等基础治疗,并同时给予疏血通注射液6 mL静脉点滴,治疗组加用朱氏头皮针疗法和肢体功能训练,每日1次,疗程5d,间隔2d,继续第2疗程,共治疗4个疗程.结果 研究结果显示治疗组肌张力减轻和神经功能缺损恢复疗效均优于对照组.结论 急性脑梗死后痉挛性瘫痪早期进行朱氏头皮针留针配合肢体训练治疗可以缓解肌张力增高,促进神经功能缺损恢复,降低痉挛性瘫痪发生率.

  16. Psychotic Symptoms Associated with Left Caudate Infarction

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    Ying-Chih Cheng

    2015-09-01

    Full Text Available Psychotic symptoms following acquired brain lesion are relatively rare, and thus, the specific association linking such symptoms to the distinct brain structure remains unclear. The frontal–subcortical circuits are thought to modulate motor activity and human behavior, and have been reported to be associated with many neuropsychiatric symptoms. We herein report the case of a 77-year-old man without previous psychiatric disorder who developed a new onset of psychotic symptoms following left caudate infarction. The presented case supports the fact that psychosis might arise from alteration of the distinct brain structure. The functional impairment of the frontal–subcortical circuits may be a critical factor linking the pathogenesis of psychosis associated with acquired brain lesion.

  17. Segmental testicular infarction following cysto-prostatectomy

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    Adam I Alleemudder

    2011-01-01

    Full Text Available Segmental (partial testicular infarction is a very rare condition of unknown cause in more than 70% of cases. Several predisposing conditions have been described, but to our knowledge, this is the first documented case and often overlooked complication occurring as a result of cysto-prostatectomy. It usually presents in an acute manner resembling testicular torsion or epididymo-orchitis and is confirmed using ultrasonography. In some cases, it may present insidiously with no pain and may be confused with a testicular tumor due to the hypo-echoic features on imaging. In unclear situations, Doppler sonography shows vascularity and a magnetic resonance scan can be useful to distinguish between the two conditions.

  18. Mortality rate in type 2 myocardial infarction

    DEFF Research Database (Denmark)

    Saaby, Lotte; Poulsen, Tina Svenstrup; Diederichsen, Axel Cosmus Pyndt

    2014-01-01

    , all hospitalized patients having cardiac troponin I measured were considered. The diagnosis of a myocardial infarction was according to the universal definition, and specified criteria were used in the classification of type 2 myocardial infarction. Follow-up was at least 1 year, with mortality......BACKGROUND: The classification of myocardial infarction into 5 types was introduced in 2007. The prognostic impact of this universal definition, with particular focus on type 2 myocardial infarction, has not been studied prospectively in unselected hospital patients. METHODS: During a 1-year period...... as the end point. RESULTS: A total of 3762 consecutive patients were studied, of whom 488 (13%) had a myocardial infarction. In 119 patients a type 2 myocardial infarction was diagnosed. After a median of 2.1 years (interquartile range, 1.6-2.5 years), 150 patients had died, with a mortality rate of 49% (58...

  19. Chronic non-transmural infarction has a delayed recovery of function following revascularization

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    Palmer John

    2010-01-01

    Full Text Available Abstract Background The time course of regional functional recovery following revascularization with regards to the presence or absence of infarction is poorly known. We studied the effect of the presence of chronic non-transmural infarction on the time course of recovery of myocardial perfusion and function after elective revascularization. Methods Eighteen patients (mean age 69, range 52-84, 17 men prospectively underwent cine magnetic resonance imaging (MRI, delayed contrast enhanced MRI and rest/stress 99m-Tc-tetrofosmin single photon emission computed tomography (SPECT before, one and six months after elective coronary artery bypass grafting (CABG or percutaneous coronary intervention (PCI. Results Dysfunctional myocardial segments (n = 337/864, 39% were classified according to the presence (n = 164 or absence (n = 173 of infarction. Infarct transmurality in dysfunctional segments was largely non-transmural (transmurality = 31 ± 22%. Quantitative stress perfusion and wall thickening increased at one month in dysfunctional segments without infarction (p Conclusions Dysfunctional segments without infarction represent repetitively stunned or hibernating myocardium, and these segments improved both perfusion and function within one month after revascularization with no improvement thereafter. Although dysfunctional segments with non-transmural infarction improved in perfusion at one month, functional recovery was mostly seen between one and six months, possibly reflecting a more severe ischemic burden. These findings may be of value in the clinical assessment of regional functional recovery in the time period after revascularization.

  20. Persistent Aura with Small Occipital Cortical Infarction: Implications for Migraine Pathophysiology

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    Sam Thissen

    2014-08-01

    Full Text Available Objective: The pathophysiology of migraine with aura is thought to be related to cortical spreading depression and cortical hypersensitivity, in which inhibitory interneurons may play a role. Persistent migraine aura (PMA without infarction is defined as auras that last longer than 1 week in the absence of infarction. We describe a case of persistent aura with a small occipital cortical infarction and discuss implications of this case and PMA for pathophysiological concepts of migrainous auras. Methods: We present a case and discuss the implications for pathophysiological concepts. Results: The case presented cannot be diagnosed as PMA as the patient was found to have an occipital cortical infarction with hypoactivity on fluorodeoxyglucose-positron emission tomography. Nevertheless, the patient suffered from persistent aura (with infarction. We argue that the infarction may have been responsible for an increased imbalance in one of the primary visual cortex networks that was already hyperexcitable due to the migraine aura condition. Conclusion: PMA with occipital infarction has not been reported previously. We believe the findings of the present case and PMA cases reported in the past may support the intracortical disinhibition hypothesis in migraine.

  1. Acute Myocardial Infarction: The First Manifestation of Ischemic Heart Disease and Relation to Risk Factors

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    Manfroi Waldomiro Carlos

    2002-01-01

    Full Text Available OBJECTIVE: To assess the association between cardiovascular risk factors and acute myocardial infarction as the first manifestation of ischemic heart disease, correlating them with coronary angiographic findings. METHODS: We carried out a cross-sectional study of 104 patients with previous acute myocardial infarction, who were divided into 2 groups according to the presence or absence of angina prior to acute myocardial infarction. We assessed the presence of angina preceding acute myocardial infarction and risk factors, such as age >55 years, male sex, smoking, systemic arterial hypertension, lipid profile, diabetes mellitus, obesity, sedentary lifestyle, and familial history of ischemic heart disease. On coronary angiography, the severity of coronary heart disease and presence of left ventricular hypertrophy were assessed. RESULTS: Of the 104 patients studied, 72.1% were males, 90.4% were white, 73.1% were older than 55 years, and 53.8% were hypertensive. Acute myocardial infarction was the first manifestation of ischemic heart disease in 49% of the patients. The associated risk factors were systemic arterial hypertension (RR=0.19; 95% CI=0.06-0.59; P=0.04 and left ventricular hypertrophy (RR=0.27; 95% CI=0,.8-0.88; P=0.03. The remaining risk factors were not statistically significant. CONCLUSION: Prevalence of acute myocardial infarction as the first manifestation of ischemic heart disease is high, approximately 50%. Hypertensive individuals more frequently have symptoms preceding acute myocardial infarction, probably due to ventricular hypertrophy associated with high blood pressure levels.

  2. THE SPEKL-TREKING PREDICTIVE VALUE OF THE ECHOCARDIOGRAPHY AT THE ACUTE MYOCARDIAL INFARCTION

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    N. A. Kosheleva

    2016-01-01

    Full Text Available Speckle-tracking echocardiography is a non-invasive method  for assessment of myocardial deformation, which is closely associated with its regional and global function. Although it is not yet introduced into clinical practice, deformation parameters are actively studied in different clinical conditions, particularly in acute myocardial infarction. Numerous studies show deformation  impairment may have important prognostic value at patients with a acute myocardial infarction.

  3. Behavioral Disorders in Association with Posterior Callosal and Frontal Cerebral Infarction

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    J. P. Lejeune

    1993-01-01

    Full Text Available Behavioral disorders were a prominent clinical feature after the surgical treatment of an anterior communicating artery aneurysm rupture in a 44-year-old man. Callosal apraxia was associated with an alien hand. The latter remained 1 year after surgery while diagonistic apraxia disappeared after 3 months. Other callosal signs included left agraphia, tactile anomia and auditory suppression. MRI revealed posterior callosal infarction and a right frontal infarct. The association of diagonistic apraxia and alien hand is rarely reported.

  4. Acute Brucellosis with Splenic Infarcts: A Case Report from a Tertiary Care Hospital in Saudi Arabia

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    Mishal Alyousef

    2015-01-01

    Full Text Available Splenic infarction is an extremely rare and unique presentation of brucellosis. Only few cases have been reported worldwide. We here report a case of a young man, presenting with acute onset of fever, left hypochondial pain, and vomiting. Further evaluation revealed multiple splenic infarcts and positive blood culture for brucellosis despite negative transesophageal echocardiography for endocarditis. Significant improvement in clinical symptoms and splenic lesions was achieved after six weeks of combination therapy against brucellosis.

  5. Impact of reperfusion therapy and infarct localization on frequency of premature ventricular beats in acute myocardial infarction

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    Davor Horvat

    2015-08-01

    Full Text Available Aim To determine the impact of infarct localization and types of reperfusion therapy on the frequency of ventricular premature beats (VPBs in patients with acute myocardial infarction (AMI and reduced left ventricular ejection fraction (LVEF. Methods A total of 705 patients with acute ST elevation myocardial infarction (STEMI were divided according to the infarct localization (anteroseptal, anterolateral, inferior and posterior and reperfusion therapy (fibrinolysis or percutaneous coronary intervention with stenting into two groups: LVEF45% was a control group. The occurrence of VPBs10 per hour defined as a significant. Results In patients with fibrinolysis therapy and LVEF<45% significant number of VPBs were in anteroseptal (p=0.017, anterolateral (p<0.001 and posterior AMI (p<0.001, but in patients with percutaneous coronary intervention (PCI and LVEF<45% significant number of VPBs were only in anteroseptal AMI (p=0.001 localization. Conclusion In patients with reduced ejection fraction in AMI, treatment with PCI method has a better antiarrhythmic effect compared to fibrinolysis treatment.

  6. Visual localisation in patients with occipital infarction.

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    Ross Russell, R W; Bharucha, N

    1984-01-01

    Visually directed pointing has been examined in a group of patients with occipital lobe infarction and in an age-matched control group. The visual field ipsilateral to the infarct showed normal localisation; there was no evidence that right sided infarction produced a bilateral disturbance. In quadrantanopia the spared quadrant on the affected side showed abnormal localisation in a few patients but this was not consistently associated with right or left sided defects. The majority of patients...

  7. A minimally invasive method for induction of myocardial infarction in an animal model using tungsten spirals.

    Science.gov (United States)

    Peukert, Daniel; Laule, Michael; Kaufels, Nicola; Schnorr, Jörg; Taupitz, Matthias; Hamm, Bernd; Dewey, Marc

    2009-06-01

    Most animal models use surgical thoracotomy with ligation of a coronary artery to induce myocardial infarction. Incision of the chest wall and myocardium affect remodeling after myocardial infarction. The aim of our study was to evaluate a new minimally invasive technique for inducing acute myocardial infarction in pigs. To this end, coronary angiography using a 6-F cardiac catheter was performed in 20 pigs. The cardiac catheter was advanced into the left circumflex artery (LCX) under electrocardiographic monitoring and small tungsten spirals were deployed in the vessel. LCX occlusion was verified by coronary angiography. Two days later, magnetic resonance imaging (MRI) was performed to estimate the extent of infarction. Thereafter, all animals were euthanized and the hearts stained with 2,3,5-triphenyltetrazolium chloride for histologic measurement of infarct size. Tungsten spirals were successfully placed in the LCX in all 20 pigs. About 13 of the 20 animals survived until the end of the experiment. The mean infarct size in the area supplied by the LCX was 4.4 +/- 2.3 cm(3) at MRI and 4.3 +/- 2.2 cm(3) at histology (r = 0.99, P < 0.001). No other myocardial regions showed infarction in any of the 13 pigs. Five of nine pigs requiring defibrillation due to ventricular fibrillation died because defibrillation was unsuccessful. One animal each died from pericarditis and pneumonia. Our results show that the minimally invasive method presented here enables reliable induction of myocardial infarction in a fairly straightforward manner. The 25% mortality rate associated with induction of myocardial infarction in our study is comparable to that reported by other investigators.

  8. The diagnostic role of gadolinium enhanced MRI in distinguishing between acute medullary bone infarct and osteomyelitis.

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    Umans, H; Haramati, N; Flusser, G

    2000-04-01

    The objective of the study was to evaluate the diagnostic utility of contrast enhanced magnetic resonance imaging (MRI) for distinguishing between acute medullary bone infarct and osteomyelitis. There were 11 patients (age 6-34 years) presented to our institution between December 1994 and February 1998 with a clinical differential diagnosis of acute bone infarct versus osteomyelitis and inconclusive radiographs were imaged using MRI. All but one received i.v. gadolinium. Nine of the patients had homozygous Sickle Cell disease (SCD) and two had Systemic Lupus Erythematosus (SLE), the latter requiring chronic methylprednisolone. Osteomyelitis was confirmed either by biopsy alone or by the combination of Gallium(67) scan in conjunction with positive blood cultures and clinical resolution following antibiotics. Infarcts without osteomyelitis were confirmed either by biopsy or resolution of symptoms without antibiotic therapy. All patients had at least six months clinical follow-up. The results found that seven of nine patients with SCD had acute infarct only. One patient with SCD had osteomyelitis only. Three patients (two SLE and one SCD) had both acute-on-chronic infarcts and superimposed osteomyelitis, one with an adjacent soft tissue abscess. Accurate distinction between infarct and osteomyelitis was impossible for one patient with SLE who did not receive contrast. All other cases were correctly diagnosed prospectively based on distinct patterns of MRI contrast enhancement. In all adult patients, acute infarcts demonstrated thin, linear rim enhancement on MRI while osteomyelitis revealed more geographic and irregular marrow enhancement. Two of four cases of osteomyelitis also demonstrated subtle cortical defects with abnormal signal traversing marrow and soft tissue. The single pediatric patient demonstrated elongated, serpiginous central medullary enhancement with periostitis. We concluded that the pattern of MR contrast enhancement may allow accurate distinction

  9. Acute myocardial infarction mortality in Cuba, 1999-2008.

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    Armas, Nurys B; Ortega, Yanela Y; de la Noval, Reinaldo; Suárez, Ramón; Llerena, Lorenzo; Dueñas, Alfredo F

    2012-10-01

    Acute myocardial infarction is one of the leading causes of death in the world. This is also true in Cuba, where no national-level epidemiologic studies of related mortality have been published in recent years. Describe acute myocardial infarction mortality in Cuba from 1999 through 2008. A descriptive study was conducted of persons aged ≥25 years with a diagnosis of acute myocardial infarction from 1999 through 2008. Data were obtained from the Ministry of Public Health's National Statistics Division database for variables: age; sex; site (out of hospital, in hospital or in hospital emergency room) and location (jurisdiction) of death. Proportions, age- and sex-specific rates and age-standardized overall rates per 100,000 population were calculated and compared over time, using the two five-year time frames within the study period. A total of 145,808 persons who had suffered acute myocardial infarction were recorded, 75,512 of whom died, for a case-fatality rate of 51.8% (55.1% in 1999-2003 and 49.7% in 2004-2008). In the first five-year period, mortality was 98.9 per 100,000 population, falling to 81.8 per 100,000 in the second; most affected were people aged ≥75 years and men. Of Cuba's 14 provinces and special municipality, Havana, Havana City and Camagüey provinces, and the Isle of Youth Special Municipality showed the highest mortality; Holguín, Ciego de Ávila and Granma provinces the lowest. Out-of-hospital deaths accounted for the greatest proportion of deaths in both five-year periods (54.8% and 59.2% in 1999-2003 and 2004-2008, respectively). Although risk of death from acute myocardial infarction decreased through the study period, it remains a major health problem in Cuba. A national acute myocardial infarction case registry is needed. Also required is further research to help elucidate possible causes of Cuba's high acute myocardial infarction mortality: cardiovascular risk studies, studies of out-of-hospital mortality and quality of care

  10. Computational modeling of acute myocardial infarction.

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    Sáez, P; Kuhl, E

    2016-01-01

    Myocardial infarction, commonly known as heart attack, is caused by reduced blood supply and damages the heart muscle because of a lack of oxygen. Myocardial infarction initiates a cascade of biochemical and mechanical events. In the early stages, cardiomyocytes death, wall thinning, collagen degradation, and ventricular dilation are the immediate consequences of myocardial infarction. In the later stages, collagenous scar formation in the infarcted zone and hypertrophy of the non-infarcted zone are auto-regulatory mechanisms to partly correct for these events. Here we propose a computational model for the short-term adaptation after myocardial infarction using the continuum theory of multiplicative growth. Our model captures the effects of cell death initiating wall thinning, and collagen degradation initiating ventricular dilation. Our simulations agree well with clinical observations in early myocardial infarction. They represent a first step toward simulating the progression of myocardial infarction with the ultimate goal to predict the propensity toward heart failure as a function of infarct intensity, location, and size.

  11. Striatocapsular infarction: MRI and MR angiography

    Energy Technology Data Exchange (ETDEWEB)

    Croisille, P. (Dept. of Neuroradiology, Hopital Neurologique et Neurochirurgical Pierre Wertheimer, Lyon (France)); Turjman, F. (Dept. of Neuroradiology, Hopital Neurologique et Neurochirurgical Pierre Wertheimer, Lyon (France)); Croisile, B. (Dept. of Neurology, Hopital Neurologique et Neurochirurgical Pierre Wertheimer, Lyon (France)); Tournut, P. (Dept. of Neuroradiology, Hopital Neurologique et Neurochirurgical Pierre Wertheimer, Lyon (France)); Laharotte, J.C. (Dept. of Neuroradiology, Hopital Neurologique et Neurochirurgical Pierre Wertheimer, Lyon (France)); Aimard, G. (Dept. of Neurology, Hopital Neurologique et Neurochirurgical Pierre Wertheimer, Lyon (France)); Trillet, M. (Dept. of Neurology, Hopital Neurologique et Neurochirurgical Pierre Wertheimer, Lyon (France)); Duquesnel, J. (Dept. of Neuroradiology, Hopital Neurologique et Neurochirurgical Pierre Wertheimer, Lyon (France)); Froment, J.C. (Dept. of Neuroradiology, Hopital Neurologique et Neurochirurgical Pierre

    1994-08-01

    We present a case of left striatocapsular infarction manifest clinically as a transient right hemiparesis. MRI showed a left striatocapsular infarct. Striatocapsular infarction, unlike lacunar infarction, is often associated with occlusive disease of the carotid artery. In order to screen the carotid vessels, cervical MR angiography (MRA) was performed during the same examination, demonstrating a left internal carotid artery occlusion, confirmed by contrast arteriography. MRA, a noninvasive modality, can be a useful adjunct to MRI, when diagnostic information concerning the cervical carotid artery is needed. (orig.)

  12. “Spice” (Synthetic Marijuana Induced Acute Myocardial Infarction: A Case Series

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    E. Ul Haq

    2017-01-01

    Full Text Available Marijuana is the most widely abused “recreational” substance in the United States, with highest prevalence in young adults. It is reported to cause ischemic strokes, hepatitis, anxiety, and psychosis. Although it is associated with dose dependent tachycardia and can lead to coronary vasospasm, it has not been directly related to acute myocardial infarction (AMI. Marijuana induced coronary vasospasm can result in endothelial denudation at the site of a vulnerable atherosclerotic plaque in response to hemodynamic stressors, potentially causing an AMI. Spice refers to herbal mixture with composition and effects similar to that of marijuana and therefore is referred to as “synthetic marijuana.” Herein, we report 3 cases of spice induced ST-segment elevation myocardial infarction. All patients were relatively young and had few or absolutely no risk factors for cardiovascular disease. All patients underwent emergent coronary angiography, with two needing stent placement and the third requiring only aspiration thrombectomy. Our case series emphasizes the importance of suspecting and investigating synthetic marijuana use in low risk young adults presenting with AMI.

  13. Topographical Disorientation after Ischemic Mini Infarct in the Dorsal Hippocampus: Whispers in Silence

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    Jamshid eFaraji

    2014-08-01

    Full Text Available Silent focal ischemic mini infarcts in the brain are thought to cause no clinically overt symptoms. Some populations of hippocampal cells are particularly sensitive to ischemic events, however, rendering hippocampal functions especially vulnerable to ischemia-induced deficits. The present study investigated whether an otherwise silent ischemic mini infarct in the hippocampus (HPC can produce impairments in spatial performance in rats. Spatial performance was assessed in the ziggurat task (ZT using a 10-trial spatial learning protocol for four days prior to undergoing hippocampal ischemic lesion or sham surgery. Hippocampal silent ischemia was induced by infusion of endothelin-1 (ET-1, a potent vasoconstrictor, into either the dorsal or the ventral hippocampus (dHPC and vHPC. When tested postoperatively in the ZT using a standard testing protocol for eight days, rats with hippocampal lesions exhibited no spatial deficit. Although spatial learning and memory in the ZT were not affected by the ET-1-induced silent ischemia, rats with dHPC stroke showed more returns when navigating the ZT as opposed to the vHPC rats. Comparison of region-specific HPC lesions in the present study indicated that dorsal hippocampal function is critically required for topographic orientation in a complex environment. Topographic disorientation as reflected by enhanced return behaviours may represent one of the earliest predictors of cognitive decline after silent ischemic insult that may be potentially traced with sensitive clinical examination in humans.

  14. Association between Obstructive Sleep Apnea and Myocardial Infarction: A Systematic Review

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    Fernanda Porto

    Full Text Available Abstract Obstructive sleep apnea (OSA has been associated to cardiovascular risk factors. However, the association between OSA and cardiovascular disease is still controversial. The objective of the present study was to verify the association between OSA and myocardial infarction (MI. This is a systematic review of the literature performed through electronic data sources MEDLINE/PubMed, PubMed Central, Web of Science and BVS -Biblioteca Virtual em Saúde (Virtual Health Library. The descriptors used were: 'obstructive sleep apnea' AND 'polysomnography' AND 'myocardial infarction' AND 'adults NOT 'treatment.' The present work analysed three prospective studies, selected from 142 articles. The studies followed a total sample of 5,067 OSA patients, mostly composed by male participants. All patients underwent night polysomnography, and all studies found an association between OSA and fatal and non-fatal cardiovascular outcomes. Thus, we were able to observe that 644 (12.7% of the 5,067 patients suffered MI or stroke, or required a revascularization procedure, and 25.6% of these cardiovascular events were fatal. MI was responsible for 29.5% of all 644 analysed outcomes. There is an association between OSA and MI, in male patients, and apnea and hypopnea index (AHI are the most reliable markers.

  15. Longitudinal strain is a marker of microvascular obstruction and infarct size in patients with acute ST-segment elevation myocardial infarction.

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    Loïc Bière

    Full Text Available OBJECTIVES: We assessed the value of speckle tracking imaging performed early after a first ST-segment elevation myocardial infarction (STEMI in order to predict infarct size and functional recovery at 3-month follow-up. METHODS: 44 patients with STEMI who underwent revascularization within 12 h of symptom onset were prospectively enrolled. Echocardiography was performed 3.9 ± 1.2 days after myocardial reperfusion, assessing circumferential (CGS, radial (RGS, and longitudinal global (GLS strains. Late gadolinium-enhanced cardiac magnetic imaging (CMR, for assessing cardiac function, infarct size, and microvascular obstruction (MVO, was conducted 5.6 ± 2.5 days and 99.4 ± 4.6 days after myocardial reperfusion. RESULTS: GLS was evaluable in 97% of the patients, while CGS and RGS could be assessed in 85%. Infarct size significantly correlated with GLS (R = 0.601, p-6.0% within the infarcted area exhibited 96% specificity and 61% sensitivity for predicting the persistence of akinesia (≥ 3 segments at 3-month follow-up. CONCLUSIONS: Speckle-tracking strain imaging performed early after a STEMI is easy-to-use as a marker for persistent akinetic territories at 3 months. In addition, GLS correlated significantly with MVO and final infarct size, both parameters being relevant post-MI prognostic factors, usually obtained via CMR.

  16. Cerebellar infarct patterns: The SMART-Medea study

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    Laurens J.L. De Cocker, MD

    2015-01-01

    Conclusions: Small cerebellar infarcts proved to be much more common than larger infarcts, and preferentially involved the cortex. Small cortical infarcts predominantly involved the posterior lobes, showed sparing of subcortical white matter and occurred in characteristic topographic patterns.

  17. The role of physical training in patients after myocardial infarction

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    Lazović Milica

    2006-01-01

    Full Text Available Introduction. Physical training is an optimal method of rehabilitation of cardiovascular patients, especially in patients with myocardial infarction. The aim of this study was to evaluate the effects of physical training in patients with myocardial infarction during the post-hospital phase and prolonged rehabilitation by determining the lest exercise parameters. Material and methods. This prospective clinical study included 230 patients after myocardial infarction. Group A (180 patients participated in organized forms of exercise (post-hospital rehabilitation and prolonged rehabilitation at home for 48±6.4 months, while the control group was without physical training. The first clinical examination and the exercise test were performed in group A after post-hospital rehabilitation and after 191±16.4 days in the control group. In all patients the last control was performed 48±6.4 months after myocardial infarction. Results. After the first control, the mean physical workload in group A was significantly higher compared with the control group (p<0.05. After a 48 month follow-up period the physical work­load was significantly higher in group A (p<0.01, while in the control group a significant increase of workload was not observed (p>0.05. Comparing the duration of exercise testing, significant differences were found after the first and last control (p<0.05; p<0.01, respectively. The double product was significantly higher in group A than in the control group after the first and last control (p<0.05; p<0.01, respectively. Conclusion. Prolonged physical training is beneficial for patients after myocardial infarction, because it improves cardiovascular functions and physical work capacity, improves angina threshold and the patient's general health. .

  18. Periostin as a modulator of chronic cardiac remodeling after myocardial infarction

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    Marcos F. Minicucci

    2013-10-01

    Full Text Available OBJECTIVE: After acute myocardial infarction, during the cardiac repair phase, periostin is released into the infarct and activates signaling pathways that are essential for the reparative process. However, the role of periostin in chronic cardiac remodeling after myocardial infarction remains to be elucidated. Therefore, the objective of this study was to investigate the relationship between tissue periostin and cardiac variables in the chronic cardiac remodeling induced by myocardial infarction. METHODS: Male Wistar rats were assigned to 2 groups: a simulated surgery group (SHAM; n = 8 and a myocardial infarction group (myocardial infarction; n = 13. After 3 months, morphological, functional and biochemical analyses were performed. The data are expressed as means±SD or medians (including the lower and upper quartiles. RESULTS: Myocardial infarctions induced increased left ventricular diastolic and systolic areas associated with a decreased fractional area change and a posterior wall shortening velocity. With regard to the extracellular matrix variables, the myocardial infarction group presented with higher values of periostin and types I and III collagen and higher interstitial collagen volume fractions and myocardial hydroxyproline concentrations. In addition, periostin was positively correlated with type III collagen levels (r = 0.673, p = 0.029 and diastolic (r = 0.678, p = 0.036 and systolic (r = 0.795, p = 0.006 left ventricular areas. Considering the relationship between periostin and the cardiac function variables, periostin was inversely correlated with both the fractional area change (r = -0.783, p = 0.008 and the posterior wall shortening velocity (r = -0.767, p = 0.012. CONCLUSIONS: Periostin might be a modulator of deleterious cardiac remodeling in the chronic phase after myocardial infarction in rats.

  19. MANAGEMENT OF DIABETES IN ACUTE MYOCARDIAL INFARCTION IN CELJE GENERAL HOSPITAL IN 1999

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    Gregor Veninšek

    2001-12-01

    Full Text Available Background. DIGAMI study showed that intrahospital mortality and mortality at one year after myocardial infarction can be significantly reduced in diabetics treated in acute phase of myocardial infarction by GI infusion and afterwards for at least three months with intensive insulin treatment. Mortality can be reduced for more than 50% in a subgroup of patients younger than 70 years, without congestive heart failure, with first myocardial infarction, not treated with insulin or digitalis. In this perspective we reviewed treatment of diabetics with acute myocardial infarction in 1999 in Celje General Hospital.Methods. We reviewed documentation of treatment of all diabetics with acute myocardial infarction treated in Celje General Hospital in 1999. We collected data on number of newly discovered diabetes, on previous treatment of diabetes, on treatment of diabetes during hospitalization and at discharge, on drugs used for treatment of diabetes and on mortality during hospitalization.Results. Diabetics presented 20% of all patients with acute myocardial infarction treated in Celje General Hospital in 1999. None of patients received GI infusion, none had intensively managed blood sugar. 24% of patients were treated with sulfonylureas in acute phase of myocardial infarction. 33% of patients were discharged from hospital with insulin therapy. Intrahospital mortality was 9%, comparable with patients without diabetes.Conclusions. In 1999 was intrahospital treatment of diabetics with acute myocardial infarction in Celje General Hospital successful as their intrahospital mortality equaled non-diabetics. Treatment of diabetes itself, during hospitalization and after discharge, on the other hand, in 1999 had not been up to date according to results of recent studies. In our opinion, it is mandatory for diabetologist to make part of the team that treats diabetic with acute myocardial infarction

  20. Acute Anterolateral Myocardial Infarction Due to Aluminum Phosphide Poisoning

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    Bita Dadpour

    2013-08-01

    Full Text Available Aluminum phosphide (AlP is a highly effective rodenticide which is used as a suicide poison. Herein, a 24 year-old man who’d intentionally ingested about 1liter of alcohol and one tablet of AlP is reported. Acute myocardial infarction due to AlP poisoning has been occurred secondary to AIP poisoning. Cardiovascular complications are poor prognostic factors in AlP poisoning

  1. Cocaine-Associated Myocardial Infarction: Should They All Be Stented?

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    Sazzli Kasim

    2011-01-01

    Full Text Available Cocaine use is a known cause of chest pain and acute myocardial infarction and frequently leads to cardiac catheterization procedure. The treatment of cocaine-related acute coronary syndromes presents unique challenges because a variety of mechanisms including atherosclerotic plaque rupture, platelet activation, and coronary vasospasm may contribute to the pathogenesis. Our case highlights important considerations taken in dealing with this acute scenario

  2. Arrhythmia in Acute Right Ventricular Infarction

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    Azin Alizadeh Asl

    2007-09-01

    Full Text Available Acute inferior myocardial infarction (MI frequently involves the right ventricle (RV.1-3 We assessed the prognostic impact of RV myocardial involvement in patients with inferior MI. One hundred seventy patients were admitted to the cardiac care unit of Madani Heart Hospital (Tabriz-Iran with the diagnosis of inferior MI with (group1 or without (group2 the simultaneous involvement of RV during the study period (from 2005 to 2006. Patients presenting within 12h of symptom onset were eligible for inclusion. Patients with simultaneous anterior wall MI or renal impairment (creatinine > 2 mg/dl, as well as those undergoing primary percutaneous translational coronary angioplasty, were excluded. Eighty eight percent of the patients with RVMI and 75% of those with isolated inferior MI had some type of arrhythmia. Atrioventricular (AV block occurred in 42% of the infarctions with RV involvement and only in 29% of the control group. Intra-ventricular conduction disturbance (IVCD was also more frequent in RVMI (29.4% vs. 13.1%, p=0.021, especially right bundle branch block (RBBB (20% vs. 7.4%, P=0.003. There was, however, no meaningful difference in the incidence of left bundle branch block (LBBB between the two groups (3.5% vs. 2.35%, P=0.95. Ventricular fibrillation (VF was observed in 5.2% and 1.2% and ventricular tachycardia in 26% and 12.2% of the patients in groups 1 and 2, respectively. In 27% of patients with RVMI, it was necessary to implant a pacemaker as compared to 10% of those in the control group. Mortality was higher in the patients with inferior infarction extended to the RV (15.3% vs. 3.5%, P= 0.0001. Thus, the differences between the findings in the two groups in terms of the occurrence of post-MI arrhythmias and conduction disorders were quite significant, but there was no meaningful difference with respect to the incidence of LBBB between the two groups. Additionally, patients with inferior MI who also had RV myocardial involvement were

  3. Rapid assessment of myocardial infarct size in rodents using multi-slice inversion recovery late gadolinium enhancement CMR at 9.4T

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    Hausenloy Derek J

    2011-09-01

    Full Text Available Abstract Background Myocardial infarction (MI can be readily assessed using late gadolinium enhancement (LGE cardiovascular magnetic resonance (CMR. Inversion recovery (IR sequences provide the highest contrast between enhanced infarct areas and healthy myocardium. Applying such methods to small animals is challenging due to rapid respiratory and cardiac rates relative to T1 relaxation. Methods Here we present a fast and robust protocol for assessing LGE in small animals using a multi-slice IR gradient echo sequence for efficient assessment of LGE. An additional Look-Locker sequence was used to assess the optimum inversion point on an individual basis and to determine most appropriate gating points for both rat and mouse. The technique was applied to two preclinical scenarios: i an acute (2 hour reperfused model of MI in rats and ii mice 2 days following non-reperfused MI. Results LGE images from all animals revealed clear areas of enhancement allowing for easy volume segmentation. Typical inversion times required to null healthy myocardium in rats were between 300-450 ms equivalent to 2-3 R-waves and ~330 ms in mice, typically 3 R-waves following inversion. Data from rats was also validated against triphenyltetrazolium chloride staining and revealed close agreement for infarct size. Conclusion The LGE protocol presented provides a reliable method for acquiring images of high contrast and quality without excessive scan times, enabling higher throughput in experimental studies requiring reliable assessment of MI.

  4. A novel sterol regulatory element-binding protein gene (sreA identified in penicillium digitatum is required for prochloraz resistance, full virulence and erg11 (cyp51 regulation.

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    Jing Liu

    Full Text Available Penicillium digitatum is the most destructive postharvest pathogen of citrus fruits, causing fruit decay and economic loss. Additionally, control of the disease is further complicated by the emergence of drug-resistant strains due to the extensive use of triazole antifungal drugs. In this work, an orthologus gene encoding a putative sterol regulatory element-binding protein (SREBP was identified in the genome of P. digitatum and named sreA. The putative SreA protein contains a conserved domain of unknown function (DUF2014 at its carboxyl terminus and a helix-loop-helix (HLH leucine zipper DNA binding domain at its amino terminus, domains that are functionally associated with SREBP transcription factors. The deletion of sreA (ΔsreA in a prochloraz-resistant strain (PdHS-F6 by Agrobacterium tumefaciens-mediated transformation led to increased susceptibility to prochloraz and a significantly lower EC50 value compared with the HS-F6 wild-type or complementation strain (COsreA. A virulence assay showed that the ΔsreA strain was defective in virulence towards citrus fruits, while the complementation of sreA could restore the virulence to a large extent. Further analysis by quantitative real-time PCR demonstrated that prochloraz-induced expression of cyp51A and cyp51B in PdHS-F6 was completely abolished in the ΔsreA strain. These results demonstrate that sreA is a critical transcription factor gene required for prochloraz resistance and full virulence in P. digitatum and is involved in the regulation of cyp51 expression.

  5. Riociguat reduces infarct size and post-infarct heart failure in mouse hearts: insights from MRI/PET imaging.

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    Carmen Methner

    Full Text Available AIM: Stimulation of the nitric oxide (NO--soluble guanylate (sGC--protein kinase G (PKG pathway confers protection against acute ischaemia/reperfusion injury, but more chronic effects in reducing post-myocardial infarction (MI heart failure are less defined. The aim of this study was to not only determine whether the sGC stimulator riociguat reduces infarct size but also whether it protects against the development of post-MI heart failure. METHODS AND RESULTS: Mice were subjected to 30 min ischaemia via ligation of the left main coronary artery to induce MI and either placebo or riociguat (1.2 µmol/l were given as a bolus 5 min before and 5 min after onset of reperfusion. After 24 hours, both, late gadolinium-enhanced magnetic resonance imaging (LGE-MRI and (18F-FDG-positron emission tomography (PET were performed to determine infarct size. In the riociguat-treated mice, the resulting infarct size was smaller (8.5 ± 2.5% of total LV mass vs. 21.8% ± 1.7%. in controls, p = 0.005 and LV systolic function analysed by MRI was better preserved (60.1% ± 3.4% of preischaemic vs. 44.2% ± 3.1% in controls, p = 0.005. After 28 days, LV systolic function by echocardiography treated group was still better preserved (63.5% ± 3.2% vs. 48.2% ± 2.2% in control, p = 0.004. CONCLUSION: Taken together, mice treated acutely at the onset of reperfusion with the sGC stimulator riociguat have smaller infarct size and better long-term preservation of LV systolic function. These findings suggest that sGC stimulation during reperfusion therapy may be a powerful therapeutic treatment strategy for preventing post-MI heart failure.

  6. Soluble TNF receptors are associated with infarct size and ventricular dysfunction in ST-elevation myocardial infarction.

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    Lennart Nilsson

    Full Text Available OBJECTIVES: The aim of the study was to investigate circulating markers of apoptosis in relation to infarct size, left ventricular dysfunction and remodeling in an ST-elevation myocardial infarction (STEMI population undergoing primary percutaneous coronary intervention (PCI. BACKGROUND: Immediate re-opening of the acutely occluded infarct-related artery via primary PCI is the treatment of choice in STEMI to limit ischemia injury. However, the sudden re-initiation of blood flow can lead to a local acute inflammatory response with further endothelial and myocardial damage, so-called reperfusion injury. Apoptosis is suggested to be a key event in ischemia-reperfusion injury, resulting in LV-dysfunction, remodeling and heart failure. METHODS: The present study is a prespecified substudy of the F.I.R.E. trial. We included 48 patients with STEMI undergoing primary PCI. Blood samples were collected prior to PCI and after 24 hours. Plasma was separated for later analysis of soluble tumor necrosis factor receptor (sTNFR 1, sTNFR2, sFas and sFas ligand (sFasL by ELISA. Infarct size, left ventricular (LV dysfunction and remodeling were assessed by cardiac magnetic resonance imaging at five days and four months after STEMI. RESULTS: The levels of sTNFR1 at 24 h as well as the relative increases in sTNFR1 and sTNFR2 over 24 h showed consistent and significant correlations with infarct size and LV-dysfunction at four months. Moreover, both sTNFRs correlated strongly with Troponin I and matrix metalloproteinase (MMP-2 measurements. Soluble Fas and sFasL did not overall correlate with measures of infarct size or LV-dysfunction. None of the apoptosis markers correlated significantly with measures of remodeling. CONCLUSIONS: In STEMI patients, circulating levels of sTNFR1 and sTNFR2 are associated with infarct size and LV dysfunction. This provides further evidence for the role of apoptosis in ischemia-reperfusion injury.

  7. Silent ST segment elevation myocardial infarction with multi-segmental renal infarction: an unusual presentation.

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    Chang, Hung-Yu; Yang, Yung-Nien

    2011-01-01

    A 36-year-old diabetic man came to our institution presenting with constant left flank pain. Left renal embolic infarction was found by abdominal computed tomography. Silent ST segment elevation myocardial infarction was noted on 12-lead electrocardiogram. Emergent coronary angiography revealed large thrombus burdens with complete occlusion at the left anterior descending artery ostium, which may be the embolic origin. Silent ST segment elevation myocardial infarction with acute flank pain and multiple segmental renal infarction is an unusual presentation. High vigilance may prevent delay of the "golden hour" to treat acute myocardial infarction.

  8. Acute myocardial infarction in a young athlete: Optical coherence tomographic features of the culprit lesion

    Directory of Open Access Journals (Sweden)

    Matjaz Klemenc

    2016-04-01

    Full Text Available Objectives: We report on a young male athlete who suffered from acute myocardial infarction immediately after a vigorous training. Methods: A comprehensive optical coherence tomographic investigation of the culprit coronary artery was performed after the combined mechanical and pharmacological thrombus removal. Results and Conclusion: The imaging discovered a tear at the junction of the non-obstructive, largely fibrotic plaque with the normal arterial wall. This exertion-related vessel damage resulted in a dynamic thrombosis that almost completely occluded the culprit artery. As the vessel obstruction was not considered flow-limiting, the stent implantation was not required and the patient was discharged on the double antiplatelet therapy and statin.

  9. Myocardial perfusion at fatal infarction

    DEFF Research Database (Denmark)

    Hvid-Jacobsen, K; Møller, J T; Kjøller, E;

    1992-01-01

    In a consecutive study of myocardial scintigraphy in acute ischemic syndrome, four patients had 99mTc-hexamibi injected intravenously before they developed fatal cardiogenic shock. Planar scintigraphy was performed after death. Slices of the hearts after autopsy were analyzed for scintigraphic......, where 83%-92% of the myocardium showed ischemia as defined by a 99mTc-hexamibi uptake below an arbitrary limit on half maximum uptake. Myocardial hypoperfusion might thus aggravate the functional impairment at myocardial infarction and lead to cardiogenic shock....

  10. Relationship between treatment delay and final infarct size in STEMI patients treated with abciximab and primary PCI

    Directory of Open Access Journals (Sweden)

    Tödt Tim

    2012-02-01

    Full Text Available Abstract Background Studies on the impact of time to treatment on myocardial infarct size have yielded conflicting results. In this study of ST-Elevation Myocardial Infarction (STEMI treated with primary percutaneous coronary intervention (PCI, we set out to investigate the relationship between the time from First Medical Contact (FMC to the demonstration of an open infarct related artery (IRA and final scar size. Between February 2006 and September 2007, 89 STEMI patients treated with primary PCI were studied with contrast enhanced magnetic resonance imaging (ceMRI 4 to 8 weeks after the infarction. Spearman correlation was computed for health care delay time (defined as time from FMC to PCI and myocardial injury. Multiple linear regression was used to determine covariates independently associated with infarct size. Results An occluded artery (Thrombolysis In Myocardial Infarction, TIMI flow 0-1 at initial angiogram was seen in 56 patients (63%. The median FMC-to-patent artery was 89 minutes. There was a weak correlation between time from FMC-to-patent IRA and infarct size, r = 0.27, p = 0.01. In multiple regression analyses, LAD as the IRA, smoking and an occluded vessel at the first angiogram, but not delay time, correlated with infarct size. Conclusions In patients with STEMI treated with primary PCI we found a weak correlation between health care delay time and infarct size. Other factors like anterior infarction, a patent artery pre-PCI and effects of reperfusion injury may have had greater influence on infarct size than time-to-treatment per se.

  11. Cerebral infarction in childhood bacterial meningitis

    OpenAIRE

    Snyder, R.D.; Stovring, J; Cushing, A H; Davis, L. E.; Hardy, T. L.

    1981-01-01

    Forty-nine children with complicated bacterial meningitis were studied. Thirteen had abnormalities on computed tomography compatible with the diagnosis of brain infarction; one had a brain biopsy with the histological appearance of infarction. Factors exist in childhood bacterial meningitis which are associated with the development of brain infraction.

  12. Experimental Approaches to Acute Myocardial Infarction

    NARCIS (Netherlands)

    D.B. Uitterdijk (André)

    2015-01-01

    markdownabstractAbstract This thesis is dedicated to i) novel methods and optimization studies to improve the diagnosis of myocardial ischemia and myocardial infarction as well as fundamental studies that precede novel therapies for myocardial infarction. In part ii) 2 novel, adjunctive therapies f

  13. Double infarction in one cerebral hemisphere.

    Science.gov (United States)

    Bogousslavsky, J

    1991-07-01

    Thirty-two patients whose first stroke was due to double infarct in one cerebral hemisphere were identified among 1,911 consecutive patients from the Lausanne Stroke Registry. The double infarct involved territories of the superficial middle cerebral artery, superficial posterior cerebral artery, lenticulostriate, anterior choroidal artery, or borderzone. The most common combination involved territories of the anterior middle cerebral artery plus the posterior middle cerebral artery. In the patients with the double infarct, the prevalence of potential cardiac sources of embolism (19%) was similar to that found in the registry in general, but the double infarct was closely associated with tight (greater than or equal to 90% of the lumen diameter) stenosis or occlusion (75%) of the internal carotid artery. The most common neurological picture mimicked large infarction in the middle cerebral artery territory, but nearly half of the patients with double infarct in one cerebral hemisphere had a specific clinical syndrome, which was not found in the 1,879 remaining patients from the registry, including hemianopia-hemiplegia (in 6), acute conduction aphasia-hemiparesis (in 2), and acute transcortical mixed aphasia (in 6), in relation to characteristic combinations of infarcts. These unique clinical and etiological correlates warrant the recognition of double infarct in one cerebral hemisphere from other acute ischemic strokes.

  14. Do episodes of anger trigger myocardial infarction?

    DEFF Research Database (Denmark)

    Möller, J; Hallqvist, J; Diderichsen, Finn

    1999-01-01

    Our objectives were to study anger as a trigger of acute myocardial infarction (MI) and to explore potential effect modification by usual behavioral patterns related to hostility.......Our objectives were to study anger as a trigger of acute myocardial infarction (MI) and to explore potential effect modification by usual behavioral patterns related to hostility....

  15. Experimental Approaches to Acute Myocardial Infarction

    NARCIS (Netherlands)

    D.B. Uitterdijk (André)

    2015-01-01

    markdownabstractAbstract This thesis is dedicated to i) novel methods and optimization studies to improve the diagnosis of myocardial ischemia and myocardial infarction as well as fundamental studies that precede novel therapies for myocardial infarction. In part ii) 2 novel, adjunctive therapies

  16. Gastric infarction following gastric bypass surgery

    Science.gov (United States)

    Do, Patrick H; Kang, Young S; Cahill, Peter

    2016-01-01

    Gastric infarction is an extremely rare occurrence owing to the stomach’s extensive vascular supply. We report an unusual case of gastric infarction following gastric bypass surgery. We describe the imaging findings and discuss possible causes of this condition. PMID:27200168

  17. INFLUENCE OF SEASON PATTERN ON PREVALENCE AND SEVERITY OF ACUTE MYOCARDIAL INFARCTION, FUNCTION OF HEMOSTASIS IN PATIENTS WITH ISCHEMIC HEART DESEASE OF CLIMATE AREA OF MIDDLE VOLGA REGION

    Directory of Open Access Journals (Sweden)

    O.K. Rybak

    2007-09-01

    Full Text Available The aim of this study is to evaluate season pattern, severity and outcome of acute myocardial infarction in dependence of yearly patterns of function of hemostasis in middle Volga Region. Season pattern of prevalence myocardial infarction with winter peak was discovered, be accompanied of increase platelet aggregation, deterioration of blood viscosity, fibrinolysis depression. Most serious clinical course of summer myocardial infarction was observed with prosperity of hemostasis.

  18. Contrast MR imaging of acute cerebral infarction

    Energy Technology Data Exchange (ETDEWEB)

    Kogame, Saeko; Syakudo, Miyuki; Inoue, Yuichi (Osaka City Univ. (Japan). Faculty of Medicine) (and others)

    1992-04-01

    Thirty patients with acute and subacute cerebral infarction (13 and 17 deep cerebral infarction) were studied with 0.5 T MR unit before and after intravenous injection of Gd-DTPA. Thirteen patients were studied within 7 days after neurological ictus, 17 patients were studied between 7 and 14 days. Two types of abnormal enhancement, cortical arterial and parenchymal enhancement, were noted. The former was seen in 3 of 4 cases of very acute cortical infarction within 4 days after clinical ictus. The latter was detected in all 7 cases of cortical infarction after the 6th day of the ictus, and one patient with deep cerebral infarction at the 12th day of the ictus. Gd-DTPA enhanced MR imaging seems to detect gyral enhancement earlier compared with contrast CT, and depict intra-arterial sluggish flow which was not expected to see on contrast CT scans. (author).

  19. Novel adjunctive treatments of myocardial infarction

    DEFF Research Database (Denmark)

    Schmidt, Michael Rahbek; Pryds, Kasper; Bøtker, Hans Erik

    2014-01-01

    Myocardial infarction is a major cause of death and disability worldwide and myocardial infarct size is a major determinant of prognosis. Early and successful restoration of myocardial reperfusion following an ischemic event is the most effective strategy to reduce final infarct size and improve...... by endovascular infusion of cold saline all reduce infarct size and may confer clinical benefit for patients admitted with acute myocardial infarcts. Equally promising, three follow-up studies of the effect of remote ischemic conditioning (RIC) show clinical prognostic benefit in patients undergoing coronary...... clinical outcome, but reperfusion may induce further myocardial damage itself. Development of adjunctive therapies to limit myocardial reperfusion injury beyond opening of the coronary artery gains increasing attention. A vast number of experimental studies have shown cardioprotective effects of ischemic...

  20. Implantation of mouse embryonic stem cell-derived cardiac progenitor cells preserves function of infarcted murine hearts.

    Directory of Open Access Journals (Sweden)

    Nicolas Christoforou

    Full Text Available Stem cell transplantation holds great promise for the treatment of myocardial infarction injury. We recently described the embryonic stem cell-derived cardiac progenitor cells (CPCs capable of differentiating into cardiomyocytes, vascular endothelium, and smooth muscle. In this study, we hypothesized that transplanted CPCs will preserve function of the infarcted heart by participating in both muscle replacement and neovascularization. Differentiated CPCs formed functional electromechanical junctions with cardiomyocytes in vitro and conducted action potentials over cm-scale distances. When transplanted into infarcted mouse hearts, CPCs engrafted long-term in the infarct zone and surrounding myocardium without causing teratomas or arrhythmias. The grafted cells differentiated into cross-striated cardiomyocytes forming gap junctions with the host cells, while also contributing to neovascularization. Serial echocardiography and pressure-volume catheterization demonstrated attenuated ventricular dilatation and preserved left ventricular fractional shortening, systolic and diastolic function. Our results demonstrate that CPCs can engraft, differentiate, and preserve the functional output of the infarcted heart.

  1. Acute non-ST elevation myocardial infarction following paclitaxel administration for ovarian carcinoma: A case report and review of literature

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    Kajal Shah

    2012-01-01

    Full Text Available We report a case of an acute non-ST elevation myocardial infarction (AMI induced by paclitaxel in a patient with ovarian cancer. A 45-year-old premenopausal lady without any co-morbidity was started on the first cycle of neoadjuvant chemotherapy with paclitaxel-based regimen for advanced stage ovarian cancer. The patient developed chest pain 3 h after paclitaxel infusion with characteristic electrocardiographic changes of antero-apical myocardial infarction. The patient recovered on conservative medical management with reversion of electrocardiogram (ECG changes. Cardiac ischemia and myocardial infarction, possibly due to coronary vasospasm, are rare adverse effects of paclitaxel with reported incidence of 0.26%. We have reported a case of paclitaxel-induced myocardial infarction with reversible cardiac dysfunction. The possibility of myocardial infarction should be considered in patients who develop chest pain or other symptoms after paclitaxel infusion.

  2. Acute multiple infarction involving the anterior circulation.

    Science.gov (United States)

    Bogousslavsky, J; Bernasconi, A; Kumral, E

    1996-01-01

    To evaluate the frequency and clinical, topographic, and etiologic patterns of acute multiple infarction involving the anterior circulation. Data analysis from a prospective acute stroke registry in a community-based primary care center. Among 751 patients with first ischemic stroke in the anterior circulation over a 4-year period, 40 patients (5%) had acute multiple infarcts involving the anterior circulation. On computed tomography and magnetic resonance imaging with gadolinium enhancement, there were four topographic patterns of infarction: (1) superficial infarcts (11 patients [28%]); (2) superficial and deep infarcts (12 patients [30%]); (3) deep infarcts (three patients [8%]); and (4) infarcts involving the anterior and the posterior circulation (14 patients [35%]). Both cerebral hemispheres were involved in one fourth of the cases. A specific clinical picture was found in up to 20% of the patients. This included global aphasia with left hemianopia, hemisensory loss or hemiparesis (in right-handed patients), transcortical mixed aphasia with hemianopia, and acute pure cognitive impairment ("dementia"). Large-artery disease was found in 13 patients (33%); a cardiac source of embolism was found in 11 patients (28%); and both were found in three patients (8%). Bilateral infarcts were related to cardioembolism (four patients) and bilateral large-artery disease (three patients). One month after stroke, one fourth of the patients were independent, one third had some disability, and 40% were either dead or completely dependent. Acute multiple infarcts involving the anterior circulation may be bilateral more frequently than is currently thought, and they are often associated with posterior circulation infarcts. They mainly involve the pial hemispheral territories, commonly being caused by cardioembolism or bilateral carotid atheroma. They may be associated with a specific neurologic-neuropsychological dysfunction pattern in up to one fifth of the patients, allowing

  3. Acute Anteroseptal Myocardial Infarction after a Negative Exercise Stress Test

    Directory of Open Access Journals (Sweden)

    Abdullah M. Al-Alawi

    2016-05-01

    Full Text Available A myocardial infarction is a rare complication which can occur after an exercise stress test. We report a 48-year-old male who was referred to the Mildura Cardiology Practice, Victoria, Australia, in August 2014 with left-sided chest pain. He underwent an exercise stress test which was negative for myocardial ischaemia. However, the patient presented to the Emergency Department of the Mildura Base Hospital 30 minutes after the test with severe retrosternal chest pain. An acute anteroseptal ST segment elevation myocardial infarction was observed on electrocardiography. After thrombolysis, he was transferred to a tertiary hospital where coronary angiography subsequently revealed significant left anterior descending coronary artery stenosis. Thrombus aspiration and a balloon angioplasty were performed. The patient was discharged three days after the surgical procedure in good health.

  4. IDIOPATHIC OMENTAL INFARCTION : A RARE CAUSE OF ACUTE PAIN ABDOMEN

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    Narendra Nath

    2015-02-01

    Full Text Available Omental torsion leading on to omental infarction is an unusual cause of acute abdominal pain in adults. Often the condition mimics common causes of acute abdomen like acute cholecystitis, acute appendicitis or acute pancreatitis. A review of literature reveals that this enigmatic condition has been managed both non - operatively and by surgery in the past. We report the case of a 46 - year - old man who presented with a 4 - day history of severe right - sided abdominal pain mimicking acute cholecystitis. Abdominal CT scan revealed a right upper quadrant mass with a whirl - like appearance, suspicious for omental infarction. He was started on conservative management with analgesics and antibiotics. He improved symptomatically and was discharged

  5. Atrial infarction is a unique and often unrecognized clinical entity

    Directory of Open Access Journals (Sweden)

    Rosana G. G. Mendes

    1999-03-01

    Full Text Available A patient with heart failure and acute atrial fibrillation received the final diagnosis of atrial infarction associated with ventricular infarction based on clinical findings of ischemia in association with atrial fibrillation and heart failure (mechanisms probably involved: contractile dysfunction and loss of atrial contribution. Although a transesophageal echocardiography, which could refine the diagnosis of anatomic abnormalities, was not performed, all evidence led to the diagnosis of atrial involvement. Electrocardiographic findings were consistent with Liu's major criterion 3. Therapy with digitalis, quinidine and angiotensin-converting enzyme inhibitors was chosen, as the patient had acute pulmonary edema. The use of beta-blockers and verapamil was restricted. No other complications, such as thrombo-embolism or atrial rupture, were noted.

  6. Acute Myocardial Infarction Caused by Filgrastim: A Case Report

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    Cemil Bilir

    2012-01-01

    Full Text Available Common uses of the granulocyte-colony stimulating factors in the clinical practice raise the concern about side effects of these agents. We presented a case report about an acute myocardial infarction with non-ST segment elevation during filgrastim administration. A 73-year-old man had squamous cell carcinoma of larynx with lung metastasis treated with the chemotherapy. Second day after the filgrastim, patient had a chest discomfort. An ECG was performed and showed an ST segment depression and negative T waves on inferior derivations. A coronary angiography had showed a critical lesion in right coronary arteria. This is the first study thats revealed that G-CSF can cause acute myocardial infarction in cancer patients without history of cardiac disease. Patients with chest discomfort and pain who are on treatment with G-CSF or GM-CSF must alert the physicians for acute coronary events.

  7. Cerebellar infarct with neurogenic pulmonary edema following viper bite

    Directory of Open Access Journals (Sweden)

    Salil Gupta

    2012-01-01

    Full Text Available Russell′s viper (Daboia russelli bites are well known to cause bleeding complications. However, thrombotic complications are rare. We present the case details of a female who was bitten by a Russell′s viper (Daboia russelli in her village. She then developed features of envenomation in the form of hemorrhagic episodes. She received 27 vials of polyvalent anti-snake venom to which the hemorrhagic complications responded. After about 48 h of the bite she developed features of cerebellar infarct along with pulmonary edema which was in all probability neurogenic in origin. She was managed with mechanical ventilation and extra ventricular drainage with good recovery. We discuss the likely pathogenesis of the infarct and pulmonary edema occurring in a patient with viper bite and other features of envenomation.

  8. Evaluation of transplantation of mesenchymal cells in acute myocardial infarction

    Directory of Open Access Journals (Sweden)

    Aliya Dzholdasbekova

    2012-12-01

    Full Text Available It has been studied in the pilot clinical research the effect of systemic (intravenous transplantation of mesenchymal stem cells (MSC of a bone marrow to 20 patients with an acute myocardial infarction with lifting segment of ST (STEMI carried out in the first 2 hours by percutaneous coronary intervention (PCI with stenting infarct related artery and the common course of drug therapy. It has been shown that the transplantation of MSCs had not caused any complications (allergic reactions, hazardous to health arrhythmias, embolism and heavy frustration of hemodynamic and had not lead to condition deterioration afterwards. In the first 3-6 months after systemic transplantation of MSCs to the patients’ heart contractive activity has been advanced which was clinically proved in the reduction of the heart failure level degree of expressiveness of warm insufficiency.

  9. Hyperkalemia induced pseudo-myocardial infarction in septic shock

    Directory of Open Access Journals (Sweden)

    S E Pothiawala

    2014-01-01

    Full Text Available Hyperkalemia is an acute life-threatening disorder presenting to the emergency department. Patients with hyperkalemia may manifest characteristic electrocardiographic changes including tented T waves, widening of the QRS complex and loss of P waves, sine wave pattern and eventually asystole. There have been only few reports of hyperkalemia causing ST segment elevation on electrocardiogram simulating an acute myocardial infarction. This case describes pseudo-myocardial infarction due to hyperkalemia and septic shock. Rapid determination of serum potassium levels by bedside blood gas analyzers serves to be a useful guide. ST segment elevation related to hyperkalemia will resolve with successful reduction of the serum potassium levels by appropriate therapy. It is important for physicians to be aware of this condition as this will aid in initiating correct therapy and prevent the patient from unnecessary interventions and the associated risk of complications.

  10. The international normalized ratio (INR as seen in a population of patients with atrial fibrillation and cerebral infarction undergoing long-term treatment with vitamin K antagonists

    Directory of Open Access Journals (Sweden)

    Szczepańska-Szerej Anna

    2015-12-01

    Full Text Available It is estimated that nearly 20% of all cerebral infarctions in the total population are the result of a complication of atrial fibrillation (AF. While oral anticoagulation with vitamin K antagonists (AVKs substantially reduces this risk, this requires regular monitoring of the international normalized ratio (INR in order to achieve therapeutic levels (2,0-3,0. The aim of this study was to evaluate a group at high risk of cerebral infarction, among patients with AF undergoing long-term treatment with VKAs, taking into account the significance of therapeutic INR values. The analysed group consisted of 90 acute ischaemic stroke patients with paroxysmal or chronic “non-valvular” AF, receiving treatment with VKAs. As a result of the study, therapeutic INR values (≥ 2 were seen in thirty-five of these individuals (38,8%, while 55 (61,2% showed non-therapeutic INR values. Moreover, there were no differences in demographics, vascular risk factors, biochemical and morphological blood parameters, mean CHA2DS2-VASc score and TOAST classification between either of the two groups. Furthermore, no additional factor that would increase their risk of cerebral infarction during the adequate treatment with VKAs was found. However, patients with non-therapeutic INR values had a statistically significantly higher frequency of concomitant moderate pathology of the bicuspid valve, p<0.05. Hence, a lack of proper control of INR can proved to be particularly dangerous for this subgroup of patients. Hence, this is a group with an elevated risk of cerebral infarction and therefore requires special oversight of VKA treatment or NOA treatment.

  11. Activation of immediate-early response gene c-Fos protein in the rat paralimbic cortices after myocardial infarction

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    Ji Yun Ahn

    2015-01-01

    Full Text Available c-Fos is a good biological marker for detecting the pathogenesis of central nervous system disorders. Few studies are reported on the change in myocardial infarction-induced c-Fos expression in the paralimbic regions. Thus, in this study, we investigated the changes in c-Fos expression in the rat cingulate and piriform cortices after myocardial infarction. Neuronal degeneration in cingulate and piriform cortices after myocardial infarction was detected using cresyl violet staining, NeuN immunohistochemistry and Fluoro-Jade B histofluorescence staining. c-Fos-immunoreactive cells were observed in cingulate and piriform cortices at 3 days after myocardial infarction and peaked at 7 and 14 days after myocardial infarction. But they were hardly observed at 56 days after myocardial infarction. The chronological change of c-Fos expression determined by western blot analysis was basically the same as that of c-Fos immunoreactivity. These results indicate that myocardial infarction can cause the chronological change of immediate-early response gene c-Fos protein expression, which might be associated with the neural activity induced by myocardial infarction.

  12. A novel sterol regulatory element-binding protein gene (sreA) identified in penicillium digitatum is required for prochloraz resistance, full virulence and erg11 (cyp51) regulation.

    Science.gov (United States)

    Liu, Jing; Yuan, Yongze; Wu, Zhi; Li, Na; Chen, Yuanlei; Qin, Tingting; Geng, Hui; Xiong, Li; Liu, Deli

    2015-01-01

    Penicillium digitatum is the most destructive postharvest pathogen of citrus fruits, causing fruit decay and economic loss. Additionally, control of the disease is further complicated by the emergence of drug-resistant strains due to the extensive use of triazole antifungal drugs. In this work, an orthologus gene encoding a putative sterol regulatory element-binding protein (SREBP) was identified in the genome of P. digitatum and named sreA. The putative SreA protein contains a conserved domain of unknown function (DUF2014) at its carboxyl terminus and a helix-loop-helix (HLH) leucine zipper DNA binding domain at its amino terminus, domains that are functionally associated with SREBP transcription factors. The deletion of sreA (ΔsreA) in a prochloraz-resistant strain (PdHS-F6) by Agrobacterium tumefaciens-mediated transformation led to increased susceptibility to prochloraz and a significantly lower EC50 value compared with the HS-F6 wild-type or complementation strain (COsreA). A virulence assay showed that the ΔsreA strain was defective in virulence towards citrus fruits, while the complementation of sreA could restore the virulence to a large extent. Further analysis by quantitative real-time PCR demonstrated that prochloraz-induced expression of cyp51A and cyp51B in PdHS-F6 was completely abolished in the ΔsreA strain. These results demonstrate that sreA is a critical transcription factor gene required for prochloraz resistance and full virulence in P. digitatum and is involved in the regulation of cyp51 expression.

  13. Global testicular infarction in the presence of epididymitis: clinical features, appearances on grayscale, color Doppler, and contrast-enhanced sonography, and histologic correlation.

    Science.gov (United States)

    Yusuf, Gibran; Sellars, Maria E; Kooiman, Gordon G; Diaz-Cano, Salvador; Sidhu, Paul S

    2013-01-01

    Epididymitis is common, presenting indolently with unilateral scrotal pain and swelling. Diagnosis is based on clinical assessment and resolves with antibiotic therapy. Recognized complications are abscess formation and segmental infarction. Global testicular infarction is rare. Diagnosis is important and requires surgical management. On grayscale sonography, global infarction may be difficult to establish. The addition of color Doppler imaging is useful but is observer experience dependent with limitations in the presence of low flow. Contrast-enhanced sonography is useful for unequivocally establishing the diagnosis. We report global testicular infarction in 2 patients with epididymitis clearly depicted on contrast-enhanced sonography, allowing immediate surgical management.

  14. Is decompressive craniectomy for malignant middle cerebral artery infarction of any worth?

    Institute of Scientific and Technical Information of China (English)

    YANG Xiao-feng; YAO Yu; HU Wei-wei; LI Gu; XU Jin-fang; ZHAO Xue-qun; LIU Wei-guo

    2005-01-01

    Objective: Malignant middle cerebral artery (MCA) infarction is characterized by mortality rate of up to 80%. The aim of this study was to determine the value of decompressive craniectomy in patients presenting malignant MCA infarction compared with those receiving medical treatment alone. Methods: Patients with malignant MCA infarction treated in our hospital between January 1996 and March 2004 were included in this retrospective analysis. The National Institute of Health Stroke Scale (NIHSS)was used to assess neurological status on admission and at one week after surgery. All patients were followed up for assessment of functional outcome by the Barthel index (BI) and modified Rankin Scale (RS) at 3 months after infarction. Results: Ten out of 24patients underwent decompressive craniectomy. The mean interval between stroke onset and surgery was 62.10 h. The mortality was 10.0% compared with 64.2% in patients who received medical treatment alone (P<0.001). The mean NIHSS score before surgery was 26.0 and 15.4 after surgery (P<0.001). At follow up, patients who underwent surgery had significantly better outcome with mean BI of 53.3, RS of 3.3 as compared to only 16.0 and 4.60 in medically treated patients. Speech function also improved in patients with dominant hemispherical infarction. Conclusion: Decompressive craniectomy in patients with malignant MCA infarction improves both survival rates and functional outcomes compared with medical treatment alone. A randomized controlled trial is required to substantiate those findings.

  15. Efeitos da tosse manualmente assistida sobre a mecânica do sistema respiratório de pacientes em suporte ventilatório total Effects of manually assisted coughing on respiratory mechanics in patients requiring full ventilatory support

    Directory of Open Access Journals (Sweden)

    Katia de Miranda Avena

    2008-06-01

    on respiratory system mechanics in patients requiring full ventilatory support. METHODS: We assessed 16 sedated patients on full ventilatory support (no active participation in ventilation. Respiratory system mechanics and oxyhemoglobin saturation were measured before and after MAC, as well as after endotracheal aspiration. Bilateral MAC was performed ten times on each patient, with three respiratory cycle intervals between each application. RESULTS: Data analysis demonstrated a decrease in resistive pressure and respiratory system resistance, together with an increase in oxyhemoglobin saturation, after MAC combined with endotracheal aspiration. No evidence of alterations in peak pressures, plateau pressures or respiratory system compliance change was observed after MAC. CONCLUSIONS: The use of MAC alters respiratory system mechanics, increasing resistive forces by removing secretions. The technique is considered safe and efficacious for postoperative patients. Using MAC in conjunction with endotracheal aspiration provided benefits, achieving the proposed objective: the displacement and removal of airway secretions.

  16. Current therapy of the right ventricle myocardial infarction

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    Orozović Vjekoslav

    2002-01-01

    Full Text Available Background. Acute myocardial infarction of the right ventricle (AMI-RV is a separate subgroup within the scope of inferoposterior infarction of the left ventricle. It still represents the population of patients at high risk due to numerous, often hardly predictable complications and high mortality rate. Methods. In fifteen-year period (1987-2001 3 765 patients with the acute myocardial infarction (AMI of different localizations of both sexes – 2 283 males and 1 482 females of the average age 61.4 ± 4.6 years were treated in our institution. Anterior myocardial infarction was diagnosed in 2 146 (56.9% patients, inferior in 1 619 (43.1% patients, out of whom right ventricular infarction (RVI was confirmed in 384 (23.7%. Thrombolytic therapy was administered in 163 (42.4% patients with RVI, and in 53 (41.7% of these patients balloon dilatation was performed with coronary stent implantation in 24 (45.2%. Results. Favorable clinical effect of the combined thrombolytic therapy and percutaneous transluminal coronary angioplasty (PTCA was achieved in 51 (96.1%, and in only 2 (3.9% of patients the expected effect wasn't achieved. Myocardial revascularization was accomplished in 6 (3.6% and 1 patient died. In 3 (3.4% patients primary balloon dilatation with the implantation of intracoronary stent was performed within 6 hours from the onset of anginal pain. In the other group of 221 (57.5% patients with RVI who did not receive thrombolytic therapy, or it had no effect, 26 (11.7% patients died, which indicated the validity and the efficacy of this treatment (p<0,01. In the whole group of patients with myocardial infarction of the right ventricle 31 (8.1% died; in the group that received thrombolytic therapy and PTCA 5 (3.1% died, while in the group treated in a conservative way 26 (11.7% died. Conclusion. Combined therapy was successful in the treatment of patients with RVI and should be administered whenever possible, since it was the best

  17. Early treatment with intravenous metoprolol for suspected acute myocardial infarction: a phase IV United States trial. Phase IV Metoprolol in Myocardial Infarction Study Group.

    Science.gov (United States)

    Antman, E M; Dupont, W D; Bonalsky, J; Califf, R M; Corwin, S; Fink, L; Hansen, D E; Kawanishi, D T; Kronenberg, M W; McKay, C R

    1989-05-01

    Recent randomized clinical trials have shown that total mortality and cardiovascular mortality are reduced by the early intravenous administration of beta-blockers to patients suspected of suffering from acute myocardial infarction. These trials were conducted on patients meeting strict entry criteria. In order to assess this therapy when applied to a broader range of myocardial infarction patients, we performed a Phase IV study of metoprolol in acute myocardial infarction. The study was designed to test whether early (less than 8 hours from onset of chest pain) intervention by practicing physicians with open label intravenous metoprolol for cases of suspected acute myocardial infarction achieved mortality results similar to those obtained in large randomized clinical trials. We studied 3824 patients treated by 741 physicians representing a broad spectrum of clinical practice in the United States. Seventy-two percent of the patients entered into the study had confirmed myocardial infarction (39% anterior, 39% inferior, 22% other locations) and 85% of all individuals treated tolerated the full intravenous dose of 15 mg of metoprolol. The 15 day total mortality and cardiovascular mortality rates were 4.9% and 4.5%; 90 day mortality rates were 6.9 and 5.9%. Patients with anterior infarctions had a significantly greater cumulative mortality rate than patients with other types of infarctions. Marked bradycardia (heart rate less than 45 beats per minute) in the first 8 hours post treatment occurred in 4.7% cases and hypotension (systolic blood pressure less than 90 mm Hg) occurred in 9.8% of cases. When compared with the results of the Göteborg and MIAMI trials of metoprolol, it appears that there is no appreciable increase in mortality or morbidity when metoprolol is used in the community practice of acute coronary care.

  18. Myocardial bridging as a cause of acute myocardial infarction: a case report

    Directory of Open Access Journals (Sweden)

    Emiroglu Yunus

    2002-09-01

    Full Text Available Abstract Background Systolic compression of a coronary artery by overlying myocardial tissue is termed myocardial bridging. Myocardial bridging usually has a benign prognosis, but some cases resulting in myocardial ischemia, infarction and sudden cardiac death have been reported. We are reporting a case of myocardial bridging which was complicated with acute myocardial infarction associated with inappropriate blood donation. Case presentation A 33 year-old-man was admitted to our emergency with acute anteroseptal myocardial infarction after a blood donation. The electrocardiography showed sinus rhythm and was consistent with an acute anteroseptal myocardial infarction. We decided to perform primary percutanous intervention (PCI. Myocardial bridging was observed in the mid segment of the left anterior descending coronary artery on coronary angiogram. PCI was canceled and medical follow up was decided. Blood transfusion was made because he had a deep anemia. A normal hemaglobin level and clinical reperfusion was achieved after ten hours by blood transfusion. At the one year follow up visit, our patient was healthy and had no cardiac complaints. Conclusions Myocardial bridging may cause acute myocardial infarction in various clinical conditions. Although the condition in this case caused profound anemia related acute myocardial infarction, its treatment and management was unusual.

  19. Urinary 1-Hydroxypyrene is Associated with Oxidative Stress and Inflammatory Biomarkers in Acute Myocardial Infarction

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    Fernando Freitas

    2014-09-01

    Full Text Available Several studies have associated exposure to environmental pollutants, especially polycyclic aromatic hydrocarbons (PAHs, with the development of cardiovascular diseases. Considering that 1-hydroxypyrene (1-OHP is the major biomarker of exposure to pyrenes, the purpose of this study was to evaluate the potential association between 1-OHP and oxidative stress/inflammatory biomarkers in patients who had suffered an acute myocardial infarction (AMI. After adopting the exclusion criteria, 58 post-infarction patients and 41 controls were sub-divided into smokers and non-smokers. Urinary 1-OHP, hematological and biochemical parameters, oxidative stress biomarkers (MDA, SOD, CAT, GPx and exogenous antioxidants and the inflammatory biomarker (hs-CRP were analyzed. 1-OHP levels were increased in post-infarct patients compared to controls (p < 0.05 and were correlated to MDA (r = 0.426, p < 0.01, CAT (r = 0.474, p < 0.001 and β-carotene (r = −0.309; p < 0.05 in non-smokers. Furthermore, post-infarction patients had elevated hs-CRP, MDA, CAT and GPx levels compared to controls for both smokers and non-smokers. Besides, β-carotene levels and SOD activity were decreased in post-infarction patients. In summary, our findings indicate that the exposure to pyrenes was associated to lipid damage and alterations of endogenous and exogenous antioxidants, demonstrating that PAHs contribute to oxidative stress and are associated to acute myocardial infarction.

  20. Reduced infarct size in neuroglobin-null mice after experimental stroke in vivo

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    Raida Zindy

    2012-08-01

    Full Text Available Abstract Background Neuroglobin is considered to be a novel important pharmacological target in combating stroke and neurodegenerative disorders, although the mechanism by which this protection is accomplished remains an enigma. We hypothesized that if neuroglobin is directly involved in neuroprotection, then permanent cerebral ischemia would lead to larger infarct volumes in neuroglobin-null mice than in wild-type mice. Methods Using neuroglobin-null mice, we estimated the infarct volume 24 hours after permanent middle cerebral artery occlusion using Cavalieri’s Principle, and compared the infarct volume in neuroglobin-null and wild-type mice. Neuroglobin antibody staining was used to examine neuroglobin expression in the infarct area of wild-type mice. Results Infarct volumes 24 hours after permanent middle cerebral artery occlusion were significantly smaller in neuroglobin-null mice than in wild-types (p  Conclusions Neuroglobin-deficiency resulted in reduced tissue infarction, suggesting that, at least at endogenous expression levels, neuroglobin in itself is non-protective against ischemic injury.

  1. Development and Characterization of a Macaque Model of Focal Internal Capsular Infarcts.

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    Yumi Murata

    Full Text Available Several studies have used macaque monkeys with lesions induced in the primary motor cortex (M1 to investigate the recovery of motor function after brain damage. However, in human stroke patients, the severity and outcome of motor impairments depend on the degree of damage to the white matter, especially that in the posterior internal capsule, which carries corticospinal tracts. To bridge the gap between results obtained in M1-lesioned macaques and the development of clinical intervention strategies, we established a method of inducing focal infarcts at the posterior internal capsule of macaque monkeys by injecting endothelin-1 (ET-1, a vasoconstrictor peptide. The infarcts expanded between 3 days and 1 week after ET-1 injection. The infarct volume in each macaque was negatively correlated with precision grip performance 3 days and 1 week after injection, suggesting that the degree of infarct expansion may have been a cause of the impairment in hand movements during the early stage. Although the infarct volume decreased and gross movement improved, impairment of dexterous hand movements remained until the end of the behavioral and imaging experiments at 3 months after ET-1 injection. A decrease in the abundance of large neurons in M1, from which the descending motor tracts originate, was associated with this later-stage impairment. The present model is useful not only for studying neurological changes underlying deficits and recovery but also for testing therapeutic interventions after white matter infarcts in primates.

  2. Predisposing Factors In Patients With Silent Myocardial Infarction Farabi Hospital (2000

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    Mahmoodi M j

    2002-09-01

    Full Text Available Myocardial infarction sequel of coronary artery diseases, can be sometimes asymptomatic, called silent myocardial infarction. Some risk factors predispose the patients to this condition. In this study, we intend to determine the predisposing factors in such patients."nMethods and Materials: We included those patients with electrocardiogram changes, consistent with myocardial infarction, who had not any symptoms of ischemia or a previous history of coronary artery disease, consulted for preoperative work up of eye surgery during the year 2000."nResults: We analyzed 100 patients with the diagnosis of silent myocardial infarction. (59 males and 41 females. Among our patients. 99 percent were above age 50 years of age. Their mean age at the time of study was 69.7 years. 78 percent of patients were illiterate. In 41 of them body mass index was above the normal limits (overweight and obese. Their past medical history revealed that 46 patients had hypertension, 38 patients had hyper-lipidemia. and 26 patients had diabetes mellitus. Also, a positive family history of coronary artery disease was seen in 52 percent of the patients. The rate of cigarette smokers and opium addicts, among our patients, was 33 and 13 percents. respectively. Analysis of electrocardiogram changes, showed that 43 patients had inferior myocardial infarction, 24 had antero-septal. and 17 of them suffered from anterior myocardial infarction."nConclusion: Almost all of our patients with silent myocardial infarction were in old age group. Diabetes mellitus, hypertension, overweight, hyper-lipidemia, and a positive family history of coronary artery disease were the most important predisposing factors, found in such patients, thus taking into account these predisposing factors and control of them would dramatically reduce the prevalence of morbidity and mortality of silent myocardial infarction.

  3. Safety of anticoagulation after hemorrhagic infarction.

    Science.gov (United States)

    Pessin, M S; Estol, C J; Lafranchise, F; Caplan, L R

    1993-07-01

    Cerebral hemorrhagic infarction visualized on CT, secondary to embolic stroke in an anticoagulated individual, is usually associated with clinically stable or improving neurologic signs; fear of transforming the hemorrhagic infarction into a hematoma, however, usually prompts cessation of anticoagulation until the blood has cleared on CT, despite the recognized risk of recurrent embolism during this non-anticoagulated period. We now report our experience with 12 patients with hemorrhagic infarction who remained anticoagulated. Eleven men and one woman, ages 33 to 77, developed hemorrhagic infarction while on heparin, warfarin, or both, for prevention of recurrent embolism. Patients were either continued on uninterrupted anticoagulation from stroke onset (n = 6), or anticoagulation was withheld for several days and then resumed (n = 4), or it was withheld for 5 and 14 days (n = 2) after stroke onset and then continued uninterrupted despite the CT appearance of hemorrhagic infarction. Eleven patients had a definite cardioembolic source for stroke (atrial fibrillation, seven; ventricular thrombus, two; and ventricular dyskinesia, two). One patient had carotid occlusion with local intra-arterial embolism. Hemorrhagic infarcts varied in size and were located in the middle cerebral artery territory in 11 patients and posterior cerebral artery territory in one. All patients remained clinically stable or improved on anticoagulation. Serial CTs showed fading hemorrhagic areas. When the risk of recurrent embolism is high, anticoagulation may be safely used in some patients with hemorrhagic infarction.

  4. Symptom-limited maximal treadmill testing after myocardial infarction.

    Science.gov (United States)

    Roberts, K C; Logan, R L

    1980-11-12

    In this paper we report our experience of routine symptom limited maximal treadmill assessment, and the methodology used with patients at the end of their convalescence after myocardial infarction. Sixty-one of 68 (90 percent) consecutive patients, mean age 55.7 years (21 to 69 years), were studied at the median time after infarction of six weeks (three to 16 weeks). No complications occurred during or after the tests. Fifty-six percent of the patients studied achieved a work capacity which was within the average range reported for healthy people of the smae age. Thirty-two percent experienced chest pain thought to be angina and 31 percent developed ST segment depression of at least 1 mm without chest pain. Although ventricular premature beats occurred in half the tests the only arrhythmia requiring any treatment was a supraventricular tachycardia. The assessment of work capacity and limiting symptoms in this way after myocardial infarction is safe and is of considerable help in patient management.

  5. Segmental Renal Infarction due to Blunt Trauma.

    Science.gov (United States)

    Alevizopoulos, Aristeidis; Hamilton, Lauren; Stratu, Natalia; Rix, Gerald

    2016-05-01

    Segmental renal infarction is a rare situation which has been reported so far in the form of case reports. It's caused usually by cardiac conditions, such as atrial fibrillation, and systemic diseases (e.g. systemic lupus erythematous). We are presenting a case of a 31 year old healthy male, who sustained a left segmental renal infarction, following a motorbike accident. We report his presentation, management and outcome. We also review the literature in search of the optimal diagnostic and treatment pathway. To our knowledge, this is the first report of segmental renal infarction due to blunt trauma.

  6. Pure dysarthria due to an insular infarction.

    Science.gov (United States)

    Hiraga, Akiyuki; Tanaka, Saiko; Kamitsukasa, Ikuo

    2010-06-01

    Cortical infarction presenting with pure dysarthria is rarely reported. Previous studies have reported pure dysarthria due to cortical stroke at the precentral gyrus or middle frontal gyrus. We report a 72-year-old man who developed pure dysarthria caused by an acute cortical infarction in the insular cortex. The role of the insula in language has been difficult to assess clinically because of the rarity of pure insular strokes. Our patient showed pure dysarthria without aphasia, indicating that pure dysarthria can be the sole manifestation of insular infarctions.

  7. [Circadian rhythm in myocardial infarct].

    Science.gov (United States)

    Enciso, R; Ramos, M A; Badui, E; Hurtado, R

    1988-01-01

    In order to determine if the beginning of the Myocardial Infarction (MI) is at random along the day or if it follows a circadian rhythm, we analyzed the clinical charts of 819 patients admitted to the Coronary Care Unite. Among them, 645 were male and 174 female. It was established that the beginning of the MI follows a circadian rhythm with maximal frequency between 8 and 9 a.m. and minimal at 0 hours (p greater than 0.01). This rhythm is sex independent. In patients younger than 45 years as well as those who received beta-block agents in less than 24 hours previous the MI no circadian rhythm was observed.

  8. Amphetamine Containing Dietary Supplements and Acute Myocardial Infarction

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    Julio Perez-Downes

    2016-01-01

    Full Text Available Weight loss is one of the most researched and marketed topics in American society. Dietary regimens, medications that claim to boost the metabolism, and the constant pressure to fit into society all play a role in our patient’s choices regarding new dietary products. One of the products that are well known to suppress appetite and cause weight loss is amphetamines. While these medications suppress appetite, most people are not aware of the detrimental side effects of amphetamines, including hypertension, tachycardia, arrhythmias, and in certain instances acute myocardial infarction. Here we present the uncommon entity of an acute myocardial infarction due to chronic use of an amphetamine containing dietary supplement in conjunction with an exercise regimen. Our case brings to light further awareness regarding use of amphetamines. Clinicians should have a high index of suspicion of use of these substances when young patients with no risk factors for coronary artery disease present with acute arrhythmias, heart failure, and myocardial infarctions.

  9. Dental Calculus Is Associated with Death from Heart Infarction

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    Birgitta Söder

    2014-01-01

    Full Text Available Objectives. We studied whether the amount of dental calculus is associated with death from heart infarction in the dental infection—atherosclerosis paradigm. Materials. Participants were 1676 healthy young Swedes followed up from 1985 to 2011. At the beginning of the study all subjects underwent oral clinical examination including dental calculus registration scored with calculus index (CI. Outcome measure was cause of death classified according to WHO International Classification of Diseases. Unpaired t-test, Chi-square tests, and multiple logistic regressions were used. Results. Of the 1676 participants, 2.8% had died during follow-up. Women died at a mean age of 61.5 years and men at 61.7 years. The difference in the CI index score between the survivors versus deceased patients was significant by the year 2009 (P<0.01. In multiple regression analysis of the relationship between death from heart infarction as a dependent variable and CI as independent variable with controlling for age, gender, dental visits, dental plaque, periodontal pockets, education, income, socioeconomic status, and pack-years of smoking, CI score appeared to be associated with 2.3 times the odds ratio for cardiac death. Conclusions. The results confirmed our study hypothesis by showing that dental calculus indeed associated statistically with cardiac death due to infarction.

  10. A Case of Skull Base Osteomyelitis with Multiple Cerebral Infarction

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    Haruka Miyabe

    2016-01-01

    Full Text Available Skull base osteomyelitis is classically documented as an extension of malignant otitis externa. Initial presentation commonly includes aural symptoms and cranial nerve dysfunctions. Here we present a case that emerged with multiple infarctions in the right cerebrum. A male in his 70s with diabetes mellitus and chronic renal failure presented with left hemiparesis. Imaging studies showed that blood flow in the carotid artery remained at the day of onset but was totally occluded 7 days later. However, collateral blood supply prevented severe infarction. These findings suggest that artery-to-artery embolization from the petrous and/or cavernous portion of the carotid artery caused the multiple infarctions observed on initial presentation. Osteomyelitis of the central skull base was diagnosed on the basis of the following findings taken together: laboratory results showing high levels of inflammation, presence of Pseudomonas aeruginosa in the otorrhea and blood culture, multiple cranial nerve palsies that appeared later, the bony erosion observed on CT, and the mass lesion on MRI. Osteomyelitis was treated successfully by long-term antibiotic therapy; however, the patient experienced cefepime-induced neurotoxicity during therapy. The potential involvement of the internal carotid artery in this rare and life-threatening disease is of particular interest in this case.

  11. Epileptic seizures in patients with a posterior circulation infarct

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    Yüksel Kaplan

    2014-08-01

    Full Text Available OBJECTIVE: The aim of this study was to investigate the frequency of seizures and the clinical features of patients with seizures related to a posterior circulation infarct (POCI. METHODS: We reviewed all ischemic stroke patients admitted to our clinic between January 2011 and January 2012. The patients’ database information was retrospectively analyzed. Fifty-five patients with a POCI were included in the study. We reviewed all patients with epileptic seizures related to a POCI. Age, gender, recurrent stroke, risk factors, etiology, radiographic localization, the seizure type and onset time, and the electroencephalographic findings of patients were evaluated. We excluded all patients who had precipitating conditions during seizures such as taking drugs, acid-base disturbances, electrolyte imbalance, and history of epilepsy. RESULTS: Seizures were observed in four patients (3 male, 1 female with a POCI related epileptic seizures (7.2%. The etiology of strokes was cardiac-embolic in 3 patients and vertebral artery dissection in 1 patient. Seizures occurred in 2 patients as presenting finding, in 1 patient within 7 days, and 1 patient within 28 days. Primary generalized tonic-clonic seizures occurred in 3 patients and simple partial seizures with secondary generalization in 1 patient. Three patients had cerebellum infarction at the left hemisphere. One patient had lateral medullary infarction at the right side. The electroencephalographic findings of patients were normal. CONCLUSION: Studies involving patients with seizures related to a POCI are novel and few in number. Three patients with seizure had cerebellum infarction. The cerebellum in these patients may contribute via different mechanisms over seizure activity.

  12. Bilateral thalamic infarction with psychiatric symptoms: case report

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    Betül Tekin Güveli

    2016-04-01

    Full Text Available Introduction: Thalamus is a mass of gray matter, which plays a role in the transmission of sensory and motor information to the primary sensory and motor centers of the cerebral cortex, cerebellum and basal ganglia. Vascular lesions of thalamus may occur in different syndromes depending on the affected nuclei. In this report, a case with acute evolving personality and behavior changes and detected bilateral thalamic infarction will be presented. Case: A 40-year-old male patient was brought to the psychiatric ER with complaints of acute excessive sleep and behavioral changing. His neurological examination was normal except for limited cooperation and dysarthria. There was hyperintensity in bilateral paramedian thalamic regions in diffusion MRI and hypointensity in the right side in the ADC. During clinical observation the patient occasionally had visual hallucinations and attempted suicide. The psychiatrist diagnosed the patient with psychotic disorder due to his general medical condition and olanzapine 10 mg / day was prescribed. Etiological tests were normal. The patient was discharged after clinical improvement on the tenth day of hospitalization. Conclusion: Bilateral thalamic infarcts are very rare in all ischemic cerebrovascular diseases and typically result in changing of consciousness, gaze palsy and memory. The most common etiological cause of bilateral thalamic infarct is cardioembolism and the prognosis is generally good. Thalamic infarcts have a clinical spectrum varying according to the location of the lesion and may even just be present with psychiatric symptoms. In acute or subacute personality and behavior changes in a patient with no history of psychiatric disorders, thalamic lesions should be considered.

  13. Acute myocardial infarction and stress cardiomyopathy following the Christchurch earthquakes.

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    Christina Chan

    Full Text Available BACKGROUND: Christchurch, New Zealand, was struck by 2 major earthquakes at 4:36 am on 4 September 2010, magnitude 7.1 and at 12:51 pm on 22 February 2011, magnitude 6.3. Both events caused widespread destruction. Christchurch Hospital was the region's only acute care hospital. It remained functional following both earthquakes. We were able to examine the effects of the 2 earthquakes on acute cardiac presentations. METHODS: Patients admitted under Cardiology in Christchurch Hospital 3 week prior to and 5 weeks following both earthquakes were analysed, with corresponding control periods in September 2009 and February 2010. Patients were categorised based on diagnosis: ST elevation myocardial infarction, Non ST elevation myocardial infarction, stress cardiomyopathy, unstable angina, stable angina, non cardiac chest pain, arrhythmia and others. RESULTS: There was a significant increase in overall admissions (p<0.003, ST elevation myocardial infarction (p<0.016, and non cardiac chest pain (p<0.022 in the first 2 weeks following the early morning September earthquake. This pattern was not seen after the early afternoon February earthquake. Instead, there was a very large number of stress cardiomyopathy admissions with 21 cases (95% CI 2.6-6.4 in 4 days. There had been 6 stress cardiomyopathy cases after the first earthquake (95% CI 0.44-2.62. Statistical analysis showed this to be a significant difference between the earthquakes (p<0.05. CONCLUSION: The early morning September earthquake triggered a large increase in ST elevation myocardial infarction and a few stress cardiomyopathy cases. The early afternoon February earthquake caused significantly more stress cardiomyopathy. Two major earthquakes occurring at different times of day differed in their effect on acute cardiac events.

  14. CLINICAL PROFILE OF ACUTE MYOCARDIAL INFARCTION YOUNG ADULTS

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    Patel G. N

    2015-08-01

    Full Text Available BACKGROUND : Although acute myocardial infarction was believed to be an uncommon entity in the young, of late there has been a rising incidence in this group of population. The analysis of its clinical profile, including the etiologic and the risk factors gains much importance, for the preventive purpose. AIMS AND OBJECTIVES: To study the clinical profile of acute MI, including the evaluation of the cardiac enzyme markers, the risk factors, the management and the complications and outcome of this g roup of patients aged 40 years or younger. RESULTS: Majority of patients belonged to the age group of 36 - 40years. 31 patients were overweight and 16 patients were obese. 46 patients (67.64% had anterior wall myocardial infarction, 22 patients had inferior wall myocardial infarction (32.35% and ST - elevation myocardial infarction was found in 69.2% of patients. Smoking/tobacco use was the most common risk factor (64.70% followed by dyslipidemia (60.29%, metabolic syndrome (52.94% diabetes mellitus (52.94 %, hyperhomocysteinemia (52.94%, alcohol consumption (48.52%, hypertension (34%, family history (26.47%, obesity (23.52%. Other than these, two patients had chronic kidney disease stage 3, two female patients were irregular oral contraceptive pill us ers, one was diagnosed as systemic lupus erythematosus and another patient had antiphospholipid antibody syndrome. Conclusions: Apart from early diagnosis and adequate treatment of acute MI in young patients, it is also essential to identify and prevent or control the risk factors at primary and secondary level.

  15. The role of cardiac magnetic resonance imaging following acute myocardial infarction

    Energy Technology Data Exchange (ETDEWEB)

    Wong, Dennis T.L.; Richardson, James D.; Puri, Rishi; Nelson, Adam J.; Teo, Karen S.L.; Worthley, Matthew I. [Royal Adelaide Hospital, Cardiovascular Research Centre, Adelaide (Australia); University of Adelaide, Department of Medicine, Adelaide (Australia); Bertaso, Angela G. [Royal Adelaide Hospital, Cardiovascular Research Centre, Adelaide (Australia); Worthley, Stephen G. [Royal Adelaide Hospital, Cardiovascular Research Centre, Adelaide (Australia); University of Adelaide, Department of Medicine, Adelaide (Australia); Cardiovascular Investigational Unit, Adelaide, SA (Australia)

    2012-08-15

    Advances in the management of myocardial infarction have resulted in substantial reductions in morbidity and mortality. However, after acute treatment a number of diagnostic and prognostic questions often remain to be answered, whereby cardiac imaging plays an essential role. For example, some patients will sustain early mechanical complications after infarction, while others may develop significant ventricular dysfunction. Furthermore, many individuals harbour a significant burden of residual coronary disease for which clarification of functional ischaemic status and/or viability of the suspected myocardial territory is required. Cardiac magnetic resonance (CMR) imaging is well positioned to fulfil these requirements given its unparalleled capability in evaluating cardiac function, stress ischaemia testing and myocardial tissue characterisation. This review will focus on the utility of CMR in resolving diagnostic uncertainty, evaluating early complications following myocardial infarction, assessing inducible ischaemia, myocardial viability, ventricular remodelling and the emerging role of CMR-derived measures as endpoints in clinical trials. (orig.)

  16. The Vanishing Stenosis: ST Elevation Myocardial Infarction and Rhythm Disturbance due to Coronary Artery Spasm—Case Report and Review of the Literature

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    J. Gosai

    2010-01-01

    Full Text Available A 62-year-old lady was admitted with clinical and electrocardiograph features of acute myocardial infarction. Urgent coronary arteriography was performed, demonstrating a single discrete stenosis of one coronary artery. Following intracoronary injection of GTN, this stenosis completely resolved, as the symptoms did. The causes of acute myocardial infarction with normal coronary arteries are reviewed.

  17. Acute inferior ST segment elevation myocardial infarction due to chemotherapy in a young man with testicular cancer

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    Veysel Tosun

    2016-12-01

    Full Text Available Testicular cancer is the most common malignancy in men between 15 and 29 years of age. cisplatin, etoposide and bleomycin combination chemotherapy remains the mainstay of testicular cancer treatment. Acute myocardial infarction is a rare complication of these chemotherapeutics. In this case report, we present a case of 36-year-old male with acute inferior ST-segment elevation myocardial infarction after bleomycin injection. Because the patient had no significant risk factors for coronary artery disease, the infarction was likely caused by the chemotherapy regimen.

  18. Determination of the Role of Oxygen in Suspected Acute Myocardial Infarction by Biomarkers

    Science.gov (United States)

    2016-01-25

    Acute Myocardial Infarction (AMI); Acute Coronary Syndrome (ACS); ST Elevation (STEMI) Myocardial Infarction; Ischemic Reperfusion Injury; Non-ST Elevation (NSTEMI) Myocardial Infarction; Angina, Unstable

  19. Subcortical infarction resulting in acquired stuttering.

    Science.gov (United States)

    Ciabarra, A M; Elkind, M S; Roberts, J K; Marshall, R S

    2000-10-01

    Stuttering is an uncommon presentation of acute stroke. Reported cases have often been associated with left sided cortical lesions, aphasia, and difficulties with other non-linguistic tests of rhythmic motor control. Three patients with subcortical lesions resulting in stuttering are discussed. In one patient the ability to perform time estimations with a computerised repetitive time estimation task was characterised. One patient had a pontine infarct with clinical evidence of cerebellar dysfunction. A second patient had a left basal ganglionic infarct and a disruption of timing estimation. A third patient had a left subcortical infarct and a mild aphasia. These findings expand the reported distribution of infarction that can result in acquired stuttering. Subcortical mechanisms of speech control and timing may contribute to the pathophysiology of acquired stuttering.

  20. Primary amyloidosis presenting as renal infarction

    Energy Technology Data Exchange (ETDEWEB)

    Arias, M. [Dept. of Radiology, Clinica Universitaria de Navarra, Pamplona (Spain); Abreu, J.A. [Dept. of Radiology, Clinica Universitaria de Navarra, Pamplona (Spain); Iglesias, A. [Dept. of Radiology, Clinica Universitaria de Navarra, Pamplona (Spain); Longo, J. [Dept. of Radiology, Clinica Universitaria de Navarra, Pamplona (Spain); Lecumberri, F. [Dept. of Radiology, Clinica Universitaria de Navarra, Pamplona (Spain); Vega, F. [Dept. of Pathology, Clinica Universitaria de Navarra, Pamplona (Spain)

    1996-06-01

    We report a case of primary amyloidosis affecting the kidney and presenting as a renal infarction on computed tomography and ultrasound examination. To our knowledge, it is the first case in the radiological literature with these imaging characteristics. (orig.)

  1. Locations of cerebral infarctions in tuberculous meningitis

    Energy Technology Data Exchange (ETDEWEB)

    Hsieh, F.Y.; Chia, L.G. (Section of Neurology, Taichung Veterans General Hospital (Taiwan)); Shen, W.C. (Section of Neuroradiology, Taichung Veterans General Hospital (Taiwan))

    1992-06-01

    The locations of cerebral infarctions were studied in 14 patients with tuberculous meningitis (TBM) and 173 patients with noninflammatory ischemic stroke (IS). In patients with TBM, 75% of infarctions occurred in the 'TB zone' supplied by medial striate and thalamoperforating arteries; only 11% occurred in the 'IS zone' supplied by lateral striate, anterior choroidal and thalamogeniculate arteries. In patients with IS, 29% of infarctions occurred in the IS zone, 29% in the subcortical white matter, and 24% in (or involving) the cerebral cortex. Only 11% occurred in the TB zone. Bilaterally symmetrical infarctions of the TB zone were common with TBM (71%) but rare with IS (5%). (orig.).

  2. [Stem cell perspectives in myocardial infarctions].

    Science.gov (United States)

    Aceves, José Luis; Archundia, Abel; Díaz, Guillermo; Páez, Araceli; Masso, Felipe; Alvarado, Martha; López, Manuel; Aceves, Rocío; Ixcamparij, Carlos; Puente, Adriana; Vilchis, Rafael; Montaño, Luis Felipe

    2005-01-01

    Myocardial infarction is the leading cause of congestive heart failure and death in industrializated countries. The cellular cardiomyoplasty has emerged as an alternative treatment in the regeneration of infarted myocardial tissue. In animals' models, different cellular lines such as cardiomyocites, skeletal myoblasts, embryonic stem cells and adult mesenchymal stem cells have been used, resulting in an improvement in ventricular function and decrease in amount of infarcted tissue. The first three cells lines have disvantages as they are allogenics and are difficult to obtain. The adult mesenchymal stem cells are autologous and can be obtained throught the aspiration of bone marrow or from peripherical circulation, after stimulating with cytokines (G-CSF). The implantation in humans with recent and old myocardial infarction have shown improvements similar to those shown in animal models. These findings encourage the continued investigation in the mechanism of cellular differentiation and implantation methods in infarcted myocardial tissue.

  3. Ambulatory ST segment monitoring after myocardial infarction

    DEFF Research Database (Denmark)

    Mickley, H

    1994-01-01

    The prevalence of transient myocardial ischaemia after myocardial infarction seems to be lower than in other subgroups with coronary artery disease. In postinfarction patients, however, a greater proportion of ischaemic episodes are silent. At present there is substantial evidence that transient...... ischaemia provides prognostic information in different subsets of patients with previous myocardial infarction, but there is considerable disagreement about how this is expressed in terms of cardiac events. Small patient numbers, patient selection, and different timing of ambulatory monitoring are proposed...... be that it can be performed early after infarction at the time of maximum risk. Secondly, it can be performed in most patients after infarction, including those recognised as being at high risk who are unable to perform an exercise stress test....

  4. Acute myocardial infarction in sub-Saharan Africa: the need for data.

    Directory of Open Access Journals (Sweden)

    Julian T Hertz

    Full Text Available BACKGROUND: Trends in the prevalence of acute myocardial infarction in sub-Saharan Africa have not been well described, despite growing recognition of the increasing burden of cardiovascular disease in low- and middle-income countries. The aim of this systematic review was to describe the prevalence of acute myocardial infarction in sub-Saharan Africa. METHODS: We searched PubMed, EMBASE, Global Health Archive, CINAHL, and Web of Science, and conducted reference and citation analyses. Inclusion criteria were: observational studies, studies that reported incidence or prevalence of acute myocardial infarction, studies conducted in sub-Saharan Africa, and studies that defined acute myocardial infarction by EKG changes or elevation of cardiac biomarkers. Studies conducted prior to 1992 were excluded. Two independent reviewers analyzed titles and abstracts, full-texts, and references and citations. These reviewers also performed quality assessment and data extraction. Quality assessment was conducted with a validated scale for observational studies. FINDINGS: Of 2292 records retrieved, seven studies met all inclusion criteria. These studies included a total of 92,378 participants from highly heterogeneous study populations in five different countries. Methodological quality assessment demonstrated scores ranging from 3 to 7 points (on an 8-point scale. Prevalence of acute myocardial infarction ranged from 0.1 to 10.4% among the included studies. INTERPRETATION: There is insufficient population-based data describing the prevalence of acute myocardial infarction in sub-Saharan Africa. Well-designed registries and surveillance studies that capture the broad and diverse population with acute myocardial infarction in sub-Saharan Africa using common diagnostic criteria are critical in order to guide prevention and treatment strategies. REGISTRATION: Registered in International Prospective Register of Systematic Reviews (PROSPERO Database #CRD42012003161.

  5. Systemic Atherosclerotic Inflammation Following Acute Myocardial Infarction: Myocardial Infarction Begets Myocardial Infarction

    Science.gov (United States)

    Joshi, Nikhil V; Toor, Iqbal; Shah, Anoop S V; Carruthers, Kathryn; Vesey, Alex T; Alam, Shirjel R; Sills, Andrew; Hoo, Teng Y; Melville, Adam J; Langlands, Sarah P; Jenkins, William S A; Uren, Neal G; Mills, Nicholas L; Fletcher, Alison M; van Beek, Edwin J R; Rudd, James H F; Fox, Keith A A; Dweck, Marc R; Newby, David E

    2015-01-01

    Background Preclinical data suggest that an acute inflammatory response following myocardial infarction (MI) accelerates systemic atherosclerosis. Using combined positron emission and computed tomography, we investigated whether this phenomenon occurs in humans. Methods and Results Overall, 40 patients with MI and 40 with stable angina underwent thoracic 18F-fluorodeoxyglucose combined positron emission and computed tomography scan. Radiotracer uptake was measured in aortic atheroma and nonvascular tissue (paraspinal muscle). In 1003 patients enrolled in the Global Registry of Acute Coronary Events, we assessed whether infarct size predicted early (≤30 days) and late (>30 days) recurrent coronary events. Compared with patients with stable angina, patients with MI had higher aortic 18F-fluorodeoxyglucose uptake (tissue-to-background ratio 2.15±0.30 versus 1.84±0.18, P50 000] versus 3800 [1000 to 9200] ng/L, P<0.0001) and greater aortic 18F-fluorodeoxyglucose uptake (2.24±0.32 versus 2.02±0.21, P=0.03) than those with non–ST-segment elevation MI. Peak plasma troponin concentrations correlated with aortic 18F-fluorodeoxyglucose uptake (r=0.43, P=0.01) and, on multivariate analysis, independently predicted early (tertile 3 versus tertile 1: relative risk 4.40 [95% CI 1.90 to 10.19], P=0.001), but not late, recurrent MI. Conclusions The presence and extent of MI is associated with increased aortic atherosclerotic inflammation and early recurrent MI. This finding supports the hypothesis that acute MI exacerbates systemic atherosclerotic inflammation and remote plaque destabilization: MI begets MI. Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT01749254. PMID:26316523

  6. The effect of written material and verbal method education on anxiety and depression in patients with myocardial infarction in selected hospitals in iran

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    NADER AGHAKHANI

    2014-10-01

    Full Text Available Introduction: Myocardial infarction (MI is the damage to the heart muscle, or myocardium, resulting from the lack of blood flow to the heart. MI patients experience mental and emotional problems such as depression and anxiety. These complications could cause delay in resuming work, decreased quality of life and increased risk of death. The role of education in facilitating adaptation is very important in these patients. The purpose of this study was to determine the effect of written material and verbal method education on anxiety and depression in patients with myocardial infarction in Urmia hospital in 2009. Methods: This study was a quasi-experimental study, comparing the effect of education on anxiety and depression in patients with myocardial infarction in hospitals affiliated to Urmia University of Medical Science. 124 patients were selected randomly and divided into two groups. The experimental group was educated through face to face training and an educational booklet (Written Material and Verbal Method. The control group did not receive any intervention. The level of anxiety and depression was evaluated, using HADS questionnaire at 3 intervals: after 48 hours of admission, the discharge day and 2 months after discharge. Results: The findings suggested that MI patients were worried about their social role, interpersonal relations and personal health. Such problems can aggravate symptoms and complicate the future care. There was no significant difference between the control and experimental groups before the intervention, but after the intervention, anxiety and depression in the experimental group was significantly less than that in the control group (p<0.05. Conclusion: Considering the beneficial results obtained from written materials and verbal method education on reducing anxiety and depression in cases with myocardial infarction, this may be one of the health care goals. More research on more patients is required to achieve more

  7. CT findings of early acute cerebral infarction

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    Kim, Tae Hoon; Choi, Woo Suk; Ryu, Kyung Nam [Kyung Hee University Hospital, Seoul (Korea, Republic of)

    1992-11-15

    The CT findings of the acute cerebral infarction are well known. However the CT findings of early stroke within 24 hours of the onset have not been sufficiently reported. The purpose of this study is to evaluate early acute cerebral infarction on CT within 24 hours after ictus. The early and accurate CT diagnosis could lead to the appropriate therapy and improved outcome of the patients. Authors retrospectively analyzed 16 patients with early acute cerebral infarction. Acute cerebral infarction was confirmed by follow-up CT in 11 patients, SPECT in 4 patients, and MRI in 1 patient. The CT findings of early acute cerebral infarction include effacement of cortical sulci or cistern (n = 16, 100%), hyperattenuation of MCA (n = 3), obscuration of lentiform nucleus (n = 6), loss of insular ribbon (n = 6) and subtle low density in hemisphere (n = 5). The most frequent finding was effacement of cortical sulci in our study, and it was thought to be the most important sign of early acute cerebral infarction.

  8. Effects of metoprolol on early infarct expansion after acute myocardial infarction.

    Science.gov (United States)

    Jain, P; Lillis, O; Cohn, P F

    1994-04-01

    The effects of metoprolol on early infarct expansion after acute myocardial infarction were studied in rats (n = 54) that underwent either left coronary artery ligation (MI) or sham operation. Immediately after surgery, the rats received either metoprolol (M) by mouth, which had been dissolved in drinking water, for 72 hours supplemented with three intraperitoneal doses over the first 24 hours or no treatment (H2O). Three days after the initial surgery, hemodynamic measurements were made before and after volume loading. The rats were killed, the hearts were removed, and passive pressure-volume curves were obtained. The hearts were then fixed at a constant pressure and analyzed morphometrically. Infarct size was nonsignificantly lower in the metoprolol-treated group compared with the untreated group (38% +/- 5% MI-M vs 48% +/- 3% MI-H2O, p = 0.10) Compared with infarcted untreated rats, infarcted metoprolol-treated rats had a lower heart rate (322 +/- 13 beats/min MI-M vs 452 +/- 19 beats/min MI-H2O, p infarcted rats treated with metoprolol compared with infarcted untreated rats (2.76 +/- 0.07 gm/kg MI-M vs 2.41 +/- 0.09 gm/kg MI-H2O, p infarcted rats treated with metoprolol compared with infarcted untreated rats (p = 0.03). There were, however, no significant differences in the expansion index, thinning ratio, or left ventricular volume between the two infarcted groups. Thus metoprolol therapy begun in the immediate postinfarction period promotes an increase in left ventricular weight and reduces operative volume stiffness but has no significant effect on indexes of early infarct expansion.

  9. Recurrent bilateral occipital infarct with cortical blindness and anton syndrome.

    Science.gov (United States)

    Kwong Yew, Kiu; Abdul Halim, Sanihah; Liza-Sharmini, Ahmad Tajudin; Tharakan, John

    2014-01-01

    Bilateral cortical blindness and Anton syndrome, are most commonly caused by ischaemic stroke. In this condition, patients have loss of vision but deny their blindness despite objective evidence of visual loss. We report a case of a patient with multiple cardiovascular risk factors who developed recurrent bilateral occipital lobe infarct with Anton syndrome. A suspicion of this condition should be raised when the patient has denial of blindness in the presence of clinical and radiological evidence of occipital lobe injury. Management of this condition should focus on the underlying cause, in which our patient requires secondary stroke prevention and rehabilitation.

  10. Spatial analysis of myocardial infarction in Iran: National report from the Iranian myocardial infarction registry

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    Ali Ahmadi

    2015-01-01

    Full Text Available Background: Myocardial infarction (MI is a leading cause of mortality and morbidity in Iran. No spatial analysis of MI has been conducted to date. The present study was conducted to determine the pattern of MI incidence and to identify the associated factors in Iran by province. Materials and Methods: This study has two parts. One part is prospective and hospital-based, and the other part is an ecological study. In this study, the data of 20,750 new MI cases registered in Iranian Myocardial Infarction Registry in 2012 were used. For spatial analysis in global and local, spatial autocorrelation, Moran′s I, Getis-Ord, and logistic regression models were used. Data were analyzed by Stata software and ArcGIS 9.3. Results: Based on autocorrelation coefficient, a specific pattern was observed in the distribution of MI incidence in different provinces (Moran′s I: 0.75, P < 0.001. Spatial pattern of incidence was approximately the same in men and women. MI incidence was clustering in six provinces (North Khorasan, Yazd, Kerman, Semnan, Golestan, and Mazandaran. Out of the associated factors with clustered MI in six provinces, temperature, humidity, hypertension, smoking, and body mass index (BMI could be mentioned. Hypertension, smoking, and BMI contributed to clustering with, respectively, 2.36, 1.31, and 1.31 odds ratio. Conclusion: Addressing the place-based pattern of incidence and clarifying their epidemiologic dimension, including spatial analysis, has not yet been implemented in Iran. Report on MI incidence rate by place and formal borders is useful and is used in the planning and prioritization in different levels of health system.

  11. Simulation analysis of economic burden in hypertension and myocardial infarction treatment with beta blockers

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    Maja Atanasijevič Kunc

    2012-02-01

    Full Text Available Background: Hypertension has become a veryfrequent chronic disease worldwide and Slovenia is no exception. It is defined as a serious risk factor for developing different cardiovascular diseases. Several important studies proved that cardiovascular diseases are the main reason of deaths in more than 50 % of cases in the developed countries. All mentioned facts are indicatingthat treatment costs in patients with hypertension and cardiovascular diseases representan important economic burden, which cannot be neglected. It may also be expected that in the next few decades the situation will become evenworse. The reasons are the expected earlier disease development due to unhealthy life style and the fact that people live longer and populations are growing older. The mentioned facts have motivated the study, which would enable the estimation of patients’ number in the observed population and the evaluation of economic burden when using beta blockers, drugs which have become an important choice in antihypertensive treatment and are also used in patients with different cardiovascular complications. The projectionsindicating the expected trends of mentioned problems in the forthcoming decades would also be of interest.Methods: To answer some of the indicated questions, a simulation model was developed, which enabled the prediction of patients with hypertension and the influence of this disease to the development of myocardial infarction. Modeling was performed using the available statistical data and published studies. Main attention was devoted to the circumstances in Slovenia, but the results were also verified using the available data for some other countries. Combination of simulation results with demographic data enabled the estimation of the number of patients observed. In addition, expenses for the observed groupsof patients were evaluated and, based on that, the economic burden was estimated. The mentioned expenses include hospitalizations

  12. Detection and localization of myocardial infarction using K-nearest neighbor classifier.

    Science.gov (United States)

    Arif, Muhammad; Malagore, Ijaz A; Afsar, Fayyaz A

    2012-02-01

    This paper presents automatic detection and localization of myocardial infarction (MI) using K-nearest neighbor (KNN) classifier. Time domain features of each beat in the ECG signal such as T wave amplitude, Q wave and ST level deviation, which are indicative of MI, are extracted from 12 leads ECG. Detection of MI aims to classify normal subjects without myocardial infarction and subjects suffering from Myocardial Infarction. For further investigation, Localization of MI is done to specify the region of infarction of the heart. Total 20,160 ECG beats from PTB database available on Physio-bank is used to investigate the performance of extracted features with KNN classifier. In the case of MI detection, sensitivity and specificity of KNN is found to be 99.9% using half of the randomly selected beats as training set and rest of the beats for testing. Moreover, Arif-Fayyaz pruning algorithm is used to prune the data which will reduce the storage requirement and computational cost of search. After pruning, sensitivity and specificity are dropped to 97% and 99.6% respectively but training is reduced by 93%. Myocardial Infarction beats are divided into ten classes based on the location of the infarction along with one class of normal subjects. Sensitivity and Specificity of above 90% is achieved for all eleven classes with overall classification accuracy of 98.8%. Some of the ECG beats are misclassified but interestingly these are misclassified to those classes whose location of infarction is near to the true classes of the ECG beats. Pruning is done on the training set for eleven classes and training set is reduced by 70% and overall classification accuracy of 98.3% is achieved. The proposed method due to its simplicity and high accuracy over the PTB database can be very helpful in correct diagnosis of MI in a practical scenario.

  13. Cardiac hemodynamics in men versus women during acute ST-segment elevation myocardial infarction.

    Science.gov (United States)

    Dreyer, Rachel P; Beltrame, John F; Neil, Christopher; Air, Tracy; Tavella, Rosanna; Hoffmann, Bernadette; Pati, Purendra K; Di Fiore, David; Arstall, Margaret; Zeitz, Christopher

    2013-07-15

    Several biologic and clinical factors contribute to the increased 30-day mortality and re-infarction rate in women with ST-segment elevation myocardial infarction (STEMI). Sex differences in cardiac hemodynamic parameters such as pulmonary capillary wedge pressure (PCWP) have not been examined and might play an important role. The objectives of the present study were to examine whether female sex is an independent determinant of PCWP during acute STEMI and whether an elevated PCWP contributes to all-cause 30-day mortality and re-infarction in women. The clinical, angiographic, and hemodynamic features of 470 consecutive patients with STEMI (n = 135 women) undergoing emergency coronary angiography with right-side heart catheterization were evaluated with respect to sex. Women had an elevated PCWP (20 ± 8 vs 16 ± 7 mm Hg, p infarct size (β = 0.001, 95% CI 0.001 to 0.002, p ≤0.001) were independent predictors of an elevated PCWP. Female sex exerted a minor independent effect on 30-day mortality and re-infarction (odds ratio 2.36, 95% CI 1.25 to 4.46, p = 0.008). However, once PCWP was entered into the mediation model, sex was no longer significant, suggesting that the effect of sex on the post-STEMI outcomes is potentially mediated through PCWP (odds ratio 1.07, 95% CI 1.02 to 1.12, p = 0.011). In conclusion, during acute STEMI, women have greater left ventricular filling pressures compared with men, independent of age, hypertension, and infarct size. The biologic explanation for this difference requires additional investigation, although it does not appear to contribute to the increased 30-day mortality and re-infarction rate observed in women.

  14. Infarct volume predicts critical care needs in stroke patients treated with intravenous thrombolysis

    Energy Technology Data Exchange (ETDEWEB)

    Faigle, Roland; Marsh, Elisabeth B.; Llinas, Rafael H.; Urrutia, Victor C. [Johns Hopkins University School of Medicine, Department of Neurology, Baltimore, MD (United States); Wozniak, Amy W. [Johns Hopkins University, Department of Biostatistics, Bloomberg School of Public Health, Baltimore, MD (United States)

    2014-10-26

    Patients receiving intravenous thrombolysis with recombinant tissue plasminogen activator (IVT) for ischemic stroke are monitored in an intensive care unit (ICU) or a comparable unit capable of ICU interventions due to the high frequency of standardized neurological exams and vital sign checks. The present study evaluates quantitative infarct volume on early post-IVT MRI as a predictor of critical care needs and aims to identify patients who may not require resource intense monitoring. We identified 46 patients who underwent MRI within 6 h of IVT. Infarct volume was measured using semiautomated software. Logistic regression and receiver operating characteristics (ROC) analysis were used to determine factors associated with ICU needs. Infarct volume was an independent predictor of ICU need after adjusting for age, sex, race, systolic blood pressure, NIH Stroke Scale (NIHSS), and coronary artery disease (odds ratio 1.031 per cm{sup 3} increase in volume, 95 % confidence interval [CI] 1.004-1.058, p = 0.024). The ROC curve with infarct volume alone achieved an area under the curve (AUC) of 0.766 (95 % CI 0.605-0.927), while the AUC was 0.906 (95 % CI 0.814-0.998) after adjusting for race, systolic blood pressure, and NIHSS. Maximum Youden index calculations identified an optimal infarct volume cut point of 6.8 cm{sup 3} (sensitivity 75.0 %, specificity 76.7 %). Infarct volume greater than 3 cm{sup 3} predicted need for critical care interventions with 81.3 % sensitivity and 66.7 % specificity. Infarct volume may predict needs for ICU monitoring and interventions in stroke patients treated with IVT. (orig.)

  15. Effects of Edaravone, a Free Radical Scavenger, on Photochemically Induced Cerebral Infarction in a Rat Hemiplegic Model

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    Satoshi Ikeda

    2013-01-01

    Full Text Available Edaravone is a free radical scavenger that protects the adjacent cortex during cerebral infarction. We created a hemiparetic model of cerebral thrombosis from a photochemically induced infarction with the photosensitive dye, rose bengal, in rats. We examined the effects of edaravone on recovery in the model. A total of 36 adult Wistar rats were used. The right sensorimotor area was irradiated with green light with a wavelength of 533 nm (10 mm diameter, and the rose bengal was injected intravenously to create an infarction. The edaravone group was injected intraperitoneally with edaravone (3 mg/kg, and the control group was injected with saline. The recovery process of the hemiplegia was evaluated with the 7-step scale of Fenny. The infarcted areas were measured after fixation. The recovery of the paralysis in the edaravone-treated group was significantly earlier than that in the untreated group. Seven days later, both groups were mostly recovered and had scores of 7, and the infarction region was significantly smaller in the edaravone-treated group. Edaravone reduced the infarction area and promoted the functional recovery of hemiparesis from cerebral thrombosis in a rat model. These findings suggest that edaravone treatment would be effective in clinical patients recovering from cerebral infarction.

  16. Structural and functional characteristics of rat hearts with and without myocardial infarct. Initial experience with doppler echocardiography

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    Valdir A. Moisés

    2000-08-01

    Full Text Available OBJECTIVE: To assess by Doppler echocardiography the structural and functional alterations of rat heart with surgical induced extensive myocardial infarction. METHODS: Five weeks after surgical ligature of the left coronary artery, 38 Wistar-EPM rats of both sexes, 10 of them with extensive infarction, undergone anatomical and functional evaluation by Doppler echocardiography and then euthanized for anatomopathological analysis. RESULTS: Echocardiography was 100% sensible and specific to anatomopathological confirmed extensive miocardial infarction. Extensive infarction lead to dilatation of left ventricle (diastolic diameter: 0.89cm vs.0.64cm; systolic: 0.72cm vs. 0.33cm and left atrium (0.55cm vs. 0.33cm; thinning of left ventricular anterior wall (systolic: 0.14cm vs. 0.23cm, diastolic: 0.11cm vs. 0.14cm; increased mitral E/ A wave relation (6.45 vs. 1.95. Signals of increased end diastolic ventricle pressure, B point in mitral valve tracing in 62.5% and signs of pulmonary hypertension straightening of pulmonary valve (90% and notching of pulmonary systolic flow (60% were observed in animals with extensive infarction. CONCLUSION: Doppler echocardiography has a high sensitivity and specificity for detection of chronic extensive infarction. Extensive infarction caused dilatation of left cardiac chambers and showed in Doppler signals of increased end diastolic left ventricular pressure and pulmonary artery pressure.

  17. Current clinical and epidemiological portrait of a patient with acute myocardial infarction (by the data of the regional vascular center

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    E. Yu. Kovalchuk

    2015-01-01

    Full Text Available Epidemiological and clinical presentation of acute myocardial infarction based upon the data collected in Regional Vascular Centre of Saint-Petersburg Scientific Research Institute of Emergency Care n. a. I. I. Dzhanelidze in 2009-2012 years. In the article, 4697 cases have been analyzed. Specific features of epidemiology and clinical presentation of acute myocardial infarction at the present stage have been considered.

  18. PSYCHOLOGICAL REACTIONS AND HEALTH BEHAVIOR FOLLOWING ACUTE MYOCARDIAL INFARCTION

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    Tatjana Milenković

    2011-06-01

    Full Text Available Psychological reactions, risk health behavior and cardiac parameters can influence rehospitalization after acute myocardial infarction.The aim of the paper was to determine the presence of psychological reactions and risk health behavior in patients with acute myocardial infarction on admission as well as the differences after six months.The research included thirty-trhee patients of both sexes, who were consecutively hospitalized due to acute myocardial infarction. A prospective clinical investigation involved the following: semi-structured interview, Mini International Neuropsychiatric Interview (M.I.N.I for pcychiatric disorders, Beck Anxiety Inventory (BAI for measuring the severity of anxiety, Beck Depression Inventory (BDI for measuring the severity of depression, KON-6 sigma test for aggression, Holms-Rahe Scale (H-R for exposure to stressful events, and Health Behavior Questionnaire: alcohol consumption, cigarette smoking, lack of physical activity. Measurement of the same parameters was done on admission and after six months. The differences were assessed using the t-test and chi-square test for p<0.05.On admission, anxiety (BAI=8.15±4.37 and depression (BDI=8.67±3.94 were mild without significant difference after six months in the group of examinees. Aggression was elevated and significantly lowered after six monts (KON-6 sigma =53,26±9, 58:41,42±7.67, t=2,13 for p<0.05. Exposure to stressful events in this period decreased (H-R=113.19±67.37:91,65±63,81, t=3,14 for p<0.05; distribution of physical activity was significantly higher compared to admission values (54.83%: 84.84%. χ2=5.07 for p<0.01.In the group of examinees with acute myocardial infarction in the period of six months, anxiety and depression remained mildly icreased, while the levels of aggression and exposure to stressful events were lowered. Risk health behavior was maintained, except for the improvement in physical activity. In the integrative therapy and

  19. [Occupational stress and myocardial infarction].

    Science.gov (United States)

    Consoli, Silla M

    2015-01-01

    Besides the best-known role of depressed mood, occupational stress deserves to be taken as a coronary risk factor. There are two basic models to define occupational stress: Karasek's model (high job psychological demands associated with low decision latitude, or even low social support at work) and Siegrist's model (imbalance between efforts and rewards received). The combination of the two models better reflects the coronary risk than each model alone. Occupational stress appears both as a risk factor and a prognostic factor after the occurrence of myocardial infarction. The relevance of the models is best in men or in younger age subjects. In women, role conflicts (occupational/domestic), the existence of excessive "intrinsic" efforts (job over investment) and association with marital stress provide more specific information. Burnout, particularly among health professionals, and bullying at work are also linked to cardiovascular risk. Occupational stress is a collective indicator of health at work, valuable to the employer. At an individual level, it can lead to therapeutic preventive approaches. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  20. Full page insight

    DEFF Research Database (Denmark)

    Cortsen, Rikke Platz

    2014-01-01

    Alan Moore and his collaborating artists often manipulate time and space by drawing upon the formal elements of comics and making alternative constellations. This article looks at an element that is used frequently in comics of all kinds – the full page – and discusses how it helps shape spatio......, something that it shares with the full page in comics. Through an analysis of several full pages from Moore titles like Swamp Thing, From Hell, Watchmen and Promethea, it is made clear why the full page provides an apt vehicle for an apocalypse in comics....

  1. Full page insight

    DEFF Research Database (Denmark)

    Cortsen, Rikke Platz

    2014-01-01

    Alan Moore and his collaborating artists often manipulate time and space by drawing upon the formal elements of comics and making alternative constellations. This article looks at an element that is used frequently in comics of all kinds – the full page – and discusses how it helps shape spatio-t......, something that it shares with the full page in comics. Through an analysis of several full pages from Moore titles like Swamp Thing, From Hell, Watchmen and Promethea, it is made clear why the full page provides an apt vehicle for an apocalypse in comics....

  2. Altered gene expression pattern in peripheral blood mononuclear cells in patients with acute myocardial infarction.

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    Marek Kiliszek

    Full Text Available BACKGROUND: Despite a substantial progress in diagnosis and therapy, acute myocardial infarction (MI is a major cause of mortality in the general population. A novel insight into the pathophysiology of myocardial infarction obtained by studying gene expression should help to discover novel biomarkers of MI and to suggest novel strategies of therapy. The aim of our study was to establish gene expression patterns in leukocytes from acute myocardial infarction patients. METHODS AND RESULTS: Twenty-eight patients with ST-segment elevation myocardial infarction (STEMI were included. The blood was collected on the 1(st day of myocardial infarction, after 4-6 days, and after 6 months. Control group comprised 14 patients with stable coronary artery disease, without history of myocardial infarction. Gene expression analysis was performed with Affymetrix Human Gene 1.0 ST microarrays and GCS3000 TG system. Lists of genes showing altered expression levels (fold change >1.5, p<0.05 were submitted to Ingenuity Pathway Analysis. Gene lists from each group were examined for canonical pathways and molecular and cellular functions. Comparing acute phase of MI with the same patients after 6 months (stable phase and with control group we found 24 genes with changed expression. In canonical analysis three pathways were highlighted: signaling of PPAR (peroxisome proliferator-activated receptor, IL-10 and IL-6 (interleukin 10 and 6. CONCLUSIONS: In the acute phase of STEMI, dozens of genes from several pathways linked with lipid/glucose metabolism, platelet function and atherosclerotic plaque stability show altered expression. Up-regulation of SOCS3 and FAM20 genes in the first days of myocardial infarction is observed in the vast majority of patients.

  3. Myocardial connective tissue growth factor (CCN2/CTGF attenuates left ventricular remodeling after myocardial infarction.

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    Jørgen Gravning

    Full Text Available AIMS: Myocardial CCN2/CTGF is induced in heart failure of various etiologies. However, its role in the pathophysiology of left ventricular (LV remodeling after myocardial infarction (MI remains unresolved. The current study explores the role of CTGF in infarct healing and LV remodeling in an animal model and in patients admitted for acute ST-elevation MI. METHODS AND RESULTS: Transgenic mice with cardiac-restricted overexpression of CTGF (Tg-CTGF and non-transgenic littermate controls (NLC were subjected to permanent ligation of the left anterior descending coronary artery. Despite similar infarct size (area of infarction relative to area at risk 24 hours after ligation of the coronary artery in Tg-CTGF and NLC mice, Tg-CTGF mice disclosed smaller area of scar tissue, smaller increase of cardiac hypertrophy, and less LV dilatation and deterioration of LV function 4 weeks after MI. Tg-CTGF mice also revealed substantially reduced mortality after MI. Remote/peri-infarct tissue of Tg-CTGF mice contained reduced numbers of leucocytes, macrophages, and cells undergoing apoptosis as compared with NLC mice. In a cohort of patients with acute ST-elevation MI (n = 42 admitted to hospital for percutaneous coronary intervention (PCI serum-CTGF levels (s-CTGF were monitored and related to infarct size and LV function assessed by cardiac MRI. Increase in s-CTGF levels after MI was associated with reduced infarct size and improved LV ejection fraction one year after MI, as well as attenuated levels of CRP and GDF-15. CONCLUSION: Increased myocardial CTGF activities after MI are associated with attenuation of LV remodeling and improved LV function mediated by attenuation of inflammatory responses and inhibition of apoptosis.

  4. A comparative study of serum histaminase and serum glutamic oxaloacetic transaminase in acute myocardial infarction

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    Gupta S

    1979-01-01

    Full Text Available Serum histaminase and SGOT were estimated in 35 cases of acute myocardial infarction and 34 cases of ischaemic heart disease (Other than acute myocardial infarction and 30, age and sex match-ed, healthy subjects which served as controls, to evaluate the com-parison of time relation activity, diagnostic and prognostic value of histaminase and SGOT. The enzymes were estimated within 6 hours, then repeated -within 24 hours, 2nd day, 3rd day, 5th day, 10th day and 15th day, ascertained from the time o f pain in the chest. Raised histaminase levels were found in 97.14%; cases, while SGOT levels were found elevated in only 91.4% cases of acute myo-cardial infarction of which 30 were electrocardiographically proved and 5 had equivocal electrocardiographic evidence of acute infarc-tion like LBBB, complete heart block, ventricular tachycardia and old myocardial infarction. Furthermore elevation of histaminase was 6.2 times whereas of SGOT only 5.2 times above the mean normal value. Serum histaminase was found elevated in all the 6 cases who presented within 6 hours of infarction, while SGOT did not rise in any of these cases. Both histaminase and SGOT reached the peak levels on the 2nd day and persisted for whole of the first week. Higher levels of these enzymes were found associated with worse prognosis. Above observations show that the serum histaminase rises earlier than SGOT and can prove the diagnosis of myocardial infarction even when SGOT and ECG fail to reveal the diagnosis. It is a more sensitive index and has higher peak rise of levels than SGOT. How-ever its pattern of rise, fall and prognostic values are similar to that of SGOT.

  5. Fibrinogen as a risk factor for premature myocardial infarction in Iranian patients: A case control study

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    Mohammad Shojaie

    2009-08-01

    Full Text Available Mohammad Shojaie, Morteza Pourahmad, Ahad Eshraghian, Hamid Reza Izadi, Farzan NaghshvarPeymanieh Hospital, Internal Medicine Department, Jahrom University of Medical Sciences, Jahrom, Fars, IranBackground: Premature myocardial infarction with life-threatening complications may become epidemic in some Asian and African countries and especially Iran. Fibrinogen is considered as one of the probable risk factors of myocardial infarction. The aim of our study was to assess fibrinogen levels as an etiology of premature myocardial infarction in young Iranian men.Findings: A case-control study was conducted between May 2005 and May 2007 to investigate the association between serum total fibrinogen level and myocardial infarction in men aged younger than 55 years admitted to the cardiac care units of Peymanieh and Motahari Hospitals affiliated to Jahrom University of Medical Sciences, Iran. The mean age of patients was 45.2 ± 4 years in patients with premature myocardial infarction and 47.06 ± 4.5 years in the control group (p = 0.085. There were no statistically significant relationships between the two groups in history of premature myocardial infarction in their first-degree relatives (p = 0.05, cigarette smoking (p = 0.46, diabetes (p = 0.49, or hypertension (p = 1. The mean plasma fibrinogen in patients (354.9 ± 60 mg/dL was elevated markedly compared with the control group (329 ± 73 mg/dL. Hyperfibrinogenemia (>340 mg/dL was detected in 81.8% of patients and 57.5% of controls (95% confidence interval, odds ratio = 3.3; p = 0.036.Conclusion: This study introduced fibrinogen as a risk factor for premature coronary artery disease in Iranian men.Keywords: myocardial infarction, cigarette, hypertension, diabetes, fibrinogen

  6. Cerebral Infarct due to Fibromuscular Dysplasia: A Case Report

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    Arzu Tay

    2013-04-01

    Full Text Available The course of cervicocephalic fibromuscular dysplasia is mainly asymptomatic. It is often found as an incidental finding on autopsy or angiography mostly in women and is commonly located in extracranial region of carotid artery. In the present article, we reported a 21 year-old man who has been initially accepted to our intensive care with a tentative diagnosis of cerebrovascular infarct after having symptoms of loss of consciousness and right hemiparesis. He later received a certain diagnosis of fibromuscular dysplasia after neuroimaging findings. This disorder should be considered in differential diagnosis of young stroke patients. [Cukurova Med J 2013; 38(2.000: 305-307

  7. Pancreatitis with Electrocardiographic Changes Mimicking Acute Myocardial Infarction

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    Paul Khairy

    2001-01-01

    Full Text Available A 64-year-old woman with mild acute pancreatitis presented with epigastric pain, nausea and vomiting while undergoing hemodialysis for chronic renal insufficiency. Serial electrocardiograms revealed new onset ST segment elevations in leads V2 to V4 mimicking an anterior myocardial infarction, followed by diffusely inverted deep T waves. No cardiac pathology was demonstrated by echocardiography or coronary angiography. A review of the literature and possible pathophysiological mechanisms of electrocardiographic changes in acute pancreatitis, such as metabolic abnormalities, hemodynamic instability, vasopressors, pericarditis, myocarditis, a cardiobiliary reflex, exacerbation of underlying cardiac pathology, coagulopathy and coronary vasospasm, are discussed.

  8. High dose intravenous immunoglobulin may be complicated by myocardial infarction

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    Kolar Vishwanath Vinod

    2014-01-01

    Full Text Available Intravenous immunoglobulin [IVIg] is useful for treating several clinical conditions and is largely considered safe, without major adverse events. Here we report a case of acute ST elevation myocardial infarction associated with high dose IVIg administration in a previously healthy 69-year-old male patient of Guillain Barre syndrome. The case is being reported to emphasize the need for treating physicians to be aware of thrombotic complications associated with IVIg. The thrombotic complications associated with IVIg are reviewed in brief , and the measures to reduce them are discussed.

  9. Methods of creatine kinase-MB analysis to predict mortality in patients with myocardial infarction treated with reperfusion therapy.

    Science.gov (United States)

    Lopes, Renato D; Lokhnygina, Yuliya; Hasselblad, Victor; Newby, Kristin L; Yow, Eric; Granger, Christopher B; Armstrong, Paul W; Hochman, Judith S; Mills, James S; Ruzyllo, Witold; Mahaffey, Kenneth W

    2013-05-02

    Larger infarct size measured by creatine kinase (CK)-MB release is associated with higher mortality and has been used as an important surrogate endpoint in the evaluation of new treatments for ST-segment elevation myocardial infarction (STEMI). Traditional approaches to quantify infarct size include the observed CK-MB peak and calculated CK-MB area under the curve (AUC). We evaluated alternative approaches to quantifying infarct size using CK-MB values, and the relationship between infarct size and clinical outcomes. Of 1,850 STEMI patients treated with reperfusion therapy in the COMplement inhibition in Myocardial infarction treated with Angioplasty (COMMA) (percutaneous coronary intervention (PCI)-treated) and the COMPlement inhibition in myocardial infarction treated with thromboLYtics (COMPLY) (fibrinolytic-treated) trials, 1,718 (92.9%) (COMMA, n = 868; COMPLY, n = 850) had at least five of nine protocol-required CK-MB measures. In addition to traditional methods, curve-fitting techniques were used to determine CK-MB AUC and estimated peak CK-MB. Cox proportional hazards modeling assessed the univariable associations between infarct size and mortality, and the composite of death, heart failure, shock and stroke at 90 days. In COMPLY, CK-MB measures by all methods were significantly associated with higher mortality (hazard ratio range per 1,000 units increase: 1.09 to 1.13; hazard ratio range per 1 standard deviation increase: 1.41 to 1.62; P MB measures were statistically significant in both the COMMA and COMPLY trials. Sophisticated curve modeling is an alternative to infarct-size quantification in STEMI patients, but it provides information similar to that of more traditional methods. Future studies will determine whether the same conclusion applies in circumstances other than STEMI, or to studies with different frequencies and patterns of CK-MB data collection.

  10. Thrombolytic therapy of acute myocardial infarction alters collagen metabolism

    DEFF Research Database (Denmark)

    Høst, N B; Hansen, S S; Jensen, L T

    1994-01-01

    infarction and receiving thrombolytic therapy. Regardless of whether acute myocardial infarction was confirmed or not, S-PIIINP increased (94-120%) 4 h after streptokinase therapy (p ....02). With confirmed acute myocardial infarction, S-PIIINP increased from 24 h towards a plateau reached at day 2-3 (p acute myocardial infarction had S-PICP above baseline at 1, 2, and 6 months (p ....05). A less pronounced S-PIIINP increase was noted with tissue-plasminogen activator than with streptokinase. Thrombolytic therapy induces collagen breakdown regardless of whether acute myocardial infarction is confirmed or not. With confirmed acute myocardial infarction collagen metabolism is altered...

  11. Is it possible to differentiate between Takotsubo cardiomyopathy and acute anterior ST-elevation myocardial infarction?

    NARCIS (Netherlands)

    Vervaat, Fabienne E.; Christensen, Thomas E.; Smeijers, Loes; Holmvang, Lene; Hasbak, Philip; Szabo, Balazs M.; Widdershoven, J.W. M. G.; Wagner, Galen S.; Bang, Lia E.; Gorgels, Anton P. M.

    2015-01-01

    Introduction Several studies have investigated the ability of the twelve-lead electrocardiogram (ECG) to reliably distinguish Takotsubo cardiomyopathy (TC) from an acute anterior ST-segment elevation myocardial infarction (STEMI). In these studies, only ECG changes were required – ST-segment

  12. MR imaging findings of orbitofacial infarction secondary to rhinoorbital mucormycosis : a case report

    Energy Technology Data Exchange (ETDEWEB)

    Joo, Jong Kwan; Lee, Jae Hee; Jeon, Eun Ju; Kim, Kyong Mee; Kim Ki Jun; Lee, Sung Yong [Our Lady of Mercy Hospital, the Catholic University of Korea, Seoul (Korea, Republic of); Choi, Kyu H. [Kangnam' s St. Mary' s Hospital, Seoul (Korea, Republic of)

    2000-02-01

    Rhino-orbital mucormycosis is the most frequently fatal fungal infection commonly occurring in patients with poorly controlled diabetes mellitus and those who are immunocompromised, and requires prompt treatment. We describe a case of rhino-orbital mucormycosis with orbital cellulitis and paranasal sinusitis, as seen on initial MR images, which on follow-up images had evolved to orbitofacial infarction. MR imaging was useful for the demonstration of orbitofacial infarction, seen as areas of lack of enhancement and thus suggesting vascular involvement by mucor hyphae. (author)

  13. DJ-1 immunoreactivity in human brain astrocytes is dependent on infarct presence and infarct age.

    Science.gov (United States)

    Mullett, Steven J; Hamilton, Ronald L; Hinkle, David A

    2009-04-01

    DJ-1 is a protein with anti-oxidative stress and anti-apoptotic properties that is abundantly expressed in reactive CNS astrocytes in chronic neurodegenerative disorders such as Parkinson's disease (PD), Alzheimer's disease (AD), and Pick's disease. Genetic mutations which eliminate DJ-1 expression in humans are sufficient to produce an early-onset form of familial PD, PARK7, suggesting that DJ-1 is a critical component of the neuroprotective arsenal of the brain. Previous studies in parkinsonism/dementia brain tissues have revealed that reactive astrocytes within and surrounding incidentally identified infarcts were often robustly immunoreactive for DJ-1, especially if the infarcts showed histological features consistent with older age. Given this, we sought to evaluate astrocytic DJ-1 expression in human stroke more extensively, and with a particular emphasis on determining whether immunohistochemical DJ-1 expression in astrocytes correlates with histological infarct age. The studies presented here show that DJ-1 is abundantly expressed in reactive infarct region astrocytes in both gray and white matter, that subacute and chronic infarct region astrocytes are much more robustly DJ-1+ than are acute infarct and non-infarct region astrocytes, and that DJ-1 staining intensity in astrocytes generally correlates with that of the reactive astrocyte marker GFAP. Confocal imaging of DJ-1 and GFAP dual-labelled human brain sections were used to confirm the localization to and expression of DJ-1 in astrocytes. Neuronal DJ-1 staining was minimal under all infarct and non-infarct conditions. Our data support the conclusion that the major cellular DJ-1 response to stroke in the human brain is astrocytic, and that there is a temporal correlation between DJ-1 expression in these cells and advanced infarct age.

  14. download full text

    African Journals Online (AJOL)

    Abstract: Immunization remains one of the most important public health ... In line with the aforementioned, the report of World Health Organization and the earlier ... The study subjects were not required to write but just to tick the appropriate ...

  15. Patterns of spontaneous and head-shaking nystagmus in cerebellar infarction: imaging correlations.

    Science.gov (United States)

    Huh, Young Eun; Kim, Ji Soo

    2011-12-01

    Horizontal head-shaking may induce nystagmus in peripheral as well as central vestibular lesions. While the patterns and mechanism of head-shaking nystagmus are well established in peripheral vestibulopathy, they require further exploration in central vestibular disorders. To define the characteristics and mechanism of head-shaking nystagmus in central vestibulopathies, we investigated spontaneous nystagmus and head-shaking nystagmus in 72 patients with isolated cerebellar infarction. Spontaneous nystagmus was observed in 28 (39%) patients, and was mostly ipsilesional when observed in unilateral infarction (15/18, 83%). Head-shaking nystagmus developed in 37 (51%) patients, and the horizontal component of head-shaking nystagmus was uniformly ipsilesional when induced in patients with unilateral infarction. Perverted head-shaking nystagmus occurred in 23 (23/37, 62%) patients and was mostly downbeat (22/23, 96%). Lesion subtraction analyses revealed that damage to the uvula, nodulus and inferior tonsil was mostly responsible for generation of head-shaking nystagmus in patients with unilateral posterior inferior cerebellar artery infarction. Ipsilesional head-shaking nystagmus in patients with unilateral cerebellar infarction may be explained by unilateral disruption of uvulonodular inhibition over the velocity storage. Perverted (downbeat) head-shaking nystagmus may be ascribed to impaired control over the spatial orientation of the angular vestibulo-ocular reflex due to uvulonodular lesions or a build-up of vertical vestibular asymmetry favouring upward bias due to lesions involving the inferior tonsil.

  16. Comparing cognitive and somatic symptoms of depression in myocardial infarction patients and depressed patients in primary and mental health care.

    Directory of Open Access Journals (Sweden)

    Nynke A Groenewold

    Full Text Available Depression in myocardial infarction patients is often a first episode with a late age of onset. Two studies that compared depressed myocardial infarction patients to psychiatric patients found similar levels of somatic symptoms, and one study reported lower levels of cognitive/affective symptoms in myocardial infarction patients. We hypothesized that myocardial infarction patients with first depression onset at a late age would experience fewer cognitive/affective symptoms than depressed patients without cardiovascular disease. Combined data from two large multicenter depression studies resulted in a sample of 734 depressed individuals (194 myocardial infarction, 214 primary care, and 326 mental health care patients. A structured clinical interview provided information about depression diagnosis. Summed cognitive/affective and somatic symptom levels were compared between groups using analysis of covariance, with and without adjusting for the effects of recurrence and age of onset. Depressed myocardial infarction and primary care patients reported significantly lower cognitive/affective symptom levels than mental health care patients (F (2,682 = 6.043, p = 0.003. Additional analyses showed that the difference between myocardial infarction and mental health care patients disappeared after adjusting for age of onset but not recurrence of depression. These group differences were also supported by data-driven latent class analyses. There were no significant group differences in somatic symptom levels. Depression after myocardial infarction appears to have a different phenomenology than depression observed in mental health care. Future studies should investigate the etiological factors predictive of symptom dimensions in myocardial infarction and late-onset depression patients.

  17. Visual agnosia and posterior cerebral artery infarcts: an anatomical-clinical study.

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    Olivier Martinaud

    Full Text Available BACKGROUND: To evaluate systematically the cognitive deficits following posterior cerebral artery (PCA strokes, especially agnosic visual disorders, and to study anatomical-clinical correlations. METHODS AND FINDINGS: We investigated 31 patients at the chronic stage (mean duration of 29.1 months post infarct with standardized cognitive tests. New experimental tests were used to assess visual impairments for words, faces, houses, and objects. Forty-one healthy subjects participated as controls. Brain lesions were normalized, combined, and related to occipitotemporal areas responsive to specific visual categories, including words (VWFA, faces (FFA and OFA, houses (PPA and common objects (LOC. Lesions were located in the left hemisphere in 15 patients, in the right in 13, and bilaterally in 3. Visual field defects were found in 23 patients. Twenty patients had a visual disorder in at least one of the experimental tests (9 with faces, 10 with houses, 7 with phones, 3 with words. Six patients had a deficit just for a single category of stimulus. The regions of maximum overlap of brain lesions associated with a deficit for a given category of stimuli were contiguous to the peaks of the corresponding functional areas as identified in normal subjects. However, the strength of anatomical-clinical correlations was greater for words than for faces or houses, probably due to the stronger lateralization of the VWFA, as compared to the FFA or the PPA. CONCLUSIONS: Agnosic visual disorders following PCA infarcts are more frequent than previously reported. Dedicated batteries of tests, such as those developed here, are required to identify such deficits, which may escape clinical notice. The spatial relationships of lesions and of regions activated in normal subjects predict the nature of the deficits, although individual variability and bilaterally represented systems may blur those correlations.

  18. Selective homocysteine lowering gene transfer improves infarct healing, attenuates remodelling, and enhances diastolic function after myocardial infarction in mice.

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    Ilayaraja Muthuramu

    Full Text Available BACKGROUND AND AIMS: Homocysteine levels predict heart failure incidence in prospective epidemiological studies and correlate with severity of heart failure in cross-sectional surveys. The objective of this study was to evaluate whether a selective homocysteine lowering intervention beneficially affects cardiac remodelling and cardiac function after myocardial infarction (MI in a murine model of combined hypercholesterolemia and hyperhomocysteinemia. METHODOLOGY AND PRINCIPAL FINDINGS: A selective homocysteine lowering gene transfer strategy was evaluated in female C57BL/6 low density lipoprotein receptor (Ldlr⁻/⁻ cystathionine-ß-synthase (Cbs⁺/⁻ deficient mice fed a hyperhomocysteinemic and high saturated fat/high cholesterol diet using an E1E3E4-deleted hepatocyte-specific adenoviral vector expressing Cbs (AdCBS. MI was induced by permanent ligation of the left anterior descending coronary artery 14 days after saline injection or gene transfer. AdCBS gene transfer resulted in a persistent more than 5-fold (p<0.01 decrease of plasma homocysteine levels and significantly improved endothelial progenitor cell function. Selective homocysteine lowering enhanced infarct healing as indicated by a 21% (p<0.01 reduction of infarct length at day 28 after MI and by an increased number of capillaries and increased collagen content in the infarct zone. Adverse remodelling was attenuated in AdCBS MI mice as evidenced by a 29% (p<0.05 reduction of left ventricular cavity area at day 28, by an increased capillary density in the remote myocardium, and by reduced interstitial collagen. The peak rate of isovolumetric relaxation was increased by 19% (p<0.05 and the time constant of left ventricular relaxation was reduced by 21% (p<0.05 in AdCBS MI mice compared to control MI mice, indicating improved diastolic function. CONCLUSION/SIGNIFICANCE: Selective homocysteine lowering gene transfer improves infarct healing, attenuates remodelling, and

  19. Factors-related to quality of life in post myocardial infarction patients

    Institute of Scientific and Technical Information of China (English)

    Ali Hassanpour Dehkordi; M. Saeed Heydarnejad

    2009-01-01

    Objective: To identify factors related to quality of life in post myocardial infarction patients. Methods: The subjects were 150 post myocardial infarction patients who were receiving follow up care at Hajar Hospital. SeE-administered questionnaires consisting of physical-and mental health-quality of life (QoL) during a 14-month follow-up were designed. A χ2 test was used to determine relationships between variables. Results: There was significant correlation between demographic variables such as insurance and retirees between the subjects tested. In addition, a significant relationship between the pain intensity, fatigne, reducing or losing job performance and QoL was found. Conclusion: The role of nurses to fulfill all social, psychotically and mental requirements of the patients with myocardial infarction is highly appreciated.

  20. About CABI Full Text

    Institute of Scientific and Technical Information of China (English)

    2012-01-01

    <正>Centre for Agriculture and Bioscience International( CABI) is a not-for-profit international Agricultural Information Institute with headquarters in Britain. It aims to improve people’s lives by providing information and applying scientific expertise to solve problems in agriculture and the environment. CABI Full-text is one of the publishing products of CABI.CABI’s full text repository is growing rapidly and has now been integrated into all our databases including CAB Abstracts,Global Health,our Internet Resources and Abstract Journals. There are currently over 60,000 full text articles available to access. These documents,made possible by agreement with third

  1. Early and long-term outcome of elective stenting of the infarct-related artery in patients with viability in the infarct-area: Rationale and design of the Viability-guided Angioplasty after acute Myocardial Infarction-trial (The VIAMI-trial

    Directory of Open Access Journals (Sweden)

    Visser Cees A

    2004-11-01

    Full Text Available Abstract Background Although percutaneous coronary intervention (PCI is becoming the standard therapy in ST-segment elevation myocardial infarction (STEMI, to date most patients, even in developed countries, are reperfused with intravenous thrombolysis or do not receive a reperfusion therapy at all. In the post-lysis period these patients are at high risk for recurrent ischemic events. Early identification of these patients is mandatory as this subgroup could possibly benefit from an angioplasty of the infarct-related artery. Since viability seems to be related to ischemic adverse events, we initiated a clinical trial to investigate the benefits of PCI with stenting of the infarct-related artery in patients with viability detected early after acute myocardial infarction. Methods The VIAMI-study is designed as a prospective, multicenter, randomized, controlled clinical trial. Patients who are hospitalized with an acute myocardial infarction and who did not have primary or rescue PCI, undergo viability testing by low-dose dobutamine echocardiography (LDDE within 3 days of admission. Consequently, patients with demonstrated viability are randomized to an invasive or conservative strategy. In the invasive strategy patients undergo coronary angiography with the intention to perform PCI with stenting of the infarct-related coronary artery and concomitant use of abciximab. In the conservative group an ischemia-guided approach is adopted (standard optimal care. The primary end point is the composite of death from any cause, reinfarction and unstable angina during a follow-up period of three years. Conclusion The primary objective of the VIAMI-trial is to demonstrate that angioplasty of the infarct-related coronary artery with stenting and concomitant use of abciximab results in a clinically important risk reduction of future cardiac events in patients with viability in the infarct-area, detected early after myocardial infarction.

  2. Treatment with hESC-Derived Myocardial Precursors Improves Cardiac Function after a Myocardial Infarction.

    Directory of Open Access Journals (Sweden)

    Jianqin Ye

    Full Text Available We previously reported the generation of a reporter line of human embryonic stem cells (hESCs with enhanced green fluorescent protein (eGFP expression driven by the α-myosin heavy chain (αMHC promoter. The GFP+/αMHC+ cells derived from this cell line behave as multipotent, human myocardial precursors (hMPs in vitro. In this study, we evaluated the therapeutic effects of GFP+/αMHC+ cells isolated from the reporter line in a mouse model of myocardial infarction (MI.MI was generated in immunodeficient mice. hMPs were injected into murine infarcted hearts under ultrasound guidance at 3 days post-MI. Human fetal skin fibroblasts (hFFs were injected as control. Cardiac function was evaluated by echocardiography. Infarct size, angiogenesis, apoptosis, cell fate, and teratoma formation were analyzed by immunohistochemical staining.Compared with control, hMPs resulted in improvement of cardiac function post-MI with smaller infarct size, induced endogenous angiogenesis, and reduced apoptosis of host cardiomyocytes at the peri-infarct zone at 28 days post-MI.Intramyocardial injection of hMPs improved cardiac function post-MI. The engraftment rate of these cells in the myocardium post-MI was low, suggesting that the majority of effect occurs via paracrine mechanisms.

  3. Postmyocardial Infarct Remodeling and Heart Failure: Potential Contributions from Pro- and Antiaging Factors

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    Halliday A. Idikio

    2011-01-01

    Full Text Available Myocardial infarction and adverse postinfarct remodeling in older persons lead to poor outcome and need greater understanding of the contributions of age-related factors on abnormal cardiac function and management. In this perspective, how normal aging processes could contribute to the events of post-myocardial infarction and remodeling is reviewed. Post-myocardial infarction and remodeling involve cardiomechanical factors and neurohormonal response. Many factors prevent or accelerate aging including immunosenescence, recruitment and regeneration of stem cells, telomere shortening, oxidative damage, antiaging hormones klotho and melatonin, nutrition, and Sirtiun protein family, and these factors could affect post-MI remodeling and heart failure. Interest in stem cell repair of myocardial infarcts to mitigate post-MI remodeling needs more information on aging of stem cells, and potential effects on stem cell use in infarct repair. Integrating genomics and proteomics methods may help find clinically novel therapy in the management of post-MI remodeling and heart failure in aged individuals.

  4. Atlas-based quantification of cardiac remodeling due to myocardial infarction.

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    Xingyu Zhang

    Full Text Available Myocardial infarction leads to changes in the geometry (remodeling of the left ventricle (LV of the heart. The degree and type of remodeling provides important diagnostic information for the therapeutic management of ischemic heart disease. In this paper, we present a novel analysis framework for characterizing remodeling after myocardial infarction, using LV shape descriptors derived from atlas-based shape models. Cardiac magnetic resonance images from 300 patients with myocardial infarction and 1991 asymptomatic volunteers were obtained from the Cardiac Atlas Project. Finite element models were customized to the spatio-temporal shape and function of each case using guide-point modeling. Principal component analysis was applied to the shape models to derive modes of shape variation across all cases. A logistic regression analysis was performed to determine the modes of shape variation most associated with myocardial infarction. Goodness of fit results obtained from end-diastolic and end-systolic shapes were compared against the traditional clinical indices of remodeling: end-diastolic volume, end-systolic volume and LV mass. The combination of end-diastolic and end-systolic shape parameter analysis achieved the lowest deviance, Akaike information criterion and Bayesian information criterion, and the highest area under the receiver operating characteristic curve. Therefore, our framework quantitatively characterized remodeling features associated with myocardial infarction, better than current measures. These features enable quantification of the amount of remodeling, the progression of disease over time, and the effect of treatments designed to reverse remodeling effects.

  5. Over-expression of calpastatin inhibits calpain activation and attenuates post-infarction myocardial remodeling.

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    Tingqiao Ye

    Full Text Available Calpain is activated following myocardial infarction and ablation of calpastatin (CAST, an endogenous inhibitor of calpains, promotes left ventricular remodeling after myocardial infarction (MI. The present study aimed to investigate the effect of transgenic over-expression of CAST on the post-infarction myocardial remodeling process.We established transgenic mice (TG ubiquitously over-expressing human CAST protein and produced MI in TG mice and C57BL/6J wild-type (WT littermates.The CAST protein expression was profoundly upregulated in the myocardial tissue of TG mice compared with WT littermates (P < 0.01. Overexpression of CAST significantly reduced the infarct size (P < 0.01 and blunted MI-induced interventricular hypertrophy, global myocardial fibrosis and collagen I and collagen III deposition, hypotension and hemodynamic disturbances at 21 days after MI. Moreover, the MI-induced up-regulation and activation of calpains were obviously attenuated in CAST TG mice. MI-induced down-regulation of CAST was partially reversed in TG mice. Additionally, the MI-caused imbalance of matrix metalloproteinases and their inhibitors was improved in TG mice.Transgenic over-expression of CAST inhibits calpain activation and attenuates post-infarction myocardial remodeling.

  6. Over-Expression of Catalase in Myeloid Cells Confers Acute Protection Following Myocardial Infarction

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    E. Bernadette Cabigas

    2014-05-01

    Full Text Available Cardiovascular disease is the leading cause of death in the United States and new treatment options are greatly needed. Oxidative stress is increased following myocardial infarction and levels of antioxidants decrease, causing imbalance that leads to dysfunction. Therapy involving catalase, the endogenous scavenger of hydrogen peroxide (H2O2, has been met with mixed results. When over-expressed in cardiomyocytes from birth, catalase improves function following injury. When expressed in the same cells in an inducible manner, catalase showed a time-dependent response with no acute benefit, but a chronic benefit due to altered remodeling. In myeloid cells, catalase over-expression reduced angiogenesis during hindlimb ischemia and prevented monocyte migration. In the present study, due to the large inflammatory response following infarction, we examined myeloid-specific catalase over-expression on post-infarct healing. We found a significant increase in catalase levels following infarction that led to a decrease in H2O2 levels, leading to improved acute function. This increase in function could be attributed to reduced infarct size and improved angiogenesis. Despite these initial improvements, there was no improvement in chronic function, likely due to increased fibrosis. These data combined with what has been previously shown underscore the need for temporal, cell-specific catalase delivery as a potential therapeutic option.

  7. Role of general practitioner in the management of acute myocardial infarction

    Directory of Open Access Journals (Sweden)

    Beeleonie Beeleonie

    2005-12-01

    Full Text Available Acute myocardial infarction (AMI has been the leading cause of death in Western countries, as well as in Indonesia. Delay in diagnosis and incorrect early management often result in failure of thrombolytic reperfusion. General practitioner (GP as the primary care, needs to be equipped with the ability to diagnose and moreover to manage AMI. A case of fail thrombolytic management in a 47 years old man after seven hours of angina typical chest pain, after previously managed by GP, is being reported. (Med J Indones 2005; 14:249-52Keywords: acute myocardial infarction, reperfusion, general practitioner

  8. A Case Associated with Comorbidities Among Cerebral Infarction, Idiopathic Thrombocytopenic Purpura, and Triple X Syndrome

    Directory of Open Access Journals (Sweden)

    Hanjun Kim

    2014-06-01

    Full Text Available A 46-year-old female presented to the emergency room due to the chief complaint of left-sided weakness. By imaging study, she was diagnosed with cerebral infarction. Thrombolytic and antiplatelet agents were not considered due to the “golden hour” for treatment having passed and a low platelet count. The peripheral blood smear, bone marrow biopsy, and aspirate findings were consistent with immune thrombocytopenic purpura. The chromosome analysis revealed the 47,XXX karyotype. To the best of our knowledge, this is the first case report associated with the comorbidities of cerebral infarction, idiopathic thrombocytopenic purpura, and triple X syndrome.

  9. Serum lactic dehydrogenase isoenzymes and serum hydroxy butyric dehydrogenase in myocardial infarction

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    Kanekar D

    1979-01-01

    Full Text Available Total serum lactate dehydrogenase activity in cases of myocar-dial infarct is difficult to interpret as abnormal values can occur in diseases of liver, kidney and skeletal muscle. The estimation of its isoenzymes is of better diagnostic help because of its tissue specificity. Serum LDH isoenzymes were studied in patients o f myocardial infarction and results are quantitated by densitometry. As LDH 1 represents serum hydroxybutyric dehydrogenase when 2-oxylbutyrate is used as substrate, serum hydroxybutyric dehydro-genase was also estimated in above patients. Greater specificity in diagnosis is achieved with SHBDH because of its myocardial nature and lower incidence of false positive results.

  10. New anticoagulant strategies in ST elevation myocardial infarction: Trials and clinical implications

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    Conor J McCann

    2008-04-01

    Full Text Available Conor J McCann, Ian BA MenownCraigavon Cardiac Centre, Craigavon Area Hospital, Craigavon, Northern Ireland, UKAbstract: New data have re-established the importance of anticoagulation of patients with ST segment elevation myocardial infarction (STEMI, both as an adjuvant to reperfusion therapy or in patients ineligible for reperfusion. Recent randomized trials have found newer agents to be superior to conventional unfractionated heparin. This article summarizes current understanding of the underlying pathophysiology of STEMI and provides a comprehensive review of emerging trial data for low molecular weight heparins, anti-factor Xa agents and direct thrombin inhibitors in this setting.Keywords: myocardial infarction, treatment, anticoagulants

  11. Acute Simultaneous Thrombotic Occlusion of Multiple Coronary Arteries in Acute Myocardial Infarction: A Case Report

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    Mohammad Mahdi Daei

    2017-05-01

    Full Text Available Introduction Simultaneous multiple coronary artery thrombosis is a rare finding in ST segment elevation myocardial infarction (STEMI, and has a high mortality rate. Case Presentation We report a case of myocardial infarction with cardiogenic shock, left bundle branch block, and multiple ST segment elevation on the electrocardiogram and thrombotic occlusion of the left circumflex, optus marginal, and left anterior descending arteries on emergency coronary angiography. Thrombus aspiration was performed at left circumflex, optus marginal, and left anterior descending arteries. Conclusions In patients with STEMI, multiple coronary thrombosis is unusual and associated with high patient mortality.

  12. Cardioprotective effect of amlodipine in oxidative stress induced by experimental myocardial infarction in rats

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    Sudhira Begum

    2007-12-01

    Full Text Available The present study investigated whether the administration of amlodipine ameliorates oxidative stress induced by experimental myocardial infarction in rats. Adrenaline was administered and myocardial damage was evaluated biochemically [significantly increased serum aspertate aminotransferase (AST, lactate dehydrogenase (LDH and malondialdehyde (MDA levels of myocardial tissue] and histologically (morphological changes of myocardium. Amlodipine was administered as pretreatment for 14 days in adrenaline treated rats. Statistically significant amelioration in all the biochemical parameters supported by significantly improved myocardial morphology was observed in amlodipine pretreatment. It was concluded that amlodipine afforded cardioprotection by reducing oxidative stress induced in experimental myocardial infarction of catecholamine assault.

  13. About CABI Full Text

    Institute of Scientific and Technical Information of China (English)

    2014-01-01

    <正>Centre for Agriculture and Bioscience International(CABI)is a not-for-profit international Agricultural Information Institute with headquarters in Britain.It aims to improve people’s lives by providing information and applying scientific expertise to solve problems in agriculture and the environment.CABI Full-text is one of the publishing products of CABI.CABI’s full text repository is growing rapidly

  14. Irreversible Loss of Vision in a Child due to Occipital Infarction after Gastroenteritis

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    Ahmad M. Mansour

    2015-03-01

    Full Text Available A 2½-year-old girl developed a bilateral occipital infarct following severe gastroenteritis with bilateral vision of light perception. Evaluations for sickle cell anemia, hemolytic anemia and coagulopathies were negative. Cortical blindness is an uncommon but dramatic complication of gastroenteritis, hence the need of prompt hydration and other supportive measures to avoid irreversible visual loss or mental sequela.

  15. Infarction of a polyp within a mesenteric cyst: An unusual presentation as an acute abdomen

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    Gon Sonia

    2010-01-01

    Full Text Available A case of mesenteric cyst in a five-year-old male child who presented with acute abdomen due to an infarcted polyp present within the cyst is reported. To the best of our knowledge, such an event has never been reported in the literature previously.

  16. Refined ambient PM2.5 exposure surrogates and the risk of myocardial infarction

    Science.gov (United States)

    Using a case-crossover study design and conditional logistic regression, we compared the relative odds of transmural (full-wall) myocardial infarction (MI) calculated using exposure surrogates that account for human activity patterns and the indoor transport of ambient PM2....

  17. Refined ambient PM2.5 exposure surrogates and the risk of myocardial infarction

    Science.gov (United States)

    Using a case-crossover study design and conditional logistic regression, we compared the relative odds of transmural (full-wall) myocardial infarction (MI) calculated using exposure surrogates that account for human activity patterns and the indoor transport of ambient PM2....

  18. Increased Expression of Visfatin in Monocytes and Macrophages in Male Acute Myocardial Infarction Patients

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    Cheng-An Chiu

    2012-01-01

    Full Text Available We demonstrated that visfatin expressed in monocytes and neutrophils and increased their reactivity in male acute ST-segment elevation myocardial infarction patients. Furthermore, visfatin was strongly appeared in lipid rich coronary rupture plaques and macrophages. These results suggest another explanation about leukocytes mediated visfatin that may play a pathogenesis role in coronary vulnerable plaques rupture.

  19. Diabetic muscle infarction in a 57 year old male: a case report

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    Litvinov Ivan V

    2012-12-01

    Full Text Available Abstract Background Diabetic muscle infarction is a rare complication of diabetes mellitus (DM and is often misdiagnosed as cellulitis. This complication is usually associated with poor disease prognosis and high mortality with previous studies reporting a risk of 50% recurrence or another macrovascular complication occurring within one year. Thus, there needs to be greater awareness of this complication of diabetes. Case presentation In the current work, we present a case report and literature review of DMI occurring in a calf of a 57 year old male. However, unlike the suspected trend, our patient has performed well after this incident and has not sustained another macrovascular event now > 15 month since his original diabetic muscle infarction. Conclusion Even though diabetic muscle infarction is an uncommon condition, it is important to consider this diagnosis in a diabetic patient. We hope that our findings and literature review will aid clinicians to better diagnose and manage this condition.

  20. Cerebral tubercular thrombophlebitis presenting as venous infarct: Magnetic resonance imaging and pathologic correlation

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    Sandhya Mangalore

    2014-01-01

    Full Text Available Central nervous system involvement by tuberculosis to produce basal meningitis, hydrocephalus, arteritis and infarcts is well-known, the brunt of the pathology being borne by the arterial vasculature to produce neurological sequelae. However, tuberculous thrombophlebitis causing venous infarction is exceedingly rare. We present imaging and pathological features of two autopsy proven cases of tuberculous thrombophlebitis with venous infarcts involving superficial venous system in one and deep venous system in the other. This is the first study presenting radiopathologic correlation of this rare complication. Tuberculous thrombophlebitis should be suspected if basal exudates and multiple white matter T2 hyperintensities are seen on neuroimaging and the imaging protocol should include both magnetic resonance arteriogram and venogram.

  1. MRI Manifestation and Early Diagnosis of Bone Infarct: A Rare Complication of Steroid Therapy for Pemphigus

    Directory of Open Access Journals (Sweden)

    UC Parashari

    2011-07-01

    Full Text Available The objective of the study was to analyse the magnetic resonance imaging (MRI manifestation of bone infarction and explore the value of such imaging in early diagnosis. In bone infarction, aseptic osteonecrosis occurs in the metaphysis and diaphysis of long bones. The “Double line” sign in MRI is most characteristic of this lesion and is seen as high signal intensity in the inner zone along with lowsignal-intensity line in the outer zone in a T2 weighted image. In clinically suspected patients, MRI can be used for early diagnosis. Here we describe a case of pemphigus resulting from steroid therapy leading to development of bone infarction in the metadiaphyseal region of the femur and tibia.

  2. Astrocyte proliferation following stroke in the mouse depends on distance from the infarct.

    Directory of Open Access Journals (Sweden)

    George E Barreto

    Full Text Available Reactive gliosis is a hallmark of brain pathology and the injury response, yet the extent to which astrocytes proliferate, and whether this is central to astrogliosis is still controversial. We determined the fraction of mature astrocytes that proliferate in a mouse stroke model using unbiased stereology as a function of distance from the infarct edge. Cumulatively 11.1±1.2% of Aldh1l1(+ astrocytes within 400 µm in the cortical penumbra incorporate BrdU in the first week following stroke, while the overall number of astrocytes does not change. The number of astrocytes proliferating fell sharply with distance with more than half of all proliferating astrocytes found within 100 µm of the edge of the infarct. Despite extensive cell proliferation primarily of microglia and neutrophils/monocytes in the week following stroke, few mature astrocytes re-enter cell cycle, and these are concentrated close to the infarct boundary.

  3. Development of ST Elevation Myocardial Infarction and Atrial Fibrillation after an Electrical Injury

    Directory of Open Access Journals (Sweden)

    Erdal Gursul

    2015-01-01

    Full Text Available Electrical energy is a type of energy that is commonly used in daily life. Ventricular premature beats, ventricular tachycardia, ventricular fibrillation, atrial tachycardia, atrial fibrillation, bundle branch blocks, and AV block are arrhythmic complications that are encountered in case of electric shocks. Myocardial infarction is one of the rarely seen complications of electric shocks yet it has fatal outcomes. Coronary arteries were detected to be normal in most of the patients who had myocardial infarction following an electric shock. So, etiology of myocardial infarction is thought to be unrelated to coronary atherosclerosis in these cases. Coronary artery vasospasm is thought to be the primary etiological cause. In our case report, we presented a patient who developed ST elevation MI with atrial fibrillation after an electric shock.

  4. Imaging Characteristics of Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leucoencephalopathy (CADASIL

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    Dragan Stojanov

    2015-02-01

    Full Text Available Cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL is an autosomal dominant vascular disorder. Diagnosis and follow-up in patients with CADASIL are based mainly on magnetic resonance imaging (MRI. MRI shows white matter hyperintensities (WMHs, lacunar infarcts and cerebral microbleeds (CMBs. WMHs lesions tend to be symmetrical and bilateral, distributed in the periventricular and deep white matter. The anterior temporal lobe and external capsules are predilection sites for WMHs, with higher specificity and sensitivity of anterior temporal lobe involvement compared to an external capsule involvement. Lacunar infarcts are presented by an imaging signal that has intensity of cerebrospinal fluid in all MRI sequences. They are localized within the semioval center, thalamus, basal ganglia and pons. CMBs are depicted as focal areas of signal loss on T2 images which increases in size on the T2*-weighted gradient echo planar images (“blooming effect”.

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

    Directory of Open Access Journals (Sweden)

    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.

  6. Postpartal recurrent non-ST elevation myocardial infarction in essential thrombocythaemia: case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Raio Luigi

    2010-06-01

    Full Text Available Abstract Normal pregnancy corresponds to a procoagulant state. Acute myocardial infarction during pregnancy is rare, yet considering the low non-pregnant risk score of childbearing women it is still surprisingly frequent. We report a case of postpartum recurrent non-ST elevation myocardial infarction in a 40-year-old caucasian woman with essential thrombocythaemia in the presence of a positive JAK-2 mutation and an elevated anti-cardiolipin IgM antibody titer. In the majority of cases of myocardial infarction in pregnancy or in the peripartal period, atherosclerosis, a thrombus or coronary artery dissection is observed. The combination of essential thrombocythaemia and elevated anti-cardiolipin IgM antibody titer in the presence of several cardiovascular risk factors seems to be causative in our case. In conclusion, with the continuing trend of childbearing at older ages, rare or unlikely conditions leading to severe events such as myocardial infarction must be considered in pregnant women.

  7. Association of blood transfusion with increased mortality in myocardial infarction

    DEFF Research Database (Denmark)

    Chatterjee, Saurav; Wetterslev, Jørn; Sharma, Abhishek

    2013-01-01

    The benefit of blood transfusion in patients with myocardial infarction is controversial, and a possibility of harm exists.......The benefit of blood transfusion in patients with myocardial infarction is controversial, and a possibility of harm exists....

  8. MicroRNA-24 Regulates Vascularity After Myocardial Infarction

    NARCIS (Netherlands)

    Fiedler, Jan; Jazbutyte, Virginija; Kirchmaier, Bettina C.; Gupta, Shashi K.; Lorenzen, Johan; Hartmann, Dorothee; Galuppo, Paolo; Kneitz, Susanne; Pena, John T. G.; Sohn-Lee, Cherin; Loyer, Xavier; Soutschek, Juergen; Brand, Thomas; Tuschl, Thomas; Heineke, Joerg; Martin, Ulrich; Schulte-Merker, Stefan; Ertl, Georg; Engelhardt, Stefan; Bauersachs, Johann; Thum, Thomas

    2011-01-01

    Background-Myocardial infarction leads to cardiac remodeling and development of heart failure. Insufficient myocardial capillary density after myocardial infarction has been identified as a critical event in this process, although the underlying mechanisms of cardiac angiogenesis are mechanistically

  9. The use of magnetic resonance and MR angiography in the detection of cerebral infarction: A complication of pediatric bacterial meningitis

    Directory of Open Access Journals (Sweden)

    Stošić-Opinćal Tatjana

    2005-01-01

    Full Text Available Bacground. Association of both cerebral infarction and acute bacterial meningitis is more common in younger patients than in the elderly. The rate of mortality and the frequency of sequel are very high inspite of the use of modern antibiotic therapy. In more than 30% of the cases of childhood bacterial meningitis, both arterial and venous infarctions can occur. The aim of this study was to present the role of the use of magnetic resonance (MRI, and MR angiography (MRA in the detection of bacterial meningitis in children complicated with cerebral infarctions. Method. In the Centre for MR, the Clinical Centre of Serbia, 25 patients with the diagnosis of bacterial meningitis, of which 9 children with cerebral infarction whose clinical conditon deteriorated acutely, despite the antibiotic therapy, underwent MRI and MR angiography examination on a 1T scanner. Examination included the conventional spin-echo techniques with T1-weighted saggital and coronal, and T2- weighted axial and coronal images. Coronal fluid attenuated inversion recovery (FLAIR and the postcontrast T1-weighted images in three orthogonal planes were also used. The use MR angiography was accomplished by the three-dimensional time-of-flight (3D TOF technique. Results. The findings included: multiple hemorrhagic infarction in 4 patients, multiple infarctions in 3 patients, focal infarction in 1 patient and diffuse infarction (1 patient. Common sites of involvement were: the frontal lobes, temporal lobes and basal ganglia. The majority of infarctions were bilateral. In 3 of the patients empyema was found, and in 1 patient bitemporal abscess was detected. In 8 of the patients MR angiography confirmed inflammatory vasculitis. Conclusion. Infarction is the most common sequel of severe meningitis in children. Since the complication of cerebral infarction influences the prognosis of meningitis, repetitive MRI examinations are very significant for the evaluation of the time course of

  10. Quality indicators for acute myocardial infarction

    DEFF Research Database (Denmark)

    Schiele, Francois; Gale, Chris P; Bonnefoy, Eric

    2016-01-01

    infarction (AMI), but no such indicators exist in Europe. In this context, the European Society of Cardiology (ESC) Acute Cardiovascular Care Association (ACCA) has reflected on the measurement of quality of care in the context of AMI (ST segment elevation myocardial infarction (STEMI) and non-ST segment...... be estimated solely on the basis of patients' clinical outcomes. Thus, measuring the process of care through quality indicators (QIs) has become a widely used practice in this context. Other professional societies have published QIs for the evaluation of quality of care in the context of acute myocardial...... elevation myocardial infarction (NSTEMI)) and created a set of QIs, with a view to developing programmes to improve quality of care for the management of AMI across Europe. We present here the list of QIs defined by the ACCA, with explanations of the methodology used, scientific justification and reasons...

  11. Myocardial Infarction Type 2 and Myocardial Injury

    DEFF Research Database (Denmark)

    Sandoval, Yader; Thygesen, Kristian

    2017-01-01

    BACKGROUND: The development and implementation of sensitive and high-sensitivity cardiac troponin assays has not only expedited the early ruling in and ruling out of acute myocardial infarction, but has also contributed to the identification of patients at risk for myocardial injury with necrosis......, as confirmed by the presence of cardiac troponin concentrations above the 99th percentile. Myocardial injury with necrosis may occur either in the presence of overt ischemia from myocardial infarction, or in the absence of overt ischemia from myocardial injury accompanying other conditions. Myocardial...... infarction type 2 (T2MI) has been a focus of attention; conceptually T2MI occurs in a clinical setting with overt myocardial ischemia where a condition other than an acute atherothrombotic event is the major contributor to a significant imbalance between myocardial oxygen supply and/or demand. Much debate...

  12. Transient myocardial ischemia after myocardial infarction

    DEFF Research Database (Denmark)

    Mickley, H

    1995-01-01

    Ambulatory ST-segment monitoring is a relatively new device in the evaluation of myocardial ischemia. The method is unique in allowing us to continuously examine the patient over an extended period of time in a changing environmental milieu. In survivors of acute myocardial infarction...... the prevalence of ambulatory or transient myocardial ischemia is lower than in patients with chronic, stable coronary artery disease. A greater proportion of ischemic episodes, however, are silent than in other subgroups with ischemic heart disease. Early after the infarction, transient myocardial ischemia...... exhibits a circadian variation with a peak activity occurring in the late evening hours. Patients with non-Q wave infarction have more transient myocardial ischemia, whereas thrombolytic therapy seems to result in less residual ischemia. Exercise testing is more sensitive than ambulatory monitoring...

  13. Exosomes and cardiac repair after myocardial infarction.

    Science.gov (United States)

    Sahoo, Susmita; Losordo, Douglas W

    2014-01-17

    Myocardial infarction is a leading cause of death among all cardiovascular diseases. The analysis of molecular mechanisms by which the ischemic myocardium initiates repair and remodeling indicates that secreted soluble factors are key players in communication to local and distant tissues, such as bone marrow. Recently, actively secreted membrane vesicles, including exosomes, are being recognized as new candidates with important roles in intercellular and tissue-level communication. In this review, we critically examine the emerging role of exosomes in local and distant microcommunication mechanisms after myocardial infarction. A comprehensive understanding of the role of exosomes in cardiac repair after myocardial infarction could bridge a major gap in knowledge of the repair mechanism after myocardial injury.

  14. Transient myocardial ischemia after myocardial infarction

    DEFF Research Database (Denmark)

    Mickley, H

    1995-01-01

    Ambulatory ST-segment monitoring is a relatively new device in the evaluation of myocardial ischemia. The method is unique in allowing us to continuously examine the patient over an extended period of time in a changing environmental milieu. In survivors of acute myocardial infarction...... the prevalence of ambulatory or transient myocardial ischemia is lower than in patients with chronic, stable coronary artery disease. A greater proportion of ischemic episodes, however, are silent than in other subgroups with ischemic heart disease. Early after the infarction, transient myocardial ischemia...... exhibits a circadian variation with a peak activity occurring in the late evening hours. Patients with non-Q wave infarction have more transient myocardial ischemia, whereas thrombolytic therapy seems to result in less residual ischemia. Exercise testing is more sensitive than ambulatory monitoring...

  15. Coincidence of cerebrovascular accident and silent myocardial infarction.

    Science.gov (United States)

    Badui, E; Estañol, B; Garcia-Rubi, D

    1982-11-01

    Although it is well known that a myocardial and a cerebral infarction may be coincident, the nature of this association is not clear. The problem is further complicated because the myocardial infarction may be silent. This is a report of 3 patients with cerebral infarct in whom a silent recent myocardial infarction was found. All patients with cerebrovascular disease should be screened for a possible myocardial lesion.

  16. Cerebellar infarct patterns: The SMART-Medea study.

    Science.gov (United States)

    De Cocker, Laurens J L; Geerlings, Mirjam I; Hartkamp, Nolan S; Grool, Anne M; Mali, Willem P; Van der Graaf, Yolanda; Kloppenborg, Raoul P; Hendrikse, Jeroen

    2015-01-01

    Previous studies on cerebellar infarcts have been largely restricted to acute infarcts in patients with clinical symptoms, and cerebellar infarcts have been evaluated with the almost exclusive use of transversal MR images. We aimed to document the occurrence and 3D-imaging patterns of cerebellar infarcts presenting as an incidental finding on MRI. We analysed the 1.5 Tesla MRI, including 3D T1-weighted datasets, of 636 patients (mean age 62 ± 9 years, 81% male) from the SMART-Medea study. Cerebellar infarct analyses included an assessment of size, cavitation and gliosis, of grey and white matter involvement, and of infarct topography. One or more cerebellar infarcts (mean 1.97; range 1-11) were detected in 70 out of 636 patients (11%), with a total amount of 138 infarcts identified, 135 of which showed evidence of cavitation. The average mean axial diameter was 7 mm (range 2-54 mm), and 131 infarcts (95%) were smaller than 20 mm. Hundred-thirty-four infarcts (97%) involved the cortex, of which 12 in combination with subcortical white matter. No infarcts were restricted to subcortical branches of white matter. Small cortical infarcts involved the apex of a deep (pattern 1) or shallow fissure (pattern 2), or occurred alongside one (pattern 3) or opposite sides (pattern 4) of a fissure. Most (87%) cerebellar infarcts were situated in the posterior lobe. Small cerebellar infarcts proved to be much more common than larger infarcts, and preferentially involved the cortex. Small cortical infarcts predominantly involved the posterior lobes, showed sparing of subcortical white matter and occurred in characteristic topographic patterns.

  17. Basal ganglia infarction demonstrated by radionuclide brain imaging

    Energy Technology Data Exchange (ETDEWEB)

    Kim, E.E.; Schacht, R.A.; Domstad, P.A.; DeLand, F.H.

    1982-11-01

    Four cases of basal ganglia infarction demonstrated by radionuclide brain imaging are presented. Bilateral basal ganglia infarctions in two patients were probably related to methanol intoxication and meningoencephalitis, and unilateral basal ganglia infarctions in two other patients were presumably due to cerebral atherosclerosis and/or hypertension. Various causes and mechanisms of basal ganglia infarction as well as positive findings of radionuclide brain imaging are briefly reviewed.

  18. Hypereosinophilia with Multiple Thromboembolic Cerebral Infarcts and Focal Intracerebral Hemorrhage

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    Lee, Eun Ju; Lee, Young Jun; Lee, Seung Ro; Park, Dong Woo; Kim, Hyun Young [Hanyang University College of Medicine, Seoul (Korea, Republic of)

    2009-10-15

    We report a case of hypereosinophilia causing multiple areas of cerebral infarcts. A 52-year-old Korean man presented with dysarthria and weakness in both arms. A brain MRI revealed multiple acute infarcts in the distal border zone with focal intracerebral hemorrhage, whereas a cerebral angiogram was not remarkable. The eosinophil count was 5,500/{mu}L and was accompanied by elevated cardiac enzyme levels. The pattern of cerebral infarcts and laboratory results suggest a thromboembolic infarction associated with hypereosinophilia.

  19. Porcine (Sus scrofa) Chronic Myocardial Infarction Model Development

    Science.gov (United States)

    2015-04-03

    Myocardial Infarction Model Development.” PRINCIPAL INVESTIGATOR (PI) / TRAINING COORDINATOR (TC): Lt Col. Daren Danielson DEPARTMENT: 60MSGS/SGCH...invasively, a myocardial infarction that was isolated to the mid-anterior, left ventricular wall. In doing so, we were able to create an infarct that...be used to investigate new methodologies for treatment of chronic myocardial infarction in individuals afflicted with chronic ischemic

  20. full on riot

    Directory of Open Access Journals (Sweden)

    Moses Iten

    2005-08-01

    Full Text Available “hey moses full on riot in lawson st the station’s on fire! been going since 4. molotov and more. full on,” reads an SMS message received on the backseat of a Tasmanian bus. What follows is a journey through the landscape of a Gunavidji, whose brothers have all gone to the land of the dead; metallic scraping in the glass cases of the Hobart Museum; a Palestinian woman giving up on her people; land-snails exposing cultural inaccuracies; photographing Australia’s war zone; entering the St Peter’s Basilica of Rome with bulldozers - all in the name of preparing to interview prominent Israeli writer Etgar Keret.

  1. Full moon and crime.

    Science.gov (United States)

    Thakur, C P; Sharma, D

    The incidence of crimes reported to three police stations in different towns (one rural, one urban, one industrial) was studied to see if it varied with the day of the lunar cycle. The period of the study covered 1978-82. The incidence of crimes committed on full moon days was much higher than on all other days, new moon days, and seventh days after the full moon and new moon. A small peak in the incidence of crimes was observed on new moon days, but this was not significant when compared with crimes committed on other days. The incidence of crimes on equinox and solstice days did not differ significantly from those on other days, suggesting that the sun probably does not influence the incidence of crime. The increased incidence of crimes on full moon days may be due to "human tidal waves" caused by the gravitational pull of the moon.

  2. Prognostic significance of sinus deceleration during dobutamine stress echocardiography test following acute myocardial infarction

    Directory of Open Access Journals (Sweden)

    Šalinger Sonja

    2006-01-01

    Full Text Available Background/Aim. Chronotropic incompetence during exercise stress testing after acute myocardial infarction is an indicator of ischemia or impaired left ventricular function. On the other side, infusion of dobutamine leads to a typical dose-dependent increase in heart rate. The aim of this study was to evaluate of paradoxical sinus deceleration during dobutamine stress echocardiography (DSE, as the sign of ischemia and impaired left ventricular function, or the consequence of infarction localization, and the estimation of prognostic significance after acute myocardial infarction. Methods. Our investigation comprised 81 patients hospitalized because of the acute myocardial infarction, and all of them had uncomplicated infarction. Fifty five patients were treated with thrombolytic therapy (67.9%; 53 patients (65.4% had anterior myocardial infarction, and 28 patients (34.6% had inferoposterior localization of myocardial infarction. After 10-12 days all of them underwent dobutamine stress echocardiography examination. During the next 3-6 months, the patients underwent coronary angiography. The average follow-up period was 36±22 months. Results. A decrease in heart rate occurred at the dobutamine doses increasing from 15-40mcg/kg/min in 9 (11.1% of the patients, in 1 patient with an anterior localization and in 8 patients with an inferoposterior localization. The decrease was sudden in 4 (44.4%, and gradual in 5 (55.6% of the patients. In 3 patients (33.3% junction rhythm was developed, and in 2 patients (22.2% AV block II-III. Only in 2 of them, there was a worsening of regional function during a high dose dobutamine infusion, but 7 of them showed an improvement during a low dose. In 7 (77.8% of the patients there was a simultaneous decrease in blood pressure. Coronary angiographic examination showed that in 4 (44.4% of the patients there was a significant coronary artery disease and they underwent the revascularization procedure. During the follow

  3. Branch Atheromatous Plaque: A Major Cause of Lacunar Infarction (High-Resolution MRI Study

    Directory of Open Access Journals (Sweden)

    Jong-Won Chung

    2012-07-01

    Full Text Available Background: Lacunar infarctions account for up to 25% of all ischemic strokes and, thus, constitute a numerically important subgroup. It is important that the two pathogeneses of lacunar infarction, that is, small-vessel occlusion and branch atheromatous disease, be differentiated because prognoses and treatment strategies differ. The authors evaluated the presence of branch atheromatous plaque in parent arteries that supply lacunar infarcts by high-resolution magnetic resonance imaging (HR-MRI. Methods: HR-MRI was performed in 15 patients with (1 a clinical presentation consistent with classical lacunar syndromes; (2 an acute lacunar infarction by diffusion-weighted imaging, measuring ≤20 mm in maximal diameter; (3 a magnetic resonance angiography showing a normal middle cerebral artery or basilar artery supplying the ischemic lesion, and (4 no other obvious etiology for small-vessel distribution ischemic stroke. Results: The median time of vessel wall imaging after index events was 4 days (range, 2–15 days. Six of the 15 patients had a lacunar infarction in the middle cerebral artery territory, and 9 had a lesion in the basilar artery territory. HR-MRI detected underlying atheromatous plaques in 9 patients (60% with a lacunar infarction. In these 9 patients, asymptomatic intracranial atherosclerotic stenosis was more frequent compared to patients without branch atheromatous plaque (55.6 vs. 16.7%. In pontine infarctions, ischemic lesions that extended to the pial base of the pons were more frequent in patients with branch atheromatous plaques (83.3 vs. 33.3%, and all the ischemic lesions and atheromatous plaques were on the same side (right, n = 2; left, n = 4. All plaques responsible for acute symptomatic lacunar infarction were enhanced in contrast-enhanced T1-weighted HR-MR images. Conclusions: HR-MRI results enabled underlying symptomatic branch atheromatous disease to be detected in lacunar infarction patients. The experience gained

  4. About CABI Full Text

    Institute of Scientific and Technical Information of China (English)

    2013-01-01

    <正>Centre for Agriculture and Bioscience International(CABI)is a not-for-profit international Agricultural Information Institute with headquarters in Britain.It aims to improve people’s lives by providing information and applying scientific expertise to solve problems in agriculture and the environment.CABI Full-text is one of the publishing products of CABI.CABI’s full text repository is growing rapidly and has now been integrated into all our databases including CAB Abstracts,Global Health

  5. Compressive full waveform lidar

    Science.gov (United States)

    Yang, Weiyi; Ke, Jun

    2017-05-01

    To avoid high bandwidth detector, fast speed A/D converter, and large size memory disk, a compressive full waveform LIDAR system, which uses a temporally modulated laser instead of a pulsed laser, is studied in this paper. Full waveform data from NEON (National Ecological Observatory Network) are used. Random binary patterns are used to modulate the source. To achieve 0.15 m ranging resolution, a 100 MSPS A/D converter is assumed to make measurements. SPIRAL algorithm with canonical basis is employed when Poisson noise is considered in the low illuminated condition.

  6. About CABI Full Text

    Institute of Scientific and Technical Information of China (English)

    2013-01-01

    <正>Centre for Agriculture and Bioscience International(CABI)is a not-for-profit international Agricultural Information Institute with headquarters in Britain.It aims to improve people’s lives by providing information and applying scientific expertise to solve problems in agriculture and the environment.CABI Full-text is one of the publishing products of CABI.CABI’s full text repository is growing rapidly and has now been integrated into all our databases including CAB Abstracts,Global Health,our Internet Resources and Jour-

  7. Treatment with the gap junction modifier rotigaptide (ZP123) reduces infarct size in rats with chronic myocardial infarction

    DEFF Research Database (Denmark)

    Haugan, Ketil; Marcussen, Niels; Kjølbye, Anne Louise;

    2006-01-01

    Treatment with non-selective drugs (eg, long-chain alcohols, halothane) that reduce gap junction intercellular communication (GJIC) is associated with reduced infarct size after myocardial infarction (MI). Therefore, it has been suggested that gap junction intercellular communication stimulating ...

  8. Acute myopericarditis masquerading as acute myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    Wen Tian; Zixin Zhang; Xiaojuan Bai; Dingyin Zeng; Guoxian Qi

    2008-01-01

    Patients with abrupt onset of chest pain, ischemic ECG abnormalities and elevated levels of cardiac markers could be given a diagnosis of acute myocardial infarction. However, some other diseases should be taken into consideration in this clinical setting when coronary arteries are proven to be normal. Here we report a case of acute myopericarditis with clinical presentation of myocardial infarction and normal coronary anatomy. The Herpes Simplex Virus Ⅱ was considered as the organism causing myopericarditis and the patient was recovered by the treatment with valacicloavir. A precise diagnosis is a prerequisite of successful treatment and favorable prognosis.

  9. Dermatomal sensory manifestations in lateral medullary infarction.

    Science.gov (United States)

    Hongo, Hiroki; Tanaka, Yasutaka; Shimada, Yoshiaki; Tanaka, Ryota; Hattori, Nobutaka; Urabe, Takao

    2014-01-01

    A 61-year-old man who experienced a sudden onset of unstable gait followed by nuchal pain was admitted to our department. The neurologic examination revealed right-sided limb ataxia, right partial ptosis, and decreased sensation to 50% of the normal side to pinprick and temperature stimuli on the left side below the level of the T-6 dermatome. A lateral medullary infarction caused by spontaneous vertebral artery dissection was diagnosed by magnetic resonance imaging and computed tomography angiography. In conclusion, lateral medullary infarction is an important entity to consider in the differential diagnosis of dermatomal sensory manifestations.

  10. Hypersexuality following bilateral thalamic infarction: case report.

    Science.gov (United States)

    Mutarelli, Eduardo G; Omuro, Antonio M P; Adoni, Tarso

    2006-03-01

    Hypersexuality is a rare but well recognized condition following brain injury. It has been described secondarily to dysfunction in the hypothalamus, the temporal and frontal lobes. We report a 63 year-old man that developed neuropsychological disturbances with hypersexuality as a prominent feature, disinhibition and moderate memory loss, hypersomnia and irritability after a bilateral paramedian thalamic infarction. A SPECT showed frontal hypoperfusion. We believe that these findings are expression of frontal-subcortical circuits dysfunction, particularly the orbitofrontal circuit, secondary to dorso medial thalamic infarction which probably plays a role in the determination of human sexual behavior. This case favors a thalamic modulation of frontal function.

  11. [Segmental testicular infarction in sickle cell anemia].

    Science.gov (United States)

    Mueller, F E

    2014-05-01

    Vascular occlusions are the clinical indicators of sickle cell disease and in urology they can lead to papillary necrosis, renal infarction or priapism. Segmental testicular infarction in patients with sickle cell disease is a rare event and only a few cases have been reported. We present a 25-year-old man with right testicular pain increasing over 3 days and sickle cell disease. Ultrasound of the right scrotum presented an inhomogeneous, mainly hypoechegenic mass with a hyperechogenic margin and no sign of blood flow. A partial orchiectomy was performed with total enucleation of the lesion, which was histologically diagnosed as benign hemorrhagic necrotic testicular tissue.

  12. MR imaging findings in diabetic muscle infarction.

    Science.gov (United States)

    Bajaj, Gitanjali; Nicholas, Richard; Pandey, Tarun; Montgomery, Corey; Jambhekar, Kedar; Ram, Roopa

    2014-10-01

    Diabetic muscle infarction is a rare, often unrecognized complication seen in patients with poorly controlled Diabetes Mellitus. The diagnosis is often missed and leads to unnecessary invasive investigations and inappropriate treatment. The patients usually present with unilateral thigh pain and swelling. MRI typically demonstrates diffuse swelling and increased T2 signal intensity within the affected muscles. The condition is self-limiting and is treated conservatively with bed rest and analgesics. Recurrences have been reported in the same or contralateral limb. We report a case of diabetic muscle infarction with spontaneous resolution of symptoms and imaging abnormality with recurrence on the contralateral side.

  13. Atypical myocardial infarction on a cruise ship.

    Science.gov (United States)

    Taylor, Christopher

    2015-01-01

    A previously asymptomatic 44-year-old male crewmember on a cruise ship experienced several brief episodes of acute chest pain within a short time frame. He was ultimately diagnosed with myocardial infarction; 5 h earlier he had been discharged from the ship's medical centre after almost 8 h of monitoring to rule-out infarction. Subsequent angiography ashore revealed a 99% occlusion of the right coronary artery. This case highlights the dangers of over-reliance on shipboard cardiac enzyme testing to clear a patient with chest pain.

  14. Association of splenic and renal infarctions in acute abdominal emergencies

    Energy Technology Data Exchange (ETDEWEB)

    Romano, Stefania E-mail: stefromano@libero.it; Scaglione, Mariano; Gatta, Gianluca; Lombardo, Patrizia; Stavolo, Ciro; Romano, Luigia; Grassi, Roberto

    2004-04-01

    Introduction: Splenic and renal infarctions are usually related to vascular disease or haematologic abnormalities. Their association is infrequent and rarely observed in trauma. In this study, we analyze our data to look at the occurrence of renal and splenic infarctions based on CT findings in a period of 4 years. Materials and Methods: We retrospectively reviewed the imaging findings of 84 patients admitted to our Department of Diagnostic Imaging from June 1998 to December 2002, who underwent emergency abdominal spiral CT examination and in whom there was evidence of splenic and/or renal infarction. Results: We found 40 cases of splenic infarction and 54 cases of renal infarction, associated in 10 patients. In 26 patients, there was also evidence of intestinal infarction. A traumatic origin was found in 19 cases; non-traumatic causes were found in 65 patients. Association between renal and splenic infarction in the same patient was related to trauma in two cases. Conclusions: Although renal and splenic infarctions are a common manifestation of cardiac thromboembolism, other systemic pathologies, infections or trauma may lead to this occurrence. Renal infarction may be clinically and/or surgically managed with success in most cases. There are potential complications in splenic infarction, such as development of pseudocysts, abscesses, hemorrhage, subcapsular haematoma or splenic rupture; splenectomy in these cases may be necessary. Some patients with splenic and/or renal infarction may be clinically asymptomatic. The high accuracy of CT examination is needed to allow a correct evaluation of infarcted organs.

  15. Cerebellar infarct patterns : The SMART-Medea study

    NARCIS (Netherlands)

    De Cocker, Laurens J L; Geerlings, Mirjam I; Hartkamp, NS; Grool, Anne M; Mali, Willem P; Van der Graaf, Yolanda; Kloppenborg, Raoul P; Hendrikse, J; Doevendans, PAFM

    2015-01-01

    OBJECTIVE: Previous studies on cerebellar infarcts have been largely restricted to acute infarcts in patients with clinical symptoms, and cerebellar infarcts have been evaluated with the almost exclusive use of transversal MR images. We aimed to document the occurrence and 3D-imaging patterns of

  16. Association of stroke and myocardial infarction in children.

    Science.gov (United States)

    Nakashima, M; Takashima, S; Hashimoto, K; Shiraishi, M

    1982-02-01

    A 9-year-old boy with cerebrovascular accident (CVA) and old myocardial infarction with mural thrombi is reported. The cause of the myocardial infarction was congenital coronary artery fistula originating from the left coronary artery and emptying into the right atrium. Although a common cause of strokes in adults, myocardial infarction has infrequently been reported as the source of emboli in children.

  17. Clinical significance of urine ferritin in patients with cerebral infarction

    Institute of Scientific and Technical Information of China (English)

    周慧

    2013-01-01

    Objective To find an indicator in urine to assist diagnosis of cerebral infarction,we investigated the changes of urine ferritin in patients with cerebral infarction.Methods Collected serum from 30 healthy volunteers and 53 patients with cerebral infarction (CI) ,with ratio ofmales to females

  18. About CABI Full Text

    Institute of Scientific and Technical Information of China (English)

    2013-01-01

    <正>Centre for Agriculture and Bioscience International( CABI) is a not-for-profit international Agricultural Information Institute with headquarters in Britain. It aims to improve people’s lives by providing information and applying scientific expertise to solve problems in agriculture and the environment. CABI Full-text is one of the publishing products of CABI.

  19. About CABI Full Text

    Institute of Scientific and Technical Information of China (English)

    2013-01-01

    <正>Centre for Agriculture and Bioscience International(CABI) is a not-for-profit international Agricultural Information Institute with headquarters in Britain. It aims to improve people’s lives by providing information and applying scientific expertise to solve problems in agriculture and the environment. CABI Full-text is one of the publishing products of CABI.

  20. About CABI Full Text

    Institute of Scientific and Technical Information of China (English)

    2011-01-01

    <正>Centre for Agriculture and Bioscience International(CABI)is a not-for-profit international Agricultural Information Institute with headquarters in Britain. It aims to improve people s lives by providing information and applying scientific expertise to solve problems in agriculture and the environment. CABI Full-text is one of the publishing products of CABI.

  1. Rehabilitation of a dentate mandible requiring a full arch rehabilitation. Immediate loading of a fixed complete denture on 8 implants placed with a bone-supported surgical computer-planned guide: a case report.

    Science.gov (United States)

    Amorfini, Leonardo; Storelli, Stefano; Romeo, Eugenio

    2011-03-01

    The use of technologies that merge computerized tomography X-ray imaging and 3-dimensional (3D) planning software allow the surgeon to digitally elaborate on the computer the position, length, and diameter of every implant to be placed. Following this approach, the placement is guided in a 3D digital model, and the implants are placed in the final position avoiding eventual anatomic structures. In this case report, the patient's remaining mandibular teeth were extracted, and the patient received 8 implants with the help of a computer surgical guide. The case was planned using SimPlant and a bone-supported guide. Because of the high precision of the planning, it was possible to realize a provisional rehabilitation before the actual surgery. The planning allows placement of parallel implants to optimize the prosthetic procedure and outcome. An immediate provisional implant was fixed with a flow composite on the temporary abutments and then refined in the dental laboratory. The patient received the provisional rehabilitation the same day of the surgery. After 6 weeks of healing, the final impression was taken and the prosthesis was finalized with a computer-aided design/computer-aided manufacturing titanium full-arch screwed framework with composite veneering. A 6-month follow-up showed good integration of the prostheses and success of all 8 implants. The use of surgical computer-guided planning changes the surgeon's approach: whereas before the use of conventional guides permitted a certain degree of offset from what was planned, the use of computer guides allows the implant to be inserted in a far more precise way. It is obvious that careful planning is the key factor to avoid implant misplacement.

  2. 46 CFR 10.215 - Medical and physical requirements.

    Science.gov (United States)

    2010-10-01

    ... infarctions, psychiatric disorders, and convulsive disorders. (2) Food handlers are not required to submit to... the sense of balance; (ii) Is able, without assistance, to climb up and down vertical ladders...

  3. "DETERMINANTS OF PREHOSPITAL DELAY IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION"

    Directory of Open Access Journals (Sweden)

    M. Alidoosti

    2004-05-01

    Full Text Available Determination of pre-hospital delay time of patients with acute myocardial infarction and seeking ways of speeding up the time for reperfusion is an important factor to lower mortality in these patients. This is a cross-sectional study to determine pre-hospital delay time, its components, and related causes and conditions, obtained in 375 patients with prolonged chest pain referred to four hospitals of Tehran University of Medical Sciences. Means of transport to hospital, reasons of ambulance disuse, decision time by the patient and finally the entire time of pre-hospital delay were specified. Suspected factors related to delays of more than 2 and 6 h were scrutinized with chi-square test. Rate of ambulance utility (18.9% directly correlated with age of patients (P<0.05. Principal motives to disuse ambulance insuccession were unrememberance (33.7%, access to private vehicle (32.8% and supposition of sufficient speed of personal reference (18.9%. Pre-hospital delay time was 8.1 ± 9.1 h (mean ± SD in whole patients and 7.6 ± 9.1 h in those with acute myocardial infarction. Delays of more than 2 and 6 hoccurred in 67.5% and 33.6% of patients, respectively. Decision time constitute three fourth of whole pre-hospital delay and was correlated with female gender, older age, history of diabetes, lower level of literacy and nocturnal onset of symptoms. In conclusion, a significant number of patients with acute myocardial infarction have pre-hospital delay of more than 2 and even 6 h, when golden time for thrombolytic therapy has already been elapsed.

  4. Relationship Between Periodontal Disease and Acute Myocardial Infarction

    Directory of Open Access Journals (Sweden)

    M Zamirian

    2008-07-01

    Full Text Available Background: Conventional risk factors for coronary artery disease and myocardial infarction do not explain all of the clinical and epidemiological features of the disease. Periodontal disease is a common bacterial and destructive disorder of oral tissues. Many studies demonstrate close association between chronic periodontitis and development of generalized inflammation, vascular endothelial injury, and atherosclesis. Periodontal disease has been convincingly emerging as an important independent risk factor for ischemic heart disease. A case - control study was carried out to assess the prevalence of periodontitis in patients with Acute myocardial Infarction (AMI and evaluate the possible relationship between AMI and chronic periodontitis. Patients and Methods: A number of 160 patients, aged 35 to 70 years old, enrolled in the study. Eighty patients (43 men, 37 women were examined four days after hospitalization due to AMI. Control group consisted of 80 persons (38 men, 42 women with normal coronary angiography. The following periodontal parameters were examined: Plaque index (PI, gingiral index (GI, bleeding on probing (BOP, probing depth (PD, clinical attachment loss (CAL and number of sites with CAL.Results: The case, compared to control showed significantly worse results for some periodontal variables studied: The mean of PD and PD > 3 mm, CAL, and number of sites with CAL, had worse results compared to control despite similar oral hygiene and frequency of brushing. The confounding factors for the present study were found to be hypertension and diabetes. Conclusion: The association between periodontitis and acute myocardial infarction was significant after adjusting for conventional risk factors for AMI.

  5. Intracoronary Cardiosphere-Derived Cells After Myocardial Infarction

    Science.gov (United States)

    Malliaras, Konstantinos; Makkar, Raj R.; Smith, Rachel R.; Cheng, Ke; Wu, Edwin; Bonow, Robert O.; Marbán, Linda; Mendizabal, Adam; Cingolani, Eugenio; Johnston, Peter V.; Gerstenblith, Gary; Schuleri, Karl H.; Lardo, Albert C.; Marbán, Eduardo

    2013-01-01

    Objectives This study sought to report full 1-year results, detailed magnetic resonance imaging analysis, and determinants of efficacy in the prospective, randomized, controlled CADUCEUS (CArdiosphere-Derived aUtologous stem CElls to reverse ventricUlar dySfunction) trial. Background Cardiosphere-derived cells (CDCs) exerted regenerative effects at 6 months in the CADUCEUS trial. Complete results at the final 1-year endpoint are unknown. Methods Autologous CDCs (12.5 to 25 × 106) grown from endomyocardial biopsy specimens were infused via the intracoronary route in 17 patients with left ventricular dysfunction 1.5 to 3 months after myocardial infarction (MI) (plus 1 infused off-protocol 14 months post-MI). Eight patients were followed as routine-care control patients. Results In 13.4 months of follow-up, safety endpoints were equivalent between groups. At 1 year, magnetic resonance imaging revealed that CDC-treated patients had smaller scar size compared with control patients. Scar mass decreased and viable mass increased in CDC-treated patients but not in control patients. The single patient infused 14 months post-MI responded similarly. CDC therapy led to improved regional function of infarcted segments compared with control patients. Scar shrinkage correlated with an increase in viability and with improvement in regional function. Scar reduction correlated with baseline scar size but not with a history of temporally remote MI or time from MI to infusion. The changes in left ventricular ejection fraction in CDC-treated subjects were consistent with the natural relationship between scar size and ejection fraction post-MI. Conclusions Intracoronary administration of autologous CDCs did not raise significant safety concerns. Preliminary indications of bioactivity include decreased scar size, increased viable myocardium, and improved regional function of infarcted myocardium at 1 year post-treatment. These results, which are consistent with therapeutic regeneration

  6. Off-Pump Repair of a Post Myocardial Infarction Ventricular Septal Defect

    Directory of Open Access Journals (Sweden)

    Feridoun Sabzi

    2014-01-01

    Full Text Available Refractory cardiogenic shock meant that traditional patch repairs requiring cardiopulmonary bypass would be poorly tolerated and external sandwich closure of post myocardial ventricular septal defect (VSD appears to be simple and effective after initial myocardial infarction (MI. The three cases presented with a VSD after of acute MI with or without thrombolysed with streptokinase during patient admission. The general condition of the three patients was poor with pulmonary edema, low cardiac output and renal failure. The heart was approached through a median sternotomy. Off-pump coronary artery bypass grafting of the coronary artery lesion was done first using octopus and beating heart surgery method and latero - lateral septal plication was performed using sandwich technique. Low cardiac output managed with intra-aortic balloon pump in these patients accompanied with inotropic drugs. Post-operative transesophageal echocardiography revealed that VSD was closed completely in one patient and in two patients small residual VSD remained. More experience is required to ascertain whether this technique will become an accepted alternative to patch repairs.

  7. Emptiness and Fullness

    DEFF Research Database (Denmark)

    Bregnbæk, Susanne; Bunkenborg, Mikkel

    As critical voices question the quality, authenticity, and value of people, goods, and words in post-Mao China, accusations of emptiness render things open to new investments of meaning, substance, and value. Exploring the production of lack and desire through fine-grained ethnography, this volume......, there is a pervasive concern with states of lack and emptiness and the contributions suggest that this play of emptiness and fullness is crucial to ongoing constructions of quality, value, and subjectivity in China....

  8. Comparison of right ventricular functions according to infarct localization using advanced echocardiographic methods in myocardial infarction with ST elevation

    Directory of Open Access Journals (Sweden)

    Mehmet Ata Akıl

    2012-12-01

    Full Text Available Objectives: In this study, we aimed to compare the effectsof infarct localization in patients with ST ElevatedMyocardial Infarction (STEMI on the right ventricular(RV functions by using advanced echocardiographicmethods.Materials and methods: A total of 89 patients withSTEMI were included into the study and patients weredivided to three groups as anterior, isolated-inferior andinferior+RV MI groups. In addition to standard echocardiographicmesurements, RV tissue doppler, RV EjectionFraction (RVEF, Myocardial performance index (MPIand TAPSE measurements of all patients were performedbetween 24-72 hours after the event.Results: Compared to groups, RV functions in inferior MIwith RV involvement group were deteriorated. Tricuspidannular plane systolic excursion (TAPSE value for theinferior MI with RV involvement (19±1mm group werelower than those for Inferior MI group without RV involvement(23±1mm and anterior MI (23±1mm (p<0.05. TheRV MPI value for inferior MI group with RV involvement(0.76±0.14 were found to be higher than those for anterior(0.64±0.1 and inferior MI (0.56±0.1 group withoutRV involvement (p<0.05. Peak Sm (r = -0.35, p =0.01, TAPSE (r = -0.47, p<0.001 and RV EF (r = -0.46,p<0.001 showed a negative correlation with RV MPI value.Furthermore, RV tricuspid E/A rate (r = -0.19, p = 0.7and RV free wall tissue doppler Em/Am rate (r = -0.26, p =0.01 displayed a negative correlation with RV MPI value.Conclusions: Use of advanced methods addition to theconventional echocardiographic methods in STEMI patients,could produce more valuable information to evaluateRV functions and provide a positive impact on treatmentstrategies.Key words: Acute myocardial infarction, right ventricle,echocardiography, TAPSE, MPI

  9. Plate Full of Color

    Centers for Disease Control (CDC) Podcasts

    2008-08-04

    The Eagle Books are a series of four books that are brought to life by wise animal characters - Mr. Eagle, Miss Rabbit, and Coyote - who engage Rain That Dances and his young friends in the joy of physical activity, eating healthy foods, and learning from their elders about health and diabetes prevention. Plate Full of Color teaches the value of eating a variety of colorful and healthy foods.  Created: 8/4/2008 by National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP).   Date Released: 8/5/2008.

  10. Infarcted mesothelial cyst: A case report

    Directory of Open Access Journals (Sweden)

    Fernando Navarro

    2017-01-01

    Conclusion: imaging following an overall unremarkable physical and laboratory workup for this patient’s abdominal pain directed our further workup and management efforts towards surgical excision of an intra-abdominal cystic mass. Histopathologic examination of the cyst was ultimately diagnostic of an infarcted mesothelial cyst.

  11. Aeromedical transport after acute myocardial infarction

    DEFF Research Database (Denmark)

    Seidelin, Jakob B; Bruun, Niels Eske; Nielsen, Henrik

    2009-01-01

    BACKGROUND: No guidelines exist for the planning of aeromedical repatriation after acute myocardial infarction (AMI). In 2004, we employed a risk evaluation-based decision-making system for repatriation of patients after AMI. The objective was to evaluate the safety of transports during 2005...

  12. Myocardial infarction : early diagnosis and cardioprotective strategies

    NARCIS (Netherlands)

    Oerlemans, M.I.F.J.

    2012-01-01

    In this thesis, we have investigated novel diagnostic and cardioprotective strategies to limit myocardial cell death and improve cardiac function after myocardial infarction. We demonstrated a new way to speed up the diagnosis of acute MI by using very small pieces of RNA (microRNAs). Using these mi

  13. [Myocardial infarction after conduction electrical weapon shock].

    Science.gov (United States)

    Ben Ahmed, H; Bouzouita, K; Selmi, K; Chelli, M; Mokaddem, A; Ben Ameur, Y; Boujnah, M R

    2013-04-01

    Controversy persists over the safety of conducted electrical weapons, which are increasingly used by law enforcement agencies around the world. We report a case of 33-year-old man who had an acute inferior myocardial infarction after he was shot in the chest with an electrical weapon. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

  14. Early assessment and treatment of myocardial infarction

    NARCIS (Netherlands)

    Hoog, V.C. de

    2015-01-01

    Although the detection and treatment of acute myocardial infarction (MI) has dramatically improved the last decades, ischemic heart disease is still a leading cause of death worldwide. Whereas mortality has declined in industrialized countries, it continues to rise in other parts of the world. There

  15. Pheochromocytoma mimicking an acute myocardial infarction.

    NARCIS (Netherlands)

    Menke-van der Houven van Oordt, C.W.; Twickler, T.B.; Asperdt, F.G. van; Ackermans, P.; Timmers, H.J.L.M.; Hermus, A.R.M.M.

    2007-01-01

    We report a 42-year-old female who presented with retrosternal pain, dyspnoea and nausea. Electrocardiography suggested a recent anterior myocardial infarction. However, emergency coronary angiography showed normal blood flow through all the coronary arteries. Paroxysmal hypertension raised the susp

  16. Acute Thrombo-embolic Renal Infarction.

    Science.gov (United States)

    Zhou, Haijiang; Yan, Yong; Li, Chunsheng; Guo, Shubin

    2016-07-01

    A 65-year-old woman was admitted for acute onset of right lower abdominal pain. She was taking anticoagulant medication regularly for rheumatic valvular disease and atrial fibrillation. Physical examination revealed no obvious abdominal or flank tenderness. Right thrombo-embolic renal infarction was diagnosed after performing computed tomography angiography (CTA).

  17. Oral Antithrombotic Use Among Myocardial Infarction Patients

    NARCIS (Netherlands)

    van der Elst, Menno E; Cisneros-Gonzalez, Nelly; de Blaey, Cornelis J; Buurma, Henk; de Boer, Anthonius

    2003-01-01

    OBJECTIVE: To examine the use of oral antithrombotics (i.e., antiplatelet agents, oral anticoagulants) after myocardial infarction (MI) in the Netherlands from 1988 to 1998. METHODS: Retrospective follow-up of 3800 patients with MI, using data from the PHARMO Record Linkage System. RESULTS: From 198

  18. CORRELATION BETWEEN FIBRINOGEN LEVEL AND CEREBRAL INFARCTION

    Institute of Scientific and Technical Information of China (English)

    Yi-cheng Zhu; Li-ying Cui; Bao-lai Hua; Jia-qi Pan

    2006-01-01

    Objective To investigate the correlation between plasma fibrinogen level and cerebral infarction (CI) as well as the difference of fibrinogen among subtypes of CI.Methods A case-controlled study was conducted with 131 cases of CI and 148 controls. Plasma fibrinogen levels were detected by the Clauss method.Results High fibrinogen level (3.09±0.94 g/L) was correlated with CI (OR=2.47, 95% CI:1.51-4.04,P<0.005) at the onset stage of the disease. Persistent high fibrinogen level (3.14±0.81 g/L) at 6-month after stroke onset was detected and correlated with CI (OR=4.34, 95% CI: 1.80-10. 51,P=0.001). Higher fibrinogen level was correlated with total anterior circulation infarction (TACI), partial anterior circulation infarction (PACI), and posterior circulation infarction (POCI) (OR = 4.008, P<0.001). Higher fibrinogen level was correlated with extracranial atherosclerosis (OR=3.220, P<0.05), but not with intracranial atherosclerosis.Conclusion Fibrinogen level may be a risk factor of CI and probably correlates with subtypes of CI and distributions of atherosclerosis.

  19. Unilateral adrenal hemorrhagic infarction in essential thrombocythemia.

    Science.gov (United States)

    Burnet, G; Lambert, M; Annet, L; Lefebvre, C

    2015-12-01

    Adrenal hemorrhage is a rare disease associated with various conditions. We report a case of a 68-year-old woman with abdominal and back pain. The diagnostic work-up showed a left adrenal gland infarction associated with essential thrombocythemia. Treatment consisted in painkillers and treating the underlying condition in order to prevent further thrombotic events.

  20. Electrocardiogram changes in acute cerebral infarction patients

    Institute of Scientific and Technical Information of China (English)

    Jing Fang; Weihong Yan

    2006-01-01

    BACKGROUND: Comparison of different stroke locations had been focused in past researches in electrocardiogram (ECG) changes of cerebral stroke patients. Some researches neglected the heart disease in the illness history.OBJECTIVE: To discuss ECG changes in different infarction locations and size of acute cerebral infarction and compare with healthy people.DESIGN: Contrast observation.SETrING: Shanghai Ninth People's Hospital.PARTICIPANTS: A total of 57 patients with cerebral infarction were selected from the Neurological Department of Ninth People's Hospital of Shanghai from March 2003 to September 2005. They were diagnosed according to the criteria revised in the 4th National Cerebral Disease Conference and brain images. Patients who had heart disease were excluded. There were 32 males and 25 females, who were 65-84 years old. Among them, 23 cases were involved in right hemisphere, 34 cases in left one, 23 in base ganglion, 11 in brain stem, 9in frontal lobe and 14 in other parts. According to their infarction size (plus size in every different scan), they were divided into three different groups: large-size group (n = 10) with size larger than 3.5 cm3, medium-sizegroup (n = 13) with size between 1.5-3.5 cm3, and small-size group (n = 34) with size smaller than 1.5 cm3.Another 50 healthy subjects were regarded as control group. There were 29 males and 21 females aged 40-82 years. All these cases knew and agreed of the examination.METHODS: Patients received 12-lead ECG examinations within the first 6-24 hours of onset while control group received it at the same time. The HR, PR, QTc, QRS, T wave and ST changes were compared between the two groups.MAIN OUTCOME MEASURES: The ECG changes and differences in two hemispheres, in different infarction lccations and sizes. RESULTS: All 57 patients and 50 healthy subjects were involved in the final analysis. ① ECG changes in infarction group and control group. There were no differences in HR, QRS time and cases with

  1. The Timing of Infarction Pain in Patients with Acute Myocardial Infarction after Previous Revascularization

    Directory of Open Access Journals (Sweden)

    Predrag M. Mitrovic

    2008-01-01

    Full Text Available Circadian variation of onset of acute myocardial infarction (AMI has been noted in many studies, but there are no data about subgroups of patients with previous coronary artery bypass grafting (CABG. Because of abnormalities in the circadian rhythm of autonomic tone after surgery, it was very interesting to analyze the circadian patterns in the onset of symptoms of AMI in various subgroups of 1784 patients with previous CABG. As in the other studies, a peak occurred in the morning hours with 26.3% of the patients, but there was a second nearly equal, but higher, peak (26.4% in the evening hours. The subgroups with specific clinical characteristics exhibited different patterns that determined these peaks in all populations. In patients older than 70 years of age, in both sexes, in smokers, diabetics, in patients with hypertension, in those undergoing beta-blocker therapy, and in patients without previous angina, two nearly equal peaks were observed, with higher evening peaks, except in those patients with hypertension and without angina. Only one peak in the evening hours was observed in a subgroup of patients with previous congestive heart failure (CHF and non-STEMI. The subgroup of patients with previous angina and previous AMI exhibited no discernible peaks. The distribution of time of onset within the four intervals was not uniform, and the difference was statistically significant only for patients undergoing beta-blocker therapy at time of onset (p = 0.0013, nonsmokers (p = 0.0283, and patients with non-STEMI (p = 0.0412. It is well known that patients with AMI have a dominant morning peak of circadian variation of onset. However, analyzing a different subgroup of patients with AMI after previous CABG, it was found that some subgroups had two peaks of onset, but a higher evening peak (patients older than 70 years of age, smokers, diabetics, and a group of patients who were taking beta-blocker therapy. This subgroup of patients, together with

  2. MIQuant--semi-automation of infarct size assessment in models of cardiac ischemic injury.

    Directory of Open Access Journals (Sweden)

    Diana S Nascimento

    Full Text Available BACKGROUND: The cardiac regenerative potential of newly developed therapies is traditionally evaluated in rodent models of surgically induced myocardial ischemia. A generally accepted key parameter for determining the success of the applied therapy is the infarct size. Although regarded as a gold standard method for infarct size estimation in heart ischemia, histological planimetry is time-consuming and highly variable amongst studies. The purpose of this work is to contribute towards the standardization and simplification of infarct size assessment by providing free access to a novel semi-automated software tool. The acronym MIQuant was attributed to this application. METHODOLOGY/PRINCIPAL FINDINGS: Mice were subject to permanent coronary artery ligation and the size of chronic infarcts was estimated by area and midline-length methods using manual planimetry and with MIQuant. Repeatability and reproducibility of MIQuant scores were verified. The validation showed high correlation (r(midline length = 0.981; r(area = 0.970 and agreement (Bland-Altman analysis, free from bias for midline length and negligible bias of 1.21% to 3.72% for area quantification. Further analysis demonstrated that MIQuant reduced by 4.5-fold the time spent on the analysis and, importantly, MIQuant effectiveness is independent of user proficiency. The results indicate that MIQuant can be regarded as a better alternative to manual measurement. CONCLUSIONS: We conclude that MIQuant is a reliable and an easy-to-use software for infarct size quantification. The widespread use of MIQuant will contribute towards the standardization of infarct size assessment across studies and, therefore, to the systematization of the evaluation of cardiac regenerative potential of emerging therapies.

  3. CYTOKINE PROFILE IN VISCERAL OBESITY AND ADVERSE CARDIOVASCULAR PROGNOSIS OF MYOCARDIAL INFARCTION

    Directory of Open Access Journals (Sweden)

    O. V. Gruzdeva

    2015-01-01

    Full Text Available Presence of myocardial infarction in patients with obesity can lead to an uncontrolled increase in proinflammatory cytokines and unfavorable course of the pathological process. Objective: to study the relationship of key inflammatory factors and the development of complications at different terms after myocardial infarction in patients with visceral obesity. The study involved 94 men with myocardial infarction. Visceral obesity was diagnosed by multi-slice computed tomography (LightspeedVCT 64 ,General Electric,USA. On the 1st and 12th day of hospitalization, we determined serum concentrations of interleukins (TNFα, IL-1β, IL-6, IL-8 IL-10 and IL-12, and C-reactive protein. Adverse cardiovascular events were documented during the next year. The most informative indicators were identified by a stepwise logistic regression analysis. In patients with myocardial infarction an imbalance of cytokine profile revealed, i.e., an increase in proinflammatory markers (TNFα, IL-1β, IL-6, IL-8, IL-12, CRP, along with decrease in IL-10, being more pronounced in cases of visceral obesity. Among the studied markers, closest relationship was observed between visceral obesity and serum concentrations of IL-6 and CRP. Over the year, adverse cardiovascular events proved to be more frequent in patients with visceral obesity. Post-infarction complication risk was associated with higher concentrations of IL-6, IL-12 and IL-10 deficiency. Hence, development of adverse cardiovascular events within a year after myocardial infarction is more typical to the patients with visceral obesity, and is accompanied by activation of proinflammatory cytokines and IL-10 deficiency.

  4. β-arrestin2 in infiltrated macrophages inhibits excessive inflammation after myocardial infarction.

    Directory of Open Access Journals (Sweden)

    Kenji Watari

    Full Text Available Beta-arrestins (β-arrestin1 and β-arrestin2 are known as cytosolic proteins that mediate desensitization and internalization of activated G protein-coupled receptors. In addition to these functions, β-arrestins have been found to work as adaptor proteins for intracellular signaling pathways. β-arrestin1 and β-arrestin2 are expressed in the heart and are reported to participate in normal cardiac function. However, the physiological and pathological roles of β-arrestin1/2 in myocardial infarction (MI have not been examined. Here, we demonstrate that β-arrestin2 negatively regulates inflammatory responses of macrophages recruited to the infarct area. β-arrestin2 knockout (KO mice have higher mortality than wild-type (WT mice after MI. In infarcted hearts, β-arrestin2 was strongly expressed in infiltrated macrophages. The production of inflammatory cytokines was enhanced in β-arrestin2 KO mice. In addition, p65 phosphorylation in the macrophages from the infarcted hearts of β-arrestin2 KO mice was increased in comparison to that of WT mice. These results suggest that the infiltrated macrophages of β-arrestin2 KO mice induce excessive inflammation at the infarct area. Furthermore, the inflammation in WT mice transplanted with bone marrow cells of β-arrestin2 KO mice is enhanced by MI, which is similar to that in β-arrestin2 KO mice. In contrast, the inflammation after MI in β-arrestin2 KO mice transplanted with bone marrow cells of WT mice is comparable to that in WT mice transplanted with bone marrow cells of WT mice. In summary, our present study demonstrates that β-arrestin2 of infiltrated macrophages negatively regulates inflammation in infarcted hearts, thereby enhancing inflammation when the β-arrestin2 gene is knocked out. β-arrestin2 plays a protective role in MI-induced inflammation.

  5. Neural Mechanisms and Delayed Gastric Emptying of Liquid Induced Through Acute Myocardial Infarction in Rats

    Directory of Open Access Journals (Sweden)

    Wilson Ranu Ramirez Nunez

    2015-02-01

    Full Text Available Background: In pathological situations, such as acute myocardial infarction, disorders of motility of the proximal gut can trigger symptoms like nausea and vomiting. Acute myocardial infarction delays gastric emptying (GE of liquid in rats. Objective: Investigate the involvement of the vagus nerve, α 1-adrenoceptors, central nervous system GABAB receptors and also participation of paraventricular nucleus (PVN of the hypothalamus in GE and gastric compliance (GC in infarcted rats. Methods: Wistar rats, N = 8-15 in each group, were divided as INF group and sham (SH group and subdivided. The infarction was performed through ligation of the left anterior descending coronary artery. GC was estimated with pressure-volume curves. Vagotomy was performed by sectioning the dorsal and ventral branches. To verify the action of GABAB receptors, baclofen was injected via icv (intracerebroventricular. Intravenous prazosin was used to produce chemical sympathectomy. The lesion in the PVN of the hypothalamus was performed using a 1mA/10s electrical current and GE was determined by measuring the percentage of gastric retention (% GR of a saline meal. Results: No significant differences were observed regarding GC between groups; vagotomy significantly reduced % GR in INF group; icv treatment with baclofen significantly reduced %GR. GABAB receptors were not conclusively involved in delaying GE; intravenous treatment with prazosin significantly reduced GR% in INF group. PVN lesion abolished the effect of myocardial infarction on GE. Conclusion: Gastric emptying of liquids induced through acute myocardial infarction in rats showed the involvement of the vagus nerve, alpha1- adrenergic receptors and PVN.

  6. Oxidized calmodulin kinase II regulates conduction following myocardial infarction: a computational analysis.

    Directory of Open Access Journals (Sweden)

    Matthew D Christensen

    2009-12-01

    Full Text Available Calmodulin kinase II (CaMKII mediates critical signaling pathways responsible for divergent functions in the heart including calcium cycling, hypertrophy and apoptosis. Dysfunction in the CaMKII signaling pathway occurs in heart disease and is associated with increased susceptibility to life-threatening arrhythmia. Furthermore, CaMKII inhibition prevents cardiac arrhythmia and improves heart function following myocardial infarction. Recently, a novel mechanism for oxidative CaMKII activation was discovered in the heart. Here, we provide the first report of CaMKII oxidation state in a well-validated, large-animal model of heart disease. Specifically, we observe increased levels of oxidized CaMKII in the infarct border zone (BZ. These unexpected new data identify an alternative activation pathway for CaMKII in common cardiovascular disease. To study the role of oxidation-dependent CaMKII activation in creating a pro-arrhythmia substrate following myocardial infarction, we developed a new mathematical model of CaMKII activity including both oxidative and autophosphorylation activation pathways. Computer simulations using a multicellular mathematical model of the cardiac fiber demonstrate that enhanced CaMKII activity in the infarct BZ, due primarily to increased oxidation, is associated with reduced conduction velocity, increased effective refractory period, and increased susceptibility to formation of conduction block at the BZ margin, a prerequisite for reentry. Furthermore, our model predicts that CaMKII inhibition improves conduction and reduces refractoriness in the BZ, thereby reducing vulnerability to conduction block and reentry. These results identify a novel oxidation-dependent pathway for CaMKII activation in the infarct BZ that may be an effective therapeutic target for improving conduction and reducing heterogeneity in the infarcted heart.

  7. Infarction of the entire corpus callosum as a complication in subarachnoid hemorrhage: A case report

    Directory of Open Access Journals (Sweden)

    Satoru Takahashi, M.D.

    2017-03-01

    Full Text Available The corpus callosum is the major commissural pathway connecting the cerebral hemispheres. This pathway receives its blood supply from anterior communicating artery, pericallosal artery, and posterior pericallosal artery. However, in some cases, the entire corpus callosum is supplied by median callosal artery; thus, occlusion of this artery can lead to infarction of the entire corpus callosum. Few reports have described this type of infarction, and no reports after subarachnoid hemorrhage (SAH exist. Here, we report on a 42-year-old female who was diagnosed with SAH after two aneurysms were discovered in bifurcation of left anterior cerebral artery (A1-A2. After successful clipping was performed, the patient was alert and had no neurological deficits; moreover, the computed tomography images that were acquired after the operation showed no evidence of infarction. Nine days after admittance to the hospital, drowsiness and weakness of the left limbs with brain swelling appeared and decompressive hemi-craniectomy was performed. Diagnostic cerebral angiography revealed vasospasms in both anterior and middle cerebral arteries, thus fasudil hydrochloride was administered intra-arterially. While blood flow in all arteries improved, diffusion-weighted magnetic resonance imaging detected infarction along the entire length of the corpus callosum and in the medial region of the right frontal lobe. We believe this infarction was due to secondary ischemia of median callosal artery. This case reminded us of the anatomical variation wherein median callosal artery is the sole blood supply line for the corpus callosum and demonstrated that infarction of the entire corpus callosum is possible.

  8. Infarction Distribution Pattern in Acute Stroke May Predict the Extent of Leptomeningeal Collaterals.

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    Rajeev Kumar Verma

    Full Text Available The aim of this study was to evaluate whether the distribution pattern of early ischemic changes in the initial MRI allows a practical method for estimating leptomeningeal collateralization in acute ischemic stroke (AIS.Seventy-four patients with AIS underwent MRI followed by conventional angiogram and mechanical thrombectomy. Diffusion restriction in Diffusion weighted imaging (DWI and correlated T2-hyperintensity of the infarct were retrospectively analyzed and subdivided in accordance with Alberta Stroke Program Early CT score (ASPECTS. Patients were angiographically graded in collateralization groups according to the method of Higashida, and dichotomized in 2 groups: 29 subjects with collateralization grade 3 or 4 (well-collateralized group and 45 subjects with grade 1 or 2 (poorly-collateralized group. Individual ASPECTS areas were compared among the groups.Means for overall DWI-ASPECTS were 6.34 vs. 4.51 (well vs. poorly collateralized groups respectively, and for T2-ASPECTS 9.34 vs 8.96. A significant difference between groups was found for DWI-ASPECTS (p<0.001, but not for T2-ASPECTS (p = 0.088. Regarding the individual areas, only insula, M1-M4 and M6 showed significantly fewer infarctions in the well-collateralized group (p-values <0.001 to 0.015. 89% of patients in the well-collateralized group showed 0-2 infarctions in these six areas (44.8% with 0 infarctions, while 59.9% patients of the poor-collateralized group showed 3-6 infarctions.Patients with poor leptomeningeal collateralization show more infarcts on the initial MRI, particularly in the ASPECTS areas M1 to M4, M6 and insula. Therefore DWI abnormalities in these areas may be a surrogate marker for poor leptomeningeal collaterals and may be useful for estimation of the collateral status in routine clinical evaluation.

  9. Temperature, air pollution, and mortality from myocardial infarction in São Paulo, Brazil

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    Sharovsky R.

    2004-01-01

    Full Text Available An increase in daily mortality from myocardial infarction has been observed in association with meteorological factors and air pollution in several cities in the world, mainly in the northern hemisphere. The objective of the present study was to analyze the independent effects of environmental variables on daily counts of death from myocardial infarction in a subtropical region in South America. We used the robust Poisson regression to investigate associations between weather (temperature, humidity and barometric pressure, air pollution (sulfur dioxide, carbon monoxide, and inhalable particulate, and the daily death counts attributed to myocardial infarction in the city of São Paulo in Brazil, where 12,007 fatal events were observed from 1996 to 1998. The model was adjusted in a linear fashion for relative humidity and day-of-week, while nonparametric smoothing factors were used for seasonal trend and temperature. We found a significant association of daily temperature with deaths due to myocardial infarction (P < 0.001, with the lowest mortality being observed at temperatures between 21.6 and 22.6ºC. Relative humidity appeared to exert a protective effect. Sulfur dioxide concentrations correlated linearly with myocardial infarction deaths, increasing the number of fatal events by 3.4% (relative risk of 1.03; 95% confidence interval = 1.02-1.05 for each 10 µg/m³ increase. In conclusion, this study provides evidence of important associations between daily temperature and air pollution and mortality from myocardial infarction in a subtropical region, even after a comprehensive control for confounding factors.

  10. [Acute myocardial infarction in the postoperative period following pneumonectomy].

    Science.gov (United States)

    López Alvarez, S; Bonome González, C; Izquierdo Villarroya, B; Barbeito Vilariño, M J; Etxainz Alvarez, A; Alvarez Refojo, F

    2002-11-01

    A 72-year-old man, smoker, with insuline-dependent diabetes and dislipemia underwent left pneumonectomy. Several episodes of intraoperative hemodynamic instability associated with electrocardiographic ST segment alterations were attributed to surgical manipulation; ischemia was not suspected. Cardiorespiratory failure, related to extensive anterior infarction, developed a few minutes after admission to the postoperative intensive care unit (PICU). Cardiopulmonary resuscitation and mechanical ventilation were required. The patient responded to treatment with beta blockers, platelet antiaggregants and statins. Tube was removed a few hours later and the patient was discharged from the PICU on the fifth day. Pneumonectomy has a high rate of morbidity and mortality, with complications mainly arising in the lung and heart. Risk from anesthesia is considered to be great in this procedure, and for that reason it is essential to identify intraoperative myocardial ischemia so that it can be treated aggressively. In patients at high cardiovascular risk who undergo lung resection, intraoperative episodes of myocardial ischemia are associated with a high incidence of postoperative miocardial infarction. Therefore, careful postoperative monitoring is needed and measures should be taken to prevent angina. Early extubation should be avoided.

  11. Spectrum of clinicoradiological findings in spinal cord infarction: Report of three cases and review of the literature

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    Ajith Sivadasan

    2013-01-01

    Full Text Available Spinal cord infarction (SCI often remains undiagnosed due to infrequent occurrence and lack of established diagnostic procedures. The unique pattern of blood supply explains the heterogeneity of clinical presentation. We present three cases of SCI to highlight the varied spectrum of clinicoradiological findings. The first patient had posterior spinal artery infarction, and spine imaging showed infarction of adjacent vertebral body, which is usually rare. The second patient had anterior spinal artery infarction and the cANCA titers were elevated. The third patient had a pure motor quadriparesis. Initial imaging did not show any cord infarction, but signal changes were noted on serial imaging. Fibrocartilagenous embolism (FCE seems the most likely etiology in the first and third cases. A high index of clinical suspicion is necessary for prompt diagnosis. Sensitivity of the initial magnetic resonance imaging remains limited, necessitating serial follow-up scans. Infarction of the adjacent vertebral body is a useful confirmatory sign. Fat suppression images can delineate the marrow signal changes better. Elderly patients with vascular risk factors and degenerative discs need to avoid mechanical triggers that predispose to FCE. Younger patients with SCI will need evaluation for cardioembolic source and vasculitis.

  12. Metoprolol in acute myocardial infarction. Development of myocardial infarction. The MIAMI Trial Research Group.

    Science.gov (United States)

    1985-11-22

    The effect of metoprolol on the development of an acute myocardial infarction (AMI) during days 0 to 3 and on late first and recurrent infarctions during days 4 to 15 has been investigated. Signs on electrocardiogram (ECG) were well balanced between the treatment groups at entry; 70% of patients had signs of suspected AMI and 19% of patients had normal ECGs. The remaining patients had abnormal ECGs but actual infarction could not be localized. The localization of suspected AMI was equivalently distributed in the 2 groups before randomization. Metoprolol altered the distribution of patients diagnosed during days 0 to 3 as having definite, possible or no AMI (p less than 0.02). In the placebo group, there were more patients with definite AMI (72.5% vs 70.5%) and less with possible AMI (5.6% vs 7.4) than in the metoprolol group. A larger proportion of patients developed a Q-wave infarction during days 0 to 3 in the placebo group (53.9%) compared with the metoprolol group (50.9%, p = 0.024). No difference in the effect of metoprolol regarding localization of the early AMI was observed. Late first myocardial infarction development (days 4 to 15) was observed in 20 patients (0.7%) in each group. Recurrent myocardial infarction tended to develop more frequently during days 4 to 15 in the placebo group compared with the metoprolol group (3.9% vs 3.0%, p = 0.08).(ABSTRACT TRUNCATED AT 250 WORDS)

  13. Three-dimensional regional strain analysis in porcine myocardial infarction: a 3T magnetic resonance tagging study

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    Soleimanifard Sahar

    2012-12-01

    Full Text Available Abstract Background Previous studies of mechanical strain anomalies in myocardial infarction (MI have been largely limited to analysis of one-dimensional (1D and two-dimensional (2D strain parameters. Advances in cardiovascular magnetic resonance (CMR methods now permit a complete three-dimensional (3D interrogation of myocardial regional strain. The aim of this study was to investigate the incremental value of CMR-based 3D strain and to test the hypothesis that 3D strain is superior to 1D or 2D strain analysis in the assessment of viability using a porcine model of infarction. Methods Infarction was induced surgically in 20 farm pigs. Cine, late gadolinium enhancement, and CMR tagging images were acquired at 11 days before (baseline, and 11 days (early and 1 month (late after induction of infarct. Harmonic phase analysis was performed to measure circumferential, longitudinal, and radial strains in myocardial segments, which were defined based on the transmurality of delayed enhancement. Univariate, bivariate, and multivariate logistic regression models of strain parameters were created and analyzed to compare the overall diagnostic accuracy of 3D strain analysis with 1D and 2D analyses in identifying the infarct and its adjacent regions from healthy myocardium. Results 3D strain differed significantly in infarct, adjacent, and remote segments (p  Conclusions Cumulative 3D strain information accurately identifies infarcts and their neighboring regions from healthy myocardium. The 3D interrogation of myocardial contractility provides incremental diagnostic accuracy in delineating the dysfunctional and nonviable myocardium in comparison with 1D or 2D quantification of strain. The infarct neighboring regions are the major beneficiaries of the 3D assessment of regional strain.

  14. Deficiency of ataxia telangiectasia mutated kinase modulates cardiac remodeling following myocardial infarction: involvement in fibrosis and apoptosis.

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    Cerrone R Foster

    Full Text Available Ataxia telangiectasia mutated kinase (ATM is a cell cycle checkpoint protein activated in response to DNA damage. We recently reported that ATM plays a protective role in myocardial remodeling following β-adrenergic receptor stimulation. Here we investigated the role of ATM in cardiac remodeling using myocardial infarction (MI as a model.Left ventricular (LV structure, function, apoptosis, fibrosis, and protein levels of apoptosis- and fibrosis-related proteins were examined in wild-type (WT and ATM heterozygous knockout (hKO mice 7 days post-MI. Infarct sizes were similar in both MI groups. However, infarct thickness was higher in hKO-MI group. Two dimensional M-mode echocardiography revealed decreased percent fractional shortening (%FS and ejection fraction (EF in both MI groups when compared to their respective sham groups. However, the decrease in %FS and EF was significantly greater in WT-MI vs hKO-MI. LV end systolic and diastolic diameters were greater in WT-MI vs hKO-MI. Fibrosis, apoptosis, and α-smooth muscle actin staining was significantly higher in hKO-MI vs WT-MI. MMP-2 protein levels and activity were increased to a similar extent in the infarct regions of both groups. MMP-9 protein levels were increased in the non-infarct region of WT-MI vs WT-sham. MMP-9 protein levels and activity were significantly lower in the infarct region of WT vs hKO. TIMP-2 protein levels similarly increased in both MI groups, whereas TIMP-4 protein levels were significantly lower in the infarct region of hKO group. Phosphorylation of p53 protein was higher, while protein levels of manganese superoxide dismutase were significantly lower in the infarct region of hKO vs WT. In vitro, inhibition of ATM using KU-55933 increased oxidative stress and apoptosis in cardiac myocytes.

  15. Digital subtraction angiography in cerebral infarction

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Sin Young; Kim, Ji Hun; Suh, Hong Kil; Kim, Hyo Heon; Kwack, Eun Young; Lee, Il Seong [College of Medicine Hallym University, Seoul (Korea, Republic of)

    1995-01-15

    The usefulness and radiographic findings of the angiography in cerebral infarction are well known. We attempted to evaluate the angiographic causes, findings, and the usefulness of DSA in cerebral infarction. The authors reviewed retrospectively DSA images of 51 patients who were diagnosed as having cerebral infarction by brain CT and/or MRI and clinical settings. DSA was performed in all 51 patients, and in 3 patients, conventional angiogram was also done. Both carotid DSA images were obtained in AP, lateral, oblique projections, and one or both vertebral DSA images in AP and lateral. The authors reviewed the patient's charts for symptoms, operative findings and final diagnosis, and analysed DSA findings of cerebral atherosclerosis with focus on 6 major cerebral arteries. Among the 51 patients of cerebral infarction 43 patients (84.3%) had cerebral atherosclerosis, 1 dissecting aneurysm, 1 moyamoya disease and 6 negative in angiogram. DSA findings of cerebral atherosclerosis were multiple narrowing in 42 patients (97.7%), tortuosity in 22 (51.2%), dilatation in 14, occlusion in 12, avascular region in 8, collaterals in 7, ulcer in 6, and delayed washout of contrast media in 3. In cerebral atherosclerosis, internal carotid artery was involved in 37 patients (86.0%), middle cerebral artery in 29 (67.4%) posterior cerebral artery in 28, anterior cerebral artery in 26, vertebral artery in 22, and basilar artery in 15. Intracranial involvement of cerebral atherosclerosis (64.9%) was more common than extracranial involvement (16.2%). In cerebral infarction MRA may be the screening test, but for more precise evaluation of vascular abnormality and its extent, DSA should be considered.

  16. Terminology and diagnostic criteria for Non-Q-wave myocardial infarction

    OpenAIRE

    Kovačević Branislava; Štajnic Miroslav; Čemerlić-Ađić Nadica; Dejanović Jadranka

    2002-01-01

    Non-Q myocardial infarction represents a specific entity of infarction. Many studies have shown that non-Q myocardial infarction differs from Q myocardial infarction not only electrocardiographically, but also from pathophysiological, histological, clinical and prognostic points of view. Non-Q myocardial infarction - terminology Until 1980's, anatomical terminology depending on ECG changes was used in the literature. Subendocardial infarction referred to non-Q myocardial infarction, while tra...

  17. Medical image of the week: artery of Percheron infarction

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    Ta TT

    2017-03-01

    Full Text Available No abstract available. Article truncated after 150 words. A 55-year-old African-American man presented to the Emergency Department for acute altered mental status which started 4 hours ago. His medical history was significant for heart failure with reduced ejection fraction, diabetes mellitus, marijuana and opioid use. On admission, the patient appeared to be in a deep sleep, unarousable, with grimacing to noxious stimuli. He occasionally moved all extremities. He was intubated for airway protection. Initial CT head non-contrast demonstrated a previous right MCA infarct, with no new acute hemorrhage. MRI/MRA brain revealed complete infarction of the artery of Percheron (AOP, likely due to a left ventricular thrombus (Figure 1. The patient remained somnolent throughout hospitalization with minimal neurologic improvement, and was ultimately transferred to a long-term care facility after a tracheostomy and PEG placement. The artery of Percheron is a rare, normal intracranial vascular variant in which a single arterial trunk originates from the posterior cerebral artery, giving rise …

  18. Use of Statins by Medicare Beneficiaries Post Myocardial Infarction

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    Mary C. Schroeder PhD

    2015-02-01

    Full Text Available Even though guidelines strongly recommend that patients receive a statin for secondary prevention after an acute myocardial infarction (MI, many elderly patients do not fill a statin prescription within 30 days of discharge. This paper assesses whether patterns of statin use by Medicare beneficiaries post-discharge may be due to a mix of high-quality and low-quality physicians. Our data come from the Centers for Medicare & Medicaid Services (CMS Chronic Condition Data Warehouse (CCW and include 100% of Medicare beneficiaries hospitalized for an acute myocardial infarction in 2008 or 2009. Our study sample included physicians treating at least 10 Medicare fee-for-service beneficiaries during their MI institutional stay. Physician-specific statin fill rates (the proportion of each physician’s patients with a statin within 30 days post-discharge were calculated to assess physician quality. We hypothesized that if the observed statin rates reflected a mix of high-quality and low-quality physicians, then physician-specific statin fill rates should follow a u-shaped or bimodal distribution. In our sample, 62% of patients filled a statin prescription within 30 days of discharge. We found that the distribution of statin fill rates across physicians was normal, with no clear distinctions in physician quality. Physicians, especially cardiologists, with relatively younger and healthier patient populations had higher rates of statin use. Our results suggest that physicians were engaging in patient-centered care, tailoring treatments to patient characteristics.

  19. Desvenlafaxine reduces apoptosis in amygdala after myocardial infarction.

    Science.gov (United States)

    Malick, Mandy; Gilbert, Kim; Barry, Mathieu; Godbout, Roger; Rousseau, Guy

    2014-10-01

    This study was designed to determine if desvenlafaxine (DV), a serotonin-norepinephrine reuptake inhibitor, can attenuate apoptosis observed in the limbic system after myocardial infarction (MI). MI was induced in rats by occlusion of the left descending artery for 40 min followed by reperfusion. Another group of sham (control) rats was similarly manipulated, but without occlusion. Half of the full cohort received DV (3 mg/kg/day intraperitoneal), starting 5 min after the onset of reperfusion; the other half received the vehicle (0.5 ml of 0.9% saline). Rats were sacrificed after 3 days for biochemical analyses and MI size measurements. Infarct size was significantly smaller in DV- compared to vehicle-treated rats. At 3 days post-MI, caspase-3 and -8 activities and terminal deoxynucleotidyltransferase-mediated dUTP nick-end labeling-positive cells were decreased in the amygdala of DV-treated rats compared to MI-vehicle controls. No difference was observed between the sham groups. The data indicates that DV given immediately after an acute MI event can reduce MI size and apoptosis in amygdala when measured three days post-MI. Copyright © 2014 Elsevier Inc. All rights reserved.

  20. VENTRICULAR FIBRILLATION IN ACUTE MYOCARDIAL INFARCTION - CASE REPORT

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    Tomislav Kostić

    2009-10-01

    Full Text Available Sudden cardiac death poses an immense problem in the middle and highly developed countries because its first expression is at the same time the last one. Ventricle tachycardia, the monomorphous and the polymorphous ones, and ventricular fibrillation are rhythm disorders that are most frequently associated with the phenomenon of sudden cardiac death. Ventricular fibrillation is the most common cause of sudden cardiac death within the first hours of the acute myocardial infarction. A 60-year-old man was admitted to our Clinic from a local hospital due to acute onset of chest pain and ECG signs of anterior ST segment elevation myocardial infarction. He had severe rhythm disturbances, about 70 epizodes of ventricular fibrilation (VF. Due to rhytmical instability of the patient, we decided that along with PCI it was necessary to implant ICD twenty-two days after the first acute coronary event.The ICD implantation ensures the best prevention against sudden cardiac death (secondary and primary in selected high-risk patients and has no alternative for any medicine known so far. It is significant that, lately, the field of application has extended to indication areas of primary prevention of sudden cardiac death, and especially to development of resynchronization implantable cardioverter defibrillator in the heart failure therapy.

  1. Microscopic and macroscopic infarct complicating pediatric epilepsy surgery.

    Science.gov (United States)

    Rubinger, Luc; Hazrati, Lili-Naz; Ahmed, Raheel; Rutka, James; Snead, Carter; Widjaja, Elysa

    2017-03-01

    There is some suggestion that microscopic infarct could be associated with invasive monitoring, but it is unclear if the microscopic infarct is also visible on imaging and associated with neurologic deficits. The aims of this study were to assess the rates of microscopic and macroscopic infarct and other major complications of pediatric epilepsy surgery, and to determine if these complications were higher following invasive monitoring. We reviewed the epilepsy surgery data from a tertiary pediatric center, and collected data on microscopic infarct on histology and macroscopic infarct on postoperative computed tomography (CT) or magnetic resonance imaging (MRI) done one day after surgery and major complications. Three hundred fifty-two patients underwent surgical resection and there was one death. Forty-two percent had invasive monitoring. Thirty patients (9%) had microscopic infarct. Univariable analyses showed that microscopic infarct was higher among patients with invasive monitoring relative to no invasive monitoring (20% vs. 0.5%, respectively, p microscopic infarct had transient right hemiparesis, and two with both macroscopic and microscopic infarct had unexpected persistent neurologic deficits. Thirty-two major complications (9.1%) were reported, with no difference in major complications between invasive monitoring and no invasive monitoring (10% vs. 7%, p = 0.446). In the multivariable analysis, invasive monitoring increased the odds of microscopic infarct (odds ratio [OR] 15.87, p = 0.009), but not macroscopic infarct (OR 2.6, p = 0.173) or major complications (OR 1.4, p = 0.500), after adjusting for age at surgery, sex, age at seizure onset, operative type, and operative location. Microscopic infarct was associated with invasive monitoring, and none of the patients had permanent neurologic deficits. Macroscopic infarct was not associated with invasive monitoring, and two patients with macroscopic infarct had persistent neurologic deficits. Wiley

  2. The Fullness of Space

    Science.gov (United States)

    Wynn-Williams, Gareth

    1992-06-01

    A brief glance at the night sky reveals a remarkable fact about the Universe: it is extremely patchy. The light we see on a moonless night comes from bright specks we call planets and stars. Between the stars we see blackness. Most of astronomy, not to mention geology, biology, and all humanistic studies, is concerned with what happens in and on these bright specks. Yet these lumps and specks, which include the Earth, the Sun, the planets of our solar system, and all the stars together occupy less than one billion billion billionth (10-27) of the total volume of the Universe. It is astonishing to think that the interstellar medium within our Galaxy, the Milky Way, is anything but empty space. But in most of the Galaxy, the density of interstellar matter is thousands of times lower than that of the best vacuum produced on Earth. In fact, there is enough interstellar matter in the Galaxy to make ten billion stars the size of the Sun. In this excellently crafted book, the author gives full treatment to the nature of the stuff between the stars and to the methods that astronomers use to study it. He explains where the matter came from in the first place, how it collects together in clouds and clumps, and the way in which new stars and planets form from material in space. Through his descriptions we see the matter as glorious gas clouds, such as the Orion Nebula, shimmering in rich hues of red and orange. Telescopes reveal inky black clouds, the molecule factories in which new stars and planets are made. Radio, infrared, and ultraviolet telescopes have given astronomers stunning new images of interstellar matter. The Fullness of Space is written for the general reader interested in science. It assumes no scientific or mathematical background, and the only equations in the whole book are found in the appendices. It is beautifully illustrated with many of the finest photographs available of dust clouds and bright nebulae. Readers from high school age to adult will find

  3. THROMBOLYSIS OR PRIMARY PCI FOR MYOCARDIAL INFARCTION WITH ST-SEGMENT ELEVATION? THE STREAM TRIAL (STRATEGIC REPERFUSION EARLY AFTER MYOCARDIAL INFARCTION

    Directory of Open Access Journals (Sweden)

    V. A. Sulimov

    2013-01-01

    Full Text Available Ambiguous data about comparability regarding clinical outcomes for prehospital thrombolysis, coupled with timely coronary angiography, and primary percutaneous coronary intervention (PCI in the early after acute ST-segment elevation myocardial infarction (STEMI, there are now.In the STREAM trial 1892 patients with STEMI diagnosed within 3 hours after onset of symptoms, and whom it was impossible to perform primary PCI within 1 h after the first medical contact, were randomly assigned into two treatment groups: a primary PCI b prehospital thrombolytic therapy with bolus tenecteplase (dose decreased by half in patients aged ≥75 years in combination with clopidogrel and enoxaparin followed by admission to the hospital, where it was possible to perform PCI. Emergency coronary angiography performed if thrombolysis failed. Coronary angiography and PCI of the infarct-related artery were performed in the period from 6 to 24 hours after randomization and thrombolytic therapy in the case of an effective thrombolysis. Primary endpoints include a composite of death, shock, congestive heart failure, or reinfarction up to 30 days.The primary endpoint occurred in 116 of 939 patients (12.4 % of the thrombolysis group and in 135 of 943 patients (14.3% of the primary PCI group (relative risk in the group thrombolysis 0.86, 95% confidence interval 0.68-1.09, p=0.21. Emergency angiography was required in 36.3% of patients in the thrombolysis, and the remaining patients, coronary angiography and PCI were performed at a mean of 17 hours after randomization and thrombolytic therapy. Thrombolysis group had more intracranial hemorrhages than primary PCI group (1.0% vs 0.2%, p=0.04; after correction protocol and dose reduction by half of tenecteplase in patients ≥75 years: 0.5% vs. 0.3%, p=0.45. The rate of non- intracranial bleeding in two treatment groups did not differ.Prehospital thrombolysis followed by coronary angiography and timely PCI provide effective

  4. THROMBOLYSIS OR PRIMARY PCI FOR MYOCARDIAL INFARCTION WITH ST-SEGMENT ELEVATION? THE STREAM TRIAL (STRATEGIC REPERFUSION EARLY AFTER MYOCARDIAL INFARCTION

    Directory of Open Access Journals (Sweden)

    V. A. Sulimov

    2015-09-01

    Full Text Available Ambiguous data about comparability regarding clinical outcomes for prehospital thrombolysis, coupled with timely coronary angiography, and primary percutaneous coronary intervention (PCI in the early after acute ST-segment elevation myocardial infarction (STEMI, there are now.In the STREAM trial 1892 patients with STEMI diagnosed within 3 hours after onset of symptoms, and whom it was impossible to perform primary PCI within 1 h after the first medical contact, were randomly assigned into two treatment groups: a primary PCI b prehospital thrombolytic therapy with bolus tenecteplase (dose decreased by half in patients aged ≥75 years in combination with clopidogrel and enoxaparin followed by admission to the hospital, where it was possible to perform PCI. Emergency coronary angiography performed if thrombolysis failed. Coronary angiography and PCI of the infarct-related artery were performed in the period from 6 to 24 hours after randomization and thrombolytic therapy in the case of an effective thrombolysis. Primary endpoints include a composite of death, shock, congestive heart failure, or reinfarction up to 30 days.The primary endpoint occurred in 116 of 939 patients (12.4 % of the thrombolysis group and in 135 of 943 patients (14.3% of the primary PCI group (relative risk in the group thrombolysis 0.86, 95% confidence interval 0.68-1.09, p=0.21. Emergency angiography was required in 36.3% of patients in the thrombolysis, and the remaining patients, coronary angiography and PCI were performed at a mean of 17 hours after randomization and thrombolytic therapy. Thrombolysis group had more intracranial hemorrhages than primary PCI group (1.0% vs 0.2%, p=0.04; after correction protocol and dose reduction by half of tenecteplase in patients ≥75 years: 0.5% vs. 0.3%, p=0.45. The rate of non- intracranial bleeding in two treatment groups did not differ.Prehospital thrombolysis followed by coronary angiography and timely PCI provide effective

  5. Imaginative Play during Childhood: Required for Reaching Full Potential

    Science.gov (United States)

    Stephens, Karen

    2009-01-01

    At a brisk pace, research findings focused on children's play are finally reaching the light of day in popular media. No longer left sitting in archives of academic journals, the benefits of play to lifelong success have been touted in radio, television, magazines, and newspapers. It gives early childhood professionals a powerful, credible…

  6. Reliability of Two Diameters Method in Determining Acute Infarct Size. Validation as New Imaging Biomarker.

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    Jochen B Fiebach

    Full Text Available In order to select patients most likely to benefit for thrombolysis and to predict patient outcome in acute ischemic stroke, the volumetric assessment of the infarcted tissue is used. However, infarct volume estimation on Diffusion weighted imaging (DWI has moderate interrater variability despite the excellent contrast between ischemic lesion and healthy tissue. In this study, we compared volumetric measurements of DWI hyperintensity to a simple maximum orthogonal diameter approach to identify thresholds indicating infarct size >70 ml and >100 ml.Patients presenting with ischemic stroke with an NIHSS of ≥ 8 were examined with stroke MRI within 24 h after symptom onset. For assessment of the orthogonal DWI lesion diameters (od-values the image with the largest lesion appearance was chosen. The maximal diameter of the lesion was determined and a second diameter was measured perpendicular. Both diameters were multiplied. Od-values were compared to volumetric measurement and od-value thresholds identifying a lesion size of > 70 ml and > 100 ml were determined. In a selected dataset with an even distribution of lesion sizes we compared the results of the od value thresholds with results of the ABC/2 and estimations of lesion volumes made by two resident physicians.For 108 included patients (53 female, mean age 71.36 years with a median infarct volume of 13.4 ml we found an excellent correlation between volumetric measures and od-values (r2 = 0.951. Infarct volume >100 ml corresponds to an od-value cut off of 42; > 70 ml corresponds to an od-value of 32. In the compiled dataset (n = 50 od-value thresholds identified infarcts > 100 ml / > 70 ml with a sensitivity of 90%/ 93% and with a specificity of 98%/ 89%. The od-value offered a higher accuracy in identifying large infarctions compared to both visual estimations and the ABC/2 method.The simple od-value enables identification of large DWI lesions in acute stroke. The cutoff of 42 is useful to

  7. Full metal jacket!

    CERN Multimedia

    Laëtitia Pedroso

    2011-01-01

    Ten years ago, standard issue clothing only gave CERN firemen partial protection but today our fire-fighters are equipped with state-of-the-art, full personal protective equipment.   CERN's Fire Brigade team. For many years, the members of CERN's Fire Brigade went on call-outs clad in their work trousers and fire-rescue coats, which only afforded them partial protection. Today, textile manufacturing techniques have moved on a long way and CERN's firemen are now kitted out with state-of-the-art personal protective equipment. The coat and trousers are three-layered, comprising fire-resistant aramide, a protective membrane and a thermal lining. The CERN Fire Brigade' new state-of-the-art personal protection equipment. "This equipment is fully compliant with the standards in force and is therefore resistant to cuts, abrasion, electrical arcs with thermal effects and, of course, fire," explains Patrick Berlinghi, the CERN Fire Brigade's Logistics Officer. You might think that su...

  8. Full Color Holographic Endoscopy

    Science.gov (United States)

    Osanlou, A.; Bjelkhagen, H.; Mirlis, E.; Crosby, P.; Shore, A.; Henderson, P.; Napier, P.

    2013-02-01

    The ability to produce color holograms from the human tissue represents a major medical advance, specifically in the areas of diagnosis and teaching. This has been achieved at Glyndwr University. In corporation with partners at Gooch & Housego, Moor Instruments, Vivid Components and peninsula medical school, Exeter, UK, for the first time, we have produced full color holograms of human cell samples in which the cell boundary and the nuclei inside the cells could be clearly focused at different depths - something impossible with a two-dimensional photographic image. This was the main objective set by the peninsula medical school at Exeter, UK. Achieving this objective means that clinically useful images essentially indistinguishable from the object human cells could be routinely recorded. This could potentially be done at the tip of a holo-endoscopic probe inside the body. Optimised recording exposure and development processes for the holograms were defined for bulk exposures. This included the optimisation of in-house recording emulsions for coating evaluation onto polymer substrates (rather than glass plates), a key step for large volume commercial exploitation. At Glyndwr University, we also developed a new version of our in-house holographic (world-leading resolution) emulsion.

  9. Workflows for Full Waveform Inversions

    Science.gov (United States)

    Boehm, Christian; Krischer, Lion; Afanasiev, Michael; van Driel, Martin; May, Dave A.; Rietmann, Max; Fichtner, Andreas

    2017-04-01

    Despite many theoretical advances and the increasing availability of high-performance computing clusters, full seismic waveform inversions still face considerable challenges regarding data and workflow management. While the community has access to solvers which can harness modern heterogeneous computing architectures, the computational bottleneck has fallen to these often manpower-bounded issues that need to be overcome to facilitate further progress. Modern inversions involve huge amounts of data and require a tight integration between numerical PDE solvers, data acquisition and processing systems, nonlinear optimization libraries, and job orchestration frameworks. To this end we created a set of libraries and applications revolving around Salvus (http://salvus.io), a novel software package designed to solve large-scale full waveform inverse problems. This presentation focuses on solving passive source seismic full waveform inversions from local to global scales with Salvus. We discuss (i) design choices for the aforementioned components required for full waveform modeling and inversion, (ii) their implementation in the Salvus framework, and (iii) how it is all tied together by a usable workflow system. We combine state-of-the-art algorithms ranging from high-order finite-element solutions of the wave equation to quasi-Newton optimization algorithms using trust-region methods that can handle inexact derivatives. All is steered by an automated interactive graph-based workflow framework capable of orchestrating all necessary pieces. This naturally facilitates the creation of new Earth models and hopefully sparks new scientific insights. Additionally, and even more importantly, it enhances reproducibility and reliability of the final results.

  10. Bivalirudin versus Heparin Monotherapy in Myocardial Infarction.

    Science.gov (United States)

    Erlinge, David; Omerovic, Elmir; Fröbert, Ole; Linder, Rikard; Danielewicz, Mikael; Hamid, Mehmet; Swahn, Eva; Henareh, Loghman; Wagner, Henrik; Hårdhammar, Peter; Sjögren, Iwar; Stewart, Jason; Grimfjärd, Per; Jensen, Jens; Aasa, Mikael; Robertsson, Lotta; Lindroos, Pontus; Haupt, Jan; Wikström, Helena; Ulvenstam, Anders; Bhiladvala, Pallonji; Lindvall, Bo; Lundin, Anders; Tödt, Tim; Ioanes, Dan; Råmunddal, Truls; Kellerth, Thomas; Zagozdzon, Leszek; Götberg, Matthias; Andersson, Jonas; Angerås, Oskar; Östlund, Ollie; Lagerqvist, Bo; Held, Claes; Wallentin, Lars; Scherstén, Fredrik; Eriksson, Peter; Koul, Sasha; James, Stefan

    2017-09-21

    The comparative efficacy of various anticoagulation strategies has not been clearly established in patients with acute myocardial infarction who are undergoing percutaneous coronary intervention (PCI) according to current practice, which includes the use of radial-artery access for PCI and administration of potent P2Y12 inhibitors without the planned use of glycoprotein IIb/IIIa inhibitors. In this multicenter, randomized, registry-based, open-label clinical trial, we enrolled patients with either ST-segment elevation myocardial infarction (STEMI) or non-STEMI (NSTEMI) who were undergoing PCI and receiving treatment with a potent P2Y12 inhibitor (ticagrelor, prasugrel, or cangrelor) without the planned use of glycoprotein IIb/IIIa inhibitors. The patients were randomly assigned to receive bivalirudin or heparin during PCI, which was performed predominantly with the use of radial-artery access. The primary end point was a composite of death from any cause, myocardial infarction, or major bleeding during 180 days of follow-up. A total of 6006 patients (3005 with STEMI and 3001 with NSTEMI) were enrolled in the trial. At 180 days, a primary end-point event had occurred in 12.3% of the patients (369 of 3004) in the bivalirudin group and in 12.8% (383 of 3002) in the heparin group (hazard ratio, 0.96; 95% confidence interval [CI], 0.83 to 1.10; P=0.54). The results were consistent between patients with STEMI and those with NSTEMI and across other major subgroups. Myocardial infarction occurred in 2.0% of the patients in the bivalirudin group and in 2.4% in the heparin group (hazard ratio, 0.84; 95% CI, 0.60 to 1.19; P=0.33), major bleeding in 8.6% and 8.6%, respectively (hazard ratio, 1.00; 95% CI, 0.84 to 1.19; P=0.98), definite stent thrombosis in 0.4% and 0.7%, respectively (hazard ratio, 0.54; 95% CI, 0.27 to 1.10; P=0.09), and death in 2.9% and 2.8%, respectively (hazard ratio, 1.05; 95% CI, 0.78 to 1.41; P=0.76). Among patients undergoing PCI for myocardial

  11. SOHO Resumes Full Operation

    Science.gov (United States)

    2003-07-01

    SOHO orbit hi-res Size hi-res: 324 kb Credits: SOHO (ESA & NASA) SOHO orbit Because of its static position, every three months the high-gain antenna loses sight of Earth. During this time, engineers will rotate the spacecraft by 180 degrees to regain full contact a few days later. Since 19 June 2003, SOHO's high-gain antenna (HGA), which transmits high-speed data to Earth, has been fixed in position following the discovery of a malfunction in its pointing mechanism. This resulted in a loss of signal through SOHO's usual 26-metre ground stations on 27 June 2003. However, 34-metre radio dishes continued to receive high-speed transmissions from the HGA until 1 July 2003. Since then, astronomers have been relying primarily on a slower transmission rate signal, sent through SOHO's backup antenna. It can be picked up whenever a 34-metre dish is available. However, this signal could not transmit all of SOHO's data. Some data was recorded on board, however, and downloaded using high-speed transmissions through the backup antenna when time on the largest, 70-metre dishes could be spared. SOHO itself orbits a point in space, 1.5 million kilometres closer to the Sun than the Earth, once every 6 months. To reorient the HGA for the next half of this orbit, engineers rolled the spacecraft through a half-circle on 8 July 2003. On 10 July, the 34-metre radio dish in Madrid re-established contact with SOHO's HGA. Then on the morning of 14 July 2003, normal operations with the spacecraft resumed through its usual 26-metre ground stations, as predicted. With the HGA now static, the blackouts, lasting between 9 and 16 days, will continue to occur every 3 months. Engineers will rotate SOHO by 180 degrees every time this occurs. This manoeuvre will minimise data losses. Stein Haugan, acting SOHO project scientist, says "It is good to welcome SOHO back to normal operations, as it proves that we have a good understanding of the situation and can confidently work around it."

  12. Meta-Analysis of the Clinical Effectiveness and Safety of Ligustrazine in Cerebral Infarction.

    Science.gov (United States)

    Yu, Tian; Guo, Xiaoheng; Zhang, Zhen; Liu, Rong; Zou, Liang; Fu, Jia; Shi, Zheng

    2016-01-01

    Objectives. To evaluate the efficacy and safety of ligustrazine in the treatment of cerebral infarction. Methods. A systematic literature search was conducted in 6 databases until 30 June 2016 to identify randomized controlled trials (RCTs) of ligustrazine in the treatment of cerebral infarction. The quality of all the included studies was evaluated. All data were analyzed by Review Manager 5.1 Software. Results. 19 RCTs totally involving 1969 patients were included. The primary outcome measures were Neurological Deficit Score (NDS) and clinical effective rate. The secondary outcome measure was adverse events. Meta-analysis showed that ligustrazine could improve clinical efficacy and NDS of cerebral infarction with [OR = 3.60, 95% CI (2.72, 4.78), P effects in improving the Blood Rheology Index (BRI) in patients compared with control group. Ten trials contained safety assessments and stated that no obvious side effects were found. Conclusions. Ligustrazine demonstrated definite clinical efficacy for cerebral infarction, and it can also improve NDS in patients without obvious adverse events. However, due to the existing low-quality research, more large-scale and multicentric RCTs are required to provide clear evidence for its clinical efficacy in the near future.

  13. Remodeling in myocardium adjacent to an infarction in the pig left ventricle.

    Science.gov (United States)

    Zimmerman, Scott D; Criscione, John; Covell, James W

    2004-12-01

    Changes in the structure of the "normal" ventricular wall adjacent to an infarcted area involve all components of the myocardium (myocytes, fibroblasts and the extracellular matrix, and the coronary vasculature) and their three-dimensional structural relationship. Assessing changes in these components requires tracking material markers in the remodeling tissue over long periods of time with a three-dimensional approach as well as a detailed histological evaluation of the remodeled structure. The purpose of the present study was to examine the hypotheses that changes in the tissue adjacent to an infarct are related to myocyte elongation, myofiber rearrangement, and changes in the laminar architecture of the adjacent tissue. Three weeks after myocardial infarction, noninfarcted tissue adjacent to the infarct remodeled by expansion along the direction of the fibers and in the cross fiber direction. These changes are consistent with myocyte elongation and myofiber rearrangement (slippage), as well as a change in cell shape to a more elliptical cross section with the major axis in the epicardial tangent plane, and indicate that reorientation of fibers either via "cell slippage" or changes in orientation of the laminar structure of the ventricular wall are quantitatively important aspects of the remodeling of the normally perfused myocardium.

  14. Nanog expression in heart tissues induced by acute myocardial infarction.

    Science.gov (United States)

    Luo, Huanhuan; Li, Qiong; Pramanik, Jogen; Luo, Jiankai; Guo, Zhikun

    2014-10-01

    Nanog is a potential stem cell marker and is considered a regeneration factor during tissue repair. In the present study, we investigated expression patterns of nanog in the rat heart after acute myocardial infarction by semi-quantitative RT-PCR, immunohistochemistry and Western blot analyses. Our results show that nanog at both mRNA and protein levels is positively expressed in myocardial cells, fibroblasts and small round cells in different myocardial zones at different stages after myocardial infarction, showing a spatio-temporal and dynamic change. After myocardial infarction, the nanog expression in fibroblasts and small round cells in the infarcted zone (IZ) is much stronger than that in the margin zone (MZ) and remote infarcted zone (RIZ). From day 7 after myocardial infarction, the fibroblasts and small cells strongly expressed nanog protein in the IZ, and a few myocardial cells in the MZ and the RIZ and the numbers of nanog-positive fibroblasts and small cells reached the highest peak at 21 days after myocardial infarction, but in this period the number of nanog-positive myocardial cells decreased gradually. At 28 days after myocardial infarction, the numbers of all nanog-positive cells decreased into a low level. Therefore, our data suggest that all myocardial cells, fibroblasts and small round cells are involved in myocardial reconstruction after cardiac infarction. The nanog-positive myocardial cells may respond to early myocardial repair, and the nanog-positive fibroblasts and small round cells are the main source for myocardial reconstruction after cardiac infarction.

  15. Correlative factors of cognitive impairment in patients with lacunar infarcts

    Institute of Scientific and Technical Information of China (English)

    Zhang Qiujuan; Yao Xiaoxin; Guo Youmin; Zhang Gejuan; Yang Junle

    2007-01-01

    Objective To study the relationships between cognitive impairment in patients with lacunar infarcts and quantitative CT measures and to determine the independent correlative factors of cognitive impairment. Methods Neuropsychological examination was conducted for 128 patients with acute lacunar infarct. Number, location, and volume of infarcts, cerebral atrophy index and severity of white matter lesions (WMLs) were measured and recorded. Results The number of lacunar infarcts in cognitive impairment (CI) group was significantly larger than that in cognitive normal (CN) group. Mean width of sulcus and sylvian fissure, index of frontal horn and ventricular-brain ratio (VBR) were significantly different in both groups. There were more patients with 3 grades or 4 grades WMLs in CI group (62%) than those in CN group (22%). The total volume of lacunar infarcts showed no statistically significant difference. Logistic regression analysis indicated that the number of lacunar infarcts in frontal subcortex and thalamus, the volume of infarcts in anterior periventricular white matter, width of cerebral sulcus and sylvian fissure were correlated with cognitive impairment respectively. Additionally, age and education were correlative factors of cognitive impairment in patients with lacunar infarct. Conclusion Correlative factors of cognitive impairment in patients with lacunar infarct are not merely one feature, but a combination of infarct features (number, location, and volume), cortical atrophy and host factors (age and education).

  16. Enlarged perivascular spaces and lacunar infarction Cerebral magnetic resonance evaluation

    Institute of Scientific and Technical Information of China (English)

    Weihong Yan; Jing Fang; Cuijuan Zhou

    2008-01-01

    BACKGROUND:Previous studies have demonstrated that enlarged perivascular spaces(EPVS)arg a result of microvaseular disease.To date,there age few reports about the relationship between EPVS and lacunar infarction.OBJECTIVE:To investigate whether EPVS is associated with lacunar infarction on the basis of cerebral magnetic resonance(MR)examination,clinical symptoms and signs,and past medical history of patients.DESIGN,TIME AND SETTING:Case contrast analysis was performed at the Department of Neurology,Shanghai Ninth People's Hospital from January 2007 to January 2008.PARTICIPANTS:Sixty-eight patients with lacunar infarction were admired to the Department of Neurology of Shanghai Ninth People's Hospital,including 37 cases with first-ever infarction,and 31 with infarction recurrence.In addition,53 healthy people were selected as controls.METHODS:All participants underwent past medical history investigation,nervous system examination.and cranial MR.The subjects were assessed using the JMW rating scale to identify the EPVS grade.MAIN OUTCOME MEASURES:EPVS scores of patients and controls;risk factors for cerebral vascular disease in patients with first-ever or recurrence of lacunar infarction.RESULTS:The EPVS grade from lacunar infarction patients was significantly higher than of the control group(P<0.05).The EPVS grade in patients with recurring lacunar infarction was significantly higher than in patients with first-ever infarction(P<0.05).In addition,hypertension incidence in patients with recurring lacunar infarction was significantly higher than in patients wim first-ever infarction (P<0.05).CONCLUSION:Results indicate that EPVS is related to the incidence of lacunar infarction.Earlier screening of EPVS.and the evaluation of EPVS severity,is of great importance to control the risk factors for cerebral vascular disease and to prevent lacunar infarction.

  17. Achieving and sustaining full employment.

    Science.gov (United States)

    Rosen, S M

    1995-01-01

    Human rights and public health considerations provide strong support for policies that maximize employment. Ample historical and conceptual evidence supports the feasibility of full employment policies. New factors affecting the labor force, the rate of technological change, and the globalization of economic activity require appropriate policies--international as well as national--but do not invalidate the ability of modern states to apply the measures needed. Among these the most important include: (I) systematic reduction in working time with no loss of income, (2) active labor market policies, (3) use of fiscal and monetary measures to sustain the needed level of aggregate demand, (4) restoration of equal bargaining power between labor and capital, (5) social investment in neglected and outmoded infrastructure, (6) accountability of corporations for decisions to shift or reduce capital investment, (7) major reductions in military spending, to be replaced by socially needed and economically productive expenditures, (8) direct public sector job creation, (9) reform of monetary policy to restore emphasis on minimizing unemployment and promoting full employment. None are without precedent in modern economies. The obstacles are ideological and political. To overcome them will require intellectual clarity and effective advocacy.

  18. Creation of Chronic Myocardial Infarction in a Pig (Sus Scrofa) Model

    Science.gov (United States)

    2015-09-01

    Objectives: The goal of this protocol was to create myocardial infarctions in mini pigs using polystyrenemicrospheres to infarct a portion of the...underwent myocardial infarctions without misadventure. Infusion of polystyrene beads into a diagonal branch of the LAD resulted In a repeatable and...controlled myocardial Infarction.Conclusion: The method reported here provided consistent and repeatable myocardial infarcts with minimal morbidity.

  19. Predictors of Dysphagia in Acute Pontine Infarction.

    Science.gov (United States)

    Lapa, Sriramya; Luger, Sebastian; Pfeilschifter, Waltraud; Henke, Christian; Wagner, Marlies; Foerch, Christian

    2017-05-01

    Little is known about the frequency and the clinical characteristics of neurogenic dysphagia in pontine strokes. In this study, we sought to identify predictors for dysphagia in a cohort of patients with isolated pontine infarctions. We included all patients admitted to our department between 2008 and 2014 having an acute (dysphagia was the primary end point of the study and was assessed by a Speech-Language Pathologist according to defined criteria. The study recruited 59 patients, 14 with and 45 without dysphagia. Median (interquartile range) stroke severity (in terms of National Institutes of Health Stroke Scale values) was higher in the dysphagic group as compared with patients without dysphagia (8.5 [6-12] versus 2 [1-5]; Pdysphagia. Dysphagia occurs frequently in patients with isolated pontine infarctions. Clinical and imaging predictors of dysphagia may help to provide optimal screening, to prevent complications and to improve long-term prognosis. © 2017 American Heart Association, Inc.

  20. Perfusion Pressure Cerebral Infarct (PPCI) trial

    DEFF Research Database (Denmark)

    Vedel, Anne G.; Holmgaard, Frederik; Rasmussen, Lars Simon

    2016-01-01

    to be caused by emboli, but inadequate blood flow caused by other mechanisms may increase ischaemia in the penumbra or cause watershed infarcts. During cardiopulmonary bypass, blood pressure can be below the lower limit of cerebral autoregulation. Although much debated, the constant blood flow provided...... by the cardiopulmonary bypass system is still considered by many as appropriate to avoid cerebral ischaemia despite the low blood pressure. Methods/design: The Perfusion Pressure Cerebral Infarct trial is a single-centre superiority trial with a blinded outcome assessment. The trial is randomising 210 patients...... with coronary vessel and/or valve disease and who are undergoing cardiac surgery with the use of cardiopulmonary bypass. Patients are stratified by age and surgical procedure and are randomised 1:1 to either an increased mean arterial pressure (70–80 mmHg) or ‘usual practice’ (40–50 mmHg) during cardiopulmonary...

  1. Acupuncture Therapy for Multiple Infarctional Dementia

    Institute of Scientific and Technical Information of China (English)

    SHEN Wei-dong; XIAO Yuan-chun

    2003-01-01

    Purpose To observe the clinical efficacy of combined electro-acupuncture and moxibustion in the treatment of multiple infarctional dementia. Methods Eighty-eight patients were randomized into two groups:treatment group in which 48 cases were treated by combined electro-acupuncture and moxibustion and control group in which 40 cases were treated by oral administration of Huperzine A. Results The total effective rate was 90% in treatment group and 71% in control group,with a significant difference ( P < 0.05 ); the score of Mini-mental State Examination (MMSE) increased more obviously in treatment group than in control group (P<0.05). Conclusion Combined electro-acupuncture and moxibustion is effective in improving the clinical symptoms of multiple infarctional dementia.

  2. Reactive thrombocytosis leading to acute myocardial infarction.

    Science.gov (United States)

    Aundhakar, Swati C; Mahajan, Sanket K; Mane, Makarand B; Lakhotiya, Akshay N

    2013-10-01

    Thrombocytosis is defined as platelet count of > 600000. An elevated platelet count may be primarily (essential) or secondary (reactive). Acute myocardial infarction and other vaso-occlusive phenomenon are seen in less than 5% of the patients of reactive thrombocytosis. Here we report such a case. A 49 yr old lady presented with chest pain and had isolated right ventricular infarction that progressed to anteroseptal wall STEMI. Her platelet count was 11 lac; the triggering factor in this case was reactive thrombocytosis secondary to lower respiratory tract infection and iron-deficiency anaemia confirmed after investigations. The clinical diagnosis was confirmed through IL6 levels. The patient was managed aggressively in ICCU, she had an uneventful recovery and was discharged with a normal platelet count.

  3. Quality of Care for Patients with Acute Myocardial Infarction. Cienfuegos 2013

    Directory of Open Access Journals (Sweden)

    Hilda María Delgado Acosta

    2016-02-01

    Full Text Available Background: is a priority of the National Health System providing quality care to patients with acute myocardial infarction. Objective: to assess medical care to patients with acute myocardial infarction admitted to the Dr. Gustavo Aldereguía Lima Hospital in Cienfuegos in June 2013 to compare the results with previous assessments. Methods: a research on health systems and services was conducted. The variables used were related to the structure (human and material resources, processes (compliance with established care protocols and results (topography of infarction, hospital stay and impact on mortality. A questionnaire was applied to 20 patients admitted with the diagnosis of acute infarction during the study period. An observation guide was also used. Data were processed using the SPSS 15.0 program and expressed in absolute values and percentages. Results: male patients predominated in the series studied and the most common risk factors were hypertension in 50 % of cases, smoking in 45 % and diabetes mellitus in 25 %. Difficulties with medical and nursing staffing were detected in the emergency department and cardiology ward, respectively. There were difficulties in the use of beta blockers and aspirin in prehospital care, especially in patients with non- ST- segment elevation acute coronary syndromes. Early arrival at the medical services led to greater opportunity to perform a thrombolysis. There were no deaths. Conclusions: although results we better in comparison with the assessment of 2011, there are still gaps in care provided to these patients.

  4. Cardioprotective Effect of the Compound Yangshen Granule in Rat Models with Acute Myocardial Infarction

    Directory of Open Access Journals (Sweden)

    Xie Ming

    2012-01-01

    Full Text Available The protective effect of Compound Yangshen Granules was observed in myocardial infarction rat model. Rats were randomly divided into 6 groups: the model group, the control group (sham operated, the positive drug group, and small, medium, and large dosage of the Yangshen granule groups, respectively. The rats in the 3 Yangshen granule groups were orally administrated with 0.7 g/kg, 1.4 g/kg, and 2.8 g/kg for 7 consecutive days, whereas the rats of the positive drug group treated with 0.14 g/kg of Danshen Dropping Pills, and rats in the control and model groups orally administrated with saline. The rat model of acute myocardial infarction was established with ligation of coronary artery. Electrocardiograms at different time points, the blood rheology, myocardial enzymes, infarct size, and myocardial morphologic changes were measured. The results demonstrated that the granules could improve blood rheology, decrease st-segment of electrocardiograms and the activities of LDH and CK in serum, reduce myocardial infarction size, and alleviate myocardial histopathologic changes. In addition, the effect of the granules depended on the dose administrated orally. The results suggest that the Yangshen granules could produce cardioprotection effect and have potential benefits in the prevention of ischemic heart disease.

  5. Primary percutaneous transluminal coronary angioplasty in the acute infarction of the right ventricle

    Directory of Open Access Journals (Sweden)

    Gligić Branko

    2003-01-01

    Full Text Available Background. Predilection site for the acute myocardial infarction of the right ventricle, (AMI-RV is the upper third of the right coronary artery and for this reason such an infarction is followed by numerous complications, primarily by conduction disorders and very often by sudden and rapid cardiogenic shock development. Methods. Primary percutaneous transluminal coronary angioplasty (PPTCA was performed on three patients in whom the acute infarction of the right ventricular was diagnosed and who had been hospitalized six hours after the beginning of chest pain. In all three patients intracoronary stent was implanted. On the admission patients had been in the threatening cardiogenic shock, with the prominent chest pain and with the elevation of ST-segment in V4R>2 mV. In the course of intervention patients were administered low-molecular intracoronary heparin with direct platelet glycoprotein IIb/IIIa inhibitors (abciximab, according to the established procedure applied in such cases. Results. The complete dilatation of the infarcted artery was established with the signs of reperfusion and the further clinical course was completely normal, there was no heart failure and patients had no subjective difficulties. Conclusion. Invasive approach in the treatment of AMI-RV is justifiable, and possibly the therapy of choice of these patients, providing well trained and equipped team is available.

  6. Toll-like receptor 4 deficiency: Smaller infarcts, but nogain in function

    Directory of Open Access Journals (Sweden)

    Hoeft Andreas

    2007-06-01

    Full Text Available Abstract Backgound It has been reported that Toll-like receptor 4 (TLR4 deficiency reduces infarct size after myocardial ischemia/reperfusion (MI/R. However, measurement of MI/R injury was limited and did not include cardiac function. In a chronic closed-chest model we assessed whether cardiac function is preserved in TLR4-deficient mice (C3H/HeJ following MI/R, and whether myocardial and systemic cytokine expression differed compared to wild type (WT. Results Infarct size (IS in C3H/HeJ assessed by TTC staining after 60 min ischemia and 24h reperfusion was significantly smaller than in WT. Despite a smaller infarct size, echocardiography showed no functional difference between C3H/HeJ and WT. Left-ventricular developed pressure measured with a left-ventricular catheter was lower in C3H/HeJ (63.0 ± 4.2 mmHg vs. 77.9 ± 1.7 mmHg in WT, p Conclusion These results demonstrate that, although a mutant TLR4 signaling cascade reduces myocardial IS and serum cytokine levels, it does not preserve myocardial function. The change in inflammatory response, secondary to a non-functional TLR-4 receptor, may contribute to the observed dichotomy between infarct size and function in the TLR-4 mutant mouse.

  7. Gender-Based Differences in Cardiac Remodeling and ILK Expression after Myocardial Infarction

    Directory of Open Access Journals (Sweden)

    Renato Rodrigues Sofia

    2014-08-01

    Full Text Available Background: Gender can influence post-infarction cardiac remodeling. Objective: To evaluate whether gender influences left ventricular (LV remodeling and integrin-linked kinase (ILK after myocardial infarction (MI. Methods: Female and male Wistar rats were assigned to one of three groups: sham, moderate MI (size: 20-39% of LV area, and large MI (size: ≥40% of LV area. MI was induced by coronary occlusion, and echocardiographic analysis was performed after six weeks to evaluate MI size as well as LV morphology and function. Real-time RT-PCR and Western blot were used to quantify ILK in the myocardium. Results: MI size was similar between genders. MI resulted in systolic dysfunction and enlargement of end-diastolic as well as end-systolic dimension of LV as a function of necrotic area size in both genders. Female rats with large MI showed a lower diastolic and systolic dilatation than the respective male rats; however, LV dysfunction was similar between genders. Gene and protein levels of ILK were increased in female rats with moderate and large infarctions, but only male rats with large infarctions showed an altered ILK mRNA level. A negative linear correlation was evident between LV dimensions and ILK expression in female rats with large MI. Conclusions: Post-MI ILK expression is altered in a gender-specific manner, and higher ILK levels found in females may be sufficient to improve LV geometry but not LV function.

  8. Serum fatty acid in patients with acute myocardial infarction in Gorgan

    Directory of Open Access Journals (Sweden)

    Abdoljalal Marjani

    2012-10-01

    Full Text Available Introduction: The present study aimed to assess serum fatty acid in patients with acute myocardial infarction in Gorgan, Iran. Material and Methods: The study conducted on the thirty and five subjects with acute myocardial infarction who were referred to the intensive Coronary Care Unit in 5th Azar in Gorgan. Results: The content of palmitoleic acid (16:1 was significantly higher in serum fatty acid of the patients than of the control groups (P=0.019, whereas oleic acid (18:1, linoleic acid (18:2, _-linolenic acid (18:3, arachidonic acid (20:4 and Eicosapentaenoic acid (EPA were significantly higher in the control groups than the patients (P<0.0001, P=0.013, P=0.042, P=0,001 and P=0.022 respectively. Conclusion: This study showed that the content of polyunsaturated fatty acids in serum fatty acid component was decreased in acute myocardial infarction patients. These results suggest that there may be some protective effects of poly unsaturated fatty acid against myocardial infarction.

  9. OCCLUSION OF ARTERY OF PERCHERON: A RARE AETIOLOGY OF BILATERAL THALAMIC INFARCT

    Directory of Open Access Journals (Sweden)

    Mane Makarand, Mane Priyanka, Mohite Rajsinh , Bhattad Prashant, Bangar Kushal, Mahajani Anup

    2015-10-01

    Full Text Available The Artery of Percheron, a rare anatomical variant of brain vascularisation, arises from the posterior cerebral artery. Occlusion of this artery leads to bilateral paramedian thalamic infarct leads to dysfunction of central nervous system. Incidence of bilateral thalamic infarct secondary to occlusion of artery of Percheron is unknown because of its rarity. Here we report a case of 35 year old female presented with altered state of consciousness and the underlying cause was occlusion of Artery of Percheron which leads to bilateral thalamic infarct detected on MRI scanning. It showed hyperintensities on T2W1 and FLAIR, and hypointensity on T1W1, restricted to bilateral ventromedial thalami showing corresponding area of high signal intensity on diffusion weighted images and hypointensity on apparent diffusion coefficient images indicating diffusion restriction, suggestive of infarct. On further investigation magnetic resonance arteriogram (MRA of the brain demonstrated a single common artery arising from the left P1 segment which divided into two branches distally supplying bilateral thalami. Patient became alright after 2 weeks of medical line of treatment.

  10. Interventions in Wnt signaling as a novel therapeutic approach to improve myocardial infarct healing

    Directory of Open Access Journals (Sweden)

    Hermans Kevin CM

    2012-09-01

    Full Text Available Abstract Following myocardial infarction, wound healing takes place in the infarct area where the non-viable cardiac tissue is replaced by a scar. Inadequate wound healing or insufficient maintenance of the extracellular matrix in the scar can lead to excessive dilatation of the ventricles, one of the hallmarks of congestive heart failure. Therefore, it is important to better understand the wound-healing process in the heart and to develop new therapeutic agents that target the infarct area in order to maintain an adequate cardiac function. One of these potential novel therapeutic targets is Wnt signaling. Wnt signaling plays an important role in embryonic myocardial development but in the adult heart the pathway is thought to be silent. However, there is increasing evidence that components of the Wnt pathway are re-expressed during cardiac repair, implying a regulatory role. Recently, several studies have been published where the effect of interventions in Wnt signaling on infarct healing has been studied. In this review, we will summarize the results of these studies and discuss the effects of these interventions on the different cell types that are involved in the wound healing process.

  11. Aortic dissection or renal infarction: Multislice computed tomographic angiography can tell

    Directory of Open Access Journals (Sweden)

    Stojanović Miloš

    2012-01-01

    Full Text Available Introduction. Acute renal infarction as a consequence of renal artery occlusion often goes unrecognized, mostly due to the non-specific clinical features. A quick diagnosis, ideally within three hours of presentation, is a key to renal function recovery. Case Outline. A 62-year-old male patient was admitted with a sudden abdominal pain, right flank pain and nausea. He had a diastolic hypertension at admission and his previous medical history showed atrial fibrillation. Initial clinical diagnosis was aortic dissection. Laboratory findings included elevated lactate dehydrogenase (LDH and serum creatinine levels. There were no signs of aortic dissection or aneurismatic lesions registered during a multislice computed tomographic (MSCT angiography. However, MSCT angiography demonstrated left “upper” renal artery thrombosis and renal infarction - avascular area of the upper two thirds of the left kidney sharply demarcated from the surrounding parenchyma. Both kidneys excreted the contrast. Anticoagulant therapy was initiated, along with antiarrythmic and antihypertensive medications. The follow-up by computed tomography was performed after nine weeks, and it showed a partial revascularization of the previously affected area. Conclusion. Concomitant presence of flank/abdominal pain, an increased risk for thromboembolism and an elevated LDH suggested a possibility of renal infarction. MSCT angiography is a non-invasive and accurate method in the diagnosis of renal artery occlusion and the resulting renal infarction.

  12. Contribution of constitutively proliferating precursor cell subtypes to dentate neurogenesis after cortical infarcts

    Directory of Open Access Journals (Sweden)

    Oberland Julia

    2010-11-01

    Full Text Available Abstract Background It is well known that focal ischemia increases neurogenesis in the adult dentate gyrus of the hippocampal formation but the cellular mechanisms underlying this proliferative response are only poorly understood. We here investigated whether precursor cells which constitutively proliferate before the ischemic infarct contribute to post-ischemic neurogenesis. To this purpose, transgenic mice expressing green fluorescent protein (GFP under the control of the nestin promoter received repetitive injections of the proliferation marker bromodeoxyuridine (BrdU prior to induction of cortical infarcts. We then immunocytochemically analyzed the fate of these BrdU-positive precursor cell subtypes from day 4 to day 28 after the lesion. Results Quantification of BrdU-expressing precursor cell populations revealed no alteration in number of radial glia-like type 1 cells but a sequential increase of later precursor cell subtypes in lesioned animals (type 2a cells at day 7, type 3 cells/immature neurons at day 14. These alterations result in an enhanced survival of mature neurons 4 weeks postinfarct. Conclusions Focal cortical infarcts recruit dentate precursor cells generated already before the infarct and significantly contribute to an enhanced neurogenesis. Our findings thereby increase our understanding of the complex cellular mechanisms of postlesional neurogenesis.

  13. Respiratory muscle endurance is limited by lower ventilatory efficiency in post-myocardial infarction patients

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    Laura M. T. Neves

    2014-03-01

    Full Text Available Background: Reduced respiratory muscle endurance (RME contributes to increased dyspnea upon exertion in patients with cardiovascular disease. Objective: The objective was to characterize ventilatory and metabolic responses during RME tests in post-myocardial infarction patients without respiratory muscle weakness. Method: Twenty-nine subjects were allocated into three groups: recent myocardial infarction group (RG, n=9, less-recent myocardial infarction group (LRG, n=10, and control group (CG, n=10. They underwent two RME tests (incremental and constant pressure with ventilatory and metabolic analyses. One-way ANOVA and repeated measures one-way ANOVA, both with Tukey post-hoc, were used between groups and within subjects, respectively. Results: Patients from the RG and LRG presented lower metabolic equivalent and ventilatory efficiency than the CG on the second (50± 06, 50± 5 vs. 42± 4 and third part (50± 11, 51± 10 vs. 43± 3 of the constant pressure RME test and lower metabolic equivalent during the incremental pressure RME test. Additionally, at the peak of the incremental RME test, RG patients had lower oxygen uptake than the CG. Conclusions : Post-myocardial infarction patients present lower ventilatory efficiency during respiratory muscle endurance tests, which appears to explain their inferior performance in these tests even in the presence of lower pressure overload and lower metabolic equivalent.

  14. Internal Watershed Infarction as an Imaging and Clinical Challenge: a Case Report

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    Marino Marčić

    2016-04-01

    Full Text Available We presented the case of a patient with internal watershed infarction with a nonspecific clinical presentation including hemiplegia, hemisensory deficit, and speech disturbance. Neuroimaging and ultrasound diagnostic procedure are important tools for diagnosis of these rare ischemic events that count for about 6% of all strokes.  Specific therapy is mandatory for the diagnosis of watershed infarction and different from the therapeutical measures than can be taken for embolic and atherothrombotic strokes. Our patient was a 69-year-old, right-handed Caucasian woman who presented to our facility with acute right side weakness and speech disturbance. He had hypothyroidism, permanent atrial fibrillation, diabetes mellitus and she was hypotensive. She reported dizziness few days before the accident. Imaging studies revealed internal watershed infarction. Therapeutic procedures were taken to restore low cerebral blood flow. Internal watershed infarction is rare (less than 10% of all strokes but well recognized a clinical feature of stroke. Specific pathophysiology generally is connected with hypoperfusion and hemodynamic mechanisms. Specific therapy is mandatory for these conditions.

  15. Treatment with the gap junction modifier rotigaptide (ZP123) reduces infarct size in rats with chronic myocardial infarction.

    Science.gov (United States)

    Haugan, Ketil; Marcussen, Niels; Kjølbye, Anne Louise; Nielsen, Morten Schak; Hennan, James K; Petersen, Jørgen Søberg

    2006-02-01

    Treatment with non-selective drugs (eg, long-chain alcohols, halothane) that reduce gap junction intercellular communication (GJIC) is associated with reduced infarct size after myocardial infarction (MI). Therefore, it has been suggested that gap junction intercellular communication stimulating compounds may increase infarct size. The antiarrhythmic peptide analogue rotigaptide (ZP123) increases cardiac gap junction intercellular communication and the purpose of the present study was to examine the effects of rotigaptide treatment on infarct size. Myocardial infarction was induced in male rats by ligation of the left anterior descending artery (LAD). Rats (n = 156) were treated with rotigaptide at three dose levels or vehicle from the onset of ischemia and for 3 weeks following LAD occlusion. Infarct size was determined using histomorphometry after 3 weeks treatment. Rotigaptide treatment producing steady state plasma levels of 0.8 +/- 0.1, 5.5 +/- 0.5, and 86 +/- 8 nmol/L had no effect on mortality, but reduced infarct size to 90 +/- 10% (P = 0.41), 67 +/- 7% (P = 0.005), and 82 +/- 7% (P = 0.13), respectively relative to vehicle-treated myocardial infarction rats (100 +/- 12%). In contrast to what was predicted, our data demonstrates that rotigaptide treatment was associated with a significant infarct size reduction. We conclude that whereas treatment with non-selective inhibitors of gap junction intercellular communication cause a reduction in infarct size, this information cannot be extrapolated to the effects of compounds that selectively increase gap junction intercellular communication.

  16. Defibrillator implantation early after myocardial infarction.

    Science.gov (United States)

    Steinbeck, Gerhard; Andresen, Dietrich; Seidl, Karlheinz; Brachmann, Johannes; Hoffmann, Ellen; Wojciechowski, Dariusz; Kornacewicz-Jach, Zdzisława; Sredniawa, Beata; Lupkovics, Géza; Hofgärtner, Franz; Lubinski, Andrzej; Rosenqvist, Mårten; Habets, Alphonsus; Wegscheider, Karl; Senges, Jochen

    2009-10-08

    The rate of death, including sudden cardiac death, is highest early after a myocardial infarction. Yet current guidelines do not recommend the use of an implantable cardioverter-defibrillator (ICD) within 40 days after a myocardial infarction for the prevention of sudden cardiac death. We tested the hypothesis that patients at increased risk who are treated early with an ICD will live longer than those who receive optimal medical therapy alone. This randomized, prospective, open-label, investigator-initiated, multicenter trial registered 62,944 unselected patients with myocardial infarction. Of this total, 898 patients were enrolled 5 to 31 days after the event if they met certain clinical criteria: a reduced left ventricular ejection fraction ( or = 150 beats per minute) during Holter monitoring (criterion 2: 208 patients), or both criteria (88 patients). Of the 898 patients, 445 were randomly assigned to treatment with an ICD and 453 to medical therapy alone. During a mean follow-up of 37 months, 233 patients died: 116 patients in the ICD group and 117 patients in the control group. Overall mortality was not reduced in the ICD group (hazard ratio, 1.04; 95% confidence interval [CI], 0.81 to 1.35; P=0.78). There were fewer sudden cardiac deaths in the ICD group than in the control group (27 vs. 60; hazard ratio, 0.55; 95% CI, 0.31 to 1.00; P=0.049), but the number of nonsudden cardiac deaths was higher (68 vs. 39; hazard ratio, 1.92; 95% CI, 1.29 to 2.84; P=0.001). Hazard ratios were similar among the three groups of patients categorized according to the enrollment criteria they met (criterion 1, criterion 2, or both). Prophylactic ICD therapy did not reduce overall mortality among patients with acute myocardial infarction and clinical features that placed them at increased risk. (ClinicalTrials.gov number, NCT00157768.) 2009 Massachusetts Medical Society

  17. Silent myocardial infarction during hypoglycemic coma.

    Science.gov (United States)

    Mahajan, Varun Vijay; Dogra, Vikas; Pargal, Iesha; Singh, Navtej

    2012-01-01

    Hypoglycemia is a common complication of treatment of diabetes mellitus. The potential neurological complications of hypoglycemia as seizures and coma are well-recognized entities. A hypoglycemic episode is a risk factor for a patient with diabetes to have cardiovascular complications. Myocardial ischemia and infarction are known to occur in the setting of hypoglycemia. In view of the potential association of the two, the diabetic patients should undergo a routine ECG in such circumstances.

  18. Impaired Sacculocollic Reflex in Lateral Medullary Infarction

    OpenAIRE

    Seonhye eKim; Hyo-Jung eKim; Ji Soo eKim

    2011-01-01

    Objective: The aim of this study was to determine saccular dysfunction by measuring cervical vestibular-evoked myogenic potentials (cVEMP) and to correlate abnormality of cVEMP with results of other vestibular function tests in lateral medullary infarction (LMI). Methods: We recorded cVEMP in 21 patients with LMI documented on MRI. cVEMP was induced by a short tone burst and was recorded in contracting sternocleidomastoid muscle while patients turned their heads forcefully to the contralatera...

  19. Renal infarction associated with adrenal pheochromocytoma.

    Science.gov (United States)

    Thewjitcharoen, Yotsapon; Atikankul, Taywin; Sunthornyothin, Sarat

    2013-09-01

    The coexistence of pheochromocytoma and renal artery stenosis had been reported occasionally from the possible mechanism of catecholoamine-induced vasospasm and extrinsic compression of renal artery in some reported cases. However, renal infarction caused by pheochromocytoma is an uncommon phenomenon. Herein, we report an interesting case of adrenal pheochromocytoma associated with renal artery thrombosis, which should be included in the differential diagnosis of pheochromocytoma patients who present with abdominal pain.

  20. Hypersexuality following bilateral thalamic infarction: case report

    OpenAIRE

    Mutarelli Eduardo G; Omuro Antonio M.P.; Adoni Tarso

    2006-01-01

    Hypersexuality is a rare but well recognized condition following brain injury. It has been described secondarily to dysfunction in the hypothalamus, the temporal and frontal lobes. We report a 63 year-old man that developed neuropsychological disturbances with hypersexuality as a prominent feature, disinhibition and moderate memory loss, hypersomnia and irritability after a bilateral paramedian thalamic infarction. A SPECT showed frontal hypoperfusion. We believe that these findings are expre...

  1. Midterm renal functions following acute renal infarction.

    Science.gov (United States)

    Ongun, Sakir; Bozkurt, Ozan; Demir, Omer; Cimen, Sertac; Aslan, Guven

    2015-10-01

    The aim of this study was to explore clinical features of renal infarction (RI) that may have a role in diagnosis and treatment in our patient cohort and provide data on midterm renal functions. Medical records of patients with diagnosis of acute RI, established by contrast enhanced computed tomography (CT) and at least 1 year follow-up data, who were hospitalized in our clinic between 1998 and 2012 were retrospectively reviewed; including descriptive data, clinical signs and symptoms, etiologic factors, laboratory findings, and prescribed treatments. Patients with solitary infarct were treated with acetylsalicylic acid (ASA) only, whereas patients with atrial fibrillation (AF) or multiple or global infarct were treated with anticoagulants. Estimated Glomerular Filtration Rate (eGFR) referring to renal functions was determined by the Modification of Diet in Renal Disease (MDRD) formula. Twenty-seven renal units of 23 patients with acute RI were identified. The mean age was 59.7 ± 15.7 years. Fourteen patients (60.8%) with RI had atrial fibrillation (AF) as an etiologic factor of which four had concomitant mesenteric ischemia at diagnosis. At presentation, 20 patients (86.9%) had elevated serum lactate dehydrogenase (LDH), 18 patients (78.2%) had leukocytosis, and 16 patients (69.5%) had microscopic hematuria. Two patients with concomitant mesenteric ischemia and AF passed away during follow up. Mean eGFR was 70.8 ± 23.2 mL/min/1.73 m(2) at admission and increased to 82.3 ± 23.4 mL/min/1.73 m(2) at 1 year follow up. RI should be considered in patients with persistent flank or abdominal pain, particularly if they are at high risk of thromboembolism. Antiplatelet and/or anticoagulant drugs are both effective treatment options according to the amplitude of the infarct for preserving kidney functions.

  2. Spatial disorientation in right-hemisphere infarction.

    OpenAIRE

    Meerwaldt, J D; van Harskamp, F

    1982-01-01

    Spatial orientation was tested with the rod orientation test. The subjects were 40 normal controls and 68 brain-damaged patients with cerebral infarcts. Patients in whom the lesion included the post-rolandic region of the right hemisphere performed worse than controls or patients with lesions at other sites. Patients with an exclusively postrolandic (usually occipital) lesion showed higher error rates than patients with a combined prerolandic and postrolandic lesion, but only for the visual p...

  3. Gas Embolic Stroke Secondary to Bowel Infarction.

    Science.gov (United States)

    Parikh, Dhruv; Leyon, Joe Joseph; Chavda, Swarupsinh

    2016-01-01

    A 69-year-old gentleman with metastatic esophageal adenocarcinoma presented with acute abdominal pain to the emergency medicine department and subsequently developed an acute left hemiplegia while in the resuscitation unit. An unenhanced computed tomography (CT) scan of the head showed right frontal cerebral gas emboli while an unenhanced CT scan of the abdomen and pelvis showed extensive portal venous gas and pneumatosis intestinalis, presumed secondary to bowel infarction.

  4. Classification and Regression Trees on Aggregate Data Modeling: An Application in Acute Myocardial Infarction

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    C. Quantin

    2011-01-01

    Full Text Available Cardiologists are interested in determining whether the type of hospital pathway followed by a patient is predictive of survival. The study objective was to determine whether accounting for hospital pathways in the selection of prognostic factors of one-year survival after acute myocardial infarction (AMI provided a more informative analysis than that obtained by the use of a standard regression tree analysis (CART method. Information on AMI was collected for 1095 hospitalized patients over an 18-month period. The construction of pathways followed by patients produced symbolic-valued observations requiring a symbolic regression tree analysis. This analysis was compared with the standard CART analysis using patients as statistical units described by standard data selected TIMI score as the primary predictor variable. For the 1011 (84, resp. patients with a lower (higher TIMI score, the pathway variable did not appear as a diagnostic variable until the third (second stage of the tree construction. For an ecological analysis, again TIMI score was the first predictor variable. However, in a symbolic regression tree analysis using hospital pathways as statistical units, the type of pathway followed was the key predictor variable, showing in particular that pathways involving early admission to cardiology units produced high one-year survival rates.

  5. The 'silence' of silent brain infarctions may be related to chronic ischemic preconditioning and nonstrategic locations rather than to a small infarction size.

    Science.gov (United States)

    Feng, Chao; Bai, Xue; Xu, Yu; Hua, Ting; Liu, Xue-Yuan

    2013-01-01

    Silent brain infarctions are the silent cerebrovascular events that are distinguished from symptomatic lacunar infarctions by their 'silence'; the origin of these infarctions is still unclear. This study analyzed the characteristics of silent and symptomatic lacunar infarctions and sought to explore the mechanism of this 'silence'. In total, 156 patients with only silent brain infarctions, 90 with only symptomatic lacunar infarctions, 160 with both silent and symptomatic lacunar infarctions, and 115 without any infarctions were recruited. Vascular risk factors, leukoaraiosis, and vascular assessment results were compared. The National Institutes of Health Stroke Scale scores were compared between patients with only symptomatic lacunar infarctions and patients with two types of infarctions. The locations of all of the infarctions were evaluated. The evolution of the two types of infarctions was retrospectively studied by comparing the infarcts on the magnetic resonance images of 63 patients obtained at different times. The main risk factors for silent brain infarctions were hypertension, age, and advanced leukoaraiosis; the main factors for symptomatic lacunar infarctions were hypertension, atrial fibrillation, and atherosclerosis of relevant arteries. The neurological deficits of patients with only symptomatic lacunar infarctions were more severe than those of patients with both types of infarctions. More silent brain infarctions were located in the corona radiata and basal ganglia; these locations were different from those of the symptomatic lacunar infarctions. The initial sizes of the symptomatic lacunar infarctions were larger than the silent brain infarctions, whereas the final sizes were almost equal between the two groups. Chronic ischemic preconditioning and nonstrategic locations may be the main reasons for the 'silence' of silent brain infarctions.

  6. Systemic inflammatory response following acute myocardial infarction.

    Science.gov (United States)

    Fang, Lu; Moore, Xiao-Lei; Dart, Anthony M; Wang, Le-Min

    2015-05-01

    Acute cardiomyocyte necrosis in the infarcted heart generates damage-associated molecular patterns, activating complement and toll-like receptor/interleukin-1 signaling, and triggering an intense inflammatory response. Inflammasomes also recognize danger signals and mediate sterile inflammatory response following acute myocardial infarction (AMI). Inflammatory response serves to repair the heart, but excessive inflammation leads to adverse left ventricular remodeling and heart failure. In addition to local inflammation, profound systemic inflammation response has been documented in patients with AMI, which includes elevation of circulating inflammatory cytokines, chemokines and cell adhesion molecules, and activation of peripheral leukocytes and platelets. The excessive inflammatory response could be caused by a deregulated immune system. AMI is also associated with bone marrow activation and spleen monocytopoiesis, which sustains a continuous supply of monocytes at the site of inflammation. Accumulating evidence has shown that systemic inflammation aggravates atherosclerosis and markers for systemic inflammation are predictors of adverse clinical outcomes (such as death, recurrent myocardial infarction, and heart failure) in patients with AMI.

  7. Systemic inflammatory response following acute myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    Lu FANG; Xiao-Lei Moore; Anthony M Dart; Le-Min WANG

    2015-01-01

    Acute cardiomyocyte necrosis in the infarcted heart generates damage-associated molecular patterns, activating complement and toll-like receptor/interleukin-1 signaling, and triggering an intense inflammatory response. Inflammasomes also recognize danger signals and mediate sterile inflammatory response following acute myocardial infarction (AMI). Inflammatory response serves to repair the heart, but excessive inflammation leads to adverse left ventricular remodeling and heart failure. In addition to local inflammation, profound systemic inflammation response has been documented in patients with AMI, which includes elevation of circulating inflammatory cytokines, chemokines and cell adhesion molecules, and activation of peripheral leukocytes and platelets. The excessive inflammatory response could be caused by a deregulated immune system. AMI is also associated with bone marrow activation and spleen monocytopoiesis, which sustains a continuous supply of monocytes at the site of inflammation. Accumulating evidence has shown that systemic inflammation aggravates atherosclerosis and markers for systemic inflammation are predictors of adverse clinical outcomes (such as death, recurrent myocardial in-farction, and heart failure) in patients with AMI.

  8. Myocardial infarction: management of the subacute period.

    Science.gov (United States)

    Mercado, Michael G; Smith, Dustin K; McConnon, Michael L

    2013-11-01

    Optimal management of myocardial infarction in the subacute period focuses on improving the discharge planning process, implementing therapies early to prevent recurrent myocardial infarction, and avoiding hospital readmission. Evidence-based guidelines for the care of patients with acute coronary syndrome are not followed up to 25% of the time. Antiplatelet therapy, renin-angiotensin-aldosterone system inhibitors, beta blockers, and statins constitute the foundation of medical therapy. Early noninvasive stress testing is an important risk assessment tool, especially in patients who do not undergo revascularization. Discharge preparation should include a review of medications, referral for exercise-based cardiac rehabilitation, activity recommendations, education about lifestyle modification and recognition of cardiac symptoms, and a clear follow-up plan. Because nonadherence to medications is common in patients after a myocardial infarction and is associated with increased mortality risk, modifiable factors associated with medication self-discontinuation should be addressed before discharge. Structured discharge processes should be used to enhance communication and facilitate the transition from the hospital to the family physician's care.

  9. Comparison of carotid artery intima - media thickness and risk factors of atherosclerosis in lacunar versus non-lacunar cerebral infarcts

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    Seyed Ali Mousavi

    2007-07-01

    Full Text Available

    BACKGROUND: Increases in the thickness of the intima-media of the carotid artery have been associated with an increased risk of myocardial infarction and stroke in subjects without a history of cardiovascular disease. Lacunar infarcts, one of the most common subtypes of ischemic stroke, show unique pathological and clinicoradiological characteristics. The present study examined the relationship between the vascular risk factors, including carotid artery intimamedia thickness (IMT, and lacunar versus non-lacunar infarcts.
    METHODS: We collected data from patients admitted to hospital with acute ischemic stroke. 195 Patients and 96 control subjects underwent B-mode ultrasonographic measurements of IMT of the common carotid artery. We examined the association of lacunar and non-lacunar infarcts with age, sex, and potential vascular risk factors.
    RESULTS: Of 195 adult patients with acute ischemic stroke, 87 were considered lacunar and 108 were considered nonlacunar strokes. Between these two groups of patients, we did not find a significantly different percentage of diabetes,
    smoking, hypertension, dyslipidemia, myocardial infarction, or previous history of ischemic stroke, alcohol, obesity,
    atherogen diet, exercise, and IMT. However, patients with lacunar infarct, diabetes mellitus (P = 0.02, and hypertension
    (P = 0.02 had a significantly higher percentage of history of prior CVA (P = 0.03 and a significantly higher percentage
    of non-lacunar infarct.
    CONCLUSIONS: The present results indicated that diabetes mellitus and hypertension are more common in patients with lacunar infarcts, and history of CVA is more common in patients with non–lacunar infarcts. We further concluded that IMT cannot differentiate subtypes of ischemic stroke. Because risk factors and clinical presentation of ischemic stroke differ among races, more national studies

  10. Recurrent Acute Myocardial Infarction in Patients with Immune Thrombocytopenic Purpura

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    Fengyi Shen

    2014-01-01

    Full Text Available Immune thrombocytopenic purpura (ITP, also known as idiopathic thrombocytopenic purpura, is an acquired immune-mediated disease of adults and children characterized by a transient or persistent decrease of platelets and, depending upon the degree of thrombocytopenia, an increased risk of bleeding. The use of standard treatments for acute myocardial infarction (AMI, such as antiplatelet agents and anticoagulants, pose serious problems in patients with ITP due to the potential higher risk of bleeding complications. There are no current guidelines available for management of ITP patients with AMI. In this brief review of the limited available literature, we discuss the proposed pathophysiological link between ITP and arterial thrombosis and the challenging medical and interventional treatment of these patients.

  11. Unexpected Multiple Organ Infarctions in a Poisoned Patient

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    Sung-Wook Park

    2015-08-01

    Full Text Available Predisposing factors for venous thrombosis can be identified in the majority of patients with established venous thromboembolism (VTE. However, an obvious precipitant may not be identified during the initial evaluation of such patients. In the present case, a 47-year-old female presented to the emergency department of our hospital after ingesting multiple drugs. She had no VTE-related risk factors or previous episodes, nor any family history of VTE. After admission to the intensive care unit sudden hypoxemia developed, and during the evaluation cerebral, renal, and splenic infarctions with pulmonary embolisms were diagnosed. However, the sources of the emboli could not be identified by transthoracic echocardiography or computed tomography angiography. Protein C deficiency was identified several days later. We recommend that hypercoagulable states be taken into consideration, especially when unexplained thromboembolic events develop in multiple or unusual venous sites.

  12. Major Cognitive Changes and Micrographia following Globus Pallidus Infarct

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    Sarah Nelson

    2014-01-01

    Full Text Available Importance. Globus pallidus (GP lesions are well known to cause motor deficits but are less commonly—and perhaps not conclusively—associated with cognitive problems. Observations. We present a 45-year-old male with no significant neurological or psychological problems who after suffering a GP infarct was subsequently found to have substantial cognitive problems and micrographia. Formal neuropsychological testing was not possible due to lack of patient follow-up. Conclusions and Relevance. Despite the conflicting literature on the association of GP lesions and cognitive deficits, our patient demonstrated significant neuropsychological changes following his stroke. In addition, evidence of micrographia likely adds to the literature on the localization of this finding. Our case thus suggests that neuropsychological testing may be beneficial after GP strokes.

  13. Splenic infarct as a diagnostic pitfall in radiology

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    Joshi Sanjeev

    2008-01-01

    Full Text Available Follow-up of colorectal carcinoma after therapy is based on symptoms, tumor markers, and imaging studies. Clinicians sometimes face diagnostic dilemmas because of unusual presentations on the imaging modalities coupled with rising serum markers. We report a case of colorectal carcinoma that presented with gastrointestinal symptoms 14 months after completion of treatment. Investigations showed rise in carcinoembryonic antigen (CEA. Suspecting disease recurrence, complete radioimaging workup was performed; the only abnormality detected was a smooth, hypodense area in the posterior third of the spleen on contrast-enhanced computed tomography abdomen. In view of the previous diagnosis of carcinoma colon, the symptoms reported by the patient, the elevated CEA, and the atypical CECT appearance, a diagnosis of splenic metastasis was made. The patient was subjected to splenectomy as a curative treatment. However, the histopathological report revealed it to be a splenic infarct. The present case reemphasizes the limitations of radiological studies in the follow-up of carcinoma colon.

  14. Right Ventricular Involvement in either Anterior or Inferior Myocardial Infarction

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    Firoozeh Abtahi

    2016-06-01

    Full Text Available Background: Unlike left ventricular function, less attention has been paid to Right Ventricular (RV function after Myocardial Infarction (MI. Objectives: The current study aimed to compare RV function in patients with inferior and anterior MI. Patients and Methods: During the study period, 60 patients consecutively presented to the Emergency Department with chest pain were divided into two groups based on their electrocardiographic findings. Accordingly, 25 patients had inferior MI (IMI group and 35 ones had anterior MI (AMI group. Echocardiography was performed 48 hours after starting the standard therapy. Conventional echocardiographic parameters and Tissue Doppler Imaging (TDI measurements were acquired from the standard views. Student t-test and the chi-square test were respectively used for comparisons of the normally distributed continuous and categorical variables in the two groups. Besides, P < 0.05 was considered to be statistically significant.

  15. Brain Infarction: Rare Neurological Presentation of African Bee Stings

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    Hernando Raphael Alvis- Miranda

    2014-01-01

    Full Text Available Bee stings are commonly encountered worldwide. Various manifestations after bee sting have been described including local reactions which are common, systemic responses such as anaphylaxis, diffuse intravascular coagulation and hemolysis. We report a case of a 74-year-old man who developed neurologic deficit 5 hours after bee stings, which was confirmed to be left frontal infarction on brain CT-scan. The case does not follow the reported pattern of hypovolemic or anaphylactic shock, hemolysis and/or rhabdomyolysis, despite the potentially lethal amount of venom injected. Diverse mechanisms have been proposed to give an explanation to all the clinical manifestation of both toxic and allergic reactions secondary to bee stings. Currently, the most accepted one state that victims can develop severe syndrome characterized by the release of a large amount of cytokines.

  16. Hepatic infarction in HELLP syndrome; a case report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Mi Jeong; Kim, Hong [Keimyung Univ. School of Medicine, Taegu (Korea, Republic of)

    2000-11-01

    Hepatic infarction is a rare but potentially life-threatening complication of pregnancy-associated preeclampsia or HELLP (hemolysis, elevated liver function tests, low platelets) syndrome. We present a case of hepatic infarction subsequent to HELLP syndrome and occurring during the immediate postpartum, and the associated radiologic findings. Sonography revealed poorly defined hypoechoic zones of infarction. Computed tomography(CT) demonstrated the characteristic features of nonenhancing, low attenuation, relatively well-defined, wedge shaped or geographic hepatic lesions, without mass effect.

  17. Truncal ataxia from infarction involving the inferior olivary nucleus.

    Science.gov (United States)

    Park, Jae Hyun; Ryoo, Sookyung; Moon, So Young; Seo, Sand Won; Na, Duk L

    2012-08-01

    Truncal ataxia in medullary infarction may be caused by involvement of the lateral part of the medulla; however, truncal ataxia in infarction involving the inferior olivary nucleus (ION) has received comparatively little attention. We report a patient with truncal ataxia due to medial medullary infarction located in the ION. A lesion in the ION could produce a contralateral truncal ataxia due to increased inhibitory input to the contralesional vestibular nucleus from the contralesional flocculus.

  18. Multiscale Characterization of Impact of Infarct Size on Myocardial Remodeling in an Ovine Infarct Model.

    Science.gov (United States)

    Zhang, Pei; Li, Tielou; Griffith, Bartley P; Wu, Zhongjun J

    2015-01-01

    The surviving myocardium initially compensates the loss of injured myocardium after myocardial infarction (MI) and gradually becomes progressively dysfunctional. There have been limited studies on the effect of infarct size on temporal and spatial alterations in the myocardium during progressive myocardial remodeling. MI with three infarct sizes, i.e. 15, 25 and 35% of the left ventricular (LV) wall, was created in an ovine infarction model. The progressive LV remodeling over a 12-week period was studied. Echocardiography, sonomicrometry, and histological and molecular analyses were carried out to evaluate cardiac function, regional tissue contractile function, structural remodeling and cardiomyocyte hypertrophy, and calcium handling proteins. Twelve weeks after MI, the 15, 25 and 35% MI groups had normalized LV end diastole volumes of 1.4 ± 0.2, 1.7 ± 0.3 and 2.0 ± 0.4 ml/kg, normalized end systole volumes of 1.0 ± 0.1, 1.0 ± 0.2 and 1.3 ± 0.3 ml/kg and LV ejection fractions of 43 ± 3, 42 ± 6 and 34 ± 4%, respectively. They all differed from the sham group (p strain), larger cardiomyocyte size and altered expression of calcium handing proteins in the adjacent myocardium compared to the remote counterpart from the infarct. A significant correlation was found between cardiomyocyte size and remodeling strain in the adjacent zone. A comparative analysis among the three MI groups showed that a larger infarct size (35 vs. 15% MI) was associated with larger remodeling strain, more serious impairment in the cellular structure and composition, and regional contractile function at regional tissue level and LV function at organ level.

  19. Extracardiac-Lodged Mesenchymal Stromal Cells Propel an Inflammatory Response Against Myocardial Infarction via Paracrine Effects.

    Science.gov (United States)

    Peng, Yi; Pan, Wei; Ou, Yali; Xu, Weifang; Kaelber, Sussannah; Borlongan, Cesario V; Sun, Meiqin; Yu, Guolong

    2016-01-01

    Transplantation of stem cells, including mesenchymal stromal cells (MSCs), improves the recovery of cardiac function after myocardial infarction (MI) in experimental studies using animal models and in patients. However, the improvement of cardiac function following MSC transplantation remains suboptimal in both preclinical and clinical studies. Understanding the mechanism of cell therapy may improve its therapeutic outcomes, but the mode of action mediating stem cell promotion of cardiac repair is complex and not fully understood. Recent studies suggest that the immunomodulatory effects of MSCs on the macrophage M1/M2 subtype transition allow the transplanted stem cells to inhibit inflammation-induced injury and promote cardiac repair in acute MI. However, equally compelling evidence shows that there is poor survival and minimal graft persistence of transplanted MSCs within the infarcted heart tissues, negating the view that graft survival per se is required for the observed high rate and long duration of the transition from proinflammatory M1 to reparative M2 macrophages in the infarcted myocardium. Therefore, we raised a novel hypothesis that the therapeutic effects of MSC transplantation for acute MI depends not primarily on the grafted cells in infarct myocardium, but that MSCs migrating to and being lodged in the extracardiac organs, demonstrating good graft survival and persistence, may render the therapeutic effects in MI. More specifically, MSC transplantation promotes the transition from M1 to M2 in extracardiac organs, such as spleen and bone marrow, and therapeutic effects are conferred to the infarcted myocardium via paracrine effects. In MSC transplantation, the conversion from proinflammatory M1 to anti-inflammatory M2 monocytes may occur remotely from the heart and may serve as one of the major pathways in regulating the dual effects of inflammation. This hypothesis, if proven valid, may represent an important new mechanism of action to be considered

  20. Cardiosphere-derived cells improve function in the infarcted rat heart for at least 16 weeks--an MRI study.

    Directory of Open Access Journals (Sweden)

    Carolyn A Carr

    Full Text Available AIMS: Endogenous cardiac progenitor cells, expanded from explants via cardiosphere formation, present a promising cell source to prevent heart failure following myocardial infarction. Here we used cine-magnetic resonance imaging (MRI to track administered cardiosphere-derived cells (CDCs and to measure changes in cardiac function over four months in the infarcted rat heart. METHODS AND RESULTS: CDCs, cultured from neonatal rat heart, comprised a heterogeneous population including cells expressing the mesenchymal markers CD90 and CD105, the stem cell marker c-kit and the pluripotency markers Sox2, Oct3/4 and Klf-4. CDCs (2 × 10(6 expressing green fluorescent protein (GFP+ were labelled with fluorescent micron-sized particles of iron oxide (MPIO. Labelled cells were administered to the infarcted rat hearts (n = 7 by intramyocardial injection immediately following reperfusion, then by systemic infusion (4 × 10(6 2 days later. A control group (n = 7 was administered cell medium. MR hypointensities caused by the MPIOs were detected at all times and GFP+ cells containing MPIO particles were identified in tissue slices at 16 weeks. At two days after infarction, cardiac function was similar between groups. By 6 weeks, ejection fractions in control hearts had significantly decreased (47 ± 2%, but this was not evident in CDC-treated hearts (56 ± 3%. The significantly higher ejection fractions in the CDC-treated group were maintained for a further 10 weeks. In addition, CDC-treated rat hearts had significantly increased capillary density in the peri-infarct region and lower infarct sizes. MPIO-labelled cells also expressed cardiac troponin I, von Willebrand factor and smooth muscle actin, suggesting their differentiation along the cardiomyocyte lineage and the formation of new blood vessels. CONCLUSIONS: CDCs were retained in the infarcted rat heart for 16 weeks and improved cardiac function.

  1. Effect of low-level laser-treated mesenchymal stem cells on myocardial infarction.

    Science.gov (United States)

    El Gammal, Zaynab H; Zaher, Amr M; El-Badri, Nagwa

    2017-07-06

    -level laser with 804 nm wavelength and 1 J/cm(2) energy density within 4 h of the infarction. This approach increased stem cell survival, proliferation, and homing. It has also decreased the infarct size and cell apoptosis, leading to enhanced heart functions. These effects were stable for 6 weeks. However, more studies are still required to assess the effects of low-level laser on the genetic makeup of the cell, the nuclei, and the mitochondria of mesenchymal stromal cells (MSCs).

  2. Cerebellar cortical infarct cavities and vertebral artery disease

    Energy Technology Data Exchange (ETDEWEB)

    Cocker, Laurens J.L. de [University Medical Center Utrecht, Department of Radiology, Utrecht (Netherlands); Kliniek Sint-Jan Radiologie, Brussels (Belgium); Compter, A.; Kappelle, L.J.; Worp, H.B. van der [University Medical Center Utrecht, Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, Utrecht (Netherlands); Luijten, P.R.; Hendrikse, J. [University Medical Center Utrecht, Department of Radiology, Utrecht (Netherlands)

    2016-09-15

    Cerebellar cortical infarct cavities are a newly recognised entity associated with atherothromboembolic cerebrovascular disease and worse physical functioning. We aimed to investigate the relationship of cerebellar cortical infarct cavities with symptomatic vertebrobasilar ischaemia and with vascular risk factors. We evaluated the MR images of 46 patients with a recent vertebrobasilar TIA or stroke and a symptomatic vertebral artery stenosis ≥50 % from the Vertebral Artery Stenting Trial (VAST) for the presence of cerebellar cortical infarct cavities ≤1.5 cm. At inclusion in VAST, data were obtained on age, sex, history of vertebrobasilar TIA or stroke, and vascular risk factors. Adjusted risk ratios were calculated with Poisson regression analyses for the relation between cerebellar cortical infarct cavities and vascular risk factors. Sixteen out of 46 (35 %) patients showed cerebellar cortical infarct cavities on the initial MRI, and only one of these 16 patients was known with a previous vertebrobasilar TIA or stroke. In patients with symptomatic vertebrobasilar ischaemia, risk factor profiles of patients with cerebellar cortical infarct cavities were not different from patients without these cavities. Cerebellar cortical infarct cavities are seen on MRI in as much as one third of patients with recently symptomatic vertebral artery stenosis. Since patients usually have no prior history of vertebrobasilar TIA or stroke, cerebellar cortical infarct cavities should be added to the spectrum of common incidental brain infarcts visible on routine MRI. (orig.)

  3. The prognostic importance of creatinine clearance after acute myocardial infarction

    DEFF Research Database (Denmark)

    Sørensen, C R; Brendorp, B; Rask-Madsen, C

    2002-01-01

    AIMS: The purpose of this study was to assess renal dysfunction as an independent predictor of mortality after acute myocardial infarction. METHODS: The study population was 6252 patients with a myocardial infarction admitted alive from 1990 to 1992. The mortality status was obtained after at least.......9-1.3) respectively. CONCLUSION: Renal dysfunction is an important risk factor after acute myocardial infarction. When the risk is adjusted for available competing risk factors only severely reduced renal function is associated with an important and independent risk of mortality after acute myocardial infarction...

  4. Bilateral cerebral hemispheric infarction associated with sildenafil citrate (Viagra) use.

    Science.gov (United States)

    Kim, K-K; Kim, D G; Ku, Y H; Lee, Y J; Kim, W-C; Kim, O J; Kim, H S

    2008-03-01

    Sildenafil citrate (Viagra) is one of the frequently prescribed drugs for men with erectile dysfunction. We describe a 52-year-old man with bilateral middle cerebral artery (MCA) territory infarction after sildenafil use. He ingested 100 mg of sildenafil and about 1 h later, he complained of chest discomfort, palpitation and dizziness followed by mental obtundation, global aphasia and left hemiparesis. Brain magnetic resonance imaging documented acute bilateral hemispheric infarction, and cerebral angiography showed occluded bilateral MCA. Despite significant bilateral MCA stenosis and cerebral infarction, systemic hypotension persisted for a day. We presume that cerebral infarction was caused by cardioembolism with sildenafil use.

  5. Evaluation of cat brain infarction model using microPET

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jong Jin; Lee, Dong Soo; Kim, Yun Hui; Hwang, Do Won; Kim, Jin Su; Chung, June Key; Lee, Myung Chul [College of Medicine, Seoul National Univ., Seoul (Korea, Republic of); Lim, Sang Moo [Korea Institite of Radiological and Medical Sciences, Seoul (Korea, Republic of)

    2004-12-01

    PET has some disadvantage in the imaging of small animal due to poor resolution. With the advent of microPET scanner, it is possible to image small animals. However, the image quality was not good enough as human image. Due to larger brain, cat brain imaging was superior to mouse or rat. In this study, we established the cat brain infarction model and evaluate it and its temporal change using microPET scanner. Two adult male cats were used. Anesthesia was done with xylazine and ketamine HCI. A burr hole was made at 1 cm right lateral to the bregma. Collagenase type IV 10 {mu}l was injected using 30 G needle for 5 minutes to establish the infarction model. {sup 18}F-FDG microPET (Concorde Microsystems Inc., Knoxville, TN) scans were performed 1, 11 and 32 days after the infarction. In addition, {sup 18}F-FDG PET scans were performed using human PET scanner (Gemini, Philips medical systems, CA, USA) 13 and 47 days after the infarction. Two cat brain infarction models were established. The glucose metabolism of an infarction lesion improved with time. An infarction lesion was also distinguishable in the human PET scan. We successfully established the cat brain infarction model and evaluated the infarcted lesion and its temporal change using {sup 18}F-FDG microPET scanner.

  6. Pulmonary infarction after repair of type B aortic dissection.

    Science.gov (United States)

    Manoly, Imthiaz; Woo, Edwin B C; Peebles, Charles; Khawaja, Saud

    2012-07-01

    Lung infarction after intrathoracic surgery is a life-threatening complication that needs urgent intervention. Although the exact etiology is not known, pulmonary infarction may be suspected for patients presenting with consolidation of the lung after intrathoracic surgery. We report a very rare case of pulmonary infarction after successful surgical treatment of a type B aortic dissection. The pulmonary infarction was treated by intrapericardial pneumonectomy. This article discusses possible etiology and management of such patients. A high index of clinical suspicion and timely investigations may allow early detection of this unusual event and avoid fatal outcomes.

  7. Bilateral renal infarction: an uncommon presentation of fibromuscular dysplasia.

    Science.gov (United States)

    Ayach, Taha; Kazory, Amir

    2013-12-01

    While fibromuscular dysplasia (FMD) is an established cause of secondary hypertension, its association with renal infarction is less well recognized. We report a middle-aged man who presented with complaints of loin pain and severe hypertension. Computed tomography angiography of the abdomen revealed bilateral renal infarction with multiple short-segment arterial dissection compatible with FMD in the absence of systemic vasculitis and other risk factors for thromboembolic events. Bilateral renal infarction complicating FMD is extremely rare and has so far been reported only in a handful of cases. Physicians encountering cases of otherwise unexplained renal infarction/ischemia need to be aware of this complication.

  8. Brain infarcts due to scorpion stings in children: MRI

    Energy Technology Data Exchange (ETDEWEB)

    Fernandez-Bouzas, A.; Ballesteros-Maresma, A. [Univ. Nacional Autonoma de Mexico, Mexico (Mexico); Morales-Resendiz, M.L. [Hospital General de Queretaro, Mexico (Mexico); Llamas-Ibarra, F. [Clinica Neurologica de Queretaro, Mexico (Mexico); Martinez-Lopez, M. [Fundacion Clinica Medica Sur., Mexico (Mexico)

    2000-02-01

    We report two children with severe neurological complications after having been stung by a scorpion. Clinical and MRI findings suggested brain infarcts. The lesions seen were in pons in one child and the right hemisphere in the other. The latter also showed possible hyperemia in the infarcted area. No vascular occlusions were observed and we therefore think the brain infarcts were a consequence of the scorpion sting. The cause of the infarct may be hypotension, shock or depressed left ventricular function, all of which are frequent in severe poisoning by scorpion sting. (orig.)

  9. Towards discrimination of infarcts from artifacts in DWI scans

    Energy Technology Data Exchange (ETDEWEB)

    Gupta, Varsha; Prakash, K.N.B.; Nowinski, Wieslaw L. [Technology and Research, Biomedical Imaging Lab, Agency for Science, Singapore (Singapore)

    2008-04-15

    Accurate and rapid quantification of infarcts from DWI scans is critical in acute ischemic stroke. Acquisition artifacts lead to hyperintense regions in DWI MR scans resulting in false positives. Discriminating infarcts and artifacts helps in reducing infarct segmentation errors. An algorithm based on two-dimensional symmetry of artifacts about the midsagittal plane and three-dimensional spatial coherence of infarct regions is proposed to characterize and separate infarcts from artifacts. The two dimensional symmetry is quantified by propagating Poisson errors in the intensity space of each pixel, and distant and spatially incoherent regions in a volume are considered as artifacts. The combination of two criteria enhances the confidence in the decision whether a hyperintense region is an infarct or artifact. The validity of the proposed algorithm is demonstrated using 51 cases. The improvement in results is demonstrated in three situations: (1) automatic infarct slice identification resulting in an average increase in (specificity, Dice Statistical Index (DSI)) by (15.2%, 6.9%) while the sensitivity decrease is by only 1.5% and (2) automatic infarct segmentation using two different algorithms: first resulting in an average DSI increase by 7.6% and second by 5.1%. On a matlab platform, the processing time is < 1 s. The proposed algorithm is useful as a fast post-processing tool to reduce artifacts in infarct processing applications. (orig.)

  10. Spinal cord infarction: a rare cause of paraplegia.

    Science.gov (United States)

    Patel, Sonali; Naidoo, Khimara; Thomas, Peter

    2014-06-25

    Spinal cord infarction is rare and represents a diagnostic challenge for many physicians. There are few reported cases worldwide with a prevalence of 1.2% of all strokes. Circulation to the spinal cord is supplied by a rich anastomosis. The anterior spinal artery supplies the anterior two thirds of the spinal cord and infarction to this area is marked by paralysis, spinothalamic sensory deficit and loss of sphincter control depending on where the lesion is. Treatment of spinal cord infarction focuses on rehabilitation with diverse outcomes. This report presents a case of acute spinal cord infarction with acquisition of MRI to aid diagnosis.

  11. Development of an assisting detection system for early infarct diagnosis

    Energy Technology Data Exchange (ETDEWEB)

    Sim, K. S.; Nia, M. E.; Ee, C. S. [Faculty of Engineering and Technology, Multimedia University, Melaka (Malaysia)

    2015-04-24

    In this paper, a detection assisting system for early infarct detection is developed. This new developed method is used to assist the medical practitioners to diagnose infarct from computed tomography images of brain. Using this assisting system, the infarct could be diagnosed at earlier stages. The non-contrast computed tomography (NCCT) brain images are the data set used for this system. Detection module extracts the pixel data from NCCT brain images, and produces the colourized version of images. The proposed method showed great potential in detecting infarct, and helps medical practitioners to make earlier and better diagnoses.

  12. In-Hospital Mortality among Rural Medicare Patients with Acute Myocardial Infarction: The Influence of Demographics, Transfer, and Health Factors

    Science.gov (United States)

    Muus, Kyle J.; Knudson, Alana D.; Klug, Marilyn G.; Wynne, Joshua

    2011-01-01

    Context/Purpose: Most rural hospitals can provide medical care to acute myocardial infarction (AMI) patients, but a need for advanced cardiac care requires timely transfer to a tertiary hospital. There is little information on AMI in-hospital mortality predictors among rural transfer patients. Methods: Cross-sectional retrospective analyses on…

  13. In-Hospital Mortality among Rural Medicare Patients with Acute Myocardial Infarction: The Influence of Demographics, Transfer, and Health Factors

    Science.gov (United States)

    Muus, Kyle J.; Knudson, Alana D.; Klug, Marilyn G.; Wynne, Joshua

    2011-01-01

    Context/Purpose: Most rural hospitals can provide medical care to acute myocardial infarction (AMI) patients, but a need for advanced cardiac care requires timely transfer to a tertiary hospital. There is little information on AMI in-hospital mortality predictors among rural transfer patients. Methods: Cross-sectional retrospective analyses on…

  14. Less use of standard guideline-based treatment of myocardial infarction in patients with chronic kidney disease

    DEFF Research Database (Denmark)

    Blicher, Thalia Marie; Hommel, Kristine; Olesen, Jonas Bjerring;

    2013-01-01

    The aim of this Danish nationwide study was to evaluate the treatment of myocardial infarction (MI) in patients with non-end-stage chronic kidney disease (CKD) and in patients requiring renal replacement therapy (RRT). Upgraded guidelines for the management of MI were implemented around 2004; hence...

  15. Potential generation of geographical inequities by the introduction of primary percutaneous coronary intervention for the management of ST segment elevation myocardial infarction

    Directory of Open Access Journals (Sweden)

    Kanka David

    2007-09-01

    Full Text Available Abstract Background Primary Percutaneous Coronary Intervention (PCI is more efficacious than thrombolysis in the management of acute myocardial infarction, but, because of the requirement for prompt treatment, there are practical challenges in developing such services. We examined the proportion of patients with ST segment Elevation Myocardial Infarction (STEMI who could receive timely treatment from a primary Percutaneous Coronary Intervention (PCI service assuming different geographical locations of potential treatment centres in three English counties. Methods and results Information on the residential location of patients with new STEMI hospitalisations recorded in Hospital Episodes Statistics was analysed and the proportion of episodes of STEMI within 60' and 45' travel time isochrones from potential primary PCI centres in three English counties was calculated. There were on average 1,815 new STEMI hospitalisations per year occurring in the studied population. Introduction of a primary PCI service in one, two or three potential treatment centres would have covered respectively 28%, 73% and 90% of such episodes within 60 minutes travel time, and 17%, 51% and 69% within 45 minutes travel time. Conclusion In the study context, a primary PCI service in an existing tertiary centre would only cover a minority of STEMI events and would generate geographical inequities. A two-centre model would improve coverage and equity considerably, but may be associated with practical, clinical quality and financial challenges.

  16. Isolated shoulder weakness as a result of a cortical infarction in the precentral gyrus

    Directory of Open Access Journals (Sweden)

    Pouya Entezami

    2015-04-01

    Full Text Available Since its discovery, our understanding of the primary motor cortex has continued to evolve. The presentations of rare, isolated, motor palsies of small muscle groups have heavily contributed to the characterization of the somatotopic representation of the human body on the cortex. We present a case of localized, left shoulder small muscle group weakness secondary to ischemic cerebral infarction in the primary motor cortex. The patient experienced full recovery over several days. Strokes causing isolated shoulder weakness are rare due to the relatively small area dedicated to shoulder motor function in the precentral gyrus. However, our patient presented with a larger area of infarction than in previously reported cases, demonstrating the large individual variability that may exist within the motor cortex somatotopic map.

  17. Circadian Influences on Myocardial Infarction

    Directory of Open Access Journals (Sweden)

    Jitka A. I. Virag

    2014-10-01

    Full Text Available Components of circadian rhythm maintenance, or clock genes, are found in all peripheral tissues, including the heart, and influence such diverse phenomena as cytokine expression immune cells, metabolic activity of cardiac myocytes, and vasodilator regulation by vascular endothelial cells. Whether circadian patterns are causally related to the observed periodicity of events, or whether they are simply epi-phenomena is not well established, but a few studies suggest that the circadian effects likely are real in their impact on cardiovascular disease incidence. Cycle disturbances may be harbingers of predisposition and subsequent response to acute and chronic cardiac injury, and identifying the complex interactions of circadian rhythms and cardiovascular disease may provide insights into possible preventative and therapeutic strategies for susceptible populations.

  18. Anti-β2 Glycoprotein-I Antibody in Acute Myocardial Infarction

    Directory of Open Access Journals (Sweden)

    Mohammad Shojaei

    2011-01-01

    Full Text Available Problem statement: Ischemic cardiac manifestations have been reported in a various percentage of patients with anti-phospholipid antibodies. Data concerning the relation between anti- Phospholipid (aPL antibodies and myocardial infarction in subjects without evidence of overt autoimmune disease are conflicting. Anti-beta2 glycoprotein-I (anti-beta2-GPI antibody is detected in various diseases like rheumatoid arthritis, systemic lupus erythematosus and anti-phospholipid antibody syndrome. The study of anti-beta2-GPI antibody in Acute Myocardial Infarction (AMI might shed light on etiologic mechanisms in the pathogenesis of acute coronary syndromes. The purpose of the present study was to determine association of plasma aPL antibodies, namely, antibeta2- GPI antibodies, with AMI. This study was designed to investigate whether prevalence of antibeta2- GPI antibodies, in patients who had acute myocardial infarction and to analyze their relationship with traditional cardiovascular risk factors. Approach: We investigated the prevalence of anti-beta2- GPI IgG in a well characterized group of patients with AMI as a case group. Sera from 74 patients with AMI and from 76 healthy subjects, matched for age and sex as a control group. Using ELISA to evaluate the presence of IgG isotype of anti-beta2-GPI autoantibodies in their sera. Results: The prevalence of anti-beta2-GPI IgG in the control group (10.50% resulted significantly lower than in patients with AMI (37.80% (pConclusion: Our findings suggest that anti-beta2-GPI IgG antibodies seemed to behave as independent risk factors for myocardial infarction, which may represent a link between autoimmunity and atherosclerosis in patients with acute myocardial infarction. Further studies with bigger patients are needed to explore association of anti-β2-GPI IgG with STEMI and NSTEMI.

  19. Selective Blockade of Periostin Exon 17 Preserves Cardiac Performance in Acute Myocardial Infarction.

    Science.gov (United States)

    Taniyama, Yoshiaki; Katsuragi, Naruto; Sanada, Fumihiro; Azuma, Junya; Iekushi, Kazuma; Koibuchi, Nobutaka; Okayama, Keita; Ikeda-Iwabu, Yuka; Muratsu, Jun; Otsu, Rei; Rakugi, Hiromi; Morishita, Ryuichi

    2016-02-01

    We previously reported that overexpression of full-length periostin, Pn-1, resulted in ventricular dilation with enhanced interstitial collagen deposition in a rat model. However, other reports have documented that the short-form splice variants Pn-2 (lacking exon 17) and Pn-4 (lacking exons 17 and 21) promoted cardiac repair by angiogenesis and prevented cardiac rupture after acute myocardial infarction. The apparently differing findings from those reports prompted us to use a neutralizing antibody to selectively inhibit Pn-1 by blockade of exon 17 in a rat acute myocardial infarction model. Administration of Pn neutralizing antibody resulted in a significant decrease in the infarcted and fibrotic areas of the myocardium, which prevented ventricular wall thinning and dilatation. The inhibition of fibrosis by Pn neutralizing antibody was associated with a significant decrease in gene expression of fibrotic markers, including collagen I, collagen III, and transforming growth factor-β1. Importantly, the number of α-smooth muscle actin-positive myofibroblasts was significantly reduced in the hearts of animals treated with Pn neutralizing antibody, whereas cardiomyocyte proliferation and angiogenesis were comparable in the IgG and neutralizing antibody groups. Moreover, the level of Pn-1 expression was significantly correlated with the severity of myocardial infarction. In addition, Pn-1, but not Pn-2 or Pn-4, inhibited fibroblast and myocyte attachment, which might account for the cell slippage observed during cardiac remodeling. Collectively, these results indicate that therapeutics that specifically inhibit Pn exon-17, via a neutralizing antibody or drug, without suppressing other periostin variants might offer a new class of medication for the treatment of acute myocardial infarction patients.

  20. A New Hybrid Method for Improving the Performance of Myocardial Infarction Prediction

    Directory of Open Access Journals (Sweden)

    Hojatollah Hamidi

    2016-06-01

    Full Text Available Abstract Introduction: Myocardial Infarction, also known as heart attack, normally occurs due to such causes as smoking, family history, diabetes, and so on. It is recognized as one of the leading causes of death in the world. Therefore, the present study aimed to evaluate the performance of classification models in order to predict Myocardial Infarction, using a feature selection method that includes Forward Selection and Genetic Algorithm. Materials & Methods: The Myocardial Infarction data set used in this study contains the information related to 519 visitors to Shahid Madani Specialized Hospital of Khorramabad, Iran. This data set includes 33 features. The proposed method includes a hybrid feature selection method in order to enhance the performance of classification algorithms. The first step of this method selects the features using Forward Selection. At the second step, the selected features were given to a genetic algorithm, in order to select the best features. Classification algorithms entail Ada Boost, Naïve Bayes, J48 decision tree and simpleCART are applied to the data set with selected features, for predicting Myocardial Infarction. Results: The best results have been achieved after applying the proposed feature selection method, which were obtained via simpleCART and J48 algorithms with the accuracies of 96.53% and 96.34%, respectively. Conclusion: Based on the results, the performances of classification algorithms are improved. So, applying the proposed feature selection method, along with classification algorithms seem to be considered as a confident method with respect to predicting the Myocardial Infarction.