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Sample records for vertebrobasilar arterial system

  1. [Intra-arterial fibrinolysis in vertebrobasilar system].

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    Castaño-Duque, C H; de Juan-Delago, M; Muñoz-Casadevall, J; Martí-Fábregas, J; Franquet, E; Ruscalleda-Nadal, J; Guardia-Mas, E

    The acute vertebrobasilar occlussion is usually a life-treatening disease leading to death or major disability. The treatment with heparin and the selective fibrinolysis no show good results, for this reason the local intra-arterial fibrinolysis appear as the choice treatment in patients with stroke and a agiography with basilar artery occlussion or intracranial vertebral artery occlusion. This tecnique has been proved to be effective treatment for selected patients with acute thromboembolic occlusion of the middle cerebral artery, ophthalmic artery and vertebrobasilar system, reducing the mortality in the vertebrobasilar system from 90% to 40%. We present a 63 years-old man with a vertebrobasilar thrombosis of a probable cardioembolic origen. He was treated with r-TPA local intra-arterial fibrinolysis, to get a recanalization of vertebrobasilar system. In the control TC we see a haemorragic sufusion in the brain stem. The follow-up see a patient with tetraparesis and palsy of the low cranial nerves and normal superior cerebral functions. The local intra-arterial fibrinolysis is the choise treatment in the vertebrobasilar thrombosis because the high morbimortality of this patology and the inefficacy of the others therapeutics. The result depend of many factors as the thrombo location, the neurologic state, the evolution time, the start of treatment, the colateral circulation, the nervous tissue reserve, etc, that have dificult predict the result, but it is best of the natural history of the disease. Is necesary, change the concept of emergency and the attitude front the isquemic cerebral disease at the sanitary leaders, the doctors, and the general population, for dispose of more means to cofront this pathology, which permit diminish the morbimortality and reduce the grade of incapacity.

  2. Variation of some arteries of the vertebrobasilar system: case report.

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    Stojanović, Borisav; Vasović, Ljiljana; Vlajković, Slobodan; Trandafilović, Milena; Mladenović, Marija

    2017-06-01

    A specificity of the vertebrobasilar system (VBS) is a convergent junction of paired vertebral arteries (VAs) in the basilar artery (BA) usually at the level of bulbopontine sulcus on the ventral side of the rhombencephalon. We revealed multiple VBS variations (a high junction of both VAs, absence of posterior inferior cerebellar arteries, short and ectatic BA, hypoplasia and initial duplication of the left anterior inferior cerebellar artery, and bilateral common trunks of the posterior cerebral and superior cerebellar arteries) in a 52-year-old male that routinely autopsied at the Institute of Forensic Medicine. Embryological base and morphological status of presented VBS variations is highlighted according to the literature data. Summarized variations of VBS can be classified as morphological rarity, and may be of clinical importance during angiographic studies or neurosurgical procedures.

  3. [Cerebral infarctions in vertebrobasilar artery atherosclerosis].

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    Anufriev, P L; Evdokimenko, A N; Gulevskaya, T S

    2018-01-01

    to obtain more specific information on the morphology and pathogenesis of cerebral infarctions occurring in vertebrobasilar artery (VBA) atherosclerosis. Macro- and microscopic investigations of the brain, its arterial system, and heart were conducted in 69 autopsy cases with infarctions located in the vertebrobasilar system (VBS) in atherosclerosis. 69 cases were found to have 206 VBA infarctions of various extent and locations. The detected infarctions were single and multiple in 27 and 42 cases, respectively. The detected infarctions included extensive (n=7), large (n=9), medium (n=63), small deep (lacunar) (n=97), and small superficial (n=30). The brain stem showed lacunar infarctions most frequently (76% of the infarctions at this site). Medium and small infarctions were identified at the same frequency in the cerebral hemispheres and cerebellum. The occurrence of 94% of the extensive and large infarctions was ascertained to be pathogenetically associated with atherothrombotic occlusion of the intracranial arteries in the VBS. 76% of the small infarctions occurred through the mechanism of cerebral vascular insufficiency in tandem atherostenosis of VBAs in conjunction with an additional decrease in cerebral blood flow under the influence of an extracerebral factor (coronary heart disease). Medium infarctions were approximately equifrequently due to the two aforementioned causes and, in some cases, to cardiogenic thromboembolism of VBAs. Infarctions were multiple in most cases; while recent large atherothrombotic infarctions were frequently concurrent with small organized infarctions resulting from tandem atherostenosis of VBAs. This investigation could establish the relationship between the site, extent, and pathogenetic factors of infarctions in the VBA bed in atherosclerosis, as well as the prognostic value of small infarctions as predictors for severe ischemic stroke.

  4. The evaluation of vertebrobasilar artery system in neuro-Behçet and Behçet disease using magnetic resonance angiography.

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    Kose, Evren; Kamisli, Suat; Dogan, Metin; Tasolar, Sevgi; Kahraman, Ayşegül; Oztanir, Mustafa Namik; Sener, Serpil

    2014-07-01

    The aim of this study is the evaluation of the vertebrobasilar artery system in patients with Behçet's and Neuro-Behçet's disease. For this aim; 20 adults with clinically diagnosed Behcet's disease, 20 adults with Neuro-Behçet's disease, and 19 age- and gender-matched controls were examined by magnetic resonance angiography (MRA). During MRA, diameters of left vertebral artery (LVA), right vertebral artery (RVA), basilar artery (BA), and proximal segment (P1) of posterior cerebral artery between origin and junction with the posterior communicating artery were measured. In all groups, LVA was dominant than RVA (P disease were larger than the other groups (P disease were larger but not statistically significant. There is no difference between the groups in terms of gender. Behçet's disease can affect vascular structures; therefore vertebrobasilar artery system should be examined in patients with Behçet's and Neuro-Behçet's disease. © 2014 Wiley Periodicals, Inc.

  5. Distal vertebral artery reconstruction when managing vertebrobasilar insufficiency

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    D. M. Galaktionov; A. V. Dubovoy; K. S. Ovsyannikov

    2017-01-01

    This article presents a literature review devoted to the reconstruction of the distal vertebral artery and a clinical case of successful surgical treatment of a patient suffering from vertebrobasilar insufficiency caused by occlusion of the vertebral artery in a proximal segment. The external carotid artery-distal vertebral artery bypass was performed by using the radial artery.Received 27 February 2017. Revised 25 July 2017. Accepted 3 August 2017.Funding: The study did not have sponsorship....

  6. Distal vertebral artery reconstruction when managing vertebrobasilar insufficiency

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    D. M. Galaktionov

    2017-11-01

    Full Text Available This article presents a literature review devoted to the reconstruction of the distal vertebral artery and a clinical case of successful surgical treatment of a patient suffering from vertebrobasilar insufficiency caused by occlusion of the vertebral artery in a proximal segment. The external carotid artery-distal vertebral artery bypass was performed by using the radial artery.Received 27 February 2017. Revised 25 July 2017. Accepted 3 August 2017.Funding: The study did not have sponsorship.Conflict of interest: The authors declare no conflict of interest. 

  7. Local intra-arterial thrombolysis in a 4-year-old male with vertebrobasilar artery thrombosis

    NARCIS (Netherlands)

    Janmaat, Mirjam; Gravendeel, Joost P; Uyttenboogaart, Maarten; Vroomen, Patrick C; Brouwer, Oebele F; Luijckx, Gert-Jan

    We report the case of a 4-year-old male with vertebrobasilar artery thrombosis for which he was treated with local intra-arterial urokinase 60 hours after onset of symptoms. Initially the patient had dysarthria and dysphagia. Brain magnetic resonance imaging (MRI) in a community hospital showed

  8. Characteristics and Outcomes of Vertebrobasilar Artery Dissection with Accompanied Atherosclerosis

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    Chun Chien

    2017-10-01

    Full Text Available Background: With the popularity of MRI use, vertebrobasilar artery dissection (VBD has been found more frequently in patients with posterior circulation ischemic stroke (PCS. The relationship between VBD and atherosclerosis is unknown. The present study aimed to prove the hypothesis that PCS with pure VBD (p-VBD and with VBD and accompanied cervical or cerebral artery atherosclerosis (a-VBD have distinct manifestations. Methods: Patients with VBD-related PCS who were prospectively enrolled in the Taipei Veterans General Hospital Stroke Registry between January 1, 2010 and August 31, 2014 were recruited for the present study. Patients who had (1 atherosclerotic plaques with or without stenotic flow in cervical arteries on Duplex ultrasonography or (2 focal >30% stenosis in cerebral arteries other than the dissecting region (usually in arterial bifurcations which are prone to atheroma formation on brain MRA were defined as a-VBD. Results: There were 91 patients (67 [73.6%] males, mean age 65.5 years [SD = 15.2, range, 21–91] with VBD-related PCS recruited for the present study; 31 were a-VBD and 60 were p-VBD. The results showed that there were significant differences in onset age, frequency of cigarette smoking, dissecting vascular involvement, and infarct locations between the 2 groups. In addition, compared with p-VBD, the a-VBD group had poorer functional recovery at 3 months and 1 year, respectively, which was independent of age, sex, vascular risk factors, stroke severity at admission, and treatment options. Conclusion: VBD-related PCS with and without accompanied atherosclerosis had different manifestations and should be regarded as distinct arterial diseases.

  9. [Parent artery occlusion therapy for giant aneurysms of the vertebrobasilar system: hemodynamic analysis by hydraulic vascular model].

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    Nagayasu, S

    1992-03-01

    Although therapeutic occlusion of the basilar artery has been an accepted treatment for inaccessible giant aneurysms, several such problems have been reported as incomplete thrombosis, growth or rupture of aneurysms, cerebral embolism originating from an aneurysmal cavity. Hemodynamic changes after occlusion therapy are suspected to be responsible for these events. It is usually difficult to solve these problems or to predict them before operation because multiple factors are related in a complex fashion in a living body. One of the effective means is to simulate these hemodynamic conditions by a hydraulic vascular model. A glass-made sphere of 2.5 cm in diameter was connected to a hydraulic vascular model of the brain and was regarded as a giant aneurysm so as to evaluate hemodynamic changes after therapeutic occlusion of the parent artery. 40% glycerol solution at 25 degrees C, having similar viscosity and specific gravity to those of human whole blood at 37 degrees C, was used as a perfusate in this study. A device to measure a half-life of the dye injected in an aneurysm was made from a stable luminous source and a Cds photocell. Good correlation was obtained between the output from the device and dye concentration in an aneurysm. Intensity change of the transmitted light was measured when the dye was injected into the aneurysm during perfusion. Half-life was calculated from thus obtained clearance curve and was regarded as an index of intra-aneurysmal stagnation. The flow volumes have been estimated in our previous study: 60 ml/min to the territory of one posterior cerebral artery (PCA) and 80 ml/min to the cerebellum and the brain stem. A. Basilar artery occlusion therapy for a basilar bifurcation aneurysm. For the simulation before occlusion therapy, the flow volume of the basilar artery (BA) was fixed to be 120 ml/min. When the BA is occluded distal to the exit of the superior cerebellar artery, a flow tangential to the aneurysmal neck occurs from the side

  10. Macrovascular Decompression of the Brainstem and Cranial Nerves: Evolution of an Anteromedial Vertebrobasilar Artery Transposition Technique.

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    Choudhri, Omar; Connolly, Ian D; Lawton, Michael T

    2017-08-01

    Tortuous and dolichoectatic vertebrobasilar arteries can impinge on the brainstem and cranial nerves to cause compression syndromes. Transposition techniques are often required to decompress the brainstem with dolichoectatic pathology. We describe our evolution of an anteromedial transposition technique and its efficacy in decompressing the brainstem and relieving symptoms. To present the anteromedial vertebrobasilar artery transposition technique for macrovascular decompression of the brainstem and cranial nerves. All patients who underwent vertebrobasilar artery transposition were identified from the prospectively maintained database of the Vascular Neurosurgery service, and their medical records were reviewed retrospectively. The extent of arterial displacement was measured pre- and postoperatively on imaging. Vertebrobasilar arterial transposition and macrovascular decompression was performed in 12 patients. Evolution in technique was characterized by gradual preference for the far-lateral approach, use of a sling technique with muslin wrap, and an anteromedial direction of pull on the vertebrobasilar artery with clip-assisted tethering to the clival dura. With this technique, mean lateral displacement decreased from 6.6 mm in the first half of the series to 3.8 mm in the last half of the series, and mean anterior displacement increased from 0.8 to 2.5 mm, with corresponding increases in satisfaction and relief of symptoms. Compressive dolichoectatic pathology directed laterally into cranial nerves and posteriorly into the brainstem can be corrected with anteromedial transposition towards the clivus. Our technique accomplishes this anteromedial transposition from an inferolateral surgical approach through the vagoaccessory triangle, with sling fixation to clival dura using aneurysm clips.

  11. Examining vertebrobasilar artery stroke in two Canadian provinces.

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    Boyle, Eleanor; Côté, Pierre; Grier, Alexander R; Cassidy, J David

    2009-02-01

    Ecological study. To determine the annual incidence of hospitalized vertebrobasilar artery (VBA) stroke and chiropractic utilization in Saskatchewan and Ontario between 1993 and 2004. To determine whether at an ecological level, the incidence of VBA stroke parallels the incidence of chiropractic utilization. Little is known about the incidence and time trends of VBA stroke diagnoses in the population. Chiropractic manipulation to the neck is believed to be a risk factor for VBA stroke. No study has yet found an association between chiropractic utilization and VBA diagnoses at the population level. All hospitalizations with discharge diagnoses of VBA stroke were extracted from administrative databases for Saskatchewan and Ontario. We included incident cases that were diagnosed between January 1993 and December 2004 for Saskatchewan and from April 1993 to March 2002 for Ontario. VBA cases that had previously been hospitalized for any stroke or transient ischemic attack (TIA) were excluded. Chiropractic utilization was measured using billing data from Saskatchewan Health and Ontario Health Insurance Plan. Denominators were derived from Statistics Canada's annual population estimates. The incidence rate of VBA stroke was 0.855 per 100,000 person-years for Saskatchewan and 0.750 per 100,000 person-years for Ontario. The annual incidence rate spiked dramatically with a 360% increase for Saskatchewan in 2000. There was a 38% increase for the 2000 incidence rate in Ontario. The rate of chiropractic utilization did not increase significantly during the study period. In Saskatchewan, we observed a dramatic increase in the incidence rate in 2000 and there was a corresponding relatively small increase in chiropractic utilization. In Ontario, there was a small increase in the incidence rate; however, chiropractic utilization decreased. At the ecological level, the increase in VBA stroke does not seem to be associated with an increase in the rate of chiropractic utilization.

  12. Examining vertebrobasilar artery stroke in two Canadian provinces.

    Science.gov (United States)

    Boyle, Eleanor; Côté, Pierre; Grier, Alexander R; Cassidy, J David

    2008-02-15

    Ecological study. To determine the annual incidence of hospitalized vertebrobasilar artery (VBA) stroke and chiropractic utilization in Saskatchewan and Ontario between 1993 and 2004. To determine whether at an ecological level, the incidence of VBA stroke parallels the incidence of chiropractic utilization. Little is known about the incidence and time trends of VBA stroke diagnoses in the population. Chiropractic manipulation to the neck is believed to be a risk factor for VBA stroke. No study has yet found an association between chiropractic utilization and VBA diagnoses at the population level. All hospitalizations with discharge diagnoses of VBA stroke were extracted from administrative databases for Saskatchewan and Ontario. We included incident cases that were diagnosed between January 1993 and December 2004 for Saskatchewan and from April 1993 to March 2002 for Ontario. VBA cases that had previously been hospitalized for any stroke or transient ischemic attack (TIA) were excluded. Chiropractic utilization was measured using billing data from Saskatchewan Health and Ontario Health Insurance Plan. Denominators were derived from Statistics Canada's annual population estimates. The incidence rate of VBA stroke was 0.855 per 100,000 person-years for Saskatchewan and 0.750 per 100,000 person-years for Ontario. The annual incidence rate spiked dramatically with a 360% increase for Saskatchewan in 2000. There was a 38% increase for the 2000 incidence rate in Ontario. The rate of chiropractic utilization did not increase significantly during the study period. In Saskatchewan, we observed a dramatic increase in the incidence rate in 2000 and there was a corresponding relatively small increase in chiropractic utilization. In Ontario, there was a small increase in the incidence rate; however, chiropractic utilization decreased. At the ecological level, the increase in VBA stroke does not seem to be associated with an increase in the rate of chiropractic utilization.

  13. Presigmoid Approach to Vertebrobasilar Artery Aneurysms: A Series of 31 Patients and Review of the Literature.

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    Tjahjadi, Mardjono; Niemelä, Mika; Kivelev, Juri; Serrone, Joseph; Maekawa, Hidetsugu; Jahromi, Behnam Rezai; Kerro, Oleg; Hafez, Ahmad; Lehto, Hanna; Kivisaari, Riku; Hernesniemi, Juha

    2016-08-01

    The presigmoid approach can be used to treat vertebrobasilar artery aneurysms when circumstances require more operative exposure. High morbidity and mortality in these cases have been reported. In this study, we describe our modified presigmoid approach for vertebrobasilar artery aneurysms and our clinical results. This series includes patients with vertebrobasilar aneurysms clipped via the modified presigmoid approach at the Department of Neurosurgery at Helsinki University Hospital from 1998 to 2014. Data were collected from the operating record books, patients' medical records, and a radiologic database server. Thirty-three presigmoid procedures of 31 patients were performed to treat 34 aneurysms (14 ruptured, 20 unruptured). The aneurysms had a mean distance from the posterior clinoid process to the aneurysm neck of 12.2 mm (range, 0-26.6 mm). A favorable outcome was achieved in 21 patients (64%). A favorable outcome was achieved in 74% of unruptured and good-grade patients, whereas favorable outcome was achieved in only 36% of poor-grade patients. Complete or near-complete occlusion was achieved in 79%. Larger aneurysms, fusiform morphology, and anterior dome projection had lower occlusion rates. We have described our experiences of using the presigmoid approach to treat vertebrobasilar aneurysms. The clinical and radiographic results are acceptable given the complex location and configuration of the treated aneurysms. Unfavorable outcomes are related to the poor admission Hunt and Hess grade, aneurysm morphology, and aneurysm size. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. Hemodynamic characteristics of the vertebrobasilar system analyzed using MRI-based models.

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    Wake-Buck, Amanda K; Gatenby, J Christopher; Gore, John C

    2012-01-01

    The vertebrobasilar system (VBS) is unique in human anatomy in that two arteries merge into a single vessel, and it is especially important because it supplies the posterior circulation of the brain. Atherosclerosis develops in this region, and atherosclerotic plaques in the vertebrobasilar confluence can progress with catastrophic consequences, including artery occlusion. Quantitative assessments of the flow characteristics in the VBS could elucidate the factors that influence flow patterns in this confluence, and deviations from normal patterns might then be used to predict locations to monitor for potential pathological changes, to detect early signs of disease, and to evaluate treatment options and efficacy. In this study, high-field MRI was used in conjunction with computational fluid dynamics (CFD) modeling to investigate the hemodynamics of subject-specific confluence models (n = 5) and to identify different geometrical classes of vertebrobasilar systems (n = 12) of healthy adult subjects. The curvature of the vessels and their mutual orientation significantly affected flow parameters in the VBS. The basilar artery geometry strongly influenced both skewing of the velocity profiles and the wall shear stress distributions in the VBS. All five subjects modeled possessed varying degrees of vertebral asymmetry, and helical flow was observed in four cases, suggesting that factors other than vertebral asymmetry influence mixing of the vertebral artery flow contributions. These preliminary studies verify that quantitative, MR imaging techniques in conjunction with subject-specific CFD models of healthy adult subjects may be used to characterize VBS hemodynamics and to predict flow features that have been related to the initiation and development of atherosclerosis in large arteries. This work represents an important first step towards applying this approach to study disease initiation and progression in the VBS.

  15. Hemodynamic characteristics of the vertebrobasilar system analyzed using MRI-based models.

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    Amanda K Wake-Buck

    Full Text Available The vertebrobasilar system (VBS is unique in human anatomy in that two arteries merge into a single vessel, and it is especially important because it supplies the posterior circulation of the brain. Atherosclerosis develops in this region, and atherosclerotic plaques in the vertebrobasilar confluence can progress with catastrophic consequences, including artery occlusion. Quantitative assessments of the flow characteristics in the VBS could elucidate the factors that influence flow patterns in this confluence, and deviations from normal patterns might then be used to predict locations to monitor for potential pathological changes, to detect early signs of disease, and to evaluate treatment options and efficacy. In this study, high-field MRI was used in conjunction with computational fluid dynamics (CFD modeling to investigate the hemodynamics of subject-specific confluence models (n = 5 and to identify different geometrical classes of vertebrobasilar systems (n = 12 of healthy adult subjects. The curvature of the vessels and their mutual orientation significantly affected flow parameters in the VBS. The basilar artery geometry strongly influenced both skewing of the velocity profiles and the wall shear stress distributions in the VBS. All five subjects modeled possessed varying degrees of vertebral asymmetry, and helical flow was observed in four cases, suggesting that factors other than vertebral asymmetry influence mixing of the vertebral artery flow contributions. These preliminary studies verify that quantitative, MR imaging techniques in conjunction with subject-specific CFD models of healthy adult subjects may be used to characterize VBS hemodynamics and to predict flow features that have been related to the initiation and development of atherosclerosis in large arteries. This work represents an important first step towards applying this approach to study disease initiation and progression in the VBS.

  16. Posterior circulation ischemia in patients with fetal-type circle of Willis and hypoplastic vertebrobasilar system.

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    Lochner, Piergiorgio; Golaszewski, Stefan; Caleri, Francesca; Ladurner, Gunther; Tezzon, Frediano; Zuccoli, Giulio; Nardone, Raffaele

    2011-12-01

    Little attention has been given to the fetal-type posterior circle of Willis (FTP) in the literature; also symptomatic basilar artery (BA) hypoplasia has been rarely reported. We aimed to illustrate that the association of a hypoplastic vertebrobasilar system (VBS) with the FTP may lead to posterior circulation ischemia. Magnetic resonance imaging and three-dimensional time-of-flight magnetic resonance angiography were performed in 88 consecutive patients with ischemic stroke or TIA in the VBS. Thirteen patients were identified with either stroke or TIA in the context of a hypoplastic VBS and a fetal origin of the posterior cerebral arteries. All patients had unilateral or bilateral FTP, hypoplastic BA and at least one hypoplastic vertebral artery. Transcranial color-coded duplex revealed decreased flow velocity and increased pulsatility index along the BA. A hypoplastic VBS may be accompanied by the FTP and its simultaneous occurrence can predispose to ischemic events in the posterior circulation.

  17. Thrombolytic therapy in patients with ischemic stroke in the vertebrobasilar system

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    K V Anisimov

    2012-01-01

    Full Text Available The paper shows the efficiency and safety of increasing the therapeutic window for systemic thrombolysis in verified ischemic stroke in the vertebrobasilar system (VBS, as well as the possibility of effective reperfusion in patients with stenotic occlusive lesions of the basilar artery and clinical signs of severe truncal stroke. Thrombolytic therapy (TLT over 4.5 hours and in a neurological deficit of >25 scores according to the National Institute of Health (NIHSS Scale should be performed only within the framework of clinical trials. TLT for stroke in the VBS may substantially alter the approach to rendering care in this pathology and contribute to an increase in the number of patients with a good functional outcome.

  18. Endovascular recanalization of acute intracranial vertebrobasilar artery occlusion using local fibrinolysis and additional balloon angioplasty

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    Kashiwagi, Junji; Okahara, Mika [Shinbeppu Hospital, Department of Radiology, Beppu, Oita (Japan); Kiyosue, Hiro; Tanoue, Shuichi; Sagara, Yoshiko; Mori, Hiromu [Oita University Faculty of Medicine, Department of Radiology, Yufu, Oita (Japan); Hori, Yuzo [Nagatomi Neurosurgical Hospital, Department of Radiology, Oita, Oita (Japan); Abe, Toshi [Kurume University School of Medicine, Department of Radiology, Kurume, Fukuoka (Japan)

    2010-05-15

    Vertebrobasilar artery occlusion (VBO) produces high mortality and morbidity due to low recanalization rate utilization in endovascular therapy. The use of percutaneous transluminal angioplasty (PTA) to improve recanalization rate additional to local intra-arterial fibrinolysis (LIF) was investigated in this study. Results obtained following recanalization therapy in acute intracranial VBO are reported. Eighteen consecutive patients with acute VBO underwent LIF with or without PTA, from August 2000 to May 2006. Eight patients were treated using LIF alone, and ten required additional PTA. Rate of recanalization, neurological status before treatment, and clinical outcomes were evaluated. Of 18 patients, 17 achieved recanalization. One procedure-related complication of subarachnoid hemorrhage occurred. Overall survival rate was 94.4% at discharge. Seven patients achieved good outcomes [modified Rankin scale (mRS) 0-2], and the other 11 had poor outcomes (mRS 3-6). Five of six patients who scored 9-14 on the Glasgow Coma Scale (GCS) before treatment displayed good outcomes, whereas ten of 12 patients who scored 3-8 on the GCS showed poor outcomes. GCS prior to treatment showed a statistically significant correlation to outcomes (p < 0.05). Moreover, the National Institutes of Health Stroke Scale (NIHSS) before treatment correlated well with mRS (correlation coefficient 0.487). No statistical difference between the good and poor outcome groups was observed for the duration of symptoms, age, etiology, and occlusion site. Endovascular recanalization can reduce mortality and morbidity of acute VBO. Good GCS and NIHSS scores prior to treatment can predict the efficacy of endovascular recanalization. (orig.)

  19. Calcifications of Vertebrobasilar Arteries on CT: Detailed Distribution and Relation to Risk Factors in 245 Ischemic Stroke Patients

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    Slaven Pikija

    2013-01-01

    Full Text Available Introduction. Intracranial atherosclerosis is responsible for a substantial proportion of strokes worldwide but its detailed morphology in the vertebrobasilar arteries (VBA is unknown. Subject and Methods. Cases with ischemic strokes were retrospectively sought from the hospital database. Native CT scans were assessed for vessel area and intracranial artery calcifications (ICACs in VBA. The calcifications were classified as focal (FCs, crescent, and circular. Results. 245 patients (mean age: years, 57.6% females had visible ICACs. Calcifications were found in 75.9%, 63.3%, and 17.1% in the left vertebral artery (LVA, the right vertebral artery (RVA, and the basilar artery (BA, respectively. FCs were present in 91.0%, 90.3%, and 100.0%; crescents in 30.3%, 29.0%, and 7.1%, and circulars in 6.4%, 4.8%, and 0.0% of the RVA, LVA, and BA, respectively. FCs in dorsolateral quadrant were least prevalent in both vertebral arteries (VAs: 46 (29.8% and 46 (27.4% for RVA and LVA, respectively. Risk factors associated with vertical dispersion of ICACs were male gender (OR : 2.69, 1.38–5.28 and diabetes (OR : 2.28, 1.04–4.99. Conclusions. FCs in VAs are least prevalent in dorsolateral quadrants. The vertical dispersion of ICACs seems to be associated with the male gender and diabetes.

  20. Evaluation of the effects of sildenafil citrate (viagra) on vertebral artery blood flow in patients with vertebro-basilar insufficiency.

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    Bozgeyik, Zulkif; Berilgen, Sait; Ozdemir, Huseyin; Tekatas, Aslan; Ogur, Erkin

    2008-01-01

    To investigate the effects of sildenafil citrate (Viagra) on the vertebral artery blood flow of patients with vertebro-basilar insufficiency (VBI) using color duplex sonography (CDS). The study included 21 patients with VBI (aged 31-76; mean 61.0 +/- 10.5 yrs). We administered a 50 mg oral dose of sildenafil citrate to all patients. Next, we measured the peak systolic velocity (Vmax), end diastolic velocity (Vmin), resistive index (RI), pulsatility index (PI), diameter, area, and flow volume (FV) of vertebral arteries using CDS before the administration of sildenafil citrate; 45 minutes after, and 75 minutes after administration. Statistical testing was performed using SPSS for windows version 11.0. The statistical test used to determine the outcome of the analysis was the repeated measures analysis of variance (ANOVA) test. Compared to the baseline values, the vertebral artery diameter, area, and FV increased significantly following the administration of sildenafil citrate. The diameter, area and FV increased from 3.39 mm at 45 minutes to 3.64 mm at 75 minutes, 9.43 cm(2) to 10.80 cm(2) at 45 minutes and 10.81 cm(2) at 75 minutes, as well as from 0.07 L/min at baseline to 0.09 L/min at 45 minutes and unchanged at 75 minutes, respectively. Sildenafil citrate elicited a significant effect on vertebral artery diameter, area and FVs.

  1. Evaluation of the Effects of Sildenafil Citrate (Viagra) on Vertebral Artery Blood Flow in Patients with Vertebro-Basilar Insufficiency

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    Bozgeyik, Zulkif; Berilgen, Sait; Ozdemir, Huseyin; Ogur, Erkin [Firat University School of Medicine, Elazig(Turkmenistan); Tekatas, Aslan [Elazig Government Hospital, Elazig (Turkmenistan)

    2008-12-15

    To investigate the effects of sildenafil citrate (Viagra) on the vertebral artery blood flow of patients with vertebro-basilar insufficiency (VBI) using color duplex sonography (CDS). The study included 21 patients with VBI (aged 31-76; mean 61.0 +- 10.5 yrs). We administered a 50 mg oral dose of sildenafil citrate to all patients. Next, we measured the peak systolic velocity (Vmax), end diastolic velocity (Vmin), resistive index (RI), pulsatility index (PI), diameter, area, and flow volume (FV) of vertebral arteries using CDS before the administration of sildenafil citrate; 45 minutes after, and 75 minutes after administration. Statistical testing was performed using SPSS for windows version 11.0. The statistical test used to determine the outcome of the analysis was the repeated measures analysis of variance (ANOVA) test. Compared to the baseline values, the vertebral artery diameter, area, and FV increased significantly following the administration of sildenafil citrate. The diameter, area and FV increased from 3.39 mm at 45 minutes to 3.64 mm at 75 minutes, 9.43 cm{sup 2} to 10.80 cm{sup 2} at 45 minutes and 10.81 cm{sup 2} at 75 minutes, as well as from 0.07 L/min at baseline to 0.09 L/min at 45 minutes and unchanged at 75 minutes, respectively. Sildenafil citrate elicited a significant effect on vertebral artery diameter, area and FVs

  2. Long-term outcome of tandem stenting for stenoses of the intracranial vertebrobasilar artery and vertebral ostium.

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    Du, B; Wong, E H C; Jiang, W-J

    2009-04-01

    Patients with symptomatic atherosclerotic stenosis of the intracranial vertebrobasilar artery (VBA) have a poor prognosis, and those with coexistent intracranial and extracranial stenoses have worse outcomes despite medical therapy. Our aim was to study the long-term outcome of patients with symptomatic atherosclerotic tandem stenoses at the intracranial VBA and the vertebral artery ostium (VAO) after elective stent placement. Ten consecutive patients (mean age, 65.3 years) with this condition underwent elective stent placement at our institution between September 2001 and December 2007. Technical success was defined as stent placement of both VAO and intracranial VBA stenoses with complete stent coverage of the lesions, residual stenosis of VBA territory after 30 days. Technical success was obtained in 9 of 10 patients without any stroke or death within 30 days. During a median follow-up duration of 32 months, 1 patient had a fatal ischemic stroke in the VBA territory at 4 months, and the other 9 patients were free from stroke recurrence. Thus, the annual stroke rate in VBA territory (including any stroke or death within 30 days) was 3.8%. This pilot study shows that elective stent placement for patients with symptomatic atherosclerotic tandem stenoses at the intracranial VBA and VAO has an acceptable long-term outcome and may be considered as an alternative to medical therapy.

  3. A rare cause of hyperprolactinemia: persistent trigeminal artery with stalk-section effect

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    Ekinci, G.; Baltacioglu, F.; Cimsit, C.; Akpinar, I.; Erzen, C. [Dept. of Radiology, Marmara University, Altunizade Istanbul (Turkey); Kilic, T.; Pamir, N. [Dept. of Neurosurgery, Faculty of Medicine, Marmara University, Altunizade Istanbul (Turkey)

    2001-04-01

    The primitive trigeminal, otic, hypoglossal, and proatlantal intersegmental arteries are fetal anastomoses between the carotid and vertebrobasilar systems. Persistent trigeminal artery (PTA) is the most frequent embryonic communication between the vertebrobasilar and carotid systems in adults. We report a case of PTA compressing the left side of the pituitary gland and stalk, in a patient with elevated blood prolactin level. (orig.)

  4. Surgical Anatomy of the Vertebrobasilar Territory and Posterior ...

    African Journals Online (AJOL)

    The pattern of the vertebrobasilar arterial complex and the posterior circle of Willis (COW) in Nigerians has not been previously reported despite various variants of these complexes existing in different populations. OBJECTIVE: To review and document the size, distribution and anomalies of the vertebrobasilar territory and ...

  5. Diagnostics And Treatment Of Patients With Blood Circulation Insufficiency In Vertebrobasilar Bed

    Directory of Open Access Journals (Sweden)

    A.M. Khachatryan

    2009-12-01

    Full Text Available For improvement of treatment results of patients with vertebrobasilar insufficiency we have analyzed data of medical examination and treatment of 182 patients stayed in clinics of Hospital Surgery and Nervous System Diseases from the 1st of January of 2005 till the 30th of June of 2009. Method of screening diagnostics, quantitative and qualitative blood flow estimation by means of Doppler ultrasonic investigation and angiography have been performed. The cause of blood circulation insufficiency in the vertebrobasilar bed at 87 patients was vertebral artery syndrome and in 95 cases there were the significant hemodynamical damages of blood flow in aorta arch branches and intracranial arteries. The neuroangiotropic therapy has been made for all patients, but the clinical improvement period was short in most cases, more prolonged effect was observed in addition of conservative therapy with plasmapheresis by indications. In the complex treatment of patients with vertebrobasilar insufficiency accompanied by degenerative diseases of spine chemical sympathectomy of vertebral artery in the III segment in the form of procaine and spirit-procaine blockades was made in 116 and 69 cases accordingly. The surgical sympathectomy was made in 15 patients. The surgical operations were made in 62 of 95 patients with significant hemodynamic pathology of blood flow in the vertebrobasilar region. In most cases isolative and combinative reconstructive surgery on carotid arteries was carried out. It played a significant role in blood flow correction. Favorable postoperative results were observed in most cases (93, 5%

  6. Vertebrobasilar And Bilateral Carotid Dolichoectasia: A Rare Entity

    Directory of Open Access Journals (Sweden)

    Vedat Ali Yürekli

    2013-12-01

    Full Text Available Dolichoectasia is a term used to describe marked widening, tortuosity and elongation of an artery. Intracranial vertebral and basilar arteries are most commonly involved. Vertebrobasilar dolichoectasia is usually asymptomatic. Both vertebrobasilar and bilateral carotid dolichoectasia has been reported very rarely in the literature. Cranial nerve compression and cerebral ischemia findings are frequently seen in symptomatic patients. We reported a 67-year-old female, without medical or family history for cerebrovascular disease, presented with vertebrobasilar and bilateral carotid dolichoectasia and subarachnoid hemorrhage, manifesting as reduced level of consciousness and weakness, and left abducens palsy.

  7. Vertebrobasilar dolichoectasia: a case report

    Directory of Open Access Journals (Sweden)

    Khoshnevisan A

    2011-08-01

    Full Text Available "nBackground: Vertebrobasilar dolichoectasia is defined as a prominent elongation, dilatation and tortuosity of the vertebral and basilar arteries. Ectatic basilar arteries may cause different neurological symptoms by several mechanisms including compressive effects and embolic or ischemic events."n "nCase presentation: In this report we present a 58-year old female patient who was admitted in Dr. Shariati General Hospital in Tehran, Iran with complaints of dysarthria, vertigo, ataxia and nausea. Neuro-imaging procedures (brain CT scan, CT angiography, and an MRI study of the blood vessels or MRA were performed. Dilation and elongation, as well as tortuosity of the vertebral and basilar arteries revealed the diagnosis of vertebrobasilar dolichoectasia. The patient was discharged from the hospital following the control of underlying diseases and neurological symptoms related to dolichoectasia without undergoing any invasive procedures."n "nConclusion: Paying attention to any minor or major neurological symptoms, as well as underlying medical conditions along with the conservative control of symptoms can be most helpful. Invasive interventions in a chronically ill patient can be very risky, therefore, medical management including control of associated or underlying diseases is recommended as the first line of treatment.

  8. Vertebrobasilar circulatory disorders

    Science.gov (United States)

    ... will keep improving for months or years. Possible Complications Complications of vertebrobasilar circulatory disorders are stroke and ... FACP, Attending Neurologist and Assistant Professor of Clinical Neurology, SUNY Stony Brook, School of Medicine, Stony Brook, ...

  9. Preliminary findings of recanalization and stenting for symptomatic vertebrobasilar artery occlusion lasting more than 24 h: A retrospective analysis of 21 cases

    Energy Technology Data Exchange (ETDEWEB)

    He, Yingkun, E-mail: heyingkun@126.com [Cerebrovascular Center, Henan Provincial People' s Hospital, Zhengzhou University, Zhengzhou (China); Wang, Ziliang [Cerebrovascular Center, Henan Provincial People' s Hospital, Zhengzhou University, Zhengzhou (China); Li, Tianxiao, E-mail: dr.litianxiao@vip.163.com [Cerebrovascular Center, Henan Provincial People' s Hospital, Zhengzhou University, Zhengzhou (China); Jiang, Wei-Jian [Stroke Center, People' s Liberation Army Second Artillery Corps General Hospital, Beijing (China); Zhu, Liangfu; Xue, Jiangyu; Bai, Weixing [Cerebrovascular Center, Henan Provincial People' s Hospital, Zhengzhou University, Zhengzhou (China); Hui, Ferdinand [Cerebrovascular Center, Cleveland Clinic Foundation, Cleveland, OH (United States)

    2013-09-15

    Purpose: To evaluate the technical feasibility, safety and short-term treatment effects of recanalization and stenting for intracranial symptomatic vertebrobasilar artery occlusion (VBAO) lasting more than 24 h. Methods and materials: Twenty-one consecutive patients with VBAO refractory to aggressive medical treatment were enrolled into this study and underwent recanalization and stenting. The rate of recanalization was evaluated radiographically and the functional outcome was examined using modified Rankin Scale (mRS) scores. Results: Median time between imaging-documented occlusion and endovascular recanalization was 10.5 days (IR, Interquartile Range: 6.5–18); technique success ratio of recanalization was 95.2%. There were 3 periprocedural complications. Median mRS score was 4 (IR, 2.5–5) prior to procedure and 4 (IR, 1–5) at discharge (P < 0.05). One stroke and one death occurred within 30 days after recanalization. Mean duration of clinical follow-up was 15.5 months. One transient ischemic attack, one stroke and one death occurred beyond 30-day window. Mean angiographic follow-up was 10.6 months in 10 patients. Four patients developed in-stent restenosis or occlusion, and two of them were symptomatic. Subgroup analyses revealed better functional recovery (lower mRS) in patients with vertebral artery occlusion (VAO) (P < 0.05). Conclusions: Endovascular recanalization and stenting for symptomatic VBAO lasting more than 24 h were technically feasible and patients with VAO benefited from the treatment with significant functional recovery. However, the complexity of the procedure and high risk of complication should prompt extreme caution.

  10. Specific features of reperfusion therapy for vertebrobasilar ischemic stroke

    Directory of Open Access Journals (Sweden)

    K. V. Anisimov

    2015-01-01

    Full Text Available Ischemic stroke in the vertebrobasilar system (VBS is characterized by the high rates of death and disability; reperfusion therapy in patients with a lesion focus in the VBS is safe and effective beyond the 4.5-hour therapeutic window. Actively developed current methods for the endovascular treatment of acute ischemic stroke enable one to increase recanalization rates and hence to improve the degree of functional recovery in this group of patients. Considering that there are no significant differences in the outcomes of systemic and selective thrombolytic therapy in patients with occlusion of the basilar arteries, the urgent problem is to increase the time from the onset of the disease to reperfusion therapy, therefore combined reperfusion therapy may be an optimal option. This approach would make it possible to initiate the therapy in a shorter period of time and to use the advantages of both reperfusion techniques. Intravenous thrombolysis as the rapidest and technically simplest method may be performed in the first step of therapy in the clinics unequipped with an X-ray surgical service, with the patient being further transported to a specialized endovascular center if the intravenous injection of a thrombolytic agent has no effect. Taking into account the fact that reperfusion therapy may be performed in patients with vertebrobasilar stroke in the wider therapeutic window, a similar organizational chart with multistep therapy for this disease might become the treatment of choice.

  11. Bilateral Abducens Paralysis Secondary to Compression of Abducens Nerve Roots by Vertebrobasilar Dolichoectasia.

    Science.gov (United States)

    Tuzcu, Esra Ayhan; Bayarogullari, Hanifi; Coskun, Mesut; Yilmaz, Cahide; Ilhan, Nilufer; Daglioglu, Mutlu Cihan; Aras, Mustafa

    2013-01-01

    Vertebrobasilar dolichoectasia is characterized by dilatation, tortuosity, and marked elongation of the vertebral and basilar arteries. Dolichoectatic arteries usually have thin arterial walls secondary to degeneration of the internal elastic lamina, reticular fibre deficiency, and smooth muscle atrophy. This anomaly is relatively uncommon and generally asymptomatic. Clinical manifestations of dolichoectasia result from the compression and displacement of adjacent structures, causing cranial nerve palsy, obstructive hydrocephalus, or ischaemic stroke. The authors present a case in which vertebrobasilar dolichoectasia led to the development of bilateral abducens nerve paralysis in a 9-year-old girl.

  12. [Vertebrobasilar insufficiency and obstructive sleep apnea].

    Science.gov (United States)

    Grgić, Vjekoslav

    2011-01-01

    The aim of this article is to point to correlation between vertebrobasilar insufficiency (VBI) and obstructive sleep apnea (OSA) that has not been perceived sufficiently till now. Namely, in the voluminous literature about sleep-disordered breathing, VBI has been cited only as one of the possible causes of central and mixed sleep apnea. However, according to our clinical observation, VBI could be one of the most important factors in etiopathogenesis of OSA. Results of recent research, which confirm the correlation between VBI and OSA, contribute to our hypothesis. High prevalence and pathogenesis of OSA in patients with VBI can be explained by hypoxia of the medulla oblongata during sleep (sleep+positional VBI --> hypoxia of the medulla oblongata --> hypoxia of the respiratory centre which regulates breathing function+hypoxia of the motor nuclei of the IX, X and XII cranial nerves whose neurons regulate the tone in upper airway muscles (IX, X) and tongue (XII) --> OSA). The development of OSA in certain patients with VBI is probably in close correlation with the degree of hypoxia of the medulla oblongata during sleep (moderate VBI --> OSA; severe VBI --> central or mixed sleep apnea). Considering the fact that VBI of vascular and/or compressive etiology can be the primary cause of OSA, the Doppler sonography examination ofVB system (VBS) with the positional functional tests should be included in the diagnostic algorithm for OSA. Since the functional and organic disorders of cervical spine can either cause circulation disturbances in VBS or aggravate insufficient circulation, especially during sleep in certain head and neck positions, detailed examination of cervical spine including physiatric examination, manual functional examination and radiological examination, should become a part of the routine examination in patients with either suspected or confirmed OSA. Circulation in VBS can be improved or normalized by an appropriate therapy for vascular disorders (for

  13. Diagnostic accuracy of premanipulative vertebrobasilar insufficiency tests: A systematic review

    NARCIS (Netherlands)

    Hutting, N.; Verhagen, A.P.; Vijverman, V.; Keesenberg, M.D.; Dixon, G.; Scholten-Peeters, G.G.M.

    2013-01-01

    STUDY DESIGN: A systematic review of diagnostic accuracy studies. OBJECTIVE: To evaluate the diagnostic accuracy of the premanipulative vertebrobasilar insufficiency (VBI) tests. SUMMARY OF BACKGROUND DATA: The aim of premanipulative vertebrobasilar testing is to evaluate the adequacy of blood

  14. The Diagnosis of Vertebrobasilar Insufficiency Using Transcranial Doppler Ultrasound

    Directory of Open Access Journals (Sweden)

    Ibrahim Alnaami

    2012-01-01

    Full Text Available Background. Vertebrobasilar insufficiency (VBI is a hemodynamic posterior circulation transient ischemic attack (TIA caused by intermittent vertebral artery occlusion that is induced by a head rotation or extension. VBI may result from large vessel atherosclerotic disease, dissection, cervical compressive lesions, and subclavian steal phenomenon. Diagnostic transcranial Doppler (TCD of VBI disease and hemodynamic posterior circulation TCD monitoring in symptomatic positions might prove a useful tool in establishing the diagnosis. Patient and Material/Method. A 50-year-old Caucasian man presented with a one-year history of episodic positional vertigo and ataxic gait that were induced by a neck extension and resolved by an upright position or a neck flexion. Computed tomography angiogram (CTA and TCD confirmed the presence of VBI where no blood flow was detected through posterior cerebral arteries in the symptomatic position (head extension position. Conclusion. TCD is a promising noninvasive technique that might have a role as a diagnostic test in VBI.

  15. Is local intra-arterial fibrinolysis contraindicated in elderly patients with cerebral artery occlusion?

    Energy Technology Data Exchange (ETDEWEB)

    Schumacher, M.; Kraft, S.; Siekmann, R. [Freiburg Univ. (Germany). Abt. Radiologie

    1998-12-01

    Local intra-arterial fibrinolysis (LIF) is an effective treatment for selected patients in acute thromboembolic occlusion of the middle cerebral artery, vertebrobasilar system or ophthalmic artery. However, the risk/benefit ratio of thrombolysis in patient subgroups requires classification. Advanced age has been regarded as a prognostic factor for poor clinical outcome. We report our experience with LIF in seven patients with a mean age of 79 years (range 76-83 years) who represented thromboembolic occlusion of the basilar, middle cerebral or pericallosal arteries. We discuss why advanced age need not contraindicate LIF. (orig.) With 3 figs., 20 refs.

  16. Neurofibromatosis type 1 associated with vertebrobasilar dolichoectasia and pontine ischemic stroke.

    Science.gov (United States)

    Giannantoni, Nadia Mariagrazia; Broccolini, Aldobrando; Frisullo, Giovanni; Pilato, Fabio; Profice, Paolo; Morosetti, Roberta; Di Lella, Giuseppe; Zampino, Giuseppe; Della Marca, Giacomo

    2015-01-01

    Neurofibromatosis type 1 (NF1) is a heterogeneous, common, neurocutaneous disorder presenting different complications during a life span, including cerebrovascular dysplasia. To our knowledge this is the first reported case of NF1 associated with vertebrobasilar dolichoectasia and pontine ischemic stroke. We describe a 57-year-old man with NF1 who presented an acute onset right-sided facial palsy and hemiplegia, dysarthria, and gait imbalance. Magnetic resonance imaging showed an acute left paramedian pontine infarct and a hypoplastic right vertebral artery. Brain Computed Tomography Angiography revealed the occurrence of vertebrobasilar dolichoectasia. Co-occurrence of VBD and NF1 might not be merely casual and it may significantly heighten the mortality rate in this multisystem disorder. We suggest a possible role of VBD in the genesis of our patient's clinical-radiological features and prompt the early detection of asymptomatic arteriopathy in individuals with NF1 in order to ameliorate patients' quality of life and life expectancy. Copyright © 2014 by the American Society of Neuroimaging.

  17. Time management in acute vertebrobasilar occlusion.

    Science.gov (United States)

    Kamper, Lars; Rybacki, Konrad; Mansour, Michael; Winkler, Sven B; Kempkes, Udo; Haage, Patrick

    2009-03-01

    Acute vertebrobasilar occlusion (VBO) is associated with a high risk of stroke and death. Although local thrombolysis may achieve recanalization and improve outcome, mortality is still between 35% and 75%. However, without recanalization the chance of a good outcome is extremely poor, with mortality rates of 80-90%. Early treatment is a fundamental factor, but detailed studies of the exact time management of the diagnostic and interventional workflow are still lacking. Data on 18 patients were retrospectively evaluated. Time periods between symptom onset, admission to hospital, time of diagnosis, and beginning of intervention were correlated with postinterventional neurological status. The Glasgow Coma Scale and National Institute of Health Stroke Scale (NIHSS) were used to examine patients before and after local thrombolysis. Additionally, multivariate statistics were applied to reveal similarities between patients with neurological improvement. Primary recanalization was achieved in 77% of patients. The overall mortality was 55%. Major complications were intracranial hemorrhage and peripheral embolism. The time period from symptom onset to intervention showed a strong correlation with the postinterventional NIHSS as well as the patient's age, with the best results in a 4-h interval. Multivariate statistics revealed similarities among the patients. Evaluation of time management in acute VBO by multivariate statistics is a helpful tool for definition of similarities in this patient group. Similarly to the door-to-balloon time for acute coronary interventions, the chances for a good outcome depend on a short time interval between symptom onset and intervention. While the only manipulable time period starts with hospital admission, our results emphasize the necessity of efficient intrahospital workflow.

  18. Duplex ultrasonography for the detection of vertebral artery stenosis A comparison with CT angiography

    NARCIS (Netherlands)

    Rozeman, Anouk D.; Hund, Hajo; Westein, Michel; Wermer, Marieke J H; Nijeholt, Geert J. Lycklama A.; Boiten, Jelis; Schimsheimer, Robert-Jan; Algra, Ale

    Objectives Vertebrobasilar stenosis is frequent in patients with posterior circulation stroke and it increases risk of recurrence. We investigated feasibility of duplex ultrasonography (DUS) for screening for extracranial vertebral artery stenosis and compared it with CT angiography (CTA). Materials

  19. Hemifacial spasm due to vertebrobasilar dolichoectasia: a case report

    Directory of Open Access Journals (Sweden)

    Mustafa AbdelHamid, MD

    2015-12-01

    Full Text Available Hemifacial spasm (HFS happens because of vascular compression of the facial nerve at the root exit zone. Vertebrobasilar dolichoectasia (VBD is a very rare cause of HFS. VBD is diagnosed by computed tomography angiography and magnetic resonance imaging. Here, we report a case of 65-year-old female patient with HFS due to VBD. We discuss the complications and the treatment options for the case.

  20. 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.)

  1. Rarefaction and blood pressure in systemic and pulmonary arteries

    OpenAIRE

    Mette S Olufsen; N. A. Hill; VAUGHAN, GARETH D. A.; Sainsbury, Christopher; Johnson, Martin

    2012-01-01

    The effects of vascular rarefaction (the loss of small arteries) on the circulation of blood are studied using a multiscale mathematical model that can predict blood flow and pressure in the systemic and pulmonary arteries. We augmented a model originally developed for the systemic arteries (Olufsen et al. 1998, 1999, 2000, 2004) to (a) predict flow and pressure in the pulmonary arteries, and (b) predict pressure propagation along the small arteries in the vascular beds. The systemic and pulm...

  2. A comparative study of CFD of canine model of common carotid fusiform aneurysm and vertebrobasilar fusiform aneurysm in human patients.

    Science.gov (United States)

    Guo, Shewei; Jiang, Peng; Liu, Jian; Yang, Xinjian; Jiang, Chuhan; Li, Youxiang; Wu, Zhongxue

    2017-09-22

    Intracranial fusiform aneurysm (IFA) is a relatively uncommon subgroup of aneurysms. There are few reports that focus on the hemodynamics of IFA. In this study, we compared the hemodynamics of the canine model of common carotid fusiform aneurysm and vertebrobasilar fusiform aneurysms in human patients. Five male mongrel dogs were randomly chosen, and there unilateral common carotid artery (CCA) and external jugular vein were surgically exposed individually. The CCA was transected and interposed by the free segment of the external jugular vein through end-to-end anastomosis to form a fusiform aneurysm. 3D digital substraction angiography data of each dog's and five randomly chosen male patients' vertebrobasilar fusiform aneurysms were obtained and then analysed by computational fluid dynamics software. The morphological and hemodynamic parameters were compared between the dogs and the patients. The morphological and hemodynamic parameters of the fusiform aneurysms were similar between the dogs and the patients. However, the hemodynamics was more complex in the patients. The canine fusiform aneurysm model exhibits high similarity in morphology and hemodynamics with human patients'. Therefore, this model can be used to study the fluid-solid interaction in the aneurysm and to explore the underlying mechanisms of the development, rupture and occurrence of IFAs, which offers a pathophysiological tool to seek better treatments of IFAs.

  3. Systemic arterial compliance following ultra-marathon.

    Science.gov (United States)

    Burr, J F; Bredin, S S D; Phillips, A; Foulds, H; Cote, A; Charlesworth, S; Ivey, A C; Drury, T C; Fougere, R; Warburton, D E R

    2012-03-01

    There is a growing interest in training for and competing in race distances that exceed the marathon; however, little is known regarding the vascular effects of participation in such prolonged events, which last multiple consecutive hours. There exists some evidence that cardiovascular function may be impaired following extreme prolonged exercise, but at present, only cardiac function has been specifically examined following exposure to this nature of exercise. The primary purpose of this study was to characterize the acute effects of participation in an ultra-marathon on resting systemic arterial compliance. Arterial compliance and various resting cardiovascular indices were collected at rest from 26 healthy ultra-marathon competitors using applanation tonometry (HDI CR-2000) before and after participation in a mountain trail running foot race ranging from 120-195 km which required between 20-40 continuous hours (31.2±6.8 h) to complete. There was no significant change in small artery compliance from baseline to post race follow-up (8.5±3.4-7.7±8.2 mL/mmHgx100, p=0.65), but large artery compliance decreased from 16.1±4.4 to 13.5±3.8 mL/mmHgx10 (p=0.003). Participation in extreme endurance exercise of prolonged duration was associated with acute reductions in large artery compliance, but the time course of this effect remains to be elucidated. © Georg Thieme Verlag KG Stuttgart · New York.

  4. Cerebral Arterial Variations Associated with Moyamoya Disease Diagnosed by MR Angiography.

    Science.gov (United States)

    Uchino, Akira; Saito, Naoko; Takahashi, Masahiro; Kurita, Hiroki; Ishihara, Shoichiro

    2014-12-01

    Moyamoya disease is a rare progressive cerebrovascular steno-occlusive disease associated with different variations of the cerebral arteries. We evaluated the types and prevalence of such variations among patients with moyamoya disease. In our institution during the past seven years, we diagnosed 72 patients (24 male, 48 female; aged 6 to 75 years, mean, 42 years) with moyamoya disease by magnetic resonance (MR) angiography using either a 3-Tesla or one of two 1.5-T imagers and a standard time-of-flight technique without contrast media. An experienced neuroradiologist retrospectively reviewed the images. There were 15 cerebral arterial variations in 13 of 72 patients with moyamoya disease (18.1%), including four basilar artery fenestrations, three ophthalmic arteries arising from the middle meningeal artery, two intracranial vertebral artery fenestrations, two persistent first cervical intersegmental arteries, two persistent trigeminal arteries, one extracranial origin of the posterior inferior cerebellar artery, and one persistent stapedial artery. Although our number of patients was small, moyamoya disease was frequently associated with variations of the cerebral arteries, especially fenestrations in the vertebrobasilar system and persistent trigeminal artery.

  5. Cerebellar arteries originating from the internal carotid artery: angiographic evaluation and embryologic explanations

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jae Young; Han, Moon Hee; Yu, In Gyu; Chang, Ki Hyun [Seoul National Univ. College of Medicine, Seoul (Korea, Republic of); Kim, Eui Jong [Kyunghee Univ. College of Medicine, Seoul (Korea, Republic of); Kim, Dae Ho [Soonchunhyang Univ. College of Medicine, Asan(Korea, Republic of)

    1997-06-01

    To find and describe the cerebellar arteries arising from the internal carotid artery, explain them embryologically, and evaluate their clinical implication. To determine the point in the internal carotid artery from which the cereballar artery arose anomalously, consecutive angiographic studies performed in the last three years were reviewed. The distribution of such anomalous cerebellar arteries, the point in the internal carotid artery from which the anomalous vessels originated, and associated findings were analyzed. Five anomalous origins of cerebellar arteries arising arising directly from the internal carotid artery were found in five patients. Three anterior inferior cerebellar arteries (AICA) and one common trunk of an AICA and a posterior inferior cerebellar artery (PICA) were found to originate from the internal carotid artery at a point close to the origin of the primitive trigeminal artery. A PICA arose from an artery presenting a course similar to the proatlantal intersegmental artery. Intracranial aneurysms in two patients, Moyamoya disease in one, and facial arteriovenous malformation in one. In our series, AICAs supplied from the arteries considered to be persistent trigeminal artery variants were the most common type. A correlation between type of anomalous cerebellar artery and type of carotid-vertebrobasilar anastomosis may exist. Cerebellar arteries originating anomalously from the internal carotid artery seem to occur as a result of the persistence of carotid-vertebrobasilar anastomoses associated with incomplete fusion of the longitudinal neural arteries. An understanding of these anomalous cerebellar arteries may help prevent accidents during therapeutic embolization and surgical treatment, as well as misinterpretation.

  6. THE SPIRIT-PROCAINE PERIARTERIAL BLOCKADES APPLICATION UPON THE THIRD SEGMENT OF VERTEBRAL ARTERY IN VERTEBRAL-BASILAR INSUFFICIENCY

    Directory of Open Access Journals (Sweden)

    I.I. Sholomov

    2008-09-01

    Full Text Available The spirit-procaine blockades are pathogenicallyjustified methods oftreatmentofthe vertebral-basilarartery insufficiency caused by vertebral pathology. Chemical desympathisation of the third portion of the vertebral artery (VA can be applied as alternative to stellate ganglionectomy and blockades of stellate ganglion or periarterial plexus of the VA at the level of the sixth cervical vertebra. In case of positive effect after procaine blockade, the next stage of the treatment is the periarterial alcoholisation of vertebral arteries by low-concentrated (30° ethyl alcohol. This effect is analogous to procaine blockade, but more steadfast Clinical and ultrasound investigations proved, thatspirit-procaine blockades improve the blood flow in vertebrobasilar arterial system, reduce the peripherical resistance of the vessels and interhemispherical asymmetry, and decrease the spasm of intracranial arteries, that leads to improvementof neurological condition.

  7. Internal Maxillary Artery to Upper Posterior Circulation Bypass Using a Superficial Temporal Artery Graft: Surgical Anatomy and Feasibility Assessment.

    Science.gov (United States)

    Tayebi Meybodi, Ali; Lawton, Michael T; Rodriguez Rubio, Roberto; Yousef, Sonia; Guo, Xiaoming; Feng, Xuequan; Benet, Arnau

    2017-11-01

    Revascularization of the upper posterior circulation (UPC), including the superior cerebellar artery (SCA) and posterior cerebral artery (PCA), may be necessary as part of the surgical treatment of complex UPC aneurysms or vertebrobasilar insufficiency. The existing bypass options have relative advantages and disadvantages. However, the use of a superficial temporal artery graft (STAg) in a bypass from the internal maxillary artery (IMA) to the UPC has not been previously assessed. We studied the surgical anatomy and assessed the technical feasibility of the IMA-STAg-UPC bypass. Fourteen cadaver heads were studied. The STAg was harvested proximally from about 15 mm below the zygomatic arch. The IMA was exposed through the lateral triangle of the middle fossa. The IMA-STAg-UPC bypass was completed using a subtemporal approach. The bypass was successfully performed in all specimens. The average length of the STAg from the donor to the recipient was 46.4 mm for the s2 SCA, and 49.5 mm for the P2 PCA. The average distal diameter of the STAg was 2.3 mm. More than 83% of STAgs had a diameter of ≥2 mm distally. At the point of anastomosis, the average diameter of the SCA was 1.9 mm, and the average diameter of the PCA was 3.0 mm. The proposed bypass is anatomically feasible and provides a suitable caliber match between the bypass components. Our results provide the anatomic basis for clinical assessment of the bypass in tackling complex lesions of the vertebrobasilar system requiring revascularization. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. Arterial intelligent transportation systems : infrastructure elements and traveler information requirements.

    Science.gov (United States)

    2009-08-01

    Applying Intelligent Transportation Systems (ITS) to arterial systems allows TxDOT to significantly enhance : transportation system operation efficiency and improve traffic mobility. However, no guidelines are available to : assist TxDOT staff in sel...

  9. Vertebrobasilar occlusions. Pathophysiology, diagnostics and treatment; Vertebrobasilaere Gefaessverschluesse. Pathophysiologie, Diagnostik und Behandlung

    Energy Technology Data Exchange (ETDEWEB)

    Fiehler, J. [Universitaetsklinikum Hamburg-Eppendorf, Klinik und Poliklinik fuer Neuroradiologische Diagnostik und Intervention, Hamburg (Germany); Thomalla, G. [Universitaetsklinikum Hamburg-Eppendorf, Klinik und Poliklinik fuer Neurologie, Hamburg (Germany)

    2009-04-15

    Acute vertebrobasilar occlusions (VBO) are dramatic clinical events with a mortality of up to 90% under standard medical treatment. If VBO is suspected a diagnosis of the vessel status has to be achieved immediately. For this purpose CT/CTA and MRI/MRA are equivalent diagnostic tools in the emergency setting. In contrast to the anterior circulation, local endovascular treatment is the established therapy for the posterior circulation as an underlying arteriosclerotic stenosis remains in 50% of the cases after intravenous fibrinolysis. Nevertheless, systemic fibrinolysis is considered the preferred option in cases where a neurointerventional center cannot be reached within a reasonable time frame and the patient can subsequently be transported for local therapy of a residual stenosis in order to prevent reocclusion ('drip and ship'). Profound clinical and pathophysiological knowledge is the absolute prerequisite for the correct application of state-of-the-art neurointerventional therapy. This review paper focuses on the clinical and pathophysiological details that are crucial for decision-making. (orig.) [German] Der akute Verschluss der A. basilaris ist ein dramatisches klinisches Ereignis mit einer Mortalitaet von bis zu 90% unter konventioneller medikamentoeser Therapie. Bei Verdacht auf eine vertebrobasilare Ischaemie muss unverzueglich die notwendige Diagnostik mit Darstellung der vertebrobasilaeren Gefaesse erfolgen. Hierbei sind die CT mit CTA oder die MRT mit MRA in der Akutsituation als gleichwertig anzusehen. Im Unterschied zum vorderen Kreislauf hat sich zur Behandlung seit langem die lokale Fibrinolyse durchgesetzt, da einem Gefaessverschluss im hinteren Stromgebiet in der Haelfte der Faelle eine lokale arteriosklerotische Stenose zu Grunde liegt. Gegenueber der systemischen Thrombolyse bietet ein endovaskulaeres Vorgehen neben der lokalen Fibrinolyse die Moeglichkeit zu einer direkten Behandlung der zur Grunde liegenden Stenose. Sollte eine

  10. Mammary artery harvesting using the Da Vinci Si robotic system

    Directory of Open Access Journals (Sweden)

    Leonardo Secchin Canale

    2014-03-01

    Full Text Available Internal mammary artery harvesting is an essential part of any coronary artery bypass operation. Totally endoscopic coronary artery bypass graft surgery has become reality in many centers as a safe and effective alternative to conventional surgery in selected patients. Internal mammary artery harvesting is the initial part of the procedure and should be performed equally safely if one wants to achieve excellence in patency rates for the bypass. We here describe the technique for mammary harvesting with the Da Vinci Si robotic system.

  11. Mammary artery harvesting using the Da Vinci Si robotic system

    Science.gov (United States)

    Canale, Leonardo Secchin; Bonatti, Johannes

    2014-01-01

    Internal mammary artery harvesting is an essential part of any coronary artery bypass operation. Totally endoscopic coronary artery bypass graft surgery has become reality in many centers as a safe and effective alternative to conventional surgery in selected patients. Internal mammary artery harvesting is the initial part of the procedure and should be performed equally safely if one wants to achieve excellence in patency rates for the bypass. We here describe the technique for mammary harvesting with the Da Vinci Si robotic system. PMID:24896171

  12. Microfluidic perfusion culture system for multilayer artery tissue models.

    Science.gov (United States)

    Yamagishi, Yuka; Masuda, Taisuke; Matsusaki, Michiya; Akashi, Mitsuru; Yokoyama, Utako; Arai, Fumihito

    2014-11-01

    We described an assembly technique and perfusion culture system for constructing artery tissue models. This technique differed from previous studies in that it does not require a solid biodegradable scaffold; therefore, using sheet-like tissues, this technique allowed the facile fabrication of tubular tissues can be used as model. The fabricated artery tissue models had a multilayer structure. The assembly technique and perfusion culture system were applicable to many different sizes of fabricated arteries. The shape of the fabricated artery tissue models was maintained by the perfusion culture system; furthermore, the system reproduced the in vivo environment and allowed mechanical stimulation of the arteries. The multilayer structure of the artery tissue model was observed using fluorescent dyes. The equivalent Young's modulus was measured by applying internal pressure to the multilayer tubular tissues. The aim of this study was to determine whether fabricated artery tissue models maintained their mechanical properties with developing. We demonstrated both the rapid fabrication of multilayer tubular tissues that can be used as model arteries and the measurement of their equivalent Young's modulus in a suitable perfusion culture environment.

  13. Arterial supply of the lower cranial nerves: a comprehensive review.

    Science.gov (United States)

    Hendrix, Philipp; Griessenauer, Christoph J; Foreman, Paul; Loukas, Marios; Fisher, Winfield S; Rizk, Elias; Shoja, Mohammadali M; Tubbs, R Shane

    2014-01-01

    The lower cranial nerves receive their arterial supply from an intricate network of tributaries derived from the external carotid, internal carotid, and vertebrobasilar territories. A contemporary, comprehensive literature review of the vascular supply of the lower cranial nerves was performed. The vascular supply to the trigeminal, facial, vestibulocochlear, glossopharyngeal, vagus, spinal accessory, and hypoglossal nerves are illustrated with a special emphasis on clinical issues. Frequently the external carotid, internal carotid, and vertebrobasilar territories all contribute to the vascular supply of an individual cranial nerve along its course. Understanding of the vasculature of the lower cranial nerves is of great relevance for skull base surgery. Copyright © 2013 Wiley Periodicals, Inc.

  14. Rapid ventricular pacing for a basilar artery pseudoaneurysm in a pediatric patient: case report.

    Science.gov (United States)

    Nimjee, Shahid M; Smith, Tony P; Kanter, Ronald J; Ames, Warwick; Machovec, Kelly A; Grant, Gerald A; Zomorodi, Ali R

    2015-06-01

    Large cerebral aneurysms of the basilar apex are difficult to treat. Recently, endovascular treatment has mitigated much of the morbidity associated with treating these lesions. However, the morphology of aneurysms of the vertebrobasilar system can preclude endovascular treatment. Rapid ventricular pacing (RVP) facilitates open surgical treatment of cerebral aneurysms. It can assist in reducing the pressure of the neck of the aneurysm, allowing safe application of a clip. The authors present a case of a pediatric patient who developed a basilar artery pseudoaneurysm that required surgery. Given the large size of the aneurysm, RVP was performed, allowing the surgeons to dissect the dome of the aneurysm from the surrounding tissue and pontine perforating branches away from the lesion to safely clip the lesion. The patient had an uneventful recovery. To the authors' knowledge, this represents the first known case of RVP to aid in basilar artery clip occlusion in a pediatric patient.

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

    Science.gov (United States)

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

    2010-08-01

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

  16. Persistent trigeminal artery: angio-tomography and angio-magnetic resonance finding

    Energy Technology Data Exchange (ETDEWEB)

    Pereira, Licia Pacheco; Nepomuceno, Lara A.M.; Coimbra, Pablo Picasso; Oliveira Neto, Sabino Rodrigues de [Hospital Geral de Fortaleza (HGF), CE (Brazil). Radiology Dept.], e-mail: licia_p@hotmail.com; Natal, Marcelo Ricardo C. [Hospital de Base do Distrito Federal, Brasilia, DF (Brazil)

    2009-09-15

    The trigeminal artery (TA) is the most common embryonic carotid-vertebrobasilar anastomosis to persist into adulthood. It typically extends from the internal carotid artery to the basilar artery. Persistent primitive arteries are usually found incidentally, but are often associated with vascular malformation, cerebral aneurysm and, in case of TA, with trigeminal neuralgia. We present one patient with TA as a cause of trigeminal neuralgia and in other three as an incidental finding, on TC and MR angiograms. (author)

  17. Modeling of the aorta artery aneurysms and renal artery stenosis using cardiovascular electronic system

    Directory of Open Access Journals (Sweden)

    Navidbakhsh Mahdi

    2007-06-01

    Full Text Available Abstract Background The aortic aneurysm is a dilatation of the aortic wall which occurs in the saccular and fusiform types. The aortic aneurysms can rupture, if left untreated. The renal stenosis occurs when the flow of blood from the arteries leading to the kidneys is constricted by atherosclerotic plaque. This narrowing may lead to the renal failure. Previous works have shown that, modelling is a useful tool for understanding of cardiovascular system functioning and pathophysiology of the system. The present study is concerned with the modelling of aortic aneurysms and renal artery stenosis using the cardiovascular electronic system. Methods The geometrical models of the aortic aneurysms and renal artery stenosis, with different rates, were constructed based on the original anatomical data. The pressure drop of each section due to the aneurysms or stenosis was computed by means of computational fluid dynamics method. The compliance of each section with the aneurysms or stenosis is also calculated using the mathematical method. An electrical system representing the cardiovascular circulation was used to study the effects of these pressure drops and the compliance variations on this system. Results The results showed the decreasing of pressure along the aorta and renal arteries lengths, due to the aneurysms and stenosis, at the peak systole. The mathematical method demonstrated that compliances of the aorta sections and renal increased with the expansion rate of the aneurysms and stenosis. The results of the modelling, such as electrical pressure graphs, exhibited the features of the pathologies such as hypertension and were compared with the relevant experimental data. Conclusion We conclude from the study that the aortic aneurysms as well as renal artery stenosis may be the most important determinant of the arteries rupture and failure. Furthermore, these pathologies play important rules in increase of the cardiovascular pulse pressure which

  18. Visual loss, homonymous hemianopia, and unilateral optic neuropathy as the presenting symptoms of vertebrobasilar dolichoectasia

    DEFF Research Database (Denmark)

    Mortzos, Panteleimon; Sørensen, Torben Lykke

    2013-01-01

    Vertebrobasilar dolichoectasia (VBD) is a relatively rare disorder for which unfortunately there is no treatment. Here we describe a case of simultaneous pre- and postchiasmal visual pathway pathology secondary to a space occupying VBD. In addition our patient demonstrates one of the very few cas...... of VBD compression of the retrochiasmal pathway with no other cranial nerve involvement....

  19. Use of flow-diverting devices in fusiform vertebrobasilar giant aneurysms

    DEFF Research Database (Denmark)

    Ertl, L; Holtmannspötter, M; Patzig, M

    2014-01-01

    and imaging follow-up. In this article, we present our experience with the treatment of fusiform vertebrobasilar giant aneurysms by flow diverting stents. We aim to stimulate a discussion of the best management paradigm for this challenging aneurysm subtype. MATERIALS AND METHODS: We retrospectively...

  20. Pathophysiology and Diagnosis of Vertebrobasilar Insufficiency: A Review of the Literature.

    Science.gov (United States)

    Lima Neto, Arlindo Cardoso; Bittar, Roseli; Gattas, Gabriel Scarabotolo; Bor-Seng-Shu, Edson; Oliveira, Marcelo de Lima; Monsanto, Rafael da Costa; Bittar, Luis Felipe

    2017-07-01

    Introduction  Vertebrobasilar insufficiency is defined as transitory ischemia of the vertebrobasilar circulation. Dizziness, vertigo, headaches, vomit, diplopia, blindness, ataxia, imbalance, and weakness in both sides of the body are the most common symptoms. Objective  To review the literature regarding the three available diagnostic testing in patients with dizziness complaints secondary to vertebrobasilar insufficiency (VBI): magnetic resonance angiography; transcranial Doppler ultrasound; and vertebrobasilar deprivation testing. Data Synthesis  We selected 28 studies that complied with our selection criteria for appraisal. The most frequent cause of the hemodynamic changes leading to VBI is atherosclerosis. The main clinical symptoms are dizziness, vertigo, headaches, vomit, diplopia, blindness, ataxia, imbalance, and weakness in both sides of the body. Even though arteriography is considered the most important exam to diagnose the disease, the inherent risks of this exam should be taken into consideration. The magnetic resonance angiography has been widely studied and is a good method to identify and localize any occlusions and stenosis in both neck and intracranial great vessels. Conclusion  Each patient with a suspected diagnosis of VBI should be individually evaluated and treated, taking in consideration the pros and cons of each diagnostic testing and treatment option.

  1. Characteristics and Fate of Systemic Artery Aneurysm after Kawasaki Disease.

    Science.gov (United States)

    Hoshino, Shinsuke; Tsuda, Etsuko; Yamada, Osamu

    2015-07-01

    To determine the long-term outcome of systemic artery aneurysms (SAAs) after Kawasaki disease (KD). We investigated the characteristics and the fate of SAAs in 20 patients using medical records and angiograms. The age of onset of KD ranged from 1 month to 20 months. The interval from the onset of KD to the latest angiogram ranged from 16 months to 24 years. The regression rate of peripheral artery aneurysm and the frequency of stenotic lesions were analyzed by the Kaplan-Meier method in 11 patients who had undergone initial angiography within 4 months. The mean duration of fever was 24 ± 12 days. All 20 patients had at least 1 symmetric pair of aneurysms in bilateral peripheral arteries, and 16 patients had multiple SAAs. The distributions of SAAs was as follows: brachial artery, 30; common iliac artery, 20; internal iliac artery, 21; abdominal aortic aneurysm, 7; and others, 29. The frequencies of regression of SAA and of the occurrence of stenotic lesions at 20 years after the onset of KD were 51% and 25%, respectively (n = 42). The diameter of all SAAs in the acute phase leading to stenotic lesions in the late period was >10 mm. SAAs occurred symmetrically and were multiple in younger infants and those with severe acute vasculitis. The fate of SAAs resembles that of coronary artery aneurysms, and depends on the diameter during the acute phase. Larger SAAs can lead to stenotic lesions in the late period. Copyright © 2015 Elsevier Inc. All rights reserved.

  2. Magnetic Resonance Imaging Follow-Up of Large or Giant Vertebrobasilar Dissecting Aneurysms After Total Embolization on Angiography.

    Science.gov (United States)

    Zhang, Yisen; Wang, Yanmin; Sui, Binbin; Li, Youxiang; Mu, Shiqing; Zhang, Ying; Wu, Zhongxue; Yang, Xinjian

    2016-07-01

    To evaluate the outcomes of large or giant vertebrobasilar dissecting aneurysms (VBDAs) after endovascular total embolization by follow-up 3T magnetic resonance imaging (MRI). Between November 2011 and July 2015, 4 patients had unruptured large or giant VBDAs that were treated with endovascular techniques with total embolization of VBDAs confirmed on follow-up angiography, but the patients had persistent or worsened symptoms. Preoperative and postoperative 3T high-resolution MRI was performed to evaluate arterial wall evolution. Follow-up angiographic results were satisfactory in all 4 patients; however, symptoms in cases 1, 2, and 4 worsened, and symptoms in case 3 did not improve. Postoperative high-resolution MRI in case 1 showed a new intramural hematoma, and postoperative high-resolution MRI of cases 2, 3, and 4 showed persistent intramural hemorrhagic signals. Follow-up MRI showed increased aneurysm size in cases 1, 2, and 4 but no size change in case 3. The efficacy of conventional endovascular treatment (e.g., internal trapping with coils, stent-assisted coiling, and stent placement without coils) for large or giant VBDAs is uncertain. Follow-up angiography alone does not adequately predict the outcome. High-resolution MRI is a worthwhile adjunct to follow these lesions. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Transbrachial artery approach for selective cerebral angiography

    Energy Technology Data Exchange (ETDEWEB)

    Touho, Hajime; Karasawa, Jun; Shishido, Hisashi; Morisako, Toshitaka; Numazawa, Shinichi; Yamada, Keisuke; Nagai, Shigeki; Shibamoto, Kenji (Osaka Neurological Inst., Toyonaka (Japan))

    1990-02-01

    Transaxillary or transbrachial approaches to the cerebral vessels have been reported, but selective angiography of all four vessels has not been possible through one route. In this report, a new technique for selective cerebral angiography with transbrachial approach is described. One hundred and twenty three patients with cerebral infarction, vertebrobasilar insufficiency, intracerebral hemorrhage, epilepsy, or cerebral tumor were examined. Those patients consisted of 85 outpatients and 38 inpatients whose age ranged from 15 years old to 82 years old. The patients were examined via the transbrachial approach (97 cases via the right brachial, 29 cases via the left). Materials included a DSA system (Digital Fluorikon 5000, General Electric Co.), a 4 French tight J-curved Simmons 80-cm catheter, a 19-gauge extra-thin-wall Seldinger needle, and a J/Straight floppy 125-cm guide-wire. Generally, the volume of the contrast agent (300 mgI/ml iopamidol) used in the common carotid artery angiogram was 6 ml, while that used in the vertebral artery angiogram was 4 ml. If catheterization of the vertebral artery or right common carotid artery was unsuccessful, about 8 ml of the contrast agent was injected into the subclavian or branchiocephalic artery. Definitive diagnosis and a decision on proper treatment of the patients can be easily obtained, and the results were clinically satisfactory. Moreover, no complications were encountered in this study. This new technique making a transbrachial approach to the cerebral vessels using the DSA system is introduced here. Neurosurgeons can use this technique easily, and they will find that it provides them with all the information they need about the patient. (author).

  4. Design Optimisation of Coronary Artery Stent Systems.

    Science.gov (United States)

    Bressloff, Neil W; Ragkousis, Giorgos; Curzen, Nick

    2016-02-01

    In recent years, advances in computing power and computational methods have made it possible to perform detailed simulations of the coronary artery stenting procedure and of related virtual tests of performance (including fatigue resistance, corrosion and haemodynamic disturbance). Simultaneously, there has been a growth in systematic computational optimisation studies, largely exploiting the suitability of surrogate modelling methods to time-consuming simulations. To date, systematic optimisation has focussed on stent shape optimisation and has re-affirmed the complexity of the multi-disciplinary, multi-objective problem at hand. Also, surrogate modelling has predominantly involved the method of Kriging. Interestingly, though, optimisation tools, particularly those associated with Kriging, haven't been used as efficiently as they could have been. This has especially been the case with the way that Kriging predictor functions have been updated during the search for optimal designs. Nonetheless, the potential for future, carefully posed, optimisation strategies has been suitably demonstrated, as described in this review.

  5. Treatment of proximal segment stenoses of vertebral arteries with baloon expandable silicon carbide coated stents

    Directory of Open Access Journals (Sweden)

    Šeruga Tomaž

    2013-01-01

    Conclusions: Stenting of the vertebral arteries can significantly improve hemodynamic conditions in the posterior circulation and prevent recurrent transient ischemic attacks and worsening of vertebro-basilar symptoms. So far, less than twenty studies have been published on the stenting of vertebral arteries worldwide. Randomized larger prospective trials are needed to confirm the benefit of endovascular treatment of vertebral artery stenosis, also by use of drugeluting stents.

  6. Arterial vasculopathy in systemic sclerosis: Computerized tomography (CT) angiographic features of macrovascular and microvascular upper limbs arteries

    NARCIS (Netherlands)

    Emad, Y.; Al-Sherbeni, H.; Ragab, Y.; Abo-El-Youn, I.; El-Shaarawy, N.; Nassar, D.Y.; Fathy, A.; Al-Hanafi, H.; Rasker, Johannes J.

    2014-01-01

    Objective To describe the CT angiographic findings of arterial vasculopathy in the major vessels as well as medium and micro vascular affection of the whole upper limbs arterial tree in patients with systemic sclerosis (SSc) with and without digital ulceration. Methods Twenty-two cases with systemic

  7. Correlates of obesity indices and systemic arterial hypertension in ...

    African Journals Online (AJOL)

    Background: The aim of the study was to determine the correlation between indices of obesity and systemic arterial hypertension in adult Nigerians. Methods: This cross-sectional descriptive survey and was carried out in Abia state, southeast Nigeria. Two thousand nine hundred and ninety nine (2,999) subjects, aged ...

  8. Assembly of a Pulmonary Artery Pressure Sensor System

    Directory of Open Access Journals (Sweden)

    J. Müntjes

    2010-01-01

    Full Text Available This paper presents an implantable system for telemonitoring the intravascular pressure in the pulmonary artery. By implanting a catheter-bound pressure and temperature sensor into the pulmonary artery, it is possible to monitor the actual value and the time variations of the intravascular pressure with a frequency of 128 Hz. Thus hospitalization of patients suffering from heart insufficiency can be avoided by early changes in therapy.Preliminary in vivo experiments have been conducted to verify the fixation mechanism and the positioning of the sensor at the right place in the pulmonary artery. It was shown that the proposed fixation mechanism and the packaging of the sensor promise to be stable.

  9. Comments on the mathematical modelling of a vertebrobasilar stenosis

    Directory of Open Access Journals (Sweden)

    Balazs ALBERT

    2016-09-01

    Full Text Available In the present paper the case of a stenosis on the basilar artery is investigated. To analyze the problem CT angiography and MRI angiography were performed. To model this real case a non-Newtonian mathematical model was taken into account for the blood flow, while the vessel walls of the arteries and the arterioles were considered to have viscoelastic and elastic behavior, respectively – as we presented already in previous papers [1], [2]. Using COMSOL Multiphysics 3.3 we performed some numerical simulations to obtain some results with regard to blood velocity, blood pressure and streamlines.

  10. Photoplethysmography system for blood pulsation detection in unloaded artery conditions

    Science.gov (United States)

    Grabovskis, A.; Marcinkevics, Z.; Rubenis, O.; Rubins, U.; Lusa, V.

    2012-06-01

    Photoplethysmography (PPG) is an optical method of blood pulsation recording and has been extensively studied for decades. Recently PPG is widely used in the medical equipment for patient monitoring and in laboratories for research and physiological studies. In spite of the technological progress in the field of medical equipment, there are no generally accepted standards for clinical PPG measurements up to date. One of the most important factors affecting PPG waveform is the contact pressure between tissue and PPG probe. The aim of the current study was to develop and evaluate a system for software-assisted PPG signal acquisition from the unloaded artery. Novel PPG waveform derived Optimal Pressure Parameter (OPP) has been proposed as the reliable indicator of unloaded artery condition. We affirm that PPG measurements provided in balanced transmural arterial pressure conditions might serve as a reference for the unification of contact manner optical plethysmography methods. It is a step forward towards the standardization of the PPG methodology, and showed that the maximal value of the OPP, obtained in the particular experimental trial, indicates the optimal PPG probe contact pressure at that moment. Our developed system has been validated in the experimental series and showed the possibility of determining the correct PPG contact pressure value with high repeatability. It is concluded that this system can provide the necessary feedback to perform reliable PPG signal acquisition from the unloaded conduit artery.

  11. Local intra-arterial fibrinolysis without arterial occlusion?

    Energy Technology Data Exchange (ETDEWEB)

    Schumacher, M.; Yin, L.; Klisch, J. [Section Neuroradiology, Univ. Hospital, Freiburg (Germany); Hetzel, A. [Dept. of Neurology, Univ. Hospital, Freiburg (Germany)

    1999-07-01

    Local intra-arterial fibrinolysis (LIF) is the best choice at present for treatment of acute vessel occlusion in the vertebrobasilar teritory and also, in selected cases, in the carotid territory. In almost all cases angiography demonstrates the site of occlusion exactly and gives information about collateral circulation. Contrary to this common approach, we report five patients with severe acute thromboembolic stroke in whom angiography revealed no occlusion of relevant arteries or their main branches. Under the hypothesis of persisting occlusion of perforating arteries to the brain stem we performed LIF in patients with a clinical basilar artery syndrome. Outcome in all but one of them was good following LIF. The clinical details are described and possible reasons discussed. (orig.)

  12. Pulmonary Arterial Hypertension in Systemic Lupus Erythematosus: Prevalence and Predictors.

    Science.gov (United States)

    Pérez-Peñate, Gregorio Miguel; Rúa-Figueroa, Iñigo; Juliá-Serdá, Gabriel; León-Marrero, Fernándo; García-Quintana, Antonio; Ortega-Trujillo, José Ramón; Erausquin-Arruabarrena, Celia; Rodríguez-Lozano, Carlos; Cabrera-Navarro, Pedro; Ojeda-Betancor, Nazario; Gómez-Sánchez, Miguel Ángel

    2016-02-01

    Pulmonary arterial hypertension (PAH) prevalence has been reported to be between 0.5% and 17% in systemic lupus erythematosus (SLE). This study assessed PAH prevalence and predictors in an SLE cohort. The Borg dyspnea scale, DLCO, N-terminal pro-brain natriuretic peptide (NT-proBNP), and Doppler echocardiographic (DE) were performed. An echocardiographic Doppler exercise test was conducted in selected patients. When DE systolic pulmonary arterial pressure was ≥ 45 mmHg or increased during exercise > 20 mmHg, a right heart catheterization was performed. Hemodynamic during exercise was measured if rest mean pulmonary arterial pressure was exercise-induced pulmonary artery pressure increase (4 with occult left diastolic dysfunction). These patients had significantly more dyspnea, higher NT-proBNP, and lower DLCO. These data confirm the low prevalence of PAH in SLE. In our cohort, occult left ventricular diastolic dysfunction was a frequent diagnosis of unexplained dyspnea. Dyspnea, DLCO, and NT-proBNP could be predictors of pulmonary hypertension in patients with SLE.

  13. Artery Soft-Tissue Modelling for Stent Implant Training System

    Directory of Open Access Journals (Sweden)

    Giovanni Aloisio

    2004-08-01

    Full Text Available Virtual reality technology can be utilised to provide new systematic training methods for surgical procedures. Our aim is to build a simulator that allows medical students to practice the coronary stent implant procedure and avoids exposing patients to risks. The designed simulation system consists of a virtual environment and a haptic interface, in order to provide both the visualization of the coronary arteries and the tactile and force feedback generated during the interactions of the surgical instruments in the virtual environment. Since the arteries are soft tissues, their shape may change during an operation; for this reason physical modelling of the organs is necessary to render their behaviour under the influence of surgeon's instruments. The idea is to define a model that computes the displacement of the tissue versus time; from the displacement it is possible to calculate the response of the tissue to the surgical tool external stimuli. Information about tools displacements and tissue responses are also used to graphically model the artery wall and virtual surgical instrument deformations generated as a consequence of their coming into contact. In order to obtain a realistic simulation, the Finite Element Method has been used to model the soft tissues of the artery, using linear elasticity to reduce computational time and speed up interaction rates.

  14. A Case Report of Locked-in Syndrome Due to Bilateral Vertebral Artery Dissection After Cervical Spine Manipulation Treated by Arterial Embolectomy

    OpenAIRE

    Ke, Jiang-qiong; Yin, Bo; Fu, Fang-Wang; Shao, Sheng-Min; Lin, Yan; Dong, Qi-Qiang; Wang, Xiao-Tong; Zheng, Guo-Qing

    2016-01-01

    Abstract Cervical spine manipulation (CSM) is a commonly spinal manipulative therapies for the relief of cervical spine-related conditions worldwide, but its use remains controversial. CSM may carry the potential for serious neurovascular complications, primarily due to vertebral artery dissection (VAD) and subsequent vertebrobasilar stroke. Here, we reported a rare case of locked-in syndrome (LIS) due to bilaterial VAD after CSM treated by arterial embolectomy. A 36-year-old right-handed man...

  15. Clopidogrel in infants with systemic-to-pulmonary-artery shunts

    DEFF Research Database (Denmark)

    Wessel, David L; Berger, Felix; Li, Jennifer S

    2013-01-01

    BACKGROUND: Infants with cyanotic congenital heart disease palliated with placement of a systemic-to-pulmonary-artery shunt are at risk for shunt thrombosis and death. We investigated whether the addition of clopidogrel to conventional therapy reduces mortality from any cause and morbidity related...... to the shunt. METHODS: In a multicenter, double-blind, event-driven trial, we randomly assigned infants 92 days of age or younger with cyanotic congenital heart disease and a systemic-to-pulmonary-artery shunt to receive clopidogrel at a dose of 0.2 mg per kilogram of body weight per day (467 infants...... days of age. RESULTS: The rate of the composite primary end point did not differ significantly between the clopidogrel group (19.1%) and the placebo group (20.5%) (absolute risk difference, 1.4 percentage points; relative risk reduction with clopidogrel, 11.1%; 95% confidence interval, -19.2 to 33.6; P...

  16. Bedside arterial blood gas monitoring system using fluorescent optical sensors

    Science.gov (United States)

    Bartnik, Daniel J.; Rymut, Russell A.

    1995-05-01

    We describe a bedside arterial blood gas (ABG) monitoring system which uses fluorescent optical sensors in the measurement of blood pH, PCO2 and PO2. The Point-of-Care Arterial Blood Gas Monitoring System consists of the SensiCathTM optical sensor unit manufactured by Optical Sensors Incorporated and the TramTM Critical Care Monitoring System with ABG Module manufactured by Marquette Electronics Incorporated. Current blood gas measurement techniques require a blood sample to be removed from the patient and transported to an electrochemical analyzer for analysis. The ABG system does not require removal of blood from the patient or transport of the sample. The sensor is added to the patient's existing arterial line. ABG measurements are made by drawing a small blood sample from the arterial line in sufficient quantity to ensure an undiluted sample at the sensor. Measurements of pH, PCO2 and PO2 are made within 60 seconds. The blood is then returned to the patient, the line flushed and results appear on the bedside monitor. The ABG system offers several advantages over traditional electrochemical analyzers. Since the arterial line remains closed during the blood sampling procedure the patient's risk of infection is reduced and the caregiver's exposure to blood is eliminated. The single-use, disposable sensor can be measure 100 blood samples over 72 hours after a single two-point calibration. Quality Assurance checks are also available and provide the caregiver the ability to assess system performance even after the sensor is patient attached. The ABG module integrates with an existing bedside monitoring system. This allows ABG results to appear on the same display as ECG, respiration, blood pressure, cardiac output, SpO2, and other clinical information. The small module takes up little space in the crowded intensive care unit. Performance studies compare the ABG system with an electrochemical blood gas analyzer. Study results demonstrated accurate and precise blood

  17. Ambulatory pulmonary arterial pressure in primary pulmonary hypertension: variability, relation to systemic arterial pressure, and plasma catecholamines.

    OpenAIRE

    Richards, A M; Ikram, H; Crozier, I G; Nicholls, M G; Jans, S

    1990-01-01

    The variability of pulmonary arterial pressure, the relation of pulmonary pressure to systemic pressure, pulmonary pressure responses to stimuli (exercise, hypoxia, smoking, free ambulation), and plasma catecholamine responses were assessed in five patients with primary pulmonary hypertension. Ambulatory monitoring techniques provided data for the computerised analysis of continuous, beat-to-beat, direct recordings of both pulmonary and systemic arterial pressures for 8 to 10 hours. The absol...

  18. Autonomic nervous system involvement in pulmonary arterial hypertension.

    Science.gov (United States)

    Vaillancourt, Mylène; Chia, Pamela; Sarji, Shervin; Nguyen, Jason; Hoftman, Nir; Ruffenach, Gregoire; Eghbali, Mansoureh; Mahajan, Aman; Umar, Soban

    2017-12-04

    Pulmonary arterial hypertension (PAH) is a chronic pulmonary vascular disease characterized by increased pulmonary vascular resistance (PVR) leading to right ventricular (RV) failure. Autonomic nervous system involvement in the pathogenesis of PAH has been demonstrated several years ago, however the extent of this involvement is not fully understood. PAH is associated with increased sympathetic nervous system (SNS) activation, decreased heart rate variability, and presence of cardiac arrhythmias. There is also evidence for increased renin-angiotensin-aldosterone system (RAAS) activation in PAH patients associated with clinical worsening. Reduction of neurohormonal activation could be an effective therapeutic strategy for PAH. Although therapies targeting adrenergic receptors or RAAS signaling pathways have been shown to reverse cardiac remodeling and improve outcomes in experimental pulmonary hypertension (PH)-models, the effectiveness and safety of such treatments in clinical settings have been uncertain. Recently, novel direct methods such as cervical ganglion block, pulmonary artery denervation (PADN), and renal denervation have been employed to attenuate SNS activation in PAH. In this review, we intend to summarize the multiple aspects of autonomic nervous system involvement in PAH and overview the different pharmacological and invasive strategies used to target autonomic nervous system for the treatment of PAH.

  19. Characteristic anatomical conformation of the vertebral artery causing vascular compression against the root exit zone of the facial nerve in patients with hemifacial spasm.

    Science.gov (United States)

    Park, Jung-Soo; Koh, Eun-Jeong; Choi, Ha-Young; Lee, Jong-Myong

    2015-03-01

    Hemifacial spasm (HFS) is caused by tortuous offending vessels near the facial nerve root exit zone. However, the definitive mechanism of offending vessel formation remains unclear. We hypothesized that vascular angulation and tortuosity, probably caused by uneven vertebral artery blood flow, result in vascular compression of the facial nerve root exit zone. The authors observed two anatomical characteristics of the vertebrobasilar arterial system in 120 subjects in the surgical group and 188 controls. The presence of the dominant vertebral artery (DVA) and laterality of the vertebrobasilar junction (VBJ) were observed. We also analyzed the morphological characteristics of the surgical group showing the presence of DVA. The morphological characteristics were classified into three types: type I had the VBJ and DVA on the same side, type II had the VBJ within 2 mm of the midline, and type III had the VBJ opposite the DVA. The DVA was more prevalent in the surgical group than in the control group (71 % versus 54 %, P DVA on the left (P DVA on the right (P DVA, which corresponds with the laterality of the HFS. In the surgical group with the DVA and HFS on the same side, type I was predominant, but in the surgical group with a contralateral DVA and HFS, type III was predominant. The presence of a DVA and shifting of the VBJ on the same side plays a role in the angulation and tortuosity of vessels in the perivertebrobasilar junction, resulting in neurovascular compression of the facial nerve root exit zone and thereby causing HFS.

  20. Clinical research of persimmon leaf extract and ginkgo biloba extract in the treatment of vertebrobasilar insufficiency.

    Science.gov (United States)

    Guo, S G; Guan, S H; Wang, G M; Liu, G Y; Sun, H; Wang, B J; Xu, F

    2015-01-01

    This paper aims to compare the curative effects of persimmon leaf extract and ginkgo biloba extract in the treatment of headache and dizziness caused by vertebrobasilar insufficiency. Sixty patients were observed, who underwent therapy with persimmon leaf extract and ginkgo biloba extract based on the treatment of nimodipine and aspirin. After 30 days, 30 patients treated with persimmon leaf extract and 30 patients with ginkgo biloba extract were examined for changes in hemodynamic indexes and symptoms, such as headache and dizziness. The results showed statistically significant differences of 88.3% for the persimmon leaf extract and 73.1% for the ginkgo biloba extract, P ginkgo biloba extract, the group of persimmon leaf extract had more apparent improvement in the whole blood viscosity, plasma viscosity, fibrinogen, hematokrit, and platelet adhesion rate, and the difference was statistically significant (P ginkgo biloba extract in many aspects, such as cerebral circulation improvement, cerebral vascular expansion, hypercoagulable state lowering and vertebrobasilar insufficiency-induced headache and dizziness relief.

  1. An Integrative Model of the Cardiovascular System Coupling Heart Cellular Mechanics with Arterial Network Hemodynamics

    Science.gov (United States)

    Kim, Young-Tae; Lee, Jeong Sang; Youn, Chan-Hyun; Choi, Jae-Sung

    2013-01-01

    The current study proposes a model of the cardiovascular system that couples heart cell mechanics with arterial hemodynamics to examine the physiological role of arterial blood pressure (BP) in left ventricular hypertrophy (LVH). We developed a comprehensive multiphysics and multiscale cardiovascular model of the cardiovascular system that simulates physiological events, from membrane excitation and the contraction of a cardiac cell to heart mechanics and arterial blood hemodynamics. Using this model, we delineated the relationship between arterial BP or pulse wave velocity and LVH. Computed results were compared with existing clinical and experimental observations. To investigate the relationship between arterial hemodynamics and LVH, we performed a parametric study based on arterial wall stiffness, which was obtained in the model. Peak cellular stress of the left ventricle and systolic blood pressure (SBP) in the brachial and central arteries also increased; however, further increases were limited for higher arterial stiffness values. Interestingly, when we doubled the value of arterial stiffness from the baseline value, the percentage increase of SBP in the central artery was about 6.7% whereas that of the brachial artery was about 3.4%. It is suggested that SBP in the central artery is more critical for predicting LVH as compared with other blood pressure measurements. PMID:23960442

  2. An integrative model of the cardiovascular system coupling heart cellular mechanics with arterial network hemodynamics.

    Science.gov (United States)

    Kim, Young-Tae; Lee, Jeong Sang; Youn, Chan-Hyun; Choi, Jae-Sung; Shim, Eun Bo

    2013-08-01

    The current study proposes a model of the cardiovascular system that couples heart cell mechanics with arterial hemodynamics to examine the physiological role of arterial blood pressure (BP) in left ventricular hypertrophy (LVH). We developed a comprehensive multiphysics and multiscale cardiovascular model of the cardiovascular system that simulates physiological events, from membrane excitation and the contraction of a cardiac cell to heart mechanics and arterial blood hemodynamics. Using this model, we delineated the relationship between arterial BP or pulse wave velocity and LVH. Computed results were compared with existing clinical and experimental observations. To investigate the relationship between arterial hemodynamics and LVH, we performed a parametric study based on arterial wall stiffness, which was obtained in the model. Peak cellular stress of the left ventricle and systolic blood pressure (SBP) in the brachial and central arteries also increased; however, further increases were limited for higher arterial stiffness values. Interestingly, when we doubled the value of arterial stiffness from the baseline value, the percentage increase of SBP in the central artery was about 6.7% whereas that of the brachial artery was about 3.4%. It is suggested that SBP in the central artery is more critical for predicting LVH as compared with other blood pressure measurements.

  3. Risk of vertebrobasilar stroke and chiropractic care: results of a population-based case-control and case-crossover study.

    Science.gov (United States)

    Cassidy, J David; Boyle, Eleanor; Côté, Pierre; He, Yaohua; Hogg-Johnson, Sheilah; Silver, Frank L; Bondy, Susan J

    2009-02-01

    Population-based, case-control and case-crossover study. To investigate associations between chiropractic visits and vertebrobasilar artery (VBA) stroke and to contrast this with primary care physician (PCP) visits and VBA stroke. Chiropractic care is popular for neck pain and headache, but may increase the risk for VBA dissection and stroke. Neck pain and headache are common symptoms of VBA dissection, which commonly precedes VBA stroke. Cases included eligible incident VBA strokes admitted to Ontario hospitals from April 1, 1993 to March 31, 2002. Four controls were age and gender matched to each case. Case and control exposures to chiropractors and PCPs were determined from health billing records in the year before the stroke date. In the case-crossover analysis, cases acted as their own controls. There were 818 VBA strokes hospitalized in a population of more than 100 million person-years. In those aged VBA stroke in those older than 45 years. Positive associations were found between PCP visits and VBA stroke in all age groups. Practitioner visits billed for headache and neck complaints were highly associated with subsequent VBA stroke. VBA stroke is a very rare event in the population. The increased risks of VBA stroke associated with chiropractic and PCP visits is likely due to patients with headache and neck pain from VBA dissection seeking care before their stroke. We found no evidence of excess risk of VBA stroke associated chiropractic care compared to primary care.

  4. Gamma knife radiosurgery to the trigeminal ganglion for treatment of trigeminal neuralgia secondary to vertebrobasilar ectasia

    Science.gov (United States)

    Somaza, Salvador; Hurtado, Wendy; Montilla, Eglee; Ghaleb, Jose

    2014-01-01

    Background: We report the result obtained using Gamma knife stereotactic radiosurgery on the trigeminal ganglion (TG) in a patient with trigeminal neuralgia (TN) secondary to vertebrobasilar ectasia (VBE). Case Description: Retrospective review of medical records corresponding to one patient with VBE-related trigeminal pain treated with radiosurgery. Because of the impossibility of visualization of the entry zone or the path of trigeminal nerve through the pontine cistern, we proceeded with stereotactic radiosurgery directed to the TG. The maximum radiation dose was 86 Gy with a 8-mm and a 4-mm collimator. The follow-up period was 24 months. The pain disappeared in 15 days, passing from Barrow Neurological Institute (BNI) grade V to BNI grade IIIa in 4 months and then to grade I. The patient did not experience noticeable subjective facial numbness. Conclusions: This experience showed that Gamma knife radiosurgery was effective in the management of VBE-related trigeminal pain, using the TG as radiosurgical target. PMID:25593782

  5. Autonomic Nervous System Responses to Concussion: Arterial Pulse Contour Analysis

    Directory of Open Access Journals (Sweden)

    Michael F La Fountaine

    2016-02-01

    Full Text Available The arterial pulse wave (APW has a distinct morphology whose contours reflect dynamics in cardiac function and peripheral vascular tone as a result of sympathetic nervous system (SNS control. With a transition from rest to increased metabolic demand, the expected augmentation of SNS outflow will not only affect arterial blood pressure and heart rate, it will also induce changes to the contours of the APW. Following a sports concussion, a transient state cardiovascular autonomic dysfunction is present. How this state affects the APW, has yet to be described. A prospective, parallel-group study on cardiovascular autonomic control (i.e., digital electrocardiogram and continuous beat-to-beat blood pressure was performed in the seated upright position in ten athletes with concussion and 7 non-injured control athletes. Changes in APW were compared at rest and during the first 60 seconds (F60 of an isometric handgrip test (IHGT in concussed athletes and non-injured controls within 48 hours (48hr and 1 week (1wk of injury. The concussion group was further separated by the length of time until they were permitted to return to play (RTP>1wk; RTP≤1wk. SysSlope, an indirect measurement of stroke volume, was significantly lower in the concussion group at rest and during F60 at 48hr and 1wk; a paradoxical decline in SysSlope occurred at each visit during the transition from rest to IHGT F60. The RTP>1wk group had lower SysSlope (405±200; 420±88; 454±236 mmHg/s, respectively at rest 48hr compared to the RTP≤1wk and controls. Similarly at 48hr rest, several measurements of arterial stiffness were abnormal in RTP>1wk compared to RTP≤1wk and controls: Peak-to-Notch Latency (0.12±0.04; 0.16±0.02; 0.17±0.05, respectively, Notch Relative Amplitude (0.70±0.03; 0.71±0.04; 0.66±0.14, respectively and Stiffness Index (6.4±0.2; 5.7±0.4; 5.8±0.5, respectively. Use of APW revealed that concussed athletes have a transient increase in peripheral artery

  6. Clinically Apparent Arterial Thrombosis in Persons with Systemic Vasculitis

    Directory of Open Access Journals (Sweden)

    Alexander Tsoukas

    2017-01-01

    Full Text Available Objective. To estimate the incidence rate of clinically apparent arterial thrombotic events and associated comorbidities in patients with primary systemic vasculitis. Methods. Using large cohort administrative data from Quebec, Canada, we identified patients with vasculitis, including polyarteritis nodosa (PAN and granulomatosis with polyangiitis (GPA. Incident acute myocardial infarctions (AMIs and cerebrovascular accidents (CVAs after the diagnosis of vasculitis were ascertained in the PAN and GPA group via billing and hospitalization data. These were compared to rates of a general population comparator group. The incidences of comorbidities (type 2 diabetes mellitus, dyslipidemia, and hypertension were also collected. Results. Among the 626 patients identified with vasculitis, 19.7% had PAN, 2.9% had Kawasaki disease, 23.8% had GPA, 52.4% had GCA, and 1.3% had Takayasu arteritis. The AMI rate was substantially higher in males aged 18–44 with PAN, with rates up to 268.1 events per 10,000 patient years [95% CI 67.1–1070.2], approximately 30 times that in the age- and sex-matched control group. The CVA rate was also substantially higher, particularly in adults aged 45–65. Patients with vasculitis had elevated incidences of diabetes, dyslipidemia, and hypertension versus the general population. Conclusion. Atherothrombotic rates were elevated in patients identified as having primary systemic vasculitis. While incident rates of cardiovascular comorbidities were also increased, the substantial elevation in AMIs seen in young adults suggests a disease-specific component which requires further investigation.

  7. Clinically Apparent Arterial Thrombosis in Persons with Systemic Vasculitis.

    Science.gov (United States)

    Tsoukas, Alexander; Bernatsky, Sasha; Joseph, Lawrence; Buckeridge, David L; Bélisle, Patrick; Pineau, Christian A

    2017-01-01

    To estimate the incidence rate of clinically apparent arterial thrombotic events and associated comorbidities in patients with primary systemic vasculitis. Using large cohort administrative data from Quebec, Canada, we identified patients with vasculitis, including polyarteritis nodosa (PAN) and granulomatosis with polyangiitis (GPA). Incident acute myocardial infarctions (AMIs) and cerebrovascular accidents (CVAs) after the diagnosis of vasculitis were ascertained in the PAN and GPA group via billing and hospitalization data. These were compared to rates of a general population comparator group. The incidences of comorbidities (type 2 diabetes mellitus, dyslipidemia, and hypertension) were also collected. Among the 626 patients identified with vasculitis, 19.7% had PAN, 2.9% had Kawasaki disease, 23.8% had GPA, 52.4% had GCA, and 1.3% had Takayasu arteritis. The AMI rate was substantially higher in males aged 18-44 with PAN, with rates up to 268.1 events per 10,000 patient years [95% CI 67.1-1070.2], approximately 30 times that in the age- and sex-matched control group. The CVA rate was also substantially higher, particularly in adults aged 45-65. Patients with vasculitis had elevated incidences of diabetes, dyslipidemia, and hypertension versus the general population. Atherothrombotic rates were elevated in patients identified as having primary systemic vasculitis. While incident rates of cardiovascular comorbidities were also increased, the substantial elevation in AMIs seen in young adults suggests a disease-specific component which requires further investigation.

  8. Internal carotid artery dissection following chiropractic treatment in a pregnant woman with Systemic Lupus Erythematosus

    Directory of Open Access Journals (Sweden)

    Morton Adam

    2012-12-01

    Full Text Available Abstract A case of internal carotid artery dissection in a pregnant woman with Systemic Lupus Erythematosus (SLE immediately following chiropractic treatment is presented. The literature regarding complications of neck manipulation during pregnancy, spontaneous dissection of craniocervical arteries in pregnancy and the postpartum period, and dissection of craniocervical arteries in SLE are reviewed. To the best of the author’s knowledge, this is the first case of carotid artery dissection following chiropractic treatment in a pregnant woman published in the literature.

  9. Venous and Arterial Thrombotic Events in Systemic Lupus Erythematosus.

    Science.gov (United States)

    Hinojosa-Azaola, Andrea; Romero-Diaz, Juanita; Vargas-Ruiz, Angel Gabriel; Nuñez-Alvarez, Carlos A; Cicero-Casarrubias, Alba; Ocampo-Torres, Mario C; Sanchez-Guerrero, Jorge

    2016-03-01

    The incidence of thrombosis in patients with systemic lupus erythematosus (SLE) is 25 to 50-fold higher than in the general population; we aimed to define the characteristics of venous thrombotic events (VTE) and arterial thrombotic events (ATE) to identify the patients at highest risk. The study included 219 patients with recent-onset SLE. At baseline, standardized medical history and laboratory tests were done. Followup visits occurred quarterly, and information about damage accrual, comorbidities, and cardiovascular risk factors was updated annually. Main outcome was development of TE after SLE diagnosis. Thirty-five patients (16%) developed TE (27 VTE, 8 ATE) during 5.21 years of followup; incidence rate 31/1000 patient-years. Most events (57%) developed within the first year of diagnosis, and 69% were not associated with lupus anticoagulant (LAC), determined with 1 method. VTE developed earlier than ATE (2.0 vs 57.5 mos, p = 0.02). In the multivariate analysis, variables preceding VTE included cutaneous vasculitis, nephrotic syndrome, dose of prednisone, and LAC in combination with anti-RNP/Sm antibodies (p LAC in combination with anti-RNP/Sm antibodies was associated with VTE and improved the accuracy for predicting it. Our study suggests that in SLE, VTE and ATE have different risk factors. Understanding these differences is helpful for identifying patients at highest risk. The use of LAC plus anti-RNP/Sm for predicting VTE deserves further study.

  10. Screening for pulmonary arterial hypertension in systemic sclerosis

    Directory of Open Access Journals (Sweden)

    J-L. Vachiéry

    2009-09-01

    Full Text Available The onset and progression of pulmonary arterial hypertension (PAH in patients with systemic sclerosis (SSc can be particularly aggressive; however, effective treatments are available. Therefore, early identification of patients with suspected PAH, confirmation of diagnosis, and intervention is essential. PAH may be challenging to diagnose in its earliest stages, particularly in populations that have multiple causes of breathlessness, and, therefore, screening is required. The optimal screening tools and methodology are, as yet, unknown, and this is confounded by a lack of consensus over which patients to screen. Current practice favours annual screening of all SSc patients using Doppler echocardiography to detect elevated right heart pressures. This will typically identify most patients with the various forms of pulmonary hypertension found in SSc. The optimum thresholds for Doppler echocardiography are still subject to investigation, especially for patients with mild pulmonary hypertension, and this technique may, therefore, yield a significant number of false-positives and a currently unknown number of false-negatives. Confirmatory right heart catheterisation remains necessary in all suspected cases. Further research is needed to identify the optimal tools and the screening approach with greatest specificity and selectivity.

  11. Medical decision-making system of ultrasound carotid artery intima-media thickness using neural networks.

    Science.gov (United States)

    Santhiyakumari, N; Rajendran, P; Madheswaran, M

    2011-12-01

    The objective of this work is to develop and implement a medical decision-making system for an automated diagnosis and classification of ultrasound carotid artery images. The proposed method categorizes the subjects into normal, cerebrovascular, and cardiovascular diseases. Two contours are extracted for each and every preprocessed ultrasound carotid artery image. Two types of contour extraction techniques and multilayer back propagation network (MBPN) system have been developed for classifying carotid artery categories. The results obtained show that MBPN system provides higher classification efficiency, with minimum training and testing time. The outputs of decision support system are validated with medical expert to measure the actual efficiency. MBPN system with contour extraction algorithms and preprocessing scheme helps in developing medical decision-making system for ultrasound carotid artery images. It can be used as secondary observer in clinical decision making.

  12. Anterior temporal artery tap to identify systemic interference using short-separation NIRS measurements

    DEFF Research Database (Denmark)

    Sood, Mehak; Jindal, Utkarsh; Chowdhury, Shubhajit Roy

    2015-01-01

    that are also affected by tDCS. An approach may be to use short optode separations to measure systemic hemodynamic fluctuations occurring in the superficial layers which can then be used as regressors to remove the systemic contamination. Here, we demonstrate that temporal artery tap may be used to better...... change in the mean rSO2 better correlated with the corresponding percent change in log-transformed mean-power of EEG within 0.5 Hz-11.25 Hz frequency band after removing the systemic contamination using the temporal artery tap method. Based on our findings, we propose that anterior temporal artery tap...

  13. Intravital live cell triggered imaging system reveals monocyte patrolling and macrophage migration in atherosclerotic arteries

    Science.gov (United States)

    McArdle, Sara; Chodaczek, Grzegorz; Ray, Nilanjan; Ley, Klaus

    2015-02-01

    Intravital multiphoton imaging of arteries is technically challenging because the artery expands with every heartbeat, causing severe motion artifacts. To study leukocyte activity in atherosclerosis, we developed the intravital live cell triggered imaging system (ILTIS). This system implements cardiac triggered acquisition as well as frame selection and image registration algorithms to produce stable movies of myeloid cell movement in atherosclerotic arteries in live mice. To minimize tissue damage, no mechanical stabilization is used and the artery is allowed to expand freely. ILTIS performs multicolor high frame-rate two-dimensional imaging and full-thickness three-dimensional imaging of beating arteries in live mice. The external carotid artery and its branches (superior thyroid and ascending pharyngeal arteries) were developed as a surgically accessible and reliable model of atherosclerosis. We use ILTIS to demonstrate Cx3cr1GFP monocytes patrolling the lumen of atherosclerotic arteries. Additionally, we developed a new reporter mouse (Apoe-/-Cx3cr1GFP/+Cd11cYFP) to image GFP+ and GFP+YFP+ macrophages "dancing on the spot" and YFP+ macrophages migrating within intimal plaque. ILTIS will be helpful to answer pertinent open questions in the field, including monocyte recruitment and transmigration, macrophage and dendritic cell activity, and motion of other immune cells.

  14. [Clinical-functional classification of combined occlusive lesions of the arterial system].

    Science.gov (United States)

    Konstantinov, B A; Belov, Iu V

    1995-01-01

    For a complex approach to the clinico-functional appraisal of the vascular system the authors suggest dividing the arterial system into 4 conventional functional basins: the coronary region (1), the brachiocephalic (2), the visceral (3), and the arterial basin of the lower extremities. In accordance with the 4 distinguished anatomo-functional vascular basins, the classification is designated by their first letters: HBVL, where H stands for the heart, B for the brain, V for the visceral vessels, and L for the lower extremities. Next to each letter is shown the functional class of arterial insufficiency of the vascular basin. The figure 0 denotes the absence of arterial stenosis. All the other figures from 1 to 4 reflect the functional severity of arterial insufficiency. The 1st functional class is characterized by the absence of a clinical picture of the disease in arterial stenosis, the 2nd class by the stage of subcompensation of circulation, and the 3rd and 4th classes by decompensation of circulation. The criteria for separating the degree of ischemia into functional classes are suggested. The HBVL classification is a working one because it not only illustrates and indicates fully the condition of arterial circulation in the vessels of the region but determines the tactics of treatment of the patient. The possibilities of the classification are illustrated by concrete clinical cases.

  15. Reducing the risk of fatal and disabling hypoglycaemia: a comparison of arterial blood sampling systems.

    Science.gov (United States)

    Brennan, K A; Eapen, G; Turnbull, D

    2010-04-01

    In 2008, the National Patient Safety Agency (NPSA) published a report after 42 incidents and two deaths where glucose-containing flush solutions were attached to the arterial line. The molar concentration of 5% glucose is 277 mmol litre(-1). Only a tiny amount of sample contamination will lead to an artificially high glucose. As the NPSA sought a solution, a bench model was constructed to compare the performance of three open and three closed arterial line systems in limiting sample contamination. All arterial line systems were set up in a standard manner and pressurized to 300 mm Hg with 5% glucose used as the flush solution. This was connected to the 'radial artery' using an 18 G needle representing the radial cannula. The radial artery was simulated using a wide-bore extension set with 'blood' flow at 60 ml min(-1). Blood was simulated by the addition of red dye to Hartmann's solution. Increasing multiples of arterial line dead space were aspirated and discarded. Blood samples were then obtained and glucose concentration was measured. Significant glucose contamination (3 mmol litre(-1) +/-3.4) was detected in all open arterial line systems up to an aspiration volume of five times the dead space. No samples from the closed systems recorded glucose concentration >1 mmol litre(-1). Recommended minimal discard volumes are inadequate in the presence of glucose as the flush solution and can lead to high blood glucose readings, inappropriate insulin use, and iatrogenic neuroglycopaenia. Our study demonstrates that the closed-loop arterial sampling system could be the universal solution sought by the NPSA.

  16. Treatment Challenges of a Primary Vertebral Artery Aneurysm Causing Recurrent Ischemic Strokes

    Directory of Open Access Journals (Sweden)

    Davide Strambo

    2017-01-01

    Full Text Available Background. Extracranial vertebral artery aneurysms are a rare cause of embolic stroke; surgical and endovascular therapy options are debated and long-term complication may occur. Case Report. A 53-year-old man affected by neurofibromatosis type 1 (NF1 came to our attention for recurrent vertebrobasilar embolic strokes, caused by a primary giant, partially thrombosed, fusiform aneurysm of the left extracranial vertebral artery. The aneurysm was treated by endovascular approach through deposition of Guglielmi Detachable Coils in the proximal segment of the left vertebral artery. Six years later the patient presented stroke recurrence. Cerebral angiography and Color Doppler Ultrasound well characterized the unique hemodynamic condition developed over the years responsible for the new embolic event: the aneurysm had been revascularized from its distal portion by reverse blood flow coming from the patent vertebrobasilar axis. A biphasic Doppler signal in the left vertebral artery revealed a peculiar behavior of the blood flow, alternately directed to the aneurysm and backwards to the basilar artery. Surgical ligation of the distal left vertebral artery and excision of the aneurysm were thus performed. Conclusion. This is the first described case of NF1-associated extracranial vertebral artery aneurysm presenting with recurrent embolic stroke. Complete exclusion of the aneurysm from the blood circulation is advisable to achieve full resolution of the embolic source.

  17. Coronary artery abnormalities in children with systemic-onset juvenile idiopathic arthritis.

    Science.gov (United States)

    Lefèvre-Utile, Alain; Galeotti, Caroline; Koné-Paut, Isabelle

    2014-05-01

    Still's disease (Systemic-onset Juvenile Idiopathic Arthritis: SoJIA) is characterised by high-spiking daily fevers, arthritis and evanescent rashes. Diagnosis of Still's disease is often challenging. Infectious diseases and other inflammatory conditions, especially in young children, Kawasaki disease may look similar. Clinicians often rely on echocardiographic evidence of coronary artery abnormalities to differentiate between Kawasaki disease and Still's disease. Coronary artery dilation would typically favour the diagnosis of Kawasaki disease. We present four children with Still's disease and coronary artery abnormalities who were initially misdiagnosed as Kawasaki disease. The first patient had pericarditis and an irregular wall of the left coronary artery, without dilation on echocardiography. The second patient had a left coronary artery dilatation and a pericarditis. The third patient had thickened left coronary artery walls, and the fourth patient had a hyperechogenicity of the left and right coronary arteries. They received IVIG without success. The diagnosis of Still's disease was made secondary with evidence of persistent arthritis. All but one patient finally needed biologic treatments. Coronary abnormalities may be observed during various febrile conditions and do not exclude the diagnosis of Still's disease. Copyright © 2013 Société française de rhumatologie. Published by Elsevier SAS. All rights reserved.

  18. Use of a wireless system to measure invasive arterial blood pressure in ponies - preliminary study.

    Science.gov (United States)

    Ricco, Carolina H; Quandt, Jane E; Novo, Roberto E; Killos, Maria; Graham, Lynelle

    2009-01-01

    To evaluate the feasibility and functionality of intra-carotid wireless device implantation in ponies, and to investigate its short-term complications. Prospective preliminary study. Five mixed breed, adult, intact male ponies weighing 104 +/- 28.8 kg (mean +/- SD) underwent surgery. Arterial blood pressure data were continuously collected from four animals. General anesthesia was induced on two consecutive days. On the first day, an intra-arterial wireless device was implanted in the right carotid artery. On the next day, a transcutaneous intra-arterial catheter was placed in the left facial artery. Data from both sources were collected. Post-mortem examination was performed. Surgical time was 27.1 +/- 11.85 minutes. All catheters remained in place with some extra vascular migration. Complications included mild seroma and hematoma. The wireless system allowed continuous monitoring in ponies throughout anesthesia and at rest and may allow for the recording of arterial blood pressure and heart rate when it would be difficult to achieve with a conventional system (e.g. during recovery from anesthesia). The wireless invasive blood pressure monitor may allow continuous measurements when only intermittent measurements would be feasible with a wired system.

  19. Stent-assited coil embolization of vertebrobasilar dissecting aneurysms: Procedual outcomes and factors for recanalization

    Energy Technology Data Exchange (ETDEWEB)

    Jeon, Jin Pyeong [Dept. of Neurosurgery, Hallym University College of Medicine, Chuncheon (Korea, Republic of); Cho, Young Dae; Cho, Won Sang; Kang, Huin Seung; Hwang, Gyo Hun; Kwon, O Ki; Han, Moon Hee [Seoul National University College of Medicine, Seoul National University Hospital, Seoul (Korea, Republic of); Rhim, Jong Kook [Dept. of Neurosurgery, Jeju National University College of Medicine, Jeju National University Hospital, Jeju (Korea, Republic of); Park, Jeong Jin [Dept. of Neurology, Konkuk University Hospital, Konkuk University School of Medicine, Seoul (Korea, Republic of)

    2016-09-15

    Outcomes of stent-assisted coil embolization (SACE) have not been well established in the setting of vertebrobasilar dissecting aneurysms (VBDAs) due to the low percentage of cases that need treatment and the array of available therapeutic options. Herein, we presented clinical and radiographic results of SACE in patients with VBDAs. A total of 47 patients (M:F, 30:17; mean age ± SD, 53.7 ± 12.6 years), with a VBDA who underwent SACE between 2008 and 2014 at two institutions were evaluated retrospectively. Medical records and radiologic data were analyzed to assess the outcome of SACE procedures. Cox proportional hazards regression analysis was conducted to determine the factors that were associated with aneurysmal recanalization after SACE.Stent-assisted coil embolization technically succeeded in all patients. Three cerebellar infarctions occurred on postembolization day 1, week 2, and month 2, but no other procedure-related complications developed. Immediately following SACE, 25 aneurysms (53.2%) showed no contrast filling into the aneurysmal sac. During a mean follow-up of 20.2 months, 37 lesions (78.7%) appeared completely occluded, whereas 10 lesions showed recanalization, 5 of which required additional embolization. Overall recanalization rate was 12.64% per lesion-year, and mean postoperative time to recanalization was 18 months (range, 3–36 months). In multivariable analysis, major branch involvement (hazard ratio [HR]: 7.28; p = 0.013) and the presence of residual sac filling (HR: 8.49, p = 0.044) were identified as statistically significant independent predictors of recanalization. No bleeding was encountered in follow-up monitoring. Stent-assisted coil embolization appears feasible and safe for treatment of VBDAs. Long-term results were acceptable in a majority of patients studied, despite a relatively high rate of incomplete occlusion immediately after SACE. Major branch involvement and coiled aneurysms with residual sac filling may predispose to

  20. Arterial stiffening, wave reflection, and inflammation in habitually exercising systemic lupus erythematosus patients.

    Science.gov (United States)

    Barnes, Jill N; Nualnim, Nantinee; Sugawara, Jun; Sommerlad, Shawn M; Renzi, Christopher P; Tanaka, Hirofumi

    2011-11-01

    Chronic systemic inflammation has been implicated in the pathogenesis of hypertension and cardiovascular disease. Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by chronic inflammation and an increased risk for cardiovascular disease. Currently few studies have evaluated the potential cardiovascular benefits of exercise in SLE. It is unknown whether the favorable effect of habitual exercise on arterial stiffness observed in healthy adults can be extended to SLE. Therefore, as an initial step, we determined the association between habitual exercise, inflammatory markers, central arterial compliance, and aortic wave reflection in healthy adults and SLE patients. We studied 41 adults, aged 33 ± 11 years (15 healthy controls, 12 sedentary SLE, and 14 physically active SLE patients). Age, body mass index, and metabolic risk factors were not different between the three groups. Carotid arterial compliance was lower whereas augmentation index (AI) and inflammatory markers (C-reactive protein (CRP), interleukin (IL)-12, tumor necrosis factor-α (TNF-α)) were higher in sedentary SLE patients compared with healthy controls, but were not different between physically active SLE patients and healthy controls. Cardiac ejection fraction was lower in sedentary SLE than physically active SLE or healthy controls. In the pooled population, carotid arterial compliance was inversely associated with TNF-α (r = -0.38; P exercising adults with SLE. Furthermore, greater arterial stiffness was associated with higher inflammatory markers, suggesting that need for studies on inflammation and SLE-associated arterial stiffening.

  1. Anatomy and arterial vascularization of female genital system of margay (Leopardus weidii

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    Andrezza Braga Soares Silva

    2016-02-01

    Full Text Available The margay (Leopardus wiedii belongs to Carnivora order and present’s nocturnal habits. There are few studies using this specie, whereas it is between feline species vulnerable to extinction. Thus, we propose a descriptive study about female genital system and behavior of the arteries responsible for the blood supply to these organs in margay. It used one exemplary victim of poaching that to death. The animal was stored in freezer. Subsequent to defrost at room temperature, it proceeded with the solution injection Leoprene Latex ‘650’ colored in red for better identification of vessels before the adjacent strutures. The specimen was fixed using an aqueous 10% formaldehyde with subsequent immersion in the same fixative solution. The genital system were dissected and the organs and arterial branches were identified and photodocumented. The female genital system of margay consists of a pair of ovaries, uterus with a pair of uterine horns, vagina and vulva. The arterial distribution of female system have a common vessel to iliac artery which branches and leads to internal pudendal artery sends a branch along the pudendal nerve pathway, urogenital artery. This, we performed divided into two branches, cranial and caudal. The cranial branch irrigates laterally cervix and uterine horns and caudal branch, vagina and vulva. The ovarian arteries, peers, originate from abdominal aorta only vascularization the ovaries. The female genital system and vascularization of the genitals organs of margay resembles of domestic carnivores including cats and some wild felines like the ocelot and find differences with the same description held in other domestic and wild species.

  2. Model of human cardiovascular system with a loop of autonomic regulation of the mean arterial pressure.

    Science.gov (United States)

    Karavaev, Anatoly S; Ishbulatov, Yurii M; Ponomarenko, Vladimir I; Prokhorov, Mikhail D; Gridnev, Vladimir I; Bezruchko, Boris P; Kiselev, Anton R

    2016-03-01

    A model of human cardiovascular system is proposed which describes the main heart rhythm, the regulation of heart function and blood vessels by the autonomic nervous system, baroreflex, and the formation of arterial blood pressure. The model takes into account the impact of respiration on these processes. It is shown that taking into account nonlinearity and introducing the autonomous loop of mean arterial blood pressure in the form of self-oscillating time-delay system allow to obtain the model signals whose statistical and spectral characteristics are qualitatively and quantitatively similar to those for experimental signals. The proposed model demonstrates the phenomenon of synchronization of mean arterial pressure regulatory system by the signal of respiration with the basic period close to 10 seconds, which is observed in the physiological experiments. Copyright © 2016 American Society of Hypertension. Published by Elsevier Inc. All rights reserved.

  3. Effect of volume expansion on systemic hemodynamics and central and arterial blood volume in cirrhosis

    DEFF Research Database (Denmark)

    Møller, Søren; Bendtsen, Flemming; Henriksen, Jens Henrik

    1995-01-01

    BACKGROUND & AIMS: Systemic vasodilatation in cirrhosis may lead to hemodynamic alterations with reduced effective blood volume and decreased arterial blood pressure. This study investigates the response of acute volume expansion on hemodynamics and regional blood volumes in patients with cirrhosis...... and in controls. METHODS: Thirty-nine patients with cirrhosis (12 patients with Child-Turcotte class A, 14 with class B, and 13 with class C) and 6 controls were studied. During hepatic vein catheterization, cardiac output, systemic vascular resistance, central and arterial blood volume, noncentral blood volume...... in patients with either class B or class C. Conversely, the noncentral blood volume increased in patients with class B and C. In both patients and controls, the cardiac output increased and the systemic vascular resistance decreased, whereas the mean arterial blood pressure did not change significantly...

  4. Acute Lead Exposure Increases Arterial Pressure: Role of the Renin-Angiotensin System

    Science.gov (United States)

    Simões, Maylla Ronacher; Ribeiro Júnior, Rogério F.; Vescovi, Marcos Vinícius A.; de Jesus, Honério C.; Padilha, Alessandra S.; Stefanon, Ivanita; Vassallo, Dalton V.; Salaices, Mercedes; Fioresi, Mirian

    2011-01-01

    Background Chronic lead exposure causes hypertension and cardiovascular disease. Our purpose was to evaluate the effects of acute exposure to lead on arterial pressure and elucidate the early mechanisms involved in the development of lead-induced hypertension. Methodology/Principal Findings Wistar rats were treated with lead acetate (i.v. bolus dose of 320 µg/Kg), and systolic arterial pressure, diastolic arterial pressure and heart rate were measured during 120 min. An increase in arterial pressure was found, and potential roles of the renin-angiotensin system, Na+,K+-ATPase and the autonomic reflexes in this change in the increase of arterial pressure found were evaluated. In anesthetized rats, lead exposure: 1) produced blood lead levels of 37±1.7 µg/dL, which is below the reference blood concentration (60 µg/dL); 2) increased systolic arterial pressure (Ct: 109±3 mmHg vs Pb: 120±4 mmHg); 3) increased ACE activity (27% compared to Ct) and Na+,K+-ATPase activity (125% compared to Ct); and 4) did not change the protein expression of the α1-subunit of Na+,K+-ATPase, AT1 and AT2. Pre-treatment with an AT1 receptor blocker (losartan, 10 mg/Kg) or an ACE inhibitor (enalapril, 5 mg/Kg) blocked the lead-induced increase of arterial pressure. However, a ganglionic blockade (hexamethonium, 20 mg/Kg) did not prevent lead's hypertensive effect. Conclusion Acute exposure to lead below the reference blood concentration increases systolic arterial pressure by increasing angiotensin II levels due to ACE activation. These findings offer further evidence that acute exposure to lead can trigger early mechanisms of hypertension development and might be an environmental risk factor for cardiovascular disease. PMID:21494558

  5. Acute lead exposure increases arterial pressure: role of the renin-angiotensin system.

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    Maylla Ronacher Simões

    Full Text Available BACKGROUND: Chronic lead exposure causes hypertension and cardiovascular disease. Our purpose was to evaluate the effects of acute exposure to lead on arterial pressure and elucidate the early mechanisms involved in the development of lead-induced hypertension. METHODOLOGY/PRINCIPAL FINDINGS: Wistar rats were treated with lead acetate (i.v. bolus dose of 320 µg/Kg, and systolic arterial pressure, diastolic arterial pressure and heart rate were measured during 120 min. An increase in arterial pressure was found, and potential roles of the renin-angiotensin system, Na(+,K(+-ATPase and the autonomic reflexes in this change in the increase of arterial pressure found were evaluated. In anesthetized rats, lead exposure: 1 produced blood lead levels of 37±1.7 µg/dL, which is below the reference blood concentration (60 µg/dL; 2 increased systolic arterial pressure (Ct: 109±3 mmHg vs Pb: 120±4 mmHg; 3 increased ACE activity (27% compared to Ct and Na(+,K(+-ATPase activity (125% compared to Ct; and 4 did not change the protein expression of the α1-subunit of Na(+,K(+-ATPase, AT(1 and AT(2. Pre-treatment with an AT(1 receptor blocker (losartan, 10 mg/Kg or an ACE inhibitor (enalapril, 5 mg/Kg blocked the lead-induced increase of arterial pressure. However, a ganglionic blockade (hexamethonium, 20 mg/Kg did not prevent lead's hypertensive effect. CONCLUSION: Acute exposure to lead below the reference blood concentration increases systolic arterial pressure by increasing angiotensin II levels due to ACE activation. These findings offer further evidence that acute exposure to lead can trigger early mechanisms of hypertension development and might be an environmental risk factor for cardiovascular disease.

  6. Eugenol dilates mesenteric arteries and reduces systemic BP by activating endothelial cell TRPV4 channels.

    Science.gov (United States)

    Peixoto-Neves, Dieniffer; Wang, Qian; Leal-Cardoso, Jose H; Rossoni, Luciana V; Jaggar, Jonathan H

    2015-07-01

    Eugenol, a vanilloid molecule found in some dietary plants, relaxes vasculature in part via an endothelium-dependent process; however, the mechanisms involved are unclear. Here, we investigated the endothelial cell-mediated mechanism by which eugenol modulates rat mesenteric artery contractility and systemic BP. The isometric tension of rat mesenteric arteries (size 200-300 μm) was measured using wire myography; non-selective cation currents (ICat ) were recorded in endothelial cells using patch clamp electrophysiology. Mean arterial pressure (MAP) and heart rate (HR) were determined in anaesthetized rats. Eugenol relaxed endothelium-intact arteries in a concentration-dependent manner and this effect was attenuated by endothelium denudation. L-NAME, a NOS inhibitor, a combination of TRAM-34 and apamin, selective blockers of intermediate and small conductance Ca(2+) -activated K(+) channels, respectively, and HC-067047, a TRPV4 channel inhibitor, but not indomethacin, a COX inhibitor, reduced eugenol-induced relaxation in endothelium-intact arteries. Eugenol activated HC-067047-sensitive ICat in mesenteric artery endothelial cells. Short interfering RNA (siRNA)-mediated TRPV4 knockdown abolished eugenol-induced ICat activation. An i.v. injection of eugenol caused an immediate, transient reduction in both MAP and HR, which was followed by prolonged, sustained hypotension in anaesthetized rats. This sustained hypotension was blocked by HC-067047. Eugenol activates TRPV4 channels in mesenteric artery endothelial cells, leading to vasorelaxation, and reduces systemic BP in vivo. Eugenol may be therapeutically useful as an antihypertensive agent and is a viable molecular candidate from which to develop second-generation TRPV4 channel activators that reduce BP. © 2015 The British Pharmacological Society.

  7. Earliest effects of sudden occlusions on pressure profiles in selected locations of the human systemic arterial system

    Science.gov (United States)

    Majka, Marcin; Gadda, Giacomo; Taibi, Angelo; Gałązka, Mirosław; Zieliński, Piotr

    2017-03-01

    We have developed a numerical simulation method for predicting the time dependence (wave form) of pressure at any location in the systemic arterial system in humans. The method uses the matlab-Simulink environment. The input data include explicitly the geometry of the arterial tree, treated up to an arbitrary bifurcation level, and the elastic properties of arteries as well as rheological parameters of blood. Thus, the impact of anatomic details of an individual subject can be studied. The method is applied here to reveal the earliest stages of mechanical reaction of the pressure profiles to sudden local blockages (thromboses or embolisms) of selected arteries. The results obtained with a purely passive model provide reference data indispensable for studies of longer-term effects due to neural and humoral mechanisms. The reliability of the results has been checked by comparison of two available sets of anatomic, elastic, and rheological data involving (i) 55 and (ii) 138 arterial segments. The remaining arteries have been replaced with the appropriate resistive elements. Both models are efficient in predicting an overall shift of pressure, whereas the accuracy of the 55-segment model in reproducing the detailed wave forms and stabilization times turns out dependent on the location of the blockage and the observation point.

  8. Serum VEGF levels are related to the presence of pulmonary arterial hypertension in systemic sclerosis

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    Sakkas Lazaros

    2009-05-01

    Full Text Available Abstract Background The association between systemic sclerosis and pulmonary arterial hypertension (PAH is well recognized. Vascular endothelial growth factor (VEGF has been reported to play an important role in pulmonary hypertension. The aim of the present study was to examine the relationship between systolic pulmonary artery pressure, clinical and functional manifestations of the disease and serum VEGF levels in systemic sclerosis. Methods Serum VEGF levels were measured in 40 patients with systemic sclerosis and 13 control subjects. All patients underwent clinical examination, pulmonary function tests and echocardiography. Results Serum VEGF levels were higher in systemic sclerosis patients with sPAP ≥ 35 mmHg than in those with sPAP LCO were independent predictors of systolic pulmonary artery pressure. Conclusion Serum VEGF levels are increased in systemic sclerosis patients with sPAP ≥ 35 mmHg. The correlation between VEGF levels and systolic pulmonary artery pressure may suggest a possible role of VEGF in the pathogenesis of PAH in systemic sclerosis.

  9. Congenital anomalous/aberrant systemic artery to pulmonary venous fistula: Closure with vascular plugs & coil embolization

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    Pankaj Jariwala

    2014-01-01

    Full Text Available A 7-month-old girl with failure to thrive, who, on clinical and diagnostic evaluation [echocardiography & CT angiography] to rule out congenital heart disease, revealed a rare vascular anomaly called systemic artery to pulmonary venous fistula. In our case, there was dual abnormal supply to the entire left lung as1 anomalous supply by normal systemic artery [internal mammary artery]2 and an aberrant feeder vessel from the abdominal aorta. Left Lung had normal bronchial connections and normal pulmonary vasculature. The fistula drained through the pulmonary veins to the left atrium leading to ‘left–left shunt’. Percutaneous intervention in two stages was performed using Amplatzer vascular plugs and coil embolization to close them successfully. The patient gained significant weight in follow up with other normal developmental and mental milestones.

  10. Acute Hearing Loss Caused by Decreasing Anterior Inferior Cerebellar Arterial Perfusion in a Patient with Vertebral Artery Stenosis.

    Science.gov (United States)

    Fukuda, Rintaro; Miyamoto, Nobukazu; Hayashida, Arisa; Ueno, Yuji; Yamashiro, Kazuo; Tanaka, Ryota; Hattori, Nobutaka

    2017-06-01

    We report a case of bilateral hearing loss caused by decreased vascular flow in the anterior inferior cerebellar artery (AICA) territory. A 74-year-old man who experienced right hearing loss 5 months ago presented with bilateral deafness and right cerebellar ataxia; however, no ischemic lesion was detected in the bilateral AICA area. After stroke treatment, hearing loss was improved. One month later, we obtained blood flow improvement in the left AICA territory on single-photon-emission computed tomography and vertebral artery stenosis on magnetic resonance angiography. Therefore, clinicians should recognize that bilateral hearing loss may be related to stroke in the vertebrobasilar artery area. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  11. Effects of diabetes mellitus and systemic arterial hypertension on elderly patients' hearing.

    Science.gov (United States)

    Rolim, Laurie Penha; Samelli, Alessandra Giannella; Moreira, Renata Rodrigues; Matas, Carla Gentile; Santos, Itamar de Souza; Bensenor, Isabela Martins; Lotufo, Paulo Andrade

    2017-09-21

    Chronic diseases can act as an accelerating factor in the auditory system degeneration. Studies on the association between presbycusis and diabetes mellitus and systemic arterial hypertension have shown controversial conclusions. To compare the initial audiometry (A1) with a subsequent audiometry (A2) performed after a 3 to 4-year interval in a population of elderly patients with diabetes mellitus and/or systemic arterial hypertension, to verify whether hearing loss in these groups is more accelerated when compared to controls without these clinical conditions. 100 elderly individuals participated in this study. For the auditory threshold assessment, a previous complete audiological evaluation (A1) and a new audiological evaluation (A2) performed 3-4 years after the first one was utilized. The participants were divided into four groups: 20 individuals in the diabetes mellitus group, 20 individuals in the systemic arterial hypertension group, 20 individuals in the diabetes mellitus/systemic arterial hypertension group and 40 individuals in the control group, matching them with each study group, according to age and gender. ANOVA and Kruskal-Wallis statistical tests were used, with a significance level set at 0.05. When comparing the mean annual increase in the auditory thresholds of the A1 with the A2 assessment, considering each study group and its respective control, it can be observed that there was no statistically significant difference for any of the frequencies for the diabetes mellitus group; for the systemic arterial hypertension group, significant differences were observed after 4kHz. For the diabetes mellitus and systemic arterial hypertension group, significant differences were observed at the frequencies of 500, 2kHz, 3kHz and 8kHz. It was observed that the systemic arterial hypertension group showed the greatest decrease in auditory thresholds in the studied segment when compared to the other groups, suggesting that among the three studied conditions

  12. Endovascular Treatment of an Aneurysmal Aberrant Systemic Artery Supplying a Pulmonary Sequestrum

    DEFF Research Database (Denmark)

    Kristensen, Katrine Lawaetz; Duus, Louise Aarup; Elle, Bo

    2015-01-01

    An aberrant systemic artery originating from the abdominal aorta supplying a pulmonary sequestration is a rare congenital malformation. This causes a left-to-left shunt. Symptoms include recurrent pneumonias, hemoptysis, and, in the long term, heart failure. Aneurysm of the aberrant vessel...

  13. Sympathetic nervous system activation, arterial shear rate, and flow-mediated dilation.

    NARCIS (Netherlands)

    Thijssen, D.H.J.; Atkinson, C.L.; Ono, K.; Sprung, V.S.; Spence, A.L.; Pugh, C.J.; Green, D.J.

    2014-01-01

    The aim of this study was to examine the contribution of arterial shear to changes in flow-mediated dilation (FMD) during sympathetic nervous system (SNS) activation in healthy humans. Ten healthy men reported to our laboratory four times. Bilateral FMD, shear rate (SR), and catecholamines were

  14. Anomalous Systemic Artery to a Normal Lung: A Rare Cause of Hemoptysis in Adults

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    Ashu Seith Bhalla

    2012-07-01

    Full Text Available Bronchopulmonary sequestration represents a spectrum of abnormalities. One of these abnormalities is an aberrant systemic arterial supply to a normal lung with no bronchial sequestration. These lesions were originally classified by Pryce as type 1. Most of these patients are asymptomatic but with time, many patients develop localized pulmonary hypertension, hemoptysis, and eventually high output cardiac failure. Multidetector computed tomography (MDCT plays an important role in the diagnosis and planning of definitive treatment by identifying the origin and course of the aberrant artery. Definitive treatment can be surgical (lobectomy or segmentectomy or endovascular.

  15. Exercise-induced brachial artery blood flow and vascular function is impaired in systemic sclerosis.

    Science.gov (United States)

    Machin, Daniel R; Clifton, Heather L; Garten, Ryan S; Gifford, Jayson R; Richardson, Russell S; Wray, D Walter; Frech, Tracy M; Donato, Anthony J

    2016-12-01

    Systemic sclerosis (SSc) is a rare autoimmune disease characterized by debilitating fibrosis and vascular dysfunction; however, little is known about the circulatory response to exercise in this population. Therefore, we examined the peripheral hemodynamic and vasodilatory responses to handgrip exercise in 10 patients with SSc (61 ± 4 yr) and 15 age-matched healthy controls (56 ± 5 yr). Brachial artery diameter, blood flow, and mean arterial pressure (MAP) were determined at rest and during progressive static-intermittent handgrip exercise. Patients with SSc and controls were similar in body stature, handgrip strength, and MAP; however, brachial artery blood flow at rest was nearly twofold lower in patients with SSc compared with controls (22 ± 4 vs. 42 ± 5 ml/min, respectively; P exercise, there were no differences in MAP between the groups, exercise-induced hyperemia and therefore vascular conductance were ∼35% lower at all exercise workloads in patients with SSc (P exercise-induced brachial artery blood flow and conduit arterial vasodilatory dysfunction during handgrip exercise in SSc and suggest that elevated oxidative stress may play a role.

  16. Incorporating autoregulatory mechanisms of the cardiovascular system in three-dimensional finite element models of arterial blood flow.

    Science.gov (United States)

    Kim, H J; Jansen, K E; Taylor, C A

    2010-07-01

    The cardiovascular system is a closed-loop system in which billions of vessels interact with each other, and it enables the control of the systemic arterial pressure and varying organ flow through autoregulatory mechanisms. In this study, we describe the development of mathematical models of autoregulatory mechanisms for systemic arterial pressure and coronary flow and discuss the connection of these models to a hybrid numerical/analytic closed-loop model of the cardiovascular system. The closed-loop model consists of two lumped parameter heart models representing the left and right sides of the heart, a three-dimensional finite element model of the aorta with coronary arteries, three-element Windkessel models and lumped parameter coronary vascular models that represent the systemic circulation, and a three-element Windkessel model to approximate the pulmonary circulation. Using the connection between the systemic arterial pressure and coronary flow regulation systems, and the hybrid closed-loop model, we studied how the heart, coronary vascular beds, and arterial system respond to physiologic changes during light exercise and showed that these models can realistically simulate temporal behaviors of the heart, coronary vascular beds, and arterial system during exercise of healthy subjects. These models can be used to study temporal changes occurring in the heart, coronary vascular beds, and arterial system during cardiovascular intervention or changes in physiological states.

  17. Exercise and arterial adaptation in humans: uncoupling localized and systemic effects.

    Science.gov (United States)

    Rowley, Nicola J; Dawson, Ellen A; Birk, Gurpreet K; Cable, N Timothy; George, Keith; Whyte, Greg; Thijssen, Dick H J; Green, Daniel J

    2011-05-01

    Previous studies have established effects of exercise training on arterial wall thickness, remodeling, and function in humans, but the extent to which these changes are locally or systemically mediated is unclear. We examined the brachial arteries of the dominant (D) and nondominant (ND) upper limbs of elite racquet sportsmen and compared them to those of matched healthy inactive controls. Carotid and superficial femoral artery responses were also assessed in both groups. High-resolution duplex ultrasound was used to examine resting diameter, wall thickness, peak diameter, and blood flow. We found larger resting arterial diameter in the preferred arm of the athletes (4.9 ± 0.5 mm) relative to their nonpreferred arm (4.3 ± 0.4 mm, P < 0.05) and both arms of control subjects (D: 4.1 ± 0.4 mm; ND: 4.0 ± 0.4, P < 0.05). Similar limb-specific differences were also evident in brachial artery dilator capacity (5.5 ± 0.5 vs. 4.8 ± 0.4, 4.8 ± 0.6, and 4.8 ± 0.6 mm, respectively; P < 0.05) following glyceryl trinitrate administration and peak blood flow (1,118 ± 326 vs. 732 ± 320, 737 ± 219, and 698 ± 174 ml/min, respectively; P < 0.05) following ischemic handgrip exercise. In contrast, athletes demonstrated consistently lower wall thickness in carotid (509 ± 55 μm), brachial (D: 239 ± 100 μm; ND: 234 ± 133 μm), and femoral (D: 479 ± 38 μm; ND: 479 ± 42 μm) arteries compared with control subjects (carotid: 618 ± 74 μm; brachial D: 516 ± 100 μm; ND: 539 ± 129 μm; femoral D: 634 ± 155 μm; ND: 589 ± 112 μm; all P < 0.05 vs. athletes), with no differences between the limbs of either group. These data suggest that localized effects of exercise are evident in the remodeling of arterial size, whereas arterial wall thickness appears to be affected by systemic factors.

  18. Computer-Aided Diagnostics of Human Arterial System

    Directory of Open Access Journals (Sweden)

    Klara Capova

    2003-01-01

    Full Text Available The paper deals with the modelling and the simulation of physiological fluid systems laying emphasise on the human vascular system. The presented simulation method has been developed as a helpful tool for the computer-aided non-invasive diagnostics of living bodies. Using the electromechanical analogy between physiological and electrical values the introduced method makes possible the description and 3D representation of the non-linear characteristics of the human haemodynamics as well. The simulation procedure and the obtained results verified by the experiment enable to visualize all physiological and pathophysiological states of the human vascular system.

  19. Percutaneous implantation of intra-arterial port system for regional drug infusion: results and complications in 110 cases

    Energy Technology Data Exchange (ETDEWEB)

    Won, Je Hwan; Lee, Jong Hyuk [College of Medicine, Ajou University, Seoul (Korea, Republic of); Ko, Kyung Hee; Won, Jong Yoon; Park, Sung Il; Lee, Do Yun [College of Medicine, Yonsei University, Seoul (Korea, Republic of); Kang, Byung Chul [Mokdong Hospital, College of Medicine, Ehwa Womans University, Seoul (Korea, Republic of)

    2000-10-01

    To investigate the feasibility and complications of a percutaneously implantable port system for regional drug infusion. For intra-arterial drug infusion, a 5.8 or 5-F pediatric venous port system was implanted in 110 patients with hepatocellular carcinoma (n=79), liver metastasis (n=16), gallbladder cancer (n=4), stomach cancer (n=3), pancreatic cancer (n=3), Burger's diseases mellitus (n=2), or lymphoma (n=1). All intra-arterial port implantations were performed percutaneously in an angiographic ward through the common femoral artery (n=98), left subclavian artery (n=10), or left superficial femoral artery (n=2). Complications were evaluated during the follow-up period, which ranged from 21 to 530 (mean, 163) days. The technical success rate for percutaneous implantation of the system was 97.3% (107 of 110 patients). The tips of the port catheter were located in the common hepatic artery (n=34), proper hepatic artery (n=49), right hepatic artery quick resulthepatic artery (n=1), descending aorta at T9 level (n=10), left popliteal artery (n=2), right external iliac artery (n=1), left external iliac artery (n=1), or left deep femoral artery (n=1). Complications were encountered in 24 patients (22.4%), namely chamber site infection (n=7), catheter dislodgement (n=7), catheter occlusion (n=3), migration of coil (n=2), disconnection between chamber and catheter (n=1), kinking of catheter (n=1), arterial occlusion (n=1), necrosis of overlying skin (n=1), and leakage around port chamber (n=1). Outcomes of complications included removal of port systems or cessation of therapy in 12 cases (11.2%), correction of catheter location using a guide wire in five (4.7%), thrombolysis with urokinase in three (2.8%), and straightening using a snare in one (0.9%). In three patients, the port system was used without reintervention. Percutaneous implantation of an intra-arterial port system showed a high technical success rate and a low rate of serious complications. The method

  20. Coronary Arteries

    Science.gov (United States)

    ... animations for grades K-6. The Coronary Arteries Coronary Circulation The heart muscle, like every other organ or ... the heart by its own vascular system, called coronary circulation. The aorta (the main blood supplier to the ...

  1. Dysregulated renin-angiotensin-aldosterone system contributes to pulmonary arterial hypertension

    Science.gov (United States)

    De Man, Frances; Tu, Ly; Handoko, Louis; Rain, Silvia; Ruiter, Gerrina; François, Charlène; Schalij, Ingrid; Dorfmüller, Peter; Simonneau, Gérald; Fadel, Elie; Perros, Frederic; Boonstra, Anco; Postmus, Piet; Van Der Velden, Jolanda; Vonk-Noordegraaf, Anton; Humbert, Marc; Eddahibi, Saadia; Guignabert, Christophe

    2012-01-01

    Rationale Patients with idiopathic pulmonary arterial hypertension (iPAH) often have a low cardiac output. To compensate, neurohormonal systems like renin-angiotensin-aldosterone system (RAAS) and sympathetic nervous system are upregulated but this may have long-term negative effects on the progression of iPAH. Objectives Assess systemic and pulmonary RAAS-activity in iPAH-patients and determine the efficacy of chronic RAAS-inhibition in experimental PAH. Measurements and Main Results We collected 79 blood samples from 58 iPAH-patients in the VU University Medical Center Amsterdam (between 2004–2010), to determine systemic RAAS-activity. We observed increased levels of renin, angiotensin (Ang) I and AngII, which was associated with disease progression (p<0.05) and mortality (p<0.05). To determine pulmonary RAAS-activity, lung specimens were obtained from iPAH-patients (during lung transplantation, n=13) and controls (during lobectomy or pneumonectomy for cancer, n=14). Local RAAS-activity in pulmonary arteries of iPAH-patients was increased, demonstrated by elevated ACE-activity in pulmonary endothelial cells and increased AngII type 1 (AT1) receptor expression and signaling. In addition, local RAAS- upregulation was associated with increased pulmonary artery smooth muscle cell proliferation via enhanced AT1-receptor signaling in iPAH-patients compared to controls. Finally, to determine the therapeutic potential of RAAS-activity, we assessed the chronic effects of an AT1-receptor antagonist (losartan) in the monocrotaline PAH-rat model (60 mg/kg). Losartan delayed disease progression, decreased RV afterload and pulmonary vascular remodeling and restored right ventricular-arterial coupling in PAH-rats. Conclusions Systemic and pulmonary RAAS-activities are increased in iPAH-patients and associated with increased pulmonary vascular remodeling. Chronic inhibition of RAAS by losartan is beneficial in experimental PAH. PMID:22859525

  2. Anatomia do circuito arterial do encéfalo em Tamanduá-mirim Anatomy of encephalon arterial circuit in lesser anteater

    Directory of Open Access Journals (Sweden)

    Ana Rita Lima

    2013-02-01

    for vessels systematization. The encephalon arterial circuit of lesser anteater surrounds the mammillary body, the interpeduncular fossa, tuber cinereum, hypophysis and optic chiasm. The rostral portion of this circuit is characterized by rostral branches of internal carotid arteries and the caudal portion is formed by caudal communicant arteries from internal carotid artery. This animal species had a type II of encephalic irrigation with participation of internal carotid arteries and vertebrobasilar system to formation of arterial circuit.

  3. Anatomical variations of the celiac trunk and hepatic arterial system: an analysis using multidetector computed tomography angiography

    Energy Technology Data Exchange (ETDEWEB)

    Araujo Neto, Severino Aires; Franca, Henrique Almeida; Mello Junior, Carlos Fernando de; Silva Neto, Eulampio Jose; Negromonte, Gustavo Ramalho Pessoa; Duarte, Claudia Martina Araujo; Cavalcanti Neto, Bartolomeu Fragoso; Farias, Rebeca Danielly da Fonseca, E-mail: severinoaires@hotmail.com [Universidade Federal da Paraiba (UFPB), Joao Pessoa, PB (Brazil)

    2015-11-15

    Objective: To analyze the prevalence of anatomical variations of celiac arterial trunk (CAT) branches and hepatic arterial system (HAS), as well as the CAT diameter, length and distance to the superior mesenteric artery. Materials And Methods: Retrospective, cross-sectional and predominantly descriptive study based on the analysis of multidetector computed tomography images of 60 patients. Results: The celiac trunk anatomy was normal in 90% of cases. Hepatosplenic trunk was found in 8.3% of patients, and hepatogastric trunk in 1.7%. Variation of the HAS was observed in 21.7% of cases, including anomalous location of the right hepatic artery in 8.3% of cases, and of the left hepatic artery, in 5%. Also, cases of joint relocation of right and left hepatic arteries, and trifurcation of the proper hepatic artery were observed, respectively, in 3 (5%) and 2 (3.3%) patients. Mean length and caliber of the CAT were 2.3 cm and 0.8 cm, respectively. Mean distance between CAT and superior mesenteric artery was 1.2 cm (standard deviation = 4.08). A significant correlation was observed between CAT diameter and length, and CAT diameter and distance to superior mesenteric artery. Conclusion: The pattern of CAT variations and diameter corroborate the majority of the literature data. However, this does not happen in relation to the HAS. (author)

  4. [Effects of a combined regime of auricular-plaster and body acupuncture in treatment of cervical spondylosis of vertebral artery type].

    Science.gov (United States)

    Zhang, Hui-Lan; Zhong, Yuan-Ming; Peng, Guo-Min; Wan, Yi-Gang

    2006-10-01

    To study effects of a combined regime of auricular-plaster and body acupuncture in treatment of cervical spondylosis of vertebral artery type and make a preliminary revelation of the mechanism. Ninety-two patients were randomly divided into 2 groups, the treatment group (n = 56) received the combined regime of auricular-plaster and body acupuncture, and the control group (n = 36) received treatment with body acupuncture. Clinical symptoms and signs, therapeutic effect and some indexes about vertebrobasilar hema-kinetics and hema-rheology were investigated before and after treatment. The treatment group was better than the control group in the clinical overall effective rate (89.29%) and the clinically control rate (17. 85%), and in improving the following indexes, including dizziness and headache, the vertebrobasilar volume and rate of blood flow etab and IR (P Malaysia and in China.

  5. Effect of volume expansion on systemic hemodynamics and central and arterial blood volume in cirrhosis

    DEFF Research Database (Denmark)

    Møller, S; Bendtsen, F; Henriksen, Jens Henrik Sahl

    1995-01-01

    and in controls. METHODS: Thirty-nine patients with cirrhosis (12 patients with Child-Turcotte class A, 14 with class B, and 13 with class C) and 6 controls were studied. During hepatic vein catheterization, cardiac output, systemic vascular resistance, central and arterial blood volume, noncentral blood volume...... in patients with either class B or class C. Conversely, the noncentral blood volume increased in patients with class B and C. In both patients and controls, the cardiac output increased and the systemic vascular resistance decreased, whereas the mean arterial blood pressure did not change significantly....... CONCLUSIONS: Only in mild cirrhosis is the effective blood volume able to increase in response to volume expansion. Our results are consistent with the peripheral vasodilatation hypothesis and the circulatory hyporeactivity occurring in advanced cirrhosis....

  6. The Impact of System Factors on Quality and Safety in Arterial Surgery: A Systematic Review.

    Science.gov (United States)

    Lear, R; Godfrey, A D; Riga, C; Norton, C; Vincent, C; Bicknell, C D

    2017-07-01

    A systems approach to patient safety proposes that a wide range of factors contribute to surgical outcome, yet the impact of team, work environment, and organisational factors, is not fully understood in arterial surgery. The aim of this systematic review is to summarize and discuss what is already known about the impact of system factors on quality and safety in arterial surgery. A systematic review of original research papers in English using MEDLINE, Embase, PsycINFO, and Cochrane databases, was performed according to PRISMA guidelines. Independent reviewers selected papers according to strict inclusion and exclusion criteria, and using predefined data fields, extracted relevant data on team, work environment, and organisational factors, and measures of quality and/or safety, in arterial procedures. Twelve papers met the selection criteria. Study endpoints were not consistent between papers, and most failed to report their clinical significance. A variety of tools were used to measure team skills in five papers; only one paper measured the relationship between team factors and patient outcomes. Two papers reported that equipment failures were common and had a significant impact on operating room efficiency. The influence of hospital characteristics on failure-to-rescue rates was tested in one large study, although their conclusions were limited to the American Medicare population. Five papers implemented changes in the patient pathway, but most studies failed to account for potential confounding variables. A small number of heterogenous studies have evaluated the relationship between system factors and quality or safety in arterial surgery. There is some evidence of an association between system factors and patient outcomes, but there is more work to be done to fully understand this relationship. Future research would benefit from consistency in definitions, the use of validated assessment tools, measurement of clinically relevant endpoints, and adherence to

  7. Status of Systemic To Pulmonary Arterial Collateral Flow After the Fontan Procedure

    OpenAIRE

    Whitehead, Kevin K.; Harris, Matthew A.; Glatz, Andrew C.; Gillespie, Matthew J.; DiMaria, Michael V.; Harrison, Neil E.; Dori, Yoav; Keller, Marc S.; Rome, Jonathan J.; Fogel, Mark A.

    2015-01-01

    We recently validated a method of quantifying systemic to pulmonary arterial collateral flow using phase-contrast magnetic resonance imaging velocity mapping (PC-MRI). Cross-sectional data suggest decreased collateral flow in patients with total cavopulmonary connections (TCPC) compared to those with superior cavopulmonary connections (SCPC). However, no studies have examined serial changes in collateral flow from SCPC to TCPC in the same patients. We sought to examine differences in collater...

  8. Basilar Artery Lateral Displacement May Be Associated with Migraine with Aura

    Directory of Open Access Journals (Sweden)

    Cen Zhang

    2018-02-01

    Full Text Available ObjectiveThe objective of this study is to determine whether structural features of the vertebrobasilar arterial system are related to migraine.BackgroundAlterations in cerebral vascular structure and function have been associated with migraine, possibly mediated by hypoperfusion and/or endothelial dysfunction triggering cortical spreading depression. Vessel tortuosity, in particular, has been associated with both altered hemodynamics and endothelial function. Symptoms of migraine with aura (MWA often localize to the occipital cortex, and evidence supports the localization of a migraine generator to the brain stem, suggesting that the vertebrobasilar system may be of particular relevance.MethodsWe performed a post hoc exploratory analysis of data collected in a prospective, observational, case-control study enrolling MWA, migraine without aura (MwoA, and control subjects in a 1:1:1 ratio. 3 T high-resolution MR angiography was used to assess vascular structure, and arterial spin-labeled perfusion MRI to measure interictal cerebral blood flow (CBF. White matter lesions were assessed using T2/FLAIR. Vertebral and basilar artery (BA diameters and BA total lateral displacement were measured.Results162 subjects were included (52 control/52 MWA/58 MwoA. Mean age was 33 ± 6 years, and 78% were female. BA diameter was similar across groups (3.6 ± 0.6 mm in all 3 groups. BA displacement was similar in MwoA (5.1 ± 3.0 mm and controls (4.9 ± 3.1 mm, but tended to be greater in MWA (6.3 ± 3.8 mm, p = 0.055 vs. controls. BA displacement increased with age (p < 0.001 was greater in men vs. women (6.6 ± 4.2 vs. 5.1 ± 3.0, p = 0.02 and with increased migraine frequency (p = 0.03. In multivariate analysis, BA displacement was significantly greater in MWA subjects (p = 0.02, with older age (p = 0.003, and in men (p = 0.046. In regression analysis adjusted for age and sex, BA displacement

  9. Polymyalgia rheumatica and systemic giant cell arteritis. Bioptic findings of the subclavian arteries in a case of aortic arch syndrome.

    Science.gov (United States)

    Di Giacomo, V; Fraioli, A; Carmenini, G; Schietroma, M; Meloni, F; Grossi, F

    1984-08-01

    A 64 year old woman complained of aches and stiffness of the neck and the shoulders with fever and E.S.R. increase. A nonsteroid anti-inflammatory treatment was unsuccessful. A clinical examination revealed absence of both radial pulses and presence of murmurs at level of the carotids. The angiographic findings confirmed an aortic arch syndrome with severe stenosis of the subclavian and axillary arteries. The diagnostic approach, in spite of a negativity of the temporal artery biopsy, was for systemic giant cell arteries with general manifestations of polymyalgia rheumatica. The biopsies of both subclavian arteries, performed during a surgery revascularization, showed a typical giant cell arteries in acute stage. The histopathological pattern of extratemporal giant cell arteries obtained by means of a surgical biopsy is really uncommon, being the previous reports performed on necroscopic findings only. In addition this case confirms that polymyalgia rheumatica implies a systemic arteries even if the clinical and histopathological signs of temporal arteritis are lacking. Therefore the temporal artery should be only considered as a particular and inconstant localization of this vasculitis.

  10. The usefulness of percutaneous transluminal angioplasty of the middle cerebral artery stenosis in patients with transient ischemic attack

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Young Chul; Lim, Hyo Soon; Kim, Jae Kyu; Seo, Jeong Jin; Jeong, Gwang Woo; Kang, Heoung Keun [Chonnam National Univ. Medical School, Kwangju (Korea, Republic of)

    2001-06-01

    To determine the effectiveness of percutaneous transluminal angioplasty(PTA) of atherosclerotic middle cerebral artery(MCA) stenosis in patients with transient ischemic attack (TIA). Ten patients with TIA who had undergone PTA were retrospectively investigated. In all ten, angiography revealed stenosis of the MCA. Mechanical dilatation was performed at the stenotic portion, and the angiographic findings after PTA, as well as peri/post-angioplastic complications, were evaluated. Four to 64 (mean, 23.5) months later, neurologic symptoms and the nature and timing of recurrent attacks were also assessed. The degree of stenosis before PTA was 50-75% in six patients and greater than 75% in four. Complete or partial angiographic recanalization of the stenotic segment occurred in nine patients (90%). During follow-up, seven patients recovered without recurrent TIA or cerebral stroke; one reported a tingling sensation and one experienced vertebrobasilar insufficiency. Motor aphasia developed in one patient after PTA, but after systemic heparinization, improved within 24 hours. One patient who suffered intracranial hemorrhage due to vascular rupture during PTA did three days later. PTA for atherosclerotic MCA stenosis in patients with TIA is an effective therapeutic method.

  11. Proposal of anatomical terminology to call the arteries of the base of the encephalon in the monkey (Cebus paella L., 1766 Nomenclatura proposta para denominar as artérias da base do encéfalo do macaco-prego (Cebus apella L., 1766

    Directory of Open Access Journals (Sweden)

    Jussara Rocha Ferreira

    2001-05-01

    Full Text Available Arteries of the encephalon basis of 30 monkeys (Cebus paella were studied. Arteries were injected with colored latex, fixed in formaldehyde solution at 10% and dissected under magnifying lenses. Since the animals died from natural causes they had been previously used in other experiments. Human and veterinary anatomical terminology and literature were used as a reference for the determination of vessels studied in the primates. Arteries of the encephalon base represent division branches of three vascular pedicules: the right and left internal carotid arteries and the basilar system. Vessels in the basilar system of the animal were called vertebral arteries; anterior spinal artery; anterior and posterior cerebelar arteries; pontine arteries; satellite cerebelar arteries; caudal and cranial cerebelar arteries. The basilar artery bifurcates into two posterior cerebral arteries (100%. The caudal area of the encephalon’s arterial circuit is thus constituted. Linking between the vertebro-basilar and the carotid segments is done by the posterior communicating artery, that caudally anastomizes (100% with the posterior cerebral artery. The internal carotid artery gives origin to the posterior communicating artery. The right and left internal carotid artery (intracranial portion compounds the carotid system. The following vessels were identified: middle cerebral artery; anterior cerebral artery; interhemispheric artery; olfactory arteries. Results report that Cebus paella presents an arterial pattern of relative morphological stabilityEstudaram-se as artérias da base do encéfalo do Cebus apella em 30 animais, vindos a óbito por morte natural no Zoológico de São Paulo e coletados durante 10 anos. O material recebeu injeção de látex corado, fixado em formol a 10%, e foi dissecado sob lupa. Encontramos dificuldade e denominar estes vasos. As terminologias anatômicas humana e veterinária e a recuperação da literatura nos serviram de base para

  12. Treatment of Large or Giant Cavernous Aneurysm Associated with Persistent Trigeminal Artery: Case Report and Review of Literature.

    Science.gov (United States)

    Ishikawa, Tatsuya; Yamaguchi, Koji; Anami, Hidenori; Sumi, Masatake; Ishikawa, Tomomi; Kawamata, Takakazu

    2017-12-01

    Primitive trigeminal artery (PTA) is the most common anomaly of primitive carotid-basilar anastomosis and is associated with cerebrovascular anomalies, such as aneurysm. Large or giant cavernous aneurysm associated with PTA is rare, and the treatment strategies differ in comparison with large or giant aneurysm without PTA. In this article, we report an unusual case of a giant cavernous aneurysm associated with PTA and review treatment strategies for large or giant cavernous aneurysm associated with PTA. A 38-year-old woman suffered from double vision. Magnetic resonance imaging revealed a mass lesion in the left cavernous sinus, and magnetic resonance angiography showed a giant aneurysm at the cavernous portion of the left internal carotid artery, associated with PTA. Coil embolization, distal to the PTA, was scheduled after high-flow bypass on the same day. Computed tomography scan showed no definite infarction after treatment. A 3-dimensional computed tomography showed disappearance of the aneurysm and good patency of bypass and PTA. The patient experienced improvements in symptoms and was discharged without neurologic deficits (modified Rankin Scale 0). The treatment strategy for large or giant cavernous aneurysm associated with PTA is different from strategies used for large or giant cavernous aneurysm without PTA. Simple ligation of internal carotid artery is inadequate because the aneurysm is supplied through the PTA, from the vertebrobasilar system. Furthermore, the treatment strategy has to be revised according to whether the PTA can be occluded. Keeping in mind PTA preservation, an appropriate strategy should be selected. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. Doppler ultrasound study of penis in men with systemic sclerosis: a correlation with Doppler indices of renal and digital arteries.

    Science.gov (United States)

    Rosato, E; Barbano, B; Gigante, A; Cianci, R; Molinaro, I; Quarta, S; Digiulio, M A; Messineo, D; Pisarri, S; Salsano, F

    2013-01-01

    Erectile dysfunction (ED) prevalence in male systemic sclerosis (SSc) is high and its pathogenesis is unclear. The aim of the study is to assess correlation between Doppler ultrasound indices of penis and kidneys or digital arteries in male systemic sclerosis. Fourteen men with systemic sclerosis were enrolled in this study. Erectile function was investigated by the International Index of Erectile Function-5. Peak systolic velocity, end diastolic velocity, resistive index, pulsative index, and systolic/diastolic ratio were measured on the cavernous arteries at the peno-scrotal junction in the flaccid state, on the interlobar artery of both kidneys and all ten proper palmar digital arteries. Ten (71 percent) patients have an International Index of Erectile Function-5 less than 21. Reduction of penis peak systolic velocity was observed in all SSc subjects. Doppler indices of cavernous arteries correlate with the International Index of Erectile Function-5. The renal and digital arteries resistive index demonstrated a good correlation (p less than 0.0001) with International Index of Erectile Function-5. A positive correlation exists between penis and kidney arteries Doppler indices: end diastolic velocity (p less than 0.05, r=0.54), resistive index (p less than 0.0001, r=0.90), systolic/diastolic ratio (p less than 0.01, r=0.69). A positive correlation was observed between penis and digital arteries Doppler indices: peak systolic velocity (p less than 0.01, r=0.68), end diastolic velocity (p less than 0.01, r=0.75), resistive index (p less than 0.001, r=0.79), systolic/diastolic ratio (p less than 0.05, r=0.59). A correlation exists between arterial impairment of penis and renal or digital arteries.

  14. A Case Report of Locked-in Syndrome Due to Bilateral Vertebral Artery Dissection After Cervical Spine Manipulation Treated by Arterial Embolectomy.

    Science.gov (United States)

    Ke, Jiang-Qiong; Yin, Bo; Fu, Fang-Wang; Shao, Sheng-Min; Lin, Yan; Dong, Qi-Qiang; Wang, Xiao-Tong; Zheng, Guo-Qing

    2016-02-01

    Cervical spine manipulation (CSM) is a commonly spinal manipulative therapies for the relief of cervical spine-related conditions worldwide, but its use remains controversial. CSM may carry the potential for serious neurovascular complications, primarily due to vertebral artery dissection (VAD) and subsequent vertebrobasilar stroke. Here, we reported a rare case of locked-in syndrome (LIS) due to bilaterial VAD after CSM treated by arterial embolectomy.A 36-year-old right-handed man was admitted to our hospital with numbness and weakness of limbs after treating with CSM for neck for half an hour. Gradually, although the patient remained conscious, he could not speak but could communicate with the surrounding by blinking or moving his eyes, and turned to complete quadriplegia, complete facial and bulbar palsy, dyspnea at 4 hours after admission. He was diagnosed with LIS. Then, the patient was received cervical and brain computed tomography angiography that showed bilateral VAD. Aortocranial digital subtraction angiography showed vertebrobasilar thrombosis, blocking left vertebral artery, and stenosis of right vertebral artery. The patient was treated by using emergency arterial embolectomy and followed by antiplatelet therapy and supportive therapy in the intensive care unit and a general ward. Twenty-seven days later, the patient's physical function gradually improved and discharged but still left neurological deficit with muscle strength grade 3/5 and hyperreflexia of limbs.Our findings suggested that CSM might have potential severe side-effect like LIS due to bilaterial VAD, and arterial embolectomy is an important treatment choice. The practitioner must be aware of this complication and should give the patients informed consent to CSM, although not all stroke cases temporally related to SCM have pre-existing craniocervical artery dissection.

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

    Science.gov (United States)

    Rabahi, Marcelo Fouad; Pereira, Sheila Alves; Silva Júnior, José Laerte Rodrigues; de Rezende, Aline Pacheco; Castro da Costa, Adeliane; de Sousa Corrêa, Krislainy; Conde, Marcus Barreto

    2015-01-01

    The diagnosis of chronic obstructive pulmonary disease (COPD) is often delayed until later stages of the disease. The purpose of the present study was to determine the prevalence of COPD among adults on treatment for systemic arterial hypertension independently of the presence of respiratory symptoms. This cross-sectional study included adults aged ≥40 years with tobacco/occupational exposure and systemic arterial hypertension diagnosed at three Primary Health Care facilities in Goiania, Brazil. Patients were evaluated using a standardized respiratory questionnaire and spirometry. COPD prevalence was measured considering the value of forced vital capacity and/or forced expiratory volume in 1 second COPD (P=0.24). The prevalence of COPD in people with no previous COPD diagnosis was greater among those with no respiratory symptoms (100%) than among those with respiratory symptoms (56.1%) (P=0.01). Our findings suggest that regardless of the presence of respiratory symptoms, individuals aged ≥40 years with tobacco/occupational exposure and arterial hypertension may benefit from spirometric evaluation.

  16. An Human-Computer Interactive Augmented Reality System for Coronary Artery Diagnosis Planning and Training.

    Science.gov (United States)

    Li, Qiming; Huang, Chen; Lv, Shengqing; Li, Zeyu; Chen, Yimin; Ma, Lizhuang

    2017-09-02

    In order to let the doctor carry on the coronary artery diagnosis and preoperative planning in a more intuitive and more natural way, and to improve the training effect for interns, an augmented reality system for coronary artery diagnosis planning and training (ARS-CADPT) is designed and realized in this paper. At first, a 3D reconstruction algorithm based on computed tomographic (CT) images is proposed to model the coronary artery vessels (CAV). Secondly, the algorithms of static gesture recognition and dynamic gesture spotting and recognition are presented to realize the real-time and friendly human-computer interaction (HCI), which is the characteristic of ARS-CADPT. Thirdly, a Sort-First parallel rendering and splicing display subsystem is developed, which greatly expands the capacity of student users. The experimental results show that, with the use of ARS-CADPT, the reconstruction accuracy of CAV model is high, the HCI is natural and fluent, and the visual effect is good. In a word, the system fully meets the application requirement.

  17. Restraint stress enhances arterial thrombosis in vivo--role of the sympathetic nervous system.

    Science.gov (United States)

    Stämpfli, Simon F; Camici, Giovanni G; Keller, Stephan; Rozenberg, Izabela; Arras, Margarete; Schuler, Beat; Gassmann, Max; Garcia, Irene; Lüscher, Thomas F; Tanner, Felix C

    2014-01-01

    Stress is known to correlate with the incidence of acute myocardial infarction. However, the molecular mechanisms underlying this correlation are not known. This study was designed to assess the effect of experimental stress on arterial thrombus formation, the key event in acute myocardial infarction. Mice exposed to 20 h of restraint stress displayed an increased arterial prothrombotic potential as assessed by photochemical injury-induced time to thrombotic occlusion. This increase was prevented by chemical sympathectomy performed through 6-hydroxydopamine (6-OHDA). Blood-born tissue factor (TF) activity was enhanced by stress and this increase could be prevented by 6-OHDA treatment. Vessel wall TF, platelet count, platelet aggregation, coagulation times (PT, aPTT), fibrinolytic system (t-PA and PAI-1) and tail bleeding time remained unaltered. Telemetric analysis revealed only minor hemodynamic changes throughout the stress protocol. Plasma catecholamines remained unaffected after restraint stress. Tumor necrosis factor alpha (TNF-α) plasma levels were unchanged and inhibition of TNF-α had no effect on stress-enhanced thrombosis. These results indicate that restraint stress enhances arterial thrombosis via the sympathetic nervous system. Blood-borne TF contributes, at least in part, to the observed effect whereas vessel wall TF, platelets, circulating coagulation factors, fibrinolysis and inflammation do not appear to play a role. These findings shed new light on the understanding of stress-induced cardiovascular events.

  18. Carotid intima-media thickness and arterial stiffness in pediatric systemic lupus erythematosus.

    Science.gov (United States)

    Su-Angka, N; Khositseth, A; Vilaiyuk, S; Tangnararatchakit, K; Prangwatanagul, W

    2017-08-01

    Objectives The carotid intima-media thickness (CIMT) and carotid arterial stiffness index (CASI) act as the surrogate markers of atherosclerosis. We aim to assess CIMT and CASI in pediatric systemic lupus erythematosus (SLE). Methods Patients ≤ 20 years old fulfilling diagnostic criteria for SLE were enrolled. Patients with active smoking, coronary heart disease, cerebrovascular disease, arterial thrombosis, family history of hypercholesterolemia, chronic liver disease, or other chronic severe diseases were excluded. The patients were categorized into four groups: active SLE, age- and sex-matched control (control A), inactive SLE, and age- and sex-matched control (control I), according to the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI). All subjects underwent ultrasound of carotid arteries to evaluate CIMT and CASI. Results One hundred and two SLE patients (26 active and 76 inactive) and one hundred and three healthy controls (26 control A and 77 control I) were enrolled. The median CIMT in all groups were not significantly different (0.43, 0.41-0.44; 0.43, 0.41-0.44; 0.42, 0.41-0.43; and 0.42, 0.41-0.43 mm, respectively).The CASI in active SLE (13.5, 11.4-17.3) was significantly higher than in control A (8.2, 7.2-9.2) ( p < 0.0001), whereas CASI in inactive SLE (12.7, 10.9-15.7) was significantly higher than in control I (8.9, 7.6-9.8). However, the CASI in active and inactive SLE was not significantly different. Conclusions The higher CASI in active and inactive pediatric SLE, implying functional change of carotid arteries, may be early evidence of increased atherosclerosis in pediatric SLE. This functional dysfunction has been found both in inactive and active SLE.

  19. Echocardiography may help detect pulmonary vasculopathy in the early stages of pulmonary artery hypertension associated with systemic sclerosis

    OpenAIRE

    Serra Walter; Chetta Alfredo; Santilli Daniele; Mozzani Flavio; Dall'Aglio Pier; Olivieri Dario; Cattabiani Maria; Ardissino Diego; Gherli Tiziano

    2010-01-01

    Abstract Background Pulmonary arterial hypertension (PAH) in patients with systemic sclerosis is associated with a poor prognosis, but this can be improved by early disease detection. Abnormal pulmonary and cardiac function can be detected early by means of echocardiography, whereas right heart catheterization is usually performed later. Objectives The purpose of this prospective study was to detect early the presence of pulmonary artery vasculopathy in patients with verified systemic scleros...

  20. Correlation between Systemic Arterial Hypertension and Bone Morphogenetic Protein-2 in Central Obese Non-Diabetic Men with Evidence of Coronary Artery Calcification

    Directory of Open Access Journals (Sweden)

    Antonia Anna Lukito

    2011-12-01

    Full Text Available BACKGROUND: Previous studies have confirmed separately the relationship between obesity, insulin-resistance, hypertension and bone morphogenetic protein-2 (BMP-2 with coronary artery calcification, a parameter of subclinical atherosclerosis. It was also reported that BMPs may function as proinflammatory, prohypertensive and proatherogenic mediators. The study aimed to assess the correlation between systemic hypertension and BMP-2 plasma concentration in central-obese non-diabetic men with evidence of coronary artery calcification. METHODS: This was a cross sectional study on 60 central-obese non-diabetic men, of an average age of 55.2 years, with evidence of coronary calcification, who came for health check-up and met the inclusion criteria consecutively as defined by waist circumference >90 cm and fasting blood glucose <126 mg/dL. Coronary calcification was defined by coronary artery calcium (CAC score ≥10 Agatson-unit Dual Source 64 slice CT scan. RESULTS: There is positive correlation between hypertension and BMP-2 in central-obese non-diabetic men with evidence of coronary artery calcification. BMP-2 plasma concentration was higher in the hypertensive subjects. The correlation was stronger in younger (<55 years old subjects and subjects with insulin-resitance. KEYWORDS: hypertension, BMP-2, coronary calcification, central obesity, age, insulin resistance.

  1. Priming Mesenchymal Stem Cells with Endothelial Growth Medium Boosts Stem Cell Therapy for Systemic Arterial Hypertension

    Directory of Open Access Journals (Sweden)

    Lucas Felipe de Oliveira

    2015-01-01

    Full Text Available Systemic arterial hypertension (SAH, a clinical syndrome characterized by persistent elevation of arterial pressure, is often associated with abnormalities such as microvascular rarefaction, defective angiogenesis, and endothelial dysfunction. Mesenchymal stem cells (MSCs, which normally induce angiogenesis and improve endothelial function, are defective in SAH. The central aim of this study was to evaluate whether priming of MSCs with endothelial growth medium (EGM-2 increases their therapeutic effects in spontaneously hypertensive rats (SHRs. Adult female SHRs were administered an intraperitoneal injection of vehicle solution n=10, MSCs cultured in conventional medium (DMEM plus 10% FBS, n=11, or MSCs cultured in conventional medium followed by 72 hours in EGM-2 (pMSC, n=10. Priming of the MSCs reduced the basal cell death rate in vitro. The administration of pMSCs significantly induced a prolonged reduction (10 days in arterial pressure, a decrease in cardiac hypertrophy, an improvement in endothelium-dependent vasodilation response to acetylcholine, and an increase in skeletal muscle microvascular density compared to the vehicle and MSC groups. The transplanted cells were rarely found in the hearts and kidneys. Taken together, our findings indicate that priming of MSCs boosts stem cell therapy for the treatment of SAH.

  2. Differential leucocyte RNA expression in the coronary arteries compared to systemic circulation discriminates between patients with and those without coronary artery disease.

    Science.gov (United States)

    Ribalta, Josep; Alipour, Arash; Sánchez-Cabo, Fátima; Vallvé, Joan-Carles; Njo, Tjin; Álvarez, Rebeca; Janssen, Hans; Liem, Anho; Dopazo, Ana; Castro-Cabezas, Manuel

    To test the hypothesis that the pattern of gene expression in circulating leukocytes may differ between vascular compartments, depending on the presence or absence of atherosclerosis, we evaluated the regional vascular differences in patterns of inflammatory cell activation. Patients (n=8) with angiographically-established coronary artery disease (CAD+) and 8 without (CAD-) had blood samples taken from a peripheral vein as well as from left and right coronary arteries. Samples were pooled resulting in 4 CAD+ samples versus 4 CAD- samples and hybridised to a Whole Human Genome Microarray 4×44K. CAD- patients had a similar gene expression profile across the different sites. CAD+ patients had statistically significant different gene expression patterns in venous vs. right and left coronary artery compartments. The expression pattern observed in the right coronary was where the most differences in gene expression were observed in CAD+ vs. CAD- patients. Overall, 1964 genes were differentially expressed between CAD+ and CAD-. Of these, 1052 were less expressed in CAD+ and 912 were more expressed in CAD+. Up to 12 of the 20 most differentially expressed genes appeared to reflect different phases of the atherosclerosis process: endothelial dysfunction, lipid accumulation, and smooth muscle cell proliferation. Gene expression of circulating leukocytes differentiates CAD+ from CAD- patients. Gene expression is significantly different between coronary arteries and the systemic circulation in CAD+ patients, but not in CAD- patients. Gene expression is significantly different between CAD+ and CAD- subjects, and appears to reflect the atherosclerosis process. These intra-individual differences may be an additional feature of established coronary artery disease. Copyright © 2016 Sociedad Española de Arteriosclerosis. Publicado por Elsevier España, S.L.U. All rights reserved.

  3. Induction (neo-adjuvant) chemotherapy: systemic and arterial delivery techniques and their clinical applications.

    Science.gov (United States)

    Stephens, F O

    1995-10-01

    Induction chemotherapy is a well tried method of improving the cure prospects of locally advanced or aggressive primary cancers. It is most simply administered by systemic (intravenous) delivery but for some cases a greater chemotherapy impact is both desirable and achievable with the use of a more concentrated regional delivery technique. Any advantage of regional chemotherapy will depend upon the type of tumour to be treated, its site and blood supply, the most effective doses, concentrations and exposure periods of the preferred agents to be used and the relative risks of systemic and regional toxicity and the techniques of delivery. In general, systemic chemotherapy is most appropriate in treating tumours without a single artery of supply; when certain agents which are inactive until modified in body tissues (such as cyclophosphamide or DTIC) are to be used; when satisfactory responses can be achieved more easily by systemic delivery; when technical skills and facilities for regional delivery are not available; or when the patient's general health, co-operation or long-term prognosis precludes the additional complexity of regional delivery. Intra-arterial infusion may have advantages in treating head and neck, gastric, liver, some locally advanced breast, limb, pelvic and possibly pancreatic malignancies. More complex techniques to achieve short-term highly concentrated chemotherapy include closed circuit perfusion; chemofiltration infusion and 'stop flow' perfusion; and regional limb infusion. These should remain the subject of ongoing studies in highly specialized units which treat tumours such as melanoma or pancreatic cancer which respond poorly to lower chemotherapy concentrations.

  4. Systemic lupus erythematosus and pulmonary arterial hypertension: links, risks, and management strategies

    Directory of Open Access Journals (Sweden)

    Tselios K

    2016-12-01

    Full Text Available Konstantinos Tselios, Dafna D Gladman, Murray B Urowitz, University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, University Health Network, Toronto, ON, Canada Abstract: Systemic lupus erythematosus (SLE is characterized by the second highest prevalence of pulmonary arterial hypertension (PAH, after systemic sclerosis, among the connective tissue diseases. SLE-associated PAH is hemodynamically defined by increased mean pulmonary artery pressure at rest (≥25 mmHg with normal pulmonary capillary wedge pressure (≤15 mmHg and increased pulmonary vascular resistance. Estimated prevalence ranges from 0.5% to 17.5% depending on the diagnostic method used and the threshold of right ventricular systolic pressure in studies using transthoracic echocardiogram. Its pathogenesis is multifactorial with vasoconstriction, due to imbalance of vasoactive mediators, leading to hypoxia and impaired vascular remodeling, collagen deposition, and thrombosis of the pulmonary circulation. Multiple predictive factors have been recognized, such as Raynaud’s phenomenon, pleuritis, pericarditis, anti-ribonuclear protein, and antiphospholipid antibodies. Secure diagnosis is based on right heart catheterization, although transthoracic echocardiogram has been shown to be reliable for patient screening and follow-up. Data on treatment mostly come from uncontrolled observational studies and consist of immunosuppressive drugs, mainly corticosteroids and cyclophosphamide, as well as PAH-targeted approaches with endothelin receptor antagonists (bosentan, phosphodiesterase type 5 inhibitors (sildenafil, and vasodilators (epoprostenol. Prognosis is significantly affected, with 1- and 5-year survival estimated at 88% and 68%, respectively. Keywords: systemic lupus erythematosus, pulmonary arterial hypertension, immunosuppressive, transthoracic echocardiogram, endothelin receptor antagonists

  5. Posterior Tibial Arterial System Deficiency Mimicking Chronic Exertional Compartment Syndrome: A Case Report.

    Science.gov (United States)

    Lavery, Kyle P; Parcells, Bertrand W; Hosea, Timothy

    2016-01-01

    A 15-year-old female competitive high school basketball player presented as an outpatient with a 3-month history of bilateral exertional calf pain. Patient history and compartment pressure measurements were consistent with the diagnosis of chronic exertional compartment syndrome, and the patient underwent bilateral fasciotomies. Postoperatively, her symptoms recurred and she was found to have a deficient posterior tibial arterial system bilaterally, as confirmed on advanced imaging. We advocate the careful consideration of vascular etiologies in athletes who present with exertional leg pain.

  6. Combined central retinal artery and vein occlusion secondary to systemic non-Hodgkin′s lymphoma

    Directory of Open Access Journals (Sweden)

    Shukla Dhananjay

    2006-01-01

    Full Text Available We report a rare case of low-grade systemic B-cell non-Hodgkin′s lymphoma (NHL causing central retinal artery and vein occlusion, which was the only manifestation of disease recurrence. A young man with resolved systemic NHL underwent fluorescein angiography, magnetic resonance imaging and computed tomography to investigate a severe unilateral visual loss. A combined vascular occlusion was observed in the right eye. Neuroimaging detected optic nerve infiltration; but no systemic/ central nervous system involvement was observed. The patient was treated with high-doses of corticosteroids and optic nerve irradiation. The optic neuropathy and vascular occlusion were resistant to treatment. The subsequent neovascular glaucoma was treated by panretinal photocoagulation, which relieved the pain, but vision was not recovered. No further recurrence was observed over the following year.

  7. Effects of surgical en bloc rotation of the arterial trunk on the conduction system in children with transposition of the great arteries, ventricular septal defect and pulmonary stenosis.

    Science.gov (United States)

    Prandstetter, Christoph; Tulzer, Andreas; Mair, Rudolf; Sames-Dolzer, Eva; Tulzer, Gerald

    2016-03-01

    The standard surgical management of patients with transposition of the great arteries, ventricular septal defect, and pulmonary stenosis is the Rastelli operation. Recently, en bloc rotation of the arterial trunk, by cutting out the aortic and the pulmonary root in one block and by rotating it 180°, has been introduced as a new option for anatomical repair. To evaluate the effects of this surgical method on the conduction system, pre-operative, post-operative, and follow-up electrocardiograms as well as patient charts were reviewed retrospectively. A total of 16 consecutive patients with transposition of the great arteries and left outflow tract obstruction were treated with en bloc rotation. During the post-operative period, there were two patients with complete atrio-ventricular block, one with junctional ectopic tachycardia, one with ventricular tachycardia, and one with supraventricular tachycardia. None of the patients had a typical right bundle branch block pattern before surgery; however, this pattern was detectable after surgery in eight out of 16 patients (50%), which persisted during the follow-up. All patients without typical right bundle branch block pattern showed a median QRS duration of 65 ms (54-112 ms) before surgery, 62 ms (54-122 ms) after surgery, and 84 ms (66-128 ms) at the last follow-up visit. This compares well with a similar Rastelli cohort, where a right bundle branch block prevalence of 77% was reported. Out of 16 patients, 12 showed non-specific ST changes and negative T-waves, which persisted during follow-up with an unknown significance for the future. Our data suggest that en bloc rotation of the arterial trunk seems not to have more negative effects on the conduction system than the Rastelli operation.

  8. Uterine-umbilical artery Doppler velocimetry in pregnant women with systemic lupus erythematosus.

    Science.gov (United States)

    Guzman, E; Schulman, H; Bracero, L; Rochelson, B; Farmakides, G; Coury, A

    1992-06-01

    We evaluated continuous wave uterine-umbilical artery Doppler velocimetry for predicting pregnancy outcome in women with systemic lupus erythematosus (SLE). Lupus anticoagulant (LAC) and anticardiolipin (ACL) antibody status also were correlated with Doppler results and outcome. Three Doppler vascular patterns were identified in 27 pregnancies of 26 women with SLE. Patients with normal flow velocity in both vessels had normal outcomes (n = 18). Reduced flow velocity of the umbilical artery only was present in five women, whose newborn infants were of lesser gestational age and birthweight, two being small for gestational age. In four pregnancies reduced flow velocity was noted in both vessels. These cases had the poorest outcome, with three perinatal losses and all fetuses being small for gestational age. Doppler velocimetry showed 100% sensitivity and negative predictive value in the detection of the small for gestational age fetus and abnormal antepartum fetal heart rate tracing. Fourteen of 18 women with normal Doppler studies did not have preeclampsia or SLE flare-ups, whereas all nine women with abnormal Doppler studies had such complications. In all 27 pregnancies the women were screened for LAC, and 21 women also were tested for the ACL antibody. Poor correlation was found between antiphospholipid antibody status and Doppler results in three of the six pregnancies with positive antibody testing the patients had normal Doppler studies and outcomes. Thus, Doppler velocimetry may help determine when these substances will affect the outcome adversely. In this study the umbilical-placental vascular system was affected more often. Uterine-umbilical arterial Doppler velocimetry uniquely identified the fetus at risk for adverse perinatal outcome in pregnancies complicated by SLE. Thus, it is a potentially valuable tool in clarifying the pathophysiology and in the management of SLE in pregnancy.

  9. Subaxial rotational vertebral artery syndrome: resection of the uncinate process and anterior fusion can be sufficient!: case report and review of the literature.

    Science.gov (United States)

    Schelfaut, Sebastiaan; Verhasselt, Skrallan; Carpentier, Karel; Moke, Lieven

    2015-03-01

    A case report on rotational vertebral artery syndrome (RVAS) and surgical treatment. To illustrate a safe treatment option of RVAS with diminished risk of iatrogenic damage to the vertebral artery. RVAS is an uncommon cause of symptomatic transient vertebrobasilar insufficiency induced by physiological head rotation with temporary significant external compression of the dominant subaxial vertebral artery. Previous reports state that the treatment of choice consists of decompression of the vessel with resection of the anterior rim of the transverse process and any fibrotic sheet or intertransverse muscle, if necessary, combined with an anterior cervical discectomy and fusion (ACDF) with uncus resection. This is a case report on RVAS and its surgical treatment. The diagnosis of RVAS due to an osteophyte of the uncinate process at level C5/C6 was confirmed using computed tomographic angiography. We performed a classic ACDF using the contralateral approach with complete resection of the uncovertebral joint at the pathologic site. In our case, the symptoms of transient vertebrobasilar insufficiency induced by head rotation completely resolved postoperatively, and computed tomographic angiography images at 3 months postoperatively showed good bony ingrowth and restoration of vertebral artery patency during extreme rotation. Classic ACDF with complete resection of the uncovertebral joint is a safe treatment option for RVAS in the subaxial cervical spine. Fusion at the pathologic level will eliminate rotation and prevent further formation of osteophytes at the operated level. Unroofing of the vertebral artery seems not always necessary, diminishing the surgical risk.

  10. System of matrix metalloproteinases and cytokine secretion in type 2 diabetes mellitus and impaired carbohydrate tolerance associated with arterial hypertension.

    Science.gov (United States)

    Kologrivova, I V; Suslova, T E; Koshel'skaya, O A; Vinnitskaya, I V; Trubacheva, O A

    2014-03-01

    The study included patients with type 2 diabetes mellitus and impaired carbohydrate tolerance associated with arterial hypertension, patients with arterial hypertension, and healthy volunteers. We evaluated the levels of matrix metalloproteinases 2 and 9 (MMP-2, MMP-9), tissue inhibitor of metalloproteinase type 1 (TIMP-1), glucose, insulin, C-peptide, glycated hemoglobin, and spontaneous and mitogen-activated cytokine secretion (IL-2, IL4, IL-6, IL-10, IL-17, TNF-α, and IFN-γ). Patients with type 2 diabetes mellitus in combination with arterial hypertension exhibited maximum TIMP-1 levels and TIMP-1/MMP-2, TIMP-1/ MMP-9 ratios as well as enhanced secretion of TNF-α, IL-6, IL-17 and reduced secretion of IL-10 in comparison with healthy individuals. The observed shifts are probably determined the development of systemic hyperinsulinemia in patients suffering from type 2 diabetes mellitus coupled with arterial hypertension.

  11. Integration of a capacitive pressure sensing system into the outer catheter wall for coronary artery FFR measurements

    Science.gov (United States)

    Stam, Frank; Kuisma, Heikki; Gao, Feng; Saarilahti, Jaakko; Gomes Martins, David; Kärkkäinen, Anu; Marrinan, Brendan; Pintal, Sebastian

    2017-05-01

    The deadliest disease in the world is coronary artery disease (CAD), which is related to a narrowing (stenosis) of blood vessels due to fatty deposits, plaque, on the arterial walls. The level of stenosis in the coronary arteries can be assessed by Fractional Flow Reserve (FFR) measurements. This involves determining the ratio between the maximum achievable blood flow in a diseased coronary artery and the theoretical maximum flow in a normal coronary artery. The blood flow is represented by a pressure drop, thus a pressure wire or pressure sensor integrated in a catheter can be used to calculate the ratio between the coronary pressure distal to the stenosis and the normal coronary pressure. A 2 Fr (0.67mm) outer diameter catheter was used, which required a high level of microelectronics miniaturisation to fit a pressure sensing system into the outer wall. The catheter has an eccentric guidewire lumen with a diameter of 0.43mm, which implies that the thickest catheter wall section provides less than 210 microns height for flex assembly integration consisting of two dies, a capacitive MEMS pressure sensor and an ASIC. In order to achieve this a very thin circuit flex was used, and the two chips were thinned down to 75 microns and flip chip mounted face down on the flex. Many challenges were involved in obtaining a flex layout that could wrap into a small tube without getting the dies damaged, while still maintaining enough flexibility for the catheter to navigate the arterial system.

  12. Persistence of intrasellar trigeminal artery and simultaneous pituitary adenoma: description of two cases and their importance for the differential diagnosis of sellar lesions.

    Science.gov (United States)

    Machado, Marcio Carlos; Kodaira, Sergio; Musolino, Nina Rosa Castro

    2014-08-01

    Persistent trigeminal artery (PTA) is the most frequent embryonic communication between the carotid and vertebrobasilar systems. However, hormonal changes or the association of PTA with other sellar lesions, such as pituitary adenomas, are extremely rare. The aim of the present study was to report two patients with intrasellar PTA and simultaneous pituitary adenoma in order to emphasize the importance of differential diagnoses for sellar lesions. Case 1. A female patient, 41 years old, was admitted with a history of chronic headache (> 20 years). Pituitary magnetic resonance imaging (MRI) showed a rounded lesion in the left portion of the pituitary gland suggestive of adenoma (most likely clinically non-functioning adenoma). In addition to this lesion, the MRI demonstrated ecstasy of the right internal carotid artery and imaging suggestive of an intrasellar artery that was subsequently confirmed by an angio-MRI of the cerebral vessels as PTA. Case 2. A female patient, 42 years old, was admitted with a history of amenorrhea and galactorrhea in 1994. Laboratorial investigation revealed hyperprolactinemia. Pituitary MRI showed a small hyposignal area in the anterior portion of pituitary gland suggestive of a microadenoma initiated by a dopaminergic agonist. Upon follow-up, aside from the first lesion, the MRI showed a well delineated rounded lesion inside the pituitary gland, similar to a vessel. Angio-MRI confirmed a left primitive PTA. Failure to recognize these anomalous vessels within the sella might lead to serious complications during transsphenoidal surgery. Therefore, although their occurrence is uncommon, a working knowledge of vascular lesions in the sella turcica or pituitary gland is important for the differential diagnosis of pituitary lesions, especially pituitary adenomas.

  13. The Role of Systemic Arterial Stiffness in Open-Angle Glaucoma with Diabetes Mellitus

    Directory of Open Access Journals (Sweden)

    Seong Hee Shim

    2015-01-01

    Full Text Available Purpose. To investigate the role of systemic arterial stiffness in glaucoma patients with diabetes mellitus (DM. Design. Retrospective, cross-sectional study. Participants. DM subjects who underwent brachial-ankle pulse wave velocity (baPWV were recruited. Methods. Glaucoma patients (n=75 and age-matched control subjects (n=92 were enrolled. Systemic examination including BaPWV and detailed eye examination were performed. The glaucoma group was divided into subgroups of normal tension glaucoma (NTG, n=55 and primary open-angle glaucoma (POAG based on an IOP of 21 mmHg. BaPWV was used to stratify the population into 4 groups based on the rate. Stepwise multiple logistic regression analysis by baPWV quartiles was used to compare the glaucoma group with the control group. Main Outcome Measures. BaPWV in glaucoma with DM patients. Results. Faster baPWV was positively associated with glaucoma (odds ratio: 3.74; 95% CI: 1.03–13.56, stepwise multiple logistic regression analysis in patients with DM. Increasing baPWV was also positively associated with glaucoma (p for trend = 0.036. The NTG subgroup showed similar results to those of the glaucoma group. Conclusions. In this study, increased arterial stiffness was shown to be associated with glaucoma and may contribute to the pathogenesis of glaucoma in DM patients.

  14. A new bipolar feedback-controlled sealing system for closure of the cystic duct and artery.

    Science.gov (United States)

    Shamiyeh, A; Schrenk, P; Tulipan, L; Vattay, P; Bogner, S; Wayand, W

    2002-05-01

    Bile leaks are serious complications after laparoscopic cholecystectomy. The aim of this study was to evaluate the feasibility of closure of the cystic duct with a new feedback-controlled bipolar sealing system (LigaSure). Ten domestic pigs underwent open cholecystectomy with the cystic duct and artery dissected and sealed with the new bipolar sealing system (LigaSure). Four and 8 days postoperatively, 5 pigs each were sacrificed and the closure of the cystic duct was evaluated. The cystic stump and the common bile duct were excised for histological examination. None of the pigs had a bile leak or a biliary peritonitis. There were no signs of postoperative bleeding or inflammation in Calot's triangle. Histology showed total necrosis of the cystic duct in the first two pigs due to too much energy used. The remaining specimens showed a regularly scaling zone without necrosis in 7 cases, and in one case a partial necrosis in the mucosa only was found. Cystic artery and cystic duct closure with the new device may be an alternative to the clip. Further trials should evaluate the feasibility and safety of the new device in the clinical setting.

  15. Low-profile stent system for treatment of atherosclerotic renal artery stenosis : The GREAT trial

    NARCIS (Netherlands)

    Sapoval, Marc; Zahringer, Markus; Pattynama, Peter; Rabbia, Claudio; Vignali, Claudio; Maleux, Geert; Boyer, Louis; Szczerbo-Trojanowska, Malgorzata; Jaschke, Werner; Hafsahl, Geir; Downes, Mark; Beregi, Jean Paul; Veeger, Nic; Talen, Aly

    PURPOSE: The Palmaz Genesis Peripheral Stainless Steel Balloon Expandable Stent in Renal Artery Treatment (GREAT) Trial was designed to assess the safety and performance of a low-profile stent for the treatment of obstructive renal artery disease by looking at 6-month renal artery patency uniformly

  16. Sildenafil Increases Systemic Saturation and Reduces Pulmonary Artery Pressure in Patients with Failing Fontan Physiology.

    Science.gov (United States)

    Morchi, Gira S; Ivy, D Dunbar; Duster, Mark C; Claussen, Lori; Chan, Kak-Chen; Kay, Joseph

    2009-04-01

    OBJECTIVE: The purpose of this study was to investigate the effect of sildenafil in patients with failing Fontan physiology. DESIGN: A retrospective chart review was performed to compare history and available data in patients with Fontan circulations before and after starting sildenafil. The paired and unpaired Student's t-tests were used for statistical analyses. PATIENTS: Six patients at our institution with Fontan physiology, persistent symptoms of cyanosis or effusion, and poor hemodynamics as measured in the catheterization laboratory were placed on sildenafil. One patient was not included in the analysis because of insufficient length of treatment. All patients had symptoms of failing Fontan hemodynamics with either persistent cyanosis or effusions. In this group, the mean pulmonary artery pressure was greater than 15 mm Hg (17.4 ± 1.5 mm Hg) with mean estimated pulmonary vascular resistance of 3.5 ± 1.0 Wood units × m(2) prior to starting sildenafil. RESULTS: Sildenafil significantly increased the systemic arterial oxyhemoglobin saturation in this group (82.8 ± 7.3% pre-treatment vs. 91.0 ± 5.5% post-treatment, P = .017). In the four out of five patients who have had follow-up catheterizations, there was a significant decrease in pulmonary artery pressure (17.4 ± 1.5 mm Hg pre-treatment vs. 13.8 ± 2.1 mm Hg post-treatment, P = .018) and in estimated pulmonary vascular resistance pre- and post-sildenafil treatment (3.5 ± 1.0 Wood units × m(2) pre-treatment vs. 2.0 ± 0.4 Wood units × m(2) post-treatment, P = .031). CONCLUSIONS: Sildenafil may be a useful adjunct to therapy in patients with failing Fontan physiology likely through its function as a pulmonary vasodilator.

  17. Implementation of variable segments to model the arterial system using electromechanical analogy

    Science.gov (United States)

    Borik, Stefan; Cap, Ivo; Babusiak, Branko; Capova, Klara

    2017-05-01

    The article deals with the design of an electrical model of variable segments of a non-symmetrical tree of small arteries This model can be used to simulate the blood pressure and flow. Peripheral arterial resistance changes are modelled by an exponentially dependent resistor. By modulating the capacitor value, we can model the arterial wall properties which depend on the arterial pressure. Simulations are performed in which vasoconstriction and vasodilation were modelled by varying the transmural pressure. As a result, we can observe the changes in the blood pressure for each arterial generation.

  18. The role of tissue renin angiotensin aldosterone system in the development of endothelial dysfunction and arterial stiffness

    Directory of Open Access Journals (Sweden)

    Annayya R Aroor

    2013-10-01

    Full Text Available Epidemiological studies support the notion that arterial stiffness is an independent predictor of adverse cardiovascular events contributing significantly to systolic hypertension, impaired ventricular-arterial coupling and diastolic dysfunction, impairment in myocardial oxygen supply and demand, and progression of kidney disease. Although arterial stiffness is associated with aging, it is accelerated in the presence of obesity and diabetes. The prevalence of arterial stiffness parallels the increase of obesity that is occurring in epidemic proportions and is partly driven by a sedentary life style and consumption of a high fructose, high salt and high fat western diet. Although the underlying mechanisms and mediators of arterial stiffness are not well understood, accumulating evidence supports the role of insulin resistance and endothelial dysfunction. The local tissue renin angiotensin aldosterone system (RAAS in the vascular tissue and immune cells and perivascular adipose tissue is recognized as an important element involved in endothelial dysfunction which contributes significantly to arterial stiffness. Activation of vascular RAAS is seen in humans and animal models of obesity and diabetes, and associated with enhanced oxidative stress and inflammation in the vascular tissue. The cross talk between angiotensin and aldosterone underscores the importance of mineralocorticoid receptors in modulation of insulin resistance, decreased bioavailability of nitric oxide, endothelial dysfunction and arterial stiffness. In addition, both innate and adaptive immunity are involved in this local tissue activation of RAAS. In this review we will attempt to present a unifying mechanism of how environmental and immunological factors are involved in this local tissue RAAS activation, and the role of this process in the development of endothelial dysfunction and arterial stiffness and targeting tissue RAAS activation.

  19. Bosentan use in systemic lupus erythematosus patients with pulmonary arterial hypertension.

    Science.gov (United States)

    Mok, M Y; Tsang, P L; Lam, Y M; Lo, Y; Wong, W S; Lau, C S

    2007-01-01

    Pulmonary arterial hypertension (PAH) in patients with systemic lupus erythematosus (SLE) is uncommon but is associated with poor survival. This study aimed to examine the long-term effects of bosentan, a dual endothelin-1 receptor antagonist, on symptomatology, haemodynamics and quality of life measures in SLE patients with symptomatic PAH. Four local patients had been followed up prospectively with pre-defined protocol during 12-months of bosentan treatment. Six minute walk distance (6MWD), NYHA functional class, Borg Dyspnoea Index (BDI) and SF-36 were measured at 0, 3, 6, 9 and 12 months. Systolic pulmonary arterial pressure (PAP) was measured by transthoracic echocardiography at zero, six and 12 months. Clinical parameters were analysed, pooling data from other SLE patients reported in the literature (n = 4). Bosentan was found to result in significant improvement in 6MWD compared to baseline [+24.8 m, +26.2 m, +54 m and +62.7 m at three (P = 0.001), six (P = 0.001), nine (P = 0.24) and 12 (P = 0.01) months respectively]. A differential effect was found with greater response in patients with lower exercise capacity. This was accompanied by decrease in NYHA functional class, BDI, transient or sustained drop in systolic PAP and mild improvement in SF-36 domains including mental health, vitality, social function and general health. Significantly deranged liver function was found in one patient.

  20. Reduced systemic microvascular density and reactivity in individuals with early onset coronary artery disease.

    Science.gov (United States)

    Tibirica, Eduardo; Souza, Elaine G; De Lorenzo, Andrea; Oliveira, Glaucia M M

    2015-01-01

    This study sought to test whether patients with early-onset coronary artery disease (EOCAD, n=30) showed systemic microvascular rarefaction and endothelial dysfunction in comparison to age- and sex-matched healthy controls (CTL, n=30), as evaluated by skin video-capillaroscopy. Functional capillary density (FCD) was defined as the number of spontaneously perfused capillaries per square millimeter of skin area and assessed by high-resolution intra-vital color microscopy in the dorsum of the middle phalanx. Capillary recruitment (capillary reserve) was evaluated using post-occlusive reactive hyperemia (PORH) after arm ischemia for 3min. The mean capillary density at rest was significantly reduced in patients with EOCAD compared to controls (CTL 95±20 and EOCAD 80±18capillaries/mm(2), P=0.0040). During PORH, capillary density was also markedly reduced in EOCAD patients (CTL 96±18 and EOCAD 71±20capillaries/mm(2), Pmicrovascular endothelial function. Thus, the early detection of these microvascular alterations in young adults at an increased risk of coronary artery disease could be useful as a surrogate marker of subclinical atherosclerosis. Copyright © 2014 Elsevier Inc. All rights reserved.

  1. Nonbronchial systemic feeding arteries in patients with hemoptysis : predictive factors at radiography

    Energy Technology Data Exchange (ETDEWEB)

    Paik, Nam Chull; Park, Kyung Joo; Chung, Kyung Il; Won, Je Hwan; Suh, Jung Ho [Ajou Univ. School of Medicine, Suwon (Korea, Republic of)

    2001-09-01

    To determine the radiographic findings which predict the presence of nonbronchial systemic feeding arteries (NBFAs) in patients undergoing embolotherapy to control hemoptysis. In 48 patients (39 men and 9 women ; mean age, 51 years) who underwent embolotherapeutic procedures for controlling hemoptysis, selective angiography was performed at the intercostal, subclavian and bronchial arteries in 65 hemithoraces (right 11, left 20, bilateral 17). Underlying diseases were tuberculosis (n=34, including three patients with aspergilloma), bronchiectasis )n=11), paragonimiasis (n=2) and metastatic cancer (n=1). The presence of NBFA at angiography was correlated with radiographic findings including pleural thickening, parenchymal distortion, and the location of lung lesions. NBFAs were found in 34 (77%) of 44 hemithoraces with pleural thickening, and in six (29%) of 21 without pleural thickening ; the sensitivity and specificity of prediction were 85% and 60%, respectively. NBFAs were observed with greater frequency as the thickness of the pleura increased, and the extent of pleural thickening correlated less with the presence of NBFA than did thickness. NBFAs were found in 35 (78%) of 45 hemithoraces with parenchymal distortion, and in five (25%) of 20 without distortion (p<0.001). In addition, the distribution of the underlying disease in the upper lung zone showed close correlation with the presence of NBFAs (p<0.05). In patients with hemoptysis, the pleural thickening revealed by radiography has a high sensitivity and a relatively low specificity for predicting the presence of NBFA, and patients with parenchymal distortion and upper lung lesions have a high incidence of NBFA.

  2. Quantitative assessment technique of HyperEye medical system angiography for coronary artery bypass grafting.

    Science.gov (United States)

    Yamamoto, Masaki; Nishimori, Hideaki; Handa, Takemi; Fukutomi, Takashi; Kihara, Kazuki; Tashiro, Miwa; Sato, Takayuki; Orihashi, Kazumasa

    2017-02-01

    The HyperEye Medical System (HEMS) uses indocyanine green (ICG) to visualize blood vessels in coronary artery bypass grafting (CABG). We performed quantitative HEMS assessment to detect grafts at risk of occlusion. We assessed the HEMS angiograms of 177 grafts from 69 patients who underwent CABG and compared the results with those of fluoroscopic coronary angiography, by measuring the increasing rate of ICG intensity, average acceleration value, and time to peak luminance intensity. Grafts in the patent and failed groups showed significant differences in their increasing rate of intensity and average acceleration value. The average accelerations value of ICG intensity of internal thoracic artery (ITA) and saphenous vein (SV) grafts were 112.3 and 144.9 intensity/s 2 in the patent group, and 71.0 and 91.8 intensity/s 2 in the failed group. The time to peak luminance intensity was 1.7 and 1.4 s in the patent group and 2.3 and 1.9 s in the failed group; these values were not significantly different. Significant reductions in the ICG intensity rate and average acceleration value can occur in failed grafts. Therefore, quantifiable changes in ICG intensity may help detect minute changes in blood flow.

  3. Immune regulation of systemic hypertension, pulmonary arterial hypertension, and preeclampsia: shared disease mechanisms and translational opportunities.

    Science.gov (United States)

    Jafri, Salema; Ormiston, Mark L

    2017-12-01

    Systemic hypertension, preeclampsia, and pulmonary arterial hypertension (PAH) are diseases of high blood pressure in the systemic or pulmonary circulation. Beyond the well-defined contribution of more traditional pathophysiological mechanisms, such as changes in the renin-angiotensin-aldosterone system, to the development of these hypertensive disorders, there is substantial clinical evidence supporting an important role for inflammation and immunity in the pathogenesis of each of these three conditions. Over the last decade, work in small animal models, bearing targeted deficiencies in specific cytokines or immune cell subsets, has begun to clarify the immune-mediated mechanisms that drive changes in vascular structure and tone in hypertensive disease. By summarizing the clinical and experimental evidence supporting a contribution of the immune system to systemic hypertension, preeclampsia, and PAH, the current review highlights the cellular and molecular pathways that are common to all three hypertensive disorders. These mechanisms are centered on an imbalance in CD4+ helper T cell populations, defined by excessive Th17 responses and impaired Treg activity, as well as the excessive activation or impairment of additional immune cell types, including macrophages, dendritic cells, CD8+ T cells, B cells, and natural killer cells. The identification of common immune mechanisms in systemic hypertension, preeclampsia, and PAH raises the possibility of new therapeutic strategies that target the immune component of hypertension across multiple disorders. Copyright © 2017 the American Physiological Society.

  4. Emergent embolization for control of massive hemorrhage from a splanchnic artery with a new coaxial catheter system

    Energy Technology Data Exchange (ETDEWEB)

    Okazaki, M.; Higashihara, H.; Koganemaru, F.; Ono, H.; Fujimitsu, R.; Yamasaki, S.; Toyoshima, H.; Sato, S.; Hoashi, T.; Kimura, T. (Fukuoka Univ. Hospital (Japan). Dept. of Diagnostic Radiology)

    1992-01-01

    Emergent superselective embolization with a 3.0 F (1 mm) coaxial catheter and a steerable guidewire was performed in 27 patients with massive hemorrhage from a small-caliber splanchnic artery. Eight patients had intraperitoneal hemorrhage, 3 had hemobilia, 9 had gastric hemorrhage, and 7 had intestinal hemorrhage. Out of 27 patients, 7 had hemorrhage from a splanchnic artery pseudoaneurysm. Complete cessation of bleeding was obtained in all patients initially, but in 3 patients gastric hemorrhage recurred later. Otherwise, there was no rebleeding nor any major complication such as marked infarction of tissue or misplacement of embolic materials. This coaxial catheter system was highly reliable for achieving superselective catheterization in small-caliber arteries, minimizing the volume of infarcted tissue and allowing maximal preservation of splanchnic organic function. We conclude that this system represents a major advance in interventional radiology. (orig.).

  5. Endovascular Treatment of an Aneurysmal Aberrant Systemic Artery Supplying a Pulmonary Sequestrum

    Energy Technology Data Exchange (ETDEWEB)

    Kristensen, Katrine Lawaetz, E-mail: klk@dadlnet.dk [Odense University Hospital, Department of Thoracic and Vascular Surgery (Denmark); Duus, Louise Aarup, E-mail: louise.brodersen@gmail.com [Sygehus Lillebaelt Vejle, Department of Radiology (Denmark); Elle, Bo, E-mail: Bo.Elle@rsyd.dk [Odense University Hospital, Department of Radiology (Denmark)

    2015-10-15

    An aberrant systemic artery originating from the abdominal aorta supplying a pulmonary sequestration is a rare congenital malformation. This causes a left-to-left shunt. Symptoms include recurrent pneumonias, hemoptysis, and, in the long term, heart failure. Aneurysm of the aberrant vessel is rarely seen. Traditionally, treatment of pulmonary sequestrations includes ligation of the feeding vessel and lobectomy. A new promising treatment is an endovascular approach. Only a few cases describe endovascular treatment of pulmonary sequestration. This is the first published case of a giant aneurysmal branch from the abdominal aorta to the normal basal segments of the lung, successfully occluded with an Amplatzer Vascular Plug II (AVP II, St.Jude Medical, MN, USA) alone.

  6. Predictors of Good Outcome After Endovascular Therapy for Vertebrobasilar Occlusion Stroke.

    Science.gov (United States)

    Bouslama, Mehdi; Haussen, Diogo C; Aghaebrahim, Amin; Grossberg, Jonathan A; Walker, Gregory; Rangaraju, Srikant; Horev, Anat; Frankel, Michael R; Nogueira, Raul G; Jovin, Tudor G; Jadhav, Ashutosh P

    2017-12-01

    Endovascular therapy is increasingly used in acute ischemic stroke treatment and is now considered the gold standard approach for selected patient populations. Prior studies have demonstrated that eventual patient outcomes depend on both patient-specific factors and procedural considerations. However, these factors remain unclear for acute basilar artery occlusion stroke. We sought to determine prognostic factors of good outcome in acute posterior circulation large vessel occlusion strokes treated with endovascular therapy. We reviewed our prospectively collected endovascular databases at 2 US tertiary care academic institutions for patients with acute posterior circulation strokes from September 2005 to September 2015 who had 3-month modified Rankin Scale documented. Baseline characteristics, procedural data, and outcomes were evaluated. A good outcome was defined as a 90-day modified Rankin Scale score of 0 to 2. The association between clinical and procedural parameters and functional outcome was assessed. A total of 214 patients qualified for the study. Smoking status, creatinine levels, baseline National Institutes of Health Stroke Scale score, anesthesia modality (conscious sedation versus general anesthesia), procedural length, and reperfusion status were significantly associated with good outcomes in the univariate analysis. Multivariate logistic regression indicated that only smoking (odds ratio=2.61; 95% confidence interval, 1.23-5.56; P =0.013), low baseline National Institutes of Health Stroke Scale score (odds ratio=1.09; 95% confidence interval, 1.04-1.13; P Stroke Scale score, and successful reperfusion status were associated with good outcome in patients with posterior circulation stroke treated with endovascular therapy. © 2017 American Heart Association, Inc.

  7. Hipertensão arterial sistêmica e anestesia Hipertensión arterial sistémica y anestesia Systemic hypertension and anesthesia

    Directory of Open Access Journals (Sweden)

    Michelle Nacur Lorentz

    2005-10-01

    evidencias de la literatura que puedan direccionar la práctica clínica. CONTENIDO: El artículo presenta incidencia y clasificación de la hipertensión arterial sistémica, además de relatar y comentar trabajos relevantes a respecto de la hipertensión arterial en el paciente quirúrgico. CONCLUSIONES: Aún no están establecidos sobre cuales niveles máximos de presión son compatibles con una cirugía electiva, siendo que, actualmente, los criterios para la suspensión de la cirugía en el paciente hipertenso mal controlado son mucho más apoyados en dados empíricos que en evidencias. Existe una inclinación en aplazar la cirugía cuando la PA es superior a 180/110 mmHg, solamente que cada caso debe ser analizado aisladamente, valorando más lesiones en órganos mira que en la presión arterial propiamente dicha.BACKGROUND AND OBJECTIVES: Due to the high incidence of systemic hypertension and the lack of consensus on pressure levels to be accepted before inducing anesthesia for elective procedures, literature associated to hypertension and anesthesia was reviewed. Considering that canceling a surgery implies expenses making Medicine increasingly more expensive and that, on the other hand, anesthesia should be induced in the safest possible manner, this study aimed at evaluating literature evidences to orient clinical practice. CONTENTS: Incidence and classification of systemic hypertension in addition to reports and comments on relevant studies approaching hypertension in surgical patients are presented. CONCLUSIONS: Maximum pressure levels compatible with elective procedures are still not established and today criteria to cancel surgery of poorly controlled hypertensive patients are more based on empirical data than on evidences. There is a trend to cancel the procedure when BP is above 180/110 mmHg, but situations should be evaluated in a case-by-case basis, giving more importance to target-organs injury than to blood pressure itself.

  8. Atherosclerotic plaque in carotid arteries in systemic lupus erythematosus: frequency and associated risk factors

    Directory of Open Access Journals (Sweden)

    Alexandre Wagner Silva de Souza

    Full Text Available CONTEXT AND OBJECTIVE: Atherosclerotic disease is an important cause of morbidity and mortality in systemic lupus erythematosus (SLE patients. No previous study has estimated carotid disease prevalence in such patients in Brazil. The aim was to evaluate the prevalence of atherosclerotic plaque in carotid arteries, in SLE patients and controls, and to verify possible associations between risk factors and carotid plaque. DESIGN AND SETTING: Cross-sectional study, at Universidade Federal de São Paulo - Escola Paulista de Medicina. METHODS: Carotid plaque prevalence was assessed by B-mode ultrasound in 82 female SLE patients of mean age 34.0 years and 62 controls of mean age 35.7 years. Plaque was defined as a distinct area of hyperechogenicity and/or focal protrusion of the vessel wall into the lumen. Risk factors for coronary disease and SLE-related variables were determined. RESULTS: 50% of patients and 29% of controls presented carotid plaque. Older age, longer disease duration, higher Systemic Lupus International Collaborating Clinics (SLICC score, higher levels of low-density lipoprotein and greater diabetes, obesity, premature ovarian failure and family history of coronary artery disease were found in patients with carotid plaque than in those without plaque. Patients with plaque were younger than controls with plaque. SLE diagnosis, obesity, older age, higher SLICC score and longer disease duration were independent risk factors for carotid plaque. CONCLUSION: Young patients with SLE present higher prevalence of carotid plaque than controls. SLE diagnosis was a significant risk factor for carotid atherosclerosis.

  9. Coronary and systemic arterial physiology and immunohistochemical markers related to early coronary arterial lesions in beagle dogs given the potassium channel opener, ZD6169, or the endothelin receptor antagonist, ZD1611.

    Science.gov (United States)

    Jones, Huw Bowen; Björkman, Jan-Arne; Schofield, Jason

    2013-07-01

    We evaluated immunohistochemistry (von Willebrand Factor [vWF] or fibrinogen) and systemic and coronary arterial physiological parameters in beagle dogs to investigate early arterial lesions induced by the potassium channel opener, ZD6169, or the endothelin receptor antagonist, ZD1611. Dogs given an oral dose of ZD6169 (experiment 1) were terminated 1 day later and showed arterial and myocardial lesions. Minimal arterial lesions exhibited few condensed medial smooth muscle cells only, with others showing segmental medial necrosis occasionally with medial/adventitial acute inflammation. Intercellular immunostaining was seen in ostensibly normal tissue, where no pathology was present in conventionally stained sections. vWF and fibrinogen are valuable tools for detecting disruption of arterial integrity. In experiment 2, 2 dogs were given a single high dose of ZD6169 or ZD1611 and BP/HR monitored by conventional measures or telemetry. Substantially reduced systolic/diastolic BP and increased HR occurred within 10 min of ZD6169 infusion: ZD1611 caused minor BP decrease and HR increase. In experiment 3, both drugs given to anaesthetized dogs induced markedly exaggerated systolic phasic forward and reverse flow in left descending and right coronary arteries. Diastolic coronary artery flows were unaffected with ZD1611 and increased slightly with ZD6169. In both coronary arteries, the ZD1611-induced increase in flows paralleled decreased resistance.

  10. Serial quantitative magnetic resonance angiography follow-up of renal artery dimensions following treatment by four different renal denervation systems.

    Science.gov (United States)

    van Zandvoort, Laurens; van Kranenburg, Matthijs; Karanasos, Antonios; Van Mieghem, Nicolas; Ouhlous, Mohammed; van Geuns, Robert-Jan; van Domburg, Ron; Daemen, Joost

    2017-04-07

    Renal sympathetic denervation (RDN) is being studied as a therapeutic option for patients with therapy-resistant hypertension. It remains unclear if the procedure affects the renal arteries in such a way that luminal narrowing might occur at the mid to longer term. The aim of the present study was to assess renal artery integrity accurately at the medium to long term using recently validated quantitative magnetic resonance angiography software in patients treated with four different RDN devices. In a prospective cohort of 27 patients referred for RDN, quantitative magnetic resonance angiography (MRA) was used to assess 52 vessels at baseline, six, and 12 months post treatment with one of four different devices. No renal artery stenosis was seen at six or 12 months. The average mean lumen area was 26.6±7.3 mm2 at baseline versus 25.0±7.1 mm² and 25.0±6.1 mm² at six and 12 months, respectively, resulting in a late loss of 1.6 mm2 at six months and 1.9 mm2 at 12 months. No differences were observed in the arterial response to RDN with the four different systems used. There was no correlation between post-procedural dissections, oedema or thrombi as detected with invasive imaging, and luminal narrowing at follow-up. Quantitative MRA of patients treated with RDN revealed no significant change in renal artery dimensions up to 12-month follow-up. The lack of a change in renal artery luminal dimensions was irrespective of the arterial response to the individual devices used.

  11. Association of systemic inflammation with epicardial fat and coronary artery calcification.

    Science.gov (United States)

    Gauss, Sören; Klinghammer, Lutz; Steinhoff, Alina; Raaz-Schrauder, Dorette; Marwan, Mohamed; Achenbach, Stephan; Garlichs, Christoph D

    2015-05-01

    Increased epicardial fat volume (EFV) has been shown to be associated with coronary atherosclerosis. While it is postulated to be an independent risk factor, a possible mechanism is local or systemic inflammation. We analyzed the relationship between coronary atherosclerosis, quantified by coronary calcium in CT, epicardial fat volume and systemic inflammation. Using non-enhanced dual-source CT, we quantified epicardial fat volume (EFV) and coronary artery calcium (CAC) in 391 patients who underwent coronary computed tomography for suspected coronary artery disease. In addition to traditional risk factors, serum markers of systemic inflammation were measured (IL-1α, IL-2, IL-4, IL-6, IL-7, IL-8, IL-10,IL-12, IL-13, IL-15, IL-17, IFN-γ, TNF-α, hs-CRP, GM-CS, G-CSF, MCP-1, MIP-1, Eotaxin and IP-10). In 94 patients follow-up data were obtained after 1.9 ± 0.5 years. The 391 patients had a mean age of 60 ± 10 years, and 69 % were males. Mean EFV was 116 ± 50 mL. Median CAC was 12 (IQR 0; 152). CAC and EFV showed a significant correlation (ρ = 0.37; P EFV and CAC were significantly correlated with the traditional risk factors like age, male gender, diabetes, smoking and hypertension. With regard to biomarkers, CAC was significantly associated (negatively) to G-CSF and IL-13. EFV (median binned) was significantly associated (positively) with IP-10 (P = 0.002) and MCP-1 (ρ = 0.037). In follow-up, EFV showed a mean annualized progression of 6 mL (IQR 3; 9) (P EFV (P EFV or CAC with systemic inflammation markers. Epicardial fat volume and the baseline extent as well as progression of coronary atherosclerosis-measured by the calcium score-are significantly correlated. While both baseline EFV and CAC displayed significant correlations with systemic inflammation markers, biomarkers were not predictive of the progression of CAC or EFV.

  12. Adjuvant Hepatic Arterial Infusion Chemotherapy After Resection for Pancreatic Cancer Using Coaxial Catheter-Port System Compared with Conventional System

    Energy Technology Data Exchange (ETDEWEB)

    Hashimoto, Aya; Tanaka, Toshihiro, E-mail: toshihir@bf6.so-net.ne.jp [Nara Medical University, Department of Radiology (Japan); Sho, Masayuki [Nara Medical University, Department of Surgery (Japan); Nishiofuku, Hideyuki; Masada, Tetsuya; Sato, Takeshi; Marugami, Nagaaki [Nara Medical University, Department of Radiology (Japan); Anai, Hiroshi [Nara City Hospital, Department of Radiology (Japan); Sakaguchi, Hiroshi [Nara Prefectural Western Medical Center, Department of Radiology (Japan); Kanno, Masatoshi [Nara Medical University, Oncology Center (Japan); Tamamoto, Tetsuro; Hasegawa, Masatoshi [Nara Medical University, Department of Radiation Oncology (Japan); Nakajima, Yoshiyuki [Nara Medical University, Department of Surgery (Japan); Kichikawa, Kimihiko [Nara Medical University, Department of Radiology (Japan)

    2016-06-15

    PurposePrevious reports have shown the effectiveness of adjuvant hepatic arterial infusion chemotherapy (HAIC) in pancreatic cancer. However, percutaneous catheter placement is technically difficult after pancreatic surgery. The purpose of this study was to evaluate the feasibility and outcome of HAIC using a coaxial technique compared with conventional technique for postoperative pancreatic cancer.Materials and Methods93 consecutive patients who received percutaneous catheter-port system placement after pancreatectomy were enrolled. In 58 patients from March 2006 to August 2010 (Group A), a conventional technique with a 5-Fr indwelling catheter was used and in 35 patients from September 2010 to September 2012 (Group B), a coaxial technique with a 2.7-Fr coaxial catheter was used.ResultsThe overall technical success rates were 97.1 % in Group B and 86.2 % in Group A. In cases with arterial tortuousness and stenosis, the success rate was significantly higher in Group B (91.7 vs. 53.8 %; P = 0.046). Fluoroscopic and total procedure times were significantly shorter in Group B: 14.7 versus 26.7 min (P = 0.001) and 64.8 versus 80.7 min (P = 0.0051), respectively. No differences were seen in the complication rate. The 1 year liver metastasis rates were 9.9 % using the conventional system and 9.1 % using the coaxial system (P = 0.678). The overall median survival time was 44 months. There was no difference in the survival period between two systems (P = 0.312).ConclusionsThe coaxial technique is useful for catheter placement after pancreatectomy, achieving a high success rate and reducing fluoroscopic and procedure times, while maintaining the safety and efficacy for adjuvant HAIC in pancreatic cancer.

  13. A new method for obtaining CT during arterial portography and CT hepatic angiography sequentially with a coaxial catheter system

    Energy Technology Data Exchange (ETDEWEB)

    Fujita, Masato; Maeda, Hiroko; Yamashita, Masato [Kyoto Second Red Cross Hospital (Japan)] [and others

    1997-04-01

    We designed a new method for obtaining CT during arterial portography (CTAP) and CT hepatic angiography (CTA) sequentially without repeated transfer of the patient between the CT scanner and the angiography suite. We needed only one arterial puncture and one ordinary angiographic coaxial catheter system with this method, which enabled both CTAP and CTA images to be successfully obtained without complication in all fifteen patients with suspected hepatocellular carcinoma. CTA demonstrated better tumor stains than dynamic CT or DSA in CTAP-positive lesions. (author)

  14. Reducing false positives of microcalcification detection systems by removal of breast arterial calcifications

    Energy Technology Data Exchange (ETDEWEB)

    Mordang, Jan-Jurre, E-mail: Jan-Jurre.Mordang@radboudumc.nl; Gubern-Mérida, Albert; Karssemeijer, Nico [Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen 6525 GA (Netherlands); Heeten, Gerard den [The National Training Centre for Breast Cancer Screening, Nijmegen 6503 GJ, The Netherlands and Department of Radiology, Amsterdam Medical Center, Amsterdam 1100 DD (Netherlands)

    2016-04-15

    Purpose: In the past decades, computer-aided detection (CADe) systems have been developed to aid screening radiologists in the detection of malignant microcalcifications. These systems are useful to avoid perceptual oversights and can increase the radiologists’ detection rate. However, due to the high number of false positives marked by these CADe systems, they are not yet suitable as an independent reader. Breast arterial calcifications (BACs) are one of the most frequent false positives marked by CADe systems. In this study, a method is proposed for the elimination of BACs as positive findings. Removal of these false positives will increase the performance of the CADe system in finding malignant microcalcifications. Methods: A multistage method is proposed for the removal of BAC findings. The first stage consists of a microcalcification candidate selection, segmentation and grouping of the microcalcifications, and classification to remove obvious false positives. In the second stage, a case-based selection is applied where cases are selected which contain BACs. In the final stage, BACs are removed from the selected cases. The BACs removal stage consists of a GentleBoost classifier trained on microcalcification features describing their shape, topology, and texture. Additionally, novel features are introduced to discriminate BACs from other positive findings. Results: The CADe system was evaluated with and without BACs removal. Here, both systems were applied on a validation set containing 1088 cases of which 95 cases contained malignant microcalcifications. After bootstrapping, free-response receiver operating characteristics and receiver operating characteristics analyses were carried out. Performance between the two systems was compared at 0.98 and 0.95 specificity. At a specificity of 0.98, the sensitivity increased from 37% to 52% and the sensitivity increased from 62% up to 76% at a specificity of 0.95. Partial areas under the curve in the specificity

  15. Use of Systemic Vasodilators for the Management of Doppler Ultrasound Arterial Abnormalities After Orthotopic Liver Transplantation.

    Science.gov (United States)

    Mohkam, Kayvan; Fanget, Florian; Darnis, Benjamin; Harbaoui, Brahim; Rode, Agnès; Charpiat, Bruno; Ducerf, Christian; Mabrut, Jean-Yves

    2016-12-01

    Doppler ultrasound (DUS) arterial abnormalities (DAA) after orthotopic liver transplantation (OLT) often represent a sign of hepatic artery (HA) complication (HAC). The standard management of DAA involves computed tomographic angiography (CTA) followed by invasive vascular intervention (IVI) or observation. We evaluated the contribution of systemic vasodilators (SVD) to the management of DAA after OLT. Between 2005 and 2015, 91 of 514 OLT recipients developed DAA (defined by HA resistive index [HARI] ultrasound was performed 2 days later, and patients were assigned to 3 groups accordingly: the normalization group (HARI >0.5), improvement group (HARI increase of >0.1 but value <0.5), or nonresponse group. We analyzed the contribution of this strategy to predict clinically significant HAC, defined as thrombosis or HAC requiring IVI. A clinically significant HAC (4 thromboses, 35 HACs requiring IVI) was found in 2.9% (n = 1/34), 32.1% (n = 9/28), and 100% (n = 29/29) of patients in the normalization, improvement, and nonresponse groups, respectively (P < 0.001). On multivariate analysis, absence of HARI normalization after SVD and time to DAA longer than 30 days were associated with clinically significant HAC. Specificity and accuracy of DUS after SVD increased from 88.1% to 95.1% and from 88.9% to 95.1% (P < 0.001), without altering its sensitivity (97.7% vs 95.5%, P = 1.000). The use of SVD improves the diagnostic performance of DUS for clinically significant HAC after OLT. It allows identifying patients at low risk for HAC, for whom CTA could be avoided, and helps choosing between observation and IVI in patients with inconclusive CTA.

  16. Small, medium but not large arteries are involved in digital ulcers associated with systemic sclerosis.

    Science.gov (United States)

    Aïssou, Linda; Meune, Christophe; Avouac, Jérôme; Meunier, Marine; Elhaï, Muriel; Sorbets, Emmanuel; Kahan, André; Allanore, Yannick

    2016-07-01

    Digital ulcers (DU) are a burden in systemic sclerosis (SSc). Microangiopathy is a cardinal feature of SSc that plays a critical role in the development of DU. However, whether injury of medium or large vessels also contributes to DU in SSc remains controversial. To measure concomitantly in SSc patients with and without active DU: (i) the Augmentation Index of the reflected wave (Aix_75) by radial applanation tonometry, an index of small and medium arterial function; (II) the aortic pulse wave velocity (PWV), a marker of large vessel injury (aortic stiffness). Sixty-three consecutive SSc patients were included (49 females, aged 60 [49-65] years, disease duration of 8.5 [5-13] years), including 10 (15.9%) with active DU. Patients with active DU versus those without had increased Aix_75 (35% [28-38] versus 28% [20-34], P=0.041) whereas no difference existed in PWV (7.0m/s [6.7-10.1] versus 7.6m/s [6.8-8.7], P=0.887), in systolic, diastolic, as well as aortic pulse pressure (P=0.126, 0.592, and 0.161, respectively). When compared to patients in the low tertile, patients having Aix_75 in the highest tertile had 10-fold more DU (OR=10.23; 95% CI 1.12 to 93.34, P=0.039). The presence of DU is associated with increased Aix_75 whereas there is no relation with PWV. These data suggest that small and medium arteries are involved in the occurrence of DU whether large vessel stiffness does not contribute. Whether Aix_75 is predictive of further DU remained to be studied. Copyright © 2015 Société française de rhumatologie. Published by Elsevier SAS. All rights reserved.

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

    Science.gov (United States)

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

    2017-06-01

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

  18. Catheter-directed gastric artery chemical embolization suppresses systemic ghrelin levels in porcine model.

    Science.gov (United States)

    Arepally, Aravind; Barnett, Brad P; Patel, Tarak H; Patel, Tarek T; Howland, Valerie; Boston, Ray C; Kraitchman, Dara L; Malayeri, Ashkan A

    2008-10-01

    To prospectively test, in a porcine model, the hypothesis that catheter-directed gastric artery chemical embolization (GACE) can result in suppression of systemic ghrelin levels and affect weight gain. This study, which had Animal Care and Use Committee approval, was performed in healthy, growing swine (weight range, 40-45 kg; n = 10). GACE was performed in five swine with the infusion of sodium morrhuate (125 mug) selectively into the gastric arteries that supply the fundus. Five control animals underwent a sham procedure with 5 mL of saline. Weight and fasting plasma ghrelin levels were obtained in animals at baseline and in weeks 1-4. Statistical testing for substantial differences in ghrelin blood levels over time and between treated and untreated animals was performed by using a cross-sectional time-series linear model with feasibility generalized least squares. The pattern of the change in ghrelin levels over time was significantly different between control and treated animals (P ghrelin levels were significantly reduced at week 1 (mean, 664.1 pg/mL +/- 103.1 [standard error of the mean], P ghrelin values in swine treated with GACE decreased from baseline to -34%, -38.6%, -42.5%, and -12.9% during weeks 1-4, respectively. In control swine, percentage change in serum ghrelin was -1.7%, -9.7%, +2.6%, and +18.2% during weeks 1-4, respectively. At the end of 4 weeks, control swine continued to gain weight, with a 15.1% increase from their original weight, while the weight in swine treated with GACE plateaued at an increase of 7.8% from the original weight. Catheter-directed GACE can suppress the appetite hormone ghrelin and affect weight gain. (c) RSNA, 2008.

  19. Label-free imaging of arterial tissues using photonic crystal fiber (PCF) based nonlinear optical microscopic system

    Science.gov (United States)

    Ko, Alex C. T.; Ridsdale, Andrew; Pegoraro, Adrian F.; Smith, Michael S. D.; Mostaço-Guidolin, Leila B.; Hewko, Mark D.; Kohlenberg, Elicia M.; Schattka, Bernie J.; Shiomi, Masashi; Stolow, Albert; Sowa, Michael G.

    2009-02-01

    Nonlinear optical (NLO) microscopy provides a minimally invasive optical method for fast molecular imaging at subcellular resolution with 3D sectioning capability in thick, highly scattering biological tissues. In the current study, we demonstrate the imaging of arterial tissue using a nonlinear optical microscope based on photonic crystal fiber and a single femto-second oscillator operating at 800nm. This NLO microscope system is capable of simultaneous imaging extracellular elastin/collagen structures and lipid distribution within aortic tissue obtained from coronary atherosclerosis-prone WHHLMI rabbits (Watanabe heritable hyperlipidemic rabbit-myocardial infarction) Clear pathological differences in arterial lumen surface were observed between healthy arterial tissue and atherosclerotic lesions through NLO imaging.

  20. The adjustable systemic-pulmonary artery shunt provides precise control of flow in vivo.

    Science.gov (United States)

    Douglas, William I; Moore, Karabeth B; Resig, Phillip P; Mohiuddin, M Waqar

    2010-01-01

    The ratio of pulmonary:systemic blood flow (Qp:Qs) remains problematic after single ventricle reconstruction. The adjustable systemic-pulmonary artery shunt (AS) was created as a solution for this problem. Prototype ASs were created using a screw-plunger mechanism as a variable resistor. A stepper motor controls plunger displacement. Six adult dogs underwent placement of a 4-mm AS in the femoral position to test its ability to control flow. Shunts were placed as arteriovenous fistulae to simulate the continuous flow of systemic-pulmonary AS. The 3.5-mm control shunts (CS) were placed on the contralateral side. The stepper motor was rotated from fully open to 3.4 mm of plunger depression for six complete cycles. Flow in the fully open AS was 687.9 +/- 28.7 cc/min* vs. 578.7 +/- 26.8 cc/min in the CS (flow +/- standard error, *p < 0.005 vs. CS). Standard deviation of flow was similar between the AS and CS, implying hysteresis in resistor function did not contribute to flow variability. Peak torque requirement to turn the resistor was 2.4 mNm. The AS offers excellent control of flow in vivo. Control of Qp:Qs may lead to improved outcomes for single ventricle reconstructions.

  1. Comparison of systemic right ventricular function in transposition of the great arteries after atrial switch and congenitally corrected transposition of the great arteries.

    Science.gov (United States)

    Morcos, Michael; Kilner, Philip J; Sahn, David J; Litt, Harold I; Valsangiacomo-Buechel, Emanuela R; Sheehan, Florence H

    2017-12-01

    In patients with transposition of the great arteries corrected by interatrial baffle (TGA) and those with congenitally corrected transposition of the great arteries (ccTGA) the right ventricle (RV) is subjected to systemic pressure and fails prematurely. Previous studies have demonstrated RV dysfunction may be more pronounced in patients with TGA. The present study sought to compare patients with TGA and ccTGA using three-dimensional (3D) techniques to comprehensively analyze the shape, volume, global and regional function in the systemic RV. We compared RV size, shape, and regional and global function in 25 patients with TGA, 17 patients with ccTGA, and 9 normal subjects. The RVs were reconstructed from cardiac Magnetic Resonance Images for 3D analyses. Compared to normal, the RV in TGA and ccTGA was dilated, rounded, and reduced in function. Compared to each other, TGA and ccTGA patients had similar RV size and shape. Global RV function was lower in TGA than ccTGA when assessed from ejection fraction (EF) (30 ± 7 vs. 35 ± 7, p = 0.02) and from normalized tricuspid annular systolic plane excursion (TAPSE) (0.10 ± 0.04 vs. 0.18 ± 0.04, p < 0.01). Basilar RV function was poorer in the TGA patients when compared to ccTGA. The systemic RVs in both TGA and ccTGA are dilated, spherical, and poorly functioning. Compared to ccTGA, TGA RVs have reduced TAPSE and worse basilar hypokinesis.

  2. Secretory clusterin is upregulated in rats with pulmonary arterial hypertension induced by systemic-to-pulmonary shunts and exerts important roles in pulmonary artery smooth muscle cells.

    Science.gov (United States)

    Liu, X; Meng, L; Li, J; Meng, J; Teng, X; Gu, H; Hu, S; Wei, Y

    2015-02-01

    Phenotype modification of pulmonary artery smooth muscle cells (PASMCs) (excessive proliferation, migration and impaired apoptosis) plays central roles in pulmonary vascular remodelling of pulmonary arterial hypertension (PAH); however, the potential mechanism and contributing factors involved in the phenotype alteration in PASMCs are still not completely elucidated. This study attempted to investigate the expression pattern of secretory clusterin (sCLU), a prosurvival protein, in systemic-to-pulmonary shunt-induced PAH rats and the potential roles of sCLU in pulmonary vascular remodelling. An original rat model of systemic-to-pulmonary shunt-induced PAH was established by combined surgery as we previously reported. Lung tissues were harvested at specific time points for real-time polymerase chain reaction, Western blot and immunohistochemisty analysis; meanwhile, plasma was collected for enzyme-linked immunosorbent assay. Cell culture experiments were performed using cultured human PASMCs (HPASMCs). Expression of sCLU was significantly increased in lungs exposed to systemic-to-pulmonary shunt. Moreover, plasma sCLU levels were markedly elevated with the progression of PAH in rats and also presented a positive correlation with pulmonary hemodynamic indices. In vitro cell culture assay indicated that sCLU expression and secretion increased with the phenotype modification of HPASMCs; furthermore, sCLU promoted HPASMCs proliferation, migration and apoptosis resistance, at least in part, via Erk1/2 and Akt signalling pathways. These results demonstrate that sCLU is functionally an important phenotype modulator of PASMCs, and its upregulation in lung tissues may exert a deteriorative role in pulmonary vascular remodelling. © 2014 Scandinavian Physiological Society. Published by John Wiley & Sons Ltd.

  3. Morphological comparison of the cardiac autonomic nervous system between normal and abnormal great arterial branching pattern with a brief review of the literature.

    Science.gov (United States)

    Kawashima, Tomokazu; Sasaki, Hiroshi

    2007-03-30

    Information on the topological relationship between arterial and peripheral autonomic nervous systems is insufficient for application to other research fields as each system has been analyzed separately during a long anatomical history. In the present study, we scrutinized the topological changes in the cardiac autonomic nervous system (CANS) in cadavers with a normal great arterial branching pattern of the aortic arch and in those with an anomalous left vertebral artery. These results were then compared with our previous report on cadavers with a retroesophageal right subclavian artery, and we attempted to consider the possible morphological causal principles of the changes. This report would be useful not only for morphological research but also to improve cardiac treatment and animal experiments. Although the CANS shift was considered when a great arterial branching anomaly appeared, additional cardiac nerves along the anomalous artery were found in addition to the normal CANS composition, based on our present and previous anomalous reports. From both developmental and anatomical viewpoints, CANS may depend on the surrounding arterial system. Therefore, a detailed analysis of the peripheral autonomic nervous system with its surrounding structures, especially the arterial system, has filled the gap between morphological and molecular embryological research in addition to the clinical significance in cardiac surgery, the understanding of experimental results, and the application to cardiac functions.

  4. An intelligent prognostic system for analyzing patients with paraquat poisoning using arterial blood gas indexes.

    Science.gov (United States)

    Hu, Lufeng; Lin, Feiyan; Li, Huaizhong; Tong, Changfei; Pan, Zhifang; Li, Jun; Chen, Huiling

    The arterial blood gas (ABG) test is used to assess gas exchange in the lung, and the acid-base level in the blood. However, it is still unclear whether or not ABG test indexes correlate with paraquat (PQ) poisoning. This study investigates the predictive value of ABG tests in prognosing patients with PQ poisoning; it also identifies the most significant indexes of the ABG test. An intelligent machine learning-based system was established to effectively give prognostic analysis of patients with PQ poisoning based on ABG indexes. In the proposed system, an enhanced support vector machine combined with a feature selection strategy was developed to predict the risk status from a pool of 103 patients (56 males and 47 females); of these, 52 subjects were deceased and 51 patients were alive. The proposed method was rigorously evaluated against the real-life dataset in terms of accuracy, sensitivity, and specificity. Additionally, the feature selection was investigated to identify correlating factors for the risk status. The results demonstrated that there were significant differences in ABG indexes between deceased and alive subjects (p-value <0.01). According to the feature selection, we found that the most important correlated indexes were associated with partial pressure of carbon dioxide (PCO2). This study discovered the relationship between ABG test and poisoning degree to provide a new avenue for prognosing PQ poisoning. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Aging in blood vessels. Medicinal agents FOR systemic arterial hypertension in the elderly.

    Science.gov (United States)

    Rubio-Ruiz, María Esther; Pérez-Torres, Israel; Soto, María Elena; Pastelín, Gustavo; Guarner-Lans, Verónica

    2014-11-01

    Aging impairs blood vessel function and leads to cardiovascular disease. The mechanisms underlying the age-related endothelial, smooth muscle and extracellular matrix vascular dysfunction are discussed. Vascular dysfunction is caused by: (1) Oxidative stress enhancement. (2) Reduction of nitric oxide (NO) bioavailability, by diminished NO synthesis and/or augmented NO scavenging. (3) Production of vasoconstrictor/vasodilator factor imbalances. (4) Low-grade pro-inflammatory environment. (5) Impaired angiogenesis. (6) Endothelial cell senescence. The aging process in vascular smooth muscle is characterized by: (1) Altered replicating potential. (2) Change in cellular phenotype. (3) Changes in responsiveness to contracting and relaxing mediators. (4) Changes in intracellular signaling functions. Systemic arterial hypertension is an age-dependent disorder, and almost half of the elderly human population is hypertensive. The influence of hypertension on the aging cardiovascular system has been studied in models of hypertensive rats. Treatment for hypertension is recommended in the elderly. Lifestyle modifications, natural compounds and hormone therapies are useful for initial stages and as supporting treatment with medication but evidence from clinical trials in this population is needed. Since all antihypertensive agents can lower blood pressure in the elderly, therapy should be based on its potential side effects and drug interactions. Copyright © 2014 Elsevier B.V. All rights reserved.

  6. CT and MRI findings of cerebral ischemic lesions in the cortical and perforating arterial system

    Energy Technology Data Exchange (ETDEWEB)

    Kameyama, Masakuni; Udaka, Fukashi; Nishinaka, Kazuto; Kodama, Mitsuo; Urushidani, Makoto; Kawamura, Kazuyuki; Inoue, Haruhisa; Kageyama, Taku [Sumitomo Hospital, Osaka (Japan)

    1995-07-01

    It is clinically useful to divide the location of infarction into the cortical and perforating arterial system. Computerized tomography (CT) and magnetic resonance imaging (MRI) now make the point of infarction a simple and useful task in daily practice. The diagnostic modality has also demonstrated that risk factors and clinical manifestations are different for infarction in the cortical as opposed to the perforating system. In this paper, we present various aspects of images of cerebral ischemia according to CT and/or MRI findings. With the advance of imaging mechanics, diagnostic capability of CT or/and MRI for cerebral infarction has markedly been improved. We must consider these points on evaluating the previously reported results. In addition, we always consider the pathological background of these image-findings for the precise interpretation of their clinical significance. In some instances, dynamic study such as PET or SPECT is needed for real interpretations of CT and/or MRI images. We paid special reference to lacunar stroke and striatocapsular infarct. In addition, `branch atheromatous disease (Caplan)` was considered, in particular, for their specific clinical significances. Large striatocapsular infarcts frequently show cortical signs and symptoms such as aphasia or agnosia in spite of their subcortical localization. These facts, although have previously been known, should be re-considered for their pathoanatomical mechanism. (author).

  7. Patency of Saphenous Vein Grafts Using the PAS-Port System During Coronary Artery Bypass Surgery.

    Science.gov (United States)

    Kubota, Hiroshi; Endo, Hidehito; Ishii, Hikaru; Tsuchiya, Hiroshi; Takahashi, Yu; Inaba, Yusuke; Noma, Mio; Yoshimoto, Akihiro; Higuchi, Satoshi; Kohshoh, Hideyasu; Taniai, Seiichi; Ishiguro, Haruhisa; Yoshino, Hideaki; Sudo, Kenichi

    2017-08-01

    Several proximal anastomosis devices have been developed to shorten the time required for a proximal anastomosis and to avoid aortic cross-/side-clamping during coronary artery bypass grafting. This study retrospectively examined the patency of saphenous vein grafts (SVGs) using the PAS-Port System (Cardia Inc, Redwood City, CA). From 2004 to 2014, 451 patients underwent coronary artery bypass graft operations requiring at least 1 proximal anastomosis using a PAS-Port device. A total of 802 PAS-Port devices were used, and 95.0% (762 of 802) were implanted successfully. Among the successfully implanted anastomoses, 76.8% (585 of 762) were evaluated using coronary angiography or multidimensional computed tomography, or both. The evaluations were performed between postoperative days 4 and 3,182 (mean, 319 ± 624 days). The early (1 to 365 days) and the midterm to long-term (more than 366 days) occlusion rates were examined. A complete postoperative clinical course was recorded for 70.7% of the patients. Overall, 93.8% (549 of 585) of the device-dependent SVGs were patent. The patency rates of device-dependent SVGs that were 1, 2, 3, 4, 5, 6, 7, and 8 years old were 90.1% ± 1.8%, 87.1% ± 2.3%, 86.1% ± 2.5%, 82.9% ± 3.3%, 80.6% ± 3.9%, 77.2% ± 5.0%, 77.2% ± 5.0%, and 70.2% ± 8.1%, respectively. The longest follow-up period was 3,182 days (8.7 years). The occlusion rate for device-dependent SVGs tended to decrease as the number of patients accumulated. The PAS-Port system provided acceptable SVG patency and clinical outcome for the early and midterm to long-term. There may be a learning curve for the use of PAS-Port device that affects the device-dependent SVG patency. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  8. The effects of low dose chemotherapy for advanced hepatocellular carcinoma through percutaneously implanted intra-arterial port system

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Hyun Seok; Won, Je Hwan; Yoo, Byung Moo; Kim, Young Soo; Cho, Sung Won [Ajou Univ. College of Medicine, Suwon (Korea, Republic of); Park, Dong Won [Suwon Medical Center, Suwon (Korea, Republic of)

    2001-07-01

    To investigate the effects of low-dose FP (5-Fluorouracil[5FU]+Cispatin[CDDP]) therapy through a percutaneously implanted intra-arterial port system in patients with advanced hepatocellular carcinoma (HCC). Twenty-five patients with advanced HCCs and portal vein thrombosis, or large HCCs which were unresectable or for which transarterial chemoembolization was thought to be ineffective, underwent intra-arterial port implantation. The mean maxinal diameter of these tumors was 13.7 (range, 5-21.5) cm, and they were located at the right lobe (n=18), the left lobe(n=3), or throughout the liver (n=4). Tumor thrombosis was detected in the main (n=14), right (n=3) and left portal vein(n=1), the right portal vein and inferior vena cava(n=2), and the inferior vena cava(n=1). The four others patients had no portal vein thrombosis. All intra-arterial port implantations were performed percutaneously in the angiographic ward through the right or left common femoral artery. The port chamber was implanted in the inguinal area and fixed using histoacryl. For intra-arterial chemotherapy, 5-FU (250 mg/day) and CDDP (10 mg/day) were used for five days every four weeks. In order to observe changes in tumor size, follow-up CT scanning was performed every two months. Implantation of the port system was successful in all cases, and patients underwent between one and eleven (mena, 3.9) sessions of chemotherapy. Port-and catheter-related complications, namely dislodgement of the catheter(n=2), wound infection(n=2), migration of the coil(n=1) and catheter occlusion(n=1) occurred in six patients (24%), and chemotherapy-related complications, namely liver failure(n=3) and gastric ulcer bleeding(n=1), in four (16%). A complete response, i. e. the disappearance of tumor thrombosis of the portal vein, was achieved in one patient (4%), a partial response in three (12%), and a minor response in four (16%); the overall response rate was 32% and the mean survival period was 7.6 months. Low-dose FP

  9. The Impact of the Fibrinolytic System on the Risk of Venous and Arterial Thrombosis

    NARCIS (Netherlands)

    Meltzer, Mirjam E.; Doggen, Catharina Jacoba Maria; de Groot, Philip G.; Rosendaal, Frits R.; Lisman, Ton

    2009-01-01

    In this review we discuss the association of overall hypofibrinolysis and individual fibrinolytic protein levels with venous and arterial thrombosis. Decreased overall fibrinolytic potential and high plasma levels of thrombin-activatable fibrinolysis inhibitor have been consistently associated with

  10. Myocardial Deformation Measured by 3-Dimensional Speckle Tracking in Children and Adolescents With Systemic Arterial Hypertension.

    Science.gov (United States)

    Navarini, Susanne; Bellsham-Revell, Hannah; Chubb, Henry; Gu, Haotian; Sinha, Manish D; Simpson, John M

    2017-12-01

    Systemic arterial hypertension predisposes children to cardiovascular risk in childhood and adult life. Despite extensive study of left ventricular (LV) hypertrophy, detailed 3-dimensional strain analysis of cardiac function in hypertensive children has not been reported. The aim of this study was to evaluate LV mechanics (strain, twist, and torsion) in young patients with hypertension compared with a healthy control group and assess factors associated with functional measurements. Sixty-three patients (26 hypertension and 37 normotensive) were enrolled (mean age, 14.3 and 11.4 years; 54% men and 41% men, respectively). All children underwent clinical evaluation and echocardiographic examination, including 3-dimensional strain. There was no difference in LV volumes and ejection fraction between the groups. Myocardial deformation was significantly reduced in those with hypertension compared with controls. For hypertensive and normotensive groups, respectively, global longitudinal strain was -15.1±2.3 versus -18.5±1.9 ( P hypertensive and normotensive children, but children with hypertension had significantly lower strain indices. Whether reduced strain might predict future cardiovascular risk merits further longitudinal study. © 2017 American Heart Association, Inc.

  11. Status of systemic to pulmonary arterial collateral flow after the fontan procedure.

    Science.gov (United States)

    Whitehead, Kevin K; Harris, Matthew A; Glatz, Andrew C; Gillespie, Matthew J; DiMaria, Michael V; Harrison, Neil E; Dori, Yoav; Keller, Marc S; Rome, Jonathan J; Fogel, Mark A

    2015-06-15

    The investigators recently validated a method of quantifying systemic-to-pulmonary arterial collateral flow using phase-contrast magnetic resonance imaging velocity mapping. Cross-sectional data suggest decreased collateral flow in patients with total cavopulmonary connections (TCPCs) compared with those with superior cavopulmonary connections (SCPCs). However, no studies have examined serial changes in collateral flow from SCPCs to TCPCs in the same patients. The aim of this study was to examine differences in collateral flow between patients with SCPCs and those with TCPCs. Collateral flow was quantified by 2 independent measures from 250 single-ventricle studies in 219 different patients (115 SCPC and 135 TCPC studies, 31 patients with both) and 18 controls, during routine studies using through-plane phase-contrast magnetic resonance imaging. Collateral flow was indexed to body surface area, aortic flow, and pulmonary venous flow. Regardless of indexing method, SCPC patients had significantly higher collateral flow than TCPC patients (1.64 ± 0.8 vs 1.03 ± 0.8 L/min/m(2), p SCPC and TCPC patients demonstrate substantial collateral flow, with SCPC patients having higher collateral flow than TCPC patients overall. On the basis of the paired subset analysis, collateral flow does not decrease in the short term after TCPC completion and trends toward an increase. In the long term, however, collateral flow decreases over time after TCPC completion. Copyright © 2015 Elsevier Inc. All rights reserved.

  12. A new scoring system for evaluating coronary artery disease by using blood pressure variability.

    Science.gov (United States)

    Zhu, Wei; Qiu, Jian; Ma, Liheng; Lei, Hongqiang; Cai, Zekun; Zhao, Hui; Deng, Yu; Ma, Jun; Xu, Lin

    2017-09-01

    The aim of this study was to develop a new scoring system using ambulatory blood pressure monitoring (ABPM) to assist in the evaluation of coronary artery disease (CAD). One hundred twenty-five subjects (53.1 ± 9.6 years of age) were included. Pearson's tests were first performed to identify the parameters that correlated with Duke Treadmill Score (DTS). Blood test parameters and blood pressure variability (BPV) measures that were extracted from the ABPM were included. Next, a multiple linear regression analysis was performed to train a new scoring system in the 84 patients from the 125 patients. Then, a correlation analysis was conducted to validate the correlation between the new scoring system and DTS in the remaining 41 subjects. A further correlation analysis was used to verify the clinical value of the new scoring system using ultrasonic cardiogram (UCG) and brachial-ankle pulse wave velocity (baPWV). Our new scoring system, which had a 24.096 - 0.083 × residual standard deviation of night systolic blood pressure (SBP) - 0.130 × age - 0.206 × average real variability of night SBP, was correlated with DTS (r = 0.312, P = 0.047). Moreover, our new scoring system was also correlated with various markers of cardiac function (r = -0.290, P = 0.001; r = -0.262, P = 0.004; r = -0.303, P = 0.001; r = -0.306, P = 0.001, respectively) measured by UCG and with baPWV (r = 0.529, P = 0.001). Furthermore, the r-values for the BPV Score versus the markers were closer to -1 than the corresponding r-values for the Duke Score vs the same parameters. And the differences in r-values between Duke Score and BPV Score were statistically significant (P = 0.022). In conclusion, the new scoring system based on ABPM has potential as a non-invasive tool for evaluating CAD.

  13. Persistent trigeminal artery: angio-tomography and angio-magnetic resonance finding Artéria trigeminal persistente: achado na angio-tomografia e angio-ressonância magnética

    Directory of Open Access Journals (Sweden)

    Lícia Pachêco Pereira

    2009-09-01

    Full Text Available The trigeminal artery (TA is the most common embryonic carotid-vertebrobasilar anastomosis to persist into adulthood. It typically extends from the internal carotid artery to the basilar artery. Persistent primitive arteries are usually found incidentally, but are often associated with vascular malformation, cerebral aneurysm and, in case of TA, with trigeminal neuralgia. We present one patient with TA as a cause of trigeminal neuralgia and in other three as an incidental finding, on TC and MR angiograms.Artéria trigeminal (AT é a anastomose carótido-vertebrobasilar mais comum a persistir na vida adulta. Tipicamente estende-se da artéria carótida interna até a artéria basilar. Artérias primitivas persistentes são usualmente um achado incidental, mas freqüentemente estão associadas a malformações vasculares, aneurismas e, no caso da AT, a neuralgia do trigêmio. Apresentamos um paciente com AT como causa de neuralgia do trigêmio e em outros três como um achado incidental, em angiogramas por tomomografia computadorizada e ressonância magnética.

  14. Jetstream Atherectomy System treatment of femoropopliteal arteries: Results of the post-market JET Registry.

    Science.gov (United States)

    Gray, William A; Garcia, Lawrence A; Amin, Ali; Shammas, Nicolas W

    2017-12-27

    To report on procedural, safety, and effectiveness outcomes of real-world practice with the Jetstream rotational atherectomy system for treatment of femoropopliteal artery lesions. Safety and effectiveness of treatment with the Jetstream device has been demonstrated in clinical trials, but outcomes during real-world clinical practice have yet to be examined. 241 patients (66% male, mean age 67years, 41% diabetes; Rutherford 1-3) with de novo or restenotic (non-stent) femoropopliteal lesions ≥4cm in length were recruited. Major adverse events (MAE), defined as amputation, death, target lesion/vessel revascularization (TLR/TVR), myocardial infarction, or angiographic distal embolization that required a separate intervention; and binary restenosis were assessed at 30days and 12months. The mean (±SD) lesion length was 16.4±13.6cm; 35% of patients received adjunctive stents. Procedural success was achieved for 98.3% of lesions. The 30-day MAE rate was 2% (5/219; 2 TLR/TVR and 3 distal embolization); there were no deaths, index limb amputations, or myocardial infarctions. At 12months, the overall estimated freedom from TLR/TVR was 81.7% and 77.2% (44/57) of patients were free from duplex ultrasound-assessed restenosis. Efficacy and patency in a diabetic subset were similar to those of the overall cohort, while maintaining a similar safety profile. In a cohort reflecting real-world practice, the Jetstream Atherectomy System demonstrated a high procedural success rate with a low rate of complications and reinterventions, especially given the relatively long lesions studied. Copyright © 2017. Published by Elsevier Inc.

  15. Transarterial embolization treatment for aberrant systemic arterial supply to the normal lung: A case report and literature review

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Bo Ra; Jo, Jeong Hyun; Park, Byeong Ho [Dept. of Radiology, Dong A University Hospital, Dong A University College of Medicine, Busan (Korea, Republic of)

    2017-06-15

    A 24-year-old man presented with dyspnea on exertion and intermittent blood-tinged sputum. He was diagnosed with aberrant systemic arterial supply to the normal lung (ASANL) based on the results of imaging studies. The patient was successfully treated with transarterial embolization using coils and a vascular plug and his symptoms disappeared during the follow-up. Herein, we reported the imaging findings of ASANL, differential diagnoses, and its treatment options. In addition, we reviewed the relevant literature.

  16. [Revascularization of the carotid and vertebral arteries in the elderly].

    Science.gov (United States)

    Illuminati, G; Bezzi, M; D'Urso, A; Giacobbi, D; Ceccanei, G; Vietri, F

    2004-01-01

    From January 1994 to July 2004, 323 patients underwent 348 revascularization of carotid bifurcation for atherosclerotic stenoses. Eighty eight patients (group A) were 75 year-old or older, whereas 235 (group B) were younger than 75 years. Postoperative mortality/neurologic morbidity rate was 1% in group A, and 1.4% in group B. At 5 years, patency and freedom from symptoms/stroke were, respectively, 91% and 92% in group A, and 89% and 91% in group B. None of these differences was statistically significant. In the same time period, 26 internal carotid arteries were revascularized in 24 patients, 75 or more aged, for a symptomatic kinking. Postoperative mortality/morbidity rate was absent, whereas, at 5 years, patency and freedom from symptoms/stroke were, respectively, 88% and 92%. Twelve vertebral arteries were revascularized in 12 patients, 75 or more aged, for invalidating symptoms of vertebrobasilar insufficiency. Postoperative mortality/neurologic morbidity rate was absent. In one case postoperative recurrence of symptoms occurred, despite a patent revascularization. Patency and freedom from symptoms/stroke were 84% and 75%, at 5 years. Revascularization of carotid and vertebral arteries in the elderly can be accomplished with good results, superposable to those of standard revascularization of carotid bifurcation in a younger patients' population.

  17. Low Social Position, Periodontal Disease, and Poor Oral Health-Related Quality of Life in Adults With Systemic Arterial Hypertension.

    Science.gov (United States)

    Rebelo, Maria A B; de Castro, Pedro H D; Rebelo Vieira, Janete M; Robinson, Peter G; Vettore, Mario V

    2016-12-01

    There is little evidence on the association between periodontal disease and oral health-related quality of life (OHRQoL) in individuals with chronic diseases, including hypertension. The aim of this study is to identify relationships among sociodemographic characteristics, smoking, tooth loss, dental caries, periodontal status, and OHRQoL in adults with systemic arterial hypertension. A cross-sectional study involving 195 adults (mean age: 55.7 years) with systemic arterial hypertension used interviews and oral examinations to collect data on sociodemographic characteristics (age, sex, income); use of antihypertensive medication; smoking; tooth loss; dental caries; periodontal status (bleeding on probing, calculus, and attachment loss); and OHRQoL/oral health impact profile. The Wilson and Cleary (Wilson IB, Cleary PD. JAMA 1995;273:59-65) conceptual model was used to test direct and indirect relationships among variables using structural equation modeling. Lower age, male sex, smoking, and lower income directly predicted worse periodontal status. Tooth loss, dental caries, worse periodontal status, and smoking were directly linked to poor OHRQoL. Age was indirectly linked to worse periodontal status via income. Income and smoking indirectly predicted poor OHRQoL via periodontal status. Findings support an effect of periodontal disease on OHRQoL in people with systemic arterial hypertension. Periodontal status mediated associations of sociodemographic characteristics and smoking with OHRQoL through different pathways.

  18. Qualitative score of systemic arteriosclerosis by vascular ultrasonography as a predictor of coronary artery disease in type 2 diabetes.

    Science.gov (United States)

    Hirata, Ayumu; Kishida, Ken; Hiuge-Shimizu, Aki; Nakatsuji, Hideaki; Funahashi, Tohru; Shimomura, Iichiro

    2011-12-01

    Patients with type 2 diabetes mellitus (T2DM) are at risk of polyvascular comorbidities and poor prognosis. Non-invasive techniques for early prediction of coronary artery disease (CAD) are desirable to prevent cardiovascular events in these patients. The aim of the present study was to investigate the association between CAD and systemic arteriosclerosis by qualitative vascular ultrasonography. The study subjects were 102 consecutive outpatients with T2DM [males/females = 60/42, age: mean ± SD 67 ± 9 (range, 40-85) years] evaluated by vascular ultrasonography for arteriosclerosis in the abdominal aorta, carotid, renal, and common iliac arteries. The total number of detected arteriosclerotic vascular lesions in the four arteries was determined. CAD was diagnosed by two cardiologists using either stress electrocardiography, myocardial scintigraphy, multi-detector row computed tomography or coronary angiography. Multiple arteriosclerotic vascular lesions (>1) were detected in 64 (63%) patients. The total systemic vascular score was significantly higher in patients with CAD than those without (average score 2.7 versus 1.0, p arteriosclerosis by the total systemic vascular score is potentially useful for the early prediction of CAD in T2DM patients. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  19. Scintigraphic assessment of regional cardiac sympathetic nervous system in patients with single-vessel coronary artery disease

    Energy Technology Data Exchange (ETDEWEB)

    Sakata, Kazuyuki; Yoshida, Hiroshi; Nawada, Ryuzo; Obayashi, Kazuhiko; Tamekiyo, Hiromichi; Mochizuki, Mamoru [Shizuoka General Hospital (Japan)

    2000-06-01

    In coronary artery disease, the cardiac sympathetic nervous system is closely associated with myocardial ischemia. I-123 metaiodobenzylguanidine (MIBG) imaging allows us to assess the cardiac sympathetic nervous system regionally. One-hundred and eleven patients with single-vessel disease underwent regional quantitative analysis of MIBG imaging before successful percutaneous transluminal coronary angioplasty (PTCA), and repeat angiography 6 months after PTCA. Based on the results of the follow-up left ventriculogram, patients were divided into 3 groups: 39 angina pectoris (AP), 48 prior myocardial infarction without asynergy (MI without asynergy) and 24 prior myocardial infarction with asynergy (Ml with asynergy). AP and MI without asynergy had significant correlations between uptake parameters and regional washout in the territory of diseased vessels, among which the severity score in AP was the most closely correlated with regional washout (r=0.79, p<0.0001). These correlations disappeared in MI with asynergy. To compare regional MIBG parameters in the territory of the diseased vessel as well as in the territories of the other major coronary arteries among the 3 groups, we examined MIBG parameters in 57 patients with left anterior descending artery (LAD) disease selected from among the study patients. Regional washout in the territory of the LAD was significantly higher in the MI without asynergy group than in the other two groups. The left circumflex artery (LCX) region showed significantly reduced MlBG uptake and an increased extent score in the MI with asynergy group compared with the AP group, although only a difference in the extent score existed between the MI with asynergy group and the AP group in the right coronary artery (RCA) region. In addition, the global ejection fraction before PTCA showed a significant negative correlation with each regional washout rate. In this way, regional quantitative analysis of MIBG imaging can detect the regional

  20. The mechanical properties of the systemic and pulmonary arteries of Python regius correlate with blood pressures.

    Science.gov (United States)

    van Soldt, Benjamin J; Danielsen, Carl Christian; Wang, Tobias

    2015-12-01

    Pythons are unique amongst snakes in having different pressures in the aortas and pulmonary arteries because of intraventricular pressure separation. In this study, we investigate whether this correlates with different blood vessel strength in the ball python Python regius. We excised segments from the left, right, and dorsal aortas, and from the two pulmonary arteries. These were subjected to tensile testing. We show that the aortic vessel wall is significantly stronger than the pulmonary artery wall in P. regius. Gross morphological characteristics (vessel wall thickness and correlated absolute amount of collagen content) are likely the most influential factors. Collagen fiber thickness and orientation are likely to have an effect, though the effect of collagen fiber type and cross-links between fibers will need further study. © 2015 Wiley Periodicals, Inc.

  1. Activation products of the haemostatic system in coronary, cerebrovascular and peripheral arterial disease.

    Science.gov (United States)

    van der Bom, J G; Bots, M L; Haverkate, F; Meijer, P; Hofman, A; Kluft, C; Grobbee, D E

    2001-02-01

    To determine the presence of a 'hypercoagulable state' as assessed by indices of thrombin and plasmin generation and of the amount of fibrin that is lysed, in patients with stable coronary, cerebral and peripheral arterial disease a population-based cross-sectional study was performed. From a population-based cohort comprising 7983 men and women aged 55 years and over, we randomly selected 127 subjects with a history of myocardial infarction, 124 with a history of stroke and/or transient ischemic attack, 131 patients with peripheral arterial disease and 263 control subjects in the same age group without arterial disease. Subjects using anticoagulant drugs were not selected. F1+2, TAT, and PAP were not associated with a history of cardiovascular events, nor with peripheral arterial disease. In contrast, positive associations were found for D-Dimer. Mean D-Dimer level was 40 microg/l (95% CI 35, 44) in control subjects; 53 microg/l (47, 61) in those with a history of myocardial infarction and 51 microg/l (45, 58) in those with a history of stroke and or transient ischemic attack. D-Dimer increased gradually with increasing severity of peripheral atherosclerosis; a decrease in ankle/arm systolic blood pressure ratio of 0.1 was associated with an increase in D-Dimer of 3.9 microg/l (p<0.01). This was more pronounced in subjects with higher F1+2, TAT and PAP concentration. In conclusion, the markers of onset of coagulation F1+2, TAT and PAP are not associated with the presence of arterial disease, but increased levels of these markers are necessary for the positive association between D-Dimer and arterial disease.

  2. Determinants of risk for venous and arterial thrombosis in primary antiphospholipid syndrome and in antiphospholipid syndrome with systemic lupus erythematosus.

    Science.gov (United States)

    Danowski, Adriana; de Azevedo, Mario Newton Leitão; de Souza Papi, Jose Angelo; Petri, Michelle

    2009-06-01

    Antiphospholipid syndrome (APS) is characterized by thrombosis (venous and arterial) and pregnancy loss in conjunction with the lupus anticoagulant, IgG or IgM anticardiolipin, or IgG or IgM anti-beta2-glycoprotein I. In most series, only a minority of patients with antiphospholipid antibodies develop a clinical manifestation. A cross-sectional study of consecutive patients in the Hopkins Lupus Center was performed. Interviews were done and records were reviewed for the following variables: gender, ethnicity, hypertension, triglycerides, cholesterol, smoking, diabetes mellitus, homocysteine, cancer, hepatitis C, hormone replacement therapy/oral contraceptives, hereditary thrombophilia, anticardiolipin antibodies IgG, IgM and IgA, and lupus anticoagulant (LAC). Our aim was to identify risk factors associated with thrombosis and pregnancy loss in patients with antiphospholipid antibodies. A total of 122 patients (84% female, 74% Caucasian) were studied. Patients were divided into 3 groups: primary APS, APS associated with systemic lupus erythematosus, and patients with systemic lupus erythematosus (SLE) with antiphospholipid antibodies but no thrombosis or pregnancy loss. Venous thrombosis was associated with high triglycerides (p=0.001), hereditary thrombophilia (p=0.02), anticardiolipin antibodies IgG>40 (p=0.04), and LAC (p=0.012). Hypertriglyceridemia was associated with a 6.4-fold increase, hereditary thrombophilia with a 7.3-fold increase, and anticardiolipin IgG>40 GPL with a 2.8-fold increase in the risk of venous thrombosis. Arterial thrombosis was associated with hypertension (p=0.008) and elevated homocysteine (p=0.044). Hypertension was associated with a 2.4-fold increase in the risk of arterial thrombosis. No correlations were found for pregnancy loss. The frequency of thrombosis and pregnancy loss is greater in APS associated with SLE than in primary APS. Risk factors differ for venous and arterial thrombosis in APS. Treatment of hypertension may be the

  3. Dynamical systems characterization of inertial effects of fluid flow in a curved artery model under pulsatile flow forcing

    Science.gov (United States)

    Leggiero, Michael; Bulusu, Kartik V.; Plesniak, Michael W.

    2013-11-01

    The main objective of this study was to examine inertial effects in a 180-degree model of curved arteries under pulsatile inflow conditions. Two-component, two-dimensional particle image velocimetery (2C-2D PIV) data were acquired upstream of and at several cross-sectional locations in the curved artery model. A blood-analog fluid comprised of 71% saturated sodium iodide solution, 28% glycerol and 1% distilled water (by volume) was subjected to multi-harmonic pulsatile inflow functions. First, signal time-lag was quantified by cross-correlating the input (voltage-time) supplied to a programmable pump and the output PIV (flow rate-time) measurements. The experiment was then treated as a linear, time-invariant system, and frequency response was estimated for phase shifts across a certain spectrum. Input-output signal dissimilarities were attributable to intrinsic inertial effects of flow. By coupling pressure-time and upstream flow rate-time measurements, the experiment was modeled using system identification methods. Results elucidate the role of inertial effects in fluid flow velocity measurements and the effect of these delays on secondary flow structure detection in a curved artery model. Supported by the NSF Grant No. CBET- 0828903 and GW Center for Biomimetics and Bioinspired Engineering.

  4. [Restenosis of carotid arteries after carotid endarterectomy: current aspects of the problem: (local and systemic risk factors). Part 1].

    Science.gov (United States)

    Losev, R Z; Kulikova, A N; Bakhmet'ev, A S

    2012-01-01

    Carotid endarterectomy is currently the most effective surgical means of preventing ischaemic stroke. Despite the fact that this type of intervention is widely used, there seems to be no tendency toward decreased incidence of such a complication as restenosis of carotid arteries.The present review deals with the results of analyzing the literature on the problem concerning carotid artery restenosis after carotid endarterectomy. Considered herein are the problems of epidemiology and prevalence of the complication involved. Special attention is paid to local and systemic risk factors for the development of restenosis. Studying risk factors of restenosis after carotid endarterectomy is of considerable importance for both prevention and choice of pathogenetically targeted treatment of patients presenting with atherosclerotic lesions of brachiocephalic vessels.

  5. The MERCI Retrieval System for the management of acute ischaemic stroke--the NNI Singapore experience.

    Science.gov (United States)

    Lee, Wickly; Sitoh, Yih-Yian; Lim, C C Tchoyoson; Lim, Winston E H; Hui, Francis K H

    2009-09-01

    Systemic and local intra-arterial thrombolysis in patients with large vessel ischaemic stroke is hampered by poor re-canalisation rates and risk of haemorrhage. The Merci Retrieval System is an endovascular device for removal of acute intracranial thrombus. We present our initial experience using this device in conjunction with existing thrombolytic therapy already in place in our institute. Prospective data in all patients presenting with large vessel ischaemic stroke treated using the Merci Retrieval System from July 2007 to March 2009 were analysed. Selection criteria for patients were similar to the multi- Merci trial of 2008. We compared re-canalisation rate, National Institutes of Health Stroke Score (NIHSS) and modified Rankin score (mRS) outcomes to the published trial results. Seventeen patients were reviewed; none suffered immediate post-procedural complications. Fifteen underwent successful thrombus retrieval but in 2 cases the device failed due to technical considerations. Sites of vascular occlusion included: ICA/ICA-'T' junctions 27%, middle cerebral artery 13% and vertebrobasilar artery 60%. Of the 15 patients treated by MERCI with or without adjuvant thrombolytic therapy, complete re-canalisation was achieved in 60%, partial re-canalisation in 20%, partial re-canalisation with persistent distal vessel occlusion in 6% and failure of re-canalisation in 14%. Asymptomatic haemorrhage occurred in 33% and there was 1 death (6%) from symptomatic haemorrhage. Pre-treatment median NIHSS was 17.88 and 9.5 immediately post-treatment. Median mRS at 30 days was 2.6 for patients who achieved complete re-canalisation and 4.5 in failure or partial re-canalisation with or without persistent distal vessel occlusion. Re-canalisation rates using the Merci Retrieval System was comparable to the multi-Merci trial. Haemorrhagic complications and safety were also found to be satisfactory. Importantly, treatment success with eventual good clinical outcome hinges strongly on

  6. A Clinical and Biomarker Scoring System to Predict the Presence of Obstructive Coronary Artery Disease

    NARCIS (Netherlands)

    Ibrahim, N.E.; Januzzi, J.L., Jr.; Magaret, C.A.; Gaggin, H.K.; Rhyne, R.F.; Gandhi, P.U.; Kelly, N.; Simon, M.L.; Motiwala, S.R.; Belcher, A.M.; Kimmenade, R.R. van

    2017-01-01

    BACKGROUND: Noninvasive models to predict the presence of coronary artery disease (CAD) may help reduce the societal burden of CAD. OBJECTIVES: From a prospective registry of patients referred for coronary angiography, the goal of this study was to develop a clinical and biomarker score to predict

  7. Evaluation of endothelial function in patients with limited systemic sclerosis by use of brachial artery Doppler ultrasound.

    Science.gov (United States)

    Fernandes, Tatiana Melo; Bica, Blanca Elena Gomes; Villela, Nivaldo Ribeiro; Salles, Elizabeth Figueiredo; Azevedo, Mario Newton Leitão de; Papi, José Angelo de Souza; Martins, Rosângela Aparecida Gomes

    2012-08-01

    The aim of this study was to compare the brachial artery endothelium-dependent and endothelium-independent dilating responses in patients with limited systemic sclerosis (LSSc) with those of healthy subjects of the same gender, age and color. Twenty adult, non-obese, non-smoker, non-diabetic, non-dyslipidemic, and non-hypertensive women, who fulfilled the American College of Rheumatology criteria for the diagnosis of SSc, were submitted to right brachial artery Doppler ultrasound. The vasodilating responses were analyzed as follows: the endothelium-dependent dilating response, after a 5-minute ischemia in the right arm; and the endothelium-independent dilating response, after administering 300 mcg of nitroglycerin (NTG) sublingually. The results were compared with the response obtained in healthy subjects. Brachial artery longitudinal diameter was significantly low at baseline 1: 3.57 ± 0.52 mm and 3.93 ± 0.39 mm for the LSSc group and the control group, respectively, P = 0.005. The vascular reactivity after the ischemia/reactive hyperemia and the NTG showed no significant difference between the groups (8.60 ± 5.45 mm vs. 9.26 ± 5.91 mm and 25.01 ± 12.55 mm vs. 19.59 ± 7.94 mm for the LSSc and control groups, respectively). Also, no statistically significant difference was found between red blood cell velocity (RBCV) after reactive hyperemia and NTG (110.2 ± 43.86 cm/s vs. 102.0 ± 25.89 cm/s and 63.80 ± 17.69 cm/s vs. 65.4 ± 12.90 cm/s in the LSSc and control groups, respectively). Although the LSSc group showed lower brachial artery diameter, the endothelium-dependent and the endothelium-independent dilating responses were preserved in both groups.

  8. Aurantio-obtusin relaxes systemic arteries through endothelial PI3K/AKT/eNOS-dependent signaling pathway in rats

    Directory of Open Access Journals (Sweden)

    Shuzhen Li

    2015-07-01

    Full Text Available Aurantio-obtusin is a natural effective compound isolated from Semen Cassiae, which possesses hypotensive and hypolipidemic effects. Although its hypotensive effect have been clarified, mechanisms Aurantio-obtusin relaxes systemic arteries remain unclear. This study was to investigate effects and mechanisms of Aurantio-obtusin on isolated mesenteric arteries (MAs. We examined MAs relaxation induced by Aurantio-obtusin on rat isolated MAs, expression and activity of endothelial nitric oxide synthase (eNOS and protein kinase B (AKT, and nitric oxide (NO production in bovine artery endothelial cells (BAECs. Findings showed Aurantio-obtusin elicited dose-dependent vasorelaxation with phenylephrine (PE precontracted rat MA rings (diameter: 200–300 μm, which can be diminished by denudation of endothelium and inhibition of eNOS activity, while having no effect on rat isolated pulmonary artery (PA rings. Aurantio-obtusin increased NO production by promoting phosphorylations of eNOS at Ser-1177 and Thr-495 in endothelial cells. Aurantio-obtusin also promoted phosphorylations of Akt at Ser-473. PI3K inhibitor LY290042 could diminish vasorelaxation induced by Aurantio-obtusin. Moreover Aurantio-obtusin also elicited dose-dependent vasorelaxation effect with PE precontracted MA rings (diameter: 100–150 μm. Therefore, vasorelaxation induced by Aurantio-obtusin was dependent on endothelium integrity and NO production, which mediated by endothelial PI3K/Akt/eNOS pathway. Results suggest Aurantio-obtusin may offer therapeutic effects in hypertension, as a new potential vasodilator.

  9. Sirolimus-eluting stents for the treatment of symptomatic extracranial vertebral artery stenoses: Early experience and 6-month follow-up; Die Behandlung symptomatischer extrakranieller Stenosen der Arteria vertebralis mit sirolimusbeschichteten Stents: erste Erfahrungen und Ergebnisse nach 6 Monaten

    Energy Technology Data Exchange (ETDEWEB)

    Lugmayr, H.; Kastner, M.; Froehler, W.; Meindl, S.; Zisch, R. [Krankenhaus Wels (Austria). Institut fuer Radiologie

    2004-10-01

    Purpose: To evaluate the clinical and morphological effectiveness of sirolimus-eluting stents in patients with stenoses in the extracranial vertebral artery and to assess the 6-month results. Materials and Methods: Sirolimus-eluting stents were implanted in 8 stenoses of the extracranial vertebral artery in 7 patients with symptoms of vertebrobasilar insufficiency. Seven stenoses were located at the ostium, and one further cranially in segment V 1. The mean grade diameter of the stenoses was 85.1% (60.9%-98.3%). Clinical and angiographic follow-up was performed over a period of 6 months in all patients. Results: All lesions were successfully stented with a residual stenosis of 20.2% (0.0-38.5%). Clinically, all patients showed resolution or improvement of the symptoms after stenting. After 6 months, 5 of the 8 stenoses developed intimal hyperplasia with a stenosis grade >50%. The mean measured grade of stenosis after 6 months was 56.2% (0.0-94.1%). Five patients had no clinical symptoms of a vertebrobasilar insufficiency while two had recurrent symptoms. Conclusion: Sirolimus-eluting stents in the extracranial vertebral artery have a high and unsatisfactory re-stenosis rate after 6 months. (orig.)

  10. Management of pediatric craniocervical arterial dissections.

    Science.gov (United States)

    Pandey, Aditya S; Hill, Elizabeth; Al-Holou, Wajd N; Gemmete, Joseph J; Chaudhary, Neeraj; Thompson, B Gregory; Garton, Hugh J L; Maher, Cormac O

    2015-01-01

    Craniocervical arterial dissections (CCADs) represent a preventable cause of acute ischemic stroke (AIS). Our objective was to describe clinical presentation, imaging features, treatment strategies, and report clinical and imaging outcomes of CCADs at a large pediatric tertiary referral center. Electronic medical records were queried using variations of the word dissection for patients under 25 years of age with neuroimaging over a 13-year period. Medical and imaging records were reviewed to identify carotid, vertebral, or intracranial dissections. Demographics, presenting symptoms, presence of AIS, mechanism of injury, dissection location, dissection treatment, and complications stemming from treatment were collected. Clinical outcome was classified according to modified Rankin Scale (mRS) score. Imaging follow-up was obtained until the dissection healed or stabilized. A total 6,289 patients met initial search criteria. Of the 42 (0.7%) patients with CCADs, 23 (54.8%) had internal carotid artery (ICA) dissections, and 17 (40.5%) had vertebrobasilar (VB) dissections. More females had ICA dissections (p = 0.002), and more males had VB dissections (p = 0.01). CCADs associated with traumatic presentation occurred in 34 patients (81.0%), while 8 (19.0%) were spontaneous. Good outcomes (mRS 0-3) were noted for 36 patients, and 5 had poor outcomes (mRS 4-6). In the 17 patients with vessel occlusion, 50.0% had partial or complete recanalization at a mean follow-up of 23.9 months. CCAD is commonly related to trauma and presents with AIS. The majority of patients experience good clinical outcome. Recanalization of initial vessel occlusion occurs in half of cases at 2 years.

  11. Liver cirrhosis and arterial hypertension

    DEFF Research Database (Denmark)

    Henriksen, Jens Henrik; Møller, Søren

    2006-01-01

    blood pressure. This review considers the alterations in systemic hemodynamics in patients with cirrhosis in relation to essential hypertension and arterial hypertension of the renal origin. Subjects with arterial hypertension (essential, secondary) may become normotensive during the development...... of cirrhosis, and arterial hypertension is rarely manifested in patients with cirrhosis, even in cases with renovascular disease and high circulating renin activity. There is much dispute as to the understanding of homoeostatic regulation in cirrhotic patients with manifest arterial hypertension. This most...

  12. Lidocaine Prevents Oxidative Stress-Induced Endothelial Dysfunction of the Systemic Artery in Rats With Intermittent Periodontal Inflammation.

    Science.gov (United States)

    Saito, Takumi; Yamamoto, Yasuhiro; Feng, Guo-Gang; Kazaoka, Yoshiaki; Fujiwara, Yoshihiro; Kinoshita, Hiroyuki

    2017-06-01

    Periodontal inflammation causes endothelial dysfunction of the systemic artery. However, it is unknown whether the use of local anesthetics during painful dental procedures alleviates periodontal inflammation and systemic endothelial function. This study was designed to examine whether the gingival or systemic injection of lidocaine prevents oxidative stress-induced endothelial dysfunction of the systemic artery in rats with intermittent periodontal inflammation caused by lipopolysaccharides (LPS). Some rats received 1500 µg LPS injections to the gingiva during a week interval from the age of 8 to 11 weeks (LPS group). Lidocaine (3 mg/kg), LPS + lidocaine (3 mg/kg), LPS + lidocaine (1.5 mg/kg), and LPS + lidocaine (3 mg/kg, IP) groups simultaneously received gingival 1.5 or 3 mg/kg or IP 3 mg/kg injection of lidocaine on the same schedule as the gingival LPS. Isolated aortas or mandibles were subjected to the evaluation of histopathologic change, isometric force recording, reactive oxygen species, and Western immunoblotting. Mean blood pressure and heart rate did not differ among the control, LPS, LPS + lidocaine (3 mg/kg), and lidocaine (3 mg/kg) groups. LPS application reduced acetylcholine (ACh, 10 to 10 mol/L)-induced relaxation (29% difference at ACh 3 × 10 mol/L, P = .01), which was restored by catalase. Gingival lidocaine (1.5 and 3 mg/kg) dose dependently prevented the endothelial dysfunction caused by LPS application (24.5%-31.1% difference at ACh 3 × 10 mol/L, P = .006 or .001, respectively). Similar to the gingival application, the IP injection of lidocaine (3 mg/kg) restored the ACh-induced dilation of isolated aortas from rats with the LPS application (27.5% difference at ACh 3 × 10 mol/L, P lidocaine (3 mg/kg), or the combination. The LPS induced a 4-fold increase in the protein expression of tumor necrosis factor-α in the periodontal tissue (P lidocaine (3 mg/kg) coadministration partly reduced the levels. Lidocaine application also decreased

  13. Genes involved in systemic and arterial bed dependent atherosclerosis--Tampere Vascular study.

    Directory of Open Access Journals (Sweden)

    Mari Levula

    Full Text Available BACKGROUND: Atherosclerosis is a complex disease with hundreds of genes influencing its progression. In addition, the phenotype of the disease varies significantly depending on the arterial bed. METHODOLOGY/PRINCIPAL FINDINGS: We characterized the genes generally involved in human advanced atherosclerotic (AHA type V-VI plaques in carotid and femoral arteries as well as aortas from 24 subjects of Tampere Vascular study and compared the results to non-atherosclerotic internal thoracic arteries (n=6 using genome-wide expression array and QRT-PCR. In addition we determined genes that were typical for each arterial plaque studied. To gain a comprehensive insight into the pathologic processes in the plaques we also analyzed pathways and gene sets dysregulated in this disease using gene set enrichment analysis (GSEA. According to the selection criteria used (>3.0 fold change and p-value <0.05, 235 genes were up-regulated and 68 genes down-regulated in the carotid plaques, 242 genes up-regulated and 116 down-regulated in the femoral plaques and 256 genes up-regulated and 49 genes down-regulated in the aortic plaques. Nine genes were found to be specifically induced predominantly in aortic plaques, e.g., lactoferrin, and three genes in femoral plaques, e.g., chondroadherin, whereas no gene was found to be specific for carotid plaques. In pathway analysis, a total of 28 pathways or gene sets were found to be significantly dysregulated in atherosclerotic plaques (false discovery rate [FDR] <0.25. CONCLUSIONS: This study describes comprehensively the gene expression changes that generally prevail in human atherosclerotic plaques. In addition, site specific genes induced only in femoral or aortic plaques were found, reflecting that atherosclerotic process has unique features in different vascular beds.

  14. Evaluation of the Solitaire system in a canine arterial thromboembolic occlusion model: is it safe for the endothelium?

    Science.gov (United States)

    Park, Soonchan; Hwang, Seon Moon; Song, Joon Seon; Suh, Dae Chul; Lee, Deok Hee

    2013-12-01

    The Solitaire system has recently been increasingly used for acute stroke treatment in which the endothelial safety immediately after its use has not been evaluated. This study was performed to evaluate the endothelial status when using a Solitaire system in a canine arterial occlusion model. Thromboembolic occlusion of both internal maxillary arteries was achieved in five mongrel dogs. In each animal, the Solitaire system (ev3, Irvine, CA, USA) was used for primary thrombectomy on the right side and for temporary stenting on the left side. Efficacy was assessed by comparing the recanalization rates, and safety was assessed using angiographic and microscopic assessments. Endothelial injuries were evaluated with light microscopy (LM) and scanning electron microscopy (SEM). Successful revascularizations were observed following primary thrombectomy in all five animals (100%) and after temporary stenting in two (40%). There was no incidence of vasospasm or vessel perforation in either group. Distal migration of the clot occurred in two animals that underwent primary thrombectomy. Endothelial injury was seen after primary thrombectomy in two animals (40%) and after temporary stenting in one (20%). The lesions presented as defects of the internal elastic lamina on LM and denudation of the wavy endothelial surface on SEM. During mechanical thrombectomy, the Solitaire system can cause endothelial injury both in primary thrombectomy and temporary stenting. Primary thrombectomy is likely to have a higher recanalization rate with increased endothelial injury.

  15. Normal reference values for vertebral artery flow volume by color Doppler sonography in Korean adults

    Energy Technology Data Exchange (ETDEWEB)

    Hong, Hyun Sook; Cha, Jang Gyu; Park, Seong Jin; Joh, Joon Hee; Park, Jai Soung; Kim, Dae Ho; Lee, Hae Kyung; Ahn, Hyun Cheol [Soonchunhyang University Bucheon Hospital, Bucheon (Korea, Republic of)

    2003-09-15

    Vertebrobasilar ischemia has been attributed to a reduction of net vertebral artery flow volume. This study was to establish the reference values for the flow volume of the vertebral artery using color Doppler sonography in the normal Korea adults. Thirty five normal Korea adults without any underlying disease including hypertension, hyperlipidemia, diabetes, heart disease, obesity (body mas index>30), or carotid artery stenosis was included. There were 17 males and 18 females, age ranged from 20 to 53 years (average=32.86 years). Flow velocities and vessel diameters were recorded in the intertransverse (V2) segment, usually at C5-6 level, bilaterally. The flow volume (Q) was calculated. (Q=time averaged mean velocity x cross sectional area of vessel) A lower Flow velocity and smaller vessel diameter were measured on the right side compared to those of the left side, resulting in a lower flow volume. The calculated flow volumes using the equation were 77.0 +- 39.7 ml/min for the right side and 127.6 +- 71.0 ml/min for the left side (p=0.0001) while the net vertebral artery flow volume was 204.6 +- 81.8 ml/min. Decrease in the vertebral artery flow volume was statistically significant with advanced age. (r=-0.36, p=0.032). Vertebral artery blood flow volume was 191.20 +- 59.19 ml/min in male, and 217.28 +- 98.67 ml/min in female (p=0.6). The normal range for the net vertebral artery flow volume defined by the 5th to 95th percentiles was between 110.06 and 364.1 ml/min. The normal range for the net vertebral artery flow volume was between 110.06 and 364.1 ml/min. Vertebral artery flow volume decreased with the increase of age. However, gender did not affect the blood flow volume.

  16. Pharmacological modulation of arterial stiffness.

    LENUS (Irish Health Repository)

    Boutouyrie, Pierre

    2011-09-10

    Arterial stiffness has emerged as an important marker of cardiovascular risk in various populations and reflects the cumulative effect of cardiovascular risk factors on large arteries, which in turn is modulated by genetic background. Arterial stiffness is determined by the composition of the arterial wall and the arrangement of these components, and can be studied in humans non-invasively. Age and distending pressure are two major factors influencing large artery stiffness. Change in arterial stiffness with drugs is an important endpoint in clinical trials, although evidence for arterial stiffness as a therapeutic target still needs to be confirmed. Drugs that independently affect arterial stiffness include antihypertensive drugs, mostly blockers of the renin-angiotensin-aldosterone system, hormone replacement therapy and some antidiabetic drugs such as glitazones. While the quest continues for \\'de-stiffening drugs\\

  17. Posterior Circulation Moyamoya Disease versus Primitive Vertebral-Basilar Artery System Moyamoya Disease: New Classification of Moyamoya Disease from the Perspective of Embryology.

    Science.gov (United States)

    Tan, Cunxin; Duan, Ran; Ye, Xun; Zhang, Dong; Wang, Rong

    2016-12-01

    Moyamoya disease (MMD) is a chronic cerebrovascular disorder with little known etiology. We aim to propose a new classification system for MMD from the perspective of embryology. MMD patients' digital subtraction angiograms were retrospectively analyzed. Every angiogram was analyzed to find the abnormal vessels and from which part of the posterior cerebral artery (PCA) the lesions begin. In 262 MMD cases, 32 pediatric patients had PCA involvement, of which 17 were male and 15 were female; 68 adults had PCA involvement, of which 33 were male and 35 were female. The initially affected part of the PCA was compared between sexes and between pediatric and adult patients, and the findings are not statistically significant (P = 0.233, P = 0.855, P = 0.343, respectively). However, of the 100 cases with PCA involvement, only 4 had the lesions begin from the first part of the PCA, and all of the 4 cases had the basilar artery lesions. All the other 96 cases had the lesions begin from the second part of the PCA or from the posterior communication artery, which is derived from the caudal ramus of the primitive intracarotid artery, leaving the first part of the PCA and basilar artery excluded from affection. MMD should be classified into primitive intracarotid artery system-involved type and primitive vertebral basilar artery system-involved type. The reason that the vertebral basilar artery is so rarely involved in MMD might be because of its late development in the brain. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Echocardiography may help detect pulmonary vasculopathy in the early stages of pulmonary artery hypertension associated with systemic sclerosis.

    Science.gov (United States)

    Serra, Walter; Chetta, Alfredo; Santilli, Daniele; Mozzani, Flavio; Dall'Aglio, Pier Paolo; Olivieri, Dario; Cattabiani, Maria Alberta; Ardissino, Diego; Gherli, Tiziano

    2010-07-05

    Pulmonary arterial hypertension (PAH) in patients with systemic sclerosis is associated with a poor prognosis, but this can be improved by early disease detection. Abnormal pulmonary and cardiac function can be detected early by means of echocardiography, whereas right heart catheterization is usually performed later. The purpose of this prospective study was to detect early the presence of pulmonary artery vasculopathy in patients with verified systemic sclerosis without significant pulmonary fibrosis, normal lung volumes and a mildly reduced lung diffusion capacity of carbon monoxide (DLCO). Nineteen consecutive female NYHA class I-II patients with scleroderma and a PAPs of 0.05 was considered significant. Right heart catheterization detected PAH in 15/19 patients; mean PAP was 30.5 mm/Hg and RVP 3.6 UW. Coronary angiography of the patients aged more than 55 years showed some evidence of significant coronary artery disease. Echocardiography showed high systolic PAP values (46 +/- 8 mmHg), whereas right ventricular function was normal (TAPSE 23 +/- 3 mm), and in line with the NYHA class. ACTpo was reduced in the patients with a systolic PAP of 0.001) and positively correlated with DLCO (p > 0.001) and the hemodynamic data.There was a good correlation between ACTpo and PVR (hemodynamic data) (r = -0615; p > 0.01). Although they need to be confirmed by studies of larger series of patients, our findings suggest that, in comparison with hemodynamic data, non-invasive echocardiographic measurements are an excellent means of identifying early-stage PAH.

  19. J-tipped guidewire as a target for puncture of the subclavian artery in the placement of a reservoir port and catheter system

    Energy Technology Data Exchange (ETDEWEB)

    Hama, Yukihiro; Kusano, Shoichi [Department of Radiology, National Defense Medical College, 3-2 Namiki, Tokorozawa, 359-0042, Saitama (Japan); Makita, Kohzoh [Department of Radiology, Social Insurance Chuo General Hospital, Tokyo (Japan)

    2004-05-01

    The aim of this study was to verify the feasibility of using a J-tipped guidewire as a target for puncture of the subclavian artery in the placement of a reservoir port and catheter system (RPCS). Twenty-five patients with various hepatic malignancies underwent percutaneous implantation of an RPCS through the left subclavian artery for regional chemotherapy. To successfully puncture the left subclavian artery, a J-tipped guidewire was used as a target with fluoroscopic guidance. Technical success and complication rates, and numbers of puncture failures, were retrospectively analyzed. Implantation of the RPCS was successful in all patients. Eight (32%) patients had minor complications and no patient had major complications. The number of puncture failures per patient was 0 to 1 (mean=0.32). The J-tipped guidewire is a safe and appropriate target for puncture of the subclavian artery in the placement of an RPCS. (orig.)

  20. Diagnostic performance of an acoustic-based system for coronary artery disease risk stratification

    DEFF Research Database (Denmark)

    Winther, Simon; Nissen, Louise; Schmidt, Samuel Emil

    2017-01-01

    OBJECTIVE: Diagnosing coronary artery disease (CAD) continues to require substantial healthcare resources. Acoustic analysis of transcutaneous heart sounds of cardiac movement and intracoronary turbulence due to obstructive coronary disease could potentially change this. The aim of this study...... was thus to test the diagnostic accuracy of a new portable acoustic device for detection of CAD. METHODS: We included 1675 patients consecutively with low to intermediate likelihood of CAD who had been referred for cardiac CT angiography. If significant obstruction was suspected in any coronary segment...

  1. Echocardiography may help detect pulmonary vasculopathy in the early stages of pulmonary artery hypertension associated with systemic sclerosis

    Directory of Open Access Journals (Sweden)

    Serra Walter

    2010-07-01

    Full Text Available Abstract Background Pulmonary arterial hypertension (PAH in patients with systemic sclerosis is associated with a poor prognosis, but this can be improved by early disease detection. Abnormal pulmonary and cardiac function can be detected early by means of echocardiography, whereas right heart catheterization is usually performed later. Objectives The purpose of this prospective study was to detect early the presence of pulmonary artery vasculopathy in patients with verified systemic sclerosis without significant pulmonary fibrosis, normal lung volumes and a mildly reduced lung diffusion capacity of carbon monoxide (DLCO. Methods Nineteen consecutive female NYHA class I-II patients with scleroderma and a PAPs of 2. They all underwent complete Doppler echocardiography, CPET, a pulmonary ventilation test (carbon monoxide lung diffusion, DLCO, HRCT. To investigate PAH by means of complete resting Doppler echocardiography estimates of systolic pulmonary artery pressure (PAPs derived from tr icuspid regurgitation, mean PAP derived from pulmonary regurgitation, pulmonary vessel resistance (PVR derived from the acceleration time of the pulmonary outflow tract (ACTpo, and right ventricular function derived from tricuspid annular plane systolic excursion (TAPSE. Right heart catheterisation was conducted only, if pulmonary hypertension was suggested by echocardiography and an abnormal ventilator test. The data are given as mean values ± SD, unless otherwise stated. The correlations between the variables were analysed using Pearson's r coefficient, and the predictive value of the variables was calculated using linear regression analysis. A p value of > 0.05 was considered significant. Results Right heart catheterization detected PAH in 15/19 patients; mean PAP was 30.5 mm/Hg and RVP 3.6 UW. Coronary angiography of the patients aged more than 55 years showed some evidence of significant coronary artery disease. Echocardiography showed high systolic PAP

  2. High arterial compliance in cirrhosis is related to low adrenaline and elevated circulating calcitonin gene related peptide but not to activated vasoconstrictor systems

    DEFF Research Database (Denmark)

    Henriksen, Jens Henrik Sahl; Møller, S; Schifter, S

    2001-01-01

    to COMP(art) disappeared. The relation of COMP(art) to CGRP and circulatory variables remained unchanged. CONCLUSION: Elevated arterial compliance in cirrhosis is related to low adrenaline, high CGRP, and systemic hyperdynamics but not to indicators of the activated vasoconstrictor systems (noradrenaline......BACKGROUND AND AIMS: Static and dynamic functions of the wall of large arteries are largely unknown in cirrhosis in vivo. The present study was undertaken to determine arterial compliance (COMP(art)) in relation to vasodilator and vasoconstrictor systems in patients with cirrhosis. In addition......, vasoactivity was manipulated by inhalation of oxygen. STUDY POPULATION AND METHODS: In 20 patients with alcoholic cirrhosis and 12 controls we determined COMP(art) (stroke volume relative to pulse pressure), cardiac output, plasma volume, systemic vascular resistance, central circulation time, plasma...

  3. Liver cirrhosis and arterial hypertension

    DEFF Research Database (Denmark)

    Henriksen, Jens Henrik; Møller, Søren

    2006-01-01

    Characteristic findings in patients with cirrhosis are vasodilatation with low overall systemic vascular resistance, high arterial compliance, increased cardiac output, secondary activation of counter-regulatory systems (renin-angiotensin-aldosterone system, sympathetic nervous system, release of...

  4. Avoiding pitfalls in diagnosing basilar artery occlusive disease: clinical and imaging clues - case report

    Directory of Open Access Journals (Sweden)

    Adriana Bastos Conforto

    Full Text Available CONTEXT: The aim of this paper was to report on the characteristics that aid in establishing the diagnosis of basilar artery occlusive disease (BAOD among patients with hemiparesis and few or minor symptoms of vertebrobasilar disease. CASE REPORT: This report describes two cases in a public university hospital in São Paulo, Brazil. We present clinical and imaging findings from two patients with hemiparesis and severe BAOD, but without clinically relevant carotid artery disease (CAD. One patient presented transient ischemic attacks consisting of spells of right hemiparesis that became progressively more frequent, up to twice a week. The neurological examination revealed slight right hemiparesis and right homonymous hemianopsia. Magnetic resonance imaging (MRI revealed pontine and occipital infarcts. Magnetic resonance angiography and digital subtraction angiography revealed severe basilar artery stenosis. The other patient presented sudden left-side hemiparesis and hypoesthesia. One year earlier, she had reported sudden onset of vertigo that, at that time, was attributed to peripheral vestibulopathy and was not further investigated. MRI showed a right-side pontine infarct and an old infarct in the right cerebellar hemisphere. Basilar artery occlusion was diagnosed. Both patients presented their symptoms while receiving aspirin, and became asymptomatic after treatment with warfarin. CONCLUSIONS: Misdiagnosing asymptomatic CAD as the cause of symptoms in BAOD can have disastrous consequences, such as unnecessary carotid endarterectomy and exposure to this surgical risk while failing to offer the best available treatment for BAOD. Clinical and imaging features provided important clues for diagnosis in the cases presented.

  5. Risk of Peripheral Arterial Occlusive Disease in Patients With Systemic Lupus Erythematosus: A Nationwide Population-Based Cohort Study.

    Science.gov (United States)

    Chuang, Ya-Wen; Yu, Mei-Ching; Lin, Cheng-Li; Yu, Tung-Min; Shu, Kuo-Hsiung; Kao, Chia-Hung

    2015-11-01

    Systemic lupus erythematosus (SLE) is associated with atherosclerosis, but the relationship between SLE and peripheral arterial occlusive disease (PAOD) remains unclear. We sought to investigate this relationship by comparing cardiovascular complications in patients with and without SLE.Data on patients from 2000 to 2011 were collected from the National Health Insurance Research Database of Taiwan. The SLE cohort was frequency-matched according to age, sex, and history of diabetes mellitus (DM) with patients without SLE (control cohort). We evaluated the risk of cardiovascular complications, including hypertension, DM, stroke, chronic obstructive pulmonary disease, heart failure, coronary artery disease, and hyperlipidemia.The study included 10,144 patients with SLE and 10,144 control patients. The incidence of PAOD was 9.39-fold higher (95% confidence interval [CI] = 7.70-11.15) in the SLE cohort than in the non-SLE cohort. Moreover, SLE was an independent risk factor for PAOD. The adjusted risk of PAOD was highest in patients with SLE who were aged ≤34 years (hazard ratio = 47.6, 95% CI = 26.8-84.4). The risk of PAOD was highest during the first year of follow-up and decreased over time.Patients with SLE exhibit a higher incidence and an independently higher risk of PAOD compared with the general population. The PAOD risk is markedly elevated in patients with SLE who are young and in whom the disease is at an early stage.

  6. Um estudo sobre hipertensão arterial sistêmica na cidade de Campo Grande, MS A study on systemic arterial hypertension in Campo Grande, MS, Brazil

    Directory of Open Access Journals (Sweden)

    Ana Rita Araújo de Souza

    2007-04-01

    Full Text Available OBJETIVOS: Detectar a real prevalência de hipertensão arterial sistêmica em Campo Grande, MS, e fatores freqüentes. MÉTODOS: Estudo transversal com amostra randomizada da população adulta da cidade de Campo Grande, MS, num total de 892 pessoas. Foi aplicado questionário sobre idade, sexo, escolaridade, tabagismo, etilismo, aspectos sobre o tratamento. Foram colhidos dados antropométricos (peso e altura. Segundo a OMS, foi considerado peso normal: IMCIMC 30. Os critérios para hipertensão foram baseados no VII Joint, com valores de corte de Pressão Arterial de 140 x 90 mmHg. RESULTADOS: A prevalência de hipertensão foi de 41,4%, variando conforme idade (até 29 anos: 11,8%; 30-39: 24,8%; 40-49: 43,3%; 50-59: 42,4%; 60-69: 48,6% e > 70: 62,3%. Houve maior prevalência nos homens (51,8%, enquanto nas mulheres foi de 33,1%. As pessoas com formação escolar de 1º grau primário tendem a apresentar maiores índices pressóricos. Nos indivíduos com sobrepeso e obesidade, observou-se maior prevalência de pressão elevada: IMC normal (27,9%, sobrepeso (45,6% e obesidade (58,6%. A partir dos 60 anos existe um maior porcentual de hipertensão sistólica isolada, representado por 16,4% (60-69 anos e de 24,6% (>70 anos. Etilismo diário ou semanal também está relacionado a maior incidência, respectivamente, de 63,2% e 47,2%. Apenas 59,7% eram sabidamente hipertensos. Das pessoas que apresentaram hipertensão, 57,3% fazem algum tratamento. Dos que fazem tratamento regularmente, 60,5% apresentaram hipertensão. CONCLUSÃO: A prevalência de hipertensão foi de 41,4%, ultrapassando a média detectada em alguns trabalhos, alertando para piora epidemiológica e repercussões cardiovasculares, o que evidencia necessidade de maior investimento público no que tange ao esclarecimento e instrução desses grupos populacionais quanto à prevenção.OBJECTIVES: To detect the actual prevalence of systemic hypertension in the city of Campo Grande, MS

  7. A middle mesenteric artery

    OpenAIRE

    Milnerowicz, Stanislaw; Milnerowicz, Artur; Taboła, Renata

    2012-01-01

    In 114 cases of the transverse colon isolated from cadavers (50 male, 64 female), anatomical examinations of the arterial system of the colon were performed. Arteriograms were obtained after dissecting and contrasting the colonic vessels with Mixobar contrast. In one case, on arteriography of the colon with its mesentery isolated from a 55-year-old male cadaver, a rare anatomical variant was found. The third mesenteric artery originated directly from the aorta—halfway between the superior and...

  8. COPPING BEHAVIOR OF CLINICALLY HEALTHY PERSONS AND PATIENTS WITH ARTERIAL HYPERTENSION DEVOTING TO VARIOUS SOCIAL GROUPS AND ADAPTIVE RESERVES OF THEIR CARDIOVASCULAR SYSTEM

    Directory of Open Access Journals (Sweden)

    E.A. Parshina

    2009-03-01

    Full Text Available Current article shows results of psychophysiological checkup of 266 clinically healthy people and of 64 patients with arterial hypertension (average age 23,54±7,05years old, from different social status categories. Was determined that all clinically healty people were choosing adaptive forms of coping behaviour and had satisfactory adaptation reserves of cardiovascular system (except certificated medical personnel, who had adaptation mechanisms stresses. For patients with arterial hypertension selection of non adaptive form of coping behaviour and fall of adaptation reserves of cardiovascular system was typical.

  9. Prevalência, reconhecimento e controle da hipertensão arterial sistêmica no estado do Rio Grande do Sul Prevalence, awareness, and control of systemic arterial hypertension in the state of Rio Grande do Sul

    Directory of Open Access Journals (Sweden)

    Iseu Gus

    2004-11-01

    Full Text Available OBJETIVO: Descrever a prevalência dos fatores de risco das doenças cardiovasculares, em particular, a hipertensão arterial sistêmica na população adulta do RS, seu nível de reconhecimento e controle, além dos fatores associados. MÉTODOS: Estudo transversal, de base populacional, com amostragem aleatória por conglomerado, em 918 adultos >20 anos, realizada de 1999-2000, tendo hipertensão arterial sistêmica definida como pressão arterial >140/90 ou uso atual de anti-hipertensivos. RESULTADOS: A prevalência de hipertensão arterial sistêmica foi de 33,7% (n=309, sendo que 49,2% desconheciam ser hipertensos; 10,4% tinham conhecimento de ser hipertensos, mas não seguiam o tratamento; 30,1% seguiam o tratamento, mas não apresentavam controle adequado e 10,4% seguiam tratamento anti-hipertensivo com bom controle. Após análise multivariada, as características associadas significativamente com a presença de hipertensão arterial sistêmica foram: idade (OR=1,06, obesidade (OR=3,03 e baixa escolaridade (OR=1,82; as mesmas características foram associadas à falta de reconhecimento da hipertensão: idade (OR=1,05, obesidade (OR=2,46 e baixa escolaridade (OR=2,17. CONCLUSÃO: A prevalência de hipertensão arterial sistêmica no RS manteve-se em níveis constantes nas últimas décadas, e seu grau de reconhecimento apresentou discreta melhora. Entretanto, o nível de controle da hipertensão arterial sistêmica não apresentou crescimento. Este estudo permitiu definir um grupo-alvo - pessoas de maior idade, obesas e de baixa escolaridade - tanto para campanhas diagnósticas, como para a obtenção de maior controle de níveis pressóricos.OBJECTIVE: To report the prevalence of cardiovascular risk factors, particularly of systemic arterial hypertension, in the adult population of the Brazilian state of Rio Grande do Sul, in addition to the public's level of awareness, hypertensive control, and associated factors. METHODS: A cross

  10. The real-world outcomes of off-pump coronary artery bypass surgery in a public health care system.

    Science.gov (United States)

    Guru, Veena; Glasgow, Kevin W; Fremes, Stephen E; Austin, Peter C; Teoh, Kevin; Tu, Jack V

    2007-03-15

    The population-based results of off-pump coronary artery bypass surgery (OPCAB) in a public health care system have not been reported. The study objective was to compare the one-year outcomes of OPCAB with those of the standard on-pump coronary artery bypass surgery (ONCAB) in the province of Ontario. The present study was a retrospective, population-based study (n=15,172, with 1660 OPCAB patients) undertaken in fiscal years 2000 and 2001 using clinical and administrative data. Multivariate regression modelling for risk adjustment and propensity matching were used to compare OPCAB with ONCAB for one-year outcomes, including death, repeat revascularization and cardiac readmission. The rate of OPCAB was 11%, with institutional rates ranging from 3% to 51%. OPCAB patients were more likely to be female and older than 79 years of age, with peripheral vascular disease and higher socioeconomic status. OPCAB patients were less likely to have surgically significant coronary disease, poor left ventricular function, an urgent status, congestive heart failure and diabetes. The risk-adjusted one-year composite outcome was higher for OPCAB (11.8%, 95% CI 10.40% to 13.29%) than ONCAB (10.8%, 95% CI 10.23% to 11.27%); however, this difference was eliminated with propensity matching. OPCAB patients had shorter hospital lengths of stay and lower blood product transfusion rates than ONCAB patients. Despite the minimal use of OPCAB in Canada's public health care system, outcome rates are similar to those of ONCAB. The benefits of OPCAB observed in randomized trials, including shorter hospital lengths of stay and lower transfusion rates, remained true in the investigators' real-world experience. The results OPCAB were at least equivalent to those of ONCAB.

  11. Left Ventricular Mass and Intrarenal Arterial Stiffness as Early Diagnostic Markers in Cardiorenal Syndrome Type 5 due to Systemic Sclerosis.

    Science.gov (United States)

    Gigante, Antonietta; Barilaro, Giuseppe; Barbano, Biagio; Romaniello, Antonella; Di Mario, Francesca; Quarta, Silvia; Gasperini, Maria Ludovica; Di Lazzaro Giraldi, Gianluca; Laviano, Alessandro; Amoroso, Antonio; Cianci, Rosario; Rosato, Edoardo

    2016-02-01

    Cardiorenal syndrome type 5 (CRS-5) includes a group of conditions characterized by a simultaneous involvement of the heart and kidney in the course of a systemic disease. Systemic sclerosis (SSc) is frequently involved in the etiology of acute and chronic CRS-5 among connective tissue diseases. In SSc patients, left ventricular mass (LVM) can be used as a marker of nutritional status and fibrosis, while altered intrarenal hemodynamic parameters are suggestive of early kidney involvement. Forty-two consecutive patients with a diagnosis of SSc without cardiac and/or renal impairment were enrolled to assess whether cardiac muscle mass can be related to arterial stiffness. Thirty subjects matched for age and sex were also enrolled as healthy controls (HC). All patients performed echocardiography and renal ultrasound. Doppler indices of intrarenal stiffness and echocardiographic indices of LVM were significantly increased in SSc patients compared to HC. A positive correlation exists between LVM/body surface area and pulsatile index (p < 0.05, r = 0.36), resistive index (p < 0.05, r = 0.33) and systolic/diastolic ratio (p < 0.05, r = 0.38). Doppler indices of intrarenal stiffness and LVM indices were significantly higher in SSc patients with digital ulcers than in SSc patients without a digital ulcer history. SSc is characterized by the presence of microvascular and multiorgan injury. An early cardiac and renal impairment is very common. LVM and intrarenal arterial stiffness can be considered as early markers of CRS onset. The clinical use of these markers permits a prompt identification of organ damage. An early diagnosis allows the appropriate setting of pharmacological management, by slowing disease progression. © 2016 S. Karger AG, Basel.

  12. Coronary Artery Bypass Grafting

    Science.gov (United States)

    ... Health Topics / Coronary Artery Bypass Grafting Coronary Artery Bypass Grafting What Is Coronary artery bypass grafting (CABG) ... multiple coronary arteries during one surgery. Coronary Artery Bypass Grafting Figure A shows the location of the ...

  13. Coronary artery disease confined to secondary branches of the left coronary system

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    Iskandrian, A.S.; Klein, B.L.; Segal, B.L.; Kimbiris, D.; Bemis, C.E.

    1981-05-01

    Among 3,000 patients studied by coronary arteriography during a 4-year period, 31 patients (1%) had coronary artery disease limited to a diagonal branch of the left anterior descending (15 patients), marginal branch of the left circumflex (10 patients), or to both branches (6 patients). Ten patients had 50-69% and twenty-one had greater than or equal to 70% diameter narrowing. The suitability for grafting was noted in 20 patients as judged by the caliber and distribution of the diseased branches. Collaterals were noted in seven patients. Disease was present in 28 men and 3 women (age range 38-70 years). At least one major coronary risk factor was present in 27 patients. Angina was noted in 27 patients; prior myocardial infarction was noted in 5 patients by history and in 4 by ECG. The left ventriculogram was normal in 22 patients and showed mild segmental asynergy in 9; ejection fraction was normal in all. Exercise ECGs were positive in 12 of 25 patients; exercise 201thallium scans were positive in 13. All patients responded to medical therapy. In conclusion, among the population of patients who undergo catheterization, coronary branch disease is rare. The clinical findings are indistinguishable from patients with major coronary disease. Prognosis remains benign and patients respond to medical therapy.

  14. Anatomical Variations of the Blood Vascular System in Veterinary Medicine: The Internal Iliac Artery of the Dog - Part Three.

    Science.gov (United States)

    Avedillo, L; Martín-Alguacil, N; Salazar, I

    2016-06-01

    The aim of this study was to analyse and describe the variability of the umbilical artery. Two hundred and thirty-two pelvic halves from 116 adult dogs were examined. To study the permeability of the umbilical artery, ten adult dogs, nine newborns and thirteen foetuses between 35 and 50 days of gestation were also used. In relation to the origin of the umbilical artery, six anatomical variations were found. From which five involved a cranial (n = 4) or caudal (n = 1) relocation of its origin, and in one case (n = 1), the umbilical artery arose from the median sacral artery. In eight cases, the umbilical artery gave off the prostatic (n = 1) or vaginal (n = 7) arteries. The permeability of the umbilical artery was the most significant anatomical variation: permeability was detected in 45% (106 of 232 pelvic halves) of all cases, from which 36 were males and 70 females. Interestingly, an equal vascular permeability in both hemipelvises was found for 82% of the dogs, thus additional data related to such feature of the umbilical artery was also recorded. In accordance with the statistical study, the main anatomical variations described showed significant values for gender, side of the body, size and profile variables. © 2015 Blackwell Verlag GmbH.

  15. A case of successful systemic thrombolysis in massive thromboembolia of pulmonary artery against the background of pregnancy

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    V. E. Tyukachev

    2017-11-01

    Full Text Available We present a clinical case of successful systemic thrombolysis in a pregnant patient with massive pulmonary embolism. A 29-year old patient at 28 weeks of pregnancy was hospitalized 2 hours after sudden suffocation in a presyncopal state and hypotension of 90/50 mm Hg. ECG showed the signs of overload of right heart chambers in the form of a typical S1-Q3-T3 (McGinn–White syndrome, as well as the Kosuge sign. Echocardiography verified pulmonary 3 Grade hypertension (81 mm Hg, enlargement of the right atrium and ventricle, 3 Grade tricuspid regurgitation and paradoxical movement of the interventricular septum. Multislice computed tomography of the chest with contrast of the pulmonary artery revealed a defect of contrast in the right main pulmonary artery, occlusive clearance, and thrombotic mass, extending to the bifurcation of the left main pulmonary artery ("clot - rider". Thrombolytic therapy was started with recombinant tissue plasminogen activator (alteplase 10 mg bolus, then 90 mg for 2 hours. The patient was daily examined by a gynecologist. The viability of the fetus, monitoring of possible hemorrhagic complications of the placenta were evaluated. After thrombolysis, the patient began to note clinical improvement in the form of a regression of dyspnea. According to echocardioscopy control, the signs of overload of right heart chambers completely regressed. There were no complications both in the mother and in the fetus during the subsequent days until discharge. On 25.05.16 there was uncomplicated delivery vaginally of live full-term girl. Thus, when there is life-threatening massive pulmonary embolism, the application of General principles of diagnosis and treatment of this disease in patients with pregnancy is warranted. The carrying out of thrombolytic therapy in massive pulmonary embolism enables to reduce the manifestations of pulmonary hypertension, right ventricular failure, and to conduct births on time. Used intravenous

  16. Renin-angiotensin system antagonists and clinical outcomes in stable coronary artery disease without heart failure.

    Science.gov (United States)

    Sorbets, Emmanuel; Labreuche, Julien; Simon, Tabassome; Delorme, Laurent; Danchin, Nicolas; Amarenco, Pierre; Goto, Shinya; Meune, Christophe; Eagle, Kim A; Bhatt, Deepak L; Steg, Philippe Gabriel

    2014-07-01

    The aim of this study was to determine whether angiotensin-converting enzyme inhibitor (ACEI) or angiotensin-II receptor blocker (ARB) use is associated with lower rates of cardiovascular events in patients with stable coronary artery disease (CAD) but without heart failure (HF) receiving contemporary medical management. Using data from the Reduction of Atherothrombosis for Continued Health (REACH) registry, we examined, using propensity score approaches, relationships between cardiovascular outcomes and ACEI/ARB use (64.1% users) in 20 909 outpatients with stable CAD and free of HF at baseline. As internal control, we assessed the relation between statin use and outcomes. At 4-year follow-up, the risk of cardiovascular death, MI, or stroke (primary outcome) was similar in ACEI/ARB users compared with non-users (hazard ratio, 1.03; 95% confidence interval [CI], 0.91-1.16; P = 0.66). Similarly, the risk of the primary outcome and cardiovascular hospitalization for atherothrombotic events (secondary outcome) was not reduced in ACEI/ARB users (hazard ratio, 1.08; 95% CI, 1.01-1.16; P = 0.04), nor were the rates of any of its components. Analyses using propensity score matching yielded similar results, as did sensitivity analyses accounting for missing covariates, changes in medications over time, or analysing separately ACEI and ARB use. In contrast, in the same cohort, statin use was associated with lower rates for all outcomes. Use of ACEI/ARB was not associated with better outcomes in stable CAD outpatients without HF. The benefit of ACEI/ARB seen in randomized clinical trials was not replicated in this large contemporary cohort, which questions their value in this specific subset. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please email: journals.permissions@oup.com.

  17. Association of isolated single umbilical artery with perinatal outcomes: Systemic review and meta-analysis.

    Science.gov (United States)

    Kim, Hyeong Ju; Kim, Jae-Hoon; Chay, Doo Byung; Park, Joo Hyun; Kim, Min-A

    2017-05-01

    The aim of this study was to evaluate the association between prenatally diagnosed isolated single umbilical artery (iSUA) and perinatal outcomes. We searched Medline, Embase, the Cochrane Library, and KoreaMed from inception to January 2016, with no language or regional restrictions, for cohort and case-control studies reporting on the relationship of iSUA and perinatal outcomes. We assessed the odds ratios (ORs) and 95% confidence intervals (CIs) for the occurrence of small for gestational age, preterm birth, pregnancy-induced hypertension, neonatal intensive care unit admission, and perinatal mortality in fetuses with iSUA compared with those in fetuses with three vessel cord. Eleven articles totaling 1,731 pregnancies with iSUA met the selection criteria. Studies varied in design, quality, outcome definition, and results. Meta-analysis carried out within predefined groups showed that the presence of an iSUA was associated with small for gestational age (OR, 2.75; 95% CI, 1.97 to 3.83; P<0.00001), preterm birth (OR, 2.10; 95% CI, 1.72 to 2.57; P<0.00001), pregnancy-induced hypertension (OR, 1.62; 95% CI, 1.00 to 2.63; P=0.05), neonatal intensive care unit admission (OR, 2.06; 95% CI, 1.33 to 3.19; P=0.001), and perinatal mortality (OR, 2.29; 95% CI, 1.32 to 3.98; P=0.003). Pregnancies complicated by iSUA are at increased risk for small for gestational age, preterm birth, pregnancy-induced hypertension, neonatal intensive care unit admission and perinatal mortality. Further, large prospective cohort studies are required to improve the quality of prenatal counseling and the neonatal care for pregnancies with iSUA.

  18. Long term follow up after surgery in congenitally corrected transposition of the great arteries with a right ventricle in the systemic circulation

    NARCIS (Netherlands)

    A.J.J.C. Bogers (Ad); S.J. Head (Stuart); P.L. de Jong (Peter); M. Witsenburg (Maarten); A.P. Kappetein (Arie Pieter)

    2010-01-01

    textabstractAim of the study: To investigate the long-term outcome of surgical treatment for congenitally corrected transposition of the great arteries (CCTGA), in patients with biventricular repair with the right ventricle as systemic ventricle.Methods: A total of 32 patients with CCTGA were

  19. Wireless data collection system for real-time arterial travel time estimates.

    Science.gov (United States)

    2011-03-01

    This project pursued several objectives conducive to the implementation and testing of a Bluetooth (BT) based system to collect travel time data, including the deployment of a BT-based travel time data collection system to perform comprehensive testi...

  20. Different Bleeding Patterns with the Use of Levonorgestrel Intrauterine System: Are They Associated with Changes in Uterine Artery Blood Flow?

    Directory of Open Access Journals (Sweden)

    Carlo Bastianelli

    2014-01-01

    Full Text Available Objective. Evaluate if different bleeding patterns associated with the use of the levonorgestrel intrauterine system (LNG-IUS are associated with different uterine and endometrial vascularization patterns, as evidenced by ultrasound power Doppler analysis. Methodology. A longitudinal study, with each subject acting as its own control was conducted between January 2010 and December 2012. Healthy volunteers with a history of heavy but cyclic and regular menstrual cycles were enrolled in the study. Ultrasonographic examination was performed before and after six months of LNG-IUS placement: uterine volume, endometrial thickness, and subendometrial and myometrial Doppler blood flow patterns have been evaluated. Results. A total of 32 women were enrolled out of 186 initially screened. At six months of follow-up, all subjects showed a reduction in menstrual blood loss; for analysis, they were retrospectively divided into 3 groups: normal cycling women (Group I, amenorrheic women (Group II, and women with prolonged bleedings (Group III. Intergroup analysis documented a statistically significant difference in endometrial thickness among the three groups; in addition, mean pulsatility index (PI and resistance index (RI in the spiral arteries were significantly lower in Group I and Group III compared to Group II. This difference persisted also when comparing—within subjects of Group III—mean PI and RI mean values before and after insertion. Conclusions. The LNG-IUS not only altered endometrial thickness, but—in women with prolonged bleedings—also significantly changed uterine artery blood flow. Further studies are needed to confirm these results and enable gynecologists to properly counsel women, improving initial continuation rates.

  1. Catheter-directed gastric artery chemical embolization for modulation of systemic ghrelin levels in a porcine model: initial experience.

    Science.gov (United States)

    Arepally, Aravind; Barnett, Brad P; Montgomery, Elizabeth; Patel, Tarak H

    2007-07-01

    To prospectively test, in a porcine model, the hypothesis that use of catheter-directed gastric artery chemical embolization (GACE) can result in substantial suppression of systemic ghrelin levels. The institutional animal care and use committee approved this study. Adult healthy swine (40-45 kg, n=8) were tested. GACE was performed by infusing morrhuate sodium selectively into the left gastric artery. Six swine (animals A-F) underwent left GACE by using a dose-escalating regimen of morrhuate sodium, whereas two control swine underwent a sham procedure. Weight and fasting plasma ghrelin levels were compared in swine at baseline and at weeks 1-4. At week 4, stomachs were excised and analyzed. Analysis of the change in ghrelin values and weight was performed with both paired t test and unpaired Student t test. In control swine (n=2), there was no significant difference in ghrelin values before (844.8 pg/mL +/- 40 [standard deviation]) and after (997 pg/mL +/- 93) the procedure (P=.5). Swine that received a low dose of morrhuate sodium (animals A-D) showed a significant increase in serum ghrelin values from 683.7 pg/mL +/- 241 to 1555.9 pg/mL +/- 312 (P=.002). At a higher dose, the mean baseline ghrelin values decreased from 466 pg/mL to 187 pg/mL +/- 162. Weight changes of +1.4% and +8.6% were seen in swine that underwent GACE and control swine, respectively. Histochemical staining showed preservation of overall tissue architecture and parietal cells. Use of GACE can result in increased or suppressed ghrelin levels. (c) RSNA, 2007.

  2. Use of Remote Pulmonary Artery Pressure Monitoring (CardioMEMS System) in Total Artificial Heart to Assess Pulmonary Hemodynamics for Heart Transplantation.

    Science.gov (United States)

    Gohar, Salman; Taimeh, Ziad; Morgan, Jeff; Frazier, O H; Arabia, Francisco; Civitello, Andrew; Nair, Ajith

    2017-11-08

    The temporary total artificial heart (TAH-t) has been valuable as a bridge to transplantation in patients with biventricular failure. However, the challenges of accurately assessing pulmonary vascular resistance after TAH-t implantation can preclude these patients from heart transplantation, especially those with pre-existing pulmonary hypertension. The CardioMEMS Heart Failure System (St. Jude's Medical, Little Canada, MN) comprises a wireless pressure sensor that is implanted percutaneously in the pulmonary artery and transmits real-time measurements of pulmonary artery pressures. Systolic and diastolic pulmonary artery (PA) pressures measurements have been well correlated between the CardioMEMS PA Sensor and traditional Swan-Ganz catheter and between the CardioMEMS PA Sensor and standard echocardiography. Here, we report the use of the CardioMEMS device in a patient with severe pulmonary hypertension supported with a SynCardia TAH-t (Tucson, AZ) during assessment for candidacy for transplantation.

  3. Evaluation of Cranial and Cervical Arteries and Brain Tissue in Transient Ischemic Attack Patients with Magnetic Resonance Angiography and Diffusion-Weighted Imaging.

    Science.gov (United States)

    Li, Jian-Long; Li, Chang-Shan; Fu, Jun-Hua; Zhang, Ke; Xu, Rui; Xu, Wen-Jian

    2015-06-15

    Magnetic resonance angiography (MRA) and diffusion-weighted imaging (DWI) have been widely used in the prediction of ischemic stroke; however, the differences of the 2 methods in detection the artery lesion differences between transient ischemic attack (TIA) and infarction patients have been long neglected. We performed the present study to investigate the differences between vessel characteristics detected by MRA and DWI in acute stroke and TIA patients. We classified 110 subjects into 2 groups and all the patients underwent both MRA and DWI. The degree of stenosis of cranial and cervical arteries, the distribution of the stenosis, the development and changes of the vessels, and the DWI scanning results of the brain tissue were all analyzed. We detected a significant difference in the number and the degree of stenosis of cranial and cervical arteries among the 3 groups (P=0.006). Compared with health controls, patients with TIA and cerebral infraction had much more severe stenosis and occlusive arteries (Psystem (4/8, 50%). Vessel characteristics were not significantly different between TIA and infarction patients. Unilateral vertebral artery hypoplasia was a predisposing factor for vertebrobasilar TIA and ischemic focus in DWI detection was always caused by severe artery lesions.

  4. Novel vasodilatory effect of intracisternal injection of magnesium sulfate solution on spastic cerebral arteries in the canine two-hemorrhage model of subarachnoid hemorrhage.

    Science.gov (United States)

    Mori, Kentaro; Miyazaki, Masahiro; Hara, Yasukazu; Aiko, Yasuhisa; Yamamoto, Takuji; Nakao, Yasuaki

    2009-01-01

    The extracellular Mg++ has a vasodilatory effect on the cerebral artery. The present study investigated the effect of intracisternal injection of MgSO4 solution on cerebral vasospasm in a canine model of subarachnoid hemorrhage (SAH). Subarachnoid hemorrhage was induced in 10 beagles using the two-hemorrhage model. Angiography of the vertebrobasilar artery was performed on Day 1 (baseline values before SAH) and on Day 7 (during cerebral vasospasm after induced SAH) before and after intracisternal injection of 0.5 ml/kg of 15 mmol/L MgSO4 solution into the cerebellomedullary cistern. The cerebrospinal fluid Mg++ concentration was significantly increased to 3.15 +/- 1.14 mEq/L after intracisternal injection from the preinjection value (1.45 +/- 0.09 mEq/L; p < 0.01). The diameters of the basilar artery, vertebral artery, and superior cerebellar artery on Day 7 were significantly decreased to 58.0 +/- 10.9%, 71.0 +/- 10.1%, and 60.9 +/- 13.8%, respectively, of their baseline diameters on Day 1 (p < 0.01). After intracisternal injection of MgSO4, these diameters significantly increased to 73.8 +/- 14.3%, 83.0 +/- 14.8%, and 74.1 +/- 13.5%, respectively (p < 0.01). Intracisternal injection of MgSO4 solution causes significant dilation of spastic cerebral arteries in the canine two-hemorrhage model of SAH.

  5. Anatomical Variations of the Blood Vascular System in Veterinary Medicine. The Internal Iliac Artery of the Dog. Part Two.

    Science.gov (United States)

    Avedillo, L; Martín-Alguacil, N; Salazar, I

    2016-04-01

    The aim of this study was to investigate the variability of the internal pudendal artery. Two hundred and thirty-two pelvic halves from 116 adult dogs were examined. Twenty-six anatomical variations were found, thirteen occurring in more than 5% of the dogs. Anatomical variations were grouped in relation to the origin of the prostatic/vaginal arteries, middle rectal artery, urethral artery, ventral perineal and caudal rectal arteries. The chi-squared test was used to analyse differences in sex, side of the body, profile and size, and the results were considered statistically significant when P ≤ 0.05. An identical vascular pattern in both hemipelvises was found for most of the anatomical variations described. © 2015 Blackwell Verlag GmbH.

  6. Topological changes of the human autonomic cardiac nervous system in individuals with a retroesophageal right subclavian artery: two case reports and a brief review.

    Science.gov (United States)

    Kawashima, Tomokazu; Sasaki, Hiroshi

    2005-11-01

    The topological changes of the human autonomic cardiac nervous system in two cadavers with a retroesophageal right subclavian artery (Rersa) were compared with the normal autonomic cardiac nervous system. The following new results were obtained in addition to the conventional deficient finding of the right recurrent laryngeal nerve. (1) Right superior cardiac nerves arising from the superior cervical ganglion were consistently observed in both cadavers, in addition to the right thoracic cardiac nerves along the Rersa. (2) A segmental accompanying tendency of the right cardiac nerves was recognized: the cardiac nerves arising from the sympathetic trunk cranial to the middle cervical ganglia ran along with the right common carotid artery, whereas the cardiac nerves arising from the sympathetic trunk caudal to the vertebral ganglion ran along the Rersa. (3) The right thoracic cardiac nerves, which have never been observed to accompany the normal right subclavian artery, ran along the proximal part of the Rersa. According to previous reports of individuals with the Rersa, a thick right thoracic cardiac nerve is commonly observed instead of a right superior cardiac nerve. However, all the cardiac nerves were recognized in both the individuals described in the present report. Therefore, we strongly disagree with the previous idea that the origin of the right cardiac nerves from the sympathetic trunk and ganglia is shifted caudally in individuals with the Rersa. The topological changes of the autonomic cardiac nervous system in two cases of Rersa also reflected spatial changes of great arteries.

  7. Arterial stiffness

    Directory of Open Access Journals (Sweden)

    Ursula Quinn

    2012-09-01

    Full Text Available Measurements of biomechanical properties of arteries have become an important surrogate outcome used in epidemiological and interventional cardiovascular research. Structural and functional differences of vessels in the arterial tree result in a dampening of pulsatility and smoothing of blood flow as it progresses to capillary level. A loss of arterial elastic properties results a range of linked pathophysiological changes within the circulation including increased pulse pressure, left ventricular hypertrophy, subendocardial ischaemia, vessel endothelial dysfunction and cardiac fibrosis. With increased arterial stiffness, the microvasculature of brain and kidneys are exposed to wider pressure fluctuations and may lead to increased risk of stroke and renal failure. Stiffening of the aorta, as measured by the gold-standard technique of aortic Pulse Wave Velocity (aPWV, is independently associated with adverse cardiovascular outcomes across many different patient groups and in the general population. Therefore, use of aPWV has been proposed for early detection of vascular damage and individual cardiovascular risk evaluation and it seems certain that measurement of arterial stiffness will become increasingly important in future clinical care. In this review we will consider some of the pathophysiological processes that result from arterial stiffening, how it is measured and factors that may drive it as well as potential avenues for therapy. In the face of an ageing population where mortality from atheromatous cardiovascular disease is falling, pathology associated with arterial stiffening will assume ever greater importance. Therefore, understanding these concepts for all clinicians involved in care of patients with cardiovascular disease will become vital.

  8. Reducing false positives of microcalcification detection systems by removal of breast arterial calcifications

    NARCIS (Netherlands)

    Mordang, J.J.; Gubern Merida, A.; Heeten, G.; Karssemeijer, N.

    2016-01-01

    PURPOSE: In the past decades, computer-aided detection (CADe) systems have been developed to aid screening radiologists in the detection of malignant microcalcifications. These systems are useful to avoid perceptual oversights and can increase the radiologists' detection rate. However, due to the

  9. Investigation of hemodynamics in an in vitro system simulating left ventricular support through the right subclavian artery using 4-dimensional flow magnetic resonance imaging.

    Science.gov (United States)

    Jung, Bernd; Müller, Christoph; Buchenberg, Waltraud; Ith, Michael; Reineke, David; Beyersdorf, Friedhelm; Benk, Christoph

    2015-07-01

    Left ventricular assist devices are an important treatment option for patients with heart failure alter the hemodynamics in the heart and great vessels. Because in vivo magnetic resonance studies of patients with ventricular assist devices are not possible, in vitro models represent an important tool to investigate flow alterations caused by these systems. By using an in vitro magnetic resonance-compatible model that mimics physiologic conditions as close as possible, this work investigated the flow characteristics using 4-dimensional flow-sensitive magnetic resonance imaging of a left ventricular assist device with outflow via the right subclavian artery as commonly used in cardiothoracic surgery in the recent past. An in vitro model was developed consisting of an aorta with its supra-aortic branches connected to a left ventricular assist device simulating the pulsatile flow of the native failing heart. A second left ventricular assist device supplied the aorta with continuous flow via the right subclavian artery. Four-dimensional flow-sensitive magnetic resonance imaging was performed for different flow rates of the left ventricular assist device simulating the native heart and the left ventricular assist device providing the continuous flow. Flow characteristics were qualitatively and quantitatively evaluated in the entire vessel system. Flow characteristics inside the aorta and its upper branching vessels revealed that the right subclavian artery and the right carotid artery were solely supported by the continuous-flow left ventricular assist device for all flow rates. The flow rates in the brain-supplying arteries are only marginally affected by different operating conditions. The qualitative analysis revealed only minor effects on the flow characteristics, such as weakly pronounced vortex flow caused by the retrograde flow via the brachiocephalic artery. The results indicate that, despite the massive alterations in natural hemodynamics due to the

  10. Coronary artery disease reporting and data system (CAD-RADSTM): Inter-observer agreement for assessment categories and modifiers.

    Science.gov (United States)

    Maroules, Christopher D; Hamilton-Craig, Christian; Branch, Kelley; Lee, James; Cury, Roberto C; Maurovich-Horvat, Pál; Rubinshtein, Ronen; Thomas, Dustin; Williams, Michelle; Guo, Yanshu; Cury, Ricardo C

    2017-12-05

    The Coronary Artery Disease Reporting and Data System (CAD-RADS) provides a lexicon and standardized reporting system for coronary CT angiography. To evaluate inter-observer agreement of the CAD-RADS among an panel of early career and expert readers. Four early career and four expert cardiac imaging readers prospectively and independently evaluated 50 coronary CT angiography cases using the CAD-RADS lexicon. All readers assessed image quality using a five-point Likert scale, with mean Likert score ≥4 designating high image quality, and CAD-RADS assessment categories and modifiers were assessed using intra-class correlation (ICC) and Fleiss' Kappa (κ).The impact of reader experience and image quality on inter-observer agreement was also examined. Inter-observer agreement for CAD-RADS assessment categories was excellent (ICC 0.958, 95% CI 0.938-0.974, p CAD-RADS assessment categories and modifiers is excellent, except for high-risk plaque (modifier V) which demonstrates fair agreement. These results suggest CAD-RADS is feasible for clinical implementation. Copyright © 2017. Published by Elsevier Inc.

  11. Anatomical Variations of the Blood Vascular System in Veterinary Medicine: The Internal Iliac Artery of the Dog: Part One.

    Science.gov (United States)

    Avedillo, L; Martín-Alguacil, N; Salazar, I

    2015-08-01

    Traditional veterinary anatomical models describe the branches of the caudal gluteal artery as the iliolumbar, cranial gluteal, lateral caudal, satellite of the ischiatic nerve and dorsal perineal arteries. However, some classical veterinary anatomy textbooks often indicate variations the general organization of the arterial tree, without giving any pattern of origin or illustrations of the different branching. The aim of this study was to investigate the presumptive variability of the caudal gluteal artery. Two hundred and thirty-two pelvic halves from 116 adult dogs were examined. Twelve anatomical variations were found, nine occurring in more than 5% of the dogs, and three in internal iliac artery, which means short caudal gluteal and internal pudendal arteries, was identified, while a 'perineal trunk' was observed as an interesting arterial variation. If the caudal segment alone is taken into consideration, identical vascular patterns in both hemi-pelvises are found in 17% of the dogs. Significant statistical correlation was found for four different types of anatomic variations and gender, two types of variations and body size, one type of variation for body side and one type of variation for head shape. © 2014 Blackwell Verlag GmbH.

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

    Science.gov (United States)

    2014-01-01

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

  13. Comparison of new-generation renal artery denervation systems: assessing lesion size and thermodynamics using a thermochromic liquid crystal phantom model.

    Science.gov (United States)

    Al Raisi, Sara I; Barry, Michael T; Qian, Pierre; Bhaskaran, Abhishek; Pouliopoulos, Jim; Kovoor, Pramesh

    2017-11-20

    The aim of this study was to evaluate and compare lesion dimensions and thermodynamics of the new-generation multi-electrode Symplicity Spyral and the new-generation multi-electrode EnligHTN renal artery denervation systems, using a thermochromic liquid crystal phantom model. A previously described renal artery phantom model was used as a platform for radiofrequency ablation. A total of 32 radiofrequency ablations were performed using the multi-electrode Symplicity Spyral (n=16) and the new-generation EnligHTN systems (n=16). Both systems were used as clinically recommended by their respective manufacturer. Lesion borders were defined by the 51°C isotherm. Lesion size (depth and width) was measured and compared between the two systems. Mean lesion depth was 2.15±0.02 mm for the Symplicity Spyral and 2.32±0.02 mm for the new-generation EnligHTN (p-value lesion width was 3.64±0.08 mm and 3.59±0.05 mm (p-value=0.61) for the Symplicity Spyral and the new-generation EnligHTN, respectively. The new-generation EnligHTN system produced lesions of greater depth compared to the Symplicity Spyral under the same experimental conditions. Lesion width was similar between both systems. Achieving greater lesion depth by use of the new-generation EnligHTN may result in better efficacy of renal artery denervation.

  14. Clinical effect of systemic chemotherapy combined with transcatheter arterial chemoembolization in treatment of breast cancer with liver metastases

    Directory of Open Access Journals (Sweden)

    LI Liye

    2016-01-01

    Full Text Available ObjectiveTo investigate the clinical effect of systemic chemotherapy combined with transcatheter arterial chemoembolization (TACE in the treatment of breast cancer with liver metastases. MethodsA total of 86 female breast cancer patients with liver metastases who were treated in the Affiliated Hospital of Shandong Academy of Medical Sciences from December 2012 to December 2014 were selected and equally divided into experimental group and control group. The patients in the control group received systemic chemotherapy, and those in the experimental group received systemic chemotherapy combined with TACE. The clinical effect, changes in lesions, and patients′ quality of life (QOL scores after treatment were compared between two groups. The t-test was applied for comparison of continuous data between the two groups, and the chi-square test was applied for comparison of categorical data between the two groups. ResultsThe experimental group had a significantly higher overall response rate than the control group (90.70% vs 58.14%, χ2=13.07, P=0.001. Compared with the control group, the experimental group had significantly smaller diameters of tumors and lymph nodes after treatment (t=4.26 and 4.63, both P<0.001, as well as significantly higher QOL scores at 3 and 6 months after treatment (t=6.30 and 3.89, both P<0001. ConclusionSystemic chemotherapy combined with TACE has a significant therapeutic effect in breast cancer patients with liver metastases, and can improve patients′ symptoms, reduce adverse drug reactions, and improve QOL. As a safe and reliable therapeutic method, it is worthy of clinical application.

  15. Multidetector computed tomography angiography of the celiac trunk and hepatic arterial system: normal anatomy and main variants

    Energy Technology Data Exchange (ETDEWEB)

    Araujo-Neto, Severino Aires; Mello-Junior, Carlos Fernando de; Franca, Henrique Almeida; Duarte, Claudia Martina Araujo; Borges, Rafael Farias; Magalhaes, Ana Guardiana Ximenes de, E-mail: severinoaires@hotmail.com [Universidade Federal da Paraiba (UFPB), Joao Pessoa, PB (Brazil)

    2016-01-15

    Although digital angiography remains as the gold standard for imaging the celiac arterial trunk and hepatic arteries, multidetector computed tomography in association with digital images processing by software resources represents a useful tool particularly attractive for its non invasiveness. Knowledge of normal anatomy as well as of its variations is helpful in images interpretation and to address surgical planning on a case-by-case basis. The present essay illustrates several types of anatomical variations of celiac trunk, hepatic artery and its main branches, by means of digitally reconstructed computed tomography images, correlating their prevalence in the population with surgical implications. (author)

  16. An Aberrant Artery Arising From Common Hepatic Artery

    Directory of Open Access Journals (Sweden)

    Surekha D. Jadhav

    2015-01-01

    Full Text Available Common hepatic artery is the branch of celiac trunk which is chief artery of the foregut. Branches of celiac trunk supply the gastrointestinal tract and its associated glands which are derived from foregut. Anatomy and variations of hepatic arterial system have become increasingly important due to increasing number of laparoscopic procedures, oncologic surgical interventions, and organ transplant cases. This case report describes a rare anatomical variation of an aberrant artery arising from common hepatic artery before the origin of gastroduodenal artery and proper hepatic artery.The aberrant artery traversed inferiorly and behind the body of the pancreas which divided into a right and left branches. The right branch ran behind the neck of the pancreas and it ended after giving few branches to head and body of pancreas. However, the left branch gave off branches to the proximal part of the jejunum. The presence of a branch arising directly from the common hepatic artery supplying the pancreas and jejunum is uncommon. Knowledge of such a rare variation is important not only for surgeons but also interventional radiologists and those studying anatomy

  17. Mannose-binding lectin variant alleles and the risk of arterial thrombosis in systemic lupus erythematosus

    DEFF Research Database (Denmark)

    Øhlenschlaeger, Tommy; Garred, Peter; Madsen, Hans O

    2004-01-01

    Cardiovascular disease is an important complication in patients with systemic lupus erythematosus (SLE). Variant alleles of the mannose-binding lectin gene are associated with SLE as well as with severe atherosclerosis. We determined whether mannose-binding lectin variant alleles were associated...

  18. Analysis and interpretation of arterial sounds using a small clinical computer system

    Science.gov (United States)

    Dewey, C. F., Jr.; Metzinger, R. W.; Holford, S. K.; Klitzner, T. S.

    1973-01-01

    A small mobile bed-side computer system is described that is capable of performing phonoangiographic analyses as well as many other common data analysis tasks in a hospital. The clinical application of phonoangiography is found to be greatly facilitated by the computer-provided availability of data acquisition and analysis capabilities.

  19. Infections Increase Risk of Arterial and Venous Thromboses in Danish Patients with Systemic Lupus Erythematosus

    DEFF Research Database (Denmark)

    Baronaite Hansen, Renata; Jacobsen, Søren

    2014-01-01

    OBJECTIVE: Infections and thromboses are known complications of systemic lupus erythematosus (SLE). We investigated if infectious episodes in patients with SLE were followed by an increased risk of thrombotic events. METHODS: A cohort of 571 patients with prevalent or incident SLE was followed...

  20. Role of the Renin-Angiotensin-Aldosterone System beyond Blood Pressure Regulation: Molecular and Cellular Mechanisms Involved in End-Organ Damage during Arterial Hypertension

    Directory of Open Access Journals (Sweden)

    Natalia Muñoz-Durango

    2016-06-01

    Full Text Available Arterial hypertension is a common condition worldwide and an important predictor of several complicated diseases. Arterial hypertension can be triggered by many factors, including physiological, genetic, and lifestyle causes. Specifically, molecules of the renin-angiotensin-aldosterone system not only play important roles in the control of blood pressure, but they are also associated with the genesis of arterial hypertension, thus constituting a need for pharmacological interventions. Chronic high pressure generates mechanical damage along the vascular system, heart, and kidneys, which are the principal organs affected in this condition. In addition to mechanical stress, hypertension-induced oxidative stress, chronic inflammation, and the activation of reparative mechanisms lead to end-organ damage, mainly due to fibrosis. Clinical trials have demonstrated that renin-angiotensin-aldosterone system intervention in hypertensive patients lowers morbidity/mortality and inflammatory marker levels as compared to placebo patients, evidencing that this system controls more than blood pressure. This review emphasizes the detrimental effects that a renin-angiotensin-aldosterone system (RAAS imbalance has on health considerations above and beyond high blood pressure, such as fibrotic end-organ damage.

  1. Role of the Renin-Angiotensin-Aldosterone System beyond Blood Pressure Regulation: Molecular and Cellular Mechanisms Involved in End-Organ Damage during Arterial Hypertension

    Science.gov (United States)

    Muñoz-Durango, Natalia; Fuentes, Cristóbal A.; Castillo, Andrés E.; González-Gómez, Luis Martín; Vecchiola, Andrea; Fardella, Carlos E.; Kalergis, Alexis M.

    2016-01-01

    Arterial hypertension is a common condition worldwide and an important predictor of several complicated diseases. Arterial hypertension can be triggered by many factors, including physiological, genetic, and lifestyle causes. Specifically, molecules of the renin-angiotensin-aldosterone system not only play important roles in the control of blood pressure, but they are also associated with the genesis of arterial hypertension, thus constituting a need for pharmacological interventions. Chronic high pressure generates mechanical damage along the vascular system, heart, and kidneys, which are the principal organs affected in this condition. In addition to mechanical stress, hypertension-induced oxidative stress, chronic inflammation, and the activation of reparative mechanisms lead to end-organ damage, mainly due to fibrosis. Clinical trials have demonstrated that renin-angiotensin-aldosterone system intervention in hypertensive patients lowers morbidity/mortality and inflammatory marker levels as compared to placebo patients, evidencing that this system controls more than blood pressure. This review emphasizes the detrimental effects that a renin-angiotensin-aldosterone system (RAAS) imbalance has on health considerations above and beyond high blood pressure, such as fibrotic end-organ damage. PMID:27347925

  2. Prevalence of carotid artery calcifications detected on panoramic radiographs and confirmed by Doppler ultrasonography: Their relationship with systemic conditions

    Directory of Open Access Journals (Sweden)

    Thalita Queiroz Abreu

    2015-01-01

    Conclusions: CACs can be detected in PRJs, and are more frequent in common carotid arteries. No significant associations were detected between the presence of unilateral or bilateral CAC in PRJ and hypertension, diabetes, or obesity.

  3. Fractals and fractal dimension of systems of blood vessels: An analogy between artery trees, river networks, and urban hierarchies

    CERN Document Server

    Chen, Yanguang

    2015-01-01

    An analogy between the fractal nature of networks of arteries and that of systems of rivers has been drawn in the previous works. However, the deep structure of the hierarchy of blood vessels has not yet been revealed. This paper is devoted to researching the fractals, allometric scaling, and hierarchy of blood vessels. By analogy with Horton-Strahler's laws of river composition, three exponential laws have been put forward. These exponential laws can be reconstructed and transformed into three linear scaling laws, which can be named composition laws of blood vessels network. From these linear scaling laws it follows a set of power laws, including the three-parameter Zipf's law on the rank-size distribution of blood vessel length and the allometric scaling law on the length-diameter relationship of blood vessels in different orders. The models are applied to the observed data on human beings and animals early given by other researchers, and an interesting finding is that human bodies more conform to natural r...

  4. Systemic inflammation in peripheral arterial disease with or without coexistent chronic obstructive pulmonary disease: analysis of selected markers.

    Science.gov (United States)

    Wozniak, Krzysztof; Sleszycka, Justyna; Safianowska, Aleksandra; Wiechno, Wieslaw; Domagala-Kulawik, Joanna

    2012-07-04

    Low-grade systemic inflammation plays an important role in the pathogenesis and natural history of chronic obstructive pulmonary disease (COPD) and peripheral arterial disease (PAD). The aim of the study was to analyze plasma concentrations of selected markers of inflammation in patients suffering from PAD with or without coexistent COPD. Thirty patients (6 women) with advanced PAD (at least IIb stage according to Fontaine scale) hospitalized due to critical limb ischemia were examined. In all patients spirometry was performed to confirm or exclude COPD. Plasma concentration of IL-6, IL-8 and TNF-α was measured using ELISA method. Statistical analysis was performed according to COPD status and according to smoking status independently. In the whole group of patients with PAD, COPD was recognized in 14 cases (for the first time in 10 cases). All patients were smokers (46.7% current, 53.3% ex-smokers). We found a significant correlation between FEV1%N (percent of norm of first second expiratory volume) and the number of years of smoking (r = -0.39; p diseases.

  5. Perceived stress status and sympathetic nervous system activation in young male patients with coronary artery disease in China.

    Science.gov (United States)

    Yang, You; Bi, Minghui; Xiao, Lin; Chen, Qiaopin; Chen, Wenron; Li, Wensheng; Wu, Yanxian; Hu, Yunzhao; Huang, Yuli

    2015-11-01

    Young Chinese male adults have faced increasing psychological stress. Whether this is associated with the increased risk of coronary artery disease (CAD) in young Chinese males remains unclear. This study aimed to evaluate the correlation and underlying mechanisms of perceived stress and CAD in young male patients. A total of 178 male patients diagnosed as young CAD (aged ≤ 55 years) by coronary angiography (CAG) were enrolled, and 181 age-matched non-CAD individuals were set as control group. Traditional cardiovascular risk factors and levels of epinephrine and norepinephrine were measured, and perceived stress status was accessed by Perceived Stress Scale (PSS). The PSS score was correlated with levels of epinephrine (r=0.45), norepinephrine (r=0.41), high-sensitivity C-reactive protein (hs-CRP) (r=0.38, pfactors, high perceived stress was an independent risk factor for CAD in young Chinese male patients. Abnormal activation of the sympathetic nervous system may play an important role linking perceived stress with the risk of CAD. Copyright © 2015 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

  6. Sonographic detection of intrarenal and intra-arterial fungus balls in a preterm infant due to systemic candidiasis

    Energy Technology Data Exchange (ETDEWEB)

    Reither, M.; Schumacher, R.; Hagel, K.J.; Hering, F.

    1983-10-01

    Shortly after birth a preterm infant suffering from aspiration syndrome and subsequent Pseudomonas aeruginosa sepsis showed signs of renal insufficiency and mycotic infection: yeast cells were identified in several urinalyses; there was also an increasing anti-candida IgM antibody titer. At the same time sonographic examinations revealed an increasing echogenicity of the renal cortex and echogenic masses of variable size which did not cause acoustic shadows in both enlarged kidneys. A few days later, we found a right-sided hydronephrosis caused by an intraureteric prevesical mass of equal echogenicity. As we could observe sonographically, the aggressive antimycotic therapy was successful. Eleven weeks later there were signs of cardiac insufficiency. An angiographically demonstrated filling defect, within the pulmonary artery, showed the same sonographic findings as the previously found intrarenal masses. The baby underwent embolectomy and recovered. The thrombotic material contained yeast cells giving evidence of systemic candidasis. Provided appropriate equipment is available, ultrasound today is an excellent non-invasive screening and followup method not only for echoencephalography, but also for more complicated neonatologic problems as seen here. The detailed observation of a changing echogenicity of the renal cortex and pelvis is important and often allows a decisive diagnostic clue before other radiological methods become conclusive.

  7. KCNA5 gene is not confirmed as a systemic sclerosis-related pulmonary arterial hypertension genetic susceptibility factor

    Science.gov (United States)

    2012-01-01

    Introduction Potassium voltage-gated channel shaker-related subfamily member 5 (KCNA5) is implicated in vascular tone regulation, and its inhibition during hypoxia produces pulmonary vasoconstriction. Recently, a protective association of the KCNA5 locus with systemic sclerosis (SSc) patients with pulmonary arterial hypertension (PAH) was reported. Hence, the aim of this study was to replicate these findings in an independent multicenter Caucasian SSc cohort. Methods The 2,343 SSc cases (179 PAH positive, confirmed by right-heart catheterization) and 2,690 matched healthy controls from five European countries were included in this study. Rs10744676 single-nucleotide polymorphism (SNP) was genotyped by using a TaqMan SNP genotyping assay. Results Individual population analyses of the selected KCNA5 genetic variant did not show significant association with SSc or any of the defined subsets (for example, limited cutaneous SSc, diffuse cutaneous SSc, anti-centromere autoantibody positive and anti-topoisomerase autoantibody positive). Furthermore, pooled analyses revealed no significant evidence of association with the disease or any of the subsets, not even the PAH-positive group. The comparison of PAH-positive patients with PAH-negative patients showed no significant differences among patients. Conclusions Our data do not support an important role of KCNA5 as an SSc-susceptibility factor or as a PAH-development genetic marker for SSc patients. PMID:23270786

  8. Activation of renin-angiotensin-aldosterone system (RAAS) in the lung of smoking-induced pulmonary arterial hypertension (PAH) rats.

    Science.gov (United States)

    Yuan, Yi-Ming; Luo, Li; Guo, Zhen; Yang, Ming; Ye, Ren-Song; Luo, Chuan

    2015-06-01

    To explore the role of the renin-angiotensin-aldosterone system (RAAS) in the pathogenesis of pulmonary arterial hypertension (PAH) induced by chronic exposure to cigarette smoke. 48 healthy male SD rats were randomly divided into four groups (12/group): control group (group A); inhibitor alone group (group B); cigarette induction group (group C); cigarette induction + inhibitor group (group D). After the establishment of smoking-induced PAH rat model, the right ventricular systolic pressure (RVSP) was detected using an inserted catheter; western blotting was used to detect the protein expression of angiotensin-converting enzyme-2 (ACE2) and angiotensin-converting enzyme (ACE); expression levels of angiotensin II (AngII) in lung tissue were measured by radioimmunoassay. After six months of cigarette exposure, the RVSP of chronic cigarette induction group was significantly higher than that of the control group; expression levels of AngII and ACE increased in lung tissues, but ACE2 expression levels reduced. Compared with cigarette exposure group, after losartan treatment, RVSP, ACE and AngII obviously decreased (Psmoking-induced PAH. © The Author(s) 2015.

  9. The role of local renin-angiotensin system in arterial chemoreceptors in sleep-breathing disorders

    OpenAIRE

    Man Lung eFung

    2014-01-01

    The renin-angiotensin system (RAS) plays pivotal roles in the regulation of cardiovascular and renal functions to maintain the fluid and electrolyte homeostasis. Experimental studies have demonstrated a locally expressed RAS in the carotid body, which is functional significant in the effect of angiotensin peptides on the regulation of the activity of peripheral chemoreceptors and the chemoreflex. The physiological and pathophysiological implications of the RAS in the carotid body have been pr...

  10. Occlusive Peripheral Arterial Disease

    Science.gov (United States)

    ... but also to the worsening of the disease. Obstructive peripheral arterial disease most commonly develops in the arteries of the legs, including the two branches of the aorta (iliac arteries), main arteries of the thighs (femoral arteries), of ... arterial disease may also develop in the part ...

  11. A noninvasive method for coronary artery diseases diagnosis using a clinically-interpretable fuzzy rule-based system

    Science.gov (United States)

    Marateb, Hamid Reza; Goudarzi, Sobhan

    2015-01-01

    Background: Coronary heart diseases/coronary artery diseases (CHDs/CAD), the most common form of cardiovascular disease (CVD), are a major cause for death and disability in developing/developed countries. CAD risk factors could be detected by physicians to prevent the CAD occurrence in the near future. Invasive coronary angiography, a current diagnosis method, is costly and associated with morbidity and mortality in CAD patients. The aim of this study was to design a computer-based noninvasive CAD diagnosis system with clinically interpretable rules. Materials and Methods: In this study, the Cleveland CAD dataset from the University of California UCI (Irvine) was used. The interval-scale variables were discretized, with cut points taken from the literature. A fuzzy rule-based system was then formulated based on a neuro-fuzzy classifier (NFC) whose learning procedure was speeded up by the scaled conjugate gradient algorithm. Two feature selection (FS) methods, multiple logistic regression (MLR) and sequential FS, were used to reduce the required attributes. The performance of the NFC (without/with FS) was then assessed in a hold-out validation framework. Further cross-validation was performed on the best classifier. Results: In this dataset, 16 complete attributes along with the binary CHD diagnosis (gold standard) for 272 subjects (68% male) were analyzed. MLR + NFC showed the best performance. Its overall sensitivity, specificity, accuracy, type I error (α) and statistical power were 79%, 89%, 84%, 0.1 and 79%, respectively. The selected features were “age and ST/heart rate slope categories,” “exercise-induced angina status,” fluoroscopy, and thallium-201 stress scintigraphy results. Conclusion: The proposed method showed “substantial agreement” with the gold standard. This algorithm is thus, a promising tool for screening CAD patients. PMID:26109965

  12. The birth of a new era: the introduction of the systemic-to-pulmonary artery shunt for the treatment of cyanotic congenital heart disease.

    Science.gov (United States)

    Vricella, Luca A; Jacobs, Marshall L; Cameron, Duke E

    2013-12-01

    Cardiac surgery was revolutionized on November 29, 1944, when Eileen Saxon underwent the first systemic-to-pulmonary artery shunt at Johns Hopkins University in Baltimore, Maryland, United States of America. The systemic-to-pulmonary artery shunt was initially developed in the laboratory and then applied to patients through the unique collaboration of Vivien Thomas, Alfred Blalock, and Helen B. Taussig. This innovation was the first operation to successfully treat cyanotic cardiac disease. The history of the first operation to successfully treat cyanotic heart disease is an extraordinary history of courage, innovation, and scientific breakthrough. Just as striking is perhaps the ability of the protagonists of this story to overcome seemingly insurmountable barriers of racial and gender discrimination and revolutionize medicine.

  13. Multiple stent delivery system Multi-LOC, a new technology for spot-stenting of the femoropopliteal artery - proof of concept study in a preclinical large animal model.

    Science.gov (United States)

    Sigl, Martin; Dudeck, Oliver; Jung, Johannes; Koelble, Heinz; Amendt, Klaus

    2017-10-01

    A new stent system was studied in a porcine model to evaluate its feasibility for spot-stenting of the femoropopliteal artery. In a preliminary study in a single pig, handling and mechanical features of the novel multiple stent delivery system were tested. The Multi-LOC system demonstrated great feasibility regarding its pushability, trackability, and crossability. Excellent visibility of the individual stents allowed exact anatomically controlled implantation. In our main study, four to five short Multi-LOC stents (13 mm long) were implanted into the femoropopliteal arteries of six domestic pigs and long (60 to 100 mm) self-expandable nitinol stents were implanted into the same target vessel contralaterally to allow for intraindividual comparison. After four weeks survival under dual antiplatelet treatment, control angiography was performed. The animals were euthanized, stented vessels were explanted, and histologic sections were examined for the presence of neointimal formation. Multi-LOC stents demonstrated no occlusion of the femoropopliteal axis (0 vs. 1 occlusion distal to a control stent), no stent fractures (0 out of 26 vs. 2 out of 6 control stents), and lower percentage diameter stenosis (0.564 ± 0.056 vs. 0.712 ± 0.089; p = 0.008) and length of stenosis (19.715 ± 5.225 vs. 39.397 ± 11.182; p = 0.007) compared to a standard control stent, which was similar in total length to the multiple stented artery segment. Histological examination confirmed myointimal hyperplasia underlying in-stent stenosis. The multiple stent delivery system was studied in a porcine model, which demonstrated its feasibility. Preclinical experience revealed favourable results concerning stent fracture, restenosis, and patency of spot-stented femoropopliteal arteries.

  14. A Novel System for Measuring Optical Properties in Arterial Blood of Man

    Directory of Open Access Journals (Sweden)

    A. Castañeda-Miranda

    2006-01-01

    Full Text Available The necessity of man–machine communication has been increasing day by day because of the great number of approaches that help to make human life agile or comfortable. Health is one of the aspects that has generated more interest in recent years. The optical technologies are new technical tools that are being implemented for medical diagnosis and for describing various processes occurring within human blood. These techniques have the virtue of being nondestructive; in addition they have the advantage of remote direction by using an in situ technique, with sensitivity capable of studying the properties of the blood through electromagnetic excitation. A device to obtain the electromagnetic spectrum in the blood has being designed and is presented in this work. This device uses a quartz lamp, emitting electromagnetic radiation between 200 nm and 2200 nm. A model for measuring the light attenuation through the blood is used. By applying a control in the frequency domain, a circuit device is designed. This device uses a database in time domain for its subsequent analysis by Fast Fourier Transformation in order to obtain absorption spectra. The acquisition time is of the order of microseconds, and the system is controlled automatically through accessible software from a personal computer.

  15. Technical feasibility and validation of a coronary artery calcium scoring system using CT coronary angiography images

    Energy Technology Data Exchange (ETDEWEB)

    Pavitt, Christopher W. [Royal Brompton Hospital, Department of Cardiology, London (United Kingdom); Royal Brompton Hospital, Department of Radiology, London (United Kingdom); Harron, Katie [Institute of Child Health, UCL, Centre for Paediatric Epidemiology and Biostatistics, London (United Kingdom); Lindsay, Alistair C.; Ray, Robin [Royal Brompton Hospital, Department of Cardiology, London (United Kingdom); Zielke, Sayeh; Rubens, Michael B. [Royal Brompton Hospital, Department of Radiology, London (United Kingdom); Gordon, Daniel [Royal Marsden Hospital, Department of Physics, London (United Kingdom); Padley, Simon P. [Royal Brompton Hospital, Department of Radiology, London (United Kingdom); Imperial College, Faculty of Medicine, London (United Kingdom); Nicol, Edward D. [Royal Brompton Hospital, Department of Cardiology, London (United Kingdom); Royal Brompton Hospital, Department of Radiology, London (United Kingdom); Imperial College, Faculty of Medicine, London (United Kingdom)

    2016-05-15

    We validate a novel CT coronary angiography (CCTA) coronary calcium scoring system. Calcium was quantified on CCTA images using a new patient-specific attenuation threshold: mean + 2SD of intra-coronary contrast density (HU). Using 335 patient data sets a conversion factor (CF) for predicting CACS from CCTA scores (CCTAS) was derived and validated in a separate cohort (n = 168). Bland-Altman analysis and weighted kappa for MESA centiles and Agatston risk groupings were calculated. Multivariable linear regression yielded a CF: CACS = (1.185 x CCTAS) + (0.002 x CCTAS x attenuation threshold). When applied to CCTA data sets there was excellent correlation (r = 0.95; p < 0.0001) and agreement (mean difference -10.4 [95 % limits of agreement -258.9 to 238.1]) with traditional calcium scores. Agreement was better for calcium scores below 500; however, MESA percentile agreement was better for high risk patients. Risk stratification was excellent (Agatston groups k = 0.88 and MESA centiles k = 0.91). Eliminating the dedicated CACS scan decreased patient radiation exposure by approximately one-third. CCTA calcium scores can accurately predict CACS using a simple, individualized, semiautomated approach reducing acquisition time and radiation exposure when evaluating patients for CAD. This method is not affected by the ROI location, imaging protocol, or tube voltage strengthening its clinical applicability. (orig.)

  16. The role of local renin-angiotensin system in arterial chemoreceptors in sleep-breathing disorders

    Directory of Open Access Journals (Sweden)

    Man Lung eFung

    2014-09-01

    Full Text Available The renin-angiotensin system (RAS plays pivotal roles in the regulation of cardiovascular and renal functions to maintain the fluid and electrolyte homeostasis. Experimental studies have demonstrated a locally expressed RAS in the carotid body, which is functional significant in the effect of angiotensin peptides on the regulation of the activity of peripheral chemoreceptors and the chemoreflex. The physiological and pathophysiological implications of the RAS in the carotid body have been proposed upon recent studies showing a significant upregulation of the RAS expression under hypoxic conditions relevant to altitude acclimation and sleep apnea and also in animal model of heart failure. Specifically, the increased expression of angiotensinogen, angiotensin-converting enzyme and angiotensin AT1 receptors plays significant roles in the augmented carotid chemoreceptor activity and inflammation of the carotid body. This review aims to summarize these results with highlights on the pathophysiological function of the RAS under hypoxic conditions. It is concluded that the maladaptive changes of the RAS in the carotid body plays a pathogenic role in sleep apnea and heart failure, which could potentially be a therapeutic target for the treatment of the pathophysiological consequence of sleep apnea.

  17. SOME FEATURES OF ARTERIAL HYPERTENSION, TAKING PLACE ON THE BACKGROUND OF OBESITY IN MEN OF WORKING AGE, EMPLOYEES IN THE SYSTEM OF INTERNAL AFFAIRS

    Directory of Open Access Journals (Sweden)

    A. O. Kovaleva

    2017-01-01

    Full Text Available Aim. The aim of the study was to reveal the peculiarities of arterial hypertension, that occurs in male law enforcement officers of working age against the background of obesity, to evaluate the factors associated with obesity that affect hypertension. Materials and methods. The study included men of working age working in the system of internal affairs bodies and hospitalized on a scheduled basis in a cardiological hospital with the main diagnosis — arterial hypertension. All studied patients were divided into two groups, the first group included patients with arterial hypertension in combination with obesity, the second group included hypertension and normal body weight. All patients underwent a general clinical and indepth anthropometric examination. Instrumental examination of patients included echocardiography, 24-hour blood pressure monitoring and pulse oximetry. In addition, all patients had an assessment of the risk of obstructive sleep apnea syndrome and studied psycho-emotional status using standard questionnaires. Results and discussion. A comparative analysis of the two groups showed that significant differences were observed with respect to some anthropometric indicators. In patients with obesity, more pronounced signs of myocardial remodeling were revealed by the results of echocardiography. Also, patients of this group were more likely to develop obstructive sleep apnea syndrome, greater propensity to anxiety, combined with eating disorders, more often in a restrictive type. A comparative analysis of the diurnal blood pressure profile of the two groups showed no significant differences, but obese patients required significantly more intensive antihypertensive therapy to achieve target blood pressure figures. Conclusion. Obesity leads to more pronounced myocardial remodeling in working age men with arterial hypertension. More intensive antihypertensive therapy is required for compensation arterial hypertension in the case of

  18. Cardiac valvular abnormalities are frequent in systemic lupus erythematosus patients with manifest arterial disease.

    Science.gov (United States)

    Jensen-Urstad, K; Svenungsson, E; de Faire, U; Silveira, A; Witztum, J L; Hamsten, A; Frostegård, J

    2002-01-01

    The objective of this study was to study cardiac valve morphology and function and ventricular function in systemic lupus erythematosus (SLE) patients with and without co-existing cardiovascular disease (CVD) and in population controls. Twenty-six women (52 +/- 8.2 years) with SLE (SLE cases) and a history of CVD (angina pectoris, myocardial infarction, cerebral infarction or intermittent claudication) were compared with 26age-matched women with SLE but without manifest CVD (SLE controls) and 26 age-matched control women (population controls). Echocardiographywas performed to assess valvular abnormalities and manifestations of ischaemic heart disease. Thirteen of the 26 SLE cases but only one of the SLE controls and one of the population controls had cardiac valvular abnormalities. Three of the SLE cases had already undergone valve replacement and another had significant aortic insufficiency; the other nine had thickening of mainly mitral leaflets without hemodynamic significance. Among SLE cases, patients with valvular abnormalities had higher homocysteine (P valvular disease. In contrast atherosclerosis as determined by IMT, oxidized LDL as measured by the monoclonal antibody E06, autoantibodies against epitopes of OxLDL (aOxLDL) or phospholipids (aPL), disease duration or activity, or acute phase reactants did not differ between SLE cases with or without valvular abnormalities. Valvular abnormalities were not more common in SLE cases with stroke as compared to those with myocardial infarction, angina or claudication. In conclusion, valvular abnormalities are strongly associated with CVD in SLE. Raised levels of homocysteine and triglycerides characterize patients with cardiac valve abnormalities.

  19. Systemic Arterial Hypertension in Patients Exposed to Cesium-137 in Goiânia-GO: Prevalence Study.

    Science.gov (United States)

    Rodrigues, José Victor Rabelo; Pinto, Murillo Macêdo; Figueredo, Roberto Miller Pires; Lima, Helen de; Souto, Rafael; Sacchetim, Sylvana de Castro

    2017-01-01

    Systemic Arterial Hypertension (SAH) in the Brazilian population, in populations not exposed to Césio-137, presents a prevalence of 28% nationwide. However, in the group of radioactivity victims, these values are unknown. To analyze the prevalence of hypertension in patients exposed to Cesium-137 in Goiânia, enrolled in the Sistema de Monitoramento dos Radioacidentados (SISRAD) (Radioactivtity Victims Monitoring System) of the Centro de Assistência aos Radioacidentados (C.A.R.A) (Assistence Center for Radioactivity Victims). This is a descriptive, observational cross-sectional epidemiological study carried out in Goiânia-Goiás, from August 2013 to October 2014, with a group of patients enrolled in the Sistema de Monitoramento dos Radioacidentados (SISRAD) of the Centro de Assistência a Radioacidentados (C.A.R.A.). A total of 102 radioactive patients were divided into two groups: group 1 with 40 and group 2 with 62 participants. A field survey was conducted with a closed and semi-structured questionnaire in which the following contexts were addressed: sociodemographic profile, life habits and personal background. A database was created using the Google Forms application from the Google Web technologies company. The duly collected and stored data were imported and analyzed in the statistical software SPSS, version 21. The prevalence of SAH reached a total of 25% (12 individuals) of the 48 interviewees, 50% of women (24) and 50% of men (24), of which 22.9% (11) of the radioactivity victims revealed to be smokers. The prevalence of SAH in the radioactivity victims population is similar to that of the population in general. A Hipertensão Arterial Sistêmica (HAS) na população brasileira, em populações não expostas ao Césio-137, apresenta prevalência de 28% em âmbito nacional. Porém, no grupo de radioacidentados, esses valores são desconhecidos. Analisar a prevalência da HAS em pacientes expostos ao Césio-137 ocorrido em Goiânia, cadastrados no

  20. Endovascular repair of arterial iliac vessel wall lesions with a self-expandable nitinol stent graft system.

    Directory of Open Access Journals (Sweden)

    Birger Mensel

    Full Text Available To assess the therapeutic outcome after endovascular repair of iliac arterial lesions (IALs using a self-expandable Nitinol stent graft system.Between July 2006 and March 2013, 16 patients (13 males, mean age: 68 years with a self-expandable Nitinol stent graft. A total of 19 lesions were treated: nine true aneurysms, two anastomotic aneurysms, two dissections, one arteriovenous fistula, two type 1B endoleaks after endovascular aneurysm repair, one pseudoaneurysm, and two perforations after angioplasty. Pre-, intra-, and postinterventional imaging studies and the medical records were analyzed for technical and clinical success and postinterventional complications.The primary technical and clinical success rate was 81.3% (13/16 patients and 75.0% (12/16, respectively. Two patients had technical failure due to persistent type 1A endoleak and another patient due to acute stent graft thrombosis. One patient showed severe stent graft kinking on the first postinterventional day. In two patients, a second intervention was performed. The secondary technical and clinical success rate was 87.5% (14/16 and 93.8% (15/16. The minor complication rate was 6.3% (patient with painful hematoma at the access site. The major complication rate was 6.3% (patient with ipsilateral deep vein thrombosis. During median follow-up of 22.4 months, an infection of the aneurysm sac in one patient and a stent graft thrombosis in another patient were observed.Endovascular repair of various IALs with a self-expandable Nitinol stent graft is safe and effective.

  1. Interstitial lung disease increases mortality in systemic sclerosis patients with pulmonary arterial hypertension without affecting hemodynamics and exercise capacity.

    Science.gov (United States)

    Michelfelder, M; Becker, M; Riedlinger, A; Siegert, E; Drömann, D; Yu, X; Petersen, F; Riemekasten, G

    2017-02-01

    Published data suggest that coexisting interstitial lung disease (ILD) has an impact on mortality in patients with systemic sclerosis (SSc) and pulmonary arterial hypertension (PAH), but there is scarce knowledge if this is reflected by hemodynamics, exercise capacity, autoantibody profile, or pulmonary function. In this partially retrospective study, 27 SSc-PAH patients were compared to 24 SSc-PAH patients with coexisting ILD respecting to survival, pulmonary function, hemodynamics, exercise capacity, and laboratory parameters. Survival was significantly worse in SSc-PAH-ILD patients than in SSc patients with isolated PAH (1, 5, and 10-year survival rates 86, 54, and 54% versus 96, 92, and 82%, p = 0.013). Compared to isolated SSc-PAH patients, patients with SSc-PAH-ILD revealed lower forced expiratory volume after 1 s (FEV1) values at the time of PAH diagnosis as well as 1 and 2 years later (p = 0.002) without significant decrease in the PAH course in both groups. At PAH diagnosis, diffusion capacity for carbon monoxide (DLCO) values were lower in the ILD-PAH group. Coexisting ILD was not associated with lower exercise capacity, different FEV1/forced vital capacity (FVC) ratio, higher WHO functional class, or reduced hemodynamics. Higher levels of antibodies against angiotensin and endothelin receptors predict mortality in all SSc-PAH patients but could not differentiate between PAH patients with and without ILD. Our study confirmed an impact of ILD on mortality in SSc-PAH patients. Pulmonary function parameters can be used to distinguish PAH from PAH-ILD. The higher mortality rate cannot be explained by differences in hemodynamics, exercise capacity, or autoantibody levels. Mechanisms of mortality remain to be studied.

  2. Effect of beta-adrenergic blockade on elevated arterial compliance and low systemic vascular resistance in cirrhosis

    DEFF Research Database (Denmark)

    Møller, S; Bendtsen, F; Henriksen, Jens Henrik Sahl

    2001-01-01

    with beta-blockers, but the effect of this treatment on arterial compliance has not been investigated. The aim of the present study was therefore to assess the effects of propranolol on the arterial compliance of patients with cirrhosis. METHODS: Twenty patients with cirrhosis underwent a haemodynamic......) of 17.8 mmHg, and responded to beta-blocker treatment with a significant reduction in the HVPG (-16%; P beta-adrenergic blockade (1.27 versus 1.29 ml/mmHg, +2%, ns), whereas...... with beta-blockers increases small vessel (arteriolar) vascular tone towards the normal level, but does not affect the elevated compliance of the larger arteries in patients with cirrhosis....

  3. Regional intra-arterial vs. systemic chemotherapy for advanced pancreatic cancer: a systematic review and meta-analysis of randomized controlled trials.

    Directory of Open Access Journals (Sweden)

    Fenghua Liu

    Full Text Available OBJECTIVE: To investigate the efficacy and safety of regional intra-arterial chemotherapy (RIAC versus systemic chemotherapy for stage III/IV pancreatic cancer. METHODS: Randomized controlled trials of patients with advanced pancreatic cancer treated by regional intra-arterial or systemic chemotherapy were identified using PubMed, ISI, EMBASE, Cochrane Library, Google, Chinese Scientific Journals Database (VIP, and China National Knowledge Infrastructure (CNKI electronic databases, for all publications dated between 1960 and December 31, 2010. Data was independently extracted by two reviewers. Odds ratios and relative risks were pooled using either fixed- or random-effects models, depending on I(2 statistic and Q test assessments of heterogeneity. Statistical analysis was performed using RevMan 5.0. RESULTS: Six randomized controlled trials comprised of 298 patients met the standards for inclusion in the meta-analysis, among 492 articles that were identified. Eight patients achieved complete remission (CR with regional intra-arterial chemotherapy (RIAC, whereas no patients achieved CR with systemic chemotherapy. Compared with systemic chemotherapy, patients receiving RIAC had superior partial remissions (RR = 1.99, 95% CI: 1.50, 2.65; 58.06% with RIAC and 29.37% with systemic treatment, clinical benefits (RR = 2.34, 95% CI: 1.84, 2.97; 78.06% with RAIC and 29.37% with systemic treatment, total complication rates (RR = 0.72, 95% CI: 0.60, 0.87; 49.03% with RIAC and 71.33% with systemic treatment, and hematological side effects (RR = 0.76, 95% CI: 0.63, 0.91; 60.87% with RIAC and 85.71% with systemic treatment. The median survival time with RIAC (5-21 months was longer than for systemic chemotherapy (2.7-14 months. Similarly, one year survival rates with RIAC (28.6%-41.2% were higher than with systemic chemotherapy (0%-12.9%.. CONCLUSION: Regional intra-arterial chemotherapy is more effective and has fewer complications than

  4. Prospective motion correction for 3D pseudo-continuous arterial spin labeling using an external optical tracking system.

    Science.gov (United States)

    Aksoy, Murat; Maclaren, Julian; Bammer, Roland

    2017-06-01

    Head motion is an unsolved problem in magnetic resonance imaging (MRI) studies of the brain. Real-time tracking using a camera has recently been proposed as a way to prevent head motion artifacts. As compared to navigator-based approaches that use MRI data to detect and correct motion, optical motion correction works independently of the MRI scanner, thus providing low-latency real-time motion updates without requiring any modifications to the pulse sequence. The purpose of this study was two-fold: 1) to demonstrate that prospective optical motion correction using an optical camera mitigates artifacts from head motion in three-dimensional pseudo-continuous arterial spin labeling (3D PCASL) acquisitions and 2) to assess the effect of latency differences between real-time optical motion tracking and navigator-style approaches (such as PROMO). An optical motion correction system comprising a single camera and a marker attached to the patient's forehead was used to track motion at a rate of 60fps. In the presence of motion, continuous tracking data from the optical system was used to update the scan plane in real-time during the 3D-PCASL acquisition. Navigator-style correction was simulated by using the tracking data from the optical system and performing updates only once per repetition time. Three normal volunteers and a patient were instructed to perform continuous and discrete head motion throughout the scan. Optical motion correction yielded superior image quality compared to uncorrected images or images using navigator-style correction. The standard deviations of pixel-wise CBF differences between reference and non-corrected, navigator-style-corrected and optical-corrected data were 14.28, 14.35 and 11.09mL/100g/min for continuous motion, and 12.42, 12.04 and 9.60mL/100g/min for discrete motion. Data obtained from the patient revealed that motion can obscure pathology and that application of optical prospective correction can successfully reveal the underlying

  5. Value of systolic pulmonary arterial pressure as a prognostic factor of death in the systemic sclerosis EUSTAR population

    DEFF Research Database (Denmark)

    Hachulla, Eric; Clerson, Pierre; Airò, Paolo

    2015-01-01

    OBJECTIVE: The aim of this study was to assess the prognostic value of systolic pulmonary artery pressure (sPAP) estimated by echocardiography in the multinational European League Against Rheumatism Scleroderma Trial and Research (EUSTAR) cohort. METHODS: Data for patients with echocardiography d...

  6. High arterial compliance in cirrhosis is related to low adrenaline and elevated circulating calcitonin gene related peptide but not to activated vasoconstrictor systems

    DEFF Research Database (Denmark)

    Henriksen, Jens Henrik; Møller, Søren; Schifter, S

    2001-01-01

    catecholamines, renin activity, endothelin-1, and calcitonin gene related peptide (CGRP) at baseline and during oxygen inhalation. RESULTS: COMP(art) was significantly increased in cirrhotic patients compared with controls (1.32 v 1.06 ml/mm Hg; p....53; prenin activity, or endothelin-1. COMP(art) was positively related to plasma volume (r=0.50; p... to COMP(art) disappeared. The relation of COMP(art) to CGRP and circulatory variables remained unchanged. CONCLUSION: Elevated arterial compliance in cirrhosis is related to low adrenaline, high CGRP, and systemic hyperdynamics but not to indicators of the activated vasoconstrictor systems (noradrenaline...

  7. Selective Embolization of Systemic Collaterals for the Treatment of Recurrent Hemoptysis Secondary to the Unilateral Absence of a Pulmonary Artery in a Child

    Energy Technology Data Exchange (ETDEWEB)

    Zhou, Yin, E-mail: zhouyin502@163.com [West China Hospital, Sichuan University, Department of Pediatric Surgery (China); Tsauo, Jiaywei, E-mail: 80732059@qq.com [West China Hospital, Sichuan University, Institute of Interventional Radiology (China); Li, Yuan, E-mail: liyuanletters@163.com [West China Hospital, Sichuan University, Department of Pediatric Surgery (China); Li, Xiao, E-mail: simonlixiao@gmail.com [West China Hospital, Sichuan University, Institute of Interventional Radiology (China)

    2015-10-15

    The unilateral absence of the pulmonary artery (UAPA) is a rare anomaly. Hemoptysis due to systemic collaterals is one of the most common complications of UAPA. To the best of the authors’ knowledge, the utility of selective embolization for the treatment of this condition in children has not been reported previously. This report describes a 6-year-old girl with isolated UAPA (IUAPA) admitted for a 10-month history of recurrent hemoptysis that had worsened during the previous 2 months. Selective embolization of the bronchial systemic collaterals was performed. The patient remained asymptomatic with no recurrence of hemoptysis 8 months after the procedure.

  8. Comparison of the severity of lower extremity arterial disease in smokers and patients with diabetes using a novel duplex Doppler scoring system.

    Science.gov (United States)

    Hiremath, Rudresh; Gowda, Goutham; Ibrahim, Jebin; Reddy, Harish T; Chodiboina, Haritha; Shah, Rushit

    2017-07-01

    The aim of this study was to validate the diagnostic feasibility of a novel scoring system of peripheral arterial disease (PAD) in smokers and patients with diabetes depending on duplex Doppler sonographic features. Patients presenting with the symptomatology of PAD were divided into three groups: diabetes only, smoking only, and smokers with diabetes. The patients were clinically examined, a clinical severity score was obtained, and the subjects were categorized into the three extrapolated categories of mild, moderate, and severe. All 106 subjects also underwent a thorough duplex Doppler examination, and various aspects of PAD were assessed and tabulated. These components were used to create a novel duplex Doppler scoring system. Depending on the scores obtained, each individual was categorized as having mild, moderate, or severe illness. The Cohen kappa value was used to assess interobserver agreement between the two scoring systems. Interobserver agreement between the traditional Rutherford clinical scoring system and the newly invented duplex Doppler scoring system showed a kappa value of 0.83, indicating significant agreement between the two scoring systems (PDoppler imaging is an effective screening investigation for lower extremity arterial disease, as it not only helps in its diagnosis, but also in the staging and grading of the disease, providing information that can be utilized for future management and treatment planning.

  9. Comparison of the severity of lower extremity arterial disease in smokers and patients with diabetes using a novel duplex Doppler scoring system

    Energy Technology Data Exchange (ETDEWEB)

    Hiremath, Rudresh; Gowda, Goutham; Ibrahim, Jebin; Reddy, Harish T.; Chodiboina, Haritha; Shah, Rushit [Radiodiagnosis and Imaging, KVG Medical College and Hospital, Sullia (India)

    2017-07-15

    The aim of this study was to validate the diagnostic feasibility of a novel scoring system of peripheral arterial disease (PAD) in smokers and patients with diabetes depending on duplex Doppler sonographic features. Patients presenting with the symptomatology of PAD were divided into three groups: diabetes only, smoking only, and smokers with diabetes. The patients were clinically examined, a clinical severity score was obtained, and the subjects were categorized into the three extrapolated categories of mild, moderate, and severe. All 106 subjects also underwent a thorough duplex Doppler examination, and various aspects of PAD were assessed and tabulated. These components were used to create a novel duplex Doppler scoring system. Depending on the scores obtained, each individual was categorized as having mild, moderate, or severe illness. The Cohen kappa value was used to assess interobserver agreement between the two scoring systems. Interobserver agreement between the traditional Rutherford clinical scoring system and the newly invented duplex Doppler scoring system showed a kappa value of 0.83, indicating significant agreement between the two scoring systems (P<0.001). Duplex Doppler imaging is an effective screening investigation for lower extremity arterial disease, as it not only helps in its diagnosis, but also in the staging and grading of the disease, providing information that can be utilized for future management and treatment planning.

  10. Individual features of autoimmune disoders in patients with arterial hypotension in structure of neurologic symptom complexes of organic lesion of the central nervous system

    Directory of Open Access Journals (Sweden)

    Елена Константиновна Зинченко

    2015-09-01

    Full Text Available This work deals with the special features of formation of individual clinical phenotype with an evident humoral sensitizing in patients with arterial hypotension in structure of neurologic symptom complexes of organic lesion of the central nervous system in accordance with the features of disorders of immune resistance and changes of the hormonal background.Materials and methods. There was carried out an examination of 201 patients: 89 with vegetative dysfunction, 50 in remote period of the closed craniocerebral trauma and 64 with cerebral arachnoiditis on the background of the chronic nidi of infection.45 examined persons with physiological arterial hypotension formed a control group. There were carried out clinical and neurological examinations, monitoring of arterial pressure, definition of the state of the primary, secondary immunity and hormonal background.Results. The main pathogenetic mechanisms in individual clinical phenotype with an evident humoral sensitizing that were formed on the background of the chronic infection are more connected with the humoral link of immunity (the high concentration of circulating immune complexes of the small values of molecular weight and peptides of the mean molecular weight, the growth of IgM content and form autoimmune disorders. This category can be related to the patients with irreversible functional states that complicates prescription of therapeutic measures.Conclusions. For patients with an evident humoral sensitizing it is reasonable to use desensitizing preparations, enterosorbents, plasmapheresis in the complex treatment. At persistent viral infection the use of specific antiviral immunoglobulins of IgG is recommended

  11. Long-term effect of prazosin and losartan administration on blood pressure, heart, carotid artery, and acetylcholine induced dilation of cardiovascular system of young Wistar rats and SHR.

    Science.gov (United States)

    Kristek, Frantisek; Malekova, Magdalena; Cacanyiova, Sona

    2013-06-01

    The long-term effects of prazosin and losartan administration on blood pressure, trophicity of the heart and carotid arteries, and responses of the cardiovascular system to acetylcholine, were studied in Wistar rats and spontaneously hypertensive rats (SHRs). Four-week-old rats were treated with prazosin (10 mg/kg b.w./day in tap water) or losartan (20 mg/kg b.w./day in tap water) for 5-6 weeks. BP was measured by plethysmographic method. Ten animals of each group were subjected to in vivo studies and subsequent to morphological investigations. The right jugular vein was cannulated for administration of acetylcholine (0.1, 1, and 10 µg). After perfusion with a glutaraldehyde fixative (120 mmHg), the carotid arteries were embedded in Durcupan ACM, and the inner diameter (ID), wall thickness (WT) (tunica intima and media), cross sectional area (CSA) (tunica intima and media), and WT/ID ratio were calculated. In Wistar rats and SHRs, prazosin and losartan administration produced a decrease in the blood pressure and trophicity of the heart. In Wistar rats, both drugs decreased the WT, CSA, and the WT/ID ratio. In addition, these drugs increased the circumferential stress of the artery without affecting the ID. In contrast, in the SHRs, only losartan administration produced these effects. Importantly, both the drugs improved the responses to acetylcholine in SHRs.

  12. Factors associated with systemic to pulmonary arterial collateral flow in single ventricle patients with superior cavopulmonary connections.

    Science.gov (United States)

    Glatz, Andrew C; Harrison, Neil; Small, Adam J; Dori, Yoav; Gillespie, Matthew J; Harris, Matthew A; Fogel, Mark A; Rome, Jonathan J; Whitehead, Kevin K

    2015-11-01

    Systemic to pulmonary arterial collateral flow (CollF) is common in single ventricle patients with superior cavopulmonary connections (SCPC), although associations with CollF are not well understood. We previously described a method to quantify CollF by cardiac MRI (CMR). We sought to identify factors associated with CollF in a large cross section of patients with SCPC. A retrospective observational cohort study of events from birth to study CMR was performed for all patients with SCPC who had CollF quantified by CMR. CollF was quantified in 96 patients at a median age of 2.6 (IQR 1.9-3.1) years and 2.1 (1.4-2.7) years after SCPC and measured 1.6±0.7 L/min/m(2) (33±11% of aortic flow and 48±16% of pulmonary venous flow). Significantly higher amounts of indices of CollF were associated with: duration of chest tubes (p≤0.05 for all), intensive care unit and hospital length of stay (p≤0.04 for all), higher O2 saturation at Stage 2 discharge (p=0.04 for CollF/aortic), female sex (p≤0.007 for CollF/aortic and CollF/pulmonary venous), and history of a Blalock-Taussig shunt (p<0.04 for CollF and CollF/aortic). Multivariable models were constructed to identify factors independently associated with CollF measures and included: female sex (p≤0.006 for all), O2 saturation at Stage 2 discharge (p=0.013 for CollF/aortic) and total chest tube days (p=0.001 for all). These models explained 20-22% of the variance in the outcomes. These data support hypotheses that perioperative morbidity and pleural inflammation play a role in CollF development and that CollF affects pulmonary blood flow. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  13. ASSESSMENT OF VERTEBRAL ARTERIES BLOOD FLOW SPECTRAL DOPPLER INDICES IN COMPARISON WITH INTERNAL AND COMMON CAROTID ARTERIES BLOOD FLOW SPECTRAL DOPPLER INDICES

    Directory of Open Access Journals (Sweden)

    H. Mazaher

    2007-05-01

    Full Text Available Vertebrobasilar insufficiency is the cause of cerebrovascular accidents in 20% of cases. There are few reports regarding spectral Doppler indices (SDIs of vertebral arteries (VAs normal blood flow. The objective of this study was to provide basic reference data about SDIs of VAs normal blood flow separately and in comparison with internal carotid arteries (ICAs and common carotid arteries (CCAs normal blood flows SDIs. This cross-sectional study performed on 70 normal patients. Color Doppler sonography (CDS and spectral Doppler sonography (SDS of right and left VAs (RVA and LVA, right and left CCAs (RCCA and LCCA, right and left ICAs (RICA and LICA, were performed. The mean PSV, EDV, and RI values of RVA blood flow were as 41.60 ± 9.6 cm/s, 14.60 ± 3.7 cm/s and 0.65 ± 0.06, and the mean PSV, EDV and RI values of LVA blood flow were as 42.20 ± 10.2 cm/s, 15.20 ± 4.2 cm/s, and 0.64 ± 0.05, respectively. There was not statistically significant difference between the mean PSV, EDV and RI values of RVA and LVA blood flows. The mean PSV and EDV values of VAs blood flows were significantly lower than the values of CCAs and ICCAs blood flows, respectively. The mean RI value of VAs blood flows was significantly lower than the mean RI Value of CCAs blood flows, but there was not statistically significant difference between the mean RI value of VAs blood flows and the mean RI value of ICAs blood flows.

  14. Carotid artery surgery

    Science.gov (United States)

    Carotid endarterectomy; CAS surgery; Carotid artery stenosis - surgery; Endarterectomy - carotid artery ... results of stenting versus endarterectomy for carotid-artery stenosis. N Engl J Med . 2016;374(11):1021- ...

  15. Carotid Artery Disease

    Science.gov (United States)

    ... head with blood. If you have carotid artery disease, the arteries become narrow or blocked, usually because ... other substances found in the blood. Carotid artery disease is serious because it can block the blood ...

  16. Coronary artery disease (image)

    Science.gov (United States)

    ... through these arteries is critical for the heart. Coronary artery disease usually results from the build-up of fatty material and plaque, a condition called atherosclerosis. As the coronary arteries narrow, the flow of blood to the ...

  17. Peripheral arterial line (image)

    Science.gov (United States)

    A peripheral arterial line is a small, short plastic catheter placed through the skin into an artery of the arm or leg. The purpose of a peripheral arterial line is to allow continuous monitoring of blood pressure ...

  18. Prevalencia de hipertensión arterial y factores asociados en la población rural marginada Prevalence and risk factors related to systemic arterial hypertension in a rural marginated population

    Directory of Open Access Journals (Sweden)

    Jesús Fernando Guerrero-Romero

    1998-07-01

    Full Text Available Objetivo. Determinar la prevalencia y los factores asociados a la hipertensión arterial sistémica (HAS en la población rural marginada de Durango, México. Material y métodos. Se realizó un estudio transversal comparativo en 627 comunidades rurales, de las que aproximadamente 90% tiene 250 o menos habitantes. Se determinaron las cifras de presión arterial y las variables sociodemográficas. Resultados. Se estudiaron 5 802 sujetos, es decir, 4 452 mujeres (76.7% y 1 350 hombres (23.3%. Se identificó HAS en 1 271 individuos (21.9%; IC95% 20.8-23.0, de los cuales 1 011 eran mujeres (22.71%; IC95% 21.5-23.9, y 260, hombres (19.26%; IC95% 17.2-21.4. Del total de la población blanco, 3 018 personas (52.0% viven en comunidades con menos de 250 habitantes, 2 080 (60.9% mujeres y 938 (31.1% hombres; en ésta se identificó HAS en 445 casos (14.74%; IC95% 13.5-16.0, de los cuales 326 son mujeres (15.7%; IC95% 14.1-17.3, y 119, hombres (12.7%; IC95% 10.6-14.9. Los principales factores de riesgo relacionados con la HAS fueron la obesidad, el diagnóstico de diabetes tipo 2 y el consumo de alcohol y tabaco. Conclusiones. Al parecer la prevalencia de HAS en la población rural marginada se relaciona con el grado de desarrollo de las comunidades.Objective. To determine the prevalence and risk factors related to systemic arterial hypertension (SAH in the rural marginated population of Durango, Mexico. Material and methods. A comparative cross-sectional study was performed in 627 rural communities, approximately 90% of which have 250 inhabitants or less. The arterial pressure and sociodemographic variables were determined. Results. A total of 5 802 subjects were studied, 4 452 women (76.7% and 1 350 men (23.3%. SAH was found in 1 271 individuals (21.9%; CI 95% 20.8-23.0 of which 1 011 were women (22.71%; CI 95% 21.5-23.9 and 260 were men (19.26%; CI 95% 17.2-21.4. Of the target population, 3 018 individuals (52.0% live in communities of less than 250

  19. A Computer-Aided Diagnosis System for Measuring Carotid Artery Intima-Media Thickness (IMT) Using Quaternion Vectors.

    Science.gov (United States)

    Kutbay, Uğurhan; Hardalaç, Fırat; Akbulut, Mehmet; Akaslan, Ünsal; Serhatlıoğlu, Selami

    2016-06-01

    This study aims investigating adjustable distant fuzzy c-means segmentation on carotid Doppler images, as well as quaternion-based convolution filters and saliency mapping procedures. We developed imaging software that will simplify the measurement of carotid artery intima-media thickness (IMT) on saliency mapping images. Additionally, specialists evaluated the present images and compared them with saliency mapping images. In the present research, we conducted imaging studies of 25 carotid Doppler images obtained by the Department of Cardiology at Fırat University. After implementing fuzzy c-means segmentation and quaternion-based convolution on all Doppler images, we obtained a model that can be analyzed easily by the doctors using a bottom-up saliency model. These methods were applied to 25 carotid Doppler images and then interpreted by specialists. In the present study, we used color-filtering methods to obtain carotid color images. Saliency mapping was performed on the obtained images, and the carotid artery IMT was detected and interpreted on the obtained images from both methods and the raw images are shown in Results. Also these results were investigated by using Mean Square Error (MSE) for the raw IMT images and the method which gives the best performance is the Quaternion Based Saliency Mapping (QBSM). 0,0014 and 0,000191 mm(2) MSEs were obtained for artery lumen diameters and plaque diameters in carotid arteries respectively. We found that computer-based image processing methods used on carotid Doppler could aid doctors' in their decision-making process. We developed software that could ease the process of measuring carotid IMT for cardiologists and help them to evaluate their findings.

  20. RX Herculink Elite® renal stent system: a review of its use for the treatment of renal artery stenosis

    Directory of Open Access Journals (Sweden)

    Colyer Jr

    2012-08-01

    Full Text Available William R Colyer JrDivision of Cardiovascular Medicine, University of Toledo Medical Center, Toledo, OH, USAAbstract: The management of renal artery stenosis (RAS remains controversial. While some evidence suggests that treatment with stent placement is beneficial, randomized trials have failed to demonstrate a significant benefit. Ongoing clinical trials should help to better define the role for stenting of RAS while avoiding limitations seen with earlier trials. When it comes to stenting for RAS, several stents have been used; however, many stents which have been used previously and which are still being used are biliary stents that are used “off-label.” These stents have typically come onto the market through the 510(k pathway. To date, a total of five stents have been approved by the United States Food and Drug Administration for use in the renal arteries. Of the five stents that have received approval, the Bridge™ Extra Support (Medtronic CardioVascular, Santa Rosa, CA and the Palmaz® (Cordis Corporation, Bridgewater, NJ stents are no longer available. Currently, the Express® SD (Boston Scientific, Natick, MA, Formula™ (Cook Medical, Bloomington, IN, and Herculink Elite® (Abbott Vascular, Santa Clara, CA stents are Food and Drug Administration approved and available for use. The Herculink Elite is the most recently approved of the renal stents, having received approval in late 2011. The Herculink Elite stent is the only cobalt chromium stent approved for use in the renal arteries. Although trial data are limited and direct comparisons among renal stents is not possible, the Herculink Elite stent has demonstrated good performance. Additionally, the design of the Herculink Elite offers some advantages that may translate into improved outcomes.Keywords: renal artery stenosis, stenting, FDA approval

  1. [Sports-related carotid artery dissection].

    Science.gov (United States)

    Berrouschot, J; Bormann, A; Routsi, D; Stoll, A

    2009-09-01

    Sports-related carotid artery dissection are very rare and were described in different kinds of sports. We report on a 45-year old man who suffered bilateral brain infarctions caused by bilateral extracranial internal carotid artery dissection after excessive weight lifting in a gym. As possible trigger factors for the dissections we assumed the abrupt extension of the neck during weight lifting and the frequent Valsalva manoeuvers with massive rise in the pressure in the carotid artery system. The patient underwent angioplasty and stenting of the stenosis of right carotid artery, the primarily occluded left carotid artery recanalized spontaneously. Secondary prevention was established by platelet aggregation inhibitors. The patient recovered completely. The pathogenesis of sports-related dissections is multifactorial. In addition to sporting activities hereditary or acquired structural aberrations in the arterial walls could be discussed. Acute focal neurological symptoms after sport should always focus on carotid or vertebral artery dissection. (c) Georg Thieme Verlag KG Stuttgart-New York.

  2. Fluid Replacement Monitoring: Effect of Dextran Overload, Norepinephrine Drip, and Positive Pressure Ventilation on Systemic Arterial, Right Atrial Pulmonary Wedge, and Left Atrial Pressures in Dogs

    Science.gov (United States)

    Hardy, James D.; Garcia, Jose B.; Hardy, Julia A.; Harkins, Mitchell H.

    1974-01-01

    The effects of dextran overload, norepinephrine drip and positive pressure ventilation upon right atrial, pulmonary wedge, left atrial and systemic arterial pressures were studied in 15 dogs. Rapid intravenous infusion of Dextran 70 invariably produced a marked and statistically significant (p < .001) rise in right atrial, pulmonary wedge and left atrial pressures. The rise in left atrial pressure invariably exceeded the rise in right atrial pressure, and the difference in maximum pressures averaged 10.8 mm Hg (p < .001). Thus acute fluid overload and pulmonary edema can be produced by rapid infusion of colloid solution in the absence of a marked rise in right atrial pressure, a point of considerable clinical importance. The rapid infusion of dextran produced a rise in systemic arterial blood pressure in all dogs so studied, though this rise was mild in some animals. This finding may explain in part the hypertension exhibited by patients in the recovery room who may have been overtransfused. A norepinephrine drip usually produced an increase in right atrial, wedge, left atrial and systemic arterial blood pressure (p < .01). When there was a significant rise in right atrial pressure and left atrial pressure, the maximum increase in left atrial pressure was always greater than the maximum increase in right atrial pressure (p < .005). This finding again emphasizes the fact that blood transfusion requirements cannot always be accurately assessed on the basis of right and left atrial pressure measurements when a vasopressor agent is being administered. Positive pressure ventilation increased both right and left atrial pressures, as expected. It was again confirmed that pulmonary wedge pressure, as measured with the Swan-Ganz catheter, is approximately equal to left atrial pressure over a wide range of induced variations. The Swan-Ganz catheter, introduced at the bedside in the intensive care unit when necessary, can provide highly useful information regarding left

  3. “Denervation” of autonomous nervous system in idiopathic pulmonary arterial hypertension by low-dose radiation: a case report with an unexpected outcome

    Directory of Open Access Journals (Sweden)

    Hohenforst-Schmidt W

    2014-03-01

    Full Text Available Wolfgang Hohenforst-Schmidt,1 Paul Zarogoulidis,2 Filiz Oezkan,3 Christian Mahnkopf,4 Gerhard Grabenbauer,5 Alfons Kreczy,6 Rolf Bartunek,7 Kaid Darwiche,3 Lutz Freitag,3 Qiang Li,8 Haidong Huang,8 Thomas Vogl,9 Patrick LePilvert,10 Theodora Tsiouda,11 Kosmas Tsakiridis,12 Konstantinos Zarogoulidis,2 Johannes Brachmann11II Medical Clinic, Coburg Clinic, University of Würzburg, Coburg, Germany; 2Pulmonary Department-Oncology Unit, G Papanikolaou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece; 3Department of Interventional Pneumology, Ruhrlandklinik, West German Lung Center, University Hospital, University of Duisburg-Essen, Essen, Germany; 4II Medizinische Klinik, Klinik für Kardiologie, Angiologie, Pneumologie, Klinikum Coburg, 5Department of Radiotherapy, 6Department of Pathology, Cytology and Molecular Diagnostics, 7Institute of Diagnostic and Interventional Radiology, Coburg Clinic, University of Wüerzburg, Coburg, Germany; 8Department of Respiratory Diseases, Changhai Hospital/First Affiliated Hospital of the Second Military Medical University, Shanghai, People’s Republic of China; 9Department of Diagnostic and Interventional Radiology, Goethe University of Frankfurt, Frankfurt, Germany; 10Interventional Drug Delivery Systems and Strategies (ID2S2, Medical Cryogenics, Lakeland Court Jupiter, FL, USA; 11Internal Medicine Unit, Theagenio Cancer Hospital, Thessaloniki, 12Cardiothoracic Surgery Department, Saint Luke Private Hospital, Thessaloniki, GreeceAbstract: Vasointestinal peptide metabolism plays a key physiological role in multimodular levels of vasodilatory, smooth muscle cell proliferative, parenchymal, and inflammatory lung reactions. In animal studies, vasointestinal peptide relaxes isolated pulmonary arterial segments from several mammalian species in vitro and neutralizes the pulmonary vasoconstrictor effect of endothelin. In some animal models, it reduces pulmonary vascular resistance in vivo and

  4. Components of the interleukin-6 transsignalling system are associated with the metabolic syndrome, endothelial dysfunction and arterial stiffness.

    Science.gov (United States)

    Weiss, Thomas W; Arnesen, Harald; Seljeflot, Ingebjorg

    2013-07-01

    The metabolic syndrome (MetS) is an increasing epidemiologic challenge and cardiovascular risk factor. Interleukin-6 (IL-6) is a cytokine that exerts its biological function via a complex orchestration of soluble and membrane bound receptors. We have investigated associations between IL-6 and its soluble receptors, soluble IL-6 receptor (sIL-6r) and soluble glycoprotein 130 (sGP130) and the metabolic syndrome. Furthermore, we have investigated possible associations with endothelial dysfunction and arterial stiffness. A total of 563 subjects were included in this study. The Adult Treatment Panel III criteria of the National Cholesterol Education Program were used for the definition of MetS. We used commercially available ELISA to analyse circulating levels of the markers. Pulse wave propagation time (PWP) was determined to assess arterial stiffness. The criteria for having MetS were filled by 221 subjects. sGP130, sIL-6r and IL-6 levels were elevated in subjects with MetS (p<0.05 for all markers), and are associated with increasing components of MetS. Particularly hypertriglyceridaemia, hypertension and fasting plasma glucose (FPG) seem to carry this association. sGP130 (p<0.01), IL-6 (p<0.05) and partially sIL-6r (p<0.05) correlated with markers of endothelial function (E-selectin, I-CAM-1, V-CAM-1) and inversely with PWP after adjustment for relevant covariates. sGP130, sIL-6r and IL-6 were significantly elevated in subjects with MetS. In addition, sGP130, IL-6 and partially sIL-6r were associated with markers of endothelial function and arterial stiffness. This finding sheds new light on the role of these inflammatory cytokines in subjects with MetS and the development and progression of clinically silent atherosclerosis. Copyright © 2013 Elsevier Inc. All rights reserved.

  5. Modelling of long-term and short-term mechanisms of arterial pressure control in the cardiovascular system: an object-oriented approach.

    Science.gov (United States)

    Fernandez de Canete, J; Luque, J; Barbancho, J; Munoz, V

    2014-04-01

    A mathematical model that provides an overall description of both the short- and long-term mechanisms of arterial pressure regulation is presented. Short-term control is exerted through the baroreceptor reflex while renal elimination plays a role in long-term control. Both mechanisms operate in an integrated way over the compartmental model of the cardiovascular system. The whole system was modelled in MODELICA, which uses a hierarchical object-oriented modelling strategy, under the DYMOLA simulation environment. The performance of the controlled system was analysed by simulation in light of the existing hypothesis and validation tests previously performed with physiological data, demonstrating the effectiveness of both regulation mechanisms under physiological and pathological conditions. Copyright © 2014 Elsevier Ltd. All rights reserved.

  6. Radial Artery Aneurysm

    Directory of Open Access Journals (Sweden)

    Ali Fedakar

    2011-04-01

    Full Text Available Upper limb aneurysms are less frequently seen than the other aneurysm. Radial arterial aneurysm is usually associated with the trauma. Interventional procedures can cause pseudoaneurysm at the radial artery puncture sites. Radial artery aneurysm may cause the thromboembolic events at the fingers and the hand. We present a case of isolated radial arterial aneurysm with idiopathic origin.

  7. Single umbilical artery

    Directory of Open Access Journals (Sweden)

    Shanthi Ramesh

    2015-01-01

    Full Text Available The umbilical cord usually contains two arteries and one vein. The vein carries the oxygenated blood from the placenta to the fetus. The arteries carry the deoxygenated blood and the waste products from the fetus to the placenta. Occasionally, primary agenesis or secondary atrophy of one of the arteries occurs resulting in single umbilical artery.

  8. Single umbilical artery

    OpenAIRE

    Shanthi Ramesh; Sangeetha Hariprasath; Gunasekaran Anandan; P John Solomon; Vijayakumar, V.

    2015-01-01

    The umbilical cord usually contains two arteries and one vein. The vein carries the oxygenated blood from the placenta to the fetus. The arteries carry the deoxygenated blood and the waste products from the fetus to the placenta. Occasionally, primary agenesis or secondary atrophy of one of the arteries occurs resulting in single umbilical artery.

  9. Single umbilical artery.

    Science.gov (United States)

    Ramesh, Shanthi; Hariprasath, Sangeetha; Anandan, Gunasekaran; Solomon, P John; Vijayakumar, V

    2015-04-01

    The umbilical cord usually contains two arteries and one vein. The vein carries the oxygenated blood from the placenta to the fetus. The arteries carry the deoxygenated blood and the waste products from the fetus to the placenta. Occasionally, primary agenesis or secondary atrophy of one of the arteries occurs resulting in single umbilical artery.

  10. Socio-demographic characteristics and quality of life of elderly patients with systemic arterial hypertension who live in rural areas: the importance of nurses' role.

    Science.gov (United States)

    Tavares, Darlene Mara dos Santos; de Paiva, Mariana Mapelli; Dias, Flavia Aparecida; Diniz, Marina Aleixo; Martins, Nayara Paula Fernandes

    2013-01-01

    To describe the socio-demographic characteristics and quality of life of elderly patients with systemic arterial hypertension; to correlate the quality of life with the time of diagnosis and number of medication, as well as to compare the quality of life with the type of medication. In this cross sectional home survey design, 460 elderly people from rural areas were involved. The data was collected with the use of the following instruments: World Health Organization Quality of Life-bref and World Health Organization Quality of Life Olders. A descriptive analysis, Pearson correlation and t-Student test (pquality of life in the physical domain. Elderly patients who used Inhibitors and Angiotensin Converting Enzyme and who did not use AT1 blocker had lower scores in relation to functioning of the senses. Those who used calcium channel blocker scored higher in relation to autonomy. there is a need for actions to control systemic arterial hypertension and its associated complications, with the purpose of improving quality of life.

  11. Systemic vasculitis is associated with a higher risk of lower extremity amputation in patients with severe peripheral arterial occlusive disease: a secondary analysis of a nationwide, population-based health claims database.

    Science.gov (United States)

    Lu, Ming-Chi; Hsu, Honda; Lin, Ching-Hsing; Koo, Malcolm

    2017-11-01

    Previous research has shown that diabetes mellitus increases the risk of lower extremity amputation in patients with peripheral arterial occlusive disease. However, to our knowledge, no studies have investigated whether systemic autoimmune disease, in particular systemic vasculitis is associated with a higher risk of lower extremity amputation in these patients. To investigate the association between systemic autoimmune disease and lower extremity amputation in patients with severe peripheral arterial occlusive disease based on a secondary analysis of a nationwide, population-based health claims database. Using the inpatient datafile of the Taiwan's National Health Insurance Research Database (NHIRD), we identified 432 patients with severe peripheral arterial occlusive disease that required hospitalization between 2000 and 2012. We also identified patients who had undergone lower extremity amputation and their comorbidities using the same datafile. The risk of lower extremity amputation was assessed using multiple logistic regression analysis, adjusting for age, sex, insured amount, the urbanization level of residence, and the presence of comorbidities. Among patients with severe peripheral arterial occlusive disease, those with systemic vasculitis exhibited a significant higher risk of lower extremity amputation (adjusted odds ratio [aOR] = 6.82, p obstructive pulmonary disease (aOR = 2.87, p = 0.007) were also significantly associated with a higher risk of lower extremity amputation. Among patients with severe peripheral arterial occlusive disease, a significantly higher risk of lower extremity amputation was observed in those with systemic vasculitis.

  12. Coronary artery bypass grafting following simultaneous treatment of abdominal aortic aneurysm and peripheral arterial disease.

    Science.gov (United States)

    Temizkan, Veysel; Ugur, Murat; Alp, Ibrahim; Ucak, Alper; Yedekci, Erturk; Yilmaz, Ahmet Turan

    2014-01-01

    Atherosclerosis might affect all arterial segments of the vascular system, thus peripheral arterial disease (PAD) accompanying coronary artery disease (CAD) is not uncommon. In addition to this coexistence, abdominal aortic aneurysm (AAA) is frequently associated with CAD. Although treatment strategies of CAD and PAD or CAD and AAA has been reported previously, treatment of these three pathologies has not been reported. The management of a therapeutic strategy is important for avoiding perioperative mortality and morbidity in CAD associated with AAA and PAD. We are reporting our simultaneous treatment strategy of three pathologies with endovascular AAA repair, stent implantation into the superficial femoral artery (SFA) and coronary artery bypass grafting (CABG).

  13. Sex differences in intracranial arterial bifurcations

    DEFF Research Database (Denmark)

    Lindekleiv, Haakon M; Valen-Sendstad, Kristian; Morgan, Michael K

    2010-01-01

    Subarachnoid hemorrhage (SAH) is a serious condition, occurring more frequently in females than in males. SAH is mainly caused by rupture of an intracranial aneurysm, which is formed by localized dilation of the intracranial arterial vessel wall, usually at the apex of the arterial bifurcation. T....... The female preponderance is usually explained by systemic factors (hormonal influences and intrinsic wall weakness); however, the uneven sex distribution of intracranial aneurysms suggests a possible physiologic factor-a local sex difference in the intracranial arteries....

  14. The experience of the illness and of the treatment for the person with systemic arterial hypertension: an ethnographic study

    Directory of Open Access Journals (Sweden)

    Silvana Maria Coelho Leite Fava

    2013-09-01

    Full Text Available OBJECTIVE: to interpret the meanings of the experience of the condition and of the treatment among people with arterial hypertension. METHOD: the authors adopted the frames of reference of interpretive and medical anthropology and of the ethnographic method. 22 people with arterial hypertension, and 10 Family Health Strategy health workers, all from Minas Gerais, participated. The authors used interviews, participant observation, focus groups, field diaries and analysis of medical records. Ethical precepts were respected. RESULTS: two nuclei of meaning emerged: "The condition as an expression of way of living", and "The perspective of the cure of the condition". Nervous problems represent the nosological and symptomatic categories, caused by the urban way of living. The participants are supported by the belief of the curing of the problem. The family, spirituality and religion constitute social support networks. The therapeutic routes interpenetrate for the cure of the problem. The 'folk' health subsystem constitutes an important route because it provides better well-being and remission of the symptoms. CONCLUSION: the gaps evidenced between the points of view of the health professionals and the interviewees allow one to re-think the praxis so as to provide comprehensive, contextualized and humanized care, which encourages the people's potential for living, for empowerment, and for self-care.

  15. DWI negative-posterior circulation infarction at 3 hours of the onset of symptoms: vertebrobasilar dolichoectasia combined with thrombosis:A case report and literature review

    Directory of Open Access Journals (Sweden)

    Yong-peng YU

    2014-06-01

    Full Text Available Objective: The role of the basilar artery morphological abnormalities (BAMA in the pathogenesis of posterior circulation infarction (PCI was summarized and analyzed based on the main line of the diagnosis and treatment of the basilar artery excessive bending combined with thrombus formation. The experience and lessons in this process was summarized which could provide reference and warning for further clinical diagnosis and treatment.  Methods: This paper described a rare case of DWI-negative PCI 3 hours after onset in a young man as well as its whole process of diagnosis and treatment and the literature of the BAMA was reviewed and summarized.  Results: This patient was diagnosed as basilar artery excessive bending combined with thrombosis by CTA, but eventually died of brain stem failure despite receiving intravenous thrombolytic therapy. Conclusion: BAMA should be fully taken into account in the pathogenesis of PCI. The clinical significance of vascular evaluation in patients with PCI and isolated vertigo should be paid enough attention to and the understanding of the clinical significance of the results of this assessment should be broadened in the clinical practice. 

  16. Assessment of conduit artery vasomotion using photoplethysmography

    Science.gov (United States)

    Kanders, Karlis; Grabovskis, Andris; Marcinkevics, Zbignevs; Aivars, Juris Imants

    2013-11-01

    Vasomotion is a spontaneous oscillation of vascular tone. The phenomenon has been observed in small arterioles and capillaries as well as in the large conduit arteries. The layer of smooth muscle cells that surrounds a blood vessel can spontaneously and periodically change its tension and thereby the arterial wall stiffness also changes. As the understanding of the phenomenon is still rather obscure, researchers would benefit from a low-cost and reliable investigation technique such as photoplethysmography (PPG). PPG is an optical blood pulsation measurement technique that can offer substantial information about the arterial stiffness. The aims of this pilot study were to evaluate the usefulness of the PPG technique in the research of vasomotion and to investigate vasomotion in the relatively large conduit arteries. Continuous 15 minute long measurements of posterior tibial artery wall stiffness were taken. Artery diameter, electrocardiogram, blood pressure and respiration were also simultaneously registered. Fast Fourier Transform power spectra were calculated to identify unique stiffness oscillations that did not correspond to fluctuations in the systemic parameters and thus would indicate vasomotion. We concluded that photoplethysmography is a convenient method for the research of the vasomotion in large arteries. Local stiffness parameter b/a is more accurate to use and easier to measure than the pulse wave velocity which describes stiffness of a segment of an artery. Conduit arteries might exhibit a low amplitude high frequency vasomotion ( 9 to 27 cycles per minute). Low frequency vasomotion is problematic to distinguish from the passive oscillations imposed by the arterial pressure.

  17. Cardiac Resynchronization for Corrected Transposition of the Great Arteries with Systemic Right Ventricle Failure after Tricuspid Valve Replacement and Ventricle Septal Defect Closure

    Directory of Open Access Journals (Sweden)

    Kosuke Fujii, MD

    2010-01-01

    Full Text Available A 32-year-old man developed systemic right ventricular (RV heart failure after ventricular septal defect (VSD closure and tricuspid valve replacement for corrected transposition of the great arteries with VSD and Ebstein anomaly. He subsequently experienced RV failure with wide QRS and atrial fibrillation (AF. Because corrective surgery for this condition seemed over risky, we decided to perform cardiac resynchronization therapy with implantation of an implantable cardioverter defibrillator (CRT-D. After CRT-D device implantation, the patient showed improved performance status in terms of New York Heart Association functional class, B-type brain natriuretic peptide levels, RV ejection fraction and cardiac electrical rhythm. CRT-D implantation is a useful approach for systemic RV failure with wide QRS duration showing right bundle branch block and AF.

  18. Investigation of the effects of chest physiotherapy in different positions on the heart and the respiratory system after coronary artery bypass surgery.

    Science.gov (United States)

    Guner, Sukriye Ilkay; Korkmaz, Fatma Demir

    2015-07-01

    This trial was conducted to investigate the effect of chest physiotherapy in different positions on the heart and the respiratory system after coronary artery bypass surgery. Patients are divided into two groups of 30 patients each in the study. To the patients in the first group (30 patients), percussion-vibration was performed in the 45° supine position, while slightly laterally lying and endotracheal aspiration was performed in the supine position. To the patients in the second group (30 patients), percussion-vibration was performed in the 0° supine position, while slightly laterally lying and endotracheal aspiration was performed in the supine position. The procedures are repeated two times for all patients and their means were taken. The pre- and postapplication values of patients were measured from central venous and arterial catheters and the values of patient monitors were recorded. Comparison of the two groups in terms of respiratory values did not reveal a significant difference, but chest physiotherapy with the head of the bed at 0° was determined to improve cardiac functions. Evaluation of the groups in terms of pre- and postphysiotherapy applications showed a significant increase in mixed venous oxygen saturation in both groups. Chest physiotherapy with the head of the bed elevated to 45° may be recommended in patients who carry a risk of pulmonary complications and who are candidates for chest physiotherapy at an early stage. © The Author(s) 2013.

  19. Risk factors for in-stent restenosis of vertebral artery origin after stent implantation: a Meta-analysis

    Directory of Open Access Journals (Sweden)

    Fang-fang HAO

    2018-01-01

    Full Text Available Objective To systematically review the risk factors for in-stent restenosis (ISR of vertebral artery origin after sent implantation to provide theoretical foundation for clinical prevention and treatment. Methods Taking vertebral artery, vertebrobasilar insufficiency, stents, drug-eluting stents, self expandable metallic stents in English and Chinese as key words, retrospective clinical studies about risk factors for ISR of vertebral artery origin were searched by using PubMed, EMBASE/SCOPUS, Cochrane Library, China Biology Medicine (CBM, China National Knowledge Infrastructure (CNKI, Wanfang Data and VIP database from January 1, 1966 to March 30, 2017. Quality assessment and Meta-analysis were made by using Newcastle-Ottawa Scale (NOS and Stata 12.0 software. Results The research enrolled 3468 articles in all, from which 11 studies were chosen after excluding duplicates and those not meeting the inclusion criteria. A total number of 1352 patients were divided into ISR group (N = 440 and non-ISR group (N = 912. The ISR incidence rate of smokers was significantly higher than non-smokers (OR = 2.179, 95%CI: 1.373-3.458; P = 0.001. The differences of bare metal stents (BMS utilization rate (OR = 2.072, 95% CI: 1.560-2.753; P = 0.000 and drug-eluting stents (DES utilization rate (OR = 0.483, 95% CI: 0.363-0.641; P = 0.000 between ISR group and non-ISR group were statistically significant. Conclusions Smoking and using BMS are risk factors for ISR of vertebral artery origin, and using DES is protective factor. Due to limited study quality, more high-quality studies are needed to verify this conclusion. DOI: 10.3969/j.issn.1672-6731.2017.12.004

  20. Ruptured Retina Artery Macroaneurysm Presenting with Recurrent ...

    African Journals Online (AJOL)

    A 74-year-old hypertensive presented with recurrent vitreous haemorrhage. Examination showed a ruptured retinal arterial macroaneurysm. Control of systemic hypertension was associated with resolution. Risk factors and management are discussed. Ruptured retinal arterial macroaneurysm should be considered in ...

  1. Anomalous left coronary artery from the pulmonary artery

    Science.gov (United States)

    ... of the left coronary artery arising from the pulmonary artery; ALCAPA; ALCAPA syndrome; Bland-White-Garland syndrome; ... children with ALCAPA, the LCA originates from the pulmonary artery. The pulmonary artery is the major blood ...

  2. The resonance theory of coronary arterial wall stress as an explanation for the distribution of coronary artery disease.

    Science.gov (United States)

    John, Lindsay C H

    2010-05-01

    The coronary arteries are unique within the arterial system in being subject to a continuous oscillatory displacement. It is hypothesised that oscillatory resonance of the coronary arteries occurs when the heart rate is the same as the arteries' Natural Frequency of oscillation. If resonance were to occur then standing waves would exist along the coronary arteries. The sites of the anti-nodes of such standing waves would be the sites of increased wall stress and therefore be expected to be predisposed to disease. Coronary artery resonance would explain the observed increased incidence of disease in the proximal segments of the arteries. It is proposed that coronary artery resonance is a previously unrecognised aetiological factor for coronary artery disease that contributes to its location. If the hypothesis is true then there are potential important consequences for the diagnosis and treatment of the disease.

  3. Antiphospholipid antibodies, steroid dose, arterial hypertension, relapses, and late-onset predict organ damage in a population of Colombian patients with systemic lupus erythematosus.

    Science.gov (United States)

    Pinto-Peñaranda, Luis F; Muñoz-Grajales, C; Echeverri Garcia, A F; Velásquez-Franco, C J; Mesa-Navas, M A; Zuluaga Quintero, M; Herrera-Uribe, S; Márquez-Hernández, J D

    2017-12-04

    Organ damage predicts mortality, increased accrual of detriment, and poor quality of life in systemic lupus erythematosus patients. The objective of this study is to determine the damage-free survival and its predictive factors in a population of Colombian subjects. The method used in this study is the retrospective follow-up of a cohort; damage was measured with SLICC/ACR index. Predictors of impairment were assessed by logistic regression and survival analysis. One hundred sixty-one individuals were included; 28.9% suffered damage, primarily neuropsychiatric, renal, and vascular. Arterial hypertension, antiphospholipid antibodies, prednisone dose, and number of relapses were all predictors of detriment. Onset after age 50 and daily prednisone dose higher than 7.5 mg determined earlier occurrence of damage.

  4. Dynamic analysis with a fractional-order chaotic system for estimation of peripheral arterial disease in diabetic foot

    Science.gov (United States)

    Li, Chien-Ming; Du, Yi-Chun; Wu, Jian-Xing; Lin, Chia-Hung; Ho, Yueh-Ren; Chen, Tainsong

    2013-08-01

    Lower-extremity peripheral arterial disease (PAD) is caused by narrowing or occlusion of vessels in patients like type 2 diabetes mellitus, the elderly and smokers. Patients with PAD are mostly asymptomatic; typical early symptoms of this limb-threatening disorder are intermittent claudication and leg pain, suggesting the necessity for accurate diagnosis by invasive angiography and ankle-brachial pressure index. This index acts as a gold standard reference for PAD diagnosis and categorizes its severity into normal, low-grade and high-grade, with respective cut-off points of ≥0.9, 0.9-0.5 and diabetics and 11 healthy adults, with analysis of dynamic errors based on various butterfly motion patterns, and color relational analysis as classifier for pattern recognition. The results show that the classification of PAD severity among these testees was achieved with high accuracy and efficiency. This noninvasive methodology potentially provides timing and accessible feedback to patients with asymptomatic PAD and their physicians for further invasive diagnosis or strict management of risk factors to intervene in the disease progression.

  5. Trajectories of Parasympathetic Nervous System Function before, during, and after Feeding in Infants with Transposition of the Great Arteries

    Science.gov (United States)

    Harrison, Tondi M.

    2011-01-01

    Background Compromised parasympathetic response to stressors may underlie feeding difficulties in infants with complex congenital heart defects, but little is known about the temporal pattern of parasympathetic response across phases of feeding. Objectives To describe initial data exploration of trajectories of parasympathetic response to feeding in 15 infants with surgically corrected transposition of the great arteries and to explore effects of feeding method, feeding skill, and maternal sensitivity on trajectories. Method In this descriptive, exploratory study, parasympathetic function was measured using high frequency heart rate variability (HF HRV), feeding skill was measured using the Early Feeding Skills assessment, and maternal sensitivity was measured using the Parent-Child Early Relational Assessment. Data were collected before, during, and after feeding at 2 weeks and 2 months of age. Trajectories of parasympathetic function and relationships with possible contributing factors were examined graphically. Results Marked between-infant variability in HF HRV across phases of feeding was apparent at both ages, although attenuated at 2 months. Four patterns of HF HRV trajectories across phases of feeding were identified and associated with feeding method, feeding skill, and maternal sensitivity. Developmental increases in HF HRV were apparent in most breastfed, but not bottle-fed, infants. Discussion This exploratory data analysis provided critical information in preparation for a larger study in which varying trajectories and potential contributing factors can be modeled in relationship to infant outcomes. Findings support inclusion of feeding method, feeding skill, and maternal sensitivity in modeling parasympathetic function across feeding. PMID:21543958

  6. Bilateral renal artery variation

    OpenAIRE

    Üçerler, Hülya; Üzüm, Yusuf; İkiz, Z. Aslı Aktan

    2015-01-01

    Each kidney is supplied by a single renal artery, although renal artery variations are common. Variations of the renal arteryhave become important with the increasing number of renal transplantations. Numerous studies describe variations in renalartery anatomy. Especially the left renal artery is among the most critical arterial variations, because it is the referred side forresecting the donor kidney. During routine dissection in a formalin fixed male cadaver, we have found a bilateral renal...

  7. Arterial hypertension and chronic liver disease

    DEFF Research Database (Denmark)

    Henriksen, Jens Henrik Sahl; Møller, S

    2005-01-01

    , calcitonin gene-related peptide, nitric oxide, and other vasodilators, and is most pronounced in the splanchnic area. This provides an effective (although relative) counterbalance to raised arterial blood pressure. Subjects with arterial hypertension (essential, secondary) may become normotensive during...... the development of chronic liver disease, and arterial hypertension is rarely manifested in patients with cirrhosis, even in those with renovascular disease and high circulating renin activity. There is much dispute as to the understanding of homoeostatic regulation in cirrhotic patients with manifest arterial......This review looks at the alterations in the systemic haemodynamics of patients with chronic liver disease (cirrhosis) in relation to essential hypertension and arterial hypertension of renal origin. Characteristic findings in patients with cirrhosis are vasodilatation with low overall systemic...

  8. Pulse Wave Propagation in the Arterial Tree

    Science.gov (United States)

    van de Vosse, Frans N.; Stergiopulos, Nikos

    2011-01-01

    The beating heart creates blood pressure and flow pulsations that propagate as waves through the arterial tree that are reflected at transitions in arterial geometry and elasticity. Waves carry information about the matter in which they propagate. Therefore, modeling of arterial wave propagation extends our knowledge about the functioning of the cardiovascular system and provides a means to diagnose disorders and predict the outcome of medical interventions. In this review we focus on the physical and mathematical modeling of pulse wave propagation, based on general fluid dynamical principles. In addition we present potential applications in cardiovascular research and clinical practice. Models of short- and long-term adaptation of the arterial system and methods that deal with uncertainties in personalized model parameters and boundary conditions are briefly discussed, as they are believed to be major topics for further study and will boost the significance of arterial pulse wave modeling even more.

  9. Vascular Aging and Arterial Stiffness

    Directory of Open Access Journals (Sweden)

    Luana de Rezende Mikael

    Full Text Available Abstract Cardiovascular diseases (CVD account annually for almost one third of all deaths worldwide. Among the CVD, systemic arterial hypertension (SAH is related to more than half of those outcomes. Type 2 diabetes mellitus is an independent risk factor for SAH because it causes functional and structural damage to the arterial wall, leading to stiffness. Several studies have related oxidative stress, production of free radicals, and neuroendocrine and genetic changes to the physiopathogenesis of vascular aging. Indirect ways to analyze that aging process have been widely studied, pulse wave velocity (PWV being considered gold standard to assess arterial stiffness, because there is large epidemiological evidence of its predictive value for cardiovascular events, and it requires little technical knowledge to be performed. A pulse wave is generated during each cardiac contraction and travels along the arterial bed until finding peripheral resistance or any bifurcation point, determining the appearance of a reflected wave. In young individuals, arteries tend to be more elastic, therefore, the reflected wave occurs later in the cardiac cycle, reaching the heart during diastole. In older individuals, however, the reflected wave occurs earlier, reaching the heart during systole. Because PWV is an important biomarker of vascular damage, highly valuable in determining the patient’s global cardiovascular risk, we chose to review the articles on vascular aging in the context of cardiovascular risk factors and the tools available to the early identification of that damage.

  10. Artery Bypass Grafting

    African Journals Online (AJOL)

    Unknown

    nary artery disease (CAD) was coronary artery bypass graft (CAB G) using a segment of saphenous vein interposed between the ascend- ing aorta and the coronary artery distal to the obstructing lesion. This was performed by David Sabiston of Duke University in 1962. With the use of the recently developed technique of ...

  11. Carotid artery surgery - slideshow

    Science.gov (United States)

    ... right- and left-internal carotid arteries, and the right- and left-external carotid arteries. The carotid arteries deliver oxygen-rich blood from the heart to both the head and brain. Review Date 6/1/2015 Updated by: Daniel ...

  12. EVALUATION OF THICKNESS OF INTIMA-MEDIA COMPLEX OF COMMON CAROTID ARTERIES IN CHILDREN WITH JUVENILE ARTHRITIS AND SYSTEMIC LUPUS ERYTHEMATOSUS

    Directory of Open Access Journals (Sweden)

    A.B. Sugak

    2010-01-01

    Full Text Available Rheumatic diseases in adults are associated with accelerated atherosclerosis, and its early signs can be stated by the thickening of intima-media complex of common carotid arteries (CCA. This symptom is detected during ultrasound examination in 49% of children with systemic lupus erythematosus, in 24% of patients with juvenile rheumatoid arthritis and in 13% of children with juvenile spondylarthritis. Besides, 36% of children with systemic lupus erythematosus and 17% — with systemic type of juvenile rheumatoid arthritis had structure changes of CCA wall. A dependence of these disorders on cholesterol and glucose levels in blood serum, overweight and Cushing syndrome, age, duration and activity of a disease, levels of ESR, C-reactive protein and white blood cells was not showed. Authors detected a correlation between the thickness of intima-media complex of CCA and hemostasis parameters.Key words: children, juvenile arthritis, systemic lupus erythematosus, intima-media complex, ultrasound diagnostics.(Voprosy sovremennoi pediatrii — Current Pediatrics. 2010;9(2:64-69

  13. A comparison of basilar artery diameters measured by T2WI and TOF MR angiography.

    Science.gov (United States)

    Çelebioğlu, Emre Can; Aldur, Muhammed Mustafa; Tunali, Selcuk; Hayran, Murvet; Taşçıoğlu, Ayşe Beliz; Sargon, F Mustafa

    2017-11-01

    The purpose of our study is to compare basilar artery diameters (BAD) measured by T2WI to diameters measured by TOF MR angiography (MRA). By doing this, we hope to understand how compatible these two methodologies are with each other. We used data from 100 patients (59 females, 41 males) who underwent a session of both T2W MRI and TOF MRA at the same time (ages between 18 and 83). We measured BAD by both T2WI and TOF MRA in three different levels. We then compared these diameters measured by two different methodologies to each other. In an area between the vertebrobasilar junction and posterior cerebral artery, all data measured by T2WI and TOF MRA in three different levels were analyzed. Average diameters measured by T2WI and TOF MRA turned out to be 79.5% correlated with each other. As a result of our mathematical model that we came up with through regression analysis, we calculated that measurements taken by T2WI on mid-pontine levels could predict TOF MRA measures with 78.3% accuracy. In T2WI and TOF MRA, average diameters measured were 2.982 ± 0.4717 and 3.205 ± 0.4281 mm, respectively. Statistical analyses showed that images measured by T2W series were significantly smaller than those measured by TOF MRA (p < 0.05). Our study showed that BAD measured by T2WI were smaller than those measured by TOF MRA. We think that it will be beneficial to refer our results to avoid T2WI and TOF MRA mismatch when evaluating BAD.

  14. Systolic blood pressure target in systemic arterial hypertension: Is lower ever better? Results from a community-based Caucasian cohort.

    Science.gov (United States)

    Di Nora, Concetta; Cioffi, Giovanni; Iorio, Annamaria; Rivetti, Luigi; Poli, Stefano; Zambon, Elena; Barbati, Giulia; Sinagra, Gianfranco; Di Lenarda, Andrea

    2017-09-08

    Extensive evidence exists about the prognostic role of systolic blood pressure (SBP) reduction ≤140mmHg. Recently, the SPRINT trial successfully tested the strategy of lowering SBP<120mmHg in patients with arterial hypertension (AH). To assess whether the SPRINT results are reproducible in a real world community population. Cross-sectional, population-based study analyzing data of 24,537 Caucasian people with AH from the Trieste Observatory of CV disease, 2010 to 2015. We selected and divided 2306 subjects with AH according to the SPRINT trial criteria; similarly, SPRINT clinical outcomes were considered. Study patients median age was 75±8years, two third male, one third had ischemic heart disease. They were older, with lower body mass index, higher SBP and Framingham CV risk score than the SPRINT patients. Three-hundred-sixty-eight patients (16%) had SBP<120mmHg. During 48 [36-60] months of follow-up, 751 patients (32%) experienced a major adverse cardiac event (MACE). The SBP <120mmHg group had higher incidence of MACE, CV deaths and all-cause death than SBP≥120mmHg group (37% vs 31%; 10% vs 4%; 19% vs 10%, all p<0.05). The condition of SBP<120mmHg was an independent predictor of MACE in multivariate Cox analysis together with older age, male gender, higher Charlson score. In our experience, the SBP<120mmHg condition is associated with worse clinical outcomes, suggesting the SPRINT results are not reproducible tout court in Caucasian community populations. These differences should be taken as a warning against aggressive reducing of SBP<120mmHg. Copyright © 2017 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

  15. Induction of PDE5 and de-sensitization to endogenous NO signaling in a systemic resistance artery under altered blood flow

    Science.gov (United States)

    Zhang, Haiying; Pakeerappa, Praveen; Jae Lee, Hyon; Fisher, Steven A.

    2009-01-01

    In the classical pathway, the opposing activities of guanylyl cyclases (GC) and phosphodiesterases (PDE), and the effect of the cGMP-dependent protein kinase (cGK) on its targets, determine the biological responses to NO signaling. Here we tested the hypothesis that vascular dysfunction may be due to altered expression and activity of these effectors of NO signaling. Every other set of rat second order mesenteric resistance arteries (MA) were ligated, resulting in chronic low flow (LF) in the upstream MA1 and high flow (HF) in the adjacent MA1 without tissue ischemia. eNOS and iNOS were up-regulated in HF and LF MA1, respectively, in the sub-acute phase (four days) of vascular remodeling. The Day4 HF/LF MA1s were under increased control of NO as indicated by reduced sensitivity to the vasoconstrictor phenylephrine and its normalization with the NOS antagonist L-NAME. PDE5 mRNA and protein were also significantly up-regulated in the HF/LF MA1 with no change in sGC or PKG1, an effect that was dependent upon NO synthesis. The PDE5 inhibitor Sildenafil was several-fold more powerful in relaxing the HF/LF MA1s, and pre-treatment with Sildenafil uncovered an increased responsiveness of HF/LF MA1s to the NO donor DEA/NO. We conclude that induction of PDE5 de-sensitizes this systemic resistance artery to sustained NO signaling under chronic HF/LF. Treatment with PDE5 antagonists, in contrast to NO donors, may more specifically and effectively increase blood flow to chronically hypo-perfused tissues. PMID:19374906

  16. Cobalt-chromium KAname™ coRonary stEnt system in the treatment of patients with coronary artery disease (KARE study).

    Science.gov (United States)

    Carrie, Didier; Schächinger, Volker; Danzi, Gian Battista; Macaya, Carlos; Zeymer, Uwe; Putnikovic, Biljana; Iniguez, Andres; Moreno, Raul; Mehmedbegovic, Zlatko; Beleslin, Branko

    2014-10-01

    To evaluate the safety and effectiveness of the Kaname™ cobalt-chromium (Co-Cr), thin strut, bare metal stent (BMS) system for the treatment of coronary artery lesions. Despite widespread use of drug-eluting stents, a certain percentage of patients with coronary artery disease are still treated with BMS. Therefore, it is essential to evaluate their clinical performance. Two hundred eighty-two patients were enrolled in this prospective, single-arm study including a predefined subset of 79 patients with small vessels. The primary end-point was freedom from target vessel failure (TVF) at 6 months. Key angiographic and intravascular ultrasound (IVUS) end-points were late loss, diameter stenosis, binary restenosis, and neointimal hyperplasia volume. Freedom from TVF at 6 months was 93.3% and at 1 year 90.8% in total population, and 92.4% and 87.3% in small vessels, respectively. Clinically driven target lesion revascularization (TLR) rates at 6 and 12 months were 4.3% and 6.4% in total population, and 3.8% and 7.6% in small vessels, respectively. At 6 months in-stent late loss was 0.75 ± 0.43 mm and binary restenosis rate was 16.9% in total population, and 0.64 ± 0.40 mm and 26.1% in small vessels, while IVUS assessed neointimal hyperplasia volume at 6 months was 128.9 ± 42.6 mm(3) for total population. There were no definite and probable stent thromboses up to 12 months. Results indicate good safety and effectiveness of the Kaname™ stent with clinically equivalent results in small and larger vessels, as such providing useful treatment option for patients with ischemic heart disease considered for BMS implantation. © 2014, Wiley Periodicals, Inc.

  17. Effects of Krill-derived phospholipid-enriched n-3 fatty acids on Ca(2+) regulation system in cerebral arteries from ovariectomized rats.

    Science.gov (United States)

    Sakai, Yasushi; Hashimoto, Michio; Enkhjargal, Budbazar; Mitsuishi, Hisashi; Nobe, Hiromi; Horie, Ichiro; Iwamoto, Takahiro; Yanagimoto, Kenichi

    2014-03-28

    To investigate the effects of n-3 polyunsaturated fatty acids on cerebral circulation, ovariectomized (OVX) rats were administered with phospholipids in krill oil (KPL) or triglycerides in fish oil (FTG); effects on the Ca(2+) regulating system in their basilar artery (BA) were then analyzed. The rats were divided into 4 groups: control, OVX, OVX given KPL (OVXP), and OVX given FTG (OVXT) orally, daily for 2weeks. Time dependent relaxation (TDR) of contractile response to 5HT in BA was determined myographically, Na(+)/Ca(2+) exchanger (NCX) 1 mRNA expression was determined by real time PCR, and nucleotides were analyzed by HPLC. The level of TDR in OVX that was significantly lower in the control was inhibited by l-NAME and indomethacin; TEA inhibited TDR totally in the control but only partly in OVXP and OVXT. Relaxation induced by the addition of 5mM KCl to the BA pre-contracted with 5-HT was inhibited by TEA in the controls, OVXP and OVXT, but not in OVX. Overexpression of NCX1 mRNA in the BA from OVX was significantly inhibited by FTG. The ratio of ADP/ATP in cerebral arteries from OVX was significantly inhibited by KPL and FTG. Levels of triglyceride and arachidonic acid in the plasma of OVX increased, but were significantly inhibited by KPL and FTG. Ovarian dysfunction affects Ca(2+) activated-, ATP-sensitive-K(+) channels and NCX1, which play crucial roles in the autoregulation of cerebral blood flow. Also, KPL may become as good a supplement as FTG for postmenopausal women. Copyright © 2014 Elsevier Inc. All rights reserved.

  18. Prospective evaluation of patients with early-/intermediate-stage hepatocellular carcinoma with disease progression following arterial locoregional therapy: candidacy for systemic treatment or clinical trials.

    Science.gov (United States)

    Memon, Khairuddin; Kulik, Laura; Lewandowski, Robert J; Gupta, Ramona; Ryu, Robert K; Miller, Frank H; Vouche, Michael; Atassi, Rohi; Ganger, Daniel; Mulcahy, Mary F; Salem, Riad

    2013-08-01

    During the course of cancer treatment, patients whose disease progresses despite therapy are offered alternative options. Similarly, patients with hepatocellular carcinoma (HCC) whose disease progresses following arterial locoregional therapies (LRTs) cross over to undergo systemic therapies or participate in clinical trials. Per current guidelines, patients must meet inclusion criteria (most importantly Child-Pugh class A status) to qualify for systemic options. The present study analyzed the candidacy for systemic agents or clinical trials of patients whose disease progresses despite LRTs. A total of 245 patients with HCC were treated with LRTs (chemoembolization, n = 123; yttrium-90 [(90)Y] radioembolization, n = 122) as part of a previously published comparative effectiveness study; 96 patients exhibiting disease progression were followed prospectively. Modes of progression (cancer stage, Child-Pugh class) were analyzed to determine candidacy for systemic therapy or clinical trials, as well as assess ultimate treatment(s) received. Among the 96 patients with disease progression, 52% and 48% had Child-Pugh class A and class B/C disease, respectively, thereby substantially limiting the latter group's eligibility for systemic therapy and/or clinical trials. Of those whose disease progressed who had advanced-stage HCC, 63% had Child-Pugh class B/C disease. By size and necrosis criteria, the local disease progression rate was higher with chemoembolization than with (90)Y radioembolization (P = .006 and P = .016, respectively). Of the 96 patients with disease progression, only 13 (13%) ultimately received systemic agents or entered clinical trials. Most patients with advanced HCC that progresses following LRTs were not candidates for clinical trials or systemic agents. There is a need for future research efforts directed at treatment options or novel trial designs that will permit inclusion of patients with progressive liver disease and suboptimal liver function

  19. Spontaneous renal artery dissection.

    Science.gov (United States)

    John, Santhosh G; Pillai, Unnikrishnan; Vaidyan, Philip B; Ishiyama, Takaaki

    2010-01-01

    Isolated spontaneous dissection of renal arteries or its branches are extremely rare. Most cases of renal artery dissection are associated with underlying pathology of the renal arteries. We report a case of spontaneous dissection of the left main renal artery and infarction of the left kidney with positive antiphospholipid antibody. Extensive work up of the patient including imaging studies confirmed the diagnosis of SRAD. Antiphospholipid antibodies may have a role in the pathogenesis of arterial dissection by causing endothelial dysfunction. This is a first literature report.

  20. Impairment of systemic microvascular endothelial and smooth muscle function in individuals with early-onset coronary artery disease: studies with laser speckle contrast imaging.

    Science.gov (United States)

    Souza, Elaine G; De Lorenzo, Andrea; Huguenin, Grazielle; Oliveira, Glaucia M M; Tibiriçá, Eduardo

    2014-01-01

    The assessment of systemic microvascular reactivity is currently considered to be critical in the stratification of cardiovascular risk. In the present study, we compared skin microvascular function in individuals with early-onset (premature) coronary artery disease (EOCAD, n=30) with that of age-matched and sex-matched healthy individuals (n=30). Using laser speckle contrast imaging, cutaneous blood flow was assessed in the forearm at rest and during reactivity tests, including postocclusive reactive hyperemia and the iontophoresis of acetylcholine or sodium nitroprusside with increasing currents of 30, 60, 90, 120, 150, and 180 μA for 10-s intervals spaced 1 min apart. Carotid intima-media thickness was evaluated using an ultrasound system and a 7.5 MHz ultrasound transducer. The endothelium-dependent skin microvascular vasodilator responses that were induced by both acetylcholine and postocclusive reactive hyperemia were significantly reduced in patients with EOCAD compared with healthy individuals. The vasodilator responses that were induced by sodium nitroprusside were also significantly reduced in individuals with EOCAD. These systemic microvascular alterations were concurrent with increased carotid intima-media thickness in these patients. Laser speckle contrast imaging identifies endothelial-dependent and endothelial-independent microvascular dysfunction in individuals presenting with EOCAD, and thus could be valuable as an early peripheral marker of atherothrombotic disease.

  1. [Screening for pulmonary arterial hypertension in patients with systemic sclerosis: Comparison of DETECT algorithm to decisions of a multidisciplinary team, in a competence centre].

    Science.gov (United States)

    Coirier, V; Lescoat, A; Fournet, M; Cazalets, C; Coiffier, G; Jouneau, S; Chabanne, C; Jégo, P

    2017-08-01

    Pulmonary arterial hypertension (PAH) is a severe complication of systemic sclerosis and detecting PAH efficiently remains challenging. The DETECT study has offered in 2013 a composite screening tool for PAH. The objective of our study was to compare the indication of right heart catheterisation (RHC) as suggested by the DETECT algorithm with the decisions of a multidisciplinary team. This prospective monocentric non-interventional study consecutively included systemic sclerosis patients when data required to apply DETECT algorithm were available. We evaluate the number of RHC as requested by this algorithm and confronted it with the indications of RHC suggested by a multidisciplinary group blinded for the result of DETECT algorithm. In total, 117 systemic sclerosis patients were included. When DETECT algorithm was applied to all patients, RHC was suggested by this algorithm for 70 patients, whereas only 15 indications were required by the multidisciplinary group; among those patients only 7 had PAH. When DETECT algorithm was applied only to the 42 patients with DLCOalgorithm is able to efficiently detect all PAH patients finally diagnosed by our multidisciplinary team. However, it increases by 3 the number of RHC that should be performed. Copyright © 2017 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier SAS. All rights reserved.

  2. Superior and anterior inferior cerebellar arteries and their relationship with cerebello-pontine angle cranial nerves revisited in the light of cranial cephalometric indexes: a cadaveric study.

    Science.gov (United States)

    Habibi, Zohreh; Meybodi, Ali Tayebi; Maleki, Farid; Tabatabai, Seyed

    2011-01-01

    The aim was to clarify the anatomical features of the superior and anterior inferior cerebellar arteries in relation to the trigeminal nerve and acoustic-facial complex and to the bony structures of the skull in a sample of male Iranian cadavers. Bilateral dissections, calvariectomy, and brain evacuation were performed on 31 adult human fresh brains and skull bases to assess the neurovascular associations, and skull base morphometry. Equations were defined to estimate posterior fossa volume and the relationships between bony and neurovascular elements. Eight SCAs were duplicated from origin. There were 9 cases of SCA-trigeminal contacts, which were at the root entry zone in 7. Mean distance from the origin of AICA to the vertebrobasilar junction was 11.80 mm, while 79% of AICAs originated from the lower half of the BA. This was significantly associated with "posterior fossa funneling" and "basilar narrowing" indexes. In most cases AICA crossed the acoustic-facial complex and coursed between neural bundles (48.3%). The AICA reached or entered the internal acoustic canal in 22.6% of cases and was medial to porous in 77.4%. We documented anatomical variations of the superior and anterior inferior cerebellar arteries along with some cephalometric equations with relevant neurovascular anatomy in Iranian cadavers.

  3. Neuropathy optic glaucomatosa induced by systemic hypertension through activation endothelin-1 signaling pathway in central retinal artery in rats

    Directory of Open Access Journals (Sweden)

    Seskoati Prayitnaningsih

    2016-11-01

    Full Text Available AIM: To evaluate effect of hypertension on retinal ganglion cell (RGC apoptosis, intraocular pressure (IOP, and the activation of endothelin-1 (ET-1 signaling pathway in central retinal artery (CRA in rats. METHODS: The experimental study was performed on 20 male Sprague Dawley rats that were divided into control group, and hypertension groups. The hypertension was induced by subcutaneous deoxycorticoacetate (DOCA 10 mg/kg twice a week and administered 0.9% NaCl solution daily for 2, 6, and 10wk. Blood pressure (BP was measured using animal BP analyzer. IOP was measured by handheld tonometry. Retinal tissue preparations by paraffin blocks were made after enucleation. The expression of ET-1, eNOS, ET-1 receptor A (ETRA, ET-1 receptor B (ETRB, and phosphorylated myosin light chain kinase (MLCK, and caldesmon (CaD in CRA and RGC apoptosis were evaluated through immunofluorescent staining method then observed using laser scanning confocal microscopy. RESULTS: BP significantly increased in all of the hypertension groups compared to control (P=0.001. Peak IOP elevation (7.78±4.14 mm Hg and RGC apoptosis (576.15±33.28 Au occurred on 2wk of hypertension. ET-1 expression (1238.6±55.1 Au and eNOS expression (2814.2±70.7 Au were found highest in 2wk of hypertension, although the ratio of ET-1/eNOS decreased since 2wk. ETRA reached peak expression in 10wk of hypertension (1219.4±6.3 Au, while ETRB significantly increased only in 2 weeks group (1069.2±9.6 Au. The highest MLCK expression (1190.09±58.32 Au, CaD (1670.28±18.36 Au were also found in 2wk of hypertension. CONCLUSION: Hypertension effects to activation of ET-1 signaling pathway significantly in CRA, elevation of IOP, and RGC apoptosis. The highest value was achieved at 2wk, which is the development phase of hypertension.

  4. [Factors associated with self-reported systemic arterial hypertension according to VIGITEL in 26 Brazilian capitals and the Federal District in 2008].

    Science.gov (United States)

    Muraro, Ana Paula; dos Santos, Debora França; Rodrigues, Paulo Rogério Melo; Braga, José Ueleres

    2013-05-01

    The scope of this article is to study the association between lifestyle, nutritional status and the prevalence of self-reported systemic arterial hypertension, weighted by the system of risk and protective factors for Chronic Non-Communicable Diseases (CNCD) by telephone surveys and standardized by age and sex, in adults from 26 Brazilian state capitals and the Federal District in 2008. For each city the prevalence of hypertension was standardized by the direct method. Multiple linear regression analysis was performed between the factors of interest and the prevalence of hypertension, weighted and standardized by gender and age. After standardization, the prevalence of hypertension tended to increase in capitals with a younger population and decrease in those with a higher proportion of elderly individuals. In regression models, the prevalence of weighted and standardized hypertension remained associated with the prevalence of excess weight and the consumption of fruit and vegetables (FV). However, physical activity was only negatively associated with the weighted prevalence of hypertension. A positive association with weighted and standardized prevalence of hypertension was observed with excess weight and regular consumption of FV.

  5. Conversion to resection of liver metastases from colorectal cancer with hepatic artery infusion of combined chemotherapy and systemic cetuximab in multicenter trial OPTILIV.

    Science.gov (United States)

    Lévi, F A; Boige, V; Hebbar, M; Smith, D; Lepère, C; Focan, C; Karaboué, A; Guimbaud, R; Carvalho, C; Tumolo, S; Innominato, P; Ajavon, Y; Truant, S; Castaing, D; De Baere, T; Kunstlinger, F; Bouchahda, M; Afshar, M; Rougier, P; Adam, R; Ducreux, M

    2016-02-01

    Systemic chemotherapy typically converts previously unresectable liver metastases (LM) from colorectal cancer to curative intent resection in ∼15% of patients. This European multicenter phase II trial tested whether hepatic artery infusion (HAI) with triplet chemotherapy and systemic cetuximab could increase this rate to 30% in previously treated patients. Participants had unresectable LM from wt KRAS colorectal cancer. Main non-inclusion criteria were advanced extra hepatic disease, prior HAI and grade 3 neuropathy. Irinotecan (180 mg/m(2)), oxaliplatin (85 mg/m(2)) and 5-fluorouracil (2800 mg/m(2)) were delivered via an implanted HAI access port and combined with i.v. cetuximab (500 mg/m(2)) every 14 days. Multidisciplinary decisions to resect LM were taken after every three courses. The rate of macroscopic complete resections (R0 + R1) of LM, progression-free survival (PFS) and overall survival (OS) were computed according to intent to treat. The patient population consisted of 42 men and 22 women, aged 33-76 years, with a median of 10 LM involving a median of six segments. Up to 3 extrahepatic lesions of liver-specific intensive chemotherapy and surgery had a high curative intent potential that deserves upfront randomized testing. EUDRACT 2007-004632-24, NCT00852228. © The Author 2015. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oup.com.

  6. Empirical description of bronchial and nonbronchial arteries with MDCT

    Energy Technology Data Exchange (ETDEWEB)

    Yu Hong, E-mail: yuhong.2002@hotmail.co [Department of Imageology, Changzheng hospital, Second Military Medical University, Shanghai 200003 (China); Liu Shiyuan, E-mail: cjr.liushiyuan@vip.163.co [Department of Imageology, Changzheng hospital, Second Military Medical University, Shanghai 200003 (China); Li Huimin, E-mail: yuhongphd@163.co [Department of Imageology, Changzheng hospital, Second Military Medical University, Shanghai 200003 (China); Xiao Xiangsheng, E-mail: cjr.xxsh@vip.163.co [Department of Imageology, Changzheng hospital, Second Military Medical University, Shanghai 200003 (China); Dong Weihua, E-mail: dongweihua2000@163.co [Department of Imageology, Changzheng hospital, Second Military Medical University, Shanghai 200003 (China)

    2010-08-15

    Purpose: We aimed to retrospectively evaluate bronchial and nonbronchial systemic arteries using multi-detector row helical computed tomographic (MDCT) angiography in patients with pulmonary disorders. Materials and Methods: Thirty-nine patients (24 men, 15 women; mean age, 63.4 years; range, 20-82 years) with congenital and acquired pulmonary disorders of the bronchial and nonbronchial systemic arteries underwent multi-detector row helical computed tomographic angiography of the thorax using a 16-detector row scanner. Each of these patients had experienced an episode of hemoptysis. Computed tomographic angiogram data, which included maximum intensity projections, multiplanar reconstruction, and three-dimensional volume-rendered images, were used to retrospectively analyse the characteristics of the bronchial and nonbronchial systemic arteries. Results: We identified a total of 128 bronchial arteries (76 on the right side and 52 on the left) in 39 patients. We detected 42 nonbronchial systemic artery branches, including 19 internal mammary artery branches, 8 subclavian artery branches, 8 inferior phrenic artery branches, 5 intercostal artery branches, 1 thyrocervical trunk branch, and 1 celiac trunk branch. Thirty-five dilated and tortuous nonbronchial systemic arteries entered into the lung parenchyma and extended down to the lesions. Every case, except the one case of sequestration, was associated with pleural thickening where the vascular structures passed through the extrapleural fat. Conclusions: The variations in both the bronchial artery anatomy and the location and type of the nonbronchial arteries were great. Nonbronchial arteries may be a significant source of hemoptysis. MDCT angiography can be used to detect detailed anatomical information about the origins and courses of bronchial and nonbronchial systemic arteries and their pathophysiologic features.

  7. testicular artery arising from an aberrant right renal artery

    African Journals Online (AJOL)

    User

    2017-08-17

    Aug 17, 2017 ... Correspondence to Dr. Emmanuel Henry Suluba, Department of Anatomy, School of Medicine,. Muhimbili University of Health and ... vein, left colic artery and the descending colon. Both right and left testicular arteries as ... anatomy of the vessels such as testicular arteries, ovarian arteries, renal arteries and.

  8. Duplicated middle cerebral artery

    Science.gov (United States)

    Perez, Jesus; Machado, Calixto; Scherle, Claudio; Hierro, Daniel

    2009-01-01

    Duplicated middle cerebral artery (DMCA) is an anomalous vessel arising from the internal carotid artery. The incidence DMCA is relatively law, and an association between this anomaly and cerebral aneurysms has been documented. There is a controversy whether DMCA may have perforating arteries. This is an important fact to consider in aneurysm surgery. We report the case of a 34-year-old black woman who suffered a subarachnoid hemorrhage and the angiography a left DMCA, and an aneurysm in an inferior branch of the main MCA. The DMCA and the MCA had perforating arteries. The aneurysm was clipped without complications. The observation of perforating arteries in our patient confirms that the DMCA may have perforating arteries. This is very important to be considered in cerebral aneurysms surgery. Moreover, the DMCA may potentially serve as a collateral blood supply to the MCA territory in cases of MCA occlusion. PMID:22140405

  9. Multivessel coronary artery thrombosis.

    Science.gov (United States)

    Kanei, Yumiko; Janardhanan, Rajesh; Fox, John T; Gowda, Ramesh M

    2009-02-01

    Simultaneous thrombosis of multiple epicardial coronary arteries is an uncommon clinical finding in ST-segment elevation myocardial infarction (STEMI). We describe a 37-year-old male present with inferior wall STEMI who was found to have large thrombi in both the right coronary artery (RCA) and the left anterior descending artery (LAD). We reviewed 23 patients with multivessel thrombosis in acute myocardial infarction in the literature. The mean age of patients was 53 +/- 14 years (32-82 years); 74% were males, and most patients had multiple risk factors for coronary artery disease. The LAD (78%) and RCA (87%) were the arteries involved for most patients. Aspiration thrombectomy was used in 3 cases. Though it is rare, STEMI with multiple culprit arteries can occur, and it is crucial to recognize this condition to determine the proper treatment, since most of these patients are critically ill.

  10. Popliteal artery entrapment syndrome.

    LENUS (Irish Health Repository)

    O'Leary, D P

    2010-01-01

    Popliteal artery entrapment syndrome is a rare abnormality of the anatomical relationship between the popliteal artery and adjacent muscles or fibrous bands in the popliteal fossa. The following is a case report of a 19 year old female, in whom popliteal artery entrapment syndrome was diagnosed, and successfully treated surgically. A review of literature is also presented and provides details on how PAES is classified, diagnosed both clinically and radiologically, and treated surgically.

  11. Celiac Artery Compression Syndrome

    Directory of Open Access Journals (Sweden)

    Mohammed Muqeetadnan

    2013-01-01

    Full Text Available Celiac artery compression syndrome is a rare disorder characterized by episodic abdominal pain and weight loss. It is the result of external compression of celiac artery by the median arcuate ligament. We present a case of celiac artery compression syndrome in a 57-year-old male with severe postprandial abdominal pain and 30-pound weight loss. The patient eventually responded well to surgical division of the median arcuate ligament by laparoscopy.

  12. An MIF Promoter Polymorphism Is Associated with Susceptibility to Pulmonary Arterial Hypertension in Diffuse Cutaneous Systemic Sclerosis

    NARCIS (Netherlands)

    Bossini-Castillo, L.; Campillo-Davo, D.; Lopez-Isac, E.; Carmona, F.D.; Simeon, C.P.; Carreira, P.; Callejas-Rubio, J.L.; Castellvi, I.; Fernandez-Nebro, A.; Rodriguez-Rodriguez, L.; Rubio-Rivas, M.; Garcia-Hernandez, F.J.; Madronero, A.B.; Beretta, L.; Santaniello, A.; Lunardi, C.; Airo, P.; Hoffmann-Vold, A.M.; Kreuter, A.; Riemekasten, G.; Witte, T. de; Hunzelmann, N.; Vonk, M.C.; Voskuyl, A.E.; Vries-Bouwstra, J. de; Shiels, P.; Herrick, A.; Worthington, J.; Radstake, T.; Martin, J.

    2017-01-01

    OBJECTIVE: Systemic sclerosis (SSc) is a fibrotic immune-mediated disease of unknown etiology. Among its clinical manifestations, pulmonary involvement is the leading cause of mortality in patients with SSc. However, the genetic factors involved in lung complication are not well defined. We aimed to

  13. An MIF promoter polymorphism is associated with susceptibility to pulmonary arterial hypertension in diffuse cutaneous systemic sclerosis

    NARCIS (Netherlands)

    Bossini-Castillo, Lara; Campillo-Davo, Diana; Lopez-Isac, Elena; Carmona, Francisco David; Simeon, Carmen P.; Carreira, Patricia; Callejas-Rubio, Jose Luis; Castellvi, Ivan; Fernandez-Nebro, Antonio; Rodriguez-Rodriguez, Luis; Rubio-Rivas, Manel; Garcia-Hernandez, Francisco J.; Madronero, Ana Belen; Beretta, Lorenzo; Santaniello, Alessandro; Lunardi, Claudio; Airo, Paolo; Hoffmann-Vold, Anna-Maria; Kreuter, Alexander; Riemekasten, Gabriela; Witte, Torsten; Hunzelmann, Nicolas; Vonk, Madelon C.; Voskuyl, Alexandre E.; de Vries-Bouwstra, Jeska; Shiels, Paul; Herrick, Ariane; Worthington, Jane; Radstake, Timothy R.D.J.; Martin, Javier

    2017-01-01

    Objective. Systemic sclerosis (SSc) is a fibrotic immune-mediated disease of unknown etiology. Among its clinical manifestations, pulmonary involvement is the leading cause of mortality in patients with SSc. However, the genetic factors involved in lung complication are not well defined. We aimed to

  14. Renal Branch Artery Stenosis

    DEFF Research Database (Denmark)

    Andersson, Zarah; Thisted, Ebbe; Andersen, Ulrik Bjørn

    2017-01-01

    Renovascular hypertension is a common cause of pediatric hypertension. In the fraction of cases that are unrelated to syndromes such as neurofibromatosis, patients with a solitary stenosis on a branch of the renal artery are common and can be diagnostically challenging. Imaging techniques...... that perform well in the diagnosis of main renal artery stenosis may fall short when it comes to branch artery stenosis. We report 2 cases that illustrate these difficulties and show that a branch artery stenosis may be overlooked even by the gold standard method, renal angiography....

  15. Atherosclerotic femoral artery aneurysms

    DEFF Research Database (Denmark)

    Levi-Mazloum, Niels Donald; Schroeder, T V

    1996-01-01

    Based on a clinical suspicion of an increase in the proportion of deep femoral aneurysms, we reviewed the case records of patients who underwent reconstructive procedures for femoral aneurysms to investigate if this could be confirmed and explained by selection of patient or modality of diagnosis...... femoral artery and 3 the deep femoral artery. The proportion of deep femoral aneurysm was therefore 3/17 = 18%. Previous series report that aneurysms of the profunda femoris artery occurs in only 1% to 2.6% of all femoral artery aneurysms. No explanation was found for this significant increase (p

  16. Geographic variation and risk factors for systemic and limb ischemic events in patients with symptomatic peripheral artery disease: Insights from the REACH Registry.

    Science.gov (United States)

    Abtan, Jérémie; Bhatt, Deepak L; Elbez, Yedid; Sorbets, Emmanuel; Eagle, Kim; Reid, Christopher M; Baumgartner, Iris; Wu, David; Hanson, Mary E; Hannachi, Hakima; Singhal, Puneet K; Steg, Philippe Gabriel; Ducrocq, Gregory

    2017-09-01

    Patients with symptomatic peripheral artery disease (PAD) are at high risk of ischemic events. However, data about predictors of this risk are limited. We analyzed baseline characteristics and 4-year follow-up of patients enrolled in the international REduction of Atherothrombosis for Continued Health (REACH) Registry with symptomatic PAD and no history of stroke/transient ischemic attack to describe annual rates of recurrent ischemic events globally and geographically. The primary outcome was systemic ischemic events (composite of cardiovascular death, myocardial infarction, or stroke) at 4 years. The secondary outcome was limb ischemic events (composite of lower limb amputation, peripheral bypass graft, and percutaneous intervention for PAD) at 2 years. Multivariate analysis identified risk factors associated with recurrent ischemic events. The primary endpoint rate reached 4.7% during the first year and increased continuously (by 4%-5% each year) to 17.6% by year 4, driven mainly by cardiovascular mortality (11.1% at year 4). Japan experienced lower adjusted ischemic rates (P < 0.01) vs North America. Renal impairment (P < 0.01), congestive heart failure (P < 0.01), history of diabetes (P < 0.01), history of myocardial infarction (P = 0.01), vascular disease (single or poly, P < 0.01), and older age (P < 0.01) were associated with increased risk of systemic ischemic events, whereas statin use was associated with lower risk (P = 0.03). The limb ischemic event rate was 5.7% at 2 years. Four-year systemic ischemic risk in patients with PAD and no history of stroke or transient ischemic attack remains high, and was mainly driven by cardiovascular mortality. © 2017 Wiley Periodicals, Inc.

  17. Grape-derived polyphenols improve aging-related endothelial dysfunction in rat mesenteric artery: role of oxidative stress and the angiotensin system.

    Directory of Open Access Journals (Sweden)

    Noureddine Idris Khodja

    Full Text Available Aging is characterized by the development of an endothelial dysfunction, which affects both the nitric oxide (NO- and the endothelium-derived hyperpolarizing factor (EDHF-mediated relaxations, associated with vascular oxidative stress and the activation of the angiotensin system. This study investigated whether red wine polyphenols (RWPs, antioxidants and potent stimulators of NO- and EDHF-mediated relaxations improve aging-related endothelial dysfunction, and, if so, examined the underlying mechanism. Mesenteric artery reactivity was determined in organ chambers, vascular oxidative stress by dihydroethidine and MitoSOX staining, and expression of target proteins by immunohistochemical staining. Control young rats (16 weeks received solvent (ethanol, 3% v/v, and middle-aged rats (46 weeks either solvent or RWPs (100 mg/kg/day in the drinking water. The acetylcholine-induced endothelium-dependent NO component was slightly reduced whereas the EDHF component was markedly blunted in rings of middle-aged rats compared to young rats. The endothelial dysfunction was associated with oxidative stress, an upregulation of angiotensin II and AT1 receptors and a down-regulation of SK(Ca, IK(Ca, and angiotensin converting enzyme. Intake of RWPs for either one or two weeks improved the NO and the EDHF components of the relaxation, and normalized oxidative stress, the expression of SK(Ca, IK(Ca and the components of the angiotensin system. The protective effect of the 2-week RWPs treatment persisted for one and two weeks following stopping intake of RWPs. Thus, intake of RWPs caused a persistent improvement of the endothelial function, particularly the EDHF component, in middle-aged rats and this effect seems to involve the normalization of the expression of SK(Ca, IK(Ca and the angiotensin system.

  18. Grape-derived polyphenols improve aging-related endothelial dysfunction in rat mesenteric artery: role of oxidative stress and the angiotensin system.

    Science.gov (United States)

    Idris Khodja, Noureddine; Chataigneau, Thierry; Auger, Cyril; Schini-Kerth, Valérie B

    2012-01-01

    Aging is characterized by the development of an endothelial dysfunction, which affects both the nitric oxide (NO)- and the endothelium-derived hyperpolarizing factor (EDHF)-mediated relaxations, associated with vascular oxidative stress and the activation of the angiotensin system. This study investigated whether red wine polyphenols (RWPs), antioxidants and potent stimulators of NO- and EDHF-mediated relaxations improve aging-related endothelial dysfunction, and, if so, examined the underlying mechanism. Mesenteric artery reactivity was determined in organ chambers, vascular oxidative stress by dihydroethidine and MitoSOX staining, and expression of target proteins by immunohistochemical staining. Control young rats (16 weeks) received solvent (ethanol, 3% v/v), and middle-aged rats (46 weeks) either solvent or RWPs (100 mg/kg/day) in the drinking water. The acetylcholine-induced endothelium-dependent NO component was slightly reduced whereas the EDHF component was markedly blunted in rings of middle-aged rats compared to young rats. The endothelial dysfunction was associated with oxidative stress, an upregulation of angiotensin II and AT1 receptors and a down-regulation of SK(Ca), IK(Ca), and angiotensin converting enzyme. Intake of RWPs for either one or two weeks improved the NO and the EDHF components of the relaxation, and normalized oxidative stress, the expression of SK(Ca), IK(Ca) and the components of the angiotensin system. The protective effect of the 2-week RWPs treatment persisted for one and two weeks following stopping intake of RWPs. Thus, intake of RWPs caused a persistent improvement of the endothelial function, particularly the EDHF component, in middle-aged rats and this effect seems to involve the normalization of the expression of SK(Ca), IK(Ca) and the angiotensin system.

  19. Gastric distension causes changes in heart rate and arterial blood pressure by affecting the crosstalk between vagal and splanchnic systems in anesthetised rats.

    Science.gov (United States)

    Sabbatini, Maurizio; Grossini, Elena; Molinari, Claudio; Mary, David A S G; Vacca, Giovanni; Cannas, Mario

    2017-04-01

    Various hindbrain nuclei have been demonstrated to be involved in the control of the cardiovascular reflexes elicited by both non-noxious and noxious gastric distension, through parasympathetic and sympathetic activation. The different role played by the branches of autonomic nervous system in exerting these effects and their crosstalk in relation to low-/high-pressure distension rate has not been examined yet. Therefore, in the present work, monolateral and bilateral vagotomy and splanchnicotomy were performed in anesthetised rats to analyse the involvement of hindbrain nuclei in haemodynamic changes caused by gastric distension at high (80 mmHg) and low (15 mmHg) pressure. The analysis of c-Fos expression in neuronal areas involved in cardiovascular control allowed us to examine their recruitment in response to various patterns of gastric distension and the crosstalk between vagal and splanchnic systems. The results obtained show that the low-pressure (non-noxious) gastric distension increases both heart rate and arterial blood pressure. In addition, the vagus nerve and hindbrain nuclei, such as nucleus ambiguous, ventrolateral medulla and lateral reticular nucleus, appear to be primarily involved in observed responses. In particular, we have found that although vagus nerve plays a central role in exerting those cardiovascular reflex changes at low gastric distension, for its functional expression an intact splanchnic system is mandatory. Hence, the absence of splanchnic input attenuates pressor responses or turns them into depressor responses. Instead at high-pressure (noxious) gastric distension, the splanchnic nerve represents the primary component in regulating the reflex cardiovascular effects.

  20. Expert consensus for performing right heart catheterisation for suspected pulmonary arterial hypertension in systemic sclerosis: a Delphi consensus study with cluster analysis.

    Science.gov (United States)

    Avouac, Jérôme; Huscher, Dörte; Furst, Daniel E; Opitz, Christian F; Distler, Oliver; Allanore, Yannick

    2014-01-01

    To establish an expert consensus on which criteria are the most appropriate in clinical practice to refer patients with systemic sclerosis (SSc) for right heart catheterisation (RHC) when pulmonary hypertension (PH) is suspected. A three stage internet based Delphi consensus exercise involving worldwide PH experts was designed. In the first stage, a comprehensive list of domains and items combining evidence based indications and expert opinions were obtained. In the second and third stages, experts were asked to rate each item selected in the list. After each of stages 2 and 3, the number of items and criteria were reduced according to a cluster analysis. A literature search and the opinions of 47 experts participating in Delphi stage 1 provided a list of seven domains containing 142 criteria. After stages 2 and 3, these domains and tools were reduced to three domains containing eight tools: clinical (progressive dyspnoea over the past 3 months, unexplained dyspnoea, worsening of WHO dyspnoea functional class, any finding on physical examination suggestive of elevated right heart pressures and any sign of right heart failure), echocardiography (systolic pulmonary artery pressure >45 mm Hg and right ventricle dilation) and pulmonary function tests (diffusion lung capacity for carbon monoxide Delphi consensus methods. Although these indications are recommended by this expert group to be used as an interim tool, it will be necessary to formally validate the present tools in further studies.

  1. Membrane diffusion- and capillary blood volume measurements are not useful as screening tools for pulmonary arterial hypertension in systemic sclerosis: a case control study

    Directory of Open Access Journals (Sweden)

    Spreeuwenberg Marieke D

    2008-10-01

    Full Text Available Abstract Background There is no optimal screening tool for the assessment of pulmonary arterial hypertension (PAH in patients with systemic sclerosis (SSc. A decreasing transfer factor of the lung for CO (TLCO is associated with the development of PAH in SSc. TLCO can be partitioned into the diffusion of the alveolar capillary membrane (Dm and the capillary blood volume (Vc. The use of the partitioned diffusion to detect PAH in SSc is not well established yet. This study evaluates whether Dm and Vc could be candidates for further study of the use for screening for PAH in SSc. Methods Eleven SSc patients with PAH (SScPAH+, 13 SSc patients without PAH (SScPAH- and 10 healthy control subjects were included. Pulmonary function testing took place at diagnosis of PAH. TLCO was partitioned according to Roughton and Forster. As pulmonary fibrosis in SSc influences values of the (partitioned TLCO, these were adjusted for fibrosis score as assessed on HRCT. Results TLCO as percentage of predicted (% was lower in SScPAH+ than in SScPAH- (41 ± 7% vs. 63 ± 12%, p vs. 39 ± 12%, p Conclusion SScPAH+ patients have lower Dm% than SScPAH- patients. There are no correlations between Dm% and hemodynamic parameters of PAH in SScPAH+. These findings do not support further study of the role of partitioning TLCO in the diagnostic work- up for PAH in SSc.

  2. The Coronary Artery Disease-Reporting and Data System (CAD-RADS): Prognostic and Clinical Implications Associated With Standardized Coronary Computed Tomography Angiography Reporting.

    Science.gov (United States)

    Xie, Joe X; Cury, Ricardo C; Leipsic, Jonathon; Crim, Matthew T; Berman, Daniel S; Gransar, Heidi; Budoff, Matthew J; Achenbach, Stephan; Ó Hartaigh, Bríain; Callister, Tracy Q; Marques, Hugo; Rubinshtein, Ronen; Al-Mallah, Mouaz H; Andreini, Daniele; Pontone, Gianluca; Cademartiri, Filippo; Maffei, Erica; Chinnaiyan, Kavitha; Raff, Gilbert; Hadamitzky, Martin; Hausleiter, Joerg; Feuchtner, Gudrun; Dunning, Allison; DeLago, Augustin; Kim, Yong-Jin; Kaufmann, Philipp A; Villines, Todd C; Chow, Benjamin J W; Hindoyan, Niree; Gomez, Millie; Lin, Fay Y; Jones, Erica; Min, James K; Shaw, Leslee J

    2018-01-01

    This study sought to assess clinical outcomes associated with the novel Coronary Artery Disease-Reporting and Data System (CAD-RADS) scores used to standardize coronary computed tomography angiography (CTA) reporting and their potential utility in guiding post-coronary CTA care. Clinical decision support is a major focus of health care policies aimed at improving guideline-directed care. Recently, CAD-RADS was developed to standardize coronary CTA reporting and includes clinical recommendations to facilitate patient management after coronary CTA. In the multinational CONFIRM (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter) registry, 5,039 patients without known coronary artery disease (CAD) underwent coronary CTA and were stratified by CAD-RADS scores, which rank CAD stenosis severity as 0 (0%), 1 (1% to 24%), 2 (25% to 49%), 3 (50% to 69%), 4A (70% to 99% in 1 to 2 vessels), 4B (70% to 99% in 3 vessels or ≥50% left main), or 5 (100%). Kaplan-Meier and multivariable Cox models were used to estimate all-cause mortality or myocardial infarction (MI). Receiver-operating characteristic (ROC) curves were used to compare CAD-RADS to the Duke CAD Index and traditional CAD classification. Referrals to invasive coronary angiography (ICA) after coronary CTA were also assessed. Cumulative 5-year event-free survival ranged from 95.2% to 69.3% for CAD-RADS 0 to 5 (p CAD-RADS, which was noninferior to the Duke Index (0.7073; p = 0.893) and traditional CAD classification (0.7095; p = 0.783). ICA rates were 13% for CAD-RADS 0 to 2, 66% for CAD-RADS 3, and 84% for CAD-RADS ≥4A. For CAD-RADS 3, 58% of all catheterizations occurred within the first 30 days of follow-up. In a patient subset with available medication data, 57% of CAD-RADS 3 patients who received 30-day ICA were either asymptomatic or not receiving antianginal therapy at baseline, whereas only 32% had angina and were receiving medical therapy. CAD-RADS effectively

  3. Patent arterial duct

    Directory of Open Access Journals (Sweden)

    Martin Robin P

    2009-07-01

    Full Text Available Abstract Patent arterial duct (PAD is a congenital heart abnormality defined as persistent patency in term infants older than three months. Isolated PAD is found in around 1 in 2000 full term infants. A higher prevalence is found in preterm infants, especially those with low birth weight. The female to male ratio is 2:1. Most patients are asymptomatic when the duct is small. With a moderate-to-large duct, a characteristic continuous heart murmur (loudest in the left upper chest or infraclavicular area is typical. The precordium may be hyperactive and peripheral pulses are bounding with a wide pulse pressure. Tachycardia, exertional dyspnoea, laboured breathing, fatigue or poor growth are common. Large shunts may lead to failure to thrive, recurrent infection of the upper respiratory tract and congestive heart failure. In the majority of cases of PAD there is no identifiable cause. Persistence of the duct is associated with chromosomal aberrations, asphyxia at birth, birth at high altitude and congenital rubella. Occasional cases are associated with specific genetic defects (trisomy 21 and 18, and the Rubinstein-Taybi and CHARGE syndromes. Familial occurrence of PAD is uncommon and the usual mechanism of inheritance is considered to be polygenic with a recurrence risk of 3%. Rare families with isolated PAD have been described in which the mode of inheritance appears to be dominant or recessive. Familial incidence of PAD has also been linked to Char syndrome, familial thoracic aortic aneurysm/dissection associated with patent arterial duct, and familial patent arterial duct and bicuspid aortic valve associated with hand abnormalities. Diagnosis is based on clinical examination and confirmed with transthoracic echocardiography. Assessment of ductal blood flow can be made using colour flow mapping and pulsed wave Doppler. Antenatal diagnosis is not possible, as PAD is a normal structure during antenatal life. Conditions with signs and symptoms of

  4. Modeling of short-term mechanism of arterial pressure control in the cardiovascular system: object-oriented and acausal approach.

    Science.gov (United States)

    Kulhánek, Tomáš; Kofránek, Jiří; Mateják, Marek

    2014-11-01

    This letter introduces an alternative approach to modeling the cardiovascular system with a short-term control mechanism published in Computers in Biology and Medicine, Vol. 47 (2014), pp. 104-112. We recommend using abstract components on a distinct physical level, separating the model into hydraulic components, subsystems of the cardiovascular system and individual subsystems of the control mechanism and scenario. We recommend utilizing an acausal modeling feature of Modelica language, which allows model variables to be expressed declaratively. Furthermore, the Modelica tool identifies which are the dependent and independent variables upon compilation. An example of our approach is introduced on several elementary components representing the hydraulic resistance to fluid flow and the elastic response of the vessel, among others. The introduced model implementation can be more reusable and understandable for the general scientific community. Copyright © 2014 Elsevier Ltd. All rights reserved.

  5. Validation of a new UNIX-based quantitative coronary angiographic system for the measurement of coronary artery lesions.

    Science.gov (United States)

    Bell, M R; Britson, P J; Chu, A; Holmes, D R; Bresnahan, J F; Schwartz, R S

    1997-01-01

    We describe a method of validation of computerized quantitative coronary arteriography and report the results of a new UNIX-based quantitative coronary arteriography software program developed for rapid on-line (digital) and off-line (digital or cinefilm) analysis. The UNIX operating system is widely available in computer systems using very fast processors and has excellent graphics capabilities. The system is potentially compatible with any cardiac digital x-ray system for on-line analysis and has been designed to incorporate an integrated database, have on-line and immediate recall capabilities, and provide digital access to all data. The accuracy (mean signed differences of the observed minus the true dimensions) and precision (pooled standard deviations of the measurements) of the program were determined x-ray vessel phantoms. Intra- and interobserver variabilities were assessed from in vivo studies during routine clinical coronary arteriography. Precision from the x-ray phantom studies (6-In. field of view) for digital images was 0.066 mm and for digitized cine images was 0.060 mm. Accuracy was 0.076 mm (overestimation) for digital images compared to 0.008 mm for digitized cine images. Diagnostic coronary catheters were also used for calibration; accuracy.varied according to size of catheter and whether or not they were filled with iodinated contrast. Intra- and interobserver variabilities were excellent and indicated that coronary lesion measurements were relatively user-independent. Thus, this easy to use and very fast UNIX based program appears to be robust with optimal accuracy and precision for clinical and research applications.

  6. Newborn lamb coronary artery reactivity is programmed by early gestation dexamethasone before the onset of systemic hypertension

    OpenAIRE

    Roghair, Robert D.; Segar, Jeffrey L.; Sharma, Ram V.; Zimmerman, Matthew C.; Jagadeesha, D. K.; Segar, Emily M.; Scholz, Thomas D.; Lamb, Fred S.

    2005-01-01

    Exposure of the early gestation ovine fetus to exogenous glucocorticoids induces organ-specific alterations in postnatal cardiovascular physiology. To determine whether early gestation corticosteroid exposure alters coronary reactivity before the development of systemic hypertension, dexamethasone (0.28 mg·kg−1 · day−1) was administered to pregnant ewes by intravenous infusion over 48 h beginning at 27 days gestation (term, 145 days). Vascular responsiveness was assessed in endothelium-intact...

  7. Myocardial deformation imaging of the systemic right ventricle by two-dimensional strain echocardiography in patients with d-transposition of the great arteries.

    Science.gov (United States)

    Kalogeropoulos, Andreas P; Georgiopoulou, Vasiliki V; Giamouzis, Grigorios; Pernetz, Maria-Alexandra; Anadiotis, Athanasios; McConnell, Michael; Lerakis, Stamatios; Butler, Javed; Book, Wendy M; Martin, Randolph P

    2009-01-01

    Functional assessment of the systemic right ventricle is often problematic in patients with Dtransposition of the great arteries (D-TGA) due to altered ventricular geometry. The clinical applicability of myocardial deformation imaging by two-dimensional strain (2DS) echocardiography in this setting is still under investigation. We evaluated 27 patients with D-TGA (age 30 +/- 6 years, 9 female, 11 with paced rhythm) by standard and 2DS echocardiography; 27 outpatients (age 29 +/- 10 years, 15 female) without structural heart disease served as controls. High-resolution two-dimensional grayscale images were analyzed offline. Global values of peak strain (GS), systolic strain rate (GSRs), and early diastolic strain rate (GSRe) of the systemic ventricle, as well as the systemic ejection fraction (EF), were recorded from apical 4-chamber views. Intraobserver reproducibility was assessed by random-order repeat analysis. Global indices of myocardial deformation (GS, GSRs, GSRe) in the systemic right ventricle were reliably obtained in all 27 patients with D-TGA, and tracking was optimal in 159/162 segments (>98%). Mean GS in patients with D-TGA was -13.2 +/- 3.8% vs. -20.6 +/- 2.6% in controls, p<0.001; mean GSRs -0.59 +/- 0.16 /s vs. -1.10 +/- 0.19 /s, p<0.001; and mean GSRe 0.68 +/- 0.21 /s vs. 1.34 +/- 0.31 /s, p<0.001. Mean systemic EF by single-plane modified Simpson was 37 +/- 11% in patients with D-TGA vs. 60 +/- 7% in controls, p<0.001. GSRs exhibited the highest discriminative value between D-TGA patients and controls. The mean absolute percent error for GS, GSRs, GSRe, and systemic EF in D-TGA patients was 6.9% (p<0.05 vs. EF), 8.9%, 12.3%, 13.1%, respectively. Myocardial deformation parameters can be reliably obtained by 2DS echocardiography in patients with D-TGA. Deformation indices of the systemic right ventricle appear to be highly reproducible, and may provide a sensitive means to detect both systolic and diastolic abnormalities in patients with D-TGA.

  8. Increased arterial compliance in decompensated cirrhosis

    DEFF Research Database (Denmark)

    Henriksen, Jens Henrik; Møller, Søren; Schifter, S

    1999-01-01

    BACKGROUND/AIMS: In patients with cirrhosis, the systemic circulation is hyperdynamic with low arterial blood pressure and reduced systemic vascular resistance. The present study was undertaken to estimate the compliance of the arterial tree in relation to severity of cirrhosis, circulating level...... of the vasodilator, calcitonin gene-related peptide (CGRP) and mean arterial blood pressure (MAP). METHODS: Arterial compliance (COMPart=deltaV/deltaP) was determined as the stroke volume relative to pulse pressure (i.e. systolic minus diastolic blood pressure) during a haemodynamic evaluation of portal hypertension...... of CGRP (r=0.34, pcompliance in cirrhosis is directly related to the severity of the disease and to the elevated level of circulating vasodilator peptide CGRP, and inversely related...

  9. [Pediatric case of congenital coronary artery fistula; surgical result and late changes in coronary artery aneurysm].

    Science.gov (United States)

    Sugawara, Masaaki; Oguma, Fumiaki; Hirahara, Hiroyuki

    2014-07-01

    Congenital coronary artery fistula is an uncommon heart anomaly involving the coronary arteries. We report here a case of a 4-year-old boy who had a coronary fistula from the right coronary artery to the right ventricle, with a coronary aneurysm. He was asymptomatic, but the calculated ratio of pulmonary blood flow to systemic blood flow was shown to be high [pulmonary flow (Qp)/systemic flow(Qs)=1.78]. The coronary angiography showed that the right coronary artery was dilated beginning at the ostium and had an aneurysm at the acute marginal portion. A large spherical aneurysm approximately 20 mm in diameter was found to have been connected with coronary fistula opening into the right ventricle. Surgical repair by closure of the fistula under direct vision, partial resection and suture closure of the aneurysm was performed. Plication of the proximal portion of the right coronary artery was not performed, and the diffusely dilated artery was left untouched. After this operation, he recovered well under anticoagulant treatment with warfarin and aspirin. Postoperative angiography was performed 17 months after the surgery to evaluate morphological changes in the coronary artery. The angiography confirmed the closure of the fistula and the regression of coronary artery dilatation.

  10. A LabVIEW model incorporating an open-loop arterial impedance and a closed-loop circulatory system.

    Science.gov (United States)

    Cole, R T; Lucas, C L; Cascio, W E; Johnson, T A

    2005-11-01

    While numerous computer models exist for the circulatory system, many are limited in scope, contain unwanted features or incorporate complex components specific to unique experimental situations. Our purpose was to develop a basic, yet multifaceted, computer model of the left heart and systemic circulation in LabVIEW having universal appeal without sacrificing crucial physiologic features. The program we developed employs Windkessel-type impedance models in several open-loop configurations and a closed-loop model coupling a lumped impedance and ventricular pressure source. The open-loop impedance models demonstrate afterload effects on arbitrary aortic pressure/flow inputs. The closed-loop model catalogs the major circulatory waveforms with changes in afterload, preload, and left heart properties. Our model provides an avenue for expanding the use of the ventricular equations through closed-loop coupling that includes a basic coronary circuit. Tested values used for the afterload components and the effects of afterload parameter changes on various waveforms are consistent with published data. We conclude that this model offers the ability to alter several circulatory factors and digitally catalog the most salient features of the pressure/flow waveforms employing a user-friendly platform. These features make the model a useful instructional tool for students as well as a simple experimental tool for cardiovascular research.

  11. Continuous cardiac output measurement: arterial pressure analysis versus thermodilution technique during cardiac surgery with cardiopulmonary bypass

    NARCIS (Netherlands)

    Lorsomradee, S.; Lorsomradee, S. R.; Cromheecke, S.; de Hert, S. G.

    2007-01-01

    This study compared cardiac output measured with an arterial pressure-based cardiac output measurement system and a thermodilution cardiac output measurement system. We studied 36 patients undergoing cardiac surgery with cardiopulmonary bypass. Simultaneous arterial pressure-based and thermodilution

  12. A farmacoterapia no idoso: revisão sobre a abordagem multiprofissional no controle da hipertensão arterial sistêmica La farmacoterapia en el anciano: una revisión sobre la actuación multiprofesional en el control de la hipertensión arterial sistémica Pharmacotherapy in the elderly: a review about the multidisciplinary team approach in systemic arterial hypertension control

    Directory of Open Access Journals (Sweden)

    Divaldo Pereira de Lyra Júnior

    2006-06-01

    Full Text Available A maior prevalência de doenças crônicas entre os idosos, como a hipertensão arterial sistêmica, implica no crescimento do consumo de medicamentos. Em conseqüência, ocorre o aumento na incidência dos problemas relacionados aos medicamentos (PRM, deixando essa população vulnerável aos vários problemas de saúde. Fundamentados na literatura, destaca-se a abordagem multiprofissional (médico, enfermeiro e farmacêutico nas atividades ligadas diretamente à farmacoterapia da hipertensão arterial sistêmica, para proporcionar ao idoso a conscientização quanto aos seus cuidados com a saúde, reduzir os PRM e obter a adesão satisfatória.La mayor prevalencia de las enfermedades crónicas entre los ancianos, tales como la hipertensión arterial sistémica, implica el crecimiento del consumo de medicamentos. En consecuencia, aumenta la incidencia de problemas relacionados a los medicamentos (PRM, dejando a esta población vulnerable a varios problemas de salud. Basados en la literatura, destacamos la actuación multiprofesional (médico, enfermero y farmacéutico en las actividades ligadas directamente a la farmacoterapia de la hipertensión arterial sistémica, para proporcionar a los ancianos una mayor comprensión de los cuidados con su salud, reducir los PRM y alcanzar la adhesión satisfactoriaThe greater prevalence of chronic diseases like systemic arterial hypertension among elderly people results in an increase of drugs use. Therefore, the incidence of a lot of drug-related problems (DRP rises, and this leads to many health problems in the population. Based on literature, authors emphasize the multidisciplinary team approach (physicians, nurses and pharmacists to activities directly related with pharmacotherapy for hypertension, granting elderly persons a better comprehension about taking care of their own health, to reduce DRP and achieve satisfactory adherence.

  13. Nova bandagem ajustável das artérias pulmonares na Síndrome de Hipoplasia de Câmaras Esquerdas A novel adjustable pulmonary artery banding system for hypoplastic left heart syndrome

    Directory of Open Access Journals (Sweden)

    Renato Samy Assadi

    2007-03-01

    ductal stent implantation and atrial septostomy has been proposed as an alternative approach. However, the surgically placed bands are fixed and may become inadequate after sternum closure or with somatic growth of the patient. We describe the first case in which a neonate with hypoplastic left heart syndrome was initially managed using a mini banding system that allows for fine percutaneous adjustments of pulmonary blood flow. METHOD: Through a mid sternotomy, a 5 day-old neonate underwent bilateral pulmonary artery banding using this new system combined with placement of a main pulmonary artery to innominate artery shunt. RESULTS: The patient had an uneventful postoperative course. Three percutaneous adjustments of the banding system were necessary to keep the arterial oxygen saturation in the 75%-85% range. On the 48th day of life, she was submitted to stent placement (6 mm within the atrial septum to treat a restrictive atrial septal defect. The Norwood operation and the bidirectional Glenn shunt were carried out on the 106th day of life. The bands were removed with no distortion of the pulmonary arteries. CONCLUSIONS: The clinical use of this innovative pulmonary artery banding system was feasible, safe and effective. It allowed for customization of the pulmonary blood flow according to the underlying clinical needs, resulting in a more precise balance between the pulmonary and systemic circulations.

  14. [Characteristics of central nervous system activity in patients with complications of arterial hypertension and dependence on psychomotor status and treatment].

    Science.gov (United States)

    Usenko, A G; Velichko, N P; Usenko, G A; Nishcheta, O V; Kozyreva, T Iu; Demin, A A

    2013-01-01

    Changes in certain CNS characteristics were used as indicators of the efficacy of antihypertensive therapy (AHT) both targeted (T-AHT) and empirical (E-AHT) designed to suppress activity of the sympathetic component of vegetative nervous system (VNS) and renin-angiotensin-aldosterone system (RAAS) in patients of different psychic status and AH. A group of 835 men (mean age 54.2+-1.8yr) was divided into cholerics, sanguinics, melancholics and phlegmatics with a high and low anxiety level (HA and LA). 416 healthy men served as controls. The following parameters were estimated: mobility of cortical processes, balance between sympathetic and parasympathetic activities, blood corrisol and aldosterone levels, oxygen utilization coefficient, resistance to breath holding, severity of dyscirculatory encephalopathy and the fraction of patients with AH complications during 12 month T-AHT for the suppression of sympathetic activity in cholerics and sanguinics by beta-adrenoblockers and PAA C- ACE inhibitors in phlegmatics and melancholics and during E-AHT (ACE inhibitors in cholerics and sanguinics, BAB in phlegmatics and melancholics). The functional activity of CNS in phlegmatics and melancholics before and during AHT was lower and severity of encephalopathy and the number ofAH complications higher than in cholerics and sanguinics. . The changes wiere more pronounced in patients with HA than in those with LA. Unlike E-AHT T-AHT (anxiolytics for cholerics and sanguinics with HA, antidepressants for phlegmatics and melancholics with HA) normalized the study parameters and decreased the frequency of complications by 2-3 times.

  15. Novel system using microliter order sample volume for measuring arterial radioactivity concentrations in whole blood and plasma for mouse PET dynamic study

    Science.gov (United States)

    Kimura, Yuichi; Seki, Chie; Hashizume, Nobuya; Yamada, Takashi; Wakizaka, Hidekatsu; Nishimoto, Takahiro; Hatano, Kentaro; Kitamura, Keishi; Toyama, Hiroshi; Kanno, Iwao

    2013-11-01

    This study aimed to develop a new system, named CD-Well, for mouse PET dynamic study. CD-Well allows the determination of time-activity curves (TACs) for arterial whole blood and plasma using 2-3 µL of blood per sample; the minute sample size is ideal for studies in small animals. The system has the following merits: (1) measures volume and radioactivity of whole blood and plasma separately; (2) allows measurements at 10 s intervals to capture initial rapid changes in the TAC; and (3) is compact and easy to handle, minimizes blood loss from sampling, and delay and dispersion of the TAC. CD-Well has 36 U-shaped channels. A drop of blood is sampled into the opening of the channel and stored there. After serial sampling is completed, CD-Well is centrifuged and scanned using a flatbed scanner to define the regions of plasma and blood cells. The length measured is converted to volume because the channels have a precise and uniform cross section. Then, CD-Well is exposed to an imaging plate to measure radioactivity. Finally, radioactivity concentrations are computed. We evaluated the performance of CD-Well in in vitro measurement and in vivo 18F-fluorodeoxyglucose and [11C]2-carbomethoxy-3β-(4-fluorophenyl) tropane studies. In in vitro evaluation, per cent differences (mean±SE) from manual measurement were 4.4±3.6% for whole blood and 4.0±3.5% for plasma across the typical range of radioactivity measured in mouse dynamic study. In in vivo studies, reasonable TACs were obtained. The peaks were captured well, and the time courses coincided well with the TAC derived from PET imaging of the heart chamber. The total blood loss was less than 200 µL, which had no physiological effect on the mice. CD-Well demonstrates satisfactory performance, and is useful for mouse PET dynamic study.

  16. Heritability of cilioretinal arteries

    DEFF Research Database (Denmark)

    Taarnhøj, Nina Charlotte; Munch, Inger C; Kyvik, Kirsten O

    2005-01-01

    of healthy monozygotic and dizygotic twins were examined using digital fundus photography and visual assessment of grayscale fundus photographs and color transparencies to detect the presence of cilioretinal arteries. RESULTS: Cilioretinal arteries were present in 45.1% of participants and 28.8% of eyes...

  17. Peripheral artery disease - legs

    Science.gov (United States)

    ... the legs, feet, and toes Painful, non-bleeding sores on the feet or toes (most often black) that are slow ... block small arteries Coronary artery disease Impotence Open sores ... (gangrene) The affected leg or foot may need to be amputated

  18. Carotid Artery Screening

    Science.gov (United States)

    ... that look for inherited genetic markers linked to disease, and imaging tests that produce pictures of the inside of the body. These ... a risk factor. Risk factors for carotid artery disease include: age high blood pressure diabetes tobacco smoking high cholesterol coronary artery disease (CAD) obesity ...

  19. BILATERAL DUPLICATION OF RENAL ARTERIES

    OpenAIRE

    Prajkta A Thete; Mehera Bhoir; M.V.Ambiye

    2014-01-01

    Routine dissection of a male cadaver revealed the presence of bilateral double renal arteries. On the right side the accessory renal artery originated from the abdominal aorta just above the main renal artery. On the left side the accessory renal artery originated from the abdominal aorta about 1 cm above the main renal artery. Knowledge of the variations of renal vascular anatomy has importance in exploration and treatment of renal trauma, renal transplantation, renal artery embolization, su...

  20. Prediction for rupture risk of carotid artery plaques: A comparative study of 3D-GSM and CAS system.

    Science.gov (United States)

    Zhang, Minyu; Zhao, Qian; Gao, Yu; Wu, Xinhuai; Wang, Jianhua

    2016-09-01

    The study aimed to explore whether GSM based on 3D-ultrasound could predict rupture of carotid plaques and to quantitatively evaluate the vulnerability of carotid plaques. 22 Patients with carotid plaques enrolled received 3D-US and 3.0T MRI examinations with intervals less than 48h. Images from two modalities were compared plane by plane. Based on the MRI analysis of plaques tissue compositions, images were divided into 4 groups: fibrous group, lipid core group, calcification group and hybrid group. GSM differences among groups were analyzed and 95% CI was calculated. Based on CAS(carotid atherosclerosis score)system, MRI images were divided into low risk group, medium-low risk group, medium-high risk group and high risk group. GSM differences were compared among groups and 95% CI was calculated. The correlation between GSM and LRNC% (lipid-rich necrotic core%) was analyzed in medium-high risk group and high risk group. Coefficient of variation(CoV) was used to compare the reproducibility of GSM in calcification group and lipid core group. A total of 164 images were matched between 3D-US and MRI. In the classification of plaque tissue composition, GSM was the highest in calcification group (n=29, 95%CI: 57.28-70.38) with a significant difference from other groups, whereas the lowest in lipid core group (n=78, 95% CI:41.79-49.36), but with no significance compared with the fibrous group and hybrid group. In CAS system, GSM was the lowest in high risk group (n=19, 95% CI: 26.44-36.56) and there were significant differences among each group (pGSM was negatively correlated with lipid core ratio (r=-0.46, p=0.003). CoV of GSM in the calcification group(10.87%) was better than in lipid core group(13.02%), both of them were acceptable. GSM obtained by 3D-US VPQ could evaluate the plaque vulnerability and be served as a new promising method to predict plaque rupture. Copyright © 2016. Published by Elsevier Ireland Ltd.

  1. Celiac artery stenosis/occlusion treated by interventional radiology

    Energy Technology Data Exchange (ETDEWEB)

    Ikeda, Osamu [Department of Diagnostic Radiology, Kumamoto University Graduate School of Medical and Pharmaceutical Sciences, 1-1-1, Honjo Kumamoto 860-8505 (Japan)], E-mail: osamu-3643ik@do9.enjoy.ne.jp; Tamura, Yoshitaka; Nakasone, Yutaka; Yamashita, Yasuyuki [Department of Diagnostic Radiology, Kumamoto University Graduate School of Medical and Pharmaceutical Sciences, 1-1-1, Honjo Kumamoto 860-8505 (Japan)

    2009-08-15

    Severe stenosis/occlusion of the proximal celiac trunk due to median arcuate ligament compression (MALC), arteriosclerosis, pancreatitis, tumor invasion, and celiac axis agenesis has been reported. However, clinically significant ischemic bowel disease attributable to celiac axis stenosis/occlusion appears to be rare because the superior mesenteric artery (SMA) provides for rich collateral circulation. In patients with celiac axis stenosis/occlusion, the most important and frequently encountered collateral vessels from the SMA are the pancreaticoduodenal arcades. Patients with celiac artery stenosis/occlusion are treated by interventional radiology (IR) via dilation of the pancreaticoduodenal arcade. In patients with dilation of the pancreaticoduodenal arcade on SMA angiograms, IR through this artery may be successful. Here we provide several tips on surmounting these difficulties in IR including transcatheter arterial chemoembolization for hepatocellular carcinoma, an implantable port system for hepatic arterial infusion chemotherapy to treat metastatic liver tumors, coil embolization of pancreaticoduodenal artery aneurysms, and arterial stimulation test with venous sampling for insulinomas.

  2. Feasibility Study of Ex Ovo Chick Chorioallantoic Artery Model for Investigating Pulsatile Variation of Arterial Geometry.

    Directory of Open Access Journals (Sweden)

    Kweon-Ho Nam

    Full Text Available Despite considerable research efforts on the relationship between arterial geometry and cardiovascular pathology, information is lacking on the pulsatile geometrical variation caused by arterial distensibility and cardiomotility because of the lack of suitable in vivo experimental models and the methodological difficulties in examining the arterial dynamics. We aimed to investigate the feasibility of using a chick embryo system as an experimental model for basic research on the pulsatile variation of arterial geometry. Optical microscope video images of various arterial shapes in chick chorioallantoic circulation were recorded from different locations and different embryo samples. The high optical transparency of the chorioallantoic membrane (CAM allowed clear observation of tiny vessels and their movements. Systolic and diastolic changes in arterial geometry were visualized by detecting the wall boundaries from binary images. Several to hundreds of microns of wall displacement variations were recognized during a pulsatile cycle. The spatial maps of the wall motion harmonics and magnitude ratio of harmonic components were obtained by analyzing the temporal brightness variation at each pixel in sequential grayscale images using spectral analysis techniques. The local variations in the spectral characteristics of the arterial wall motion were reflected well in the analysis results. In addition, mapping the phase angle of the fundamental frequency identified the regional variations in the wall motion directivity and phase shift. Regional variations in wall motion phase angle and fundamental-to-second harmonic ratio were remarkable near the bifurcation area. In summary, wall motion in various arterial geometry including straight, curved and bifurcated shapes was well observed in the CAM artery model, and their local and cyclic variations could be characterized by Fourier and wavelet transforms of the acquired video images. The CAM artery model with

  3. Severe gastric variceal haemorrhage due to splenic artery thrombosis and consecutive arterial bypass

    Directory of Open Access Journals (Sweden)

    Wasmuth Hermann E

    2011-06-01

    Full Text Available Abstract Background Upper gastrointestinal haemorrhage is mainly caused by ulcers. Gastric varicosis due to portal hypertension can also be held responsible for upper gastrointestinal bleeding. Portal hypertension causes the development of a collateral circulation from the portal to the caval venous system resulting in development of oesophageal and gastric fundus varices. Those may also be held responsible for upper gastrointestinal haemorrhage. Case presentation In this study, we describe the case of a 69-year-old male with recurrent severe upper gastrointestinal bleeding caused by arterial submucosal collaterals due to idiopathic splenic artery thrombosis. The diagnosis was secured using endoscopic duplex ultrasound and angiography. The patient was successfully treated with a laparoscopic splenectomy and complete dissection of the short gastric arteries, resulting in the collapse of the submucosal arteries in the gastric wall. Follow-up gastroscopy was performed on the 12th postoperative week and showed no signs of bleeding and a significant reduction in the arterial blood flow within the gastric wall. Subsequent follow-up after 6 months also showed no further gastrointestinal bleeding as well as subjective good quality of life for the patient. Conclusion Submucosal arterial collaterals must be excluded by endosonography via endoscopy in case of recurrent upper gastrointestinal bleeding. Laparoscopic splenectomy provides adequate treatment in preventing any recurrent bleeding, if gastric arterial collaterals are caused by splenic artery thrombosis.

  4. Preventive Effects of Resveratrol on Endocannabinoid System and Synaptic Protein Modifications in Rat Cerebral Cortex Challenged by Bilateral Common Carotid Artery Occlusion and Reperfusion

    Directory of Open Access Journals (Sweden)

    Gianfranca Carta

    2018-01-01

    Full Text Available This study aims to evaluate the putative roles of a single acute dose of resveratrol (RVT in preventing cerebral oxidative stress induced by bilateral common carotid artery occlusion, followed by reperfusion (BCCAO/R and to investigate RVT’s ability to preserve the neuronal structural integrity. Frontal and temporal-occipital cortices were examined in two groups of adult Wistar rats, sham-operated and submitted to BCCAO/R. In both groups, 6 h before surgery, half the rats were gavage-fed with a single dose of RVT (40 mg/per rat in 300 µL of sunflower oil as the vehicle, while the second half received the vehicle alone. In the frontal cortex, RVT pre-treatment prevented the BCCAO/R-induced increase of lipoperoxides, augmented concentrations of palmitoylethanolamide and docosahexaenoic acid, increased relative levels of the cannabinoid receptors type 1 (CB1 and 2 (CB2, and peroxisome-proliferator-activated-receptor (PPAR-α proteins. Increased expression of CB1/CB2 receptors mirrored that of synaptophysin and post-synaptic density-95 protein. No BCCAO/R-induced changes occurred in the temporal-occipital cortex. Collectively, our results demonstrate that, in the frontal cortex, RVT pre-treatment prevents the BCCAO/R-induced oxidative stress and modulates the endocannabinoid and PPAR-α systems. The increased expression of synaptic structural proteins further suggests the possible efficacy of RVT as a dietary supplement to preserve the nervous tissue metabolism and control the physiological response to the hypoperfusion/reperfusion challenge.

  5. Ischemic stroke: carotid and vertebral artery disease

    Energy Technology Data Exchange (ETDEWEB)

    Vilela, P.; Goulao, A. [Hospital Garcia de Orta, Servico de Neurorradiologia, Almada (Portugal)

    2005-03-01

    Ischemic strokes may have distinct aetiologies, including several different intrinsic arterial pathological disorders. The diagnosis and understanding of these arterial diseases is critical for the correct management of stroke as different treatment approaches are undertaken according to the aetiology. Atherosclerosis is by far the most common arterial disease among adults, and other pathological processes include arterial dissection, small vessel disease, inflammatory and non-inflammatory vasculopathy and vasomotor disorders. In children, there are several vasculopathies responsible for vaso-occlusive disease such as sickle-cell anemia, acute regressive angiopathy and Moya-Moya disease, neurofibromatosis, dissections, vasculitis associated with intracranial and systemic infections. An overview of the major carotid and vertebral pathological diseases responsible for ischemic stroke in adults and children, highlighting the accuracy of the different imaging modalities for its diagnosis and the imaging appearance of these diseases, is given. (orig.)

  6. A four-tier classification system of pulmonary artery metrics on computed tomography for the diagnosis and prognosis of pulmonary hypertension.

    Science.gov (United States)

    Truong, Quynh A; Bhatia, Harpreet Singh; Szymonifka, Jackie; Zhou, Qing; Lavender, Zachary; Waxman, Aaron B; Semigran, Marc J; Malhotra, Rajeev

    2017-12-06

    We aimed to develop a severity classification system of the main pulmonary artery diameter (mPA) and its ratio to the ascending aorta diameter (ratio PA) for the diagnosis and prognosis of pulmonary hypertension (PH) on computed tomography (CT) scans. In 228 patients (136 with PH) undergoing right heart catheterization (RHC) and CT for dyspnea, we measured mPA and ratio PA. In a derivation cohort (n = 114), we determined cutpoints for a four-tier severity grading system that would maximize sensitivity and specificity, and validated it in a separate cohort (n = 114). Cutpoints for mPA were defined with ≤27 mm(F) and ≤29 mm(M) as the normal reference range; mild as >27 to 29 to 34 mm. Cutpoints for ratio PA were defined as normal ≤0.9; mild>0.9 to 1.0; moderate>1.0 to 1.1; and severe>1.1. Sensitivities for normal tier were 99% for mPA and 93% for ratio PA; while specificities for severe tier were 98% for mPA>34 mm and 100% for ratio PA>1.1. C-statistics for four-tier mPA and ratio PA were both 0.90 (derivation) and both 0.85 (validation). Severity of mPA and ratio PA corresponded to hemodynamics by RHC and echocardiography (both p 1.1 had worse survival than normal values (all p ≤ 0.01). A CT-based four-tier severity classification system of PA diameter and its ratio to the aortic diameter has high accuracy for PH diagnosis with increased mortality in patients with moderate-severe severity grades. These results may support clinical utilization on chest and cardiac CT reports. Copyright © 2013 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.

  7. Coronary Artery Bypass

    Directory of Open Access Journals (Sweden)

    Kadri Ceberut

    2011-01-01

    Full Text Available Ancient schwannoma is a rare variant of neural tumors though rarely seen in the thorax. The combination with coronary artery diseases is also rare. Here we describe a 66 year-old male who had undergone one-stage combined surgery for thoracic ancient schwannomas removal and coronary artery disease. The masses were, respectively, 13 cm in the middle mediastinum and 5 cm in diameter originating from the intercostal nerve. The tumors were successfully removed using sternotomy, and then a coronary artery bypass grafting was performed. Here we discuss this rare tumor in relation to the relevant literature.

  8. Arterial Elasticity, Strength, Fatigue, and Endurance in Older Women

    Directory of Open Access Journals (Sweden)

    Gary R. Hunter

    2014-01-01

    Full Text Available Arterial health may influence muscle function in older adults. Study purpose was to determine whether arterial elasticity is related to strength, central and peripheral fatigue, fatigue at rest, and treadmill endurance. Subjects were 91 healthy women aged >60. Treadmill endurance and maximal oxygen uptake (VO2 max were measured. Peripheral and central fatigue for the knee extensors were evaluated using two isometric fatigue tests (one voluntary and one adding electrical stimulation. Arterial elasticity was determined using radial artery pulse wave analysis. Linear multiple regression was used in statistical analysis. Large artery elasticity was associated with central fatigue (P<0.01 and treadmill endurance (P<0.02 after adjusting for VO2 max and knee extension strength. Subjective fatigue at rest was related to large artery elasticity after adjusting for ethnic origin (<0.02. Strength was significantly related to small artery elasticity after adjusting for ethnic origin, leg lean tissue, age, and blood pressure. Arterial elasticity is independently related to strength and fatigue in older women, especially in the central nervous system where arterial elasticity is independently related to perceptions of fatigue at rest and central fatigue. These results suggest that arterial health may be involved with the ability of the central nervous system to activate muscle in older women.

  9. Hepatic Arterial Infusion in Combination with Modern Systemic Chemotherapy is Associated with Improved Survival Compared with Modern Systemic Chemotherapy Alone in Patients with Isolated Unresectable Colorectal Liver Metastases: A Case-Control Study.

    Science.gov (United States)

    Dhir, Mashaal; Jones, Heather L; Shuai, Yongli; Clifford, Amber K; Perkins, Samantha; Steve, Jennifer; Hogg, Melissa E; Choudry, M Haroon A; Pingpank, James F; Holtzman, Matthew P; Zeh, Herbert J; Bahary, Nathan; Bartlett, David L; Zureikat, Amer H

    2017-01-01

    In the era of effective modern systemic chemotherapy (CT), the role of hepatic arterial infusion of fluoxuridine (HAI-FUDR) in the treatment of isolated unresectable colorectal liver metastasis (IU-CRCLM) remains controversial. This study aimed to compare the overall survival (OS) of HAI-FUDR in combination with modern systemic CT versus modern systemic CT alone in patients with IU-CRCLM. This was a case-control study of IU-CRCLM patients who underwent HAI + modern systemic CT or modern systemic CT alone. Modern systemic CT was defined as the use of multidrug regimens containing oxaliplatin and/or irinotecan ± biologics. Overall, 86 patients met the inclusion criteria (n = 40 for the HAI + CT group, and n = 46 for the CT-alone group). Both groups were similar in demographics, primary and stage IV tumor characteristics, and treatment-related variables (carcinoembryonic antigen, use of biologic agents, total number of lines of systemic CT administered) (all p > 0.05). Additionally, both groups were comparable with respect to liver tumor burden [median number of lesions (13.5 vs. 15), percentage of liver tumor replacement (37.5 vs. 40 %), and size of largest lesion] (all p > 0.05). Median OS in the HAI + CT group was 32.8 months compared with 15.3 months in the CT-alone group (p modern systemic CT alone.

  10. Combined moderate and high intensity exercise with dietary restriction improves cardiac autonomic function associated with a reduction in central and systemic arterial stiffness in obese adults: a clinical trial

    Directory of Open Access Journals (Sweden)

    Min Hu

    2017-10-01

    Full Text Available Objective The present study aimed to assess the effects of exercise with dietary restriction on cardiac autonomic activity, arterial stiffness, and cardiovascular biomarkers in obese individuals. Methods Seventeen obese adults completed an 8-week exercise and dietary program. Anthropometry, body composition, and multiple biochemical markers were measured. We used carotid-femoral pulse wave velocity (cfPWV, brachial-ankle pulse wave velocity (baPWV, central blood pressure, and augmentation index (AIx to assess arterial stiffness. To determine cardiac autonomic activity, heart rate variability (HRV was analyzed by standard deviation of normal-to-normal intervals (SDNN, square root of the mean squared differences of successive normal-to-normal intervals (RMSSD, total power (TF, low-frequency power in normalized units (LFnu, high-frequency power in normalized units (HFnu, and low-frequency power/high-frequency power (LF/HF. Results Following the exercise and diet intervention, obese subjects had significant reductions in body weight, body mass index, body fat percentage, brachial systolic blood pressure, and resting heart rate, and they had shown improvements in blood chemistry markers such as lipid profiles, insulin, and high-sensitivity C-reactive protein. There was a significant reduction in both cfPWV and baPWV following the intervention when compared to baseline levels. Moreover, the AIx and aortic systolic blood pressure were significantly reduced after the intervention. The diet and exercise intervention significantly increased cardiac autonomic modulation (determined by improved SDNN, RMSSD, TP LF, HF, and LF/HF, which was partly due to changes in heart rate, insulin resistance, and the inflammatory pattern. Furthermore, we observed a correlation between enhanced cardiac autonomic modulation (LF/HF and decreased arterial stiffness, as measured by central cfPWV and systemic baPWV. Discussion An 8-week combined intervention of diet and

  11. Anatomy of renal arterial supply.

    Science.gov (United States)

    Khamanarong, K; Prachaney, P; Utraravichien, A; Tong-Un, T; Sripaoraya, K

    2004-05-01

    A thorough knowledge of the variations of the renal artery has grown in importance with the increasing numbers of renal transplants, vascular reconstructions, and various surgical and radiologic techniques. The literature indicates that multiple renal arteries are found in 9- 76% of cadavers. The purpose of this study is to establish the incidence and characteristics of variations of renal arteries in Thais. A total of 267 Thai cadavers were dissected in the anatomy laboratory. The anatomical findings included: a single hilar artery in 82% of cases; double renal arteries in 17% of cases (one hilar artery with an upper polar artery occurred in 7%; two hilar arteries in 7%, and one hilar artery combined with one lower polar artery in 3%); and triple renal arteries occurred in 1% (two hilar arteries with one upper polar artery in 0.4% and two hilar arteries with one lower polar artery in 0.6%). In preparation for interventions, such as living renal donation, vascular reconstruction, renovascular hypertension, or radical nephrectomy, the results indicate that preoperative renal imaging is necessary and that operative techniques with attention to multiple renal arteries should be considered. Copyright 2004 Wiley-Liss, Inc.

  12. Coronary Artery Bypass Surgery

    Science.gov (United States)

    ... don't help, you may need coronary artery bypass surgery. The surgery creates a new path for ... narrowed area or blockage. This allows blood to bypass (get around) the blockage. Sometimes people need more ...

  13. Pulmonary Arterial Hypertension

    Science.gov (United States)

    Pulmonary Arterial Hypertension What Is Pulmonary Hypertension? To understand pulmonary hypertension (PH) it helps to understand how blood ows throughout your body. While the heart is one organ, it ...

  14. Coronary artery spasm

    Science.gov (United States)

    ... blocker or a long-acting nitrate long-term. Beta-blockers are another type of medicine that is used with other coronary artery problems. However, beta-blockers may make this problem worse. They should be ...

  15. Peripheral Arterial Disease

    Science.gov (United States)

    Peripheral arterial disease (PAD) happens when there is a narrowing of the blood vessels outside of your heart. The cause of ... smoking. Other risk factors include older age and diseases like diabetes, high blood cholesterol, high blood pressure, ...

  16. Arterial bypass leg - slideshow

    Science.gov (United States)

    ... presentations/100155.htm Arterial bypass leg - series—Normal anatomy To use the sharing features on this page, ... Bethesda, MD 20894 U.S. Department of Health and Human Services National Institutes of Health Page last updated: ...

  17. Mesenteric artery ischemia

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/001156.htm Mesenteric artery ischemia To use the sharing features on this page, ... be removed. Outlook (Prognosis) The outlook for chronic mesenteric ischemia is good after a successful surgery. However, it ...

  18. Carotid Artery Disease

    Science.gov (United States)

    ... heart. It also helps you lose weight, control diabetes and reduce stress. Limit alcohol. Control chronic conditions. Managing conditions such as diabetes and high blood pressure helps protect your arteries. ...

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

    Science.gov (United States)

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

    2017-01-15

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

  20. Novel system using microliter order sample volume for measuring arterial radioactivity concentrations in whole blood and plasma for mouse PET dynamic study.

    Science.gov (United States)

    Kimura, Yuichi; Seki, Chie; Hashizume, Nobuya; Yamada, Takashi; Wakizaka, Hidekatsu; Nishimoto, Takahiro; Hatano, Kentaro; Kitamura, Keishi; Toyama, Hiroshi; Kanno, Iwao

    2013-11-21

    This study aimed to develop a new system, named CD-Well, for mouse PET dynamic study. CD-Well allows the determination of time-activity curves (TACs) for arterial whole blood and plasma using 2-3 µL of blood per sample; the minute sample size is ideal for studies in small animals. The system has the following merits: (1) measures volume and radioactivity of whole blood and plasma separately; (2) allows measurements at 10 s intervals to capture initial rapid changes in the TAC; and (3) is compact and easy to handle, minimizes blood loss from sampling, and delay and dispersion of the TAC. CD-Well has 36 U-shaped channels. A drop of blood is sampled into the opening of the channel and stored there. After serial sampling is completed, CD-Well is centrifuged and scanned using a flatbed scanner to define the regions of plasma and blood cells. The length measured is converted to volume because the channels have a precise and uniform cross section. Then, CD-Well is exposed to an imaging plate to measure radioactivity. Finally, radioactivity concentrations are computed. We evaluated the performance of CD-Well in in vitro measurement and in vivo (18)F-fluorodeoxyglucose and [(11)C]2-carbomethoxy-3β-(4-fluorophenyl) tropane studies. In in vitro evaluation, per cent differences (mean±SE) from manual measurement were 4.4±3.6% for whole blood and 4.0±3.5% for plasma across the typical range of radioactivity measured in mouse dynamic study. In in vivo studies, reasonable TACs were obtained. The peaks were captured well, and the time courses coincided well with the TAC derived from PET imaging of the heart chamber. The total blood loss was less than 200 µL, which had no physiological effect on the mice. CD-Well demonstrates satisfactory performance, and is useful for mouse PET dynamic study.

  1. Robotically assisted totally endoscopic coronary artery bypass surgery

    OpenAIRE

    Canale, Leonardo Secchin; Mick, Stephanie; Mihaljevic, Tomislav; Nair, Ravi; Bonatti, Johannes

    2013-01-01

    Robotically assisted totally endoscopic coronary artery bypass surgery has emerged as a feasible and efficient alternative to conventional full sternotomy coronary artery bypass graft surgery in selected patients. This minimally invasive approach using the daVinci robotic system allows fine intrathoracic maneuvers and excellent view of the coronary arteries. Both on-pump and off-pump operations can be performed to treat single and multivessel disease. Hybrid approaches have the potential of o...

  2. Coronary artery fistulas

    Directory of Open Access Journals (Sweden)

    V. M. Subbotin

    2015-01-01

    Full Text Available Coronary artery fistulas are classified as abnormalities of termination and referred to as major congenital anomalies. Most coronary artery fistulas are small, unaccompanied by clinical symptoms, and diagnosed by echocardiography or coronarography performed for an unrelated cause. Such fistulas usually do not cause any complications and can spontaneously resolve. However, larger fistulas are usually >3 tones the size of a normal caliber of a coronary artery and may give rise to clinical symptoms in these cases. The clinical symptoms of coronary artery fistulas may mimic those of various heart diseases depending on which chamber a fistula drains into. Most fistulas are congenital. Congenital coronary artery fistulas may occur as an isolated malformation or be concurrent with other cardiac anomalies, more frequently with critical pulmonary stenosis or atresia with an intact interventricular septum and pulmonary stenoses, Fallot's tetralogy, aortic coarctation, and left heart hypoplasia. When choosing a treatment modality, one should take into account the number of fistula communications, the feeding vessel, localization of drainage, degree of myocardial damage, and hemodynamic relevance of the shunt caused by the presence of a fistula. The goal of treatment is to obliterate a fistula by preserving normal coronary blood flow. The risk for persisting fistula should be balanced with the potential risk of complications related to a procedure of coronarography and fistula occlusion. Percutaneous transcatheter coil occlusion of coronary artery fistulas is the modality of choice in children with the suitable anatomy of fistula communications and without concomitant congenital heart diseases.

  3. Low level termination of external carotid artery and its clinical significance: A case report

    Directory of Open Access Journals (Sweden)

    Surekha Devadasa Shetty

    2015-09-01

    Full Text Available The external carotid arterial system is a complex vascular system providing nourishment to the territorial areas of the head and neck. The branches of the external carotid artery are the key landmarks for adequate exposure and appropriate placement of cross-clamps on the carotid arteries during carotid endarterectomy. Knowledge of anatomical variation of the external carotid artery is important in head and neck surgeries. Variations in the branching pattern of the external carotid artery are well known and documented. We report a rare case of low-level termination of the external carotid artery. It terminated by dividing into maxillary and superficial temporal arteries deep into the posterior belly of the digastric muscle, one inch below the angle of the mandible. The occipital and posterior auricular arteries arose from a common trunk given off by the external carotid artery. [Arch Clin Exp Surg 2015; 4(3.000: 160-163

  4. [Arterial obliterative disease and physical activity].

    Science.gov (United States)

    Landi, Anna; Jassó, István

    2007-06-10

    Regular physical exercise represents an essential element in treating patients with second-stage peripheral arterial occlusive disease. Peripheral arterial occlusive disease is a characteristic clinical manifestation of atherothrombotic processes. Its prevalence is 2-3%, consequently, it is estimated to be 200,000-300,000 patients in Hungary. Coronary artery disease and atherothrombosis of the carotid artery system may frequently coexist with peripheral arterial obliterative disease. Treatment of peripheral arterial obliterative disease influences their prevalence and prognosis as well. The main aim of regular physical exercise is to improve the quality of life of patients by increasing the functional capacity of the lower limbs. During exercise beneficial vascular changes occur like haemodynamic changes consisting of increasing pressure-gradient of stenotic artery and opening of collateral vessels, as well as improvement of the endothelial dysfunction. It favourably influences lipid profile by decreasing LDL cholesterol and increasing HDL cholesterol. Physical exercise beneficially affects blood rheology as well. It also brings about structural changes in the skeletal muscles, increases the enzyme levels in the oxidative metabolic processes and enhances the density of capillaries in the skeletal muscle fibres. According to the data published so far, patients with peripheral arterial obliterative disease are recommended to take part in supervised treadmill walking at least 3 days per week for 30-60 minutes each session containing 5-5 minute warm-up and cool-down periods. The training should be of intermittent intensity at the pain-free threshold. The physiological benefits are optimised at 3-6 months. The home-based training programme is also remarkably useful.

  5. Automatic labeling of cerebral arteries in magnetic resonance angiography.

    Science.gov (United States)

    Dunås, Tora; Wåhlin, Anders; Ambarki, Khalid; Zarrinkoob, Laleh; Birgander, Richard; Malm, Jan; Eklund, Anders

    2016-02-01

    In order to introduce 4D flow magnetic resonance imaging (MRI) as a standard clinical instrument for studying the cerebrovascular system, new and faster postprocessing tools are necessary. The objective of this study was to construct and evaluate a method for automatic identification of individual cerebral arteries in a 4D flow MRI angiogram. Forty-six elderly individuals were investigated with 4D flow MRI. Fourteen main cerebral arteries were manually labeled and used to create a probabilistic atlas. An automatic atlas-based artery identification method (AAIM) was developed based on vascular-branch extraction and the atlas was used for identification. The method was evaluated by comparing automatic with manual identification in 4D flow MRI angiograms from 67 additional elderly individuals. Overall accuracy was 93%, and internal carotid artery and middle cerebral artery labeling was 100% accurate. Smaller and more distal arteries had lower accuracy; for posterior communicating arteries and vertebral arteries, accuracy was 70 and 89%, respectively. The AAIM enabled fast and fully automatic labeling of the main cerebral arteries. AAIM functionality provides the basis for creating an automatic and powerful method to analyze arterial cerebral blood flow in clinical routine.

  6. History and Current Status of Robotic Totally Endoscopic Coronary Artery Bypass

    National Research Council Canada - National Science Library

    Lee, Jeffrey D; Srivastava, Mukta; Bonatti, Johannes

    2012-01-01

    Robotic totally endoscopic coronary artery bypass (TECAB) is a minimally invasive endoscopic surgical approach using the daVinci robotic telemanipulation system to perform coronary artery bypass grafting on the arrested or beating heart...

  7. Multicentre randomised placebo-controlled trial of oral anticoagulation with apixaban in systemic sclerosis-related pulmonary arterial hypertension: the SPHInX study protocol.

    Science.gov (United States)

    Calderone, Alicia; Stevens, Wendy; Prior, David; Nandurkar, Harshal; Gabbay, Eli; Proudman, Susanna M; Williams, Trevor; Celermajer, David; Sahhar, Joanne; Wong, Peter K K; Thakkar, Vivek; Dwyer, Nathan; Wrobel, Jeremy; Chin, Weng; Liew, Danny; Staples, Margaret; Buchbinder, Rachelle; Nikpour, Mandana

    2016-12-08

    Systemic sclerosis (SSc) is a severe and costly multiorgan autoimmune connective tissue disease characterised by vasculopathy and fibrosis. One of the major causes of SSc-related death is pulmonary arterial hypertension (PAH), which develops in 12-15% of patients with SSc and accounts for 30-40% of deaths. In situ thrombosis in the small calibre peripheral pulmonary vessels resulting from endothelial dysfunction and an imbalance of anticoagulant and prothrombotic mediators has been implicated in the complex pathophysiology of SSc-related PAH (SSc-PAH), with international clinical guidelines recommending the use of anticoagulants for some types of PAH, such as idiopathic PAH. However, anticoagulation has not become part of standard clinical care for patients with SSc-PAH as only observational evidence exists to support its use. Therefore, we present the rationale and methodology of a phase III randomised controlled trial (RCT) to evaluate the efficacy, safety and cost-effectiveness of anticoagulation in SSc-PAH. This Australian multicentre RCT will compare 2.5 mg apixaban with placebo, in parallel treatment groups randomised in a 1:1 ratio, both administered twice daily for 3 years as adjunct therapy to stable oral PAH therapy. The composite primary outcome measure will be the time to death or clinical worsening of PAH. Secondary outcomes will include functional capacity, health-related quality of life measures and adverse events. A cost-effectiveness analysis of anticoagulation versus placebo will also be undertaken. Ethical approval for this RCT has been granted by the Human Research Ethics Committees of all participating centres. An independent data safety monitoring board will review safety and tolerability data for the duration of the trial. The findings of this RCT are to be published in open access journals. ACTRN12614000418673, Pre-results. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence

  8. A Vertebral Artery Dissection with Basilar Artery Occlusion in a Child

    Directory of Open Access Journals (Sweden)

    Katleen Devue

    2014-01-01

    Full Text Available This paper presents the case report of an 11-year-old boy with an acute dissection with thrombosis of the left vertebral artery and thrombosis of the basilar artery. The patient was treated with acute systemic thrombolysis, followed by intra-arterial thrombolysis, without any clinical improvement, showing left hemiplegia, bilateral clonus, hyperreflexia, and impaired consciousness. MRI indicated persistent thrombosis of the arteria basilaris with edema and ischemia of the right brainstem. Heparinization for 72 hours, followed by a two-week LMWH treatment and subsequent oral warfarin therapy, resulted in a lasting improvement of the symptoms. Vertebral artery dissection after minor trauma is rare in children. While acute basilar artery occlusion as a complication is even more infrequent, it is potentially fatal, which means that prompt diagnosis and treatment are imperative. The lack of class I recommendation guidelines for children regarding treatment of vertebral artery dissection and basilar artery occlusion means that initial and follow-up management both require a multidisciplinary approach to coordinate emergency, critical care, interventional radiology, and child neurology services.

  9. Allicin improves carotid artery intima-media thickness in coronary artery disease patients with hyperhomocysteinemia.

    Science.gov (United States)

    Liu, De-Shan; Wang, Shu-Li; Li, Jun-Mei; Liang, Er-Shun; Yan, Ming-Zhong; Gao, Wei

    2017-08-01

    Homocysteine (Hcy) is an important and independent risk factor for atherosclerotic diseases, such as coronary artery disease and ischemic cerebrovascular disease. Increased carotid artery intima-media thickness (IMT) is a non-invasive marker of systemic atherosclerosis. Allicin treatment may decrease serum Hcy levels and improve impaired endothelial function in rats with hyperhomocysteinemia (HHcy). The present study hypothesized that allicin has an anti-atherosclerotic effect in coronary heart disease and tested the effects of allicin treatment on carotid artery IMT and plasma Hcy levels in coronary heart disease patients with HHcy. Sixty-two coronary heart disease patients with HHcy were randomly divided into an allicin group and a control group. All patients underwent diagnostic assessment, plasma Hcy assay, blood lipid measurement and B-mode ultrasound of the carotid artery prior to and after treatment. Plasma Hcy levels were determined by high-performance liquid chromatography and fluorescence detection. Carotid artery IMT was calculated using an automated algorithm based on a validated edge-detection technique. After 12 weeks, significant decreases in carotid artery IMT, plasma Hcy levels, total cholesterol and triglycerides were observed in the allicin group (all Pallicin group were significantly greater than those in the control group (all PAllicin was able to decrease Hcy levels, total cholesterol and triglycerides as well as carotid artery IMT.

  10. Multilocular True Ulnar Artery Aneurysm in a Pediatric Patient.

    Science.gov (United States)

    Stalder, Mark W; Sanders, Christopher; Lago, Mary; Hilaire, Hugo St

    2016-01-01

    Ulnar artery aneurysms are an exceedingly rare entity in the pediatric population and have no consistent etiologic mechanism. We present the case of a 15-year-old male with a multilocular ulnar artery aneurysm in the setting of no antecedent history of trauma, no identifiable connective tissue disorders, and no other apparent etiological factors. Furthermore, the patient's arterial palmar arch system was absent. The aneurysm was resected, and arterial reconstruction was successfully performed via open surgical approach with cephalic vein interposition graft. We believe this treatment modality should be considered as the primary approach in all of these pediatric cases in consideration of the possible pitfalls of less comprehensive measures.

  11. Electronic database of arterial aneurysms

    Directory of Open Access Journals (Sweden)

    Fabiano Luiz Erzinger

    2014-12-01

    Full Text Available Background:The creation of an electronic database facilitates the storage of information, as well as streamlines the exchange of data, making easier the exchange of knowledge for future research.Objective:To construct an electronic database containing comprehensive and up-to-date clinical and surgical data on the most common arterial aneurysms, to help advance scientific research.Methods:The most important specialist textbooks and articles found in journals and on internet databases were reviewed in order to define the basic structure of the protocol. Data were computerized using the SINPE© system for integrated electronic protocols and tested in a pilot study.Results:The data entered onto the system was first used to create a Master protocol, organized into a structure of top-level directories covering a large proportion of the content on vascular diseases as follows: patient history; physical examination; supplementary tests and examinations; diagnosis; treatment; and clinical course. By selecting items from the Master protocol, Specific protocols were then created for the 22 arterial sites most often involved by aneurysms. The program provides a method for collection of data on patients including clinical characteristics (patient history and physical examination, supplementary tests and examinations, treatments received and follow-up care after treatment. Any information of interest on these patients that is contained in the protocol can then be used to query the database and select data for studies.Conclusions:It proved possible to construct a database of clinical and surgical data on the arterial aneurysms of greatest interest and, by adapting the data to specific software, the database was integrated into the SINPE© system, thereby providing a standardized method for collection of data on these patients and tools for retrieving this information in an organized manner for use in scientific studies.

  12. Management of a patient with lupus anticoagulant and antiphospholipid syndrome for off-pump coronary artery bypass grafting using the Hepcon system.

    Science.gov (United States)

    Jervis, Karinne; Senthilnathan, Venkatachalam; Lerner, Adam B

    2009-04-01

    Patients with serum lupus anticoagulant antibodies (LAC) with or without antiphospholipid syndrome who present for cardiac surgery provide a unique set of challenges. Chief among these are the interference with anticoagulation monitoring by LAC. We present a case of such a patient who presented to us for coronary artery bypass grafting. We follow with a review of LAC and antiphospholipid syndrome and present a strategy for ensuring adequate anticoagulation during cardiac surgery in the background of previously published reports.

  13. Juice Powder Concentrate and Systemic Blood Pressure, Progression of Coronary Artery Calcium and Antioxidant Status in Hypertensive Subjects: A Pilot Study

    Directory of Open Access Journals (Sweden)

    M. C. Houston

    2007-01-01

    Full Text Available Because micronutrients from plants may have beneficial cardiovascular effects, the hypothesis that an encapsulated juice powder concentrate might affect several measures of vascular health was tested in free living adults at low cardiovascular risk. Blood pressure, vascular compliance, lipid and antioxidant markers, and serial electron beam tomography (to calculate a coronary artery calcium score as a measure of atherosclerosis burden, were monitored in 51 pre-hypertensive and hypertensive subjects over 2 years. By the end of follow-up, systolic and diastolic blood pressure decreased significantly (−2.4 ± 1.0 mmHg, P < 0.05 and −2.2 ± 0.6 mmHg, P < 0.001, and large artery compliance improved significantly (1.9 ± 0.6 ml mmHg−1 × 100, P < 0.01. The progression of coronary artery calcium score was smaller than expected compared with a historical database (P < 0.001. Laboratory testing showed a significant decrease in homocysteine (P = 0.05, HDL cholesterol (P = 0.025 and Apo A (P = 0.004, as well as a significant increase in β-carotene, folate, Co-Q10 and α-tocopherol (all P < 0.001. The phytonutrient concentrate we utilized induced several favorable modifications of markers of vascular health in the subjects. This study supports the notion that plant nutrients are important components of a heart healthy diet.

  14. Analysis of damping characteristics of arterial catheter blood ...

    African Journals Online (AJOL)

    Background. For many reasons, the invasive measurement of systolic and diastolic blood pressure should be accurate. Accuracy is determined, in part, by the damping characteristics of the arterial catheter blood pressure monitoring system. Objectives. To ascertain the damping characteristics of arterial catheter blood ...

  15. Anatomical surgical arterial segments of the kidneys of Santa Inês ovines

    Directory of Open Access Journals (Sweden)

    Antônio Chaves de Assis Neto

    2007-03-01

    Full Text Available The main goal of the study was describe the distribution of the renal arteries of the renal parenchyma and the proportional area of the arterial vascular system. The renal arterial vascularization in Santa Ines ovines was analyzed in fifteen pairs of organs of male adult animal, after attainment of vascular models through the techniques of corrosion and arteriography. The renal artery always appeared single, and before reaching the renal hilus, it bifurcated into sectorial dorsal and ventral arteries, giving rise to the segmentary arteries which varied from 6 to 10 in number in the right kidney and 7 to 11 in the left kidney. These vessels vascularized independent areas in each renal sector, the renal arterial segments, separated by non-vascularized planes. Bilateral symmetry of the arterial segmentation was found in 13.33% of cases. In accordance with the arterial characterization, the realization of setoriectomy and segmentectomy on the kidneys of Santa Ines ovines is therefore deemed possible.

  16. Endovascular uterine artery interventions

    Directory of Open Access Journals (Sweden)

    Chandan J Das

    2017-01-01

    Full Text Available Percutaneous vascular embolization plays an important role in the management of various gynecologic and obstetric abnormalities. Transcatheter embolization is a minimally invasive alternative procedure to surgery with reduced morbidity and mortality, and preserves the patient's future fertility potential. The clinical indications for transcatheter embolization are much broader and include many benign gynecologic conditions, such as fibroid, adenomyosis, and arteriovenous malformations (AVMs, as well as intractable bleeding due to inoperable advanced-stage malignancies. The most well-known and well-studied indication is uterine fibroid embolization. Uterine artery embolization (UAE may be performed to prevent or treat bleeding associated with various obstetric conditions, including postpartum hemorrhage (PPH, placental implantation abnormality, and ectopic pregnancy. Embolization of the uterine artery or the internal iliac artery also may be performed to control pelvic bleeding due to coagulopathy or iatrogenic injury. This article discusses these gynecologic and obstetric indications for transcatheter embolization and reviews procedural techniques and outcomes.

  17. Endovascular uterine artery interventions

    Science.gov (United States)

    Das, Chandan J; Rathinam, Deepak; Manchanda, Smita; Srivastava, D N

    2017-01-01

    Percutaneous vascular embolization plays an important role in the management of various gynecologic and obstetric abnormalities. Transcatheter embolization is a minimally invasive alternative procedure to surgery with reduced morbidity and mortality, and preserves the patient's future fertility potential. The clinical indications for transcatheter embolization are much broader and include many benign gynecologic conditions, such as fibroid, adenomyosis, and arteriovenous malformations (AVMs), as well as intractable bleeding due to inoperable advanced-stage malignancies. The most well-known and well-studied indication is uterine fibroid embolization. Uterine artery embolization (UAE) may be performed to prevent or treat bleeding associated with various obstetric conditions, including postpartum hemorrhage (PPH), placental implantation abnormality, and ectopic pregnancy. Embolization of the uterine artery or the internal iliac artery also may be performed to control pelvic bleeding due to coagulopathy or iatrogenic injury. This article discusses these gynecologic and obstetric indications for transcatheter embolization and reviews procedural techniques and outcomes. PMID:29379246

  18. Ruptured jejunal artery aneurysm

    Science.gov (United States)

    Costa, Sílvia; Costa, Alexandre; Pereira, Tiago; Maciel, Jorge

    2013-01-01

    Visceral artery aneurysms (VAAs), unlike aortic aneurysms, are very rare, but are also a potentially lethal vascular disease. Jejunal artery aneurysms only account for less than 3% of VAAs, but have a 30% risk of rupture, with 20% death rate, presenting with only few and vague symptoms. We report the case of a 76-year-old man presenting at the emergency department (ED) with a crampy epigastric pain and vomiting. An ultrasound performed diagnosed free abdominal fluid and immediate CT scan diagnosed jejunal artery aneurysm spontaneously rupturing, followed by hypovolaemic shock. Emergent surgery was undertaken, and aneurysmectomy, followed by partial enterectomy with primary anastomosis were performed, because of segmentary jejunal ischaemia. The patient's recovery was unremarkable. High level of suspicion, rapid diagnosis capability and prompt surgical or endovascular intervention, as well as an effective teamwork in the ED are critical to avoid the devastating consequences of ruptured VAAs. PMID:23771962

  19. Superficial Femoral Artery Intervention by Single Transpedal Arterial Access.

    Science.gov (United States)

    Amoroso, Nicholas S; Shah, Sooraj; Liou, Michael; Ratcliffe, Justin; Lala, Moinakhtar; Diwan, Ravi; Huang, Yili; Rosero, Hugo; Coppola, John; Bertrand, Olivier F; Kwan, Tak W

    2015-11-01

    Atherosclerotic disease of the superficial femoral artery (SFA) is frequently seen and can be treated with percutaneous interventions, traditionally via femoral artery access. There are limited reports of transpedal artery access for peripheral artery interventions, but none to date describing routine primary transpedal artery approach for SFA stenting. In this preliminary study, we report 4 patients who underwent successful endovascular SFA stenting using a single transpedal artery access via a new ultra-low profile 6 Fr sheath (Glidesheath Slender; Terumo Corporation). All patients underwent successful SFA stenting without complication. Procedure time varied from 51 to 72 minutes. The mean contrast amount used was 56 mL; mean fluoroscopy time was 21 minutes; mean radiation dose was 91 mGy. At 1-month follow-up, duplex ultrasonography showed that all pedal arteries had remained patent. Transpedal artery approach as a primary approach to SFA stenting appears feasible and safe. Comparative trials with standard percutaneous femoral approach are warranted.

  20. Isolated celiac artery dissection.

    Science.gov (United States)

    DiMusto, Paul D; Oberdoerster, Molly M; Criado, Enrique

    2015-04-01

    Spontaneous celiac artery dissection is rare, and its natural history is not well studied. The objective of this study was to review our experience with the evaluation and management of this condition. During the last 8 years, 19 patients (14 men, five women) presented with the diagnosis of spontaneous celiac artery dissection. Each patient's clinical course was retrospectively reviewed, and patients were contacted for assessment of current symptoms. All patients had computed tomography scans documenting a celiac artery dissection without concomitant aortic dissection. Ages ranged from 39 to 76 years. Seven patients presented with abdominal pain, and 12 were diagnosed incidentally. All patients were initially treated with observation because none had threatened end organs. Patients presenting with aspirin or clopidogrel therapy were continued on these medications, but no patients were prescribed any medications due to their dissection. Three patients continued to have abdominal pain and eventually underwent celiac artery stenting. Pain improved after the intervention in all three. One patient with aneurysmal degeneration of the celiac artery underwent surgical repair. No other patients required intervention. Eighteen patients had follow-up within a year of data collection in the clinic or over the phone. The average time from the initial diagnosis to follow-up for the entire cohort was 46 months. None had abdominal or back pain related to the celiac dissection, had lost weight, or had to change their eating habits. Celiac artery dissection can be safely managed initially with observation. If abdominal pain is persistent, endovascular stenting may stabilize or improve the pain, and surgical reconstruction can be done for aneurysmal degeneration or occlusion, both unusual events. Long-term anticoagulation does not appear necessary in these patients. Copyright © 2015 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

  1. Popliteal Artery Entrapment Syndrome

    DEFF Research Database (Denmark)

    Altintas, Ümit; Helgstrand, Ulf Johan Vilhelm; Hansen, Marc A

    2013-01-01

    The purpose of this study was to report our experience with popliteal artery entrapment syndrome (PAES) with special emphasis on the applicability of duplex ultrasound scanning (DUS) when diagnosing PAES. In addition to examining the correlation between DUS and intraoperative findings in symptoma......The purpose of this study was to report our experience with popliteal artery entrapment syndrome (PAES) with special emphasis on the applicability of duplex ultrasound scanning (DUS) when diagnosing PAES. In addition to examining the correlation between DUS and intraoperative findings...

  2. Carotid artery stenting; Karotisangioplastie

    Energy Technology Data Exchange (ETDEWEB)

    Fiehler, Jens [Universitaetsklinikum Eppendorf, Hamburg (Germany). Klinik und Poliklinik fuer Neuroradiologische Diagnostik und Intervention, Diagnostikzentrum

    2009-09-15

    An ipsilateral stenosis of the internal carotid artery is found in 10 - 15 % of all ischemic strokes and indicates an increased risk of a second stroke. Carotid artery stenting (CAS) is a therapy that is established for many years. CAS reveals complication rates and long-term efficacy comparable to carotid endarterectomy (TEA). Especially younger patients seem to benefit from CAS. Abilities and experiences of the therapist and the choice of the techniques used are critical for patient safety. The efficacy of CAS for treatment of asymptomatic carotid stenosis is probable but still unproven in prospective-randomized trial. (orig.)

  3. 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

    Directory of Open Access Journals (Sweden)

    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.

  4. Energetic and spatial constraints of arterial networks

    Directory of Open Access Journals (Sweden)

    Sandro Rossitti

    1995-06-01

    Full Text Available The principle of minimum work (PMW is a parametric optimization model for the growth and adaptation of arterial trees. A balance between energy dissipation due to frictional resistance of laminar flow (shear stress and the minimum volume of the blood and vessel wall tissue is achieved when the vessel radii are adjusted to the cube root of the volumetric flow. The PMW is known to apply over several magnitudes of vessel calibers, and in many different organs, including the brain, in humans and in animals. Animal studies suggest that blood flow in arteries is approximately proportional to the cube of the vessel radius, and that arteries alter their caliber in response to sustained changes of blood flow according to PMW. Remodelling of the retinal arteriolar network to long-term changes in blood flow was observed in humans. Remodelling of whole arterial networks occurs in the form of increase or diminishing of vessel calibers. Shear stress induced endothelial mediation seems to be the regulating mechanism for the maintenance of this optimum blood flow/vessel diameter relation. Arterial trees are also expected to be nearly space filing. The vascular system is constructed in such a way that, while blood vessels occupy only a small percentage of the body volume leaving the bulk to tissue, they also crisscross organs so tightly that every point in the tissue lies on the boundary between an artery and a vein. This review describes how the energetic optimum principle for least energy cost for blood flow is also compatible with the spatial constraints of arterial networks according to concepts derived from fractal geometry.

  5. Preliminary report: biomechanics of vertebral artery segments C1-C6 during cervical spinal manipulation.

    Science.gov (United States)

    Wuest, Sarah; Symons, Bruce; Leonard, Timothy; Herzog, Walter

    2010-05-01

    The purpose of this study was to measure strains in the human vertebral artery (VA) within the cervical transverse foramina and report the first results on the mechanical loading of segments of the VA during spinal manipulation of the cervical spine. Eight piezoelectric ultrasound crystals of 0.5-mm diameter were sutured into the lumen of the left and right VA of one cadaver. Four hundred-nanosecond ultrasound pulses were sent between the crystals to measure the instantaneous lengths of the VA segments (total segments n = 14) at a frequency of 200 Hz. Vertebral artery engineering strains were then calculated from the instantaneous lengths during cervical spinal range of motion testing, chiropractic cervical spinal manipulation adjustments, and vertebrobasilar insufficiency testing. The results of this study suggest complex and nonintuitive strain patterns of the VA within the cervical transverse foramina. Consistent (for 2 chiropractors) and repeatable (for 3 repeat measurements for each chiropractor) elongation and shortening of adjacent VA segments were observed simultaneously and could not be explained with a simple model of neck movement. We hypothesized that they were caused by variations in the location and stiffness of the VA fascial attachments to the vertebral foramina and by coupled movements of the cervical vertebrae. However, in agreement with previous work on VA strains proximal and distal to the cervical transverse foramina, strains for cervical spinal manipulations were consistently lower than those obtained for cervical rotation. Although general conclusions should not be drawn from these preliminary results, the findings of this study suggest that textbook mechanics of the VA may not hold, that VA strains may not be predictable from neck movements alone, and that fascial connections within the transverse foramina and coupled vertebra movements may play a crucial role in VA mechanics during neck manipulation. Furthermore, the engineering strains

  6. Location of the internal carotid artery and ophthalmic artery ...

    African Journals Online (AJOL)

    Yasin Hamarat

    2017-10-06

    Oct 6, 2017 ... There are some published results of OA anatomical studies [18,20-22]. .... right eye) and the depth of intracranial segment of ophthal- mic artery ... internal carotid artery and segments of ophthalmic artery in high tension glaucoma patients. No. of glaucoma patients. Eye. ICA edge, mm. IOA, mm. EOA, mm.

  7. Pulmonary arterial hypertension in children after neonatal arterial switch operation

    NARCIS (Netherlands)

    Zijlstra, Willemijn MH; Elmasry, Ola; Pepplinkhuizen, Shari; Ivy, D Dunbar; Bonnet, Damien; Lévy, Marilyne; Gavilan, Jose Luis; Torrent-Vernetta, Alba; Mendoza, Alberto; Del Cerro, Maria Jesus; Moledina, Shahin; Berger, Rolf M. F.

    OBJECTIVES: Paediatric pulmonary arterial hypertension (PAH) after neonatal arterial switch operation (ASO) for transposition of the great arteries (TGA) is a clinically recognised entity with an estimated incidence of 0.6%-1.0%. Nevertheless, a clinical characterisation is lacking. We present an

  8. A rare case of Cystic artery arising from Gastroduodenal artery ...

    African Journals Online (AJOL)

    An uncommon anatomical variation in the origin and course of cystic artery was found during human cadaveric dissection in our laboratory. A blood vessel was seen arising from the gastroduodenal artery about 1 cm distal to its origin from the common hepatic artery. The vessel when traced towards its termination was found ...

  9. Validation of brachial artery pressure reconstruction from finger arterial pressure

    NARCIS (Netherlands)

    Guelen, Ilja; Westerhof, Berend E.; van der Sar, Gertrude L.; van Montfrans, Gert A.; Kiemeneij, Ferdinand; Wesseling, Karel H.; Bos, Willem Jan W.

    2008-01-01

    Objective Measurement of finger artery pressure with Finapres offers noninvasive continuous blood pressure, which, however, differs from brachial artery pressure. Generalized waveform filtering and level correction may convert the finger artery pressure waveform to a brachial waveform. An upper-arm

  10. Screening for Carotid Artery Stenosis

    Science.gov (United States)

    Understanding Task Force Recommendations Screening for Carotid Artery Stenosis The U.S. Preventive Services Task Force (Task Force) ... final recommendation statement on Screening for Carotid Artery Stenosis. This final recommendation statement applies to adults who ...

  11. Arterial stiffness, hypertension, and rational use of nebivolol

    Directory of Open Access Journals (Sweden)

    Enrico Agabiti-Rosei

    2009-05-01

    Full Text Available Enrico Agabiti-Rosei, Enzo Porteri, Damiano RizzoniClinica Medica, Department of Medical and Surgical Sciences, University of Brescia, ItalyAbstract: Arterial stiffness plays a key role in the pathophysiology of the cardiovascular system. Some indices of arterial stiffness (pulse wave velocity, augmentation index, characteristics of central blood pressure waveform may be presently calculated and evaluated in the clinical setting. Age and blood pressure are the two major clinical determinants of increased arterial stiffness, while molecular determinants of arterial stiffness are related to fibrotic components of the extracellular matrix, mainly elastin, collagen and fibronectin. Increased arterial stiffness has been consistently observed in conditions such as hypertension, dyslipidemia and diabetes. Arterial stiffness evaluated by means of carotid-femoral pulse wave velocity yielded prognostic significance beyond and above traditional risk factors. A more favorable effect of calcium channel blockers, diuretics and ACE inhibitors compared with β-blockers on indices of arterial stiffness was observed in several studies. It is conceivable that newer β-blockers with additional vasodilating properties, such as nebivolol, which has favorable effects on carbohydrate and lipid metabolism, as well as on endothelial function and on oxidative stress, may have favorable effects on arterial stiffness, compared with atenolol. In fact, in recent studies, nebivolol was demonstrated to improve artery stiffness to a greater extent than older β-blockers. Because endothelial dysfunction and increased arterial stiffness play an important role in the early atherosclerotic processes and are associated with poor outcomes and increased mortality, independently of blood pressure, the ability of nebivolol to enhance release of endothelium-derived nitric oxide, and consequently improve endothelial function and arterial stiffness, may have significant clinical

  12. Exercise promotes collateral artery growth mediated by monocytic nitric oxide.

    Science.gov (United States)

    Schirmer, Stephan H; Millenaar, Dominic N; Werner, Christian; Schuh, Lisa; Degen, Achim; Bettink, Stephanie I; Lipp, Peter; van Rooijen, Nico; Meyer, Tim; Böhm, Michael; Laufs, Ulrich

    2015-08-01

    Collateral artery growth (arteriogenesis) is an important adaptive response to hampered arterial perfusion. It is unknown whether preventive physical exercise before limb ischemia can improve arteriogenesis and modulate mononuclear cell function. This study aimed at investigating the effects of endurance exercise before arterial occlusion on MNC function and collateral artery growth. After 3 weeks of voluntary treadmill exercise, ligation of the right femoral artery was performed in mice. Hindlimb perfusion immediately after surgery did not differ from sedentary mice. However, previous exercise improved perfusion restoration ≤7 days after femoral artery ligation, also when exercise was stopped at ligation. This was accompanied by an accumulation of peri-collateral macrophages and increased expression of endothelial nitric oxide synthase and inducible nitric oxide synthase (iNOS) in hindlimb collateral and in MNC of blood and spleen. Systemic monocyte and macrophage depletion by liposomal clodronate but not splenectomy attenuated exercise-induced perfusion restoration, collateral artery growth, peri-collateral macrophage accumulation, and upregulation of iNOS. iNOS-deficient mice did not show exercise-induced perfusion restoration. Transplantation of bone marrow-derived MNC from iNOS-deficient mice into wild-type animals inhibited exercise-induced collateral artery growth. In contrast to sedentary controls, thrice weekly aerobic exercise training for 6 months in humans increased peripheral blood MNC iNOS expression. Circulating mononuclear cell-derived inducible nitric oxide is an important mediator of exercise-induced collateral artery growth. © 2015 American Heart Association, Inc.

  13. Pulmonary artery sling: Case report

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Gil Hyun; Lee, Sun Wha; Cha, Sung Ho [Kyunghee University College of Medicine, Seoul (Korea, Republic of)

    1993-09-15

    Aberrant left-sided pulmonary artery(pulmonary artery sling) is an uncommon anomaly,which may cause significant respiratory abnormality. We report a case of pulmonary artery sling which is combined with persistent left superior vena cava and dextrocardia. This case were identified by esophagogram and CT and confirmed by MRI and angiography. We consider that MRI is a valuable new method for the diagnosis of aberrant left-sided pulmonary artery.

  14. Cilioretinal artery occlusion following intranasal cocaine insufflations

    Directory of Open Access Journals (Sweden)

    Balaji Kannan

    2011-01-01

    Full Text Available Cocaine is used to produce a euphoric effect by abusers, who may be unaware of the devastating systemic and ocular side effects of this drug. We describe the first known case of cilioretinal artery occlusion after intranasal cocaine abuse.

  15. Cilioretinal artery occlusion following intranasal cocaine insufflations

    Science.gov (United States)

    Kannan, Balaji; Balaji, Vijayalakshmi; Kummararaj, Sherin; Govindarajan, Kummararaj

    2011-01-01

    Cocaine is used to produce a euphoric effect by abusers, who may be unaware of the devastating systemic and ocular side effects of this drug. We describe the first known case of cilioretinal artery occlusion after intranasal cocaine abuse. PMID:21836348

  16. Unusually Looped and Muzzled Branches of Right Coronary Artery

    Directory of Open Access Journals (Sweden)

    Anitha Guru

    2017-01-01

    Full Text Available Coronary artery disease (CAD is the major cause of death in developed countries as it accounts on an average for 1 of every 5 deaths. Morphological variations of coronary arterial system is one of the causative factor for CAD. Anatomical knowledge of all possible variant patterns of coronary arterial system is imperative in the diagnostic and therapeutic approach of CAD. We report here a rare branching pattern of right coronary artery (RCA. The origin of RCA was normal but the course and branching pattern of it were atypical. RCA was not occupying its usual position in atrioventricular (coronary sulcus and its course was incomplete. It gave a ventricular branch to right ventricle, which presented an unusual looping pattern. It terminated as right marginal artery following its muzzled appearance within the musculature of the ventricle.

  17. Fiber Bragg grating based arterial localization device

    Science.gov (United States)

    Ho, Siu Chun Michael; Li, Weijie; Razavi, Mehdi; Song, Gangbing

    2017-06-01

    A critical first step to many surgical procedures is locating and gaining access to a patients vascular system. Vascular access allows the deployment of other surgical instruments and also the monitoring of many physiological parameters. Current methods to locate blood vessels are predominantly based on the landmark technique coupled with ultrasound, fluoroscopy, or Doppler. However, even with experience and technological assistance, locating the required blood vessel is not always an easy task, especially with patients that present atypical anatomy or suffer from conditions such as weak pulsation or obesity that make vascular localization difficult. With recent advances in fiber optic sensors, there is an opportunity to develop a new tool that can make vascular localization safer and easier. In this work, the authors present a new fiber Bragg grating (FBG) based vascular access device that specializes in arterial localization. The device estimates the location towards a local artery based on the bending of a needle inserted near the tissue surrounding the artery. Experimental results obtained from an artificial circulatory loop and a mock artery show the device works best for lower angles of needle insertion and can provide an approximately 40° range of estimation towards the location of a pulsating source (e.g. an artery).

  18. Intracranial artery dissection

    NARCIS (Netherlands)

    Sikkema, T.; Uyttenboogaart, Maarten; Eshghi, O.; De Keyser, J.; Brouns, R.; van Dijk, J.M.C.; Luijckx, G. J.

    The aim of this narrative review is to evaluate the pathogenesis, clinical features, diagnosis, treatment and prognosis of intracranial artery dissection (IAD). IAD is a rare and often unrecognized cause of stroke or subarachnoid haemorrhage (SAH), especially in young adults. Two types of IAD can be

  19. Artery Bypass Grafting

    African Journals Online (AJOL)

    development of CABG without CPB as occurring in three stages. Figure 1: The early stage: Grafts were limited to ... This interest led to the development of techniques such as mini- mally invasive direct coronary artery surgery (MIDCAB), surgery ... Diazepam 0.1 rng/kg P0. Cyclimorph 0.lmg/kg IMI on call to theatre. Theatre ...

  20. Peripheral artery bypass - leg

    Science.gov (United States)

    ... 25638515 www.ncbi.nlm.nih.gov/pubmed/25638515 . White CJ. Endovascular treatment of peripheral artery disease. In: Creager MA, Beckman JA, Loscalzo J, eds. Vascular Medicine: A Companion to Braunwald's Heart Disease . 2nd ed. Philadelphia, PA: Elsevier Saunders; 2013:chap 20. Review Date 1/31/2017 ...

  1. Pulmonary artery aneurysm

    African Journals Online (AJOL)

    Enrique

    2). An echocardiogram confirmed pulmonary valvular stenosis with post-stenotic dilatation and pul- monary artery aneurysm formation. The pulmonary valve pressure gradi- ent was > 28 mmHg. The patient set- tled on low-dose diuretic therapy, and following cardiothoracic surgical con- sultation it was decided that no surgi-.

  2. Avanços recentes do impacto da apneia obstrutiva do sono na hipertensão arterial sistêmica Avances recientes del impacto de la Apnea Obstructiva del Sueño en la Hipertensión Arterial Sistémica Recent advances of the impact of obstructive sleep apnea on systemic hypertension

    Directory of Open Access Journals (Sweden)

    Rodrigo P. Pedrosa

    2011-08-01

    repercusiones sistémicas que pueden incluir la hipoxia intermitente, la reducción abrupta de la presión intratorácica y la ocurrencia de microdespertares con fragmentación del sueño. En las últimas décadas, innúmeras evidencias señalan de forma consistente la AOS como un importante factor envuelto en la ocurrencia de enfermedades cardiovasculares. Particularmente, la relación entre la AOS y la Hipertensión Arterial Sistémica (HAS es la que encuentra un mayor conjunto de evidencias. Actualmente, se encuentran datos que consideran la AOS una importante causa secundaria de HAS. Más que eso, la AOS está independientemente asociada a un peor control presórico, alteración del descenso nocturno de la presión arterial y a la presencia de lesiones de órganos-blanco, tales como la hipertrofia del ventrículo izquierdo y la microalbuminuria. Estudios randomizados sugieren que el tratamiento de la AOS, especialmente con la presión positiva continua de vías aéreas superiores (CPAP, considerado el tratamiento estándar para la AOS, promueve reducción significativa de la presión arterial en las 24 horas, efecto ese más significativo en el subgrupo de pacientes con HAS no controlada y en los pacientes con HAS resistente. A despecho de todas esas evidencias, la AOS aun continúa siendo subdiagnosticada. El objetivo de esta revisión es discutir los recientes avances en los mecanismos fisiopatológicos, en la presentación clínica y en el tratamiento de la AOS, y el beneficio sobre la presión arterial.Obstructive sleep apnea (OSA is a common clinical condition in the general population, especially among patients with cardiovascular diseases. More than just a local phenomenon of upper respiratory tract obstruction, OSA leads to systemic consequences that may include intermittent hypoxia, sudden reduction of the intrathoracic pressure, and the occurrence of micro-awakenings with sleep fragmentation. In the past decades, innumerous evidences have consistently pointed to

  3. Inverting Notions of the Biological Role of the Renin → Angiotensin-II → Aldosterone System and the Function of Arterial Pressure as a Metabolism Regulator

    OpenAIRE

    Vladimir N. Titov

    2014-01-01

    The phylogenetic theory of general pathology postulates that notions of the biological role of arterial pressure (AP) in physiology and pathology have been subjected to inversion. The nephron’s activation of the synthesis of the components renin → angiotensin-II (A-II) and the augmentation of aldosterone secretion are directed not at an increase in AP but at preserving the volume of the piece of the third world ocean, privatized by each species, - the pool of the intercellular milieu in which...

  4. Superselective pseudo-continuous arterial spin labeling angiography

    Energy Technology Data Exchange (ETDEWEB)

    Jensen-Kondering, Ulf [Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein, Kiel (Germany); Lindner, Thomas, E-mail: thomas.lindner@uksh.de [Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein, Kiel (Germany); Osch, Matthias J.P. van [C. J. Gorter Center for High Field MRI, Department of Radiology, Leiden University Medical Center, Leiden (Netherlands); Rohr, Axel; Jansen, Olav [Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein, Kiel (Germany); Helle, Michael [Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein, Kiel (Germany); Now with Philips GmbH Innovative Technologies, Research Laboratories, Hamburg (Germany)

    2015-09-15

    Highlights: • Superselective arterial spin labeling was capable of acquiring angiograms of individually selected arteries. • Image quality was similar compared with a routinely used time-of-flight angiography. • Superselective arterial spin labeling was utilized in patients with arterio-venous malformations and made it possible to visualize individual feeding vessels in a complete non-invasive way - Abstract: Purpose: To evaluate the utility of a novel non-contrast enhanced, vessel-selective magnetic resonance angiography (MRA) approach based on superselective pseudo-continuous arterial spin labeling (ASL) for the morphologic assessment of intracranial arteries when compared to a clinically used time-of-flight (TOF) MRA. Materials and methods: Three sets of selective ASL angiographies (right and left internal carotid artery, basilar artery) as well as one TOF data set were obtained from each of the five volunteers included in this study on a clinical 1.5T system. The depiction of arterial segments as well as their delineation was evaluated and independently analyzed by two radiologists. Additionally, the ASL angiography approach was performed in two patients suffering from arterio-venous malformations (AVM) in order to illustrate potential applications in a clinical setting. Results: In both angiography techniques, intracranial arteries and their segments (distal branches up to A5 segments of the anterior cerebral arteries, M8 segments of the middle cerebral arteries, and P5 segments of the posterior cerebral arteries) were continuously depicted with excellent inter-reader agreement (κ > 0.81). In AVM patients, reconstructed images of the TOF angiography presented similar information about the size and shape of the AVM as did superselective ASL angiography. In addition, the acquired ASL angiograms of selected vessels allowed assessing the blood supply of individually labeled arteries to the AVM which could also be confirmed by digital subtraction angiography

  5. [Intra-arterial fibrinolysis in acute thrombosis of the basilar artery].

    Science.gov (United States)

    Solaz, J; Martínez-Rodrigo, J; Lonjedo, E; Poyatos, C; Vega, M; Palmero, J

    1998-12-01

    Ischemia in the territory of the basilar artery presents with a variable clinical picture of hemiparesia-tetraplegia, progressive deterioration of level of consciousness, irregular respiration and apnea leading to irreversible coma and death in between 75% and 86% of cases. The usual treatment is supportive. We present the case of a 49 year old woman with acute thrombosis of the basilar artery and a progressive course leading to coma. No bulbar lesions were seen on the CT scan done in the Emergency Department. Thrombosis of the basilar artery and permeable bilateral carotid systems were shown on arteriography. There were no contra-indications to fibrinolysis. Following local fibrinolytic treatment with urokinase the patient had full recovery from her neurological disorder and no sequelae. The basilar artery remained permeable six months later. Emergency treatment with cerebral intra-arterial fibrinolysis within the first six hours, in a case of neurological deficit progressing in the basilar artery territory, with persistence of brain-stem functions and no signs of decerebration (provided there are no contra-indications to fibrinolysis and the initial cerebral CT scan shows no bulbar lesions) may save the patient's life, with total or partial recovery of brain-stem function.

  6. Arterial elasticity, strength, fatigue, and endurance in older women.

    Science.gov (United States)

    Hunter, Gary R; Neumeier, William H; Bickel, C Scott; McCarthy, John P; Fisher, Gordon; Chandler-Laney, Paula C; Glasser, Stephen P

    2014-01-01

    Arterial health may influence muscle function in older adults. Study purpose was to determine whether arterial elasticity is related to strength, central and peripheral fatigue, fatigue at rest, and treadmill endurance. Subjects were 91 healthy women aged >60. Treadmill endurance and maximal oxygen uptake (VO2 max) were measured. Peripheral and central fatigue for the knee extensors were evaluated using two isometric fatigue tests (one voluntary and one adding electrical stimulation). Arterial elasticity was determined using radial artery pulse wave analysis. Linear multiple regression was used in statistical analysis. Large artery elasticity was associated with central fatigue (P elasticity after adjusting for ethnic origin (elasticity after adjusting for ethnic origin, leg lean tissue, age, and blood pressure. Arterial elasticity is independently related to strength and fatigue in older women, especially in the central nervous system where arterial elasticity is independently related to perceptions of fatigue at rest and central fatigue. These results suggest that arterial health may be involved with the ability of the central nervous system to activate muscle in older women.

  7. Pediatric nonaortic arterial aneurysms.

    Science.gov (United States)

    Davis, Frank M; Eliason, Jonathan L; Ganesh, Santhi K; Blatt, Neal B; Stanley, James C; Coleman, Dawn M

    2016-02-01

    Pediatric arterial aneurysms are extremely uncommon. Indications for intervention remain poorly defined and treatments vary. The impetus for this study was to better define the contemporary surgical management of pediatric nonaortic arterial aneurysms. A retrospective analysis was conducted of 41 children with 61 aneurysms who underwent surgical treatment from 1983 to 2015 at the University of Michigan. Arteries affected included: renal (n = 26), femoral (n = 7), iliac (n = 7), superior mesenteric (n = 4), brachial (n = 3), carotid (n = 3), popliteal (n = 3), axillary (n = 2), celiac (n = 2), ulnar (n = 2), common hepatic (n = 1), and temporal (n = 1). Intracranial aneurysms and aortic aneurysms treated during the same time period were not included in this study. Primary outcomes analyzed were postoperative complications, mortality, and freedom from reintervention. The study included 27 boys and 14 girls, with a median age of 9.8 years (range, 2 months-18 years) and a weight of 31.0 kg (range, 3.8-71 kg). Multiple aneurysms existed in 14 children. Obvious factors that contributed to aneurysmal formation included: proximal juxta-aneurysmal stenoses (n = 14), trauma (n = 12), Kawasaki disease (n = 4), Ehlers-Danlos type IV syndrome (n = 1), and infection (n = 1). Preoperative diagnoses were established using arteriography (n = 23), magnetic resonance angiography (n = 6), computed tomographic arteriography (n = 5), or ultrasonography (n = 7), and confirmed during surgery. Indications for surgery included risk of expansion and rupture, potential thrombosis or embolization of aneurysmal thrombus, local soft tissue and nerve compression, and secondary hypertension in the case of renal artery aneurysms. Primary surgical techniques included: aneurysm resection with reanastomsis, reimplantation, or angioplastic closure (n = 16), interposition (n = 10) or bypass grafts (n = 2), ligation (n = 9), plication (n = 8), endovascular occlusion (n = 3), and nephrectomy (n = 4) in

  8. Promoting Pulmonary Arterial Growth via Right Ventricle-to-Pulmonary Artery Connection in Children With Pulmonary Atresia, Ventricular Septal Defect, and Hypoplastic Pulmonary Arteries.

    Science.gov (United States)

    Rabinowitz, Edon J; Epstein, Shilpi; Kohn, Nina; Meyer, David B

    2017-09-01

    Complete repair of pulmonary atresia (PA) ventricular septal defect (VSD) with hypoplastic or absent native pulmonary arteries, often with major aortopulmonary collateral arteries (MAPCAs), involves construction of an adequate sized pulmonary arterial tree. We report our results with a previously described staged strategy using initial right ventricle (RV)-to-reconstructed pulmonary arterial tree (RV-PA) connection to promote pulmonary arterial growth and facilitate later ventricular septation. We retrospectively reviewed data for all patients (N = 10) with initial echocardiographic diagnosis of PA-VSD and hypoplastic pulmonary arteries operated in our center from October 2008 to August 2016. Pulmonary arterial vessel size measured on preoperative and postoperative angiography was used to calculate Nakata index. Seven patients had PA-VSD, three had virtual PA-VSD, and seven had MAPCAs. All underwent creation of RV-PA connection at a median age of 7.5 days and weight 3.6 kg. Eight patients had RV-PA conduits, two had a transannular patches, and seven had major pulmonary artery reconstruction simultaneously. There were no deaths or serious morbidity; one conduit required revision prior to complete repair. Complete repair with ventricular septation and RV pressure less than half systemic was achieved in all patients at a median age of 239 days. Nakata index in neonatal period was 54 mm2/m2 (range 15-144 mm2/m2) and at time of septation 184 mm2/m2 (range 56-510 mm2/m2; P = .004). Growth rates of right and left branch pulmonary arteries were similar. The 10 patients underwent 28 catheterizations with 13 interventions in 8 patients prior to full repair. Early palliative RV-PA connection promotes pulmonary arterial growth and facilitates eventual full repair with VSD closure with low RV pressure and operative risk.

  9. Caliber-Persistent Artery

    Directory of Open Access Journals (Sweden)

    Sabrina Araújo Pinho Costa

    2015-01-01

    Full Text Available Caliber-persistent artery (CPLA of the lip is a common vascular anomaly in which a main arterial branch extends to the surface of the mucous tissue with no reduction in its diameter. It usually manifests as pulsatile papule, is easily misdiagnosed, and is observed more frequently among older people, suggesting that its development may involve a degenerative process associated with aging; CPLA is also characterized by the loss of tone of the adjacent supporting connective tissue. Although the diagnosis is clinical, high-resolution Doppler ultrasound is a useful noninvasive tool for evaluating the lesion. This report describes the case of a 58-year-old male patient who complained of a lesion of the lower lip with bleeding and recurrent ulceration. The patient was successfully treated in our hospital after a diagnosis of CPLA and is currently undergoing a clinical outpatient follow-up with no complaints.

  10. Refractory spasm of coronary arteries and grafted conduits after isolated coronary artery bypass surgery.

    Science.gov (United States)

    Lorusso, Roberto; Crudeli, Elena; Lucà, Fabiana; De Cicco, Giuseppe; Vizzardi, Enrico; D'Aloia, Antonio; Gelsomino, Sandro

    2012-02-01

    Refractory vascular spasm (RVS) concomitantly involving the entire coronary artery system and grafted conduits after coronary artery bypass grafting (CABG) surgery is a rare, but dreadful event. No consensus exists in terms of appropriate management. Between 1986 and 2009, 5,762 patients underwent isolated CABG at our institution, and 7 patients experienced RVS involving the coronary arteries and implanted conduits. Mean age was 65.6 years and 3 were female. All patients received from 3 to 5 distal anastomoses, including use of the left internal mammary artery. During the same time period, 18 patients experienced perioperative vasospasm of a single coronary artery or of a grafted conduit. All diffuse RVS events occurred between 3 and 8 hours after surgery. All patients had diffuse ischemic-like electrocardiographic changes, and 5 patients rapidly developed cardiogenic shock in the intensive care unit. Angiography was quickly performed in all patients and showed diffuse RVS involving either the native coronary arteries or the anastomosed arterial and venous conduits. The first 5 patients of this series died in the catheterization lab due to rapidly evolving refractory cardiogenic shock and unresponsive cardiac arrest, despite intraaortic counterpulsation and aggressive pharmacologic interventions (selective vasodilators and systemic inotropes). In the last 2 patients, extracorporeal membrane oxygenation was quickly instituted (1 in the catheterization lab, 1 in the operating room) and RVS could be successfully managed with complete resolution of ongoing vasospasm. In the single vascular spasm, there was only 1 death for refractory cardiac arrest, whereas all the other patients were successfully treated with direct infusion of vasodilators. Diffuse RVS after CABG is a rare but lethal condition. Our experience, although limited, indicates that in such cases an aggressive treatment, that is, prompt extracorporeal membrane oxygenation institution and controlled

  11. Robotically assisted totally endoscopic coronary artery bypass surgery

    Science.gov (United States)

    Canale, Leonardo Secchin; Mick, Stephanie; Mihaljevic, Tomislav; Nair, Ravi

    2013-01-01

    Robotically assisted totally endoscopic coronary artery bypass surgery has emerged as a feasible and efficient alternative to conventional full sternotomy coronary artery bypass graft surgery in selected patients. This minimally invasive approach using the daVinci robotic system allows fine intrathoracic maneuvers and excellent view of the coronary arteries. Both on-pump and off-pump operations can be performed to treat single and multivessel disease. Hybrid approaches have the potential of offering complete revascularization with the “best of both worlds” from surgery (internal mammary artery anastomosis in less invasive fashion) and percutaneous coronary intervention (least invasive approach). In this article we review the indications, techniques, short and long term results, as well as current developments in totally endoscopic robotic coronary artery bypass operations. PMID:24251021

  12. Application of the DETECT algorithm for detection of risk of pulmonary arterial hypertension in systemic sclerosis: data from a Czech tertiary centre.

    Science.gov (United States)

    Soukup, Tomas; Pudil, Radek; Kubinova, Katerina; Hromadkova, Lucie; Dusek, Jaroslav; Tosovsky, Marian; Bradna, Petr; Hrncir, Zbynek; Bures, Jan

    2016-01-01

    The early, simple and reliable detection of pulmonary arterial hypertension (PAH) in SSc (DETECT) study described a new algorithm for early detection of PAH in patients with SSc. The aim of this retrospective, single-centre, cross-sectional study was to apply a modified DETECT calculator in patients with SSc in the East Bohemian region, Czech Republic, to assess the risk of PAH and to compare these results with PAH screening based on the European Society of Cardiology/European Respiratory Society (ESC/ERS) 2009 guidelines. Sixty patients were recruited with a diagnosis of SSc (according to ACR criteria), aged 27-78 years. A modified DETECT algorithm using the modified parameter of (1.4 × right ventricle diameter)(2) in place of right atrium area was applied to all patients. Right heart catheterization (RHC) was performed in all patients with an estimated (by echocardiography) increased systolic pulmonary artery pressure ≥50 mm Hg in accordance with the ESC/ERS guidelines; however, RHC was not performed in patients solely recommended for RHC using the modified DETECT algorithm. Using the modified DETECT calculator, 24/58 (41.4%) patients were recommended for RHC, compared with 14/58 (24.1%) when applying the ESC/ERS 2009 guidelines. PAH was diagnosed in 7/58 (12.1%) patients. During follow-up, PAH was diagnosed in six patients. Of these, four were modified DETECT score-positive for 2 years and all for 1 year before PAH diagnosis. The modified DETECT algorithm detects all patients with PAH diagnosed according to ECS/ERS 2009 guidelines and RHC. Data of the 2-year follow-up indicate a possible positive predictive role for the modified DETECT calculator. © The Author 2015. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  13. Anomalies associated with single umbilical artery at perinatal autopsy.

    Science.gov (United States)

    Nayak, Shalini S; Shukla, Anju; Girisha, Katta M

    2015-01-01

    We evaluated 214 fetuses sent for autopsy with gestational ages ranging from 12 to 39 weeks. Of these, seventeen fetuses (7.9%) had single umbilical artery. Thirteen of these fetuses were aborted after antenatal detection of severe malformations and 4 died in utero. Genito-urinary system (n=6) and central nervous system (n=4) were the most common sites of involvement. Presence of single umbilical artery warrants a detailed evaluation of the fetus for other anomalies.

  14. Functional impairment of precerebral arteries in Huntington disease.

    Science.gov (United States)

    Kobal, Jan; Cankar, Ksenija; Pretnar, Janja; Zaletel, Marjan; Kobal, Lucijan; Teran, Natasa; Melik, Ziva

    2017-01-15

    Cardiovascular pathology of Huntington disease (HD) appears to be complex; while microvascular dysfunction seems to appear early, deaths from cardiomyopathy and stroke might occur in the late phase of HD. Our study evaluated global risk factors for coronary heart disease (CHD), structure and function of precerebral arteries in 41 HD subjects and 41 matched controls. HD subjects were divided into groups by the United Huntington disease rating scale (presymptomatic-PHD, early-EHD, midstage-MHD and late-LHD). CHD risk factors assessment and Doppler examination of precerebral arteries were performed, including measurements of the carotid artery intima-media thickness (IMT), and parameters indicating local carotid artery distensibility (stiffness index β, pulse wave velocity, pressure strain elasticity module and carotid artery compliance). In the HD and controls we identified a comparable number of non-obstructive plaques (50% lumen narrowing) were found. There was significantly increased IMT in MHD. In PHD and EHD the parameters of arterial stiffness were significantly higher and the carotid artery compliance was significantly lower. Our results reveal functional vascular pathology in PHD, EHD, and MHD. Precerebral arteries dysfunction in HD therefore appears to be mostly functional and in agreement with recently described autonomic nervous system changes in HD. Copyright © 2016 Elsevier B.V. All rights reserved.

  15. Coronary Artery Anomalies in Animals

    Directory of Open Access Journals (Sweden)

    Brian A. Scansen

    2017-04-01

    Full Text Available Coronary artery anomalies represent a disease spectrum from incidental to life-threatening. Anomalies of coronary artery origin and course are well-recognized in human medicine, but have received limited attention in veterinary medicine. Coronary artery anomalies are best described in the dog, hamster, and cow though reports also exist in the horse and pig. The most well-known anomaly in veterinary medicine is anomalous coronary artery origin with a prepulmonary course in dogs, which limits treatment of pulmonary valve stenosis. A categorization scheme for coronary artery anomalies in animals is suggested, dividing these anomalies into those of major or minor clinical significance. A review of coronary artery development, anatomy, and reported anomalies in domesticated species is provided and four novel canine examples of anomalous coronary artery origin are described: an English bulldog with single left coronary ostium and a retroaortic right coronary artery; an English bulldog with single right coronary ostium and transseptal left coronary artery; an English bulldog with single right coronary ostium and absent left coronary artery with a prepulmonary paraconal interventricular branch and an interarterial circumflex branch; and a mixed-breed dog with tetralogy of Fallot and anomalous origin of all coronary branches from the brachiocephalic trunk. Coronary arterial fistulae are also described including a coronary cameral fistula in a llama cria and an English bulldog with coronary artery aneurysm and anomalous shunting vessels from the right coronary artery to the pulmonary trunk. These examples are provided with the intent to raise awareness and improve understanding of such defects.

  16. Management of iatrogenic pulmonary artery injury during pulmonary artery banding

    Directory of Open Access Journals (Sweden)

    Neeti Makhija

    2017-01-01

    Full Text Available Pulmonary Artery banding (PAB is limited to selected patients who cannot undergo primary repair due to complex anatomy, associated co-morbidities, as a part of staged univentricular palliation, and for preparing the left ventricle prior to an arterial switch operation. We report a catastrophic iatrogenic complication in which the pulmonary artery was injured during the PAB. We discuss its multi-pronged management.

  17. Management of Iatrogenic Pulmonary Artery Injury during Pulmonary Artery Banding

    Science.gov (United States)

    Makhija, Neeti; Aggarwal, Shivani; Talwar, Sachin; Ladha, Suruchi; Das, Deepanwita; Kiran, Usha

    2017-01-01

    Pulmonary Artery banding (PAB) is limited to selected patients who cannot undergo primary repair due to complex anatomy, associated co-morbidities, as a part of staged univentricular palliation, and for preparing the left ventricle prior to an arterial switch operation. We report a catastrophic iatrogenic complication in which the pulmonary artery was injured during the PAB. We discuss its multi-pronged management. PMID:28701613

  18. Arterial responses during migraine headache

    DEFF Research Database (Denmark)

    Iversen, Helle Klingenberg; Nielsen, T H; Olesen, J

    1990-01-01

    The superficial temporal artery has been thought to be the main focus of pain during migraine attacks, but its diameter has never been measured directly. The use of a new, high-resolution ultrasound machine to measure arterial size in 25 migraine patients with unilateral head pain showed...... that the lumen was wider on the painful than on the non-painful side during a migraine attack. The diameters of both radial arteries and the temporal artery on the non-painful side were smaller during than between attacks. The generalised vasoconstriction was not shared by the temporal artery on the affected...... side, which suggests a local vasodilatory response. The findings suggest that cephalic arteries may play a role in migraine pathogenesis....

  19. A Lumped Parameter Method to Calculate the Effect of Internal Carotid Artery Occlusion on Anterior Cerebral Artery Pressure Waveform

    Directory of Open Access Journals (Sweden)

    Abdi M.

    2016-03-01

    Full Text Available Background and Objective: Numerical modeling of biological structures would be very helpful tool to analyze hundreds of human body phenomena and also diseases diagnosis. One physiologic phenomenon is blood circulatory system and heart hemodynamic performance that can be simulated by utilizing lumped method. In this study, we can predict hemodynamic behavior of one artery of circulatory system (anterior cerebral artery when disease such as internal carotid artery occlusion is occurred. Method: Pressure-flow simulation is one the leading common approaches for modeling of circulatory system behavior and forecasts of hemodynamic in numerous physiological conditions. In this paper, by using lumped model (electrical analogy, CV system is simulated in MATLAB software (SIMULINK environment. Results: The performance of healthy blood circulation and heart is modeled and the obtained results used for further analyses. The stenosis of internal carotid artery at different rates was, then, induced in the circuit and the effects are studied. In stenosis cases, the effects of internal carotid artery occlusion on left anterior cerebral artery pressure waveform are investigated. Conclusion: The findings of this study may have implications not only for understanding the behavior of human biological system at healthy condition but also for diagnosis of diseases in circulatory and cardiovascular system of human body.

  20. Understanding Arteries | Coronary Artery Disease | NIH MedlinePlus the Magazine

    Science.gov (United States)

    ... Artery If plaque continues to build up, the space inside the artery narrows. The artery walls become ... Plaque forms within the artery walls, narrowing the space inside and sometimes blocking blood flow. This process ...

  1. Investigation of Brain Arterial Circle Malformations Using Electrical Modelling and Simulation

    Directory of Open Access Journals (Sweden)

    Klara Capova

    2006-01-01

    Full Text Available The paper deals with the cerebral arterial system investigation by means of electrical modelling and simulations. The main attention is paid to the brain arterial circle malformations (stenoses and aneurysms and their determination and evaluation by computer-aided methods as tools of a non-invasive diagnostics. The compensation possibilities of brain arterial circle in case of presence of concrete arterial malformations are modelled and simulated. The simulation results of brain arteries blood pressures and volume flow velocities time dependences are presented and discussed under various health conditions.

  2. Resistant spontaneous coronary artery spasm.

    Science.gov (United States)

    Keskin, Kudret; Şahin, Alparslan; Yıldız, Süleyman Sezai; Aksan, Gökhan

    2015-10-01

    Coronary artery spasm should always be suspected in patients who have myocardial infarction with normal coronary arteries. This case report presents a 33-year-old woman with anterior myocardial infarction, whose coronary angiograph revealed normal left anterior descending artery and new onset complete occlusion of the circumflex artery at the time of the procedure. Nitroglycerin up to 800 mcg was administered without success. In such resistant cases, when all efforts fail, including prompt recognition and application of vasodilator drugs, retracting the catheter and waiting may play a role.

  3. Multiple Giant Coronary Artery Aneurysms

    Science.gov (United States)

    Usuku, Hiroki; Kojima, Sunao; Kuyama, Naoto; Hanatani, Shinsuke; Araki, Satoshi; Tsujita, Kenichi; Tsunoda, Ryusuke; Fukui, Toshihiro; Hokimoto, Seiji

    2017-01-01

    A 74-year-old man was admitted to our hospital with chest pain and dyspnea associated with ST elevation in leads II, III and aVF. An echocardiogram showed an enlarged mass lesion measuring nearly 80 mm. Coronary angiography showed two giant coronary artery aneurysms (CAAs) in the right coronary artery (RCA). CAAs were also seen in the left main trunk and left anterior descending artery. Computed tomography showed the CAA in the RCA was ruptured into the right atrium. We therefore diagnosed this patient with multiple CAAs, myocardial infarction and coronary artery rupture. He underwent successful surgical excision and coronary bypass surgery. PMID:28768966

  4. Countercurrent aortography via radial artery

    Energy Technology Data Exchange (ETDEWEB)

    Sohn, Hyung Kuk; Lee, Young Chun; Lee, Seung Chul; Jeon, Seok Chol; Joo, Kyung Bin; Lee, Seung Ro; Kim, Soon Yong [College of Medicine, Hanyang University, Seoul (Korea, Republic of)

    1987-06-15

    Countercurrent aortography via radial artery was performed for detection of aortic arch anomalies in 4 infants with congenital heart disease. Author's cases of aortic arch anomalies were 3 cases of PDA, 1 case of coarctation of aorta, and 1 case of occlusion of anastomosis site on subclavian artery B-T shunt. And aberrant origin of the right SCA, interrupted aortic arch, hypoplastic aorta, anomalous origin of the right pulmonary artery from the ascending aorta can be demonstrated by this method. Countercurrent aortography affords an safe and simple method for detection of aortic arch anomalies without retrograde arterial catheterization, especially in small infants or premature babies.

  5. [Single umbilical artery (SUA)].

    Science.gov (United States)

    Staribratova, D; Belovezhdov, V; Milchev, N; Batashki, I; Apiosjan, Zh

    2010-01-01

    Single umbilical artery (SUA) is the most common abnormality of the umbilical cord. It is associated with an increased incidence of atresia of hollow organs, renal abnormalities, limb reduction defects and spontaneous abortions. The aim of our study is to establish the association of SUA with types of malformations and the corresponding pathology of pregnancy and parturition. Although our investigation is in proof of the association of SUA with anomalies of GIT, CCS and CNS, most of our cases exhibit circulatory disturbances leading to pathology of pregnancy and delivery.

  6. Noninvasive 24-hour ambulatory arterial blood pressure monitoring in cirrhosis

    DEFF Research Database (Denmark)

    Møller, Søren; Wiinberg, N; Henriksen, Jens Henrik

    1995-01-01

    Cirrhotic patients have disturbed systemic hemodynamics with reduced arterial blood pressure, but this has not been investigated during daily activity and sleep. Systolic (SBP), diastolic (DBP), and mean arterial blood pressure (MAP), and heart rate (HR) were measured by an automatic ambulant......, but surprisingly normal arterial blood pressure during the nighttime, and the circadian variation in blood pressure and HR is diminished, probably because of an almost unaltered cardiac output during the 24 hours. These results may reflect a major defect in the ability of optimal regulation of blood pressure...

  7. Penetrating neck injury: Collaterals for another life after ligation of common carotid artery and subclavian artery

    Directory of Open Access Journals (Sweden)

    Annu Babu

    2017-02-01

    Full Text Available Neck, being not protected by skeleton, is vulnerable to external trauma and injury which involves blood vessels, trachea, esophagus and other endocrine and nervous system organs. Vascular injuries can not only cause potentially life-threatening hemorrhage but also need profound surgical expertise in management. Development of collateral circulation in neck is well known; however, there is scarcity of literature on the role of collateral formation in neck trauma. Here, we present a unique case of penetrating gunshot injury to neck with right common carotid and right subclavian artery injury with hemorrhagic shock managed with ligation of these vessels as a life-saving procedure. The patient presented with no neurological or motor deficits in immediate postoperative period owing to the collateral circulation between right vertebral artery and right common carotid and right subclavian artery.

  8. Contrast-enhanced MR angiography of the arterial and portovenous system of the liver with varying concentrations of contrast medium; Kontrastmittel-gestuetzte 3D-MR-Angiographie des arteriellen und portalvenoesen Gefaesssysteme der Leber mit unterschiedlicher KM-Konzentration

    Energy Technology Data Exchange (ETDEWEB)

    Vosshenrich, R.; Engeroff, B.; Obenauer, S.; Grabbe, E. [Klinikum der Georg-August-Universitaet, Goettingen (Germany). Abt. Diagnostische Radiologie

    2003-09-01

    Purpose: To evaluate the diagnostic value of a higher concentrated contrast medium (gadobutrol) for contrast-enhanced MRA of the hepatic arteries and portovenous system. Materials and methods: The examinations were performed on a 1.5-Tesla whole body imaging system (Magnetom Symphony Quantum, Siemens) with a 30-mTesla/m gradient field strength using a phased-array body coil. A 3D FLASH sequence (TR/TE/FA 3.88 ms/1.44 ms/25 ) was used imaging the hepatic arteries and portovenous system after determination of the circulation time. The study included 50 patients, with 25 patients (group 1) injected with 0.2 mmol Gd-GTPA/kg body weight and 25 patients (group 2) injected with 0.1 mmol gadobutrol/kg body weight. The signal-to-noise ratio (SNR) and the contrast-to-noise ratio (CNR) were calculated for both groups. The image quality was graded by three radiologists on a 5-point scale. Results: The highest SNR was measured in group 1, with no statistically significant differences of the SNR in the abdominal aortal, coeliac trunk and common hepatic artery. CNR was also similar in both groups. Likewise, portal, superior mesenteric and splenic veins showed no statistically significant differences. All cases were found to have a good image quality. Conclusion: For MRA of the hepatic arteries and the portal veins, the higher concentrated Gd-DTPA contrast medium gadobutrol can be used at half the dosage recommended for the standard Gd-DTPA contrast medium. (orig.) [German] Ziel: Die vorliegende Studie soll den Stellenwert eines hoeher konzentrierten Kontrastmittels (KM) fuer die 3D-MR-Angiographie (MRA) der arteriellen und portalvenoesen Lebergefaesse evaluieren. Methoden: Die Durchfuehrung der Untersuchungen erfolgte an einem Magnetom Symphony/Quantum mit einer Feldstaerke von 1.5 T und einer Gradientenstaerke von 30 mT/m unter Verwendung einer Koerper-Array-Spule. Zur Anwendung kam eine 3D-FLASH-Sequenz (TR/TE/FA 3,88 ms/1,44 ms/25 ). Untersucht wurde das arterielle und

  9. Anomalous left the pulmonary dilemma coronary artery artery from a ...

    African Journals Online (AJOL)

    a continuous murmur associated with angina-like attacks in older patients. Autopsy on these patients reveals a grossly dilated left coronary artery with viable anastomoses between the two coro- nary arteries. Finalll' sudden death is reported in 30% of adults with this anomaly.4, ,10 Characteristically, autopsy shows a large.

  10. Arterial occlusion to treat basilar artery dissecting aneurysm

    NARCIS (Netherlands)

    Cui, Qing Ke; Liu, Wei Dong; Liu, Peng; Li, Xue Yuan; Zhang, Lian Qun; Ma, Long Jia; Ren, Yun Fei; Wu, Ya Ping; Wang, Zhi Gang

    2015-01-01

    Object: To explore the clinical feasibility of employing occlusion to treat basilar artery dissecting aneurysm. Methods: One patient, male and 46 years old, suffered transient numbness and weakness on the right limbs. Cerebral angiography indicated basilar artery dissecting aneurysm. The patient

  11. Anomalous left the pulmonary dilemma coronary artery artery from a ...

    African Journals Online (AJOL)

    ; 8: 787-80I. 6. Wilson CL, Dlabal PW, Holeyfield RW, Akins CW, Knauf DG. Anomalous origin of left coronary artery from pulmonary artery: case report and review of. lileralUre concerning teenagers and adults.J Thorac Cardicn'asc SlIrg 1977; ...

  12. Association between internal carotid artery dissection and arterial tortuosity

    Energy Technology Data Exchange (ETDEWEB)

    Saba, Luca; Piga, Mario [Azienda Ospedaliero Universitaria (A.O.U.), Department of Radiology, Monserrato, Cagliari (Italy); Argiolas, Giovanni Maria; Siotto, Paolo [Azienda Ospedaliero Brotzu (A.O.B.), Department of Radiology, di Cagliari (Italy); Sumer, Suna; Wintermark, Max [Neuroradiology Division, Neuroradiology, UVA Department of Radiology, Charlottesville, VA (United States); Raz, Eytan [New York University School of Medicine, Department of Radiology, New York, NY (United States); Sapienza University of Rome, Department of Neurology and Psychiatry, Rome (Italy); Sanfilippo, Roberto; Montisci, Roberto [Azienda Ospedaliero Universitaria (A.O.U.), Department of Vascular Surgery, di Cagliari (Italy)

    2014-10-18

    Carotid artery dissection is an important cause of ischemic stroke in all age groups, particularly in young patients. The purpose of this work was to assess whether there is an association between the presence of an internal carotid artery dissection (ICAD) and the arterial tortuosity. This study considered 124 patients (72 males and 52 females; median age 57 years) with CT/MR diagnosis of ICAD of the internal carotid artery were considered in this multi-centric retrospective study. The arterial tortuosity was evaluated and, when present, was categorized as elongation, kinking, or coiling. For each patient, both the right and left sides were considered for a total number of 248 arteries in order to have the same number of cases and controls. Fisher's exact test was applied to test the association between elongation, kinking, coiling, dissection, and the side affected by CAD. Fisher's exact test showed a statistically significant association between the ICAD and kinking (p = 0.0089) and coiling (p = 0.0251) whereas no statistically significant difference was found with arterial vessel elongation (p = 0.444). ICAD was more often seen on the left side compared to the right (p = 0.0001). These results were confirmed using both carotid arteries of the same patient as dependent parameter with p = 0.0012, 0.0129, and 0.3323 for kinking, coiling, and elongation, respectively. The presence of kinking and coiling is associated with ICAD. (orig.)

  13. Progressive arterial wall stiffening in patients with increasing diastolic blood pressure.

    Science.gov (United States)

    van den Berkmortel, F W; van der Steen, M; Hoogenboom, H; Wollersheim, H; van Langen, H; Thien, T

    2001-10-01

    Hypertension is an established risk factor for cardiovascular disease. Risk factor patterns for various cardiovascular complications are different. We studied the relationship between increasing diastolic blood pressure and arterial wall dynamics of various peripheral arteries in hypertensives to increase insight in the variability of properties within the arterial tree. Eighty-six untreated hypertensives participated in this cross-sectional study. The study-population was divided into quartiles with increasing diastolic office blood pressure. Cross-sectional compliance and distensibility coefficients of the carotid and femoral arteries were determined, using a vessel wall movement detector system (Wall Track System). Diameters of both common carotid arteries enlarged (right: from 7.4 +/- 0.2 to 7.9 +/- 0.2 mm) while cross-sectional compliance (right: from 0.61 +/- 0.04 to 0.42 +/- 0.04 mm(2)/kPa) and distensibility coefficients (right: from 14.2 +/- 1.0 to 9.0 +/- 1.0 10(-3)/kPa) gradually dropped with increasing diastolic blood pressure. Cross-sectional compliance and diameter of the right common femoral artery remained unchanged while distensibility coefficient decreased although less gradually when compared with the carotid arteries. In untreated hypertensives gradual arterial wall stiffening of the carotid arteries occurred with increasing diastolic blood pressure. Gradual changes were less clear in the common femoral artery which points to the heterogeneity of the arterial tree.

  14. The run-off resistance (ROR) assessed on MR angiograms may serve as a valid scoring system in patients with symptomatic peripheral arterial disease (PAD) and correlates with the ankle-brachial pressure index (ABI).

    Science.gov (United States)

    Gorny, O; Santner, W; Fraedrich, G; Jaschke, W; Greiner, A; Schocke, M F

    2012-06-01

    To investigate the correlation between the hemodynamic parameter ankle-brachial pressure index (ABI) and the run-off resistance (ROR) assessed on MR angiograms (MRA) in patients with peripheral arterial disease (PAD) Fontaine Stage I and II and its potential as reliable reporting system in clinical routine. Contrast-enhanced MRA was performed in 321 PAD patients using a 1.5T MR scanner with moving bed technique. The ROR and resting ABI were determined in each patient's leg and correlation analysis was performed using the Pearson test. A significant negative correlation (r = -.513; pROR (mean 11.03±5.42) and resting ABI (mean .81±.26) was identified. An even more pronounced correlation was found in patients younger than median age who had higher ABI values (r = -.608; pROR scoring system evaluated in this series correlates better with the ABI than previously published scoring systems and could be suggested as reporting system for routine MRA evaluation. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  15. Inflammatory mediators of coronary artery ectasia

    OpenAIRE

    Yuan, Shi-Min

    2014-01-01

    The exact mechanisms underlying coronary artery ectasia (CAE) remain uncertain. This study aims to investigate whether and how inflammatory mediators play a role in the pathogenesis of CAE. The data sources of this study were located by literature searches on MEDLINE, Highwire Press and Google search engine for the year range 2000-2013. The most sensitive of the four types of plasma inflammatory mediators were cell adhesion molecules and systemic inflammatory markers followed by cytokines, wh...

  16. Automated carotid artery intima layer regional segmentation

    Science.gov (United States)

    Meiburger, Kristen M.; Molinari, Filippo; Rajendra Acharya, U.; Saba, Luca; Rodrigues, Paulo; Liboni, William; Nicolaides, Andrew; Suri, Jasjit S.

    2011-07-01

    Evaluation of the carotid artery wall is essential for the assessment of a patient's cardiovascular risk or for the diagnosis of cardiovascular pathologies. This paper presents a new, completely user-independent algorithm called carotid artery intima layer regional segmentation (CAILRS, a class of AtheroEdge™ systems), which automatically segments the intima layer of the far wall of the carotid ultrasound artery based on mean shift classification applied to the far wall. Further, the system extracts the lumen-intima and media-adventitia borders in the far wall of the carotid artery. Our new system is characterized and validated by comparing CAILRS borders with the manual tracings carried out by experts. The new technique is also benchmarked with a semi-automatic technique based on a first-order absolute moment edge operator (FOAM) and compared to our previous edge-based automated methods such as CALEX (Molinari et al 2010 J. Ultrasound Med. 29 399-418, 2010 IEEE Trans. Ultrason. Ferroelectr. Freq. Control 57 1112-24), CULEX (Delsanto et al 2007 IEEE Trans. Instrum. Meas. 56 1265-74, Molinari et al 2010 IEEE Trans. Ultrason. Ferroelectr. Freq. Control 57 1112-24), CALSFOAM (Molinari et al Int. Angiol. (at press)), and CAUDLES-EF (Molinari et al J. Digit. Imaging (at press)). Our multi-institutional database consisted of 300 longitudinal B-mode carotid images. In comparison to semi-automated FOAM, CAILRS showed the IMT bias of -0.035 ± 0.186 mm while FOAM showed -0.016 ± 0.258 mm. Our IMT was slightly underestimated with respect to the ground truth IMT, but showed uniform behavior over the entire database. CAILRS outperformed all the four previous automated methods. The system's figure of merit was 95.6%, which was lower than that of the semi-automated method (98%), but higher than that of the other automated techniques.

  17. Automated carotid artery intima layer regional segmentation

    Energy Technology Data Exchange (ETDEWEB)

    Meiburger, Kristen M; Molinari, Filippo [Biolab, Department of Electronics, Politecnico di Torino, Torino (Italy); Acharya, U Rajendra [Department of ECE, Ngee Ann Polytechnic (Singapore); Saba, Luca [Department of Radiology, A.O.U. di Cagliari, Cagliari (Italy); Rodrigues, Paulo [Department of Computer Science, Centro Universitario da FEI, Sao Paulo (Brazil); Liboni, William [Neurology Division, Gradenigo Hospital, Torino (Italy); Nicolaides, Andrew [Vascular Screening and Diagnostic Centre, London (United Kingdom); Suri, Jasjit S, E-mail: filippo.molinari@polito.it [Fellow AIMBE, CTO, Global Biomedical Technologies Inc., CA (United States)

    2011-07-07

    Evaluation of the carotid artery wall is essential for the assessment of a patient's cardiovascular risk or for the diagnosis of cardiovascular pathologies. This paper presents a new, completely user-independent algorithm called carotid artery intima layer regional segmentation (CAILRS, a class of AtheroEdge(TM) systems), which automatically segments the intima layer of the far wall of the carotid ultrasound artery based on mean shift classification applied to the far wall. Further, the system extracts the lumen-intima and media-adventitia borders in the far wall of the carotid artery. Our new system is characterized and validated by comparing CAILRS borders with the manual tracings carried out by experts. The new technique is also benchmarked with a semi-automatic technique based on a first-order absolute moment edge operator (FOAM) and compared to our previous edge-based automated methods such as CALEX (Molinari et al 2010 J. Ultrasound Med. 29 399-418, 2010 IEEE Trans. Ultrason. Ferroelectr. Freq. Control 57 1112-24), CULEX (Delsanto et al 2007 IEEE Trans. Instrum. Meas. 56 1265-74, Molinari et al 2010 IEEE Trans. Ultrason. Ferroelectr. Freq. Control 57 1112-24), CALSFOAM (Molinari et al Int. Angiol. (at press)), and CAUDLES-EF (Molinari et al J. Digit. Imaging (at press)). Our multi-institutional database consisted of 300 longitudinal B-mode carotid images. In comparison to semi-automated FOAM, CAILRS showed the IMT bias of -0.035 {+-} 0.186 mm while FOAM showed -0.016 {+-} 0.258 mm. Our IMT was slightly underestimated with respect to the ground truth IMT, but showed uniform behavior over the entire database. CAILRS outperformed all the four previous automated methods. The system's figure of merit was 95.6%, which was lower than that of the semi-automated method (98%), but higher than that of the other automated techniques.

  18. Carotid artery stenosis -- self-care

    Science.gov (United States)

    ... medlineplus.gov/ency/patientinstructions/000717.htm Carotid artery stenosis - self-care To use the sharing features on ... feel their pulse under your jawline. Carotid artery stenosis occurs when the carotid arteries become narrowed or ...

  19. Genetics Home Reference: pulmonary arterial hypertension

    Science.gov (United States)

    ... Home Health Conditions Pulmonary arterial hypertension Pulmonary arterial hypertension Printable PDF Open All Close All Enable Javascript ... view the expand/collapse boxes. Description Pulmonary arterial hypertension is a progressive disorder characterized by abnormally high ...

  20. Increased arterial compliance in cirrhosis is related to decreased arterial C-type natriuretic peptide, but not to atrial natriuretic peptide

    DEFF Research Database (Denmark)

    Henriksen, Jens Henrik Sahl; Gülberg, V; Gerbes, A L

    2003-01-01

    BACKGROUND: Increased arterial compliance (COMPart) has recently been described in patients with cirrhosis, particularly in advanced disease. The aim of the present study was to relate COMPart with arterial levels of the circulating natriuretic peptides: atrial natriuretic peptide (ANP) and C...... with cirrhosis showed the well-known hyperdynamic circulation with elevated cardiac output, low arterial blood pressure, and reduced systemic vascular resistance. COMPart in the patients with cirrhosis (1.30 mL/mmHg) was significantly (P

  1. Capsaicin and arterial hypertensive crisis

    National Research Council Canada - National Science Library

    Patanè, Salvatore; Marte, Filippo; La Rosa, Felice Carmelo; La Rocca, Roberto

    2010-01-01

    ...] . A case has also been reported of an arterial hypertensive crisis in a patient with a large ingestion of peppers and chili peppers the day before [5] . We present a case of an arterial hypertensive crisis in a 19-year-old Italian man with an abundant ingestion of peppers and chili peppers the preceding day. On August 4, 2008, a 19-year-...