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Relation of admission white blood cell count to left ventricular remodeling after anterior wall acute myocardial infarction.
Bauters, Anne; Ennezat, Pierre V; Tricot, Olivier; Lallemant, Robert; Aumégeat, Valérie; Segrestin, Benoit; Quandalle, Philippe; Lamblin, Nicolas; Bauters, Christophe
We investigated whether a high white blood cell (WBC) count on admission for acute myocardial infarction (AMI) may be associated with a higher risk of subsequent left ventricular (LV) remodeling. We included 107 patients with anterior AMI. Echocardiographic studies were performed at hospital discharge, at 3 months, and at 1 year after AMI. LV remodeling (>20% increase in end-diastolic volume) was observed in 27% of patients. WBC counts during hospitalization were higher in patients who subsequently underwent LV remodeling (p = 0.003 for WBC count on admission). The increase in end-diastolic volume from baseline to 1 year was greater for patients in the higher tertile of WBC count on admission (p = 0.04). When adjusting for baseline clinical and echocardiographic characteristics by multivariate analysis, WBC count on admission was independently associated with LV remodeling (odds ratio 1.23, 95% confidence interval 1.04 to 1.45, p = 0.018). In conclusion, a high WBC count on admission for AMI is an independent predictor of LV remodeling, even when predischarge echocardiographic variables are taken into account. PMID:17631066
Effect of low dose acetylsalicylic acid on the frequency and hematologic activity of left ventricular thrombus in anterior wall acute myocardial infarction
Kuepper, A.J.V.; Verheugt, F.W.; Peels, C.H.; Galema, T.W.; den Hollander, W.; Roos, J.P.
In this prospective, randomized, placebo-controlled trial the effect of 100 mg acetylsalicylic acid (ASA) once daily on the incidence, hematologic activity and embolic potential of left ventricular (LV) thrombosis was studied in 100 consecutive patients with a first anterior wall acute myocardial infarction (AMI). Patients were randomized to ASA or placebo less than 12 hours after onset of symptoms. Heparin, 5,000 IU subcutaneously twice daily, was given to all patients during immobilization. Echocardiography was performed less than 24 hours, 48 to 72 hours and 1, 2, and 12 weeks after AMI. LV thrombosis was detected by echocardiography in 30 (33%) of the 92 evaluable patients (15 patients given ASA and 15 given placebo). Indium-111 platelet scintigraphy was done in 17 of the 22 patients with an LV thrombus at the second week echocardiogram. Among 7 ASA-treated patients, 4 had positive images; among 10 placebo patients, 5 had positive images. LV thrombus resolution was noted in 3 of 9 patients with a positive scan and in 5 of 8 patients with a negative platelet scan. In 7 of 10 ASA-treated patients and 5 of 12 placebo-treated patients thrombus resolution was observed (difference not significant). Systemic embolism occurred in 2 patients, both given ASA, during the first week after AMI. Thus, low dose ASA has no effect on the incidence, hematologic activity and embolic potential of LV thrombosis in anterior wall AMI.
Acute Anterior Myocardial Infarction Accompanied by Acute Inferior Myocardial Infarction: A Very Rare Coronary Artery Anomaly
Alsancak, Y.; Sezenöz, B.; Duran, M.; Unlu, S.; Turkoglu, S.; Yalc?n, R.
Coronary artery anomalies are rare and mostly silent in clinical practice. First manifestation of this congenital abnormality can be devastating as syncope, acute coronary syndrome, and sudden cardiac death. Herein we report a case with coronary artery anomaly complicated with ST segment myocardial infarction in both inferior and anterior walls simultaneously diagnosed during primary percutaneous coronary intervention.
Clinical significance of inferior ST elevation during acute anterior myocardial infarction.
Tamura, A.; Kataoka, H.; Nagase, K.; Mikuriya, Y.; Nasu, M.
OBJECTIVES--To clarify the genesis and clinical significance of inferior ST elevation during acute anterior myocardial infarction. PATIENTS AND DESIGN--A total of 106 patients with first acute anterior myocardial infarction (< or = 6 h) were divided into two groups according to the presence (group A, n = 12) or absence (group B, n = 94) of ST elevation of > or = 1 mm in at least two of the inferior leads on the admission electrocardiogram. RESULTS--On admission electrocardiograms, group A had a smaller summed ST deviation in the lateral limb leads than group B. On emergency coronary arteriograms, the incidence of a wrapped left anterior descending artery was higher in group A than in group B (100% v 27%, P < 0.01). The incidence of occlusion of a left anterior descending artery distal to its first diagonal branch was higher in group A than in group B (100% v 46%, P < 0.01). Peak serum creatine kinase activity and in-hospital mortality tended to be lower in group A than in group B. Group A had better left ventricular ejection fraction and regional wall motion in the anterobasal and anterolateral regions in the chronic phase than group B. In contrast, regional wall motion in the diaphragmatic region was reduced to a greater extent in group A than in group B. CONCLUSIONS--Inferior ST elevation during acute anterior myocardial infarction appears only in the presence of a combination of a lesser degree of transmural ischaemic myocardium in the anterobasal and anterolateral wall together with transmural ischaemic myocardium in the inferior wall; in all cases there was occlusion of a wrapped left anterior descending artery distal to its first diagonal branch. Patients with such an ST elevation appear to have a better in-hospital prognosis than those without it. PMID:8541164
Early results of a novel technique for anterior vaginal wall prolapse repair: anterior vaginal wall darn
Background The aim of this study was to describe the results of a 1-year patient follow-up after anterior vaginal wall darn, a novel technique for the repair of anterior vaginal wall prolapse. Methods Fifty-five patients with anterior vaginal wall prolapse underwent anterior vaginal wall darn. The anterior vaginal wall was detached using sharp and blunt dissection via an incision beginning 1 cm proximal to the external meatus and extending to the vaginal apex. The space between the tissues that attach the lateral vaginal walls to the arcus tendineus fasciae pelvis was then darned. Cough Stress Test, Pelvic Organ Prolapse Quantification, seven-item Incontinence Impact Questionnaire, and six-item Urogenital Distress Inventory scores were performed 1-year postoperatively to evaluate recovery. Results One-year postoperatively, all patients were satisfied with the results of the procedure. No patient had vaginal mucosal erosion or any other complication. Conclusions One-year postoperative findings for patients in this series indicate that patients with stage II–III anterior vaginal wall prolapse were successfully treated with the anterior vaginal wall darn technique. PMID:24973955
Flap Coverage of Anterior Abdominal Wall Defects
Sacks, Justin M.; Broyles, Justin M.; Baumann, Donald P.
Reconstruction of complex defects of the anterior abdomen is both challenging and technically demanding for reconstructive surgeons. Advancements in the use of pedicle and free tissue transfer along with the use of bioprosthetic and synthetic meshes have provided for novel approaches to these complex defects. Accordingly, detailed knowledge of abdominal wall and lower extremity anatomy in combination with insight into the design, implementation, and limitations of various flaps is essential to solve these complex clinical problems. Although these defects can be attributed to a myriad of etiologic factors, the objectives in abdominal wall reconstruction are consistent and include the restoration of abdominal wall integrity, protection of intraabdominal viscera, and the prevention of herniation. In this article, the authors review pertinent anatomy and the various local, regional, and distant flaps that can be utilized in the reconstruction of these complex clinical cases of the anterior abdomen. PMID:23372457
Anterior Abdominal Wall Haemangioma with Inguinal Extension
Dubhashi, Siddharth P; Choudhary, Kaushal
Haemangioma are common benign vascular tumour but Intramuscular haemangiomas are rare tumours comprising less than 1% of all. The most frequent sites are extremities, head and neck whereas abdominal wall is a quiet rare location. Ultrasonography is an appropriate initial diagnostic modality and MRI is the investigation of choice. A rare case presented to us as Intramuscular haemangioma of anterior abdominal wall with inguinal extension. Ultrasonography with Doppler study and MRI was suggestive of same finding. Intraoperatively patient had huge haemangioma involving external oblique, internal oblique and transverse abdominus muscle. Wide local excision with meshplasty was done as part of muscle had to be removed. Histology confirmed the diagnosis of Intramuscular Haemangioma. PMID:25584266
Comparing angiography features of inferior versus anterior myocardial infarction regarding severity and extension in a cohort of Iranian patients
Kazazi, Elham Hakki; Sheikhvatan, Mehrdad; Mahmoodian, Mehran; Fathollahi, Mahmood Sheikh; Sadeghian, Hakimeh
BACKGROUND: The location of acute myocardial infarction (MI) is an important prognostic factor for risk stratification of patients with first ST-segment elevation MI (STEMI). The main goal of this study was to compare the severity and extension of coronary involvement in inferior and anterior MI. METHODS: This study reviewed angiographic reports of 579 patients with a first anterior wall STEMI and 690 with a first inferior STEMI that were referred to Tehran Heart Center between March 2004 and September 2007. The number of coronary vessels involvement and the presence of left main lesion were determined based on angiography reports. The Gensini score was also calculated for each patient from the coronary arteriogram. RESULTS: Incidence of left main lesion was similar between the two groups. Although coronary arteries involvement according to Gensini score was more severe in anterior wall MI group compared with inferior wall MI group, the number of involved coronary arteries was significantly higher in the inferior MI patients. Recommendation of coronary artery bypass grafting, percutaneous coronary intervention (PCI) or medical treatment were the same for both groups; however, patients with anterior MI were treated more with primary PCI. CONCLUSIONS: According to our angiography database, despite anterior wall MI is associated with more severity of coronary artery disease; inferior wall MI is more extent with regard to the number of involved coronary vessels. Location of MI can predict the severity and extension of infarction. PMID:22091263
Cannulation needle-induced anterior wall tenting of internal jugular vein causing posterior wall penetration.
Yoshida, Hitoshi; Yaguchi, Shinya; Itaya, Hiroyuki; Ito, Kazuo; Hatanaka, Ryo; Nakai, Kishiko; Hirota, Kazuyoshi
Unintentional posterior venous wall penetration during internal jugular vein (IJV) cannulation may cause critical arterial injuries in spite of ultrasound guidance. We aimed to evaluate whether small venous diameter and anterior venous wall tenting by a needle would be associated with posterior venous wall penetration, and to seek factors related to the venous wall tenting. We conducted a retrospective review in patients who underwent IJV cannulation. Using an ultrasound view obtained when puncturing, venous diameter, venous wall thickness, anterior venous wall tenting length, and needle angle were measured, and posterior venous wall penetration was determined. Eleven cannulations in 56 patients were assigned to posterior venous wall penetration. Small venous diameter (p = 0.004), and long anterior venous wall tenting (p = 0.007) were associated with posterior venous wall penetration. The longer anterior venous tenting would be expected with reducing needle angle (p = 0.004) or increasing anterior venous wall thickness (p = 0.006). In conclusion, small IJV and anterior venous wall tenting lead to posterior venous wall penetration. Anterior venous wall tenting is longer with reducing needle angle, or increasing the anterior venous wall thickness. PMID:25365942
Imaging electrical excitation inside the myocardial wall
Mitrea, Bogdan G; Caldwell, Bryan J; Pertsov, Arkady M
Cardiac arrhythmias are often triggered by ectopic membrane depolarization originating deep inside the myocardial wall. Here we propose a new method utilizing a novel near-infrared voltage-sensitive fluorescent dye DI-4-ANBDQBS to determine the three-dimensional (3D) coordinates of the sources of such depolarization. We tested the method in live preparations of pig left and right ventricular myocardium (thickness 8-18 mm) and phantoms imitating the optical properties of myocardial tissue. The method utilizes an alternating transillumination approach that involves comparing pairs of simultaneously recorded broad-field epifluorescence and transillumination images produced at two alternating directions of illumination. Recordings were taken simultaneously by two CCD cameras facing the endocardial and epicardial surfaces of the heart at a frame rate up to 3 KHz. In live preparations, we were able to localize the origin of the depolarization wave with a precision of ±1.3mm in the transmural direction and 3 mm in the image plane. The accuracy of detection was independent of the depth of the source inside ventricular wall. PMID:21412467
Anterior sagittal approach without splitting the rectal wall
Leite, Mila Torii Corręa; Fachin, Camila Girardi; de Albuquerque Maranhăo, Renato Frota; Shida, Márcia Emília Francisco; Martins, José Luiz
INTRODUCTION The anterior sagittal transrectal approach (ASTRA) has already become popular to treat lesions in the proximal urethra such as trauma, duplicity and stenosis, prostatic utricle, urethral–vaginal fistulas and urogenital sinus anomalies. It provides much better exposure than the traditional perineal approach. Morbidity caused by this technique could be potentially decreased if the anterior sagittal access were to be made without sectioning the rectum. We report our initial experience using anterior approach without rectal sectioning for the treatment of three different types of pelvic disorders. PRESENTATION OF CASE Anterior sagittal access without sectioning the rectal wall was carried out in three different clinical cases – a vaginoplasty in a female patient with congenital adrenal hyperplasia; to treat paradoxical urinary incontinence in a patient with proximal hypospadias (46XY karyotype) and another one with gonadal dysgenesis (46XO/XY karyotype). DISCUSSION Several surgical techniques have been reported to repair congenital or acquired lesions in the posterior urethra with high morbidity and no guarantees of adequate and safe surgical exposition. ASTRA provides an excellent exposure, splitting only the anterior rectal wall. In this study, the anterior sagittal approach was applied without splitting the rectal wall to repair different posterior urethral anomalies, providing excellent exposure without compromising the fecal continence mechanism. CONCLUSION The anterior sagittal approach without splitting the rectum is a feasible procedure which provides excellent exposure to the posterior urethra in most cases and leads to less morbidity as it avoids the splitting and suturing of the rectum anterior wall. PMID:23811390
QRS mapping in the evaluation of acute anterior myocardial infarction.
von Essen, R; Merx, W; Doerr, R; Effert, S; Silny, J; Rau, G
In 42 patients with acute anterior myocardial infarction (AMI), we studied the course of Q-wave development and R-wave reduction during the first 48 hours after the onset of chest pain. We used precordial mapping in relation to clinical features, hemodynamic measurements and enzyme release. Q waves developed within 6-14 hours (mean 9 hours) after onset of symptoms. R-wave amplitudes demonstrated nearly a reflected image: They reduced abruptly 5-11 hours (mean 9 hours) after onset of chest pain, coinciding with ST-segment elevation. In 14 patients (group A, 33%) after initial QRS alterations, there were no further changes. Twenty patients (group B, 48%) had a distinct new increase of Q waves (delta sigma Q = 3.0 +/- 2.0 mV/hours) and further R-wave reduction (-delta sigma R = 1.0 +/- 0.6 mV/hour) simultaneous with new severe chest pain and a delayed second increase of enzyme release corresponding with extension of infarction. There were no significant differences between the groups in age, hemodynamics and infarct size calculated from creatine kinase release. Eight patients (group C, 19%) had contradictory findings. Our findings are consistent with previous results indicating that the critical period for intervention is very small except in patients with extension of necrosis. PMID:7397969
Assessment of left ventricular volume and mass by cine magnetic resonance imaging in patients with anterior myocardial infarction intra-observer and inter-observer variability on contour detection
Niels A. A. Matheijssen; Leo H. B. Baur; Johan H. C. Reiber; Edo A. van der Velde; Paul R. M. van Dijkman; Rob J. van der Geest; Albert de Roos; Ernst E. van der Wall
Remodeling of the left ventricle after myocardial infarction can be documented by calculation of left ventricular volume and mass, using endocardial and epicardial tracings of multilevel multiphase short-axis cine magnetic resonance (MR) imaging series. We assessed left ventricular volume and mass from 8 slices and during 12 phases of the cardiac cycle in seven patients with an anterior wall myocardial
Prone decubitus: A solution to inferior wall attenuation in thallium-201 myocardial tomography
Esquerre, J.P.; Coca, F.J.; Martinez, S.J.; Guiraud, R.F.
We propose an efficient method to suppress inferior wall attenuation in /sup 201/TI 180 degrees myocardial tomography. We systematically performed redistribution studies in both supine and prone decubitus, assuming that the latter should result in shifting with respect to each other's cardiac structures and diaphragm as well as subphrenic organs possibly responsible for attenuation. The comparison of both studies in 25 normal subjects by visual interpretation and circumferential profiles analysis showed a complete suppression of significant attenuation in the inferior wall in prone studies. In addition and consequently, the standard deviation of activity in this area was markedly reduced and became close to its value in anterior and lateral walls. This simple technique now routinely performed in over 400 patients drastically improves specificity in the evaluation of inferior wall abnormalities by suppressing attenuation artifacts and, incidently, the effect of high individual variability in left phrenic and subphrenic anatomic configuration.
False inferoposterior fatty acid uptake rest defects in patients with first anterior myocardial infarction.
Walamies, M; Turjanmaa, V; Virtanen, V; Uusitalo, A
Fatty acid scintigraphy is an interesting new technique for assessing the extent of myocardial infarction. We studied 19 patients with electrocardiographically verified first anterior myocardial infarction using radioiodinated phenylpentadecanoic acid and single photon emission computed tomography (SPECT). Besides the expected lesions in the territory of the left ascending coronary artery, a total of nine patients (47%) had severe (uptake < 50% of maximum) defects in the presumptive territory of the right coronary artery at rest. A link between the size of anterior injury and the occurrence of inferoposterior lesions was established. Over 20% paradoxical relative filling-in was seen in four of these inferoposterior defects in the subsequent exercise imaging, but only once anteriorly. Exercise-induced ischaemia (reduction in relative uptake > 20%) was demonstrated in 11 cases (58%). Ischaemia occurred most frequently in patients with small infarcts, and it did not coincide with the reversed redistribution. We conclude that the inferoposterior rest defects are unlikely to have been caused by technical artefacts or local injury, and should perhaps rather be linked with general strain in the left ventricle during the early phase of myocardial remodeling after anterior infarction. In any case, our results indicate that shortly after infarction myocardial viability should be evaluated very cautiously. PMID:8047318
Advantages of technetium pyrophosphate scintigraphy over plasma enzyme analysis in estimation of anterior myocardial infarct size
S Saltissi; P S Robinson; M M Webb-Peploe; D J Coltart; D N Croft
Infarct size was estimated by cumulative creatine kinase MB isoenzyme (CKMB-r) release and by technetium 99m stannous pyrophosphate (TcPYP) scintigraphy in 27 patients with acute anterior myocardial infarction. In eight patients, scintigraphy showed a central area of reduced tracer uptake surrounded by a peripheral rim of increased TcPYP accumulation (\\
Anterior thoracic wall giant tumor--special surgical procedure.
Grozavu, C; Fera, A; Ilia?, M; Marin, D; Pantile, D; Dabelea, C
We describe the case of a 39 years old male known with an anterior thoracic traumatism in 1993 who observed ananterior thoracic wall tumor since 2000. After one and half year of empiric treatment the tumor starts growing very fast, reaching 30/40/35 cm by the date of his hospital admission (march 2003). Due to this accelerate growth and the size of the tumor the patient is proposed for a particular surgical procedure removing the tumor along with the anterior thoracic wall and the reconstruction using "spider web" technique, Thoratex reinforced mesh and muscle flaps. Thisprocedure had agood result, the patient returned to his anterior lifestyle few months after. The patient did not come for follow-up, although he was recommended to come every tree months. Four years after surgery (2007) the patient came back with local recurrence of the tumor. In 2007 the patient underwent another surgical intervention, removing the tumor recurrence. Chest wall tumors are complex surgical conditions requiring complex treatment. The empiric treatment and the fact that the patient did not come as planned for follow-up, prolonged his sufferance, leading to a second surgical intervention. PMID:22712358
Quantification of regional myocardial wall motion by cardiovascular magnetic resonance
Jiang, Kai
Cardiovascular magnetic resonance (CMR) is a versatile tool that also allows comprehensive and accurate measurement of both global and regional myocardial contraction. Quantification of regional wall motion parameters, such as strain, strain rate, twist and torsion, has been shown to be more sensitive to early-stage functional alterations. Since the invention of CMR tagging by magnetization saturation in 1988, several CMR techniques have been developed to enable the measurement of regional myocardial wall motion, including myocardial tissue tagging, phase contrast mapping, displacement encoding with stimulated echoes (DENSE), and strain encoded (SENC) imaging. These techniques have been developed with their own advantages and limitations. In this review, two widely used and closely related CMR techniques, i.e., tissue tagging and DENSE, will be discussed from the perspective of pulse sequence development and image-processing techniques. The clinical and preclinical applications of tissue tagging and DENSE in assessing wall motion mechanics in both normal and diseased hearts, including coronary artery diseases, hypertrophic cardiomyopathy, aortic stenosis, and Duchenne muscular dystrophies, will be discussed. PMID:25392821
Anterior vaginal wall repair (surgical treatment of urinary incontinence) - series (image)
This procedure is used to repair the vaginal wall herniation that occurs with urethrocele, cystocele, or rectocele. ... release a portion of the anterior (front) vaginal wall that is attached to the base of the ...
Myocardial Perfusion in Patients With a Totally Occluded Left Anterior Descending Coronary Artery Reinjected by a Normal Right Coronary Artery: The Role of Collateral Circulation
Elie Chammas; Ayman Hussein; Ghada Ballane; Antoine Helou; Ahmad Yatim; Walid Tarcha; Georges Ghanem
In this article, myocardial perfusion in patients with a totally occluded left anterior descending artery reinjected by a normal right coronary artery is assessed using stress single photon emission computed tomography (SPECT). In all, 20 patients, with a totally occluded left anterior descending artery reinjected by normal right coronary artery, underwent myocardial single photon emission computed tomography imaging within 60
The efficacy of Marlex mesh in the repair of severe, recurrent vaginal prolapse of the anterior midvaginal wall
Thomas M. Julian
OBJECTIVE: The study assesses the efficacy and complications of Marlex mesh in repairing severe recurrent anterior vaginal wall prolapse. STUDY DESIGN: Twenty-four patients with two or more postsurgical recurrences of severe anterior vaginal wall prolapse were divided into control and treatment groups. Transvaginal repair was similar between groups except for reinforcement of the anterior vaginal wall with synthetic mesh. Two
Measurement of left ventricular volume after anterior myocardial infarction: comparison of magnetic resonance imaging, echocardiography, and radionuclide ventriculography
K. H. Darasz; S. R. Underwood; J. Bayliss; S. M. Forbat; J. Keegan; P. A. Poole-Wilson; G. C. Sutton
We have compared echocardiography (echo) and radionuclide ventriculography (RNV) with magnetic resonance imaging (MRI) for the measurement of left ventricular (LV) volume and ejection fraction. Seventy asymptomatic patients were studied up to 12 days after first Q wave anterior myocardial infarction and again after 6 months. Each patient had LV volume measured by all three techniques within 24 hours of
Aging Adversely Affects Postinfarction Inflammatory Response and Early Left Ventricular Remodeling after Reperfused Acute Anterior Myocardial Infarction
Keitaro Mahara; Toshihisa Anzai; Tsutomu Yoshikawa; Yuichiro Maekawa; Teruo Okabe; Yasushi Asakura; Toru Satoh; Hideo Mitamura; Masahiro Suzuki; Akira Murayama; Satoshi Ogawa
Background and Aims: We have demonstrated that an increased peak serum C-reactive protein (CRP) level after acute myocardial infarction (AMI) was a major predictor of left ventricular (LV) remodeling. We sought to clarify the effect of aging on the postinfarction inflammatory response and LV remodeling. Methods: We studied 102 patients who underwent primary angioplasty for a first anterior Q-wave AMI.
Surgical management of anterior vaginal wall prolapse: an evidencebased literature review
C. Maher; K. Baessler
The aim of this review is to summarize the available literature on surgical management of anterior vaginal wall prolapse. A Medline search from 1966 to 2004 and a hand-search of conference proceedings of the International Continence Society and International Urogynecological Association from 2001 to 2004 were performed. The success rates for the anterior colporrhaphy vary widely between 37 and 100%.
Surgical management of anterior vaginal wall prolapse: an evidencebased literature review
Christopher Maher; Kaven Baessler
The aim of this review is to summarize the available literature on surgical management of anterior vaginal wall prolapse. A Medline search from 1966 to 2004 and a hand-search of conference proceedings of the International Continence Society and International Urogynecological Association from 2001 to 2004 were performed. The success rates for the anterior colporrhaphy vary widely between 37 and 100%.
Automatic Quantitation of Regional Myocardial Wall Motion and Thickening From Gated Technetium99m Sestamibi Myocardial Perfusion Single-Photon Emission Computed Tomography
Guido Germano; Jacob Erel; Howard Lewin; Paul B. Kavanagh; Daniel S. Berman
Objectives. We developed an automatic quantitative algorithm for the measurement of regional myocardial wall motion and wall thickening from three-dimensional gated technetium-99m sestamibi myocardial perfusion single-photon emission computed tomographic images.Background. The algorithm measures the motion of the three-dimensional endocardial surface using a modification of the centerline method, as well as wall thickening using both geometry (gaussian fit) and partial volume
Chondrosarcoma of the anterior chest wall: surgical resection and reconstruction with titanium mesh
Ersöz, Elçin; Evman, Serdar; Alpay, Levent; Aky?l, Mustafa; Vayvada, Mustafa; Gürer, Deniz; Bayram, Serkan
Primary malignant tumors of the chest wall are uncommon. Chondrosarcoma is the most common malignancy of the sternum. The current therapy for chondrosarcoma requires adequate surgical excision. A 52-year-old man presented with a lower-sternal mass. Thorax computed tomography (CT) revealed a well-lineated, hypodense and round mass, which highly suggested the sarcoma of the chest wall. The tumor involved 1/3 distal part of the corpus sterni. Incisional biopsy of the mass was reported as chondrosarcoma. In order to obtain disease-free surgical margins, 1/3 distal part of the sternum with costochondral junctions was resected and reconstruction of anterior chest wall was performed with titanium mesh. The postoperative course was uneventful. The titanium mesh provided the essential rigidity and minimal elasticity over the surgical wound. Our findings show that this technique is adequate even for reconstructing extensive defects of the anterior chest wall. PMID:25364538
Concomitant surgical correction of severe stress urinary incontinence and anterior vaginal wall prolapse by anterior vaginal wall wrap: 18 months outcomes
Zargham, Mahtab; Alizadeh, Farshid; Tadayyon, Farhad; Khorrami, Mohammad-Hatef; Nouri-Mahdavi, Kia; Gharaati, Mohammad Reza; Izadpanahi, Mohammad Hossein; Yazdani, Mohammad; Mazdak, Hamid
Background: The aim of this study is to evaluate the outcome of an innovative, minimally invasive sling technique with autologous tissue in women with concomitant incontinence and anterior vaginal wall prolapse (AVWP). Materials and Methods: Fifty-six women with stress urinary incontinence (SUI) or mixed urinary incontinence and AVWP were randomly assigned into two groups: In Group A (26 patients), anterior colporrhaphy (Kelly placation) and sling placement using a strip of anterior vaginal wall were performed, and in Group B (30 patients), transvaginal mesh correction of AVWP and tension-free vaginal tape (TVT) insertion (retropubic – craniocaudal route) using polypropylene mesh were carried out. The patients were followed-up for over 18 months and were assessed objectively using a 48 h frequency-volume chart, a 48 h pad test and a standardized stress test. Related surgical complications and outcomes were recorded and compared. Results: Surgical cure rates for Group A and Group B at the first (3 days) and last (18 months) post-operative visits were 62% and 84%; and 54%, and 72%, respectively (P = 0.09 and 0.31). Complications occurred in 9 patients (44%) of Group B, but only 3 patients (12%) in Group A. Conclusion: Vaginal sling surgery using an anterior vaginal wall strip can improve SUI and in comparison with propylene mesh is associated with lower complication rates. Although, the surgical success rate of this technique is lower than T-Sling, larger studies with selected patients will help assess the suitable patients for this pelvic reconstructive surgery. PMID:24516492
A simple technique of laparoscopic full-thickness anterior abdominal wall repair of retrosternal (Morgagni) hernias
Georges Azzie; Kiki Maoate; Spencer Beasley; Wilhelm Retief; Arie Bensoussan
Background\\/Purpose: Previous reports of laparoscopic repair of Morgagni hernias in children have involved relatively complex laparoscopic techniques. This report describes a simpler method of repair that we have applied to 4 children. Methods: Four children with retrosternal (Morgagni) hernias underwent primary laparoscopic repair by placement of interrupted synthetic nonabsorbable sutures through the full-thickness of the anterior abdominal wall, incorporating the
Laparoscopic Extraperitoneal Uterine Suspension to Anterior Abdominal Wall Bilaterally Using Synthetic Mesh to Treat Uterovaginal Prolapse
Gang Chen; Bin Ling; Jia Li; Ping Xu; Weiping Hu; Weidong Zhao; Dabao Wu
Between August 2007 and May 2009, 28 patients with uterovaginal prolapse, stage 2 or greater, and who desired uterine preservation, underwent laparoscopic extraperitoneal uterine suspension to the anterior abdominal wall bilaterally using mesh. The primary outcome was recurrence, which was evaluated using point C. Secondary outcomes were effects on quality of life (Pelvic Floor Distress Inventory [PFDI-20] and Pelvic Floor
Reconstruction with a patient-specific titanium implant after a wide anterior chest wall resection
Turna, Akif; Kavakli, Kuthan; Sapmaz, Ersin; Arslan, Hakan; Caylak, Hasan; Gokce, Hasan Suat; Demirkaya, Ahmet
The reconstruction of full-thickness chest wall defects is a challenging problem for thoracic surgeons, particularly after a wide resection of the chest wall that includes the sternum. The location and the size of the defect play a major role when selecting the method of reconstruction, while acceptable cosmetic and functional results remain the primary goal. Improvements in preoperative imaging techniques and reconstruction materials have an important role when planning and performing a wide chest wall resection with a low morbidity rate. In this report, we describe the reconstruction of a wide anterior chest wall defect with a patient-specific custom-made titanium implant. An infected mammary tumour recurrence in a 62-year old female, located at the anterior chest wall including the sternum, was resected, followed by a large custom-made titanium implant. Latissimus dorsi flap and split-thickness graft were also used for covering the implant successfully. A titanium custom-made chest wall implant could be a viable alternative for patients who had large chest wall tumours. PMID:24227881
Mechanotransduction of trigeminal ganglion neurons innervating inner walls of rat anterior eye chambers.
Meng, Qingli; Fang, Peng; Hu, Zhuangli; Ling, Yun; Liu, Haixia
To address mechanoreceptive roles of trigeminal ganglion (TG) nerve endings in the inner walls of rat anterior eye chambers, we investigated the mechanotransduction process and mechanosensitive (MS) channel on somata of TG neurons innervating this area in vitro. Rat TG neurons innervating inner walls of anterior chambers were labeled by anterior chamber injection of 1,1'-dilinoleyl-3,3,3',3'-tetramethylindocarbocyanine, 4-chlorobenzenesulfonate (FAST DiI). The neuronal cell bodies were voltage clamped using a whole cell patch-clamp technique, while it was deformed by ejection of bath solution to verify mechanotransduction. Immunofluorescence staining was performed on sections of TG ganglia to determine the specific MS channel proteins. Mechanical stimuli induced MS currents in 55 out of 96 FAST DiI-labeled TG neurons. The MS currents exhibited mechanical intensity-dependent and clamp voltage-dependent characteristics. Mechanical stimulation further enhanced the membrane potential and increased the frequency of action potentials. Transient receptor potential ankyrin 1 (TRPA1), TRP vanilloid 4 (TRPV4), acid-sensing ion channel (ASIC) 2 and ASIC3 channel proteins were expressed in FAST DiI-labeled TG neurons. The inhibitory effect of HC-030031, a specific inhibitor of TRPA1, on MS currents demonstrated that TRPA1 was an essential MS channel protein. Taken together, our results show that mechanical stimuli induce MS currents via MS channels such as TRPA1 to trigger mechanotransduction in TG neurons innervating inner walls of anterior chambers. Our results indicate the existence of mechanoreceptive TG nerve endings in inner walls of anterior chambers. Whether the mechanoreceptive TG nerve endings play a role in intraocular pressure sensation warrants further investigation. PMID:25904679
[A case of ventricular free wall rupture in acute myocardial infarction treated conservatively with success].
Kochanowski, J; Stanis?awska, J; Opolski, G; S?omka, K; Kraska, A
A sixty year old man developed clinical signs of pericardial tamponade on fifth day of acute myocardial infarction. An echocardiogram showed a pericardial effusion and rupture of left ventricular free wall. After pericardial puncture and four days pericardial drainage, the fissure of rupture was closed by formation of thrombus and pseudoaneurysm. After six weeks patient was discharged in good condition. PMID:2046228
Integrated wall stress: a new methodological approach to assess ventricular workload and myocardial contractile reserve
Background Wall stress is a useful concept to understand the progression of ventricular remodeling. We measured cumulative LV wall stress throughout the cardiac cycle over unit time and tested whether this "integrated wall stress (IWS)" would provide a reliable marker of total ventricular workload. Methods and results We applied IWS to mice after experimental myocardial infarction (MI) and sham-operated mice, both at rest and under dobutamine stimulation. Small infarcts were created so as not to cause subsequent overt hemodynamic decompensation. IWS was calculated over one minute through simultaneous measurement of LV internal diameter and wall thickness by echocardiography and LV pressure by LV catheterization. At rest, the MI group showed concentric LV hypertrophy pattern with preserved LV cavity size, LV systolic function, and IWS comparable with the sham group. Dobutamine stimulation induced a dose-dependent increase in IWS in MI mice, but not in sham mice; MI mice mainly increased heart rate, whereas sham mice increased LV systolic and diastolic function. IWS showed good correlation with a product of peak-systolic wall stress and heart rate. We postulate that this increase in IWS in post-MI mice represents limited myocardial contractile reserve. Conclusion We hereby propose that IWS provides a useful estimate of total ventricular workload in the mouse model and that increased IWS indicates limited LV myocardial contractile reserve. PMID:23919327
[Use of nickel-titanium alloys in plasty of the anterior abdominal wall].
Veronski?, G I; Zotov, V A
The work presents results of the surgical treatment of postoperative hernias of the abdominal wall using explants of titanium nickelide in 48 patients. Data of biopsy of the anterior abdominal wall muscles in these patients are given. The anatomo-morphological and functional incompetence is shown. A method of preparing the patients with giant hernias to operation with the help of dynamic pneumocompression is described. The indications to using the explants in hernioplasty are determined by the methods of somatometry and intraoperative dynamometry. The data of three methods of combined hernioplasty are presented: with the use of a superelastic network from a nickelide-titanium alloy; explant with tractional properties, effect of the "shape memory"; method of extracorporeal extension of the abdominal wall at the postoperative period. The nearest and long-term results followed-up during 3 years are shown. PMID:11188829
Value of ST-segment elevation pattern in predicting infarct size and left ventricular function at discharge in patients with reperfused acute anterior myocardial infarction
Masami Kosuge; Kazuo Kimura; Toshiyuki Ishikawa; Naomitsu Kuji; Osamu Tochikubo; Mitsugi Sugiyama; Masao Ishii
Background The implication of the shape of ST elevation in the acute phase of myocardial infarction (MI) remains unclear. Methods and Results We examined the relation between the shape of ST elevation and infarct size in 77 patients who had a first acute anterior MI with successful reperfusion within 6 hours from symptom onset. A 12-lead electrocardiogram was recorded immediately
Long-term clinical outcomes of the left ventricular thrombus in patients with ST elevation anterior myocardial infarction
Ebrahimi, Mahmoud; Fazlinezhad, Afsoon; Alvandi-Azari, Masoomeh; Abdar Esfahani, Morteza
BACKGROUND This study was performed to determine the size of left ventricular thrombus (LVT), risk of systemic embolization and response to medical treatment during 18 months of follow up in the patients with anterior-ST elevation myocardial infarction (aSTEMI). METHODS This cross-sectional study was performed on thirty-five patients with anterior myocardial infarction (MI), in Emam Reza Hospital and Ghaem Hospital, Mashhad, Iran, from August 2008 to January 2011. Warfarin was prescribed for all the patients. Transthoracic echocardiographic study was performed on the 1st, 2nd, 4th, 6th, 12th and 18th months. Outcomes included rate of death, MI, stroke, systemic embolization, major bleeding and change in thrombus size following treatment. RESULTS The resolve rate of clot on the 2nd, 4th, 6th, 12th and 18th months was 64.7, 86.6, 81.4, 81.4 and 100 percent, respectively. In five patients with complete clot resolution, clot reformation occurred after warfarin discontinuation. In these patients, left ventricular ejection fraction (LVEF) improvement was poor. During the study period, five patients died due to severe heart failure. One patient developed hematuria whereas non-experienced thromboembolic events. The mean LVEF at study initiation was 30.8 ± 0.92%, which improved to 42 ± 0.84% (P < 0.05) at the end. CONCLUSION All LVT was resolved with a combination therapy of antiplatelet and warfarin without any thromboembolic event. In patients with a poor improvement in the LV function, due to the risk of LVT reformation, lifelong warfarin therapy was recommended.
Rapid Estimation of Left Ventricular Ejection Fraction in Acute Myocardial Infarction by Echocardiographic Wall Motion Analysis
Jens Berning; Jens Rokkedal Nielsen; Jeppe Launbjerg; Jan Fogh; Hans Mickley; Poul Erik Andersen
Echocardiographic estimates of left ventricular ejection fraction (ECHO-LVEF) in acute myocardial infarction (AMI) were obtained by a new approach, using visual analysis of left ventricular wall motion in a nine-segment model. The method was validated in 41 patients using radionuclide ventriculography (RNV) and contrast ventriculography measurements of LVEF for comparison. ECHO-LVEF from the 41 patients correlated well with the reference
Decreases in Electrocardiographic R-Wave Amplitude and QT Interval Predict Myocardial Ischemic Infarction in Rhesus Monkeys with Left Anterior Descending Artery Ligation
Han, Pengfei; Xie, Yuping; Chen, Jianmin; Xiao, Ying; Kang, Y. James
Clinical studies have demonstrated the predictive values of changes in electrocardiographic (ECG) parameters for the preexisting myocardial ischemic infarction. However, a simple and early predictor for the subsequent development of myocardial infarction during the ischemic phase is of significant value for the identification of ischemic patients at high risk. The present study was undertaken by using non-human primate model of myocardial ischemic infarction to fulfill this gap. Twenty male Rhesus monkeys at age of 2–3 years old were subjected to left anterior descending artery ligation. This ligation was performed at varying position along the artery so that it produced varying sizes of myocardial infarction at the late stage. The ECG recording was undertaken before the surgical procedure, at 2 h after the ligation, and 8 weeks after the surgery for each animal. The correlation of the changes in the ECG waves in the early or the late stage with the myocardial infarction size was analyzed. The R wave depression and the QT shortening in the early ischemic stage were found to have an inverse correlation with the myocardial infarction size. At the late stage, the R wave depression, the QT prolongation, the QRS score, and the ST segment elevation were all closely correlated with the developed infarction size. The poor R wave progression was identified at both the early ischemic and the late infarction stages. Therefore, the present study using non-human primate model of myocardial ischemic infarction identified the decreases in the R wave and the QT interval as early predictors of myocardial infarction. Validation of these parameters in clinical studies would greatly help identifying patients with myocardial ischemia at high risk for the subsequent development of myocardial infarction. PMID:23967258
Experience with management of anterior abdominal wall defects using bovine pericard.
van Tuil, Cornelia; Saxena, Amulya K; Willital, Günter H
During 5 years from 1999 until 2003, our experience with 29 (100%) neonates managed for anterior abdominal wall defects is presented. Twenty-one (72%) neonates presented with gastroschisis and 8 (28%) neonates with giant omphaloceles. The male:female ratio was almost equal in gastroschisis (1:1) while a male predominance was observed in omphaloceles (6:1). A primary closure of the defect was possible in 5 (17%) cases and a single patch along with skin closure was achieved in a further 9 (31%) cases. In 15 (52%) neonates the defect was large and two patches were employed to sufficiently cover the defect. All patients (97%), except one (mortality due to extreme prematurity), were managed successfully. Depending upon the size of the defect and the metabolic condition of the neonate, the defect closure was completed after a mean of 85.7 days. Special protocols were created to manage the bovine pericard patches, which behaved differently to lyophilized dura patches previously used at our center. Integration of the patches was successful in 28 (97%) neonates; however, one neonate with gastroschisis presented significant challenges in the management. Bovine pericard patches are optimal biomaterials for the closure of anterior abdominal wall defects in gastroschisis and omphaloceles. PMID:16283075
A new description of the anterior abdominal wall in man and mammals.
Rizk, N N
The ventral abdominal walls of 116 specimens (41 human and 75 from nine mammalian families) of various ages and both sexes were studied anatomically and histologically. In man, each abdominal aponeurosis was bilaminar, and each wall of the rectus sheath was trilaminar (plywood-like). The two layers of the internal oblique emerged, in part of its extent, superficial to the external oblique and also passed deep to the transversus abdominis. All the six aponeurotic layers were oblique and crossed the mid-line, forming the following digastric muscles: the two external obliques together, the two transversus abdominis muscles together, one internal oblique (anterior layer) with the opposite external oblique (posterior layer) and one internal oblique (posterior layer) with the opposite transversus abdominis (anterior layer). The linea alba might be considered less the insertion of the abdominal muscles, but rather the common area of decussation of their intermediate aponeuroses. In all mammals, the internal oblique aponeurosis passed either superficial to that of the external oblique or deep to that of the transversus. The transversus aponeurosis was always oblique and in all eutheria it split into two layers. All abdominal aponeuroses crossed the middle line forming digastric muscles between the two sides. The functional significance and surgical application of these findings are discussed. Images Fig. 2 Fig. 3 Fig. 4 Fig. 5 Fig. 6 Fig. 7 Fig. 8 Fig. 9 Fig. 10 Fig. 11 Fig. 12 Fig. 13 Fig. 14 Fig. 15 PMID:6452433
Study of myocardial regional wall motion parameter's accuracy by software perfusion phantom.
Fidler, V; Fettich, J; Prepadnik, M
Gated perfusion myocardial scintigraphy permits simultaneous evaluation of perfusion as well as regional contractile function of the left ventricle. Fourier analysis of regional myocardial spatial movement with respect to the myocardial geometric centre gives circular amplitude and phase profiles of ventricular contraction, in addition to regional maximum activity that represents an index of perfusion. To introduce such combined perfusion-contraction analysis the accuracy of the indices mentioned above should be evaluated for different doses of radioactivity typically administered to a patient. A mathematical software phantom, consisting of a half circularly profiled ring activity embedded in uniform background activity and noise generated by a Poisson-shaped random number generator, was constructed and used for this purpose. A 64 x 64 matrix and sequence of 16 frames per study was used. The maximum number of counts per pixel ranged from 10 to 100, simulating low count thallium and high count rate Tc-MIBI-gated studies. The relative standard error analysis (R.S.E.) with a 95.5% confidence level for a thallium type of 10 counts per pixel study exceeded 11%, while it reached acceptable values below 3% for studies with 60 and more counts per pixel. These results indicate that high count rate gated technetium-MIBI myocardial perfusion studies could also be used for reliable left ventricular regional wall motion evaluation. PMID:1407874
Automatic Delineation of the Myocardial Wall from CT Images via Shape Segmentation and Variational Region Growing
Zhu, Liangjia; Gao, Yi; Appia, Vikram; Yezzi, Anthony; Arepalli, Chesnal; Faber, Tracy; Stillman, Arthur; Tannenbaum, Allen
Prognosis and diagnosis of cardiac diseases frequently require quantitative evaluation of the ventricle volume, mass, and ejection fraction. The delineation of the myocardial wall is involved in all of these evaluations, which is a challenging task due to large variations in myocardial shapes and image quality. In this work, we present an automatic method for extracting the myocardial wall of the left and right ventricles from cardiac CT images. In the method, the left and right ventricles are located sequentially, in which each ventricle is detected by first identifying the endocardium and then segmenting the epicardium. To this end, the endocardium is localized by utilizing its geometric features obtained on-line from a CT image. After that, a variational region-growing model is employed to extract the epicardium of the ventricles. In particular, the location of the endocardium of the left ventricle is determined via using an active contour model on the blood-pool surface. To localize the right ventricle, the active contour model is applied on a heart surface extracted based on the left ventricle segmentation result. The robustness and accuracy of the proposed approach is demonstrated by experimental results from 33 human and 12 pig CT images. PMID:23744658
Resting myocardial wall motion, end systolic and end diastolic volume, and mass with cardiac PET correlates with myocardial blood flow changes during hyperemia
K. T Hickey; K. N Giedd; R. R Sciacca; O Rodriguez; R. L Chou; S. R Bergmann; S Bokhari
Objective: The aim of this study was to examine the relationship between regional wall motion (WM), LV ejection fraction (EF), end systolic volume (ESV), end diastolic volume (EDV) and mass (M) obtained with gated 13NH3at rest with changes in myocardial blood flow (MBF) during hyperemia.Methods: 40 patients (59 + 11 years; 32 males) undergoing PET imaging to measure MBF at
Comprehensive analysis of myocardial infarction due to left circumflex artery occlusion: comparison with infarction due to right coronary artery and left anterior descending artery occlusion
Huey, B.L.; Beller, G.A.; Kaiser, D.L.; Gibson, R.S.
Forty consecutive patients with creatine kinase-MB confirmed myocardial infarction due to circumflex artery occlusion (Group 1) were prospectively evaluated and compared with 107 patients with infarction due to right coronary artery occlusion (Group 2) and 94 with left anterior descending artery occlusion (Group 3). All 241 patients underwent exercise thallium-201 scintigraphy, radionuclide ventriculography, 24 h Holter electrocardiographic (ECG) monitoring and coronary arteriography before hospital discharge and were followed up for 39 +/- 18 months. There were no significant differences among the three infarct groups in age, gender, number of risk factors, prevalence and type of prior infarction, Norris index, Killip class and frequency of in-hospital complications. Acute ST segment elevation was present in only 48% of patients in Group 1 versus 71 and 72% in Groups 2 and 3, respectively (p = 0.012), and 38% of patients with a circumflex artery-related infarct had no significant ST changes (that is, elevation or depression) on admission (versus 21 and 20% for patients in Groups 2 and 3, respectively) (p = 0.001). Abnormal R waves in lead V1 were more common in Group 1 than in Group 2 (p less than 0.003) as was ST elevation in leads I, aVL and V4 to V6 (p less than or equal to 0.048). These differences in ECG findings between Group 1 and 2 patients correlated with a significantly higher prevalence of posterior and lateral wall asynergy in the group with a circumflex artery-related infarct. Infarct size based on peak creatine kinase levels and multiple radionuclide variables was intermediate in Group 1 compared with that in Group 2 (smallest) and Group 3 (largest). During long-term follow-up, the probability of recurrent cardiac events was similar in the three infarct groups.
Speckle tracking analysis of the left ventricular anterior wall shows significantly decreased relative radial strain patterns in dystrophin deficient mice after 9 months of age
Spurney, Christopher; Yu, Qing; Nagaraju, Kannaboyina
Background: Duchenne muscular dystrophy (DMD) is an inherited X-linked disorder with an incidence of 1 in 3,500 male births. Early treatment of DMD cardiomyopathy is under investigation and echocardiographic analysis of strain patterns may provide measures to better quantify early treatment outcomes. Methods: We compared cardiac function in 3, 9 and 12 month old dystrophin deficient mdx mice to wild type (C57BL10/J) using in vivo high frequency echocardiography (Vevo 770, VisualSonics, Inc., Toronto, CA) and 2D speckle tracking [Velocity Vector Imaging (VVI), Siemens Medical Solutions, Inc., Malvern, PA]. Mice were anesthetized with 1-2% inhaled isoflurane and images were obtained using a 30 MHz transducer in modified parasternal long and short axis views obtained at the level of the papillary muscles. Myocardial motion was analyzed using VVI in single-beat reconstructed images. Results: M-mode imaging showed significantly decreased shortening fraction in mdx mice compared to wild type at 12 months of age (SF% 26.6±3 vs. 32.2±2; p=0.002). Mdx mice showed significantly increased cardiac fibrosis at 12 months of age compared to controls (p<0.0001). Speckle tracking analysis of the left anterior mid ventricular wall segment showed significantly decreased relative radial strain in mdx mice at 9 and 12 months (4.5±1.3% vs. 8.4±0.7%; p=0.001). There were no significant differences in circumferential or longitudinal strain. Conclusion: Mdx mice show significantly decreased LV anterior mid wall radial strain with mild cardiomyopathy after 9 months of age compared to wild type. Speckle tracking analysis may provide novel outcome measures for preclinical cardiac drug treatment studies in DMD. PMID:22307449
Comparison of wall thickening and ejection fraction by cardiovascular magnetic resonance and echocardiography in acute myocardial infarction
Martha Nowosielski; Michael Schocke; Agnes Mayr; Kathrin Pedarnig; Gert Klug; Almut Köhler; Thomas Bartel; Silvana Müller; Thomas Trieb; Otmar Pachinger; Bernhard Metzler
OBJECTIVES: The purpose of this study was to compare cardiovascular magnetic resonance (CMR) and echocardiography (echo) in patients treated with primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) with emphasis on the analysis of left ventricular function and left ventricular wall motion characteristics. METHODS: We performed CMR and echo in 52 patients with first AMI shortly after primary
Cardiovascular magnetic resonance myocardial feature tracking detects quantitative wall motion during dobutamine stress
Background Dobutamine stress cardiovascular magnetic resonance (DS-CMR) is an established tool to assess hibernating myocardium and ischemia. Analysis is typically based on visual assessment with considerable operator dependency. CMR myocardial feature tracking (CMR-FT) is a recently introduced technique for tissue voxel motion tracking on standard steady-state free precession (SSFP) images to derive circumferential and radial myocardial mechanics. We sought to determine the feasibility and reproducibility of CMR-FT for quantitative wall motion assessment during intermediate dose DS-CMR. Methods 10 healthy subjects were studied at 1.5 Tesla. Myocardial strain parameters were derived from SSFP cine images using dedicated CMR-FT software (Diogenes MRI prototype; Tomtec; Germany). Right ventricular (RV) and left ventricular (LV) longitudinal strain (EllRV and EllLV) and LV long-axis radial strain (ErrLAX) were derived from a 4-chamber view at rest. LV short-axis circumferential strain (EccSAX) and ErrSAX; LV ejection fraction (EF) and volumes were analyzed at rest and during dobutamine stress (10 and 20 ?g · kg-1· min-1). Results In all volunteers strain parameters could be derived from the SSFP images at rest and stress. EccSAX values showed significantly increased contraction with DSMR (rest: -24.1 ± 6.7; 10 ?g: -32.7 ± 11.4; 20 ?g: -39.2 ± 15.2; p < 0.05). ErrSAX increased significantly with dobutamine (rest: 19.6 ± 14.6; 10 ?g: 31.8 ± 20.9; 20 ?g: 42.4 ± 25.5; p < 0.05). In parallel with these changes; EF increased significantly with dobutamine (rest: 56.9 ± 4.4%; 10 ?g: 70.7 ± 8.1; 20 ?g: 76.8 ± 4.6; p < 0.05). Observer variability was best for LV circumferential strain (EccSAX ) and worst for RV longitudinal strain (EllRV) as determined by 95% confidence intervals of the difference. Conclusions CMR-FT reliably detects quantitative wall motion and strain derived from SSFP cine imaging that corresponds to inotropic stimulation. The current implementation may need improvement to reduce observer-induced variance. Within a given CMR lab; this novel technique holds promise of easy and fast quantification of wall mechanics and strain. PMID:21992220
Arteries of the anterior wall of the maxilla in sinus lift surgery.
Rysz, M; Ciszek, B; Rogowska, M; Krajewski, R
Knowledge of the anatomical course of the anterior maxillary wall and alveolar process arteries is essential for sinus lift procedures. The aim of this study was to analyse the localization of anastomoses between the infraorbital and posterior superior alveolar artery on 101 computed tomography (CT) scans of maxillary sinuses (patients aged 18-70 years). The distance from the anastomosis to the bone point was measured on CT scans for each tooth location; for edentulous patients measurements were made to the lower edge of the alveolar process, and for dentate patients to the neck of the tooth. Measurements were done independently by two observers. The anastomosis analysed was identified on 50% of CT scans. The distance to the anastomosis was longest above the premolar (20.4 mm from tooth cervical line) and shortest above the first molar (15.9 mm to the edge of the alveolar process). The anastomosis can be localized on a CT scan for exact positioning of the antrotomy in 50% of patients. For the remaining patients, the anatomical information provided in this study can be used to reduce the risk of damage to the anastomosis. This study provides information on the distance from the anastomosis to the neck of preserved teeth in partially edentulous patients, which can be used as a reference point during sinus lift procedures. PMID:24703496
Sutureless repair for left ventricular free wall rupture after acute myocardial infarction.
Aoyagi, Shigeaki; Tayama, Keiichiro; Otsuka, Hiroyuki; Okazaki, Teiji; Shintani, Yusuke; Wada, Kumiko; Kosuga, Kenichi
We report three cases of left ventricular free wall rupture (LVFWR) after acute myocardial infarction, which were repaired using a sutureless technique without cardiopulmonary bypass. At operation, a sheet of fibrin tissue-adhesive collagen fleece (TachoComb) was secured to the hematoma surrounding the tear and the infarcted area under compression by the surgeon's fingers. After complete hemostasis, several sheets of an absorbable gelatin sponge (Gelfoam) were glued onto the collagen fleece in layers. Intra-aortic balloon pumping was electively performed. Concomitant coronary artery bypass grafting was not carried out. All patients survived the operation but recurrence of the rupture occurred on postoperative day 10 in one patient and an LV aneurysm was found four months after repair in another patient. The sutureless technique may be a simple and fast option for treatment of an oozing type LVFWR; however, careful follow-up is mandatory. PMID:24428225
Prolonged wall motion abnormalities after chest pain at rest in patients with unstable angina: a possible manifestation of myocardial stunning.
Jeroudi, M O; Cheirif, J; Habib, G; Bolli, R
Although myocardial "stunning" would be expected to occur in unstable angina, there is no published report in which the recovery of regional left ventricular function was serially monitored in this syndrome. To determine whether the time course of the regional wall motion abnormalities associated with unstable angina is consistent with myocardial stunning, 20 consecutive patients with unstable angina were studied prospectively. Regional left ventricular wall motion was assessed by two-dimensional echocardiography during or immediately after angina at rest and at serial times thereafter. Six of the 20 patients fulfilled the inclusion criteria. The recovery of segmental wall motion after chest pain was consistently found to be delayed in all six patients, but a considerable variability was observed. In at least two subjects, the improvement was rapid and the wall motion abnormalities disappeared almost completely within 2 hours after the chest pain. Both of these patients had the shortest duration of angina (approximately 10 minutes). In contrast, in three other patients with longer duration of chest pain, the improvement was slower and significant wall motion abnormalities were still present at 24 hours after the chest pain. In five control patients who had angiographically-documented coronary artery disease but no recent episode of angina, there was no significant change in segmental wall motion during a period of observation equivalent to that used in the unstable angina group. This study evaluated for the first time the time course of wall motion abnormalities in patients with unstable angina. The results demonstrate that angina at rest is followed by a prolonged depression of contractile function, which may persist for up to 24 hours or even longer. Because none of the patients had evidence of acute myocardial infarction or recurrent ischemia, our observations suggest myocardial stunning as the pathophysiologic substrate for the slow recovery of wall motion. The present results are consistent with the concept that myocardial stunning does occur in unstable angina and indeed may be a component of the natural history of this disorder; however, further investigations using simultaneous measurements of function and flow will be necessary to unequivocally distinguish myocardial stunning from hibernation and silent ischemia. PMID:8172052
The thickness and the lengths of the anterior wall of adult maxilla of the West Anatolian Turkish people
Candan Arman; Ipek Ergür; Atay Atabey; Mustafa Güvencer; Amac Kiray; Esin Korman; Suleyman Tetik
The maxilla is the key structure on facial formation and stability. The knowledge about maxillary thickness and dimensions\\u000a is crucial during facial reconstruction including this bone. In this study, anthropometric measurements of anterior wall of\\u000a the maxilla on the dry human skulls were aimed. Sixty maxillae of 30 adult dry skulls of West Anatolian people were evaluated.\\u000a Four vertical lines
Vaginal Repair of Cystocele with Anterior Wall Mesh via Transobturator Route: Efficacy and Complications with Up to 3-Year Followup
Moore, Robert D.; Miklos, John R.
Study Objective. The objective of this study was to report on the safety and efficacy of cystocele repair with anterior wall mesh placed via a transobturator route (Perigee system, AMS, Minnetonka, MN). Design. Single center retrospective study. Setting. Single center hospital setting and Urogynecology practice in the United States. Patients. 77 women presenting with symptomatic anterior wall prolapse. Intervention. Repair of cystocele with an anterior wall Type I soft-polypropylene mesh placed via a transobturator approach. Concomitant procedures in other compartment were also completed as indicated. Measurements and Main Results. 77 women underwent the Perigee procedure at our institution over a 2-year period. The mesh was attached to the pelvic sidewalls at the level of the bladder neck and near the ischial spine apically with needles passed through the groins and obturator space. Mean follow-up was 18.2 months (range 3–36 months). Objective cure rate was 93%. Subjectively only two patients have had recurrent symptoms of prolapse, and only 1 of these has required repeat surgery for cystocele. Mesh exposure vaginally occurred in 5 patients (6.5%); however all were treated with estrogen and/or local excision of exposed mesh and had no further sequelae. There were no incidences of chronic pain, infection, or abscess, and no patient required complete mesh removal for infection, pain, or extrusion. Conclusion. In select patients with anterior wall prolapse, repair with mesh augmentation via the transobturator route is a safe and effective procedure with up to 3 years of follow-up. PMID:19710939
Difference between Outcome of Left Circumflex Artery and Right Coronary Artery Related Acute Inferior Wall Myocardial Infarction in Patients Undergoing Adjunctive Angioplasty after Fibrinolysis
Sohrabi, Bahram; Separham, Ahmad; Madadi, Reza; Toufan, Mehrnoush; Mohammadi, Nasibeh; Aslanabadi, Naser; Kazemi, Babak
Introduction: Prognostic differences between anterior and inferior wall Myocardial Infarction (MI) has been extensively investigated, but there is limited information about similar comparison between inferior wall MI caused by right coronary artery (RCA) and left circumflex artery (LCX) occlusion. The aim of present study was to compare prognostic differences between LCX- and RCA-related acute inferior wall ST-segment elevation MI (STEMI) treated by routine adjunctive angioplasty after receiving thrombolytic therapy (TLT). Methods: Between March 2012 and June 2013 one hundred fifty consecutive patients with acute inferior wall STEMI were studied. Patients were divided into two groups according to the infarct related artery (LCX vs. RCA). All patients underwent routine adjunctive angioplasty after TLT during the index hospitalization and clinical characteristics and outcomes were compared. Results: RCA and LCX arteries were occluded in 97 (64.7%) and 53 (35.3%) of patients, respectively. Two groups were similar in baseline characteristics except multiple-vessel disease was more prevalent with LCX occlusion (p= 0.008). There was a higher cardiac enzyme release (p< 0.001), more significant mitral regurgitation (MR) (p= 0.015), and lower left ventricular ejection fraction (LVEF) (p= 0.01) in patients with LCX occlusion. Multivariate analysis showed cTn-I release, occurrence of MR, and lower LVEF as independent factors leading to poor outcome. Conclusions: There were higher cTn-I release, MR occurrence, and lower LVEF in LCX-related acute inferior wall STEMI, all associated with poor outcome. Therefore, patients with ECG finding in favour of LCX occlusion should be considered as high risk and an invasive approach should be planned. PMID:25031825
A 3-D Finite Element Model of Anterior Vaginal Wall Support to Evaluate Mechanisms Underlying Cystocele Formation
Chen, Luyun; Ashton-Miller, James A.; DeLancey, John O.L.
Objectives To develop a 3D computer model of the anterior vaginal wall and its supports, validate that model, and then use it to determine the combinations of muscle and connective tissue impairments that result in cystocele formation, as observed on dynamic magnetic resonance imaging (MRI). Methods A subject-specific 3D model of the anterior vaginal wall and its supports was developed based on MRI geometry from a healthy nulliparous woman. It included simplified representations of the anterior vaginal wall, levator muscle, cardinal and uterosacral ligaments, arcus tendineus fascia pelvis and levator ani, paravaginal attachments, and the posterior compartment. This model was then imported into ABAQUS™ and tissue properties were assigned from the literature. An iterative process was used to refine anatomical assumptions until convergence was obtained between model behavior under increases of abdominal pressure up to 168 cmH2O and deformations observed on dynamic MRI. Results Cystocele size was sensitive to abdominal pressure and impairment of connective tissue and muscle. Larger cystocele formed in the presence of impairments in muscular and apical connective tissue support compared to either support element alone. Apical impairment resulted in a larger cystocele than paravaginal impairment. Levator ani muscle impairment caused a larger urogenital hiatus size, longer length of the distal vagina exposed to a pressure differential, larger apical descent and resulted in a larger cystocele size. Conclusions Development of a cystocele requires a levator muscle impairment, an increase in abdominal pressure, and apical and paravaginal support defects. PMID:19481208
Metabolic Syndrome is Associated With Higher Wall Motion Score and Larger Infarct Size After Acute Myocardial Infarction
Hajsadeghi, Shokoufeh; Chitsazan, Mitra; Chitsazan, Mandana; Haghjoo, Majid; Babaali, Nima; Norouzzadeh, Zahra; Mohsenian, Maryam
Background: Infarct size is an important surrogate end point for early and late mortality after acute myocardial infarction. Despite the high prevalence of metabolic syndrome in patients with atherosclerotic diseases, adequate data are still lacking regarding the extent of myocardial necrosis after acute myocardial infarction in these patients. Objectives: In the present study we aimed to compare myocardial infarction size in patients with metabolic syndrome to those without metabolic syndrome using peak CK-MB and cardiac troponin I (cTnI) at 72 hours after the onset of symptoms. Patients and Methods: One-hundred patients with metabolic syndrome (group I) and 100 control subjects without metabolic syndrome (group II) who experienced acute myocardial infarction were included in the study. Diagnosis of metabolic syndrome was based on the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) guidelines published in 2001. Myocardial infarction size was compared between the two groups of patients using peak CK-MB and cTnI level in 72 hours after the onset of symptoms. Results: Peak CK-MB and cTnI in 72 hours were found to be significantly higher in patients with metabolic syndrome compared with control subjects (both P < 0.001). Patients with metabolic syndrome also had markedly higher wall motion abnormality at 72 hours after the onset of symptoms as assessed by echocardiographically-derived Wall Motion Score Index (WMSI) (P < 0.001). Moreover, statistically significant relationships were found between WMSI and peak CK-MB and also cTnI at 72 hours (Spearman's rho = 0.56, P < 0.001 and Spearman's rho = 0.5, P < 0.001; respectively). However, association between WMSI and left ventricular ejection fraction was insignificant (Spearman's rho = -0.05, P = 0.46). Conclusions: We showed that patients with metabolic syndrome have larger infarct size compared to control subjects. PMID:25789257
Effects of Intravenous Levosimendan on Human Coronary Vasomotor Regulation, Left Ventricular Wall Stress, and Myocardial Oxygen Uptake
Andrew D. Michaels; Barry McKeown; Michael Kostal; Kalpesh T. Vakharia; Mark V. Jordan; Ivor L. Gerber; Elyse Foster; Kanu Chatterjee
Background—Levosimendan is a calcium-sensitizing agent and an inodilator under current investigation in the treatment of decompensated heart failure. The effects of intravenous levosimendan on the human coronary vasculature, together with myocardial wall stress and oxygen uptake, have not been adequately studied. Methods and Results—Ten adult patients underwent right- and left-heart catheterization. Baseline coronary blood flow was determined with quantitative coronary
Local administration of TGF-beta1 to reinforce the anterior abdominal wall in a rat model of incisional hernia.
Korenkov, M; Yuecel, N; Koebke, J; Schierholz, J; Morsczeck, Ch; Tasci, I; Neugebauer, E A M; Nagelschmidt, M
The purpose of this study was to investigate different forms of the local application of TGF-beta(1) for augmentation of the anterior abdominal wall in an appropriate model of an incisional hernia. Sixty male Sprague-Dawley rats were divided into six groups. Artificial defects of the anterior abdominal wall were closed with one of the following methods: running Prolene suture, Vicryl mesh, prolene suture followed by an intramuscular injection of 1 mug TGF-beta(1), Vicryl mesh coated with 1 mug TGF-beta(1), and prolene suture coated with 1 mug TGF-beta(1). A control group did not receive any defect and treatment. Six weeks after operation, tensile strength, collagen content, gene expression of collagen I and III, blood vessels, and thickness of collagen fibres were evaluated. Tensile strength was strongest in the controls (14.2 (10.5-18 N)). There was no increase in tensile strength due to the administration of TGF-beta(1). On the contrary, bolus injection of the growth factor resulted in a significantly decreased strength of the wound tissue when compared to the groups 1, 4, 5, and 6 (9.1 (4.2-9.1 N)). These results correlated with the gene expression of collagen I and III. Local application of TGF-beta(1) did not augment the strength of the abdominal wall after 6 weeks. PMID:15912258
Asynchronous left ventricular wall motion early after coronary thrombosis
D Gibson; H Mehmel; F Schwarz; K Li; W Kübler; H Mehmet
To study regional wall motion early in the development of acute myocardial infarction, left ventriculograms performed in 24 patients before thrombolysis and within 3.5(1.2) (mean (SD] hours of the onset of pain were digitised frame by frame. Isometric and contour plots of regional wall motion were constructed. In 19 patients (seven with anterior descending, eight with right, and four with
Single-incision vaginal approach to treat cystocele and vault prolapse with an anterior wall mesh anchored apically to the sacrospinous ligaments
Robert D. Moore; Gretchen K. Mitchell; John R. Miklos
Introduction and hypothesis The safety and early efficacy of a new technique to treat cystocele and\\/or concomitant apical prolapse through a single vaginal\\u000a incision with a lightweight mesh anchored apically bilaterally to the sacrospinous ligaments is reported.\\u000a \\u000a \\u000a \\u000a \\u000a Methods Women with anterior compartment and\\/or apical prolapse ?stage II underwent repair through a single anterior vaginal wall incision\\u000a with the Anterior Elevate System (AES).
Imaging observations of a schwannoma of low malignant potential in the anterior abdominal wall: A case report
Neurilemmoma, also known as schwannoma, is an uncommon benign neoplasm that is most commonly found in the trunk and head and neck regions. The present study reports the case of a 67-year-old female with schwannoma localized in the anterior abdominal wall and analyzes the ultrasound and computed tomography (CT) imaging observations of the schwannoma. A dynamic time-intensity curve was also recorded in the study. A well-defined, elliptic low echo level, heterogeneous mass was observed during ultrasound examination. The CT scan revealed a solid, heterogeneous, low-density mass in the abdominal wall. Contrast-enhanced scans showed a heterogeneously enhanced mass during the arterial and venous phase. Centripetal fill-in was demonstrated and the mass was markedly, homogenously enhanced relative to the muscles during the delayed phase. Peak enhancement was observed during the venous phase and then slowly declined. However, the mass was hyperattenuated during the delayed phase. The lesion was completely excised and no evidence of recurrence has been identified during the 3 months of follow-up. The present study suggested that a diagnosis of schwannoma should be considered for certain patients with masses in the abdominal wall. Peripheral enhancement during the arterial and venous phases and homogeneous enhancement in the delayed phase are the significant imaging findings of a schwannoma. PMID:25120678
Imaging observations of a schwannoma of low malignant potential in the anterior abdominal wall: A case report.
Liu, Yongkang; Chen, Xiao; Wang, Tianyao; Wang, Zhongqiu
Neurilemmoma, also known as schwannoma, is an uncommon benign neoplasm that is most commonly found in the trunk and head and neck regions. The present study reports the case of a 67-year-old female with schwannoma localized in the anterior abdominal wall and analyzes the ultrasound and computed tomography (CT) imaging observations of the schwannoma. A dynamic time-intensity curve was also recorded in the study. A well-defined, elliptic low echo level, heterogeneous mass was observed during ultrasound examination. The CT scan revealed a solid, heterogeneous, low-density mass in the abdominal wall. Contrast-enhanced scans showed a heterogeneously enhanced mass during the arterial and venous phase. Centripetal fill-in was demonstrated and the mass was markedly, homogenously enhanced relative to the muscles during the delayed phase. Peak enhancement was observed during the venous phase and then slowly declined. However, the mass was hyperattenuated during the delayed phase. The lesion was completely excised and no evidence of recurrence has been identified during the 3 months of follow-up. The present study suggested that a diagnosis of schwannoma should be considered for certain patients with masses in the abdominal wall. Peripheral enhancement during the arterial and venous phases and homogeneous enhancement in the delayed phase are the significant imaging findings of a schwannoma. PMID:25120678
[Clinical usefulness of 201Tl/99mTc-PYP dual myocardial quantitative gated SPECT program using low-dose dobutamine loading in assessment of myocardial viability in patient with acute myocardial infarction--a case report].
Irie, Hidekazu; Ito, Kazuki; Koide, Masahiro; Taniguchi, Takuya; Yokoi, Hirokazu; Nakamura, Reo; Kinoshita, Noriyuki; Hashimoto, Tetsuo; Tamaki, Shunichi; Sawada, Takahisa; Azuma, Akihiro; Matsubara, Hiroaki
An 86-year-old man with chest pain was admitted to our hospital. Coronary angiography revealed 99% stenosis of the mid segment of the left anterior descending coronary artery, therefore, a coronary stent was implanted. Immediately after the stent implantation, 99% stenosis occurred at the proximal site of the 1st diagonal artery because of stent jeal. On the 4th hospital day, ECG-gated 201TL/99mTc-PYP dual myocardial quantitative gated SPECT was performed at rest and during low-dose dobutamine loading. The 201Tl scintigraphy revealed moderately reduced uptake in the anterior, septal and apical walls, and 99mTc-PYP uptake was observed in the mid-anterior wall. A three-dimensional surface display of gated 201Tl SPECT images showed severe hypokinesis in the anterior, septal and apical walls at rest. On the other hand, during low-dose dobutamine loading, improved wall motion was observed in the basal anterior and septal walls, while no change was observed in the midanterior and apical wall movements. Three-dimensional surface display of gated 201Tl/99mTc-PYP dual SPECT images revealed similar patterns of wall motion as those of gated 201Tl SPECT images at rest. During low-dose dobutamine loading, on the other hand, a three-dimensional surface display of gated 201Tl/99mTc-PYP dual SPECT images revealed improved wall motion in the basal anterior, septal and apical walls, but worsened wall motion of the mid-anterior wall. After 6 months, a follow-up coronary angiography revealed no re-stenosis of the stent, but 99% stenosis at the proximal aspect of the 1st diagonal artery. Left ventriculography revealed improved wall motion in the apex and akinesis of the mid-anterior wall. These wall motion findings were similar to those visualized in the three-dimensional surface display of gated 201Tl/99mTc-PYP dual SPECT images during low-dose dobutamine loading in the acute phase. These results suggest that 201Tl/99mTc-PYP dual myocardial quantitative gated SPECT using low-dose dobutamine loading could be useful for the assessment of myocardial viability after reperfusion therapy in patients with acute myocardial infarction. PMID:16838664
Efficacy and Safety of "Tension-free" Placement of Gynemesh PS for the Treatment of Anterior Vaginal Wall Prolapse
Lee, Young-Suk; Han, Deok-Hyun; Lim, Soo-Hyun; Kim, Tae-Heon; Choo, Myung-Soo; Seo, Ju-Tae; Lee, Jeong-Zoo; Chung, Byung-Soo; Lee, Jeong-Gu
Purpose To evaluate the efficacy and safety of the tension-free placement of a monofilament polypropylene mesh for the repair of an anterior vaginal wall prolapse (AVWP). Materials and Methods Women aged ? 30 years with an AVWP stage of II or greater were included. Forty-nine women underwent trans-vaginal repair using a Gynemesh™ PS. Forty-six women who had symptomatic stress urinary incontinence received a midurethral sling (MUS). At the 12-month follow-up, evaluations were made for changes in the Pelvic Organ Prolapse Quantification (POP-Q) stage and Pelvic Floor Distress Inventory. Cure was defined as a POP-Q stage of 0 and improvement as a stage of I. Complications were also evaluated. Results The cure rate was 71.4%, and the improvement rate was 18.4%. Obstructive/discomfort, irritative, and stress subscale scores of the Urinary Distress Inventory anterior and posterior subscale scores of the POP Distress Inventory and the obstructive subscale score of the Colo-Rectal-Anal Distress Inventory were significantly improved. Thirty-two of the 46 women (69.6%) who received MUS procedures reported no leakage after surgery. Complications were 2 cases of increased intraoperative bleeding and 1 case of vaginal erosion. Conclusions Trans-vaginal repair using a Gynemesh™ PS is a feasible and effective procedure for the treatment of AVWP with no significant complications. PMID:21120174
Comparative histological analysis of anterior vaginal wall in women with pelvic organ prolapse or control subjects. A pilot study.
Badiou, Wassim; Granier, Guillaume; Bousquet, Philippe-Jean; Monrozies, Xavier; Mares, Pierre; de Tayrac, Renaud
The purpose of this study was to compare smooth muscle content of anterior vaginal wall in women with pelvic organ prolapse (POP) and control subjects. Specimens were taken in the midline from the apex of anterior vaginal cuff from eleven women with POP and eight control subjects operated for hysterectomy without prolapse. Masson's trichrome stain was used to determine the distribution of collagen in the extracellular matrix of the vaginal muscularis and to quantify the collagen in area of interest. Slides of alpha smooth muscle actin were detected using antibodies. Morphometric analysis was used to compare and to quantify the smooth muscle content of the vaginal muscularis. Fractional area of nonvascular vaginal smooth muscle of women with POP was significantly decreased in comparison to control subjects (41.9 vs 61.9%, p = 0.005). Fractional area of connective tissue was significantly increased (56.8 vs 35%, p = 0.004). Fractional area of blood vessels was similar (2.2 vs 3.4%, p = 0.20). PMID:18183343
Texture analysis improves level set segmentation of the anterior abdominal wall
Xu, Zhoubing [Electrical Engineering, Vanderbilt University, Nashville, Tennessee 37235 (United States)] [Electrical Engineering, Vanderbilt University, Nashville, Tennessee 37235 (United States); Allen, Wade M. [Institute of Imaging Science, Vanderbilt University, Nashville, Tennessee 37235 (United States)] [Institute of Imaging Science, Vanderbilt University, Nashville, Tennessee 37235 (United States); Baucom, Rebeccah B.; Poulose, Benjamin K. [General Surgery, Vanderbilt University Medical Center, Nashville, Tennessee 37235 (United States)] [General Surgery, Vanderbilt University Medical Center, Nashville, Tennessee 37235 (United States); Landman, Bennett A. [Electrical Engineering, Vanderbilt University, Nashville, Tennessee 37235 and Institute of Imaging Science, Vanderbilt University, Nashville, Tennessee 37235 (United States)] [Electrical Engineering, Vanderbilt University, Nashville, Tennessee 37235 and Institute of Imaging Science, Vanderbilt University, Nashville, Tennessee 37235 (United States)
Purpose: The treatment of ventral hernias (VH) has been a challenging problem for medical care. Repair of these hernias is fraught with failure; recurrence rates ranging from 24% to 43% have been reported, even with the use of biocompatible mesh. Currently, computed tomography (CT) is used to guide intervention through expert, but qualitative, clinical judgments, notably, quantitative metrics based on image-processing are not used. The authors propose that image segmentation methods to capture the three-dimensional structure of the abdominal wall and its abnormalities will provide a foundation on which to measure geometric properties of hernias and surrounding tissues and, therefore, to optimize intervention.Methods: In this study with 20 clinically acquired CT scans on postoperative patients, the authors demonstrated a novel approach to geometric classification of the abdominal. The authors' approach uses a texture analysis based on Gabor filters to extract feature vectors and follows a fuzzy c-means clustering method to estimate voxelwise probability memberships for eight clusters. The memberships estimated from the texture analysis are helpful to identify anatomical structures with inhomogeneous intensities. The membership was used to guide the level set evolution, as well as to derive an initial start close to the abdominal wall.Results: Segmentation results on abdominal walls were both quantitatively and qualitatively validated with surface errors based on manually labeled ground truth. Using texture, mean surface errors for the outer surface of the abdominal wall were less than 2 mm, with 91% of the outer surface less than 5 mm away from the manual tracings; errors were significantly greater (2–5 mm) for methods that did not use the texture.Conclusions: The authors' approach establishes a baseline for characterizing the abdominal wall for improving VH care. Inherent texture patterns in CT scans are helpful to the tissue classification, and texture analysis can improve the level set segmentation around the abdominal region.
[Marked 99mTc-PYP myocardial accumulation immediately after reperfusion in a patient with acute myocardial infarction].
Adachi, Yoshihiko; Ito, Kazuki; Nishikawa, Susumu; Yuba, Tatsuya; Tsubakimoto, Yoshinori; Takata, Hiroki; Kato, Shuji; Azuma, Akihiro; Sugihara, Hiroki; Nakagawa, Masao
We reported a case of a 72-year-old man with chest pain. An electrocardiogram showed ST segment elevation in I, II, III, aVL, aVF and V1-6 leads. 99mTc-tetrofosmin myocardial SPECT showed defect in the anterior, septal, apical and inferior walls. Coronary angiography showed 99% stenosis of the proximal right coronary artery and total occlusion of the midsegment of the left anterior descending coronary artery. Therefore, direct PTCA was performed for each lesion to achieve reperfusion. We didnt's see reperfusion injury during PTCA of the left coronary artery. On the other side, we saw severe reperfusion injury, such as slow-flow, arrhythmia and falling blood pressure during PTCA of the right coronary artery. After four hours, 99mTc-PYP myocardial SPECT showed marked uptake in the apical and inferior walls, and mild uptake in the anterior and posterior walls. After three days, severely-reduced uptake of 99mTc-PYP in the apex was noted, and mild uptake in the mid-portion of the anterior wall and the mid-portion of the inferior wall. Though reperfusion injury was seen, three was mild myocardial uptake of 99mTc-PYP in the area of the right coronary artery. On the other side, despite no reperfusion injury, there showed marked uptake during the acute phase and defect during the subacute phase in the area of the left coronary artery. Wall motion of the left ventricle was normal in the area of the right coronary artery and akinesis was seen on the left. These findings suggest that 99mTc-tetrofosmin and 99mTc-PYP myocardial SPECT are useful for visualization of reperfusion injury during the acute phase and for estimation of function during the chronic phase, better even than electrocardiogram or coronary angiography. PMID:12701202
Reappearance of anterior QRS forces after coronary bypass surgery. An electrovectorcardiographic study.
Zeft, H J; Friedberg, H D; King, J F; Manley, J C; Huston, J H; Johnson, W D
This report describes the reappearance of anterior QRS electrical forces in six patients after direct coronary arterial bypass surgery. Each patient had severe coronary artery disease including a segmental stenosis of the left anterior descending artery. Revascularization was performed by direct anastomosis of the left mammary artery to the left anterior descending coronary artery and saphenous vein bypass of other stenotic coronary arteries. Preoperative electrocardiograms and vectorcardiograms showed patterns of anterior wall myocardial infarction with absent or diminutive anterior QRS forces. In each case, postoperative studies demonstrated the regeneration of anterior QRS forces within 10 days of operation. Although these patients represent a small percent of those with a preoperative pattern of infarction who undergo coronary revascularization, the findings demonstrate that electrically silent areas of myocardium may be altered and are not always synonymous with myocardial cell death. Chronic myocardial ischemia may in certain instances produce electrocardiographic and vectorcardiographic patterns of myocardial infarction that may be reversible upon reestablishment of perfusion to ischemic areas. PMID:1080350
[Myocardial infarction due to left main occlusion in a patient with Leriche's syndrome].
Zurakowski, Aleksander; Bo?kowski, Micha?; Nowakowski, Przemys?aw; Agopsowicz, Maciej; Buszman, Pawe?
We present the case of a 55 year-old male admitted to Malopolskie Centrum Sercowo-Naczyniowe PAKS in Chrzanów with diagnosis of anterior wall myocardial infarction (STEMI). We decided to treat the patient invasively because of presence of chest pain, persistent ST elevation and signs of haemodinamical instability. As it revealed later patient needed combination of PCI of left main/left anterior descending artery with PTA of iliac artery. PMID:22267439
Peeling off the Mask: Pseudo Myocardial Infarction Pattern on Electrocardiogram During AICD Implantation
Kumar, Sudeep; Kapoor, Aditya; Moorthy, Nagaraja; Lokhandwala, Yash
Lead induced transient right bundle branch block is not uncommon during pacemaker implantation. We describe a patient with old anterior wall myocardial infarction with severe left ventricular dysfunction presenting with recurrent ventricular tachycardia who developed transient right bundle branch block and pseudomyocardial infacrction pattern during AICD implantation. PMID:25852248
Hypopharyngeal Wall Exposure within the Surgical Field : The Role of Axial Rotation of the Thyroid Cartilage during Anterior Cervical Surgery
Choi, Byung Kwan; Cho, Won Ho; Choi, Chang Hwa; Song, Geun Sung; Kim, Choongrak
Objective Esophageal/hypopharyngeal injury can be a disastrous complication of anterior cervical surgery. The amount of hypopharyngeal wall exposure within the surgical field has not been studied. The objective of this study is to evaluate the chance of hypopharyngeal wall exposure by measuring the amount of axial rotation of the thyroid cartilage (ARTC) and posterior projection of the hypopharynx (PPH). Methods The study was prospectively designed using intraoperative ultrasonography. We measured the amount of ARTC in 27 cases. The amount of posterior projection of the hypopharynx (PPH) also was measured on pre-operative CT and compared at three different levels; the superior border of the thyroid cartilage (SBTC), cricoarytenoid joint and tip of inferior horn of the thyroid cartilage (TIHTC). The presence of air density was also checked on the same levels. Results The angle of ARTC ranged from -6.9° to 29.7°, with no statistical difference between the upper and lower cervical group. The amount of PPH was increased caudally. Air densities were observed in 26 cases at the SBTC, but none at the TIHTC. Conclusion Within the confines of the thyroid cartilage, surgeons are required to pay more attention to the status of hypopharynx/esophagus near the inferior horn of the thyroid cartilage. The hypopharynx/esophagus at the TIHTC is more likely to be exposed than at the upper and middle part of the thyroid cartilage, which may increase the risk of injury by pressure. Surgeons should be aware of the fact that the visceral component at C6-T1 surgeries also rotates as much as when the thyroid cartilage is engaged with a retractor. The esophagus at lower cervical levels warrants more careful retraction because it is not protected by the thyroid cartilage. PMID:21286476
MRI evaluation of tibial tunnel wall cortical bone formation after platelet-rich plasma applied during anterior cruciate ligament reconstruction
Rupreht, Mitja; Vogrin, Matjaž; Hussein, Mohsen
Background After anterior cruciate ligament (ACL) reconstruction, formation of cortical sclerotic bone encircling the femoral and tibial tunnel is a part of intratunnel graft healing. During the physiological cascades of soft tissue healing and bone growth, cellular and hormonal factors play an important role. The purpose of this study was to non-invasively but quantitatively assess the effect of intraoperatively applied platelet-rich plasma (PRP) on the formation of cortical bone encircling the tibial tunnel. Patients and methods In fifty patients, standard arthroscopic ACL reconstructions were performed. The PRP group (n = 25) received a local application of PRP while the control group (n = 25) did not receive PRP. The proximal tibial tunnel was examined by MRI in the paraxial plane where the portion of the tibial tunnel wall circumference consisting of sclerotic cortical bone was assessed with testing occurring at one, two and a half and six months after surgery. Results At one month after surgery, differences between the groups in the amount of cortical sclerotic bone encircling the tunnel were not significant (p = 0.928). At two and a half months, the sclerotic portion of the tunnel wall in the PRP group (36.2%) was significantly larger than in the control (22.5%) group (p = 0.004). At six months, the portion of sclerotic bone in the PRP group (67.1%) was also significantly larger than in the control (53.5%) group (p = 0.003). Conclusions Enhanced cortical bone formation encircling the tibial tunnel at 2.5 and 6 months after ACL graft reconstruction results from locally applied platelet-rich plasma. PMID:23801907
Myocardial Bridging of the Left Anterior Descending Coronary Artery: Depiction Rate and Morphologic Features by Dual-Source CT Coronary Angiography
Hwang, Jin Ho; Roh, Hong Gee; Song, Meong Gun; Shin, Je Kyoun; Chee, Hyun Kun; Kim, Joon Suk
Objective To evaluate the depiction rate and morphologic features of myocardial bridging (MB) of the left anterior descending coronary artery (LAD) using dual-source CT (DSCT). Materials and Methods CT scans from a total of 1,353 patients who underwent DSCT were reviewed retrospectively for LAD-MB. Seventy-eight patients were excluded due to poor image quality or poor enhancement of the coronary artery. The length and depth of the MB were analyzed and classified as superficial or deep with respect to the depth (? 1 or > 1 mm) of the LAD tunneled segment. Superficial MB was subdivided into complete or incomplete types according to full or partial encasement of the myocardium. Results Of the 1,275 patients included in this study, 557 cases of MB were found from 536 patients (42%). Superficial MB was observed in 368 of 557 (66%) cases, and deep MB was seen in 189 of 557 (34%) cases. Superficial MB showed 2 types: complete (128 of 368, 35%) and incomplete (240 of 368, 65%). The mean length of a tunneled segment for superficial MB was 16.4 ± 8.6 mm. The mean length and depth of a tunneled segment for deep MB were 27.6 ± 12.8 mm and 3.0 ± 1.4 mm, respectively. The incidence of atherosclerotic plaques in a 2-cm-long segment proximal to MB was 16%. Conclusion The depiction rate of LAD-MB using DSCT in a large series of patients was 42%, with two-thirds of MB segments being the superficial type. PMID:20808694
Donna Y. Deng; Matthew P. Rutman; Larissa V. Rodriguez; Shlomo Raz
The goal of repair is to restore pelvic anatomic support of the anterior vaginal wall. This is rarely an independent surgery.\\u000a Often, surgery entails addressing incontinence as well as prolapse of the uterus and posterior compartment. The end result\\u000a must restore anatomy and function by restoring normal vaginal axis and depth while preserving urinary, bowel, and sexual function.\\u000a Treatment of
Morphological aspects of myocardial bridges
Lujinovi?, Almira; Kulenovi?, Amela; Kapur, Eldan; Gojak, Refet
Although some myocardial bridges can be asymptomatic, their presence often causes coronary disease either through direct compression of the "tunnel" segment or through stimulation and accelerated development of atherosclerosis in the segment proximally to the myocardial bridge. The studied material contained 30 human hearts received from the Department of Anatomy. The hearts were preserved 3 to 5 days in 10% formalin solution. Thereafter, the fatty tissue was removed and arterial blood vessels prepared by careful dissection with special reference to the presence of the myocardial bridges. Length and thickness of the bridges were measured by the precise electronic caliper. The angle between the myocardial bridge fibre axis and other axis of the crossed blood vessel was measured by a goniometer. The presence of the bridges was confirmed in 53.33% of the researched material, most frequently (43.33%) above the anterior interventricular branch. The mean length of the bridges was 14.64±9.03 mm and the mean thickness was 1.23±1.32 mm. Myocardial bridge fibres pass over the descending blood vessel at the angle of 10-90 degrees. The results obtained on a limited sample suggest that the muscular index of myocardial bridge is the highest for bridges located on RIA, but that the difference is not significant in relation to bridges located on other branches. The results obtained suggest that bridges located on other branches, not only those on RIA, could have a great contractive power and, consequently, a great compressive force, which would be exerted on the wall of a crossed blood vessel. PMID:24289755
Anterior Myocardial Territory May Replace the Heart as Organ at Risk in Intensity-Modulated Radiotherapy for Left-Sided Breast Cancer
Tan Wenyong [Department of Radiotherapy, Hubei Cancer Hospital, Wuhan (China); Key Laboratory of Molecular Biophysics of the Ministry of Education, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan (China); Liu Dong [Department of Radiotherapy, Hubei Cancer Hospital, Wuhan (China); Xue Chenbin [Key Laboratory of Molecular Biophysics of the Ministry of Education, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan (China); Xu Jiaozhen; Li Beihui [Department of Radiotherapy, Hubei Cancer Hospital, Wuhan (China); Chen Zhengwang [Key Laboratory of Molecular Biophysics of the Ministry of Education, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan (China); Hu Desheng [Department of Radiotherapy, Hubei Cancer Hospital, Wuhan (China); Wang Xionghong, E-mail: firstname.lastname@example.com [Department of Radiotherapy, Hubei Cancer Hospital, Wuhan (China)
Purpose: We investigated whether the heart could be replaced by the anterior myocardial territory (AMT) as the organ at risk (OAR) in intensity-modulated radiotherapy (IMRT) of the breast for patients with left-sided breast cancer. Methods and Materials: Twenty-three patients with left-sided breast cancer who received postoperative radiation after breast-conserving surgery were studied. For each patient, we generated five IMRT plans including heart (H), left ventricle (LV), AMT, LV+AMT, and H+LV as the primary OARs, respectively, except both lungs and right breast, which corresponded to IMRT(H), IMRT(LV), IMRT(AMT), IMRT(LV+AMT), and IMRT(H+LV). For the planning target volumes and OARs, the parameters of dose-volume histograms were compared. Results: The homogeneity index, conformity index, and coverage index were not compromised significantly in IMRT(AMT), IMRT(LV) and IMRT(LV+ AMT), respectively, when compared with IMRT(H). The mean dose to the heart, LV, and AMT decreased 5.3-21.5% (p < 0.05), 19.9-29.5% (p < 0.05), and 13.3-24.5% (p < 0.05), respectively. Similarly, the low (e.g., V5%), middle (e.g., V20%), and high (e.g., V30%) dose-volume of the heart, LV, and AMT decreased with different levels. The mean dose and V10% of the right lung increased by 9.2% (p < 0.05) and 27.6% (p < 0.05), respectively, in IMRT(LV), and the mean dose and V5% of the right breast decreased significantly in IMRT(AMT) and IMRT(LV+AMT). IMRT(AMT) was the preferred plan and was then compared with IMRT(H+LV); the majority of dose-volume histogram parameters of OARs including the heart, LV, AMT, both lungs, and the right breast were not statistically different. However, the low dose-volume of LV increased and the middle dose-volume decreased significantly (p < 0.05) in IMRT(AMT). Also, those of the right lung (V10%, V15%) and right breast (V5%, V10%) decreased significantly (p < 0.05). Conclusions: The AMT may replace the heart as the OAR in left-sided breast IMRT after breast-conserving surgery to decrease the radiation dose to the heart.
Effects of angiotensin-converting enzyme inhibition and bradykinin peptides in rats with myocardial infarction
Qu, Zhe; Xu, Hongxin; Tian, Yihao
Background and objective: Angiotensin-converting enzyme (ACE) inhibitors have been reported to decrease myocardial remodeling and faciliate cardiac function improvement in the setting myocardial infarction by affecting bradykinin. The purpose of this study was to evaluate the combination effects of perindopril and bradykinin (BK) in rats with myocardial infarction. Methods: Wistar Rats underwent to left anterior descending (LAD) coronary artery ligation were allocated into MI group (n = 6); Perindopril group (n = 7); Perindopril + BK group (n = 7). An additional sham operation group (Sham group, n = 6) were also established. After 4 weeks, the left ventricle function, myocardial tissue morphology, myocardial collagen volume faction, infracted ventricular wall thickness, myocardial infarction area and neovascular formation were evaluated. Results: Combination treatment with perindopril and BK were showed significant improvement on LVEDV, LVEF and LVFS than MI group. Moreover, a significant improvement on LVEF was found in Perindopril + BK group than Perindopril group but not on LVEDV and LVFS between these two groups. Furthermore, neo-vessel density was significantly increased in Perindopril + BK group than other groups while no significant improvement on vessel density was found after the treatment of perindopril. In addition, myocardial infarction thickness improvement was found in Perindopril and group than MI group while combination treatment with perindopril and BK can significant improve the myocardial infarction thickness than perindopril only. Conclusions: Combination treatment with ACE inhibitor perindopril and BK can significantly improve the ventricle function in the rat model of myocardial infarction. Our data suggest BK can serve as adjuvant treatment in myocardial infarction treatment.
[Clinical significance of mitral valve insufficiency detected by Doppler echocardiography in acute myocardial infarction].
Kraska, T; Liszewska-Pfejfer, D; Dziduszko-Fedorko, E; Jakubowska-Najnigier, M; Opolski, G; Stanis?awska-Nielepkiewicz, J; Stawicki, S; Zawadzka-By?ko, M
Doppler echocardiography revealed in the third week of the recent myocardial infarction a pattern of mitral insufficiency in 27 (36%) of the 75 patients studied. Mitral insufficiency was usually associated with the more severe clinical course of myocardial infarction, with more frequent supraventricular and ventricular arrhythmias, heart failure, and with more extensive infarction area, as compared with the patients without mitral failure. A decreased contractibility of the left ventricle wall (especially in patients with anterior myocardial infarction accompanied by mitral insufficiency and enlargement ventricular dimension) may suggest its role in the development of mitral insufficiency in myocardial infarction. The results show the need of Doppler echocardiography in recent myocardial infarction to detect patients with an increased risk. PMID:2080111
Dyspareunia and chronic pelvic pain after polypropylene mesh augmentation for transvaginal repair of anterior vaginal wall prolapse
Lawrence L. Lin; Alexandra L. Haessler; Matt H. Ho; Lance H. Betson; Red M. Alinsod; Narender N. Bhatia
Synthetic mesh augmentations for pelvic floor reconstructive surgeries are increasing in usage and popularity. Many studies\\u000a are focusing on the anatomical success rates of transvaginal anterior compartment repairs with synthetic mesh, with minimal\\u000a attention on its postoperative complications. We present a case report on a 59-year-old postmenopausal woman who underwent\\u000a an anterior repair with 6×4-cm polypropylene mesh. Postoperatively, she developed
Rationale and Design of a Randomized, Double-Blind, Placebo-Controlled Clinical Trial to Evaluate the Efficacy of B-type Natriuretic Peptide For the Preservation of Left Ventricular Function Post Anterior Myocardial Infarction
Sangaralingham, S. Jeson; Burnett, John C.; McKie, Paul M.; Schirger, John A.; Chen, Horng H.
Background B-type natriuretic peptide (BNP) is a hormone with pleiotropic cardio-protective properties. Previously in our non-placebo controlled, un-blinded pilot study (BELIEVE) in human ST-elevation anterior acute myocardial infarction (AMI), a 72 hour intravenous infusion (IV) of recombinant human BNP (nesiritide) at a dose of 0.006 ug/kg/min suppressed plasma aldosterone and reduced cardiac dilatation while improved left ventricular ejection fraction (LV EF) at 1 month compared to baseline. Methods and Design The BELIEVE II study is a phase II, randomized, double-blind, placebo-controlled, single center clinical trial to assess the efficacy of 72 hour IV infusion of nesiritide therapy (0.006 ug/kg/min), in humans with first time ST-elevation anterior AMI and successful reperfusion, in preventing adverse LV remodeling and preserving LV function. A total of 60 patients will be randomized to placebo or nesiritide therapy. The primary efficacy endpoint is LV end-systolic and end-diastolic dimensions determined by MUGA scan between placebo and nesiritide group at 30 days; secondary endpoints include 30 day LV EF, diastolic function, infarct size, LV mass and combined total mortality and heart failure hospitalization. Conclusion This will be the first randomized, double-blind, placebo-controlled clinical trial that will assess the clinical efficacy of nesiritide in human ST-elevation anterior AMI. PMID:23910581
Segmental myocardial wall motion during minimally invasive coronary artery bypass grafting using open and endoscopic surgical techniques.
Mierdl, S; Byhahn, C; Lischke, V; Aybek, T; Wimmer-Greinecker, G; Dogan, S; Viehmeyer, S; Kessler, P; Westphal, Klaus
Current options for minimally invasive surgical treatment of single-vessel coronary artery disease include beating heart procedures without cardiopulmonary bypass (CPB) via mini-thoracotomy (MIDCAB) and totally endoscopic robot-assisted techniques (TECAB) with CPB. Both procedures are associated with potential myocardial stress before revascularization, such as single-lung ventilation (SLV), temporary coronary artery occlusion, cardiac luxation, intrathoracic carbon dioxide insufflation, and extended CPB and operating time. In this echocardiographic study we sought to evaluate the extent of intraoperative segmental wall motion abnormalities (SWMA) during MIDCAB and TECAB surgery and to identify factors affecting SWMA. Forty-six patients with single-vessel coronary artery disease were studied. Sixteen patients were operated using the MIDCAB technique and 30 patients with TECAB. In both groups sequential transesophageal echocardiograms were recorded during the entire procedure. Hemodynamic data and oxygenation variables were acquired simultaneously. In both groups, mild but obvious perioperative SWMA were identified and noted to increase during the course of the operation. These SWMA were more pronounced in the TECAB group. Independent of operating time, these changes disappeared completely after revascularization. No significant hemodynamic compromise was observed. We conclude that MIDCAB and TECAB techniques are associated with significant perioperative SWMA. The appearance of more profound SWMA in the TECAB group compared with the MIDCAB patients might have been the result of intrathoracic CO(2) insufflation, as SLV was used in both groups. No persistent SWMA or post-CPB SWMA were apparent in either group. More extensive intraoperative ventricular SWMA was detected in the TECAB group, suggesting that a more frequent risk for right ventricular dysfunction may exist during TECAB procedures. PMID:15673848
Biphasic thallium 201 SPECT-imaging for the noninvasive diagnosis of myocardial perfusion abnormalities in a child with Kawasaki disease--a case report
Hausdorf, G.; Nienaber, C.A.; Spielman, R.P.
The mucocutaneous lymph node syndrome (Kawasaki disease) is of increasing importance for the pediatric cardiologist, for coronary aneurysms with the potential of thrombosis and subsequent stenosis can develop in the course of the disease. The authors report a 2 1/2-year-old female child in whom, fourteen months after the acute phase of Kawasaki disease, myocardial infarction occurred. Biphasic thallium 201 SPECT-imaging using dipyridamole depicted anterior wall ischemia and inferolateral infarction. This case demonstrates that noninvasive vasodilation-redistribution thallium 201 SPECT-imaging has the potential to predict reversible myocardial perfusion defects and myocardial necrosis, even in small infants with Kawasaki disease.
Regional distribution of 123I-(ortho-iodophenyl)-pentadecanoic acid and 99Tcm-MIBI in relation to wall motion after thrombolysis for acute myocardial infarction.
Franken, P R; De Geeter, F; Dendale, P; Block, P; Bossuyt, A
To characterize the myocardium after thrombolytic therapy for infarction single photon emission computed tomographic (SPECT) studies with 123I-(ortho-iodophenyl)-pentadecanoic acid (oPPA) and 99Tcm-methoxyisobutyl isonitrile (MIBI) were obtained at rest in nine patients within a fortnight after the acute event. A decreased oPPA activity compared to MIBI was observed in 15/45 segments (7/9 patients). The segments with discordant oPPA/MIBI activities showed less severe wall motion abnormalities than the segments with concordant decreased oPPA and MIBI activities (P = 0.004). A significant association was found between discordant oPPA/MIBI activities and the early evolution of wall motion following thrombolysis: discordant oPPA/MIBI activities were present in nine of the 11 segments (82%) with improved wall motion, while the wall motion of the seven segments with similar decreased oPPA and MIBI activities was unchanged or had deteriorated (P = 0.018). It is concluded that metabolic abnormalities often persist longer than perfusion and wall motion abnormalities soon after thrombolysis, and that 123I-oPPA in combination with 99Tcm-MIBI is useful to demonstrate myocardial areas which have been salvaged by thrombolysis. PMID:8479672
Peritoneal fluid causing inferior attenuation on SPECT thallium-201 myocardial imaging in women
Rab, S.T.; Alazraki, N.P.; Guertler-Krawczynska, E.
On SPECT thallium images, myocardial left ventricular (LV) anterior wall attenuation due to breast tissue is common in women. In contrast, in men, inferior wall counts are normally decreased compared to anterior counts. The purpose of this report is to describe cases of inferior wall attenuation of counts in women caused by peritoneal fluid, not myocardial disease. Twelve consecutive SPECT thallium myocardial studies performed in women on peritoneal dialysis, being evaluated for kidney transplant, were included in this study. For all studies, 3.5 mCi 201Tl were injected intravenously. Thirty-two images were acquired over 180 degrees (45 degrees RAO progressing to 45 degrees LPO) at 40 sec per stop. SPECT images were reviewed in short axis, horizontal long and vertical long axes. Data were also displayed in bullseye format with quantitative comparison to gender-matched normal files. Ten of 12 female patients studied had inferior wall defects on images, confirmed by bullseye display. All patients had approximately 2 liters of peritoneal fluid. Review of planar rotational views showed diaphragm elevation and fluid margin attenuations affecting left ventricular inferior wall. Thus, peritoneal fluid is a cause of inferior attenuation on 201Tl cardiac imaging.
Early radionuclide scans for risk assessment in suspected acute myocardial infarction.
Norris, S. L.; Haywood, L. J.; Sobel, E.; Hung, G. L.; deGuzman, M.; Siegel, M.
First-day thallium-201 myocardial perfusion scans and technetium-99m RBC gated scintiangiography were performed during the initial clinical and prognostic evaluation of 69 patients with suspected acute myocardial infarction. Patients were monitored for clinical course, diagnosis confirmation, and use of specialty services (cardiac catheterization, percutaneous balloon angioplasty, and cardiac surgery) during hospitalization. Myocardial infarction, confirmed in 20 patients, was associated with significantly more left ventricular dilatation, lower ejection fractions, lower peak left ventricular filling rates, wall motion abnormalities, and thallium-201 perfusion defects than nonmyocardial infarction patients. Among all patients, left ventricular dilatation carried a relative risk of myocardial infarction of 5.8; low ejection fraction and right ventricular dilatation were strongly associated with myocardial infarction. A logistic model for congestive heart failure included: left ventricular dilation, lower mean left ventricular filling rates and time to peak filling rates, and abnormal thallium-201 lung:heart uptakes. Among nonmyocardial infarction patients, subsequent cardiac catheterization was predicted by the presence of anterior thallium-201 perfusion defects, Killip functional class II-III, and ischemia on ECG. These findings suggest that early detection of myocardial perfusion defects and cardiac dysfunction by radionuclide scans enhances initial evaluation of suspected acute myocardial infarction patients. Additional studies are needed to confirm these findings. PMID:9433058
Chronic instrumentation and its lack of effect on the hemodynamics and regional myocardial blood flow of conscious dogs.
Inou, T; Tomoike, H; Watanabe, K; Mizukami, M; Kikuchi, Y; Nakamura, M
The effects of chronic instrumentation on regional myocardial performance and regional myocardial blood flow were studied in 8 mongrel dogs. Regional segment lengths were measured by an ultrasonic dimension gauge technique at two areas of the left anterior descending coronary artery (LAD) and left circumflex coronary artery (LCX). Regional myocardial blood flow was measured by a tracer microsphere technique. These measurements were repeated while the animals were conscious on the 4th, 11th, 21st and 28th days after instrumentation. On the 4th day, the heart rate was rather high and regional shortening at both the LAD and LCX areas remained suppressed. After the 11th day, hemodynamic variables such as heart rate, left ventricular pressure and regional wall motion were fairly constant. Regional myocardial blood flow and its distribution were also constant throughout the experimental period. Fibrosis of the epicardium invariably induced by surgical procedures did not affect the distribution of regional blood flow as compared with that of the interventricular septum. Thus, a stable hemodynamic state was recorded after the 11th day following surgical manipulation and the implantation of sensors and catheters did not affect the level of regional myocardial blood flow or its distribution at rest. Such long term reproducible measurements of regional wall motion and regional myocardial blood flow may facilitate chronic studies of cardiovascular physiology. PMID:3159917
Dosimetric Comparison of Intensity-Modulated Radiotherapy Plans, With or Without Anterior Myocardial Territory and Left Ventricle as Organs at Risk, in Early-Stage Left-Sided Breast Cancer Patients
Tan Wenyong [Key Laboratory of Molecular Biophysics of the Ministry of Education, Huazhong University of Science and Technology College of Life Science and Technology, Wuhan (China); Wang Xiaohong; Qiu Dasheng [Department of Radiotherapy, Hubei Cancer Hospital, Wuhan (China); Liu Dong [Department of Radiology, Hubei Cancer Hospital, Wuhan (China); Jia Shaohui; Zeng Fanyu [Department of Radiotherapy, Hubei Cancer Hospital, Wuhan (China); Chen Zhengwang [Key Laboratory of Molecular Biophysics of the Ministry of Education, Huazhong University of Science and Technology College of Life Science and Technology, Wuhan (China); Li Beihui; Xu Jiaozhen; Wei Lai [Department of Radiotherapy, Hubei Cancer Hospital, Wuhan (China); Hu Desheng, E-mail: firstname.lastname@example.com [Department of Radiotherapy, Hubei Cancer Hospital, Wuhan (China)
Purpose: We evaluated heart sparing using an intensity-modulated radiotherapy (IMRT) plan with the left ventricle (LV) and/or the anterior myocardial territory (AMT) as additional organs at risk (OARs). Methods and Materials: A total of 10 patients with left-sided breast cancer were selected for dosimetric planning. Both lungs, the right breast, heart, LV, and AMT were defined as OARs. We generated one tangential field plan and four IMRT plans for each patient. We examined the dose-volume histogram parameters of the planning target volume and OARs. Results: Compared with the tangential field plan, the mean dose to the heart in the IMRT plans did not show significant differences; however, the dose to the AMT and LV decreased by 18.7-45.4% and 10.8-37.4%, respectively. The maximal dose to the heart decreased by 18.6-35.3%, to the AMT by 22.0-45.1%, and to the LV by 23.5-45.0%, And the relative volumes of the heart (V{sub {>=}12}), AMT (V{sub >11}) and LV (V{sub >10}) decreased significantly with different levels, respectively. The volume of the heart, AMT, LV, both lungs, and right breast receiving {>=}5 Gy showed a significant increase. Compared with the IMRT (H) plan, the mean dose to the heart, AMT, and LV decreased by 17.5-21.5%, 25.2-29.8%, and 22.8-29.8% and the maximal dose by 13.6-20.6%, 23.1-29.6%, and 17.3-29.1%, respectively. The IMRT plans for both lungs and the right breast showed no significant differences. Conclusions: The IMRT plans with the addition of the AMT and/or LV as OARs considerably increased heart sparing. We recommend including the LV as an additional OAR in such plans.
iPSC-derived human mesenchymal stem cells improve myocardial strain of infarcted myocardium
Miao, Qingfeng; Shim, Winston; Tee, Nicole; Lim, Sze Yun; Chung, Ying Ying; Ja, K P Myu Mia; Ooi, Ting Huay; Tan, Grace; Kong, Geraldine; Wei, Heming; Lim, Chong Hee; Sin, Yoong Kong; Wong, Philip
We investigated global and regional effects of myocardial transplantation of human induced pluripotent stem cell (iPSC)-derived mesenchymal stem cells (iMSCs) in infarcted myocardium. Acute myocardial infarction (MI) was induced by ligation of left coronary artery of severe combined immunodeficient mice before 2 × 105 iMSCs or cell-free saline were injected into peri-infarcted anterior free wall. Sham-operated animals received no injection. Global and regional myocardial function was assessed serially at 1-week and 8-week by segmental strain analysis by using two dimensional (2D) speckle tracking echocardiography. Early myocardial remodelling was observed at 1-week and persisted to 8-week with global contractility of ejection fraction and fractional area change in saline- (32.96 ± 14.23%; 21.50 ± 10.07%) and iMSC-injected (32.95 ± 10.31%; 21.00 ± 7.11%) groups significantly depressed as compared to sham control (51.17 ± 11.69%, P < 0.05; 34.86 ± 9.82%, P < 0.05). However, myocardial dilatation was observed in saline-injected animals (4.40 ± 0.62 mm, P < 0.05), but not iMSCs (4.29 ± 0.57 mm), when compared to sham control (3.74 ± 0.32 mm). Furthermore, strain analysis showed significant improved basal anterior wall strain (28.86 ± 8.16%, P < 0.05) in the iMSC group, but not saline-injected (15.81 ± 13.92%), when compared to sham control (22.18 ± 4.13%). This was corroborated by multi-segments deterioration of radial strain only in saline-injected (21.50 ± 5.31%, P < 0.05), but not iMSC (25.67 ± 12.53%), when compared to sham control (34.88 ± 5.77%). Improvements of the myocardial strain coincided with the presence of interconnecting telocytes in interstitial space of the infarcted anterior segment of the heart. Our results show that localized injection of iMSCs alleviates ventricular remodelling, sustains global and regional myocardial strain by paracrine-driven effect on neoangiogenesis and myocardial deformation/compliance via parenchymal and interstitial cell interactions in the infarcted myocardium. PMID:24974908
Subacute left ventricular free-wall rupture in early course of acute myocardial infarction. Clinical report of two cases and review of the literature.
Varbella, F; Bongioanni, S; Sibona Masi, A; Iazzolino, E; Alunni, G; Conte, M R; Brusca, A
Left ventricular free wall rupture (LVFWR) may complicate an acute myocardial infarction (AMI); its frequency ranges from 1 to 6 percent. In the era of coronary care units, LVFWR is the second cause of in-hospital death, after pump failure. The subacute presentation accounts for 2-3 percent of total hospital admissions for AMI. Heart rupture may not be suddenly fatal and sometimes there is enough time for surgical repair. Electromechanical dissociation is neither the only nor the main clinical presentation. More subtle symptoms occurring hours or days before the final event include unexplained hypotension and transient bradycardia and some ECG features such as persistent ST-segment elevation with T-waves failing to invert in the same leads. On echocardiographic subcostal view, pericardial effusion of more than 5-10 mm, with echo-dense masses overlying the heart independently of cardiac tamponade, is highly suggestive of heart rupture. If pericardiocentesis yields hemorrhagic fluid, surgical intervention is mandatory, providing both diagnostic confirmation and definitive treatment. Medical management strategies (prolonged bed rest, beta-blockade therapy) are still experimental but could become suitable for particular subsets of patients (elderly patients and patients at a high surgical risk). We report two cases of subacute LVFWR and review the currently available literature. PMID:10088074
Heart rate variability in the early hours of an acute myocardial infarction.
Lombardi, F; Sandrone, G; Spinnler, M T; Torzillo, D; Lavezzaro, G C; Brusca, A; Malliani, A
The occurrence of an autonomic disturbance early in acute myocardial infarction (AMI) has been reported: signs of sympathetic activation were mainly observed in relation to an anterior localization, whereas signs of vagal overactivity were more frequent in inferior wall AMI. Information is limited in relation to the persistence of these alterations during the early hours of AMI. We studied 33 patients with an AMI within 188 +/- 16 minutes from the onset of symptoms and 1 week after hospital admission. From a 20-minute Holter recording, we computed with autoregressive methodology, time and frequency domain indexes of heart rate variability. At admission, patients with an anterior wall AMI exhibited a smaller RR variance (593 +/- 121 ms2) than did those with an inferior wall AMI (1,122 +/- 191 ms2). In both groups the spectral profile was characterized by a predominant (73 +/- 4 and 61 +/- 4 normalized units) low frequency and by a small (13 +/- 2 and 22 +/- 3 normalized units) high-frequency component, indicating the presence of a sympathetic excitation and of a diminished vagal modulation. Although signs of sympathetic activation were more evident in patients with anterior wall AMI, no evidence of a vagal hyperactivity was observed in patients with inferior wall AMI. In the latter group, we noticed 1 week after the acute event an increase in the low-frequency component, which reached the values observed in patients with anterior wall AMI. Thrombolysis did not affect heart rate variability parameters. Thus, this study suggests the presence of an autonomic disturbance characterized by signs of sympathetic excitation and of a reduced vagal modulation, which was more evident in patients with an anterior localization early after AMI. PMID:8644654
Noninvasive Assessment of Myocardial Mechanics of the Left Ventricle in Rabbits Using Velocity Vector Imaging
Zhou, Jia; Pu, Da-Rong; Tian, Lei-Qi; Tong, Hai; Liu, Hong-Yu; Tang, Yan; Zhou, Qi-Chang
Background Our study aimed to investigate the feasibility of velocity vector imaging (VVI) to analyze left ventricular (LV) myocardial mechanics in rabbits at basal state. Material/Method The animals used in this study were 30 New Zealand white rabbits. All rabbits underwent routine echocardiography under VVI-mode at basal state. The 2-dimensional (2-D) echocardiography images acquired included parasternal left long-axis views and short-axis views at the level of LV mitral valve, papillary muscles, and apex. Images were analyzed by VVI software. Results At basal state, longitudinal LV velocity decreased from the basal to the apical segment (P<0.05). In the short axis direction, the highest peak myocardial velocity was found between the anterior septum and anterior wall for each segment at the same level; the peak strains and strain rates (SR) were the highest in the anterior and lateral wall compared to other segments (all P<0.05). During systole, LV base rotated in a clockwise direction and LV apex rotated in a counter-clockwise direction, while during diastole, both LV base and apex rotated in the direction opposite to systole. The rotation angle, rotation velocity and unwinding velocity in the apical segment were greater than the basal segment (P<0.05). Conclusions VVI is a reliable tool for evaluating LV myocardial mechanics in rabbits at basal state, and the LV long-axis short-axis and torsional motions reflect the normal regular patterns. Our study lays the foundation for future experimental approaches in rabbit models and for other applications related to the study of human myocardial mechanics. PMID:26031608
Myocardial Infarction and Functional Outcome Assessment in Pigs
Koudstaal, Stefan; Jansen of Lorkeers, Sanne J.; Gho, Johannes M.I.H.; van Hout, Gerardus P.J; Jansen, Marlijn S.; Gründeman, Paul F.; Pasterkamp, Gerard; Doevendans, Pieter A.
Introduction of newly discovered cardiovascular therapeutics into first-in-man trials depends on a strictly regulated ethical and legal roadmap. One important prerequisite is a good understanding of all safety and efficacy aspects obtained in a large animal model that validly reflect the human scenario of myocardial infarction (MI). Pigs are widely used in this regard since their cardiac size, hemodynamics, and coronary anatomy are close to that of humans. Here, we present an effective protocol for using the porcine MI model using a closed-chest coronary balloon occlusion of the left anterior descending artery (LAD), followed by reperfusion. This approach is based on 90 min of myocardial ischemia, inducing large left ventricle infarction of the anterior, septal and inferoseptal walls. Furthermore, we present protocols for various measures of outcome that provide a wide range of information on the heart, such as cardiac systolic and diastolic function, hemodynamics, coronary flow velocity, microvascular resistance, and infarct size. This protocol can be easily tailored to meet study specific requirements for the validation of novel cardioregenerative biologics at different stages (i.e. directly after the acute ischemic insult, in the subacute setting or even in the chronic MI once scar formation has been completed). This model therefore provides a useful translational tool to study MI, subsequent adverse remodeling, and the potential of novel cardioregenerative agents. PMID:24796715
Quantification of diagnostic accuracy using nitrate enhanced Tc-99m sestamibi gated myocardial SPECT in assessing myocardial viability: prospective analysis.
Khan, Zahid Rahman; Syed, Aitizazuddin; Noor, Lubna; Shah, Syed Sadiq; Hafizullah, Mohammad
The aim of this prospective study was to assess myocardial viability with nitrate-enhanced Tc-99m sestamibi gated single-photon emission computed tomography in patients with known coronary artery disease. We enrolled 48 consecutive patients (39 men, 9 women) aged 24-82 years, with coronary artery disease and history of myocardial infarction. A Tc-99m sestamibi study was conducted at rest as baseline, followed by a nitrate-enhanced study the next day. Of 960 segments analyzed, 244 of 480 in the left anterior descending coronary artery territory showed viability on the baseline study, and 276 were viable according to the nitrate-enhanced study. Similarly, of 192 right coronary segments analyzed, 148 showed viability on the baseline study compared to 153 on the nitrate study. Of 288 left circumflex territory segments analyzed, 206 showed viability on the baseline study compared to 241 on the nitrate study. The overall improvement of viability with the nitrate study was 12.04%. On the gated studies, the overall improvement with nitrate was 2.02%. The gated study also allowed grading of wall motion and thickness. It was concluded that nitrate-augmented Tc-99m sestamibi myocardial imaging significantly improved the detection of hibernating myocardium, with gated images further improving the accuracy of detection in borderline cases. PMID:22499958
Myocardial perfusion imaging using contrast echocardiography.
Pathan, Faraz; Marwick, Thomas H
Microbubbles are an excellent intravascular tracer, and both the rate of myocardial opacification (analogous to coronary microvascular perfusion) and contrast intensity (analogous to myocardial blood volume) provide unique insights into myocardial perfusion. A strong evidence base has been accumulated to show comparability with nuclear perfusion imaging and incremental diagnostic and prognostic value relative to wall motion analysis. This technique also provides the possibility to measure myocardial perfusion at the bedside. Despite all of these advantages, the technique is complicated, technically challenging, and has failed to scale legislative and financial hurdles. The development of targeted imaging and therapeutic interventions will hopefully rekindle interest in this interesting modality. PMID:25817740
Sternal Cleft and Pectus Excavatum: A Combined Approach for the Correction of a Complex Anterior Chest Wall Malformation in a Teenager.
Tocchioni, Francesca; Ghionzoli, Marco; Lo Piccolo, Roberto; Deaconu, Diana E; Facchini, Flavio; Milanez De Campos, Jose R; Messineo, Antonio
Congenital sternal cleft is a rare chest wall malformation. Because of the flexibility of the chest in infants, surgical repair should be performed by primary closure in the neonatal period. In adolescents and adults, different techniques have been suggested to overcome the lack of sternal bone tissue. We describe a very rare case of an 18-year-old woman with a complete bifid sternum associated with pectus excavatum for whom a satisfactory cosmetic and functional result was obtained by adequate surgical planning, which entailed a combination of two standardized surgical techniques. PMID:26046903
A Tissue Engineering Approach to Progenitor Cell Delivery Results in Significant Cell Engraftment and Improved Myocardial Remodeling
Simpson, David; Liu, Hong; Fan, Tai-Hwang Michael; Nerem, Robert; Dudley, Samuel C.
Cell replacement therapy has become an attractive solution for myocardial repair. Typical cell delivery techniques, however, suffer from poor cell engraftment and inhomogeneous cell distributions. Therefore, we assessed the hypothesis that an epicardially applied, tissue-engineered cardiac patch containing progenitor cells would result in enhanced exogenous cell engraftment. Human mesenchymal stem cells (hMSCs) were embedded into a rat tail type I collagen matrix to form the cardiac patch. Myocardial infarction was induced by left anterior descending coronary artery ligation in immunocompetent male cesarean-derived fischer rats, and patches with or without cells were secured to hearts with fibrin sealant. After patch formation, hMSCs retained a viability of >90% over 5 days in culture. In addition, >75% of hMSCs maintained a high degree of potency prior to patch implantation. After 4 days in culture, patches were applied to the epicardial surface of the infarct area and resulted in 23% ± 4% engraftment of hMSCs at 1 week (n = 6). Patch application resulted in a reduction in left ventricle interior diameter at systole, increased anterior wall thickness, and a 30% increase in fractional shortening. Despite this improvement in myocardial remodeling, hMSCs were not detectable at 4 weeks after patch application, implying that improvement did not require long-term cell engraftment. Patches devoid of progenitor cells showed no improvement in remodeling. In conclusion, pluripotent hMSCs can be efficiently delivered to a site of myocardial injury using an epicardial cardiac patch, and such delivery results in improved myocardial remodeling after infarction. PMID:17525236
Naloxone improves functional recovery of myocardial stunning in conscious dogs through its action on the central nervous system.
Weber, T P; Stypmann, J; Meissner, A; Hartlage, M G; Van Aken, H; Rolf, N
This study tests the hypothesis that naloxone, but not its quarternary salt, naloxone methiodide (which does not enter the central nervous system), improves recovery from myocardial stunning in conscious dogs. Twenty dogs were chronically instrumented for measurement of heart rate, left atrial, aortic and left ventricular pressure (LVP), LV dP x dtmax(-1) and myocardial wall thickening fraction (WTF). Regional myocardial blood flow was determined with coloured microspheres. Occluder around the left anterior descending artery (LAD) allowed induction of reversible LAD ischaemia. Each of the 20 dogs underwent two LAD ischaemic challenges. Experiments (performed on separate days, in crossover fashion) were: (i) 10 min of LAD occlusion after application of naloxone 63 microg kg(-1) or naloxone methiodide 63 microg kg(-1) and (ii) occlusion without naloxone or naloxone methiodide. WTF was measured at baseline and until complete recovery occurred. LAD ischaemia significantly reduced LAD WTF with (mean (SD) 54 (15)% lower than baseline) and without naloxone (55 (16)% lower than baseline), without significant haemodynamic differences. Between I to 30 min of reperfusion, WTF was significantly higher with naloxone (P < 0.05). There was no difference in WTF with or without naloxone methiodide. We conclude that naloxone improved recovery from myocardial stunning in conscious dogs, and that this was centrally mediated. PMID:11573630
The effects of thoracic epidural anesthesia on functional recovery from myocardial stunning in propofol-anesthetized dogs.
Rolf, N; Meissner, A; Van Aken, H; Weber, T P; Hammel, D; Möllhoff, T
The purpose of this investigation was to examine the effects of thoracic epidural anesthesia (TEA) on myocardial stunning during propofol anesthesia. Six dogs were chronically instrumented for measurement of left atrial, aortic, and left ventricular pressure, maximal rate of increase of left ventricular pressure, and myocardial wall-thickening fraction (WTF). Myocardial blood flow was determined with colored microspheres. Experiments were performed on separate days with 1) 10 min of left anterior descending artery (LAD) ischemia during propofol anesthesia without TEA, and 2) 10 min of LAD ischemia during propofol anesthesia with TEA. WTF was measured as baseline (BL) prior to propofol anesthesia and at predetermined time points until complete recovery from stunning. Propofol anesthesia caused a significant decrease of WTF in the LAD-perfused myocardium (LAD-WTF) compared to BL in awake animals. LAD ischemia led to a further significant decrease of LAD-WTF. There were no significant differences in LAD-WTF between the two experimental conditions at any of the time points measured. TEA did not change subendocardial blood flow in nonischemic myocardium. During ischemia neither the subendocardial/subepicardial nor the occluded/normal zone blood flow ratio were affected by TEA. After myocardial ischemia during propofol anesthesia TEA does not affect functional recovery of stunned myocardium in dogs. PMID:9085946
Recovery from myocardial stunning is faster with desflurane compared with propofol in chronically instrumented dogs.
Meissner, A; Weber, T P; Van Aken, H; Zbieranek, K; Rolf, N
Volatile anesthetics exert a protective role in myocardial ischemia. An increase in sympathetic tone might exert deleterious effects on the ischemic myocardium. The use of the volatile anesthetic desflurane in myocardial ischemia is controversial because of its sympathetic activation. We compared propofol and desflurane on myocardial stunning in chronically instrumented dogs. Mongrel dogs (n = 8) were chronically instrumented for measurement of heart rate, left atrial, aortic, and left ventricular pressure, rate of rise of left ventricular pressure, and myocardial wall-thickening fraction (WTF). An occluder around the left anterior descending artery (LAD) allowed the induction of reversible LAD-ischemia. Two experiments were performed in a cross-over fashion on separate days: 1) Induction of 10 min of LAD-ischemia during desflurane anesthesia and 2) Induction of 10 min of LAD-ischemia during propofol anesthesia. Both anesthetics were discontinued immediately after completion of ischemia. WTF was measured at predetermined time points until complete recovery from ischemic dysfunction occurred. Both anesthetics caused a significant decrease of WTF in the LAD-perfused myocardium. LAD-ischemia led to a further significant decrease of LAD-WTF in both groups. During the first 3 h of reperfusion, WTF was significantly larger in the desflurane group. Mean arterial pressure and heart rate were greater during ischemia and the first 10 min of reperfusion in the desflurane group compared with the propofol group. Recovery from myocardial stunning in dogs was faster when desflurane was used at the time of ischemia as compared with propofol anesthesia. The mechanism for this difference is unclear, but sympathetic activation by desflurane was not a limiting factor for ischemic tolerance in chronically instrumented dogs. PMID:11093975
Thoracic epidural anesthesia improves functional recovery from myocardial stunning in conscious dogs.
Rolf, N; Van de Velde, M; Wouters, P F; Möllhoff, T; Weber, T P; Van Aken, H K
The effects of thoracic epidural anesthesia (TEA) on the contractile performance of ischemic and postischemic myocardium have not been well investigated. The purpose of this investigation was to examine the effects of TEA on severity and duration of myocardial stunning in an experimental model for sublethal acute myocardial ischemia. Seven dogs were chronically instrumented for measurement of heart rate (HR), left atrial (LAP), aortic and left ventricular pressure (LVP), LV dP/dtmax' and myocardial wall-thickening fraction (WTF). An occluder around the left anterior descending artery (LAD) allowed induction of reversible LAD ischemia. TEA was performed with lidocaine 4 mg/kg through a chronically implanted epidural catheter at the second thoracic level. Regional myocardial blood flow was determined with colored microspheres. Two experiments were performed in a cross-over design on separate days: Experiment 1, induction of 10 min of LAD ischemia without TEA; and Experiment 2, induction of 10 min of LAD ischemia with TEA. WTF was measured at baseline (BL) and predetermined time points until complete recovery from ischemic dysfunction occurred. LAD ischemia caused a significant decrease of LAD-WTF with (-28% +/- 5.1% versus BL) and without TEA (-15.5% +/- 5.3% versus BL). After 3 h of reperfusion, WTF as percent of BL values was significantly higher with TEA (P < 0.001). BL values of WTF were reached after 24 h with TEA and after more than 48 h without TEA (P < 0.05). There were no significant differences for mean arterial pressure (MAP), heart rate (HR), LVP, LAP, and LVdP/dtmax between the groups during ischemia and reperfusion. In nonischemic myocardium TEA caused an increase of subendocardial blood flow. During ischemia neither the subendocardial/subepicardial nor the occluded/ normal zone blood flow was affected by TEA. TEA attenuates myocardial stunning in conscious dogs. This finding is consistent with data regarding a reduction of infarct size due to TEA. PMID:8895266
[Characteristics of left ventricular regional wall relaxation at the infarction site].
Kanamasa, K; Ishikawa, K; Osato, S; Ogai, T; Oda, A; Kadowaki, H; Ogawa, I; Katori, R
In order to investigate relaxation characteristics of the infarcted wall, segment lengths of the left ventricular wall were calculated in 6 patients with anterior myocardial infarction and in 9 angiographically normal subjects. The biplane left coronary cineangiography was performed and coordinates of ramifying points of the left coronary artery on the infarcted or non-infarcted wall were measured and the spatial lengths (segment lengths) on each wall were calculated. If the two points are on the left anterior descending artery (LAD) in infarcted patients, a calculated length is regarded as a segment length in the infarcted portion, while if the length is calculated between the two points located on the coronary artery other than LAD, it is a non-infarcted segment. Each segment length was calculated in frame by frame covering one cardiac cycle. The maximum length (Lmax), minimum length (Lmin) and the length at the beginning of P wave of the electrocardiogram (LECG P) were calculated. The extent of relaxation of the segment caused by atrial kick was calculated as (Lmax--LECG P)/Lmax X 100, (% delta Lla). This value was 2.8 +/- 1.5 and 3.5 +/- 1.4% on anterior and inferior walls, respectively, in 9 normal subjects and 3.6 +/- 1.2 and 4.0 +/- 0.9% in 6 patients with anterior infarction, revealing no significant difference among 4 values. This indicates that the amount of lengthening of the segment by atrial kick remains unchanged even if the wall is infarcted. The extent of diastolic lengthening of the segment by rapid and slow fillings, which excludes atrial filling, was calculated as (LECG P--Lmin)/Lmax X 100, (% delta L1-la).(ABSTRACT TRUNCATED AT 250 WORDS) PMID:6678953
Extraction of Myocardial Contractility Patterns From Short-Axes MR Images Using
Frangi, Alejandro
firstname.lastname@example.com Abstract. Regional myocardial wall motion analysis has been used in clinical sequence. Two most important phases for myocardial contrac- tion are the end-diastole (ED), or the start of contraction, and the end-systole (ES), or the end of contraction. Abnormal myocardial contraction is mainly
Ultrasound targeted microbubble destruction promotes angiogenesis and heart function by inducing myocardial microenvironment change.
Ling, Zhi-Yu; Shu, Shi-yu; Zhong, Shi-Gen; Luo, Jie; Su, Li; Liu, Zeng-Zhang; Lan, Xian-Bin; Yuan, Geng-Biao; Zheng, Yuan-Yi; Ran, Hai-Tao; Wang, Zhi-Gang; Yin, Yue-Hui
The myocardial microenvironment plays a decisive role in the survival, migration and differentiation of stem cells. We studied myocardial micro-environmental changes induced by ultrasound-targeted microbubble destruction (UTMD) and their influence on the transplantation of mesenchymal stem cells (MSCs). Various intensities of ultrasound were applied to the anterior chest in canines with myocardial infarction after intravenous injection of microbubbles. The expression of cytokines and adhesion molecules in the infarcted area of the myocardium was detected after three sessions of UTMD in 1 wk. Real-time quantitative reverse transcription polymerase chain reaction (RTQ-PCR) showed that the expression of vascular cell adhesion molecule-1 (VCAM-1), stromal cell-derived factor-1 (SDF-1) and vascular endothelial growth factor (VEGF) in the 1.5 W/cm(2) and 1 W/cm(2) groups was markedly increased compared with the 0.5 W/cm(2) or the control groups (3.8- to 4.7-fold, p < 0.01), and the expression of interleukin-1? (IL-1?) in the 1.5 W/cm(2) group was increased twofold over the 1.0 W/cm(2) group, whereas the 0.5 W/cm(2) group experienced no significant changes. UTMD at 1.0 W/cm(2) was performed as previously described before mesenchymal stem cell (MSC) transplantation. Myocardial perfusion, angiogenesis and heart function were investigated before and 1 month after MSC transplantation. Coronary angiography and 99mTc-tetrofosmin scintigraphy revealed that myocardial perfusion was markedly improved after UTMD + MSCs treatment (p < 0.05). At echocardiographic analysis, heart function and the wall motion score index were significantly improved by UTMD + MSCs treatment compared with MSCs or UTMD alone and the control. In a canine model of myocardial infarction, therapeutic effects were markedly enhanced by MSC transplantation after the myocardial micro-environmental changes induced by UTMD; therefore, this novel method may be useful as an efficient approach for cellular therapy. PMID:23969167
Relationship between myocardial bridging and coronary arteriosclerosis.
Sun, Jian Ling; Huang, Wei Min; Guo, Ji Hong; Li, Xiao Ying; Ma, Xian Lin; Wang, Chong Yu
The objective of the study was to explore the prevalence and characteristics of myocardial bridging in patients who underwent coronary angiography and to also evaluate the correlation between bridged coronary segments and atherosclerosis. For this purpose, clinical materials of 1,500 patients who had received coronary angiography were retrospectively analyzed. The location and length of the myocardial bridge were recorded as well as the extent and location of coronary artery stenosis was described. Segments proximal and distal to the bridging were evaluated for coronary arteriosclerosis as were the remaining coronary segments. We found that myocardial bridging was present in 179 (11.9 %) patients. Bridges were frequently (84.9 %) localized in the mid-distal segment of the left anterior descending (LAD) artery. Myocardial bridging was not considered a significant risk factor for coronary atherosclerosis (odds ratio 0.58) compared with traditional cardiovascular risk factors. The incidence of coronary arteriosclerosis in the distal segments was significantly less affected than the proximal segments (P < 0.01). It was, therefore, concluded that myocardial bridging frequently localized in the mid-distal segment of the LAD artery. The presence of myocardial bridging promotes proximal atherosclerosis but it is not an additional risk factor for coronary atherosclerosis. PMID:23076634
Transcatheter Embolization of a Coronary Fistula Originating from the Left Anterior Descending Artery by Using N-Butyl 2-Cyanoacrylate
Karagoz, Tevfik; Celiker, Alpay [Hacettepe University, Faculty of Medicine, Section of Pediatric Cardiology (Turkey)], E-mail: firstname.lastname@example.com, E-mail: email@example.com; Cil, Barbaros; Cekirge, Saruhan [Hacettepe University, Faculty of Medicine, Department of Radiology (Turkey)
In this report, we describe a successful percutaneous transcatheter n-butyl 2-cyanoacrylate embolization of a coronary fistula originating from the left anterior descending artery in an adolescent with unexpected recurrent attacks of myocardial ischemia.
Transient integral boundary layer method to calculate the translesional pressure drop and the fractional flow reserve in myocardial bridges
Bernhard, Stefan; Möhlenkamp, Stefan; Tilgner, Andreas
Background The pressure drop – flow relations in myocardial bridges and the assessment of vascular heart disease via fractional flow reserve (FFR) have motivated many researchers the last decades. The aim of this study is to simulate several clinical conditions present in myocardial bridges to determine the flow reserve and consequently the clinical relevance of the disease. From a fluid mechanical point of view the pathophysiological situation in myocardial bridges involves fluid flow in a time dependent flow geometry, caused by contracting cardiac muscles overlying an intramural segment of the coronary artery. These flows mostly involve flow separation and secondary motions, which are difficult to calculate and analyse. Methods Because a three dimensional simulation of the haemodynamic conditions in myocardial bridges in a network of coronary arteries is time-consuming, we present a boundary layer model for the calculation of the pressure drop and flow separation. The approach is based on the assumption that the flow can be sufficiently well described by the interaction of an inviscid core and a viscous boundary layer. Under the assumption that the idealised flow through a constriction is given by near-equilibrium velocity profiles of the Falkner-Skan-Cooke (FSC) family, the evolution of the boundary layer is obtained by the simultaneous solution of the Falkner-Skan equation and the transient von-Kármán integral momentum equation. Results The model was used to investigate the relative importance of several physical parameters present in myocardial bridges. Results have been obtained for steady and unsteady flow through vessels with 0 – 85% diameter stenosis. We compare two clinical relevant cases of a myocardial bridge in the middle segment of the left anterior descending coronary artery (LAD). The pressure derived FFR of fixed and dynamic lesions has shown that the flow is less affected in the dynamic case, because the distal pressure partially recovers during re-opening of the vessel in diastole. We have further calculated the wall shear stress (WSS) distributions in addition to the location and length of the flow reversal zones in dependence on the severity of the disease. Conclusion The described boundary layer method can be used to simulate frictional forces and wall shear stresses in the entrance region of vessels. Earlier models are supplemented by the viscous effects in a quasi three-dimensional vessel geometry with a prescribed wall motion. The results indicate that the translesional pressure drop and the mean FFR compares favourably to clinical findings in the literature. We have further shown that the mean FFR under the assumption of Hagen-Poiseuille flow is overestimated in developing flow conditions. PMID:16790065
Myocardial infarction in young people with normal coronary arteries
Williams, M; Restieaux, N; Low, C
Myocardial infarction occurring in young people with angiographically normal coronary arteries is well described but the pathophysiology of this condition remains unknown. Coronary artery spasm in association with thrombus formation and minimal atheromatous disease or spontaneous coronary artery dissection are possible causes. Two young men presented with severe chest pain after acute alcohol intoxication and each sustained an extensive anterior myocardial infarction. Investigations including intravascular ultrasound showed no evidence of atherosclerotic coronary artery disease. Coronary artery spasm associated with acute alcohol intoxication as well as a prothrombotic state and endothelial damage related to cigarette smoking may be mechanisms leading to acute myocardial infarction in these cases. Acute myocardial infarction occurs in young persons with normal coronary arteries and the diagnosis should be considered in young patients presenting with severe chest pain, particularly those abusing cocaine or alcohol, so that reperfusion therapy can be initiated promptly.?? Keywords: myocardial infarction; coronary vasospasm; alcohol; intravascular ultrasound PMID:9538315
Precision of Myocardial Contour Estimation from Tagged MR Images with a
Atalar, Ergin
Precision of Myocardial Contour Estimation from Tagged MR Images with a "Black-Blood" Technique P identification (ie, endocardium and epicar- dium) for the calculation of gross myocardial wall thick- ening. More the intrinsic motion within the myocar- dial wall. MR tagging produces localized perturbations of magnetization
Ablation of C/EBP homologous protein increases the acute phase mortality and doesn't attenuate cardiac remodeling in mice with myocardial infarction.
Luo, Guangjin; Li, Qingman; Zhang, Xiajun; Shen, Liang; Xie, Jiahe; Zhang, Jingwen; Kitakaze, Masafumi; Huang, Xiaobo; Liao, Yulin
Endoplasmic reticulum stress is a proapoptotic and profibrotic stimulus. Ablation of C/EBP homologous protein (CHOP) is reported to reverse cardiac dysfunction by attenuating cardiac endoplasmic reticulum stress in mice with pressure overload or ischemia/reperfusion, but it is unclear whether loss of CHOP also inhibits cardiac remodeling induced by permanent-infarction. In mice with permanent ligation of left coronary artery, we found that ablation of CHOP increased the acute phase mortality. For the mice survived to 4 weeks, left ventricular anterior (LV) wall thickness was larger in CHOP knockout mice than in the wildtype littermates, while no difference was noted on posterior wall thickness, LV dimensions, LV fractional shortening and ejection fraction. Similarly, invasive assessment of LV hemodynamics, morphological analysis of heart and lung weight indexes, myocardial fibrosis and TUNEL-assessed apoptosis showed no significant differences between CHOP knockout mice and their wildtype ones, while in mice with ischemia for 45 min and reperfusion for 1 week, myocardial fibrosis and apoptosis in the infarct area were significantly attenuated in CHOP knockout mice. These findings indicate that ablation of CHOP doesn't ameliorate cardiac remodeling induced by permanent-myocardial infarction, which implicates that early reperfusion is a prerequisite for ischemic myocardium to benefit from CHOP inhibition. PMID:26111448
Anterior chest wall inflammation by whole-body magnetic resonance imaging in patients with spondyloarthritis: lack of association between clinical and imaging findings in a cross-sectional study
Introduction Inflammatory involvement of the anterior chest wall (ACW) affects the quality of life of patients with spondyloarthritis (SpA), although involvement of the ACW is often neglected on clinical and imaging evaluation. Whole-body (WB) MRI is an imaging method used to assess the ACW in addition to the sacroiliac joints and spine without inconvenience for patients. Our goals in this study were to describe the distribution of ACW inflammation by WB MRI in both early and established SpA and associations between clinical and imaging findings indicative of inflammation. Methods The ACWs of 122 consecutive SpA patients (95 with ankylosing spondylitis (AS) and 27 with nonradiographic SpA (nrSpA)) and 75 healthy controls were scanned by sagittal and coronal WB MRI. The MRI scans were scored independently in random order by seven readers blinded to patient identifiers. Active and structural inflammatory lesions of the ACW were recorded on a web-based data entry form. ACW pain by patient self-report, ACW tenderness on physical examination according to the Maastricht Ankylosing Spondylitis Enthesitis Score (MASES) and lesions detected by MRI were analyzed descriptively. ? statistics served to assess the agreement between clinical and imaging findings. Results ACW pain or tenderness was present in 26% of patients, with little difference between AS and nrSpA patients. Bone marrow edema (BME), erosion and fat infiltration were recorded in 44.3%, 34.4% and 27.0% of SpA patients and in 9.3%, 12.0% and 5.3% of controls, respectively. Lesions found by MRI occurred more frequently in AS patients (BME, erosion and fat infiltration in 49.5%, 36.8% and 33.7%, respectively) than in nrSpA patients (25.9%, 25.9% and 3.7%, respectively). The joint most frequently affected by lesions found on MRI scans was the manubriosternal joint. The ? values between clinical assessments and MRI inflammation ranged from -0.10 to only 0.33 for both AS and nrSpA patients. Conclusions Among SpA patients, 26% had clinical involvement of the ACW. WB MRI signs of ACW inflammation were found in a substantial proportion of patients with AS (49.5%) and nrSpA (25.9%). There was no association between clinical assessments of ACW, including the MASES, and MRI features. PMID:22226453
Proteinases and myocardial extracellular matrix turnover
Suresh C. Tyagi
Extracellular structural remodeling is the compensatory response of the tissue following pathological stage. Myocardial infarction, which leads to adverse remodeling, thinning of the ventricle wall, dilatation and heart failure, is one of the leading causes of death. Remodeling implies an alteration in the extracellular matrix and in the spatial orientation of cells and intracellular components. The extracellular matrix is responsible
[Interesting PYP, Tl-201, MIBG and AM myocardial SPECT images in a patient under successful reperfusion therapy].
Tanaka, T; Aizawa, T; Kato, K; Ogasawara, K; Kirigaya, H; Okamoto, K
Various types of radiopharmacons such as Tl-201, Tc-99m pyrophosphate (PYP), I-123 Metaiodobenzylguanidine (MIBG) and In-111 antimyosin Fab (AM), were applied to a patients under successful reperfusion therapy. In the patient QS waves in precordial leads and elevated serum enzyme activity was noted, however well anterior wall movement was maintained in chronic phase. At 4th hospital day PYP uptake was noted at apical region and basal anteroseptal region. Most portion of PYP uptake was overlapped by Tl-201 uptake. Depressed Tl-201 uptake in subacute phase improved. In chronic phase depressed MIBG uptake was noted at the region corresponding to the abnormal region in acute phase. Then months after the ischemic event AM uptake was noted at the region which maintained contractility. From these findings it was concluded as followings. Salvaged jeopardized myocardium remained ischemia in subacute phase. The lesions noted in the MIBG images showed depressed myocardial norepinephrine activity. This suggested that sympathetic nervous function was damaged by severe ischemia and the depressed sympathetic nervous function persisted long after myocardial perfusion had been restored. From abnormal AM uptake ten months after ischemic event it was suspected that myocardial cell membrane damage caused by severe ischemia might be persistent at the region which maintained contractility. Radioisotope image was useful to study pathological myocardium due to ischemic event. PMID:1837571
Bilateral Anterior Shoulder Dislocation
Siu, Yuk Chuen; Lui, Tun Hing
Introduction: Unilateral anterior shoulder dislocation is one of the most common problems encountered in orthopedic practice. However, simultaneous bilateral anterior dislocation of the shoulders is quite rare. Case Presentation: We report a case of a 75-year-old woman presented with simultaneous bilateral anterior shoulder dislocation following a trauma, complicated with a traction injury to the posterior cord of the brachial plexus. Conclusions: Bilateral anterior shoulder dislocation is very rare. The excessive traction force during closed reduction may lead to nerve palsy. Clear documentation of neurovascular status and adequate imaging before and after a reduction should be performed. PMID:25685749
Spontaneous coronary artery dissection: a neglected cause of acute myocardial ischaemia and sudden death
C. Basso; G. L. Morgagni; G. Thiene
Spontaneous coronary artery dissection is a rare cause of acute myocardial ischaemia. Eight consecutive fatal cases which occurred in women aged 34-54 years (mean 43) are described. The dissection involved the left anterior descending coronary artery in four, the left main trunk in two, the right coronary artery in one, and both left anterior descending and circumflex arteries in one.
Anteriorly based pedicled flaps for skull base reconstruction.
Meier, Joshua C; Bleier, Benjamin S
The expansion of endoscopic skull base surgery has resulted in the creation of large defects that must be repaired to ensure separation of the cranial vault from the nasal cavity. The workhorse of anterior skull base reconstruction remains the nasoseptal or Hadad-Bassagasteguy flap. Despite its success, the nasoseptal flap is limited in its ability to reach extremely anterior defects including those involving the frontal break, posterior frontal table, and anterior cribiform plate. Alternative approaches utilizing anteriorly pedicled flaps have been described which exploit the vascular supply to the anterior septum and lateral nasal wall. The diminutive nature of the anterior septal blood supply has led to the elaboration of a bipedicled anterior septal flap which is capable of reliable reconstruction of both the frontal beak as well as posterior frontal table defects. Similarly anteriorly based inferior turbinate flaps pedicled largely on anterior ethmoid arborizations have been used successfully to reconstruct anterior defects. In light of the limitations of the nasoseptal flap, the addition of anteriorly pedicled flaps to the clinical armamentarium offers the opportunity to provide vascularized mucosal coverage of virtually any region of the skull base which can be reached endoscopically. PMID:23257553
Feasibility of voxel-based statistical analysis method for myocardial PET
NASA Astrophysics Data System (ADS)
Ram Yu, A.; Kim, Jin Su; Paik, Chang H.; Kim, Kyeong Min; Moo Lim, Sang
Although statistical parametric mapping (SPM) analysis is widely used in neuroimaging studies, to our best knowledge, there was no application to myocardial PET data analysis. In this study, we developed the voxel based statistical analysis method for myocardial PET which provides statistical comparison results between groups in image space. PET Emission data of normal and myocardial infarction rats were acquired For the SPM analysis, a rat heart template was created. In addition, individual PET data was spatially normalized and smoothed. Two sample t-tests were performed to identify the myocardial infarct region. This developed SPM method was compared with conventional ROI methods. Myocardial glucose metabolism was decreased in the lateral wall of the left ventricle. In the result of ROI analysis, the mean value of the lateral wall was 29% decreased. The newly developed SPM method for myocardial PET could provide quantitative information in myocardial PET study.
Utility of technetium-t-butyl isonitrile (99mTc-TBI) myocardial imaging in coronary artery disease.
Nair, N; Nayak, U N; Ramanathan, P; Ramamoorthy, N; Sachdeva, S S
99mTc-t-butyl isonitrile is a useful agent for myocardial perfusion imaging. The superior physical advantages of technetium over 201thallium make larger doses possible for imaging. Accumulation in the myocardium is unidirectional in that once attached it does not leave the myocardium and hence two separate injections are needed for rest and stress imaging. High liver uptake frequently conceals the inferior wall and high early uptakes make immediate post-injection imaging almost impossible at least up to 45-60 min. This agent, however, was seen to accurately identify under-perfused areas and distinguish between ischaemia and infarct in our patients. Agreement with 201Tl and with GBP study of regional wall motion was excellent. While its individual sensitivity and specificity are quite high at 82.6 and 90.9%, in combined GBP studies the sensitivity rose to 93.4%. It is concluded that Tc-TBI is a valuable agent for myocardial perfusion scintigraphy, especially in a developing country like India where Tc-MIBI cannot be routinely used, since it is expensive, and where regular supplies of 201Tl are also not always feasible due to the high cost of importing. 99mTc-TBI can be made cheaply here and in a select population, notably in those with left anterior descending and circumflex coronary artery disease, it can provide valuable information. PMID:1522026
Depression Increases Sympathetic Activity and Exacerbates Myocardial Remodeling after Myocardial Infarction: Evidence from an Animal Experiment
Liu, Tao; Yuan, Xiaoran; Ruan, Bing; Sun, Lifang; Tang, Yanhong; Yang, Bo; Hu, Dan; Huang, Congxin
Depression is an independent risk factor for cardiovascular events and mortality in patients with myocardial infarction (MI). Excessive sympathetic activation and serious myocardial remodeling may contribute to this association. The aim of this study was to discuss the effect of depression on sympathetic activity and myocardial remodeling after MI. Wild-type (WT) rats were divided into a sham group (Sham), a myocardial infarction group (MI), a depression group (D), and a myocardial infarction plus depression group (MI+D). Compared with controls, the MI+D animals displayed depression-like behaviors and attenuated body weight gain. The evaluation of sympathetic activity showed an increased level in plasma concentrations of epinephrine and norepinephrine and higher expression of myocardial tyrosine hydroxylase in the MI+D group than the control groups (p<0.05 for all). Cardiac function and morphologic analyses revealed a decreased fractional shortening accompanied by increased left ventricular dimensions, thinning myocardium wall, and reduced collagen repair in the MI+D group compared with the MI group (p<0.05 for all). Frequent premature ventricular contractions, prolonged QT duration and ventricular repolarization duration, shorted effective refractory period, and increased susceptibility to ventricular arrhythmia were displayed in MI+D rats. These results indicate that sympathetic hyperactivation and exacerbated myocardial remodeling may be a plausible mechanism linking depression to an adverse prognosis after MI. PMID:25036781
Mechanical complications of acute myocardial infarction.
Kutty, Ramesh S; Jones, Nicola; Moorjani, Narain
Acute myocardial infarction (AMI) can result in ischemic, mechanical, arrhythmic, embolic, or inflammatory complications. The development of mechanical complications following AMI is associated with a significantly reduced short-term and long-term survival. Since the introduction of primary percutaneous coronary intervention as the principal reperfusion strategy following acute ST-elevation myocardial infarction, the incidence of mechanical complications, including rupture of the left ventricular free wall, papillary muscle, and ventricular septum, has reduced significantly to less than 1%. Despite high operative mortality, the lack of an effective medical alternative makes surgical repair the mainstay of current management for these patients. PMID:24188218
Transient myocardial ischemia: experimental echocardiographic demonstration and evaluation of myocardial contraction abnormalities.
Kerber, R E; Taylor, A L; Hiratzka, L F; McPherson, D D; Kieso, R A
A continuing theme in our laboratory has been the use of echocardiographically-measured systolic myocardial wall thickening to demonstrate and evaluate the consequences of regional myocardial ischemia. This presentation focuses on two areas: the immediate mechanical consequences of induced myocardial ischemia in two experimental models: canine and human; the correlation between persistent regional myocardial dysfunction and morphologic infarction after sequences of coronary artery occlusion and reperfusion. Many experiments using animal models have demonstrated that acute myocardial ischemia produces almost immediate replacement of normal systolic myocardial wall thickening by systolic thinning. Less is known about the immediate mechanical response of human myocardium to acute ischemia. This was studied in 5 open-chest humans undergoing various cardiac operations. Wall thickening was continuously displayed by a 7 MHz M-mode echocardiographic transducer coupled to the epicardium by suction to maintain constant position. Coronary flow velocity was displayed by a pulsed Doppler device coupled to an epicardial coronary artery by suction. Ischemia was induced by the surgeon who manually occluded the coronary artery with a soft-tipped Kitner dissector or vascular forceps for 30 seconds. It was found that cessation of coronary flow was accompanied by reductions in normal systolic thickening but systolic thinning or expansion only rarely occurred. In contrast, when the identical techniques were used in 5 dogs, systolic thinning always occurred immediately after coronary arterial occlusion. This suggests that there are important species differences between canine and human myocardium in the immediate mechanical response to myocardial ischemia.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3756577
[Myocardial infarction and thromboembolism during pregnancy].
Härtel, Dirk; Sorges, Eckhard; Carlsson, Jörg; Römer, Volker; Tebbe, Ulrich
Acute myocardial infarction is a very rare event during pregnancy and bears the problem of misdiagnosis. However, about 150 cases have been published worldwide with a preponderance of anterior wall infarcts. With more women delaying childbearing until an older age and increasing prevalence of smoking in young women, it can be expected that all forms of coronary artery disease--including acute myocardial infarction--will be seen more often in the future. Among the causes of coronary artery occlusion in pregnancy are (1) rupture of very small coronary artery plaques triggered by different events, e.g., hypertension; (2) plain coronary artery disease; (3) dissection of coronary arteries; (4) coronary artery spasms with/without arterial thrombosis. Prompt diagnosis and immediate therapy are necessary to lower the high mortality of mother and fetus. The gold standard in the therapy of acute myocardial infarction during pregnancy is immediate coronary angiography and percutaneous transluminal coronary angioplasty (PTCA) with or without stent implantation. Application of thrombolytics (recombinant tissue plasminogen activator [rt-PA], r-PA, streptokinase [SK], urokinase [UK]) has been reported in single patients but should be limited to cases where acute PTCA is not available and where the infarct occurs before the 14th week of pregnancy because of possible embryopathy. If the patient is in the last 10 weeks of pregnancy, anticipation of delivery should be part of the medical planning. Consultation with an obstetrician must be obtained as soon as the patient enters the hospital. Besides bleeding complications, venous thrombosis with pulmonary embolism is among the most common causes of death during pregnancy. Pregnancy-related changes in physiology - increase in the resistance to flow from the lower extremities to the heart - and congenital coagulation abnormalities are most important to be recognized. This leads to the fact that superficial and deep venous thromboses occur more often in pregnancy than in the nonpregnant state. Among the coagulation abnormalities found in pregnancy are hypercoagulability (increased levels of fibrinogen, factor VII, factor VIII, factor X), decreased fibrinolytic activity due to an increased level of plasminogen activator inhibitor, increased adhesion and aggregation of platelets, decreased level of protein C and of the APC (activated protein C) ratio. Individual risks factors justifying diagnostic screening include contraception, smoking, immobilization, infection, adiposity, placental insufficiency, and a family history of thrombosis. It is even more important to establish/rule out the diagnosis of thrombosis in pregnancy than in the nonpregnant state, because the use of anticoagulants carries certain risks during pregnancy. Doppler vein studies should be used for diagnosis. If necessary, venography may be used with shielding of the maternal abdomen. Therapy consists of subcutaneous application of heparin, compression, and early mobilization. Alternatively, especially for long-term management, treatment with low molecular weight heparins is feasible. Thrombolytic treatment is contraindicated in most cases due to the high risk of bleeding complications. However, the application of thrombolytics can be contemplated in single cases after careful consideration of the pros and cons. Most cases of pulmonary embolism should also be handled conservatively with heparin. Only in massive pulmonary embolism with severe hemodynamic compromise, thrombolytic treatment is indicated. To guide future therapy in the patients, it is necessary to establish the lifetime risk of recurrent events by determining: APC resistance, prothrombin mutation 20210 A, homocysteine, AT III, protein C and S, antiphospholipid antibodies, and anticardiolipin antibodies. PMID:12756475
Coronary vasodilator reserve. Comparison of the effects of papaverine and adenosine on coronary flow, ventricular function, and myocardial metabolism.
Christensen, C W; Rosen, L B; Gal, R A; Haseeb, M; Lassar, T A; Port, S C
To evaluate coronary flow reserve during cardiac catheterization, intracoronary adenosine and papaverine have been used in the clinical setting. Although papaverine maximizes coronary blood flow, it induces several toxic side effects that reduce its desirability as a coronary dilator. This investigation was designed to compare the subselective intracoronary administration of papaverine with that of adenosine in an animal model. In dogs (n = 34), we studied the effects of each agent on hemodynamics, regional myocardial blood flow, contractility (sonomicrometric and echocardiographic), metabolism (coronary arterial and venous lactate and tissue high-energy phosphates), and electrocardiographic (ST and QT intervals) parameters. Barbiturate and morphine anesthesia/analgesia was induced, and a left thoracotomy was performed. An arterial shunt was created from the left carotid artery to the left anterior descending coronary artery. Two separate groups were studied: group 1 (n = 16) for regional myocardial blood flow and mechanical function and group 2 (n = 18) for biochemical measurements. Adenosine (67 +/- 2 micrograms/min) or papaverine (6 +/- 1 mg/min) was infused into the coronary shunt at a rate of 0.5 + 0.1 ml/min for a maximum duration of 3.5 minutes. Regional myocardial blood flows were determined at control (predrug) and maximal coronary flow using radiolabeled microspheres. All hemodynamic, wall motion, biochemical, and electrocardiographic parameters were also measured at these times. Both drugs produced comparable increases in total and regional coronary blood flows (adenosine, 1.21 +/- 0.15 to 4.83 +/- 0.36 ml/min/g; papaverine, 1.21 +/- 0.05 to 4.89 +/- 0.28 ml/min/g) upon infusion into the left anterior descending coronary artery. Papaverine produced significant (p less than 0.05) changes in subendocardial ST segment electrocardiogram (-2.5 mm), QT prolongation (8 +/- 2%), myocardial creatine phosphate (47% decrease), and coronary sinus serum lactate (277% increase) compared with control. In addition, intracoronary papaverine induced an abnormal contractile pattern. No significant changes in any of these parameters (i.e., ST segment, QT prolongation, myocardial creatine phosphate level, or lactate level) were observed with intracoronary adenosine infusions. We conclude that intracoronary adenosine is comparable to papaverine for maximizing coronary blood flow without the deleterious properties observed with intracoronary papaverine. PMID:1984887
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Myocardial injury after ischemia-reperfusion in mice deficient in Akt2 is associated with increased cardiac macrophage density.
Li, Xue; Mikhalkova, Deana; Gao, Erhe; Zhang, Jin; Myers, Valerie; Zincarelli, Carmen; Lei, Yonghong; Song, Jianliang; Koch, Walter J; Peppel, Karsten; Cheung, Joseph Y; Feldman, Arthur M; Chan, Tung O
Akt2 protein kinase has been shown to promote cell migration and actin polymerization in several cell types, including macrophages. Because migrating macrophages constitute an important inflammatory response after myocardial ischemia, we determined cardiac macrophage expression after ischemia-reperfusion (I/R) injury and cryo-injury in mice lacking Akt2 (Akt2-KO). At 7 days post-I/R, Akt2-KO cardiac tissues showed an increase in immunohistochemical staining for macrophage markers (Galectin 3 and F4/80) compared with wild-type (WT) mice, indicating macrophage density was increased in the injured Akt2-KO myocardium. This change was time dependent because macrophage density was similar between WT and Akt2-KO myocardium at 3 days post-I/R, but by 7 and 14 days post-I/R, macrophage density was significantly increased in Akt2-KO myocardium. Concomitantly, infarct size was larger and cardiac function was reduced in Akt2-KO mice subjected to I/R. However, when cryo-infarction produced similar infarct sizes in the anterior wall in both WT and Akt2-KO mice, macrophage density remained higher in Akt2-KO mouse myocardium, suggesting Akt2 regulates myocardial macrophage density independent of infarct size. Consistently, bone marrow from Akt2-KO mice enhanced myocardial macrophage density in both C57/B6 WT and Akt2-KO recipient mice. Finally, reciprocal ex-vivo coculturing of macrophages and cardiac myocytes showed that activated Akt2-KO peritoneal macrophages had reduced mobility and adhesion when compared with WT littermate controls. Thus, although Akt-2 KO mice did not affect the initial inflammation response after injury and Akt2 deficiency has been shown to impair cell migration or motility in macrophages, our data suggested a novel mechanism in which increasing retention of Akt2-KO macrophages resulted in increasing cardiac Akt2-KO macrophage density in the myocardial space. PMID:21890689
Primary Angioplasty Versus Systemic Thrombolysis in Anterior Myocardial Infarction
Eulogio Garcia; Jaime Elizaga; Nicasio Perez-Castellano; Jose A. Serrano; Javier Soriano; Manuel Abeytua; Javier Botas; Rafael Rubio; Esteban Lopez de Sa ´; Jose L. Lopez-Sendon; Juan L. Delcan
0.23, 95% confidence interval 0.06 to 0.85). During hospitalization, patients treated by angioplasty had a lower frequency of postinfarction angina or positive stress test (11.9% vs. 25.2%, p 5 0.01) and less frequently underwent percutaneous or surgical revascularization after the initial treatment (22.0% vs. 47.7%, p , 0.001) than did patients treated by t-PA. At six month follow-up, patients treated
Diagnostic accuracy of contrast echocardiography during adenosine stress for detection of abnormal myocardial perfusion: a prospective comparison with technetium-99 m sestamibi single-photon emission computed tomography.
Abdelmoneim, Sahar S; Bernier, Mathieu; Dhoble, Abhijeet; Moir, Stuart; Hagen, Mary E; Ness, Sue Ann C; Pellikka, Patricia A; Abdel-Kader, Samir S; Mulvagh, Sharon L
Myocardial contrast echocardiography (MCE) utilizes compressible microbubbles behaving similarly to red blood cells. Destruction of microbubbles and observation of the gradual refill into the myocardium are key to evaluating perfusion using real-time MCE. We aimed to assess the feasibility and diagnostic accuracy of qualitative MCE utilizing a 17-segment model for localization of myocardial perfusion abnormalities compared with simultaneous technetium-99 m sestamibi single-photon emission computed tomography (SPECT). From July 2005 through August 2007, 97 patients with known or suspected coronary artery disease underwent simultaneous SPECT and realtime MCE during adenosine stress. Qualitative MCE and tracer uptake were analyzed visually using a 17-segment model in a blinded manner. Diagnostic accuracy and 95% confidence interval (CI) were determined. Myocardial contrast echocardiography was completed in 91 patients (age, mean [SD], 69.3 [10.9] years; body mass index, 30.0 [6.3]; 59 males [65%]). Myocardial contrast echocardiography analysis was feasible in 88 (97%) patients (261 of 264 [99%] territories; 1299 of 1497 [87%] segments). At patient level, MCE sensitivity was 88% (95% CI, 79%-94%); specificity was 85% (77%-90%). For disease detection in individual coronary territories, sensitivity and specificity were 84% (71%-92%) and 79% (72%-84%) for the left anterior descending artery; 62% (38%-80%) and 88% (83%-91%) for the left circumflex artery; and 73% (57%-82%) and 94% (89%-97%) for the right coronary artery. For MCE combined with wall-motion analysis, concordance with SPECT improved from 80% to 86%. Myocardial contrast echocardiography interobserver concordance was 81% (kappa [SE], 0.611 [0.78]). Myocardial contrast echocardiography accuracy was comparable in patients classified in accordance with presence of diabetes mellitus, myocardial infarction, hypertension, or percutaneous coronary intervention. Improved MCE specificity in detecting perfusion defects was seen in patients with no history of coronary bypass graft surgery (P = 0.005). Real-time MCE with a 17-segment model for analysis has good feasibility and accuracy in evaluation of myocardial perfusion during adenosine stress. PMID:20339973
Revision of anterior cervical pseudoarthrosis with anterior allograft fusion and plating.
Coric, D; Branch, C L; Jenkins, J D
Anterior cervical discectomy and fusion is an efficacious procedure used to treat a variety of cervical spinal disorders, including spondylosis, myelopathy, herniated discs, trauma, and degenerative disc disease. Pseudarthrosis, or failure of fusion, may be the most common complication of spinal fusion procedures. Nineteen consecutive patients with symptomatic pseudarthrosis following failed anterior cervical fusions were treated with anterior cervical revision using iliac crest allografts and either the Cervical Spine Locking Plate system (10 patients) or the Trapezial Osteosynthetic Plate system (nine patients). The mean age of the nine men and 10 women undergoing treatment was 49.1 years (range 25-72 years). Eleven patients (57.9%) exhibited pseudarthrosis at one level, six (31.5%) at two levels, and two (10.5%) at three levels. The indications for revision were intractable neck pain with radiculopathy (17 patients) or myelopathy (two patients), with evidence of pseudarthrosis on plain cervical radiography as well as computerized tomography (CT) or single-photon emission computerized tomography (SPECT) scanning, or both. All eight patients evaluated with SPECT showed increased focal uptake consistent with pseudarthrosis, which was subsequently confirmed intraoperatively in all eight. The average follow-up period was 22.4 months (range 12-42 months). Solid osseous fusion was achieved over all 28 levels in all 18 patients available for follow-up review (100%). One patient died 4 months postoperatively from myocardial infarction related to preexisting coronary artery disease. There were no intraoperative complications; postoperatively, two patients (10.5%) experienced transient hoarseness. Anterior revision of failed cervical fusions using allograft interbody fusion material and anterior plating is a safe and efficacious procedure. In this series, the use of allografts avoided donor site morbidity without adversely affecting fusion rates. Rigid internal fixation was achieved by means of anterior plating without increasing surgical morbidity rates. The SPECT imaging technique has the potential to reliably confirm the diagnosis of pseudarthrosis. PMID:9171175
The course of myocardial hypertrophy in hypertrophic cardiomyopathy. Results of a 10-year follow-up.
Gregor, P; Widimský, P
Sixty-nine patients with hypertrophic cardiomyopathy were followed up for a minimum period of 10 years, with detailed quantitation of myocardial hypertrophy using two-dimensional echocardiography at a two-year interval. The parameters determined included maximum myocardial wall thickness, mean myocardial wall thickness (defined as the arithmetic mean of myocardial wall thickness values measured in ten areas of approximately the same size the LV and septal myocardium had been divided into), and the extent of hypertrophy (percentage of the myocardium affected by hypertrophy). Other echocardiographic parameters as well as clinical, ECG and Holter data were also assessed. Seven patients (10%) showed a gradual increase in mean myocardial wall thickness (associated with an increase in maximum myocardial wall thickness and in the extent of hypertrophy in two). By contrast, a progressive decrease in hypertrophy was observed in six patients (9%). In either case, the observed changes tended to involve areas in segments outside the zone of maximum wall thickness. Generally, the changes in hypertrophy were not related to the development of clinical or Holter manifestations, and were unaffected by verapamil or beta-blocker therapy. There was no death among these patients unlike the five deaths in a group with stationary hypertrophy. Based on their results, the authors conclude that changes in myocardial hypertrophy (regardless of whether there is progression or regression) probably make part of natural variations in the course of the disease, and have no clinical or prognostic implications for the majority of patients. PMID:8348815
Myocardial perfusion assessed by contrast echocardiography correlates with angiographic perfusion parameters in patients with a first acute myocardial infarction successfully treated with angioplasty
Tomaszuk-Kazberuk, Anna; Sobkowicz, Bozena; Kaminski, Karol; Gugala, Kamil; Mezynski, Grzegorz; Dobrzycki, Slawomir; Lewczuk, Anna; Kazberuk, Waldemar; Musial, Wlodzimierz J
BACKGROUND: Angiographic flow in an epicardial artery does not define perfusion at the microvascular level. AIM: To compare myocardial contrast echocardiography (MCE) with angiographic methods of assessing microvascular reperfusion in patients with acute myocardial infarction (AMI). METHODS: One hundred consecutive patients with a first ST segment elevation myocardial infarction and single-vessel disease were successfully treated with primary percutaneous coronary intervention. Regional contrast score index (RCSI), corrected Thrombolysis In Myocardial Infarction (TIMI) frame count (cTFC), TIMI myocardial perfusion grade (TMPG) and myocardial blush grade were evaluated. RESULTS: Among 717 asynergic segments on MCE, 168 revealed a lack of perfusion. TMPG and cTFC correlated significantly with RCSI (P=0.031 and P=0.027, respectively). Myocardial blush grade did not correlate with RCSI (P=0.067). Patients with anterior AMI had significantly more segments with a perfusion defect on MCE than patients with inferior AMI (P=0.0001). CONCLUSIONS: MCE results correlate with angiographic methods of perfusion assessment such as TMPG and cTFC. Anterior AMI is associated with a greater extent of perfusion defect. MCE results correlate also with recovery of systolic left ventricular function and clinical outcome at six month follow-up. PMID:18685744
Variability of myocardial perfusion dark rim Gibbs artifacts due to sub-pixel shifts
Pedro Ferreira; Peter Gatehouse; Peter Kellman; Chiara Bucciarelli-Ducci; David Firmin
BACKGROUND: Gibbs ringing has been shown as a possible source of dark rim artifacts in myocardial perfusion studies. This type of artifact is usually described as transient, lasting a few heart beats, and localised in random segments of the myocardial wall. Dark rim artifacts are known to be unpredictably variable. This article aims to illustrate that a sub-pixel shift, i.e.
Hemin, inducer of heme-oxygenase 1, improves functional recovery from myocardial stunning in conscious dogs
Thomas Peter Weber; Andreas Meissner; Peter Boknik; Maike Grosse Hartlage; Thomas Möllhoff; Hugo Van Aken; Norbert Rolf
Objective: To examine the effects of pretreatment with hemin, an inducer of the potential antioxidative enzyme heme-oxygenase 1 (HO-1) or heat-shock protein 32, on myocardial stunning. Design: Randomized animal study. Setting: Animal laboratory of a university hospital. Participants: Chronically instrumented mongrel dogs (n = 44). Interventions: Dogs underwent chronic instrumentation for measurement of hemodynamics and myocardial wall thickening fraction (WTF).
The Effect of Preinfarction Angina as Ischemic Preconditioning on Myocardial Protection
Tae-Young Choi; Seung-Jae Tahk; Myeong-Ho Yoon; So-Yeon Choi; Min-Cheol Kim; Heung-Mo Yang; Jung-Hyun Choi; Zhen-Guo Zheng; Long Qi; Hyuk-Jae Chang; Gyo-Seung Hwang; Joon-Han Shin
Background and Objectives:By measuring the coronary flow reserve (CFR) and echocardiographic left ventri- cular function, the purpose of this study was to evaluate the effect of pre-infarction angina (PA) on myocardial protection in patients with acute myocardial infarction (AMI). Subjects and Methods:Sixty-two patients (mean 54±10 years, 51 males) with first anterior AMI were studied. CFR, defined as the ratio of
Anterior mediastinal fibrosis with superior vena caval obstruction complicating the synovitis-acne-pustulosis-hyperostosis-osteomyelitis syndrome.
Cunningham, T; Farrell, J; Veale, D; Fitzgerald, O
A syndrome of predominantly palmo-plantar pustular psoriasis associated with anterior chest wall (sternoclavicular, manubriosternal) inflammation has previously been described. In this case, a further patient is reported where chest wall involvement is complicated by anterior mediastinal fibrosis and superior vena caval obstruction. PMID:8495263
Anterior mandibular ameloblastoma
Bhandarwar, Ajay H.; Bakhshi, Girish D.; Borisa, Ashok D.; Wagh, Amol; Kapoor, Rajat; Kori, Channabasappa G.
Ameloblastoma is a benign odontogenic tumor. These are usually asymptomatic until a large size is attained. Ameloblastoma has tendency to spread locally and has a high recurrence rate. Majority of ameloblastomas (80%) arise from the mandible. Ameloblastoma arising from anterior mandibular region (symphysis-menti) is rare. Very few cases of midline anterior ameloblastomas are reported in the literature. They often require wide local excision. Reconstruction of mandible in these cases is challenging. We present a case of mandibular ameloblastoma arising from symphysis-menti. Patient underwent wide surgical excision of the tumor followed by immediate reconstruction using free fibular vascular flap, stabilized with titanium reconstructive plates. A brief case report ands review of literature is presented. PMID:24765429
Large ventricular aneurysms occurring after myocardial infarction.
Letac, B; Leroux, G; Cribier, A; Soyer, R
We have studied 33 patients with a large ventricular aneurysm complicating an anterior myocardial infarction. The features of myocardial infarction progressing towards an aneurysm were no previous history of coronary disease, severe infarction as shown by the severity of pain and the presence of pericardial rub and heart failure, and large increase in serum levels of cardiac enzymes. A large aneurysm usually follows a large infarction resulting from the total or partial occlusion of the left anterior descending artery, which is involved alone in about half the patients and is associated with lesions of the circumflex and right coronary arteries in the other half. In most cases, standard radiography showed an abnormal cardiac configuration, but in 7 patients (21%) there was no radiological evidence of aneurysm. ST segment elevation (mean 2.7 mm) was reported in all subjects but one. Heart failure was present in most patients and was an indication for surgical treatment in one-third of the patients. A large aneurysm was not a contraindication to operation even when at angiography the aneurysm seemed to occupy almost all the left ventricle. Twenty-one patients were operated upon for resection of the aneurysm with a mortality rate of 14 per cent. PMID:656217
Relation between myocardial oxygen consumption and myocardial blood volume: A study using myocardial contrast echocardiography
D. Elizabeth Le; Jian-Ping Bin; Matthew P. Coggins; Kevin Wei; Jonathan R. Lindner; Sanjiv Kaul
Myocardial blood volume (MBV) is the volume of blood residing in myocardial vessels, 90% of which is in capillaries. MBV can be measured in vivo using myocardial contrast echocardiography (MCE). It has been shown that when increases in coronary blood flow (CBF) are not associated with increase in myocardial oxygen consumption (MVO2), MBV does not increase. We hypothesized that MBV
Microvascular obstruction after successful fibrinolytic therapy in acute myocardial infarction. Comparison of reteplase vs reteplase+abciximab: A cardiovascular magnetic resonance study
Background. About one third of patients with TIMI 3 after reperfusion have evidence of microvascular obstruction (MO) which represents an independent predictor of myocardial wall rupture. This explains all efforts made to prevent MO. Magnetic resonance imaging (MRI) has proved to be particularly useful in detecting MO. The aim of this study was to evaluate with MRI if different fibrinolytic regimens in acute myocardial infarction display different effects on left ventricle (LV) volumes and ejection fraction (EF), as well as on myocardial infarct size (MIsz) and MO. Methods. Twenty male patients, mean age 58 years, affected by acute myocardial infarction, ten anterior and ten inferior, were treated with: full dose reteplase in ten, and half dose reteplase plus full dose abciximab (R+Abcx) in the other ten patients. In the fourth day after hospital admission, MRI STIR T2 images were used to quantify MIsz, while 2dflash cineloops were used after the injection of gadolinium, to quantify LV volumes, EF and to detect MO. Results. LV EF was higher in R+Abcx 51±10 than in reteplase 41±8. MIsz was similar in both treatment groups: however a close relationship was present between MIsz and EF in the reteplase group indicating that the greater the MIsz the lower the EF. In R+Abcx this relationship was no longer present, suggesting a protective effect of the drug on microcirculation. In fact extensive MO was present in 25% of all cases, 80% of which in the reteplase group while only 20% in R+Abcx. Conclusion. R+Abcx prevents MO: compared to traditional fibrinolytic therapy it allows better LV function and most likely improved long term survival. PMID:21977252
Recurrent myocardial infarction secondary to Prinzmetal's variant angina
Murdoch, Dale; Dhillon, Priyanka; Niranjan, Selvanayagam
Prinzmetal's variant angina describes chest pain secondary to reversible coronary artery vasospasm in the context of both diseased and non-diseased coronary arteries. Symptoms typically occur when the patient is at rest and are associated with transient ST-segment elevation. Acute episodes respond to glyceryl trinitrate, but myocardial infarction and other potentially fatal complications can occur, and long-term management can be challenging. Although it is not well understood, the underlying mechanism appears to involve a combination of endothelial damage and vasoactive mediators. In this case, a 35-year-old woman with myocardial infarction secondary to coronary artery vasospasm experienced recurrent chest pain. Coronary angiography revealed severe focal stenosis in the mid left anterior descending artery, which completely resolved after administration of intracoronary glyceryl trinitrate. The patient was discharged on nitrates and calcium channel blockers. The patient re-presented with another myocardial infarction, requiring up-titration of medical therapy. PMID:26034323
Harmful immune reactions during acute myocardial infarction.
Laskarin, G; Zaputovic, L; Persic, V; Ruzic, A; Sotosek Tokmadzic, V
Acute coronary syndrome, including myocardial infarction, can occur as a result of ischaemia-reperfusion injury caused by acute occlusion of the coronary vessel/s following the rupture of an atherosclerotic plaque. Superimposed thrombosis at the lesion obstructs blood supply to the myocardium causing myocardial necrosis and ischaemic inflammation. Although not fully described, researchers believe that this process is initiated by a dysfunctional endothelium that activates the nearby leukocytes in the blood stream, thus attracting them to the arterial wall and initiating a cascade of complex mechanisms that lead to myocardial infarction. Interestingly, this process is two sided as the leaking soluble factors from a damaged and/or necrotic myocardium enter the systemic circulation, activating the innate and adaptive cell-mediated immune responses, which include increasing cytotoxic mediators. We hypothesize that this unwanted side effect of increase in proinflammatory mediators can lead to harmful systemic immune reactions directed towards various dysfunctional endothelia. Additionally, a strong inflammatory response, caused by myocardial damage, can impair ventricular function, on top of baseline necrosis. To evaluate this hypothesis, we propose to use in vivo tests to measure endothelial dysfunction, as well as ventricular dysfunction by ultrasound methods, and their correlation with immunological and/or biochemical parameters. These tests will be useful in assessing the risk and therapeutic outcome in patients with acute coronary syndrome. PMID:22398389
Quantification of resting myocardial blood flow velocity in normal humans using real-time contrast echocardiography. A feasibility study
Malm, Siri; Frigstad, Sigmund; Helland, Frode; Oye, Kjetil; Slordahl, Stig; Skjarpe, Terje
Background Real-time myocardial contrast echocardiography (MCE) is a novel method for assessing myocardial perfusion. The aim of this study was to evaluate the feasibility of a very low-power real-time MCE for quantification of regional resting myocardial blood flow (MBF) velocity in normal human myocardium. Methods Twenty study subjects with normal left ventricular (LV) wall motion and normal coronary arteries, underwent low-power real-time MCE based on color-coded pulse inversion Doppler. Standard apical LV views were acquired during constant IV. infusion of SonoVue®. Following transient microbubble destruction, the contrast replenishment rate (?), reflecting MBF velocity, was derived by plotting signal intensity vs. time and fitting data to the exponential function; y (t) =A (1-e-?(t-t0)) + C. Results Quantification was feasible in 82%, 49% and 63% of four-chamber, two-chamber and apical long-axis view segments, respectively. The LAD (left anterior descending artery) and RCA (right coronary artery) territories could potentially be evaluated in most, but contrast detection in the LCx (left circumflex artery) bed was poor. Depending on localisation and which frames to be analysed, mean values of were 0.21–0.69 s-1, with higher values in medial than lateral, and in basal compared to apical regions of scan plane (p = 0.03 and p < 0.01). Higher ?-values were obtained from end-diastole than end-systole (p < 0.001), values from all-frames analysis lying between. Conclusion Low-power real-time MCE did have the potential to give contrast enhancement for quantification of resting regional MBF velocity. However, the technique is difficult and subjected to several limitations. Significant variability in ? suggests that this parameter is best suited for with-in patient changes, comparing values of stress studies to baseline. PMID:15958173
Myocardial lactate dehydrogenase isoenzyme distribution in the normal heart
H.-P. Schultheiß; G. Bispink; V. Neuhoff; H.-D. Bolte
Summary The isoenzyme pattern of the lactate-dehydrogenase (LDH) in different parts of the heart was measured by micro-isoelectric focusing. Samples were taken from the right and left auricle, the outer, middle and inner layer of the myocardial wall of both ventricles and from the papillary muscle of the left ventricle. The results show that the activity of LDHtotal and the
Interaction between Apical Supports and Levator Ani in Anterior Vaginal Support: Theoretical Analysis
Chen, Luyun; Ashton-Miller, James A.; Hsu, Yvonne; DeLancey, John O. L.
Objective To use a biomechanical model to explore how impairment of the pubovisceral portion of the levator ani muscle and/or the apical vaginal suspension might interact to affect anterior vaginal wall prolapse severity. Method A biomechanical model of the anterior vaginal wall and its support system was developed and implemented. The anterior vaginal wall and main muscular and connective tissue support elements, namely the levator plate, pubovisceral muscle, cardinal and uterosacral ligaments, were included and their geometry based on mid-sagittal plane magnetic resonance scans. Material properties were based on published data. The change in the sagittal profile of the anterior vaginal wall during a maximum Valsalva was then simulated when different combinations of muscle and connective tissue impairment were present. Results Under raised intra-abdominal pressure, the magnitude of anterior vaginal wall prolapse was shown to be a combined function of both pubovisceral muscle and uterosacral and/or cardinal ligament ("apical supports") impairment. Once a certain degree of pubovisceral impairment was reached, the genital hiatus opened and a prolapse developed. The larger the pubovisceral impairment, the larger the anterior wall prolapse became. A 90% impairment of apical support led to an increase in anterior wall prolapse from 0.3 cm to 1.9 cm (a 530% increase) at 60% pubovisceral muscle impairment, and from 0.7 cm to 2.4 cm (a 240% increase) at 80% pubovisceral muscle impairment. Conclusions These results suggest that a prolapse can develop as a result of impairment of the muscular and apical supports of the anterior vaginal wall. PMID:16880302
Emotional responsivity and transient myocardial ischemia.
Carels, R A; Sherwood, A; Babyak, M; Gullette, E C; Coleman, R E; Waugh, R; Jiang, W; Blumenthal, J A
This study examined the relationship between "emotional responsivity" (i.e., individuals who exhibit relatively large variations of self-reported tension levels) and myocardial ischemia. One hundred thirty-six patients with coronary artery disease underwent 48 hr ambulatory electrocardiographic (ECG) monitoring and laboratory mental stress testing using radionuclide angiocardiography. Compared with individuals characterized as low emotional responders, a higher proportion of individuals characterized as high emotional responders exhibited wall motion abnormalities in response to laboratory mental stress testing and were more likely to exhibit ECG ST-segment depression (> or = 1 mm for > or = 1 min) during routine daily activities. These results suggest that emotional responsivity may represent an individual difference characteristic that is associated with an increased likelihood of exhibiting myocardial ischemia in both the laboratory and the real-world setting. PMID:10450634
Effect of hydroxy safflower yellow A on myocardial apoptosis after acute myocardial infarction in rats.
Zhou, M X; Fu, J H; Zhang, Q; Wang, J Q
This study aimed to investigate the effect of hydroxy safflower yellow A (HSYA) on myocardial apoptosis after acute myocardial infarction (AMI) in rats. We randomly divided 170 male Wistar rats into 6 groups (N = 23): normal control, sham, control, SY (90 mg/kg), HSYA high-dose (HSYA-H, 40 mg/kg), and HSYA low-dose groups (HSYA-L, 20 mg/kg). Myocardial ischemic injury was induced by ligating the anterior descending coronary artery, and the degree of myocardial ischemia was evaluated using electrocardiography and nitroblue tetrazolium staining. Bax and Bcl-2 expressions in the ischemic myocardium were determined using immunohistochemical analysis. Peroxisome proliferator-activated receptor-? (PPAR-?) expression in the myocardium of rats with AMI was determined using reverse transcription-polymerase chain reaction. Compared to rats in the control group, those in the HYSA-H, HSYA-L, and SY groups showed a decrease in the elevated ST segments and an increase in the infarct size. The rats in the drug-treated groups showed a significantly lower percentage of Bax-positive cells and a significantly higher percentage of Bcl-2-positive cells than those in the control group (P < 0.05). Moreover, mRNA expression of PPAR-? in the ischemic myocardium of rats in the SY, HSYA-L, and HSYA-H groups was significantly lower than that in the control group (P < 0.05). Thus, HSYA and SY can attenuate myocardial ischemia in rats, possibly by increasing the level of Bcl-2/Bax, and PPAR-? may be not a necessary link in this process. PMID:25966078
Cutts, Steven; Prempeh, Mark; Drew, Steven
INTRODUCTION Anterior dislocation of the shoulder is commonly seen in accident and emergency (A&E) and trauma clinics. In this article, we review the existing literature on the injury and the recent trends in management. MATERIALS AND METHODS We have discussed this condition with our colleagues and performed a Medline search ('anterior shoulder dislocation') of the relevant papers. We also describe key historical publications and recent developments regarding immobilisation of the joint. RESULTS Management decisions regarding this condition continue to vary between units, especially for recurrent and posterior dislocation. This paper lays some emphasis on the choice of analgesic agent when attempting shoulder reduction in the A&E setting. A summary of the data from our own department has provided a graphical representation of the classical age and sex distribution for this condition. CONCLUSIONS Shoulder dislocation is a common injury. Delays in diagnosis remain the single biggest obstacle to optimum results in this group of patients. A significant proportion will require eventual surgery and up to a third of these patients will go on to develop long-term shoulder arthritis. Even patients who have experienced a single episode of dislocation may go on to develop long-term sequelae. PMID:19126329
Bioengineered anterior cruciate ligament
NASA Technical Reports Server (NTRS)
Altman, Gregory (Inventor); Kaplan, David (Inventor); Vunjak-Novakovic, Gordana (Inventor); Martin, Ivan (Inventor)
The present invention provides a method for producing an anterior cruciate ligament ex vivo. The method comprises seeding pluripotent stem cells in a three dimensional matrix, anchoring the seeded matrix by attachment to two anchors, and culturing the cells within the matrix under conditions appropriate for cell growth and regeneration, while subjecting the matrix to one or more mechanical forces via movement of one or both of the attached anchors. Bone marrow stromal cells are preferably used as the pluripotent cells in the method. Suitable matrix materials are materials to which cells can adhere, such as a gel made from collagen type I. Suitable anchor materials are materials to which the matrix can attach, such as Goinopra coral and also demineralized bone. Optimally, the mechanical forces to which the matrix is subjected mimic mechanical stimuli experienced by an anterior cruciate ligament in vivo. This is accomplished by delivering the appropriate combination of tension, compression, torsion, and shear, to the matrix. The bioengineered ligament which is produced by this method is characterized by a cellular orientation and/or matrix crimp pattern in the direction of the applied mechanical forces, and also by the production of collagen type I, collagen type III, and fibronectin proteins along the axis of mechanical load produced by the mechanical forces. Optimally, the ligament produced has fiber bundles which are arranged into a helical organization. The method for producing an anterior cruciate ligament can be adapted to produce a wide range of tissue types ex vivo by adapting the anchor size and attachment sites to reflect the size of the specific type of tissue to be produced, and also adapting the specific combination of forces applied, to mimic the mechanical stimuli experienced in vivo by the specific type of tissue to be produced. The methods of the present invention can be further modified to incorporate other stimuli experienced in vivo by the particular developing tissue, some examples of the stimuli being chemical stimuli, and electro-magnetic stimuli. Some examples of tissue which can be produced include other ligaments in the body (hand, wrist, elbow, knee), tendon, cartilage, bone, muscle, and blood vessels.
The Effects of Thoracic Epidural Anesthesia on Functional Recovery from Myocardial Stunning in Propofol-Anesthetized Dogs
Norbert Rolf; Andreas MeiiJner; Hugo Van Aken; Thomas P. Weber; Dieter Hammel; Thomas Mijllhoff
The purpose of this investigation was to examine the effects of thoracic epidural anesthesia (TEA) on myo- cardial stunning during propofol anesthesia. Six dogs were chronically instrumented for measurement of left atrial, aortic, and left ventricular pressure, maximal rate of increase of left ventricular pressure, and myocardial wall-thickening fraction (WTF). Myocardial blood flow was determined with colored microspheres. Experi- ments
Interpretation of acute myocardial infarction with persistent 'hyperacute T waves' by cardiac magnetic resonance
Zorzi, Alessandro; Perazzolo Marra, Martina; Migliore, Federico; Tarantini, Giuseppe; Iliceto, Sabino
Peaked and tall T waves represent a hyperacute electrocardiogram (ECG) manifestation of coronary artery occlusion which usually evolves into ST-segment elevation. We sought to investigate using cardiac magnetic resonance (CMR) the myocardial tissue changes underlying an atypical ECG pattern of presentation of left anterior descending artery (LAD) occlusion consisting of persistent hyperacute T waves and mild ST-segment depression. This ECG pattern is often associated with the presence of collateral circulation, which may modulate myocyte action potential changes in response to ischemia and prevent the appearance of ST-segment elevation. However, CMR findings resembled those of typical anterior myocardial infarction with nearly transmural necrosis in the large myocardial area supplied by LAD. Accordingly, persistent hyperacute T waves should be regarded as an equivalent to ST-segment elevation and immediate reperfusion therapy should be considered. PMID:24062926
Bryant, Catherine L C; Lunniss, Peter J; Knowles, Charles H; Thaha, Mohamed A; Chan, Christopher L H
Up to 80% of patients with rectal cancer undergo sphincter-preserving surgery. It is widely accepted that up to 90% of such patients will subsequently have a change in bowel habit, ranging from increased bowel frequency to faecal incontinence or evacuatory dysfunction. This wide spectrum of symptoms after resection and reconstruction of the rectum has been termed anterior resection syndrome. Currently, no precise definition or causal mechanisms have been established. This disordered bowel function has a substantial negative effect on quality of life. Previous reviews have mainly focused on different colonic reconstructive configurations and their comparative effects on daily function and quality of life. The present Review explores the potential mechanisms underlying disturbed functions, as well as current, novel, and future treatment options. PMID:22935240
Acute assessment of microvascular perfusion patterns by myocardial contrast echocardiography during myocardial infarction: relation to timing and extent of functional recovery
Czitrom, D; Karila-Cohen, D; Brochet, E; Juliard, J; Faraggi, M; Aumont, M; Assayag, P; Steg, P
Objective—To examine the relation between the initial microvascular perfusion pattern, as assessed by intracoronary myocardial contrast echocardiography (MCE), immediately after restoration of TIMI (thrombolysis in myocardial infarction) (TIMI) grade 3 flow during acute myocardial infarction, and the extent and timing of functional recovery in the area at risk.?Setting—Referral centre for interventional cardiology.?Methods—Intracoronary MCE was performed 15 minutes after TIMI grade 3 recanalisation of the infarct artery in 25 patients. Segmental myocardial contrast patterns were graded semiquantitatively (0, none; 0.5, heterogeneous; 1, homogeneous). Functional recovery was assessed by echocardiography on days 9 and 42.?Results—Among 174 myocardial segments in the area at risk, wall motion recovery on day 9 was observed in 40% of MCE grade 1 segments but there was no significant recovery in grade 0 or 0.5 segments. On day 42, recovery had occurred in 56% of MCE grade 1 segments (p < 0.0001 v MCE grade 0 and 0.5; p = 0.0001 v MCE grade 1 on day 9), and 22% of MCE grade 0.5 segments (p = 0.02 v MCE grade 0; p = 0.0005 v MCE grade 0.5 on day 9); MCE grade 0 segments did not recover. Negative predictive value in predicting recovery by contrast enhancement was 95% and 89% by days 9 and 42, respectively.?Conclusions—Contractile recovery occurs earliest in well reperfused segments. Up to one quarter of segments with heterogeneous contrast enhancement show wall motion recovery within the first six weeks. Myocardial perfusion after recanalisation in acute myocardial infarction, even if heterogeneous, is a prerequisite for postischaemic functional recovery. Thus preservation of acute myocardial perfusion is associated with more complete and early functional recovery.?? Keywords: acute myocardial infarction; myocardial contrast echocardiography; microcirculation; functional recovery PMID:10220538
Abdominal Wall Schwannoma: Case Report and Review of the Literature
Mishra, A.; Hamadto, M.; Azzabi, M.; Elfagieh, M.
A 29-year-old female had presented to surgical outpatient's department complaining of lump in the anterior abdominal wall. Ultrasound and magnetic resonance imaging revealed a solid degenerated tumor in the anterior abdominal wall. It was surgically excised, and histopathology confirmed it to be "ancient" schwannoma. To our knowledge, this is the second reported case of an abdominal wall ancient schwannoma in the medical literature. PMID:23841008
Abdominal wall schwannoma: case report and review of the literature.
Mishra, A; Hamadto, M; Azzabi, M; Elfagieh, M
A 29-year-old female had presented to surgical outpatient's department complaining of lump in the anterior abdominal wall. Ultrasound and magnetic resonance imaging revealed a solid degenerated tumor in the anterior abdominal wall. It was surgically excised, and histopathology confirmed it to be "ancient" schwannoma. To our knowledge, this is the second reported case of an abdominal wall ancient schwannoma in the medical literature. PMID:23841008
Different contribution of extent of myocardial injury to left ventricular systolic and diastolic function in early reperfused acute myocardial infarction
Background We sought to investigate the influence of the extent of myocardial injury on left ventricular (LV) systolic and diastolic function in patients after reperfused acute myocardial infarction (AMI). Methods Thirty-eight reperfused AMI patients underwent cardiac magnetic resonance (CMR) imaging after percutaneous coronary revascularization. The extent of myocardial edema and scarring were assessed by T2 weighted imaging and late gadolinium enhancement (LGE) imaging, respectively. Within a day of CMR, echocardiography was done. Using 2D speckle tracking analysis, LV longitudinal, circumferential strain, and twist were measured. Results Extent of LGE were significantly correlated with LV systolic functional indices such as ejection fraction (r?=?-0.57, p?0.001), regional wall motion score index (r?=?0.52, p?=?0.001), and global longitudinal strain (r?=?0.56, p?0.001). The diastolic functional indices significantly correlated with age (r?=?-0.64, p?0.001), LV twist (r?=?-0.39, p?=?0.02), average non-infarcted myocardial circumferential strain (r?=?-0.52, p?=?0.001), and LV end-diastolic wall stress index (r?=?-0.47, p?=?0.003 with e') but not or weakly with extent of LGE. In multivariate analysis, age and non-infarcted myocardial circumferential strain independently correlated with diastolic functional indices rather than extent of injury. Conclusions In patients with timely reperfused AMI, not only extent of myocardial injury but also age and non-infarcted myocardial function were more significantly related to LV chamber diastolic function. PMID:24512272
Non-ST-elevation myocardial infarction after a wasp sting.
Gawlik, Radoslaw; Pezold, Marcin; Bo?ek, Andrzej
We report a case of a 56-year-old woman with loss of conscious transferred to the cardiology unit where non-ST-elevation myocardial infarction was diagnosed. The patient reported a wasp sting a few minutes before the accident. The cardiac troponin level was high and confirmed damage of the heart muscle. Finally, echocardiography and myocardial perfusion scintigraphy revealed an ejection fraction of 50% with hypokinesia of posterior walls. Cardiac consequences of the insect venom sting are discussed in this article. PMID:25254013
Non-ST-elevation myocardial infarction after a wasp sting
Pezold, Marcin; Bo?ek, Andrzej
We report a case of a 56-year-old woman with loss of conscious transferred to the cardiology unit where non-ST-elevation myocardial infarction was diagnosed. The patient reported a wasp sting a few minutes before the accident. The cardiac troponin level was high and confirmed damage of the heart muscle. Finally, echocardiography and myocardial perfusion scintigraphy revealed an ejection fraction of 50% with hypokinesia of posterior walls. Cardiac consequences of the insect venom sting are discussed in this article. PMID:25254013
The additional value of first pass myocardial perfusion imaging during peak dose of dobutamine stress cardiac MRI for the detection of myocardial ischemia
Janssen, Caroline H. C.; Kuijpers, Dirkjan; van Dijkman, Paul R. M.; Overbosch, Jelle; Willems, Tineke P.; Oudkerk, Matthijs
Purpose of this study was to assess the additional value of first pass myocardial perfusion imaging during peak dose of dobutamine stress Cardiac-MR (CMR). Dobutamine Stress CMR was performed in 115 patients with an inconclusive diagnosis of myocardial ischemia on a 1.5 T system (Magnetom Avanto, Siemens Medical Systems). Three short-axis cine and grid series were acquired during rest and at increasing doses of dobutamine (maximum 40 ?g/kg/min). On peak dose dobutamine followed immediately by a first pass myocardial perfusion imaging sequence. Images were graded according to the sixteen-segment model, on a four point scale. Ninety-seven patients showed no New (Induced) Wall Motion Abnormalities (NWMA). Perfusion imaging showed absence of perfusion deficits in 67 of these patients (69%). Perfusion deficits attributable to known previous myocardial infarction were found in 30 patients (31%). Eighteen patients had NWMA, indicative for myocardial ischemia, of which 14 (78%) could be confirmed by a corresponding perfusion deficit. Four patients (22%) with NWMA did not have perfusion deficits. In these four patients NWMA were caused by a Left Bundle Branch Block (LBBB). They were free from cardiac events during the follow-up period (median 13.5 months; range 6–20). Addition of first-pass myocardial perfusion imaging during peak-dose dobutamine stress CMR can help to decide whether a NWMA is caused by myocardial ischemia or is due to an (inducible) LBBB, hereby preventing a false positive wall motion interpretation. PMID:17566871
Anterior chamber depth during hemodialysis
Gracitelli, Carolina Pelegrini Barbosa; Stefanini, Francisco Rosa; Penha, Fernando; Góes, Miguel Ângelo; Draibe, Sérgio Antonio; Canziani, Maria Eugęnia; Junior, Augusto Paranhos
Background Exacerbation of chronic glaucoma or acute glaucoma is occasionally observed in patients undergoing hemodialysis (HD) because of anterior chamber depth changes during this therapy. Purpose To evaluate anterior chamber depth and axial length in patients during HD sessions. Methods A total of 67 eyes of 35 patients were prospectively enrolled. Axial length and anterior chamber depth were measured using ultrasonic biometry, and these measures were evaluated at three different times during HD sessions. Body weight and blood pressure pre- and post-HD were also measured. Results There was no difference in the axial length between the three measurements (P = 0.241). We observed a significantly decreased anterior chamber depth (P = 0.002) during HD sessions. Conclusion Our results support the idea that there is a change in anterior chamber depth in HD sessions. PMID:23976841
[Giant anterior communicating artery aneurysm (author's transl)].
Ito, H; Shima, T; Yamamoto, S
A case of giant aneurysm arising from the anterior communicating artery, 24 X 28 X 30 mm in diameter was found in a 30 year old man. About ten years ago he became blind and recently developed right anosmia and diencephalic seizures. No subarachnoid hemorrhage, however, was found. Radiograms and tomograms of the cranium showed a ring-like calcification, but by angiography it couldn't be recognized as a giant aneurysm. The right frontal craniotomy and partial resection, therefore, was performed. A histological study of the resected material revealed that it was a spontaneously thrombosed giant aneurysm. The inner layer of its wall had neither endothelium nor elastic lamina, but had deposits of calcium salt. The outer layer was composed of collagen fibers without cell infiltration. The aneurysm was thrombosed except for its neck but its organization occurred incompletely. We want to emphasize the importance of a correct preoperative diagnosis, as an erroneous operative procedure can result in disaster. Volume, viscosity and tension of flowing blood into the aneurysm as well as the size of its neck and dome regulate dynamic properties. These properties may determine the enlargement rate or growth of the aneurysm. The dynamic characteristics and features of the inner surface of the aneurysmal wall may regulate the formation of thrombosis in the aneurysm. The intraluminal thrombosis and strength of aneurysmal wall, for example, calcium deposits, may prohibit aneurysm from its rupture. PMID:1238924
38 CFR 3.379 - Anterior poliomyelitis.
Code of Federal Regulations, 2012 CFR
...2012-07-01 false Anterior poliomyelitis. 3.379 Section 3.379 ...Specific Diseases § 3.379 Anterior poliomyelitis. If the first manifestations of acute anterior poliomyelitis present themselves in a...
38 CFR 3.379 - Anterior poliomyelitis.
Code of Federal Regulations, 2010 CFR
...2010-07-01 false Anterior poliomyelitis. 3.379 Section 3.379 ...Specific Diseases § 3.379 Anterior poliomyelitis. If the first manifestations of acute anterior poliomyelitis present themselves in a...
38 CFR 3.379 - Anterior poliomyelitis.
Code of Federal Regulations, 2011 CFR
...2011-07-01 false Anterior poliomyelitis. 3.379 Section 3.379 ...Specific Diseases § 3.379 Anterior poliomyelitis. If the first manifestations of acute anterior poliomyelitis present themselves in a...
38 CFR 3.379 - Anterior poliomyelitis.
Code of Federal Regulations, 2014 CFR
...2014-07-01 false Anterior poliomyelitis. 3.379 Section 3.379 ...Specific Diseases § 3.379 Anterior poliomyelitis. If the first manifestations of acute anterior poliomyelitis present themselves in a...
38 CFR 3.379 - Anterior poliomyelitis.
Code of Federal Regulations, 2013 CFR
...2013-07-01 false Anterior poliomyelitis. 3.379 Section 3.379 ...Specific Diseases § 3.379 Anterior poliomyelitis. If the first manifestations of acute anterior poliomyelitis present themselves in a...
The gene encoding 5-lipoxygenase activating protein confers risk of myocardial infarction and stroke.
Helgadottir, Anna; Manolescu, Andrei; Thorleifsson, Gudmar; Gretarsdottir, Solveig; Jonsdottir, Helga; Thorsteinsdottir, Unnur; Samani, Nilesh J; Gudmundsson, Gudmundur; Grant, Struan F A; Thorgeirsson, Gudmundur; Sveinbjornsdottir, Sigurlaug; Valdimarsson, Einar M; Matthiasson, Stefan E; Johannsson, Halldor; Gudmundsdottir, Olof; Gurney, Mark E; Sainz, Jesus; Thorhallsdottir, Margret; Andresdottir, Margret; Frigge, Michael L; Topol, Eric J; Kong, Augustine; Gudnason, Vilmundur; Hakonarson, Hakon; Gulcher, Jeffrey R; Stefansson, Kari
We mapped a gene predisposing to myocardial infarction to a locus on chromosome 13q12-13. A four-marker single-nucleotide polymorphism (SNP) haplotype in this locus spanning the gene ALOX5AP encoding 5-lipoxygenase activating protein (FLAP) is associated with a two times greater risk of myocardial infarction in Iceland. This haplotype also confers almost two times greater risk of stroke. Another ALOX5AP haplotype is associated with myocardial infarction in individuals from the UK. Stimulated neutrophils from individuals with myocardial infarction produce more leukotriene B4, a key product in the 5-lipoxygenase pathway, than do neutrophils from controls, and this difference is largely attributed to cells from males who carry the at-risk haplotype. We conclude that variants of ALOX5AP are involved in the pathogenesis of both myocardial infarction and stroke by increasing leukotriene production and inflammation in the arterial wall. PMID:14770184
Thallium myocardial perfusion scans for the assessment of right ventricular hypertrophy in patients with cystic fibrosis. A comparison with other noninvasive techniques
Newth, C.J.; Corey, M.L.; Fowler, R.S.; Gilday, D.L.; Gross, D.; Mitchell, I.
The incidence of right ventricular hypertrophy in 32 patients with cystic fibrosis was studied using thallium 201 (TI-201) myocardial perfusion scans, and compared with other noninvasive techniques including electrocardiography, vectorcardiography, and M-mode echocardiography. The patients (mean age, 17.3 yr; range, 7 to 33) had a wide range of clinical and pulmonary abnormalities (mean Shwachman-Kulczycki score, 66.6). In the total study group, TI-201 scans, like the vectorcardiograms and the M-mode echocardiograms, gave a surprisingly high proportion of positive predictions for right ventricular hypertrophy (RVH) (44%). The correlations with all other noninvasive methods were uniformly poor, so caution must be exercised in using this technique to predict early RVH in order to follow the natural history of cor pulmonale in cystic fibrosis. At the time of the study, 6 patients had clinical evidence of right ventricular failure, and in this disease setting must have had RVH. In 3 patients, RVH was confirmed at autopsy, and it was successfully predicted by TI-201 scans in 5 of the 6 patients. The false negative scan may have been due to regional myocardial ischemia secondary to severe right ventricular failure. In contrast, the vectorcardiogram, using Fowler's new criteria, made a successful prediction of RVH in all 6 patients, and the electro cardiogram in only 3. Although the M-mode echocardiogram was abnormal in all patients, it would have predicted RVH (with increased right ventricular anterior wall thickness) in only 1 patient. We concluded that TI-201 myocardial perfusion cans are good at confirming RVH in cases with established right ventricular failure, but have no advantage over vectorcardiographic assessments, which are logistically easier to perform and carry no radiation risks.
Perioperative Assessment of Myocardial Deformation
Duncan, Andra E.; Alfirevic, Andrej; Sessler, Daniel I.; Popovic, Zoran B.; Thomas, James D.
Evaluation of left ventricular performance improves risk assessment and guides anesthetic decisions. However, the most common echocardiographic measure of myocardial function, the left ventricular ejection fraction (LVEF), has important limitations. LVEF is limited by subjective interpretation which reduces accuracy and reproducibility, and LVEF assesses global function without characterizing regional myocardial abnormalities. An alternative objective echocardiographic measure of myocardial function is thus needed. Myocardial deformation analysis, which performs quantitative assessment of global and regional myocardial function, may be useful for perioperative care of surgical patients. Myocardial deformation analysis evaluates left ventricular mechanics by quantifying strain and strain rate. Strain describes percent change in myocardial length in the longitudinal (from base to apex) and circumferential (encircling the short-axis of the ventricle) direction and change in thickness in the radial direction. Segmental strain describes regional myocardial function. Strain is a negative number when the ventricle shortens longitudinally or circumferentially and is positive with radial thickening. Reference values for normal longitudinal strain from a recent meta-analysis using transthoracic echocardiography are (mean ± SD) ?19.7 ± 0.4%, while radial and circumferential strain are 47.3 ± 1.9 and ?23.3 ± 0.7%, respectively. The speed of myocardial deformation is also important and is characterized by strain rate. Longitudinal systolic strain rate in healthy subjects averages ?1.10 ± 0.16 sec?1. Assessment of myocardial deformation requires consideration of both strain (change in deformation), which correlates with LVEF, and strain rate (speed of deformation), which correlates with rate of rise of left ventricular pressure (dP/dt). Myocardial deformation analysis also evaluates ventricular relaxation, twist, and untwist, providing new and noninvasive methods to assess components of myocardial systolic and diastolic function. Myocardial deformation analysis is based on either Doppler or a non-Doppler technique, called speckle-tracking echocardiography. Myocardial deformation analysis provides quantitative measures of global and regional myocardial function for use in the perioperative care of the surgical patient. For example, coronary graft occlusion after coronary artery bypass grafting is detected by an acute reduction in strain in the affected coronary artery territory. In addition, assessment of left ventricular mechanics detects underlying myocardial pathology before abnormalities become apparent on conventional echocardiography. Certainly, patients with aortic regurgitation demonstrate reduced longitudinal strain before reduction in LVEF occurs, which allows detection of subclinical left ventricular dysfunction and predicts increased risk for heart failure and impaired myocardial function after surgical repair. In this review we describe the principles, techniques, and clinical application of myocardial deformation analysis. PMID:24557101
Coronary hyperperfusion and myocardial metabolism in isolated and intact hearts
Miller, W.P.; Shimamoto, N.; Nellis, S.H.; Liedtke, A.J. (Univ. of Wisconsin Medical School, Madison (USA))
The authors determined the independent influence of coronary hyperperfusion on myocardial metabolism in isolated and intact hearts. In an isovolumic blood-perfused rat heart preparation working against a left ventricular (LV) balloon, the effect of increasing coronary perfusion pressure from 100 to 150 mmHg was assessed. They concluded that coronary hyperperfusion was not an independent stimulus to myocardial VO{sub 2}. To further test this, the effect of coronary hyperperfusion on myocardial metabolism was studied in an intact working swine heart preparation where the cardiac output was fixed with a right heart bypass circuit. Fatty acid oxidation in the left anterior descending bed was assessed by production of {sup 14}CO{sub 2} from ({sup 14}C(U))palmitate. They conclude that coronary hyperperfusion is not an independent determinant of myocardial oxidation or fatty acid utilization, and enhancement of mechanical function by the garden-hose effect appears to be dependent on the parameters of LV performance that are controlled.
Quantitative Texture Analysis and Transesophageal Echocardiography to Characterize the Acute Myocardial Contusion
Amichi, Abdelaziz; Laugier, Pascal
Myocardial contusion (MC) is a common injury following blunt chest trauma without any specific symptoms. Several techniques such as electrocardiogram, estimation of myocardial band fraction of creatine phosphokinase, chest radiography and the scintiscanning missed efficiency to characterize the MC. Another technique based on transesophageal echocardiography [TEE] allows to visualize the structures of the heart with a good spatial resolution. We postulated that the quantitative texture analysis of regional image texture in two- dimensional [2D] TEE echocardiograms would be an accurate method to differentiate normal from abnormal myocardial wall. This preliminary experimental study demonstrated the feasibility of the proposed technique. PMID:19587806
Unusual mechanism of myocardial infarction in prosthetic valve endocarditis
Atik, Fernando A; Campos, Vanessa G; da Cunha, Claudio R; de Oliveira, Felipe Bezerra Martins; Otto, Maria Estefânia Bosco; Monte, Guilherme U
A 46-year-old man with bicuspid aortic valve and severe calcific aortic stenosis was submitted to aortic valve replacement with a stented bioprosthesis. He developed Staphylococcus epidermidis prosthetic valve endocarditis a month later, presenting in the emergency room with acute myocardial infarction. The mechanism of myocardial ischemia was a large aortic root abscess causing left main extrinsic compression. He was urgently taken to the operating room, and an aortic root replacement with cryopreserved homograft was performed, associated with autologous pericardium patch closure of aortic to right atrium fistula and coronary artery bypass grafting of the left anterior descending. After a difficult postoperative period with multiple problems, he was eventually discharged home. At 36-month follow-up, he is asymptomatic with no recurrent infection, and the left main coronary artery is widely patent on control chest computed tomography.
[Usefulness of 201Tl/123I-BMIPP myocardial SPECT to evaluate myocardial viability and area at risk in acute myocardial infarction--comparison with 201Tl/99mTc-PYP dual SPECT].
Isobe, N; Toyama, T; Hoshizaki, H; Oshima, S; Taniguchi, K
To evaluate the area at risk and the myocardial viability of acute myocardial infarction (AMI), we compared rest 123I-beta-methyl iodophenyl pentadecanoic acid (123I-BMIPP) and 201Tl myocardial SPECT with 201Tl/99mTc-PYP dual SPECT (D-SPECT) in 65 patients (mean age 64 +/- 11 years) with AMI. D-SPECT was performed in 3 to 5 days, 123I-BMIPP myocardial SPECT in 5 to 7 days, and left ventriculography on 1 month after onset of AMI. Furthermore, 201Tl/123I-BMIPP myocardial SPECT and left ventriculography were performed on 4 months after onset of AMI. The area which showed the reduced 123I-BMIPP uptake was larger than that showed the accumulation of 99mTc-PYP. The improvement of regional wall motion on 4 months after onset of AMI tended to be more closely correlated with the existence of discrepancy zone between 201Tl and 123I-BMIPP uptake than that of overlap zone between 201Tl and 99mTc-PYP uptake in acute period. We conclude that 201Tl/123I-BMIPP myocardial SPECT is more useful to evaluate the area at risk and myocardial viability of AMI than D-SPECT. PMID:9183144
A neurosurgical view of anatomical evaluation of anterior C1–C2 for safer transoral odontoidectomy
Kaptanoglu, Erkan; Cemil, Berker; Karahan, S. Tuna; Esmer, Ali F?rat; Elhan, Alaiddin
An anatomical study for evaluation of anterior C1–C2. To provide essential anatomic data for safer transoral odontoidectomy. The surface dimensions of the atlas vertebra and the transoral approach for odontoidectomy have been described in detail. Anterior arcus of C1 must be drilled out to reach odontoid process for transoral odontoidectomy. The thickness of anterior ring of C1 has not been studied before. Sixty, dried adult atlas and 60 axis vertebrae and ten cadaveric craniocervical specimens were measured for the following: (1) bony drilling depth (BDD), the distance from the anterior wall of anterior ring of C1 to anterior wall of odontoid; (2) minimum drilling diameter (MDD), distance of minimum C1 anterior ring removal for odontoid resection on horizontal plane; (3) maximum bony drilling diameter (MBDD), distance of maximum C1 anterior ring removal for odontoid resection on horizontal plane. Lateral border of this diameter is limited by medial borders of the lateral mass; (4) the widest odontoid diameters (WOD) on coronal sections were measured. On 60 atlas and axis vertebrae, the BDD was 7.0 ± 1.2 mm on dry bones, the distance between the medial borders of the lateral mass (MBDD) was 16.1 ± 1.5 mm, and the WOD on coronal sections (WOD) was 9.8 ± 0.8 mm. On cadavers, the distance between the two edges of C1 anterior ring removal for odontoid resection (MDD) was 10.8 ± 1.1 mm and the WOD on coronal sections (WOD) was 10.1 ± 1.4 mm. An odontoid surgery through transoral approach is safe and feasible. A quantitative understanding of the anterior anatomy of C-1 and C-2 is necessary when considering transoral odontoid resection. In this study the authors define safe zones for anterior atlas and axis. PMID:18351401
Follow-up after polypropylene mesh repair of anterior and posterior compartments in patients with recurrent prolapse
A. Gauruder-Burmester; P. Koutouzidou; J. Rohne; M. Gronewold; R. Tunn
To retrospectively analyze the outcome of surgery in women followed up for 1 year after vaginal repair with the Apogee? (support\\u000a of posterior vaginal wall) or Perigee? (support of anterior vaginal wall) system. A total of 120 patients with recurrent cystocele\\u000a and\\/or rectocele or with combined vaginal vault prolapse were treated by either posterior or anterior mesh interposition depending\\u000a on the
Tissue engineering for myocardial regeneration
Tatsuya Shimizu; Masayuki Yamato; Akihiko Kikuchi; Teruo Okano
Recent progress in stem cell biology has shown the possibility of implantable human myocardial cell sources. It has encouraged\\u000a myocardial tissue engineering for rescuing damaged hearts. The present strategy is to repair not all of the myocardial tissue,\\u000a but part of it. There are two approaches. The first is direct injection of dissociated cell suspensions via the pericardium,\\u000a coronary arteries,
[Stress and myocardial infarction].
Csef, H; Hefner, J
Most people throughout the world die from the consequences of cardiovascular disease. Stress and psychosocial burdens have, in the past, been underestimated with regard to the importance of their impact on the development and course of such diseases. In the INTERHEART study, psychosocial burdens occupy third place among the risk factors for developing acute myocardial infarction. The relevance of these factors is underscored by more recent studies, also with regard to the prognosis in already manifest CAH. The causes of mental stresses may be intrapsychic problems (e.g. depression). The roots may, however, also be found in the private sphere or at the workplace. On the basis of specific history-taking, relevant risk constellations can be identified for a comparatively low expenditure of time. Specific therapeutic approaches aimed at reducing and coping with stress may, in future, help prevent diseases of the heart and lower the risk of contracting a myocardial infarction. PMID:15832759
Biomarkers of Myocardial Necrosis
Robert H. Christenson; Hassan M. E. Azzazy
\\u000a Biochemical markers play a crucial role in accurate diagnosis of myocardial necrosis and, more importantly, for assessing\\u000a risk and directing appropriate therapy that improves clinical outcome. Development and utilization of biomarkers has evolved\\u000a substantially over the past three decades. The earliest biomarkers, such as alanine aminotransferase and lactate dehydrogenase,\\u000a have fallen out of use with the development of moer sensitive
Noncardioplegic Myocardial Preservation
Davis, Zev; Hoeksema, Tammo D.; Guillory, Joel R.; Chen, Aloysius J.; Garibaldi, Abel A.; Eisenberg, Brenda R.
Despite the widespread use of K + cardioplegia, the optimal method of intraoperative myocardial preservation remains controversial. Since 1975, in more than 3,500 patients who have undergone myocardial revascularization at our institutions, intraoperative protection has been provided by a technique of cold-blood perfusion without K + cardioplegia. This report describes our technique, analyzes quantitative ultrastructural changes in four patients before and after bypass to assess cellular damage, and details the clinical and angiographic findings in a subgroup of 157 patients followed postoperatively for up to 6 years. In 100 patients in whom multiple vessels were bypassed, vessels were patent on restudy, thereby excluding technical failure as a cause of impaired left ventricular function. Postoperatively, global left ventricular function was unchanged in 80% and improved in 19%, as compared with preoperative function. Left ventricular function deteriorated in only one patient. We conclude that intraoperative oxygenation by cold-blood perfusion is a successful method of myocardial preservation. (Texas Heart Institute Journal 1987; 14:39-46) Images PMID:15227328
The Early-Onset Myocardial Infarction Associated PHACTR1 Gene Regulates Skeletal and Cardiac Alpha-Actin Gene Expression
Kelloniemi, Annina; Szabo, Zoltan; Serpi, Raisa; Näpänkangas, Juha; Ohukainen, Pauli; Tenhunen, Olli; Kaikkonen, Leena; Koivisto, Elina; Bagyura, Zsolt; Kerkelä, Risto; Leosdottir, Margret; Hedner, Thomas; Melander, Olle
The phosphatase and actin regulator 1 (PHACTR1) locus is a very commonly identified hit in genome-wide association studies investigating coronary artery disease and myocardial infarction (MI). However, the function of PHACTR1 in the heart is still unknown. We characterized the mechanisms regulating Phactr1 expression in the heart, used adenoviral gene delivery to investigate the effects of Phactr1 on cardiac function, and analyzed the relationship between MI associated PHACTR1 allele and cardiac function in human subjects. Phactr1 mRNA and protein levels were markedly reduced (60%, P<0.01 and 90%, P<0.001, respectively) at 1 day after MI in rats. When the direct myocardial effects of Phactr1 were studied, the skeletal ?-actin to cardiac ?-actin isoform ratio was significantly higher (1.5-fold, P<0.05) at 3 days but 40% lower (P<0.05) at 2 weeks after adenovirus-mediated Phactr1 gene delivery into the anterior wall of the left ventricle. Similarly, the skeletal ?-actin to cardiac ?-actin ratio was lower at 2 weeks in infarcted hearts overexpressing Phactr1. In cultured neonatal cardiac myocytes, adenovirus-mediated Phactr1 overexpression for 48 hours markedly increased the skeletal ?-actin to cardiac ?-actin ratio, this being associated with an enhanced DNA binding activity of serum response factor. Phactr1 overexpression exerted no major effects on the expression of other cardiac genes or LV structure and function in normal and infarcted hearts during 2 weeks' follow-up period. In human subjects, MI associated PHACTR1 allele was not associated significantly with cardiac function (n = 1550). Phactr1 seems to regulate the skeletal to cardiac ?-actin isoform ratio. PMID:26098115
Transthoracic coronary flow reserve and dobutamine derived myocardial function: a 6-month evaluation after successful coronary angioplasty
Cicala, Silvana; Galderisi, Maurizio; Guarini, Pasquale; D'Errico, Arcangelo; Innelli, Pasquale; Pardo, Moira; Scognamiglio, Giancarlo; de Divitiis, Oreste
After percutaneous transluminal coronary angioplasty (PTCA), stress-echocardiography and gated single photon emission computerized tomography (g-SPECT) are usually performed but both tools have technical limitations. The present study evaluated results of PTCA of left anterior descending artery (LAD) six months after PTCA, by combining transthoracic Doppler coronary flow reserve (CFR) and color Tissue Doppler (C-TD) dobutamine stress. Six months after PTCA of LAD, 24 men, free of angiographic evidence of restenosis, underwent standard Doppler-echocardiography, transthoracic CFR of distal LAD (hyperemic to basal diastolic coronary flow ratio) and C-TD at rest and during dobutamine stress to quantify myocardial systolic (Sm) and diastolic (Em and Am, Em/Am ratio) peak velocities in middle posterior septum. Patients with myocardial infarction, coronary stenosis of non-LAD territory and heart failure were excluded. According to dipyridamole g-SPECT, 13 patients had normal perfusion and 11 with perfusion defects. The 2 groups were comparable for age, wall motion score index (WMSI) and C-TD at rest. However, patients with perfusion defects had lower CFR (2.11 ± 0.4 versus 2.87 ± 0.6, p < 0.002) and septal Sm at high-dose dobutamine (p < 0.01), with higher WMSI (p < 0.05) and stress-echo positivity of LAD territory in 5/11 patients. In the overall population, CFR was related negatively to high-dobutamine WMSI (r = -0.50, p < 0.01) and positively to high-dobutamine Sm of middle septum (r = 0.55, p < 0.005). In conclusion, even in absence of epicardial coronary restenosis, stress perfusion imaging reflects a physiologic impairment in coronary microcirculation function whose magnitude is associated with the degree of regional functional impairment detectable by C-TD. PMID:15581428
Quantitative analysis of regional myocardial performance in coronary artery disease
NASA Technical Reports Server (NTRS)
Stewart, D. K.; Dodge, H. T.; Frimer, M.
Findings from a group of subjects with significant coronary artery stenosis are given. A group of controls determined by use of a quantitative method for the study of regional myocardial performance based on the frame-by-frame analysis of biplane left ventricular angiograms are presented. Particular emphasis was placed upon the analysis of wall motion in terms of normalized segment dimensions, timing and velocity of contraction. The results were compared with the method of subjective assessment used clinically.
Brugada syndrome: a case report of an unusual association with vasospastic angina and coronary myocardial bridging.
Imazio, Massimo; Ghisio, Aldo; Coda, Luisella; Tidu, Massimo; Belli, Riccardo; Trinchero, Rita; Brusca, Antonio
This report describes a case of an unusual association between vasospastic angina, coronary myocardial bridging, and Brugada syndrome. The patient complained of chest pain followed by rhythmic palpitation and syncope. Brugada syndrome ECG markers were documented with transient ST-segment elevation in lateral leads. A coronary angiogram showed a myocardial bridging in the left anterior descending artery and coronary vasospasm was reproduced after intracoronary ergonovine injection in the circumflex coronary artery. Ventricular fibrillation was induced by programmed electrical stimulation. The described association can be important because interaction between ischemia and Brugada syndrome electrophysiological substrate could modulate individual susceptibility to life-threatening ventricular tachyarrhythmias. PMID:11991381
Pseudo Wellens T-waves in patients with suspected myocardial infarction: How cardiac magnetic resonance imaging can help the diagnosis
Chiara Bucciarelli-Ducci; Pablo Denes; Thomas A. Holly; Edwin Wu
Wellens' syndrome is characterized by symmetrically inverted T-waves in the precordial leads suggestive of impending myocardial infarction due to a critical proximal left anterior descending (LAD) stenosis. We describe three unusual cases of patients with such electrocardiographic abnormality in which coronary angiography ruled out the presence of critical coronary stenosis and cardiac magnetic resonance imaging excluded the presence of acute
Evaluation of the association of proximal coronary culprit artery lesion location with clinical outcomes in acute myocardial infarction
Juhana Karha; Sabina A Murphy; Ajay J Kirtane; James A de Lemos; Julian M Aroesty; Christopher P Cannon; Elliott M Antman; Eugene Braunwald; C. Michael Gibson
Impaired coronary artery blood flow and left anterior descending (LAD) artery culprit location are angiographic variables that have been associated with poorer outcomes after fibrinolytic administration in patients with acute myocardial infarction (AMI). We hypothesized that culprit lesion location in the proximal portion of the culprit artery would also be associated with poorer clinical outcomes compared with a mid or
Progressive failure of coronary flow during reperfusion of myocardial infarction: Documentation of the no reflow phenomenon with positron emission tomography
Richmond W. Jeremy; Jonathan M. Links; Lewis C. Becker
During reperfusion of a myocardial infarct, development of microvascular occlusion may result in regional hypoperfusion (no reflow) despite a patent infarct-related artery. This study examined the extent and time course of no reflow with use of rubidium-82 positron emission tomography. In 12 anesthetized dogs, the left anterior descending coronary artery was occluded for 90 min and then freely reperfused. Regional
Perioperative myocardial infarction in patients undergoing myocardial revascularization surgery
Pretto, Pericles; Martins, Gerez Fernandes; Biscaro, Andressa; Kruczan, Dany David; Jessen, Barbara
Introduction Perioperative myocardial infarction adversely affects the prognosis of patients undergoing coronary artery bypass graft and its diagnosis was hampered by numerous difficulties, because the pathophysiology is different from the traditional instability atherosclerotic and the clinical difficulty to be characterized. Objective To identify the frequency of perioperative myocardial infarction and its outcome in patients undergoing coronary artery bypass graft. Methods Retrospective cohort study performed in a tertiary hospital specialized in cardiology, from May 01, 2011 to April 30, 2012, which included all records containing coronary artery bypass graft records. To confirm the diagnosis of perioperative myocardial infarction criteria, the Third Universal Definition of Myocardial Infarction was used. Results We analyzed 116 cases. Perioperative myocardial infarction was diagnosed in 28 patients (24.1%). Number of grafts and use and cardiopulmonary bypass time were associated with this diagnosis and the mean age was significantly higher in this group. The diagnostic criteria elevated troponin I, which was positive in 99.1% of cases regardless of diagnosis of perioperative myocardial infarction. No significant difference was found between length of hospital stay and intensive care unit in patients with and without this complication, however patients with perioperative myocardial infarction progressed with worse left ventricular function and more death cases. Conclusion The frequency of perioperative myocardial infarction found in this study was considered high and as a consequence the same observed average higher troponin I, more cases of worsening left ventricular function and death. PMID:25859867
Arthroscopic Augmentation With Subscapularis Tendon in Anterior Shoulder Instability With Capsulolabral Deficiency
Maiotti, Marco; Massoni, Carlo
The treatment of chronic shoulder instability with poor quality of the anterior capsulolabral tissue is still controversial. In these cases the Latarjet procedure is certainly more effective in preventing recurrence than an arthroscopic capsular repair. However, several studies have reported a variety of severe complications related to the Latarjet procedure because of the use of bone augmentation and hardware implantation; moreover, the arthroscopic version of the Latarjet procedure is technically difficult and potentially dangerous because of the proximity of neurovascular structures. The aim of this report is to describe an innovative arthroscopic technique consisting of an augmentation of the anterior capsulolabral tissue using the articular portion of the subscapularis tendon and knotless suture anchors paired with high-strength tape for its fixation to the anterior glenoid edge. In the absence of severe bone deficiency of the anterior glenoid edge, this procedure can minimize arthroscopic technique failures, restoring the anterior capsulolabral wall without any significant reduction of shoulder functionality. PMID:24266004
Transient mitral regurgitation: An adjunctive sign of myocardial ischemia during dipyridamole-thallium imaging
Lette, J.; Gagnon, A.; Lapointe, J.; Cerino, M.
A patient developed transient exacerbation of a mitral insufficiency murmur and a reversible posterior wall perfusion defect during dipyridamole-thallium imaging. Coronary angiography showed significant stenoses of both the right and the circumflex coronary arteries that supply the posterior papillary muscle. Cardiac auscultation for transient mitral incompetence, a sign of reversible papillary muscle dysfunction, is a simple and practical adjunctive test for myocardial ischemia during dipyridamole-thallium imaging. It may confirm that an isolated reversible posterior wall myocardial perfusion defect is truly ischemic in nature as opposed to an artifact resulting from attenuation by the diaphragm.
Anatomy and CT reconstruction of the anterior area of sphenoid sinus
Wang, Shousen; Zhang, Jinchao; Xue, Liang; Wei, Liangfeng; Xi, Zhiyu; Wang, Rumi
Background: The anatomical structures of anterior area of sphenoid sinus are observed by CT reconstruction of radiographic images in some studies. However, the detailed anatomic information of the extended transsphenoidal approach is still incomplete. Method: Fifteen cases (30 sides) of adult cadaveric skulls and 20 cases (40 sides) of bleached adult dry skulls were observed and measured under microscope. CT imaging data were obtained from 12 patients. Results: Anatomy of anterior area of sphenoid sinus and sphenopalatine artery observed from CT three-dimensional reconstructed images was consistent with that observed from adult cadaveric skulls and bleached adult dry skulls. The anterior sphenoid sinus wall resembled a bird head, with midline protrude prismatically. The sphenoid ostia on both sides were in shape of bird-eyes, and the sphenoidal rostrum below was like the beak. The "shallowest point" was firstly reported in this study and was defined as the nearest point from the nostril to the anterior sphenoid sinus wall. It was located about 5.5 mm from sphenoid sinus ostium, and 5 mm from the upper edge of the posterior choanae. It was an important anatomical reference mark in locating the sphenoid sinus ostium in the anterior sinus wall. Conclusion: The three-dimensional images reconstructed by CT scan can visually display the bone structure of anterior area of sphenoid sinus, sphenopalatine artery and its main branches. Virtual endoscopy reconstruction can confirm the structural details of CT reconstruction and simulate transsphenoidal surgery. PMID:26131095
Diffuse anterior retinoblastoma: A review?
Jijelava, Kristen P.; Grossniklaus, Hans E.
Diffuse anterior retinoblastoma is a rare variant of diffuse infiltrating retinoblastoma which occurs in up to 1–2% of cases of retinoblastoma. In diffuse anterior retinoblastoma there is a small focus of tumor in the peripheral retina from which free tumor cells enter the aqueous humor and implant on the ciliary body, iris, lens and trabecular meshwork. Patients most commonly present with pseudouveitis, pseudohypopyon and increased intraocular pressure. The differential diagnosis is broad and all of the reported cases relied upon aspirates from the aqueous humor in order to make the diagnosis prior to proceeding with treatment. Treatment involves enucleation and, depending upon the extent of the tumor, may require systemic chemotherapy or external beam radiation. This review summarizes the 7 previously reported cases of diffuse anterior retinoblastoma, discusses pathologic features, and addresses the challenges of early diagnosis and future directions. PMID:24227977
The stability of myocardial area at risk estimated electrocardiographically in patients with ST elevation myocardial infarction.
Carlsen, Esben A; Hassell, Mariëlla E C J; van Hellemond, Irene E G; Bouwmeester, Sjoerd; Terkelsen, Christian J; Ringborn, Michael; Bang, Lia E; Wagner, Galen S
In patients with ST-elevation myocardial infarction (STEMI) the amount of myocardial area at risk (MaR) indicates the maximal potential loss of myocardium if the coronary artery remains occluded. During the time course of infarct evolution ischemic MaR is replaced by necrosis, which results in a decrease in ST segment elevation and QRS complex distortion. Recently it has been shown that combining the electrocardiographic (ECG) Aldrich ST and Selvester QRS scores result in a more accurate estimate of MaR than using either method alone. Therefore, we hypothesized that the combined Aldrich and Selvester score, indicating MaR, is stable until myocardial reperfusion therapy. In a retrospective analysis of a study population of 114 patients, 33 patients were included. The combined Aldrich and Selvester score was determined in ECGs recorded in the ambulance (ECG1) and in the hospital before reperfusion (ECG2). The combined Aldrich and Selvester score was considered stable if the difference between ECG1 and ECG2 was <4.5-percentage point. Stability of the combined Aldrich and Selvester score was observed in 12/33 patients (36.4%), and in regards to anterior and inferior ST elevation in 4/14 patients (28.6%) and 8/19 patients (42.1%), respectively. The median time between the recording of ECG1 and ECG2 was 75 minutes, however the changes in ECG scores were independent of the time between ECG recordings. Patients not meeting the stability criterion either had a decrease (9 patients) or increase (12 patients) of the combined Aldrich and Selvester score. In conclusion, the ECG estimated MaR was stable between the earliest recording time and initiation of reperfusion treatment only in a subgroup of the patients with STEMI. The findings of this study may suggest heterogeneity in regards to the development of the MaR and could indicate a potential need for differentiation in the acute treatment. PMID:24878032
Beta endorphin release in patients after spontaneous and provoked acute myocardial ischaemia.
Oldroyd, K G; Harvey, K; Gray, C E; Beastall, G H; Cobbe, S M
BACKGROUND--In animal models of circulatory shock and heart failure concentrations of the endogenous opioid peptide beta endorphin are raised and opioid receptor blockade improves haemodynamic variables and survival. This study was performed to identify whether acute myocardial ischaemia provokes the release of beta endorphin in humans. METHODS--Observational study in a university cardiology centre. Serial measurements of beta endorphin made by specific radioimmunoassay were correlated with other clinical and neuroendocrine variables that were measured prospectively. Fifty five patients with acute myocardial ischaemia and 26 patients undergoing elective coronary angioplasty of the left anterior descending coronary artery were studied. RESULTS--beta endorphin concentrations were raised above the upper limit of normal in 31/42 (74%) patients with confirmed myocardial infarction, 3/13 (23%) patients with unstable angina, and 10/24 (42%) patients after coronary angioplasty. There was no evidence of myocardial release of beta endorphin. There were significant positive correlations between beta endorphin and the concentrations of adrenocorticotrophic hormone, cortisol, and arginine vasopressin. In patients with acute myocardial ischaemia there was a significant positive correlation between the peak concentrations of creatine kinase and beta endorphin but no correlation with visual analogue scores of the intensity of chest pain. The highest beta endorphin concentrations were seen in patients whose clinical course was complicated by the development of heart failure. CONCLUSIONS--beta endorphin release is a component of the neuroendocrine activation associated with myocardial ischaemia/infarction. Images PMID:1313275
Treatment After Myocardial Infarction
Wilbert S. Aronow; Macy Pavilion
Persons after myocardial infarction (MI) should have their modifiable coronary artery risk factors intensively treated. Hypertension\\u000a should be treated with beta blockers and angiotensin-converting enzyme (ACE) inhibitors. The blood pressure should be reduced\\u000a to <140\\/90 mmHg and to <130\\/80 mmHg in persons with diabetes or renal insufficiency. The serum low-density lipoprotein cholesterol\\u000a should be reduced to 1c reduced to <7.0%. Aspirin or
Left anterior descending coronary artery dissection after blunt chest trauma.
Sadr-Ameli, Mohammad Ali; Amiri, Elaheh; Pouraliakbar, Hamidreza; Heidarali, Mona
Coronary artery dissection is a well-known albeit unusual complication of blunt chest trauma. It is also an uncommon cause of myocardial infarction. Only a few such cases have been reported, probably due to the high rate of sudden death. We report a case of left anterior descending (LAD) coronary artery dissection in a healthy 38-year-old female caused by blunt chest trauma. The patient was referred to our hospital with a complaint of chest pain. Electrocardiography showed T-wave inversion, echocardiography a revealed circumferential pericardial effusion, and the coronary angiogram demonstrated a thrombotic dissection of the LAD. Troponin I was the only biomarker with elevated level. CT coronary angiography was performed using the subtotal occlusion of the LAD and illustrated a relatively good LAD run-off, and thallium scintigraphy displayed viable myocardium in this territory. Despite the total occlusion of the LAD in our case, myocardial injury was not significant due to the relatively good LAD run-off. She underwent coronary artery bypass graft surgery with an excellent result. PMID:24444069
Stephen R. Christian; M. Bret Anderson; Ronald Workman; William F. Conway; Thomas L. Pope
nterior knee pain (AKP) is a common complaint in primary care and orthopedic clinics. In fact, in the sports medicine clinic, up to 25% of patients with knee complaints have symptoms of anterior knee pain (1). Adolescent females and other young individuals are at particular risk for AKP. In these individuals, symptoms are usually related to increased use, fre- quently
123I-metaiodobenzylguanidine myocardial scintigraphy in Parkinson's disease
Orimo, S; Ozawa, E; Nakade, S; Sugimoto, T; Mizusawa, H
OBJECTIVES—123I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy is clinically used to estimate local myocardial sympathetic nerve damage in some forms of heart disease, autonomic nerve disturbance in diabetic neuropathy, and disturbance of the autonomic nervous system in neurodegenerative disease. In the present study, examinations were performed to clarify (1) the proportion of cardiac sympathetic nerve disturbance in Parkinson's disease, (2) the usefulness of 123I-MIBG myocardial scintigraphy to detect sympathetic nerve disturbances compared with autonomic function tests, (3) cardiac function in patients who have a decreased MIBG uptake in 123I-MIBG myocardial scintigraphy, (4) the usefulness of 123I-MIBG myocardial scintigraphy to differentiate Parkinson's disease from the other neurological diseases mimicking it.?METHODS—123I-MIBG myocardial scintigraphy was performed, together with autonomic function tests and cardiac examinations in 46 patients with Parkinson's disease and 25 patients with vascular parkinsonism, essential tremor, or multiple system atrophy.?RESULTS—In an anterior image study, the average count per pixel in heart to mediastinum (H/M) ratio decreased in 80% of the patients with Parkinson's disease in the early phase and 84% in the late phase. The mean H/M ratio in Parkinson's disease was significantly lower than that in controls and the other diseases. The H/M ratio tended to decrease with the disease progression. In almost half of the patients in Hoehn and Yahr stage I, the H/M ratio was already decreased. The sympathetic skin response in upper and lower limbs, head up tilt test, and coefficient of variation of R-R interval were abnormal in 17%, 31%, 30%, and 17% of the patients, respectively. All the patients with abnormal autonomic functions were in Hoehn and Yahr stage III, IV, or V. Echocardiography showed normal left ventricular function. Twenty four hour Holter electrocardiography detected no serious arrhythmias except for one patient with non-sustained ventricular tachycardia.?CONCLUSION—123I-MIBG myocardial scintigraphy might detect early disturbances of the sympathetic nervous system in Parkinson's disease and might give useful diagnostic information to differentiate vascular parkinsonism, essential tremor, and multiple system atrophy from Parkinson's disease.?? PMID:10406987
(1) Coronary Events Caused by Myocardial Bridge
Yoko, Kawawa; Ehiichi, Kohda; Toshiharu, Ishii
Myocardial bridge (MB), which covers a part of the left anterior descending coronary artery (LAD), is a normal anatomical variant structure (45% in frequency by autopsy) in LAD. MB contraction plays the role of a "double-edged sword" on the coronary events, suppressing coronary atherosclerosis under the MB, yet generating abnormal blood flow associated with coronary heart diseases (CHDs). High shear stress driven by MB compression causes the suppression of vascular permeability and vasoactive protein expression such as e-NOS and endothelin-1, which leads to the suppression of atherosclerosis in the LAD segment under the MB. However, despite the prevalent view of MB as benignancy by conventional coronary angiography (5-6% in frequency), with advance of imaging technique such as multislice spiral computed tomography [(MSCT); 16% in frequency], cardiologists are now frequently aware of symptomatic MB occurring not only in hospitalized patients, but also in young athletes free from atherosclerosis. Moreover, the large mass volume of MB muscle induces atherosclerosis evolution at the settled site in LAD proximal to MB and contributes to the occurrence of myocardial infarction. These events upon the coronary events result from the different pathophysiological mechanisms induced by contractile force of MB, which is solely determined just by the integration of anatomical properties of MB, such as the location, length and thickness of MB in an individual LAD. A recent MSCT provides the objective quantification of the anatomical variables that correlate with the histopathological results in relation to the occurrence of CHD. In this review, we therefore discuss the necessity to explore MB as a inherent chance anatomical risk factor for CHD. PMID:23555365
Angiomyogenesis for Myocardial Repair
Akbar, Syed Ali; Ashraf, Muhammad
Abstract The conventional therapeutic modalities for myocardial infarction have limited success in preventing the progression of left ventricular remodeling and congestive heart failure. The heart cell therapy and therapeutic angiogenesis are two promising strategies for the treatment of ischemic heart disease. After extensive assessment of safety and effectiveness in vitro and in experimental animal studies, both of these approaches have accomplished the stage of clinical utility, albeit with limited success due to the inherent limitations and problems of each approach. Neomyogenesis without restoration of regional blood flow may be less meaningful. A combined stem-cell and gene-therapy approach of angiomyogenesis is expected to yield better results as compared with either of the approaches as a monotherapy. The combined therapy approach will help to restore the mechanical contractile function of the weakened myocardium and alleviate ischemic condition by restoration of regional blood flow. In providing an overview of both stem cell therapy and gene therapy, this article is an in-depth and critical appreciation of combined cell and gene therapy approach for myocardial repair. Antioxid. Redox Signal. 11, 1929–1944. PMID:19361254
Highly automatic quantification of myocardial oedema in patients with acute myocardial infarction using bright blood T2-weighted CMR
Background T2-weighted cardiovascular magnetic resonance (CMR) is clinically-useful for imaging the ischemic area-at-risk and amount of salvageable myocardium in patients with acute myocardial infarction (MI). However, to date, quantification of oedema is user-defined and potentially subjective. Methods We describe a highly automatic framework for quantifying myocardial oedema from bright blood T2-weighted CMR in patients with acute MI. Our approach retains user input (i.e. clinical judgment) to confirm the presence of oedema on an image which is then subjected to an automatic analysis. The new method was tested on 25 consecutive acute MI patients who had a CMR within 48 hours of hospital admission. Left ventricular wall boundaries were delineated automatically by variational level set methods followed by automatic detection of myocardial oedema by fitting a Rayleigh-Gaussian mixture statistical model. These data were compared with results from manual segmentation of the left ventricular wall and oedema, the current standard approach. Results The mean perpendicular distances between automatically detected left ventricular boundaries and corresponding manual delineated boundaries were in the range of 1-2 mm. Dice similarity coefficients for agreement (0=no agreement, 1=perfect agreement) between manual delineation and automatic segmentation of the left ventricular wall boundaries and oedema regions were 0.86 and 0.74, respectively. Conclusion Compared to standard manual approaches, the new highly automatic method for estimating myocardial oedema is accurate and straightforward. It has potential as a generic software tool for physicians to use in clinical practice. PMID:23548176
Multimodality Evaluation of the Viability of Stem Cells Delivered Into Different Zones of Myocardial Infarction
Ta-Chuan Hung; Yoriyasu Suzuki; Takashi Urashima; Anthony Caffarelli; Grant Hoyt; Ahmad Y. Sheikh; Alan C. Yeung; Irving Weissman; Robert C. Robbins; Jeff W. M. Bulte; Phillip C. Yang
Background—We tested the hypothesis that multimodality imaging of mouse embryonic stem cells (mESCs) provides accurate assessment of cellular location, viability, and restorative potential after transplantation into different zones of myocardial infarction. Methods and Results—Mice underwent left anterior descending artery ligation followed by transplantation of dual-labeled mESCs with superparamagnetic iron oxide and luciferase via direct injection into 3 different zones of
Myocardial Bridge as a Structure of "Double-Edged Sword" for the Coronary Artery
Myocardial bridge (MB) is a chance anatomical structure, comprised of the myocardial tissue, with which the coronary artery running in epicardial adipose tissue is partly covered. It is predominantly present in the left anterior descending artery (LAD) and recognizable through imaging techniques as changes in blood flow within the LAD that arises from MB contraction at cardiac systole. Such changes in blood flow influence the pathophysiology of coronary circulation and atherosclerosis development, thus generating controversy as to whether MB predisposes individual to myocardial infarction (MI). However, recent histomorphometric studies have shown that the individual anatomic properties of MB, such as location, length and thickness, consistently play a critical role in the occurrence of MI. This review article comprehensively addresses the pathophysiological mechanisms of MI occurrence together with the benign suppressive effect of coronary atherosclerosis by MB. PMID:24995053
In vivo determination of acute myocardial ischemia based on photoacoustic imaging with a focused transducer
NASA Astrophysics Data System (ADS)
Li, Zhifang; Li, Hui; Chen, Haiyu; Xie, Wengming
The location and ischemia extent are two important parameters for evaluating the acute myocardial ischemia (AMI). A focused-transducer-based photoacoustic imaging method was employed to assess time-dependent AMI. Our preliminary results show that the photoacoustic signal could identify the myocardium. The intensity and area of photoacoustic images of myocardium could be used for characterizing the ischemia extent and scope of myocardial ischemia. The results also imply that the intensity and area of photoacoustic images are the rapid fall of an exponential model with an increase of delaying time after the left anterior descending coronary artery (LAD) occlusion. These experimental results were consistent with the clinical characteristics. The findings suggest that the photoacoustic imaging be a potential tool for the real-time assessment of acute myocardial ischemia during surgical operation.
Cardiac-Specific SOCS3 Deletion Prevents In Vivo Myocardial Ischemia Reperfusion Injury through Sustained Activation of Cardioprotective Signaling Molecules
Nagata, Takanobu; Yasukawa, Hideo; Kyogoku, Sachiko; Oba, Toyoharu; Takahashi, Jinya; Nohara, Shoichiro; Minami, Tomoko; Mawatari, Kazutoshi; Sugi, Yusuke; Shimozono, Koutatsu; Pradervand, Sylvain; Hoshijima, Masahiko; Aoki, Hiroki; Fukumoto, Yoshihiro; Imaizumi, Tsutomu
Myocardial ischemia reperfusion injury (IRI) adversely affects cardiac performance and the prognosis of patients with acute myocardial infarction. Although myocardial signal transducer and activator of transcription (STAT) 3 is potently cardioprotective during IRI, the inhibitory mechanism responsible for its activation is largely unknown. The present study aimed to investigate the role of the myocardial suppressor of cytokine signaling (SOCS)-3, an intrinsic negative feedback regulator of the Janus kinase (JAK)-STAT signaling pathway, in the development of myocardial IRI. Myocardial IRI was induced in mice by ligating the left anterior descending coronary artery for 1 h, followed by different reperfusion times. One hour after reperfusion, the rapid expression of JAK-STAT–activating cytokines was observed. We precisely evaluated the phosphorylation of cardioprotective signaling molecules and the expression of SOCS3 during IRI and then induced myocardial IRI in wild-type and cardiac-specific SOCS3 knockout mice (SOCS3-CKO). The activation of STAT3, AKT, and ERK1/2 rapidly peaked and promptly decreased during IRI. This decrease correlated with the induction of SOCS3 expression up to 24 h after IRI in wild-type mice. The infarct size 24 h after reperfusion was significantly reduced in SOCS3-CKO compared with wild-type mice. In SOCS3-CKO mice, STAT3, AKT, and ERK1/2 phosphorylation was sustained, myocardial apoptosis was prevented, and the expression of anti-apoptotic Bcl-2 family member myeloid cell leukemia-1 (Mcl-1) was augmented. Cardiac-specific SOCS3 deletion led to the sustained activation of cardioprotective signaling molecules including and prevented myocardial apoptosis and injury during IRI. Our findings suggest that SOCS3 may represent a key factor that exacerbates the development of myocardial IRI. PMID:26010537
Anterior cruciate ligament (ACL) injury - aftercare
... of tissue that connects bone to bone. The anterior cruciate ligament (ACL) is located inside your knee joint and ... Amy E, Micheo W. Anterior cruciate ligament tear. In: Frontera WR, ... of Physical Medicine and Rehabilitation . 2nd ed. St. Louis, ...
S1pr2/G?13 signaling controls myocardial migration by regulating endoderm convergence.
Ye, Ding; Lin, Fang
A key process during vertebrate heart development is the migration of bilateral populations of myocardial precursors towards the midline to form the primitive heart tube. In zebrafish, signaling mediated by sphingosine-1-phosphate (S1P) and its cognate G protein-coupled receptor (S1pr2/Mil) is essential for myocardial migration, but the underlying mechanisms remain undefined. Here, we show that suppression of G?(13) signaling disrupts myocardial migration, leading to the formation of two bilaterally located hearts (cardia bifida). Genetic studies indicate that G?(13) acts downstream of S1pr2 to regulate myocardial migration through a RhoGEF-dependent pathway. Furthermore, disrupting any component of the S1pr2/G?(13)/RhoGEF pathway impairs endoderm convergence during segmentation, and the endodermal defects correlate with the extent of cardia bifida. Moreover, endoderm transplantation reveals that the presence of wild-type anterior endodermal cells in G?(13)-deficient embryos is sufficient to rescue the endoderm convergence defect and cardia bifida, and, conversely, that the presence of anterior endodermal cells defective for S1pr2 or G?(13) in wild-type embryos causes such defects. Thus, S1pr2/G?(13) signaling probably acts in the endoderm to regulate myocardial migration. In support of this notion, cardiac-specific expression of G?(13) fails to rescue cardia bifida in the context of global G?(13) inhibition. Our data demonstrate for the first time that the G?(13)/RhoGEF-dependent pathway functions downstream of S1pr2 to regulate convergent movement of the endoderm, an event that is crucial for coordinating myocardial migration. PMID:23318642
[Myocardial oxidative stress injury and myocardial ultrastructure in septic rats].
Bai, Jing; Zhang, Wenli; Zhang, Junwei; Cheng, Aibin; Li, Zhiqiang; Wang, Hongyang
Objective To investigate the mechanism of myocardial injury in septic rats by cecal ligation and puncture. Methods Fifty-four male Sprague-Dawley (SD) rats were randomly divided into 3 groups: normal group (n=6), sham group (n=24), sepsis group (n=24). Cecal ligation and puncture (CLP) was adopted to reproduce animal models of sepsis. The contents of cardiac troponin I (cTnI) and nitric oxide (NO) in serum and the activities of superoxide dismutase (SOD) and malondialdehyde (MDA) in myocardium were detected in each group 3, 6, 12, 24 hours after the operation (with 6 rats at each time point). The changes of myocardial pathomorphology were observed by HE staining under a microscope. The ultrastructural changes of myocardial cells were observed by the electron microscopy. Results The levels of serum cTnI and NO in the sepsis group were much higher than those in the sham group and the normal group. At the same time, the activity of MDA in myocardium in the sepsis group was also significantly higher than that in the other two groups. While the activity of SOD was obviously lower. Besides, ultrastructural changes in sepsis ones included myocardial cell edema, inflammatory cell infiltration, interstitial angiectasis and hyperemia and visible focal myocardial necrosis. Myocardial cell injury was more serious in sepsis rats compared with the other two groups. Electron microscopy showed different degrees of disorganized myofibrils, widened intercalated disc gap, decreased mitochondrial cristae and vacuolation of myocardium in sepsis group. Conclusion The myocardial cell injury is due to oxidative stress injury in septic rats. As the disease progresses, the myocardial ultrastructure damage becomes worse gradually. PMID:25940291
Cardioprotection of vitexin on myocardial ischemia/reperfusion injury in rat via regulating inflammatory cytokines and MAPK pathway.
Dong, Liu-Yi; Li, Sheng; Zhen, Yi-Lan; Wang, Ya-Nan; Shao, Xu; Luo, Zhi-Gang
This study was conducted to demonstrate myocardial protective effects and possible underlying mechanisms of vitexin on myocardial ischemia/reperfusion (I/R) injury in rats. Occluding the anterior descending artery for 30 min and restoring blood perfusion for 60 min in rat established a model of myocardial I/R. The elevation of the ST segment of Electrocardiograph (ECG) was observed. The infarct size of the rat heart was assessed by triphenyltetrazolium chloride staining (TTC). LDH, CK, SOD activities and MDA content were determined. An immunohistochemical analysis was applied to measure the expression of myocardial NF-?Bp65 and TNF-?. ERK/phospho-ERKand c-Jun/phospho-c-Jun protein expression was examined via Western Blot. Vitexin significantly reduced the elevation of the ST segment of ECG and myocardial infarct size. LDH and CK activities and MDA content were attenuated in serum, while SOD activity was markedly enhanced. Vitexin significantly attenuated I/R-induced increases of myocardial NF-?B and TNF-?. Moreover, Western Blot analysis presented that vitexin markedly enhanced the expression of phospho-ERK and weakened the expression of phospho-c-Jun compared to I/R group. The significant protective effect against myocardial ischemical/reperfusion injury in rat, which is exhibited by vitexin, may be related to its antioxidative and anti-inflammatory effects by regulating inflammatory cytokines and the MAPK pathway. PMID:24228599
Anterior spinal cord syndrome of unknown etiology
Klakeel, Merrine; Thompson, Justin; McDonald, Frank
A spinal cord injury encompasses a physical insult to the spinal cord. In the case of anterior spinal cord syndrome, the insult is a vascular lesion at the anterior spinal artery. We present the cases of two 13-year-old boys with anterior spinal cord syndrome, along with a review of the anatomy and vasculature of the spinal cord and an explanation of how a lesion in the cord corresponds to anterior spinal cord syndrome. PMID:25552812
Left ventricular early myocardial dysfunction after chronic misuse of anabolic androgenic steroids: a Doppler myocardial and strain imaging analysis
D'Andrea, Antonello; Caso, Pio; Salerno, Gemma; Scarafile, Raffaella; De Corato, Giuseppe; Mita, Claudia; Salvo, Giovanni Di; Severino, Sergio; Cuomo, Sergio; Liccardo, Biagio; Esposito, Nicolino; Calabrň, Raffaele
Background Anabolic androgenic steroids (AAS) are sometimes used by power athletes to improve performance by increasing muscle mass and strength. Recent bioptical data have shown that in athletes under the pharmacological effects of AAS, a focal increase in myocardial collagen content might occur as a repair mechanism against myocardial damage. Objective To investigate the potential underlying left ventricular myocardial dysfunction after chronic misuse of AAS in athletes by use of Doppler myocardial imaging (DMI) and strain rate imaging (SRI). Methods Standard Doppler echocardiography, DMI, SRI and ECG treadmill test were undertaken by 45 bodybuilders, including 20 athletes misusing AAS for at least 5?years (users), by 25 anabolic?free bodybuilders (non?users) and by 25 age?matched healthy sedentary controls, all men. The mean (SD) number of weeks of AAS use per year was 31.3 (6.4) in users, compared with 8.9 (3.8)?years in non?users, and the mean weekly dosage of AAS was 525.4 (90.7)?mg. Results The groups were matched for age. Systolic blood pressure was higher in athletes (145 (9) vs 130 (5)?mm Hg) than in controls. Left ventricular mass index did not significantly differ between the two groups of athletes. In particular, both users and non?users showed increased wall thickness and relative wall thickness compared with controls, whereas left ventricular ejection fraction, left ventricular end?diastolic diameter and transmitral Doppler indexes were comparable for the three groups. Colour DMI analysis showed significantly lower myocardial early: myocardial atrial diastolic wave ratios in users at the level of the basal interventricular septum (IVS) and left ventricular lateral wall (p<0.01), in comparison with both non?users and controls. In addition, in users, peak systolic left ventricular strain rate and strain were both reduced in the middle IVS (both p<0.001) and in the left ventricular lateral free wall (both p<0.01). By stepwise forward multivariate analyses, the sum of the left ventricular wall thickness (? coefficient?=??0.32, p<0.01), the number of weeks of AAS use per year (??=??0.42, p<0.001) and the weekly dosage of AAS (??=??0.48, p<0.001) were the only independent determinants of middle IVS strain rate. In addition, impaired left ventricular strain in users was associated with a reduced performance during physical effort (p<0.001). Conclusions Several years after chronic misuse of AAS, power athletes show a subclinical impairment of both systolic and diastolic myocardial function, strongly associated with mean dosage and duration of AAS use. The combined use of DMI and SRI may therefore be useful for the early identification of patients with more diffused cardiac involvement, and eventually for investigation of the reversibility of such myocardial effects after discontinuation of the drug. PMID:17178777
Treatment of ostial lesions of the left anterior descending coronary artery with Palmaz-Schatz coronary stent
Nicoletta B. De Cesare; Antonio L. Bartorelli; Stefano Galli; Alessandro Loaldi; Franco Fabbiocchi; Paolo Sganzerla; Piero Montorsi; Maurizio D. Guazzi
We evaluated acute and long-term clinical and angiographic results of elective Palmaz-Schatz coronary stent implantation for left anterior descending coronary artery (LAD) ostial stenosis in 23 consecutive patients. Eight patients had stable angina, 14 had unstable angina, and 1 had recent myocardial infarction. Sixteen patients had single-vessel, 5 had double-vessel, and 2 had triple-vessel disease. Clinical success without major complications
Anterior cranial base glioneuronal heterotopia
Dattatraya Muzumdar; Jean Michaud; Enrique C. G. Ventureyra
Background Cranial base glioneuronal heterotopia is a nest or linear array of glioneuronal tissue within the basal meninges. It is thought to arise from aberrant migration of embryonic neuroepithelial tissues into the subarachnoid space. It frequently mimics tumors and may extend through basal skull bones into extracranial soft tissues.Case report We describe a case of intracranial anterior skull base leptomeningeal glioneuronal heterotopia
Depression after myocardial infarction.
Kavanagh, T.; Shephard, R. J.; Tuck, J. A.
The Minnesota Multiphasic Personality Inventory was completed by 101 patients 16 to 18 months after a proved myocardial infarction. The data suggested a bimodal distribution of patients. One class of patients had a relatively "normal" personality score apart from a tendency to hypomania. The second class had severe depression, with associated hysteria, hypochondriasis and psychasthenia. The severely depressed patients were older, with a greater tendency to hypertension and angina, and a tendency to smaller gains in aerobic power despite an equal intensity of endurance training. The distinction between "normal" and "depressed" postinfarction patients seems of some clinical importance, for the two classes of patients require opposite supportive techniques--restraint and encouragement, respectively. PMID:1148970
Matrix metalloproteinase expression in cardiac myocytes following myocardial infarction in the rabbit
Anne M. Romanic; Cynthia L. Burns-Kurtis; Bernard Gout; Isabelle Berrebi-Bertrand; Eliot H. Ohlstein
Myocardial infarction (MI), leads to cardiac remodeling, thinning of the ventricle wall, ventricular dilation, and heart failure, and is a leading cause of death. Interactions between the contractile elements of the cardiac myocytes and the extracellular matrix (ECM) help maintain myocyte alignment required for the structural and functional integrity of the heart. Following MI, reorganization of the ECM and the
Refined ambient PM2.5 exposure surrogates and the risk of myocardial infarction
Using a case-crossover study design and conditional logistic regression, we compared the relative odds of transmural (full-wall) myocardial infarction (MI) calculated using exposure surrogates that account for human activity patterns and the indoor transport of ambient PM2....
Mechanical Complications after Myocardial Infarction Reliably Predicted Using C-Reactive Protein Levels and Lymphocytopenia
Anouk Widmer; André Z. Linka; Christine H. Attenhofer Jost; Barbara Buergi; Hans Peter Brunner-La Rocca; Franco Salomon; Burkhardt Seifert; Rolf Jenni
We assessed the accuracy of C-reactive protein (CRP) levels and lymphocyte counts to predict a mechanical complication (MC) after myocardial infarction (MI). Within 10 years, we identified 36 patients with 39 echocardiographically confirmed MC within 30 days of MI: ventricular septal defect (17 cases), papillary muscle rupture (10 cases), and left ventricular free wall rupture (12 cases). They were compared
Dobutamine magnetic resonance imaging as a predictor of myocardial functional recovery after revascularisation
Trent, R; Waiter, G; Hillis, G; McKiddie, F; Redpath, T; Walton, S
OBJECTIVE—To assess the use of dobutamine magnetic resonance imaging (MRI) as a preoperative predictor of myocardial functional recovery after revascularisation, comparing wall motion and radial wall thickening analyses by observer and semi-automated edge detection.?PATIENTS—25 men with multivessel coronary disease and resting wall motion abnormalities were studied with preoperative rest and stress MRI.?MAIN OUTCOME MEASURES—Observer analysis for radial wall thickening was compared with a normal range, while wall motion analysis used a standard four point scale. Semi-automated analysis was performed using an edge detection algorithm. Segments displaying either improved or worsened thickening or motion with dobutamine were considered viable. Postoperative rest images were performed 3-6 months after coronary artery bypass grafting (CABG) for comparison.?RESULTS—For observer analysis the values for sensitivity and specificity were 50% and 72% for wall motion, with respective values of 50% and 68% for thickening. With semi-automated edge detection the figures for motion were 60% and 73%, with corresponding values of 79% and 58% for thickening. Combining thickening and motion for the semi-automated method to describe any change in segmental function yielded a sensitivity of 71% and specificity of 70%.?CONCLUSIONS—Dobutamine MRI is a reasonably good predictor of myocardial functional recovery after CABG. The use of semi-automated edge detection analysis improved results.???Keywords: dobutamine; magnetic resonance imaging myocardial viability; coronary artery bypass grafting PMID:10618334
Proposed Recommendations for Myocardial Revascularisation.
Ward, Michael
This discussion paper presents proposed recommendations for myocardial revascularisation in the Australasian clinical setting based on underlying evidence-based principles and an understanding of local factors which may limit the provision of ideal practice. Recommendations are proposed for myocardial revascularisation in common clinical scenarios and also for special categories, such as patients with diabetes, chronic renal impairment, advanced age, chronic total occlusions and Indigenous patients. PMID:26050954
Thrombus burden and myocardial damage during primary percutaneous coronary intervention.
Napodano, Massimo; Dariol, Gilberto; Al Mamary, Ahmed H; Marra, Martina Perazzolo; Tarantini, Giuseppe; D'Amico, Gianpiero; Frigo, Anna Chiara; Buja, Paolo; Razzolini, Renato; Iliceto, Sabino
Large thrombus burden (LTB) lesions in the context of primary percutaneous coronary intervention (p-PCI) have been related to unsuccessful angiographic reperfusion and unfavorable clinical outcomes. However, the hazard of LTB treatment on myocardial damage has not been evaluated. We investigated the impact of LTB on myocardial damage using contrast-enhanced cardiac magnetic resonance (CE-CMR) in the setting of p-PCI. In 327 patients, who underwent p-PCI without thrombus aspiration within 12 hours from symptom onset, we prospectively assessed the impact of LTB on infarct size and microvascular damage using CE-CMR. LTB was defined by the presence of Thrombolysis In Myocardial Infarction thrombus score ?3 in patent infarct-related artery (IRA); or by "cut-off" occlusion pattern and/or large reference vessel diameter (?3.5 mm) in occluded IRA. One hundred ninety-seven patients (60.2%) showed LTB and 130 (39.8%) did not. Distal embolization occurred in 18.8% patients with versus 6.9% without LTB (p = 0.003). At CE-CMR, patients with LTB had larger infarct size index (27.5 ± 11.1 vs 22.1 ± 17.5, p = 0.009) and more often transmural necrosis (70.5% vs 55.4%, p = 0.008) compared with patients without LTB. Excluding patients with distal embolization, patients with LTB still had larger necrosis. At multivariate analysis, occluded (IRA) at baseline, anterior infarction, and presence of LTB predicted transmural necrosis. In conclusion, LTB in the setting of p-PCI is related to larger myocardial damage as detected by CE-CMR, regardless of angiographic detectable distal embolization. PMID:24630783
Delayed Esophageal Pseudodiverticulum after Anterior Cervical Spine Fixation: Report of 2 Cases
Sadrizadeh, Ali; Soltani, Ehsan; Abili, Mehdi; Dehghanian, Paria
Introduction: Although perforation of the esophagus, in the anterior cervical spine fixation, is well established, cases with delayed onset, especially cases that present pseudodiverticulum, are not common. In addition, management of the perforation in this situation is debated. Case Report: Delayed esophageal pseudodiverticulum was managed in two patients with a history of anterior spine fixation. Patients were operated on, the loose plate and screws were extracted, the wall of the diverticulum was excised, the perforation on the nasogastric tube was suboptimally repaired, and a closed suction drain was placed there. The NGT was removed on the 7th day and barium swallow demonstrated no leakage at the operation site; therefore, oral feeding was started without any problem Conclusion: In cases with delayed perforation, fistula, or diverticulum removal of anterior fixation instruments, gentle repair of the esophageal wall without persistence on definitive and optimal perforation closure, wide local drainage, early enteral nutrition via NGT, and antibiotic prescription is suggested. PMID:25938087
Automatic implantable cardioverter/defibrillator discharges and acute myocardial injury
Avitall, B.; Port, S.; Gal, R.; McKinnie, J.; Tchou, P.; Jazayeri, M.; Troup, P.; Akhtar, M. (Univ. of Wisconsin-Milwaukee Clinical Campus (USA))
Multiple defibrillations by the automatic implantable cardioverter/defibrillator (AICD) have been reported to result in localized epicardial damage. No data exist, however, regarding whether this damage can be detected in the clinical setting or whether it interferes with the detection of true myocardial infarction. Forty-nine patients who received defibrillations by patch electrodes were studied prospectively. We attempted to document the presence of myocardial injury with the following three commonly used modalities for the detection of myocardial infarction: serial electrocardiographic changes, serial creatine phosphokinase (CPK) and CPK-MB release, and technetium 99m pyrophosphate scanning. Fifteen patients received defibrillations by AICD patches at the time of AICD generator replacement. Nine patients received defibrillations at the time of new AICD lead placement. The average total energy delivered was 85 +/- 29 J. None of these patients had detectable myocardial injury. Ten patients had defibrillations by the AICD patches at the time of bypass operation. One patient in this group developed acute myocardial infarction in the inferior wall after posterior descending coronary bypass operation, as detected by electrocardiogram, 99mTc pyrophosphate scanning, and CPK-MB analysis. Fifteen patients were evaluated for spontaneous AICD discharges. Thirteen had a maximum of five consecutive shocks, and cumulative energy delivered was not greater than 330 J. None of these patients had detectable injury. Two patients had CPK-MB release of 15.3% and 7.5%, respectively. One of these patients had a positive 99mTc pyrophosphate scan. These two patients received 12 and 17 rapid and consecutive AICD discharges, respectively, with cumulative delivered energy of 360 and 510 J, respectively.
Differential MR Delayed Enhancement Patterns of Chronic Myocardial Infarction between Extracellular and Intravascular Contrast Media
Wang, Jian; Xiang, Bo; Lin, Hung Yu; Liu, Hongyu; Freed, Darren; Arora, Rakesh C.; Tian, Ganghong
Objectives Because the distribution volume and mechanism of extracellular and intravascular MR contrast media differ considerably, the enhancement pattern of chronic myocardial infarction with extracellular or intravascular media might also be different. This study aims to investigate the differences in MR enhancement patterns of chronic myocardial infarction between extracellular and intravascular contrast media. Materials and Methods Twenty pigs with myocardial infarction underwent cine MRI, first pass perfusion MRI and delayed enhancement MRI with extracellular or intravascular media at four weeks after coronary occlusion. Myocardial blood flow (MBF) was determined with microsphere measurement. The infarction histopathological changes were evaluated by hematoxylin and eosin staining and Masson's trichrome method. Results Cine MRI revealed the reduced wall thickening in chronic infarction compared with normal myocardium. Moreover, significant wall thinning in chronic infarction was observed in cine MRI. Peak first-pass signal intensity didn't significantly differ between chronic infarction and normal myocardium no matter what kinds of contrast media. At the following delayed enhancement phase, extracellular media-enhanced signal intensity was significantly higher in chronic infarction than in normal myocardium. Conversely, intravascular media-enhanced signal intensity was almost equivalent among chronic infarction and normal myocardium. At four weeks after infarction, MBF in chronic infarction approached to that in normal myocardium. Large thick-walled vessels were detected at peri-infarction zones. The cardiomyocytes were replaced by scar tissue consisting of dilated blood vessels and discrete fibers of collagen. Conclusions Chronic infarction was characterized by the significantly reduced wall thickening and the definite wall thinning. First-pass myocardial perfusion defect was not detected in chronic infarction with two media due to the significantly recovered MBF and well-developed collateral vessels. Infarction remodeling enlarged the extracellular compartment, which was available for extracellular media but not accessible to intravascular media. Extracellular media identified chronic infarction as the hyper-enhancement; nonetheless, intravascular media didn't provide delayed enhancement. PMID:25816056
AcvR1-mediated BMP signaling in second heart field is required for arterial pole development: Implications for myocardial differentiation and regional identity
Thomas, Penny S.; Rajderkar, Sudha; Lane, Jamie; Mishina, Yuji; Kaartinen, Vesa
BMP signaling plays an essential role in second heart field-derived heart and arterial trunk development, including myocardial differentiation, right ventricular growth, and interventricular, outflow tract and aortico-pulmonary septation. It is mediated by a number of different BMP ligands, and receptors, many of which are present simultaneously. The mechanisms by which they regulate morphogenetic events and degree of redundancy amongst them have still to be elucidated. We therefore assessed the role of BMP Type I receptor AcvR1 in anterior second heart field-derived cell development, and compared it with that of BmpR1a. By removing Acvr1 using the driver Mef2c[AHF]-Cre, we show that AcvR1 plays an essential role in arterial pole morphogenesis, identifying defects in outflow tract wall and cushion morphology that preceded a spectrum of septation defects from double outlet right ventricle to common arterial trunk in mutants. Its absence caused dysregulation in gene expression important for myocardial differentiation (Isl1, Fgf8) and regional identity (Tbx2, Tbx3, Tbx20, Tgfb2). Although these defects resemble to some degree those in the equivalent Bmpr1a mutant, a novel gene knock-in model in which Bmpr1a was expressed in the Acvr1 locus only partially restored septation in Acvr1 mutants. These data show that both BmpR1a and AcvR1 are needed for normal heart development, in which they play some non-redundant roles, and refine our understanding of the genetic and morphogenetic processes underlying Bmp-mediated heart development important in human congenital heart disease. PMID:24680892
Importance of Reference Muscle Selection in Quantitative Signal Intensity Analysis of T2-Weighted Images of Myocardial Edema Using a T2 Ratio Method
Carbone, Iacopo; Childs, Helene; Aljizeeri, Ahmed; Merchant, Naeem; Friedrich, Matthias G.
Objectives. The purpose of our study was to identify the suitability of various skeletal muscles as reference regions for calculating the T2 SI ratio for a semiautomated quantification of the extent of myocardial edema with T2-weighted images. Methods. Thirty-four patients with acute myocardial infarction (MI) were enrolled. The extent of myocardial edema was determined by T2 SI ratio map, using 4 different muscles as reference: major and minor pectoralis, serratus anterior, teres minor-infraspinatus, and subscapularis. The size of myocardial edema as visually quantified was used as the standard of truth. The control group consisted of 15 patients with chronic MI. Intra- and interobserver variability were assessed. Results. Due to poor image quality four patients were excluded from the analysis. In acute MI patients, serratus anterior muscle showed the strongest correlation with the visual analysis (r = 0.799; P < 0.001) and low inter- and intraobserver variability, while the other muscles resulted in a significant interobserver variability. In contrast, the use of other muscles as a reference led to overestimating edema size. Conclusions. In acute MI patients, serratus anterior resulted to be the most reliable and reproducible muscle for measuring the extent of myocardial edema. PMID:26185752
Restoration of autophagic flux in myocardial tissues is required for cardioprotection of sevoflurane postconditioning in rats
Zhang, Yu-lin; Yao, Yun-tai; Fang, Neng-xin; Zhou, Cheng-hui; Gong, Jun-song; Li, Li-huan
Aim: Sevoflurane postconditioning (SpostC) has been shown to protect the heart from ischemia-reperfusion (I/R) injury. In this study, we examined whether SpostC affected autophagic flux in myocardial tissues that contributed to its cardioprotective effects in rats following acute I/R injury. Methods: SD rats underwent 30 min of left anterior descending coronary artery ligation followed by 120 min of reperfusion. The rats were subjected to inhalation of 2.4% (v/v) sevoflurane during the first 5 min of reperfusion, and chloroquine (10 mg/kg, ip) was injected 1 h before I/R. Myocardial infarct size was estimated using TTC staining. Autophagosomes in myocardial tissues were detected under TEM. Expression of LC3B-II, beclin-1, p62/SQSTM1, cathepsin B, caspase-3 and cleaved PARP was assessed using Western blot analysis. Plasma cardiac troponin I was measured using ELISA. Cardiomyocyte apoptosis was evaluated with TUNEL staining. Results: I/R procedure produced severe myocardium infarct and apoptosis accompanied by markedly increased number of autophagosomes, as well as increased levels of LC3B-II, beclin-1 and p62 in myocardial tissues. SpostC significantly reduced infarct size, attenuated myocardial apoptosis, restored intact autophagic flux and improved the lysosomal function in myocardial tissues. Administration of chloroquine that blocked autophagic flux abrogated the cardioprotective effects of SpostC. Conclusion: SpostC exerts its cardioprotective effects in rats following I/R injury via restoring autophagic flux in myocardial tissues. PMID:24793309
Myocardial bridging in a survivor of sudden cardiac near-death: role of intracoronary doppler flow measurements and angiography during dobutamine stress in the clinical evaluation
R. A. Tio; I. C. Van Gelder; P. W. Boonstra; H. J. Crijns
Extensive myocardial bridging in the left anterior descending coronary artery was found in a 46 year old survivor of sudden cardiac near-death. Positron emission tomography and dobutamine stress echocardiography revealed ischaemia in the myocardium distal to the bridging. Spasm was excluded as cause of the ischaemia by intracoronary infusion of acetylcholine. Further evaluation of the haemodynamic importance of the bridging
Abdominal wall competence in transverse abdominal island flap operations.
Hartrampf, C R
This study critically evaluates the abdominal wall in 82 patients following breast and chest wall reconstruction using the transverse abdominal island flap operation. Experience with these patients led to an awareness of the important muscle and ligamentous structures in the anterior abdominal wall. An operative procedure is presented for selective harvesting of the transverse abdominal island flap in a manner that preserves viability of the flap and at the same time reestablishes abdominal competence. PMID:6230981
Imaging and Modeling of Myocardial Metabolism
Sebastian Obrzut; Neema Jamshidi; Afshin Karimi; Ulrika Birgersdotter-Green; Carl Hoh
Current imaging methods have focused on evaluation of myocardial anatomy and function. However, since myocardial metabolism\\u000a and function are interrelated, metabolic myocardial imaging techniques, such as positron emission tomography, single photon\\u000a emission tomography, and magnetic resonance spectroscopy present novel opportunities for probing myocardial pathology and\\u000a developing new therapeutic approaches. Potential clinical applications of metabolic imaging include hypertensive and ischemic\\u000a heart
Characterization of reversible myocardial dysfunction by magnetic resonance imaging.
Fedele, F; Scopinaro, F; Montesano, T; Di Cesare, E; Di Renzi, P; Vitarelli, A; Dagianti, A
Some recent cardiovascular applications of nuclear magnetic resonance imaging (MRI) are discussed, on the basis of both literature and personal data. Management of coronary patients has become directed to strategies aiming at salvaging the ischemic myocardium, and MRI can play an important role in providing the necessary data leading to an appropriate assessment. Due to its capability in showing morphofunctional information on wall thickness and thickening, cine-MRI technique can be used to detect myocardial ischemia and infarction, since it allows the acquisition of 16 or more frames of the cardiac cycle which can be displayed in a cine loop format. In an Italian Cooperative Study the role of MRI in discriminating stunned from necrotic areas has been investigated. Comparison of fractional area change by echo versus cine-MR turned out to be almost completely overlapping, but cine-MRI allowed a more accurate measurement of systolic wall thickening due to better visualization of endo- and epicardial borders (more sensitive marker of kinetic damage than wall motion). Other studies have also been performed in order to determine the capability of contrast agents of allowing differentiation between reperfused reversible and irreversible myocardial injury and allowing distinction between reperfused and occlusive myocardial infarction. In a recent study we investigated the MRI possibility of identifying viable myocardium in severely chronic systolic dysfunctioning areas by comparing, in corresponding left ventricular segments, regional perfusion and metabolism at IPPA scintigraphy and regional signal intensity at MR images obtained before and after paramagnetic contrast media administration. The potential role of MRI was shown in the identification of viable myocardium with the use of contrast medium, that is of crucial importance in this respect. PMID:7959535
The internal mammary artery graft: the best choice for bypass of the diseased left anterior descending coronary artery.
Tector, A J; Schmahl, T M; Canino, V R
The atherosclerotic plaque that critically obstructs the proximal left anterior descending coronary artery is three times more likely to produce a fatal myocardial infarction than lesions in the other coronary arteries. Severe obstruction in a bypass graft to the proximally stenosed left anterior descending artery is probably at high risk of provoking a fatal infarction. Selection of the bypass graft with adequate flow and the greatest longevity is of great importance. Review of 298 patients who received internal mammary artery grafts illustrates that this bypass has excellent long-term patency, minimal attrition, and little evidence suggesting late atherosclerotic formation. Difficulties with anastomosis and pedicle injury during preparation (the most frequent reasons for internal mammary artery failure) can be reduced to 2% or less by introducing magnification and microsurgical techniques. The properly prepared internal mammary artery graft has the longest lasting patency and should be used when bypassing proximal left anterior descending lesions. PMID:6135516
ERIC Educational Resources Information Center
Greenman, Jim
In this article, the author emphasizes the importance of "working" walls in children's programs. Children's programs need "working" walls (and ceilings and floors) which can be put to use for communication, display, storage, and activity space. The furnishings also work, or don't work, for the program in another sense: in aggregate, they serve as…
Magnesium therapy for acute myocardial infarction
LeRoy E. Rabbani
The use of magnesium therapy for acute myocardial infarction remains controversial despite recent clinical trials such as ISIS-4. Magnesium has numerous beneficial effects in the setting of myocardial infarction, including inhibitory effects on platelet aggregation. Clinical trials of magnesium therapy for myocardial infarction have yielded conflicting results that may be related to the difference in the timing of magnesium administration.
Relationship Between MDCT?Imaged Myocardial Fat and Ventricular Tachycardia Substrate in Arrhythmogenic Right Ventricular Cardiomyopathy
Komatsu, Yuki; Jadidi, Amir; Sacher, Frederic; Denis, Arnaud; Daly, Matthew; Derval, Nicolas; Shah, Ashok; Lehrmann, Heiko; Park, Chan?Il; Weber, Reinhold; Arentz, Thomas; Pache, Gregor; Sermesant, Maxime; Ayache, Nicholas; Relan, Jatin; Montaudon, Michel; Laurent, François; Hocini, Mélčze; Haďssaguerre, Michel; Jaďs, Pierre; Cochet, Hubert
Background Myocardial fibrofatty infiltration is a milieu for ventricular tachycardia (VT) in arrhythmogenic right ventricular cardiomyopathy (ARVC) and can be depicted as myocardial hypodensity on contrast?enhanced multidetector computed tomography (MDCT) with high spatial and temporal resolution. This study aimed to assess the relationship between MDCT?imaged myocardial fat and VT substrate in ARVC. Methods and Results We studied 16 patients with ARVC who underwent ablation and preprocedural MDCT. High?resolution imaging data were processed and registered to high?density endocardial and epicardial maps in sinus rhythm on 3?dimensional electroanatomic mapping (3D?EAM) (626±335 and 575±279 points/map, respectively). Analysis of the locations of low?voltage and fat segmentation included the following endocardial and epicardial regions: apex, mid (anterior, lateral, inferior), and basal (anterior, lateral, inferior). The location of local abnormal ventricular activities (LAVA) was compared with fat distribution. RV myocardial fat was successfully segmented and integrated with 3D?EAM in all patients. The ? agreement test demonstrated a good concordance between the epicardial low voltage and fat (?=0.69, 95% CI 0.54 to 0.84), but fair concordance with the endocardium (?=0.41, 95% CI 0.27 to 0.56). The majority of LAVA (520/653 [80%]) were located within the RV fat segmentation, of which 90% were not farther than 20 mm from its border. Registration of MDCT allowed direct visualization of the coronary arteries, thus avoiding coronary damage during epicardial radiofrequency delivery. Conclusions The integration of MDCT?imaged myocardial fat with 3D?EAM provides valuable information on the extent and localization of VT substrate and demonstrates ablation targets clustering in its border region. PMID:25103203
The effect of normalization in reducing variability in regional wall thickening
Paul Yang; Catherine M. Otto; Florence H. Sheehan
This study was performed to evaluate a new method for measuring regional left ventricular wall thickening in terms of its variability, normal range, and diagnostic sensitivity. Two-dimensional echocardiographic images in the parasternal short-axis view of 44 normal patients and 17 patients with recent myocardial infarction were analyzed. Regional wall thickness was measured according to the centerline method at 100 chords.
Improved Detection of Myocardial Involvement in Acute Inflammatory Cardiomyopathies Using T2 Mapping
Thavendiranathan, Paaladinesh; Walls, Michael; Giri, Shivraman; Verhaert, David; Rajagopalan, Sanjay; Moore, Sean; Simonetti, Orlando P.; Raman, Subha V.
Background T2-weighted cardiac magnetic resonance (CMR) is useful in diagnosing acute inflammatory myocardial diseases such as myocarditis and tako-tsubo cardiomyopathy (TTCM). We hypothesized that quantitative T2 mapping could better delineate myocardial involvement in these disorders vs. T2-weighted imaging. Methods and Results Thirty patients with suspected myocarditis or TTCM referred for CMR who met established diagnostic criteria underwent myocardial T2 mapping. T2 values were averaged in involved and remote myocardial segments, both defined by a reviewer blinded to T2 data. In myocarditis, T2 was 65.2±3.2ms in the involved myocardium vs. 53.5±2.1 in remote myocardium (p<0.001). In TTCM, T2 was 65.6±4.0ms in the involved myocardium vs. 53.6±2.7ms in remote segments (p<0.001). T2 values were similar across remote myocardial segments in patients and all myocardial segments in controls (p>0.05 for all). T2 maps provided diagnostic data even in patients with difficulty breath-holding. A T2 cutoff of 59ms identified areas of myocardial involvement with sensitivity and specificity of 94% and 97%, respectively. T2 mapping revealed regions of abnormal T2 beyond those identified by wall motion abnormalities or LGE-positivity. Conventional T2-weighted short tau inversion recovery (T2W-STIR) images were uninterpretable in 7 patients due to artifact and unremarkable in 2 who had elevated T2 values. T2-prepared steady state free precession (T2p-SSFP) images showed areas of signal hyperintensity in only17/30 patients. Conclusions Quantitative T2 mapping reliably identifies myocardial involvement in patients with myocarditis and TTCM. T2 mapping delineated greater extent of myocardial disease in both conditions compared to that identified by wall motion abnormalities, T2W-STIR, T2p-SSFP or LGE. Quantitative T2 mapping warrants consideration as a robust technique to identify myocardial injury in patients with acute myocarditis or TTCM. PMID:22038988
In vivo myocardial cell pH in the dog. Response to ischemia and infusion of alkali.
Effros, R M; Haider, B; Ettinger, P O; Ahmed Sultan, S; Oldewurtel, H A; Marold, K; Regan, T J
Myocardial cell pH has been measured with 5,5-dimethyl-2,4-oxazolidinedione (DMO) in intact anesthetized dogs by a transient indicator dilution technique. Bolus injections of labeled DMO, vascular, extracellular, and water indicators were made into the anterior descending coronary artery, and blood samples were collected from the great cardiac vein. The steady-state distribution of DMO between cells and plasma was calculated from the indicator mean transit times, and the plasma pH. Myocardial cell pH was determined from the distribution value and plasma pH. Normal myocardial cell pH averaged 6.94. Changes in myocardial cell pH after infusions of acid or alkali. Myocardial ischemia induced by inflation of a coronary artery balloon resulted in progressive decreases in cellular pH to average values of 6.83 within the initial 15 min and to 6.59 within the interval between 20 and 70 min. Infusions of Na2CO3 tended to diminish intracellular acidosis although these infusions had little effect on the difference in pH between the myocardial cell and extracellular fluid. Images PMID:235567
Anatomic Anterior Cruciate Ligament Reconstruction
Murawski, Christopher D.; Wolf, Megan R.; Araki, Daisuke; Muller, Bart; Tashman, Scott
Anatomic anterior cruciate ligament (ACL) reconstruction is common procedure performed by orthopedic surgeons, particularly in association with sports-related injuries. Whereas traditional reconstruction techniques used a single bundle graft that was typically placed in a non-anatomic position, a renewed interest in anatomy has facilitated the popularization of anatomic reconstruction techniques. Recently, a focus has been placed on individualizing ACL surgery based on each patient's native anatomical characteristics (e.g., insertion site size, notch size, and shape), thereby dictating the ultimate procedure of choice. As subjective outcome measurements have demonstrated varying outcomes with respect to single- versus double-bundle ACL reconstruction, investigators have turned to more objective techniques, such as in vivo kinematics, as a means of evaluating joint motion and cartilage contact mechanics. Further investigation in this area may yield important information with regard to the potential progression to osteoarthritis after ACL reconstruction, including factors affecting or preventing it.
Experimental and Numerical Analysis of Screw Fixation in Anterior Cruciate Ligament Reconstruction
NASA Astrophysics Data System (ADS)
Chizari, Mahmoud; Wang, Bin; Snow, Martyn; Barrett, Mel
This paper reports the results of an experimental and finite element analysis of tibial screw fixation in anterior cruciate ligament (ACL) reconstruction. The mechanical properties of the bone and tendon graft are obtained from experiments using porcine bone and bovine tendon. The results of the numerical study are compared with those from mechanical testing. Analysis shows that the model may be used to establish the optimum placement of the tunnel in anterior cruciate ligament reconstruction by predicting mechanical parameters such as stress, strain and displacement at regions in the tunnel wall.
Myocardial contusion following nonfatal blunt chest trauma
Kumar, S.A.; Puri, V.K.; Mittal, V.K.; Cortez, J.
Currently available diagnostic techniques for myocardial contusion following blunt chest trauma were evaluated. We investigated 30 patients prospectively over a period of 1 year for the presence of myocardial contusion. Among the 30 patients, eight were found to have myocardial contusion on the basis of abnormal electrocardiograms, elevated creatine phosphokinase MB fraction (CPK-MB), and positive myocardial scan. Myocardial scan was positive in seven of eight patients (87.5%). CPK-MB fraction was elevated in four of eight patients (50%). Definitive electrocardiographic changes were seen in only two of eight patients (25%). It appears that myocardial scan using technetium pyrophosphate and CPK-MB fraction determinations are the most reliable aids in diagnosis of myocardial contusion following blunt chest trauma.
Selective importance of the rat anterior thalamic nuclei for configural learning involving distal spatial cues.
Dumont, Julie R; Amin, Eman; Aggleton, John P
To test potential parallels between hippocampal and anterior thalamic function, rats with anterior thalamic lesions were trained on a series of biconditional learning tasks. The anterior thalamic lesions did not disrupt learning two biconditional associations in operant chambers where a specific auditory stimulus (tone or click) had a differential outcome depending on whether it was paired with a particular visual context (spot or checkered wall-paper) or a particular thermal context (warm or cool). Likewise, rats with anterior thalamic lesions successfully learnt a biconditional task when they were reinforced for digging in one of two distinct cups (containing either beads or shredded paper), depending on the particular appearance of the local context on which the cup was placed (one of two textured floors). In contrast, the same rats were severely impaired at learning the biconditional rule to select a specific cup when in a particular location within the test room. Place learning was then tested with a series of go/no-go discriminations. Rats with anterior thalamic nuclei lesions could learn to discriminate between two locations when they were approached from a constant direction. They could not, however, use this acquired location information to solve a subsequent spatial biconditional task where those same places dictated the correct choice of digging cup. Anterior thalamic lesions produced a selective, but severe, biconditional learning deficit when the task incorporated distal spatial cues. This deficit mirrors that seen in rats with hippocampal lesions, so extending potential interdependencies between the two sites. PMID:24215178
Primary immunolocalization of estrogen and progesterone target cells in the human anterior cruciate ligament.
Liu, S H; al-Shaikh, R; Panossian, V; Yang, R S; Nelson, S D; Soleiman, N; Finerman, G A; Lane, J M
To identify estrogen and progesterone target cells in the human anterior cruciate ligament immunohistochemical localization of both estrogen and progesterone receptors was performed in 17 specimens of human anterior cruciate ligament. All ligament specimens were obtained at surgery. Thirteen specimens were from women, and four were from men: the average age was 57 years (range, 18-78 years). Eleven specimens (from nine women and two men) came from total knee replacements for osteoarthritis of the knee: three (from two women and one man), from reconstructions of the anterior cruciate ligament: two (both from women), from medial meniscectomies; and one (from a man), from an amputation secondary to chondrosarcoma of the pelvis. An immunoperoxidase method using monoclonal antibodies to the estrogen and progesterone receptors was employed to identify estrogen and progesterone target cells in the anterior cruciate ligament. Staining of both receptors was demonstrable in 14 specimens and in the remaining three specimens less than 15% of the cells were stained. Both estrogen and progesterone receptors were localized to synoviocytes in the synovial lining, fibroblasts in the anterior cruciate ligament stroma and cells in the blood vessel walls of the ligament. This demonstration of receptors for estrogen and progesterone in the cells of anterior cruciate ligament suggests that female sex hormones may have an effect on its structure and composition. PMID:8764860
ERIC Educational Resources Information Center
Hanratty, Thomas J.
This paper gives an account of research on the structure of turbulence close to a solid boundary. Included is a method to study the flow close to the wall of a pipe without interferring with it. (Author/JN)
Electrocardiograms Corresponding to the Development of Myocardial Infarction in Anesthetized WHHLMI Rabbits (Oryctolagus cuniculus), an Animal Model for Familial Hypercholesterolemia
Kobayashi, Tsutomu; Ito, Takashi; Yamada, Satoshi; Kuniyoshi, Nobue; Shiomi, Masashi
The aim of this study was to determine whether features indicative of myocardial ischemia occur in the electrocardiograms (ECG) in myocardial infarction-prone Watanabe heritable hyperlipidemic (WHHLMI) rabbits, an animal model for human familial hypercholesterolemia. ECG were recorded in 110 anesthetized WHHLMI rabbits (age, 10 to 39 mo) by using unipolar and bipolar limb leads with or without chest leads. We noted the following electrocardiographic changes: T wave inversion (37.4%), ST segment depression (31.8%), deep Q wave (16.3%), reduced R wave amplitude (7.3%), ST segment elevation (2.7%), and high T wave (1.8%). These ECG changes resembled those in human patients with coronary heart disease. Histopathologic examination revealed that the left ventricular wall showed acute myocardial lesions, including loss of cross-striations, vacuolar degeneration, coagulation necrosis of cardiac myocytes, and edema between myofibrils, in addition to chronic myocardial lesions such as myocardial fibrosis. The coronary arteries that caused these ECG changes were severely stenosed due to atherosclerotic lesions. Ischemic ECG changes corresponded to the locations of the myocardial lesions. Normal ECG waveforms were similar between WHHLMI rabbits and humans, in contrast to the large differences between rabbits and mice or rats. In conclusion, ischemic ECG changes in WHHLMI rabbits reflect the location of myocardial lesions, making this model useful for studying coronary heart disease. PMID:23114045
Domes, Trustin; Szafran, Olga; Bilous, Cheryl; Olson, Odell; Spooner, G. Richard
OBJECTIVE To assess the quality of care of acute myocardial infarction (AMI) in a rural health region. DESIGN Clinical audit employing multiple explicit criteria of care elements for emergency department and in-hospital AMI management. The audit was conducted using retrospective chart review. SETTING Twelve acute care health centres and hospitals in the East Central Health Region, a rural health region in Alberta, where medical and surgical services are provided almost entirely by family physicians. PARTICIPANTS Hospital inpatients with a confirmed discharge diagnosis of AMI (ICD-9-CM codes 410.xx) during the period April 1, 2001, to March 31, 2002, were included (177 confirmed cases). MAIN OUTCOME MEASURES Quality of AMI care was assessed using guidelines from the American College of Cardiology and the American Heart Association and the Canadian Cardiovascular Outcomes Research Team and Canadian Cardiovascular Society. Quality of care indicators at three stages of patient care were assessed: at initial recognition and AMI management in the emergency department, during in-hospital AMI management, and at preparation for discharge from hospital. RESULTS In the emergency department, the quality of care was high for most procedural and therapeutic audit elements, with the exception of rapid electrocardiography, urinalysis, and provision of nitroglycerin and morphine. Average door-to-needle time for thrombolysis was 102.5 minutes. The quality of in-hospital care was high for most elements, but low for nitroglycerin and angiotensin-converting enzyme (ACE) inhibitors, daily electrocardiography, and counseling regarding smoking cessation and diet. Few patients received counseling for lifestyle changes at hospital discharge. Male and younger patients were treated more aggressively than female and older patients. Sites that used care protocols achieved better results in initial AMI management than sites that did not. Stress testing was not readily available in the rural region studied. CONCLUSION Quality of care for patients with AMI in this rural health region was high for most guideline elements. Standing orders, protocols, and checklists could improve care. Training and resource issues will need to be addressed to improve access to stress testing for rural patients. Clinical audit should be at the core of a system for local monitoring of quality of care. PMID:16926968
[Sewer gas induced myocardial toxicity].
Antonelli, Dante; Sabanchiev, Avi; Rosner, Ehud; Turgeman, Yoav
We report the case of a 19 year-old worker who collapsed after acute exposure to sewer gas. He rapidly developed cardiorespiratory failure with electrocardiographic, echocardiographic and laboratory findings of myocardial involvement. The mainstay of the therapy was mainly supportive treatment with a successful outcome. PMID:25189024
JAMA Patient Page: Myocardial Infarction
... Heart Blocked Coronary Artery Insertion of Stent After Balloon Angioplasty Stent in Place and Blood Flow Restored Aorta Femoral artery Catheter for stent insertion H E A R T D I S E A S E The Journal of the American Medical Association JAMA PATIENT PAGE Myocardial Infarction M yocardial ...
Myocardial perfusion scintigraphy: the evidence
S. R. Underwood; C. Anagnostopoulos; M. Cerqueira; P. J. Ell; E. J. Flint; M. Harbinson; A. D. Kelion; A. Al-Mohammad; E. M. Prvulovich; L. J. Shaw; A. C. Tweddel
This review summarises the evidence for the role of myocardial perfusion scintigraphy (MPS) in patients with known or suspected coronary artery disease. It is the product of a consensus conference organised by the British Cardiac Society, the British Nuclear Cardiology Society and the British Nuclear Medicine Society and is endorsed by the Royal College of Physicians of London and the
Myocardial revascularization in Jehovah Witnesses.
Seifert, P E; Auer, J E; Hohensee, P
The refusal of certain patients to accept blood transfusions need not be a deterrent to surgery. We report on nine Jehovah's Witnesses who over a one-year period underwent myocardial revascularization without significant blood loss or decrease in hematocrit values. PMID:2786287
Anterior segment imaging in pediatric ophthalmology
Kamiar Mireskandari; Nasrin N. Tehrani; Cynthia VandenHoven; Asim Ali
Anterior segment imaging in the pediatric population using commercially available equipment is rewarding but can be challenging. Successful imaging requires familiarity with the imaging modality used, a positive attitude, and the ability to quickly develop rapport with children. In this review, we demonstrate how external and slitlamp photography, Scheimpflug imaging, handheld digital fundus camera, ultrasound biomicroscopy, and anterior segment optical
Full myocardial revascularization with bilateral internal mammary artery Y grafts
Naidoo, Rishendran; Byth, Karen; Chen, Cheng; Denniss, A. Robert
Background Bilateral internal mammary artery (BIMA) grafting in coronary artery surgery provides better long term outcomes than single internal mammary artery and saphenous vein grafting but the optimum configuration of BIMAs has not been established. This study analyzed perioperative and late outcomes of patients who underwent BIMA grafting with a composite Y configuration. Methods Patients (n=922) who underwent BIMA Y grafting were identified from a cardiac surgical database and then cross matched against hospital and cardiology databases and the state death register to identify episodes of repeat coronary angiography, cardiac surgical re-intervention and death. Analysis of repeat angiography was performed after retrieval of the angiogram reports. Results In 95% of patients, full myocardial revascularization was achieved with BIMAs alone, using a composite Y configuration with an average of 4.1 IMA to coronary artery anastomoses per patient. The perioperative mortality was 1.5% and the 5-, 10- and 15-year survival estimates were 95%, 87% and 77% respectively. Analysis of 166 symptom-driven post-discharge coronary angiograms showed grafts to the left anterior descending artery and increasing severity of coronary artery stenosis at preoperative angiography as predictors of anastomotic patency. Conclusions Full myocardial revascularization can be achieved with reasonable safety in most patients with triple vessel disease and good left ventricular function, and provides good late survival. PMID:23977621
[Acute myocardial infarction in the postoperative period following pneumonectomy].
López Alvarez, S; Bonome González, C; Izquierdo Villarroya, B; Barbeito Vilarińo, M J; Etxainz Alvarez, A; Alvarez Refojo, F
A 72-year-old man, smoker, with insuline-dependent diabetes and dislipemia underwent left pneumonectomy. Several episodes of intraoperative hemodynamic instability associated with electrocardiographic ST segment alterations were attributed to surgical manipulation; ischemia was not suspected. Cardiorespiratory failure, related to extensive anterior infarction, developed a few minutes after admission to the postoperative intensive care unit (PICU). Cardiopulmonary resuscitation and mechanical ventilation were required. The patient responded to treatment with beta blockers, platelet antiaggregants and statins. Tube was removed a few hours later and the patient was discharged from the PICU on the fifth day. Pneumonectomy has a high rate of morbidity and mortality, with complications mainly arising in the lung and heart. Risk from anesthesia is considered to be great in this procedure, and for that reason it is essential to identify intraoperative myocardial ischemia so that it can be treated aggressively. In patients at high cardiovascular risk who undergo lung resection, intraoperative episodes of myocardial ischemia are associated with a high incidence of postoperative miocardial infarction. Therefore, careful postoperative monitoring is needed and measures should be taken to prevent angina. Early extubation should be avoided. PMID:12516493
Acute myopericarditis in an adolescent mimicking acute myocardial infarction.
Sharma, Jayendra; Fernandes, Nithi; Alvarez, Dora; Khanna, Shefali
Acute myopericarditis is primarily a pericarditic syndrome with variable myocardial involvement, as evidenced by elevated cardiac enzymes. It is a rare entity, exclusively seen in male adolescents and accounts for less than 2% of the cases of inpatient admissions for chest pain/pericarditis in the pediatric age group. The electrocardiographic changes of pericarditis include J point/ST segment elevation, which needs to be differentiated from the benign early repolarization pattern that is common in young adolescents and the subtle anterior ST segment elevation myocardial infarction. Differentiating acute myopericarditis from acute coronary syndromes can be challenging because they share the presenting triad of acute chest pain, ST segment changes, and elevated cardiac enzymes. The accurate distinction of myopericarditis from acute myocarditis or acute coronary syndrome is important because of their differences in risk for specific complications, prognosis, and treatment implications. We present a case of acute myopericarditis in an adolescent who presented with atypical precordial chest pain, accompanied by inferolateral focal electrocardiographic changes and significant elevation of cardiac enzymes. The differential diagnosis and management of myopericarditis is reviewed with a focus on electrocardiographic changes and troponin assays. PMID:25229187
Hypoxic Conditioning Suppresses Nitric Oxide Production upon Myocardial Reperfusion
Ryou, Myoung-Gwi; Sun, Jie; Oguayo, Kevin N.; Manukhina, Eugenia B.; Downey, H. Fred; Mallet, Robert T.
Physiologically modulated concentrations of nitric oxide (NO) are generally beneficial, but excessive NO can injure myocardium by producing cytotoxic peroxynitrite. Recently we reported that intermittent, normobaric hypoxia conditioning (IHC) produced robust cardioprotection against infarction and lethal arrhythmias in a canine model of coronary occlusion-reperfusion. This study tested the hypothesis that IHC suppresses myocardial nitric oxide synthase (NOS) activity and thereby dampens explosive, excessive NO formation upon reperfusion of occluded coronary arteries. Mongrel dogs were conditioned by a 20 d program of IHC (FIO2 9.5–10%; 5–10 min hypoxia/cycle, 5–8 cycles/d with intervening 4 min normoxia). One day later, ventricular myocardium was sampled for NOS activity assays, and immunoblot detection of the endothelial NOS isoform (eNOS). In separate experiments, myocardial nitrite (NO2?) release, an index of NO formation, was measured at baseline and during reperfusion following 1 h occlusion of the left anterior descending coronary artery (LAD). Values in IHC dogs were compared with respective values in non-conditioned, control dogs. IHC lowered left and right ventricular NOS activities by 60%, from 100–115 to 40–45 mU/g protein (P < 0.01), and decreased eNOS content by 30% (P < 0.05). IHC dampened cumulative NO2? release during the first 5 min reperfusion from 32 ± 7 to 14 ± 2 lmol/g (P < 0.05), but did not alter hyperemic LAD flow (15 ± 2 vs. 13 ± 2 ml/g). Thus, IHC suppressed myocardial NOS activity, eNOS content, and excessive NO formation upon reperfusion without compromising reactive hyperemia. Attenuation of the NOS/NO system may contribute to IHC-induced protection of myocardium from ischemia-reperfusion injury. PMID:18408142
Myocardial bridging analysis by coronary computed tomographic angiography in a Saudi population
Donkol, Ragab Hani; Saad, Zizi
AIM: To assess the incidence, location, morphology and clinical association of myocardial bridging in a Saudi population using coronary computed tomographic angiography (CCTA). METHODS: A total of 350 CCTA of Saudi patients were included in this study (236 men, 114 women) with a mean age of 56.3 years. All patients were examined for appropriateness criteria of CCTA indications (typical chest pain, recent onset cardiomyopathy, left bundle branch block, etc.). The scans were retrospectively reviewed for the presence of myocardial bridging and any other pathological association. RESULTS: Myocardial bridging was found in 89 of 350 (22.5%) patients. Most of the intramuscular segments were of the superficial type and found in the mid left anterior descending (LAD) (24.6%), followed by distal LAD (3.7%), diagonal branches (2%), ramus intermedius artery (1.4%) and obtuse marginal artery (0.8%). No myocardial bridging was detected in the right coronary or circumflex arteries. No significant differences were found between males and females (P = 0.14). Coronary artery atherosclerosis was found in 51 of 89 (57.3%) patients with MB. Atherosclerotic plaques were not detected in the intramuscular or distal segment of bridging arteries. Dynamic compression was observed in 35 (94.5%) patients with full encasement. No evidence of myocardial hypoperfusion was found in the territories supplied by the bridging arteries. CONCLUSION: CCTA is excellent in analyzing myocardial bridging in a Saudi population and the results are comparable to other populations. However, finding the real incidence may need a large multicenter study. PMID:24340142
Spontaneous hyphema associated with anterior uveitis.
Fong, D S; Raizman, M B
Few reports have described hyphema in association with anterior uveitis. Five cases of anterior chamber haemorrhage are reported in patients with five different anterior uveitic entities: Reiter's syndrome, juvenile chronic arthritis, ankylosing spondylitis, idiopathic anterior uveitis, and herpes simplex. Hyphema has been reported in association with idiopathic non-granulomatous anterior uveitis, but not with the other four entities. In three cases, iris rubeosis was present. In two cases the patients were taking non-steroidal anti-inflammatory agents. The hyphemas occurred at times of heightened inflammation and resolved spontaneously without complication in all but one case, a boy with idiopathic uveitis who required surgery to remove the blood. The clinical outcome of these cases provides evidence that conservative medical management is usually sufficient. Images PMID:8218031
Vaginal Wall Sling for Anatomical Incontinence and Intrinsic Sphincter Dysfunction: Efficacy and Outcome Analysis
Shlomo Raz; Lynn Stothers; George P. H. Young; Julie Short; Barbara Marks; Ashok Chopra; Gregory R. Wahle
PurposeA prospective cohort study was done to determine the efficacy and clinical outcome of a new technique for anterior vaginal wall sling construction to treat urinary incontinence due to intrinsic sphincter dysfunction or anatomical incontinence.
Intraoperative measurement of pharynx/esophagus retraction during anterior cervical surgery. Part II: perfusion.
Heese, Oliver; Fritzsche, Erik; Heiland, Max; Westphal, Manfred; Papavero, Luca
Early postoperative dysphagia after anterior cervical surgery is a well-known phenomenon with so far unknown etiology. We hypothesised that direct pressure induced by the medial retractor blade on pharynx/esophagus mucosal wall leads to local ischemia. Subsequently postoperative hyperemia and swelling of the pharynx/esophagus may result in swallowing disturbance. To prove the hypothesis local blood flow inside the pharynx/esophagus wall during anterior cervical surgery was measured using a laser Doppler (LD) perfusion monitor unit. Fifteen patients underwent standard anterior cervical discectomy and fusion (ACDF). The LD probe was placed underneath the medial retractor blade in order to gain information at the maximum point of pressure applied onto the pharynx/esophagus wall. Local perfusion was measured prior to retractor opening (5 min), during spreading of the retractor and after its closure (5 min). Perfusion was measured semiquantitatively in perfusion units (PU). Local perfusion ranged from 30 to 210 PU (mean 107) prior to retractor opening, from 7 to 60 PU (mean 30) with open retractor and from 15 to 280 PU (mean 117) after retractor closure. In all 15 patients the open retractor led to hypoperfusion ranging from 21 to 93% compared to the baseline level. In seven patients a reactive hyperemia at the end of the procedure was detected (32-89% compared to baseline level). In four patients after hypoperfusion during spreading of the retractor the baseline levels were reached again and in four patients perfusion remained diminished even after retractor closure. To best of our knowledge, this is the first report on intraoperative measurement of local perfusion of the pharynx/esophagus wall during anterior cervical surgery. Diminished local perfusion was observed in all patients during spreading of the retractor and post-procedure hyperemia was recorded in 46% of the patients. The local ischemia of the pharynx/esophagus wall may be a crucial step in the development of postoperative dysphagia. PMID:16477447
Automated Detection of Regional Wall Motion Abnormalities Based on a Statistical Model Applied to Multislice Short-Axis Cardiac MR Images
Avan Suinesiaputra; Alejandro F. Frangi; Theodorus A. M. Kaandorp; Hildo J. Lamb; Jeroen J. Bax; Johan H. C. Reiber; Boudewijn P. F. Lelieveldt
In this paper, a statistical shape analysis method for myocardial contraction is presented that was built to detect and locate regional wall motion abnormalities (RWMA). For each slice level (base, middle, and apex), 44 short-axis magnetic resonance images were selected from healthy volunteers to train a statistical model of normal myocardial contraction using independent component analysis (ICA). A classification algorithm
How should an infected perinephric haematoma be drained in a tetraplegic patient with baclofen pump implanted in the abdominal wall? – A case report
Subramanian Vaidyanathan; Bakul M Soni; Peter L Hughes; Gurpreet Singh; John WH Watt; Tun Oo; Pradipkumar Sett
BACKGROUND: We present a case to illustrate controversies in percutaneous drainage of infected, perinephric haematoma in a tetraplegic patient, who had implantation of baclofen pump in anterior abdominal wall on the same side as perinephric haematoma. CASE PRESENTATION: A 56-year-old male with C-4 tetraplegia had undergone implantation of programmable pump in the anterior abdominal wall for intrathecal infusion of baclofen
Pediatric Myocardial Stunning Underscores the Cardiac Toxicity of Conventional Hemodialysis Treatments
Hothi, Daljit K.; Rees, Lesley; Marek, Jan; Burton, James; McIntyre, Christopher W.
Background and objective: In adults, hemodialysis (HD)-induced ischemia causes reversible myocardial dysfunction (myocardial stunning) that is progressive with raised attendant mortality. Children share an increased risk for death from a spectrum of uremia-related cardiovascular abnormalities but in the absence of significant classical atheromatous coronary artery disease; therefore, we elected to assess children who were on HD for the occurrence of myocardial stunning to investigate the relative importance of characteristic uremic cardiovascular abnormalities in the development of ischemic cardiac injury. Design, setting, participants, & measurements: We included all single-center long-term HD patients (n = 12; range 2 to 17 yr), excluding those with structural cardiac disease. Patients underwent conventional thrice-weekly HD for 4 h using high-flux membranes. We measured regional left ventricle wall motion using serial echocardiography (before HD, during HD, and 15 min after HD). Significant stunning was defined as a 20% reduction in regional wall motion (RRWM) in two or more segments and hyperkinesis as an either >20 or >50% increase in shortening fraction (SF). Results: Eleven of 12 patients developed myocardial stunning with varying degrees of compensatory hyperkinesis in unaffected segments, maintaining left ventricular ejection fraction throughout HD. The mean segmental %SF[Overall] and %SF[RRWM] fell during HD (2.19 to 1.77 and 2.72 to 1.37, respectively). Intradialytic BP reduction was significantly associated with mean segmental %SF[RRWM]. Conclusions: Children who receive conventional HD experience myocardial stunning. These data, in combination with previous adult studies of intradialytic myocardial blood flow, suggest a characteristic cardiovascular phenotype in HD patients that predisposes to significant demand ischemia. PMID:19339406
Ability of the no-reflow phenomenon during an acute myocardial infarction to predict left ventricular dysfunction at one-month follow-up
Michael D. Kenner; Edward J. Zajac; George T. Kondos; Ravi Dave; Jacqueline Wiewall Winkelmann; Julie Joftus; Aleksandras Laucevicius; Alexandras Kybarskis; Egidius Berukstis; Arvydas Urbonas; Steven B. Feinstein
Despite angiographically successful opening of an infarct-related vessel within a 6-hour time frame, some patients do not recover left ventricular regional wall function in the infarct zone after an acute myocardial infarction (AMI). Recent evidence suggests that this finding is due to the no-reflow phenomenon, or failure to recover tissue perfusion despite patent epicardial arteries. We performed myocardial contrast echocardiography
Transient ST elevation and left ventricular asynergy associated with normal coronary artery and Tc-99m PYP Myocardial Infarct Scan in subarachnoid hemorrhage.
Chang, P C; Lee, S H; Hung, H F; Kaun, P; Cheng, J J
A 72-year-old woman who presented with transient electrocardiographic ST segment elevation and left ventricular asynergy in an acute phase of subarachnoid hemorrhage was found to have normal coronary angiogram and normal Tc-99m PYP myocardial infarct scan. These findings suggested that noninvasive Tc-99m PYP myocardial infarct scan could substitute coronary angiogram for differentiating wall motion and electrocardiographic abnormalities secondary to subarachnoid hemorrhage from those caused by coronary artery disease in patients with subarachnoid hemorrhage. PMID:9510495
Course of impaired left ventricular function after acute myocardial infarction predicted with planar thallium-201 chloride and F18-fluorodeoxyglucose imaging
Johannes M. Huitink; Frans C. Visser; Jeroen J. Bax; Arthur van Lingen; Cees A. Visser
Planar rest myocardial thallium-201 chloride (201T1)\\/F18-fluorodeoxyglucose (FDG) imaging has been shown to distinguish between viable and non-viable tissue. Twenty-five patients (60 ± 9 years) with acute myocardial infarction were studied using this technique within 6 ± 2 days (T1) after infarction and again after 42 ± 4 days (T6). Serial assessment of wall motion with 2D-echocardiography was performed to determine
Beneficial effects of a polysaccharide from Salvia miltiorrhiza on myocardial ischemia-reperfusion injury in rats.
Song, Mingbao; Huang, Lan; Zhao, Gang; Song, Yaoming
In the present study, one water-soluble polysaccharide (SMP1) was isolated from the roots of Salvia miltiorrhiza. The cardio-protective potential of SMP1 was studied in the ischemia-reperfusion (I/R) model of rats in vivo. Results showed that 30 min of left anterior descending coronary artery occlusion (LAD) followed by 4 h of reperfusion markedly decreased myocardial superoxide dismutase (SOD), Na(+)-K(+)-ATPase and Ca(2+)-Mg(2+)-ATPase activities and increased myocardial malondialdehyde (MDA) level and serum activities of creatine kinase (CK) and lactate dehydrogenase (LDH) in I/R rats. An increase in infarct size and high apoptosis index of cardiac cell were also observed in IR rats. Administration of SMP1 400 and 800 mg/kg significantly reversed these biochemical parameters in the I/R rats to the normal levels in sham control rats. The infarct sizes and the percent of TUNEL-positive cells were found significantly decreased in SMP1-treated groups compared to I/R rats. Taken together, the present study clearly suggests SMP1 has a protective effect against myocardial I/R injury in rats by ameliorating oxidative stress and inhibiting myocardial apoptosis. PMID:24053850
Case of angina pectoris at rest and during effort due to coronary spasm and myocardial bridging
Teragawa, Hiroki; Fujii, Yuichi; Ueda, Tomohiro; Murata, Daiki; Nomura, Shuichi
We present a case of a 71-year-old male who had chest symptoms at rest and during effort. He had felt chest oppression during effort for 1 year, and his chest symptoms had recently worsened. One month before admission he felt chest squeezing at rest in the early morning. He presented at our institution to evaluate his chest symptoms. Electrocardiography and echocardiography failed to show any specific changes. Because of the possibility that his chest symptoms were due to myocardial ischemia, he was admitted to our institution for coronary angiography (CAG). An initial CAG showed mild atherosclerotic changes in the proximal segment of the left anterior descending coronary artery (LAD) and mid-segment of the left circumflex coronary artery. Subsequent spasm provocation testing using acetylcholine revealed a bilateral coronary vasospasm, which was relieved after the intracoronary infusion of nitroglycerin. Finally, a CAG showed myocardial bridging (MB) of the mid-distal segments of the LAD. Fractional flow reserve using the intravenous administration of adenosine triphosphate was positive at 0.77, which jumped up to 0.90 through the myocardial bridging segments when the pressure wire was pulled back. Thus, coronary vasospasm and MB might have contributed to his chest symptoms at rest and during effort. Interventional cardiologists should consider the presence of MB as a potential cause of myocardial ischemia. PMID:26131343
Wiener filtering improves quantification of regional myocardial perfusion with thallium-201 SPECT
Links, J.M.; Jeremy, R.W.; Dyer, S.M.; Frank, T.L.; Becker, L.C. (Johns Hopkins Medical Institutions, Baltimore, MD (USA))
Quantitation of myocardial perfusion with thallium-201 (201Tl) SPECT is limited by finite resolution and image noise. This study examined whether Wiener filtering could improve quantitation of the severity of myocardial perfusion deficits. In 19 anesthetized dogs, adjustable stenoses were placed on the left anterior descending (LAD, n = 12) or circumflex (LCx, n = 7) arteries. Thallium-201 SPECT images were acquired during maximal coronary vasodilation with dipyridamole, and simultaneous measurements of myocardial blood flow were made with microspheres. The relationship between SPECT and microsphere flow deficits in the LAD region was significantly better (p less than 0.05) with Wiener filtering (Y = 0.90X + 0.03, r = 0.78) than with conventional Hanning filtering (Y = 0.66X + 0.34, r = 0.61). Similarly, in the LCx region the relationship between SPECT and microsphere perfusion deficits was better (p less than 0.01) with the Wiener filter (Y = 0.91X + 0.07, r = 0.66) than with the Hanning filter (Y = 0.36X + 0.50, r = 0.40). Wiener filtering improves quantitation of the severity of regional myocardial perfusion deficits, allowing better assessment of the functional significance of coronary artery stenoses.
Localization of anti-mitochondrial antibody in experimental canine myocardial infarcts.
Willerson, J T; Kulkarni, P; Stone, M; Lewis, S E; Eigenbrodt, E; Bonte, F J; Parkey, R W; Buja, L M
Alterations in cell and subcellular membrane integrity occur during evolving ischemic myocardial injury. We tested the hypothesis that an antibody against human liver mitochondria [anti-mitochondrial antibody developing in a patient with primary biliary cirrhosis] could identify altered cell membrane integrity in experimental canine myocardial infarcts. The proximal left anterior descending coronary arteries of 12 dogs were ligated and 1 hr later 131I-labeled F(ab')2 fragments from either a control human IgG (6 dogs) or anti-mitochondrial IgG (6 dogs) were injected. The 131I-labeled F(ab')2 anti-mitochondrial fragments concentrated maximally in the central infarct subendocardium [infarct-to-normal ratio of 9.2 +/- 3.5 (mean +/- SD) vs. 4.6 +/- 3.3 for control F(ab')2 IgG, P < 0.05]. There was also 1 1/2- to 2-fold greater anti-mitochondrial antibody F(ab')2 accumulation in the central infarct epicardium and the peripheral infarct subendocardium and subepicardium. Thus, an anti-mitochondrial antibody obtained from a patient with primary biliary cirrhosis concentrates in irreversibly damaged myocardium after experimental canine myocardial infarction. Presumably this occurs because of altered cell membrane integrity, which allows exposure of mitochondria to the anti-mitochondrial antibody. The F(ab')2 fragments of anti-mitochondrial antibodies labeled with suitable radionuclides should allow noninvasive scintigraphic detection of experimental acute myocardial infarcts. Images PMID:6935688
Comparison of radionuclide and enzymatic estimate of infarct size in patients with acute myocardial infarction
Hirsowitz, G.S.; Lakier, J.B.; Marks, D.S.; Lee, T.G.; Goldberg, A.D.; Goldstein, S.
A comparison was made of the estimated size of the myocardial infarction occurring in 26 patients with a first infarction using creatine kinase (CK) enzyme release between radionuclide gated blood pool measurement of total and regional ventricular function and thallium-201 scintigraphic measurement of myocardial perfusion defects. Creatine kinase estimates of infarct size (enzymatic infarct size) correlated closely with the percent of abnormal contracting regions, left ventricular ejection fraction and thallium-201 estimates of percent of abnormal perfusion area (r . 0.78, 0.69 and 0.74, respectively, p less than 0.01). A close correlation also existed between percent abnormal perfusion area and percent of abnormal contracting regions (r . 0.81, p less than 0.01) and left ventricular ejection fraction (r . 0.69, p less than 0.01). Enzymatic infarct size was larger in anterior (116 +/- 37 CK-g-Eq) than inferior (52 +/- 29 CK-g-Eq) myocardial infarction (p less than 0.01) and was associated with significantly more left ventricular functional impairment as determined by left ventricular ejection fraction (33 +/- 7 versus 60 +/- 10%) (p less than 0.01) and percent abnormal perfusion area (58 +/- 14 versus 13 +/- 12) (p less than 0.01). No significant correlation was observed between enzymatic infarct size and right ventricular ejection fraction. These different methods of estimating infarct size correlated closely with each other in these patients with a first uncomplicated myocardial infarction.
Acute myocardial infarct imaging with indium-111-labeled monoclonal antimyosin Fab
Khaw, B.A.; Yasuda, T.; Gold, H.K.; Leinbach, R.C.; Johns, J.A.; Kanke, M.; Barlai-Kovach, M.; Strauss, H.W.; Haber, E.
Indium-111 monoclonal antimyosin Fab scintigraphy was used to detect myocardial necrosis in 52 of 54 patients (96.3%) with acute myocardial infarction. Infarcts were visualized when coronary arteries were persistently occluded (n = 10), became patent after thrombolysis (n = 33), or became patent after spontaneous reperfusion (n = 7). Posteroinferolateral visualizations were obtained in two patients with clinical and enzymatic evidence of infarction but normal electrocardiograms. Of the two patients in whom no infarcts were visualized, one had an anterior myocardial infarct. This patient underwent successful thrombolytic therapy, with attendant minimization of creatine kinase release. The other patient had a small, nonreperfused inferior myocardial infarct. Five patients with a history of remote infarction and acute necrosis showed antimyosin uptake only in regions concordant with the acute episodes of infarction, and radiolabeled antimyosin Fab localized in neither old infarcts nor normal, noninfarcted myocardium. Antimyosin Fab scintigraphy, thus, appears to be a highly specific means of delineating necrotic myocardium, at least in this limited and selected group of patients.
Left ventricular wall thickness and disease duration in systemic sclerosis.
Hegedüs, I.; Czirják, L.
Myocardial thickness, left ventricular functions, and right heart overloading were investigated in 80 patients with systemic sclerosis by echocardiography. Based on the left ventricular wall thickness, three groups were formed. Fifteen patients with asymmetrical left ventricular wall hypertrophy (Group 1) showed shorter mean disease duration with marked diastolic and mild systolic left ventricular functional impairment. The 25 patients with wall thinning (Group 3) had a slight increase in left ventricular diameters, impaired systolic functions and longer disease duration. Group 2 with wall thickness exhibited mixed changes. Patients with increased wall thickness tended to have a shorter disease duration than patients with wall thinning. Patients with systemic sclerosis showed systolic and diastolic function impairment as compared to the 18 control healthy individuals. Pericardial disease was found in 23 cases (28.7%). PMID:8321792
Anterior Cruciate Ligament Graft Choices
Macaulay, Alec A.; Perfetti, Dean C.; Levine, William N.
Context: Reconstruction of the anterior cruciate ligament (ACL) is a common surgical procedure; however, there is no consensus to what the best graft option is to replace the injured ACL. The main options available consist of allografts and autografts, which include patellar tendon, hamstring tendon, and quadriceps tendon autografts. Evidence Acquisition: The PubMed database was searched in August 2010 for English-language articles pertaining to ACL grafts. Results: Postoperative outcome variables were analyzed to determine similarities and differences among the different graft options. These variables include stability, strength, function, return to sports, patient satisfaction, complications, and cost. Conclusions: Both allografts and the 3 main options for autografts can provide excellent results in ACL reconstruction and lead to a high percentage of satisfied patients. However, differences exist among the graft choices. Both the similarities and the differences are important to discuss with a patient who will be undergoing ACL reconstruction so that he or she has the best information available when making a choice of graft. PMID:23016071
Clinical features of anterior bradyrhythmia.
Shiohama, N; Shinomiya, S; Nagaoka, M
The present study examined the clinical significance of anterior bradyrhythmia (AB), which was described by Gibbs and Gibbs in 1964. The significance of AB in this report was indefinite because of unclear criteria and underdeveloped neuroradiology. We proposed a set of criteria of AB and reevaluated the clinical significance of the EEG pattern in correlation with the clinical and the computerized topography (CT) findings of the patients. The study material was 4019 EEGs examined in our laboratory during a 1-year period (1991). AB was recorded in 20 patients (0.5%), whose mean age was 69.8 years. Its incidence tended to increase with age. Sixteen patients [table: see text] (80%) had dementia and were classified into two types according to clinical features, as Binswanger (B)-type and Alzheimer (A)-type. B-type patients had gait disturbance, urinary incontinence, hemiparesis, and ECG abnormalities, and showed leuko-araiosis on CT. A-type patients had only dementia, and showed frontoparietal atrophy on CT. Delirium was found in 7 (35%) out of the 20 patients with AB, which may be an additional factor related to the appearance of the EEG pattern. B-type had lower frequency of AB than A-type. Both types showed slowed background activities; the alpha rhythm of B-type had lower frequency and tended to have higher amplitude than that of A-type. These EEG abnormalities may be indicative of subcortical or cortical dysfunction in the frontal areas. PMID:8261643
[The clinical picture, diagnosis and combined therapy of the cardiospinal syndromes in myocardial infarct].
Sadykova, G K
As a result of complex studies, out of 275 patients with myocardial infarction, cardiospinal syndromes were distinguished in 68 cases (24,6%). Of these, 14 manifested a syndrome of the anterior spinal artery, 6 a syndrome of the posterior longitudinal arteries. Disturbances of spinal circulation in the system of the radicular spinal arteries were revealed in 48 patients. Clinically, they involved a cardiohumerospinal syndrome (18 patients), cardio-intercostal spinal syndrome (9 patients), and cardio-lumbosacral syndrome (21 patients). Complex therapy of the cardiospinal syndromes (besides myocardial infarction treatment) included parenteral administration of 10% sodium salicylate, solkoseryl, troxevasin, dibazol, galanthamine (in the postinfarction period), proserin, as well as oral administration of antisclerotic, metabolic, nootropic and venotonic drugs. Complete regression of the spinal symptoms was recorded in 35, improvement in 12 patients. In the remaining patients, the recovery was negligible, and such patients were administered repeated courses of treatment. PMID:8042374
Myocardial perfusion imaging and gated cardiac blood pool scanning: clinical application.
Pitt, B; Strauss, H W
Myocardial perfusion imaging with thallium-201 and gated cardiac blood pool scanning are finding increasing use in clinical cardiology. These noninvasive techniques have been found useful in detecting myocardial infarction independent of the electrocardiogram and determining the site and extent of the infarct as well as its effect on left ventricular function. These studies provide important prognostic data and are proving to be of value in evaluating patients with cardiogenic shock. Neither the thallium-201 myocardial perfusion image nor the gated cardiac blood pool scan can distinguish between acute and chronic myocardial damage. In clinical situations where this is important, infarct avid imaging with technetium-99m pyrophosphate allows determination of whether a given perfusion defect or wall motion abnormality is acute. Myocardial perfusion imaging with thallium-201 at rest and after exercise is also proving to be of value in evaluating patients with suspected ischemic heart disease. Initial studies suggest that the technique may be more sensitive than exercise electrocardiography and is of special value in minimizing the occurrence of false positive exercise tests for the diagnosis of ischemic heart disease. The combined tracers technique is also of value in the evaluation of patients undergoing coronary bypass graft surgery and those with cardiomyopathy. PMID:136890
Myocardial perfusion imaging with thallium-201: correlation with coronary arteriography and electrocardiography
Sternberg, Leonard; Wald, Robert W.; Feiglin, David H.I.; Morch, John E.
Myocardial perfusion imaging with thallium-201 and electrocardiography with the subject at rest and undergoing submaximal treadmill exercise were performed in 19 men and 3 women. Selective coronary arteriography and left ventriculography showed that 7 had normal coronary arteries and 15 had coronary artery disease. The 11 persons with electrocardiographic evidence of an old myocardial infarct (q waves) had a perfusion defect at rest in the area of the infarct and a segmental abnormality of wall motion apparent on the left ventriculogram corresponding to the perfusion defect. Myocardial perfusion imaging and electrocardiography were equally sensitive in detecting coronary artery disease in exercising individuals: perfusion defects were noted in 7 of the 15 persons with coronary artery disease, and diagnostic ST-segment depression was present in 8 of the 15. Combination of the results of the two tests with exercise permitted the identification of 11 of the 15 persons and improved the sensitivity. Combination of the results of rest and exercise imaging and electrocardiography permitted the identification of 94% of the patients with coronary artery disease. Myocardial perfusion imaging with 201TI in the subject at rest is a sensitive indicator of previous myocardial infarction. Imaging after the subject has exercised is a useful adjunct to conventional exercise electrocardiography, especially in those whose exercise electrocardiogram is non-interpretable. ImagesFIG. 1FIG. 2FIG. 3FIG. 4FIG. 5 PMID:630487
NSDL National Science Digital Library
Hadrian's Wall is an historical monument built by the Romans in Britain and spans more than 2,000 years of history. Standing as a "reminder of past glories of one of the world's greatest civilisations," the Wall is equipped with museums, forts, and events that bring Roman history to life. Designed by the World Heritage Site, this Web site offers tourist information (such as travel and hotel arrangements) for anyone interested in visiting this historical landmark that ranks along with the great wonders of the world.
Trypan blue dye for anterior segment surgeries
Jhanji, V; Chan, E; Das, S; Zhang, H; Vajpayee, R B
Use of vital dyes in ophthalmic surgery has gained increased importance in the past few years. Trypan blue (TB) has been a popular choice among anterior segment surgeons mainly due to its safety, ease of availability, and remarkable ability to enable an easy surgery in difficult situations mostly related to visibility of the targeted tissue. It is being used in cataract surgery since nearly a decade and its utilization has been extended to other anterior segment surgeries like trabeculectomy and corneal transplantation. This review will discuss the techniques and outcome of TB dye-assisted anterior segment surgeries. PMID:21681214
Anterior ankle arthroscopy: indications, pitfalls, and complications.
Epstein, David M; Black, Brandee S; Sherman, Seth L
Anterior ankle arthroscopy is a useful, minimally invasive technique for diagnosing and treating ankle conditions. Arthroscopic treatment offers the benefit of decreased surgical morbidity, less postoperative pain, and earlier return to activities. Indications for anterior ankle arthroscopy continue to expand, including ankle instability, impingement, management of osteochondritis dissecans, synovectomy, and loose body removal. Anterior ankle arthroscopy has its own set of inherent risks and complications. Surgeons can decrease the risk of complications through mastery of ankle anatomy and biomechanics, and by careful preoperative planning and meticulous surgical technique. PMID:25726482
[Neuropeptides of anterior pituitary origin].
Peillon, F; Le Dafniet, M; Pagesy, P; Li, J Y; Benlot, C; Lagoguey, A; Brandi, A M; Joubert, D
Several neuropeptides classically associated with the hypothalamus have been found in the anterior pituitary. The question arises whether they are locally synthesized and if they play a paracrine or autocrine role on pituitary hormone secretion. Using normal and tumoral human pituitaries we found neuropeptides (TRH, SRIH, GHRH) and dopamine in variable quantities according to the nature of the tissue. They were all present in normal pituitaries, while stimulatory hormones (TRH and GHRH) were predominantly found in tumoral tissue, implying an imbalance of pathophysiological importance between the stimulatory and inhibitory control of hypophyseal hormones (PRL and GH) in pituitary adenomas. Both normal and tumoral pituitaries released TRH, SRIH and GHRH in large amounts suggesting their local synthesis. The in situ synthesis was demonstrated for SRIH by the evidence of SRIH mRNA, the detection of SRIH immunoreactivity in peculiar cells and the presence of SRIH precursor. The possible role of these pituitary neuropeptides was suggested for instance by the negative correlation found in vitro between SRIH and GH secretions. Moreover neuropeptides could interact on each other. Indeed DA stimulated TRH release while PRL secretion decreased at the same time. Pulses of TRH had differential effects on SRIH release according to the nature of the tissue as TRH inhibited SRIH release from adenoma while it stimulated SRIH release from normal pituitary. Concerning the effects of SRIH and GHRH on GH secretion, there was an endogenous regulatory pattern comparable to that described in rat portal blood vessels. Pulses of GHRH induced GH secretion only when endogenous SRIH release was not stimulated.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2291627
Impaired perfusion after myocardial infarction is due to reperfusion induced ?PKC-mediated myocardial damage
Fumiaki Ikeno; Koichi Inagaki; Mehrdad Rezaee; Daria Mochly-Rosen
Objective: To improve myocardial flow during reperfusion after acute myocardial infarction and to elucidate the molecular and cellular basis that impedes it. According to the AHA\\/ACC recommendation, an ideal reperfusion treatment in patients with acute myocardial infarction (AMI) should not only focus on restoring flow in the occluded artery, but should aim to reduce microvascular damage to improve blood flow
Myocardial Depression in Sepsis and Septic Shock
A. Kumar; J. E. Parrillo
Myocardial dysfunction is an important component in the hemodynamic collapse induced by sepsis and septic shock. A series\\u000a of inflammatory cascades triggered by the inciting infection generate circulatory myocardial depressant substances, including\\u000a TNF-?, IL-1?, PAF and lysozyme. Current evidence suggests that septic myocardial depression in humans is characterized by\\u000a reversible biventricular dilatation, decreased systolic contractile function, and decreased response to
Pulsed Doppler echocardiographic analysis of mitral regurgitation after myocardial infarction.
Loperfido, F; Biasucci, L M; Pennestri, F; Laurenzi, F; Gimigliano, F; Vigna, C; Rossi, E; Favuzzi, A; Santarelli, P; Manzoli, U
In 72 patients with previous myocardial infarction (MI), mitral regurgitation (MR) was assessed by pulsed-wave Doppler echocardiography and compared with physical and 2-dimensional echocardiographic findings. MR was found by Doppler in 29 of 42 patients (62%) with anterior MI, 11 of 30 (37%) with inferior MI (p less than 0.01) and in none of 20 normal control subjects. MR was more frequent in patients who underwent Doppler study 3 months after MI than in those who underwent Doppler at discharge (anterior MI = 83% vs 50%, p less than 0.01; inferior MI = 47% vs 27%, p = not significant). Of 15 patients who underwent Doppler studies both times, 3 (all with anterior MI) had MR only on the second study. Of the patients with Doppler MR, 12 of 27 (44%) with a left ventricular (LV) ejection fraction (EF) greater than 30% and 1 of 13 (8%) with an EF of 30% or less (p less than 0.01) had an MR systolic murmur. Mitral prolapse or eversion and papillary muscle fibrosis were infrequent in MI patients, whether or not Doppler MR was present. The degree of Doppler MR correlated with EF (r = -0.61), LV systolic volume (r = 0.47), and systolic and diastolic mitral anulus circumference (r = 0.52 and 0.51, respectively). Doppler MR was present in 24 of 28 patients (86%) with an EF of 40% or less and in 16 of 44 (36%) with EF more than 40% (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3766410
LV wall segmentation using the variational level set method (LSM) with additional shape constraint for oedema quantification
NASA Astrophysics Data System (ADS)
Kadir, K.; Gao, H.; Payne, A.; Soraghan, J.; Berry, C.
In this paper an automatic algorithm for the left ventricle (LV) wall segmentation and oedema quantification from T2-weighted cardiac magnetic resonance (CMR) images is presented. The extent of myocardial oedema delineates the ischaemic area-at-risk (AAR) after myocardial infarction (MI). Since AAR can be used to estimate the amount of salvageable myocardial post-MI, oedema imaging has potential clinical utility in the management of acute MI patients. This paper presents a new scheme based on the variational level set method (LSM) with additional shape constraint for the segmentation of T2-weighted CMR image. In our approach, shape information of the myocardial wall is utilized to introduce a shape feature of the myocardial wall into the variational level set formulation. The performance of the method is tested using real CMR images (12 patients) and the results of the automatic system are compared to manual segmentation. The mean perpendicular distances between the automatic and manual LV wall boundaries are in the range of 1-2 mm. Bland-Altman analysis on LV wall area indicates there is no consistent bias as a function of LV wall area, with a mean bias of -121 mm2 between individual investigator one (IV1) and LSM, and -122 mm2 between individual investigator two (IV2) and LSM when compared to two investigators. Furthermore, the oedema quantification demonstrates good correlation when compared to an expert with an average error of 9.3% for 69 slices of short axis CMR image from 12 patients.
Genetics of premature myocardial infarction
Robert Roberts
Common multigene disorders account for 80% of deaths in the world and all have significant genetic predisposition. Coronary\\u000a artery disease and myocardial infarction (MI) account for more than 40% of these deaths. The genetic component is due to multiple\\u000a genes, each contributing only minimally to the phenotype. Linkage analysis, which has been successful in identifying rare\\u000a disorders that cause MI,
Myocardial Ischemia with Penetrating Thoracic Trauma
Elms, Andrew R.; Wong, Garret; Wisner, David; Bair, Aaron
Penetrating trauma is a rare cause of myocardial infarction. Our report describes a 47-year-old female who presented with a gunshot wound from a shotgun and had an ST-elevation myocardial infarction. The patient received emergent coronary angiography, which demonstrated no evidence of coronary atherosclerotic disease but did show occlusion of a marginal vessel secondary to a pellet. The patient was managed medically for the myocardial infarction without cardiac sequelae. Patients with penetrating trauma to the chest should be evaluated for myocardial ischemia. Electrocardiography, echocardiography and cardiac angiography play vital roles in evaluating these patients and helping to guide management. PMID:21691532
Traditional Chinese Medicine Shuang Shen Ning Xin Attenuates Myocardial Ischemia/Reperfusion Injury by Preserving of Mitochondrial Function
Li, Xueli; Liu, Jianxun; Lin, Li; Guo, Yujie; Lin, Chengren; Zhang, Cuixiang; Yang, Bin
To investigate the potential cardioprotective effects of Shuang Shen Ning Xin on myocardial ischemia/reperfusion injury. Wistar rats were treated with trimetazidine (10?mg/kg/day, ig), Shuang Shen Ning Xin (22.5, 45?mg/kg/day, ig), or saline for 5 consecutive days. Myocardial ischemia/reperfusion injury was induced by ligation of the left anterior descending coronary artery for 40?min and reperfusion for 120?min on the last day of administration. It is found that Shuang Shen Ning Xin pretreatment markedly decreased infarct size and serum LDH levels, and this observed protection was associated with reduced myocardial oxidative stress and cardiomyocyte apoptosis after myocardial ischemia/reperfusion injury. In addition, further studies on mitochondrial function showed that rats treated with Shuang Shen Ning Xin displayed decreased mitochondrial swelling and cytosolic cytochrome c levels, which were accompanied by a preservation of complex I activities and inhibition of mitochondrial permeability transition. In conclusion, the mitochondrial protective effect of Shuang Shen Ning Xin could be a new mechanism, by which Shuang Shen Ning Xin attenuates myocardial ischemia/reperfusion injury. PMID:25031602
Short-term pretreatment with atorvastatin attenuates left ventricular dysfunction, reduces infarct size and apoptosis in acute myocardial infarction rats
Chen, Tie-Long; Zhu, Guang-Li; He, Xiao-Long; Wang, Jian-An; Wang, Yu; Qi, Guo-An
Background: Atorvastatin showed a number of cardiovascular benefits, however, the role and underlying molecular mechanisms of short-term atorvastatin-mediated protection remain unclear. Methods: 30 rats were randomly divided into 3 groups: sham group, acute myocardial infarction model group and atorvastatin group. The rats of acute myocardial infarction model were established by ligation of the left anterior descending of coronary arteries. Before surgery, rats in the atorvastatin group received 20 mg/kg/d atorvastatin for 7 days in atorvastatin group. After 4 hours of model established, changes in hemodynamics parameters were recorded and myocardial infarct size was achieved by Evans blue-TTC staining. Myocardium apoptosis was evaluated by TUNEL. The expression of FAS, FAS-L, Bcl-2, Bax, p-BAD, Caspase-8 and Caspase-3 in myocardium were examined by Western blot. Results: In the atorvastatin group, left ventricular function was elevated and infarct size was decreased compared with the model group. Moreover, in the atorvastatin group, the cell apoptosis index was reduced in response to myocardial infarction. The expressions of Bcl-2 were increased and Bax, p-BAD, Fas, Fas-L, caspase-8 and caspase-3 in myocardium were decreased in atorvastatin group. Conclusions: Short-term atorvastatin pretreatment restored left ventricular function and limited infarct size in acute myocardial infarction, which were associated with reduction of the apoptosis in myocardium through Bcl-2 and Fas pathway. PMID:25663976
Detection of coronary artery disease using real-time myocardial contrast echocardiography: a comparison with dual-isotope resting thallium-201/stress technectium-99m sestamibi single-photon emission computed tomography.
Lin, Shoa-Lin; Chiou, Kuan-Rau; Huang, Wei-Chun; Peng, Nan-Jing; Tsay, Daw-Guey; Liu, Chun-Peng
Real-time myocardial contrast echocardiography (MCE) has the potential to evaluate myocardial perfusion and wall motion (WM) simultaneously. The purposes of this study were to correlate the diagnostic value of MCE with radionuclide single-photon emission computed tomography (SPECT), and to assess the sensitivity and specificity of real-time MCE in detecting coronary artery disease (CAD). Seventy patients with clinically suspected CAD underwent MCE and SPECT at baseline and after dipyridamole infusion. Segmental perfusion with MCE using low mechanical index after 0.3-0.4-ml bolus injections of perfluorocarbon exposed sonicated dextrose albumin solution was performed. All patients had a dual-isotope (rest thallium-201, stress sestamibi) study performed both at baseline and after dipyridamole infusion, and 40 patients had subsequent quantitative coronary angiography. Abnormalities were noted in 27 patients (38.6%) by MCE, in 29 patients (41.4%) by WM analysis, and in 30 patients (42.9%) by SPECT imaging. When MCE and WM analysis were combined, the agreement with SPECT imaging improved from 75.7% (Kappa = 0.50) to 82.0% (Kappa = 0.62). In 40 patients (120 territories) who underwent coronary angiography, good perfusion concordance was achieved for the left anterior descending and left circumflex arteries, and was fair for the right coronary arteries. Compared with quantitative angiography, there was no difference in sensitivity, specificity, and accuracy in detecting significant CAD among the three modalities. The combination of MCE and WM had a better sensitivity (84%), specificity (93.3%), and accuracy (87.5%) than the MCE and WM analysis alone. However, the difference did not reach statistical significance. Real-time MCE has a good agreement with SPECT imaging for detecting CAD. The combination of MCE and WM appears to have higher sensitivity, specificity, and accuracy in detecting CAD than either technique alone. PMID:16865298
Cardiopulmonary bypass in revascularization and fluid management of exercise-induced acute myocardial infarction.
Whitson, Bryan A; Nath, Dilip S; Knudtson, Joshua R; Shumway, Sara J
A 52-year-old man was resuscitated from a cardiac arrest during a marathon run. During initial evaluation, he received a significant amount of crystalloid fluid to maintain end-organ perfusion. Based on electrocardiogram findings, myocardial infarction was suspected and an angiogram was performed. An acute thrombosis of the left anterior descending vessel was noted, angioplastied, and stented. Given that he was in cardiogenic shock, acidotic, and hemodynamically labile, an emergent coronary artery bypass grafting with cardiopulmonary bypass was performed to simultaneously revascularize the myocardium and remove intravascular fluid. PMID:16948763
Anterior regeneration in the hemichordate Ptychodera flava
Rychel, Amanda L.; Swalla, Billie J.
Ptychodera flava is a hemichordate whose anterior structures regenerate reproducibly from posterior trunk pieces when amputated. We characterized the cellular processes of anterior regeneration with respect to programmed cell death and cell proliferation, following wound healing. We found scattered proliferating cells at day two of regeneration using a PCNA antibody. On day four, most proliferating cells were associated with the nerve tract under the epidermis, and on day six, a small proboscis derived from proliferated cells was regenerated, and a mouth had broken though the epidermis. TUNEL detected elevated levels of apoptosis in the endoderm that began furthest away from the region of wound healing, then moved anteriorly over eight days. Posterior to anterior apoptosis is likely to remove digestive endoderm for later differentiation of pharyngeal endoderm. We hypothesize that P. flava regeneration is nerve dependent and that remodeling in the gut endoderm plays an important role in regeneration. PMID:18924231
Indications and techniques for anterior cervical plating.
Rhee, John M; Park, Jong-Beom; Yang, Jun-Young; Riew, Daniel K
Anterior cervical plating is commonly performed to stabilize anterior cervical fusions. Modern plating options include dynamic plates, with screws that can either toggle within fixed holes or translate within slotted holes. Regardless of the plating system used, paramount to success and avoidance of complications with plated anterior cervical fusions are meticulous plating techniques, exacting graft carpentry, and understanding the biomechanical limitations of plating in certain situations, such as multilevel corpectomies reconstructed with a single-strut graft. In order to prevent graft-related complications associated with long-strut grafts, additional posterior fixation and fusion, or alternative corpectomy constructs, such as multilevel anterior cervical discectomy and fusion, corpectomy-discectomy, and corpectomy-corpectomy, should be considered instead if the pattern of stenosis allows. PMID:16565534
Double jeopardy: two major complications of a myocardial infarction in one patient.
Selder, Jasper; Riezebos, Robert
A 62-year-old woman with no cardiac history was admitted to the hospital with an ambulant inferoposterolateral myocardial infarction. She experienced two major complications, namely, a free-wall rupture of the infarcted area, on which a bovine pericardial patch was glued surgically, and, a few days later, a posteromedial papillary muscle rupture, for which a mitral valve replacement was performed. She survived both complications and is now rehabilitating at home. PMID:26148495
Smooth Muscle Cell Transplantation into Myocardial Scar Tissue Improves Heart Function
Ren-Ke Li; Zhi-Qiang Jia; Richard D. Weisel; Frank Merante; Donald A. G. Mickle
This study was designed to evaluate the effect of smooth muscle cell transplantation into myocardial ventricular scar formed by cryo-necrosis. The left ventricular free wall (LVFW) of adult rats was cryo-necrosed. At 4 weeks after cryo-injury cultured fetal rat stomach smooth muscle cells (transplanted group,n=10) or culture medium (control,n=10) were transplanted. Sham animals (n=8) were similarly operated but without cryo-necrosis
Early occlusion of the non-infarct-related coronary artery following successful primary percutaneous coronary intervention in ST-elevation myocardial infarction
Pr?gowski, Jerzy; Bekta, Pawe?; Chmielak, Zbigniew; Witkowski, Adam
We present a clinical case of early occlusion of the non-infarct-related artery (non-IRA) in a patient with ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI). Several hours after successful percutaneous treatment of the occluded right coronary artery the patient developed a second myocardial infarction, which was caused by acute occlusion of the left anterior descending artery, which had a significant lesion in the proximal segment. The lesion was diagnosed during the first catheterization, but was left untreated. We discuss the potential advantages and risks associated with the ad-hoc multivessel PCI strategy in STEMI.
Failure of anterior cruciate ligament reconstruction.
Whitehead, Timothy S
Failure after anterior cruciate ligament reconstruction is a potentially devastating event that affects a predominantly young and active population. This review article provides a comprehensive analysis of the potential causes of failure, including graft failure, loss of motion, extensor mechanism dysfunction, osteoarthritis, and infection. The etiology of graft failure is discussed in detail with a particular emphasis on failure after anatomic anterior cruciate ligament reconstruction. PMID:23177471
Myocardial viability assessment with dynamic low-dose iodine-123-iodophenylpentadecanoic acid metabolic imaging: comparison with myocardial biopsy and reinjection SPECT thallium after myocardial infarction.
Murray, G L; Schad, N C; Magill, H L; Vander Zwaag, R
Aggressive cardiac revascularization requires recognition of stunned and hibernating myocardium, and cost considerations may well govern the technique used. Dynamic low-dose (1 mCi) [123I]iodophenylpentadecanoic acid (IPPA) metabolic imaging is a potential alternative to PET using either 18FDG or 15O-water. Resting IPPA images were obtained from patients with severe ischemic cardiomyopathy, and transmural myocardial biopsies were obtained during coronary bypass surgery to confirm viability. Thirty-nine of 43 (91%) biopsies confirmed the results of the IPPA images with a sensitivity for viability of 33/36 (92%) and a specificity of 6/7 (86%). Postoperatively, wall motion improved in 80% of IPPA-viable, dysfunctional segments. Furthermore, when compared to reinjection thallium (SPECT-TI) scans after myocardial infarction, IPPA-SPECT-TI concordance occurred in 27/35 (77%) (K = 0.536, p = 0.0003). Similar to PET, IPPA demonstrated more viability than SPECT-TI, 26/35 (74%) versus 18/35 (51%) (p = 0.047). Metabolic IPPA cardiac viability imaging is a safe, inexpensive technique that may be a useful alternative to PET. PMID:8151413
Comparisons of anterior segment biometry between Chinese and Caucasians using anterior segment optical coherence tomography
C. K. Leung; P.-M. Palmiero; R. N. Weinreb; H. Li; Z. Sbeity; S. Dorairaj; D. Leung; S. Liu; J. M. Liebmann; N. Congdon; D. S. Lam; R. Ritch
PurposeTo compare anterior segment parameters between eyes of Chinese and Caucasians using anterior segment optical coherence tomography and to evaluate the association between these parameters and anterior chamber angle width between the two ethnic groups.Methods60 Chinese and 60 Caucasians, 30 with open angles and 30 with narrow angles (defined as Shaffer grade ?2 in ?3 quadrants during dark room gonioscopy)
Quantification of myocardial infarction: a comparison of single photon-emission computed tomography with pyrophosphate to serial plasma MB-creatine kinase measurements
Jansen, D.E.; Corbett, J.R.; Wolfe, C.L.; Lewis, S.E.; Gabliani, G.; Filipchuk, N.; Redish, G.; Parkey, R.W.; Buja, L.M.; Jaffe, A.S.
Single photon-emission computed tomography (SPECT) with /sup 99m/Tc-pyrophosphate (PPi) has been shown to estimate size of myocardial infarction accurately in animals. The authors tested the hypothesis that SPECT with /sup /sup 99m//Tc-PPi and blood pool subtraction can provide prompt and accurate estimates of size of myocardial infarction in patients. SPECT estimates are potentially available early after the onset of infarction and should correlate with estimates of infarct size calculated from serial measurements of plasma MB-creatine kinase (CK) activity. Thirty-three patients with acute myocardial infarction and 16 control patients without acute myocardial infarction were studied. Eleven of the patients had transmural anterior myocardial infarction, 16 had transmural inferior myocardial infarction, and six had nontransmural myocardial infarction. SPECT was performed with a commercially available rotating gamma camera. Identical projection images of the distribution of 99mTc-PPi and the ungated cardiac blood pool were acquired sequentially over 180 degrees. Reconstructed sections were color coded and superimposed for purposes of localization of infarct. Areas of increased PPi uptake within myocardial infarcts were thresholded at 65% of peak activity. The blood pool was thresholded at 50% and subtracted to determine the endocardial border for the left ventricle. Myocardial infarcts ranged in size from 1 to 126 gram equivalents (geq) MB-CK. The correlation of MB-CK estimates of size of infarct with size determined by SPECT (both in geq) was good (r = .89 with a regression line of y = 13.1 + 1.5x).
Myocardial perfusion scintigraphy: the evidence
Anagnostopoulos, C.; Cerqueira, M.; Ell, P. J.; Flint, E. J.; Harbinson, M.; Kelion, A. D.; Al-Mohammad, A.; Prvulovich, E. M.; Shaw, L. J.; Tweddel, A. C.
This review summarises the evidence for the role of myocardial perfusion scintigraphy (MPS) in patients with known or suspected coronary artery disease. It is the product of a consensus conference organised by the British Cardiac Society, the British Nuclear Cardiology Society and the British Nuclear Medicine Society and is endorsed by the Royal College of Physicians of London and the Royal College of Radiologists. It was used to inform the UK National Institute of Clinical Excellence in their appraisal of MPS in patients with chest pain and myocardial infarction. MPS is a well-established, non-invasive imaging technique with a large body of evidence to support its effectiveness in the diagnosis and management of angina and myocardial infarction. It is more accurate than the exercise ECG in detecting myocardial ischaemia and it is the single most powerful technique for predicting future coronary events. The high diagnostic accuracy of MPS allows reliable risk stratification and guides the selection of patients for further interventions, such as revascularisation. This in turn allows more appropriate utilisation of resources, with the potential for both improved clinical outcomes and greater cost-effectiveness. Evidence from modelling and observational studies supports the enhanced cost-effectiveness associated with MPS use. In patients presenting with stable or acute chest pain, strategies of investigation involving MPS are more cost-effective than those not using the technique. MPS also has particular advantages over alternative techniques in the management of a number of patient subgroups, including women, the elderly and those with diabetes, and its use will have a favourable impact on cost-effectiveness in these groups. MPS is already an integral part of many clinical guidelines for the investigation and management of angina and myocardial infarction. However, the technique is underutilised in the UK, as judged by the inappropriately long waiting times and by comparison with the numbers of revascularisations and coronary angiograms performed. Furthermore, MPS activity levels in this country fall far short of those in comparable European countries, with about half as many scans being undertaken per year. Currently, the number of MPS studies performed annually in the UK is 1,200/million population/year. We estimate the real need to be 4,000/million/year. The current average waiting time is 20 weeks and we recommend that clinically appropriate upper limits of waiting time are 6 weeks for routine studies and 1 week for urgent studies. PMID:15129710
Modified anterior approach to the bladder neck: simple and reproducible procedure for anterior bladder neck transection during robot-assisted radical prostatectomy.
Shimbo, Masaki; Hattori, Kazunori; Endo, Fumiyasu; Matsushita, Kazuhito; Iwabuchi, Toshihisa; Tobisu, Kenichi; Muraishi, Osamu
To evaluate the feasibility and reproducibility of a simple technique for identifying the initial cutting point of the bladder neck during robot-assisted radical prostatectomy. To precisely identify the prostatovesical junction, we first pulled the anterior bladder wall in an upward direction with the second arm to identify the precise location of the prostatovesical junction where anterior bladder neck dissection is initiated. After one experienced surgeon had established this technique, three surgeons who were less experienced in robot-assisted radical prostatectomy utilized this method for 50 consecutive robot-assisted radical prostatectomy cases. The pathological results and the time required to transect the anterior bladder wall were evaluated. There were no cases of positive resection margin on the site of bladder neck. The mean resection time was not significantly different when comparing less experienced surgeons with the experienced surgeon (P?=?0.29). In conclusion, this method is a simple and reproducible way to identify the bladder neck during robot-assisted radical prostatectomy. This technique is also useful (for laparoscopic or open radical prostatectomy) even in difficult scenarios, such as post-transurethral resection of prostate cases. PMID:24825076
Similar effect of revascularization on technetium-99m( )sestamibi and 15-(p-iodophenyl)pentadecanoic acid uptake in myocardial infarction patients.
Bendel, S; Kettunen, R; Hartikainen, J; Remes, J; Vanninen, E; Yang, J; Kuikka, J; Huikuri, H
To study its usefulness as a tracer for assessment of the perfusion and viability of myocardium, 15-(p-iodophenyl)pentadecanoic acid (IPPA) was compared with technetium-99m sestamibi (MIBI). Dual-tracer single-photon emission tomography rest imaging was performed no more than 2 months before and 3 months after coronary artery bypass grafting in 28 patients with previous anterior (n=13) or inferior (n=15) infarction. The size of MIBI and IPPA defects decreased from 14%+/-12% and 13%+/-9% to 10%+/-11% and 9%+/-7%, respectively (P<0.001 for both). The MIBI uptake increased in the infarct zones from 35%+/-11% to 43%+/-8% (P<0.001), and in the peri-infarct zones from 50%+/-11% to 55%+/-10% (P<0.05). The IPPA uptake increased in the infarct zones from 37%+/-11% to 44%+/-13% (P<0.001), and in the peri-infarct zones from 51%+/-11% to 57%+/-12% (P<0.05). In nine patients with improved regional echocardiographic wall motion score after bypass surgery, the pre-operative uptake values of both MIBI and IPPA in the infarct and peri-infarct zones were on average slightly but not significantly higher than in 19 patients with no observed improvement in regional wall motion score. In patients with improved regional wall motion, the MIBI scans and the IPPA scans showed (non-significant) decreases in defect size and increases in infarct and peri-infarct zone uptake after bypass surgery. Similar (in some cases significant) changes were observed in the patients without improvement in wall motion. Thus IPPA and MIBI provided similar information about perfusion and viability in pre- and postoperative evaluation of patients with clinically evident myocardial infarction and with normal global ejection fraction. Regardless of the tracer used, the resolution capability of the dual-tracer method with a rest imaging protocol was not sufficient to differentiate viable from non-viable infarction defects in unselected individual patients with a normal ejection fraction. PMID:10541829
Regional lymph node radiotherapy in breast cancer: single anterior supraclavicular field vs. two anterior and posterior opposed supraclavicular fields
Houshyari, Mohammad; Kashi, Amir Shahram Yousefi; Varaki, Sakineh Soleimani; Rakhsha, Afshin; Blookat, Eftekhar Rajab
Background: The treatment of lymph nodes engaged in breast cancer with radiotherapy leads to improved locoregional control and enhanced survival rates in patients after surgery. The aim of this study was to compare two treatment techniques, namely single anterior posterior (AP) supraclavicular field with plan depth and two anterior and posterior opposed (AP/PA) supraclavicular fields. In the study, we also examined the relationships between the depth of supraclavicular lymph nodes (SCLNs) and the diameter of the wall of the chest and body mass index (BMI). Methods: Forty patients with breast cancer were analyzed using computed tomography (CT) scans. In planning target volume (PTV), the SCLNs and axillary lymph nodes (AXLNs) were contoured, and, with the attention to PTV, supraclavicular (SC) depth was measured. The dosage that reached the aforementioned lymph nodes and the level of hot spots were investigated using two treatment methods, i.e., 1) AP/PA and 2) AP with three-dimensional (3D) planning. Each of these methods was analyzed using the program Isogray for the 6 MV compact accelerator, and the diameter of the wall of the chest was measured using the CT scan at the center of the SC field. Results: Placing the plan such that 95% of the target volume with 95% or greater of the prescribed dose of 50 Gy (V95) had ?95% concordance in both treatment techniques. According to the PTV, the depth of SCLNs and the diameter of the wall of the chest were 3–7 and 12–21cm, respectively. Regression analysis showed that the mean SC depth (the mean Plan depth) and the mean diameter of the wall of the chest were related directly to BMI (p<0.0001, adjusted R2=0.67) and (p<0.0001, adjusted R2=0.71), respectively. Conclusion: The AP/PA treatment technique was a more suitable choice of treatment than the AP field, especially for overweight and obese breast cancer patients. However, in the AP/PA technique, the use of a single-photon, low energy (6 MV) caused more hot spots than usual. PMID:26120411
Cardiovascular magnetic resonance T2-weighted imaging of myocardial edema in acute myocardial infarction.
Abdel-Aty, Hassan; Schulz-Menger, Jeanette
Technical advances in cardiovascular magnetic resonance (CMR) T2-weighted imaging have allowed in-vivo visualization and accurate quantification of myocardial edema, a substantial feature of myocardial ischemic/reperfusion injury. In acute myocardial infarction, myocardial edema imaging can be used to differentiate acute from chronic irreversible injury. This can also be of particular importance in the sub-acute phase in which laboratory markers are equivocal or in the setting of missed infarction. Furthermore, CMR-T2-weighted edema imaging identifies the area at risk and thus can be used to quantify the area of salvaged myocardium after coronary reperfusion by comparing the area of irreversible injury to that of the myocardium at risk. Another exciting area of research employs edema imaging to monitor the effect of interventions that target reduction of myocardial edema. The premise is that myocardial edema results in vascular compression, and may thus contribute to failure of myocardial tissue reperfusion even after reestablishing the patency of the infarct related coronary artery. This can be used to monitor the efficiency of novel therapeutic strategies targeting post-infarction myocardial edema. This mini review will address the pathophysiological, clinical and some technical issues related to edema imaging in acute myocardial infarction. Some recent patents on myocardial edema, Magnetic resonance imaging and myocardial infarction are also addressed. PMID:18221104
Myocardial sestamibi uptake in healthy subjects is related to age, gender and habitus.
Bouvier, F; Bevegĺrd, S; Nejat, M; Jensen-Urstad, M
The object of this study was to evaluate the effect of gender, age and anthropometric data on regional isotope uptake in myocardial perfusion scintigraphy using 99mTc-MIBI-SPECT (myocardial sestamibi single-photon emission technique). Seventy-one healthy, non-smoking subjects, 42 men and 29 women between 40 and 80 years of age, with less than 5% likelihood of having coronary artery disease were studied. All subjects underwent a maximal exercise and rest MIBI-SPECT using a 2-day protocol and a 180 degrees anterior circular rotation. No correction for scatter or attenuation was made. Normalized regional activity was different in men and women in the anterior and inferior regions, with higher values anteriorly in men and inferiorly in women. Regional activity also differed with age in both women and men with higher relative activity in the anterior regions in the oldest age groups. Higher activities were seen in the basal parts of the left ventricle at rest compared with stress in both men and women. Regional isotope uptake was significantly affected by habitus expressed as body mass index (BMI) and thoracic circumference. Different protocols for stress and rest seem to be needed for men and women in different age groups, and for stress and rest when performing semiquantitative MIBI-SPECT and comparing data with a normal file of healthy subjects. Furthermore, such anthropometric data as BMI and/or thoracic circumference should be considered in order to minimize the risk for false-positive or false-negative scintigraphic results. PMID:10068869
Signs and symptoms in diagnosing acute myocardial infarction and acute coronary syndrome: a diagnostic meta-analysis
Bruyninckx, Rudi; Aertgeerts, Bert; Bruyninckx, Pieter; Buntinx, Frank
Background Prompt diagnosis of acute myocardial infarction or acute coronary syndrome is very important. Aim A systematic review was conducted to determine the accuracy of 10 important signs and symptoms in selected and non-selected patients. Design of study Diagnostic meta-analysis. Method Using MEDLINE, CINAHL, EMBASE, tracing references, and by contacting experts, studies were sought out that described one of the 10 signs and symptoms on one or both conditions. Studies were excluded if they were not based on original data. Validity was assessed using QUADAS and all data were pooled using a random effects model. Results Sixteen of the 28 included studies were about patients who were non-selected. In this group, absence of chest-wall tenderness on palpation had a pooled sensitivity of 92% (95% confidence interval [CI] = 86 to 96) for acute myocardial infarction and 94% (95% CI = 91 to 96) for acute coronary syndrome. Oppressive pain followed with a pooled sensitivity of 60% (95% CI = 55 to 66) for acute myocardial infarction. Sweating had the highest pooled positive likelihood ratio (LR+), namely 2.92 (95% CI = 1.97 to 4.23) for acute myocardial infarction. The other pooled LR+ fluctuated between 1.05 and 1.49. Negative LRs (LR?) varied between 0.98 and 0.23. Absence of chest-wall tenderness on palpation had a LR? of 0.23 (95% CI = 0.18 to 0.29). Conclusions Based on this meta-analysis it was not possible to define an important role for signs and symptoms in the diagnosis of acute myocardial infarction or acute coronary syndrome. Only chest-wall tenderness on palpation largely ruled out acute myocardial infarction or acute coronary syndrome in low-prevalence settings. PMID:18307844
NASA Technical Reports Server (NTRS)
2005-01-0113 May 2005 This Mars Global Surveyor (MGS) Mars Orbiter Camera (MOC) image shows gullies on northern wall of a south mid-latitude crater. Location near: 35.8oS, 220.9oW Image width: 3 km (1.9 mi) Illumination from: upper left Season: Southern Spring
P. Murdin
A vast sheet-like aggregation of galaxies that is about 800 million light-years long, 280 million light-years `high', but only about 15-20 million light-years `thick'. One of the largest known structures in the universe, it lies at a distance of about 300 million light-years. The coma cluster, one of the nearest great clusters of galaxies, forms part of the `wall'....
Cardioprotective activity of silymarin in ischemia-reperfusion-induced myocardial infarction in albino rats
Rao, Pragada Rajeswara; Viswanath, Routhu Kasi
BACKGROUND There is comprehensive experimental and clinical evidence that either exogenous supplementation of natural antioxidants or augmentation of endogenous antioxidants attenuates myocardial infarction. OBJECTIVES To investigate the effects of chronic administration of silymarin against ischemia-reperfusion-induced myocardial infarction in rats. METHODS Silymarin was administered orally to Wistar albino rats (200 g to 250 g) in three different doses (100 mg/kg, 250 mg/kg and 500 mg/kg), by gastric gavage for one week. At the end of this period, control (ischemia-reperfusion) groups and silymarin-treated groups were subjected to 30 min occlusion of the left anterior descending coronary artery and thereafter reperfused for 4 h. RESULTS Ischemia-reperfusion resulted in significant cardiac necrosis, indicated by elevated levels of serum marker enzymes such as serum glutamate oxaloacetate transaminase, serum glutamate pyruvate transaminase, lactate dehydrogenase, creatine kinase-isoenzyme and creatine kinase. A significant rise in the end products of myocardial lipid peroxides (malondialdehydes [MDAs]), loss of antioxidative enzymes (superoxide dismutase, catalase, glutathione S-transferase and reduced glutathione) and increased levels of myeloperoxidase in heart tissue were observed in the animals subjected to in vivo myocardial ischemia-reperfusion injury. Infarct size was measured by using the staining agent 2,3,5-triphenyltetrazolium chloride. A lead II electrocardiogram was monitored at various intervals throughout the experiment. DISCUSSION The present study showed that silymarin protected the endogenous antioxidant enzymes, suppressed the neutrophil infiltration during ischemia-reperfusion and limited the infarct size, with concomitant reduction in serum MDA, tissue MDA and serum marker enzymes in rats subjected to 30 min coronary artery occlusion followed by 4 h of reperfusion. Pretreatment with silymarin also protected rat hearts from a further drop in mean arterial blood pressure during reperfusion, and restored heart rate at the end of the reperfusion period. CONCLUSIONS The present study suggests that the phytochemical silymarin has cardioprotective activity against ischemia-reperfusion-induced myocardial infarction in rats. PMID:18651002
Myocardial oxygen consumption in aortic valve disease with and without left ventricular dysfunction.
Schwitter, J; Eberli, F R; Ritter, M; Turina, M; Krayenbuehl, H P
OBJECTIVE--To assess whether and to what extent myocardial oxygen consumption is modified by hypertrophy and alterations in contractility in patients with aortic valve disease and to evaluate the influence of regression of left ventricular hypertrophy and improvement of contractility on myocardial oxygen consumption after successful aortic valve replacement. DESIGN--A cohort analytical study to investigate the influence of the "explanatory" variables of myocardial oxygen consumption by multiple regression analysis. A comparison of myocardial oxygen consumption in preoperative patients with that after operation in a group with comparable severity of aortic valve disease before operation (analysis of covariance). PATIENTS--In six controls and in 43 patients with aortic valve disease and normal coronary arteries standard haemodynamic variables were measured, left ventricular biplane cineangiography performed, and coronary sinus blood flow measured by thermodilution. The patients were divided into three groups: 19 preoperative patients with normal ejection fraction (greater than or equal to 57%) (group 1); nine preoperative patients with reduced ejection fraction (less than 57%) (group 2); 16 postoperative patients (one with preoperative and postoperative measurements (group 3). Postoperative evaluation was performed 12-51 months after surgery. MAIN OUTCOME MEASUREMENTS--Myocardial oxygen consumption/100 g left ventricular muscle mass and its suspected "explanatory" variables--that is, peak systolic left ventricular circumferential wall stress, heart rate, contractility (assessed by left ventricular ejection fraction), and left ventricular muscle mass index. RESULTS--Multiple regression analysis showed that the product of peak systolic stress and heart rate (p less than 0.0001) and ejection fraction (p less than 0.03) were positively correlated with myocardial oxygen consumption/100 g and that left ventricular muscle mass index (p less than 0.002) was negatively correlated with myocardial oxygen consumption/100 g (r = 0.72; n = 50 measurements). Myocardial oxygen consumption per 100 g at a given stress-rate product was higher in the controls than in group 1 (hypertrophied ventricles with normal ejection fraction) and was also higher in group 1 than in group 2 (hypertrophied ventricles with reduced ejection fraction). In a subgroup of the postoperative patients with complete regression of hypertrophy and normalisation of contractility, myocardial oxygen consumption per 100 g at a given stress-rate product was indistinguishable from that in controls. CONCLUSIONS--When the actual stress-rate product was used as an index of overall left ventricular performance the results suggested that mechanical efficiency was increased in hypertrophied ventricles especially when contractility was decreased. These changes in mechanical efficiency seemed to be reversible during the postoperative course when muscle mass and contractility returned to normal. PMID:1531759
[Myocardial infarction as complication of acute pancreatitis].
Asfalou, I; Miftah, F; Kendoussi, M; Raissouni, M; Benyass, A; Moustaghfir, A; Zbir, E; Hda, A; Hamani, A
We report a case of an acute pancreatitis complicated by myocardial infarction with normal coronary arteries on angiography. This observation presents a double interest. First, it illustrates unusual forms of coronary disease represented by the non-atherosclerotic infarction. On the other hand, it shows that the multiple visceral damage associated with acute pancreatitis can include myocardial infarction which complications aggravate prognosis. PMID:21232905
Neuroendocrine activation after acute myocardial infarction
H M McAlpine; J J Morton; B Leckie; A Rumley; G Gillen; H J Dargie
The extent of neuroendocrine activation, its time course, and relation to left ventricular dysfunction and arrhythmias were investigated in 78 consecutive patients with suspected acute myocardial infarction. High concentrations of arginine vasopressin were found within six hours of symptoms, even in the absence of myocardial infarction (n = 18). Plasma catecholamine concentrations also were highest on admission, whereas renin and
Acute myocardial infarction: 'telomerasing' for cardioprotection.
Sanchis-Gomar, Fabian; Lucia, Alejandro
Reactivating the telomerase gene through gene therapy after acute myocardial infarction (AMI) has been recently reported to improve survival in mice. Given that regular physical exercise also activates this gene, therapeutic and lifestyle interventions targeting telomerase need to be explored as possible additions to the current armamentarium for myocardial regeneration. PMID:25725977
Apoptosis in myocardial ischaemia and infarction
Krijnen, P A J; Nijmeijer, R; Meijer, C J L M; Visser, C A; Hack, C E; Niessen, H W M
Recent studies indicate that, in addition to necrosis, apoptosis also plays a role in the process of tissue damage after myocardial infarction, which has pathological and therapeutic implications. This review article will discuss studies in which the role and mechanisms of apoptosis in myocardial infarction were analysed in vivo and in vitro in humans and in animals. PMID:12401816
Isoprenaline-induced myocardial necrosis in dogs.
Gopinath, C.; Thuring, J.; Zayed, I.
Subcutaneous injections of isoprenaline sulphate in dogs (1-3 mg/kg) resulted in myocardial injury. Good correlation was observed between abnormal ECG recordings, serum enzyme concentrations and myocardial lesions in the acute phase of injury. However, in cases where less extensive myocardial injury was produced due to lower doses of isoprenaline or in cases of the reparative phase of the isoprenaline-induced myocardial injury, serum enzymes were not useful indicators of the change. Similary, ECG recordings taken peripherally also did not show alteration in the reparative phase of the injury in spite of extensive myocardial lesions. Images Fig. 5 Fig. 6 Fig. 7 Fig. 8 Fig. 9 Fig. 10 PMID:656315
Traditional Formula, Modern Application: Chinese Medicine Formula Sini Tang Improves Early Ventricular Remodeling and Cardiac Function after Myocardial Infarction in Rats
Liu, Jiangang; Peter, Karoline; Shi, Dazhuo; Zhang, Lei; Dong, Guoju; Zhang, Dawu; Breiteneder, Heimo; Ma, Yan
Sini Tang (SNT) is a traditional Chinese herbal formula consisting of four different herbs: the root of Aconitum carmichaelii, the bark of Cinnamomum cassia, the rhizome of Zingiber officinale, and the root of Glycyrrhiza uralensis. This study aims to evaluate the improvement of early ventricular remodeling and cardiac function in myocardial infarction (MI) rats by SNT. A MI model was established by ligation of the left anterior descending coronary artery. Following treatment for 4 weeks, ultrasonic echocardiography was performed. Myocardial histopathological changes were observed using haematoxylin and eosin staining. Collagens (type I and type III), transforming growth factor-?1 (TGF-?1), and Toll-like receptors (TLR-2 and TLR-4) were measured in plasma, serum, and myocardial tissue. SNT treatment decreased the infarct size, the left ventricular cavity area/heart cavity area ratio, and the left ventricle dimension at end systole and increased the left ventricular ejection fraction. SNT reduced the levels of TLR-2 and TLR-4 in myocardial tissue significantly and decreased the collagens content in serum and in myocardial tissue. SNT could partially reduce the level of TGF-?1 in serum and in myocardial tissue. Our data suggest that the Chinese medicine formula SNT has the potential to improve early ventricular remodeling and cardiac function after MI. PMID:24971143
Fatty acids for myocardial imaging.
Corbett, J R
Radioiodinated free fatty acids are tracers that can be used to assess both myocardial perfusion and metabolism. There have been several fatty acids and structurally modified fatty acids studied since Evans' initial report of radiolabeled I-123 oleic acid in 1965. The radiolabeling of a phenyl group added to the long chain fatty acids in the omega-terminal position opposite the carboxyl terminal group prevents nonspecific deiodination and the rapid release of free iodine as the tracer undergoes beta-oxidation. The additional inclusion of a methyl or dimethyl group to the chain slows oxidation resulting in prolonged myocardial retention. The longer retention of the radiolabel permits longer image acquisitions more compatible with single photon emission computed tomography (SPECT) imaging, especially with single-detector imaging systems. Several protocols have been implemented using these compounds, particularly 15-(para-iodophenyl)-3-R,S-methyl pentadecanoic BMIPP, to detect abnormal fatty acid metabolism in ischemic heart disease as well as in nonischemic and hypertrophic cardiomyopathies. Successful management of patients with ischemic cardiomyopathies depends on the accurate identification of hibernating myocardium. The studies covered in this review suggest that both IPPA and BMIPP, especially when combined with markers of myocardial perfusion, may be excellent tracers of viable and potentially functional myocardium. Future studies with larger numbers of patients are needed to confirm the results of these studies and to compare their efficacy with that of other available imaging modalities. Cost and distribution issues will have to be resolved for these metabolic tracers to compete in the commercial marketplace. Otherwise they will likely be available only on a limited basis for research use. As progress is made with these issues and with the development of newer imaging systems, the use of radioiodinated and fluorinated fatty acids is likely to be increasingly attractive. PMID:10433339
Animal models of primary myocardial diseases.
Liu, S. K.; Tilley, L. P.
Feline and canine cardiomyopathies (primary myocardial diseases) were reviewed and divided into three groups based on the clinical, hemodynamic, angiocardiographic, and pathologic findings: (1) feline and canine hypertrophic cardiomyopathy, (2) feline and canine congestive (dilated) cardiomyopathy, and (3) feline restrictive cardiomyopathy. All three groups consisted predominantly of mature adult male cats and dogs. Cardiomyopathy in the hamster and turkey was also reviewed. The most common presenting signs were dyspnea and/or thromboembolism in the cat, systolic murmurs with gallop rhythms on auscultation, cardiomegaly with (groups 1 and 3) or without (group 2) pulmonary edema, abnormal electrocardiograms, elevated left ventricular end-diastolic pressures, and angiocardiographic evidence of mitral regurgitation with left ventricular concentric hypertrophy (group 1), left ventricular dilatation (group 2), or midventricular stenosis (group 3). Some cats in groups 1 and 3 also had evidence of left ventricular outflow obstruction. The principal pathologic findings in all of the cats and dogs were left atrial dilation, hypertrophy, increased septal:left ventricular free wall thickness ratio with disorganization of cardiac muscle cells (group 1); dilatation of the four chambers with degeneration of cardiac muscle cells (group 2); and extensive endocardial fibrosis and adhesion of the left ventricle (group 3). Aortic thromboembolism was commonly observed in the cats of all three groups. These clinical and pathologic findings indicate that cardiomyopathy in the cat or dog is similar to the three forms of cardiomyopathy in humans (hypertrophic, congestive, and restrictive). Images FIG. 2 FIG. 3 FIG. 5 FIG. 6 FIG. 7 FIG. 8 FIG. 9 FIG. 11 FIG. 12 FIG. 13 FIG. 15 FIG. 16 FIG. 17 FIG. 20 FIG. 21 FIG. 22 FIG. 24 FIG. 25 PMID:6447412
Impairment of Myocardial Mitochondria in Viral Myocardial Disease and Its Reflective Window in Peripheral Cells
Wei, Jin; Gao, Deng-Feng; Wang, Hao; Yan, Rui; Liu, Zhi-Quan; Yuan, Zu-Yi; Liu, Jian; Chen, Ming-Xia
Background Viral myocardial disease (VMD) is a common disease inducing heart failure. It has not been clear the roles of mitochondrial damage in the pathological changes of cardiomyocytes in VMD. Methods Myocardial tissues and lymphocytes were collected from 83 VMD patients. Control groups included 12 cases of healthy accidental death with myocardial autopsy and 23 healthy blood donors. The mouse model of viral myocarditis (VMC) was established by Coxsackie virus B3 infection and myocardial tissues and skeletal muscle were collected. Mitochondrial DNA (mtDNA) deletion rate was quantitatively determined using polymerase chain reaction. Results There was significantly difference of myocardial mitochondrial DNA deletion rate between VMD or VMC group and control group (P<0.05). Moreover, the loss of mitochondrial membrane phospholipids was significantly different between VMD or VMC group and control group. In VMC mice, there were negative correlations between myocardial mtDNA3867 deletion rate and left ventricular peak systolic pressure (LVPSP) (r?=??0.66, P<0.05), and between myocardial mtDNA3867 deletion rate and +dp/dtmax (r?=??0.79, P<0.05), while there was positive correlation between myocardial mtDNA3867 deletion rate and ?dp/dtmax (r?=?0.80, P<0.05). Conclusion Mitochondrial damage is an important pathophysiological mechanism leading to myocardial injury and cardiac dysfunction. The mitochondrial damage in the skeletal muscle and lymphocytes reflect a "window" of myocardial mitochondrial damage. PMID:25551390
[Radioisotope study (first pass) of left ventricular function in 2 oblique projections using gold-195m after myocardial infarction].
Schad, N; Bruzzone, F; Nickel, O; Le Thi, O
The radioisotope 195Aum because of its short halflife of 30 seconds and reduced radiation exposure allows routine first pass examinations in two oblique projections, i.e. right anterior and left anterior oblique. The value of the additional left anterior oblique projection has been examined in 30 patients after previous myocardial infarction by functional imaging in two oblique projections. The multicrystal gamma camera connected with a microprocessor and a contrast injector have been used. For assessment of left ventricular function the following functional images have been adopted: the regional ejection fractions (rEF), the regional ejection rates (rEJR) and the regional mean transit times (rMTT). The right anterior oblique view resulted diagnostic for miocardial infarction in 26 of 30 patients (86,6%). The left anterior oblique view was informative with respect of septal extension 17 times (58,6%), lateral extension 9 times (31%), septal and lateral extension 3 times. With regard of the different functional images the rMTT showed the severe dysfunction in the infarcted zones in all patients (100%), the rEJR in 29 patients (96,6%), the rEF in 28 cases (93,3%). In 4 cases dyskinesia was observed, twice in the left anterior oblique view and also twice in the right anterior oblique view. In patients with previous MI it is necessary to record the second left anterior oblique projection which can be done routinely by the use of 195Aum and first pass technique. On functional images, maximum information is obtained by the rMTT which visualizes the zones of severe dysfunction and its extension. PMID:6536986
[Clinical research of safflower injection on hibernating myocardial revascularization].
Zheng, Chang-Zhu; Xian, Yu-Qiong; Chen, Jing; Xu, Ying-Hui; Shi, Qian; Wang, Yu-Hua; Ju, Hai-Ning
Coronary artery disease (CAD) is one of the leading causes of death. Safflower attracts great attention owing to its anti-ischemia/reperfusion injury effect. Ninety-three patients with CAD were included and randomized into safflower treatment group, PCI group and control group. Low-dose dobutamine stress echocardiography (DSE) was performed to measure end-systolic volume (ESV), end-diastolic volume (EDV), left ventricular ejection fraction (LVEF) and wall motion score index (WMSI) to determine the recovery of hibernating myocardium and cardiac function in all patients before treatment and after 3-month follow-up. The study was to investigate the effects of safflower on hibernating myocardial revascularization and cardiac function. It was found that LVEF was significantly improved, while the ESV and WMSI were significantly reduced after 2-week treatment in safflower and PCI treatment groups. No significant differences were found between safflower and PCI treatment groups in ESV, EDV, WMSI and LVEF after treatment Safflower injection effectively improved hibernating myocardial function. PMID:25011274
Anteriorly placed splenic vein: a case report.
Lal, Hira; Boruah, Deb K; Yadav, Ankusha; Samal, Amrita
Splenic vein located anterior to pancreas is a rare congenital anomaly. To date, only one case has been reported in literature. A thorough knowledge of the normal anatomy, most frequent variations, and congenital and acquired anomalies of the spleno-portal axis is of great importance for hepatobiliary and pancreatic surgeons. It is therefore essential for preoperative evaluation of the anatomical details of the spleno-portal venous axis to be made by imaging. We report such a case of anteriorly placed splenic vein in a 40-year-old female prospective renal donor. To the best of our knowledge, this represents the second reported case of an anteriorly placed splenic vein. PMID:25972673
Morphometric Study of the Anterior Thalamoperforating Arteries
Kim, Sung-Ho; Yeo, Dong-Kyu; Shim, Jae-Joon; Yoon, Seok-Mann; Chang, Jae-Chil
Objective To evaluate the morphometry of the anterior thalamoperforating arteries (ATPA). Methods A microanatomical study was performed in 79 specimens from 42 formalin-fixed adult cadaver brains. The origins of the ATPAs were divided into anterior, middle, and posterior segments according to the crowding pattern. The morphometry of the ATPAs, including the premammillary artery (PMA), were examined under a surgical microscope. Results The anterior and middle segments of the ATPAs arose at mean intervals of 1.75±1.62 mm and 5.86±2.05 mm from the internal carotid artery (ICA), and the interval between these segments was a mean of 3.17±1.64 mm. The posterior segment arose at a mean interval of 2.43±1.46 mm from the posterior cerebral artery (PCA), and the interval between the middle and posterior segments was a mean of 3.45±1.39 mm. The mean numbers of perforators were 2.66±1.19, 3.03±1.84, and 1.67±0.98 in the anterior, middle, and posterior segments, respectively. The PMA originated from the middle segment in 66% of cases. A perforator-free zone was located >2 mm from the ICA in 30.4% and >2 mm from the PCA in 67.1% of cases. Conclusion Most perforators arose from the anterior and middle segments, within the anterior two-thirds of the posterior communicating artery (PCoA). The safest perforator-free zone was located closest to the PCA. These anatomical findings may be helpful to verify safety when treating lesions around the PCoA and in the interpeduncular fossa.
Nosenko, V.I. [Triangle Trading and Technology Corp., Laguna Hills, CA (United States)
Protecting the shells of blast furnaces is being resolved by installing cast iron cooling plates. The cooling plates become non-operational in three to five years. The problem is that defects occur in manufacturing the cooling plates. With increased volume and intensity of work placed on blast furnaces, heat on the cast iron cooling plates reduces their reliability that limits the interim repair period of blast furnaces. Scientists and engineers from the Ukraine studied this problem for several years, developing a new method of cooling the blast furnace shaft called the cooling wall. Traditional cast iron plates were replaced by a screen of steel tubes, with the area between the tubes filled with fireproof concrete. Before placing the newly developed furnace shaft into operation, considerable work was completed such as theoretical calculations, design, research of temperature fields and tension. Continual testing over many years confirms the value of this research in operating blast furnaces. The cooling wall works with water cooling as well as vapor cooling and is operating in 14 blast furnaces in the Ukraine and two in Russia, and has operated for as long as 14 years.
Lymphangiogenesis in myocardial remodelling after infarction
Ishikawa, Y; Akishima-Fukasawa, Y; Ito, K; Akasaka, Y; Tanaka, M; Shimokawa, R; Kimura-Matsumoto, M; Morita, H; Sato, S; Kamata, I; Ishii, T
Ishikawa Y, Akishima-Fukasawa Y, Ito K, Akasaka Y, Tanaka M, Shimokawa R, Kimura-Matsumoto M, Morita H, Sato S, Kamata I & Ishii T (2007) Histopathology51, 345–353 Lymphangiogenesis in myocardial remodelling after infarction Aims The lymphatic system is involved in fluid homeostasis of the cardiac interstitium, but lymphangiogenesis in myocardial remodelling has not previously been examined histopathologically. The aim was to investigate by D2-40 immunohistochemistry the sequential changes in lymphatic distribution in the process of myocardial remodelling after myocardial infarction (MI). Methods and results Myocardial tissues in various phases of healing after MI were obtained from 40 autopsied hearts. D2-40+ lymphatic vessel density (LD) and CD34+ blood vessel density (BD) in the lesion were determined. BD decreased with advance of myocardial necrosis, subsequently increased at the early stage of granulation and thereafter decreased with the progression of scar formation. In contrast, lymphatic vessels were not detected in lesions with coagulation necrosis, and newly formed lymphatics first appeared in the early stages of granulation. A subsequent increase in LD was demonstrated in the late stages of granulation, and lymphatics remained up to the scar phase. Vascular endothelial growth factor-C was consistently expressed in viable cardiomyocytes around the lesion in all of these stages. Conclusion In myocardial remodelling after MI, lymphangiogenesis lags behind blood vessel angiogenesis; newly formed lymphatics may be involved mainly in the maturation of fibrosis and scar formation through the drainage of excessive proteins and fluid. PMID:17727476
Cardioplegia and myocardial preservation during cardiopulmonary bypass.
Engelman, R M; Levitsky, S; O'Donoghue, M J; Auvil, J
A standard experimental protocol was developed to explore the role of hypothermia and potassium cardioplegia in myocardial preservation during 120 minutes of ischemic arrest followed by 30 minutes of reperfusion. Seven different experimental groups of six animals each were evaluated using an in-vivo pig heart preparation. Hypothermic arrest without cardioplegia and cardioplegic arrest at normothermia were each compared to hypothermic cardioplegia. In addition, the use of an asanguineous hypothermic coronary perfusate without cardioplegia was compared to both multidose cardioplegia and single-dose cardioplegia followed by the same asanguineous perfusate. The parameters measured included: myocardial contractility and compliance, myocardial blood flow, endocardial/epicardial blood flow ratio, and electron microscopic studies. Myocardial preservation was inadequate with hypothermic arrest alone (without cardioplegia; and with cardioplegia at normothermia. In both experimental groups, myocardial contractility and compliance were so depressed that the) could not be accurately measured following ischemia and reperfusion while coronary blood flow remained significantly elevated. Preservation was improved but still inadequate following myocardial washout with a normokalemic or hypokalemic perfusate and following single dose cardioplegia plus myocardial washout. In the latter four groups, contractility ranged from 42 to 78% of control, and there was a decrease in compliance of 16 to 78%. Adequate preservation was found only after hypothermia and multidose potassium (35 mEq/L) cardioplegia. In this group, contractility was 129 +/- 13% of control and compliance increased by 21 +/- 24% compared to that of the control. PMID:14740689
Traumatic abdominal wall hernia: a case report.
Bansal, Somendra; Vyas, Kailash C
Traumatic abdominal wall hernias are rare injuries despite the high incidence of blunt abdominal traumas. The mechanism of this injury includes a sudden increase in intra-abdominal pressure and extensive shear forces applied to the abdominal wall. We report a case of traumatic hernia of the anterior abdominal wall in a 42-year-old woman presented with blunt injury of the upper abdomen. She was attacked by a bull. She had a clinically evident abdominal fascial disruption with intact skin and was hemodynamically stable. The presence of localized pain, bruising and a reducible swelling or a cough impulse suggested the diagnosis. An emergency mesh repair of the defect was performed, and she recovered well. PMID:25972694
Area at Risk and Viability after Myocardial Ischemia and Reperfusion Can Be Determined by Contrast-Enhanced Cardiac Magnetic Resonance Imaging
M. Vosseler; N. Abegunewardene; N. Hoffmann; S. E. Petersen; D. Becker; D. Cleppien; P. Kunz; K.-F. Kreitner; M. Lauterbach; B. Bierbach; C. Düber; T. Gori; T. Münzel; L. M. Schreiber; G. Horstick
Background\\/Aims: Clinical differentiation between infarcted and viable myocardium in the ischemic area at risk is controversial. We investigated the potential of contrast-enhanced cardiac magnetic resonance imaging (ceCMRI) in determining the area at risk 24 h after ischemia. Methods: Myocardial ischemia was induced by percutaneous coronary intervention of the left anterior descending coronary artery in pigs. Coronary occlusion time was 30
Anti-Apoptotic Effect of Magnolol in Myocardial Ischemia and Reperfusion Injury Requires Extracellular Signal-Regulated Kinase1\\/2 Pathways in Rat In Vivo
Magnolol, an active component extracted from Magnolia officinalis, has been reported to have protective effect on ischemia and reperfusion (I\\/R)-induced injury in experimental animals. The aim of the present investigation was to further evaluate the mechanism(s) by which magnolol reduces I\\/R- induced myocardial injury in rats in vivo. Under anesthesia, left anterior descending (LAD) coronary artery was occluded for 30
Myocardial Fibrosis in Hypertrophic Cardiomyopathy Demonstrated by Integrated Cardiac F-18 FDG PET/MR.
Kong, Eun-Jung; Lee, Sang-Hee; Cho, Ihn-Ho
Hypertrophic cardiomyopathy (HCM) is a common condition defined as a diffuse or segmental left ventricular (LV) hypertrophy with a nondilated and hyperdynamic chamber as well as cardiac arrhythmias. Cardiac MR (CMR) imaging is a key modality for evaluation of HCM. In addition to the assessment of LV wall thickness, LV function and aortic flow, CMR is capable of estimation of late gadolinium enhancement (LGE) in affected myocardium which has been shown to have a direct correlation with incidence and severity of arrhythmias in HCM. In patients with HCM, LGE on CMR is presumed to represent intramyocardial fibrosis. Meanwhile, F-18 FDG myocardial PET has been sporadically studied in HCM, mostly for evaluation of the metabolic status of a hypertrophic myocardial segment, especially after interventions or to demonstrate partial myocardial fibrosis. We presented here the case of a 25-year-old male patient referred for simultaneous F-18 FDG cardiac PET/MR for the evaluation of septal hypertrophy. The PET/MR revealed myocardial fibrosis in the septum associated with FDG-defect and LGE. PMID:24900107
[Myocardial infarction. New universal definition and its implementation in clinical practice].
Vafaie, M; Katus, H A
The third version of the Universal Definition of Myocardial Infarction (MI) was published in 2012. The diagnosis of acute myocardial infarction (AMI) should only be made in a clinical setting consistent with acute myocardial ischaemia when evidence of myocardial necrosis is present. The diagnostic criteria for MI are fulfilled when a rise and/or fall of cardiac biomarkers (preferentially troponins) occurs with at least one value above the 99th percentile of the upper reference limit. In addition, there should be symptoms of ischaemia, new changes in electrocardiogram (ECG), imaging evidence of a new loss of viable myocardium or new regional wall motion abnormality, or the identification of an intracoronary thrombus by angiography or autopsy. This revised definition updates previous versions by including changes to diagnostic ECG criteria, placing a higher emphasis on cardiac imaging, modifying the criteria for subtypes of MI and implementing high sensitivity cardiac troponin (cTn) assays. A guideline-based algorithm for management of patients with suspected acute coronary syndrome allowing "early rule-in" and "rule-out" of non-STEMI with high sensitivity cTn assays is also presented. PMID:24189779
Advanced Echocardiography in Adult Zebrafish Reveals Delayed Recovery of Heart Function after Myocardial Cryoinjury
Kossack, Mandy; Juergensen, Lonny; Fuchs, Dieter; Katus, Hugo A.; Hassel, David
Translucent zebrafish larvae represent an established model to analyze genetics of cardiac development and human cardiac disease. More recently adult zebrafish are utilized to evaluate mechanisms of cardiac regeneration and by benefiting from recent genome editing technologies, including TALEN and CRISPR, adult zebrafish are emerging as a valuable in vivo model to evaluate novel disease genes and specifically validate disease causing mutations and their underlying pathomechanisms. However, methods to sensitively and non-invasively assess cardiac morphology and performance in adult zebrafish are still limited. We here present a standardized examination protocol to broadly assess cardiac performance in adult zebrafish by advancing conventional echocardiography with modern speckle-tracking analyses. This allows accurate detection of changes in cardiac performance and further enables highly sensitive assessment of regional myocardial motion and deformation in high spatio-temporal resolution. Combining conventional echocardiography measurements with radial and longitudinal velocity, displacement, strain, strain rate and myocardial wall delay rates after myocardial cryoinjury permitted to non-invasively determine injury dimensions and to longitudinally follow functional recovery during cardiac regeneration. We show that functional recovery of cryoinjured hearts occurs in three distinct phases. Importantly, the regeneration process after cryoinjury extends far beyond the proposed 45 days described for ventricular resection with reconstitution of myocardial performance up to 180 days post-injury (dpi). The imaging modalities evaluated here allow sensitive cardiac phenotyping and contribute to further establish adult zebrafish as valuable cardiac disease model beyond the larval developmental stage. PMID:25853735
Elevated Serum Tryptase and Endothelin in Patients with ST Segment Elevation Myocardial Infarction: Preliminary Report
Lewicki, Lukasz; Siebert, Janusz; Marek-Trzonkowska, Natalia; Masiewicz, Emilia; Kolinski, Tomasz; Reiwer-Gostomska, Magdalena; Targonski, Radoslaw; Trzonkowski, Piotr
An inflammatory response plays a crucial role in myocardial damage after an acute myocardial infarction. Objectives. To measure serum concentrations of several mediators in patients with an acute myocardial infarction (STEMI) and to assess their potential relationship with a risk of coronary instability. Patients and Methods. The 33 patients with STEMI and 19 healthy volunteers were analyzed. The clinical data were obtained; as well serum concentrations of tryptase, endothelin (ET-1), angiogenin, soluble c-kit, and PDGF were measured. Results. Patients with STEMI had higher serum tryptase and ET-1 than healthy volunteers (2,5 ± 0,4?ng/mL versus 1,1 ± 0,4?ng/mL and 0,7 ± 0,1?ng/mL versus 0,3 ± 0,1?ng/mL, resp.). Subjects with significant lesion in left anterior descending artery (LAD) had lower serum ET-1 compared to those with normal LAD (0,6 ± 0,2?pg/mL versus 0,9 ± 0,4?pg/mL). Patients with three-vessel coronary artery disease (CAD) had higher level of soluble c-kit compared to those with one- or two-vessel CAD: 19,9 ± 24,1?ng/mL versus 5,6 ± 1,9?ng/mL. Conclusions. Elevated serum tryptase and ET-1 may be markers of increased coronary instability; some cytokines may be related to the extension of CAD.
Thallium scintigraphy in human transplants: A way to detect myocardial damage
Richter, J.; Herreros, J.; Serena, A.; Domper, M.; Ramirez, J.C.; Arcas, R. (Universidad de Navarra, Pamplona (Spain))
An original index has been derived from thallium images to detect histopathologic changes in heart transplant patients. One hundred eighty-four static and end-diastolic images with thallium were recorded 5 minutes after injection in the left anterior oblique projection. Twenty patients and 14 healthy volunteers were studied. The epicardial and endocardial borders were determined, and the difference of these values was considered the myocardial area. The results in heart transplants were compared with the results of endomyocardial biopsies (N = 142). A significant decrease (p less than 0.01) was found in the index of the myocardial area between normal biopsy results and mild and moderate rejection. Differences were not detected between studies performed in several postoperative periods in the absence of rejection. The results in healthy volunteers prove that the index does not change between studies performed at different times in the same subject, although the value obtained from the end-diastolic image was more constant. On the basis of these results, it is possible to suggest that the decrease in the myocardial area during rejection is the result of a fall of thallium uptake by the myocardium. Capillary endothelial hyperplasia, perivascular infiltration, and myocytolysis can justify these changes, although the presence of other histologic findings, such as intramyocardial edema, could influence the value of this index. We conclude that the uptake of thallium decreases during acute rejection episodes; the results obtained from the images, in this work, are an expression of this event.
Exosomes Derived from Human Umbilical Cord Mesenchymal Stem Cells Relieve Acute Myocardial Ischemic Injury
Zhao, Yuanyuan; Sun, Xiaoxian; Cao, Wenming; Ma, Jie; Sun, Li; Qian, Hui; Zhu, Wei; Xu, Wenrong
This study is aimed at investigating whether human umbilical cord mesenchymal stem cell- (hucMSC-) derived exosomes (hucMSC-exosomes) have a protective effect on acute myocardial infarction (AMI). Exosomes were characterized under transmission electron microscopy and the particles of exosomes were further examined through nanoparticle tracking analysis. Exosomes (400??g protein) were intravenously administrated immediately following ligation of the left anterior descending (LAD) coronary artery in rats. Cardiac function was evaluated by echocardiography and apoptotic cells were counted using TUNEL staining. The cardiac fibrosis was assessed using Masson's trichrome staining. The Ki67 positive cells in ischemic myocardium were determined using immunohistochemistry. The effect of hucMSC-exosomes on blood vessel formation was evaluated through tube formation and migration of human umbilical vein endothelial cells (EA.hy926 cells). The results indicated that ligation of the LAD coronary artery reduced cardiac function and induced cardiomyocyte apoptosis. Administration of hucMSC-exosomes significantly improved cardiac systolic function and reduced cardiac fibrosis. Moreover, hucMSC-exosomes protected myocardial cells from apoptosis and promoted the tube formation and migration of EA.hy926 cells. It is concluded that hucMSC-exosomes improved cardiac systolic function by protecting myocardial cells from apoptosis and promoting angiogenesis. These effects of hucMSC-exosomes might be associated with regulating the expression of Bcl-2 family.
Cardiac repair in a porcine model of acute myocardial infarction with human induced pluripotent stem cell-derived cardiovascular cells.
Ye, Lei; Chang, Ying-Hua; Xiong, Qiang; Zhang, Pengyuan; Zhang, Liying; Somasundaram, Porur; Lepley, Mike; Swingen, Cory; Su, Liping; Wendel, Jacqueline S; Guo, Jing; Jang, Albert; Rosenbush, Daniel; Greder, Lucas; Dutton, James R; Zhang, Jianhua; Kamp, Timothy J; Kaufman, Dan S; Ge, Ying; Zhang, Jianyi
Human induced pluripotent stem cells (hiPSCs) hold promise for myocardial repair following injury, but preclinical studies in large animal models are required to determine optimal cell preparation and delivery strategies to maximize functional benefits and to evaluate safety. Here, we utilized a porcine model of acute myocardial infarction (MI) to investigate the functional impact of intramyocardial transplantation of hiPSC-derived cardiomyocytes, endothelial cells, and smooth muscle cells, in combination with a 3D fibrin patch loaded with insulin growth factor (IGF)-encapsulated microspheres. hiPSC-derived cardiomyocytes integrated into host myocardium and generated organized sarcomeric structures, and endothelial and smooth muscle cells contributed to host vasculature. Trilineage cell transplantation significantly improved left ventricular function, myocardial metabolism, and arteriole density, while reducing infarct size, ventricular wall stress, and apoptosis without inducing ventricular arrhythmias. These findings in a large animal MI model highlight the potential of utilizing hiPSC-derived cells for cardiac repair. PMID:25479750
Sustained release nitrite therapy results in myocardial protection in a porcine model of metabolic syndrome with peripheral vascular disease.
Bradley, Jessica M; Islam, Kazi N; Polhemus, David J; Donnarumma, Erminia; Brewster, Luke P; Tao, Ya-Xiong; Goodchild, Traci T; Lefer, David J
Metabolic syndrome (MetS) reduces endothelial nitric oxide (NO) bioavailability and exacerbates vascular dysfunction in patients with preexisting vascular diseases. Nitrite, a storage form of NO, can mediate vascular function during pathological conditions when endogenous NO is reduced. The aims of the present study were to characterize the effects of severe MetS and obesity on dyslipidemia, myocardial oxidative stress, and endothelial NO synthase (eNOS) regulation in the obese Ossabaw swine (OS) model and to examine the effects of a novel, sustained-release formulation of sodium nitrite (SR-nitrite) on coronary vascular reactivity and myocardial redox status in obese OS subjected to critical limb ischemia (CLI). After 6 mo of an atherogenic diet, obese OS displayed a MetS phenotype. Obese OS had decreased eNOS functionality and NO bioavailability. In addition, obese OS exhibited increased oxidative stress and a significant reduction in antioxidant enzymes. The efficacy of SR-nitrite therapy was examined in obese OS subjected to CLI. After 3 wk of treatment, SR-nitrite (80 mg·kg(-1)·day(-1) bid po) increased myocardial nitrite levels and eNOS function. Treatment with SR-nitrite reduced myocardial oxidative stress while increasing myocardial antioxidant capacity. Ex vivo assessment of vascular reactivity of left anterior descending coronary artery segments demonstrated marked improvement in vasoreactivity to sodium nitroprusside but not to substance P and bradykinin in SR-nitrite-treated animals compared with placebo-treated animals. In conclusion, in a clinically relevant, large-animal model of MetS and CLI, treatment with SR-nitrite enhanced myocardial NO bioavailability, attenuated oxidative stress, and improved ex vivo coronary artery vasorelaxation. PMID:25957218
Post-Myocardial Infarction Risk Stratification
Meldrum, Donald A.N.
Increased morbidity and mortality after a myocardial infarct are related to residual myocardial ischemia, ventricular dysrhythmias, and left ventricular dysfunction. Clinical assessment of the survivor of an acute myocardial infarct, together with non-invasive assessment involving a combination of symptom-limited low-level treadmill stress testing, ambulatory electrocardiography and radionuclide studies of selected patients, allows stratification of patients into low-risk, intermediate-risk and high-risk sub-groups. This process results in the tailoring of further investigation and treatment to the individual patient and avoids unnecessary interventions and therapies in the low-risk population. PMID:21263908
Vortex formation and recirculation zones in left anterior descending artery stenoses: computational fluid dynamics analysis
NASA Astrophysics Data System (ADS)
Katritsis, D. G.; Theodorakakos, A.; Pantos, I.; Andriotis, A.; Efstathopoulos, E. P.; Siontis, G.; Karcanias, N.; Redwood, S.; Gavaises, M.
Flow patterns may affect the potential of thrombus formation following plaque rupture. Computational fluid dynamics (CFD) were employed to assess hemodynamic conditions, and particularly flow recirculation and vortex formation in reconstructed arterial models associated with ST-elevation myocardial infraction (STEMI) or stable coronary stenosis (SCS) in the left anterior descending coronary artery (LAD). Results indicate that in the arterial models associated with STEMI, a 50% diameter stenosis immediately before or after a bifurcation creates a recirculation zone and vortex formation at the orifice of the bifurcation branch, for most of the cardiac cycle, thus allowing the creation of stagnating flow. These flow patterns are not seen in the SCS model with an identical stenosis. Post-stenotic recirculation in the presence of a 90% stenosis was evident at both the STEMI and SCS models. The presence of 90% diameter stenosis resulted in flow reduction in the LAD of 51.5% and 35.9% in the STEMI models and 37.6% in the SCS model, for a 10 mmHg pressure drop. CFD simulations in a reconstructed model of stenotic LAD segments indicate that specific anatomic characteristics create zones of vortices and flow recirculation that promote thrombus formation and potentially myocardial infarction.
Patency of the infarct-related coronary artery--a pertinent factor in late recovery of myocardial fatty acid metabolism among patients receiving thrombolytic therapy?
Walamies, M; Virtanen, V; Koskinen, M; Uusitalo, A
The decrease in mortality among patients receiving thrombolytic therapy for myocardial infarction is greater than would be expected from the improvement in left ventricular contractile function alone; thus some additional advantage of recanalization of the infarct-related coronary artery probably exists. Changes in the post-infarction myocardial metabolic state with respect to artery patency have not been studied with a gamma camera previously. A single-photon emission tomography scan using the fatty acid analogue para-123I-iodophenylpentadecanoic acid was performed at rest before hospital discharge on nine patients with first anterior myocardial infarction. All patients had received intravenous thrombolytic therapy at the beginning of the insult. The semiquantitative analysis of the left ventricle included a total of 44 segments in each patient. The test was repeated 3 months later, with the patients divided into two groups: six patients had an angiographically patent left anterior descending coronary artery (group A), and three an occluded artery (group B). In group A the number of myocardial segments with abnormal (< 70% of maximum) fatty acid uptake was initially 20.2 +/- 4.7 (mean +/- SD) and was reduced to 11.3 +/- 6.1 during the follow-up (95% confidence interval of the decrease 16.0-1.7 segments). In group B the number of these aberrant segments was fairly constant (21.7 +/- 13.1, initial test, and 21.3 +/- 13.3, retest). Our preliminary results suggest that even when thrombolytic therapy fails to prevent myocardial infarction, myocardial fatty acid metabolism has a better change of recovering if the relevant coronary artery has regained its patency.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7995291
Anterior plating of unstable cervical spine fractures
D C Mann; B W Braner; J S Keene; A B Levin; David Mann
Medical records and radiographs of 16 patients who had anterior decompression, bone grafting, and plating of grade III and IV (Allen 1982) unstable cervical spine injuries were reviewed. Surgery was performed within 15 days of injury, reductions were achieved and maintained at follow-up, and fusion occurred in all cases. Neurologic function stabilised or improved in all cases. However, 3 patients
Anterior cruciate ligament reconstruction. Autograft or allograft?
DiStefano, V
Refinements in arthroscopic techniques have fostered an upsurge in arthroscopically assisted anterior cruciate ligament reconstruction. This article explores the relative merits of autogenous and allogeneic tissue used for this purpose and describes several important technical points in the author's preferred method of surgery. PMID:8418970
Anatomical single bundle anterior cruciate ligament reconstruction
Michael R. Carmont; Sven Scheffler; Tim Spalding; Jeremy Brown; Paul M. Sutton
We present a review of the literature looking at the anatomy of the Anterior Cruciate Ligament, the biomechanical aspects\\u000a of ACL reconstruction, review the outcomes of single and double bundle ACL reconstruction and present the current techniques\\u000a for anatomic single bundle reconstruction.
Chlamydia in Anterior Ischemic Optic Neuropathy
Pia V. Vécsei; Karl Kircher; Andreas Reitner; Gelas Khanakha; Gerold Stanek
There is an increasing body of evidence linking the common respiratory human pathogen Chlamydia pneumoniae with atherosclerosis and other vascular disorders. Our research was designed to investigate the association of this organism with anterior ischemic optic neuropathy (AION), representing an acute ischemic disorder of the optic nerve head. Sera were examined of 14 consecutive patients with AION and of 14
Anterior segment dysgenesis in mosaic Turner syndrome
I C Lloyd; P M Haigh; J Clayton-Smith; P Clayton; D A Price; A E A Ridgway; D Donnai
AIMS\\/BACKGROUNDFemales with Turner syndrome commonly exhibit ophthalmological abnormalities, although there is little information in the literature documenting findings specific to Turner syndrome mosaics. Ophthalmic findings are described in four patients with mosaic Turner syndrome. All had anterior chamber abnormalities and all four had karyotypic abnormalities with a 45, X cell line. The possible relation between the karyotypic and the phenotypic
Accelerated rehabilitation after anterior cruciate ligament reconstruction
K. Donald Shelbourne; Paul Nitz
To overcome many of the complications after ACL reconstruction (prolonged knee stiffness, limitation of complete extension, delay in strength recovery, anterior knee pain), yet still maintain knee stability, we devel oped a rehabilitation protocol that emphasizes full knee extension on the first postoperative day and immediate weightbearing according to the patient's tolerance. Of 800 patients who underwent intraarticular ACL patellar
Membrane extensions are associated with proper anterior migration of muscle cells during Caenorhabditis elegans embryogenesis.
Viveiros, Ryan; Hutter, Harald; Moerman, Donald G
C. elegans body wall muscle is formed after a series of well-orchestrated steps. With the onset of specification embryonic muscle cells accumulate under the hypodermal seam cells at the left and right sides of the embryo. Shortly thereafter they begin to migrate dorsally and ventrally resting beneath the dorsal and ventral hypodermis eventually forming the four muscle quadrants present upon hatching. In this study we describe the plasma membrane dynamics of these migrating cells and observe the extension of filopodia and lamellipodia during dorso-ventral migration but not during the earlier stages of accumulation. We also describe an anterior migration event during embryonic muscle morphogenesis, whereby the anterior-most pair of cells in each of the four muscle quadrants extends long processes to the anterior tip of the developing embryo. Anteriormost muscle cells then follow these extensions into their final positions in the developing embryo. Using RNAi and mutant analysis, we have identified laminin as being involved in mediating the dorsal-ventral muscle migrations. Finally we show that the ?-integrin INA-1, the ephrin VAB-2 and its receptor VAB-1 and the Robo receptor SAX-3 indirectly promote the proper extension of the ventral anterior muscle processes by organizing the embryonic neurons so as to provide a clear path for muscle membrane extension. PMID:21820426
[Two surgically treated cases with dural arteriovenous malformation in the anterior cranial fossa].
Yamaguchi, Shintaro; Takeuchi, Yasuharu; Nakayama, Kenji; Arakawa, Masahiro; Shigemori, Minoru
Dural arteriovenous fistulae(dAVF) in the anterior cranial fossa comprise about 6% of all dAVFs, and is usually detected after intracranial hemorrhage. However, non-hemorrhagic symptoms are uncommon. We encountered two patients with hemorrhagic and non-hemorrhagic dAVF in the anterior cranial fossa. Both cases were successfully treated using craniotomy and histopathological examination was performed. A 71-year-old male experienced sudden onset of nausea and headache, followed by progression of left hemiparesis and disturbance of consciousness due to intracerebral and subdural hematoma in 2005. Intracerebral venous aneurysm adjacent to the intracerebral hematoma originated from the draining cortical red vein was identified and successfully treated by operation. Histopathological examination revealed disappearance of the internal elastic lamina and scant muscle tissue in the venous aneurysmal wall originating from draining cortical vein. A 69-year-old male suffered sudden onset of mild headache, followed by progression of bruits in 2005. MRI suggested dAVF in the left anterior cranial fossa. 123I-IMP SPECT revealed an area of low perfusion in the left frontotemporal region. Histopathological examination after surgical treatment revealed thickening of the intima and an indistinct lamina elastica interna, indicating progressive degenerative changes of the arterialized vein likely to result in hemorrhage. Surgical obliteration of fistulae is reasonable even in the dAVF of the anterior cranial fossa with ischemic onset. PMID:16359034
Mirjam Cveti˙c; Harald H. Soleng
We review the status of domain walls in N = 1 supergravity theories for the vacuum domain walls as well as dilatonic domain walls. We concentrate on a systematic analysis of the nature of the space-time in these domain wall backgrounds and the special role that supersymmetry is playing in determining the nature of such configurations. Isotropic vacuum domain walls
Usefulness of plasma brain natriuretic peptide concentration for predicting subsequent left ventricular remodeling after coronary angioplasty in patients with acute myocardial infarction.
Hirayama, Atsushi; Kusuoka, Hideo; Yamamoto, Hiroyoshi; Sakata, Yasushi; Asakura, Masanori; Higuchi, Yoshiharu; Mizuno, Hiroya; Kashiwase, Kazunori; Ueda, Yasunori; Okuyama, Yuji; Hori, Masatsugu; Kodama, Kazuhisa
To determine the relation between plasma brain natriuretic peptide (BNP) and remodeling in terms of infarct-related artery (IRA) patency, 106 patients with a first anterior wall acute myocardial infarction with a patent IRA at 1 month were studied. The IRA reoccluded at 6 months in 17 patients (reoccluded IRA) and was patent in 89 patients (patent IRA). The 2 groups did not differ with respect to clinical characteristics, hemodynamic variables, and left ventricular function at 1 month, except for left ventricular end-diastolic and systolic volumes, which were significantly greater in the reoccluded IRA group. Plasma BNP concentration in the reoccluded IRA group (336 +/- 288 pg/ml) was significantly higher than that in the patent IRA group (116 +/- 106 pg/ml) at 1 month. BNP concentration decreased significantly at 6 months in the 2 groups (reoccluded IRA vs patent IRA 152 +/- 162 vs 44 +/- 58 pg/ml, p <0.05). The increase in left ventricular volume from 1 to 6 months was significantly correlated with plasma BNP concentration at 1 month in the patent IRA group (r = 0.314, p < 0.01) and the reoccluded group (r = 0.634, p < 0.01). Linear regression analysis showed that the correlation between the 2 parameters in the 2 groups was similar. Based on stepwise multivariate linear regression analysis, only plasma BNP concentration was significantly correlated with the increase in left ventricular volume from 1 to 6 months in the 2 groups. In conclusion, these results suggest that plasma BNP concentration predicts left ventricular dilation independently of IRA patency. PMID:16893696
The Excitatory Synaptic Transmission of the Nucleus of Solitary Tract Was Potentiated by Chronic Myocardial Infarction in Rats
Feng, Ban; Zhang, Zi-Nan; Lei, Jie; Li, Yun-Qing; Du, Jian-Qing; Chen, Tao
Angina pectoris is a common clinical symptom that often results from myocardial infarction. One typical characteristic of angina pectoris is that the pain does not match the severity of the myocardial ischemia. One possible explanation is that the intensity of cardiac nociceptive information could be dynamically regulated by certain brain areas. As an important nucleus for processing cardiac nociception, the nucleus of the solitary tract (NTS) has been studied to some extent. However, until now, the morphological and functional involvement of the NTS in chronic myocardial infarction (CMI) has remained unknown. In the present study, by exploring left anterior descending coronary artery ligation surgery, we found that the number of synaptophysin-immunoreactive puncta and Fos-immunoreactive neurons in the rat NTS two weeks after ligation surgery increased significantly. Excitatory pre- and postsynaptic transmission was potentiated. A bath application of a Ca2+ channel inhibitor GABApentin and Ca2+ permeable AMPA receptor antagonist NASPM could reverse the potentiated pre- and postsynaptic transmission, respectively. Meanwhile, rats with CMI showed significantly increased visceral pain behaviors. Microinjection of GABApentin or NASPM into the NTS decreased the CMI-induced visceral pain behaviors. In sum, our results suggest that the NTS is an important area for the process of cardiac afference in chronic myocardial infarction condition. PMID:25756354
Myocardial damage by resuscitation methods.
Bunai, Yasuo; Akaza, Kayoko; Tsujinaka, Masatake; Nakazawa, Takashi; Nagai, Atsushi; Nakamura, Isao; Nagano, Toru; Ohya, Isao
Medico-legal autopsy cases were reviewed to detect myocardial changes induced by resuscitation methods. Myofibrillar degeneration (MFD) induced by resuscitation methods was classified into two types according to Luxol fast blue staining: contraction band (CB) and diffuse staining (DS). In the cases in which cardiopulmonary resuscitation had been performed, myocytes showing CB or DS formed small foci and were distributed in the papillary muscles, septum, and inner to middle layers of the myocardium. MFD induced by vasopressors was characterized by solitary distribution of degenerating myocytes that mainly showed DS and sometimes CB. When direct current countershocks had been performed, focal MFD in the subepicardial zone appeared to be a characteristic feature. PMID:12935617
Myocardial infarction in young adults
Egred, M; Viswanathan, G; Davis, G
Although myocardial infarction (MI) mainly occurs in patients older than 45, young men or women can suffer MI. Fortunately, its incidence is not common in patients younger than 45 years. However, the disease carries a significant morbidity, psychological effects, and financial constraints for the person and the family when it occurs at a young age. The causes of MI among patients aged less than 45 can be divided into four groups: (1) atheromatous coronary artery disease; (2) non-atheromatous coronary artery disease; (2) hyper-coagulable states; (4) MI related to substance misuse. There is a considerable overlap between all the groups. This article reviews the literature and highlights the practical issues involved in the management of young adults with MI. PMID:16344295
Repetitive myocardial infarctions secondary to delirium tremens.
Schwartzberg, David; Shiroff, Adam
Delirium tremens develops in a minority of patients undergoing acute alcohol withdrawal; however, that minority is vulnerable to significant morbidity and mortality. Historically, benzodiazepines are given intravenously to control withdrawal symptoms, although occasionally a more substantial medication is needed to prevent the devastating effects of delirium tremens, that is, propofol. We report a trauma patient who required propofol sedation for delirium tremens that was refractory to benzodiazepine treatment. Extubed prematurely, he suffered a non-ST segment myocardial infarction followed by an ST segment myocardial infarction requiring multiple interventions by cardiology. We hypothesize that his myocardial ischemia was secondary to an increased myocardial oxygen demand that occurred during his stress-induced catecholamine surge during the time he was undertreated for delirium tremens. This advocates for the use of propofol for refractory benzodiazepine treatment of delirium tremens and adds to the literature on the instability patients experience during withdrawal. PMID:25197580
Prognostic Significance of Imaging Myocardial Sympathetic Innervation.
Malhotra, Saurabh; Fernandez, Stanley F; Fallavollita, James A; Canty, John M
There has been a longstanding interest in understanding whether the presence of inhomogeneity in myocardial sympathetic innervation can predict patients at risk of sudden cardiac arrest from lethal ventricular arrhythmias. The advent of radiolabeled norepinephrine analogs has allowed this to be imaged in patients with ischemic and non-ischemic cardiomyopathy using single, photon emission computed tomography (SPECT) and positron emission tomography (PET). Several observational studies have demonstrated that globally elevated myocardial sympathetic tone (as reflected by reduced myocardial norepinephrine analog uptake) can predict composite cardiac end-points including total cardiovascular mortality. More recent studies have indicated that quantifying the extent of regional denervation can predict the risk of lethal ventricular arrhythmias and sudden cardiac death. This review will summarize our current understanding of the prognostic significance of altered myocardial sympathetic innervation. PMID:26087899
Medical emergencies: atrial fibrillation and myocardial infarction.
Somasundaram, K; Ball, J
In this, the first of two article on medical emergencies, we discuss the definitions, epidemiology, pathophysiology, acute and chronic management of atrial fibrillation and acute myocardial necrosis in the peri-operative and intensive care settings. PMID:23210559
Repetitive Myocardial Infarctions Secondary to Delirium Tremens
Schwartzberg, David; Shiroff, Adam
Delirium tremens develops in a minority of patients undergoing acute alcohol withdrawal; however, that minority is vulnerable to significant morbidity and mortality. Historically, benzodiazepines are given intravenously to control withdrawal symptoms, although occasionally a more substantial medication is needed to prevent the devastating effects of delirium tremens, that is, propofol. We report a trauma patient who required propofol sedation for delirium tremens that was refractory to benzodiazepine treatment. Extubed prematurely, he suffered a non-ST segment myocardial infarction followed by an ST segment myocardial infarction requiring multiple interventions by cardiology. We hypothesize that his myocardial ischemia was secondary to an increased myocardial oxygen demand that occurred during his stress-induced catecholamine surge during the time he was undertreated for delirium tremens. This advocates for the use of propofol for refractory benzodiazepine treatment of delirium tremens and adds to the literature on the instability patients experience during withdrawal. PMID:25197580
A Crucial Role of Glycoprotein VI for Platelet Recruitment to the Injured Arterial Wall In Vivo
Steffen Massberg; Meinrad Gawaz; Sabine Grüner; Valerie Schulte; Ildiko Konrad; Dietlind Zohlnhöfer; Ulrich Heinzmann; Bernhard Nieswandt
Platelet adhesion and aggregation at sites of vascular injury is crucial for hemostasis but may lead to arterial occlusion in the setting of atherosclerosis and precipitate diseases such as myocardial infarction. A current hypothesis suggests that platelet glycoprotein (GP) Ib interaction with von Willebrand factor recruits flowing platelets to the injured vessel wall, where subendothelial fibrillar collagens support their firm
Measurement of anterior chamber diameter and biometry of anterior segment by Scheimpflug slitlamp photography
Lerman, S.; Hockwin, O.
Twenty-eight fresh donor eyes (Georgia Lions Eye Bank) ranging in age from four months to 87 years were used for an in vitro study to determine the feasibility of obtaining accurate anterior chamber diameter measurements with our Scheimpflug ultraviolet-visible slitlamp densitography apparatus. The in vivo study was performed on 16 hybrid monkeys (of varying age). These data were within 0.1 mm of measurements obtained with a modified paracentesis needle specially designed to obtain such measurements. The results of the foregoing study demonstrate that the Scheimpflug slitlamp photographic analyses can provide an accurate measurement of the anterior chamber diameter without entering the globe surgically. This will enable the surgeon to determine the diameter and order an anterior chamber IOL of a specified size prior to surgery. The authors have devised an automated program to analyze the negatives and provide direct anterior chamber diameter measurements.
Longitudinal anterior knee laxity related to substantial tibial tunnel enlargement after anterior cruciate ligament revision.
Quatman, Carmen E; Paterno, Mark V; Wordeman, Samuel C; Kaeding, Christopher C
Allograft and bioabsorbable screw use in anterior cruciate ligament (ACL) revision surgery is common. However, both allograft and bioabsorbable screws have been associated with immunologic reactions that lead to tunnel enlargement. Long-term studies examining tibial tunnel enlargement in this population are currently not available. We report a case of severe tibial and femoral tunnel enlargement 6.5 years after ACL revision surgery with anterior tibialis and semitendinosus allograft and bioabsorbable screw fixation. Longitudinal knee arthrometer data, knee examination with the patient under anesthesia, and arthroscopic inspection of the graft showed minimal effects of severe tunnel enlargement on anterior knee laxity and graft integrity. To our knowledge, this is the first case report of a longitudinal assessment of anterior knee laxity associated with severe tunnel enlargement. Surgeons should be aware of this condition and the clinical consequences that may accompany bone tunnel enlargement after ACL surgery. PMID:21802626
Anterior Dislodgement of a Fusion Cage after Transforaminal Lumbar Interbody Fusion for the Treatment of Isthmic Spondylolisthesis
Oh, Hyeong Seok; Lee, Sang-Ho
Transforaminal lumbar interbody fusion (TLIF) is commonly used procedure for spinal fusion. However, there are no reports describing anterior cage dislodgement after surgery. This report is a rare case of anterior dislodgement of fusion cage after TLIF for the treatment of isthmic spondylolisthesis with lumbosacral transitional vertebra (LSTV). A 51-year-old man underwent TLIF at L4-5 with posterior instrumentation for the treatment of grade 1 isthmic spondylolisthesis with LSTV. At 7 weeks postoperatively, imaging studies demonstrated that banana-shaped cage migrated anteriorly and anterolisthesis recurred at the index level with pseudoarthrosis. The cage was removed and exchanged by new cage through anterior approach, and screws were replaced with larger size ones and cement augmentation was added. At postoperative 2 days of revision surgery, computed tomography (CT) showed fracture on lateral pedicle and body wall of L5 vertebra. He underwent surgery again for paraspinal decompression at L4-5 and extension of instrumentation to S1 vertebra. His back and leg pains improved significantly after final revision surgery and symptom relief was maintained during follow-up period. At 6 months follow-up, CT images showed solid fusion at L4-5 level. Careful cage selection for TLIF must be done for treatment of spondylolisthesis accompanied with deformed LSTV, especially when reduction will be attempted. Banana-shaped cage should be positioned anteriorly, but anterior dislodgement of cage and reduction failure may occur in case of a highly unstable spine. Revision surgery for the treatment of an anteriorly dislodged cage may be effectively performed using an anterior approach. PMID:24175028
Jeffrey W. Holmes; Thomas K. Borg; James W. Covell
? Abstract Therapies for myocardial,infarction have historically been developed by trial and error, rather than from an understanding of the structure and function of the healing infarct. With exciting new,bioengineering,therapies for myocardial,infarction on the horizon, we have reviewed the time course of structural and mechanical changes in the healing infarct in an attempt to identify key structural determinants,of mechanics at
Gender differences in myocardial blood flow dynamics
Claire S Duvernoy; Christian Meyer; Vanadin Seifert-Klauss; Firat Dayanikli; Ichiro Matsunari; Judith Rattenhuber; Cornelia Höss; Henner Graeff; Markus Schwaiger
ObjectivesThe purpose of the study was to compare myocardial blood flow (MBF) in hyperlipidemic postmenopausal women and age-matched hyperlipidemic men, and to analyze the relationship between cholesterol subfractions and myocardial blood flow in men and women.BackgroundWomen are protected from coronary artery disease (CAD) events until well after menopause, in part due to gender-specific differences in lipid profiles.MethodsTo examine the effect
Improved exercise myocardial perfusion during lidoflazine therapy
Shapiro, W.; Narahara, K.A.; Park, J.
Lidoflazine is a synthetic drug with calcium-channel blocking effects. In a study of 6 patients with severe classic angina pectoris, single-blind administration of lidoflazine was associated with improved myocardial perfusion during exercise as determined by thallium-201 stress scintigraphy. These studies demonstrate that lidoflazine therapy is associated with relief of angina, an increased physical work capacity, and improved regional myocardial perfusion during exercise.
Acute myocardial infarction secondary to thyrotoxicosis.
Timurkaynak, Timur; Aydogdu, Gulten; Cengel, Atiye
Angina and myocardial infarction have been reported in hyperthyroidism with normal coronary arteries, presumably secondary to thyroid-induced coronary artery spasm. We report the case of a very young female patient with an atypical presentation of acute myocardial infarction mimicking pulmonary embolization secondary to thyrotoxicosis. Hyperthyroidism should be kept in mind in younger patients in the differential diagnosis of coronary artery disease. PMID:12542124
[National Myocardial Infarction Registry of Hungary].
Jánosi, András; Ofner, Péter
The authors delineate the circumstances of the creation of the National Myocardial Infarction Registry program. This web-based program started in January 1, 2010 as a "pilot" study with the voluntary participation of 12 centres. As a result of professional consensus, the number of participating institutions has continuously increased and, since March 1, 2013, data supply has become obligatory for hospitals treating patients with myocardial infarction. In December, 2013 a new modification of certain health and health insurance related acts such as Act XLVII/1997 regulated the operation of National Myocardial Infraction Registry. At present 65 institutions provide data regularly. The number of patients with myocardial infarction in the database was 24308 in January 1, 2014. The authors summarize the data which accumulated during almost four years of functioning of the National Myocardial Infarction Registry Program. The incidence of myocardial infarction was defined by reviewing the number of pre hospital and hospital cases in five districts of the capital and Szabolcs-Szatmár-Bereg County of Hungary. Reviewing the records patients with ST-elevation and non-ST-elevation myocardial infarction revealed that treatment of 91% of ST-elevation patients occurred in hospitals with cardiac catheterization laboratory, and 82% of patients had primary percutaneous coronary intervention. In-hospital, 30-day and 1-year mortality were defined for patients treated for both types of myocardial infarction. Based on national and international experience, the authors emphasize that professional characteristics of patient care can only be assessed using specific patient registries and these data are essential in the development of an efficient health-care system. PMID:24796779
Successful management of a huge thrombus in coronary aneurysmatic dilatation after failed mechanical thrombectomy during acute myocardial infarction.
Ielasi, Alfonso; Anzuini, Angelo
The benefit of the routine application of aspiration thrombectomy in primary percutaneous coronary intervention (PPCI) is now well established. The optimal management of patients who have 'failed' thrombectomy, characterized by a large residual thrombus burden after repeated mechanical thrombectomy, however, is not known. We report a case of failed aspiration thrombectomy in a 55-year-old man who was admitted to our institution with chest pain non-ST-elevation myocardial infarction due to a huge nonocclusive thrombus in an aneurysmatic segment of the left anterior descending coronary artery. Aspiration thrombectomy did little to reduce thrombus load and so the patient was treated with unfractioned heparin infusion and warfarin. Repeat coronary angiography at 7 days revealed complete thrombus resolution with thrombolysis in myocardial infarction grade 3 anterograde flow.This case demonstrates the potential for appropriate anticoagulation therapy as a treatment option for the management of patients following failed thrombectomy in PPCI. PMID:22929567
Anatomic Outside-In Anterior Cruciate Ligament Reconstruction Using a Suspension Device for Femoral Fixation
Espejo-Baena, Alejandro; Espejo-Reina, Alejandro
Cortical suspension is one of the most frequently used methods of femoral fixation in anterior cruciate ligament reconstruction. We present a simple technique for anterior cruciate ligament reconstruction using a suspension device for femoral fixation. The purposes of this technique are to ensure greater contact between the graft and the tunnel walls—a goal that is achieved by using the femoral fixation device with the shortest possible loop—to avoid the flip step and the need for hyperflexion, and in short, to minimize the risk of complications that can occur when using the anteromedial portal to drill the femoral tunnel. To this end, both the femoral and tibial tunnels are created in an outside-in manner and with the same guide. The graft is passed through in a craniocaudal direction, and the suspension device is fitted inside an expansion piece for a better adaptation to the femoral cortex. PMID:24904774
Fiber-based polarization-sensitive OCT for birefringence imaging of the anterior eye segment
Yamanari, Masahiro; Tsuda, Satoru; Kokubun, Taiki; Shiga, Yukihiro; Omodaka, Kazuko; Yokoyama, Yu; Himori, Noriko; Ryu, Morin; Kunimatsu-Sanuki, Shiho; Takahashi, Hidetoshi; Maruyama, Kazuichi; Kunikata, Hiroshi; Nakazawa, Toru
We demonstrate a prototype system of polarization-sensitive optical coherence tomography (PS-OCT) designed for clinical studies of the anterior eye segment imaging. The system can measure Jones matrices of the sample with depth-multiplexing of two orthogonal incident polarizations and polarization-sensitive detection. An optical clock is generated using a quadrature modulator and a logical circuit to double the clock frequency. Systematic artifacts in measured Jones matrices are theoretically analyzed and numerically compensated using signals at the surface of the sample. Local retardation images of filtering blebs after trabeculectomy show improved visualization of subconjunctival tissue, sclera, and scar tissue of the bleb wall in the anterior eye segment. PMID:25780730
Fiber-based polarization-sensitive OCT for birefringence imaging of the anterior eye segment.
Yamanari, Masahiro; Tsuda, Satoru; Kokubun, Taiki; Shiga, Yukihiro; Omodaka, Kazuko; Yokoyama, Yu; Himori, Noriko; Ryu, Morin; Kunimatsu-Sanuki, Shiho; Takahashi, Hidetoshi; Maruyama, Kazuichi; Kunikata, Hiroshi; Nakazawa, Toru
We demonstrate a prototype system of polarization-sensitive optical coherence tomography (PS-OCT) designed for clinical studies of the anterior eye segment imaging. The system can measure Jones matrices of the sample with depth-multiplexing of two orthogonal incident polarizations and polarization-sensitive detection. An optical clock is generated using a quadrature modulator and a logical circuit to double the clock frequency. Systematic artifacts in measured Jones matrices are theoretically analyzed and numerically compensated using signals at the surface of the sample. Local retardation images of filtering blebs after trabeculectomy show improved visualization of subconjunctival tissue, sclera, and scar tissue of the bleb wall in the anterior eye segment. PMID:25780730
Myocardial oxygenation and functional recovery in infarct rat hearts transplanted with mesenchymal stem cells
Chacko, Simi M.; Khan, Mahmood; Kuppusamy, M. Lakshmi; Pandian, Ramasamy P.; Varadharaj, Saradhadevi; Selvendiran, Karuppaiyah; Bratasz, Anna; Rivera, Brian K.; Kuppusamy, Periannan
Stem cell therapy for myocardial tissue repair is limited by the poor survival of transplanted cells, possibly because of inadequate supply of oxygen and nutrients. The purpose of this study was to assess the oxygenation level and functional recovery after allogenic transplantation of mesenchymal stem cells (MSC) in a rat model of myocardial infarction (MI). Myocardial oxygen tension (Po2) was measured by electron paramagnetic resonance oximetry using an implantable oxygen-sensing spin probe (OxySpin). MSCs incubated with OxySpins showed substantial uptake of the probe without affecting its oxygen sensitivity or calibration. The cells internalized with OxySpins were able to differentiate into osteogenic, adipogenic, cardiomyocyte, and endothelial cell lineages. The labeled cells tested positive for CD44 and CD29 markers and negative for the hematopoietic markers CD14 and CD45. For the in vivo studies, MI was induced in rats by permanently ligating the left anterior descending coronary artery. MSCs with OxySpins were transplanted in the infarct region of hearts. A significant increase in Po2 was observed in the MSC group compared with the untreated MI group (18.1 ± 2.6 vs. 13.0 ± 1.8 mmHg, n = 4, P < 0.05) at 4 wk after transplantation. Echocardiography showed a significant improvement in ejection fraction and fraction shortening, which inversely correlated with the magnitude of fibrosis in the treated hearts. The cell-transplanted hearts also showed an increase in vascular endothelial growth factor level and capillary density in the infarct region. The study established our ability to measure and correlate changes in myocardial tissue oxygenation with cardiac function in infarcted rat hearts treated with MSCs. PMID:19286938
Neural Mechanisms and Delayed Gastric Emptying of Liquid Induced Through Acute Myocardial Infarction in Rats
Nunez, Wilson Ranu Ramirez; Ozaki, Michiko Regina; Vinagre, Adriana Mendes; Collares, Edgard Ferro; de Almeida, Eros Antonio
Background In pathological situations, such as acute myocardial infarction, disorders of motility of the proximal gut can trigger symptoms like nausea and vomiting. Acute myocardial infarction delays gastric emptying (GE) of liquid in rats. Objective Investigate the involvement of the vagus nerve, ? 1-adrenoceptors, central nervous system GABAB receptors and also participation of paraventricular nucleus (PVN) of the hypothalamus in GE and gastric compliance (GC) in infarcted rats. Methods Wistar rats, N = 8-15 in each group, were divided as INF group and sham (SH) group and subdivided. The infarction was performed through ligation of the left anterior descending coronary artery. GC was estimated with pressure-volume curves. Vagotomy was performed by sectioning the dorsal and ventral branches. To verify the action of GABAB receptors, baclofen was injected via icv (intracerebroventricular). Intravenous prazosin was used to produce chemical sympathectomy. The lesion in the PVN of the hypothalamus was performed using a 1mA/10s electrical current and GE was determined by measuring the percentage of gastric retention (% GR) of a saline meal. Results No significant differences were observed regarding GC between groups; vagotomy significantly reduced % GR in INF group; icv treatment with baclofen significantly reduced %GR. GABAB receptors were not conclusively involved in delaying GE; intravenous treatment with prazosin significantly reduced GR% in INF group. PVN lesion abolished the effect of myocardial infarction on GE. Conclusion Gastric emptying of liquids induced through acute myocardial infarction in rats showed the involvement of the vagus nerve, alpha1- adrenergic receptors and PVN. PMID:25494017
Physiological cost of vocational activities after myocardial infarction.
Denolin, H; Riviere, A
Oxygen consumption was measured during 30 min of work in 16 patients, after a myocardial infarction (anterior or posterior), and compared with 16 normal subjects, of the same age, involved in the same activities, in a steel factory. The VO2 at work of the patients was a little lower than in normals. The mean heart rate for 8 h was also a little lower in patients than in normals. The patients used a higher percentage of their residual capacity (VO2 max) as evaluated on a bicycle ergometer in the laboratory; the difference may be important between patients with a residual coronary insufficiency and controls. There are no important differences in the psychological attitudes of the two groups; the patient seems to be more motivated. From this study, based on a limited number of patients who had returned to work and had no complaints in daily life, it appears that the patients were working more 'economically' that the normals, that they are able to use a higher percentage of their residual physiological capacity and that the psychological attitude is comparable in the two groups towards work. Return to previous work should never be excluded a priori in post-infarction patients with good clinical progress. PMID:3243300
Photoacoustic tomography of ex vivo mouse hearts with myocardial infarction
NASA Astrophysics Data System (ADS)
Holotta, Markus; Grossauer, Harald; Kremser, Christian; Torbica, Pavle; Völkl, Jakob; Degenhart, Gerald; Esterhammer, Regina; Nuster, Robert; Paltauf, Günther; Jaschke, Werner
In the present study, we evaluated the applicability of ex vivo photoacoustic imaging (PAI) on small animal organs. We used photoacoustic tomography (PAT) to visualize infarcted areas within murine hearts and compared these data to other imaging techniques [magnetic resonance imaging (MRI), micro-computed tomography] and histological slices. In order to induce ischemia, an in vivo ligation of the left anterior descending artery was performed on nine wild-type mice. After varying survival periods, the hearts were excised and fixed in formaldehyde. Samples were illuminated with nanosecond laser pulses delivered by a Nd:YAG pumped optical parametric oscillator. Ultrasound detection was achieved using a Mach-Zehnder interferometer (MZI) working as an integrating line detector. The voxel data were computed using a Fourier-domain based reconstruction algorithm, followed by inverse Radon transforms. The results clearly showed the capability of PAI to visualize myocardial infarction and to produce three-dimensional images with a spatial resolution of approximately 120 ?m. Regions of affected muscle tissue in PAI corresponded well with the results of MRI and histology. Photoacoustic tomography utilizing a MZI for ultrasound detection allows for imaging of small tissue samples. Due to its high spatial resolution, good soft tissue contrast and comparatively low cost, PAT offers great potentials for imaging.
Investigating intrinsic myocardial mechanics: The role of MR tagging, velocity phase mapping, and diffusion imaging
Sharmeen Masood; Guang-Zhong Yang; Dudley J. Pennell; David N. Firmin
Assessment of myocardial mechanics is an integral part of understanding and predicting heart disease. This review covers the two most common magnetic resonance (MR) methods used to measure myocardial motion: myocardial tagging and myocardial velocity mapping. Myocardial tag- ging has been well established in clinical research, despite its time-consuming postprocessing procedure. Myocardial velocity mapping uses the phase shifts of the
Four year experience with the AO Anterior Thoracolumbar Locking Plate
J S Thalgott; M B Kabins; M Timlin; K Fritts; J M Giuffre
For decades spinal surgeons have attempted to design simple, single stage anterior internal fixation systems for the thoracic and lumbar spine. Early devices presented both biomechanical and technical problems. The AO Anterior Thoracolumbar Locking Plate (ATLP) was designed to solve some of the problems encountered with early anterior instrumentation. The ATLP system is constructed in Commercially Pure titanium. It is
Methanol Extract of Cassia mimosoides var. nomame Attenuates Myocardial Injury by Inhibition of Apoptosis in a Rat Model of Ischemia-Reperfusion
Lim, Sun Ha; Lee, Jongwon
Interruption of blood flow through coronary arteries and its subsequent restoration triggers the generation of a burst of reactive oxygen species (ROS), leading to myocardial cell death. In this study, we determined whether a methanol extract of Cassia mimosoides var. nomame Makino could prevent myocardial ischemia-reperfusion injury. When radical scavenging activity of the extract was measured in vitro using its ?,?-diphenyl-?-picrylhydrazyl (DPPH) radical quenching ability, the extract showed an activity slightly lower than that of ascorbic acid. Three days after oral administration of the extract (400 mg/kg/day) to rats, myocardial ischemia/reperfusion injury was generated by 30 min of ligation of the left anterior descending coronary artery (LAD), followed by 3 hr reperfusion. Compared with the vehicle-treated group, administration of the extract significantly reduced infarct size (IS) (ratio of infarct area to area at risk) in the extract-treated group by 28.3%. Reduction in the cellular injury was mediated by attenuation of Bax/Bcl-2 ratio by 33.3%, inhibition of caspase-3 activation from procas-pase-3 by 40%, and subsequent reduction in the number of apoptotic cells by 66.3%. These results suggest that the extract attenuates myocardial injury in a rat model of ischemia-reperfusion by scavenging ROS, including free radicals, and consequently blocking apoptotic cascades. Therefore, intake of Cassia mimosoides var. nomame Makino might be beneficial for preventing ischemic myocardial injury. PMID:24471081
Allograft maturation in anterior cruciate ligament reconstruction.
Lee, Cassandra A; Meyer, Jeffrey V; Shilt, Jeffrey S; Poehling, Gary G
This case report describes the histologic incorporation of a freeze-dried Achilles tendon allograft used for arthroscopic anterior cruciate ligament (ACL) reconstruction. The patient had regained stability from the procedure but had worsening pain over the medial compartment. The patient underwent total knee arthroplasty 2.5 years after ACL reconstruction. The surgeon was able to observe the graft in situ and examine the histology of the graft tunnel interface. This interface demonstrated Sharpey's fibers. PMID:15243424
Hand-assisted laparoscopic low anterior resection
A. Pietrabissa; C. Moretto; A. Carobbi; U. Boggi; M. Ghilli; F. Mosca
Background: Laparoscopic low anterior resection for rectal cancer has never gained wide acceptance among general surgeons,\\u000a mainly due to the technical difficulties encountered during pelvic dissection. It has therefore been stated that these patients\\u000a should undergo open rather than laparoscopic surgery. Hand-assisted laparoscopic surgery (HALS) is a new technique that has\\u000a the potential to overcome many of the existing limitations
Laparoscopic cardiomyotomy and anterior partial fundoplication forachalasia
R. Ackroyd; D. I. Watson; P. G. Devitt; G. G. Jamieson
Background: Although surgical myotomy is considered the gold standard, many different treatments have been advocated for achalasia.\\u000a There are now a number of reports of cardiomyotomy being performed laparoscopically. Methods: This is a prospective study\\u000a of 82 patients (47 male and 35 female; median age, 47 years) who underwent laparoscopic cardiomyotomy and anterior partial\\u000a fundoplication for achalasia. Results: Four of
Complications of anterior compartment vaginal surgery
Eric S. Rovner
Many complications can be associated with anterior compartment surgery of the vagina. With the integration of synthetic materials\\u000a into the surgical armamentarium for the repair of stress urinary incontinence in the form of midurethral slings, and for the\\u000a repair of vaginal prolapse as a primary procedure or to augment an existing repair, the spectrum of complications related\\u000a to this type
Mechanical circulatory support as a bridge to definitive surgical repair after post-myocardial infarct ventricular septal defect.
Hobbs, Reilly; Korutla, Varun; Suzuki, Yoshikazu; Acker, Michael; Vallabhajosyula, Prashanth
Ventricular septal defect (VSD) after myocardial infarction (MI) is an uncommon but serious complication. Patients refractory to attempts at medical stabilization and requiring emergency surgery have expected mortality rates greater than 50%. We present three cases of extracorporeal membrane oxygenation bridge to surgical repair in patients with multisystem organ failure who would otherwise require emergent cardiac surgery with associated risk and review the literature for mechanical circulatory support for patients with anterior and posterior post-MI VSD. doi: 10.1111/jocs.12561 (J Card Surg 2015;30:535-540). PMID:25940559
Sealing a ruptured non-culprit coronary plaque in a patient with acute myocardial infarction with bioresorbable vascular scaffolds.
Cuesta, Javier; Rivero, Fernando; Bastante, Teresa; Benedicto, Amparo; Diego, Guillermo; Alfonso, Fernando
A 49-year-old man was admitted to the emergency department suffering from a large anterior myocardial infarction that was treated by rescue PCI. The patient also had a moderate but complex lesion in the proximal segment of the right coronary artery. Optical coherence tomography showed striking images of a ruptured and ulcerated plaque with significant thrombus content. Although the lumen was not compromised, these unique findings prompted us to treat this non-culprit lesion. We selected a bioresorbable vascular scaffold with the aim of sealing and passivating this complicated and high-risk plaque. PMID:25707734
Cardiac Wound Healing Post-myocardial Infarction: A Novel Method to Target Extracellular Matrix Remodeling in the Left Ventricle
Zamilpa, Rogelio; Zhang, Jianhua; Chiao, Ying Ann; Bras, Lisandra de Castro; Halade, Ganesh; Ma, Yonggang; Hacker, Sander O.; Lindsey, Merry L.
Myocardial infarction (MI) is a leading cause of death worldwide. Permanent ligation of the left anterior descending coronary artery (LAD) is a commonly used surgical model to study post-MI effects in mice. LAD occlusion induces a robust wound healing response that includes extracellular matrix (ECM) remodeling. This chapter provides a detailed guide on the surgical procedure to permanently ligate the LAD. Additionally, we describe a prototype method to enrich cardiac tissue for ECM, which allows one to focus on ECM remodeling in the left ventricle following surgically induced MI in mice. PMID:24029944
Incremental value of contrast myocardial perfusion to detect intermediate versus severe coronary artery stenosis during stress-echocardiography
Nicola Gaibazzi; Fausto Rigo; Angelo Squeri; Fabrizio Ugo; Claudio Reverberi
BACKGROUND: We aimed to compare the incremental value of contrast myocardial perfusion imaging (MPI) for the detection of intermediate versus severe coronary artery stenosis during dipyridamole-atropine echocardiography (DASE). Wall motion (WM) assessment during stress-echocardiography demonstrates suboptimal sensitivity to detect coronary artery disease (CAD), particularly in patients with isolated intermediate (50%-70%) coronary stenosis. METHODS: We performed DASE with MPI in 150
The effect of captopril and losartan on the electrophysiology of myocardial cells of myocardial ischemia rats
Shi, Xiangmin; Shan, Zhaoling; Yuan, Hongtao; Guo, Hongyang; Wang, Yutang
Objective: This study aims to investigate the effect of captopril and losartan on the electrophysiology of myocardial cells parameters in ventricular vulnerable period and effective refractory period of myocardial ischemia rats. Methods: 96 wistar rats were enrolled in the study and divided into six groups: Captopril myocardial ischemia group, losartan myocardial ischemia group, myocardial ischemia control group, captopril normal group, losartan normal group and normal control group (n=16). We observed morphological changes of myocardial tissue in each group. The cardiac electrophysiological parameters in effective refractory period of each group were measured. Creatine kinase (CK), alanine aminotransferase (GOT), lactate dehydrogenase (LDH), the expression of Cardiotrophin 1 (CT-1) and malonaldehyde (MDA) were detected. Results: Compared the losartan and captopril group with the control group, (P<0.05). Losartan and captopril can shorten the ventricular vulnerable period of the normal group and ischemic group. There was no interaction effect between losartan and captopril group and the acute myocardial ischemia group. The effect of losartan and captopril on time window in ventricular vulnerable period showed that compared with the control group (P<0.05). Losartan and captopril had a significant effect on prolonged effective refractory period of normal and ischemic rats. There was no interaction effect between losartan and captopril group and the acute myocardial ischemia group. Compared with the myocardial ischemia control group, CK, GOT, LDH and MDA decreased in captopril and losartan myocardial ischemia groups (P<0.05). Conclusion: Losartan and captopril had a significant effect on prolonged effective refractory period and shorten ventricular vulnerable period, they can also effectively prevent arrhythmias. PMID:25664036
Fatal delayed cardiac tamponade due to rupture of micropseudoaneurysm of left anterior descending coronary artery following stab to the chest.
Xing, Jingjun; Li, Shangxun; Zhang, Lin; Yang, Yi; Duan, Yijie; Li, Wenhe; Zhou, Yiwu
Traumatic coronary pseudoaneurysm has been described to be mainly associated to iatrogenic lesion of the coronary arteries. However, chest-stab-wound-related coronary pseudoaneurysm caused by isolated partial incision of a coronary artery giving rise to fatal delayed cardiac tamponade is very rare. We describe an autopsy case in which this potentially fatal complication developed 8 days later after a thoracic stab wound. Unfortunately, the imaging examination failed to detect this defect during hospitalization. Postmortem examination revealed that the posterior wall of the left anterior descending coronary artery was intact but that the anterior wall was incised, forming a micropseudoaneurysm which had ruptured. This case highlights that isolated coronary artery injuries must be considered in any patient with a penetrating wound to the thorax, and coronary pseudoaneurysms should not be missed in these patients. PMID:25541181
Evaluation in dogs and humans of three potential technetium-99m myocardial perfusion agents
Gerundini, P.; Savi, A.; Gilardi, M.C.; Margonato, A.; Vicedomini, G.; Zecca, L.; Hirth, W.; Libson, K.; Bhatia, J.C.; Fazio, F.
The biodistribution of the three cationic /sup 99m/Tc complexes (/sup 99m/Tc(TMP)6)+, (/sup 99m/Tc(POM-POM)3)+, and (/sup 99m/Tc(TBIN)6)+--where TMP represents trimethylphosphite, POM-POM represents 1,2-bis(dimethyoxyphosphino)ethane, and TBIN represents t-butylisonitrile--have been evaluated in humans and dogs. Each agent was studied in three normal volunteers at rest, while (/sup 99m/Tc(POM-POM)3)+ and (/sup 99m/Tc(TBIN)6)+ were each studied in one normal volunteer at exercise. Even though all three agents yield good myocardial images in dogs, none appear suitable for clinical use as myocardial perfusion imaging radiopharmaceuticals. In humans, (/sup 99m/Tc(TMP)6)+ and (/sup 99m/Tc(POM-POM)3)+ clear very slowly from the blood and provide myocardial images only several hours after injection. (/sup 99m/Tc(TBIN)6)+ clears rapidly from the blood, but accumulation in the lung obscures the myocardial image for the first hour after injection; at later times, activity in the liver and spleen masks the apical wall. These results correlate with the blood-binding properties of the three complexes. (/sup 99m/Tc(TMP)6)+ and (/sup 99m/Tc(POM-POM)3)+ bind tightly to the plasma of human blood, but not to the plasma of dog blood; (/sup 99m/Tc(TBIN)6)+ does not bind tightly to the plasma of either dog or human blood. Among the Tc(I) complexes studied to date in humans, (/sup 99m/Tc(TBIN)6)+ appears to be unique in biodistribution pattern, blood-binding properties, and the fact that exercise improves the ultimate myocardial image. All the Tc(I) complexes appear to undergo myocardial accumulation by a mechanism different from that utilized by Tc(III) complexes. Animal studies alone are not adequate to evaluate the potential utility of /sup 99m/Tc cationic complexes for myocardial perfusion studies.
[Acute stent thrombosis and reverse transient left ventricular dilatation after performing a single-photon emission computed tomography myocardial perfusion].
Miranda, B; Pizzi, M N; Aguadé-Bruix, S; Domingo, E; Candell-Riera, J
A 63-year-old male patient with a history of stent implantation in the left anterior descending three months before. Due to the presentation of vegetative symptoms, he was referred for gated-SPECT myocardial perfusion. During acquisition of the resting images he presented chest pain and ST segment elevation, so that urgent cardiac catheterization was performed, showing stent thrombosis. Rest perfusion imaging showed a defect in anterior and apical perfusion, more severe and extensive than in the stress images, with striking left ventricular dilatation and a fall in the ejection fraction related to the acute ischemia phenomenon. Intense exercise is associated with a transient activation of the coagulation system and hemodynamic changes that might induce thrombosis, especially in recently implanted coronary stents that probably still have not become completely endothelialized. PMID:25129322
Favorable left ventricular remodeling following large myocardial infarction by exercise training. Effect on ventricular morphology and gene expression.
Orenstein, T L; Parker, T G; Butany, J W; Goodman, J M; Dawood, F; Wen, W H; Wee, L; Martino, T; McLaughlin, P R; Liu, P P
Continued adverse remodeling of myocardium after infarction may lead to progressive ventricular dilation and heart failure. We tested the hypothesis that exercise training in a healed myocardial infarction-dysfunction rat model can favorably modify the adverse effects of ventricular remodeling including attenuation of abnormal myosin gene expression. Sprague-Dawley rats were subjected to either proximal LAD ligation or sham operation. At 5 wk after the operation, animals were randomly assigned to sedentary conditions or 6 wk of graduated swim training, creating four experimental groups: infarct sedentary (IS), infarct exercise (IE), sham sedentary (SS), and sham exercise (SE). At 11 wk all rats were sacrificed and analyzed. Compared to sedentary infarct controls, exercise training attenuated left ventricular (LV) dilation and allowed more hypertrophy of the non infarct wall. The exercise-trained hearts also showed a reduction in the estimated peak wall tension. Northern blot analysis showed an increase in beta-myosin heavy chain expression in the hearts of the sedentary infarction group soon after infarction when compared to sham controls. However, with exercise training, there was a significant attenuation of the beta-myosin heavy chain expression in the myocardium. Exercise training in a model of left ventricular dysfunction after healed myocardial infarction can improve the adverse remodeling process by attenuating ventricular dilation and reducing wall tension. The abnormal beta-myosin expression was also attenuated in the exercise trained group. This is evidence that abnormal gene expression following severe myocardial infarction dysfunction can be favorably modified by an intervention. Images PMID:7635980
Acute Ventricular Wall Thickening: Sepsis, Thrombotic Microangiopathy, or Myocarditis?
Hoton, Delphine; Castanares-Zapatero, Diego
Background. Acute myocardial oedema has been documented in experimental models of ischemia-reperfusion injury or sepsis and is usually investigated by magnetic resonance imaging. Purpose. We describe a case of acute ventricular wall thickening documented by echocardiography in a patient developing sepsis and thrombotic microangiopathy. Case Description. A 40-year-old woman, with a history of mixed connective tissue disease, was admitted with laryngeal oedema and fever. She developed Streptococcus pneumoniae septicaemia and subsequent laboratory abnormalities were consistent with a thrombotic microangiopathy. Echocardiography revealed an impressive diffuse thickening of the whole myocardium (interventricular septum 18?mm; posterior wall 16?mm) with diffuse hypokinesia and markedly reduced left ventricular ejection fraction (31%). There was also a moderate pericardial effusion. Echocardiography was normal two months before. The patient died from acute heart failure. Macroscopic and microscopic examination of the heart suggested that the ventricular wall thickening was induced by oedematous changes, together with an excess of inflammatory cells. Conclusion. Acute ventricular wall thickening that corresponded to myocardial oedema as a first hypothesis was observed at echocardiography during the course of septicaemia complicated by thrombotic microangiopathy. PMID:25861483
NSDL National Science Digital Library
In this activity, students will learn to identify the distinguishing characteristics of a stone wall. They will first draw a picture of a stone wall from memory, then go outside to view and sketch a real wall. Following the field activity, they will construct models of walls using modeling clay. A recipe for the clay ('model magic') is provided.
Mullenhoff, D.J.; Johnston, B.C.; Azevedo, S.G.
A report is made on the demonstration of a first-generation Wall Surveyor that is capable of surveying the interior and thickness of a stone, brick, or cement wall. LLNL`s Micropower Impulse Radar is used, based on emitting and detecting very low amplitude and short microwave impulses (MIR rangefinder). Six test walls were used. While the demonstrator MIR Wall Surveyor is not fieldable yet, it has successfully scanned the test walls and produced real-time images identifying the walls. It is planned to optimize and package the evaluation wall surveyor into a hand held unit.
Quantifying Acute Myocardial Injury Using Ratiometric Fluorometry
Ranji, Mahsa; Matsubara, Muneaki; Leshnower, Bradley G.; Hinmon, Robin H.; Jaggard, Dwight L.; Chance, Britton; Gorman, Robert C.
Early reperfusion is the best therapy for myocardial infarction (MI). Effectiveness, however, varies significantly between patients and has implications for long-term prognosis and treatment. A technique to assess the extent of myocardial salvage after reperfusion therapy would allow for high-risk patients to be identified in the early post-MI period. Mitochondrial dysfunction is associated with cell death following myocardial reperfusion and can be quantified by fluorometry. Therefore, we hypothesized that variations in the fluorescence of mitochondrial nicotinamide adenine dinucleotide (NADH) and flavoprotein (FP) can be used acutely to predict the degree of myocardial injury. Thirteen rabbits had coronary occlusion for 30 min followed by 3 h of reperfusion. To produce a spectrum of infarct sizes, six animals were infused cyclosporine A prior to ischemia. Using a specially designed fluorometric probe, NADH and FP fluorescence were measured in the ischemic area. Changes in NADH and FP fluorescence, as early as 15 min after reperfusion, correlated with postmortem assessment infarct size (r = 0.695, p < 0.01). This correlation strengthened with time (r = 0.827, p < 0.001 after 180 min). Clinical application of catheter-based myocardial fluorometry may provide a minimally invasive technique for assessing the early response to reperfusion therapy. PMID:19272908
Contemporary perspective on endogenous myocardial regeneration
Milasinovic, Dejan; Mohl, Werner
Considering the complex nature of the adult heart, it is no wonder that innate regenerative processes, while maintaining adequate cardiac function, fall short in myocardial jeopardy. In spite of these enchaining limitations, cardiac rejuvenation occurs as well as restricted regeneration. In this review, the background as well as potential mechanisms of endogenous myocardial regeneration are summarized. We present and analyze the available evidence in three subsequent steps. First, we examine the experimental research data that provide insights into the mechanisms and origins of the replicating cardiac myocytes, including cell populations referred to as cardiac progenitor cells (i.e., c-kit+ cells). Second, we describe the role of clinical settings such as acute or chronic myocardial ischemia, as initiators of pathways of endogenous myocardial regeneration. Third, the hitherto conducted clinical studies that examined different approaches of initiating endogenous myocardial regeneration in failing human hearts are analyzed. In conclusion, we present the evidence in support of the notion that regaining cardiac function beyond cellular replacement of dysfunctional myocardium via initiation of innate regenerative pathways could create a new perspective and a paradigm change in heart failure therapeutics. Reinitiating cardiac morphogenesis by reintroducing developmental pathways in the adult failing heart might provide a feasible way of tissue regeneration. Based on our hypothesis "embryonic recall", we present first supporting evidence on regenerative impulses in the myocardium, as induced by developmental processes. PMID:26131310
Microwave Spectroscopy of Myocardial Ischemia and Infarction. 2. Biophysical Reconstruction
Serguei Y. Semenov; Robert H. Svenson; Alexander E. Bulyshev; Alexander E. Souvorov; Alexei G. Nazarov; Yuri E. Sizov; Vitaly G. Posukh; Andrey Pavlovsky; George P. Tatsis
The proposed dielectrical relaxation model of the myocardium in the microwave spectrum has been verified both on test solutions and on normal canine myocardium. Furthermore, the model was utilized to reconstruct the changes in tissue properties (including myocardial bulk resistance and water content) following myocardial acute ischemia and chronic infarction. It was shown that the reconstructed myocardial resistance and water
[Myocardial infarction in a young patient--with underlying vasculitis].
Romppanen, Hannu; Niemelä, Matti; Kervinen, Kari; Ylitalo, Kari; Huikuri, Heikki
Myocardial infarction in a young patient is rare, and its diagnosis and treatment may be delayed. Vasculitis can cause inflammation in the coronary artery and cause a myocardial infarction even in a young person. We describe a sudden myocardial infarction caused by vasculitis in two young adults having chest pain symptoms. PMID:19860082
Myocardial metastases from renal cell carcinoma mimicking ischemia on myocardial perfusion scintigraphy.
Pelletier-Galarneau, Matthieu; Hibbert, Rebecca; Zuckier, Lionel S
A 60-year-old man with history of metastatic renal cell carcinoma and atypical chest pain was referred for dipyridamole Tc-tetrofosmin perfusion scintigraphy (MPS). Two years earlier, the patient was noted to have myocardial metastases on cardiac MRI. On the MPS, perfusion defects were present at stress in multiple vascular territories; resting myocardial uptake was homogeneous. These findings suggested multivessel atherosclerotic heart disease. In fact, retrospective rigid fusion with prior chest CT and cardiac MRI demonstrated that the reversible perfusion defects corresponded to metastatic deposits in the myocardium. This unusual case illustrates how myocardial metastases can mimic ischemia on MPS. PMID:24873803
Action of acetylstrophanthidin on experimental myocardial infarction.
NASA Technical Reports Server (NTRS)
Nola, G. T.; Pope, S. E.; Harrison, D. C.
An experimental animal model with acute myocardial infarction of a size insufficient to produce profound heart failure or shock was used to study the effects of acute infarction on digitalis tolerance and the hemodynamic changes produced by moderate and large doses of acetylstrophanthidin. With acute myocardial infarction, digitalis toxic arrhythmias could be precipitated with significantly lower doses of digitalis than in animals without myocardial infarction. There was no precise correlation between the size of infarction and the toxic dose of glycoside. Coronary artery ligation produced a stable but relatively depressed circulatory state, as evidenced by lowered cardiac output and stroke volume and elevated systemic vascular resistance and left atrial mean pressure. When digitalis was infused, the following significant changes were observed at nontoxic doses: (1) elevation of aortic and left ventricular pressures; (2) further decline in cardiac output; and (3) decreased left atrial mean pressure.
Assessing Myocardial Disease Using T1? MRI
Han, Yuchi; Liimatainen, Timo; Gorman, Robert C.
There is great interest to use magnetic resonance imaging (MRI) for non-invasive assessment of myocardial disease in ischemic and non-ischemic cardiomyopathies. Recently, there has been a renewed interest to use a magnetic resonance imaging (MRI) technique utilizing spin locking radiofrequency (RF) pulses, called T1? MRI. The spin locking RF pulse creates sensitivity to some mechanisms of nuclear relaxation such as 1H exchange between water and amide, amine and hydroxyl functional groups in molecules; consequently, there is the potential to non-invasively, and without exogenous contrast agents, obtain important molecular information from diseased myocardial tissue. The purpose of this article is to review and critically examine the recent published literature in the field related to T1? MRI of myocardial disease. PMID:24688628
Assessing Myocardial Disease Using T1? MRI.
Han, Yuchi; Liimatainen, Timo; Gorman, Robert C; Witschey, Walter R T
There is great interest to use magnetic resonance imaging (MRI) for non-invasive assessment of myocardial disease in ischemic and non-ischemic cardiomyopathies. Recently, there has been a renewed interest to use a magnetic resonance imaging (MRI) technique utilizing spin locking radiofrequency (RF) pulses, called T1? MRI. The spin locking RF pulse creates sensitivity to some mechanisms of nuclear relaxation such as (1)H exchange between water and amide, amine and hydroxyl functional groups in molecules; consequently, there is the potential to non-invasively, and without exogenous contrast agents, obtain important molecular information from diseased myocardial tissue. The purpose of this article is to review and critically examine the recent published literature in the field related to T1? MRI of myocardial disease. PMID:24688628
Cardiomyocyte mineralocorticoid receptor function post myocardial infarction.
Fraccarollo, Daniela; Bauersachs, Johann
Clinical trials have clearly demonstrated that mineralocorticoid receptor (MR) blockade improves outcome in patients with chronic systolic heart failure and left ventricular dysfunction after myocardial infarction; however, the underlying mechanisms as well as the cell-specific functional role of MR activation are still under investigation. Extrarenal effects of MR blockade on cardiovascular extracellular matrix turnover and oxidative stress, on myocardial structural and electrical remodeling, and on sympathoadrenergic stimulation, platelet activation, endothelial dysfunction, and macrophage polarization appear to be important mechanisms. Recent scientific advances, involving mice with cardiomyocyte-restricted inactivation of the MR gene suggest that the clinical benefits of MR blocking therapy in myocardial infarction and heart failure are mediated largely via cardiomyocyte-dependent mechanisms, and they provide strong evidence that more favorable effects on cardiac dysfunction and failure can be achieved by early initiation of MR blockade postinfarction. PMID:22578239
Simultaneous Bilateral Anterior Approach Total Hip Arthroplasty.
Gondusky, Joseph S; Pinkos, Kevin A; Choi, Leera; Patel, Jay J; Barnett, Steven; Gorab, Robert S
Simultaneous bilateral total hip arthroplasty (THA) has been performed successfully, with good outcomes and low complication rates reported. Most published studies on the topic used anterolateral or posterior surgical approaches. The anterior approach is performed under live fluoroscopy with the patient supine, obviating the need for patient repositioning during bilateral surgery. The authors report their experience with simultaneous bilateral anterior approach total hip arthroplasty. The authors retrospectively reviewed data for 75 patients (150 hips). Mean follow-up was 26 months (range, 5-60 months). Mean patient age was 59 years and the majority were American Society of Anesthesiology class 2 (range, 1-3). Mean total surgical time was 144 minutes (72 minutes per hip). Mean blood loss was 565 mL. Mean hospital length of stay was 2.75 days (range, 1-4 days). Ninety-six percent of patients were able to ambulate on postoperative day 1. Sixty-eight percent of patients were discharged to home. Mean Harris Hip Score improved from 50 to 97. All patients noted a return to preoperative level of activity or higher. Complications included 1 atraumatic minimally displaced trochanteric fracture occurring 2 weeks postoperatively, 1 pulmonary embolism on postoperative day 3 treated without sequelae, 1 episode of postoperative atrial fibrillation, and 4 minor local wound complications. No readmission, infection, nerve palsy, dislocation, reoperation, or death occurred. Anterior approach THA has the advantage of a single supine position for bilateral simultaneous surgery and the current study supports its use in appropriate patients. [Orthopedics. 2015; 38(7):e611-e615.]. PMID:26186324
Noninvasive quantitation of myocardial blood flow in human subjects with oxygen-15-labeled water and positron emission tomography
Bergmann, S.R.; Herrero, P.; Markham, J.; Weinheimer, C.J.; Walsh, M.N. (Washington Univ. School of Medicine, St. Louis, MO (USA))
Noninvasive measurement of myocardial blood flow in absolute terms (i.e., milliliters per gram per min) has been difficult to accomplish despite the intrinsically quantitative power of positron emission tomography because of the nonphysiologic nature of tracers that have been employed conventionally as well as the limited spatial resolution of currently available instruments. It was previously demonstrated that myocardial blood flow in animals can be quantitated accurately with the diffusible tracer oxygen-15-labeled water (H2(15)O) when the arterial input function and myocardial radiotracer concentration were measured directly. To extend the approach for completely noninvasive measurement of blood flow, a parameter estimation procedure was developed whereby effects of limited tomographic spatial resolution and cardiac motion were compensated for within the operational flow model. In validation studies in 18 dogs, myocardial blood flow measured with positron emission tomography after intravenously administered H2(15)O correlated closely with flow measured with concomitantly administered radiolabeled microspheres over the range of 0.29 to 5.04 ml/g per min (r = 0.95). Although regional ischemia was clearly identifiable tomographically, absolute flow could not be determined accurately in ischemic regions in four dogs because of poor count statistics related to wall thinning. Subsequently, myocardial blood flow was measured in 11 normal human subjects. Flow was homogeneous throughout the myocardium, averaged 0.90 +/- 0.22 ml/g per min at rest and increased to 3.55 +/- 1.15 ml/g per min after intravenous administration of dipyridamole. Therefore, positron emission tomography with H2 15O and the approach developed permits noninvasive measurement of myocardial blood flow in absolute terms in humans and should facilitate objective assessment of interventions designed to enhance nutritive perfusion.
Patterns of Muscular Strain in the Embryonic Heart Wall
Damon, Brooke J.; Rémond, Mathieu C.; Bigelow, Michael R.; Trusk, Thomas C.; Xie, Wenjie; Perucchio, Renato; Sedmera, David; Denslow, Stewart; Thompson, Robert P.
The hypothesis that inner layers of contracting muscular tubes undergo greater strain than concentric outer layers was tested by numerical modeling and by confocal microscopy of strain within the wall of the early chick heart. We modeled the looped heart as a thin muscular shell surrounding an inner layer of sponge-like trabeculae by two methods: calculation within a two-dimensional three-variable lumped model and simulated expansion of a three-dimensional, four-layer mesh of finite elements. Analysis of both models, and correlative microscopy of chamber dimensions, sarcomere spacing, and membrane leaks, indicate a gradient of strain decreasing across the wall from highest strain along inner layers. Prediction of wall thickening during expansion was confirmed by ultrasonography of beating hearts. Degree of stretch determined by radial position may thus contribute to observed patterns of regional myocardial conditioning and slowed proliferation, as well as to the morphogenesis of ventricular trabeculae and conduction fascicles. PMID:19418446
Serum total antioxidant activity after myocardial infarction.
Miller, N J; Johnston, J D; Collis, C S; Rice-Evans, C
Serum total antioxidant activity (TAA), albumin and uric acid were measured on admission, and for the next 2 days in 56 patients suffering myocardial infarction, 20 of whom received streptokinase. The 'antioxidant gap', the difference between the serum TAA and the sum of the serum albumin and uric acid activity, was calculated. No significant changes in serum total antioxidant activity were observed in either group of patients between admission, day 1 and day 2. However, a decline in the 'antioxidant gap' after myocardial infarction was associated with a significantly higher mortality. PMID:9022893
Rectal-wall dose dependence on postplan timing after permanent-seed prostate brachytherapy
Taussky, Daniel [Department of Radiation Oncology, Princess Margaret Hospital, Toronto (Canada); Yeung, Ivan [Department of Radiation Physics, Princess Margaret Hospital, Toronto (Canada); Williams, Theresa [Department of Radiation Medicine, Princess Margaret Hospital, Toronto (Canada); Pearson, Shannon [Department of Radiation Medicine, Princess Margaret Hospital, Toronto (Canada); McLean, Michael [Department of Radiation Oncology, Princess Margaret Hospital, Toronto (Canada); Pond, Gregory [Department of Biostatistics, Princess Margaret Hospital, Toronto (Canada); Crook, Juanita [Department of Radiation Oncology, Princess Margaret Hospital, Toronto (Canada)]. E-mail: email@example.com
Purpose: Dose to rectal wall after permanent-seed prostate brachytherapy is dependent on distance between posterior prostatic seeds and anterior rectal wall and is influenced by postimplant periprostatic edema. We analyzed the effect of postplan timing on anterior rectal-wall dose. Methods and Materials: Twenty patients received permanent seed {sup 125}I brachytherapy as monotherapy (145 Gy). Implants were preplanned by use of transrectal ultrasound (TRUS) and carried out by use of preloaded needles. Postimplant dosimetry was calculated by use of magnetic resonance imaging-computed tomography fusion on Days 1, 8, and 30. The anterior rectal-wall dose is reported as the isodose enclosing 1.0 or 2.0 cc of rectal wall and as the RV100 in cc. Results: The dose to rectal wall increased progressively over time. The median increase in dose to 1.0 cc of rectal wall (RD [1 cc]) from Day 1 to 30 was 39.2 Gy (p < 0.001). RV100 increased from a median of 0.07 cc on Day 1 to 0.67 cc on Day 30. The most significant predictor of rectal-wall dose (RD [1 cc], RD [2 cc], or RV100) was the time of evaluation (p < 0.001). Conclusion: Although periprostatic edema cannot be quantified by postimplant imaging, the dose to the anterior rectal wall increases significantly over time as prostatic and periprostatic edema resolve. Critical-organ dose reporting and guidelines for minimizing toxicity must take into account the time of the assessment.
Imaging three-dimensional myocardial mechanics using navigator-gated volumetric spiral cine DENSE MRI.
Zhong, Xiaodong; Spottiswoode, Bruce S; Meyer, Craig H; Kramer, Christopher M; Epstein, Frederick H
A navigator-gated 3D spiral cine displacement encoding with stimulated echoes (DENSE) pulse sequence for imaging 3D myocardial mechanics was developed. In addition, previously described 2D postprocessing algorithms including phase unwrapping, tissue tracking, and strain tensor calculation for the left ventricle (LV) were extended to 3D. These 3D methods were evaluated in five healthy volunteers, using 2D cine DENSE and historical 3D myocardial tagging as reference standards. With an average scan time of 20.5 ± 5.7 min, 3D data sets with a matrix size of 128 × 128 × 22, voxel size of 2.8 × 2.8 × 5.0 mm(3), and temporal resolution of 32 msec were obtained with displacement encoding in three orthogonal directions. Mean values for end-systolic mid-ventricular mid-wall radial, circumferential, and longitudinal strain were 0.33 ± 0.10, -0.17 ± 0.02, and -0.16 ± 0.02, respectively. Transmural strain gradients were detected in the radial and circumferential directions, reflecting high spatial resolution. Good agreement by linear correlation and Bland-Altman analysis was achieved when comparing normal strains measured by 2D and 3D cine DENSE. Also, the 3D strains, twist, and torsion results obtained by 3D cine DENSE were in good agreement with historical values measured by 3D myocardial tagging. PMID:20574967
Erythropoietin has an antiapoptotic effect after myocardial infarction and stimulates in vitro aortic ring sprouting
Mansson Broberg, Agneta [Department of Cardiology, M52 Karolinska University Hospital, S14186 Stockholm (Sweden); Grinnemo, Karl-Henrik [Department of Cardiothoracic Surgery, Karolinska University Hospital (Sweden); Genead, Rami; Danielsson, Christian; Andersson, Agneta B.; Waerdell, Eva [Department of Cardiology, M52 Karolinska University Hospital, S14186 Stockholm (Sweden); Sylven, Christer [Department of Cardiology, M52 Karolinska University Hospital, S14186 Stockholm (Sweden)], E-mail: firstname.lastname@example.com
Aims were to explore if darbepoietin-{alpha} in mouse can induce angiogenesis and if moderate doses after myocardial infarction stimulates periinfarct capillary and arteriolar densities, cell proliferation, and apoptosis. Myocardial infarction was induced by ligation of LAD. Mouse aortic rings (0.8 mm) were cultured in matrigel and the angiogenic sprouting was studied after addition of darbepoietin-{alpha} with and without VEGF-165. After 12 days the hemoglobin concentration was 25% higher in the darbepoietin-{alpha} treated mice than in the control group. No difference in capillary densities in the periinfarct or noninfarcted areas was seen with darbepoietin-{alpha}. Cell proliferation was about 10 times higher in the periinfarct area than in the noninfarcted wall. Darbepoietin-{alpha} treatment led to a decrease of cell proliferation (BrdU, (p < 0.02)) and apoptosis (TUNEL, p < 0.005) with about 30% in the periinfarct area. Darbepoietin-{alpha} and VEGF-165 both independently induced sprouting from aortic rings. The results suggest that darbepoietin-{alpha} can induce angiogenesis but that moderate doses after myocardial infarction are not angiogenic but antiapoptotic.
Interference Screw Fixation of Soft Tissue Grafts in Anterior Cruciate Ligament Reconstruction: Part 1Effect of Tunnel Compaction by Serial Dilators Versus Extraction Drilling on the Initial Fixation Strength
Janne T. Nurmi; Pekka Kannus; Harri Sievänen; Timo Järvelä; Markku Järvinen; Teppo L. N. Järvinen
Background:Compaction of the bone-tunnel walls by serial dilation is believed to enhance the interference screw fixation strength of the soft tissue grafts in anterior cruciate ligament (ACL) reconstruction.Hypothesis:Serial dilation enhances the fixation strength of soft tissue grafts in ACL reconstruction over extraction drilling.Study Design:Randomized experimental study.Methods:Initial fixation strength of the doubled anterior tibialis tendon grafts (fixed with a bioabsorbable interference
Anterior Transpetrosal Approach to the Prepontine Epidermoids
Shimamoto, Yoshinori; Kawase, Takeshi; Sasaki, Hikaru; Shiobara, Ryuzou; Yamada, Fumito
We have operated on nine patients with a prepontine epidermoid extending to the bilateral cistern or the unilateral middle fossa using the anterior transpetrosal approach since 1986. The preoperative symptoms were unilateral trigeminal neuralgia, hearing disturbance, gait disturbance, double vision, facial hypesthesia, hemifacial spasm, and dysphagia. The most common neurological sign was unilateral trigeminal nerve disturbance. In two patients with useful hearing preoperatively lost, the labyrinth and mastoid air cells as well as the petrous apex were resected to extend the surgical field. Tumors were totally removed, except for capsules that were tightly adhered to the brain stem, cranial nerve, and vessels. The trigeminal neuralgia, hemifacial spasm, and dysphagia disappeared, but double vision improved only one out of three cases, and facial hypesthesia was unchanged in all cases. There were no postoperative deaths. New abducens palsy appeared in four cases and cerebrospinal fluid (CSF) leakage appeared in three cases postoperatively, but later these symptoms disappeared. In one case, postoperative chemical meningitis developed, and a ventricular shunt was required later to treat hydrocephalus. Postoperative follow-up, an average of 5,7 years, did not show any increases in any of the tumors. Based on our experience, we conclude that the anterior transpetrosal approach is more useful than the retromastoid suboccipital approach to resect the epidermoid located mainly in the prepontine cistern. ImagesFigure 2Figure 3Figure 4Figure 5Figure 6 PMID:17171121
Biomechanical analysis of the anterior cervical fusion.
Fernandes, P C; Fernandes, P R; Folgado, J O; Levy Melancia, J
This paper presents a biomechanical analysis of the cervical C5-C6 functional spine unit before and after the anterior cervical discectomy and fusion. The aim of this work is to study the influence of the medical procedure and its instrumentation on range of motion and stress distribution. First, a three-dimensional finite element model of the lower cervical spine is obtained from computed tomography images using a pipeline of image processing, geometric modelling and mesh generation software. Then, a finite element study of parameters' influence on motion and a stress analysis at physiological and different post-operative scenarios were made for the basic movements of the cervical spine. It was confirmed that the results were very sensitive to intervertebral disc properties. The insertion of an anterior cervical plate influenced the stress distribution at the vertebral level as well as in the bone graft. Additionally, stress values in the graft decreased when it is used together with a cage. PMID:21806410
[Treatment of unreduced anterior shoulder dislocation].
Noack, W; Strohmeier, M
We evaluated the results of treatment in six patients with unreduced chronic anterior dislocations of the shoulder. In three patients the dislocations had not been recognized by the initial treating physician. In the remaining three patients the dislocations initially had been diagnosed but reduction had failed and the dislocations had remained unreduced. In one of the six shoulders the dislocation was left unreduced. The dislocation existed for 3.5 years and there was absence of disabling functional impairment, pain or neurovascular disturbance. In five of six shoulders the function was severely impaired. One of five shoulders with an anterior dislocation of three weeks duration could be reduced by closed manipulation. Four shoulders underwent open reduction. In all patients the humeral head could be preserved. Associated osseous lesions of the glenoid or the humeral head (Hill-Sachs lesions, fractures) were treated by rotation osteotomies according to Weber and the Eden-Lange-Hybinette procedure. Preoperatively all shoulders were graded as poor. Postoperatively the results in one was graded as excellent, in three as good and in one (algodystrophy of the left arm) as fair. PMID:3176187
Geometry of anterior open bite correction.
Abramson, Zachary R; Susarla, Srinivas M; Lawler, Matthew E; Choudhri, Asim F; Peacock, Zachary S
Correction of anterior open bite is a frequently encountered and challenging problem for the craniomaxillofacial surgeon and orthodontist. Accurate clinical evaluation, including cephalometric assessment, is paramount for establishing the diagnosis and appropriate treatment plan. The purposes of this technical note were to discuss the basic geometric principles involved in the surgical correction of skeletal anterior open bites and to offer a simple mathematical model for predicting the amount of posterior maxillary impaction with concomitant mandibular rotation required to establish an adequate overbite. Using standard geometric principles, a mathematical model was created to demonstrate the relationship between the magnitude of the open bite and the magnitude of the rotational movements required for correction. This model was then validated using a clinical case. In summary, the amount of open bite closure for a given amount of posterior maxillary impaction depends on anatomic variables, which can be obtained from a lateral cephalogram. The clinical implication of this relationship is as follows: patients with small mandibles and steep mandibular occlusal planes will require greater amounts of posterior impaction. PMID:25950521
Approach-avoidance activation without anterior asymmetry
Uusberg, Andero; Uibo, Helen; Tiimus, Riti; Sarapuu, Helena; Kreegipuu, Kairi; Allik, Jüri
Occasionally, the expected effects of approach-avoidance motivation on anterior EEG alpha asymmetry fail to emerge, particularly in studies using affective picture stimuli. These null findings have been explained by insufficient motivational intensity of, and/or overshadowing interindividual variability within the responses to emotional pictures. These explanations were systematically tested using data from 70 students watching 5 types of affective pictures ranging from very pleasant to unpleasant. The stimulus categories reliably modulated self-reports as well as the amplitude of late positive potential, an ERP component reflecting orienting toward motivationally significant stimuli. The stimuli did not, however, induce expected asymmetry effects either for the sample or individual participants. Even while systematic stimulus-dependent individual differences emerged in self-reports as well as LPP amplitudes, the asymmetry variability was dominated by stimulus-independent interindividual variability. Taken together with previous findings, these results suggest that under some circumstances anterior asymmetry may not be an inevitable consequence of core affect. Instead, state asymmetry shifts may be overpowered by stable trait asymmetry differences and/or stimulus-independent yet situation-dependent interindividual variability, possibly caused by processes such as emotion regulation or anxious apprehension. PMID:24653710
Antioxidant Delivery Pathways in the Anterior Eye
Tissues in the anterior segment of the eye are particular vulnerable to oxidative stress. To minimise oxidative stress, ocular tissues utilise a range of antioxidant defence systems which include nonenzymatic and enzymatic antioxidants in combination with repair and chaperone systems. However, as we age our antioxidant defence systems are overwhelmed resulting in increased oxidative stress and damage to tissues of the eye and the onset of various ocular pathologies such as corneal opacities, lens cataracts, and glaucoma. While it is well established that nonenzymatic antioxidants such as ascorbic acid and glutathione are important in protecting ocular tissues from oxidative stress, less is known about the delivery mechanisms used to accumulate these endogenous antioxidants in the different tissues of the eye. This review aims to summarise what is currently known about the antioxidant transport pathways in the anterior eye and how a deeper understanding of these transport systems with respect to ocular physiology could be used to increase antioxidant levels and delay the onset of eye diseases. PMID:24187660
Meta-Analysis Comparing Zero-Profile Spacer and Anterior Plate in Anterior Cervical Fusion
Lu, Teng; Liang, Baobao; Xu, Junkui; Zhou, Jun; Lv, Hongjun; Qin, Jie; Cai, Xuan; Huang, Sihua; Li, Haopeng; Wang, Dong; He, Xijing
Background Anterior plate fusion is an effective procedure for the treatment of cervical spinal diseases but is accompanied by a high incidence of postoperative dysphagia. A zero profile (Zero-P) spacer is increasingly being used to reduce postoperative dysphagia and other potential complications associated with surgical intervention. Studies comparing the Zero-P spacer and anterior plate have reported conflicting results. Methodology A meta-analysis was conducted to compare the safety, efficacy, radiological outcomes and complications associated with the use of a Zero-P spacer versus an anterior plate in anterior cervical spine fusion for the treatment of cervical spinal disease. We comprehensively searched PubMed, Embase, the Cochrane Library and other databases and performed a meta-analysis of all randomized controlled trials (RCTs) and prospective or retrospective comparative studies assessing the two techniques. Results Ten studies enrolling 719 cervical spondylosis patients were included. The pooled data showed significant differences in the operation time [SMD = –0.58 (95% CI = ?0.77 to 0.40, p < 0.01)] and blood loss [SMD = ?0.40, 95% CI (?0.59 to –0.21), p < 0.01] between the two groups. Compared to the anterior plate group, the Zero-P group exhibited a significantly improved JOA score and reduced NDI and VAS. However, anterior plate fusion had greater postoperative segmental and cervical Cobb's angles than the Zero-P group at the last follow-up. The fusion rate in the two groups was similar. More importantly, the Zero-P group had a lower incidence of earlier and later postoperative dysphagia. Conclusions Compared to anterior plate fusion, Zero-P is a safer and effective procedure, with a similar fusion rate and lower incidence of earlier and later postoperative dysphagia. However, the results of this meta-analysis should be accepted with caution due to the limitations of the study. Further evaluation and large-sample RCTs are required to confirm and update the results of this study. PMID:26067917
Cutaneous Metastasis of Medullary Carcinoma Thyroid Masquerading as Subcutaneous Nodules Anterior Chest and Mandibular Region
Mannan, Rahul; Kaur, Jasmine; Kaur, Jasleen; Piplani, Sanjay; Kaur, Harleen
Cutaneous metastasis of underlying primary malignancies can present to dermatologist with chief complaints of cutaneous lesions. The underlying malignancy is generally diagnosed much later after a complete assessment of the concerned case. Medullary carcinoma thyroid (MCT) is a relatively uncommon primary neoplasia of the thyroid. Very few cases presenting as cutaneous metastases of MCT have been reported in the literature. Most of the cases which have been reported are of the papillary and the follicular types. We here report a case of a patient who presented in the dermatology clinic with the primary complaint of multiple subcutaneous nodules in anterior chest wall and left side of body of mandible. By systematic application of clinical and diagnostic skills these nodules were diagnosed as cutaneous metastasis of MCT bringing to the forefront a history of previously operated thyroid neoplasm. So clinically, the investigation of a flesh coloured subcutaneous nodule, presenting with a short duration, particularly in scalp, jaw, or anterior chest wall should include possibility of metastastic deposits. A dermatologist should keep a possibility of an internal organ malignancy in patients while investigating a case of flesh coloured subcutaneous nodules, presenting with short duration. A systematic application of clinical and diagnostic skills will eventually lead to such a diagnosis even when not suspected clinically at its primary presentation. A prompt and an emphatic diagnosis and treatment will have its bearing on the eventual outcome in all these patients. PMID:25478248
Review of 31 cases of anterior thoracolumbar fixation with the anterior thoracolumbar locking plate system.
Wilson, J A; Bowen, S; Branch, C L; Meredith, J W
Anterior fixation devices for the thoracolumbar spine have gained wide acceptance as viable alternatives to long-segment posterior fixation in cases of thoracolumbar spine trauma. This review was undertaken to evaluate the safety and efficacy of the Synthes anterior thoracolumbar locking plate (ATLP) system. Over a 3-year period, 31 patients with unstable traumatic fractures of the thoracolumbar spine underwent corpectomy, placement of a structural bone graft, and anterior fixation in which the Synthes ATLP system was used. Long-term follow-up data were obtained in 29 patients. Two patients were lost to follow up, one at 4 months and the other at 1 year. In the remaining patients, the average length of follow up was 20 months. In all patients radiographic evidence of solid bone fusion was demonstrated on follow-up plain x-ray films, and there were no signs or symptoms of pseudarthrosis. No patient suffered neurological deterioration as a result of surgery, and there was relatively little morbidity associated with this plating system. To date, none of the patients in this study has developed any delayed complications related to the fixation device. In one patient, who had sustained a severe flexion injury, loosening of the anterior fixation device occurred, and the patient developed progressive kyphosis, which required a posterior stabilization procedure. These results appear slightly better than those obtained in published studies in which other anterior plating systems were used, indicating that this system is safe and effective in the treatment of unstable fractures of the thoracolumbar spine. PMID:16918232
Reliability of myocardial salvage assessment by cardiac magnetic resonance imaging in acute reperfused myocardial infarction
Steffen DeschHubertus; Hubertus Engelhardt; Josefine Meissner; Ingo Eitel; Mahdi Sareban; Georg Fuernau; Suzanne de Waha; Matthias Grothoff; Matthias Gutberlet; Gerhard Schuler; Holger Thiele
Myocardial salvage assessed by cardiac magnetic resonance imaging (CMRI) holds promise as a surrogate endpoint in studies\\u000a comparing different treatment strategies for ST-elevation myocardial infarction (STEMI). The aim of this study was to evaluate\\u000a the reliability of salvaged myocardium measurements by CMRI. Twenty patients underwent CMRI on 2 consecutive days early after\\u000a reperfused STEMI to assess the area at risk
Assessment of myocardial blood perfusion improved by CD151 in a pig myocardial infarction model
Hou-juan Zuo; Zheng-xiang Liu; Xiao-chun Liu; Jun Yang; Tao Liu; Sha Wen; Dao-wen Wang; Xin Zhang
Aim:To appraise the efficacy of CD151-induced myocardial therapeutic angiogenesis in a pig myocardial infarction model.Methods:CD151 and anti-CD151 were constructed into the recombinant adeno-associated virus (rAAV) vector. All 26 pigs were subjected to coronary artery ligation or no surgery. Eight weeks after coronary artery ligation, the expression of CD151 was measured by Western blot and immunostaining. Capillary density was evaluated using
[Myocardial rhabdomyolysis following paraphenylene diamine poisoning].
Ababou, A; Ababou, K; Mosadik, A; Lazreq, C; Sbihi, A
Acute intoxication with paraphenylene diamine, a mineral compound used as hair dye, associated asphyxia due to cervical oedema and rhabdomyolysis. We report the case of a patient with lethal cardiogenic shock secondary to myocardial rhabdomyolysis confirmed by a postmortem biopsy. PMID:10730172
Screening for Myocardial Infarction and Ischemic Stroke
Devin L. Brown; Lynda D. Lisabeth; Stanley J. Chetcuti; P. Michael Grossman; Thomas Alexander; J. Douglas Pappas; Mauro Moscucci; Kim A. Eagle; Nelda M. Garcia; Melinda A. Smith; Lewis B. Morgenstern
Studies that accurately identify myocardial infarction (MI) and stroke within populations would provide valuable epidemiological information as well as data on vascular disease prevention. We performed a pilot study to assess the feasibility of adding MI surveillance to an ongoing population-based stroke surveillance study, the Brain Attack Surveillance in Corpus Christi (BASIC) Project. We also tested two screening methods for
Management of anxiety after acute myocardial infarction
Susan K. Frazier; Debra K. Moser; Jennifer L. O'Brien; Bonnie J. Garvin; Kyungeh An; Marlene Macko
Background: Anxiety is common after acute myocardial infarction (AMI) and may induce complications and poorer outcome because of activation of the sympathetic nervous system and the hypothalamic pituitary adrenal axis. Little is known about critical care nurses' management of anxiety in the initial days after AMI. Objective: The purpose of this study was to describe pharmacological and nonpharmacological anxiety management
Decreased selenium levels in acute myocardial infarction
Kok, F.J.; Hofman, A.; Witteman, J.C.M.; de Bruijn, A.M.; Kruyssen, D.H.C.M.; de Bruin, M.; Valkenburg, H.A. (Erasmus Univ. Medical School, Rotterdam (Netherlands))
To study the association between selenium status and the risk of myocardial infarction, the authors compared plasma, erythrocyte, and toenail selenium levels and the activity of erythrocyte glutathione peroxidase among 84 patients with acute myocardial infarction and 84 population controls. Mean concentrations of all selenium measurements were lower in cases than controls. The differences were statistically significant, except for the plasma selenium level. A positive trend in the risk of acute myocardial infarction from high to low toenail selenium levels was observed, which persisted after adjustment for other risk factors for myocardial infarction. In contrast, erythrocyte glutathione peroxidase activity was significantly higher in cases than controls. Because toenail selenium level reflects blood levels up to one year before sampling, these findings suggest that a low selenium status was present before the infarction and, thus, may be of etiologic relevance. The higher glutathione peroxidase activity in the cases may be interpreted as a defense against increased oxidant stress either preceding or following the acute event.
Abdominal wall surgery is surgery that improves the appearance of flabby, stretched-out abdominal (belly) muscles and skin. It ... tummy tuck" to more complicated, extensive surgery. Abdominal wall surgery is not the same as liposuction, which ...
Save or sacrifice the internal mammary pedicle during anterior mediastinotomy?
Apostolakis, Efstratios; Papakonstantinou, Nikolaos A.; Chlapoutakis, Serafeim; Prokakis, Christos
Ligation and dissection of internal mammary vessels is the most under-estimated complication of anterior mediastinotomy. However, patients requiring anterior mediastinotomy may experience long survival that makes the development of ischemic heart disease throughout their life possible. Therefore, the un-judicial sacrifice of the internal mammary pedicle may deprive them from the benefit to have their internal mammary artery used as a graft in order to successfully bypass severe left anterior descending artery stenoses. We recommend the preservation of the internal mammary pedicle during anterior mediastinotomy, which should be a common message among our colleagues from the beginning of their training. PMID:24987471
The Acellular Myocardial Flap: A Novel Extracellular Matrix Scaffold Enriched with Patent Microvascular Networks and Biocompatible Cell Niches
Schulte, Jason B.; Simionescu, Agneta
There is a great need for acellular, fully vascularized, and biocompatible myocardial scaffolds that provide agreeable biological, nutritional, and biomechanical niches for reseeded cells for in vitro and in vivo applications. We generated myocardial flap scaffolds comprising porcine left-anterior ventricular myocardium and its associated coronary arteries and veins and investigated the combinatorial effects of sodium dodecyl sulfate (SDS) and sodium hydroxide (NaOH) perfusion on both the myocardial extracellular matrix (ECM) and the vascular ECM. Results showed that all scaffolds displayed a fully intact and patent vasculature, with arterial burst pressures indistinguishable from native coronary arteries and perfusion to the level of capillaries. Scaffolds were free of cellular proteins and retained collagen and elastin ECM components, exhibited excellent mechanical properties, and were cytocompatible toward relevant seeded cells. SDS perfusion preserved collagen IV, laminin, and fibronectin well, but only reduced DNA content by 33%; however, this was further improved by post-SDS nuclease treatments. By comparison, NaOH was very effective in removing cells and eliminated more than 95% of tissue DNA, but also significantly reduced levels of laminin and fibronectin. Such constructs can be readily trimmed to match the size of the infarct and might be able to functionally integrate within host myocardium and be nourished by direct anastomotic connection with the host's own vasculature; they might also be useful as physiologically accurate models for in vitro studies of cardiac physiology and pathology. PMID:23151037
Time-Course of the Effects of QSYQ in Promoting Heart Function in Ameroid Constrictor-Induced Myocardial Ischemia Pigs
Qiu, Qi; Lin, Yang; Xiao, Cheng; Li, Chun; Wang, Yong; Yang, Kexu; Suo, Wei; Li, Yu; Chuo, Wenjing; Wei, Yongxiang; Wang, Wei
We aim to investigate the therapeutic effects of QSYQ on a pig myocardial ischemia (MI) model and to determine its mechanism of action. The MI model was induced by Ameroid constriction of the left anterior descending coronary (LAD) in Ba-Ma miniature pigs. Four groups were created: model group, digoxin group, QSYQ group, and sham-operated group. Heart function, Ang II, CGMP, TXB2, BNP, and cTnT were evaluated before (3 weeks after operation: 0 weeks) and at 2, 4, and 8 weeks after drug administration. After 8 weeks of administration, the pigs were sacrificed for cardiac injury measurements. Pigs with MI showed obvious histological changes, including BNP, cTnT, Ang II, CGRP, TXB2, and ET, deregulated heart function, and increased levels of apoptotic cells in myocardial tissue. Treatment with QSYQ improved cardiac remodeling by counteracting those events. The administration of QSYQ was accompanied by a restoration of heart function and of the levels of Ang II, CGRP, TXB2, ET BNP, and cTnT. In addition, QSYQ attenuated administration, reduced the apoptosis, and decreased the level of TNF-? and active caspase-3. In conclusion, administration of QSYQ could attenuate Ameroid constrictor induced myocardial ischemia, and TNF-? and active caspase-3 seemed to be the critical potential target of QSYQ. PMID:24817898
GYY4137 protects against myocardial ischemia and reperfusion injury by attenuating oxidative stress and apoptosis in rats
Meng, Guoliang; Wang, Jing; Xiao, Yujiao; Bai, Wenli; Xie, Liping; Shan, Liyang; Moore, Philip K.; Ji, Yong
Abstract Hydrogen sulfide (H2S) is a gasotransmitter that regulates cardiovascular functions. The present study aimed to determine the protective effect of slow-releasing H2S donor GYY4137 on myocardial ischemia and reperfusion (I/R) injury and to investigate the possible signaling mechanisms involved. Male Sprague-Dawley rats were treated with GYY4137 at 12.5 mg/(kg·day), 25 mg/(kg·day) or 50 mg/(kg·day) intraperitoneally for 7 days. Then, rats were subjected to 30 minutes of left anterior descending coronary artery occlusion followed by reperfusion for 24 hours. We found that GYY4137 increased the cardiac ejection fraction and fractional shortening, reduced the ischemia area, alleviated histological injury and decreased plasma creatine kinase after myocardial I/R. Both H2S concentration in plasma and cystathionine-?-lyase (CSE) activity in the myocardium were enhanced in the GYY4137 treated groups. GYY4137 also decreased malondialdehyde and myeloperoxidase levels in serum, attenuated superoxide anion level and suppressed phosphorylation of mitogen activated protein kinases in the myocardium after I/R. Meanwhile, GYY4137 increased the expression of Bcl-2 but decreased the expression of Bax, caspase-3 activity and apoptosis in the myocardium. The data suggest that GYY4137 protects against myocardial ischemia and reperfusion injury by attenuating oxidative stress and apoptosis.
Imaging of myocardial infarction using carbon nanotube micro-computed tomography and delayed contrast enhancement
NASA Astrophysics Data System (ADS)
Burk, Laurel M.; Wang, Kohan; Kang, Eunice; Rojas, Mauricio; Willis, Monte; Lee, Yueh Z.; Lu, Jianping; Zhou, Otto
We demonstrate the application of our cardiac- and respiratory-gated carbon nanotube (CNT) micro-CT system by evaluating murine myocardial infarction models with a delayed contrast enhancement technique. Myocardial infarction was induced in 8 wild-type male mice. The ischemia reperfusion model was achieved by surgical occlusion of the LAD artery for 30 minutes followed by 24 hours of reperfusion. Free-breathing subjects were anesthetized with isoflurane during imaging. Respiratory and cardiac signals were monitored externally to gate the scan. Micro-CT data was obtained at 50kV, 3mA cathode current for 15ms per projection. All images were acquired during end exhalation at either 0msec or 55msec after the R-wave (diastole or systole, respectively). Following administration of Omnipaque 300mgI/mL at 0.1ml/5g, images were obtained at 0msec after the R-wave. Fenestra VC was then administered at a 0.1ml/5g dose, followed by images 0 and 55msec after the R-wave. Hearts were then harvested, sliced 1mm thick and stained with TTC. All animals survived surgery and imaging; all demonstrated obvious delayed contrast enhancement in the left ventricular wall in Omnipaque images. Fenestra VC revealed cardiac functional changes quantified by low ejection fractions. All subjects demonstrated areas of myocardial infarct in the LAD distribution on both TTC staining and micro-CT imaging. CNT enabled gated cardiac micro-CT imaging demonstrates the ability to consistently identify areas of myocardial infarct in mice, providing a powerful tool for the study of cardiovascular biology. Further work is ongoing to streamline the imaging protocol and perform more quantitative analysis of the images.
NSDL National Science Digital Library
In this lesson, students will learn why and how stone walls were built. A prior knowledge of New England colonists and the history of New England is helpful. After a directed reading and discussion, they will take a nature walk to an area where they can examine a stone wall. The students will then use notebook and pencil to sketch the wall and make observations of the stones, the plants growing nearby, and other materials they see around the wall.
Efficacy of coronary artery bypass surgery with gastroepiploic artery. Assessment with thallium 201 myocardial scintigraphy
Kusukawa, J.; Hirota, Y.; Kawamura, K.; Suma, H.; Takeuchi, A.; Adachi, I.; Akagi, H. (Osaka Medical College, Takatsuki (Japan))
This study describes the efficacy of the right gastroepiploic artery (GEA) as graft material for coronary artery bypass grafting (CABG) as assessed by exercise thallium 201 myocardial scintigraphy in eight patients (age, 59.4 {plus minus} 9.35 years (mean {plus minus} SD)) who underwent CABG with the GEA graft in the past 2 years. Planar and single-photon-emission computed tomographic (SPECT) images were obtained during and 3 hours after exercise. Planar images were evaluated quantitatively with the percentile-washout method, and SPECT images were evaluated qualitatively with a bull's-eye, polar-coordinate map. All patients had triple-vessel disease, and in situ GEAs were anastomosed to the right coronary artery in seven patients and to the left anterior descending coronary artery in one. The internal mammary artery graft was concomitantly used in all patients. The mean number of grafts per patient was 3.0 (range, 2-4). Preoperative exercise testing could not be performed in two patients because of emergency operation. By qualitative assessment with the polar-coordinate map, four patients showed improvement, one did not show any change, and one became worse due to perioperative myocardial infarction.
Artemisinin prevents electric remodeling following myocardial infarction possibly by upregulating the expression of connexin 43.
Gu, Yongwei; Wu, Gang; Wang, Xin; Wang, Xi; Wang, Yulin; Huang, Congxin
Artemisinin has been demonstrated to exert beneficial effects on ventricular remodeling. The present study investigated whether artemisinin was able to decrease the ventricular fibrillation threshold (VFT) in rats following myocardial infarction (MI) and aimed to determine the possible underlying mechanisms. The rats were subjected to surgery to induce MI by ligation of the left anterior descending artery and were randomly allocated to receive vehicle or artemisinin (75 mg/kg/day) treatment for four weeks. Programmed electrical stimulation demonstrated a significantly increased VFT in the artemisinin-treated group compared with the vehicle-treated group. The electrophysiological improvement of the VFT was accompanied by increased immunofluorescence-stained connexin 43 (Cx43), myocardial Cx43 protein and mRNA levels in artemisinin-treated rats. The present study also demonstrated that artemisinin significantly decreased tissue tumor necrosis factor (TNF)-? levels at the infarcted border zone. Thus, artemisinin demonstrated a protective effect on ventricular arrhythmias following MI. Although the precise mechanism by which artemisinin modulates the dephosphorylation of Cx43 is unknown, it is likely that artemisinin increased the expression of Cx43 via the inhibition of TNF-?. PMID:25110145
Effect of tumor necrosis factor-? on neutralization of ventricular fibrillation in rats with acute myocardial infarction.
Chen, Yu; Zhang, Qing; Liao, Yu-Hua; Cao, Zhe; Du, Yi-Mei; Xia, Jia-Ding; Yang, Hua; Chen, Zhi-Jian
The purpose of this study was to explore the effects of tumor necrosis factor-? (TNF-?) on ventricular fibrillation (VF) in rats with acute myocardial infarction (AMI). Rats were randomly classified into AMI group, sham operation group and recombinant human tumor necrosis factor receptor:Fc fusion protein (rhTNFR:Fc) group. Spontaneous and induced VFs were recorded. Monophasic action potentials (MAPs) among different zones of myocardium were recorded at eight time points before and after ligation and MAP duration dispersions (MAPDds) were calculated. Then expression of TNF-? among different myocardial zones was detected. After ligation of the left anterior descending coronary artery, total TNF-? expression in AMI group began to markedly increase at 10?min, reached a climax at 20-30 min, and then gradually decreased. The time-windows of VFs and MAPDds in the border zone performed in a similar way. At the same time-point, the expression of TNF-? in the ischemia zone was greater than that in the border zone, and little in the non-ischemia zone. Although the time windows of TNF-? expression, the MAPDds in the border zone and the occurrence of VFs in the rhTNFR:Fc group were similar to those in the AMI group, they all decreased in the rhTNFR:Fc group. Our findings demonstrate that TNF-? could enlarge the MAPDds in the border zone, and promote the onset of VFs. PMID:21584281
Inhalation of concentrated ambient air particles exacerbates myocardial ischemia in conscious dogs.
Wellenius, Gregory A; Coull, Brent A; Godleski, John J; Koutrakis, Petros; Okabe, Kazunori; Savage, Sara T; Lawrence, Joy E; Murthy, G G Krishna; Verrier, Richard L
Short-term increases in ambient air pollution have been associated with an increased incidence of acute cardiac events. We assessed the effect of inhalation exposure to concentrated ambient particles (CAPs) on myocardial ischemia in a canine model of coronary artery occlusion. Six mongrel dogs underwent thoracotomy for implantation of a vascular occluder around the left anterior descending coronary artery and tracheostomy to facilitate particulate exposure. After recovery (5-13 weeks), pairs of subjects were exposed for 6 hr/day on 3 or 4 consecutive days. Within each pair, one subject was randomly assigned to breathe CAPs on the second exposure day and filtered air at other times. The second subject breathed CAPs on the third exposure day and filtered air at other times. Immediately after each exposure, subjects underwent 5-min coronary artery occlusion. We determined ST-segment elevation, a measure of myocardial ischemia heart rate, and arrhythmia incidence during occlusion from continuous electrocardiograms. Exposure to CAPs (median, 285.7; range, 161.3-957.3 microg/m3) significantly (p = 0.007) enhanced occlusion-induced peak ST-segment elevation in precordial leads V4 (9.4 +/- 1.7 vs. 6.2 +/- 0.9 mm, CAPs vs. filtered air, respectively) and V5 (9.2 +/- 1.3 vs. 7.5 +/- 0.9 mm). ST-segment elevation was significantly correlated with the silicon concentration of the particles and other crustal elements possibly associated with urban street dust (p = 0.003 for Si). No associations were found with CAPs mass or number concentrations. Heart rate was not affected by CAPs exposure. These results suggest that exacerbation of myocardial ischemia during coronary artery occlusion may be an important mechanism of environmentally related acute cardiac events. PMID:12676590
Myocardial ischemia, reperfusion, and infarction in chronically instrumented, intact, conscious, and unrestrained mice
Lujan, Heidi L.; Janbaih, Hussein; Feng, Han-Zhong; Jin, Jian-Ping
In the United States alone, the National Heart, Lung, and Blood Institute (NHLBI) has invested several hundred million dollars in pursuit of myocardial infarct-sparing therapies. However, due largely to methodological limitations, this investment has not produced any notable clinical application or cardioprotective therapy. Among the major methodological limitations is the reliance on animal models that do not mimic the clinical situation. In this context, the limited use of conscious animal models is of major concern. In fact, whenever possible, studies of cardiovascular physiology and pathophysiology should be conducted in conscious, complex models to avoid the complications associated with the use of anesthesia and surgical trauma. The mouse has significant advantages over other experimental models for the investigation of infarct-sparing therapies. The mouse is inexpensive, has a high throughput, and presents the ability of one to create genetically modified models. However, successful infarct-sparing therapies in anesthetized mice or isolated mouse hearts may not be successful in more complex models, including conscious mice. Accordingly, a conscious mouse model of myocardial ischemia and reperfusion has the potential to be of major importance for advancing the concepts and methods that drive the development of infarct-sparing therapies. Therefore, we describe, for the first time, the use of an intact, conscious, and unrestrained mouse model of myocardial ischemia-reperfusion and infarction. The conscious mouse model permits occlusion and reperfusion of the left anterior descending coronary artery in an intact, complex model free of the confounding influences of anesthetics and surgical trauma. This methodology may be adopted for advancing the concepts and ideas that drive cardiovascular research. PMID:22538514
Impaired Autophagy Contributes to Adverse Cardiac Remodeling in Acute Myocardial Infarction
Chen, Fajiang; He, Xiaoen; Cai, Yi; Zhang, Guiping; Yi, Quan; He, Meixiang; Luo, Jiandong
Objective Autophagy is activated in ischemic heart diseases, but its dynamics and functional roles remain unclear and controversial. In this study, we investigated the dynamics and role of autophagy and the mechanism(s), if any, during postinfarction cardiac remodeling. Methods and results Acute myocardial infarction (AMI) was induced by ligating left anterior descending (LAD) coronary artery. Autophagy was found to be induced sharply 12–24 hours after surgery by testing LC3 modification and Electron microscopy. P62 degradation in the infarct border zone was increased from day 0.5 to day 3, and however, decreased from day 5 until day 21 after LAD ligation. These results indicated that autophagy was induced in the acute phase of AMI, and however, impaired in the latter phase of AMI. To investigate the significance of the impaired autophagy in the latter phase of AMI, we treated the mice with Rapamycin (an autophagy enhancer, 2.0 mg/kg/day) or 3-methyladenine (3MA, an autophagy inhibitor, 15 mg/kg/day) one day after LAD ligation until the end of experiment. The results showed that Rapamycin attenuated, while 3MA exacerbated, postinfarction cardiac remodeling and dysfunction respectively. In addition, Rapamycin protected the H9C2 cells against oxygen glucose deprivation in vitro. Specifically, we found that Rapamycin attenuated NF?B activation after LAD ligation. And the inflammatory response in the acute stage of AMI was significantly restrained with Rapamycin treatment. In vitro, inhibition of NF?B restored autophagy in a negative reflex. Conclusion Sustained myocardial ischemia impairs cardiomyocyte autophagy, which is an essential mechanism that protects against adverse cardiac remodeling. Augmenting autophagy could be a therapeutic strategy for acute myocardial infarction. PMID:25409294
Acupuncture Promotes Angiogenesis after Myocardial Ischemia through H3K9 Acetylation Regulation at VEGF Gene
Xu, Bin; Hu, Chen-Jun; Lu, Sheng-Feng; Shen, Wei-Xing; Huang, Yan; Hong, Hao; Li, Qian; Wang, Ning; Liu, Xuan-Liang; Liang, Fanrong; Zhu, Bing-Mei
Background Acupuncture exerts cardioprotective effects on several types of cardiac injuries, especially myocardial ischemia (MI), but the mechanisms have not yet been well elucidated. Angiogenesis mediated by VEGF gene expression and its modification through histone acetylation has been considered a target in treating myocardial ischemia. This study aims to exam whether modulation of angiogenesis through H3K9 acetylation regulation at VEGF gene is one possible cardioprotective mechanism of acupuncture. Results We generated rat MI models by ligating the left anterior descending coronary artery and applied electroacupuncture (EA) treatment at the Neiguan (PC6) acupoint. Our results showed that acupuncture reversed the S-T segment change, reduced Q-wave area, decreased CK, CK-MB, LDH levels, mitigated myocardial remodeling, and promoted microvessel formation in the MI heart. RNA-seq analysis showed that VEGF-induced angiogenesis signaling was involved in the modulation of EA. Western blot results verified that the protein expressions of VEGF, Ras, phospho-p44/42 MAPK, phospho-p38 MAPK, phospho-SAPK/JNK and Akt, were all elevated significantly by EA treatment in the MI heart. Furthermore, increased H3K9 acetylation was also observed according with the VEGF. ChIP assay confirmed that EA treatment could notably stimulate the recruitment of H3K9ace at the VEGF promoter. Conclusions Our study demonstrates for the first time that acupuncture can effectively up-regulate VEGF expression through H3K9 acetylation modification directly at the VEGF promoter and hence activate VEGF-induced angiogenesis in rat MI models. We employed high throughput sequencing in this study and, for the first time, generated genome-wide gene expression profiles both in the rat MI model and in acupuncture treatment. PMID:24722278
Effect of High Dose Rosuvastatin Loading before Primary Percutaneous Coronary Intervention on Infarct Size in Patients with ST-Segment Elevation Myocardial Infarction
Kim, Ji Won; Kim, Eun Kyoung; Kim, Yong Cheol; Joe, Dai-Yeol; Ko, Jum Suk; Rhee, Sang Jae; Lee, Eun Mi; Yoo, Nam Jin; Kim, Nam-Ho; Oh, Seok Kyu; Jeong, Jin-Won
Background and Objectives High dose rosuvastatin loading before percutaneous coronary interventions (PCI) reduces the myocardial damage and the incidence of adverse cardiac events in patients with stable angina and acute coronary syndrome. However, no studies are present yet about rosuvastatin loading in patients with ST-segment elevation myocardial infarction (STEMI) in a primary PCI setting. Subjects and Methods A total of 475 patients who underwent primary PCI for STEMI were studied. The study population was divided into two groups with 208 patients in the statin group=40 mg rosuvastatin loading before primary PCI and 267 patients in the control group=no statin pretreatment. At median 3 days after PCI a single-photon emission computed tomography (SPECT) was performed with technetium 99m tetrofosmin For this study were compared infarct size, corrected Thrombolysis in Myocardial Infarction (TIMI) frame count and the myocardial blush grade (MBG) between the both groups. Results Baseline clinical and procedural characteristics were similar between the groups. Infarct size, as assessed by SPECT, was significantly smaller (19.0±15.9% vs. 22.9±16.5%, p=0.009) in the statin group than in the control group. Patients of the statin group showed a lower corrected TIMI frame count (28.2±19.3 vs. 32.6±21.4, p=0.020), and higher MBG (2.49±0.76 vs. 2.23±0.96, p=0.001) than the patients of the control group. The multivariate analysis revealed that rosuvastatin loading {odds ratio (OR) 0.61}, pain to balloon time (OR 2.05), anterior myocardial infarction (OR 3.89) and final the MBG (OR 2.93) were independent predictors of a large infarct size. Conclusion A high dose rosuvastatin loading before the primary PCI reduced the infarct size by microvascular myocardial perfusion improvement. PMID:24653736
Edi Halyo
We describe domain walls that live on $A_2$ and $A_3$ singularities. The walls are BPS if the singularity is resolved and non--BPS if it is deformed and fibered. We show that these domain walls may interpolate between vacua that support monopoles and/or vortices.
ERIC Educational Resources Information Center
Tarr, Patricia
This article critically examines classroom walls from four perspectives: (1) reading the environment; (2) walls that silence; (3) the purpose of display; and (4) aesthetics. The author offers some suggestions for teachers to consider when purchasing materials and in planning how to use classroom walls to enhance the educational setting. She…
NSDL National Science Digital Library
This outline provides a list of key terms used to describe stone walls. The definitions for each term can be found in the corresponding chapter and section of the book 'Exploring Stone Walls'. Users can use the outline as a checklist, marking off the terms that best describe the wall they are investigating.
Halogenation of microcapsule walls
NASA Technical Reports Server (NTRS)
Davis, T. R.; Schaab, C. K.; Scott, J. C.
Procedure for halogenation of confining walls of both gelatin and gelatin-phenolic resin capsules is similar to that used for microencapsulation. Ten percent halogen content renders capsule wall nonburning; any higher content enhances flame-retardant properties of selected internal phase material. Halogenation decreases permeability of wall material to encapsulated materials.
Effect of transducer standoff on the detection, spatial extent, and quantification of myocardial contrast defects caused by coronary stenoses.
Porter, T R; Xie, F; Li, S; Kricsfeld, D; Deligonul, U
Intermittent harmonic imaging during a continuous infusion of microbubbles may be able to quantify myocardial perfusion abnormalities. Measurements of the spatial extent of these perfusion abnormalities depends on homogenous destruction of the microbubbles in the elevation plane of the transducer. We hypothesized that uneven microbubble destruction caused by attenuation of beam intensity could alter quantitative measurements of perfusion abnormalities during stress. To test this hypothesis, we measured the spatial extent of perfusion defects at peak dobutamine stress with a continuous intravenous infusion of perfluorocarbon-exposed sonicated dextrose albumin and intermittent harmonic imaging in dogs with nonflow-limiting coronary stenoses in the left anterior descending artery. The spatial extent of perfusion defects was also measured during total occlusion of the artery. Measurements were made at standoffs of 2- to 3-cm and 4- to 5-cm distance from transducer surface to myocardium. These spatial extents were correlated with risk area determined after death. The risk area during left anterior descending occlusion at a standoff of 2 to 3 cm was significantly larger at a 1500-ms pulsing interval (6.5 +/- 2.6 cm(2) for 2- to 3-cm standoff versus 3.7 +/- 1.4 cm(2) for 4- to 5-cm standoff; P =.01). The spatial extent at the 2- to 3-cm standoff more closely approximated risk area measured with Monastral Blue (7.8 +/- 2.7 cm(2)). Myocardial perfusion abnormalities during peak dobutamine stress were significantly smaller with the 4- to 5-cm standoff and undetectable in 4 of the 5 dogs. We conclude that ultrasound beam attenuation can reduce the size of a myocardial perfusion abnormality observed with intermittent harmonic imaging during a continuous infusion of microbubbles. This may reduce the sensitivity of this technique when transthoracic imaging is used. PMID:10552356
Comparison of Scheimpflug imaging and spectral domain anterior segment optical coherence tomography for detection of narrow anterior chamber angles
D S Grewal; G S Brar; R Jain; S P S Grewal
PurposeTo compare the performance of anterior chamber volume (ACV) and anterior chamber depth (ACD) obtained using Scheimpflug imaging with angle opening distance (AOD500) and trabecular-iris space area (TISA500) obtained using spectral domain anterior segment optical coherence tomography (SD-ASOCT) in detecting narrow angles classified using gonioscopy.MethodsIn this prospective, cross-sectional observational study, 265 eyes of 265 consecutive patients underwent sequential Scheimpflug imaging,
[Noninvasive diagnosis of cardiac involvement by technetium-99m-pyrophosphate (Tc-99m PYP) myocardial scintigraphy in 2 cases of familial amyloid polyneuropathy and 1 case of secondary amyloidosis].
Takezaki, M; Ishida, Y; Morozumi, T; Tani, A; Sato, H; Hori, M; Kitabatake, A; Kamada, T; Kimura, K; Kozuka, T
To validate the significance of technetium-99m-pyrophosphate (Tc-99m PYP) myocardial scintigraphy in diagnosing cardiac amyloidosis, 2 patients with familial amyloid polyneuropathy (FAP) and 1 patient with amyloidosis secondary to chronic rheumatic arthritis were studied. All three patients had echocardiographic abnormalities, which were increased wall thickness of the interventricular septum and the left ventricular posterior wall, and granular sparkling appearance in the septum. In 2 patients with FAP, abnormal myocardial uptake of Tc-99m PYP was diffusely detected in Tc-99m PYP SPECT. In the remaining 1 patient with secondary amyloidosis, however, Tc-99m PYP SPECT showed no abnormality, although we had confirmed the presence of myocardial amyloid deposits (type AA amyloid protein) with high amount in the histological examination. Thus, these results indicate that Tc-99m PYP scintigraphy may have a limitation in detecting cardiac involvement in secondary amyloidosis although it is useful in FAP. PMID:2560088
Current Trends in Anterior Cruciate Ligament Reconstruction
Kim, Ha Sung; Jo, Ah Reum
The advances in the knowledge of anatomy, surgical techniques, and fixation devices have led to the improvement of anterior cruciate ligament (ACL) reconstruction over the past 10 years. Nowadays, double bundle and anatomical single bundle ACL reconstruction that more closely restores the normal anatomy of the ACL are becoming popular. Although there is still no definite conclusion whether double bundle ACL reconstruction provides better clinical results than single bundle reconstruction, the trend has shifted to anatomic reconstruction regardless of single bundle or double bundle techniques. We could not find any significant differences in the clinical outcomes and stability after ACL reconstruction according to the type of graft or fixation device. Therefore, surgeons should select an ideal ACL reconstruction according to the patient's condition and surgeon's experience. PMID:24368993
Anterior insula degeneration in frontotemporal dementia
The human anterior insula is anatomically and functionally heterogeneous, containing key nodes within distributed speech–language and viscero-autonomic/social–emotional networks. The frontotemporal dementias selectively target these large-scale systems, leading to at least three distinct clinical syndromes. Examining these disorders, researchers have begun to dissect functions which rely on specific insular nodes and networks. In the behavioral variant of frontotemporal dementia, early-stage frontoinsular degeneration begets progressive "Salience Network" breakdown that leaves patients unable to model the emotional impact of their own actions or inactions. Ongoing studies seek to clarify local microcircuit- and cellular-level factors that confer selective frontoinsular vulnerability. The search for frontotemporal dementia treatments will depend on a rich understanding of insular biology and could help clarify specialized human language, social, and emotional functions. PMID:20512369
Pathology Case Study: Large Anterior Abdominal Mass
NSDL National Science Digital Library
Pushkar, Irina
This is a case study presented by the University of Pittsburgh Department of Pathology which describes a 72 year old woman who presents with a three day history of constipation and a five year history of a large anterior abdominal mass in the right lower quadrant. Visitors are provided with patient history, admission data, hospital treatment course, and gross and microscopic descriptions, including images, and are given the opportunity to diagnose the patient. A "Final Diagnosis" section provides a discussion of the findings as well as references. This is an excellent resource for students in the health sciences to familiarize themselves with using patient history and laboratory results to diagnose disease. It is also a helpful site for educators to use to introduce or test student learning in surgical pathology.
Individualized anatomic anterior cruciate ligament reconstruction.
van Eck, Carola F; Widhalm, Harrald; Murawski, Christopher; Fu, Freddie H
Abstract Anterior cruciate ligament (ACL) injuries are often seen in young participants in sports such as soccer, football, and basketball. Treatment options include conservative management as well as surgical intervention, with the goal of enabling the patient to return to cutting and pivoting sports and activities. Individualized anatomic ACL reconstruction is a surgical technique that tailors the procedure to the individual patient using preoperative measurements on plain radiographs and magnetic resonance imaging and intraoperative measurement to map the patients' native ACL anatomy in order to replicate it as closely as possible. Anatomic ACL reconstruction, therefore, is defined as reconstruction of the ACL to its native dimensions, collagen orientation, and insertion site. The surgical reconstruction is followed by a specific rehabilitation protocol that is designed to enable the patient to regain muscle strength and proprioception while facilitating healing of the reconstructed ACL prior to the patient's returning to sports activities. PMID:25684559
Anterior Cingulate epilepsy: mechanisms and modulation.
Chang, Wei-Pang; Shyu, Bai-Chuang
Epilepsy is a common neurological disorder, about 1% population worldwide suffered from this disease. In 1989, the International League Against Epilepsy (ILAE) classified anterior cingulate epilepsy as a form of frontal lobe epilepsy (FLE). FLE is the second most common type of epilepsy. Previous clinical studies showed that FLE account an important cause in refractory epilepsy, therefore to find alternative approach to modulate FLE is very important. Basic research using animal models and brain slice have revealed some insights on the epileptogenesis and modulation of seizure in anterior cingulate cortex (ACC). Interneurons play an important role in the synchronization of cingulate epilepsy. Research has shown that the epileptogenesis of seizure originated from mesial frontal lobe might be caused by a selective increase in nicotine-evoked ?-aminobutyric acid (GABA) inhibition, because the application of the GABAA receptor antagonist picrotoxin inhibited epileptic discharges. Gap junctions are also involved in the regulation of cingulate epilepsy. Previous studies have shown that the application of gap junction blockers could attenuate ACC seizures, while gap junction opener could enhance them in an in vitro preparation. ?-Opioid receptors have been shown to be involved in the epileptic synchronization mechanism in ACC seizures in a brain slice preparation. Application of the ?-opioid agonist DAMGO significantly abolished the ictal discharges in a 4-aminopyridine induced electrographic seizure model in ACC. Basic research has also found that thalamic modulation has an inhibitory effect on ACC seizures. Studies have shown that the medial thalamus may be a target for deep brain stimulation to cure ACC seizures. PMID:24427123
Variability of myocardial perfusion dark rim Gibbs artifacts due to sub-pixel shifts
Ferreira, Pedro; Gatehouse, Peter; Kellman, Peter; Bucciarelli-Ducci, Chiara; Firmin, David
Background Gibbs ringing has been shown as a possible source of dark rim artifacts in myocardial perfusion studies. This type of artifact is usually described as transient, lasting a few heart beats, and localised in random segments of the myocardial wall. Dark rim artifacts are known to be unpredictably variable. This article aims to illustrate that a sub-pixel shift, i.e. a small displacement of the pixels with respect to the endocardial border, can result in different Gibbs ringing and hence different artifacts. Therefore a hypothesis for one cause of dark rim artifact variability is given based on the sub-pixel position of the endocardial border. This article also demonstrates the consequences for Gibbs artifacts when two different methods of image interpolation are applied (post-FFT interpolation, and pre-FFT zero-filling). Results Sub-pixel shifting of in vivo perfusion studies was shown to change the appearance of Gibbs artifacts. This effect was visible in the original uninterpolated images, and in the post-FFT interpolated images. The same shifted data interpolated by pre-FFT zero-filling exhibited much less variability in the Gibbs artifact. The in vivo findings were confirmed by phantom imaging and numerical simulations. Conclusion Unless pre-FFT zero-filling interpolation is performed, Gibbs artifacts are very dependent on the position of the subendocardial wall within the pixel. By introducing sub-pixel shifts relative to the endocardial border, some of the variability of the dark rim artifacts in different myocardial segments, in different patients and from frame to frame during first-pass perfusion due to cardiac and respiratory motion can be explained. Image interpolation by zero-filling can be used to minimize this dependency. PMID:19473492
Cyp26 enzymes are required to balance the cardiac and vascular lineages within the anterior lateral plate mesoderm
Rydeen, Ariel B.; Waxman, Joshua S.
Normal heart development requires appropriate levels of retinoic acid (RA) signaling. RA levels in embryos are dampened by Cyp26 enzymes, which metabolize RA into easily degraded derivatives. Loss of Cyp26 function in humans is associated with numerous developmental syndromes that include cardiovascular defects. Although previous studies have shown that Cyp26-deficient vertebrate models also have cardiovascular defects, the mechanisms underlying these defects are not understood. Here, we found that in zebrafish, two Cyp26 enzymes, Cyp26a1 and Cyp26c1, are expressed in the anterior lateral plate mesoderm (ALPM) and predominantly overlap with vascular progenitors (VPs). Although singular knockdown of Cyp26a1 or Cyp26c1 does not overtly affect cardiovascular development, double Cyp26a1 and Cyp26c1 (referred to here as Cyp26)-deficient embryos have increased atrial cells and reduced cranial vasculature cells. Examining the ALPM using lineage tracing indicated that in Cyp26-deficient embryos the myocardial progenitor field contains excess atrial progenitors and is shifted anteriorly into a region that normally solely gives rise to VPs. Although Cyp26 expression partially overlaps with VPs in the ALPM, we found that Cyp26 enzymes largely act cell non-autonomously to promote appropriate cardiovascular development. Our results suggest that localized expression of Cyp26 enzymes cell non-autonomously defines the boundaries between the cardiac and VP fields within the ALPM through regulating RA levels, which ensures a proper balance of myocardial and endothelial lineages. Our study provides novel insight into the earliest consequences of Cyp26 deficiency that underlie cardiovascular malformations in vertebrate embryos. PMID:24667328
Prone Positioning Causes the Heart To Be Displaced Anteriorly Within the Thorax: Implications for Breast Cancer Treatment
Chino, Junzo P. [Department of Radiation Oncology, Duke University Medical Center, Durham, NC (United States)], E-mail: firstname.lastname@example.com; Marks, Lawrence B. [Department of Radiation Oncology, Duke University Medical Center, Durham, NC (United States)
Introduction: Prone positioning has been suggested as an alternative to the conventional supine position for patients receiving breast radiotherapy, but few data exist on how this may alter heart location. We herein quantitatively compare the intrathoracic location of the heart in the prone and supine positions in patients treated for breast cancer. Methods and Materials: In 16 patients treated with tangent photons for breast cancer, the computed tomography planning images (obtained in the supine position) and diagnostic magnetic resonance images (obtained in the prone position) were studied. For each case, the distance between the anterior pericardium and the anterior chest wall was measured at nine specific points; three points at each of three axial levels. The differences in the measurements between the prone and supine positions were compared with the Wilcoxon signed-rank test. Results: There is a systematic displacement of the lateral and superior aspect of the heart closer to the chest wall in the prone vs. supine position (mean displacement 19 mm (95% confidence interval 13.7-25.1 mm, p < 0.001); the medial and inferior aspects remain fixed. There was also a reduction in volume of lung interposed between the heart and chest wall when prone (mean decrease of 22 mL, p < 0.001 for difference). Conclusions: The superior and lateral aspects of the heart typically move anteriorly during prone positioning compared with the supine position. This may have negative consequences in situations in which the high-risk target tissues include the chest wall or deep breast.
Myocardial infarction and intramyocardial injection models in swine
McCall, Frederic C; Telukuntla, Kartik S; Karantalis, Vasileios; Suncion, Viky Y; Heldman, Alan W; Mushtaq, Muzammil; Williams, Adam R; Hare, Joshua M
Sustainable and reproducible large animal models that closely replicate the clinical sequelae of myocardial infarction (MI) are important for the translation of basic science research into bedside medicine. Swine are well accepted by the scientific community for cardiovascular research, and they represent an established animal model for preclinical trials for US Food and Drug Administration (FDA) approval of novel therapies. Here we present a protocol for using porcine models of MI created with a closed-chest coronary artery occlusion-reperfusion technique. This creates a model of MI encompassing the anteroapical, lateral and septal walls of the left ventricle. This model infarction can be easily adapted to suit individual study design and enables the investigation of a variety of possible interventions. This model is therefore a useful tool for translational research into the pathophysiology of ventricular remodeling and is an ideal testing platform for novel biological approaches targeting regenerative medicine. This model can be created in approximately 8–10 h. PMID:22790084
NSDL National Science Digital Library
This resource provides an overview of the distribution and occurrence of stone walls in New England. Topics include what constitutes a stone wall province and three critical factors in the occurrence of stone walls: bedrock geology, glacial history, and land use history. Users can determine the type of stone wall in any given area by using the maps to determine its location, determine the type of bedrock, type of surface materials, and type of settlement history for that spot. Referring to the text of 'Exploring Stone Walls', they can determine which type of stone wall province contains those types of rock and surface process and read the description of what the most common type of stone walls should be in that area.
Olive, Keith A. [William I. Fine Theoretical Physics Institute, University of Minnesota, Minneapolis, Minnesota, 55455 (United States); School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota, 55455 (United States); Peloso, Marco [School of Physics and Astronomy, University of Minnesota, Minneapolis, Minnesota, 55455 (United States); Uzan, Jean-Philippe [Institut d'Astrophysique de Paris, UMR-7095 du CNRS, Universite Pierre et Marie Curie, 98 bis bd Arago, 75014 Paris (France); Department of Mathematics and Applied Mathematics, Cape Town University, Rondebosch 7701 (South Africa); National Institute for Theoretical Physics (NITheP), Stellenbosch 7600 (South Africa)
We consider the signatures of a domain wall produced in the spontaneous symmetry breaking involving a dilatonlike scalar field coupled to electromagnetism. Domains on either side of the wall exhibit slight differences in their respective values of the fine-structure constant, {alpha}. If such a wall is present within our Hubble volume, absorption spectra at large redshifts may or may not provide a variation in {alpha} relative to the terrestrial value, depending on our relative position with respect to the wall. This wall could resolve the contradiction between claims of a variation of {alpha} based on Keck/Hires data and of the constancy of {alpha} based on Very Large Telescope data. We derive the properties of the wall and the parameters of the underlying microscopic model required to reproduce the possible spatial variation of {alpha}. We discuss the constraints on the existence of the low-energy domain wall and describe its observational implications concerning the variation of the fundamental constants.
Anterior ethmoidal artery emerging anterior to bulla ethmoidalis: An abnormal anatomical variation in Waardenburg's syndrome
Wong, Danny K. C.; Shao, Angus; Campbell, Raewyn
In endoscopic sinus surgery, the anterior ethmoidal artery (AEA) is usually identified as it traverses obliquely across the fovea ethmoidalis, posterior to the bulla ethmoidalis and anterior to or within the ground lamella's attachment to the skull base. Injury to the AEA may result in hemorrhage, retraction of the AEA into the orbit, and a retrobulbar hematoma. The resulting increase in intraorbital pressure may threaten vision. Waardenburg's syndrome (WS) is a rare congenital, autosomal dominantly inherited disorder, distinguished by characteristic facial features, pigmentation abnormalities, and profound, congenital, sensorineural hearing loss. We present a case of AEAs located anterior to the bulla ethmoidalis in a 36-year-old male with WS and chronic rhinosinusitis. The anatomic abnormality was not obvious on a preoperative computed tomography scan and was discovered intraoperatively when the left AEA was injured, resulting in a retrobulbar hematoma. The hematoma was immediately identified and decompressed endoscopically without lasting complications. The AEA on the right was identified intraoperatively and preserved. The characteristic craniofacial features in WS were probably associated with the abnormal vascular anatomy. Endoscopic sinus surgeons should be aware of these potential anatomic anomalies in patients with abnormal craniofacial development. PMID:25565054
Fetal and neonatal outcome in patients with anterior abdominal wall defects (gastroschisis and omphalocele).
Juhasz-Böss, Ingolf; Goelz, Rangmar; Solomayer, Erich-Franz; Fuchs, Jörg; Meyberg-Solomayer, Gabriele
Fetuses with gastroschisis and omphalocele frequently show intrauterine growth restriction (IUGR). The aim of our study was to evaluate the intrauterine course of IUGR and the neonatal outcome in a large patient collective. We retrospectively included all euploid fetuses with gastroschisis and omphalocele between 2001 and 2009 in a single tertiary center. Patients' characteristics, serial ultrasound examinations and neonatal outcomes were evaluated. From 39 fetuses (28 gastroschisis, 11 omphalocele) 61.5% had IUGR <5th percentile and 15.4% had IUGR<10th percentile. The rate of IUGR did not differ significantly between the two groups during pregnancy. Newborns with gastroschisis showed an average weight of 2386 g, and those with omphalocele showed an average weight of 3148 g (P<0.001). Nevertheless, newborns with omphalocele were more frequently eutrophic than those with gastroschisis (88.8% vs. 52.2%, P=0.079). On average, only one surgical intervention was necessary for the definitive repair of the defect (65.5% of the newborns). Children with gastroschisis remained hospitalized nearly twice as long as children with an omphalocele (38 vs. 20 days). IUGR rates during pregnancy did not differ significantly between fetuses with gastroschisis and omphalocele although patients with defects of omphalocele were more frequently eutrophic at birth. Most newborns needed only one operation for definitive surgical treatment. The mean hospitalization time after this intervention was 4 weeks. PMID:22085153
Fluidized wall for protecting fusion chamber walls
Maniscalco, James A. (Danville, CA); Meier, Wayne R. (Livermore, CA)
Apparatus for protecting the inner wall of a fusion chamber from microexplosion debris, x-rays, neutrons, etc. produced by deuterium-tritium (DT) targets imploded within the fusion chamber. The apparatus utilizes a fluidized wall similar to a waterfall comprising liquid lithium or solid pellets of lithium-ceramic, the waterfall forming a blanket to prevent damage of the structural materials of the chamber.
Brief Communications Eye Position Representation in Human Anterior
Miall, Chris
Brief Communications Eye Position Representation in Human Anterior Parietal Cortex Daniela Balslev1TMS,withoutaffectingtheperceivedstraightaheadatbaselineoraftermotorcortexrTMS.We conclude that the anterior parietal cortex in humans encodes eye position and that this signal has eye position information. The human extraocular muscles (EOMs) have muscle spindles that sense muscle
Influence of Head Trauma on Outcome Following Anterior Temporal Lobectomy
Lori A. Schuh; Thomas R. Henry; Gail Fromes; Mila Blaivas; Donald A. Ross; Ivo Drury
Background: There is controversy in the literature re- garding the importance of risk factors in developing epi- lepsy and seizure outcome following anterior temporal lobectomy. Some of the existing studies may be biased because of patient selection and limitations in determin- ing predisposition. Objective: To investigate the role of risk factors for epi- lepsy in determining outcome following anterior tem-
Biometry of the Anterior Eye Segment by Scheimpflug Photography
Otto Hockwin; Erich Weigelin; Heike Laser; Viorel Dragomirescu
Scheimpflug photos of 262 cataract patients, classified according to various forms of opacifications characteristic for senile cataracts were evaluated by biometric methods. The measured values on cornea thickness, depth of anterior chamber, lens thickness, and radii of curvatures of cornea and anterior lens surface show that a correlation between some of the parameters and certain forms of opacities must be
Anterior Cruciate Ligament Strain Behavior During Rehabilitation Exercises In Vivo
Bruce D. Beynnon; Braden C. Fleming; Robert J. Johnson; Claude E. Nichols; Per A. Renström; Malcolm H. Pope
Before studying the biomechanical effects of rehabili tation exercises on the reconstructed knee, it is impor tant to understand their effects on the normal anterior cruciate ligament. The objective of this investigation was to measure the strain behavior of this ligament dur ing rehabilitation activities in vivo. Participants were pa tient volunteers with normal anterior cruciate ligaments instrumented with the
Regional and Temporal Nonuniformity of Shape and Wall Movement in the Normal Left Ventricle
G. Barletta; M. Baroni; R. Del Bene; A. Toso; F. Fantini
Asymmetry of left ventricular (LV) shape and asynchrony of regional LV movement have been described in the normal human heart, but never correlated to each other. In 16 normal subjects, right anterior oblique ventriculography was used to obtain volumes, regional wall motion (centerline method) and curvature (windowed Fourier series approximation of contours) over the entire cardiac cycle. The apex had
Original article Beneficial effects of soluble epoxide hydrolase inhibitors in myocardial infarction
Hammock, Bruce D.
Original article Beneficial effects of soluble epoxide hydrolase inhibitors in myocardial inhibitors Myocardial infarction Epoxyeicosatrienoic acids Oxylipin profiling Myocardial infarction (MI previously demonstrated the beneficial effects of several potent soluble epoxide hydrolase (sEH) inhibitors
Involvement of endoplasmic reticulum stress-associated apoptosis in a heart failure model induced by chronic myocardial ischemia.
Xin, Wei; Li, Xiaoying; Lu, Xiaochun; Niu, Kun; Cai, Jimei
Apoptosis plays a critical role in the pathogenesis of chronic myocardial ischemia (CMI) and heart failure (HF). Endoplasmic reticulum stress (ERS) is one of the newly defined signaling pathways which initiate apoptosis. Previous studies have shown that ERS-associated apoptosis is involved in the pathogenesis of HF induced by pressure-overload and acute myocardial infarction. Also, in vitro experiments have proved that ischemia is a strong stimulus of ERS. This study aimed to demonstrate whether ERS-associated apoptosis is involved in the pathogenesis of CMI-induced HF. We established a HF model induced by CMI in mini pigs via placement of an ameroid constrictor around the proximal anterior descending branch of the left coronary artery (LAD). Furthermore, we used myocardial perfusion imaging, echocardiographic and hemodynamic measurements, hematoxylin-eosin staining, and terminal deoxynucleotidyl transferase-mediated DNA nick-end labeling staining to identify the existence of myocardial ischemia and cardiac dysfunction and of enhanced apoptosis in the ischemic heart. We performed immunohistochemistry, Western blot, and real-time PCR to analyze the hallmark of ERS glucose-regulated protein 78 (GRP78). The ERS-associated apoptotic pathways, CCAAT/enhancer-binding protein homologous protein (CHOP), caspase-12, and c-Jun NH2-terminal kinase 1 (JNK1) were also examined. We found that all three of these pathways were activated and that GRP78 protein and mRNA levels were significantly enhanced in the myocardium of HF mini pigs induced by CMI. These results suggest that ERS is present in the CMI-induced HF pig model, and that ERS-associated apoptosis is involved in the pathophysiology of HF induced by CMI. PMID:21305250
Comparative study of rest technetium-99m sestamibi SPET and low-dose dobutamine stress echocardiography for the early assessment of myocardial viability after acute myocardial infarction: importance of the severity of the infarct-related stenosis.
Claeys, M J; Rademakers, F E; Vrints, C J; Krug, B; Bosmans, J M; Conraads, V; Bossaert, L L; Snoeck, J P; Blockx, P P
Rest technetium-99m sestamibi single-photon emission tomography (SPET) has been shown to underestimate viability in some patients with chronic ischaemic myocardial dysfunction. The present study was designed to appraise the value of 99mTc-sestamibi as a viability tracer in patients with a recent myocardial infarction and to determine factors that might influence its accuracy in assessing infarct size. Therefore, rest 99mTc-sestamibi SPET, low-dose dobutamines stress echocardiography and quantitative coronary angiography were performed in 51 patients with a recent myocardial infarction. Perfusion activity and regional wall motion were scored semi-quantitatively using the same segmental division of the left ventricle. Assessment of 99mTc-sestamibi uptake as a marker of viability was performed by comparing a binary uptake score (viable=>50% vs necrotic ==50% of the maximal tracer activity) with a binary wall motion classification during low-dose dobutamine infusion (viable=normal/hypokinetic vs necrotic=akinetic/dyskinetic). Infarct size, expressed as the number of segments with evidence of necrotic tissue, was significantly greater in the scintigraphic study than in the echocardiographic study (2.8+/-1.5 vs 2.2+/-1.3, P=0.006). This overestimation of infarct size by 99mTc-sestamibi was present only in patients with a severe infarct-related stenosis (% diameter stenosis >/=65%-100%) and particularly those with "late" reperfusion therapy (time delay >/=180 min). In patients without a severe infarct-related stenosis, 99mTc-sestamibi was able to accurately distinguish viable from necrotic segments. Thus, rest 99mTc-sestamibi scintigraphy early after acute myocardial infarction may underestimate residual viability within the infarct region, particularly in patients with low flow state coronary anatomy, as a result of a severe infarct-related stenosis and/or late reperfusion therapy. PMID:8662112
Low carbohydrate diet decreases myocardial insulin signaling and increases susceptibility to myocardial ischemia
Wang, Peipei; Tate, Joshua M.; Lloyd, Steven G.
Aims Low Carbohydrate Diets (LCD) are a popular intervention for weight loss, but the effect of such diets on myocardial ischemia is not known. Myocardial energy substrates and insulin signaling pathways may be affected by these diets, and both may play a role in protection of ischemic myocardium. We investigated whether LCD increases susceptibility to cardiac injury during ischemia and reperfusion in the isolated rat heart. Main Methods Rats were fed LCD (60% kcal from fat / 30% protein / 10% carbohydrate) or a control diet (CONT; 16% / 19% / 65%) for 2 weeks. Hearts from rats fed with LCD or CONT were isolated and subjected to normal perfusion in Langendorff mode, with 30 min global low flow ischemia (LFI; 0.3 ml/min) followed by 60 min reperfusion, or 60 min LFI followed by 120 min reperfusion. Key Findings LCD diet led to an increase in 3-hydroxybutyrate and lower circulating insulin. LCD diet also resulted in impaired left ventricular performance during LFI, reduced recovery of function following LFI and reperfusion, and 10- to 20-fold increased injury as measured by lactate dehydrogenase release and histologic infarct area. LCD diet also led to lower myocardial glycogen stores and glycogen utilization during LFI, and lower insulin signaling as assessed by Akt phosphorylation at the end of LFI and reperfusion, but no differences in ERK 1/2 phosphorylation. Significance These results demonstrate that LCD affects myocardial energy substrates, affects insulin signaling, and increases myocardial injury following ischemia-reperfusion in the isolated heart. PMID:18951908
Regional left ventricular myocardial contractility and stress in a finite element model of posterobasal myocardial infarction.
Wenk, Jonathan F; Sun, Kay; Zhang, Zhihong; Soleimani, Mehrdad; Ge, Liang; Saloner, David; Wallace, Arthur W; Ratcliffe, Mark B; Guccione, Julius M
Recently, a noninvasive method for determining regional myocardial contractility, using an animal-specific finite element (FE) model-based optimization, was developed to study a sheep with anteroapical infarction (Sun et al., 2009, "A Computationally Efficient Formal Optimization of Regional Myocardial Contractility in a Sheep With Left Ventricular Aneurysm," ASME J. Biomech. Eng., 131(11), p. 111001). Using the methodology developed in the previous study (Sun et al., 2009, "A Computationally Efficient Formal Optimization of Regional Myocardial Contractility in a Sheep With Left Ventricular Aneurysm," ASME J. Biomech. Eng., 131(11), p. 111001), which incorporates tagged magnetic resonance images, three-dimensional myocardial strains, left ventricular (LV) volumes, and LV cardiac catheterization pressures, the regional myocardial contractility and stress distribution of a sheep with posterobasal infarction were investigated. Active material parameters in the noninfarcted border zone (BZ) myocardium adjacent to the infarct (T(max_B)), in the myocardium remote from the infarct (T(max_R)), and in the infarct (T(max_I)) were estimated by minimizing the errors between FE model-predicted and experimentally measured systolic strains and LV volumes using the previously developed optimization scheme. The optimized T(max_B) was found to be significantly depressed relative to T(max_R), while T(max_I) was found to be zero. The myofiber stress in the BZ was found to be elevated, relative to the remote region. This could cause further damage to the contracting myocytes, leading to heart failure. PMID:21428685
[Lornoxicam for prevention of myocardial injury during acute ST-elevation myocardial infarction].
Parnes, E Ia; Gavrilova, S A
10% of patients with acute ST-elevation myocardial infarction (STEMI) treated with reperfusion therapy fail to develop an enzyme rise, but do exhibit transient ECG changes, which are consistent with an aborted myocardial infarction. Following reperfusion by primary PCI in STEMI, oxidative stress and an inflammatory response are induced immediately. Inflammation is a critical component of STEMI. Both COX isoforms are involved in reperfusion and ischemic myocardial injury. To evaluate the effectiveness of lornoxicam - nonselective NSAID, in decrease of myocardial injury during acute ST-elevation myocardial infarction. We analyzed 22 patients with STEMI, 14 of them received 16 mg and 8 mg lornoxicam after 20 min and 8 hours, respectively, after arrival to hospital. 12 f them received alteplase, 10 patients with cardiac pain up to 24 hours from the beginning, did not receive reperfusion therapy. All patients received anticoagulants, antiplatlet therapy, -blockers. The primary end point was all-cause mortality by the day 30 and hospitalization due to congestive heart failure by the 1st year. There was no difference in mortality and heart failure by the 30 day and 1st year respectively, between the patients with STEMI treated with lornoxicam or placebo. Randomized controlled trials are needed to explore potential cardioprotective effects of lornoxicam in patients with acute STEMI. PMID:21627610
Postconditioning with simvastatin decreases myocardial injury in rats following acute myocardial ischemia
The aim of the present study was to investigate whether postconditioning with simvastatin attenuated myocardial ischemia reperfusion injury by inhibiting the expression of high mobility group box 1 (HMGB1) in rat myocardium following acute myocardial ischemia. In total, 30 male Sprague-Dawley rats were divided into sham operation (sham; n=10), acute myocardial infarction (AMI; n=10) and simvastatin (sim; n=10) groups. The AMI and sim groups were subjected to ischemia for 30 min, followed by reperfusion for 180 min. The rats in the sim group were administered 20 mg/kg simvastatin intravenously 5 min prior to reperfusion. Subsequently, the infarct size, serum cardiac troponin (c-TnI), tumor necrosis factor (TNF)-? and myocardial malondialdehyde (MDA) levels and superoxide dismutase (SOD) activity were measured. Western blot analysis was used to detect the protein expression of HMGB1. Postconditioning with simvastatin was shown to decrease the infarct size and HMGB1 expression levels in the myocardium following AMI (P<0.05). In addition, postconditioning with simvastatin not only decreased the serum levels of c-TnI and TNF-? (P<0.05), but also inhibited the increase in MDA levels and the reduction in SOD activity (P<0.05). Therefore, postconditioning with simvastatin was shown to attenuate myocardial injury. The underlying mechanism may be associated with the downregulation of HMGB1 expression in the ischemic myocardium. PMID:25780404
Validity of instrumented measurement of anterior laxity of the knee at different force levels
T Siebel; F Geiger; D Pöhlmann; J Heisel
The Kneelax arthrometer is a tibia referenced sytem for objectively testing and reproducing the anterior stability of the anterior cruciate ligament (ACL). It measures the extent of anterior translation of the tibia on the femur, under anterior drawer forces of 44, 67, 89, and 132 N. The compliance of the system, calculated as the increase in anterior displacement between the
Anterior-posterior patterning within the Caenorhabditis elegans endoderm.
Schroeder, D F; McGhee, J D
The endoderm of higher organisms is extensively patterned along the anterior/posterior axis. Although the endoderm (gut or E lineage) of the nematode Caenorhabditis elegans appears to be a simple uniform tube, cells in the anterior gut show several molecular and anatomical differences from cells in the posterior gut. In particular, the gut esterase ges-1 gene, which is normally expressed in all cells of the endoderm, is expressed only in the anterior-most gut cells when certain sequences in the ges-1 promoter are deleted. Using such a deleted ges-1 transgene as a biochemical marker of differentiation, we have investigated the basis of anterior-posterior gut patterning in C. elegans. Although homeotic genes are involved in endoderm patterning in other organisms, we show that anterior gut markers are expressed normally in C. elegans embryos lacking genes of the homeotic cluster. Although signalling from the mesoderm is involved in endoderm patterning in other organisms, we show that ablation of all non-gut blastomeres from the C. elegans embryo does not affect anterior gut marker expression; furthermore, ectopic guts produced by genetic transformation express anterior gut markers generally in the expected location and in the expected number of cells. We conclude that anterior gut fate requires no specific cell-cell contact but rather is produced autonomously within the E lineage. Cytochalasin D blocking experiments fully support this conclusion. Finally, the HMG protein POP-1, a downstream component of the Wnt signalling pathway, has recently been shown to be important in many anterior/posterior fate decisions during C. elegans embryogenesis (Lin, R., Hill, R. J. and Priess, J. R. (1998) Cell 92, 229-239). When RNA-mediated interference is used to eliminate pop-1 function from the embryo, gut is still produced but anterior gut marker expression is abolished. We suggest that the C. elegans endoderm is patterned by elements of the Wnt/pop-1 signalling pathway acting autonomously within the E lineage. PMID:9811572
Meier, W R
The key feature of liquid wall chambers is the use of a renewable liquid layer to protect chamber structures from target emissions. Two primary options have been proposed and studied: wetted wall chambers and thick liquid wall (TLW) chambers. With wetted wall designs, a thin layer of liquid shields the structural first wall from short ranged target emissions (x-rays, ions and debris) but not neutrons. Various schemes have been proposed to establish and renew the liquid layer between shots including flow-guiding porous fabrics (e.g., Osiris, HIBALL), porous rigid structures (Prometheus) and thin film flows (KOYO). The thin liquid layer can be the tritium breeding material (e.g., flibe, PbLi, or Li) or another liquid metal such as Pb. TLWs use liquid jets injected by stationary or oscillating nozzles to form a neutronically thick layer (typically with an effective thickness of {approx}50 cm) of liquid between the target and first structural wall. In addition to absorbing short ranged emissions, the thick liquid layer degrades the neutron flux and energy reaching the first wall, typically by {approx}10 x x, so that steel walls can survive for the life of the plant ({approx}30-60 yrs). The thick liquid serves as the primary coolant and tritium breeding material (most recent designs use flibe, but the earliest concepts used Li). In essence, the TLW places the fusion blanket inside the first wall instead of behind the first wall.
Nociceptive processing by anterior cingulate pyramidal neurons.
Shyu, Bai-Chuang; Sikes, Robert W; Vogt, Leslie J; Vogt, Brent A
Although the cingulate cortex is frequently activated in acute human pain studies, postsynaptic responses are not known nor are links between nociceptive afferents, neuronal responses, and outputs to other structures. Intracellular potentials were recorded from neurobiotin-injected, pyramidal neurons in anterior cingulate area 24b following noxious stimulation of the sciatic nerve in anesthetized rabbits. Layer IIIc pyramids had extensive and horizontally oriented basal dendrites in layer IIIc where nociceptive afferents terminate. They had the longest excitatory postsynaptic potentials (EPSPs; 545 ms) that were modulated with hyperpolarizing currents. Pyramids in layer V had an intermediate tuft of oblique apical dendrites in layer IIIc that were 150-350 microm from somata in layer Va and 351-550 microm in layer Vb. Although average EPSP durations were short in layers II-IIIab (222 +/- 31), Va (267 +/- 65), and Vb (159 +/- 31), there were five neurons in layers IIIab-Va that had EPSP durations lasting >300 ms (548 +/- 63 ms). Neurons in layers IIIc, Va, and Vb had the highest amplitude EPSPs (6.25, 6.84 +/- 0.58, and 6.4 +/- 0.47 mV, respectively), whereas those in layers II-IIIab were 5 +/- 0.56 mV. Nociceptive responses in layer Vb were complex and some had initial inhibitory postsynaptic potentials with shorter-duration EPSPs. Layers II-IIIab had dye-coupled pyramids and EPSPs in these layers had short durations (167 +/- 33 ms) compared with those in layers IIIc-Va (487 +/- 28 ms). In conclusion there are two populations of anterior cingulate cortex pyramids with EPSPs of significantly different durations, although their dendritic morphologies do not predict EPSP duration. Short-duration EPSPs are thalamic-mediated, nociceptive responses lasting < or =200 ms. Longer, "integrative" EPSPs are >350 ms and are likely modulated by intracortical axon collateral discharges. These findings suggest that links between nociception and projections to cortical and motor systems are instantaneous because nociceptive responses are generated directly by pyramidal projection neurons in all layers. PMID:20357067
Protective effects of M40403, a selective superoxide dismutase mimetic, in myocardial ischaemia and reperfusion injury in vivo.
Masini, Emanuela; Cuzzocrea, Salvatore; Mazzon, Emanuela; Marzocca, Cosimo; Mannaioni, Pier Francesco; Salvemini, Daniela
1. Myocardial injury caused by ischaemia and reperfusion comes from multiple pathogenic events, including endothelial damage, neutrophil extravasation into tissue, mast cell activation, and peroxidation of cell membrane lipids. These events are followed by myocardial cell alterations resulting eventually in cell necrosis. An enhanced formation of reactive oxygen species is widely accepted as a stimulus for tissue destruction and cardiac failure. 2. In this study, we have investigated the cardioprotective effects of M40403 in myocardial ischaemia-reperfusion injury. M40403 is a low molecular weight, synthetic manganese containing superoxide dismutase mimetic (SODm) that selectively removes superoxide anion. Ischaemia was induced in rat hearts in vivo by ligating the left anterior descending coronary artery. Thirty minutes after the induction of ischaemia, the ligature was removed and reperfusion allowed to occur for at least 60 min. M40403 (0.1-1 mg kg(-1)) was given intravenously 15 min before ischaemia. 3. The results obtained in this study showed that M40403 significantly reduced the extent of myocardial damage, mast cell degranulation and the incidence of ventricular arrhythmias. Furthermore, M40403 significantly attenuated, in a dose-dependent manner, neutrophil infiltration in the myocardium as well as the associated induction of lipid peroxidation. Calcium overload seen post-reperfusion of the ischaemic myocardium was also reduced by M40403. 4. Immunohistochemical analysis for nitrotyrosine revealed a positive staining in cardiac tissue taken after reperfusion: this was attenuated by M40403. Moreover reperfused cardiac tissue sections showed positive staining for P-selectin and for anti-intercellular adhesion molecule (ICAM-1) in the vascular endothelial cells. M40403 treatment markedly reduced the intensity and degree of P-selectin and ICAM-1 in these tissues. No staining for nitrotyrosine, P-selectin or ICAM-1 was found in cardiac tissue taken at the end of the ischaemic period. 5. Overall, M40403 treatment reduced the morphological signs of myocardial cell injury and significantly improved survival. 6. Taken together, these results clearly indicate that M40403 treatment exerts a protective effect against ischaemia-reperfusion-induced myocardial injury, supporting a key role for superoxide anion in reperfusion injuries. This suggests that synthetic enzymes of SOD such as M40403, offer a novel therapeutic approach for the treatment of ischaemic heart disease where superoxide anion plays a dominant role. PMID:12110615
Protective effects of M40403, a selective superoxide dismutase mimetic, in myocardial ischaemia and reperfusion injury in vivo
Masini, Emanuela; Cuzzocrea, Salvatore; Mazzon, Emanuela; Marzocca, Cosimo; Mannaioni, Pier Francesco; Salvemini, Daniela
Myocardial injury caused by ischaemia and reperfusion comes from multiple pathogenic events, including endothelial damage, neutrophil extravasation into tissue, mast cell activation, and peroxidation of cell membrane lipids. These events are followed by myocardial cell alterations resulting eventually in cell necrosis. An enhanced formation of reactive oxygen species is widely accepted as a stimulus for tissue destruction and cardiac failure. In this study, we have investigated the cardioprotective effects of M40403 in myocardial ischaemia-reperfusion injury. M40403 is a low molecular weight, synthetic manganese containing superoxide dismutase mimetic (SODm) that selectively removes superoxide anion. Ischaemia was induced in rat hearts in vivo by ligating the left anterior descending coronary artery. Thirty minutes after the induction of ischaemia, the ligature was removed and reperfusion allowed to occur for at least 60 min. M40403 (0.1–1 mg kg?1) was given intravenously 15 min before ischaemia. The results obtained in this study showed that M40403 significantly reduced the extent of myocardial damage, mast cell degranulation and the incidence of ventricular arrhythmias. Furthermore, M40403 significantly attenuated, in a dose-dependent manner, neutrophil infiltration in the myocardium as well as the associated induction of lipid peroxidation. Calcium overload seen post-reperfusion of the ischaemic myocardium was also reduced by M40403. Immunohistochemical analysis for nitrotyrosine revealed a positive staining in cardiac tissue taken after reperfusion: this was attenuated by M40403. Moreover reperfused cardiac tissue sections showed positive staining for P-selectin and for anti-intercellular adhesion molecule (ICAM-1) in the vascular endothelial cells. M40403 treatment markedly reduced the intensity and degree of P-selectin and ICAM-1 in these tissues. No staining for nitrotyrosine, P-selectin or ICAM-1 was found in cardiac tissue taken at the end of the ischaemic period. Overall, M40403 treatment reduced the morphological signs of myocardial cell injury and significantly improved survival. Taken together, these results clearly indicate that M40403 treatment exerts a protective effect against ischaemia-reperfusion-induced myocardial injury, supporting a key role for superoxide anion in reperfusion injuries. This suggests that synthetic enzymes of SOD such as M40403, offer a novel therapeutic approach for the treatment of ischaemic heart disease where superoxide anion plays a dominant role. PMID:12110615
MicroRNA24 regulates vascularity after myocardial infarction
J. Fiedler; V. Jazbutyte; B. C. Kirchmaier; S. K. Gupta; J. Lorenzen; D. Hartmann; P. Galuppo; S. Kneitz; J. Pena; C. Sohn-Lee; X. Loyer; J. Soutschek; T. Brand; T. Tuschl; J. Heineke; U. Martin; S. Schulte-Merker; G. Ertl; S. Engelhardt; J. Bauersachs; T. Thum
BACKGROUND: Myocardial infarction leads to cardiac remodeling and development of heart failure. Insufficient myocardial capillary density after myocardial infarction has been identified as a critical event in this process, although the underlying mechanisms of cardiac angiogenesis are mechanistically not well understood. METHODS AND RESULTS: Here, we show that the small noncoding RNA microRNA-24 (miR-24) is enriched in cardiac endothelial cells
Periprocedural myocardial infarction resulting in a ventricular septal defect.
Kim, Jeong-Won; Kim, Dong Jin; Kim, Tae-Hoon; Cho, Kwang Ree
Although periprocedural myocardial infarction frequently occurs with the robustness of percutaneous coronary intervention, the prognosis of the periprocedural myocardial infarction has been known to be relatively good compared with that of spontaneous myocardial infarction. We present a patient with a postinfarction ventricular septal defect, with cardiogenic shock, that developed 7 days after a percutaneous coronary intervention. Emergency surgical repair combined with coronary artery bypass grafting saved the patient, without complications. PMID:25841858
Myocardial Edema Imaging in Acute Coronary Syndromes
Walls, Michael C.; Verhaert, David; Raman, Subha V.
Acute coronary syndromes (ACS) continue to be the most common morbid condition of industrialized nations. The advent of and technical improvements in revascularization and medical therapy have led to a steady decline in mortality rates. However, many patients who suffer unstable angina or myocardial infarction require further testing and risk stratification to guide therapeutic selection and prognosis assignment. Myocardial edema imaging with cardiac magnetic resonance (CMR) affords the ability to define the amount of myocardium at risk, refine estimates of prognosis and provide guidance for therapies with excellent sensitivity compared to standard clinical markers. This review will discuss the rationale for edema imaging, how it is performed using CMR and its potential clinical applications. PMID:22102557
[Energy metabolism and myocardial function in myocardiodystrophy].
Temirova, K V; Kurlygina, L A; Zavodskaia, I S; Novikova, N A
A total of 92 patients with chronic tonsilitis and cardiovascular changes were subjected to clinical observations, ECG analysis, potassium and nitroglycerine tests, and studies of the lactic acid level and creatinekinase activity as indces of myocardial metabolism. The examinations were conducted prior to and following tonsillectomy. In a majority of patients a correlation was revealed between the degree of ECG changes and the serum lactic acid level, as well as between the ECG improvement and a reduction of the lactic acid level following tonsillectomy. Three stages of tonsillogenic myocardiodystrophy were distinguished. The obtained data indicate the rationale of the used tests for the evaluation of the myocardial meabolism alterations and of the efficacy of treatment of chronic tonsillitis patients. PMID:1011536
Imaging Cell Therapy for Myocardial Regeneration
Zhang, Hualei; Qiao, Hui; Ferrari, Victor A.
Noninvasive or minimally invasive imaging techniques are essential for developing strategies and assessing outcomes of cell-based therapies for myocardial regeneration, also referred to as cellular cardiomyoplasty. Imaging-based monitoring of cell survival is useful for selection of optimal cell type and evaluating strategies to enhance engraftment. Imaging-derived surrogate end points including global and regional contractile function, myocardial blood flow, or perfusion and bioenergetics have been used in clinical trials or in relevant large animal models to evaluate the therapeutic effect and mechanisms of action of cellular cardiomyoplasty. New techniques are emerging to assess electrical integration of donor cells with host cardiomyocytes. This review will summarize and highlight important and informative findings revealed by imaging in clinical and preclinical cellular cardiomyoplasty studies over the past 3 years. PMID:22905280
Acute myocardial infarction induced by ephedrine alkaloids.
Enders, Jason M; Dobesh, Paul P; Ellison, James N
A 45-year-old woman was hospitalized to rule out acute myocardial infarction after coming to the emergency department with a complaint of substernal chest pressure. Her initial electrocardiogram indicated normal sinus rhythm with T-wave inversion and nonspecific ST changes suggestive of possible ischemia. She had no medical problems and took no prescription drugs. Further evaluation revealed that for approximately 4 years she had been taking Metabolife 356 preparations--a source of ephedrine alkaloids--for weight loss, and that she was at low risk for atherosclerotic coronary artery disease. Due to elevated cardiac markers, cardiac catheterization was performed, which revealed no atherosclerosis in the coronary arteries. The patient's acute myocardial infarction was attributed to coronary artery vasospasm induced by ephedrine alkaloids. Clinicians should be aware of the growing evidence that supports life-threatening cardiovascular toxicities associated with these substances. PMID:14695044
Matrix metalloproteinases: drug targets for myocardial infarction
Yabluchanskiy, Andriy; Li, Yaojun; Chilton, Robert J.; Lindsey, Merry L.
Myocardial infarction (MI) remains a major cause of morbidity and mortality worldwide. Rapid advances in the treatment of acute MI have significantly improved short-term outcomes in patient, due in large part to successes in preventing myocardial cell death and limiting infarct area during the time of ischemia and subsequent reperfusion. Matrix metalloproteases (MMPs) play key roles in post-MI cardiac remodeling and in the development of adverse outcomes. This review highlights the importance of MMPs in the injury and remodeling response of the left ventricle and also discusses their potential as therapeutic targets Additional pre-clinical and clinical research is needed to further investigate and understand the cardioprotective effects of MMPs inhibitors. PMID:23316962
Quantitative evaluation of ischemic myocardial scar tissue by unenhanced T1 mapping using 3.0 Tesla MR scanner
Okur, Aylin; Kantarc?, Mecit; K?zrak, Ye?im; Y?ld?z, Sema; Pirimo?lu, Berhan; Karaca, Leyla; O?ul, Hayri; Sevimli, Serdar
PURPOSE We aimed to use a noninvasive method for quantifying T1 values of chronic myocardial infarction scar by cardiac magnetic resonance imaging (MRI), and determine its diagnostic performance. MATERIALS AND METHODS We performed cardiac MRI on 29 consecutive patients with known coronary artery disease (CAD) on 3.0 Tesla MRI scanner. An unenhanced T1 mapping technique was used to calculate T1 relaxation time of myocardial scar tissue, and its diagnostic performance was evaluated. Chronic scar tissue was identified by delayed contrast-enhancement (DE) MRI and T2-weighted images. Sensitivity, specificity, and accuracy values were calculated for T1 mapping using DE images as the gold standard. RESULTS Four hundred and forty-two segments were analyzed in 26 patients. While myocardial chronic scar was demonstrated in 45 segments on DE images, T1 mapping MRI showed a chronic scar area in 54 segments. T1 relaxation time was higher in chronic scar tissue, compared with remote areas (1314±98 ms vs. 1099±90 ms, P < 0.001). Therefore, increased T1 values were shown in areas of myocardium colocalized with areas of DE and normal signal on T2-weighted images. There was a significant correlation between T1 mapping and DE images in evaluation of myocardial wall injury extent (P < 0.05). We calculated sensitivity, specificity, and accuracy as 95.5%, 97%, and 96%, respectively. CONCLUSION The results of the present study reveal that T1 mapping MRI combined with T2-weighted images might be a feasible imaging modality for detecting chronic myocardial infarction scar tissue. PMID:25010366
The Role of Fibers in the Femoral Attachment of the Anterior Cruciate Ligament in Resisting Tibial Displacement
Kawaguchi, Yasuyuki; Kondo, Eiji; Takeda, Ryo; Akita, Keiichi; Yasuda, Kazunori; Amis, Andrew A.
Purpose The purpose was to clarify the load-bearing functions of the fibers of the femoral anterior cruciate ligament (ACL) attachment in resisting tibial anterior drawer and rotation. Methods A sequential cutting study was performed on 8 fresh-frozen human knees. The femoral attachment of the ACL was divided into a central area that had dense fibers inserting directly into the femur and anterior and posterior fan-like extension areas. The ACL fibers were cut sequentially from the bone: the posterior fan-like area in 2 stages, the central dense area in 4 stages, and then the anterior fan-like area in 2 stages. Each knee was mounted in a robotic joint testing system that applied tibial anteroposterior 6-mm translations and 10° or 15° of internal rotation at 0° to 90° of flexion. The reduction of restraining force or moment was measured after each cut. Results The central area resisted 82% to 90% of the anterior drawer force; the anterior fan-like area, 2% to 3%; and the posterior fan-like area, 11% to 15%. Among the 4 central areas, most load was carried close to the roof of the intercondylar notch: the anteromedial bundle resisted 66% to 84% of the force and the posterolateral bundle resisted 16% to 9% from 0° to 90° of flexion. There was no clear pattern for tibial internal rotation, with the load shared among the posterodistal and central areas near extension and mostly the central areas in flexion. Conclusions Under the experimental conditions described, 66% to 84% of the resistance to tibial anterior drawer arose from the ACL fibers at the central-proximal area of the femoral attachment, corresponding to the anteromedial bundle; the fan-like extension fibers contributed very little. This work did not support moving a single-bundle ACL graft to the side wall of the notch or attempting to cover the whole attachment area if the intention was to mimic how the natural ACL resists tibial displacements. Clinical Relevance There is ongoing debate about how best to reconstruct the ACL to restore normal knee function, including where is the best place for ACL graft tunnels. This study found that the most important area on the femur, in terms of resisting displacement of the tibia, was in the central-anterior part of the femoral ACL attachment, near the roof of the intercondylar notch. The testing protocol did not lead to data that would support using a large ACL graft tunnel that attempts to cover the whole natural femoral attachment area. PMID:25530509
The Current Status of Engineering Myocardial Tissue
Runqian Sui; Xiaobo Liao; Xinmin Zhou; Qi Tan
Myocardial infarction (MI) remains a common fatal disease all over the world. The adult cardiac myocytes regenerative capability\\u000a is very limited after infarct injury. Heart transplantation would be the best therapeutic option currently but is restricted\\u000a due to the lack of donor organs and the serious side effects of immune suppression. The emerging of tissue engineering has\\u000a evolved to provide
Selective serotonin reuptake inhibitors and myocardial infarction
William H. Sauer; Jesse A. Berlin; Stephen E. Kimmel
Background—Depression is an independent risk factor for myocardial infarction (MI). Selective serotonin reuptake inhibitors (SSRIs) may reduce this risk through attenuation of serotonin-mediated platelet activation in addition to treatment of depression itself. Methods and Results—A case-control study of first MI in smokers 30 to 65 years of age was conducted among all 68 hospitals in an 8-county area during a
Acute Myocardial Infarction and Postinfarct Remodeling
David C. Isbell; Christopher M. Kramer
In the wake of an acute myocardial infarction (AMI), accurate assessment of the left ventricle (LV) is of paramount importance\\u000a as functional impairment or chamber dilatation predicts increased mortality (1–3). In a study of 866 postinfarct patients, a resting LV ejection fraction (EF) less than 0.40 predicted higher 1-year mortality\\u000a than did an LVEF greater than 0.40 (1). Others have
Microwave spectroscopy of myocardial ischemia and infarction. 2. Biophysical reconstruction.
Semenov, S Y; Svenson, R H; Bulyshev, A E; Souvorov, A E; Nazarov, A G; Sizov, Y E; Posukh, V G; Pavlovsky, A; Tatsis, G P
The proposed dielectrical relaxation model of the myocardium in the microwave spectrum has been verified both on test solutions and on normal canine myocardium. Furthermore, the model was utilized to reconstruct the changes in tissue properties (including myocardial bulk resistance and water content) following myocardial acute ischemia and chronic infarction. It was shown that the reconstructed myocardial resistance and water content correlate dynamically with the process of the development of acute myocardial ischemic injury. In chronic cases the reconstructed resistance and water content of infarcted myocardium are significantly different from that of normal myocardium: the resistance is lower and water content is higher than in normal myocardium. PMID:10645788
Incidental myocardial infarction in Ehlers-Danlos syndrome type IV?
Gilchrist, Emma R; Duflou, Johan A
Ehlers-Danlos Syndrome Type IV is an illness that often leads to premature death due to arterial rupture or dissection and is characterized by very fragile connective tissue. This report documents the death of a 30-year-old man with Ehlers-Danlos Syndrome Type IV from myocardial rupture and cardiac tamponade following a myocardial infarction. We believe that Ehlers-Danlos Syndrome Type IV contributed to the coronary atherosclerosis and myocardial rupture in this young man and that this disease led indirectly to his death by myocardial infarction, an unusual cause of death in this syndrome. PMID:15813560
Cardiovascular magnetic resonance by non contrast T1-mapping allows assessment of severity of injury in acute myocardial infarction
Background Current cardiovascular magnetic resonance (CMR) methods, such as late gadolinium enhancement (LGE) and oedema imaging (T2W) used to depict myocardial ischemia, have limitations. Novel quantitative T1-mapping techniques have the potential to further characterize the components of ischemic injury. In patients with myocardial infarction (MI) we sought to investigate whether state-of the art pre-contrast T1-mapping (1) detects acute myocardial injury, (2) allows for quantification of the severity of damage when compared to standard techniques such as LGE and T2W, and (3) has the ability to predict long term functional recovery. Methods 3T CMR including T2W, T1-mapping and LGE was performed in 41 patients [of these, 78% were ST elevation MI (STEMI)] with acute MI at 12-48 hour after chest pain onset and at 6 months (6M). Patients with STEMI underwent primary PCI prior to CMR. Assessment of acute regional wall motion abnormalities, acute segmental damaged fraction by T2W and LGE and mean segmental T1 values was performed on matching short axis slices. LGE and improvement in regional wall motion at 6M were also obtained. Results We found that the variability of T1 measurements was significantly lower compared to T2W and that, while the diagnostic performance of acute T1-mapping for detecting myocardial injury was at least as good as that of T2W-CMR in STEMI patients, it was superior to T2W imaging in NSTEMI. There was a significant relationship between the segmental damaged fraction assessed by either by LGE or T2W, and mean segmental T1 values (P < 0.01). The index of salvaged myocardium derived by acute T1-mapping and 6M LGE was not different to the one derived from T2W (P = 0.88). Furthermore, the likelihood of improvement of segmental function at 6M decreased progressively as acute T1 values increased (P < 0.0004). Conclusions In acute MI, pre-contrast T1-mapping allows assessment of the extent of myocardial damage. T1-mapping might become an important complementary technique to LGE and T2W for identification of reversible myocardial injury and prediction of functional recovery in acute MI. PMID:22309452
Effect of Coronary Thrombectomy in Cardiogenic Shock Complicating ST-Segment Elevation Myocardial Infarction.
Suzuki, Makoto; Sumiyoshi, Tetsuya; Miyachi, Hideki; Yamashita, Jun; Yamasaki, Masao; Miyauchi, Katsumi; Yamamoto, Takeshi; Nagao, Ken; Tomoike, Hitonobu; Takayama, Morimasa
Optimal coronary reflow is the critical key issue to ameliorate clinical outcomes in patients with cardiogenic shock complicating ST-segment elevation myocardial infarction (Shock-STEMI). We investigated our hypothesis that pre-percutaneous coronary intervention (PCI) procedural coronary thrombectomy may provide clinical advantages to attempt optimal coronary reflow in patients with Shock-STEMI. Of 7,650 patients with acute myocardial infarction registered in the Tokyo CCU Network Scientific Council from January 2009 to December 2011, a total of 180 consecutive patients (144 men, 68 ± 13 years) with Shock-STEMI who showed pre-PCI procedural Thrombolysis in Myocardial Infarction flow grade 0 (absent initial coronary flow) were recruited. Achievements of post-PCI procedural Thrombolysis in Myocardial Infarction flow grade 3 (optimal coronary reflow) and also in-hospital mortality were evaluated in those in accordance with and without coronary thrombectomy. Coronary thrombectomy was performed in 128 patients with Shock-STEMI (71% of all). Overall in-hospital mortality was 41% and that in anterior Shock-STEMI with a necessity of mechanical circulatory support increased by 59% (i.e., profound shock). Coronary thrombectomy did not affect any improvements in the achievement of optimal coronary reflow (65% vs 58%, p = 0.368) and in-hospital mortality (42% vs 37%, p = 0.484) in these patients. Even when focused on 76 patients with profound shock, neither an achievement of optimal coronary reflow (56% vs 47%, p = 0.518) nor in-hospital mortality (58% vs 65%, p = 0.601) were different between with and without coronary thrombectomy. Multivariate logistic analysis did not demonstrate any association of coronary thrombectomy (p = 0.798), left main Shock-STEMI (p = 0.258), and use of mechanical circulatory support (p = 0.119) except a concentration of hemoglobin (for each 1 g/dl increase, odds ratio 1.247, 95% confidence interval 1.035 to 1.531, p = 0.019) with optimal coronary reflow. In conclusion, pre-PCI procedural coronary thrombectomy may have serious limitations on attempting optimal coronary reflow that indicates a necessity of promising strategies for this critical illness. PMID:25888301
Current trends in anterior cruciate ligament reconstruction.
Duquin, Thomas R; Wind, William M; Fineberg, Marc S; Smolinski, Robert J; Buyea, Cathy M
In 2006, a survey regarding anterior cruciate ligament (ACL) reconstruction was mailed to physician members of the American Orthopaedic Society for Sports Medicine. A total of 993 responses were received from 1747 possible respondents (57%). The number of ACL reconstructions per year ranged from 1 to 275 (mean=55). The most important factors in the timing of surgery were knee range of motion and effusion. Bone-patellar tendon-bone (BPTB) autograft was most commonly preferred (46%), followed by hamstring tendon autograft (32%) and allografts (22%). Five years earlier, BPTB grafts were more frequent and hamstring tendon and allografts were less frequent (63%, 25%, and 12%, respectively). A single-incision arthroscopic technique was used by 90%. Most allowed return to full activity at 5 to 6 months, with a trend toward earlier return for BPTB grafts; quadriceps strength was an important factor in the decision. There was limited experience (4%) with double-bundle and computer-assisted ACL reconstruction. Arthroscopic-assisted, single-incision reconstruction using a BPTB autograft fixed with metal interference screws remains the most common technique used for primary ACL reconstruction. In the past 5 years, the use of alternative graft sources and methods of fixation has increased. Consensus regarding the best graft type, fixation method, and postoperative protocol is still lacking. PMID:19216345
Guideline on anterior cruciate ligament injury
The Dutch Orthopaedic Association has a long tradition of development of practical clinical guidelines. Here we present the recommendations from the multidisciplinary clinical guideline working group for anterior cruciate ligament injury. The following 8 clinical questions were formulated by a steering group of the Dutch Orthopaedic Association. What is the role of physical examination and additional diagnostic tools? Which patient-related outcome measures should be used? What are the relevant parameters that influence the indication for an ACL reconstruction? Which findings or complaints are predictive of a bad result of an ACL injury treatment? What is the optimal timing for surgery for an ACL injury? What is the outcome of different conservative treatment modalities? Which kind of graft gives the best result in an ACL reconstruction? What is the optimal postoperative treatment concerning rehabilitation, resumption of sports, and physiotherapy? These 8 questions were answered and recommendations were made, using the "Appraisal of Guidelines for Research and Evaluation" instrument. This instrument seeks to improve the quality and effectiveness of clinical practical guidelines by establishing a shared framework to develop, report, and assess. The steering group has also developed 7 internal indicators to aid in measuring and enhancing the quality of the treatment of patients with an ACL injury, for use in a hospital or practice. PMID:22900914
Infection after arthroscopic anterior cruciate ligament reconstruction.
Kim, Seung-Ju; Postigo, Ricardo; Koo, Sowon; Kim, Jong Hun
Septic arthritis is a rare but potentially devastating complication of anterior cruciate ligament (ACL) reconstruction surgery. The purpose of this study was to provide an evidence-based summarization of the treatment and outcome of infection after ACL reconstruction with a pooled analysis of the reported cases. The authors conducted a systematic review of published studies that evaluated the outcome of septic arthritis after arthroscopic ACL reconstruction. A structured literature review of multiple databases referenced articles from 1950 to 2012. A total of 22,836 knees from 14 published studies were assessed. Postoperative septic arthritis occurred in 121 knees, with a pooled percentage of 0.5%. Mean duration of follow-up after ACL reconstruction was 53.6 months (range, 4-218 months). An average of 1.92 procedures (range, 1-5 procedures) were performed to eradicate the infection. The grafts were retained in 77% of cases. Postoperative intravenous antibiotics were used for at least 5 days (range, 5-90 days) after debridement. At final follow-up, mean postoperative Lysholm score was 80.2 (range, 23-100). No reinfection was observed in 121 patients. This study has helped to further elucidate the outcomes of infection after ACL reconstruction. Once an infection is encountered, culture-specific antibiotics and surgical joint irrigation with graft retention are recommended as initial treatment. Graft removal can be considered only for those infections resistant to initial treatment. PMID:24992054
Principles of postoperative anterior cruciate ligament rehabilitation
Saka, Tolga
It is known that anterior cruciate ligament (ACL) reconstruction needs to be combined with detailed postoperative rehabilitation in order for patients to return to their pre-injury activity levels, and that the rehabilitation process is as important as the reconstruction surgery. Literature studies focus on how early in the postoperative ACL rehabilitation period rehabilitation modalities can be initiated. Despite the sheer number of studies on this topic, postoperative ACL rehabilitation protocols have not been standardized yet. Could common, "ossified" knowledge or modalities really prove themselves in the literature? Could questions such as "is postoperative brace use really necessary?", "what are the benefits of early restoration of the range of motion (ROM)?", "to what extent is neuromuscular electrical stimulation (NMES) effective in the protection from muscular atrophy?", "how early can proprioception training and open chain exercises begin?", "should strengthening training start in the immediate postoperative period?" be answered for sure? My aim is to review postoperative brace use, early ROM restoration, NMES, proprioception, open/closed chain exercises and early strengthening, which are common modalities in the very comprehensive theme of postoperative ACL rehabilitation, on the basis of several studies (Level of Evidence 1 and 2) and to present the commonly accepted ways they are presently used. Moreover, I have presented the objectives of postoperative ACL rehabilitation in tables and recent miscellaneous studies in the last chapter of the paper. PMID:25232521
Principles of postoperative anterior cruciate ligament rehabilitation.
Saka, Tolga
It is known that anterior cruciate ligament (ACL) reconstruction needs to be combined with detailed postoperative rehabilitation in order for patients to return to their pre-injury activity levels, and that the rehabilitation process is as important as the reconstruction surgery. Literature studies focus on how early in the postoperative ACL rehabilitation period rehabilitation modalities can be initiated. Despite the sheer number of studies on this topic, postoperative ACL rehabilitation protocols have not been standardized yet. Could common, "ossified" knowledge or modalities really prove themselves in the literature? Could questions such as "is postoperative brace use really necessary?", "what are the benefits of early restoration of the range of motion (ROM)?", "to what extent is neuromuscular electrical stimulation (NMES) effective in the protection from muscular atrophy?", "how early can proprioception training and open chain exercises begin?", "should strengthening training start in the immediate postoperative period?" be answered for sure? My aim is to review postoperative brace use, early ROM restoration, NMES, proprioception, open/closed chain exercises and early strengthening, which are common modalities in the very comprehensive theme of postoperative ACL rehabilitation, on the basis of several studies (Level of Evidence 1 and 2) and to present the commonly accepted ways they are presently used. Moreover, I have presented the objectives of postoperative ACL rehabilitation in tables and recent miscellaneous studies in the last chapter of the paper. PMID:25232521
Focal Atrial Tachycardia Surrounding the Anterior Septum
Wang, Zulu; Ouyang, Jinge; Liang, Yanchun; Jin, Zhiqing; Yang, Guitang; Liang, Ming; Li, Shibei; Yu, Haibo
Background— Focal atrial tachycardias (ATs) surrounding the anterior atrial septum (AAS) have been successfully ablated from the right atrial septum (RAS), the aortic cusps, and the aortic mitral junction. However, the strategy for mapping and ablation of AAS-ATs has not been well defined. Methods and Results— Of 227 consecutive patients with AT, 47 (20.7%; mean age, 56.3±11.6 years) with AAS-ATs were studied; among them, initial ablation was successful at RAS in only 5 of 14 patients and at noncoronary cusp (NCC) in 28 of 33 patients. In 45 of the 47 patients, the 46 of 48 AAS-ATs were eliminated at RAS in 8 patients, NCC in 35 patients (earliest activation time at NCC was later than that at RAS by 5–10 ms in 6 patients), and aortic mitral junction in 3 patients (all with negative P wave in lead aVL and positive P wave in the inferior leads), including 1 patient whose 2 ATs were eliminated separately from the NCC and the aortic mitral junction. Conclusions— Most of the ATs surrounding the AAS can be eliminated from within the NCC, which is usually the preferential ablation site. Ablation at the RAS and aortic mitral junction should be considered when supported by P-wave morphologies on surface ECG and results of activation mapping and ablation. PMID:25908691
Curative radiotherapy for anterior commissure laryngeal carcinoma.
Persky, M S; Lagmay, V M; Cooper, J; Constantinides, M; O'Leary, R
There is continuing controversy surrounding the most effective treatment of glottic carcinoma involving the anterior commissure (AC). Surgery has been the preferred method of treatment, since studies previously indicated early tumor invasion of the thyroid cartilage at the AC, thereby assuming less curability by radiotherapy (RT). Subsequent laryngeal anatomic studies and refinement of RT techniques have brought into question the ineffectiveness of curative irradiation. A retrospective review of 174 patients with early-stage glottic carcinoma treated with standard fractionation curative RT revealed 34 patients with T1 and T2 lesions involving the AC. Allowing for a follow-up of at least 3 years, we observed only a 12% (4 of 34 patients) local recurrence rate after RT alone, with excellent voice quality and no major complications related to the irradiation. The 4 local recurrences were controlled by total laryngectomy, although 2 patients developed distant metastatic disease. Radiotherapy represents an effective method of treating T1 squamous cell carcinoma of the glottis with AC involvement. The small number of T2 glottic carcinomas in this study prevents a meaningful conclusion concerning treatment of these lesions. PMID:10685566
Effects of triiodothyronine supplementation after myocardial ischemia.
Dyke, C M; Ding, M; Abd-Elfattah, A S; Loesser, K; Dignan, R J; Wechsler, A S; Salter, D R
Cardiopulmonary bypass causes a "euthyroid-sick" state characterized by low levels of circulating triiodothyronine. Triiodothyronine supplementation in this setting has been postulated to improve postischemic left ventricular function by increasing the availability of myocardial high-energy phosphates. These postulates have not been substantiated, however, using load-independent parameters of left ventricular function and analysis of high-energy phosphate metabolism. To test these hypotheses, 14 healthy pigs (30 to 40 kg) were placed on cardiopulmonary bypass and instrumented with left ventricular minor-axis ultrasonic crystals and micromanometer-tipped pressure catheters. Hearts were subjected to 30 minutes of global, normothermic ischemia. Triiodothyronine (0.1 mg/kg; n = 7) or placebo (n = 7) was administered in a random, investigator-blinded fashion at the removal of the aortic cross-clamp and after 60 minutes of reperfusion. Hemodynamic, metabolic, and ultrastructural data were obtained before ischemia and after 30, 60, 90, and 120 minutes of reperfusion. By 90 minutes of reperfusion left ventricular contractility had returned to preischemic levels in hearts supplemented with triiodothyronine, despite postischemic myocardial adenosine triphosphate levels of 50% to 60% of baseline in both groups. Ultrastructurally, the sarcoplasmic reticulum and mitochondria were significantly better preserved in the group treated with triiodothyronine. This study suggests that triiodothyronine supplementation significantly enhances postischemic left ventricular functional recovery and that this recovery is due to mechanisms other than enhanced availability of myocardial high-energy phosphates. PMID:8347001
Clinical myocardial perfusion PET/CT.
Di Carli, Marcelo F; Dorbala, Sharmila; Meserve, Jolene; El Fakhri, Georges; Sitek, Arkadiusz; Moore, Stephen C
The field of nuclear cardiology is witnessing growing interest in the use of cardiac PET for the evaluation of patients with coronary artery disease (CAD). The available evidence suggests that myocardial perfusion PET provides an accurate means for diagnosing obstructive CAD, which appears superior to SPECT especially in the obese and in those undergoing pharmacologic stress. The ability to record changes in left ventricular function from rest to peak stress and to quantify myocardial perfusion (in mL/min/g of tissue) provides an added advantage over SPECT for evaluating multivessel CAD. There is growing and consistent evidence that gated myocardial perfusion PET also provides clinically useful risk stratification. Although the introduction of hybrid PET/CT technology offers the exciting possibility of assessing the extent of anatomic CAD (CT coronary angiography) and its functional consequences (ischemic burden) in the same setting, there are technical challenges in the implementation of CT-based transmission imaging for attenuation correction. Nonetheless, this integrated platform for assessing anatomy and biology offers a great potential for translating advances in molecularly targeted imaging into humans. PMID:17475968