RESUMEN

Human semen is composed of a heterogeneous population of spermatozoa with varying degrees of structural and functional differentiation and normality, which result in subpopulations of different quality. Using a discontinuous Percoll gradient, we separated three subsets of spermatozoa (65/45%, 90/65% and 90% fractions) from normozoospermic semen samples from healthy donors and proceeded to characterise their morphology, viability, motility and proteasome activity. In addition, the presence of proteasome subunit transcripts was investigated using reverse transcription-polymerase chain reaction (RT-PCR). The results obtained showed significant differences in sperm motility, viability and morphology between the cells collected from each of the fractions. In particular, normal sperm morphology was 4.5 times higher in the 90% pellet in comparison with the 65/45% interface. In addition, there were significant differences in proteasomal activity between spermatozoa recovered from the 90% pellet and spermatozoa recovered from the 65/45% interface. Finally, there was a positive correlation between sperm proteasomal enzymatic activity and sperm motility and normal morphology after separation by a discontinuous Percoll gradient. The results of the RT-PCR revealed the presence of transcripts for the proteasome subunits ß1, ß2 and ß5 in the human spermatozoa analysed. In conclusion, poor quality spermatozoa isolated from a Percoll gradient display an intrinsic proteasome activity deficiency, which may be associated with their low fertilising potential.

Asunto(s)

Separación Celular/métodos , Complejo de la Endopetidasa Proteasomal/genética , Complejo de la Endopetidasa Proteasomal/metabolismo , ARN Mensajero/análisis , Espermatozoides/enzimología , Espermatozoides/fisiología , Supervivencia Celular , Centrifugación por Gradiente de Densidad , Humanos , Masculino , Povidona , Subunidades de Proteína/genética , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Dióxido de Silicio , Motilidad Espermática , Espermatozoides/citología

RESUMEN

OBJETIVO: las prótesis de núcleo (PDN-SOLO) reconstruyen la anatomía y preservan la biomecánica del disco intervertebral con un índice de migración de 10 por ciento y de hundimiento de 19 por ciento. Por eso, proponemos un sistema de fijación para evitar estas complicaciones. MÉTODOS: fueron utilizados veinte pacientes con seguimiento mínimo de tres años. La valoración de dolor con EVA, función con Escala de Oswestry (EO) y disco por estudios radiográficos y resonancia magnética fueron aplicadas. El análisis estadístico fue por t de Student. RESULTADOS: El grupo comprende 8 mujeres y 12 hombres con una edad promedio de 37.6 años. Los valores preoperatorios de EVA fueron 7.6 puntos y EO de 67 por ciento, la altura del espacio intervertebral (El) de 7.67 mm. A tres años, EVA de dolor de 0.7 y EO a menos de 6 por ciento (p<0.000). Incremento altura disco promedio 2 mm. La prótesis presentó movilidad en rotación con respecto a colocación inicial en 12 pacientes. En dos casos, el implante migró con necesidad de retiro. La evaluación de EVA y EO fue de 0.7 puntos y 1.4 por ciento. La ganancia de altura del espacio intersomático mejoró 2.5 mm. Una migración a los 23 meses por esfuerzo físico no indicado representando un 5 por ciento y no existiendo ningún hundimiento. CONCLUSIÓN: se puede concluir que había una reducción del dolor y el grado de discapacidad asociada a las plataformas de menor edema y aumento del espacio intervertebral.

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OBJETIVO: as próteses de núcleo (PDN-SOLO) reconstituem a anatomia e preservam a biomecânica do disco intervertebral, com um índice de migração de 10 por cento e de afundamento de 19 por cento. Por isso, foi proposto um sistema de fixação para evitar essas complicações. MÉTODOS: foram utilizados 20 pacientes com seguimento mínimo de três anos. A avaliação da dor com EVA, função com Escala de Oswestry (EO) e disco por estudos radiológicos e ressonância magnética foram aplicados. A análise estatística foi por teste t de Student. RESULTADOS: Fizeram parte do estudo 12 homens e 8 mulheres, com média de idade de 37,6 anos. Valores pré-operatórios da EVA foram de 7,6 pontos e EO de 67 por cento, a altura do espaço intervertebral (EI) de 7,67 mm. Durante três anos, a EVA de dor foi de 0,7 e a EO foi menos de 6 por cento (p<0,000). Houve aumento da altura discal média de 2 mm. A prótese apresentou mobilidade em rotação durante a colocação inicial em 12 pacientes. Em dois casos o implante migrou com necessidade de remoção. A avaliação de EVA e EO foi de 0,7 pontos e 1,4 por cento. A ganância de altura do espaço intersomático melhorou 2,5 mm. Uma migração aos 23 meses por esforço físico não-indicado representou 5 por cento. Não houve nenhum afundamento. CONCLUSÃO: pode-se concluir que houve uma redução da dor e do grau de incapacidade associados com menos edema das plataformas e aumento do espaço intervertebral.

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OBJECTIVE: The prosthetic nucleus (PDN-SOLO) reconstruct the anatomy and preserve the biomechanics of intervertebral disc with a migration rate of 10 percent and sinking rate of 19 percent. Therefore, a fixing system to avoid these complications was proposed. METHODS: A total of 20 patients were followed-up for at least three years. The assessment of pain with VAS, Oswestry Scale function (OS) and disk by radiological studies and magnetic resonance imaging were applied. Statistical analysis was made by Student's t-test. RESULTS: The subjects were 12 men and 8 women with a mean age of 37.6 years. VAS preoperative values were 7.6 points and OS 67 percent, the height of intervertebral space was 7.67 mm. For three years, the VAS pain score was 0.7 and OS less than 6 percent (p<0.000). There was an increase of average disc height of 2 mm. Prosthesis showed mobility in rotation during the initial placement in 12 patients. In 2 cases the implant migrated and it was necessary to remove it. The VAS evaluation and OS were 0.7 points and 1.4 percent. The height greed of intersomatic space improved in 2.5 mm. A migration in 23 months by non-indicated physical exertion represented 5 percent. There was no sinking. CONCLUSION: We can be concluded that there was a reduction of pain and degree of disability associated with less edema platforms and increase the intervertebral space.

Asunto(s)

Humanos , Fenómenos Biomecánicos , Desplazamiento del Disco Intervertebral/diagnóstico , Prótesis Articulares , Espectroscopía de Resonancia Magnética , Radiografía

RESUMEN

Slow or no-reflow phenomenon (SNR) complicates 10%-15% of cases of percutaneous intervention (PCI) in aortocoronary saphenous vein grafts (SVG). At present, there are no uniform, effective strategies to predict or prevent this common and potentially serious complication. The purpose of our study was to characterize variables correlated with the risk of SNR in SVG PCI in the era of stenting and glycoprotein IIb/IIIa receptor inhibitors. We identified 2,898 consecutive patients who had PCI, of whom 163 underwent PCI of at least one SVG. The clinical and angiographic characteristics of patients who developed SNR (SNR group) were compared with those who did not (no-SNR group). A total of 23 patients experienced SNR and 140 did not. Using a stepwise multivariate logistic regression analysis, four independent predictors for SNR were detected: probable thrombus (OR 6.9; 95% CI, 2.1-23.9; P = 0.001), acute coronary syndromes (OR 6.4; 95% CI, 2.0-25.3; P = 0.003), degenerated vein graft (OR 5.2; 95% CI, 1.7-16.6; P = 0.003), and ulcer (OR 3.4; 95% CI, 0.99-11.6; P = 0.04). The risk of developing SNR could be estimated according to the number of predictors found: low-grade risk (1%-10%) if < or = one variable was present, moderate risk (20%-40%) if two variables were present, and high risk (60%-90%) if three or more variables were present. We identified and quantified current risk factors for SNR and concluded that the risk of developing SNR during PCI in SVG can be predicted by simple clinical and angiographic variables obtained before PCI. This information may be useful when the risk of PCI has to be balanced against alternative strategies such as medical therapy or redo-bypass surgery or in the selection of those patients that will most benefit from the use of protection devices during PCI.

Asunto(s)

Aorta/cirugía , Puente de Arteria Coronaria , Vasos Coronarios/cirugía , Vena Safena/cirugía , Anciano , Puente de Arteria Coronaria/instrumentación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Valor Predictivo de las Pruebas , Medición de Riesgo , Stents , Texas , Resultado del Tratamiento

RESUMEN

BACKGROUND: No proven neuroprotective treatment exists for ischemic brain injury after cardiac arrest. Mild-to-moderate induced hypothermia (MIH) is effective in animal models. METHODS AND RESULTS: A safety and feasibility trial was designed to evaluate mild-to-moderate induced hypothermia by use of external cooling blankets after cardiac arrest. Inclusion criteria were return of spontaneous circulation within 60 minutes of advanced cardiac life support, hypothermia initiated within 90 minutes, persistent coma, and lack of acute myocardial infarction or unstable dysrhythmia. Hypothermia to 33 degrees C was maintained for 24 hours followed by passive rewarming. Nine patients were prospectively enrolled. Mean time from advanced cardiac life support to return of spontaneous circulation was 11 minutes (range 3 to 30); advanced cardiac life support to initiation of hypothermia was 78 minutes (range 40 to 109); achieving 33 degrees C took 301 minutes (range 90 to 690). Three patients completely recovered, and 1 had partial neurological recovery. One patient developed unstable cardiac dysrhythmia. No other unexpected complications occurred. CONCLUSIONS: Mild-to-moderate induced hypothermia after cardiac arrest is feasible and safe. However, external cooling is slow and imprecise. Efforts to speed the start of cooling and to improve the cooling process are needed.

Asunto(s)

Apoyo Vital Cardíaco Avanzado/métodos , Isquemia Encefálica/prevención & control , Paro Cardíaco/terapia , Hipotermia Inducida/métodos , Adulto , Anciano , Temperatura Corporal , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/etiología , Estudios de Cohortes , Supervivencia sin Enfermedad , Electroencefalografía , Servicios Médicos de Urgencia , Epilepsia/etiología , Estudios de Factibilidad , Femenino , Paro Cardíaco/complicaciones , Paro Cardíaco/diagnóstico , Humanos , Hipotermia Inducida/efectos adversos , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Neumonía por Aspiración/etiología , Respiración Artificial , Tasa de Supervivencia , Factores de Tiempo , Tomografía Computarizada por Rayos X , Resultado del Tratamiento

Asunto(s)

Angioplastia Coronaria con Balón , Anticuerpos Monoclonales/uso terapéutico , Enfermedad Coronaria/terapia , Fragmentos Fab de Inmunoglobulinas/uso terapéutico , Inhibidores de Agregación Plaquetaria/uso terapéutico , Complejo GPIIb-IIIa de Glicoproteína Plaquetaria/antagonistas & inhibidores , Stents , Ticlopidina/análogos & derivados , Ticlopidina/uso terapéutico , Tirosina/análogos & derivados , Tirosina/uso terapéutico , Abciximab , Anciano , Clopidogrel , Enfermedad Coronaria/tratamiento farmacológico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tirofibán , Resultado del Tratamiento

RESUMEN

BACKGROUND: The histological appearance of stenosis in de novo saphenous venous grafts (DNSVG) consists of diffuse atherosclerosis that contains blood elements, necrotic debris and limited fibrocollagenous tissue. The friable nature of these lesions complicates percutaneous intervention (PCI) procedures. On the other hand, in-stent restenosis (ISR) of SVG is due primarily to atherosclerotic plaque or fibromuscular hyperplasia, with thrombus formation playing a secondary role. The purpose of this study is to compare the results of PCI in these two types of SVG lesions. METHODS: We reviewed our institutional interventional database from March 1996 through February 2000 and identified all consecutive patients who underwent PCI of at least one SVG. One hundred and ten patients were identified: 89 undergoing DNSVG intervention and 21 patients with ISR lesions. RESULTS: Acute coronary syndromes, degenerated and thrombus-containing lesions were more common in the DNSVG group. "Slow-, no-reflow" complicated 20% of the DNSVG lesions compared to none of the ISR lesions (p = 0.02). Post-procedural myocardial infarction was higher in the DNSVG group (13.5% versus 0%; p = 0.1) and correlated significantly with the occurrence of "slow-, no-reflow" (r = 0.43; p = 0.0001). Utilizing statistical modeling to adjust for baseline differences between the groups, ISR lesions were associated with a low risk of procedural complications (r = 0.22; p = 0.03). CONCLUSION: This study demonstrates that in this relatively high-risk population, PCI is safer in ISR lesions than in de novo SVG lesions.

Asunto(s)

Angioplastia Coronaria con Balón , Vena Safena/trasplante , Anciano , Puente de Arteria Coronaria , Femenino , Oclusión de Injerto Vascular/cirugía , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/etiología , Complicaciones Posoperatorias , Stents , Resultado del Tratamiento

RESUMEN

OBJECTIVE: We examined long-term outcomes of patients with in-stent restenosis (ISR) who underwent different percutaneous interventions at the discretion of individual operators: balloon angioplasty (BA), repeat stent or rotational atherectomy (RA). We also examined long-term outcomes of patients with ISR who underwent coronary artery bypass surgery (CABG). BACKGROUND: In-stent restenosis remains a challenging problem, and its optimal management is still unknown. METHODS: Symptomatic patients (n = 510) with ISR were identified using cardiac catheterization laboratory data. Management for ISR included BA (169 patients), repeat stenting (117 patients), RA (107 patients) or CABG (117 patients). Clinical outcome events of interest included death, myocardial infarction, target vessel revascularization (TVR) and a combined end point of these major adverse cardiovascular events (MACE). Mean follow-up was 19+/-12 months (range = 6 to 61 months). RESULTS: Patients with ISR treated with repeat stent had significantly larger average post-procedure minimal lumen diameter compared with BA or RA (3.3+/-0.4 mm vs. 3.0+/-0.4 vs. 2.9+/-0.5, respectively, p < 0.05). Incidence of TVR and MACE were similar in the BA, stent and RA groups (39%, 40%, 33% for TVR and 43%, 40%, 33% for MACE, p = NS). Patients with diabetes who underwent RA had similar outcomes as patients without diabetes, while patients with diabetes who underwent BA or stent had worse outcomes than patients without diabetes. Patients who underwent CABG for ISR, mainly because of the presence of multivessel disease, had significantly better outcomes than any percutaneous treatment (8% for TVR and 23% for MACE). CONCLUSIONS: In this large cohort of patients with ISR and in the subset of patients without diabetes, long-term outcomes were similar in the BA, repeat stent and RA groups. Tissue debulking with RA yielded better results only in diabetic patients. Bypass surgery for patients with multivessel disease and ISR provided the best outcomes.

Asunto(s)

Enfermedad Coronaria/complicaciones , Enfermedad Coronaria/cirugía , Complicaciones de la Diabetes , Stents , Angioplastia Coronaria con Balón , Aterectomía Coronaria , Puente de Arteria Coronaria , Femenino , Humanos , Masculino , Persona de Mediana Edad , Recurrencia , Factores de Tiempo , Resultado del Tratamiento

RESUMEN

Slow or no reflow (SNR) complicates 10-15% of cases of percutaneous intervention (PI) in saphenous vein bypass graft (SVG). To date there have been limited options for the prevention and treatment of this common and potentially serious complication. We evaluated the procedural outcome of 143 consecutive SVG interventions. We compared patients who received pre-intervention intra-graft adenosine boluses with those who did not. In addition we examined the efficacy of adenosine boluses to reverse slow-no reflow events. Angiograms were reviewed and flow graded (TIMI grade) by film readers blinded to the use of any intraprocedural drug or clinical history. Seventy patients received intragraft adenosine boluses before percutaneous intervention (APPI), 73 received no preintervention adenosine (NoAPPI). There were no significant angiographic differences between the two groups at baseline. A total of 20 patients experienced SNR. The incidence of SNR was similar in the two groups (APPI = 14.2% vs. NoAPPI = 13.6%, P = 0.9). SNR was treated with repeated, rapid boluses (24 microg each) of intra-graft adenosine. Reversal of SNR was observed in 10 of 11 patients (91%) who received high doses of adenosine (>/=5 boluses, mean 7.7 +/- 2.6) and in 3 of 9 (33%) of those who received low doses (<5 boluses, mean 1.5 +/- 1.2). Final TIMI flow was significantly better in the high dose than in the low dose group (final TIMI 2.7 +/- 0.6 vs. 2 +/- 0.8, P = 0.04). No significant untoward complications were observed during adenosine infusion. These findings suggest that SNR after PI in SVG is not prevented by pre-intervention adenosine, but it can be safely and effectively reversed by delivery of multiple, rapid and repeated boluses of 24 microg of intra-graft adenosine.

Asunto(s)

Adenosina/uso terapéutico , Puente de Arteria Coronaria , Circulación Coronaria , Complicaciones Posoperatorias/prevención & control , Vena Safena/trasplante , Vasodilatadores/uso terapéutico , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Flujo Sanguíneo Regional , Estudios Retrospectivos , Resultado del Tratamiento

RESUMEN

Acute reintervention was performed in 26 of 1,620 patients after coronary stenting (1.6%). Half of the patients had stent thrombosis and the other half residual anatomic problems. The mean time for reintervention was shorter in patients with stent thrombosis. All patients with stent thrombosis had a sudden recurrence of chest pain. Electrocardiographic changes were more common with stent thrombosis. Composite end point occurred in 10 patients (77%) with stent thrombosis versus 5 (39%) in the other group (p = 0.04).

Asunto(s)

Angioplastia Coronaria con Balón/métodos , Enfermedad Coronaria/terapia , Stents/efectos adversos , Anciano , Angioplastia Coronaria con Balón/efectos adversos , Distribución de Chi-Cuadrado , Angiografía Coronaria , Enfermedad Coronaria/diagnóstico por imagen , Enfermedad Coronaria/mortalidad , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/prevención & control , Probabilidad , Recurrencia , Estudios Retrospectivos , Medición de Riesgo , Tasa de Supervivencia , Resultado del Tratamiento

RESUMEN

BACKGROUND: Acute and subacute stent thromboses (ASST) are the major thrombotic complications of coronary stenting. The time course of ASST seems to be related to the type of antithrombotic therapy (four days in patients treated with aspirin and coumadin compared to 12 hours with the use of aspirin and ticlopidine). In this report, we compared the timing of ASST in patients treated with aspirin, ticlopidine/clopidogrel, heparin and tirofiban with that in patients treated with the same drugs but without tirofiban. METHODS: Retrospective analysis of the Hermann intervention database between January 1997 and October 1999 was performed. We identified 13 patients who required reintervention in the first week after a successful coronary stenting ( 1 stent). Four patients were treated with tirofiban (Group 1) and 9 were not (Group 2). RESULTS: The median time from stent deployment to ASST was 7 hours (interquartile range, 2.5Eth 33 hours) in group 2 compared to 84.5 hours (interquartile range, 56Eth 124.5 hours) in group 1. The mean time from stent deployment to ASST was 90.3 +/- 43.1 hours in group 1 versus 12.8 +/- 15.3 hours in group 2 (p = 0.0005). All episodes of ASST occurred 3 days in patients treated with tirofiban, whereas they occurred in the first 2 days in all patients not treated with tirofiban. CONCLUSION: Prophylactic tirofiban treatment delays the time to stent thrombosis after successful coronary artery stent implantation for more than two days. Patients at high risk for stent thrombosis treated with short-acting glycoprotein IIb/IIIa platelet receptor inhibitors may warrant close follow-up during the first week after stenting.

Asunto(s)

Angioplastia Coronaria con Balón/instrumentación , Oclusión de Injerto Vascular/prevención & control , Inhibidores de Agregación Plaquetaria/uso terapéutico , Complejo GPIIb-IIIa de Glicoproteína Plaquetaria/antagonistas & inhibidores , Stents , Tirosina/análogos & derivados , Tirosina/uso terapéutico , Angiografía Coronaria , Enfermedad Coronaria/diagnóstico por imagen , Enfermedad Coronaria/terapia , Femenino , Oclusión de Injerto Vascular/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Falla de Prótesis , Estudios Retrospectivos , Factores de Tiempo , Tirofibán

RESUMEN

Percutaneous intervention in acute myocardial infarction has been associated with a high incidence of "no reflow," ranging from 11% to 30%, with an increased risk of complications. The role of intracoronary adenosine for the prevention of this phenomenon has not been evaluated fully. We studied the procedural outcomes of 79 patients who underwent percutaneous intervention in the context of acute myocardial infarction. Twenty-eight patients received no intracoronary adenosine, and 51 received intracoronary adenosine boluses (24-48 microg before and after each balloon inflation). Eight patients who were not given adenosine experienced no reflow (28.6%) and higher rates of in-hospital death, while only three of 51 patients (5.9%; P = 0.014) in the adenosine group experienced no reflow. No untoward complications were noted during adenosine infusion. Intracoronary adenosine bolus administration during percutaneous intervention in the context of acute myocardial infarction is easy and safe and may significantly lessen the incidence of no reflow, which may improve the outcome of this procedure.

Asunto(s)

Adenosina/administración & dosificación , Angioplastia Coronaria con Balón , Vasos Coronarios/fisiopatología , Infarto del Miocardio/terapia , Grado de Desobstrucción Vascular , Adenosina/uso terapéutico , Adulto , Anciano , Femenino , Mortalidad Hospitalaria , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/mortalidad , Infarto del Miocardio/fisiopatología , Estudios Retrospectivos , Resultado del Tratamiento

RESUMEN

Se realizó una investigación de casos y controles sobre escabiosis en la provincia Ciego de Ávila, Cuba.El universo de estudio fueron 50 enfermos (casos) y 100 controles, se consideró caso al que tuviera un cuadro clínico compatible donde se planteara el diagnóstico inicial por un médico de la atención primaria y se ratificara el diagnóstico por un dermatólogo. A ambos grupos se les aplicó un cuestionario, el cual había sido validado anteriormente.Se calcularon razones de ventaja (OR) y sus intervalos de confianza. Como factores de riesgo se encontró: compartir la cama tres o más personas, presencia de dos o menos habitaciones en la vivienda, la escolaridad de los padres, el cambio de sábanas cada quince días o más, el cambio de la toalla con igual frecuencia y el intercambio de toallas dentro del núcleo familiar.En el presente estudio se detectaron factores de riesgo higiénicos y socio-económicos (AU)

Asunto(s)

Adolescente , Femenino , Preescolar , Lactante , Masculino , Niño , Humanos , Escabiosis/epidemiología , Factores de Riesgo , Cuba/epidemiología , Estudios de Casos y Controles , Factores Socioeconómicos , Intervalos de Confianza , Saneamiento de Viviendas , Demografía , Oportunidad Relativa

RESUMEN

Acute parathyroid hormone exposure induces vascular smooth muscle relaxation. In contrast, continuous infusion of parathyroid hormone leads to vasoconstriction and an elevation of blood pressure. Despite the known effects of parathyroid hormone on vascular smooth muscle, possible direct effects on the vascular endothelium have not previously been investigated. Using a human umbilical vein endothelial cell line, we found that parathyroid hormone increased both intracellular calcium and cellular cAMP content in these endothelial cells. Furthermore, exposure of these cells to increasing concentrations of parathyroid hormone stimulated both [(3)H]thymidine incorporation and endothelin-1 secretion. Parathyroid hormone/parathyroid hormone-related peptide receptor mRNA could be detected at low levels in these cells. In summary, these data demonstrate that endothelium-derived cells contain functional parathyroid hormone receptors. The potential physiological role of these receptors remains to be determined.

Asunto(s)

Endotelio Vascular/metabolismo , Receptores de Hormona Paratiroidea/metabolismo , Venas Umbilicales/metabolismo , Calcio/metabolismo , Línea Celular , Cromatografía Líquida de Alta Presión , AMP Cíclico/biosíntesis , Endotelina-1/metabolismo , Endotelio Vascular/citología , Colorantes Fluorescentes , Fura-2 , Gliceraldehído-3-Fosfato Deshidrogenasas/metabolismo , Humanos , Fosfatos de Inositol/metabolismo , Hormona Paratiroidea/metabolismo , ARN Mensajero/biosíntesis , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Transducción de Señal/fisiología , Timidina/metabolismo , Venas Umbilicales/citología

RESUMEN

Rotational atherectomy (RA) of complex, calcified lesions has been associated with a high incidence of no reflow ranging from 6%-15% and concomitant myocardial necrosis with adverse prognostic implications. There are no uniform strategies for preventing this complication. The role of intracoronary adenosine for the prevention of this phenomenon during RA has not been fully evaluated. We studied the procedural outcome of 122 patients who underwent RA of complex native coronary artery lesions. Fifty-two patients received no adenosine but a variety of other agents. Seventy patients received intracoronary adenosine boluses (24 to 48 microgram prior to and after each RA run). There was no difference in the type of lesion studied, run time, or Burr to artery ratio (0.6-0.7) between the two groups. Six patients without adenosine experienced no reflow (11.6%), with resultant infarction in the target artery territory, while only 1 of 70 patients (1.4%, P - 0.023) in the adenosine group experienced no reflow. No untoward complications were observed during adenosine infusion. Intracoronary adenosine bolus administered during rotational atherectomy is easy, safe, and may significantly reduce the incidence of no reflow, which may improve the 30-day outcome of this procedure.

Asunto(s)

Adenosina/administración & dosificación , Aterectomía Coronaria/métodos , Enfermedad de la Arteria Coronaria/cirugía , Complicaciones Posoperatorias/prevención & control , Vasodilatadores/administración & dosificación , Angiografía Coronaria , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Vasos Coronarios , Femenino , Humanos , Inyecciones Intraarteriales , Periodo Intraoperatorio , Masculino , Complicaciones Posoperatorias/epidemiología , Estudios Retrospectivos , Resultado del Tratamiento

RESUMEN

En este estudio consideramos que el reforzamiento del ligamento supra e interespinoso con corion (dermis) estabiliza la columna lumbar y evita la lumbalgia posquirúrgica en el caso de la cirugía de hernias de disco. Se evaluó a los pacientes después de su cirugía mediante estudios de rayos X; valorando el grado de inestabilidad con y sin movimiento, se describió la técnica utilizada y se observaron los cambios degenerativos intervertebrales con un seguimiento a 4 años de la cirugía. Los resultados mostraron que existe notable disminución de los rangos de movimiento del segmento afectado, se evitó la lumbalgia postoperatoria, no existe movimiento intersomático anormal de los cuerpos vertebrales, y para concluir nuestro objetivo con significancia estadística continuaremos el seguimiento sumando un mayor número de pacientes

Asunto(s)

Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Columna Vertebral/cirugía , Columna Vertebral , Desplazamiento del Disco Intervertebral/cirugía , Desplazamiento del Disco Intervertebral/diagnóstico , Ligamentos/cirugía , Ligamentos/lesiones , Inestabilidad de la Articulación , Estudios Prospectivos , Epidemiología Descriptiva

RESUMEN

Protein kinase C (PKC) plays an important role in the mitogenic response of endothelial cells to growth factors. PKC alpha and beta1 are the predominant classical isoforms expressed by bovine aortic endothelial cells (BAECs). The present studies were undertaken to elucidate the effect of PKC alpha and beta1 overexpression in BAEC growth. A series of BAEC lines that stably overexpress the full-length PKC alpha and beta1 cDNA were generated by using a replication-defective recombinant retrovirus. The level of PKC alpha and beta1 cDNA expression was determined by assaying for PKC alpha and beta1 mRNA transcripts. PKC alpha and beta1 protein levels were analysed by Western blotting. Functional analysis of these overexpressing lines was performed by measuring PKC activity and phorbol ester-binding assays. PKC alpha and beta1 overexpression had distinctive effects on BAEC growth and cell-cycle progression. Relative to untransfected BAECs and BAECs transfected with the viral vector alone, BAECs that overproduced PKC alpha exhibited reduced proliferation in vitro and increased accumulation of cells in the G2/M phase of the cell cycle. Growth inhibition was greater in cell lines overexpressing higher levels of PKC alpha. Conversely, a 5-fold greater increase in PKC beta1 activity promoted BAEC growth and shortened BAEC doubling time, whereas cells with a 2- to 4-fold increase in enzyme activity had growth profiles similar to those of both control groups. These results suggest that PKC alpha and beta1 overexpression has reciprocal effects on BAEC growth.

Asunto(s)

Endotelio Vascular/citología , Endotelio Vascular/enzimología , Isoenzimas/genética , Proteína Quinasa C/genética , Animales , Bovinos , Ciclo Celular , División Celular , Células Clonales , ADN Complementario/genética , Expresión Génica , Proteína Quinasa C beta , Proteína Quinasa C-alfa , ARN Mensajero/genética , ARN Mensajero/metabolismo , Transducción de Señal , Transfección

RESUMEN

Estrogen replacement therapy (ERT) in women after menopause is associated with prevention of clinical coronary artery disease. However, few studies have investigated possible benefits from ERT in postmenopausal women undergoing treatment for established coronary disease. We therefore retrospectively reviewed the clinical outcomes of 428 postmenopausal women undergoing percutaneous transluminal coronary balloon angioplasty (PTCA) to test the hypothesis that ERT has a beneficial effect in this setting. The women were divided into 2 groups based on ERT status at the time of the procedure. Estrogen users were younger (60 +/- 10 vs 68 +/- 9 years, p <0.001), more commonly had family histories of coronary heart disease (54% vs 41%, p = 0.04), had less incidence of hypertension (63% vs 76%, p = 0.02), and had slightly fewer diseased vessels per patient (1.3 +/- 0.5 vs 1.5 +/- 0.7, p = 0.03) compared with nonusers. No in-hospital deaths occurred in estrogen users compared with 5% hospital mortality in nonusers (p = 0.01). The combined outcome of death or myocardial infarction (MI) also was lower in estrogen users (4% vs 12%, p = 0.04). Of 348 women discharged after successful PTCA, 336 (97%) were able to be contacted at an average follow-up interval of 22 +/- 17 months (range 5 to 82). Estrogen users had superior event-free survival both for death as well as for death or nonfatal MI. Repeat revascularizations were similar in both groups (32% vs 24%, p = 0.15). In a Cox proportional-hazards model, nonusers had 4 times the likelihood of death after angioplasty compared with estrogen users (OR = 4.025, 95% CI = 1.3 to 13.4, p = 0.02). We conclude that estrogen replacement may offer protection against clinical coronary events in postmenopausal women who already have established coronary disease and are undergoing balloon angioplasty. The benefit was independent of age, smoking, presence of diabetes mellitus, or the number of diseased coronary vessels. However, it did not include a reduction in repeat revascularization procedures, suggesting no reduction in restenosis.

Asunto(s)

Angioplastia Coronaria con Balón , Enfermedad Coronaria/terapia , Terapia de Reemplazo de Estrógeno , Posmenopausia , Salud de la Mujer , Adulto , Supervivencia sin Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Modelos Logísticos , Persona de Mediana Edad , Oportunidad Relativa , Estudios Retrospectivos , Texas , Resultado del Tratamiento

RESUMEN

We have previously reported that exposure of endothelial cells to cyclic strain elicited a rapid but transient generation of inositol 1,4,5-trisphosphate (IP3), which reached a peak 10 s after the initiation of cyclic deformation. To address the effect of cyclic strain on intracellular Ca2+ concentration ([Ca2+]i) and its temporal relationship to IP3 generation, confluent bovine aortic endothelial cells were grown on flexible membranes, loaded with aequorin and the membranes placed in a custom-designed flow-through chamber. The chamber was housed inside a photomultiplier tube, and vacuum was utilized to deform the membranes. Our results indicate that the initiation of 10% average strain induced a rapid increase in [Ca2+]i which contained two distinct components: a large initial peak 12 s after the initiation of stretch which closely followed the IP3 peak, and a subsequent lower but sustained phase. Pretreatment with 5 microM GdCl3 for 10 min or nominally Ca2+-free medium (CFM) for 3 min reduced the magnitude of the initial rise and abolished the sustained phase. Repetitive 10% average strain at a frequency of 60 cycles/min also elicited a single IP3 peak at 10 s. However, there was also a large initial [Ca2+]i peak followed by multiple smaller transient [Ca2+]i elevations. Preincubation with 5 microM GdCl3 or CFM diminished the initial [Ca2+]i transient and markedly inhibited the late-phase component. Preincubation with 25 microM 2,5-di-(t-butyl)-1,4-benzohydroquinone (BHQ) attenuated the initial [Ca2+]i transient. Cyclic-strain-mediated IP3 formation in confluent endothelial cells at 10 s, however, was not modified by pretreatment with 25 microM BHQ, 500 microM NiCl2, 10 nM charybdotoxin, 5 microM GdCl3 or CFM. We conclude that in endothelial cells exposed to cyclic strain, Ca2+ enters the cytosol from intracellular and extracellular pools but IP3 formation is not dependent on Ca2+ entry via the plasma membrane.

Asunto(s)

Ciclo Celular/fisiología , Endotelio Vascular/metabolismo , Espacio Extracelular/metabolismo , Líquido Intracelular/metabolismo , Animales , Aorta Torácica , Calcio/metabolismo , Bovinos , Ciclo Celular/efectos de los fármacos , Células Cultivadas , Medios de Cultivo/farmacología , Endotelio Vascular/citología , Gadolinio/farmacología , Hidroquinonas/farmacología , Inositol 1,4,5-Trifosfato/metabolismo , Cinética , Estrés Mecánico

RESUMEN

Confluent bovine aortic endothelial cells (EC) were grown on flexible membranes and subjected to 10% average strain at 60 cycles/min for up to 500 s. A biphasic increase in diacylglycerol (DAG) occurred, with an initial transient peak at 10 s followed by sustained elevation to 500 s. The early peak corresponded to the transient formation of inositol 1,4,5-trisphosphate, demonstrating hydrolysis of L-alpha-phosphatidylinositol (PI) by PI-specific phospholipase C. To determine the origin of the sustained DAG phase, we incubated confluent bovine aortic EC with 1 microCi/ml [14C]myristate overnight and subjected them to cyclic strain. There was a decrease in phosphatidylcholine (PC) and a corresponding increase in DAG at 10 s and 250 s, suggesting PC hydrolysis with the generation of DAG at both an early (10 s) and a late (250 s) phase. [14C]phosphatidylethanol, a specific product of phospholipase D (PLD) in the presence of 1% ethanol, was measured in EC preincubated with [14C]myristate. Cyclic strain led to an immediate and sustained activation of PLD. Increased ethanol concentration led to a consistent decrease in DAG. Furthermore, when EC were pretreated with 1% ethanol, the strain-induced proliferative response was attenuated.

Asunto(s)

Diglicéridos/biosíntesis , Endotelio Vascular/metabolismo , Animales , Bovinos , Células Cultivadas , Endotelio Vascular/citología , Etanol/farmacología , Hidrólisis , Periodicidad , Fosfatidilcolinas/metabolismo , Estrés Mecánico , Timidina/metabolismo , Factores de Tiempo

RESUMEN

Percutaneous aortic and mitral valvuloplasty are recognized as alternative interventions in cases of severe symptomatic aortic and mitral stenosis. We described the acute hemodynamic results, immediate clinical outcomes, and complications in 27 patients treated consecutively at Hermann Hospital with either percutaneous balloon aortic or mitral valvuloplasty. We review the possible mechanisms of action of balloon valvulotomy and the current indications for either procedure. Balloon aortic valvuloplasty is indicated in elderly patients with severe aortic stenosis in whom open-heart surgery is contraindicated or carries excessive mortality. All patients with symptomatic mitral stenosis are potential candidates for balloon mitral valvulotomy. In centers with an experienced interventional team in transseptal catheterization and an active surgical program, balloon valvulotomy is the initial procedure of choice for significant mitral stenosis with mobile leaflets and minimal chordal thickening.

Asunto(s)

Estenosis de la Válvula Aórtica/terapia , Cateterismo , Estenosis de la Válvula Mitral/terapia , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Humanos