RESUMEN
Decline in cardiac high-energy phosphate metabolism [phosphocreatine-to-ATP (PCr/ATP) ratio] and whole body metabolism increase the risk of heart failure and metabolic diseases. The aim of the present study was to assess the relationship between PCr/ATP ratio and measures of body metabolic function. A total of 35 healthy women (56+/-14.0 years of age) underwent cardiac 31P magnetic resonance spectroscopy to assess PCr/ATP ratio - an index of cardiac high-energy phosphate metabolism. Fasting and 2-hour glucose levels were assessed using oral glucose tolerance test. Indirect calorimetry was performed to determine oxygen consumption and resting metabolic rate. There were no significant relationships between PCr/ATP ratio and resting metabolic rate (r=-0.09, p=0.62), oxygen consumption (r=-0.11, p=0.54), fasting glucose levels (r=-0.31, p=0.07), and 2-hour plasma glucose (r=-0.10, p=0.58). Adjusted analysis for covariates including age, body mass index, fat mass, and physical activity, had no significant influence on the relationship between PCr/ATP ratio and body metabolism. In conclusion, the lack of relationship between cardiac PCr/ATP ratio, glucose control and metabolic rate may suggest that overall metabolic function does not influence cardiac high-energy phosphate metabolism.
Asunto(s)
Adenosina Trifosfato/metabolismo , Metabolismo/fisiología , Miocardio/metabolismo , Fosfocreatina/metabolismo , Adiposidad , Adulto , Anciano , Envejecimiento , Glucemia/análisis , Índice de Masa Corporal , Ejercicio Físico , Femenino , Humanos , Persona de Mediana Edad , Consumo de OxígenoRESUMEN
Cerebral arteriovenous malformation (AVM) presents a great health threat due to its high probability of rupture that can cause severe brain damage. Image segmentation alone is not sufficient to support AVM embolization procedure. In order to successfully navigate the catheter and perform embolization, the segmented blood vessels need to be classified into feeding arteries, draining veins and the AVM nidus. For this reason we address here the AVM localization and vessel decomposition problem. We propose in this paper a novel AVM localization and vessel delineation method using ordered thinning-based skeletonization. The main focus of vessel delineation is the delineation of draining veins since it is essential for the embolization procedure. The main contribution is a graph-based method for exact extraction of draining veins which, in combination with our earlier work on AVM detection, allows the AVM decomposition into veins, arteries and the nidus (with an emphasis on the draining veins). We validate the proposed approach on blood vessel phantoms representing the veins and the AVM structure, as well as on cerebral 3D digital rotational angiography (3DRA) images before and after embolization, paired with digital subtraction angiography (DSA) images. Results on AVM delineation show high correspondence to the ground truth structures and indicate potentials for use in surgical planning.
Asunto(s)
Angiografía Cerebral , Procesamiento de Imagen Asistido por Computador/métodos , Malformaciones Arteriovenosas Intracraneales/diagnóstico por imagen , Femenino , Humanos , MasculinoRESUMEN
BACKGROUND: An association between gestational hypertension (GH) and changes of maternal cardiac function was previously reported. AIM: The study assessed the effect of non-dipping pattern of blood pressure (BP) in GH on haemodynamic function and intrauterine growth restriction (IUGR). METHODS: This study included 126 women (91 with GH and 35 normotensive controls). Based on the BP values measured by ambulatory blood pressure monitoring (ABPM), all hypertensive women were classified in dipper (46 women) or in non-dipper group (45 women). All participants underwent echocardiography and ABPM during the third trimester. RESULTS: Participants with GH and non-dipping pattern had significantly lower velocity of longitudinal systolic function (s') (p<0.0005), and cardiac output index (COi) compared to dippers (p<0.0005) and controls (p=0.002). Diastolic velocities at the mitral valve annulus were also lower in non-dippers e's (non-dippers vs dippers p=0.023; non-dippers vs controls p<0.0005) and e'l (non-dippers vs dippers p=0.048; non-dippers vs controls p<0.0005). There were significant differences in the index of the left ventricle filling pressure E/e' and myocardial mass index between women with GH and controls, but with no significant difference among dippers and non-dippers. Total vascular resistance was increased in non-dipping group compared to normotensives and dippers (p<0.0005). Multivariate regression analysis revealed that the peak night-time diastolic BP, left ventricular mass index and CO index were identified as independent predictors of IUGR. CONCLUSION: Changes in maternal hemodynamics, as well as IUGR, are strongly related to the non-dipping pattern of BP.
Asunto(s)
Presión Sanguínea/fisiología , Retardo del Crecimiento Fetal/fisiopatología , Hipertensión Inducida en el Embarazo/fisiopatología , Adulto , Determinación de la Presión Sanguínea , Gasto Cardíaco , Estudios de Casos y Controles , Ecocardiografía , Femenino , Hemodinámica , Humanos , Embarazo , Resultado del Embarazo , Estudios ProspectivosRESUMEN
Rectus sheath haematoma, an uncommon complication related to subcutaneous administration of enoxaparin, has overall mortality of 4%. Possible mechanisms include unintended intramuscular injection of enoxaparin, and enhanced anticoagulant effect in the elderly and patients with increased bleeding risk. We describe the case of an 80 year-old female patient who was treated after a non-ST-elevated myocardial infarction, with enoxaparin, aspirin and clopidogrel. After a single dose of enoxaparin, the patient developed massive rectus sheath haematoma that was promptly diagnosed and was surgically managed. The patient recovered uneventfully. With incremented use of low-molecular weight heparins in the elderly, one may expect a growing number of bleeding complications.
Asunto(s)
Anticoagulantes/efectos adversos , Enoxaparina/efectos adversos , Hematoma/inducido químicamente , Anciano de 80 o más Años , Diagnóstico Diferencial , Femenino , Hematoma/diagnóstico , Hematoma/cirugía , Humanos , Infarto del Miocardio/tratamiento farmacológico , RectoRESUMEN
BACKGROUND AND OBJECTIVE: Due to increased life expectancy, the risk profile of the patients undergoing cardiac surgery changed dramatically. This is especially important in case of concomitant coronary artery disease and carotid artery stenosis (CAS). Careful decision making and appropriate surgical strategy in these patients is critical for the success of the operation. Controversy about relationship between staged and concomitant carotid endarterectomy (CEA) and coronary artery bypass grafting (CABG) still exists. In the current study, we present our case lood in treating patients with concomitant carotid artery stenosis and coronary artery disease. PATIENTS AND METHODS: CABG with additional CEA due to neurologic symptoms or high grade (>80%) CAS has been performed in 835 patients in the period of 1982-2010. Results of evaluation of perioperative mortality and morbidity in regard to the surgical approach have been discussed. RESULTS: The average patient age was 62.6 +/- 8.7 years. Echocardiography revealed that 28% of the patients had poor left ventricle ejection fraction (<30%). Coronarography demonstrated that 21.4% of the operated patients had significant left main coronary artery stenosis (>60%). In terms of neurological status, majority of the patients (88.3%) were neurologically asymptomatic. The overall mortality regardless the sequence of procedures was 2.3% (19 patients). In the group of concomitantly treated patients 44.6% (50 patients) required triple coronary bypass while the mean number of coronary bypasses was 2.6. Postoperative neurologic complications were present in 102 patients (12.2%). Eighty-four patients (10.0%) have had TIA, while 18 patients (2.2%) have had permanent neurologic deficit while 4 patients (0.5%) died as a result of it. CONCLUSIONS: It is imperative that every patient being considered for CABG should undergo ultrasonic evaluation of the carotid arteries regardless the neurological symptomatology. Concomitant surgery on patients with severe CAS and coronary disease carries a slightly higher operative risk and, therefore, should be avoided. Concomitant surgical treatment should only be considered in patients with unstable angina and significant CAS in whom we may expect higher morbidity and mortality.
Asunto(s)
Estenosis Carotídea/cirugía , Puente de Arteria Coronaria , Estenosis Coronaria/cirugía , Endarterectomía Carotidea , Anciano , Estenosis Carotídea/complicaciones , Estenosis Carotídea/diagnóstico , Estenosis Carotídea/mortalidad , Trastornos Cerebrovasculares/etiología , Distribución de Chi-Cuadrado , Angiografía Coronaria , Puente de Arteria Coronaria/efectos adversos , Puente de Arteria Coronaria/mortalidad , Estenosis Coronaria/complicaciones , Estenosis Coronaria/diagnóstico , Estenosis Coronaria/mortalidad , Ecocardiografía , Endarterectomía Carotidea/efectos adversos , Endarterectomía Carotidea/mortalidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Selección de Paciente , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Serbia , Índice de Severidad de la Enfermedad , Factores de Tiempo , Resultado del Tratamiento , Ultrasonografía DopplerRESUMEN
The serine protease inhibitor antithrombin III (AT-III), an α2-globulin synthesized in the liver and endothelial cells, is the principal in vivo inhibitor of blood coagulation inactivating mainly thrombin. AT-III deficiency presents a rare hereditary or acquired disorder that most often comes to light when a patient suffers recurrent venous thrombosis and pulmonary embolism. Triggers for the onset of the thrombosis include various mechanisms such as pregnancy, delivery, surgery, trauma, and contraceptive pill use. Decreased response to heparin may be the first sign of AT-III deficiency. Since heparin is a conditio sine qua non for cardiopulmonary bypass, rapid consumption of AT-III promoted by heparin may lead to systemic thrombosis. The effect of heparin on graft patency after CABG in patients with AT-III deficiency, particularly with respect to early graft thrombosis, has not been fully investigated. The early detection and timely treatment of this disorder may impact perioperative morbidity. We present a case of simultaneous thrombosis of three venous grafts after elective coronary artery bypass surgery in a patient with AT-III deficiency.
Asunto(s)
Deficiencia de Antitrombina III/diagnóstico , Deficiencia de Antitrombina III/etiología , Puente de Arteria Coronaria/efectos adversos , Cardiopatías/diagnóstico , Cardiopatías/etiología , Trombosis/diagnóstico , Trombosis/etiología , Diagnóstico Diferencial , Femenino , Humanos , Persona de Mediana EdadRESUMEN
Certain lifestyle and environmental factors play an important role on breast cancer (BC) risk, but data on the influence of nutritional factors are still conflicting. Migrational data have pointed to nutrition as one of the more relevant external factors involved. So far, the only well established nutrition-related risk factors for BC are obesity and alcohol consumption. The evidence that body fatness is a cause of postmenopausal breast cancer is convincing as is the evidence that alcoholic drinks are a cause of BC in all ages. On the other hand, body fatness probably protects against BC diagnosed premenopause. It is more likely that the BC risk is related to life-long dietary habits. The general preventive recommendation often includes a reduction of alcohol, red meat and total dietary fat, and increase in vegetable and fruit consumption. The purpose of this work was to summarize and present current opinions on the influence of diet and nutrition on BC etiology and to suggest possible preventive measures.
Asunto(s)
Neoplasias de la Mama/etiología , Dieta , Índice de Masa Corporal , Neoplasias de la Mama/prevención & control , Grasas de la Dieta/efectos adversos , Ejercicio Físico , Femenino , Frutas , Humanos , Factores de Riesgo , VerdurasRESUMEN
PURPOSE: To analyse the clinical characteristics and patterns of cardiac myxomas and to evaluate the clinical course and surgical treatment results. METHODS: In this retrospective study we evaluated the clinical presentation, diagnostic methods and surgical treatment outcome in all patients (n=17) with cardiac myxoma treated at the Institute of Cardiovascular Diseases of Vojvodina between the 1.1.2006-31.1.2009. RESULTS: Patients with cardiac myxoma constituted 0.52% of all patients having had heart operations for different reasons. The average patient age was 56.59 years and 12 (70.88%) patients were female and 5 (29.12%) male. Left atrial myxomas were by far more frequent (16 patients, 94.11%) than right atrial myxomas (1 patient, 5.88%). The average time of symptom presence was around 12 months while 4 patients (23.53%) were asymptomatic. The most common symptom was dyspnoea (53%) and fatigue (41%). Total extirpation of tumor mass was achieved in all cases. The tumor size ranged from 1.7x1 cm to 9.5x3.3 cm (average of 2x2.86) and histological examination confirmed the diagnosis of cardiac myxoma in every instance. The 30-day mortality after surgical extirpation of atrial myxomas was 0%. CONCLUSION: Cardiac myxoma may mimic a huge variety of other cardiac diseases. Echocardiography plays an important role in diagnosing this disease. Because of relatively low risk, surgical treatment is recommended for most patients with excellent postoperative prognosis.
Asunto(s)
Procedimientos Quirúrgicos Cardíacos , Neoplasias Cardíacas/diagnóstico , Neoplasias Cardíacas/cirugía , Mixoma/diagnóstico , Mixoma/cirugía , Adulto , Anciano , Femenino , Atrios Cardíacos/patología , Atrios Cardíacos/cirugía , Neoplasias Cardíacas/complicaciones , Neoplasias Cardíacas/mortalidad , Humanos , Masculino , Persona de Mediana Edad , Mixoma/complicaciones , Mixoma/mortalidad , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Serbia , Factores de Tiempo , Resultado del TratamientoRESUMEN
Quadricuspid aortic valve, a rare congenital anomaly, is often related to severe aortic regurgitation and has a significant morbidity. The first described case was reported in 1862. Quadricuspid aortic valve is, in most cases, an isolated malformation, but it can be associated with other concomitant anomalies. We present here the case of a quadricuspid aortic valve discovered by intraoperative transesophageal echocardiography and successfully replaced with a mechanical aortic valve.