(1/4783) Anti-heart autoantibodies in ischaemic heart disease patients.
One hundred and ninety-nine ischaemic heart disease (IHD) patients were studied with regard to the prevalence of anti-heart autoantibodies (AHA). The incidence of AHA in IHD patients was 1%: one out of 102 patients who suffered acute myocardial infarction (AMI), one out of seventy-two patients who suffered from acute coronary insufficiency (ACI), and none out of twenty-five patients with other signs and symptoms of IHD, had AHA in their sera. An additional 2% of patients who suffered from AMI developed detectable antibody levels during a follow-up period of 15 days. In comparison,, 53% of patients (eight out of fifteen) who underwent heart surgery and who had no AHA prior to operation, developed these antibodies in their sera during 1-2 weeks following operation. (+info)
(2/4783) Failing firefighters: a survey of causes of death and ill-health retirement in serving firefighters in Strathclyde, Scotland from 1985-94.
During the decade beginning 1 January 1985, 887 full-time firefighters, all male, left the service of Strathclyde Fire Brigade (SFB). There were 17 deaths--compared to 64.4 expected in the Scottish male population aged 15-54 years--giving a standardized mortality ratio (SMR) of 26, and 488 ill-health retirements (IHR). None of the deaths was attributable to service, the major causes being: myocardial infarction--five, (expected = 17.3; SMR = 29); cancers--three (colon, kidney and lung) (expected = 13.6; SMR = 22); road traffic accidents--two (expected = 4.17; SMR = 48) and suicide--two (expected = 4.9; SMR = 41). Amalgamating the deaths and IHRs showed that the six most common reasons for IHR were musculoskeletal (n = 202, 40%), ocular (n = 61, 12.1%), 'others' (n = 58, 11.5%), injuries (n = 50, 9.9%), heart disease (n = 48, 9.5%) and mental disorders (n = 45, 8.9%). Over 300 IHRs (over 60%) occurred after 20 or more years service. When the IHRs were subdivided into two quinquennia, there were 203 and 302 in each period. Mean length of service during each quinquennium was 19.4 vs. 21.3 years (p = 0.003) and median length was 21 years in both periods; interquartile range was 12-26 years in the first and 17-27 years in the second period (p = 0.002), but when further broken down into diagnostic categories, the differences were not statistically significant, with the exception of means of IHRs attributed to mental disorders (14.5 vs. 19 years, p = 0.03). (+info)
(3/4783) Enhanced myocardial glucose use in patients with a deficiency in long-chain fatty acid transport (CD36 deficiency).
CD36 is a multifunctional, 88 kDa glycoprotein that is expressed on platelets and monocytes/macrophages. CD36 also has high homology with the long-chain fatty acid (LFA) transporter in the myocardium. Although platelet and monocyte CD36 levels can indicate a CD36 deficiency, they cannot predict specific clinical manifestations in the myocardium of a given person. We examined the hypothesis that a deficiency in LFA transport augments myocardial glucose uptake in patients with a type I CD36 deficiency. METHODS: Seven fasting patients with a type I CD36 deficiency and 9 controls were assessed by cardiac radionuclide imaging using beta-methyl-p-iodophenyl-pentadecanoic acid (BMIPP) as a LFA tracer and by PET with 18F-fluorodeoxyglucose (FDG). RESULTS: None of the patients with a CD36 deficiency showed myocardial uptake of BMIPP. The percentage dose uptake of BMIPP in these subjects was significantly lower than that in normal controls (1.31+/-0.24 versus 2.90+/-0.2; P < 0.005). PET studies revealed that myocardial FDG accumulation was substantially increased in patients with a CD36 deficiency. Quantitative analysis showed that the percentage dose uptake of FDG in patients with a CD36 deficiency was significantly higher than that in normal controls (1.28+/-0.35 versus 0.43+/-0.22; P< 0.01). CONCLUSION: CD36 functions as a major myocardial LFA transporter and its absence may cause a compensatory upregulation of myocardial glucose uptake. (+info)
(4/4783) Cardiocutaneous fistula.
Infection of the Teflon pledgets on the heart suture line after left ventricular aneurysm repair, presenting late with a fistulous tract connecting the heart with the skin (cardiocutaneous fistula) is an uncommon but potentially serious condition. The case is reported of a 73 year old man who developed a cardiocutaneous fistula extending through the left hemidiaphragm and draining at the abdominal wall, which developed six years after left ventricular aneurysmectomy. Following radiographic evaluation, which established the diagnosis, the Teflon pledgets and fistulous tract were successfully surgically removed. Prompt diagnosis depends on a high index of suspicion. Eradication of infection requires excision of infected material, which must be planned on an individual basis. (+info)
(5/4783) Usefulness of fractional flow reserve to predict clinical outcome after balloon angioplasty.
BACKGROUND: After regular coronary balloon angioplasty, it would be helpful to identify those patients who have a low cardiac event rate. Coronary angiography alone is not sensitive enough for that purpose, but it has been suggested that the combination of optimal angiographic and optimal functional results indicates a low restenosis chance. Pressure-derived myocardial fractional flow reserve (FFR) is an index of the functional severity of the residual epicardial lesion and could be useful for that purpose. METHODS AND RESULTS: In 60 consecutive patients with single-vessel disease, balloon angioplasty was performed by use of a pressure instead of a regular guide wire. Both quantitative coronary angiography (QCA) and measurement of FFR were performed 15 minutes after the procedure. A successful angioplasty result, defined as a residual diameter stenosis (DS) <50%, was achieved in 58 patients. In these patients, DS and FFR, measured 15 minutes after PTCA, were analyzed in relation to clinical outcome. In those 26 patients with both optimal angiographic (residual DS by QCA =35%) and optimal functional (FFR >/=0.90) results, event-free survival rates at 6, 12, and 24 months were 92+/-5%, 92+/-5%, and 88+/-6%, respectively, versus 72+/-8%, 69+/-8%, and 59+/-9%, respectively, in the remaining 32 patients in whom the angiographic or functional result or both were suboptimal (P=0.047, P=0.028, and P=0.014, respectively). CONCLUSIONS: In patients with a residual DS =35% and FFR >/=0.90, clinical outcome up to 2 years is excellent. Therefore, there is a complementary value of coronary angiography and coronary pressure measurement in the evaluation of PTCA result. (+info)
(6/4783) An unusual family of benign "X" linked muscular dystrophy with cardiac involvement.
A family of benign X-linked muscular dystrophy is described. Two of the 3 affected members appear quite representative of Becker's dystrophy. A third shows no pseudohypertrophy, only gross atrophy, affecting proximal and distal muscles and also shows early onset contractures and electrocardiographic abnormalities and is in these ways much more representative of the variety described by Emery and Dreifuss (1966). Two of the cases have distinctly abnormal electrocardiograms with extensive and deep Q waves and abnormal R/S ratios and VI. Both these have shown progression of electrocardiographic abnormalities during a 2-year follow-up. The family is reported to document this very unusual occurrence. (+info)
(7/4783) Intensive care management of stroke patients.
Two hundred eighty patients were admitted to an intensive care stroke unit over a one-year period. Subsequent investigation indicated that only 199 of these patients actually had cerebral ischemic or hemorrhagic lesions, 10 had other cerebrovascular lesions, and the remaining 71 patients had unrelated diseases, predominantly seizures. Detailed analysis of 103 stroke patients revealed an overall incidence of 59% hypertension, and 72% had hypertensive, ischemic or valvular heart disease. Fifty percent of the patients had various cardiac arrhythmias, some of which were responsible for the acute cerebrovascular lesion. Fourteen patients died during the acute phase, 11 from apparently irreversible cerebral selling, mainly due to cerebral hemorrhage. Secondary complications such as pneumonia, pulmonary embolism, pressure sores and urinary infection were almost nonexistent, but beneficial effects on the primary cerebral lesions were more difficult to demonstrate. (+info)
Cardiac glycosides have played a prominent role in the therapy of congestive heart failure since William Withering codified their use in his late 18th century monograph on the efficacy of the leaves of the common foxglove plant (Digitalis purpurea). Despite their widespread acceptance into medical practice in the ensuing 200 years, both the efficacy and the safety of this class of drugs continue to be a topic of debate. Moreover, despite the fact that the molecular target for the cardiac glycosides, the alpha-subunit of sarcolemmal Na+K+-ATPase (or sodium pump) found on most eukaryotic cell membranes, has been known for several decades, it remains controversial whether the sympatholytic or positive inotropic effects of these agents is the mechanism most relevant to relief of heart failure symptoms in humans with systolic ventricular dysfunction. Herein, we review the molecular and clinical pharmacology of this venerable class of drugs, as well as the manifestations of digitalis toxicity and their treatment. We also review in some detail recent clinical trials designed to examine the efficacy of these drugs in heart failure, with a focus on the Digoxin Investigation Group data set. Although, in our opinion, the data on balance warrant the continued use of these drugs for the treatment of symptoms of heart failure in patients already receiving contemporary multidrug therapy for this disease, the use of digitalis preparations will inevitably decline with the maturation of newer pharmacotherapies. (+info)