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Bivalirudin and Heparin Effects on Coronary Flow, Microcirculation and Recovery of Left Ventricular Systolic Function after Primary Coronary Angioplasty
No full textIn ST elevation myocardial infarction (STEMI) treated by primary per-coetaneous coronary intervention (PPCI), bivalirudin caused less bleeding and was as effective as combined heparin and IIb IIIa antagonist.Aim: Compare the effects of bivalirudin and heparin on coronary flow, microcirculation and recovery of left ventricular systolic function in patients with STEMI undergoing PPCI.Methods: Forty five patients with anterior STEMI undergoing PPCI, 30 treated with heparin and 15 with bivalirudin were compared. All patients had complete trans-thoracic Doppler echocardiographic studies and sampling of blood velocities in the left anterior descending coronary artery (LAD) early after PPCI and 5 days later.Results: TIMI and myocardial blush grades were similar in both groups before after PPCI. Peak LAD diastolic velocities early after PPCI were higher in the bivalirudin group 42.2±14.4 compared to the heparin group 34.06±8.27 cm/sec, p<0.03. Peak velocities in the LAD did not change significantly on follow up in both groups. Early diastolic velocity integrals in the LAD in patients treated with bivalirudin, 12.3±4.2 were higher than in those treated with heparin, 8.91±3.21cm, p<0.02, and this difference between the groups was maintained on late evaluation. Left ventricular systolic function parameters were similar in both treatment groups early and late after PPCI, however only heparin was associated with increase in these parameters on discharge from the hospital.Conclusions: Bivalirudin treatment in patients with anterior STEMI treated by PPCI was associated with higher LAD velocities and integrals compared to heparin, however only heparin increased LV systolic function after PPCI
Effects of an Accent Management Program on Intelligibility of Non- Native Speakers of American English
No full textWhile a foreign or regional accent may preserve ties to cultural and ethnic identities, some individuals choose to seek accent management services to improve employment prospects or because of a personal desire to sound more like native speakers. English is a dominant language within the global economy and speech intelligibility plays a role in successful professional communications. Although an accent is a language difference and not a disorder, speech-language pathologists are uniquely suited to provide such services due to their training in segmental and prosodic aspects of speech. The purpose of this study was to evaluate whether a 14-session program targeting segmental and prosodic aspects of American English resulted in increased intelligibility on both scripted and spontaneous speech tasks. A pre-post-test small group design as well as individual performance of seven speakers of various native languages was used to examine outcomes.Statistically significant pre-post differences were noted on intelligibility measures of spontaneous and scripted speech tasks. Large effect sizes were observed. These preliminary findings suggest that accent management instruction designed to target both segmental and prosodic aspects of American English has promise
Pheochromocytoma and Neurofibromatosis Type 1: An Exceptional Association
No full textThe association of a pheochromocytoma to a neurofibromatosis type 1 is a rare association.We relate the observation of a 62 years female patient who had, sinced a young age, showed café au lait spots and neurofibromas on the entire body, and been monitored for the last 4 years for high blood pressure with headaches, excessive sweating and palpitations. Dosage of urine catecholamine metabolites has revealed a rate elevated to 20 times the normal. Adrenal tomodensitometry has revealed a voluminous heterogeneous mass occupying the right adrenal loge, presenting a narrow contact with the inferior vena cava, and with the upper pole of the right kidney, measuring 10.5 x 9.3 x 8.7 cm, along with a small heterogeneous mass of the left adrenal.Under the scope of the neurofibromatosis, fundus photography has been performed and showed Lisch nodules, while cerebral tomodensitometry results were normal.After undergoing bilateral andrenalectomy, anatomopathological examination has revealed a completely excised pheochromocytoma on the right adrenal, and a macro-nodular adrenal hyperplasia on the left adrenal.Metaiodobenzylguanidine scan has not showed any ectopic placement of the pheochromocytoma, and urinary methoxy derivatives were normal post-surgery.Screening and adequate surgical support of the pheochromocytoma, for patients with neurofibromatosis type 1 presenting high blood pressure, allows to avoid complications
Case Report: Marked Effect of Cilostazol on Delirium in a Dementia Patient with Deep White Matter Lesions: Potential Etiology- Targeted Pharmacotherapy for Delirium
No full textAntipsychotics have been mainly used as pharmacotherapy for delirium. Their use is, however, only considered a symptom-targeted, but not an etiology-targeted therapy. Moreover, antipsychotics may also have some adverse effects in elderly patients. We report a case of an elderly dementia patient with deep white matter lesions whose delirium was markedly resolved with a platelet aggregation inhibitor, cilostazol. No antipsychotic drugs were used. To our knowledge, there have been no reports regarding the effect of cilostazol on delirium, despite not a few studies on cognitive function of Alzheimer disease and cerebrovascular disease. This case suggests that cilostazol is a potentially effective agent as an etiology-targeted therapy for delirium due to its possible increased regional cerebral blood flow
Abnormal Chords of Left Ventricle as Cardiac Manifestations of Connective Tissue Dysplasia Syndrome
No full textThe article highlights the major problems of diagnostics and clinical relevance of such minor structural heart abnormalities as left ventricular abnormal chords. Possible hemodynamic changes, clinical manifestations and cardio-vascular complications associated with abnormal chords are presented. Abnormal chords of the ventricles (VAC) are connective tissue and muscular formations, which have ectopic attachment unlike normal chords. Abnormal chords are the most common cardiac manifestations of non-differentiated connective tissue dysplasia syndrome (CTDS). Commonly, they are associated with mitral valve prolapse as well as with other phenotypical manifestations of connective tissue dysplasia – joint hypermobility, increased skin extensibility, scoliotic posture, duplication and ptosis of kidneys etc. Modern views concerning the prevalence of this pathology, its clinical manifestations, diagnostic peculiarities as well as prognostic value of different topical and quantitative variants of abnormal chords are given. The effect of abnormal chords on arrhythmogenesis of left ventricle, development of cardialgia and myocardial ischemia development, heart cavity remodeling, systolic and diastolic function of the left ventricle are discussed. Pathogenetic relationship between multiple abnormal chords and such serious hereditary disease as left ventricular non-compaction is emphasized. The article focuses on the statement that the patients with left ventricular abdominal chords like all patients with minor structural heart abnormalities should be placed into “the risk group†because of possible development of ventricular arrhythmias, heart remodeling and chronic heart failure
The Nephroprotective Effects of Oral Urinary Alkalization with Blemaren® on the Outcome of Patients with Severe Myocardial Infarction
No full textObjectives: Acute cardiac dysfunction often leads to acute kidney injury (AKI). The harmful effect of myoglobin seems to be dependent on the acidic urine pH. This study aimed to discover whether urinary alkalinization with an oral combination of sodium citrate, citric acid and potassium hydrogen carbonate (Blemaren®) reduces the prevalence of AKI in patients with severe myocardial infarction.Methods: In this retrospective cohort study, the data from >6.600 consecutive patients between 09/2005-06/2015 were analyzed. Finally, 359 patients with severe myocardial infarction (defined as creatine kinase- levels CKmax> 80µkat/l) could be included. To prevent AKI, 307 patients received Blemaren® treatment. The following statistical methods were used to compare the cohorts: Mann- Whitney- U- test with confirmation by t-test; chi- square- test based on Pearson; statistical correlation analysis based on Pearson; linear and binary logistic regression and Log- Rank- test for comparison of cumulative survival.Results: No significant association between the development of urea, creatinine and GFR with oral urinary alkalization using Blemaren® (p=0.898; p=0.962; p=0.645) was found. Furthermore, in subgroup analyses, Blemaren®- treatment contributed no benefit for high-risk groups (arterial hypertension, cardiogenic shock and initial renal impairment) in terms of development of AKI (p>0.05). Finally, Blemaren® treatment did not improve in-hospital survival, mid-term mortality of about 1 and 2 years or cumulative survival (all p>0.05).Conclusion: Oral urine alkalization with Blemaren® in severe myocardial infarction to prevent AKI and to improve patients’ outcome is no longer appropriate
Scoring - Plus Drug Coated Balloon in Femoro-Popliteal Lesions - 6 Months Results of the DCB-Trak-Registry
No full textBackground: Recent trials demonstrated favorable results with drug-coated-balloons (DCB) in femoro-popliteal lesions. Additional vessel preparation with a scoring-balloon prior to DCB-angioplasty might reduce rates of flow-limiting dissections and subsequent need for bail-out stenting due to a controlled laceration of the intimal layer. However, clinical data for this combined procedure are lacking.Methods: In a single center registry, 20 consecutive patients with femoro-popliteal lesions were treated with a scoring-balloon (VascuTrak®) and a DCB subsequently. The primary endpoint was the clinically driven target lesion revascularization (TLR). Secondary endpoints were clinically driven target vessel revascularization (TVR), binary restenosis (PSV>2.4), change in rutherford classification and ABI. Safety endpoints were major cardiovascular events (cardiovascular death, MI, stroke, death) and need for amputation.Results: The procedure was successful in 17 patients, 1 patient was lost to follow-up. Therefore 16 patients (4 female) were analyzed at the 6 months follow-up visit. There were no clinically driven TLR or TVR after 6 months. Rutherford classification improved from 3.5±0.97 to 0.88±0.72 (p<0.01) after 6 months. ABI increased from 0.85±0.26 to 1.02±0.19 (p=0.01) after the procedure with no further change at 6 months (1.01±0.15, p=0.83). Duplex ultrasound was performed in 9 patients at 6 months, with one binary restenosis (11%). There were neither major cardiovascular events nor amputations at 6 months follow-up.Conclusions: Vessel preparation with a scoring-balloon prior to DCB-angioplasty in femoro-popliteal lesions is suggested to improve clinical outcome of patients without any safety concerns. Further trials with more patients are needed for validation of the results of our registry
The Metabolic Syndrome in Polycystic Ovarian Disease
No full textPolycystic ovarian disease (PCOS) is the most common endocrine disorder among women in genital activity (prevalence: 5 and 10%). It is a frequent cause of hirsutism and infertility in women and affects 3-10% of women overall population. Whatever the age of onset, PCOS predisposes to metabolic and early cardiovascular complications. The PCOS is frequently associated with obesity, insulin resistance and hyperinsulinemia. There is a greater risk of glucose intolerance, diabetes mellitus (10%) and hyperlipidemia (more than half of women).The aim of our study was to report the frequency of metabolic syndrome (MS) in PCOS and specify its clinical and biological characteristics. This is a prospective, descriptive study which concerned 66 primary PCOS patients. The frequency of metabolic syndrome was 48.5%. The average age was 33.9 ± 9.22 years (16 – 45) Just under half of the patients (42.4%) were obese at diagnosis. The mean BMI was 32.4 kg / m2 ± 0.3. A slightly more than 2/3 of PCOS patients (72.6%) have a and roidobesity. The average waist circumference PCOS patients was 87.5 ± 0.1 cm. Nearly a third of patients have abnormal glucose tolerance. They have an average triglycerides, mean arterial pressure, mean blood glucose, insulin and an average index HOMA significantly higher (p: 10- 3). Their HDL level is significantly reduced (p <10-3). A little over a quarter of PCOS patients with metabolic syndrome: 37.5%) have all of the risk factors for MS at diagnosis
