Medicine and Health Sciences Commons^™

Takayasu Arteritis With Coronary Aneurysms Causing Acute Myocardial Infarction In A Young Man, Sana Ouali, Slim Kacem, Fatma Ben Fradj, Rim Gribaa, Elyes Naffeti, Fahmi Remedi, Chedia Laaoueni, Essia Boughzela

The Texas Heart Institute Journal

Takayasu arteritis is an inflammatory condition that involves the large cardiac vessels, predominantly the aorta and its main branches. It typically affects young women (age, ≤40 yr), most often Asians and Latin Americans. Herein, we describe a rare manifestation of Takayasu arteritis in a 19-year-old black Tunisian man who presented with acute inferior myocardial infarction and complete atrioventricular block after occlusion from a giant aneurysm in the right coronary artery. The coronary artery disease was associated with aneurysmal dilations in the carotid, vertebral, and right renal arteries. Medical therapy improved Thrombolysis in Myocardial Infarction flow in the area of the …

On Getting What We Deserve: Differeing Perspectives, Herbert L Fred

The Texas Heart Institute Journal

No abstract provided.

Interposition Grafting Of Large Extracranial Carotid Aneurysm, Marlous Huyzer, Michel M P J Reijnen, Johannes E M Sybrandy, Jacob Buth, Clark J Zeebregts

The Texas Heart Institute Journal

Extracranial carotid aneurysms are a rare entity and carry an inherent risk of thromboembolic complications. Treatment options consist of endovascular and conventional surgical techniques. We describe the cases of 3 patients who were treated with an interposition graft for a large extracranial carotid aneurysm.

The patients had presented with an extracranial carotid aneurysm with a diameter of 30 to 43 mm. In all cases, the aneurysm was excluded by means of an interposition graft, without major perioperative complications. There was 1 case of temporary paresis of the facial nerve and another of temporary paresis of the vocal cord. After a …

Paclitaxel Induces Thrombomodulin Downregulation In Human Aortic Endothelial Cells, Huang-Joe Wang, Te-Ling Lu, Haimei Huang, Huey-Chun Huang

The Texas Heart Institute Journal

Patients with paclitaxel-eluting stents are at risk of developing stent thrombosis upon premature discontinuation of dual antiplatelet therapy. In this study, we set out to clarify whether paclitaxel can modulate thrombomodulin expression in human aortic endothelial cells. Human aortic endothelial cells were stimulated with paclitaxel. Methoxyphenyl tetrazolium inner salt cell viability assay, Western blot analysis, real-time polymerase chain reaction, and immunohistochemical assay were performed. In human aortic endothelial cells, paclitaxel (10(-5) to 10(-9) mol/L) treatment for 13 hours caused significant cytotoxicity at drug concentrations greater than 10(-7) mol/L. Paclitaxel (10(-5) to 10(-9) mol/L) treatment for 5 hours downregulated thrombomodulin expression …

The Evaluation And Management Of Electrical Storm, Michael Eifling, Mehdi Razavi, Ali Massumi

The Texas Heart Institute Journal

Electrical storm is an increasingly common and life-threatening syndrome that is defined by 3 or more sustained episodes of ventricular tachycardia, ventricular fibrillation, or appropriate shocks from an implantable cardioverter-defibrillator within 24 hours. The clinical presentation can be dramatic. Electrical storm can manifest itself during acute myocardial infarction and in patients who have structural heart disease, an implantable cardioverter-defibrillator, or an inherited arrhythmic syndrome. The presence or absence of structural heart disease and the electrocardiographic morphology of the presenting arrhythmia can provide important diagnostic clues into the mechanism of electrical storm. Electrical storm typically has a poor outcome.

The effective …

Heart Disease And Hormones, Stephanie A Coulter

The Texas Heart Institute Journal

Results from more than 40 observational studies conducted in women over 3 decades have repeatedly indicated the cardioprotective effects of postmenopausal hormone replacement therapy (HRT). Women taking estrogen in these observational trials experienced a consistent 30% to 50% reduction in cardiovascular (CV) events. The biologic benefit of estrogen has been attributed to improvements in lipid profiles and endothelial function.

Left Atrial Ablation For Atrial Fibrillation: Creating The “Box Lesion” With A Bipolar Radiofrequency Device, Leonid Sternik, Hartzel V Schaff, David Luria, Michael Glikson, Alexander Kogan, Ateret Malachy, Maya First, Ehud Raanani

The Texas Heart Institute Journal

The maze procedure is the gold standard for the ablation of atrial fibrillation, and the “box lesion” around the pulmonary veins is the most important part of this procedure. We have created this lesion with a bipolar radiofrequency ablator, abandoning the usual use of this device (to achieve bilateral epicardial isolation of the pulmonary veins).

From March 2004 through the end of May 2010, we performed surgical ablation of atrial fibrillation in 240 patients. Of this number, 205 underwent operation by a hybrid maze technique and the remaining 35 (our study cohort) underwent the creation of a box lesion around …

A Dosing Study Of Bone Marrow Mononuclear Cells For Transendocardial Injection In A Pig Model Of Chronic Ischemic Heart Disease, Guilherme V Silva, Marlos R Fernandes, Cristiano O Cardoso, Ricardo R Sanz, Edie M Oliveira, Pilar Jimenez-Quevedo, Javier Lopez, Franca S Angeli, Yi Zheng, James T Willerson, Emerson C Perin

The Texas Heart Institute Journal

We studied the effect of the dose of bone marrow mononuclear cells, delivered via transendocardial injection, upon capillary density and fibrosis in pigs with chronic ischemic heart disease.

Pigs (n = 16) that had undergone ameroid constrictor placement (left circumflex coronary artery) to induce chronic ischemia were divided equally into 4 groups on the basis of bone marrow mononuclear cell dose: control (saline injection) and 50, 100, or 200 × 106 bone marrow mononuclear cells. Thirty days after ameroid placement, each pig received 13 transendocardial NOGA-guided injections. An implantable loop recorder monitored possible arrhythmias caused by cell transplantation. Thirty days …

Troubleshooting Implantable Cardioverter-Defibrillators: An Overview For Physicians Who Are Not Electrophysiologists, Mohammad Saeed

The Texas Heart Institute Journal

No abstract provided.

Cd34-Positive Stem Cells In The Treatment Of Heart And Vascular Disease In Human Beings, Alexander R Mackie, Douglas W Losordo

The Texas Heart Institute Journal

Bone marrow-derived CD34(+) cells are a well-characterized population of stem cells that have traditionally been used clinically to reconstitute the hematopoietic system after radiation or chemotherapy. More recently, CD34(+) cells have also been shown to induce therapeutic angiogenesis in animal models of myocardial, peripheral, and cerebral ischemia. The mechanism by which CD34(+) cells promote therapeutic angiogenesis is not completely understood, although evidence supports both direct incorporation of the cells into the expanding vasculature and paracrine secretion of angiogenic growth factors that support the developing microvasculature. Phase I and phase II clinical trials have explored the usefulness of CD34(+) cells in …

Sirolimus-Eluting Stents Versus Bare-Metal Stents In Routine Clinical Use, Muhammad Munir, Jonathan Aliota, Amany Ahmed, Anwarullah Mohammed, Vei Vei Lee, Macarthur A Elayda, James M Wilson

The Texas Heart Institute Journal

Conflicting patient outcomes have been reported after the use of sirolimus-eluting stents or bare-metal stents. In this nonrandomized study, we examine the outcomes after placement of sirolimus-eluting versus bare-metal stents in an unselected population of patients who underwent percutaneous coronary revascularization.

We used THIRD-base, a longitudinal data registry of patients who underwent revascularization at our institution, to compare demographics and outcomes in patients treated with a sirolimus-eluting or bare-metal stent from January 2001 through June 2006. Outcome measures included major acute coronary and cerebral events at 30 days, target-vessel failure at 9 months and at 3 years, and stent thrombosis. …

Endovascular Repair Of Aortoesophageal And Aortobronchial Fistulae, Roberto Chiesa, Andrea Kahlberg, Yamume Tshomba, Enrico M Marone, Massimiliano M Marrocco-Trischitta, Germano Melissano

The Texas Heart Institute Journal

Aortoesophageal fistulae (AEF) and aortobronchial fistulae (ABF) are uncommon, but are in general fatal if left untreated. Conventional treatment requires surgical replacement of the thoracic aorta, along with several adjunctive procedures to repair the esophageal or tracheobronchial lesion.The mortality rates associated with open surgery reach 61% in cases of primary fistula and 78% in secondary fistula.

Thoracic endovascular aortic repair (TEVAR) has been proposed as an alternative strategy to surgical management.Although less invasive, this technique has important limitations in treating AEF and ABF, the chief of which is the high risk of graft contamination. Moreover, we still lack sufficient data …

Robotic Cardiac Surgery By 2031, W Randolph Chitwood

The Texas Heart Institute Journal

No abstract provided.

Central Venous Pressure And Pulmonary Capillary Wedge Pressure, Tony S Ma, Biykem Bozkurt, David Paniagua, Biswajit Kar, Kumudha Ramasubbu, Carl F Rothe

The Texas Heart Institute Journal

Heart-failure phenotypes include pulmonary and systemic venous congestion. Traditional heart-failure classification systems include the Forrester hemodynamic subsets, which use 2 indices: pulmonary capillary wedge pressure (PCWP) and cardiac index. We hypothesized that changes in PCWP and central venous pressure (CVP), and in the phenotypes of heart failure, might be better evaluated by cardiovascular modeling. Therefore, we developed a lumped-parameter cardiovascular model and analyzed forms of heart failure in which the right and left ventricles failed disproportionately (discordant ventricular failure) versus equally (concordant failure). At least 10 modeling analyses were carried out to the equilibrium state. Acute discordant pump failure was …

Usefulness Of The Echocardiographic Multi-Parameter Score (Emps) In Evaluating Left Ventricular Global Heart Function, Bingyuan Zhou, Junhua Yang, Xiangjun Yang, Yongming He, Caiming Zhao, Sudan Xu, Huifeng Wang

The Texas Heart Institute Journal

In this study, we established a new index by combining several echocardiographic parameters to quantify heart failure. We selected 233 consecutive patients who underwent both echocardiographic and plasma B-type natriuretic peptide (BNP) tests within 24 hours after referral for suspected heart failure. The echocardiographic parameters included systolic function, diastolic function, left ventricular chamber remodeling, valvular lesions, systolic pulmonary arterial pressure, and regional wall-motion abnormality. Each factor was scored from 1 to 3 points according to its severity. The total point from these 6 factors is the echocardiographic multi-parameter score (EMPS).

The EMPS for 37, 51, 77, and 38 patients from …

Micro-Ultrasonographic Imaging Of Atherosclerotic Progression And Correlation With Inflammatory Markers In Apolipoprotein-E Knockout Mice, Rong-Juan Li, Ya Yang, Yan-Hong Wang, Jin-Jie Xie, Li Song, Zheng Wang, Yao-Zhong Zhang, Yan-Wen Qin, Zhi-An Li, Xiao-Shan Zhang

The Texas Heart Institute Journal

We studied prospectively whether atherosclerotic progression in apolipoprotein-E knockout mice could be noninvasively and accurately measured by use of high-resolution ultrasonographic biomicroscopy. We examined the correlation between the ultrasonographic characterization of ascending aortic atherosclerotic plaque and plasma C-reactive protein, interleukin-1, and interleukin-6 levels in these mice.

In 4 age groups (8, 16, 24, and 32 wk) of 8 male knockout mice each (atherosclerotic groups) and age-matched male C57BL/6 mice (control groups), we used ultrasonographic biomicroscopy to measure maximal plaque thickness or intima-media thickness in the ascending aorta. We compared the findings with corresponding histologic measurements, and we measured plasma C-reactive …

Acetate Causes Alcohol Hangover Headache In Rats, Christina R. Maxwell, Rebecca Jay Spangenberg, Jan B. Hoek, Stephen D. Silberstein, Michael L. Oshinsky

Department of Neurology Faculty Papers

Background

The mechanism of veisalgia cephalgia or hangover headache is unknown. Despite a lack of mechanistic studies, there are a number of theories positing congeners, dehydration, or the ethanol metabolite acetaldehyde as causes of hangover headache.

Methods

We used a chronic headache model to examine how pure ethanol produces increased sensitivity for nociceptive behaviors in normally hydrated rats.

Results

Ethanol initially decreased sensitivity to mechanical stimuli on the face (analgesia), followed 4 to 6 hours later by inflammatory pain. Inhibiting alcohol dehydrogenase extended the analgesia whereas inhibiting aldehyde dehydrogenase decreased analgesia. Neither treatment had nociceptive effects. Direct administration of acetate …

Stem Cells For Spinal Cord Regeneration: Current Status, Zain A. Sobani, Syed A. Quadri, Ather Enam

Section of Neurosurgery

Background: Nearly 11,000 cases of spinal cord injury (SCI) are reported in the United States annually. Current management options give a median survival time of 38 years, however, no rehabilitative measures are available. Stem cells have been under constant research given their ability to differentiate into neural cell lines replacing non functional tissue. Efforts have been made to establish new synapses and provide a conducive environment, by grafting cells from autologous and fetal sources, including embryonic or adult stem cells, Schwann cells, genetically modified fibroblasts, bone stromal cells, and olfactory ensheathing cells and combinations/ variants thereof.
Methods: In order to …

Physician’S Ability To Manually Detect Isolated Elevation In Leg Intracompartmental Pressure., Franklin D. Shuler Md, Matthew J. Dietz

Orthopaedics

Background: Serial physical examination is recommended for patients for whom there is a high index of suspicion for compartment syndrome. This examination is more difficult when performed on an obtunded patient and relies on the sensitivity of manual palpation to detect compartment firmness—a direct manifestation of increased intracompartmental pressure. This study was performed to establish the sensitivity of manual palpation for detecting critical pressure elevations in the leg compartments most frequently involved in clinical compartment syndrome.

Methods: Reproducible, sustained elevation of intracompartmental pressure was established in fresh cadaver leg specimens. Pressures tested included 20 and 40 mm Hg (negative controls) …

Cast-Saw Burns: Evaluation Of Skin, Cast, And Blade Temperatures Generated During Cast Removal, Franklin D. Shuler Md, Frank N. Grisafi

Orthopaedics

Background: The use of an oscillating saw for cast removal creates a potential for iatrogenic injury and patient discomfort. Burns and abrasions can occur from the heat created by frictional forces and direct blade contact. With use of a cadaver model system, skin temperature measurements were recorded during cast removal with an oscillating saw.

Methods: Casts of uniform thickness were applied to cadavers equilibrated to body temperature. The casts were removed by a single individual while simultaneously measuring temperatures at the skin-padding interface, cast-padding interface, and the blade. Variables tested include two removal techniques, two casting materials (fiberglass and plaster), …

The Pseudomonas Aeruginosa Magnesium Transporter Mgte Inhibits Transcription Of The Type Iii Secretion System, Gregory G. Anderson, Timothy L. Yahr, Rustin R. Lovewell, George A. O'Toole

Dartmouth Scholarship

Pseudomonas aeruginosa is an opportunistic pathogen that causes life-long pneumonia in individuals with cystic fibrosis (CF). These long-term infections are maintained by bacterial biofilm formation in the CF lung. We have recently developed a model of P. aeruginosa biofilm formation on cultured CF airway epithelial cells. Using this model, we discovered that mutation of a putative magnesium transporter gene, called mgtE, led to increased cytotoxicity of P. aeruginosa toward epithelial cells. This altered toxicity appeared to be dependent upon expression of the type III secretion system (T3SS). In this study, we found that mutation of mgtE results in increased T3SS …

Anxiety And Depression Among Outpatients With Type 2 Diabetes: A Multi-Centre Study Of Prevalence And Associated Factors., Ali Khan Khuwaja, Saima Lalani, Raheem Dhanani, Iqbal Syed Azam, Ghazala Rafique, Franklin White

Department of Family Medicine

Background: Anxiety and depression contribute to poor disease outcomes among individuals with diabetes. This study aimed to assess the prevalence of anxiety and depression and to identify their associated factors including metabolic components among people with type 2 diabetes. Methods: We conducted a cross-sectional, multi-center study in four out-Patient clinics in Karachi, Pakistan. In all, 889 adults with type-2 diabetes were included in this study. Anxiety and depression were measured by using the Hospital Anxiety and Depression Scale (HADS). Multivariable analysis using multiple logistic regression was carried out to evaluate the combined effect of various factors associated with anxiety and …

Psychiatric Comorbidity In Transformed Migraine: Presentation, Treatment, Impact And Outcome, Muhammad A. Abbas M.D, Haseeba Ismaiel, M.D, William B. Young M.D., Mary Hopkins, Stephen D. Silberstein, M.D

Jefferson Journal of Psychiatry

Transformed migraine is one of the subtypes of chronic daily headache (CDH), and is similar to chronic migraine, described in the new International Headache Society (IHS) classification 2004. The term CDH refers to the Headache disorders experienced 15 or more days a month and includes headaches associated with medication overuse. CDH can be divided into primary and secondary varieties. Primary CDH is not related to a structural or systemic illness. It includes diseases such as Transformed migraine (TM). Chronic tension-type headache (CTTH), new daily persistent headache (NDPH), and hemicrania continua (HC). Secondary CDH has an identifiable underlying cause, including post-traumatic …

Resident Teaching Expectations And Medical Student Feedback, Michael Ignatowski

Jefferson Journal of Psychiatry

Objective Much of resident teaching of medical students occurs in an informal manner, with bedside teaching a common focus. Hence, the ability to monitor such teaching is limited. Feedback about how students perceive the teaching is perhaps one way to more effectively monitor and influence resident teaching.

Ten Year Follow Up Of A Psychiatry Residency Program Merger, Alvi A. Azad, Julianne Flynn, Thomas Matthews, Kenneth Matthews, Joseph Chozinski

Jefferson Journal of Psychiatry

Objective: To report on the successful merger of a civilian and military psychiatry residency. Methods: The reasons for and the history of the merger between the University of Texas Health Science Center at San Antonio and Wilford Hall Air Force Medical Center psychiatry residencies is described. Results: After some false starts, a bottom-up approach was implemented by first merging seminars, then rotations. Conclusions: Combining two psychiatry residencies in order to capitalize on both their strengths can yield a product even greater than the sum of their two programs and the key to a lasting merger is to start with two …

2010 Newsmakers: Celebrating Our Own, Paul Mayne, Jason Winders

Data and Test Instruments

How will we remember 2010? Probably through these faces. This year, the Western News starts a new, if not wholly original, tradition. Our Newsmakers 2010 section celebrates the best of research, academia and volunteer spirit that we have to offer on this campus. We spotlight, in brief words and striking images, the accomplishments of some of our favourites from the last year. One of the most powerful women in Canada. A student with an eye for the greater good. And a man who would do anything, including posing with a zebra, for the United Way. A football coach. A ground-breaking …

Patient Perceptions Of Physician Empathy, Satisfaction With Physician, Interpersonal Trust, And Compliance, Mohammadreza Hojat, Daniel Z. Lewis, Kaye Maxwell, Fred Markham, Richard Wender, Joseph S. Gonnella

Department of Psychiatry and Human Behavior Faculty Papers

Objectives: This study was designed to investigate psychometric properties of the Jefferson Scale of Patient Perceptions of Physician Empathy (JSPPPE), and to examine correlations between its scores and measures of overall satisfaction with physicians, personal trust, and indicators of patient compliance.

Methods: Research participants included 535 out-patients (between 18-75 years old, 66% female). A survey was mailed to participants which included the JSPPPE (5-item), a scale for measuring overall satisfaction with the primary care physician (10-item), and demographic questions. Patients were also asked about compliance with their physician's recommendation for preventive tests (colonoscopy, mammogram, and PSA for age and gender …

Conformation Dependent Monoclonal Antibodies Distinguish Different Replicating Strains Or Conformers Of Prefibrillar Aβ Oligomers, Rakez Kayed, Isabel Canto, Leonid Breydo, Suhail Rasool, Tamas Lukacsovich, Jessica Wu, Ricardo Albay, Anna Pensalfini, Stephen Yeung, Elizabeth Head, J. Lawrence Marsh, Charles Glabe

Sanders-Brown Center on Aging Faculty Publications

BACKGROUND: Age-related neurodegenerative diseases share a number of important pathological features, such as accumulation of misfolded proteins as amyloid oligomers and fibrils. Recent evidence suggests that soluble amyloid oligomers and not the insoluble amyloid fibrils may represent the primary pathological species of protein aggregates.

RESULTS: We have produced several monoclonal antibodies that specifically recognize prefibrillar oligomers and do not recognize amyloid fibrils, monomer or natively folded proteins. Like the polyclonal antisera, the individual monoclonals recognize generic epitopes that do not depend on a specific linear amino acid sequence, but they display distinct preferences for different subsets of prefibrillar oligomers. Immunological …

A Comparative Study Of Embedded And Anesthetized Zebrafish In Vivo On Myocardiac Calcium Oscillation And Heart Muscle Contraction, Brian S. Muntean, Christine M. Horvat, James H. Behler, Wissam A. Aboualaiwi, Andromeda M. Nauli, Frederick E. Williams, Surya M. Nauli

Pharmacy Faculty Articles and Research

The zebrafish (Danio rerio) has been used as a model for studying vertebrate development in the cardiovascular system. In order to monitor heart contraction and cytosolic calcium oscillations, fish were either embedded in methylcellulose or anesthetized with tricaine. Using high-resolution differential interference contrast and calcium imaging microscopy, we here show that dopamine and verapamil alter calcium signaling and muscle contraction in anesthetized zebrafish, but not in embedded zebrafish. In anesthetized fish, dopamine increases the amplitude of cytosolic calcium oscillation with a subsequent increase in heart contraction, whereas verapamil decreases the frequency of calcium oscillation and heart rate. Interestingly, verapamil also …

Vitamin A Supplementation For Preventing Morbidity And Mortality In Children From 6 Months To 5 Years Of Age, Aamer Imdad, Kurt Herzer, Evan Mayo-Wilson, Mohammad Yawar Yakoob, Zulfiqar Ahmed Bhutta

Woman and Child Health

Background: Vitamin A deficiency (VAD) is a major public health problem in low and middle income countries affecting 190 million children under 5. VAD can lead to many adverse health consequences, including death.
Objectives: To evaluate the effect of vitamin A supplementation (VAS) for preventing morbidity and mortality in children aged 6 months to 5 years.
Search strategy: We searched the Cochrane Central Register of Controlled Trials (CENTRAL 2010 Issue 2), MEDLINE (1950 to April Week 2 2010), EMBASE (1980 to 2010 Week 16), Global Health (1973 to March 2010), Latin American and Caribbean Health Sciences (LILACS), metaRegister of Controlled …