Medicine and Health Sciences Commons^™

Pcb-Contaminated Food In The Canadian Arctic: Interactions Between Environmental Policy, Cultural Values, And The Healthcare System, Katharine K. Brieger

Pomona Senior Theses

Current Canadian policies do not adequately prevent water contamination or mitigate the effects of existing polychlorinated biphenyl pollution. There is conflict between the Canadian government and the Inuit people over how to approach the pollution problem, arising from a clash of cultural values and traditions. Legislation related to healthcare is an inherently sensitive issue and some measures that seem acceptable to westernized societies are not appropriate for the Inuit. The purpose of this thesis is to answer (a) why polychlorinated biphenyls (PCBs) are in the Arctic, (b) what the effects of PCBs are on the Arctic people, and (c) how …

Closure Of A Para-Valvular Aortic Leak With The Use Of 2 Amplatzer Devices And Real-Time 2− And 3-Dimensional Transesophageal Echocardiography, Kurt S Hoffmayer, Christian Zellner, Damon M Kwan, Suma Konety, Elyse Foster, Phillip Moore, Yerem Yeghiazarians

The Texas Heart Institute Journal

Paravalvular leaks are well-recognized sequelae of mechanical aortic valve implantation. Clinical manifestations include hemolysis, arrhythmias, and congestive heart failure. Frequently, patients who receive mechanical aortic valves are poor candidates for repeat valve surgery, and the reoperative mortality rate is high. Percutaneous intervention has recently become an alternative to surgery in selected patients. Herein, we describe the percutaneous closure of an aortic paravalvular leak in a 45-year-old man who had undergone 2 aortic valve replacements with mechanical valves. The patient, who was at high surgical risk due to comorbidities, underwent the implantation of 2 AMPLATZER devices with the use of real-time …

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 …

Management Of Acute Regurgitation In Left-Sided Cardiac Valves, Nahush A Mokadam, Karen K Stout, Edward D Verrier

The Texas Heart Institute Journal

The management of acute, severe cardiac valvular regurgitation requires expeditious multidisciplinary care. Although acute, severe valvular regurgitation can be a true surgical emergency, accurate diagnosis and subsequent treatment decisions require clinical acumen, appropriate imaging, and sound judgment. An accurate and timely diagnosis is essential for successful outcomes and requires appropriate expertise and a sufficiently high degree of suspicion in a variety of settings. Whereas cardiovascular collapse is the most obvious and common presentation of acute cardiac valvular regurgitation, findings may be subtle, and the clinical presentation can often be nonspecific. Consequently, other acute conditions such as sepsis, pneumonia, or nonvalvular …

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 …

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.

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

The Texas Heart Institute Journal

No abstract provided.

Surgical Management Of Double-Chambered Right Ventricle In Adults, Ahmad K Darwazah, Mohammed Eida, Vivian Bader, Mohammed Khalil

The Texas Heart Institute Journal

Double-chambered right ventricle is a congenital anomaly in which the right ventricle is divided into 2 portions by anomalous muscle bundles. These cases often present in children, but rarely in adults.

We discuss 2 cases of double-chambered right ventricle, in patients aged 42 and 35 years. When cases remain asymptomatic until adulthood, they can present with unusual symptoms that lead to incorrect diagnosis. Our cases represent 2 very different manifestations of double-chambered right ventricle, which differ in presentation, in the site of abnormal obstructive muscle bundles, and in the presence of associated lesions. Both of our patients underwent successful surgical …

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 …

High-Risk Diabetic Patients With Unprotected Left Main Coronary Artery Disease: Characteristics And Medium-Term Outcomes Of Percutaneous Revascularization With Drug-Eluting Stents, Jose F Díaz Fernández, Carlos Sánchez González, Manuel Jiménez Navarro, Juan C Fernández Guerrero, Antonio Gómez Menchero, Juan H Alonso Briales, Rosa María Cardenal Piris, Juan Herrador, Manuel Guzmán Herrera, Jose M Hernández García

The Texas Heart Institute Journal

Percutaneous coronary intervention with drug-eluting stents is an alternative for patients with high-risk unprotected left main coronary artery disease; those with diabetes mellitus are at even higher risk. Recent advances in percutaneous coronary intervention could lead to better results. The aim of this study was to evaluate medium-term results in a real-world sample of high-risk diabetic patients undergoing percutaneous coronary intervention with drug-eluting stents for unprotected left main coronary artery disease.

From 3 tertiary hospitals, we retrospectively identified 334 high-risk patients, of whom 141 (42%) were diabetic and 193 (58%) were nondiabetic. The diabetes mellitus group showed a higher prevalence …

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 …

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

The Texas Heart Institute Journal

No abstract provided.

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. …

Mechanical Behavior Of Fully Expanded Commercially Available Endovascular Coronary Stents, Josip Tambaca, Suncica Canic, Mate Kosor, R David Fish, David Paniagua

The Texas Heart Institute Journal

The mechanical behavior of endovascular coronary stents influences their therapeutic efficacy. Through computational studies, researchers can analyze device performance and improve designs. We developed a 1-dimensional finite element method, net-based algorithm and used it to analyze the effects of radial loading and bending in commercially available stents. Our computational study included designs modeled on the Express, Cypher, Xience, and Palmaz stents.

We found that stents that did not fully expand were less rigid than the fully expanded stents and, therefore, exhibited larger displacement. Stents with an open-cell design, such as Express-like or Xience-like stents, had a higher bending flexibility. Stents …

Cardiac Surgery: A Century Of Progress, Allen B Weisse

The Texas Heart Institute Journal

Well into the first decades of the 20th century, medical opinion held that any surgical attempts to treat heart disease were not only misguided, but unethical. Despite such reservations, innovative surgeons showed that heart wounds could be successfully repaired. Then, extracardiac procedures were performed to correct patent ductus arteriosus, coarctation of the aorta, and tetralogy of Fallot. Direct surgery on the heart was accomplished with closed commissurotomy for mitral stenosis. The introduction of the heart-lung machine and cardiopulmonary bypass enabled the surgical treatment of other congenital and acquired heart diseases. Advances in aortic surgery paralleled these successes. The development of …

Robotic Cardiac Surgery By 2031, W Randolph Chitwood

The Texas Heart Institute Journal

No abstract provided.

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 …

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 …

Heterogeneity Of Left Ventricular Signal Characteristics In Response To Acute Vagal Stimulation During Ventricular Fibrillation In Dogs, Alireza Nazeri, Macarthur A Elayda, Lubomir Dragnev, Christopher M Frank, Jihong Qu, Valtino X Afonso, Abdi Rasekh, Mohammad Saeed, Jie Cheng, Mossaab Shuraih, Ali Massumi, Mehdi Razavi

The Texas Heart Institute Journal

Studies have shown that long-term vagal stimulation is protective against ventricular fibrillation; however, the effects of acute vagal stimulation during ventricular fibrillation in the normal heart have not been investigated. We examined the effects of acute vagal stimulation on ventricular fibrillation in a canine model. In 4 dogs, we induced 30-second periods of ventricular fibrillation by means of intraventricular pacing. During 2 of the 4 periods of fibrillation that we analyzed, vagal stimulation was delivered through electrodes in the caudal ends of the vagus nerves. Noncontact unipolar electrograms were recorded from 3 ventricular regions: the basal septum, apical septum, and …

Aadej Comm 42 3&4 2011

AADEJ - The Communicator

The Communicator is the official journal of the American Association of Dental Editors and Journalists (AADEJ). It is published quarterly, distributed digitally via email to members, and posted on the Association's website, AADEJ.org. Each issue includes regular updates from the editorial team and AADEJ board, as well as feature articles on current issues in the field.

This is a combined issue for 2011, issue 3 and 4.

The Role Of Medical Training Background In Patient Satisfaction, Mariam Zia Qureshi

All Graduate Theses, Dissertations, and Other Capstone Projects

The number of international medical graduates (IMG) is increasing and their ability to satisfy patients has never been studied. The purpose of this study is to examine if there is a difference between the patient satisfaction scores of US medical graduates (USMGs) and IMGs. This is a retrospective study in which 2627 returned patient experience surveys of 55 physicians working in Medical Practice in South Western Mayo Health System were evaluated. These surveys were returned from August 2009 to August 2010. An independent t-test and t-inverse test was conducted with significance level of 0.05. The results of t-test lead to …

Best Practices For Working With Undocumented Latino Youth, Elizabeth J. Braun

All Graduate Theses, Dissertations, and Other Capstone Projects

Research Question: What are evidence supported individual, group and community practices to address the needs of Latino youth experiencing mental health issues related to undocumented legal status and risk of deportation?

Best Practices For Treating Co-Occuring Disorders In A Chemical Dependency Treatment Setting, Michelle Dick

All Graduate Theses, Dissertations, and Other Capstone Projects

The purpose of this capstone project was to identify best practices for treating co-occurring disorders that could be utilized with adult males being treated for chemical dependency at the House of Hope, Inc. Identification of these practices will more effectively meet the needs of the clients served at House of Hope, Inc. and allow the agency to increase their capacity to better service clients with co-occurring disorders.

Evidence-Based Strategies For Working With Veterans, Bethany Fopma

All Graduate Theses, Dissertations, and Other Capstone Projects

According to the Veterans Health Administration (VHA), 3.3 million veterans (41%) live in rural areas. Due to geographical barriers, these veterans often lack access to needed services and providers. This research project analyzed studies that utilized telehealth in delivering services to veterans with PTSD. While more research in this area needs to be conducted, telehealth technology shows promising results for improving veterans’ symptoms and providing veterans with satisfactory services. Research Question: Is telehealth medicine an effective intervention in treating veterans with PTSD?

Factors That Contribute To Patient Length Of Stay At St. Peter Regional Treatment Center, Brenda Karch

All Graduate Theses, Dissertations, and Other Capstone Projects

This research project employed a quantitative review of archived data comprised of patients that had been discharged from St. Peter Regional Treatment Center between 2002-2010. These patients were admitted to Minnesota Security Hospital for treatment and progressed through the program to Forensic Transition Services and eventually discharged to the community.

Effectiveness Of The Whytry Curriculum With Adults Participating In A Vocational Training Program, Erika Kern

All Graduate Theses, Dissertations, and Other Capstone Projects

The purpose of this research project is to evaluate the effectiveness of the WhyTry curriculum with adults participating in a vocational training program specifically to develop retail skills. WhyTry is an interactive, multisensory program used to motivate participants to change patterns of indifference by using analogies, videos, and music to stimulate and inspire them to succeed. The curriculum has elements of Solution Focused Brief Therapy, Social and Emotional Intelligence, and multi-sensory learning (WhyTry, 2011). My research question is as follows: Is the WhyTry curriculum effective in increasing self-esteem and self-efficacy with adults who are participating in a vocational training program? …

Understanding The Role Of Attachments And Schemas: A Model For Working With Sex Offenders, Carol J. Ries

All Graduate Theses, Dissertations, and Other Capstone Projects

The purpose of this project is to research, develop, present, and evaluate a training module to increase knowledge of the role of attachments and schemas in working with sex offenders and to provide a model for working with sex offenders. Research Questions: 1. To what extent will a training module on the role of attachments and schemas increase attendees’ understanding of these topics? 2. Will a training module increase the likelihood that attendees will apply this knowledge of attachments and schemas in their work with clients?

Computer-Based Training: Understanding Mental Health Civil Commitment, Tiffany Sandbo

All Graduate Theses, Dissertations, and Other Capstone Projects

The purpose of this training is to enhance health and mental health professionals’ knowledge about the mental health civil commitment law and process in Minnesota. The goal is upon completion of this training: 1)Trainees will understand the mental health civil commitment law and process in Minnesota. 2)Trainees will understand your role in the mental health civil commitment process.

Recommendations For The Provision Of Patient Activities, Jean Schlichting

All Graduate Theses, Dissertations, and Other Capstone Projects

Federal Code § 485.645 is entitled “Special requirements for CAH (Critical Access Hospital) providers of long-term care services (“swing beds”).” It states that a CAH must be in substantial compliance with the skilled nursing facility requirements found in § 483. § 483.15 states that the facility must provide a comprehensive activities program that is designed to meet the physical, mental and psychosocial interests and needs of each patient. To ensure the program is meeting the interests and needs of patients, it also states that a comprehensive activities assessment should be completed with each patient. A wealth of research finds that …

Shelter Program For Homeless Males With Substance Use And Mental Illness: A Strength And Effectiveness Based Approach, Kotatee Tamba

All Graduate Theses, Dissertations, and Other Capstone Projects

Homelessness represents one of the United States most pressing and complex problems. Approximately, nine percent of the nation’s homeless are considered to be rural. Locally, homelessness in Steele County continues to be a problem. A one night survey of homeless individuals in southeastern Minnesota revealed that there are 217 people experiencing homelessness on any given night. Homeless males have been found to be at greater risk of becoming homeless and tend to remain homeless for longer periods of time. The high risks associated with substance use, lack of adequate shelters and limited access to health care services in rural communities …