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Dilation
Kinds of Dilation Selected AbstractsRISK FACTORS FOR RECURRENT BILE DUCT STONES AFTER ENDOSCOPIC PAPILLARY BALLOON DILATION: LONG-TERM FOLLOW-UP STUDYDIGESTIVE ENDOSCOPY, Issue 2 2009Akira Ohashi Background:, Little is known about the long-term results of endoscopic papillary balloon dilation (EPBD) for bile duct stones. Methods:, Between 1995 and 2000, 204 patients with bile duct stones successfully underwent EPBD and stone removal. Complete stone clearance was confirmed using balloon cholangiography and intraductal ultrasonography (IDUS). Long-term outcomes of EPBD were investigated retrospectively in the year 2007, and risk factors for stone recurrence were multivariately analyzed. Results:, Long-term information was available in 182 cases (89.2%), with a mean overall follow-up duration of 9.3 years. Late biliary complications occurred in 22 patients (12.1%), stone recurrence in 13 (7.1%), cholangitis in 10 (5.5%), cholecystitis in four, and gallstone pancreatitis in one. In 11 of 13 patients (84.6%), stone recurrence developed within 3 years after EPBD. All recurrent stones were bilirubinate. Multivariate analysis identified three risk factors for stone recurrence: dilated bile duct (>15 mm), previous cholecystectomy, and no confirmation of clean duct using IDUS. Conclusion:, Approximately 7% of patients develop stone recurrence after EPBD; however, retreatment with endoscopic retrograde cholangiopancreatography is effective. Careful follow up is necessary in patients with dilated bile duct or previous cholecystectomy. IDUS is useful for reducing stone recurrence after EPBD. [source] PROBLEMS INHERENT TO BALLOON DILATION FOR THE TREATMENT OF COMMON BILE DUCT STONES IN COMPARISON WITH ENDOSCOPIC SPHINCTEROTOMYDIGESTIVE ENDOSCOPY, Issue 2 2000Masao Tanaka First page of article [source] SLOW INOTROPIC RESPONSE OF INTACT LEFT VENTRICLE TO SUDDEN DILATION CRITICALLY DEPENDS ON A MYOCARDIAL DIALYSABLE FACTORCLINICAL AND EXPERIMENTAL PHARMACOLOGY AND PHYSIOLOGY, Issue 5-6 2007Paulo JF Tucci SUMMARY 1Slow inotropic response following a sudden myocardium stretch seems to be an autocrine/paracrine mechanism the basis of which is not yet completely defined. 2We compared the canine left ventricle (LV) response to sudden dilation when the LV was supported by the arterial blood of a support dog with when it was supported by an oxygenator + haemodialyser system. 3A slow inotropic response (SIR) after dilation was seen in all six hearts supported by the donor dog, attaining 87 ± 6% of immediate increase, whereas a mere 10% SIR occurred in only one out of seven hearts maintained by the oxygenator + haemodialyser. 4These results indicate that SIR genesis involves one or more renewable components essential to the intracellular calcium gain elicited by stretch. [source] Mitral Regurgitation Associated with Mitral Annular Dilation in Patients with Lone Atrial Fibrillation: An Echocardiographic StudyECHOCARDIOGRAPHY, Issue 8 2009Takashi Kihara M.D. Background: Whether and how lone atrial fibrillation (AF) is associated with functional mitral regurgitation (MR) remain unclear. Method: We studied 12 lone AF patients without left ventricular (LV) dysfunction and/or dilatation, who underwent mitral valve annuloplasty for functional mitral regurgitation (MR). Ten lone AF patients without MR served as controls. Results: Lone AF Patients with MR had a greater mitral valve annular area and left atrial area than those without MR. There were no differences in LV volumes or LV ejection fraction. Conclusions: Therefore, we concluded that left atrial dilation and corresponding mitral annular dilation may cause MR in lone AF patients without LV dysfunction and/or dilatation. [source] Factors affecting fluid flow in strike,slip fault systems: coupled deformation and fluid flow modelling with application to the western Mount Isa Inlier, AustraliaGEOFLUIDS (ELECTRONIC), Issue 1 2009A. FORD Abstract Deformation and focused fluid flow within a mineralized system are critical in the genesis of hydrothermal ore deposits. Dilation and integrated fluid flux due to coupled deformation and fluid flow in simple strike,slip fault geometries were examined using finite difference analysis in three dimensions. A series of generic fault bend and fault jog geometries consistent with those seen in the western Mount Isa Inlier were modelled in order to understand how fault geometry parameters influence the dilation and integrated fluid flux. Fault dip, fault width, bend/jog angle, and length were varied, and a cross-cutting fault and contrasting rock types were included. The results demonstrate that low fault dips, the presence of contrasts in rock type, and wide faults produce highest dilation and integrated fluid flux values. Increasing fault bend lengths and angles increases dilation and integrated fluid flux, but increasing fault jog length or angle has the opposite effect. There is minimal difference between the outputs from the releasing and restraining fault bend and jog geometries. Model characteristics producing greater fluid flows and/or gradients can be used in a predictive capacity in order to focus exploration on regions with more favorable fault geometries, provided that the mineralized rocks had Mohr,Coulomb rheologies similar to the ones used in the models. [source] The Use of a Femoral Arterial Cannula for Effective Dilation for Percutaneous Femoral Venous CannulationJOURNAL OF CARDIAC SURGERY, Issue 1 2005Hrvoje Gasparovic M.D. The technique presented may be particularly helpful when redo sternotomy is deemed hazardous and cardiopulmonary bypass is judged mandatory prior to redo sternotomy. The patient presented in this paper had two previous cardiac operations with prior surgical exposure of femoral vessels in whom institution of cardiopulmonary bypass prior to sternotomy was of paramount importance due to a 7-cm ascending aortic aneurysm. [source] Abrupt Aortic Root Dilation After the Ross Procedure,Is This a Progressive Phenomenon?JOURNAL OF CARDIAC SURGERY, Issue 5 2003Rafael E. Villavicencio M.D. Several mechanisms are described. [source] Mid-term Results of the Ross ProcedureJOURNAL OF CARDIAC SURGERY, Issue 4 2001Domenico Paparella M.D. Although the Ross procedure has been performed for over three decades, its role in the management of patients with aortic valve disease is not well established. This study reviews our experience with this operation. From 1990 to 1999, 155 patients underwent the Ross procedure. The mean age of 106 men and 49 women was 35 years. Most patients (85%) had congenital aortic valve disease. The pulmonary autograft was implanted in the subcoronary position in 2 patients, as an aortic root inclusion in 78, and aortic root replacement in 75. The follow-up extended from 9 to 114 months, mean of 45 ± 28 months, and it was complete. All patients have had Doppler echocardiographic studies. There was only one operative and one late death. The survival was 98% at 7 years. The freedom from 3+ or 4+ aortic insufficiency was 86% at 7 years and the freedom from reoperation on the pulmonary autograft was 95% at 7 years. Dilation of the aortic annulus and/or sinotubular junction was the most common cause of aortic insufficiency. One patient required three reoperations on the biological pulmonary valve. Most patients (96%) have no cardiac symptoms. The Ross procedure has provided excellent functional results in most patients, but progressive aortic insufficiency due to dilation of the aortic annulus and/or sinotubular junction is a potential problem in a number of patients. [source] Defibrillation Causes Immediate Cardiac Dilation in HumansJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 8 2003Erin Sylvester B.S. Introduction: Prior studies in isolated heart tissue have shown both excitation and deexcitation to be the primary mechanism of defibrillation. This article presents the first evidence in man of deexcitation immediately following defibrillation by tracking the heart's mechanical response. Methods and Results: The geometric changes of the ventricular chambers were measured before and after defibrillation in seven human subjects receiving an implantable cardioverter defibrillator (ICD). The ICD was used to produce approximately three episodes of ventricular fibrillation and defibrillation in each subject. Twenty-two two-dimensional echocardiographic images of the right ventricle (RV) and 11 images of the left ventricle (LV) were recorded and analyzed at 30 frames per second. Just over 2 seconds of each episode were digitized, beginning half a second before the defibrillation shock. Individual frames were analyzed to yield cross-sectional, ventricular chamber area as a function of time. Immediately following defibrillation, ventricular chambers dilated with significant fractional area increase (RV: 1.58 ± 0.25, LV: 1.10 ± 0.06), with peak dilation at 194 ± 114 msec. Conclusion: Defibrillation causes a rapid increase in ventricular chamber area due to relaxation of the myocardium, suggesting that defibrillation synchronizes the cardiac cells to the deexcited state in man. (J Cardiovasc Electrophysiol, Vol. 14, pp. 832-836, August 2003) [source] Electrical Remodeling and Atrial Dilation During Atrial Tachycardia are Influenced by Ventricular Rate: Role of Developing TachycardiomyopathyJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 12 2001BAS A. SCHOONDERWOERD M.D. Atrial Remodeling in Tachycardiomyopathy. Introduction: Atrial fibrillation (AF) and congestive heart failure (CHF) are two clinical entities that often coincide. Our aim was to establish the influence of concomitant high ventricular rate and consequent development of CHF on electrical remodeling and dilation during atrial tachycardia. Methods and Results: A total of 14 goats was studied. Five goats were subjected to 3:1 AV pacing (A-paced group, atrial rate 240 beats/min, ventricular rate 80 beats/min). Nine goats were subjected to rapid 1:1 AV pacing (AV-paced group, atrial and ventricular rates 240 beats/min). During 4 weeks, right atrial (RA) and left ventricular (LV) diameters were measured during sinus rhythm. Atrial effective refractory periods (AERP) and inducibility of AF were assessed at three basic cycle lengths (BCL). After 4 weeks of rapid AV pacing, RA and LV diameters had increased to 151% and 113% of baseline, whereas after rapid atrial pacing alone, these parameters were unchanged. Right AERP (157 ± 10 msec vs 144 ± 16 msec at baseline with BCL of 400 msec in the A-paced and AV-paced group, respectively) initially decreased in both groups, reaching minimum values within 1 week. Subsequently, AERP partially recovered in AV-paced goats, whereas AERP remained short in A-paced goats (79 ± 7 msec vs 102 ± 12 msec after 4 weeks; P < 0.05). Left AERP demonstrated a similar time course. Inducibility of AF increased in both groups and reached a maximum during the first week in both groups, being 20% and 48% in the A-paced and AV-paced group, respectively. Conclusion: Nature and time course of atrial electrical remodeling and dilation during atrial tachycardia are influenced by concurrent high ventricular rate and consequent development of CHF. [source] Dilated intercellular space in chronic laryngitis and gastro-oesophageal reflux disease: at baseline and post-lansoprazole therapyALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 7 2010M. F. Vaezi Aliment Pharmacol Ther 2010; 32: 916,924 Summary Background, Dilation of intercellular spaces is reported to be an early morphological marker in gastro-oesophageal reflux. It remains unknown if this marker is useful in diagnosing reflux-related chronic laryngitis. Aim, To determine histopathology and electron microscopic changes in oesophageal and laryngeal epithelium in chronic laryngitis. Methods, In this prospective blinded study, we enrolled 53 participants: 15 controls, 20 patients with GERD and 18 patients with chronic laryngitis. The latter two groups were subsequently treated with lansoprazole 30 mg bid for 12-weeks. Baseline and postacid suppressive therapy biopsies were obtained from distal oesophagus and laryngeal postcricoid areas. Biopsy specimens were evaluated for histopathology and dilated intercellular space changes. Results, There was no significant increase in oesophageal or laryngeal epithelium intercellular spaces among GERD or laryngitis patients compared with controls at baseline or postacid suppressive therapy. Only patients with GERD had significantly (P = 0.03) higher proportion of moderate-to-severe oesophageal spongiosis and basal cell hyperplasia, which normalized postacid suppressive therapy. Conclusions, There was no increase in the width of intercellular spaces in the oesophagus or larynx in GERD or chronic laryngitis at baseline or postacid suppressive therapy. Our findings question the uniform presence of dilated intercellular space in patients with GERD. [source] Extracellular Arginine Rapidly Dilates In Vivo Intestinal Arteries and Arterioles Through a Nitric Oxide MechanismMICROCIRCULATION, Issue 2 2008Laura Pezzuto ABSTRACT Objective: Arginine used for nitric oxide formation can be from intracellular stores or transported into cells. The study evaluated the rapidity, and primary site of NO and vascular resistance responses to arginine at near physiological concentrations (100,400 , M). Methods: Arginine was applied to a single arteriole through a micropipette to determine the fastest possible responses. For vascular blood flow and [NO] responses, arginine was added to the bathing media. Results: Dilation of single arterioles to arginine began in 10,15 seconds and application over the entire vasculature increased [NO] in , 60,90 seconds, and flow increased within 120,300 seconds. Resting periarteriolar [NO] for arterioles was 493.6 ± 30.5 nM and increased to 696.1 ± 68.2 and 820.1 ± 110.5 nM at 200 and 400 , M L-arginine. The blood flow increased 50% at 400,1200 , M L-arginine. The reduced arterial resistance during topical arginine was significantly greater than microvascular resistance at 100 and 200 , M arginine. All responses were blocked by L-NAME. Conclusions: This study demonstrated arterial resistance responses are as or more responsive to arginine induced NO formation as arterioles at near physiological concentrations of arginine. The vascular NO and resistance responses occurred rapidly at L-arginine concentrations at and below 400 , M, which predict arginine transport processes were involved. [source] Hydrogen Peroxide-Dependent Arteriolar Dilation in Contracting Muscle of Rats Fed Normal and High Salt DietsMICROCIRCULATION, Issue 8 2007Paul J. Marvar ABSTRACT Objective: High dietary salt intake decreases the arteriolar dilation associated with skeletal muscle contraction. Because hydrogen peroxide (H2O2) can be released from contracting muscle fibers, this study was designed to assess the possible contribution of H2O2 to skeletal muscle functional hyperemia and its sensitivity to dietary salt. Methods: The authors investigated the effect of catalase treatment on arteriolar dilation and hyperemia in contracting spinotrapezius muscle of rats fed a normal salt (0.45%, NS) or high salt (4%, HS) diet for 4 weeks. Catalase-sensitive 2,,7,-dichlorofluorescein (DCF) fluorescence was measured as an index of H2O2 formation, and the mechanism of arteriolar dilation to H2O2 was probed in each group using pharmacological inhibitors. Results: DCF fluorescence increased with muscle contraction, but not if catalase was present. Catalase also reduced arteriolar dilation and hyperemia during contraction in both dietary groups. Exogenous H2O2 dilated arterioles in both groups, with greater responses in HS rats. Guanylate cyclase inhibition did not affect arteriolar responses to H2O2 in either group, but KCa or KATP channel inhibition equally reduced these responses, and KATP channel inhibition equally reduced functional hyperemia in both groups. Conclusions: These results indicate that locally produced H2O2 contributes to arteriolar dilation and hyperemia in contracting skeletal muscle, and that the effect of H2O2 on arteriolar tone in this vascular bed is mediated largely through K+ channel activation. High dietary salt intake does not reduce the contribution of H2O2 to active hyperemia, or alter the mechanism through which H2O2 relaxes arteriolar smooth muscle. [source] Decreased Arteriolar Sensitivity to Shear Stress in Adult Rats is Reversed by Chronic Exercise ActivityMICROCIRCULATION, Issue 2 2002Dong Sun M.D., Ph.D. Objective: We tested the hypothesis that the decline in endothelium-dependent arteriolar dilation in adult rats is reversed by chronic exercise activity. Methods: Rats were divided into young (8,10 weeks)-sedentary (SEDY), adult (29,32 weeks)-sedentary (SEDA), and adult-exercised (EXA, treadmill exercise for 18,20 weeks) groups. Responses of isolated arterioles (,50 µm at 80 mm Hg) of gracilis muscle were assessed to increases in perfusate flow and vasoactive agents. Results: With no differences in basal tone, maximal flow-induced dilations were not different between arterioles of SEDY and SEDA rats (71 ± 2 and 72 ± 2% of passive diameter, respectively), yet the sensitivity of arterioles to shear stress (WSS50) was significantly less in SEDA than in SEDY rats (35 ± 4 vs. 23 ± 3 dyne/cm2, respectively). In vessels of EXA rats, maximal flow-induced dilation was significantly augmented (88 ± 2% of passive diameter) and WSS50 (15 ± 1 dyn/cm2) was significantly reduced. Dilation to acetylcholine was enhanced in arterioles of EXA, whereas dilation to sodium nitroprusside was not different in vessels of the three groups. Conclusion: Chronic exercise activity reverses age related reduction in sensitivity of arterioles to increases in wall shear stress. [source] Balloon Dilation of an Esophageal Stenosis in a Patient with Recessive Dystrophic Epidermolysis BullosaPEDIATRIC DERMATOLOGY, Issue 6 2000L. Naehrlich M.D. A balloon dilation was successfully performed under flexible endoscopic and fluoroscopic control. The early and long-term follow-up was characterized by the disappearance of dysphagia, weight gain, and improvement of his skin lesions. [source] In reference to A Novel Approach for Dilation of Neopharyngeal Stricture Following Total Laryngectomy Using the Tracheoesophageal Puncture SiteTHE LARYNGOSCOPE, Issue 5 2009William J. Richtsmeier MD No abstract is available for this article. [source] In reference to Technique, Utility, and Safety of Awake Tracheoplasty Using Combined Laser and Balloon DilationTHE LARYNGOSCOPE, Issue 6 2008Stanley M. Shapshay MD No abstract is available for this article. [source] Heart changes in 17-day-old fetuses of diabetic ICR (Institute of Cancer Research) mothers: Improvement with maternal immune stimulationCONGENITAL ANOMALIES, Issue 1 2009Juan Claudio Gutierrez ABSTRACT Maternal diabetes mellitus is associated with increased fetal teratogenesis, including cardiovascular defects. Non-specific maternal immune stimulation with Freund's complete adjuvant (FCA) or interferon gamma (IFN,) has been associated with protection against birth malformations. Using a diabetic mouse model, late-gestation fetal heart and great vessel morphology were analyzed. Four groups of mice were used: non-diabetic females as a control group, hyperglycemic females induced by streptozotocin as a diabetic group, and diabetic females injected either with FCA or IFN,. At day 17 of gestation, females were euthanized and one fetus was arbitrarily selected per litter for fixation and sectioning. Treatment-induced changes in cardiac development were assessed from digital images of serial sections taken at standardized levels in the thorax. One-way parametric and non-parametric ANOVA and ordinal logistic regression were performed to compare the difference among groups (P < 0.05). Maternal hyperglycemia altered morphology of the late-gestation fetal mouse heart by causing ventricular chamber dilation, sectional myocardial reduction, and an increase in transversal aortic area. FCA protected the fetal heart from cavitary dilation in diabetic mothers. FCA and IFN, protected the fetal heart against reduction of myocardial area, and ascending thoracic aorta dilation. Consequences of late gestation heart chamber dilation and myocardial reduction are not yet known. Maternal immune stimulation partially protected against these developmental defects by mechanisms that remain unclear. [source] Early and Midterm Results of an Alternative Procedure to Homografts in Primary Repair of Truncus Arteriosus CommunisCONGENITAL HEART DISEASE, Issue 3 2010Pedro Curi-Curi MD ABSTRACT Background., Repair of truncus arteriosus communis (TAC) in the neonatal and early infant period has become a standard practice. We report our experience on primary repair of TAC with a bovine pericardial-valved woven Dacron conduit as an alternative procedure to homografts, with a focus on early and midterm results. Methods., From January 2001 to December 2007, 15 patients with mean age 1.5 years (range 3 months to 8 years), underwent primary repair of simple TAC. Cases with cardiogenic shock, complex-associated cardiac lesions, or adverse anatomy of the truncal valve were excluded. The Collett and Edwards anatomical type classification of TAC was as follows: type I, 13 (87%); and type II, 2 (13%). Right ventricular outflow tract was reconstructed in all the cases with a bovine pericardial-valved woven Dacron conduit. Results., Overall mortality was 6.6% (1 death due to severe pulmonary hypertension). At a mean follow-up of 31 months (range 6,51), there were no deaths (5-year actuarial survival 93.4%). Out of the 14 midterm survivors, three developed stenosis of the pericardial-valved woven Dacron conduit, but only one underwent interventional procedure including percutaneous balloon dilation with stenting for associated left pulmonary artery hypoplasia. The rate of patients with no surgical or percutaneous reinterventions performed because of obstruction of the right ventricular outflow tract reconstruction in the midterm (5 years) was 86%. Conclusions., Truncus arteriosus communis repair with a bovine pericardial-valved woven Dacron conduit can be performed with a very low perioperative mortality and satisfactory midterm morbidity, favorably compared with that reported for the use of homografts. Interventional cardiac catheterization may delay the time of reoperation for inevitable conduit replacement due to stenosis. [source] Disparity in regional and systemic circulatory capacities: do they affect the regulation of the circulation?ACTA PHYSIOLOGICA, Issue 4 2010J. A. L. Calbet Abstract In this review we integrate ideas about regional and systemic circulatory capacities and the balance between skeletal muscle blood flow and cardiac output during heavy exercise in humans. In the first part of the review we discuss issues related to the pumping capacity of the heart and the vasodilator capacity of skeletal muscle. The issue is that skeletal muscle has a vast capacity to vasodilate during exercise [,300 mL (100 g),1 min,1], but the pumping capacity of the human heart is limited to 20,25 L min,1 in untrained subjects and ,35 L min,1 in elite endurance athletes. This means that when more than 7,10 kg of muscle is active during heavy exercise, perfusion of the contracting muscles must be limited or mean arterial pressure will fall. In the second part of the review we emphasize that there is an interplay between sympathetic vasoconstriction and metabolic vasodilation that limits blood flow to contracting muscles to maintain mean arterial pressure. Vasoconstriction in larger vessels continues while constriction in smaller vessels is blunted permitting total muscle blood flow to be limited but distributed more optimally. This interplay between sympathetic constriction and metabolic dilation during heavy whole-body exercise is likely responsible for the very high levels of oxygen extraction seen in contracting skeletal muscle. It also explains why infusing vasodilators in the contracting muscles does not increase oxygen uptake in the muscle. Finally, when ,80% of cardiac output is directed towards contracting skeletal muscle modest vasoconstriction in the active muscles can evoke marked changes in arterial pressure. [source] A Case Report of Rapid Progressive Coarctation and Severe Middle Aortic Syndrome in an Infant with Williams SyndromeCONGENITAL HEART DISEASE, Issue 5 2009E. Kevin Hall MD ABSTRACT Williams syndrome is a genetic disorder caused by multiple contiguous gene deletions in chromosome 7. Presentation in early life is most often a result of luminal stenosis of right- and left-sided arterial vasculature. We report the case of a newborn infant who had a rapidly progressing diffuse form of arteriopathy that required two surgeries and one percutaneous balloon dilation within the first 2 months of her life. [source] Selective Application of the Pediatric Ross Procedure Minimizes Autograft FailureCONGENITAL HEART DISEASE, Issue 6 2008David L.S. Morales MD ABSTRACT Objective., Pulmonary autograft aortic root replacement (Ross' operation) is now associated with low operative risk. Recent series suggest that patients with primary aortic insufficiency have diminished autograft durability and that patients with large discrepancies between pulmonary and aortic valve sizes have a low but consistent rate of mortality. Therefore, Ross' operation in these patients has been avoided when possible at Texas Children's Hospital. Our objective was to report outcomes of Ross' operation when selectively employed in pediatric patients with aortic valve disease. Methods., Between July 1996 and February 2006, 55 patients (mean age 6.8 ± 5.5 years) underwent Ross' procedure. Forty-seven patients (85%) had a primary diagnosis of aortic stenosis, three (5%) patients had congenital aortic insufficiency, and five (9%) patients had endocarditis. Forty-two (76%) patients had undergone prior aortic valve intervention (23 [55%] percutaneous balloon aortic valvotomies, 12 [29%] surgical aortic valvotomies, 12 [29%] aortic valve replacements, 2 [5%] aortic valve repairs). Fourteen (25%) patients had ,2 prior aortic valve interventions. Thirty-two patients (58%) had bicuspid aortic valves. Follow-up was 100% at a mean of 3 ± 2.5 years. Results., Hospital and 5-year survival were 100% and 98%, respectively. Morbidity included one reoperation (2%) for bleeding. Median length of hospital stay was 6 days (3 days,3 months). Six (11%) patients needed a right ventricular to pulmonary artery conduit exchange at a median time of 2.3 years. Freedom from moderate or severe neoaortic insufficiency at 6 years is 97%. Autograft reoperation rate secondary to aortic insufficiency or root dilation was 0%. Conclusions., By selectively employing Ross' procedure, outcomes of the Ross procedure in the pediatric population are associated with minimal autograft failure and mortality at mid-term follow-up. [source] Feasibility of Biventricular Pacing in Patients With Recent Myocardial Infarction: Impact on Ventricular RemodelingCONGESTIVE HEART FAILURE, Issue 1 2007Eugene S. Chung MD To test the hypothesis that biventricular pacing after a myocardial infarction with reduced ejection fraction can attenuate left ventricular (LV) remodeling, the authors studied 18 patients (myocardial infarction within 30,45 days, ejection fraction ,30%, narrow QRS) randomized to biventricular therapy (biventricular therapy + defibrillator) (biventricular group) or implantable cardioverter-defibrillator alone (control group). At 1, 6, and 12 months, there were no differences in functional or clinical parameters (New York Heart Association, quality of life, 6-minute walk). Twelve-month LV volume remained stable in the biventricular group, but increased in the control group (median LV end-diastolic volume increase, 6.5 mL in biventricular vs 35 mL in control; P=.03; median LV end-diastolic volume decrease, 5.5 mL in biventricular vs 30.5-mL increase in control; P=.11). Biventricular therapy also prevented an increase in sphericity index at 12 months (median, ,2% in biventricular vs 37% in control; P=.06). Delivery of biventricular therapy early after myocardial infarction appears safe and feasible and may attenuate subsequent LV dilation. [source] Changes in reactivity of rat arteries subjected to dynamic stretchACTA PHYSIOLOGICA, Issue 1 2000Dvoretsky The effect of dynamic stretch on the reactivity of the rat tail and mesenteric artery segments was studied. Segments mounted on a myograph were stretched by a computer-controlled motorized micromanipulator. Dynamic stretch (1, 5 or 7 Hz) inhibited the artery constriction induced by noradrenaline (10 ,M), 5-hydroxytryptamine (0.7 ,M), or electrical field stimulation of intramural nerves. In contrast, dynamic stretch enhanced the tetrodotoxin-insensitive dilation induced by electrical field stimulation of noradrenaline-contracted arteries. Maximal increase of dilation evoked by electrical field stimulation (24.5 ± 5.0% in mesenteric and 50.3 ± 15.6% in the tail artery) was observed at a dynamic stretch-frequency of 5 Hz. An inhibitor of nitric oxide synthesis, NG -nitro- L -arginine (100 ,M), abolished the difference in reactivity between static and dynamic conditions. The results indicate that dynamic stretch of the arteries activates nitric oxide synthesis/secretion, thus reducing constrictor and increasing dilator responses to the stimuli used. [source] Efficacy of the Flashlamp-Pumped Pulsed-Dye Laser in Nonsurgical Delay of Skin FlapsDERMATOLOGIC SURGERY, Issue 7 2003Ali Riza Erçöçen MD Objective. The purpose of this article was to determine the effectiveness of laser delay by use of the flashlamp-pumped pulsed-dye laser operating at a wavelength of 585 nm; to elucidate the comparable or dissimilar macroscopic, microscopic, and hemodynamic changes between laser and surgical delay methods; and to clarify the possible mechanisms underlying the delay effect of laser. Methods. A standardized caudally based random dorsal rat flap model was used in this study: Acute random skin flaps served as control subjects (group 1). Surgical delay was employed by incision of lateral longitudinal borders both without (group 2) and with (group 3) undermining, and laser delay methods were performed by laser irradiation of both lateral longitudinal borders (group 4) and the entire surface (group 5) of the proposed flap. Evaluation was done by histologic examination, India ink injection, laser Doppler perfusion imaging, and measurement of flap survival. Results. Histologically, dilation and hypertrophy of subpapillary and subdermal vessels were evident in groups 2, 3, and 4; on the other hand, degranulation of mast cells in the vicinity of occluded vessels at the 1st hour of laser delay and a striking mast cell proliferation and degranulation in association with newly formed vessels (angiogenesis) at the 14th day of laser delay were prominent in group 5. India ink injections revealed longitudinally arranged large-caliber vessels and cross-filling between the vessels of adjacent territories in groups, 2, 3, and 4, but only small-caliber vessels in group 5. Compared with the acute flaps, both surgical and laser delay significantly increased the mean flap perfusion to the maximal levels after a 14-day delay period, and all delay procedures improved flap survival; the most significant increase in surviving area was observed in group 3, whereas the less significant increase in surviving area was in group 5. Conclusion. This study demonstrates that laser delay is as effective as surgical delay and that laser delay by lasering lateral borders leads to dilation and longitudinal rearrangement of the existing vessels rather than angiogenesis, whereas laser delay by lasering the entire surface results in delay effect by inducing angiogenesis due to activation and degranulation of the mast cells. [source] Effects of physical exercise versus rosiglitazone on endothelial function in coronary artery disease patients with prediabetesDIABETES OBESITY & METABOLISM, Issue 9 2010S. Desch We conducted a three-arm, parallel-group, randomized, controlled trial to compare the effects of rosiglitazone and physical exercise on endothelial function in patients with coronary artery disease and impaired fasting glucose or impaired glucose tolerance over a 6-month period. Group A received rosiglitazone tablets 8 mg daily (n = 16), group B underwent a structured physical exercise programme (n = 15) and group C served as a control group (n = 12). At baseline and after 6 months, brachial artery ultrasound imaging was performed to assess reactive flow-mediated dilation (FMD). Rosiglitazone treatment and exercise both led to significant improvements in insulin resistance at 6 months, whereas no change was observed in control patients. FMD improved significantly in physical exercise patients, whereas no change could be observed in patients receiving rosiglitazone or in the control group. Between-group comparisons also showed a significant relative improvement in FMD in exercise patients compared with rosiglitazone. [source] The effects of lipid-lowering drug therapy on cardiovascular responsiveness in type 2 diabetic patientsDIABETES OBESITY & METABOLISM, Issue 1 2006Laurence Guy HowesArticle first published online: 18 MAR 200 Type 2 diabetes is associated with a high prevalence of dyslipidaemia and a high incidence of cardiovascular disease. Lipid lowering therapy with HMG Co-A reductase inhibitors (statins) reduce the risk of cardiovascular events in type 2 diabetic and non-diabetic patients, effects which are believed to be partly due to improvements in vascular function. The aetiology of abnormal vascular function in type 2 diabetics is likely to be multifactorial and the pattern of vascular dysfunction in type 2 diabetes may differ from that which occurs in non-diabetic patients with dyslipidaemia. Abnormalities in endothelium derived hyperpolarising factor (EDHF) mediated vasodilation in resistance vessels may be more prominent in both type 1 and type 2 diabetes than in non-diabetic patients with endothelial dysfunction. The effects of lipid lowering therapy on vascular responsiveness may differ in type 2 diabetic patients from those found in non-diabetic patients. Statin therapy does not appear to improve responses to endothelial dependent vasodilators in type 2 diabetics, but may alter the ratio between nitric oxide (NO) and EDHF mediated responses. Fibrate therapy improves flow mediated dilation of brachial arteries in type 2 diabetic patients, but only appears to improve endothelium dependant vasodilator responses in resistance vessels when given in conjunction with co-enzyme Q. [source] Association between plasma osteoprotegerin concentrations and urinary albumin excretion in Type 2 diabetesDIABETIC MEDICINE, Issue 4 2009G. D. Xiang Abstract Aims Osteoprotegerin (OPG) is a recently identified inhibitor of bone resorption. Recent studies indicate that OPG is also associated with endothelial dysfunction in Type 2 diabetes. The aim was to investigate the relationship between plasma OPG levels and urinary albumin excretion (UAE) in Type 2 diabetic patients. Methods This study included 154 newly diagnosed Type 2 diabetic patients and 46 healthy subjects. Plasma OPG and 24-h UAE were measured. High-resolution ultrasound was used to measure flow-mediated (endothelium-dependent arterial) dilation (FMD). Results Compared with the normoalbuminuric subgroup, OPG levels in the microalbuminuric subgroup were significantly higher, and OPG levels in macroalbuminuria subgroup were significantly higher than those in the normoalbuminuria and albuminuria subgroups. Multiple regression analysis showed that only FMD (r = ,0.26), C-reactive protein (r = 0.23), fasting blood glucose (r = 0.25), 2-h blood glucose (r = 0.21), HbA1c (r = 0.28), UAE (r = 0.27) and retinopathy (r = 0.27) were significant factors associated with OPG. Pearson's correlation analyses showed a positive correlation between OPG and logUAE (r = 0.440) and negative correlations between OPG and FMD (r = ,0.284), and between FMD and logUAE (r = ,0.602). Conclusions Plasma OPG levels are significantly associated with UAE in Type 2 diabetic patients. [source] Primary sclerosing cholangitis as a cause of false positive bile duct brushing cytology: Report of two cases.DIAGNOSTIC CYTOPATHOLOGY, Issue 2 2005Lester J. Layfield M.D. Abstract Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease of unknown etiology characterized by ongoing inflammation, destruction, and fibrosis of intrahepatic and extrahepatic bile ducts. Irregular narrowing and dilation of the biliary duct system produces the characteristic beaded pattern seen on cholangiogram. Malignant degeneration resulting in cholangiocarcinoma is a well-recognized sequela of PSC. Bile duct brushing cytology is the primary screening technique for cholangiocarcinoma. It is associated with a relatively low sensitivity but high specificity. Few false positive bile duct brushings have been reported in the literature, with the majority of these having occurred in a background of PSC. We report two patients with PSC in whom bile duct brush cytologies were falsely positive for carcinoma. Diagn. Cytopathol. 2005;32:119,124. © 2005 Wiley-Liss, Inc. [source] MANAGEMENT OF THE BILE DUCT STONE: CURRENT SITUATION IN JAPANDIGESTIVE ENDOSCOPY, Issue 2010Ichiro Yasuda Endoscopic treatment is now recognized as the standard treatment for common bile duct stones worldwide. Endoscopic treatment routinely involves endoscopic sphincterotomy in most countries including Japan and endoscopic papillary balloon dilation is also a widely used alternative to endoscopic sphincterotomy in Japan. Surgery in any form, including laparoscopic surgery, is mainly performed when endoscopic treatments are unsuccessful or unfavorable. Other therapeutic modalities considered under certain circumstances include lithotripsy under the guidance of percutaneous transhepatic cholangioscopy, peroral cholangioscopy, or enteroscopy; electrohydraulic lithotripsy or laser lithotripsy; and extracorporeal shock-wave lithotripsy. [source] | |||||||||||||||||||||||||||||||||||||||||||||||||