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Sample records for multiple giant coronary

  1. Giant coronary artery aneurysms complicating Kawasaki disease in Mexican children.

    PubMed

    Garrido-García, Luis M; Morán-Villaseñor, Edna; Yamazaki-Nakashimada, Marco A; Cravioto, Patricia; Galván, Fernando

    2017-08-29

    One of the most important complications of Kawasaki disease is the development of giant coronary aneurysms. Risk factors for their development are still not clear. A retrospective analysis was conducted at the National Institute of Paediatrics in Mexico City, Mexico. It included all patients with a diagnosis of acute Kawasaki disease between August, 1995 and August, 2015. Clinical and laboratory findings, as well as echocardiographic measurements, were recorded. Patients with giant coronary aneurysms (z-score⩾10) were compared with the rest of the patients. A value of p<0.05 was considered statistically significant. Odds ratios and their 95% confidence intervals were calculated to define risk factors. During the study period, 416 patients were diagnosed with Kawasaki disease. Of them, 34 developed giant coronary aneurysms during the acute stage of the disease. In the multivariate analysis, patients younger than 1 year, those with a higher duration of illness at the time of diagnosis, and those who received additional intravenous immunoglobulin showed a significantly higher frequency of giant coronary aneurysms. One of the main factors associated with the development of giant coronary aneurysms was the delay in the diagnosis of Kawasaki disease. This finding highlights the importance of maintaining a high suspicion of the disease, which would enable an early diagnosis and prompt treatment and decrease the risk for developing giant coronary aneurysms.

  2. Giant right coronary artery aneurysms presenting as a cardiac mass

    PubMed Central

    Wang, Huanhuan; Zhang, Yin; Xie, Yanbo; Wang, Hongyue; Yuan, Jinqing

    2016-01-01

    Abstract Introduction: Coronary artery aneurysm (CAA) is defined as coronary dilatation which exceeds the diameter of the normal adjacent artery segments or the diameter of the patient's largest coronary artery by 1.5 times. The incidence of giant CAA is difficult to be determined, since only few reports have been described in the literature. Methods and Results: A 65-year-old man was referred to our hospital because of a “mass” in the right heart detected on echocardiography at a regular medical health examination, while he experienced no any symptoms. Coronary angiography showed the severe stenosis of the left anterior descending artery (LAD) and the left circumflex artery (LCX) and the diffusely ectatic change of the right coronary artery (RCA), but no mass was found in any of these arteries. Coronary computed tomography angiography (CTA) confirmed that the “mass” was the giant aneurysms of RCA with thrombus. He received coronary artery bypass graft (CABG) with thrombectomy. The histopathology showed the deposits of lipid and hyalin in the tunica intima, the focal calcifications, the very thin tunica media, and the disappearance of the part of the tunica media in the RCA. Conclusions: Coronary artery aneurysm which may contain thrombus can complicate a diagnostic coronary angiography due to the risk of distal embolization and may lead to myocardial infarction. This case report demonstrates 2 RCA aneurysms with a thrombus presenting as a giant “mass” which was successfully treated by CABG with thrombectomy. PMID:27661045

  3. Technical Considerations of Giant Right Coronary Artery Aneurysm Exclusion

    PubMed Central

    Barr, James; Kourliouros, Antonios

    2016-01-01

    Giant coronary artery aneurysms are rare clinical entities. We report the case of a 49-year-old man who presented with dyspnoea and exertional chest pain. Investigations confirmed an aneurysmal right coronary artery measuring 4 cm with a fistulous communication to the right atrium. Following right atriotomy, the fistula was oversewn and the aneurysmal right coronary artery ligated at its origin and at several points along its course. A saphenous vein graft was anastomosed to the posterior descending artery. Persistent ventricular fibrillation occurred upon chest closure, attributed to ischaemia following ligation of the aneurysmal coronary artery. Emergent resternotomy and internal defibrillation were successfully performed. The sternum was stented open to reduce right ventricular strain and closed the following day. The patient made an unremarkable recovery. We here address the technical challenges associated with surgical repair of right coronary aneurysms and the physiology and management of potential complications. PMID:28018699

  4. Primary percutaneous coronary intervention for acute myocardial infarction in a pediatric patient with giant coronary aneurysm due to Kawasaki disease.

    PubMed

    Mongiovì, Maurizio; Alaimo, Annalisa; Vernuccio, Federica; Pieri, Daniele

    2014-01-01

    We report a case of acute myocardial infarction in an 8-year-old boy with a history of Kawasaki disease and giant coronary aneurysms in the right and left coronary arteries. We performed coronary angiography and percutaneous coronary intervention 4 hours after the onset of symptoms. This case suggests that primary percutaneous coronary intervention might be safe and effective in the long-term treatment of acute myocardial infarction due to coronary sequelae of Kawasaki. © 2013 Wiley Periodicals, Inc.

  5. Congenital Giant Right Coronary Artery to Pulmonary Artery Fistula and Congenital Left Main Coronary Artery Atresia: A Case Report.

    PubMed

    Ding, Ya-Hui; Zou, Hai

    2016-02-01

    Both of congenital giant RCA, RCA to PA fistula, and CLMCA-A are one of exceedingly rare vascular abnormalities. We present the case of a 34-year-old man with multiple congenital coronary anomalies above, and a successful surgical intervention was proceeded for our patient.This is a case of a 34-year-old man presented with apical systolic murmur and exertional chest pain. Furthermore, a dilated left heart and abnormal pulmonary blood flow was observed in this patient. Coronary CTA and selective CAG showed a 15-mm diameter RCA with a fistula to pulmonary trunk and CLMCA-A. During cardiac surgery, the coronary abnormalities were confirmed and the outlet of the fistula was closed. After surgery, less chest pain, respiratory infection, and left heart failure were observed in this patient.This case illustrates that the surgery of closing the fistula between the giant RCA and pulmonary trunk could improve the symptoms and signs for this patient. It could be predicted that simplified operation could be a promising therapy for patient with giant RCA to PA fistula and CLMCA-A. Moreover, CABG should be taken full account of when myocardial ischemia was found in the blood-supply area of LAD.

  6. Interesting images: Multiple coronary artery aneurysms.

    PubMed

    Howard, Jonathon M; Viswanath, Omar; Armas, Alfredo; Santana, Orlando; Rosen, Gerald P

    2017-01-01

    We present the case of a 65-year-old male who presented with stable angina and dyspnea on exertion. His initial workup yielded a positive treadmill stress test for reversible apical ischemia, and transthoracic echocardiogram demonstrated impaired systolic function. Cardiac catheterization was then performed, revealing severe atherosclerotic disease including multiple coronary artery aneurysms. As a result, the patient was advised to and subsequently underwent a coronary artery bypass graft. This case highlights the presence of multiple coronary artery aneurysms and the ability to appreciate these pathologic findings on multiple imaging modalities, including coronary angiogram, transesophageal echocardiography, and direct visualization through the surgical field.

  7. Interesting Images: Multiple Coronary Artery Aneurysms

    PubMed Central

    Howard, Jonathon M; Viswanath, Omar; Armas, Alfredo; Santana, Orlando; Rosen, Gerald P

    2017-01-01

    We present the case of a 65-year-old male who presented with stable angina and dyspnea on exertion. His initial workup yielded a positive treadmill stress test for reversible apical ischemia, and transthoracic echocardiogram demonstrated impaired systolic function. Cardiac catheterization was then performed, revealing severe atherosclerotic disease including multiple coronary artery aneurysms. As a result, the patient was advised to and subsequently underwent a coronary artery bypass graft. This case highlights the presence of multiple coronary artery aneurysms and the ability to appreciate these pathologic findings on multiple imaging modalities, including coronary angiogram, transesophageal echocardiography, and direct visualization through the surgical field. PMID:28701599

  8. Two Cases of Super-Giant Coronary Aneurysms after Kawasaki Disease

    PubMed Central

    Lee, Joowon; Kwon, Bo Sang; Bae, Eun Jung; Noh, Chung Il

    2014-01-01

    Acute giant coronary aneurysm after Kawasaki disease (KD) is a catastrophic complication that can be fatal and very difficult to manage. However, no fixed consensus has been reached for the management of super-giant coronary aneurysms in the acute setting. Here, we report the successful management of young children with super-giant coronary aneurysms after KD. Based on our experience, hemodynamic stabilization to prevent further coronary dilation or rupture and strict anticoagulation to avoid thrombus formation are mandatory in the management of this condition. PMID:24497892

  9. [Giant coronary aneurysms in infants with Kawasaki disease].

    PubMed

    Sánchez Andrés, Antonio; Salvador Mercader, Inmaculada; Seller Moya, Julia; Carrasco Moreno, José Ignacio

    2017-08-01

    Kawasaki disease (KD) is an acute vasculitis of unknown origin and predominant in males. The long-term effects of the disease depend on whether there are coronary lesions, particularly aneurysms. The prognosis of patients with giant aneurysms is very poor due to their natural progression to coronary thrombosis or severe obstructive lesions. A series of 8 cases is presented where the epidemiology and diagnostic methods are described. The treatment of the acute and long-term cardiovascular sequelae is also reviewed. A descriptive analysis was conducted on patients admitted to the Paediatric Cardiology Unit of La Fe University Hospital (Valencia) with KD and a coronary lesion. More than one artery was involved in all patients. Although early diagnosis was established in only two cases, none of the patients had severe impairment of ventricular function during the acute phase. Treatment included intravenous gammaglobulin and acetylsalicylic acid at anti-inflammatory doses during the acute phase. A combination of dual antiplatelet therapy and corticosteroids was given in cases of coronary thrombosis. The silent aneurysms continue to persist. KD is the most common cause of acquired heart disease in children. The delay in diagnosis is associated with a greater likelihood of coronary lesions that could increase the risk of cardiovascular events in adulthood. Thus, this subgroup requires close clinical monitoring for a better control of cardiovascular risk factors over time. Copyright © 2016 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

  10. Interposition vein graft for giant coronary aneurysm repair

    NASA Technical Reports Server (NTRS)

    Firstenberg, M. S.; Azoury, F.; Lytle, B. W.; Thomas, J. D.

    2000-01-01

    Coronary aneurysms in adults are rare. Surgical treatment is often concomitant to treating obstructing coronary lesions. However, the ideal treatment strategy is poorly defined. We present a case of successful treatment of a large coronary artery aneurysm with a reverse saphenous interposition vein graft. This modality offers important benefits over other current surgical and percutaneous techniques and should be considered as an option for patients requiring treatment for coronary aneurysms.

  11. Interposition vein graft for giant coronary aneurysm repair

    NASA Technical Reports Server (NTRS)

    Firstenberg, M. S.; Azoury, F.; Lytle, B. W.; Thomas, J. D.

    2000-01-01

    Coronary aneurysms in adults are rare. Surgical treatment is often concomitant to treating obstructing coronary lesions. However, the ideal treatment strategy is poorly defined. We present a case of successful treatment of a large coronary artery aneurysm with a reverse saphenous interposition vein graft. This modality offers important benefits over other current surgical and percutaneous techniques and should be considered as an option for patients requiring treatment for coronary aneurysms.

  12. Recurrent Giant Cell Tumor of Skull Combined with Multiple Aneurysms

    PubMed Central

    Kim, Dae Hwan

    2016-01-01

    Giant cell tumors are benign but locally invasive and frequently recur. Giant cell tumors of the skull are extremely rare. A patient underwent a surgery to remove a tumor, but the tumor recurred. Additionally, the patient developed multiple aneurysms. The patient underwent total tumor resection and trapping for the aneurysms, followed by radiotherapy. We report this rare case and suggest some possibilities for treating tumor growth combined with aneurysm development. PMID:27195256

  13. [A Giant Right Coronary Artery Aneurysm Exceeding 8-cm in Size].

    PubMed

    Akutsu, Hirohiko; Kawahito, Koji; Kurumisawa, Soki; Aizawa, Kei; Misawa, Yoshio

    2015-06-01

    A coronary artery aneurysm(CAA) that exceeds 20 mm in diameter is rare. In this case report, we describe the operative correction of a giant right CAA measuring greater than 8 cm in diameter. A 51-year-old male with a history of Kawasaki disease at 7 years of age was admitted to our hospital for evaluation of an abnormal shadow on a chest radiograph. Multi-detector row computed tomography (MDCT) demonstrated a giant, 82-mm right coronary aneurysm in the right atrioventricular groove with a layered thrombus. The patient underwent aneurysmectomy and coronary artery bypass grafting using the right internal thoracic artery under cardiopulmonary bypass. The postoperative course was uneventful, and postoperative MDCT revealed complete resection of the aneurysm and good patency of the bypass graft. The patient was discharged on the 8th postoperative day in good health.

  14. Giant Coronary Artery Aneurysm Causing Acute Anterior Myocardial Infarction

    PubMed Central

    Yanık, Ahmet; Akçay, Murat; Menekşe, Serdar; Yazgan, Uğur Gökmen

    2016-01-01

    A 70-year-old man with hypertension was admitted to our coronary ICU with acute anterior MI. Emergent primary PCI was planned and coronary angiography was performed. LAD artery was totally occluded in the proximal segment just after a huge 32 × 26 mm sized aneurysm. Emergent CABG operation was performed in 75 minutes because of multivessel disease including the RCA and left circumflex artery. Aneurysm was ligated and coronary bypass was performed using LIMA and saphenous grafts. The postoperative course of the patient was uneventful. He was discharged with medical therapy including ASA, clopidogrel, and atorvastatin. He was asymptomatic at his polyclinic visit in the first month. PMID:27891151

  15. Giant Coronary Artery Aneurysm Causing Acute Anterior Myocardial Infarction.

    PubMed

    Yanık, Ahmet; Arslan, Uğur; Akçay, Murat; Menekşe, Serdar; Yazgan, Uğur Gökmen

    2016-01-01

    A 70-year-old man with hypertension was admitted to our coronary ICU with acute anterior MI. Emergent primary PCI was planned and coronary angiography was performed. LAD artery was totally occluded in the proximal segment just after a huge 32 × 26 mm sized aneurysm. Emergent CABG operation was performed in 75 minutes because of multivessel disease including the RCA and left circumflex artery. Aneurysm was ligated and coronary bypass was performed using LIMA and saphenous grafts. The postoperative course of the patient was uneventful. He was discharged with medical therapy including ASA, clopidogrel, and atorvastatin. He was asymptomatic at his polyclinic visit in the first month.

  16. Strict management of a pregnant patient with giant coronary artery aneurysm due to Kawasaki disease.

    PubMed

    Taniguchi, Kosuke; Ono, Hiroshi; Sato, Anna; Kinomoto, Satoko; Tagawa, Naomi; Umehara, Nagayoshi; Kato, Hitoshi; Sago, Haruhiko

    2015-10-01

    Coronary artery aneurysms (CAA) may occur in Kawasaki disease (KD). Patients with giant CAA (diameter >8 mm), in particular, have higher risk of myocardial infarction. Previous reports have demonstrated the necessity of anticoagulation therapy in such cases. The management of patients with KD complicated by giant CAA later in life, however, remains controversial. Here, we describe the strict management in the case of a 28-year-old pregnant Japanese woman with KD with giant CAA (diameter, 11 mm). Instead of warfarin, the patient was given low-dose aspirin and i.v. unfractionated heparin during pregnancy to prevent thrombosis in the giant CAA. At 38 weeks of gestation, she had spontaneous delivery of a healthy baby. No thrombotic or bleeding complications were observed. The strict anticoagulation therapy resulted in successful pregnancy and delivery without any adverse events.

  17. A case of atypical Kawasaki disease with giant coronary artery aneurysm containing thrombus

    PubMed Central

    Attard, Montalto S; Grech, V

    2016-01-01

    Introduction Kawasaki disease (KD) is an acute febrile, systemic vasculitic syndrome of unknown etiology, occurring primarily in children younger than 5 years of age. Administration of IVIG within the first 10 days after onset of fever in combination with high dose aspirin reduces the risk of coronary artery damage in KD. Though rare, giant aneurysms of the coronary arteries may develop in untreated cases and prove extremely challenging to manage. Case Presentation A 9-month-old Caucasian boy presented to our paediatric emergency department with a 4-week history of intermittent pyrexia and irritability. Typical mucocutaneous signs of Kawasaki Disease were absent upon presentation. A trans-thoracic echocardiogram identified a giant aneurysm of the left anterior descending artery with thrombus formation in-situ and the child was managed with intravenous immunoglobulin, steroids, high dose aspirin therapy and later warfarinisation. Discussion Cardiovascular sequelae of Kawasaki disease include giant coronary artery aneurysms with thrombosis. Enlargement of a coronary aneurysm after the acute phase of Kawasaki disease is uncommon and the outcome of interventional approaches poorly studied. PMID:28405208

  18. A case of atypical Kawasaki disease with giant coronary artery aneurysm containing thrombus.

    PubMed

    Micallef, Eynaud S; Attard, Montalto S; Grech, V

    2016-01-01

    Kawasaki disease (KD) is an acute febrile, systemic vasculitic syndrome of unknown etiology, occurring primarily in children younger than 5 years of age. Administration of IVIG within the first 10 days after onset of fever in combination with high dose aspirin reduces the risk of coronary artery damage in KD. Though rare, giant aneurysms of the coronary arteries may develop in untreated cases and prove extremely challenging to manage. A 9-month-old Caucasian boy presented to our paediatric emergency department with a 4-week history of intermittent pyrexia and irritability. Typical mucocutaneous signs of Kawasaki Disease were absent upon presentation. A trans-thoracic echocardiogram identified a giant aneurysm of the left anterior descending artery with thrombus formation in-situ and the child was managed with intravenous immunoglobulin, steroids, high dose aspirin therapy and later warfarinisation. Cardiovascular sequelae of Kawasaki disease include giant coronary artery aneurysms with thrombosis. Enlargement of a coronary aneurysm after the acute phase of Kawasaki disease is uncommon and the outcome of interventional approaches poorly studied.

  19. Transcatheter Closure of Congenital Coronary Artery Fistulas with a Giant Coronary Artery Aneurysm in Children: Experiences from a Single Center

    PubMed Central

    Li, Yi-Fan; Zhang, Zhi-Wei; Wang, Shu-Shui; Xie, Zhao-Feng; Zhang, Xu; Li, Yu-Fen

    2017-01-01

    Background: Transcatheter closure of congenital coronary artery fistulas (CCAFs) is an alternative therapy to surgery; however, data regarding transcatheter closure for CCAF with a giant coronary artery aneurysm (CAA) in pediatric patients are still limited due to the rarity of the disease. We aimed to evaluate the efficacy and safety of transcatheter closure for CCAF with a giant CAA in a pediatric population at a single center. Methods: Medical records of pediatric patients (<18 years old) who underwent transcatheter closure of CCAF with a giant CAA between April 2007 and September 2016 at Guangdong Cardiovascular Institute (Guangdong, China) were reviewed. Results: Twelve patients (median age, 6.1 years; range, 1.9–11.0 years) underwent successful transcatheter closure procedures. One patient underwent closure at both the entry and exit points of the CAA, three patients underwent closure at the exit point of the CAA, and eight patients underwent closure at the entry point of the CAA. After a mean follow-up of 7.2 years (range, 0.5–9.8 years), one patient (with closure at the exit point of the CAA) underwent transcatheter re-intervention because of a significant residual shunt. She eventually underwent a surgical procedure due to aneurysm dilation after the second intervention. One patient experienced thrombus formation within the CAA after the procedure. Among those with closure at the entry point of the CAA, a mild-to-moderate residual shunt was detected in three patients. Conclusions: Transcatheter closure appears to be a safe and effective alternative therapy for CCAF with a giant CAA in the pediatric population. Closure at the entry point of the CAA, and closure at both the entry and exit points when feasible, may reduce the risk of postinterventional complications. PMID:28776543

  20. Giant coronary artery aneurysms in juvenile polyarteritis nodosa: a case report

    PubMed Central

    2012-01-01

    Juvenile polyarteritis nodosa (PAN) is a rare, necrotizing vasculitis, primarily affecting small to medium-sized muscular arteries. Cardiac involvement amongst patients with PAN is uncommon and reports of coronary artery aneurysms in juvenile PAN are exceedingly rare. We describe a 16 year old girl who presented with fever, arthritis and two giant coronary artery aneurysms, initially diagnosed as atypical Kawasaki disease and treated with IVIG and methylprednisolone. Her persistent fevers, arthritis, myalgias were refractory to treatment, and onset of a vasculitic rash suggested an alternative diagnosis. Based on angiographic abnormalities, polymyalgia, hypertension and skin involvement, this patient met criteria for juvenile PAN. She was treated with six months of intravenous cyclophosphamide and high dose corticosteroids for presumed PAN related coronary vasculitis. Maintenance therapy was continued with azathioprine and the patient currently remains without evidence of active vasculitis. She remains on anticoagulation for persistence of the aneurysms. This case illustrates a rare and unusual presentation of giant coronary artery aneurysms in the setting of juvenile PAN. PMID:22222048

  1. Acute Interstitial Nephritis Following Multiple Asian Giant Hornet Stings

    PubMed Central

    Li, Xiang-Dong; Liu, Zheng; Zhai, Ying; Zhao, Ming; Shen, Hai-Yan; Li, Yi; Zhang, Bo; Liu, Tao

    2015-01-01

    Patient: Male, 42 Final Diagnosis: Acute interstitial nephritis Symptoms: Difficulty breathing • headache • numbness • oliguria Medication: Methylprednisolone Clinical Procedure: Plasma exchange Specialty: Nephrology Objective: Rare disease Background: The Asian giant hornet is the largest wasp species in the world. Its stings can cause acute interstitial nephritis and acute renal failure. From July to October, 2013, Asian giant hornet attacks have killed 42 people and injured 1675 people with their powerful venomous stings in Hanzhong, Ankang, and Shangluo, three cities in the southern part of Shaanxi Province, China. Case Report: We report here a case of a 42-year-old man with acute interstitial nephritis following multiple Asian giant hornet stings. On admission, the patient had difficulty breathing, headache, and numbness in both limbs (arm and leg). He was treated in the Emergency Department and Department of Nephrology with plasma exchange and dialysis within 24 hours after being stung. A kidney biopsy revealed acute interstitial nephritis with interstitial infiltrations of eosinophils and lymphocytes. After intensive treatment, his liver function recovered within 10 days. Along with oral methylprednisolone, his renal function recovered 1 month later. Conclusions: This case shows that acute interstitial nephritis happens several days after being stung. Since the number of deaths in southern Shaanxi province is much higher than other places, our report draws the attention of fellow clinicians to the acute interstitial nephritis following multiple Asian giant hornet stings. PMID:26076055

  2. Kawasaki Disease With Giant Coronary Aneurysms Requiring a Ventricular Assist Device to Separate From Extracorporeal Membrane Oxygenation: Coronary Issues Can Be a Pediatric Problem Too!

    PubMed

    Adler, Adam C; Kodavatiganti, Ramesh

    2016-08-15

    Kawasaki disease, although common in children, may rarely affect the coronary arteries, leading to aneurysm formation and potential for coronary thrombus formation. Extremely rarely, coronary aneurysms from Kawasaki disease can thrombose, resulting in ischemic myocardium. We present a case of a 31-month-old patient requiring a left ventricular assist device after thrombosis of giant coronary aneurysms led to ischemic cardiomyopathy. At the termination of the surgical procedure, we encountered 2 periods of ventricular assist device dropout requiring intervention. With the increase in the number of pediatric patients with assist devices, we review the basic care for a patient requiring emergent surgery.

  3. Multiple coronary arterial loops as a cause of myocardial ischemia

    NASA Technical Reports Server (NTRS)

    Bashour, Tali T.; Mansour, Nagi N.; Lee, Damon

    1993-01-01

    A case of long-standing angina with ischemia documented by exercise testing and thallium scintigraphy in a patient who had multiple proximal loops in all three major coronary arteries in the absence of luminal stenosis, is reported.

  4. Giant calcific pericardial cyst: certainly unexpected during primary percutaneous coronary intervention.

    PubMed

    Güvenç, Tolga Sinan; Hayıroğlu, Mert İlker; Gümüşdağ, Ayça; Ekmekçi, Ahmet; Erer, Hatice Betül; Keskin, Muhammed; Eren, Mehmet

    2016-12-01

    Pericardial cyst is a rare congenital anomaly that is usually diagnosed during evaluation for right-sided heart failure. We report a 50-year-old man with a primary diagnosis of ST-segment elevation myocardial infarction at admission, whose emergent angiography revealed a calcific mass close to right coronary artery. Further analysis of the mass with computed tomography and three-dimensional echocardiography revealed a giant pericardial cyst causing partial obstruction of superior vena cava. Unlike previous cases reported, the patient had no symptoms compatible with right-sided heart failure. © 2016, Wiley Periodicals, Inc.

  5. A case of giant saphenous vein graft aneurysm followed serially after coronary artery bypass surgery

    PubMed Central

    Akutsu, Naotaka; Hiro, Takafumi; Oya, Toshiyuki; Fukamachi, Daisuke; Haruta, Hironori; Iida, Korehito; Kougo, Takaaki; Mineki, Takashi; Nishida, Toshihiko; Murata, Nobuhiro; Oshima, Toru; Hata, Hiroaki; Shiono, Motomi; Hirayama, Atsushi

    2016-01-01

    Abstract Saphenous vein graft aneurysm (SVGA) is one of the chronic complications after coronary aorta bypass grafting (CABG) and may be caused by atherosclerosis-like phenomena of the vein graft, weakness around the vein valve, rupturing of the suture of the graft anastomosis, or perioperative graft injury. We describe a case of a large, growing saphenous vein graft aneurysm that was followed serially by chest radiography and computed tomography. Eighteen years after CABG, an SVGA (23 × 24 mm) was incidentally detected. The patient was asymptomatic and was followed conservatively. Four years later, coronary computed tomographic angiography showed that the giant aneurysm had grown to 52.1 by 63.8 mm and revealed a second, smaller aneurysm. Finally, the SVG was ultimately resected without bypass via off-pump surgery. Therefore, this case suggested that aggressive treatment that includes surgical intervention should be considered before the aneurysm becomes larger, even if it is asymptomatic.

  6. Giant Hernia of Morgagni with Acute Coronary Syndrome: A Rare Case Report and Review of Literature.

    PubMed

    Ahmad, Munir; Al-Arifi, Ahmed; Najm, Hani K

    2015-09-01

    Hernia of Morgagni is a congenital defect of the sternal part of the diaphragm and frequently presents on the right side of the midline. The hernial sac is usually small and can be dealt with through either an abdominal approach or through a lateral thoracotomy incision. Median sternotomy as an approach to repair these defects has very rarely been described in the literature when concomitant cardiac surgical procedures were required. We report the case of a 42 year-old male with Morgagni hernia that was approached through median sternotomy because of concomitant requirement for open heart surgery. The patient presented with acute coronary syndrome necessitating urgent coronary artery bypass surgery and was found to have a giant hernia of Morgagni due to bilateral defects. This entity is very rarely described and may pose difficulty in repair due to excessive adhesions to the surrounding thoracic or mediastinal tissues. Median sternotomy seems to be the ideal approach to deal with these giant lesions. Clinical presentation of Morgagni hernia and different options for surgical repair of the defect are discussed with reference to relevant literature.

  7. Telescoping Technique to Engage Left Main Coronary Artery in a Case of Giant Aortic Aneurysm in a Geriatric Patient

    PubMed Central

    Shah, Priyank; Vasudev, Rahul; Bikkina, Mahesh; Virk, Hartaj

    2016-01-01

    We present a case of a geriatric male with giant ascending aortic aneurysm (AAA) who underwent successful coronary angiography using telescoping technique for evaluation his coronary arteries before surgery for AAA. Since the ascending aorta and root were extremely dilated, we knew it would not have been possible to engage the coronaries using regular catheters and standard technique. Hence, telescopic technique was used. Amplatz left 3 (AL3) 7F (French) guide catheter (90 cm) was initially used, and nonselective injection of contrast was done to see the coronary ostium. After that, a 5F multipurpose catheter (110 cm) was telescoped through 7F AL3 guide catheter to engage the ostium of the left main coronary artery. Using this technique, images of coronaries were obtained, and it showed minimal luminal irregularities in major epicardial coronary arteries. The patient underwent successful surgery with aortic valve replacement and excision of aneurysm with graft placement. Although this technique has been described previously in enlarged aortas, this is the first to our knowledge use of telescoping technique in giant aortic aneurysm in a geriatric patient. PMID:27833782

  8. Successful surgical treatment of a giant right coronary artery aneurysm with a patent left internal thoracic artery graft.

    PubMed

    Nakahara, Yoshinori; Yoshida, Shigehiko; Yamamoto, Yosuke; Uemura, Hisashi; Yamagishi, Shunsuke; Furuhata, Ken; Hanzawa, Yoshikatu; Kanemura, Takeyuki; Osaka, Shinichi

    2017-05-01

    We report a rare case of a giant right coronary artery aneurysm 13 years after coronary artery bypass grafting. Coronary angiography at the time of primary surgery demonstrated irregular aneurysmal dilatation in the mid-right coronary artery that expanded greatly over a 13-year period to a maximum diameter of 80 mm. The patient underwent aneurysmectomy and interposition using a saphenous vein graft through a right lateral thoracotomy. The patient did not undergo dissection or clamping of the left internal thoracic artery graft, and myocardial protection was obtained using systemic hypothermia and hyperkalaemia in addition to continuous antegrade cardioplegia. Postoperatively, coronary computed tomography showed a lack of residual aneurysm and good flow in the saphenous vein graft. The patient made an uneventful recovery.

  9. Multiple Outflows in the Giant Eruption of a Massive Star

    NASA Astrophysics Data System (ADS)

    Humphreys, Roberta M.; Martin, John C.; Gordon, Michael S.; Jones, Terry J.

    2016-08-01

    The supernova impostor PSN J09132750+7627410 in NGC 2748 reached a maximum luminosity of ≈-14 mag. It was quickly realized that it was not a true supernova, but another example of a nonterminal giant eruption. PSN J09132750+7627410 is distinguished by multiple P Cygni absorption minima in the Balmer emission lines that correspond to outflow velocities of -400, -1100, and -1600 km s-1. Multiple outflows have been observed in only a few other objects. In this paper we describe the evolution of the spectrum and the P Cygni profiles for 3 months past maximum, the post-maximum formation of a cool, dense wind, and the identification of a possible progenitor. One of the possible progenitors is an infrared source. Its pre-eruption spectral energy distribution suggests a bolometric luminosity of -8.3 mag and a dust temperature of 780 K. If it is the progenitor, it is above the AGB limit, unlike the intermediate-luminosity red transients. The three P Cygni profiles could be due to ejecta from the current eruption, the wind of the progenitor, or previous mass-loss events. We suggest that they were all formed as part of the same high-mass-loss event and are due to material ejected at different velocities or energies. We also suggest that multiple outflows during giant eruptions may be more common than reported. Based on observations obtained with the Large Binocular Telescope (LBT), an international collaboration among institutions in the United States, Italy, and Germany. LBT Corporation partners are the University of Arizona on behalf of the Arizona university system; Istituto Nazionale di Astrofisica, Italy; LBT Beteiligungsgesellschaft, Germany, representing the Max-Planck Society, the Astrophysical Institute Potsdam, and Heidelberg University; The Ohio State University and The Research Corporation, on behalf of the University of Notre Dame, University of Minnesota, and University of Virginia.

  10. Gallstone ileus with a giant stone and associated multiple stones.

    PubMed

    Ozbalci, G S; Tanrikulu, Y; Kismet, K; Dinc, S; Akkus, M A

    2012-01-01

    Gallstone ileus is an uncommon cause of small bowel obstruction. Gallstone ileus accounts for only about 1-3 % of cases of mechanical obstructions of the small bowel. It usually occurs in the elderly with a female predominance and may result in high mortality rates. The diagnosis is difficult and early diagnosis reduces the mortality. Terminal ileum is the most common site of gallstone impaction. We report a case of gallstone ileus in an 81-year-old female patient who was admitted to our clinic for abdominal pain, vomiting and constipation. The ultrasonography of abdomen revealed a decrease in bowel motion, and dilated bowel segments. Intraoperatively, a giant gallstone and associated multiple stones were found in the ileum 80 cm from the ileocecal valve and extracted from a longitudinal enterotomy (Fig. 4, Ref. 24).

  11. Multiple Coronary Artery Microfistulas in a Girl with Kleefstra Syndrome

    PubMed Central

    Vargiami, Euthymia; Ververi, Athina; Al-Mutawa, Hamda; Gioula, Georgia; Gerou, Spyridon; Rouvalis, Fotios; Kambouris, Marios; Zafeiriou, Dimitrios I.

    2016-01-01

    Kleefstra syndrome is characterized by hypotonia, developmental delay, dysmorphic features, congenital heart defects, and so forth. It is caused by 9q34.3 microdeletions or EHMT1 mutations. Herein a 20-month-old girl with Kleefstra syndrome, due to a de novo subterminal deletion, is described. She exhibits a rare and complex cardiopathy, encompassing multiple coronary artery microfistulas, VSD/ASD, and PFO. PMID:27239352

  12. Multiple giant duodenal ulcers associated with duodenal gastrinoma.

    PubMed

    Fujihara, Shintaro; Mori, Hirohito; Nishiyama, Noriko; Kobayashi, Mitsuyoshi; Kobara, Hideki; Masaki, Tsutomu

    2012-02-01

    A 59-year-old Japanese man with a history of chronic hepatitis C and cirrhosis was admitted to hospital because of severe abdominal pain and diarrhea. His discomfort had begun 2 months earlier and was localized to the upper abdomen. Upper gastrointestinal endoscopy showed multiple ulcerative lesions from the duodenal bulb to the descending part of the duodenum, one of which was a giant ulcer that filled half of the intestinal lumen. Despite continuous intravenous lansoprazole therapy, his abdominal symptoms did not improve. Upper gastrointestinal endoscopy was again performed to detect the tumor, but it was difficult to observe the tumor with a conventional endoscope. We then inverted a transnasal endoscope into the duodenum, and this enabled us to detect a 15-mm submucosal tumor in the upper wall of the duodenal bulb. Examination of specimens from endoscopic ultrasonography fine-needle aspiration biopsy of the tumor revealed gastrinoma in the duodenal bulb. We decided to perform an operative resection. The patient's symptoms resolved after surgery, and he remained asymptomatic at follow-up 18 months later. Therefore, when it is difficult to detect the tumor directly by conventional endoscopy, we recommend that attempts be made to detect the tumor by inverting a transnasal endoscope into the duodenal bulb.

  13. Coronary CT angiography (cCTA): automated registration of coronary arterial trees from multiple phases

    NASA Astrophysics Data System (ADS)

    Hadjiiski, Lubomir; Zhou, Chuan; Chan, Heang-Ping; Chughtai, Aamer; Agarwal, Prachi; Kuriakose, Jean; Kazerooni, Ella; Wei, Jun; Patel, Smita

    2014-08-01

    Coronary computed tomography angiography (cCTA) is a commonly used imaging modality for the evaluation of coronary artery disease. cCTA is generally reconstructed in multiple cardiac phases because different coronary arteries may be better visualized in some phases than in others due to the periodic cardiac motion. We are developing an automated registration method for coronary arterial trees from multiple-phase cCTA that has potential application in building a ‘best-quality’ tree to facilitate image analysis and detection of stenotic plaques. Given the segmented left or right coronary arterial (LCA or RCA) trees from the multiple phases as input, the adjacent phase pairs, where displacements are relatively small, are registered by a specifically designed method based on a cubic B-spline with fast localized optimization (CBSO). For the phase pairs with large displacements, a global registration using an affine transform with quadratic terms and nonlinear simplex optimization (AQSO) is followed by a local registration using CBSO to refine the AQSO registered volumes. 26 LCA and 26 RCA trees with six cCTA phases from 26 patients were used for registration evaluation. The average distances for the tree pairs between the adjacent phases with small displacements before and after CBSO registration were 0.96  ±  0.79 and 0.76  ±  0.61 mm respectively for LCA, and 0.93  ±  0.97 and 0.64  ±  0.43 mm, respectively for RCA. The average distance differences before and after registration were statistically significant (p < 0.001) for both LCA and RCA trees. The average distances for the distant phases with large displacements before registration, after AQSO registration, and finally after the CBSO registration were 2.85  ±  1.46, 1.62  ±  0.76, and 0.97  ±  0.43 mm, respectively for LCA, and 4.03  ±  2.36, 2.18  ±  1.11, and 0.97  ±  0.44 mm, respectively for RCA. The average distance differences between every two

  14. Coronary CT angiography (cCTA): automated registration of coronary arterial trees from multiple phases.

    PubMed

    Hadjiiski, Lubomir; Zhou, Chuan; Chan, Heang-Ping; Chughtai, Aamer; Agarwal, Prachi; Kuriakose, Jean; Kazerooni, Ella; Wei, Jun; Patel, Smita

    2014-08-21

    Coronary computed tomography angiography (cCTA) is a commonly used imaging modality for the evaluation of coronary artery disease. cCTA is generally reconstructed in multiple cardiac phases because different coronary arteries may be better visualized in some phases than in others due to the periodic cardiac motion. We are developing an automated registration method for coronary arterial trees from multiple-phase cCTA that has potential application in building a 'best-quality' tree to facilitate image analysis and detection of stenotic plaques. Given the segmented left or right coronary arterial (LCA or RCA) trees from the multiple phases as input, the adjacent phase pairs, where displacements are relatively small, are registered by a specifically designed method based on a cubic B-spline with fast localized optimization (CBSO). For the phase pairs with large displacements, a global registration using an affine transform with quadratic terms and nonlinear simplex optimization (AQSO) is followed by a local registration using CBSO to refine the AQSO registered volumes. 26 LCA and 26 RCA trees with six cCTA phases from 26 patients were used for registration evaluation. The average distances for the tree pairs between the adjacent phases with small displacements before and after CBSO registration were 0.96  ±  0.79 and 0.76  ±  0.61 mm respectively for LCA, and 0.93  ±  0.97 and 0.64  ±  0.43 mm, respectively for RCA. The average distance differences before and after registration were statistically significant (p < 0.001) for both LCA and RCA trees. The average distances for the distant phases with large displacements before registration, after AQSO registration, and finally after the CBSO registration were 2.85  ±  1.46, 1.62  ±  0.76, and 0.97  ±  0.43 mm, respectively for LCA, and 4.03  ±  2.36, 2.18  ±  1.11, and 0.97  ±  0.44 mm, respectively for RCA. The average distance differences

  15. Giant viruses: The difficult breaking of multiple epistemological barriers.

    PubMed

    Claverie, Jean-Michel; Abergel, Chantal

    2016-10-01

    The discovery of the first "giant virus", Mimivirus, in 2003 could solely have been that of an exceptional freak, a blind alley of evolution as occasionally encountered in biology, albeit without conceptual significance. On the contrary, once broken this epistemological barrier, additional unrelated families of giant viruses such as the Pandoraviruses, the Pithoviruses and most recently Mollivirus, were quickly unraveled, suggesting that an entire chapter of microbiology had been ignored since Pasteur and Ivanovski. In this article, we examine to what extent the giant viruses challenge previous definitions of viruses, the diversity of forms they could take, and how they might have evolved from extinct ancestral cellular lineages. Inspired by the epistemology of Gaston Bachelard, we will also suggest the reasons for which giant viruses laid hidden in plain sight for more than a century. Finally, we propose a new definition for "viruses" that paradoxically emphasize the fact that they do not encode a single universally shared macromolecule or biochemical function. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

  16. Automated registration of coronary arterial trees from multiple phases in coronary CT angiography (cCTA)

    NASA Astrophysics Data System (ADS)

    Hadjiiski, Lubomir; Zhou, Chuan; Chan, Heang-Ping; Chughtai, Aamer; Agarwal, Prachi; Kuriakose, Jean; Patel, Smita; Wei, Jun; Kazerooni, Ella

    2013-03-01

    We are developing an automated registration method for coronary arterial trees from multiple-phase cCTA to build a best-quality tree to facilitate detection of stenotic plaques. Cubic B-spline with fast localized optimization (CBSO) is designed to register the initially segmented left and right coronary arterial trees (LCA or RCA) separately in adjacent phase pairs where displacements are small. First, the corresponding trees in phase 1 and 2 are registered. The phase 3 tree is then registered to the combined tree. Similarly the trees in phases 4, 5, and 6 are registered. An affine transform with quadratic terms and nonlinear simplex optimization (AQSO) is designed to register the trees between phases with large displacements, namely, registering the combined tree from phases 1, 2, and 3 to that from phases 4, 5, and 6. Finally, CBSO is again applied to the AQSO registered volumes for final refinement. The costs determined by the distances between the vessel centerlines, bifurcation points and voxels of the trees are minimized to guide both CBSO and AQSO registration. The registration performance was evaluated on 22 LCA and 22 RCA trees on 22 CTA scans with 6 phases from 22 patients. The average distance between the centerlines of the registered trees was used as a registration quality index. The average distances for LCA and RCA registration for 6 phases and 22 patients were 1.49 and 1.43 pixels, respectively. This study demonstrates the feasibility of using automated method for registration of coronary arterial trees from multiple cCTA phases.

  17. Giant aneurysm of the left anterior descending coronary artery in a pediatric patient with Behcet's disease.

    PubMed

    Cook, Amanda L; Rouster-Stevens, Kelly; Williams, Derek A; Hines, Michael H

    2010-07-01

    Behcet's disease is a rare autoimmune vasculitis characterized by oral aphthosis, genital ulcers, and ocular and cutaneous lesions. Vascular involvement usually affects the veins more commonly than the arteries, and coronary arterial involvement is extremely rare. We report an adolescent with Behcet's disease who developed a large pseudoaneurysm of the left anterior descending coronary artery requiring a coronary arterial bypass graft.

  18. Acute Coronary Thrombosis and Multiple Coronary Aneurysms in a 22-Year-Old Man with the Human Immunodeficiency Virus

    PubMed Central

    Ayers, Jennifer; Mandell, Ryan; Sanghvi, Kintur; Aboujaoude, Rania; Hsi, David H.

    2014-01-01

    The human immunodeficiency virus (HIV) can cause diverse cardiovascular complications. In HIV patients on antiretroviral therapy, the prevalence of myocardial infarction has steadily increased over the years. Young patients who are naïve to antiretroviral therapy and who experience coronary events are not well represented in the medical literature. We describe the case of a 22-year-old man, infected with HIV for 4 years and never treated with antiretroviral therapy, who emergently presented with a non-ST-segment-elevation myocardial infarction. Coronary angiograms revealed thrombosis and multiple coronary artery aneurysms; however, no areas of atherosclerotic stenosis were apparent. He was successfully treated with coronary stenting, antiplatelet therapy, and anticoagulation. Nine months after the initial presentation, he exhibited excellent exercise capacity, and no ischemia was evident. We discuss the various therapeutic approaches in this case. PMID:24808786

  19. Giant viruses, giant chimeras: the multiple evolutionary histories of Mimivirus genes.

    PubMed

    Moreira, David; Brochier-Armanet, Céline

    2008-01-18

    Although capable to evolve, viruses are generally considered non-living entities because they are acellular and devoid of metabolism. However, the recent publication of the genome sequence of the Mimivirus, a giant virus that parasitises amoebas, strengthened the idea that viruses should be included in the tree of life. In fact, the first phylogenetic analyses of a few Mimivirus genes that are also present in cellular lineages suggested that it could define an independent branch in the tree of life in addition to the three domains, Bacteria, Archaea and Eucarya. We tested this hypothesis by carrying out detailed phylogenetic analyses for all the conserved Mimivirus genes that have homologues in cellular organisms. We found no evidence supporting Mimivirus as a new branch in the tree of life. On the contrary, our phylogenetic trees strongly suggest that Mimivirus acquired most of these genes by horizontal gene transfer (HGT) either from its amoebal hosts or from bacteria that parasitise the same hosts. The detection of HGT events involving different eukaryotic donors suggests that the spectrum of hosts of Mimivirus may be larger than currently known. The large number of genes acquired by Mimivirus from eukaryotic and bacterial sources suggests that HGT has been an important process in the evolution of its genome and the adaptation to parasitism.

  20. Giant viruses, giant chimeras: The multiple evolutionary histories of Mimivirus genes

    PubMed Central

    2008-01-01

    Background Although capable to evolve, viruses are generally considered non-living entities because they are acellular and devoid of metabolism. However, the recent publication of the genome sequence of the Mimivirus, a giant virus that parasitises amoebas, strengthened the idea that viruses should be included in the tree of life. In fact, the first phylogenetic analyses of a few Mimivirus genes that are also present in cellular lineages suggested that it could define an independent branch in the tree of life in addition to the three domains, Bacteria, Archaea and Eucarya. Results We tested this hypothesis by carrying out detailed phylogenetic analyses for all the conserved Mimivirus genes that have homologues in cellular organisms. We found no evidence supporting Mimivirus as a new branch in the tree of life. On the contrary, our phylogenetic trees strongly suggest that Mimivirus acquired most of these genes by horizontal gene transfer (HGT) either from its amoebal hosts or from bacteria that parasitise the same hosts. The detection of HGT events involving different eukaryotic donors suggests that the spectrum of hosts of Mimivirus may be larger than currently known. Conclusion The large number of genes acquired by Mimivirus from eukaryotic and bacterial sources suggests that HGT has been an important process in the evolution of its genome and the adaptation to parasitism. PMID:18205905

  1. Multiple coronary artery-left ventricular fistulas associated with hereditary hemorrhagic telangiectasia.

    PubMed

    Jacob, M A; Goyal, S B; Pacifico, L; Spodick, D H

    2001-10-01

    Coronary artery-left ventricular (LV) fistulas are extremely rare and can cause myocardial ischemia from coronary steal. We describe an elderly woman who presented with unstable angina from multiple and extensive coronary artery-LV fistulas. She also had clinical features suggestive of hereditary hemorrhagic telangiectasia (HHT). Association of coronary artery-LV fistulas with HHT has not been reported and can pose a management dilemma in view of the risks of extensive cardiopulmonary surgery and potential complications of myocardial ischemia, stroke, and brain abscess.

  2. Coronary heart disease multiple risk factor reduction. Providers' perspectives.

    PubMed

    Rosal, Milagros C; Ockene, Judith K; Luckmann, Roger; Zapka, Jane; Goins, Karin Valentine; Saperia, Gordon; Mason, Theresa; Donnelly, Gary

    2004-08-01

    Although primary care physicians understand the importance of preventive services for patients with multiple risk factors (MRF) for coronary heart disease, physician intervention is limited. This study investigated (1) physicians' views of challenges faced in managing patients with MRF; (2) the counseling and management methods they utilize; and (3) possible strategies to enhance MRF intervention in the primary care setting. Two focus groups were conducted with primary care physicians from varying settings to gain insight into these issues noted above. Each group was co-facilitated by a physician and a behavioral scientist using a previously developed semistructured interview guide. The group discussions were tape recorded and subsequently transcribed. Transcripts were analyzed using the constant comparative method for analysis. Physicians are challenged by knowledge limitations (contribution of individual risk factors to overall risk); limited support (guidelines, materials, and staff); and logistic difficulties (organizational issues, time limitations). Their approach to MRF management tends to be highly individualized with an initial preference for lifestyle change interventions rather than prescription of medications with some qualifying circumstances. Physicians favored a serial rather than a parallel approach to MRF intervention, starting with behaviors that the patient perceives as a priority. Proposed solutions to current challenges emphasize physician education and the development of innovative approaches that include physician assistance and a team approach. Physicians are aware of and sensitive to the complexity of MRF management for their patients and themselves. However, future MRF interventions will require nonphysician staff involvement and increased systems support.

  3. Giant right coronary artery aneurysm secondary to Kawasaki disease in child: a case report.

    PubMed

    Zhang, Shanshan; Liu, Geli; Yu, Tielian; Zhou, Guiming; Zheng, Rongxiu

    2015-01-01

    Coronary artery aneurysm or ectasia was reported in approximately 15% to 25% of the affected children, particularly in the proximal end of the main blood vessel and the left anterior descending part. Rare patients have been reported with aneurysm in the distal end of the right coronary artery. In this case report, we present a rare case with aneurysm in the distal end of the right coronary artery. Multi-slice computed tomography was performed for the coronary angiography. Aspirin (10 mg/kg body weight per day) and gamma globulin (2 kg/kg body weight) was administrated via intravenous injection. The patient is currently in a healthy status with a 12-month follow up.

  4. On-pump beating heart coronary surgery for high risk patients requiring emergency multiple coronary artery bypass grafting.

    PubMed

    Ferrari, Enrico; Stalder, Nicolas; von Segesser, Ludwig K

    2008-07-02

    Cardiopulmonary bypass (CPB) with aortic cross-clamping and cardioplegic arrest remains the method of choice for patients requiring standard myocardial revascularization. Therefore, very high-risk patients presenting with acute coronary syndrome, unstable angina, onset of cardiac decompensation and requiring emergency multiple myocardial revascularization, can have a poor outcome. The on-pump beating heart technique can reduce the mortality and the morbidity in such a selected group of patients and this report describes our clinical experience. Out of 290 patients operated for CABG from January 2005 to January 2006, 25 (8.6%) selected high-risk patients suffering from life threatening coronary syndrome (mean age 69 +/- 7 years) and requiring emergency multiple myocardial revascularization, underwent on-pump beating heart surgery. The mean pre-operative left ventricle ejection fraction (LVEF) was 27 +/- 8%. The majority of them (88%) suffered of tri-vessel coronary disease and 6 (24%) had a left main stump disease. Nine patients (35%) were on severe cardiac failure and seven among them (28%) received a pre-operative intra-aortic balloon pump. The pre-operative EuroScore rate was equal or above 8 in 18 patients (73%). All patients underwent on-pump-beating heart coronary revascularization. The mean number of graft/patient was 2.9 +/- 0.6 and the internal mammary artery was used in 23 patients (92%). The mean CPB time was 84 +/- 19 minutes. Two patients died during the recovery stay in the intensive care unit, and there were no postoperative myocardial infarctions between the survivors. Eight patients suffered of transitorily renal failure and 1 patient developed a sternal wound infection. The mean hospital stay was 12 +/- 7 days. The follow-up was complete for all 23 patients survived at surgery and the mean follow-up time was 14 +/- 5 months. One patient died during the follow-up for cardiac arrest and 2 patients required an implantable cardiac defibrillator. One

  5. ST-elevation myocardial infarction in a young adult secondary to giant coronary aneurysm thrombosis: an important sequela of Kawasaki disease and a management challenge.

    PubMed

    Potter, Elizabeth L; Meredith, Ian T; Psaltis, Peter James

    2016-01-20

    Thrombosis of a coronary artery aneurysm (CAA) is a rare trigger for ST-elevation myocardial infarction (STEMI) and an important cause of STEMI in young adults previously affected by Kawasaki disease. Initial management should proceed in line with standard STEMI-management guidelines advocating antiplatelet medication and emergency coronary angiography. Acute CAA thrombosis presents the interventional cardiologist with unique challenges during attempted percutaneous revascularisation. In the absence of consensus guidelines, experiential reporting can therefore be of great value. We report on a 36-year-old Vietnamese woman presenting with an inferior STEMI secondary to two giant thrombosed aneurysms of the right coronary artery. Coronary wiring and thrombus aspiration temporarily improved coronary flow but recurrent thrombus with distal embolisation resulted in ventricular fibrillation and cardiogenic shock. Emergency surgical revascularisation subsequently provided a definitive and successful outcome. We discuss the challenges of percutaneous coronary intervention in this scenario and review previous reports to give an overview of principles of decision-making and management. 2016 BMJ Publishing Group Ltd.

  6. Left Main Coronary Artery Stenting to Relieve Extrinsic Compression by a Giant Pulmonary Artery Aneurysm in a Patient with Idiopathic Pulmonary Artery Hypertension.

    PubMed

    Pan, Hung-Chih; Wang, Kuo-Yang; Liang, Kae-Woei

    2016-10-01

    Pulmonary artery aneurysm (PAA) is a rare but lethal disease. We present a female patient with idiopathic pulmonary artery hypertension (IPAH)-related PAA, who suffered from unstable angina pectoris. Multi-detector computed tomography and coronary angiogram revealed extrinsic compression of the left main coronary artery (LMCA) caused by a giant PAA with severe ostial stenosis. Intravascular ultrasound showed an oval-shaped ostium of the LMCA, indicating extrinsic compression. After successful LMCA stent implantation, chest pain was greatly relieved. This case illustrates that beyond right ventricle ischaemia and coronary atherosclerotic disease, LMCA compression by PAA should be considered in the differential diagnosis of angina in patients with IPAH related PAA. In addition, intravascular ultrasound can be used to confirm the diagnosis and guide the stent implantation safely. Copyright © 2016 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

  7. Multiple skin cancers in a single patient: Multiple pigmented Bowen's disease, giant basal cell carcinoma, squamous cell carcinoma.

    PubMed

    Saini, Ravi; Sharma, Nidhi; Pandey, Kritika; Puri, K J P S

    2015-01-01

    Basal cell carcinoma (BCC) and squamous cell carcinoma are the most common type of nonmelanoma skin cancers (NMSCs). Bowen's disease (BD), a premalignant condition, has a marginal potential (3-5%) to progress to invasive carcinoma. We report here a rarest of a rare case of multiple pigmented BD with overlying squamous cell cancer along with a giant neglected BCC on the scalp of a 76-year-old man. The occurrence of multiple BD and NMSC in a single patient compelled us to explore the following hypothesis: (1) The multiple precancerous and cancerous lesions can be due to common etiopathogenesis. Chronic ultraviolet exposure, immunosupresssion, human papillomavirus infection, dietary factors, and environmental factors including arsenic exposure were probed in to. (2) There is evolution of precancerous lesions into a different type of cancers in different time frame. (3) The new cancerous lesions are subsequent cancers that developed after neglected untreated primary cancer.

  8. Coronary Artery Disease - Multiple Languages: MedlinePlus

    MedlinePlus

    ... sharing features on this page, please enable JavaScript. Arabic (العربية) Bosnian (Bosanski) Chinese - Simplified (简体中文) Chinese - Traditional ( ... español) Tagalog (Tagalog) Ukrainian (Українська) Vietnamese (Tiếng Việt) Arabic (العربية) Coronary Artery Disease (CAD) (Arabic) (CAD) تصلب ...

  9. HUBBLE SPACE TELESCOPE REVEALS MULTIPLE SUB-GIANT BRANCH IN EIGHT GLOBULAR CLUSTERS

    SciTech Connect

    Piotto, G.; Nascimbeni, V.; Milone, A. P.; Aparicio, A.; Anderson, J.; Bellini, A.; Bedin, L. R.; Cassisi, S.; Marino, A. F. E-mail: luigi.bedin@oapd.inaf.it E-mail: aparicio@iac.es E-mail: bellini@stsci.edu E-mail: amarino@MPA-Garching.MPG.DE

    2012-11-20

    In the last few years many globular clusters (GCs) have revealed complex color-magnitude diagrams, with the presence of multiple main sequences (MSs), broad or multiple sub-giant branches (SGBs) and MS turnoffs, and broad or split red giant branches (RGBs). After a careful correction for differential reddening, high-accuracy photometry with the Hubble Space Telescope (HST) presented in this paper reveals a broadened or even split SGB in five additional Milky Way GCs: NGC 362, NGC 5286, NGC 6656, NGC 6715, and NGC 7089. In addition, we confirm (with new and archival HST data) the presence of a split SGB in 47 Tuc, NGC 1851, and NGC 6388. The fraction of faint SGB stars with respect to the entire SGB population varies from one cluster to another and ranges from {approx}0.03 for NGC 362 to {approx}0.50 for NGC 6715. The average magnitude difference between the bright SGB and the faint SGB is almost the same at different wavelengths. This peculiarity is consistent with the presence of two groups of stars with either an age difference of about 1-2 Gyr or a significant difference in their overall C+N+O content.

  10. Multiple populations along the asymptotic giant branch of the globular cluster M4

    NASA Astrophysics Data System (ADS)

    Lardo, C.; Salaris, M.; Savino, A.; Donati, P.; Stetson, P. B.; Cassisi, S.

    2017-04-01

    Nearly all Galactic globular clusters host stars that display characteristic abundance anticorrelations, like the O-rich/Na-poor pattern typical of field halo stars, together with O-poor/Na-rich additional components. A recent spectroscopic investigation questioned the presence of O-poor/Na-rich stars amongst a sample of asymptotic giant branch (AGB) stars in the cluster M4, at variance with the spectroscopic detection of a O-poor/Na-rich component along both the cluster red giant branch (RGB) and horizontal branch. This is contrary to what is expected from the cluster horizontal branch morphology and horizontal branch stellar evolution models. Here, we have investigated this issue by employing the CUBI = (U - B) - (B - I) index, that previous studies have demonstrated to be very effective in separating multiple populations along both the RGB and AGB sequences. We confirm previous results that the RGB is intrinsically broad in the V-CUBI diagram, with the presence of two components that nicely correspond to the two populations identified by high-resolution spectroscopy. We find that AGB stars are distributed over a wide range of CUBI values, in close analogy with what is observed for the RGB, demonstrating that the AGB of M4 also hosts multiple stellar populations.

  11. Light chain multiple myeloma presenting with spinal plasmacytoma: Unusual radiological appearance mimicking giant cell tumor.

    PubMed

    Satija, Bhawna; Gupta, Rajat; Kumar, Sanyal; Chandoke, Raj

    2015-01-01

    Plasmacytoma, an initial presentation of multiple myeloma, is extremely rare and an unusual cause of spinal cord compression in a young male. A 35-year-old man presented with complaints of progressive weakness and tingling of bilateral lower limbs, severe backache for 3 months, and bladder and bowel incontinence for 1 week duration. Imaging demonstrated lytic destruction of 10 th and 11 th dorsal vertebrae with large soft tissue component and compression of the spinal cord. Biopsy was performed under computed tomography guidance and the histopathology demonstrated presence of plasmacytoma. Serum electrophoresis and bone marrow examination confirmed the diagnosis of light chain multiple myeloma. Though the magnetic resonance imaging the appearance of spinal plasmacytoma is nonspecific, a minibrain appearance has been considered pathognomonic. This case is reported for the unusual radiological appearance of this entity mimicking giant cell tumor.

  12. Nonlinear SU(2,1) Model of Multiple Giant Dipole Resonance Coulomb Excitation

    NASA Astrophysics Data System (ADS)

    Hussein, Mahir; de Toledo Piza, Antonio; Vorov, Oleg

    2000-10-01

    We construct a three-dimensional analytically soluble model of the nonlinear effects in Coulomb excitation of multiphonon Giant Dipole Resonances (GDR) based on the SU(2,1) algebra^1. Analytical expressions for the multi-phonon transition probabilities are derived. For reasonably small magnitude of nonlinearity x~= 0.15-0.3, the enhancement factor for the Double Giant Resonance excitation probabilities and the cross sections reaches values 1.3-2 compatible^1,2 with experimental data from relativistic ion collision experiments^3. The full 3-dimensional model predicts enhancement of the multiple GDR cross sections at low and high bombarding energies (with the minimum at ~= 1.3 GeV for the Pb+Pb colliding system). Enhancement factors for Double GDR measured in thirteen different processes with various projectiles and targets at different bombarding energies are well reproduced with the same value of the nonlinearity parameter with the exception of the anomalous case of ^136Xe which requires a larger value. The work has been supported by the FAPESP and by the CNPq. References ^1 M. S. Hussein, A. F. R. de Toledo Piza and O. K.Vorov, Ann. Phys. (N.Y.), 2000, to appear. ^2 M. S. Hussein, A. F. R. de Toledo Piza and O. K.Vorov, Phys. Rev. C59,R1242 (1999). ^3 T. Aumann, P.F. Bortignon, and H. Emling, Annu. Rev. Nucl. Part. Sci. 48, 351 (1998).

  13. One-year outcomes of coronary artery bypass graft surgery versus percutaneous coronary intervention with multiple stenting for multisystem disease: a meta-analysis of individual patient data from randomized clinical trials.

    PubMed

    Mercado, Nestor; Wijns, William; Serruys, Patrick W; Sigwart, Ulrich; Flather, Marcus D; Stables, Rodney H; O'Neill, William W; Rodriguez, Alfredo; Lemos, Pedro A; Hueb, Whady A; Gersh, Bernard J; Booth, Jean; Boersma, Eric

    2005-08-01

    We aimed to provide a quantitative analysis of the 1-year clinical outcomes of patients with multisystem coronary artery disease who were included in recent randomized trials of percutaneous coronary intervention with multiple stenting versus coronary artery bypass graft surgery. An individual patient database was composed of 4 trials (Arterial Revascularization Therapies Study, Stent or Surgery Trial, Argentine Randomized Trial of Percutaneous Transluminal Coronary Angioplasty Versus Coronary Artery Bypass Surgery in Multivessel Disease 2, and Medicine, Angioplasty, or Surgery Study 2) that compared percutaneous coronary intervention with multiple stenting (N = 1518) versus coronary artery bypass graft surgery (N = 1533). The primary clinical end point of this study was the combined incidence of death, myocardial infarction, and stroke at 1 year after randomization. Secondary combined end points included the incidence of repeat revascularization at 1 year. All analyses were based on the intention-to-treat principle. After 1 year of follow-up, 8.7% of patients randomized to percutaneous coronary intervention with multiple stenting versus 9.1% of patients randomized to coronary artery bypass graft surgery reached the primary clinical end point (hazard ratio 0.95 and 95% confidence interval 0.74-1.2). Repeat revascularization procedures occurred more frequently in patients allocated to percutaneous coronary intervention with multiple stenting compared with coronary artery bypass graft surgery (18% vs 4.4%; hazard ratio 4.4 and 95% confidence interval 3.3-5.9). The percentage of patients who were free from angina was slightly lower after percutaneous coronary intervention with multiple stenting than after coronary artery bypass graft surgery (77% vs 82%; P = .002). One year after the initial procedure, percutaneous coronary intervention with multiple stenting and coronary artery bypass graft surgery provided a similar degree of protection against death, myocardial

  14. Coronary Artery Bypass Grafting

    MedlinePlus

    ... from the NHLBI on Twitter. What Is Coronary Artery Bypass Grafting? Coronary artery bypass grafting (CABG) is ... bypass multiple coronary arteries during one surgery. Coronary Artery Bypass Grafting Figure A shows the location of ...

  15. Unstable angina pectoris secondary to multiple calcified coronary artery masses. Successful treatment with coronary artery bypass surgery.

    PubMed

    Przybojewski, J Z; Barnard, P M; Van der Walt, J J; Botha, J A

    1986-05-24

    A 31-year-old doctor's wife suffered from severe unstable angina pectoris (AP) due to two large, heavily calcified masses involving the right coronary artery and the left anterior descending branch of the left coronary artery. The causes of the masses could not be determined with certainty, but in view of the history (which included the ingestion of large quantities of raw boerewors (traditional spiced sausage) and histopathological findings, we believe that they were coronary artery aneurysms which developed secondary to coronary arteritis many years previously. The possibility of echinococcal (hydatid) infection is also discussed. Cardiac surgery entailed total excision of both masses, together with sections of their accompanying coronary arteries which had become fibrotic as a result of the arteritis, and reestablishment of coronary blood flow by the insertion of two saphenous vein coronary artery bypass grafts. Her AP was dramatically relieved and she continues to be asymptomatic without taking anti-anginal drugs.

  16. RED GIANTS IN ECLIPSING BINARY AND MULTIPLE-STAR SYSTEMS: MODELING AND ASTEROSEISMIC ANALYSIS OF 70 CANDIDATES FROM KEPLER DATA

    SciTech Connect

    Gaulme, P.; McKeever, J.; Rawls, M. L.; Jackiewicz, J.; Mosser, B.; Guzik, J. A.

    2013-04-10

    Red giant stars are proving to be an incredible source of information for testing models of stellar evolution, as asteroseismology has opened up a window into their interiors. Such insights are a direct result of the unprecedented data from space missions CoRoT and Kepler as well as recent theoretical advances. Eclipsing binaries are also fundamental astrophysical objects, and when coupled with asteroseismology, binaries provide two independent methods to obtain masses and radii and exciting opportunities to develop highly constrained stellar models. The possibility of discovering pulsating red giants in eclipsing binary systems is therefore an important goal that could potentially offer very robust characterization of these systems. Until recently, only one case has been discovered with Kepler. We cross-correlate the detected red giant and eclipsing-binary catalogs from Kepler data to find possible candidate systems. Light-curve modeling and mean properties measured from asteroseismology are combined to yield specific measurements of periods, masses, radii, temperatures, eclipse timing variations, core rotation rates, and red giant evolutionary state. After using three different techniques to eliminate false positives, out of the 70 systems common to the red giant and eclipsing-binary catalogs we find 13 strong candidates (12 previously unknown) to be eclipsing binaries, one to be a non-eclipsing binary with tidally induced oscillations, and 10 more to be hierarchical triple systems, all of which include a pulsating red giant. The systems span a range of orbital eccentricities, periods, and spectral types F, G, K, and M for the companion of the red giant. One case even suggests an eclipsing binary composed of two red giant stars and another of a red giant with a {delta}-Scuti star. The discovery of multiple pulsating red giants in eclipsing binaries provides an exciting test bed for precise astrophysical modeling, and follow-up spectroscopic observations of many

  17. Analysis on the evolution process of BFW-like model with discontinuous percolation of multiple giant components

    NASA Astrophysics Data System (ADS)

    Zhang, Renquan; Wei, Wei; Guo, Binghui; Zhang, Yang; Zheng, Zhiming

    2013-03-01

    Recently, the modified BFW model on random graphs [W. Chen, R.M. D’Souza, Phys. Rev. Lett. 106 (2011) 115701], which shows a discontinuous percolation transition with multiple giant components, has attracted much attention from physicists and statisticians. In this paper, by establishing the evolution equations on the modified BFW model, the evolution process and steady-states on both random graphs and finite-dimensional lattices are analyzed. On a random graph, by varying the edge accepted rate α, the system stabilizes in a steady-state with different numbers of giant components. Moreover, a close correspondence is built between the values of α and the number of giant components in steady-states, the efficiency of which is verified by the numerical simulations. Then, the sizes of giant components for different evolution strategies can be obtained by solving some constraints derived from the evolution equations. Meanwhile, a similar analysis is expanded to finite-dimensional lattices, and we find the BFW (α) model on a finite-dimensional lattice has different steady-states from those on a random graph, but they have the same evolution mechanism. The analysis of the evolution process and steady-state is of great help to explain the properties of discontinuous percolation and the role of nonlocality.

  18. Exercise training enhances multiple mechanisms of relaxation in coronary arteries from ischemic hearts

    PubMed Central

    Deer, Rachel R.

    2013-01-01

    Exercise training of coronary artery disease patients is of considerable interest, since it has been shown to improve vascular function and, thereby, enhance blood flow into compromised myocardial regions. However, the mechanisms underlying exercise-induced improvements in vascular function have not been fully elucidated. We tested the hypothesis that exercise training increases the contribution of multiple mediators to endothelium-dependent relaxation of coronary arteries in the underlying setting of chronic coronary artery occlusion. To induce gradual occlusion, an ameroid constrictor was placed around the proximal left circumflex coronary artery in Yucatan miniature swine. At 8 wk postoperatively, pigs were randomly assigned to sedentary or exercise (treadmill, 5 days/wk) regimens for 14 wk. Exercise training significantly enhanced the contribution of nitric oxide, prostanoids, and large-conductance Ca2+-dependent K+ (BKCa) channels to endothelium-dependent, bradykinin-mediated relaxation in nonoccluded and collateral-dependent arteries. Combined nitric oxide synthase, prostanoid, and BKCa channel inhibition ablated the enhanced relaxation associated with exercise training. Exercise training significantly increased nitric oxide levels in response to bradykinin in endothelial cells isolated from nonoccluded and collateral-dependent arteries. Bradykinin treatment significantly increased PGI2 levels in all artery treatment groups and tended to be further enhanced after nitric oxide synthase inhibition in exercise-trained pigs. No differences were found in whole cell BKCa channel currents, BKCa channel protein levels, or arterial cyclic nucleotide levels. Although redundant, upregulation of parallel vasodilator pathways appears to contribute to enhanced endothelium-dependent relaxation, potentially providing a more refined control of blood flow after exercise training. PMID:23997097

  19. Automated identification of best-quality coronary artery segments from multiple-phase coronary CT angiography (cCTA) for vessel analysis

    NASA Astrophysics Data System (ADS)

    Zhou, Chuan; Chan, Heang-Ping; Hadjiiski, Lubomir M.; Chughtai, Aamer; Wei, Jun; Kazerooni, Ella A.

    2016-03-01

    We are developing an automated method to identify the best quality segment among the corresponding segments in multiple-phase cCTA. The coronary artery trees are automatically extracted from different cCTA phases using our multi-scale vessel segmentation and tracking method. An automated registration method is then used to align the multiple-phase artery trees. The corresponding coronary artery segments are identified in the registered vessel trees and are straightened by curved planar reformation (CPR). Four features are extracted from each segment in each phase as quality indicators in the original CT volume and the straightened CPR volume. Each quality indicator is used as a voting classifier to vote the corresponding segments. A newly designed weighted voting ensemble (WVE) classifier is finally used to determine the best-quality coronary segment. An observer preference study is conducted with three readers to visually rate the quality of the vessels in 1 to 6 rankings. Six and 10 cCTA cases are used as training and test set in this preliminary study. For the 10 test cases, the agreement between automatically identified best-quality (AI-BQ) segments and radiologist's top 2 rankings is 79.7%, and between AI-BQ and the other two readers are 74.8% and 83.7%, respectively. The results demonstrated that the performance of our automated method was comparable to those of experienced readers for identification of the best-quality coronary segments.

  20. Progression of coronary artery calcification in black and white women: do the stresses and rewards of multiple roles matter?

    PubMed

    Janssen, Imke; Powell, Lynda H; Jasielec, Mateusz S; Matthews, Karen A; Hollenberg, Steven M; Sutton-Tyrrell, Kim; Everson-Rose, Susan A

    2012-02-01

    Black women experience higher rates of cardiovascular disease (CVD) than white women, though evidence for racial differences in subclinical CVD is mixed. Few studies have examined multiple roles (number, perceived stress, and/or reward) in relation to subclinical CVD, or whether those effects differ by race. The aim of this study was to investigate the effects of multiple roles on 2-year progression of coronary artery calcium. Subjects were 104 black and 232 white women (mean age 50.8 years). Stress and reward from four roles (spouse, parent, employee, caregiver) were assessed on five-point scales. Coronary artery calcium progression was defined as an increase of ≥10 Agatston units. White women reported higher rewards from their multiple roles than black women, yet black women showed cardiovascular benefits from role rewards. Among black women only, higher role rewards were related significantly to lower progression of coronary artery calcium, adjusting for body mass index, blood pressure, and other known CVD risk factors. Blacks reported fewer roles but similar role stress as whites; role number and stress were unrelated to coronary artery calcium progression. Rewarding roles may be a novel protective psychosocial factor for progression of coronary calcium among black women.

  1. Suspected Giant cell aortitis : from multiple aortic structural damage to fatal listeria sepsi. A case report.

    PubMed

    Silvestri, Valeria; Isernia, Giacomo

    2017-03-16

    Giant cell arteritis ( GCA) is an inflammatory vasculopathy affecting large and middle-sized vessels , specifically cranial arteries derived from carotid artery. Isolated extracranial vessel involvement can occur. Interest in extravascular manifestations is recently increasing because of diffusion of sensitive and specific imaging tools such as 18FDG PET TC . Patients have an increased relative risk of severe infection. Listeria monocytogenes infection risk is increased, and vascular system involvement and graft infection have been, even though rarely, reported. We report the case of a 72 year old woman with a history of suspected giant cell aortitis , previous surgical treatment of ascendant and descendant thoracic aortic aneurysm, presenting 7 year after TEVAR with thoracic pain , fever, inflammatory indexes increase, leukocytosis, listeria sepsis and rapidly increasing type I proximal endoleak on CT. 18 FDG PET positivity was associated. Endograft listeria infection on aortitis reactivation was suspected but death for multi-organ failure and absence of autopsy data couldn't confirm diagnosis . Listeria vascular graft infection has been reported previously. Giant cell arteritis is a predisposing condition. We report the first case of endograft infection by listeria monocytogenes in a patient with positive history of suspected giant cell aortic aneurysm.

  2. Simultaneous thrombosis of multiple coronary arteries in a patient with rheumatoid arthritis

    PubMed Central

    Kalayci, Arzu; Arslan, Erol; Bakar, Salih Murat; Guneri, Mahmut; Dizman, Rafet; Kivanc, Eylem; Karabay, Can Yucel

    2016-01-01

    We present a case of simultaneous coronary thrombosis of the left main, the left anterior descending artery and the right coronary artery in a patient, recently diagnosed with rheumatoid arthritis. PMID:27489603

  3. Numerical and experimental investigations of the flow-pressure relation in multiple sequential stenoses coronary artery.

    PubMed

    Li, S; Chin, Cheng; Thondapu, Vikas; Poon, Eric K W; Monty, Jason P; Li, Yingguang; Ooi, Andrew S H; Tu, Shengxian; Barlis, Peter

    2017-07-01

    Virtual fractional flow reserve (vFFR) has been evaluated as an adjunct to invasive fractional flow reserve (FFR) in the light of its operational and economic benefits. The accuracy of vFFR and the complexity of hyperemic flow simulation are still not clearly understood. This study investigates the flow-pressure relation in an idealised multiple sequential stenoses coronary artery model via numerical and experimental approaches. Pressure drop is linearly correlated with flow rate irrespective of the number of stenosis. Computational fluid dynamics results are in good agreement with the experimental data, demonstrating reasonable accuracy of vFFR. It was also found that the difference between data obtained with steady and pulsatile flows is negligible, indicating the steady flow may be used instead of pulsatile flow conditions in vFFR computation. This study adds to the current understanding of vFFR and may improve its clinical applicability as an adjunct to invasively determined FFR.

  4. [Coronary angioplasty of multiple vessels and lesions in unstable functional class-IV angina].

    PubMed

    Frutos Rangel, E; García García, R; Fernández Valadez, E; Zúñiga Sedano, J; Verduzco Bazavilvazo, S; Siordia Zamorano, R; García y Otero, J M

    1991-01-01

    A select group of 26, class IV unstable angina patients that had multiple lesions or multivessel disease were treated with percutaneous transluminal coronary angioplasty (PTCA). Complete revascularization was the endpoint in all patients. Seventy lesions were dilated (mean = 2.6 lesions per patient). In the tandem multi-lesion group (13 patients) 2.23 lesions per patient were approached (Range 2-3) and in the multivessel disease group (13 patients) a mean of 3.15 lesions per patient were attempted (Range 2-6). An overall success rate of 96% per patient (25/26 patients) and 95.7% primary success per lesion were achieved with no mortality. We report the results of a select group of unstable angina patients with multi-lesion or multivessel disease who underwent PTCA. A careful performance was associated with high primary success in the high risk group achieving clinical and angiographic improvement.

  5. Aspirin resistance in patients with acute coronary events: risk factors and prevalence as determined by whole blood multiple electrode aggregometry.

    PubMed

    Ibrahim, O; Maskon, O; Darinah, Noor; Raymond, A A; Rahman, M M

    2013-11-01

    To determine the prevalence of aspirin resistance and associated risk factors based on biochemical parameters using whole blood multiple electrode aggregometry. The study was conducted at the outpatients cardiology clinic of the Universiti Kebangsaan Malaysia Medical Centre (UKMMC) from August 2011 to February 2012. Subjects on aspirin therapy were divided into two groups; first-ever coronary event and recurrent coronary event. Aspirin resistance was measured by a Multiplate(®) platelet analyser. A total of 74 patients (63 male, 11 female), with a mean age of 57.93 ± 74.1years were enrolled in the study. The patients were divided into two groups -first-ever coronary event group (n=52) and recurrent coronary event group (n=22). Aspirin resistance was observed in 12 out of 74 (16%) of the study patients, which consisted of 11 patients from the first-ever coronary event group and one patient from the recurrent coronary event group. There were significant correlations between aspirin resistance and age (r = -0.627; p = 0.029), total cholesterol (r = 0.608; p = 0.036) and LDL (r = 0.694; p = 0.012). LDL was the main predictor for area under the curve (AUC) for aspirin resistance. However, there was no association between aspirin resistance and cardiovascular events in both groups in this study. Aspirin resistance was observed in 16% of the study population. LDL was the major predictor of aspirin resistance. No association was found in the study between aspirin resistance with recurrent coronary events.

  6. Systematic review of randomised controlled trials of multiple risk factor interventions for preventing coronary heart disease.

    PubMed Central

    Ebrahim, S.; Smith, G. D.

    1997-01-01

    OBJECTIVE: To assess the effectiveness of multiple risk factor intervention in reducing cardiovascular risk factors, total mortality, and mortality from coronary heart disease among adults. DESIGN: Systematic review and meta-analysis of randomised controlled trials in workforces and in primary care in which subjects were randomly allocated to more than one of six interventions (stopping smoking, exercise, dietary advice, weight control, antihypertensive drugs, and cholesterol lowering drugs) and followed up for at least six months. SUBJECTS: Adults aged 17-73 years, 903000 person years of observation were included in nine trials with clinical event outcomes and 303000 person years in five trials with risk factor outcomes alone. MAIN OUTCOME MEASURES: Changes in systolic and diastolic blood pressure, smoking rates, blood cholesterol concentrations, total mortality, and mortality from coronary heart disease. RESULTS: Net decreases in systolic and diastolic blood pressure, smoking prevalence, and blood cholesterol were 4.2 mm Hg (SE 0.19 mm Hg), 2.7 mm Hg (0.09 mm Hg), 4.2% (0.3%), and 0.14 mmol/l (0.01 mmol/l) respectively. In the nine trials with clinical event end points the pooled odds ratios for total and coronary heart disease mortality were 0.97 (95% confidence interval 0.92 to 1.02) and 0.96 (0.88 to 1.04) respectively. Statistical heterogeneity between the studies with respect to changes in mortality and risk factors was due to trials focusing on hypertensive participants and those using considerable amounts of drug treatment, with only these trials showing significant reductions in mortality. CONCLUSIONS: The pooled effects of multiple risk factor intervention on mortality were insignificant and a small, but potentially important, benefit of treatment (about a 10% reduction in mortality) may have been missed. Changes in risk factors were modest, were related to the amount of pharmacological treatment used, and in some cases may have been overestimated

  7. Acute coronary syndrome: a rare case of multiple endocrine neoplasia syndromes with pheochromocytoma and medullary thyroid carcinoma

    PubMed Central

    Maloberti, Alessadro; Meani, Paolo; Pirola, Roberto; Varrenti, Marisa; Boniardi, Marco; De Biase, Anna Maria; Vallerio, Paola; Bonacina, Edgardo; Mancia, Giuseppe; Loli, Paola; Giannattasio, Cristina

    2015-01-01

    Pheochromocytoma is a tumor arising from neuroectodermal chromaffin tissues in the adrenal gland or extra-adrenal paraganglia (paragangliomas). The prevalence of the tumor is 0.1%-0.6% in the hypertensive population, of which 10%-20% are malignant. Pheochromocytoma produces, stores, and secretes catecholamines, as well as leads to hypertensive crisis, arrhythmia, angina, and acute myocardial infarction without coronary artery diseases. We report a case of acute coronary syndrome (ACS) with a final diagnosis of multiple endocrine neoplasia with pheochromocytoma and medullary thyroid carcinoma (MTC). PMID:26487970

  8. Acute coronary syndrome: a rare case of multiple endocrine neoplasia syndromes with pheochromocytoma and medullary thyroid carcinoma.

    PubMed

    Maloberti, Alessadro; Meani, Paolo; Pirola, Roberto; Varrenti, Marisa; Boniardi, Marco; De Biase, Anna Maria; Vallerio, Paola; Bonacina, Edgardo; Mancia, Giuseppe; Loli, Paola; Giannattasio, Cristina

    2015-09-01

    Pheochromocytoma is a tumor arising from neuroectodermal chromaffin tissues in the adrenal gland or extra-adrenal paraganglia (paragangliomas). The prevalence of the tumor is 0.1%-0.6% in the hypertensive population, of which 10%-20% are malignant. Pheochromocytoma produces, stores, and secretes catecholamines, as well as leads to hypertensive crisis, arrhythmia, angina, and acute myocardial infarction without coronary artery diseases. We report a case of acute coronary syndrome (ACS) with a final diagnosis of multiple endocrine neoplasia with pheochromocytoma and medullary thyroid carcinoma (MTC).

  9. Multiple giant angiokeratoma of Fordyce on the shaft of the penis masquerading as keratoacanthoma*

    PubMed Central

    Ghosh, Sudip Kumar; Ghosh, Shouvik; Agarwal, Megha

    2015-01-01

    The term 'angiokeratoma' includes a wide range of dermatological conditions of hyperkeratotic vascular disorders with a similar histologic combination of hyperkeratosis and superficial dermal vascular ectasia. Angiokeratomas can be classified into localized and systemic forms. Angiokeratoma of Fordyce (AKF) is a localized form of angiokeratoma, clinically characterized by 1- to 6-mm, black, blue, or dark red, dome-shaped papules located on the scrotum, shaft of penis, labia majora, clitoris, inner thigh, and lower abdomen. We describe herein a case of giant angiokeratoma of Fordyce on shaft of the penis in an elderly man, clinically masquerading as keratoacanthoma. PMID:26312700

  10. Increased myocardial ischemia during nitrate therapy: caused by multiple coronary artery-left ventricle fistulae?

    PubMed

    Heper, Gulumser; Kose, Sedat

    2005-01-01

    We present the case of a 54-year-old man who had crescendo angina during nitrate therapy. Selective coronary angiograms showed no atherosclerotic lesions, but did show plexuses of intramural vessels that connected the distal thirds of the left and right coronary systems with the left ventricle. The cause of our patient's increased myocardial ischemia during nitrate therapy may have been the coronary "steal" phenomenon.

  11. A simplified approach for evaluating multiple test outcomes and multiple disease states in relation to the exercise thallium-201 stress test in suspected coronary artery disease

    SciTech Connect

    Pollock, S.G.; Watson, D.D.; Gibson, R.S.; Beller, G.A.; Kaul, S. )

    1989-09-01

    This study describes a simplified approach for the interpretation of electrocardiographic and thallium-201 imaging data derived from the same patient during exercise. The 383 patients in this study had also undergone selective coronary arteriography within 3 months of the exercise test. This matrix approach allows for multiple test outcomes (both tests positive, both negative, 1 test positive and 1 negative) and multiple disease states (no coronary artery disease vs 1-vessel vs multivessel coronary artery disease). Because this approach analyzes the results of 2 test outcomes simultaneously rather than serially, it also negates the lack of test independence, if such an effect is present. It is also demonstrated that ST-segment depression on the electrocardiogram and defects on initial thallium-201 images provide conditionally independent information regarding the presence of coronary artery disease in patients without prior myocardial infarction. In contrast, ST-segment depression on the electrocardiogram and redistribution on the delayed thallium-201 images may not provide totally independent information regarding the presence of exercise-induced ischemia in patients with or without myocardial infarction.

  12. Additional coronary sinus shocking lead as rescue therapy after multiple internal and external defibrillation failures.

    PubMed

    Chauveau, Samuel; Dulac, Arnaud; Sebbag, Laurent; Morel, Elodie; Chevalier, Philippe

    2017-06-01

    High defibrillation threshold (DFT) and defibrillation failure can lead to intractable ventricular arrhythmias. Additional coronary sinus coil is an effective strategy to achieve marked reduction in DFT. However, physicians should retain this might prevent future coronary sinus lead placement in case the patient would develop complete left bundle branch block.

  13. Vascular and cardiac contractile reserve in the dog heart with chronic multiple coronary occlusions.

    PubMed

    Schwarz, F; Flameng, W; Mack, B; Türschmann, W; Schaper, W

    1976-11-01

    Nineteen mongrel dogs survived chronic occlusion of the left circumflex and of the right coronary artery without infarction due to the timely development of a collateral circulation. Only 38 per cent of the conductance of the arteries before occlusion was restored by collateral vessels. In these animals and in 15 control dogs with normal coronary arteries myocardial contractility, contractility reserve, and myocardial blood flow were studied. The same was done in dogs with chronic coronary artery occlusion after aortocoronary bypass. Myocardial blood flow was determined woth the tracer microsphere technique. Contractility reserve was tested and defined as isovolumetric left ventricular pressure and dp/dt max with norepinephrine infusion and cross-clamping of the aorta. Contractile reserve was not significantly different between normal dogs and dogs with chronic coronary artery occlusion before and after aortocoronary bypass. Myocardial blood flow during control conditions was homogenously distributed in all three groups studied. The ratio of blood flow to the endocardium and the epicardium was not significantly different from inity. Coronary reserve was determined at peak reactive hyperemia following a 20 second period of coronary artery occlusion, with ongoing norepinephrine infusion. Under these conditions subendocardial fow in normal dogs rose by a factor of 7.9 while subepicardial flow increased 7.4 times. In dogs with chronic occlusion of two coronary arteries the increase of myocardial flow was nonnomogenous; subendocardial flow to areas supplied by a normal coronary artery rose by a factor of 7.0 while subepicardial flow increased 5.7 times control. Subendocardial collateral flow rose by a factor of 2.4 and subepicardial collateral flow increased 3.5 times control. In normal dogs norepinephrine alone did not result in maximal coronary flow but only 57 per cent thereof. Dogs with chronic coronary occlusion, however, required the entire coronary reserve in

  14. Prevalence and Predictors of Multiple Coronary Plaque Ruptures: In Vivo 3-Vessel Optical Coherence Tomography Imaging Study.

    PubMed

    Vergallo, Rocco; Uemura, Shiro; Soeda, Tsunenari; Minami, Yoshiyasu; Cho, Jin-Man; Ong, Daniel S; Aguirre, Aaron D; Gao, Lei; Biasucci, Luigi M; Crea, Filippo; Yu, Bo; Lee, Hang; Kim, Chong-Jin; Jang, Ik-Kyung

    2016-11-01

    Plaque rupture may be the local expression of a widespread coronary instability. This study aimed to investigate: (1) the prevalence and characteristics of nonculprit plaque rupture; (2) the pancoronary atherosclerotic phenotype in patients with and without nonculprit plaque rupture; and (3) the prevalence and predictors of multiple plaque ruptures. Six hundred and seventy-five nonculprit plaques from 261 patients (34 acute myocardial infarction, 73 unstable angina pectoris, and 154 stable angina pectoris) were analyzed by 3-vessel optical coherence tomography. Nonculprit plaque ruptures were identified in 51 patients (20%). Patients with nonculprit plaque ruptures had higher prevalence of thin-cap fibroatheroma (51% versus 13%; P<0.001) in the 3 major epicardial coronary vessels. Multiple plaque ruptures were observed in 20% of patients (38% acute myocardial infarction versus 10% unstable angina pectoris versus 19% stable angina pectoris; P=0.042). Thin-cap fibroatheroma, intimal vasculature, and macrophages were independent morphological predictors of multiple plaque ruptures, whereas acute myocardial infarction and chronic kidney disease were independent clinical predictors. Patients with nonculprit plaque ruptures showed higher 1-year rates of nontarget lesion revascularization (11.8% versus 4.4%; P=0.039). Nonculprit plaque ruptures were observed in 20% of patients with coronary artery disease and were associated with pancoronary vulnerability and higher 1-year revascularization rate. © 2016 American Heart Association, Inc.

  15. Long-Term Prognosis for Patients with Kawasaki Disease Complicated by Large Coronary Aneurysm (diameter ≥6 mm)

    PubMed Central

    Bang, Ji Seok; Kwon, Bo Sang; Song, Mi Kyung; An, Hyo Soon; Song, Young Whan; Bae, Eun Jung; Noh, Chung Il

    2017-01-01

    Background and Objectives Some patients with Kawasaki disease (KD) develop large coronary aneurysms and subsequent coronary stenosis or obstruction, leading to ischemic heart disease. This study examined the long-term outcomes of patients with KD complicated by large coronary aneurysms. Subjects and Methods The medical records of 71 patients (53 men and 18 women) diagnosed with large coronary aneurysms (diameter ≥6 mm) between December 1986 and December 2013 were retrospectively reviewed from our institutional database. Results The mean age at onset was 4.6±3.3 years, and the mean follow-up duration was 12.5±6.9 years. Maximum coronary artery internal diameter ranged from 6.1 to 25 mm. Giant coronary aneurysms occurred in 48 patients and coronary aneurysms 6-8 mm in diameter developed in 23 patients. Coronary stenosis and/or complete occlusion occurred in 30 patients (42.3%). Catheter and/or surgical interventions (mean: 1.5 interventions, range: 1-5 interventions) were performed in 20 patients (28.2%), 9 months to 18 years after KD onset, resulting in 33.7% cumulative coronary intervention rates at 20 years after onset. There were no differences in cumulative coronary intervention rates between two coronary aneurysm groups (6-8 mm vs. ≥8 mm). Myocardial infarction occurred in 7 patients with a giant aneurysm and there was one death. Conclusions Long-term survival of patients with KD complicated by large coronary aneurysm was good even though 28.2% of patients underwent multiple catheter or surgical interventions. Careful follow-up is also necessary in KD patients with coronary aneurysms 6-8 mm in diameter, such as those with giant aneurysms. PMID:28765744

  16. Automatic selection of best quality vessels from multiple-phase coronary CT angiography (cCTA)

    NASA Astrophysics Data System (ADS)

    Liu, Jordan; Hadjiiski, Lubomir; Chan, Heang-Ping; Zhou, Chuan; Wei, Jun; Chughtai, Aamer; Kuriakose, Jean; Agarwal, Prachi; Kazerooni, Ella

    2015-03-01

    We are developing an automated method to select the best-quality vessels from coronary arterial trees in multiplephase cCTA and build a best-quality tree to facilitate the detection of stenotic plaques. Using our previously developed vessel registration method, the vessels from different phases were automatically registered. Branching points on the centerline are projected onto the registered trees. The centerlines are split into branches based on the projected branching points. Each tree branch is then straightened. The registered trees and centerline branches are used to determine the correspondence of branches between phases so that each branch can be compared to its corresponding branches in the other phases. A vessel quality measure (VQM) is calculated as the average radial gradients at the vessel wall over the entire vessel branch. The quality of the corresponding branches from all phases is automatically compared using the VQM. An observer preference study was conducted with two radiologists to visually compare the quality of the vessels. For each branch, the pair that was automatically determined to be the best and worst quality by the VQM was used for the radiologists' visual assessment. Each radiologist, blinded to the VQM, evaluated pairs of corresponding branches and provided their preference. The performance of the automatic selection using VQM was evaluated as the percentage of the total number of vessel pairs for which the automatic selection agreed with the radiologist's selection of the higher quality branch in the pair. The agreement between the first radiologist and the automated selection was 80% and that between the second radiologist and the automated selection was 82%. In comparison, the agreement between the two radiologists was 90%. This preliminary study demonstrates the feasibility of using an automated method to select the best-quality vessels from multiple cCTA phases.

  17. Effect of multiple clinical factors on recurrent angina after percutaneous coronary intervention

    PubMed Central

    Zhang, Jing; Liu, Chengyu; Pan, Chenliang; Bai, Ming; Zhang, Jin; Peng, Yu; Zheng, Dingchang; Zhang, Zheng

    2016-01-01

    Abstract Recurrent angina (RA) has an important influence on health status of patients after percutaneous coronary intervention (PCI). This study aimed to retrospectively investigate the effect of multiple clinical factors on both short-term and long-term development of RA. A total of 398 ST-segment elevation myocardial infarction (STEMI) patients were studied for up to 12 months. The primary clinical outcome, RA, was assessed at 1-month and 12-month. In multivariate analyses, the effect of clinical factors, including baseline demographics, medical history, infarction-related arteries, procedural characteristics of PCI, and the use of medicines, was investigated in patients with and without RA. The Logistic regression analysis showed that the patients with treatment through radial approach PCI (odds ratio [OR]: 0.42, 95% confidence interval [CI]: 0.18–0.96, P < 0.05) were less likely to have RA during 1-month assessment. During 12 months after PCI, male patients (OR: 0.53, 95% CI: 0.29–0.96, P < 0.05), and/or those treated with radial approach PCI (OR: 0.45, 95% CI: 0.21–0.97, P < 0.05) were less likely to have RA, whereas the patients with infarction related artery (IRA) in left anterior descending (LAD) (OR: 2.41, 95% CI: 1.20–4.84, P < 0.01) were more likely to have RA at follow-up. The Cox regression analysis further revealed that the patients with infarction of the LAD artery (hazard ratio [HR]: 2.08, 95% CI: 1.10–3.92, P < 0.05), but not with treatment through radial artery during PCI (HR: 0.42, 95% CI: 0.18–0.96, P < 0.05) had higher potential of development of RA during 12 months after PCI. We studied the effects of multiple clinical factors on the development of RA after PCI. Our findings suggest that patients with infarction of the LAD artery, and/or treatment not through radial artery during PCI were associated with higher risk of RA and may require close follow-up. PMID:27741110

  18. Multiple risk factor interventions for primary prevention of coronary heart disease

    PubMed Central

    Ebrahim, Shah; Beswick, Andrew; Burke, Margaret; Smith, George Davey

    2014-01-01

    Background Primary prevention programmes in many countries attempt to reduce mortality and morbidity due to coronary heart disease (CHD) through risk factor modification. It is widely believed that multiple risk factor intervention using counselling and educational methods is efficacious and cost-effective and should be expanded. Recent trials examining risk factor changes have cast considerable doubt on the effectiveness of these multiple risk factor interventions. Objectives To assess the effects of multiple risk factor intervention for reducing cardiovascular risk factors, total mortality, and mortality from CHD among adults without clinical evidence of established cardiovascular disease. Search strategy MEDLINE was searched for the original review to 1995. This was updated by searching the Cochrane Central Register of Controlled Trials on The Cochrane Library Issue 3 2001, MEDLINE(2000 to September 2001) and EMBASE (1998 to September 2001). Selection criteria Intervention studies using counselling or education to modify more than one cardiovascular risk factor in adults from general populations, occupational groups, or high risk groups. Trials of less than 6 months duration were excluded. Data collection and analysis Data were extracted by two reviewers independently. Investigators were contacted to obtain missing information. Main results A total of 39 trials were found of which ten reported clinical event data. In the ten trials with clinical event end-points, the pooled odds ratios for total and CHD mortality were 0.96 (95% confidence intervals (CI) 0.92 to 1.01) and 0.96 (95% CI 0.89 to 1.04) respectively. Net changes in systolic and diastolic blood pressure, and blood cholesterol were (weighted mean differences) −3.6 mmHg (95% CI −3.9 to −3.3 mmHg), −2.8 mmHg (95% CI −2.9 to −2.6 mmHg) and −0.07 mMol/l (95% CI −0.8 to −0.06 mMol/l) respectively. Odds of reduction in smoking prevalence was 20% (95% CI 8% to 31%). Statistical heterogeneity

  19. Spectroscopy and Photometry of Multiple Populations along the Asymptotic Giant Branch of NGC 2808 and NGC 6121 (M4)

    NASA Astrophysics Data System (ADS)

    Marino, A. F.; Milone, A. P.; Yong, D.; Da Costa, G.; Asplund, M.; Bedin, L. R.; Jerjen, H.; Nardiello, D.; Piotto, G.; Renzini, A.; Shetrone, M.

    2017-07-01

    We present a photometric and spectroscopic study of multiple populations along the asymptotic giant branch (AGB) of the intermediate-metallicity globular clusters (GCs) NGC 2808 and NGC 6121 (M4). Chemical abundances of O, Na, Mg, Al, Si, Ca, Sc, Ti, V, Cr, Fe, Co, Ni, Zn, Y, and Ce in AGB stars from high-resolution FLAMES+UVES@VLT spectra are reported for both clusters. Our spectroscopic results have been combined with multiwavelength photometry from the Hubble Space Telescope UV survey of Galactic GCs and ground-based photometry, as well as proper motions derived by combining stellar positions from ground-based images and Gaia DR1. Our analysis reveals that the AGBs of both clusters host multiple populations with different chemical compositions. In M4, we have identified two main populations of stars with different Na/O content lying on distinct AGBs in the {m}{{F}438{{W}}} versus {C}{{F}275{{W}},{{F}}336{{W}},{{F}}438{{W}}} and the V versus {C}{{U},{{B}},{{I}}} pseudo-color-magnitude diagrams. In the more massive and complex GC NGC 2808, three groups of stars with different chemical abundances occupy different locations on the so-called “chromosome map” photometric diagram constructed for AGB stars. The spectroscopic + photometric comparison of stellar populations along the AGB and the red giants of this GC suggests that the AGB hosts stellar populations with a range in helium abundances from primordial to high contents of Y˜ 0.32. By contrast, from our data set, there is no evidence for stars with extreme helium abundance (Y˜ 0.38) on the AGB, suggesting that the most He-rich stars of NGC 2808 do not reach this phase. Based on observations collected at the European Organisation for Astronomical Research in the Southern Hemisphere under ESO programs 093.D-0789 and 094.D-0455 and on observations with the NASA/ESA Hubble Space Telescope, obtained at the Space Telescope Science Institute, which is operated by AURA, Inc., under NASA contract NAS 5-26555.

  20. A rare case of acute myocardial infarction with multivessel coronary artery ectasia successfully treated with percutaneous coronary intervention and systemic thrombolysis.

    PubMed

    Kuno, Toshiki; Numasawa, Yohei; Sugiyama, Kazutoshi; Yamazaki, Hiroyuki; Motoda, Hiroyuki; Kamei, Syusaku; Takahashi, Toshiyuki

    2015-01-01

    Coronary artery ectasia (CAE) is defined as a coronary artery dilatation with a diameter ≥1.5 times greater than that of a normal adjacent artery. All 3 coronary vessels can be affected by CAE, but the incidence of multivessel CAE among patients undergoing coronary angiography is quite low. We herein report an extremely rare case of acute myocardial infarction due to massive thrombi in the giant right coronary artery with multivessel CAE. Thrombus aspiration during percutaneous coronary intervention may be limited in giant coronary artery cases, and systemic thrombolysis may be effective in patients with massive thrombi in the giant coronary artery.

  1. Multiple coronary thrombosis and stent implantation to the subtotally occluded right renal artery in a patient with essential thrombocytosis: a case report with review.

    PubMed

    Ozben, Beste; Ekmekci, Ahmet; Bugra, Zehra; Umman, Sabahattin; Meric, Mehmet

    2006-08-01

    Essential thrombocytosis is a myeloproliferative disorder of unknown etiology manifested clinically by the overproduction of platelets in the absence of a definable cause. Platelet dysfunction in essential thrombocytosis results in both hemorrhage and thrombosis. It is one of the rare causes of ischemic cardiovascular events. Fewer than 20 cases of essential thrombocytosis with involvement of coronary arteries leading to acute coronary syndromes or myocardial infarction have been reported. We report a case of multiple coronary thrombosis involving the left anterior descending artery and circumflex artery and stent implantation to the subtotally stenotic right renal artery in a women with unstable angina pectoris, essential thrombocytosis and previous history of renal artery trombosis.

  2. Progression of Coronary Artery Calcification in Black and White Women: Do the Stresses and Rewards of Multiple Roles Matter?

    PubMed Central

    Janssen, Imke; Powell, Lynda H.; Jasielec, Mateusz S.; Matthews, Karen A.; Hollenberg, Steven M.; Sutton-Tyrrell, Kim; Everson-Rose, Susan A.

    2013-01-01

    Background Black women experience higher rates of cardiovascular disease (CVD) than white women, though evidence for racial differences in subclinical CVD is mixed. Few studies have examined multiple roles (number, perceived stress, and/or reward) in relation to subclinical CVD, or whether those effects differ by race. Purpose To investigate the effects of multiple roles on 2-year progression of coronary artery calcification (CAC). Methods Subjects were 104 black and 232 white women (mean age 50.8 years). Stress and reward from four roles (spouse, parent, employee, caregiver) were assessed on 5-point scales. CAC progression was defined as an increase of ≥10 Agatston units. Results White women reported higher rewards from their multiple roles than black women, yet black women showed cardiovascular benefits from role rewards. Among black women only, higher role rewards were related significantly to lower CAC progression, adjusting for BMI, blood pressure, and other known CVD risk factors. Blacks reported fewer roles but similar role stress as whites; role number and stress were unrelated to CAC progression. Conclusion Rewarding roles may be a novel protective psychosocial factor for progression of coronary calcium among black women. PMID:21901270

  3. Visualization of multiple influences on ocellar flight control in giant honeybees with the data-mining tool Viscovery SOMine.

    PubMed

    Kastberger, G; Kranner, G

    2000-02-01

    Viscovery SOMine is a software tool for advanced analysis and monitoring of numerical data sets. It was developed for professional use in business, industry, and science and to support dependency analysis, deviation detection, unsupervised clustering, nonlinear regression, data association, pattern recognition, and animated monitoring. Based on the concept of self-organizing maps (SOMs), it employs a robust variant of unsupervised neural networks--namely, Kohonen's Batch-SOM, which is further enhanced with a new scaling technique for speeding up the learning process. This tool provides a powerful means by which to analyze complex data sets without prior statistical knowledge. The data representation contained in the trained SOM is systematically converted to be used in a spectrum of visualization techniques, such as evaluating dependencies between components, investigating geometric properties of the data distribution, searching for clusters, or monitoring new data. We have used this software tool to analyze and visualize multiple influences of the ocellar system on free-flight behavior in giant honeybees. Occlusion of ocelli will affect orienting reactivities in relation to flight target, level of disturbance, and position of the bee in the flight chamber; it will induce phototaxis and make orienting imprecise and dependent on motivational settings. Ocelli permit the adjustment of orienting strategies to environmental demands by enforcing abilities such as centering or flight kinetics and by providing independent control of posture and flight course.

  4. The significance of coronary topography for operative technique and tactics in multiple myocardial revascularization with jump-grafts.

    PubMed

    Eschenbruch, E M; Pabst, F; Tollenaere, P; Roskamm, H; Schmuziger, M

    1981-08-01

    Aortocoronary bypass procedures for proximal lesions are accepted with widely documented excellent results, but are still controversial in their application for diffuse disease. However, failures of the single graft technique to small coronary branches with marginal flows are markedly reduced by the jump technique. In our experience with 447 angiographic controls from April 1978 to December 1980, the jump-graft patency rate was 87.8% versus 84.9% for single grafts, and as high as 96.3% in the subgroup of multiple jumps (sequential grafts). The sequence of the anastomoses as far as the individual flow is concerned significantly influences the results of the jump-graft technique.

  5. Multiple occurrences of giant virus core genes acquired by eukaryotic genomes: the visible part of the iceberg?

    PubMed

    Filée, Jonathan

    2014-10-01

    Giant Viruses are a widespread group of viruses, characterized by huge genomes composed of a small subset of ancestral, vertically inherited core genes along with a large body of highly variable genes. In this study, I report the acquisition of 23 core ancestral Giant Virus genes by diverse eukaryotic species including various protists, a moss and a cnidarian. The viral genes are inserted in large scaffolds or chromosomes with intron-rich, eukaryotic-like genomic contexts, refuting the possibility of DNA contaminations. Some of these genes are expressed and in the cryptophyte alga Guillardia theta, a possible non-homologous displacement of the eukaryotic DNA primase by a viral D5 helicase/primase is documented. As core Giant Virus genes represent only a tiny fraction of the total genomic repertoire of these viruses, these results suggest that Giant Viruses represent an underestimated source of new genes and functions for their hosts. Copyright © 2014 Elsevier Inc. All rights reserved.

  6. Multiple Infectious Agents and the Origins of Atherosclerotic Coronary Artery Disease.

    PubMed

    Lawson, James S

    2016-01-01

    Although deaths due to atherosclerotic coronary artery disease (ACAD) have fallen dramatically during the past 50 years, ACAD remains as the leading cause of death in all continents, except Africa, where deaths due to infections are still dominant. Although food and nutrition have a proven role in atherosclerosis, the underlying causes of ACAD remain unknown. This is despite a century of intensive research dominated by investigations into the saturated fat hypothesis. In this review, it is hypothesized that the rise and fall in ACAD during the past 100 years is primarily due to the parallel rise and fall in the prevalence of coronary atheroma, the underlying disease. It is further hypothesized that infectious pathogens initiate atherosclerosis mainly during infancy and childhood. It is speculated that widespread use of antibiotics and vaccines against bacterial and viral infections may be the reason for the dramatic fall in coronary atheroma and ACAD during the past 50 years. The relevant evidence and a working hypothesis are included in this review.

  7. Multiple Infectious Agents and the Origins of Atherosclerotic Coronary Artery Disease

    PubMed Central

    Lawson, James S.

    2016-01-01

    Although deaths due to atherosclerotic coronary artery disease (ACAD) have fallen dramatically during the past 50 years, ACAD remains as the leading cause of death in all continents, except Africa, where deaths due to infections are still dominant. Although food and nutrition have a proven role in atherosclerosis, the underlying causes of ACAD remain unknown. This is despite a century of intensive research dominated by investigations into the saturated fat hypothesis. In this review, it is hypothesized that the rise and fall in ACAD during the past 100 years is primarily due to the parallel rise and fall in the prevalence of coronary atheroma, the underlying disease. It is further hypothesized that infectious pathogens initiate atherosclerosis mainly during infancy and childhood. It is speculated that widespread use of antibiotics and vaccines against bacterial and viral infections may be the reason for the dramatic fall in coronary atheroma and ACAD during the past 50 years. The relevant evidence and a working hypothesis are included in this review. PMID:27672638

  8. Prevalence of high-risk thallium-201 scintigraphic findings in left main coronary artery stenosis: comparison with patients with multiple- and single-vessel coronary artery disease

    SciTech Connect

    Nygaard, T.W.; Gibson, R.S.; Ryan, J.M.; Gascho, J.A.; Watson, D.D.; Beller, G.A.

    1984-02-01

    To determine the prevalence of high-risk thallium-201 (Tl-201) scintigraphic findings in patients with left main (LM) coronary artery disease (CAD), quantitative exercise Tl-201 scintigrams were analyzed in 295 consecutive patients with angiographic (greater than or equal to 50% stenosis) CAD, of which 43 (14%) had greater than or equal to 50% LM stenosis. A high-risk scintigram was defined as one that demonstrated (1) a LMCAD scintigraphic pattern (greater than or equal to 25% homogeneous decrease in Tl-201 activity in the middle and upper septal and posterolateral walls on the 45 degree left anterior oblique projection); (2) abnormal Tl-201 uptake or washout in multiple vascular scan segments indicative of multivessel disease; and (3) increased lung Tl-201 uptake on the initial anterior projection image. Of the 43 patients with LMCAD, 41 (95%) had an abnormal scintigram. Thirty-three (77%) had 1 or more high-risk scintigraphic findings, including 29 (67%) with a multivessel CAD scan pattern, of which 6 (14%) demonstrated a typical LMCAD pattern; and 18 (42%) with abnormal lung Tl-201 uptake. The prevalence of a high-risk scintigram in patients with LMCAD was significantly greater than that in 53 patients with 3-vessel disease (58%) (p . 0.05), 99 patients with 2-vessel disease (60%) (p . 0.04) and 100 patients with 1-vessel disease (41%) (p less than 0.0001).

  9. A case of percutaneous coronary intervention procedure successfully bailed out from multiple complications in hemodialysis patient.

    PubMed

    Kawamura, Yota; Nagaoka, Masakazu; Ito, Daiki; Iseki, Harukazu; Ikari, Yuji

    2013-01-01

    A 73 year-old male who underwent coronary artery bypass surgery (CABG) 8 years ago had PCI performed on him for a diffuse calcified stenotic lesion in the right coronary artery (RCA). Following 2.5 mm non-compliant balloon dilatation supported with a child catheter (Dio from Goodman), we implanted a stent to the distal RCA through this catheter. However, because the tip of Dio was trapped by the implanted stent, it was stretched and almost ruptured by pulling it. Next, we tried to implant a stent for mid RCA with buddy wire technique, but we could not deploy it because of calcification. When we tried to withdraw this stent system, the stent was accidentally dislodged from the balloon. We could withdraw the stent with twisting two wires. However, because one of these wires had crossed a small artery in the distal RCA at twisting, a tip of this wire was fractured when the stent was removed. We could remove this wire with gooseneck snare. Finally, we successfully implanted stents in the mid RCA with balloon anchor technique and to the proximal RCA.

  10. Analog electrical model of the coronary circulation in case of multiple revascularizations.

    PubMed

    Maasrani, Mahmoud; Verhoye, Jean-Philippe; Corbineau, Herve; Drochon, Agnes

    2008-07-01

    In this work, we propose an analog electrical model of the coronary circulation for patients with obstructive disease undergoing revascularization. In this clinical situation, the collateral circulation to the occluded artery is difficult to ascertain via preoperative measurements and well-developed collaterals might induce long-term restenosis of the revascularized artery due to flow competition mechanisms. The proposed model allows an original biomechanical analysis of per-operative hemodynamic data in order to assess quantitative evaluation of pressures and flows inside the native stenosed arteries, the collateral network and the bypass grafts. Average cardiac cycle values are analysed. In the case of 3-vessel disease and chronic occlusion of the right coronary artery, the quantitative results confirm the protective effects of the collateral flows in the pathological situation, but also show that the revascularization of the occluded right artery is fully justified since the collateral flows remain low, even when the left territory is revascularized. The model thus provides a computational tool to evaluate therapeutic strategies for each patient.

  11. Logistic regression analysis of multiple noninvasive tests for the prediction of the presence and extent of coronary artery disease in men

    SciTech Connect

    Hung, J.; Chaitman, B.R.; Lam, J.; Lesperance, J.; Dupras, G.; Fines, P.; Cherkaoui, O.; Robert, P.; Bourassa, M.G.

    1985-08-01

    The incremental diagnostic yield of clinical data, exercise ECG, stress thallium scintigraphy, and cardiac fluoroscopy to predict coronary and multivessel disease was assessed in 171 symptomatic men by means of multiple logistic regression analyses. When clinical variables alone were analyzed, chest pain type and age were predictive of coronary disease, whereas chest pain type, age, a family history of premature coronary disease before age 55 years, and abnormal ST-T wave changes on the rest ECG were predictive of multivessel disease. The percentage of patients correctly classified by cardiac fluoroscopy (presence or absence of coronary artery calcification), exercise ECG, and thallium scintigraphy was 9%, 25%, and 50%, respectively, greater than for clinical variables, when the presence or absence of coronary disease was the outcome, and 13%, 25%, and 29%, respectively, when multivessel disease was studied; 5% of patients were misclassified. When the 37 clinical and noninvasive test variables were analyzed jointly, the most significant variable predictive of coronary disease was an abnormal thallium scan and for multivessel disease, the amount of exercise performed. The data from this study provide a quantitative model and confirm previous reports that optimal diagnostic efficacy is obtained when noninvasive tests are ordered sequentially. In symptomatic men, cardiac fluoroscopy is a relatively ineffective test when compared to exercise ECG and thallium scintigraphy.

  12. A complete metal jacket case using ten paclitaxel-eluting stents for multiple de novo coronary artery lesions.

    PubMed

    Suh, Soon Yong; Rha, Seung-Woon; Choi, Cheol Ung; Kim, Jin Won; Kim, Eung Ju; Park, Chang Gyu; Seo, Hong Seog; Oh, Dong Joo

    2007-02-07

    Although full metal jacket using drug-eluting stent (DES) for a single coronary artery disease has sparsely been described before, there is no report of safety and efficacy of complete metal jacket from left main (LM) to three major coronary arteries. We report a complete metal jacket case using 10 paclitaxel-eluting stents (PES; Taxus, Boston Scientific) for a triple vessel diffuse de novo coronary diseases who refused coronary artery bypass graft.

  13. Multiple composite grafts (k, π or double-Y) in coronary artery surgery: a choice or a necessity?

    PubMed

    Mannacio, Vito; Cirillo, Plinio; Mannacio, Luigi; Antignano, Anita; Mottola, Michele; Vosa, Carlo

    2015-01-01

    Composite grafts allow complete arterial revascularization with minimal aortic manipulations. The Y-T configuration supplies all distal branches adequately, whereas it is unclear whether complex composite configurations (K, Π or double-Y) are equally at rest or when challenged by maximal requirements. Forty-seven patients who underwent off-pump coronary artery revascularization by multiple arterial composite grafts (K, Π or double-Y) were retrospectively evaluated. Indication for this surgical option was porcelain aorta or conduit unavailability. Composite systems were evaluated by intraoperative flow measurements and perioperative transthoracic Doppler ultrasonography, 12 months later also by exercise test, sestamibi scintigraphy at rest and during induced hyperaemia and by 64-slice multidetector CT angiography. A total of 141 distal anastomoses were implanted as composite grafts. Perioperative flow measurements and 12-month Doppler ultrasonography were adequate at rest. At stress test, chest pain and/or induced ECG evidence of ischaemia are found in 16 patients (39%). During dipyridamole-induced hyperaemia, single-photon emission computed tomography image revealed that mean summed stress score was 7.2 ± 5.7, summed difference score 5.3 ± 4.2 and coronary flow reserve 1.7 ± 0.2. Multiple composite grafts, albeit adequate at rest, were unable to meet flow requirements during maximal hyperaemia. In daily practice, their use must be not a choice but rather a necessity in those patients without alternative options. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  14. Prediction of Coronary Artery Disease Risk Based on Multiple Longitudinal Biomarkers

    PubMed Central

    Yang, Lili; Yu, Menggang; Gao, Sujuan

    2016-01-01

    In the last decade, few topics in the area of cardiovascular disease (CVD) research have received as much attention as risk prediction. One of the well documented risk factors for CVD is high blood pressure (BP). Traditional CVD risk prediction models consider BP levels measured at a single time and such models form the basis for current clinical guidelines for CVD prevention. However, in clinical practice, BP levels are often observed and recorded in a longitudinal fashion. Information on BP trajectories can be powerful predictors for CVD events. We consider joint modeling of time to coronary artery disease and individual longitudinal measures of systolic and diastolic BPs in a primary care cohort with up to 20 years of follow-up. We applied novel prediction metrics to assess the predictive performance of joint models. Predictive performances of proposed joint models and other models were assessed via simulations and illustrated using the primary care cohort. PMID:26439685

  15. Single versus multiple internal mammary artery grafting for coronary artery bypass: 15-year follow-up of a clinical practice trial.

    PubMed

    Burfeind, William R; Glower, Donald D; Wechsler, Andrew S; Tuttle, Robert H; Shaw, Linda K; Harrell, Frank E; Rankin, J Scott

    2004-09-14

    The long-term clinical advantages of using routine multiple internal mammary artery (IMA) grafts for coronary artery bypass (CAB) are not clear. This study was designed to test the hypothesis that multiple IMA grafts would provide better 15-year outcomes when compared with single IMA and vein grafts. Between 1984 and 1987, 1067 consecutive patients undergoing isolated CAB were referred to 1 surgeon practicing primarily single and another surgeon maximizing multiple IMA grafts (clinical practice trial). A 207-patient subset with multiple IMAs underwent postoperative graft angiography at 1 to 32 weeks to define initial IMA patency. Patients were followed-up yearly, and the groups were analyzed as (I) surgical strategy (surgeon operating) (single=413 versus multiple=654), (II) ultimate operation performed (single=418 versus multiple=449), or (III) single versus multiple coronary systems revascularized with IMAs (single=490 versus multiple=377). Advantages of this study design were that an entire referral population was examined, multiple IMAs were applied to the entire spectrum of baseline patient risk, 15-year follow-up provided a complete prognostic picture, and the subgroups were potentially comparable at baseline. In all 3 analyses, single and multiple groups were statistically similar with respect to baseline, operative, and immediate postoperative variables. Early IMA patency was 98.5% (333/338 grafts patent), validating the quality of IMA procedures. Unadjusted and adjusted 15-year outcome analyses for I, II, and III for death, myocardial infarction, percutaneous coronary intervention, redo coronary bypass, and the composite of all events identified multiple versus single as a significant predictor of outcome for the composite end point in adjusted analysis III (hazard ratio=0.808; 95% CI, 0.689 to 0.948; P=0.009), because of a 5% to 10% absolute reduction in each of the outcome variables at 15 years. Moreover, >50% reduction in reoperation rate was observed at

  16. Relationship of the estrogen surge and multiple mates to cub paternity in the giant panda (Ailuropoda melanoleuca): implications for optimal timing of copulation or artificial insemination.

    PubMed

    Huang, Yan; Zhang, Hemin; Li, Desheng; Zhang, Guiquan; Wei, Rongping; Huang, Zhi; Zhou, Yingmin; Zhou, Qiang; Liu, Yang; Wildt, David E; Hull, Vanessa

    2012-11-01

    The effectiveness of ex situ breeding programs for endangered species can be limited by challenges in mimicking mating competitions that naturally occur among multiple mates in the wild. The objective of this study was to evaluate the impact of timed natural matings and/or artificial inseminations in the context of the urinary estrogen surge on cub production in the giant panda (Ailuropoda melanoleuca). We used a large cohort of giant pandas, including 12 females and 17 males. DNA paternity exclusion was used to pinpoint accurately the interval during the estrogen surge that coincided with the ideal sperm deposition time to produce offspring. Of the 31 cubs (in 19 pregnancies), 22 (71.0%; 15 pregnancies) were produced from matings occurring on the day of or the day after the maximal urinary estrogen peak. Sixteen of the 19 pregnancies (84.2%) produced at least one offspring sired by the first male mating with the dam. There was a preponderance of twins (12 of 19; 63.2%), and dual paternities were discovered in 3 of 12 twin sets (25%). These findings indicate a strong relationship between the excreted estrogen surge and sperm deposition to achieve pregnancy in the giant panda. To ensure the production of the most genetically diverse young, it is imperative that the most appropriate male mate first and on the day of or the day after the highest detected estrogen value. There is no advantage to increasing the number of copulations or mating partners within 1 day of the estrogen peak on the incidence of twinning, although this practice may increase the prevalence of dual paternity in cases of multiple births.

  17. Successful endovascular reconstruction of a recurrent giant middle cerebral artery aneurysm with multiple telescoping flow diverters in a pediatric patient.

    PubMed

    Ikeda, Daniel S; Marlin, Evan S; Shaw, Andrew; Powers, Ciarán J

    2015-01-01

    Intracranial aneurysms of the pediatric population are rare, but giant fusiform aneurysms (GFAs) of the middle cerebral artery (MCA) are common within this cohort of patients. These aneurysms are difficult to treat and often require advanced microsurgical skills, as they are usually not amenable to direct clipping. Here, we report the successful treatment of a recurrent GFA of the MCA with three telescoping Pipeline Embolization Devices 6 months after attempted clip reconstruction in a pediatric patient. © 2015 S. Karger AG, Basel.

  18. Targeting multiple pathways reduces renal and cardiac fibrosis in rats with subtotal nephrectomy followed by coronary ligation.

    PubMed

    Oosterhuis, N R; Bongartz, L G; Verhaar, M C; Cheng, C; Xu, Y J; van Koppen, A; Cramer, M J; Goldschmeding, R; Gaillard, C A; Doevendans, P A; Braam, B; Joles, J A

    2017-07-01

    Multiple interacting pathways contribute to progression of renal and cardiac damage in chronic kidney disease followed by chronic heart failure (renocardiac syndrome). We hypothesized that simultaneous pharmacological modulation of critical pathways implicated in renocardiac syndrome would effectively reduce fibrosis in and preserve function of heart and kidney. Rats were subjected to subtotal nephrectomy followed 9 weeks later by coronary artery ligation. From week 11 until week 16, rats received vehicle or losartan, or a combination of the NF-kB inhibitor PDTC, the NO donor molsidomine and superoxide dismutase mimetic tempol, or a combination of all four of these plus metoprolol together. At week 16, renal and cardiac structure, function and gene expression were assessed. Individual and combined treatments were similarly effective in limiting cardiac fibrosis and further decline in systolic function. Combined treatment with all five drugs reduced renal fibrosis and CTGF gene expression more effectively than other strategies. Combining all five drugs reduced heart rate, inotropy and mean arterial pressure (MAP). Thus, in our model of chronic renocardiac syndrome, combined treatments similarly decreased cardiac fibrosis and stabilized systolic function as losartan alone, perhaps suggesting a dominant role for a single factor such as angiotensin II type 1 (AT1) receptor activation or inflammation in the network of aberrant systems in the heart. However, tubulointerstitial fibrosis was most effectively reduced by a five-drug regimen, pointing to additive effects of multiple pathophysiological pathways in the kidney. © 2016 Scandinavian Physiological Society. Published by John Wiley & Sons Ltd.

  19. Adding multiple risk factors improves Framingham coronary heart disease risk scores

    PubMed Central

    Hu, Guizhou; Root, Martin; Duncan, Ashlee W

    2014-01-01

    Purpose Since the introduction of the Framingham Risk Score (FRS), numerous versions of coronary heart disease (CHD) prediction models have claimed improvement over the FRS. Tzoulaki et al challenged the validity of these claims by illustrating methodology deficiencies among the studies. However, the question remains: Is it possible to create a new CHD model that is better than FRS while overcoming the noted deficiencies? To address this, a new CHD prediction model was developed by integrating additional risk factors, using a novel modeling process. Methods Using the National Health Nutritional Examination Survey III data set with CHD-specific mortality outcomes and the Atherosclerosis Risk in Communities data set with CHD incidence outcomes, two FRSs (FRSv1 from 1998 and FRSv2 from National Cholesterol Education Program Adult Treatment Panel III), along with an additional risk score in which the high density lipoprotein (HDL) component of FRSv1 was ignored (FRSHDL), were compared with a new CHD model (NEW-CHD). This new model contains seven elements: the original Framingham equation, FRSv1, and six additional risk factors. Discrimination, calibration, and reclassification improvements all were assessed among models. Results Discrimination was improved for NEW-CHD in both cohorts when compared with FRSv1 and FRSv2 (P<0.05) and was similar in magnitude to the improvement of FRSv1 over FRSHDL. NEW-CHD had a similar calibration to FRSv2 and was improved over FRSv1. Net reclassification for NEW-CHD was substantially improved over both FRSv1 and FRSv2, for both cohorts, and was similar in magnitude to the improvement of FRSv1 over FRSHDL. Conclusion While overcoming several methodology deficiencies reported by earlier authors, the NEW-CHD model improved CHD risk assessment when compared with the FRSs, comparable to the improvement of adding HDL to the FRS. PMID:25228812

  20. Adding multiple risk factors improves Framingham coronary heart disease risk scores.

    PubMed

    Hu, Guizhou; Root, Martin; Duncan, Ashlee W

    2014-01-01

    Since the introduction of the Framingham Risk Score (FRS), numerous versions of coronary heart disease (CHD) prediction models have claimed improvement over the FRS. Tzoulaki et al challenged the validity of these claims by illustrating methodology deficiencies among the studies. However, the question remains: Is it possible to create a new CHD model that is better than FRS while overcoming the noted deficiencies? To address this, a new CHD prediction model was developed by integrating additional risk factors, using a novel modeling process. Using the National Health Nutritional Examination Survey III data set with CHD-specific mortality outcomes and the Atherosclerosis Risk in Communities data set with CHD incidence outcomes, two FRSs (FRSv1 from 1998 and FRSv2 from National Cholesterol Education Program Adult Treatment Panel III), along with an additional risk score in which the high density lipoprotein (HDL) component of FRSv1 was ignored (FRSHDL), were compared with a new CHD model (NEW-CHD). This new model contains seven elements: the original Framingham equation, FRSv1, and six additional risk factors. Discrimination, calibration, and reclassification improvements all were assessed among models. Discrimination was improved for NEW-CHD in both cohorts when compared with FRSv1 and FRSv2 (P<0.05) and was similar in magnitude to the improvement of FRSv1 over FRSHDL. NEW-CHD had a similar calibration to FRSv2 and was improved over FRSv1. Net reclassification for NEW-CHD was substantially improved over both FRSv1 and FRSv2, for both cohorts, and was similar in magnitude to the improvement of FRSv1 over FRSHDL. While overcoming several methodology deficiencies reported by earlier authors, the NEW-CHD model improved CHD risk assessment when compared with the FRSs, comparable to the improvement of adding HDL to the FRS.

  1. Coronary Heart Disease Risk between Active and Inactive Women with Multiple Sclerosis.

    ERIC Educational Resources Information Center

    Slawta, Jennifer N.; McCubbin, Jeffrey A.; Wilcox, Anthony R.; Fox, Susan D.; Nalle, Darek J.; Anderson, Gail

    2002-01-01

    Investigated whether abdominal fat accumulation and levels of triglyceride, high-density lipoprotein cholesterol, and glucose differed between 123 active and inactive women with multiple sclerosis (MS). Results indicated that low-to-moderate leisure time physical activity significantly related to less abdominal fat accumulation, lower triglyceride…

  2. Coronary Heart Disease Risk between Active and Inactive Women with Multiple Sclerosis.

    ERIC Educational Resources Information Center

    Slawta, Jennifer N.; McCubbin, Jeffrey A.; Wilcox, Anthony R.; Fox, Susan D.; Nalle, Darek J.; Anderson, Gail

    2002-01-01

    Investigated whether abdominal fat accumulation and levels of triglyceride, high-density lipoprotein cholesterol, and glucose differed between 123 active and inactive women with multiple sclerosis (MS). Results indicated that low-to-moderate leisure time physical activity significantly related to less abdominal fat accumulation, lower triglyceride…

  3. Small bowel intussusception caused by multiple intestinal metastases from a giant cell carcinoma of the lung: a case report.

    PubMed

    Mandeville, Y; de Gheldere, C; Vanclooster, P

    2015-01-01

    Small bowel obstruction (SBO) due to intussusception in adults is a rare condition. Diagnosis at the time of admission is usually challenging. More often than not, a bowel intussusception in adults is secondary to an organic condition, frequently malignancies. Therefore, a surgical approach is indicated most of the times. We report the case of a forty-nine years old lady presenting with a SBO secondary to small bowel metastases with two ileo-ileal intussusceptions, one of which was missed at initial surgical exploration. A giant cell carcinoma of the lung (GCCL) with small bowel metastases was diagnosed subsequently. The case is presented as well as a brief review of literature.

  4. Small Bowel Intussusception Caused by Multiple Intestinal Metastases from a Giant Cell Carcinoma of the Lung: a Case Report.

    PubMed

    Mandeville, Y; de Gheldere, C; Vanclooster, P

    2015-01-01

    Small bowel obstruction (SBO) due to intussusception in adults is a rare condition. Diagnosis at the time of admission is usually challenging. More often than not, a bowel intussusception in adults is secondary to an organic condition, frequently malignancies. Therefore, a surgical approach is indicated most of the times. We report the case of a forty-nine years old lady presenting with a SBO secondary to small bowel metastases with two ileo-ileal intussusceptions, one of which was missed at initial surgical exploration. A giant cell carcinoma of the lung (GCCL) with small bowel metastases was diagnosed subsequently. The case is presented as well as a brief review of literature.

  5. The role of tree nuts and peanuts in the prevention of coronary heart disease: multiple potential mechanisms.

    PubMed

    Kris-Etherton, Penny M; Hu, Frank B; Ros, Emilio; Sabaté, Joan

    2008-09-01

    Epidemiologic and clinical trial evidence has demonstrated consistent benefits of nut and peanut consumption on coronary heart disease (CHD) risk and associated risk factors. The epidemiologic studies have reported various endpoints, including fatal CHD, total CHD death, total CHD, and nonfatal myocardial infarct. A pooled analysis of 4 U.S. epidemiologic studies showed that subjects in the highest intake group for nut consumption had an approximately 35% reduced risk of CHD incidence. The reduction in total CHD death was due primarily to a decrease in sudden cardiac death. Clinical studies have evaluated the effects of many different nuts and peanuts on lipids, lipoproteins, and various CHD risk factors, including oxidation, inflammation, and vascular reactivity. Evidence from these studies consistently shows a beneficial effect on these CHD risk factors. The LDL cholesterol-lowering response of nut and peanut studies is greater than expected on the basis of blood cholesterol-lowering equations that are derived from changes in the fatty acid profile of the diet. Thus, in addition to a favorable fatty acid profile, nuts and peanuts contain other bioactive compounds that explain their multiple cardiovascular benefits. Other macronutrients include plant protein and fiber; micronutrients including potassium, calcium, magnesium, and tocopherols; and phytochemicals such as phytosterols, phenolic compounds, resveratrol, and arginine. Nuts and peanuts are food sources that are a composite of numerous cardioprotective nutrients and if routinely incorporated in a healthy diet, population risk of CHD would therefore be expected to decrease markedly.

  6. Whole-heart magnetic resonance coronary angiography with multiple breath-holds and automatic breathing-level tracking

    NASA Astrophysics Data System (ADS)

    Kuhara, Shigehide; Ninomiya, Ayako; Okada, Tomohisa; Kanao, Shotaro; Kamae, Toshikazu; Togashi, Kaori

    2010-05-01

    Whole-heart (WH) magnetic resonance coronary angiography (MRCA) studies are usually performed during free breathing while monitoring the position of the diaphragm with real-time motion correction. However, this results in a long scan time and the patient's breathing pattern may change, causing the study to be aborted. Alternatively, WH MRCA can be performed with multiple breath-holds (mBH). However, one problem in the mBH method is that patients cannot hold their breath at the same position every time, leading to image degradation. We have developed a new WH MRCA imaging method that employs both the mBH method and automatic breathing-level tracking to permit automatic tracking of the changes in breathing or breath-hold levels. Evaluation of its effects on WH MRCA image quality showed that this method can provide high-quality images within a shorter scan time. This proposed method is expected to be very useful in clinical WH MRCA studies.

  7. [Gigantic coronary aneurysm arisen from coronary fistula between the left circumflex artery and the left ventricle].

    PubMed

    Uchida, T; Andou, H; Yasutsune, T; Iwai, T; Fukumura, F; Tanaka, J

    2008-12-01

    A 71-year-old male was referred to our hospital due to abnormality detected by a chest roentgenogram. He had no symptoms except for slight chest oppression. He was found to have a giant coronary aneurysm. It was originated from a coronary artery (left circum flex branch) left ventricular fistula. The orifice of this fistula to the left ventricle was also dilated and formed diverticulum. Ligation of the feeding coronary branch, closure of the aneurysmal fistula in the left ventricular wall and aneurysmectomy were performed under cardiopulmonary bypass. Postoperative course was uneventful. A giant aneurysm originated from a coronary-left ventricular fistula was considered to be very rare.

  8. Coronary Arteries

    MedlinePlus

    ... and animations for grades K-6. The Coronary Arteries Coronary Circulation The heart muscle, like every other ... into two main coronary blood vessels (also called arteries). These coronary arteries branch off into smaller arteries, ...

  9. Self-condensation of a thiazole-peptide bearing a 21-membered loop into a library of giant macrocycles with multiple orthogonal loops.

    PubMed

    Singh, Yogendra; Hoang, Huy N; Flanagan, Bernadine; Fairlie, David P

    2006-03-16

    [reaction: see text] Tetrapeptide analogue H-[Glu-Ser-Lys(Thz)]-OH, containing a turn-inducing thiazole constraint, was used as a template to produce a 21-membered structurally characterized loop by linking Glu and Lys side chains with a Val-Ile dipeptide. This template was oligomerized in one pot to a library (cyclo-[1](n)(), n = 2-10) of giant symmetrical macrocycles (up to 120-membered rings), fused to 2-10 appended loops that were carried intact through multiple oligomerization (chain extension) and cyclization (chain terminating) reactions of the template. A three-dimensional solution structure for cyclo-[1](3) shows all three appended loops projecting from the same face of the macrocycle. This is a promising approach to separating peptide motifs over large distances.

  10. Rare multiple fistulas with large saccular aneurysms originating from left anterior descending artery and left main coronary artery.

    PubMed

    Emre, Ender; Aktas, Mujdat; Sahin, Tayfun; Ural, Ertan; Ural, Dilek

    2014-12-16

    A 49-year-old female patient consulted us for a cardiac evaluation before undergoing colon adenocarcinoma surgery. Three years prior, the patient underwent coronary angiography for dyspnea. The coronary angiography examination revealed a fistula originating from the left anterior descending artery and left main coronary artery, which had soft aneurysmal sacs and most likely drained into the pulmonary artery. Parasternal short axis echocardiography revealed a color flow that could be related to the fistula, but the other echocardiographic findings were normal. The patient did not accept the proposed examination and invasive treatment.

  11. Rare multiple fistulas with large saccular aneurysms originating from left anterior descending artery and left main coronary artery

    PubMed Central

    Emre, Ender; Aktas, Mujdat; Sahin, Tayfun; Ural, Ertan; Ural, Dilek

    2014-01-01

    A 49-year-old female patient consulted us for a cardiac evaluation before undergoing colon adenocarcinoma surgery. Three years prior, the patient underwent coronary angiography for dyspnea. The coronary angiography examination revealed a fistula originating from the left anterior descending artery and left main coronary artery, which had soft aneurysmal sacs and most likely drained into the pulmonary artery. Parasternal short axis echocardiography revealed a color flow that could be related to the fistula, but the other echocardiographic findings were normal. The patient did not accept the proposed examination and invasive treatment. PMID:25516873

  12. Visualization and quantitation of coronary arteries using multiple-view energy subtraction digital radiography. Interim report 30 September 1983-29 September 1984

    SciTech Connect

    Macovski, A.

    1984-08-27

    The authors have studied a general approach to the imaging of coronary arteries using minimally invasive intravenous administration of contrast material. Using conventional DSA techniques this visualization would fail due to motion, low SNR, and intervening iodinated structures. The authors have implemented the digital fluoroscopy system with a rotating gantry and tested it on phantoms. Evaluation of stenosis in coronary arteries is difficult with low SNR images. The authors have studied and implemented a vessel outlining system using a global estimation procedure. The most recent approach has significantly improved computational efficiency. The processing of multiple-energy data to eliminate the moving soft tissue results in a noise penalty. The authors have studied and implemented an approach to restore the original SNR by deriving the high frequency components from a non-selective image. The authors have also implemented a scatter-cancellation system for minimizing this source of error.

  13. Progress in coronary angioplasty.

    PubMed

    Silverton, P

    1986-10-01

    Angioplasty offers an alternative to bypass grafting for an increasing number of patients with coronary artery disease. Improvements in catheter design and manufacture have been responsible for an enlargement of the indications which now include patients with multiple vessel coronary artery disease and those with acute evolving myocardial infarction. The application of laser technology may assist in the reopening of chronically occluded arteries.

  14. The Gaia-ESO Spectroscopic Survey: CNO abundances in giants of the multiple-population globular cluster NGC 1851

    NASA Astrophysics Data System (ADS)

    Tautvaisiene, Grazina; Drazdauskas, Arnas; Lardo, Carmela; Martell, Sarah; Pancino, Elena; Stonkute, Edita

    2015-08-01

    It has been suspected already more than thirty year ago that NGC 1851 is not chemically homogeneous. By now, it is clear that NGC 1851 has two distinct subgiant branches, however explanations of their origin so far lack consensus. Some authors explain them by two generations of stars, the first being primordial, while the second one being born from the ejecta of a fraction of the stars of the earlier one. There are suggestions that NGC 1851 might be the result of a merger of two globular clusters, or originated as the nucleus of a dwarf galaxy that was captured by the Milky Way. In this presentation, we provide a crucial missing information on CNO abundances determined in a homogeneous way for a large sample of NGC 1851 giants. High-resolution spectra were obtained with the VLT UVES spectrograph in a framework of the Gaia-ESO Survey. From the investigated stars we clearly see that the two NGC 1851 populations have by about 0.2 dex difference in metallicity, the sums of C+O+N differ by about 0.1 dex, the mean C/N ratio values differ by about 0.5 dex, chemical elements that are insensitive to internal stellar mixing show normal Galactic abundances of the corresponding metallicities. This leads us to the conclusion that NGC 1851 is a binary cluster. We provide interpretations of these and other results of the study.

  15. Intravascular Ultrasound-Guided Percutaneous Coronary Intervention Improves the Clinical Outcome in Patients Undergoing Multiple Overlapping Drug-Eluting Stents Implantation

    PubMed Central

    Ahn, Sung Gyun; Sung, Joong Kyung; Lee, Ji-Hyun; Lee, Jun-Won; Youn, Young-Jin; Ahn, Min-Soo; Kim, Jang-Young; Yoo, Byung-Su; Lee, Seung-Hwan; Choe, Kyung-Hoon

    2013-01-01

    Background and Objectives Stented segment length is a predictive factor for restenosis and stent thrombosis still in the drug-eluting stent (DES) era, and the benefit of routine intravascular ultrasound (IVUS) is still unclear. The aim of the present study was to investigate whether IVUS-guided percutaneous coronary intervention (PCI) improved the vascular outcomes as compared with conventional PCI in the treatment of diffuse coronary artery disease. Subjects and Methods From our registry database from January 2006 to May 2009, we identified 85 consecutive patients with de novo coronary lesions treated with at least 64 mm of multiple, overlapping DES. The 2-year rate of major adverse cardiovascular events (MACE), defined as the composite of cardiovascular death, non-fatal myocardial infarction, target lesion revascularization (TLR), or stent thrombosis, was compared according to the use of IVUS. Results The 2-year MACE rate was lower in the IVUS-guided group than that of the angiography-guided group (8% vs. 33.3%, p=0.005). The incidence of TLR was lower in patients with IVUS use than in those without IVUS use (0% vs. 27.8%, p<0.001). On Cox proportional hazard analysis, no IVUS use {hazard ratio (HR) 5.917, 95% confidence interval (CI) 1.037-33.770, p=0.045} and age (HR 1.097, 95% CI 1.006-1.138, p=0.032) were unfavorable predictors for the 2-year MACE. Conclusion The use of IVUS may improve the effectiveness and safety of multiple overlapping drug-eluting stenting for long, diffuse coronary lesions. PMID:23682282

  16. Multiple origins of European populations of the giant liver fluke Fascioloides magna (Trematoda: Fasciolidae), a liver parasite of ruminants.

    PubMed

    Králová-Hromadová, Ivica; Bazsalovicsová, Eva; Stefka, Jan; Spakulová, Marta; Vávrová, Silvia; Szemes, Tomáš; Tkach, Vasyl; Trudgett, Alan; Pybus, Margo

    2011-03-01

    The giant liver fluke, Fascioloides magna, a liver parasite of free-living and domestic ruminants of Europe and North America, was analysed in order to determine the origin of European populations and to reveal the biogeography of this originally North American parasite on the European continent. The variable fragments of the mitochondrial cytochrome c oxidase subunit I (cox1; 384bp) and nicotinamide dehydrogenase subunit I (nad1; 405bp) were used. Phylogenetic trees and haplotype networks were constructed and the level of genetic structuring was evaluated using population genetic tools. In F. magna individuals originating from all European foci of infection (Italy, Czech Republic and Danube floodplain forests involving the territories of Slovakia, Hungary and Croatia) and from four of five major North American enzootic areas, 16 cox1 and 18 nad1 haplotypes were determined. The concatenated sequence set produced 22 distinct haplotypes. The European fluke populations were less diverse than those from North America in that they contained proportionately fewer haplotypes (eight), while a more substantial level of genetic diversity and a greater number of haplotypes (15) were recorded in North America. Only one haplotype was shared between the European (Italy) and North American (USA/Oregon and Canada/Alberta) flukes, supporting a western North American origin of the Italian F. magna population. Haplotypes found in Italy were distinct from those determined in the remaining European localities which indicates that introduction of F. magna to the European continent occurred more than once. In the Czech focus of infection, a south-eastern USA origin was revealed. Identical haplotypes, common to parasites from the Czech Republic and from an expanding focus in Danube floodplain forests, implies that the introduction of F. magna to the Danube region came from an already established Czech focus of infection. Copyright © 2010 Australian Society for Parasitology Inc. Published

  17. Adenosine Attenuates Human Coronary Artery Smooth Muscle Cell Proliferation By Inhibiting Multiple Signaling Pathways that Converge on Cyclin D

    PubMed Central

    Dubey, Raghvendra K.; Fingerle, Juergen; Gillespie, Delbert G.; Mi, Zaichuan; Rosselli, Marinella; Imthurn, Bruno; Jackson, Edwin K.

    2015-01-01

    The goal of this study was to determine whether and how adenosine affects the proliferation of human coronary artery smooth muscle cells (HCASMCs). In HCASMCs, 2-chloroadenosine (stable adenosine analogue), but not N6-cyclopentyladenosine, CGS21680, or N6-(3-iodobenzyl)-adenosine-5'-N-methyluronamide, inhibited HCASMC proliferation (A2B-receptor profile). 2-Chloroadenosine increased cAMP, reduced phosphorylation (activation) of ERK and Akt (protein kinases known to increase cyclin D expression and activity, respectively), and reduced levels of cyclin D1 (cyclin that promotes cell-cycle progression in G1). Moreover, 2-chloroadenosine inhibited expression of Skp2 (promotes proteolysis of p27Kip1) and up-regulated levels of p27Kip1 (cell-cycle regulator that impairs cyclin D function). 2-Chloroadenosine also inhibited signaling downstream of cyclin D including hyperphosphorylation of retinoblastoma protein and expression of cyclin A (S phase cyclin). Knockdown of A2B receptors prevented the effects of 2-chloroadenosine on ERK1/2, Akt, Skp2, p27Kip1, cyclin D1, cyclin A, and proliferation. Likewise, inhibition of adenylyl cyclase and protein kinase A abrogated 2-chloroadenosine’s inhibitory effects on Skp2 and stimulatory effects on p27Kip1, and rescued HCASMCs from 2-chloroadenosine-mediated inhibition. Knockdown of p27Kip1 also reversed the inhibitory effects of 2-chloroadenosine on HCASMC proliferation. In vivo, peri-arterial (rat carotid artery) 2-chloroadenosine (20 µmol/L for 7 days) down-regulated vascular expression of Skp2, up-regulated vascular expression of p27Kip1, and reduced neointima hyperplasia by 71% (p<0.05; neointimal thickness: control, 37,424±18,371 pixels; treated, 10,352±2,824 pixels). Conclusion The adenosine/A2B receptor/cAMP/protein kinase A axis inhibits HCASMC proliferation by blocking multiple signaling pathways (ERK1/2, Akt, and Skp2) that converge at cyclin D, a key G1 cyclin that controls cell-cycle progression. PMID:26416848

  18. Adenosine Attenuates Human Coronary Artery Smooth Muscle Cell Proliferation by Inhibiting Multiple Signaling Pathways That Converge on Cyclin D.

    PubMed

    Dubey, Raghvendra K; Fingerle, Jürgen; Gillespie, Delbert G; Mi, Zaichuan; Rosselli, Marinella; Imthurn, Bruno; Jackson, Edwin K

    2015-12-01

    The goal of this study was to determine whether and how adenosine affects the proliferation of human coronary artery smooth muscle cells (HCASMCs). In HCASMCs, 2-chloroadenosine (stable adenosine analogue), but not N(6)-cyclopentyladenosine, CGS21680, or N(6)-(3-iodobenzyl)-adenosine-5'-N-methyluronamide, inhibited HCASMC proliferation (A2B receptor profile). 2-Chloroadenosine increased cAMP, reduced phosphorylation (activation) of ERK and Akt (protein kinases known to increase cyclin D expression and activity, respectively), and reduced levels of cyclin D1 (cyclin that promotes cell-cycle progression in G1). Moreover, 2-chloroadenosine inhibited expression of S-phase kinase-associated protein-2 (Skp2; promotes proteolysis of p27(Kip1)) and upregulated levels of p27(Kip1) (cell-cycle regulator that impairs cyclin D function). 2-Chloroadenosine also inhibited signaling downstream of cyclin D, including hyperphosphorylation of retinoblastoma protein and expression of cyclin A (S phase cyclin). Knockdown of A2B receptors prevented the effects of 2-chloroadenosine on ERK1/2, Akt, Skp2, p27(Kip1), cyclin D1, cyclin A, and proliferation. Likewise, inhibition of adenylyl cyclase and protein kinase A abrogated 2-chloroadenosine's inhibitory effects on Skp2 and stimulatory effects on p27(Kip1) and rescued HCASMCs from 2-chloroadenosine-mediated inhibition. Knockdown of p27(Kip1) also reversed the inhibitory effects of 2-chloroadenosine on HCASMC proliferation. In vivo, peri-arterial (rat carotid artery) 2-chloroadenosine (20 μmol/L for 7 days) downregulated vascular expression of Skp2, upregulated vascular expression of p27(Kip1), and reduced neointima hyperplasia by 71% (P<0.05; neointimal thickness: control, 37 424±18 371 pixels; treated, 10 352±2824 pixels). In conclusion, the adenosine/A2B receptor/cAMP/protein kinase A axis inhibits HCASMC proliferation by blocking multiple signaling pathways (ERK1/2, Akt, and Skp2) that converge at cyclin D, a key G1 cyclin

  19. Giant Cell Arteritis

    MedlinePlus

    ... Patient / Caregiver Diseases & Conditions Giant Cell Arteritis Giant Cell Arteritis Fast Facts Giant cell arteritis (GCA) is ... polymyalgia rheumatica (also called PMR). What is giant cell arteritis? GCA is a type of vasculitis or ...

  20. Giant osteochondroma of axis in a child with multiple hereditary exostoses: case report and review of literature.

    PubMed

    Tahasildar, Naveen; Sudesh, Pebam; Goni, Vijay; Tripathy, Sujit Kumar

    2012-05-01

    Though osteochondromas are the most common benign bone tumour, their spinal involvement is less frequent. We report a case of osteochondroma in a 5-year-old female child with multiple hereditary exostoses that originated from posterior elements of C2 vertebra, not involving spinal canal and caused restriction of neck movement. It was excised from its base without disturbing the continuity of lamina. Two years later she had normal neck movements without any recurrence. The rarity of this tumour at this location, with such a large size at an early age, makes this article unique.

  1. Left Anterior Descending Coronary Artery and Multiple Peripheral Mycotic Aneurysms Due to Mycobacterium Bovis Following Intravesical Bacillus Calmette-Guerin Therapy: A Case Report

    PubMed Central

    Duvnjak, Petar; Laguna, Mario

    2016-01-01

    The use of live attenuated intravesicular Bacillus Calmette-Guerin (BCG) therapy is a generally accepted safe and effective method for the treatment of superficial transitional cell carcinoma (TCC) of the bladder. Although rare, < 5% of patient’s treated with intravesicular BCG therapy may develop potentially serious complications, including localized infections to the genitourinary tract, mycotic aneurysms and osteomyelitis. We present here a case of a 63-year-old male who developed left coronary and multiple peripheral M. Bovis mycotic aneurysms as a late complication of intravesicular BCG therapy for superficial bladder cancer. The patient initially presented with acute onset pain and swelling in the left knee > 2 years following initial therapy, and initial workup revealed a ruptured saccular aneurysm of the left popliteal artery as well as incidental bilateral common femoral artery aneurysms. Following endovascular treatment and additional workup, the patient was discovered to have additional aneurysms in the right popliteal artery and left anterior descending artery (LAD). Surgical pathology and bacterial cultures obtained from the excised femoral aneurysms and surgical groin wounds were positive for Mycobacterium Bovis, and the patient was initiated on a nine-month antimycobacterial course of isoniazid, rifampin and ethambutol. Including the present case, there has been a total of 32 reported cases of mycotic aneurysms as a complication from intravesicular BCG therapy, which we will review here. The majority of reported cases involve the abdominal aorta; however, this represents the first known reported case of a coronary aneurysm. PMID:27761190

  2. Tracking Advanced Planetary Systems (TAPAS) with HARPS-N . I. A multiple planetary system around the red giant star TYC 1422-614-1

    NASA Astrophysics Data System (ADS)

    Niedzielski, A.; Villaver, E.; Wolszczan, A.; Adamów, M.; Kowalik, K.; Maciejewski, G.; Nowak, G.; García-Hernández, D. A.; Deka, B.; Adamczyk, M.

    2015-01-01

    Context. Stars that have evolved off the main sequence are crucial for expanding the frontiers of knowledge on exoplanets toward higher stellar masses and for constraining star-planet interaction mechanisms. These stars have an intrinsic activity, however, which complicates the interpretation of precise radial velocity (RV) measurements, and therefore they are often avoided in planet searches. Over the past ten years, we have monitored about 1000 evolved stars for RV variations in search for low-mass companions under the Penn State - Toruń Centre for Astronomy Planet Search program with the Hobby-Eberly Telescope. Selected prospective candidates that required higher RV precision measurements have been followed with HARPS-N at the 3.6 m Telescopio Nazionale Galileo. Aims: We aim to detect planetary systems around evolved stars, to be able to build sound statistics on the frequency and intrinsic nature of these systems, and to deliver in-depth studies of selected planetary systems with evidence of star-planet interaction processes. Methods: We obtained 69 epochs of precise RV measurements for TYC 1422-614-1 collected over 3651 days with the Hobby-Eberly Telescope, and 17 epochs of ultra-precise HARPS-N data collected over 408 days. We complemented these RV data with photometric time-series from the All Sky Automatic Survey archive. Results: We report the discovery of a multiple planetary system around the evolved K2 giant star TYC 1422-614-1. The system orbiting the 1.15 M⊙ star is composed of a planet with mass msini = 2.5 MJ in a 0.69 AU orbit, and a planet or brown dwarf with msini = 10 MJ in an orbit of 1.37 AU. The multiple planetary system orbiting TYC 1422-614-1 is the first finding of the TAPAS project, a HARPS-N monitoring of evolved planetary systems identified with the Hobby-Eberly Telescope. Based on observations obtained with the Hobby-Eberly Telescope, which is a joint project of the University of Texas at Austin, the Pennsylvania State University

  3. Coronary microembolization.

    PubMed

    Skyschally, Andreas; Leineweber, Kkirsten; Gres, Petra; Haude, Michael; Erbel, Raimund; Heusch, Gerd

    2006-09-01

    Atherosclerotic plaque rupture is the key event in the pathogenesis of acute coronary syndromes and it also occurs during coronary interventions. Atherosclerotic plaque rupture does not always result in complete thrombotic occlusion of the epicardial coronary artery with subsequent impending myocardial infarction, but may in milder forms result in the embolization of atherosclerotic and thrombotic debris into the coronary microcirculation. This review summarizes the present experimental pathophysiology of coronary microembolization in animal models of acute coronary syndromes and highlights the main consequences of coronary microembolization--reduced coronary reserve, microinfarction, inflammation and oxidative modification of contractile proteins, contractile dysfunction and perfusion-contraction mismatch.Furthermore, the review presents the available clinical evidence for coronary microembolization in patients and compares the clinical observations with observations in the experimental model.

  4. Surviving All Odds: A Unique Case of Multiple Congenital Unruptured Sinus of Valsalva Aneurysms Involving Both Left and Right Coronary Sinuses with Biventricular Dysfunction and Heart Block

    PubMed Central

    Vijay B, Aniketh; Mathew, Navin

    2016-01-01

    Aneurysms of the sinus of Valsalva are very uncommon, with an incidence ranging from 0.1 to 3.5% of all congenital heart defects. Very few cases have been reported in the literature that presented with involvement of two or more sinuses. We report a case of 27-year-old male with a history of exertional breathlessness of one-month duration. After complete evaluation using transesophageal echocardiography (TEE) and multiple detector computed tomography (MDCT) scanning, the patient was diagnosed to have large congenital unruptured sinus of Valsalva aneurysms involving both left and right coronary sinuses with extension into the interventricular septum. The patient also displayed second-degree heart block (Mobitz type 2) and biventricular dysfunction. The patient was managed successfully. We present the case with an aim to highlight the management challenges including intraoperative and postoperative complications that are associated with unruptured sinus of Valsalva aneurysms of ≥2 sinuses. PMID:27882249

  5. Edge-to-Edge Technique to Minimize Ovelapping of Multiple Bioresorbable Scaffolds Plus Drug Eluting Stents in Revascularization of Long Diffuse Left Anterior Descending Coronary Artery Disease.

    PubMed

    Rigatelli, Gianluca; Avvocata, Fabio Dell'; Ronco, Federico; Giordan, Massimo; Roncon, Loris; Caprioglio, Francesco; Grassi, Giuseppe; Faggian, Giuseppe; Cardaioli, Paolo

    2016-06-01

    Implantation of Drug Eluting Stents (DES) plus bioresorbable scaffolds (BVS) in very long diffuse left anterior descending coronary artery (LAD) disease may be problematic because of multiple devices overlapping. We sought to assess the short and mid-tern outcomes of combined implantation of DES and BVS using a novel "edge-to-edge" technique in patients with diffuse LAD disease. Patients with long diffuse LAD disease were enrolled in a prospective registry from 1st August 2014 to 1st August 2015 and treated with IVUS-aided percutaneous coronary intervention using a DES plus a single or multiple BVS using a novel "edge-to-edge" technique. Clinical follow up and invasive follow up driven by clinical justification was performed. Twenty-three patients (5 females, mean age 59.1± 9.1 years) were enrolled. Mean length of LAD disease was 73.1 ± 20.6 mm. Mean number of DES and BVS implanted was 1.2 ± 0.4 and 1.7 ± 1.3, respectively. At a mean follow-up of 11.3 ± 3.8 months, no stent thrombosis or MACE were observed. Angiographic and IVUS follow-up at a mean of 6.6 ± 0.7 months showed no significant angiographic restenosis and no appreciable stent gaps. In revascularization of long diffuse disease of the LAD, the edge-to-edge implantation technique appears to be feasible resulting in no restenosis or thrombosis on the short-term follow-up. (J Interven Cardiol 2016;29:275-284). © 2016, Wiley Periodicals, Inc.

  6. Characterization of TCF21 Downstream Target Regions Identifies a Transcriptional Network Linking Multiple Independent Coronary Artery Disease Loci.

    PubMed

    Sazonova, Olga; Zhao, Yuqi; Nürnberg, Sylvia; Miller, Clint; Pjanic, Milos; Castano, Victor G; Kim, Juyong B; Salfati, Elias L; Kundaje, Anshul B; Bejerano, Gill; Assimes, Themistocles; Yang, Xia; Quertermous, Thomas

    2015-05-01

    To functionally link coronary artery disease (CAD) causal genes identified by genome wide association studies (GWAS), and to investigate the cellular and molecular mechanisms of atherosclerosis, we have used chromatin immunoprecipitation sequencing (ChIP-Seq) with the CAD associated transcription factor TCF21 in human coronary artery smooth muscle cells (HCASMC). Analysis of identified TCF21 target genes for enrichment of molecular and cellular annotation terms identified processes relevant to CAD pathophysiology, including "growth factor binding," "matrix interaction," and "smooth muscle contraction." We characterized the canonical binding sequence for TCF21 as CAGCTG, identified AP-1 binding sites in TCF21 peaks, and by conducting ChIP-Seq for JUN and JUND in HCASMC confirmed that there is significant overlap between TCF21 and AP-1 binding loci in this cell type. Expression quantitative trait variation mapped to target genes of TCF21 was significantly enriched among variants with low P-values in the GWAS analyses, suggesting a possible functional interaction between TCF21 binding and causal variants in other CAD disease loci. Separate enrichment analyses found over-representation of TCF21 target genes among CAD associated genes, and linkage disequilibrium between TCF21 peak variation and that found in GWAS loci, consistent with the hypothesis that TCF21 may affect disease risk through interaction with other disease associated loci. Interestingly, enrichment for TCF21 target genes was also found among other genome wide association phenotypes, including height and inflammatory bowel disease, suggesting a functional profile important for basic cellular processes in non-vascular tissues. Thus, data and analyses presented here suggest that study of GWAS transcription factors may be a highly useful approach to identifying disease gene interactions and thus pathways that may be relevant to complex disease etiology.

  7. Coronary artery fistulas

    PubMed Central

    Said, S.A.M.; Thiadens, A.A.H.J.; Fieren, M.J.C.H.; Meijboom, E.J.; van der Werf, T.; Bennink, G.B.W.E.

    2002-01-01

    The aetiology of congenital coronary artery fistulas remains a challenging issue. Coronary arteries with an anatomically normal origin may, for obscure reasons, terminate abnormally and communicate with different single or multiple cardiac chambers or great vessels. When this occurs, the angiographic morphological appearance may vary greatly from discrete channels to plexiform network of vessels. Coronary arteriovenous fistulas (CAVFs) have neither specific signs nor pathognomonic symptoms; the spectrum of clinical features varies considerably. The clinical presentation of symptomatic cases can include angina pectoris, myocardial infarction, fatigue, dyspnoea, CHF, SBE, ventricular and supraventricular tachyarrhythmias or even sudden cardiac death. CAVFs may, however, be a coincidental finding during diagnostic coronary angiography (CAG). CAG is considered the gold standard for diagnosing and delineating the morphological anatomy and pathway of CAVFs. There are various tailored therapeutic modalities for the wide spectrum of clinical manifestations of CAVFs, including conservative pharmacological strategy, percutaneous transluminal embolisation and surgical ligation. ImagesFigure 1Figure 2Figure 3Figure 4 PMID:25696067

  8. Noninvasive Imaging in Coronary Artery Disease

    PubMed Central

    Heo, Ran; Nakazato, Ryo; Kalra, Dan; Min, James K.

    2014-01-01

    Noninvasive cardiac imaging is widely used to evaluate the presence of coronary artery disease. Recently, with improvements in imaging technology, noninvasive imaging has also been used for evaluation of the presence, severity, and prognosis of coronary artery disease. Coronary CT angiography and MRI of coronary arteries provide an anatomical assessment of coronary stenosis, whereas the hemodynamic significance of a coronary artery stenosis can be assessed by stress myocardial perfusion imaging, such as SPECT/PET and stress MRI. For appropriate use of multiple imaging modalities, the strengths and limitations of each modality are discussed in this review. PMID:25234083

  9. A rare case of asymptomatic bilateral submandibular gland sialolithiasis: a giant, fistulized calculus on the right and multiple calculi on the left.

    PubMed

    Emir, Hatice; Kaptan, Zeynep Kizilkaya; Uzunkulaoglu, Hakki; Dogan, Sedat

    2010-10-01

    Sialolithiasis is the most common disease of the submandibular gland; sialoliths account for at least 80% of all salivary duct calculi. We present a rare case of asymptomatic bilateral submandibular gland sialoliths. On the right, the patient had a giant (35 × 35 mm) sialolith that had fistulized into the oral cavity. In the left submandibular gland, he had 30 differently sized sialoliths.

  10. Regulation of Coronary Blood Flow.

    PubMed

    Goodwill, Adam G; Dick, Gregory M; Kiel, Alexander M; Tune, Johnathan D

    2017-03-16

    The heart is uniquely responsible for providing its own blood supply through the coronary circulation. Regulation of coronary blood flow is quite complex and, after over 100 years of dedicated research, is understood to be dictated through multiple mechanisms that include extravascular compressive forces (tissue pressure), coronary perfusion pressure, myogenic, local metabolic, endothelial as well as neural and hormonal influences. While each of these determinants can have profound influence over myocardial perfusion, largely through effects on end-effector ion channels, these mechanisms collectively modulate coronary vascular resistance and act to ensure that the myocardial requirements for oxygen and substrates are adequately provided by the coronary circulation. The purpose of this series of Comprehensive Physiology is to highlight current knowledge regarding the physiologic regulation of coronary blood flow, with emphasis on functional anatomy and the interplay between the physical and biological determinants of myocardial oxygen delivery. © 2017 American Physiological Society. Compr Physiol 7:321-382, 2017.

  11. Development of a concept for a personalized approach in the perioperative antiplatelet therapy administration/discontinuation management based on multiple electrode aggregometry in patients undergoing coronary artery surgery.

    PubMed

    Petricevic, Mate; Milicic, Davor; White, Alexandra; Boban, Marko; Mihaljevic, Martina Zrno; Piljic, Dragan; Rotim, Ante; Buca, Ante; Mihalj, Mario; Biocina, Bojan

    2015-10-01

    In patients undergoing coronary artery surgery, improvements in clinical outcomes currently rely on continued refinements of the surgical technique and modulation of adjuvant pharmacotherapy. Despite medical and technological advances, negligible rate of bleeding and ischemic events still persist necessitating further improvements in patient management. Platelet function testing (PFT) might play an important role in meticulous balancing between the risk of bleeding and thrombotic events. A suitable balance can be achieved by implementing a personalized, PFT based approach in antiplatelet therapy (APT) administration/discontinuation management. Despite emerging evidence on the widespread variability in platelet inhibitory response to APT, numerous PFT devices and heterogeneity in reporting study results hamper pooling of the evidence which in turn results with a lack of consensus in "on treatment" platelet reactivity associated with ischemic and bleeding events in perioperative phase. The literature on multiple electrode aggregometry (Multiplate(®); Roche Diagnostics, Mannheim, Germany) in coronary artery disease patients was reviewed systematically. Based on the evidence evaluating the relationship between "drug specific" PFT and bleeding or adverse ischemic events, we sought to define therapeutic window for the most commonly administered antiplatelet drugs such as aspirin (ASPI test) and adenosine-diphosphate receptor blockers (ADP test). Preoperatively, APT administration was primarily focused to avoid bleeding complications. ASPI test value of 20 AUC and ADP test value of <73 AUC were set as cut-off values that delineate bleeding tendency. Postoperatively, "therapeutic window" was set to avoid both bleeding and adverse ischemic events. Therapeutic ranges were as follows: 20 AUC < ASPItest ≤ 30 AUC and 19AUC < ADP ≤ 46AUC, respectively. This is the first attempt to define PFT based "therapeutic window" according to, perioperative APT administration

  12. Total temporary occlusion of blood flow for several hours to treat a giant deep arteriovenous malformation: A series of multiple operations to save a young life

    PubMed Central

    Kozyrev, Danil A.; Jahromi, Behnam Rezai; Hernesniemi, Juha

    2016-01-01

    Background: The treatment of giant deep arteriovenous malformations (AVMs) remains challenging. Case Description: We report a case of giant deep AVM diagnosed in a 9-year-old girl, for whom the AVM rupture occurred 9 years later. At the age of 9, the girl developed mild left hemiparesis. Magnetic resonance imaging revealed a giant deep AVM. The patient underwent one course of stereotactic radiotherapy followed by serial imaging. At the age of 18, we admitted her to our department with left hemiparesis and a loss of consciousness. Computed tomography showed intracerebral hemorrhage related to AVM. The treatment process proved challenging, with recurrent intracerebral hemorrhages. During the second operation, we used total temporary occlusion for almost 4 hours. Eventually, after 4 rounds of embolizations, 4 microsurgical operations, and a month-and-a-half after admission, AVM was successfully occluded. Five years after this treatment, the patient regained the ability to walk without assistance, although a moderate disability with visual changes remained (Modified Rankin Scale score 3). Conclusion: This case illustrates that the cumulative risk of rupture of a high-grade AVM in young patients is evident, while treatment may prove successful with satisfactory results. PMID:27625889

  13. Structure of giant muscle proteins

    PubMed Central

    Meyer, Logan C.; Wright, Nathan T.

    2013-01-01

    Giant muscle proteins (e.g., titin, nebulin, and obscurin) play a seminal role in muscle elasticity, stretch response, and sarcomeric organization. Each giant protein consists of multiple tandem structural domains, usually arranged in a modular fashion spanning 500 kDa to 4 MDa. Although many of the domains are similar in structure, subtle differences create a unique function of each domain. Recent high and low resolution structural and dynamic studies now suggest more nuanced overall protein structures than previously realized. These findings show that atomic structure, interactions between tandem domains, and intrasarcomeric environment all influence the shape, motion, and therefore function of giant proteins. In this article we will review the current understanding of titin, obscurin, and nebulin structure, from the atomic level through the molecular level. PMID:24376425

  14. Atmospheres of Extrasolar Giant Planets

    NASA Astrophysics Data System (ADS)

    Marley, M. S.; Fortney, J.; Seager, S.; Barman, T.

    The key to understanding an extrasolar giant planet's spectrum - and hence its detectability and evolution - lies with its atmosphere. Now that direct observations of thermal emission from extrasolar giant planets (EGPs) are in hand, atmosphere models can be used to constrain atmospheric composition, thermal structure, and ultimately the formation and evolution of detected planets. We review the important physical processes that influence the atmospheric structure and evolution of EGPs and consider what has already been learned from the first generation of observations and modeling. We pay particular attention to the roles of cloud structure, metallicity, and atmospheric chemistry in affecting detectable properties through Spitzer Space Telescope observations of the transiting giant planets. Our review stresses the uncertainties that ultimately limit our ability to interpret EGP observations. Finally we will conclude with a look to the future as characterization of multiple individual planets in a single stellar system leads to the study of comparative planetary architectures.

  15. Giant Magnons Meet Giant Gravitons

    SciTech Connect

    Hofman, Diego M.

    2008-07-28

    We study the worldsheet reflection matrix of a string attached to a D-brane in AdS{sub 5}xS{sup 5}. The D-brane corresponds to a maximal giant graviton that wraps an S{sup 3} inside S{sup 5}. In the gauge theory, the open string is described by a spin chain with boundaries. We focus on open strings with a large SO(6) charge and define an asymptotic boundary reflection matrix. Using the symmetries of the problem, we review the computation of the boundary reflection matrix, up to a phase. We also discuss weak and strong coupling computations where we obtain the overall phase factor and test our exact results.

  16. Relationship between pharmacokinetics and pharmacodynamics of clopidogrel in patients undergoing percutaneous coronary intervention: comparison between vasodilator-stimulated phosphoprotein phosphorylation assay and multiple electrode aggregometry.

    PubMed

    Danese, E; Fava, C; Beltrame, F; Tavella, D; Calabria, S; Benati, M; Gelati, M; Gottardo, R; Tagliaro, F; Guidi, G C; Cattaneo, M; Minuz, P

    2016-02-01

    ESSENTIALS: The reliability of platelet tests as markers of the variable bioavailability of clopidogrel is not yet defined. Kinetics of clopidogrel active metabolite (CAM) and platelet response were studied in ischemic heart disease. CAM plasma maximum concentration (Cmax ) predicted vasodilator-stimulated phosphoprotein (VASP-P). Timely performed VASP-P, not an aggregation-based test, may be a surrogate for clopidogrel bioavailability. The high inter-individual variability in the inhibition of platelet function by clopidogrel is mostly explained by high variability in its transformation to an active metabolite (CAM). Objective We investigated the relations between pharmacokinetics and pharmacodynamics of CAM by comparing two methods of platelet function. We enrolled 14 patients undergoing percutaneous coronary interventions for non-ST-segment elevation acute coronary syndrome or inducible myocardial ischemia. Plasma concentrations of clopidogrel and CAM, phosphorylation of vasodilator-stimulated phosphoprotein (VASP-P), expressed as a platelet reactivity index (PRI) and whole-blood platelet aggregation (multiple electrode aggregometer, MEA) were measured before and after a 600-mg clopidogrel loading dose (nine time-points) and before and after 75-mg maintenance doses on days 2, 7 and 30. Plasma concentrations of clopidogrel and CAM were highly variable. CAM reached maximal concentration (Cmax ) (median, 110.8 nm; range, 41.9-484.8) 0.5-2 h after the loading dose. A sigmoid dose-response curve defined the relations between CAMCmax and PRI after 3 to 24 h (IC50 , 459.6 nm; 95% confidence interval, 453.4-465.7; R(2) = 0.82). PRI was unchanged from baseline in patients with the lowest CAMCmax (< 83 nm, n = 7), indicating low sensitivity of VASP-P. PRI values were also predicted by CAMCmax at days 2, 7 and 30. Platelet aggregation measured by MEA did not show significant relations with either PRI or with CAM pharmacokinetics at any time-point. After 600 mg clopidogrel

  17. Asymptomatic fistula from a giant aneurysmatic left anterior descending artery to the right ventricular outflow tract.

    PubMed

    Mustelier, Juan Valiente; Rego, Julio Oscar Cabrera; Aquiles, Eddy W Olivares; Llerena, Luis Roberto

    2010-12-01

    Coronary artery fistulas are unusual congenital or acquired coronary artery abnormalities in which blood is shunted into a cardiac chamber, great vessel or other structure, bypassing the myocardial capillary network (Jung et al. in Cardiovasc Ultrasound 5:10, 2007). We present a young adult patient with an asymptomatic fistula from a giant aneurysmatic left anterior descending artery to the right ventricular outflow tract, first diagnosed by echocardiography examination and further confirmed by 128-slice computed tomography coronary angiography.

  18. Case Report: Incidental Finding of a Giant Cardiac Mass

    PubMed Central

    2014-01-01

    Coronary artery fistula (CAF) is a rare anomalous connection between a coronary artery and another coronary artery, major vessel, or cardiac chamber. Prevalence of CAF is reportedly 1% to 2% in patients who undergo coronary angiography.1 One of the most common complications of CAF is formation of a coronary artery aneurysm (CAA). A study conducted by Said and colleagues in 1995 found that CAA formation was present in 26% of patients who had proven CAF by way of angiography.2 Although a precise definition of the term “giant” CAA is still lacking, it generally refers to a dilatation that exceeds the reference vessel diameter by four times.3 We report an interesting case of a 38-year-old patient who was incidentally found to have a presumed large right ventricular aneurysm, which after an open-heart surgery was identified as a CAF with formation of an unruptured giant CAA. PMID:25114764

  19. Transforming giants.

    PubMed

    Kanter, Rosabeth Moss

    2008-01-01

    Large corporations have long been seen as lumbering, inflexible, bureaucratic--and clueless about global developments. But recently some multinationals seem to be transforming themselves: They're engaging employees, moving quickly, and introducing innovations that show true connection with the world. Harvard Business School's Kanter ventured with a research team inside a dozen global giants--including IBM, Procter & Gamble, Omron, CEMEX, Cisco, and Banco Real--to discover what has been driving the change. After conducting more than 350 interviews on five continents, she and her colleagues came away with a strong sense that we are witnessing the dawn of a new model of corporate power: The coordination of actions and decisions on the front lines now appears to stem from widely shared values and a sturdy platform of common processes and technology, not from top-down decrees. In particular, the values that engage the passions of far-flung workforces stress openness, inclusion, and making the world a better place. Through this shift in what might be called their guidance systems, the companies have become as creative and nimble as much smaller ones, even while taking on social and environmental challenges of a scale that only large enterprises could attempt. IBM, for instance, has created a nonprofit partnership, World Community Grid, through which any organization or individual can donate unused computing power to research projects and see what is being done with the donation in real time. IBM has gained an inspiring showcase for its new technology, helped business partners connect with the company in a positive way, and offered individuals all over the globe the chance to contribute to something big.

  20. Giant papillary conjunctivitis.

    PubMed Central

    Donshik, P C

    1994-01-01

    Giant papillary conjunctivitis is a syndrome found frequently as a complication of contact lenses. Many variables can affect the onset and severity of the presenting signs and symptoms. Rigid gas permeable contact lenses appear to result in less severe signs and symptoms, with a longer time before the development of giant papillary conjunctivitis. Nonionic, low-water-content soft contact lenses tend to produce less severe signs and symptoms than ionic, low-water-content soft contact lenses. Enzymatic treatment appears to lessen the severity of signs and symptoms. The association of an allergy appears to play a role in the onset of the severity of the signs and symptoms but does not appear to affect the final ability of the individual to wear contact lenses. Using multiple treatment options, such as changing the polymer to a glyceryl methyl methacrylate or a rigid lens, or utilizing a soft lens on a frequent-replacement basis, can result in a success rate of over 90%. In individuals who still have a return of symptoms, the use of topical mast cell stabilizers or a nonsteroidal anti-inflammatory drug as an adjunctive therapy offers the added possibility of keeping these patients in contact lenses. Images FIGURE 1 FIGURE 2 FIGURE 3 FIGURE 4 FIGURE 5 FIGURE 6 FIGURE 7 FIGURE 11 A FIGURE 11 B FIGURE 11 C FIGURE 11 D PMID:7886881

  1. Giant Cell Arteritis

    MedlinePlus

    Giant cell arteritis is a disorder that causes inflammation of your arteries, usually in the scalp, neck, and arms. ... arteries, which keeps blood from flowing well. Giant cell arteritis often occurs with another disorder called polymyalgia ...

  2. Giant cell tumor occurring in familial Paget's disease of bone: report of clinical characteristics and linkage analysis of a large pedigree.

    PubMed

    Gianfrancesco, Fernando; Rendina, Domenico; Merlotti, Daniela; Esposito, Teresa; Amyere, Mustapha; Formicola, Daniela; Muscariello, Riccardo; De Filippo, Gianpaolo; Strazzullo, Pasquale; Nuti, Ranuccio; Vikkula, Mikka; Gennari, Luigi

    2013-02-01

    Neoplastic degeneration represents a rare but serious complication of Paget's disease of bone (PDB). Although osteosarcomas have been described in up to 1% of PDB cases, giant cell tumors are less frequent and mainly occur in patients with polyostotic disease. We recently characterized a large pedigree with 14 affected members of whom four developed giant cell tumors at pagetic sites. The high number of affected subjects across multiple generations allowed us to better characterize the clinical phenotype and look for possible susceptibility loci. Of interest, all the affected members had polyostotic PDB, but subjects developing giant cell tumors showed an increased disease severity with a reduced clinical response to bisphosphonate treatment and an increased prevalence of bone pain, deformities, and fractures. Together with an increased occurrence of common pagetic complications, affected patients of this pedigree also evidenced a fivefold higher prevalence of coronary artery disease with respect to either the unaffected family members or a comparative cohort of 150 unrelated PDB cases from the same geographical area. This association was further enhanced in the four cases with PDB and giant cell tumors, all of them developing coronary artery disease before 60 years of age. Despite the early onset and the severe phenotype, PDB patients from this pedigree were negative for the presence of SQSTM1 or TNFRSF11A mutations, previously associated with enhanced disease severity. Genome-wide linkage analysis identified six possible candidate regions on chromosomes 1, 5, 6, 8, 10, and 20. Because the chromosome 8 and 10 loci were next to the TNFRSF11B and OPTN genes, we extended the genetic screening to these two genes, but we failed to identify any causative mutation at both the genomic and transcription level, suggesting that a different genetic defect is associated with PDB and potentially giant cell tumor of bone in this pedigree. Copyright © 2013 American Society for

  3. Giant impacts on giant planets

    NASA Astrophysics Data System (ADS)

    de Pater, Imke

    2013-10-01

    The 2009 impact and recent superbolides on Jupiter caught the world by surprise and cast doubt on impactor flux estimates for the outer solar system. Enhanced amateur planetary imaging techniques yield both high spatial resolution {enabling the 2009 impact debris field detection} and rapid frame rates {enabling the 2010/2012 impact flash detections and lightcurve measurements}.We propose a ToO program to image future impacts on Jupiter and Saturn. To remove the possibility of impact cloud non-detections, the program will be triggered only if an existing impact debris field is seen, an object on a collision course with Jupiter or Saturn is discovered, or an impact light curve is measured with an estimated total energy large enough to generate an impact cloud in a giant planet atmosphere {10^20 J}.HST provides the only way to image these events in the ultraviolet, providing information on aerosol altitudes and on smaller particles that are less visible to ground-based infrared observations. High-resolution imaging with proper timing {not achievable from the ground} is required to measure precisely both the velocity fields of impact sites and the optical spectrum of impact debris. HST observations of past impacts on Jupiter have also served both as cornerstones of science investigations at other wavelengths and as vehicles for effective public outreach.Large outer solar system impacts are governed by the same physics as in the terrestrial events that dominate the impact threat to humans. Studying the behavior of impactors of various sizes and compositions, as they enter the atmosphere at varying angles and speeds, will better quantify terrestrial impact hazards.

  4. Giant impacts on giant planets

    NASA Astrophysics Data System (ADS)

    de Pater, Imke

    2014-10-01

    The 2009 impact and recent superbolides on Jupiter caught the world by surprise and cast doubt on impactor flux estimates for the outer solar system. Enhanced amateur planetary imaging techniques yield both high spatial resolution (enabling the 2009 impact debris field detection) and rapid frame rates (enabling the 2010/2012 impact flash detections and lightcurve measurements).We propose a ToO program to image future impacts on Jupiter and Saturn. To remove the possibility of impact cloud non-detections, the program will be triggered only if an existing impact debris field is seen, an object on a collision course with Jupiter or Saturn is discovered, or an impact light curve is measured with an estimated total energy large enough to generate an impact cloud in a giant planet atmosphere (10^20 J).HST provides the only way to image these events in the ultraviolet, providing information on aerosol altitudes and on smaller particles that are less visible to ground-based infrared observations. High-resolution imaging with proper timing (not achievable from the ground) is required to measure precisely both the velocity fields of impact sites and the optical spectrum of impact debris. HST observations of past impacts on Jupiter have also served both as cornerstones of science investigations at other wavelengths and as vehicles for effective public outreach.Large outer solar system impacts are governed by the same physics as in the terrestrial events that dominate the impact threat to humans. Studying the behavior of impactors of various sizes and compositions, as they enter the atmosphere at varying angles and speeds, will better quantify terrestrial impact hazards.

  5. Giant impacts on giant planets

    NASA Astrophysics Data System (ADS)

    de Pater, Imke

    2012-10-01

    The 2009 impact on Jupiter caught the world by surprise and cast doubt on impactor flux estimates for the outer solar system. Enhanced amateur planetary imaging techniques yield both high spatial resolution {enabling the 2009 impact debris field detection} and rapid frame rates {enabling the 2010 impact flash detections and lightcurve measurements}.We propose a Target of Opportunity program to image future impacts on Jupiter and Saturn. To remove the possibility of impact cloud non-detections, the program will be triggered only if an existing impact debris field is seen, an object on a collision course with Jupiter or Saturn is discovered, or an impact light curve is measured with an estimated total energy large enough to generate an impact cloud in a giant planet atmosphere.HST provides the only way to image these events in the ultraviolet, providing information on aerosol altitudes and on smaller particles that are less visible to ground-based infrared observations. High-resolution imaging with proper timing {not achievable from the ground} is required to measure precisely both the velocity fields of impact sites and the optical spectrum of impact debris. HST observations of past impacts on Jupiter have also served both as cornerstones of science investigations at other wavelengths and as vehicles for effective public outreach.Large outer solar system impacts are governed by the same physics as in the terrestrial events that dominate the impact threat to humans. Studying the behavior of impactors of various sizes and compositions, as they enter the atmosphere at varying angles and speeds, will better quantify terrestrial impact hazards.

  6. Coronary collaterals.

    PubMed

    Gorlin, R

    1976-01-01

    Coronary collaterals are probably enlargements of pre-existing channels which respond to local vasodilators and which function whenever pressure differences exist across them. Thus, in human coronary atherosclerosis collaterals are only seen when there is a severe intervening arterial obstruction (in excess of 75%). Coronary collaterals follow epicardial and intramycardial pathways, and the intermediary connections may be at vessels of highly varying caliber. The flow potential of most collateral pathways in man is possibly adequate for segmental myocardial function at lower than normal demands but clearly is inadequate for most, if not all, stressful interventions. In the last analysis, coronary collaterals in man are more an indication of severe regional ischemia (present or potential) than a sign of biological "compensation'' for a perfusion deficit.

  7. Multivessel spontaneous coronary artery dissection of left and right coronary systems

    PubMed Central

    Asrar ul Haq, Muhammad; Mutha, Vivek; van Gaal, William J

    2013-01-01

    Spontaneous coronary artery dissection (SCAD) involving multiple coronary arteries simultaneously is extremely rare. It should be considered in younger patients, especially who do not have traditional cardiac risk factors. We present a case of young male patient presenting with acute coronary syndrome associated with ST segments elevation on ECG following physical stress whose coronary angiography revealed SCAD of the left anterior descending as well as the right coronary artery and discuss the therapeutic options with a brief review of the limited evidence. PMID:24158301

  8. Management of large coronary dissection after STAR.

    PubMed

    Godino, Cosmo; Viani, Giacomo M; Spagnolo, Pietro; Pavon, Anna G; Colombo, Antonio; Carlino, Mauro

    2014-01-01

    The guided-STAR technique is an alternative anterograde approach for treatment of coronary chronic total occlusion (CTO) and it is usually followed by implantation of multiple stents. We describe a case of residual long coronary dissection left unstented after guided-STAR, with good results at 2months follow-up. This case emphasizes the fact that sometimes even the longest coronary dissections can be left unstented especially in the contest of a CTO. © 2014.

  9. Enhanced current-perpendicular-to-plane giant magnetoresistance effect in half-metallic NiMnSb based nanojunctions with multiple Ag spacers

    SciTech Connect

    Wen, Zhenchao; Yamamoto, Tatsuya; Kubota, Takahide; Takanashi, Koki

    2016-06-06

    Current-perpendicular-to-plane giant magnetoresistance (CPP-GMR) heterostructure devices using half-metallic NiMnSb Heusler alloy electrodes with single, dual, and triple Ag spacers were fabricated. The NiMnSb alloy films and Ag spacers show (001) epitaxial growth in all CPP-GMR multilayer structures. The dual-spacer CPP-GMR nanojunction exhibited an enhanced CPP-GMR ratio of 11% (a change in the resistance-area product, ΔRA, of 3.9 mΩ μm{sup 2}) at room temperature, which is approximately twice (thrice) of 6% (1.3 mΩ μm{sup 2}) in the single-spacer device. The enhancement of the CPP-GMR effects in the dual-spacer devices could be attributed to improved interfacial spin asymmetry. Moreover, it was observed that the CPP-GMR ratios increased monotonically as the temperatures decreased. At 4.2 K, a CPP-GMR ratio of 41% (ΔRA = 10.5 mΩ μm{sup 2}) was achieved in the dual-spacer CPP-GMR device. This work indicates that multispacer structures provide an efficient enhancement of CPP-GMR effects in half-metallic material-based CPP-GMR systems.

  10. Enhanced current-perpendicular-to-plane giant magnetoresistance effect in half-metallic NiMnSb based nanojunctions with multiple Ag spacers

    NASA Astrophysics Data System (ADS)

    Wen, Zhenchao; Kubota, Takahide; Yamamoto, Tatsuya; Takanashi, Koki

    2016-06-01

    Current-perpendicular-to-plane giant magnetoresistance (CPP-GMR) heterostructure devices using half-metallic NiMnSb Heusler alloy electrodes with single, dual, and triple Ag spacers were fabricated. The NiMnSb alloy films and Ag spacers show (001) epitaxial growth in all CPP-GMR multilayer structures. The dual-spacer CPP-GMR nanojunction exhibited an enhanced CPP-GMR ratio of 11% (a change in the resistance-area product, ΔRA, of 3.9 mΩ μm2) at room temperature, which is approximately twice (thrice) of 6% (1.3 mΩ μm2) in the single-spacer device. The enhancement of the CPP-GMR effects in the dual-spacer devices could be attributed to improved interfacial spin asymmetry. Moreover, it was observed that the CPP-GMR ratios increased monotonically as the temperatures decreased. At 4.2 K, a CPP-GMR ratio of 41% (ΔRA = 10.5 mΩ μm2) was achieved in the dual-spacer CPP-GMR device. This work indicates that multispacer structures provide an efficient enhancement of CPP-GMR effects in half-metallic material-based CPP-GMR systems.

  11. The Electric Giant Resonances

    NASA Astrophysics Data System (ADS)

    van der Woude, A.

    The following sections are included: * Introduction * Experimental Methods to Study Giant Resonances * Introduction * The Tools * Introduction * Tools for Isoscalar Scattering * INELASTIC α-SCATTERING * INELASTIC PROTON SCATTERING * Tools for Isovector Excitations * γ-ABSORPTION AND PARTICLE CAPTURE REACTIONS * CHARGE EXCHANGE REACTIONS - THE (π+, π0) REACTION * Tools For Isoscalar And Isovector Excitations * INELASTIC ELECTRON SCATTERING * GIANT RESONANCE EXCITATION BY FAST HEAVY IONS * From Multipole Cross Section To Multipole Strength * The Electric Isoscalar Resonances * The Isoscalar Giant Monopole Resonance * Systematics on the GMR * Compressibility and the Giant Monopole Resonance * Introduction * The Compressibility of nuclear matter from the GMR energies * Discussion * The Isoscalar Giant Quadrupole Resonance * General Trends In Medium-Heavy and Heavy Nuclei * The GQR In Light Nuclei * The Isoscalar 3- Strength, LEOR and HEOR * Isoscalar 4+ Strength * Miscellaneous; Isoscalar 1- and L > 4-Strength * The Electric Isovector Giant Resonances * The Isovector Giant Dipole Resonance: GDR * The Isovector Giant Monopole Resonances: IVGMR * The Isovector Quadrupole Resonance: IVGQR * The Effect of Ground State Deformation on the Shape of Giant Resonance: Microscopic Picture * Giant Resonances Built on Excited States * Introduction * Capture Reactions on Light Nuclei * Statistical decay of GDR γ Emission in Heavy Compound Systems * Introduction * Theoretical Predictions * Some Experimental Results * Summary and Outlook * Acknowledgements * General References * References

  12. Sensory ecology: giant eyes for giant predators?

    PubMed

    Partridge, Julian C

    2012-04-24

    Mathematical models suggest the enormous eyes of giant and colossal squid evolved to see the bioluminescence induced by the approach of predatory whales. Copyright © 2012 Elsevier Ltd. All rights reserved.

  13. Two cases of giant pyogenic granuloma of scalp

    PubMed Central

    Chandra, B. Satish; Rao, P. Narasimha

    2013-01-01

    Pyogenic granuloma is a benign vascular tumor of unknown etiology, though multiple factors play a role in its onset, e.g., trauma, chronic irritation, drugs etc., It is commonly seen in children and adolescents. Giant pyogenic granuloma is its atypical variant. We are presenting two cases of giant pyogenic granuloma, one, in a 28-year-old adult, presenting as a giant fluffy swelling of scalp and the other in a 11-year-old child, presenting as a giant ulcerated globular swelling of the scalp. PMID:24350008

  14. Woven right coronary artery: a case report and review of the literature.

    PubMed

    Iyisoy, Atila; Celik, Turgay; Yuksel, U Cagdas; Isik, Ersoy

    2010-07-01

    Woven coronary artery is an extremely rare and is still not a clearly defined coronary anomaly in which epicardial coronary artery is divided into multiple thin channels at any segment of the coronary artery, and subsequently, these multiple channels merge again in a normal conduit. A few cases have been reported till now. In this case report, we present a 58-year-old male with a woven right coronary artery.

  15. Comparative study of traditional long incision vein harvesting and multiple incisions with small skin bridges in patients with coronary artery bypass grafting at King Abdullah University Hospital--Jordan.

    PubMed

    Hijazi, Emad Mohamed

    2010-01-01

    Saphenous vein harvesting can be associated with wound complications, incision pain, infection, and poor cosmetic outcome. The objective of our study is to determine the difference in wound complication and infection rates between two saphenous vein harvesting techniques, long incision versus multiple short interrupted incisions (tunneling) for coronary artery bypass grafting at the King Abdullah University Hospital--Jordan. Retrospectively we analyzed data from 1,050 consecutive elective coronary artery bypass procedures performed from May 5, 2003, to December 31, 2007, in our institution. Saphenectomy using traditional Long incision vein harvesting (Group 1) performed in six hundred and fifty patients (n=650), while saphenectomy using multiple incisions with small skin bridges--tunneling (Group 2) performed in four hundred patients (n=400). Saphenectomy performed by the cardiac surgery assistant or main cardiac surgeon. Inflammation, dehiscence, cellulites, lymphangitis, drainage, necrosis, or abscess necessitating dressing, antibiotics or debridement before complete healing without eschar were defined as wound complications. There was no statistical difference in preoperative risk factors in both groups. Test results were considered significant when P<0.05. Leg wound complications observed more in traditional long incision vein harvesting technique (P=0.0005). Female gender, obesity, diabetes are associated with an increased incidence of wound problems (P<0.05). Saphenous vein harvest using saphenous vein tunneling was associated with fewer wound complications than the traditional longitudinal method.

  16. Multiplicity

    DTIC Science & Technology

    1991-04-01

    practice as a "[descent] into that inner circle of the Inferno where the damned endlessly degate multiplicity for sentencing." United States v. Barnard...select the charges to be brought in a particular case"). 19 Brown v. Ohio, 432 U.S. 161, 165 (1977). 20 Whalen v. United States, 445 U.S. at 689. 21...parte Lange, 8-5 U.S. (19 Wall.) 163 (1874). Cf. Brown v. Ohio, 432 U.S. at 165 ("once the legislature has acted courts may not impose more than one

  17. Giant Herbig-Haro Flows

    NASA Astrophysics Data System (ADS)

    Reipurth, Bo; Bally, John; Devine, David

    1997-12-01

    We present the discovery of a number of Herbig-Haro flows which extend over parsec-scale distances. The largest of these is the well known HH 111 jet complex, which is shown, through CCD images and a proper motion study, to have an angular extent of almost one degree on the sky, corresponding to 7.7 pc, making it the largest known HH flow. In our imaging survey we also found that T Tauri is at the center of a huge bipolar HH flow, HH 355, with a total extent of 38 arcmin, corresponding to 1.55 pc, and aligned with the axis of the tiny HH 255 flow surrounding the infrared companion T Tau S. We additionally have found a number of other giant HH flow candidates, including HH 315 at PV Cep, HH 41/295 at Haro 5a/6a, HH 300 in Bl8w, HH 354 in Li 165, HH 376 in Li 152, and HH 114/115 and HH 243/244/245/179 in the X Orionis molecular ring. It thus appears that it is common for HH flows to attain parsec-scale dimensions. The ubiquity of parsec-scale HH flows profoundly alters our view of the impact of young stars on their environment. Giant flows have dynamical ages comparable to the duration of the accretion phase of the sources, and provide a fossil record of their mass loss and accretion history. Multiple internal working surfaces and their S-shaped point symmetry provide evidence for variability of ejection velocity and orientation of the source jets. Giant HH flows are either longer or comparable in length to associated CO outflows, providing evidence for unified models in which HH flows power CO flows. Many giant flows have burst out of their source cloud cores and are dissociating molecules and injecting momentum and kinetic energy into the interclump medium of the host clouds. They contribute to the UV radiation field, and may produce C I and C ii in cloud interiors. Giant flows may contribute to the chemical rejuvenation of clouds, the generation of turbulent motions, and the self-regulation of star formation. The terminal working surfaces of giant flows may be

  18. Coronary arteriography and angioplasty

    SciTech Connect

    King, S.B.; Douglas, J.S.

    1985-01-01

    This book explores biomedical radiography of the heart. Topics considered include six bench marks in the history of cardiac catheterization; normal coronary anatomy; anomalies of the coronary arteries; pathoanotomy of the coronary arteries and complications; indications, limitations, and risks of coronary arteriography and left ventriculography; catheterization techniques in coronary arteriography and left ventriculography: the Sones technique; catheterization techniques in coronary arteriography and left ventriculography: the Judkins technique; modification of Judkins catheters; catheterization techniques in coronary arteriography and left ventriculography multipurpose technique; new views in coronary arteriography; quantitative evaluation of left ventricular function; complications of coronary arteriography: management during and following the procedure; interpretation of coronary arteriograms and left ventriculograms; prevalence and distribution of disease in patients catheterized for suspected coronary disease at Emory University Hospital; the Cardiac Catheterization Laboratory; selection for surgery or percutaneous transluminal coronary angioplasty; intracoronary thrombolysis; and percutaneous transluminal coronary angioplasty.

  19. Mechanisms controlling the number and latitudinal spacing of jets-streams on multiple jet planets: from terrestrial planets to gas giants

    NASA Astrophysics Data System (ADS)

    Kaspi, Yohai; Chemke, Rei

    2015-11-01

    Zonal jets dominate the atmospheric dynamics of a wide range of planetary systems as observed in all Solar System planetary atmospheres and even observed on exoplanets. Specifically, when the ratio between the eddy length scale and the planetary scale becomes small these planetary atmospheres develop multiple jets. In this study we use an idealized general circulation model to demonstrate how such multiple-jets are formed and what controls their latitudinal width and spacing. We find that for each latitude, over a wide range of parameters, the jet spacing scales with the Rhines scale. The simulations show the presence of a critical latitude, where poleward (equatorward) of this latitude the Rhines scale is larger (smaller) than the Rossby deformation radius. Poleward of this latitude, a classic geostrophic turbulence picture appears with a -5/3 spectral slope of inverse energy cascade from the deformation radius up to the Rhines scale. A shallower slope than the classic -3 slope of forward cascade is found from the deformation radius down to the viscosity scale, due to the broad input of baroclinic eddy kinetic energy. At these latitudes, eddy-eddy interactions transfer barotropic eddy kinetic energy from the input scales of baroclinic eddy kinetic energy up to the jet scale and down to smaller scales. We provide scaling laws for the number of eddy driven jets, their latitudinal width and speed as a function of a broad range of planetary parameters.

  20. Giant-cell aortitis: an unusual case of Bentall operation.

    PubMed

    Lemaire, Anaïs; Cuttone, Fabio; Caprio, Sabino; Massetti, Massimo; Galateau-Salle, Françoise

    2014-03-01

    Noninfectious ascending aortitis is a very rare cause of ascending aortic aneurysm. We report a case of the truly fortuitous finding of this rare condition in a 67-year-old man operated on for an ascending aortic aneurysm associated with dystrophic aortic valve regurgitation. Intraoperative inspection revealed dissection of the aorta just above the left main coronary artery. A modified Bentall operation was performed. The pathological diagnosis was giant cell arteritis.

  1. Combination of a Giant Dissected Ascending Aortic Aneurysm with Multiple Fistulae into the Cardiac Chambers Caused by Prosthetic Aortic Valve Endocarditis.

    PubMed

    Sabzi, Feridoun; Faraji, Reza

    2016-02-01

    The combination of a dissected ascending aortic aneurysm (AA) with multiple fistulae to the periaortic root structures is a life-threatening complication that occurs rarely after infective endocarditis of the prosthetic aortic valve. Many risk factors are potentially associated with this complication, including aortic diameter, connective tissue disease of the aortic wall, hypertension and infection. We report a rare case of dissected ascending AA with fistulae to the left atrium and pulmonary artery and a paravalvular leak in a 47-year-old woman with a history of an aortic valve replacement. The patient had presented to the Imam Ali Hospital, Kermanshah, Iran, in January 2015 with clinical features of heart failure. After initially being treated for congestive heart failure, she underwent open-heart surgery via a classic Bentall procedure and double fistula closure. She was discharged 23 days after the operation in good condition. A six-month follow-up showed normal functioning of the composite conduit prosthetic valve and no fistulae recurrence.

  2. Giant prostatic calculi

    PubMed Central

    Najoui, Mohammed; Qarro, Abdelmounaim; Ammani, Abdelghani; Alami, Mohammed

    2013-01-01

    Prostatic parenchymal calculi are common, usually incidental, findings on morphological examinations. They are typically asymptomatic and may be present in association with normal glands, benign prostatic hyperplasia, and prostate cancer. However giant prostatic calculi are rare. Less than 20 cases have been reported in the literature. We present the case of a 35-year-old man with two giant prostatic calculi that replaced the entire gland. He underwent an open cystolithotomy, two giant stones were removed from the prostate, and we used a lithotripsy in situ for extraction of stone fragments. PMID:23565316

  3. Unstable giant gravitons

    SciTech Connect

    Mello Koch, Robert de; Ives, Norman; Smolic, Jelena; Smolic, Milena

    2006-03-15

    We find giant graviton solutions in Frolov's three parameter generalization of the Lunin-Maldacena background. The background we study has {gamma}-tilde{sub 1}=0 and {gamma}-tilde{sub 2}={gamma}-tilde{sub 3}={gamma}-tilde. This class of backgrounds provides a nonsupersymmetric example of the gauge theory/gravity correspondence that can be tested quantitatively, as recently shown by Frolov, Roiban, and Tseytlin. The giant graviton solutions we find have a greater energy than the point gravitons, making them unstable states. Despite this, we find striking quantitative agreement between the gauge theory and gravity descriptions of open strings attached to the giant.

  4. Giant venous aneurysm jeopardising internal mammary arterial graft patency.

    PubMed

    Van Caenegem, Olivier; le Polain de Waroux, Jean-Benoit; de Kerchove, Laurent; Coche, Emmanuel

    2012-09-01

    The authors report a 79-year old man with a history of coronary bypass surgery, presenting with acute heart failure and elevated troponin. Coronarography revealed a giant saphenous vein graft aneurysm, which was compressing the left internal mammary artery bypass graft. This was confirmed by a multislice enhanced-ECG gated cardiac CT, showing the venous aneurysm responsible for external compression of the arterial graft and its functional occlusion. Myocardial ischaemia, the mechanism leading to cardiac failure, was confirmed by hypoperfusion of the sub-endocardial area shown by the CT. The aneurysm was surgically removed without complications. The patient recovered and his cardiac function improved. This is the first recorded case of compression of the left internal mammary artery by an giant saphenous vein graft aneurysm having triggered severe myocardial ischaemia and heart failure. The authors review the incidence and complications of giant venous bypass graft aneurysms reported in the literature.

  5. Giant venous aneurysm jeopardising internal mammary arterial graft patency

    PubMed Central

    Van Caenegem, Olivier; le Polain de Waroux, Jean-Benoit; de Kerchove, Laurent; Coche, Emmanuel

    2012-01-01

    The authors report a 79-year old man with a history of coronary bypass surgery, presenting with acute heart failure and elevated troponin. Coronarography revealed a giant saphenous vein graft aneurysm, which was compressing the left internal mammary artery bypass graft. This was confirmed by a multislice enhanced-ECG gated cardiac CT, showing the venous aneurysm responsible for external compression of the arterial graft and its functional occlusion. Myocardial ischaemia, the mechanism leading to cardiac failure, was confirmed by hypoperfusion of the sub-endocardial area shown by the CT. The aneurysm was surgically removed without complications. The patient recovered and his cardiac function improved. This is the first recorded case of compression of the left internal mammary artery by an giant saphenous vein graft aneurysm having triggered severe myocardial ischaemia and heart failure. The authors review the incidence and complications of giant venous bypass graft aneurysms reported in the literature. PMID:22723090

  6. Bilateral Giant Juvenile Fibroadenoma of Breast.

    PubMed

    Makkar, Nikhil; Singh, Sumitoj; Paul, Surinder; Sandhu, Mandeep Singh; Kumar, Ashok

    2017-06-01

    Fibroadenomas are benign lesions of breast commonly found in young age group. These focal tumours contain both mesenchymal and glandular tissue. Giant juvenile fibroma of breast is rare variant of fibroadenoma found usually in less than 20 years of age. They present with rapid enlargement of single or multiple, discrete, painless large nodule of breast. A 14-years-old premenarche girl presented with large bilateral breast lumps for two months. FNAC showed features of juvenile fibroadenoma. Breast conserving surgical excision of lumps was performed and histopathology confirmed the diagnosis of juvenile fibroadenoma. Giant juvenile fibroadenomas are characterised by rapid enlargement of encapsulated mass. The aetiology is unknown, although end-organ hypersensitivity to normal level of estrogen is postulated. We present a case of bilateral giant juvenile fibroadenoma for its rarity.

  7. [Emergency coronary artery bypass grafting for acute coronary syndrome].

    PubMed

    Yamaguchi, Atsushi; Murayama, Takanori

    2012-09-01

    Since the drug eluting stents appeared in Japan, the indication for percutaneous coronary intervention has become wide-spread for the treatment of coronary artery disease. In the past decade, 216 patients underwent emergency/urgent coronary artery bypass grafting (CABG) in our institution, while the annual numbers of both emergency and elective CABG cases have declined. On the contrary to the decreasing number, emergency CABG patients were significantly getting older with multiple co-morbidities. Thus, off-pump CABG is likely to be beneficial for preventing postoperative complications, leading to the decreased postoperative mortality. When emergency CABG patients developed refractory myocardial ischemia and unstable hemodynamics, a percutaneous cardiopulmonary support system was quickly applicable and useful for on-pump beating CABG achieving complete surgical revascularization. For keeping satisfactory hemodynamics during CABG, communication between cardiovascular surgeons, anesthesiologists, and perfusionists is most important.

  8. Diffuse coronary artery ectasia in a patient with left main coronary artery trifurcation

    PubMed Central

    Desperak, Piotr; Bujak, Kamil; Głowacki, Jan; Gąsior, Mariusz

    2016-01-01

    The term coronary ectasia is reserved to describe a diffuse dilatation of coronary artery segments that have a diameter that exceeds the size of normal adjacent coronary segments by 1.5 times. The occurrence of coronary artery ectasia (CAE) ranges from 3% to 8% in the group of patients undergoing coronary computed tomography angiography. The CAE is associated with traditional risk factors and often co-exists with coronary atherosclerosis, which suggests that ectasia may represent an advanced form of atherosclerosis. Nevertheless, there is a lack of consensus on the clinical implications and management of patients in whom the occurrence of CAE is observed, especially in patients without concomitant obstructive atherosclerosis. Here, we present a rare case of a 62-year-old patient with multiple CAEs and left main trifurcation. PMID:27785148

  9. Tracks of a Giant

    NASA Image and Video Library

    2010-08-25

    The giant, 70-meter-wide antenna at NASA Deep Space Network complex in Goldstone, Calif., tracks a spacecraft on Nov. 17, 2009. This antenna, officially known as Deep Space Station 14, is also nicknamed the Mars antenna.

  10. The Next Giant Step

    NASA Image and Video Library

    Artist Robert McCall painted "The Next Giant Step" in 1979 to commemorate the heroism and courage of spaceflight pioneers. Located in the lobby of Johnson's building 2, the mural depicts America's ...

  11. Silvics of Giant Sequoia

    Treesearch

    C. Phillip Weatherspoon

    1986-01-01

    Ecological relationships-including habitat and life history---of giant sequoia (Sequoiadendron giganteum [Lindl.] Buchholz) in natural stands are summarized. Such silvical information provides an important foundation for sound management of the species.

  12. The Giant Cell.

    ERIC Educational Resources Information Center

    Stockdale, Dennis

    1998-01-01

    Provides directions for the construction of giant plastic cells, including details for building and installing the organelles. Also contains instructions for preparing the ribosomes, nucleolus, nucleus, and mitochondria. (DDR)

  13. Giant Earlobe Epidermoid Cyst

    PubMed Central

    Pérez-Guisado, Joaquín; Scilletta, Alessandra; Cabrera-Sánchez, Emilio; Rioja, Luis F; Perrotta, Rosario

    2012-01-01

    Epidermoid cysts represent the most common cutaneous cysts. They are usually small and benign; however, sometimes they can grow to giant epidermoid cists, and occasionally malignancies develop. Giant epidermoid cysts at the earlobe have never been described but in other locations. We describe a case of a giant epidermoid cyst at the earlobe, a location where such a large cyst has never been reported before. The mass was completely resected and the wound of the pedunculated base was sutured with four stitches of nylon 5/0. Histopathology confirmed the presumptive diagnosis of an epidermoid cyst. Six months after the resection, the patient did not have any relapse of the epidermoid cyst. The earlobe is a potential location for giant epidermoid cysts. Although the clinical diagnosis could be enough, due to the possibility of malignancy and to ensure appropriate diagnosis, we consider that all cysts should be sent to the anatomic pathology laboratory for histological evaluation. PMID:22557855

  14. The Giant Cell.

    ERIC Educational Resources Information Center

    Stockdale, Dennis

    1998-01-01

    Provides directions for the construction of giant plastic cells, including details for building and installing the organelles. Also contains instructions for preparing the ribosomes, nucleolus, nucleus, and mitochondria. (DDR)

  15. Giant Cell Arteritis and Polymyalgia Rheumatica

    MedlinePlus

    ... Controlfamilydoctor.org editorial staff Home Diseases and Conditions Giant Cell Arteritis and Polymyalgia Rheumatica Condition Giant Cell Arteritis and Polymyalgia Rheumatica Share Print Giant ...

  16. Capella: Separating the Giants

    NASA Astrophysics Data System (ADS)

    Young, P. R.; Dupree, A. K.

    2002-01-01

    Images from the Faint Object Camera (FOC) on the Hubble Space Telescope (HST) are used to spatially separate the two giants of Capella (α Aurigae; HD 34029) for the first time at ultraviolet wavelengths. The images were obtained with broadband filters that isolate the wavelength regions 2500-3000 Å and 1300-1500 Å. The cool G8 giant is found to be weaker than the hot G1 giant by factors of around 4 and 17, respectively, in these bands. The latter factor is largely due to the much stronger G1 continuum at short wavelengths. No evidence is found for material lying between the two stars in the images. In addition, the objective prisms of the FOC were used to obtain low-resolution spectra from 1200 to 3000 Å, allowing individual emission lines from each star to be spatially separated. Cool-to-hot star ratios for the emission lines H I Lyα, O I λ1305, Si II λ1816, C II λ1335, He II λ1640, and Si IV λ1393 are presented, showing that the cool giant is weaker than the hot giant by factors of 5-10 in these lines. The O I emission is only a factor of 2.5 weaker in the cool giant, most probably resulting from fluorescence in the extended atmosphere of the cool giant. The line ratios are compared with values derived from International Ultraviolet Explorer and HST/Goddard High Resolution Spectrograph spectra, which could separate the stars spectrally but not spatially. Reasonable agreement is found although the FOC ratios generally imply lower contributions from the cool giant. Based on observations with the NASA/ESA Hubble Space Telescope obtained at the Space Telescope Science Institute, which is operated by AURA, Inc., under NASA contract NAS 5-26555.

  17. Giant aneurysm of an aortocoronary venous bypass graft compressing the right ventricle

    PubMed Central

    van de Wal, R.M.A.; van Werkum, J.W.; le Cocq d’Armandville, M-C.; Plokker, H.W.T.; Morshuis, W.J.

    2007-01-01

    A 69-year-old man with a history of coronary artery bypass grafting and a recent inferoposterior myocardial infarction presented to the hospital for diagnostic coronary angiography. Physical examination, laboratory analyses, coronary angiography, echocardiography, and CT scan were performed. A giant aneurysm of the aortocoronary venous bypass graft, associated with compression of the right side of the heart, was revealed. After surgical resection and replacement of the venous graft the patient died due to right ventricular failure. (Neth Heart J 2007;15:252-4.17923880Neth Heart J 2007;15:252-4.) PMID:17923880

  18. Coronary magnetic resonance imaging.

    PubMed

    Manning, Warren J; Nezafat, Reza; Appelbaum, Evan; Danias, Peter G; Hauser, Thomas H; Yeon, Susan B

    2007-02-01

    This article highlights the technical challenges and general imaging strategies for coronary MRI. This is followed by a review of the clinical results for the assessment of anomalous CAD, coronary artery aneurysms, native vessel integrity, and coronary artery bypass graft disease using the more commonly applied MRI methods. It concludes with a brief discussion of the advantages/disadvantages and clinical results comparing coronary MRI with multidetector CT (MDCT) coronary angiography.

  19. Globally intertwined evolutionary history of giant barrel sponges

    NASA Astrophysics Data System (ADS)

    Swierts, Thomas; Peijnenburg, Katja T. C. A.; de Leeuw, Christiaan A.; Breeuwer, Johannes A. J.; Cleary, Daniel F. R.; de Voogd, Nicole J.

    2017-09-01

    Three species of giant barrel sponge are currently recognized in two distinct geographic regions, the tropical Atlantic and the Indo-Pacific. In this study, we used molecular techniques to study populations of giant barrel sponges across the globe and assessed whether the genetic structure of these populations agreed with current taxonomic consensus or, in contrast, whether there was evidence of cryptic species. Using molecular data, we assessed whether giant barrel sponges in each oceanic realm represented separate monophyletic lineages. Giant barrel sponges from 17 coral reef systems across the globe were sequenced for mitochondrial (partial CO1 and ATP6 genes) and nuclear (ATPsβ intron) DNA markers. In total, we obtained 395 combined sequences of the mitochondrial CO1 and ATP6 markers, which resulted in 17 different haplotypes. We compared a phylogenetic tree constructed from 285 alleles of the nuclear intron ATPsβ to the 17 mitochondrial haplotypes. Congruent patterns between mitochondrial and nuclear gene trees of giant barrel sponges provided evidence for the existence of multiple reproductively isolated species, particularly where they occurred in sympatry. The species complexes in the tropical Atlantic and the Indo-Pacific, however, do not form separate monophyletic lineages. This rules out the scenario that one species of giant barrel sponge developed into separate species complexes following geographic separation and instead suggests that multiple species of giant barrel sponges already existed prior to the physical separation of the Indo-Pacific and tropical Atlantic.

  20. Giant congenital melanocytic nevus.

    PubMed

    Viana, Ana Carolina Leite; Gontijo, Bernardo; Bittencourt, Flávia Vasques

    2013-01-01

    Giant congenital melanocytic nevus is usually defined as a melanocytic lesion present at birth that will reach a diameter ≥ 20 cm in adulthood. Its incidence is estimated in <1:20,000 newborns. Despite its rarity, this lesion is important because it may associate with severe complications such as malignant melanoma, affect the central nervous system (neurocutaneous melanosis), and have major psychosocial impact on the patient and his family due to its unsightly appearance. Giant congenital melanocytic nevus generally presents as a brown lesion, with flat or mammilated surface, well-demarcated borders and hypertrichosis. Congenital melanocytic nevus is primarily a clinical diagnosis. However, congenital nevi are histologically distinguished from acquired nevi mainly by their larger size, the spread of the nevus cells to the deep layers of the skin and by their more varied architecture and morphology. Although giant congenital melanocytic nevus is recognized as a risk factor for the development of melanoma, the precise magnitude of this risk is still controversial. The estimated lifetime risk of developing melanoma varies from 5 to 10%. On account of these uncertainties and the size of the lesions, the management of giant congenital melanocytic nevus needs individualization. Treatment may include surgical and non-surgical procedures, psychological intervention and/or clinical follow-up, with special attention to changes in color, texture or on the surface of the lesion. The only absolute indication for surgery in giant congenital melanocytic nevus is the development of a malignant neoplasm on the lesion.

  1. Giant congenital melanocytic nevus*

    PubMed Central

    Viana, Ana Carolina Leite; Gontijo, Bernardo; Bittencourt, Flávia Vasques

    2013-01-01

    Giant congenital melanocytic nevus is usually defined as a melanocytic lesion present at birth that will reach a diameter ≥ 20 cm in adulthood. Its incidence is estimated in <1:20,000 newborns. Despite its rarity, this lesion is important because it may associate with severe complications such as malignant melanoma, affect the central nervous system (neurocutaneous melanosis), and have major psychosocial impact on the patient and his family due to its unsightly appearance. Giant congenital melanocytic nevus generally presents as a brown lesion, with flat or mammilated surface, well-demarcated borders and hypertrichosis. Congenital melanocytic nevus is primarily a clinical diagnosis. However, congenital nevi are histologically distinguished from acquired nevi mainly by their larger size, the spread of the nevus cells to the deep layers of the skin and by their more varied architecture and morphology. Although giant congenital melanocytic nevus is recognized as a risk factor for the development of melanoma, the precise magnitude of this risk is still controversial. The estimated lifetime risk of developing melanoma varies from 5 to 10%. On account of these uncertainties and the size of the lesions, the management of giant congenital melanocytic nevus needs individualization. Treatment may include surgical and non-surgical procedures, psychological intervention and/or clinical follow-up, with special attention to changes in color, texture or on the surface of the lesion. The only absolute indication for surgery in giant congenital melanocytic nevus is the development of a malignant neoplasm on the lesion. PMID:24474093

  2. Spontaneous multi-focal coronary artery spasm: a case report

    PubMed Central

    Ostovan, Mohammad Ali; Khanian, Mahdi Sajedi; Hamidi, Sahand; Fattahi, Mostafa; Dehghani, Pooyan

    2016-01-01

    Spontaneous coronary artery vasospasm is one of the important causes of acute chest pain syndromes. The diagnosis of diffuse multifocal spasm can be quite challenging and it could be easily mistaken for diffuse coronary artery disease. The use of intracoronary nitroglycerin can relieve spasm and reveal the real extent of coronary artery disease. Herein we present a case presenting with acute myocardial infarction due to severe coronary artery spasm that had even received fibrinolytic therapy. Multiple narrowing was shown during coronary angiography and the patient was scheduled for percutaneous coronary intervention (PCI). But after intracoronary (IC) injection of nitroglycerin, all of lesions disappeared completely and the diagnosis of coronary spasm was confirmed. PMID:27777700

  3. Giant star seismology

    NASA Astrophysics Data System (ADS)

    Hekker, S.; Christensen-Dalsgaard, J.

    2017-06-01

    The internal properties of stars in the red-giant phase undergo significant changes on relatively short timescales. Long near-uninterrupted high-precision photometric timeseries observations from dedicated space missions such as CoRoT and Kepler have provided seismic inferences of the global and internal properties of a large number of evolved stars, including red giants. These inferences are confronted with predictions from theoretical models to improve our understanding of stellar structure and evolution. Our knowledge and understanding of red giants have indeed increased tremendously using these seismic inferences, and we anticipate that more information is still hidden in the data. Unraveling this will further improve our understanding of stellar evolution. This will also have significant impact on our knowledge of the Milky Way Galaxy as well as on exo-planet host stars. The latter is important for our understanding of the formation and structure of planetary systems.

  4. The Shared Crosstalk of Multiple Pathways Involved in the Inflammation between Rheumatoid Arthritis and Coronary Artery Disease Based on a Digital Gene Expression Profile

    PubMed Central

    Zhang, Zhiguo; Jiang, Miao; He, Dan; Bian, Yanqin; Zhang, Ge; Bian, Zhaoxiang; Lu, Aiping

    2014-01-01

    Rheumatoid arthritis (RA) and coronary artery disease (CAD) are both complex inflammatory diseases, and an increased prevalence of CAD and a high rate of mortality have been observed in RA patients. But the molecular mechanism of inflammation that is shared between the two disorders is unclear. High-throughput techniques, such as transcriptome analysis, are becoming important tools for genetic biomarker discovery in highly complex biological samples, which is critical for the diagnosis, prognosis, and treatment of disease. In the present study, we reported one type of transcriptome analysis method: digital gene expression profiling of peripheral blood mononuclear cells of 10 RA patients, 10 CAD patients and 10 healthy people. In all, 213 and 152 differently expressed genes (DEGs) were identified in RA patients compared with normal controls (RA vs. normal) and CAD patients compared with normal controls (CAD vs. normal), respectively, with 73 shared DEGs between them. Using this technique in combination with Ingenuity Pathways Analysis software, the effects on inflammation of four shared canonical pathways, three shared activated predicted upstream regulators and three shared molecular interaction networks were identified and explored. These shared molecular mechanisms may provide the genetic basis and potential targets for optimizing the application of current drugs to more effectively treat these diseases simultaneously and for preventing one when the other is diagnosed. PMID:25514790

  5. An Innocent Giant

    PubMed Central

    Solanki, Lakhan Singh; Dhingra, Mandeep; Raghubanshi, Gunjan; Thami, Gurvinder Pal

    2014-01-01

    A cutaneous horn (cornu cutaneum) is a protrusion from the skin composed of a cornified material. It may be associated with a benign, premalignant, or malignant lesion at the base, masking numerous dermatoses. In a 24-year-old female, a giant cutaneous horn arising from a seborrheic keratosis located on the leg is presented. This case has been reported to emphasize that a giant cutaneous horn may also occur in young patients, even in photoprotected areas, and are not always associated with malignancy. PMID:25484426

  6. Giant and thrombosed left ventricular aneurysm.

    PubMed

    de Agustin, Jose Alberto; de Diego, Jose Juan Gomez; Marcos-Alberca, Pedro; Rodrigo, Jose Luis; Almeria, Carlos; Mahia, Patricia; Luaces, Maria; Garcia-Fernandez, Miguel Angel; Macaya, Carlos; de Isla, Leopoldo Perez

    2015-07-26

    Left ventricular aneurysms are a frequent complication of acute extensive myocardial infarction and are most commonly located at the ventricular apex. A timely diagnosis is vital due to the serious complications that can occur, including heart failure, thromboembolism, or tachyarrhythmias. We report the case of a 78-year-old male with history of previous anterior myocardial infarction and currently under evaluation by chronic heart failure. Transthoracic echocardiogram revealed a huge thrombosed and calcified anteroapical left ventricular aneurysm. Coronary angiography demonstrated that the left anterior descending artery was chronically occluded, and revealed a big and spherical mass with calcified borders in the left hemithorax. Left ventriculogram confirmed that this spherical mass was a giant calcified left ventricular aneurysm, causing very severe left ventricular systolic dysfunction. The patient underwent cardioverter-defibrillator implantation for primary prevention.

  7. Giant and thrombosed left ventricular aneurysm

    PubMed Central

    de Agustin, Jose Alberto; de Diego, Jose Juan Gomez; Marcos-Alberca, Pedro; Rodrigo, Jose Luis; Almeria, Carlos; Mahia, Patricia; Luaces, Maria; Garcia-Fernandez, Miguel Angel; Macaya, Carlos; de Isla, Leopoldo Perez

    2015-01-01

    Left ventricular aneurysms are a frequent complication of acute extensive myocardial infarction and are most commonly located at the ventricular apex. A timely diagnosis is vital due to the serious complications that can occur, including heart failure, thromboembolism, or tachyarrhythmias. We report the case of a 78-year-old male with history of previous anterior myocardial infarction and currently under evaluation by chronic heart failure. Transthoracic echocardiogram revealed a huge thrombosed and calcified anteroapical left ventricular aneurysm. Coronary angiography demonstrated that the left anterior descending artery was chronically occluded, and revealed a big and spherical mass with calcified borders in the left hemithorax. Left ventriculogram confirmed that this spherical mass was a giant calcified left ventricular aneurysm, causing very severe left ventricular systolic dysfunction. The patient underwent cardioverter-defibrillator implantation for primary prevention. PMID:26225205

  8. Isolated giant molluscum contagiosum mimicking epidermoid cyst

    PubMed Central

    Uzuncakmak, Tugba K.; Kuru, Burce C.; Zemheri, Ebru I.; Zindanci, Ilkin; Turkoglu, Zafer; Kavala, Mukaddes

    2016-01-01

    Molluscum contagiosum is a benign cutaneous viral infection which is caused by double- stranded DNA poxvirus. It affects mainly children and young adults and usually presents with single or multiple umblicated papules or nodules on face, arms, legs and anogenital regions. It may present in atypical size and clinical appearance in patients with altered or impaired immunity and rarely in immuncompetent patients. Herein we present an immuncompetent young adult patient with isolated giant molluscum contagiosum, which was mimicking epidermoid cyst clinically. PMID:27648389

  9. Expanding pseudoaneurysm compressing the coronary arteries and causing cardiogenic shock.

    PubMed

    Maliske, Seth M; Alshawabkeh, Laith; Schouweiler, Katie; Sigurdsson, Gardar

    2015-01-01

    A 37-year-old man who recently underwent aortic valve replacement after endocarditis presented with cardiogenic shock. A large expansile pseudoaneurysm was subsequently discovered using multiple imaging modalities. Although transesophageal echocardiography is important in diagnosing valve endocarditis, coronary CT angiography of prosthetic valves is feasible and image quality is good. In this case, coronary CT angiography allowed for better understanding of transesophageal echocardiography images and earlier diagnosis of coronary involvement as cause for left ventricular dysfunction.

  10. Multivessel Coronary Thrombosis in a Patient with Idiopathic Thrombocytopenic Purpura

    PubMed Central

    Yagmur, Julide; Cansel, Mehmet; Acikgoz, Nusret; Yagmur, Murat; Eyupkoca, Ferhat; Ermis, Necip; Akturk, Erdal

    2012-01-01

    A 49-year-old woman who had idiopathic thrombocytopenic purpura was admitted to our hospital with severe chest pain. Electrocardiography revealed inferolateral myocardial infarction. The patient underwent immediate coronary angiography, which revealed thrombi in the left coronary system. Percutaneous intervention was not indicated, because the thrombi had occluded the distal segments of multiple coronary arteries. Administration of tirofiban satisfactorily dissolved the thrombi. PMID:23304046

  11. High regression rate of coronary aneurysms developed in patients with immune globulin-resistant Kawasaki disease treated with steroid pulse therapy.

    PubMed

    Adachi, Shinya; Sakaguchi, Heima; Kuwahara, Takashi; Uchida, Yasushi; Fukao, Toshiyuki; Kondo, Naomi

    2010-04-01

    Kawasaki disease is an acute vasculitis syndrome of unknown etiology that mainly affects small and medium-size arteries, particularly the coronary artery. Coronary artery lesions may develop into aneurismal formation and thrombotic occlusion, and progress to ischemic heart disease. The aim of the present study was to investigate the effect of steroid pulse therapy following intravenous immune globulin (IVIG) treatment on the regression rate of aneurysms in Kawasaki disease. Among 93 sequential patients referred to us, because of coronary artery lesions in the acute phase, we found 23 aneurysms in 12 patients during the period from January 1997 to January 2008. We divided them into two groups: a non-steroid group, 7 patients (13 aneurysms) treated with single or multiple IVIG but no steroid pulse therapy; and a steroid group, 5 patients (10 aneurysms) treated with multiple IVIG followed by steroid pulse therapy. We compared the regression rate of the aneurysms between the two groups, retrospectively. The regression rates of the aneurysms in the steroid group were significantly higher than those in the non-steroid group when we analyzed 1) all aneurysms (p = 0.007), 2) giant aneurysms (aneurismal diameter was 4 or more x normal, or > 8 mm) (p = 0.018), and 3) aneurysms in IVIG-resistant patients who were resistant to initial IVIG therapy (p = 0.035). All aneurysms, including the giant aneurysms in the steroid group, regressed, and the regression rate of the aneurysms in the non-steroid group was about 46%(6/13). Steroid pulse therapy may be beneficial for IVIG-resistant patients. Our data suggest that steroid pulse therapy may lead to regression of aneurysms.

  12. Development of a high-volume, multiple-operator program for percutaneous chronic total coronary occlusion revascularization: procedural, clinical, and cost-utilization outcomes.

    PubMed

    Karmpaliotis, Dimitri; Lembo, Nicholas; Kalynych, Anna; Carlson, Harold; Lombardi, William L; Anderson, Chad N; Rinehart, Sarah; Kirkland, Ben; Shemwell, Kathie C; Kandzari, David E

    2013-07-01

    Development of a specialized chronic total coronary occlusion (CTO) revascularization program attentive to procedural guidelines, quality oversight, and cost/resource utilization has not been described. A single-center CTO interventional program was initiated with requirements including: extensive didactic training, on-site proctorship, routine determination of case appropriateness, adherence to procedural safety guidelines, and a 2-operator/case approach. Clinical and angiographic characteristics, procedural outcomes, in-hospital clinical events, and cost/resource utilization were examined. Among 145 patients, 160 consecutive CTO revascularization procedures were attempted between October 2009 and December 2010. Selected procedural and technical characteristics included: bilateral femoral access, 90.0%; planned retrograde guidewire placement, 37.5%; re-entry catheter, 10.0%; reattempt, 10.6%; fluoroscopic time, 67.4 ± 45.5 min; contrast volume, 403 ± 215 mL. Average stent number and total stent length per CTO vessel were 2.6 ± 1.1 and 64.7 ± 30.7 mm, respectively. Overall CTO success rate was 85.6% (137/160). In-hospital adverse outcomes included: death 0.6%; emergency bypass surgery, 0.6%; tamponade, 0.6%; myocardial infarction, 1.9%; transient nephropathy, 1.2%. Compared with patients undergoing non-CTO PCI, procedural and total cost per patient were significantly higher among the CTO cohort despite overall similar contribution margins ($5,173 ± 12,052 versus $5,730 ± 8,958, P = 0.58). Following initiation of a dedicated program with implementation of quality and performance guidelines, complex CTO revascularization may be safely performed with outcomes comparable with reports from established centers. Despite higher resource utilization, CTO revascularization is associated with a positive contribution margin. Requirement of educational and performance standards, mentorship from experts, consensus review for appropriateness and provision of catheterization

  13. Shadows on a Giant

    NASA Image and Video Library

    2012-07-02

    Saturn rings cast wide shadows on the planet, and the shadow of a moon also graces the gas giant in this scene from NASA Cassini spacecraft. The moon Enceladus is not shown in this view, but it does cast a small, elongated shadow.

  14. Giant scrotal elephantiasis.

    PubMed

    Kuepper, Daniel

    2005-02-01

    How much can a man carry? Penoscrotal elephantiasis is a debilitating syndrome. This is a case report of a patient with giant genital elephantiasis secondary to long-standing lymphogranuloma venereum infection in Ethiopia. Complete surgical resection of the pathologic tissue and penile reconstruction was undertaken with good cosmetic and functional results.

  15. [Giant retroperitoneal liposarcoma].

    PubMed

    Mezzour, Mohamed Hicham; El Messaoudi, Yasser Arafat; Fekak, Hamid; Rabii, Redouane; Marnissi, Farida; Karkouri, Mehdi; Salam, Siham; Iraki, Moulay Ahmed; Joual, Abdenbi; Meziane, Fathi

    2006-02-01

    The authors report a case of giant retroperitoneal liposarcoma. The diagnosis was suspected after scanography and magnetic resonance imaging and confirmed by the histological analysis of the extracted piece after surgical treatment. Postoperative evolution was favourable after one year without recurrence or distant metastasis. The authors discuss the pathologic and therapeutic aspects and the prognosis of retroperitoneal liposarcoma.

  16. Electroluminescence of Giant Stretchability.

    PubMed

    Yang, Can Hui; Chen, Baohong; Zhou, Jinxiong; Chen, Yong Mei; Suo, Zhigang

    2016-06-01

    A new type of electroluminescent device achieves giant stretchability by integrating electronic and ionic components. The device uses phosphor powders as electroluminescent materials, and hydrogels as stretchable and transparent ionic conductors. Subject to cyclic voltage, the phosphor powders luminesce, but the ionic conductors do not electrolyze. The device produces constant luminance when stretched up to an area strain of 1500%.

  17. Coronary Artery Anomalies

    MedlinePlus

    ... Center for Coronary Artery Anomalies Doctors at the Texas Heart Institute's Center for Coronary Artery Anomalies (CCAA) ... comments. Terms of Use and Privacy Policy © Copyright Texas Heart Institute All rights reserved.

  18. Counseling the Coronary Patient

    ERIC Educational Resources Information Center

    Semmler, Caryl; Semmler, Maynard

    1974-01-01

    The article discusses counseling sessions designed to a) help the coronary patient adjust to cardiovascular disease, b) diminish patient anxieties and fears, and c) educate the patient and family members on controlling risk factors to deter another coronary attack. (JS)

  19. Coronary artery fistula

    MedlinePlus

    Congenital heart defect - coronary artery fistula; Birth defect heart - coronary artery fistula ... attaches to one of the chambers of the heart (the atrium or ventricle) or another blood vessel ( ...

  20. Counseling the Coronary Patient

    ERIC Educational Resources Information Center

    Semmler, Caryl; Semmler, Maynard

    1974-01-01

    The article discusses counseling sessions designed to a) help the coronary patient adjust to cardiovascular disease, b) diminish patient anxieties and fears, and c) educate the patient and family members on controlling risk factors to deter another coronary attack. (JS)

  1. Coronary heart disease

    MedlinePlus

    Heart disease, Coronary heart disease, Coronary artery disease; Arteriosclerotic heart disease; CHD; CAD ... buildup of plaque in the arteries to your heart. This may also be called hardening of the ...

  2. Coronary artery disease

    MedlinePlus Videos and Cool Tools

    ... heart muscle itself. Damage to or blockage of a coronary artery can result in injury to the heart. Normally, blood flows through a coronary artery unimpeded. However, a process called atherosclerosis ...

  3. Assessment of coronary ischaemia by myocardial perfusion dipyridamole stress technetium-99 m tetrofosmin, single-photon emission computed tomography, and coronary angiography in children with Kawasaki disease: pre- and post-coronary bypass grafting.

    PubMed

    Mostafa, Mostafa S; Sayed, Ashraf O; Al Said, Yasser M

    2015-06-01

    Coronary artery lesions in Kawasaki disease invasively assessed by coronary angiography. Evaluation of myocardial perfusion by single-photon emission computed tomography may identify the haemodynamic significance of coronary lesions. To evaluate diagnostic accuracy of dipyridamole stress technetium-99 m tetrofosmin, single-photon emission computed tomography as a possible alternative to invasive coronary angiography for detection and follow-up of myocardial ischaemia in patients with Kawasaki disease, and pre- and post-coronary bypass grafting. Coronary angiography and single-photon emission computed tomography were performed on 21 patients who were classified into three groups - group I (stenosis), group II (giant aneurysms), and group III (small aneurysms). Of the 21 patients, 16 (groups I and II) patients with myocardial perfusion defects, who underwent coronary bypass grafting, were followed up with single-photon emission computed tomography. In group I, all patients had significant coronary stenosis and 100% of them had perfusion defects in the anterior and septal walls. In group II, all patients had giant aneurysms and 83% of them had inferior and inferolateral perfusion defects. In group III, all patients had small aneurysms and 100% of them had normal perfusion. Pre-coronary bypass grafting myocardial ischaemic defects disappeared in all patients after surgery. Sensitivity, specificity, and accuracy of single-photon emission computed tomography were 94, 100, and 95%, respectively. Technetium-99 m tetrofosmin single-photon emission computed tomography can be applied as an accurate non-invasive diagnostic technique for detecting myocardial perfusion defects with coronary artery lesions, and to show improved or even normalised perfusion of the myocardium in patients after surgical revascularisation.

  4. Coronary Artery Fistula

    DTIC Science & Technology

    2007-04-01

    ascending aorta and pulmonary artery) and congenital coronary artery stenosis . Most coronary artery fistulas are congenital but may also...MILITARY MEDICINE, 172, 4: xi-xii, 2007 Military Medicine, Vol. 172, 4, April 2007 Radiology Corner Case #11 Coronary Artery Fistula...man with a single episode of vague sub- sternal chest pain was referred for evaluation of possible coronary artery disease. His medical history was

  5. Management of Coronary Artery Calcium and Coronary CTA Findings.

    PubMed

    Thomas, Dustin M; Divakaran, Sanjay; Villines, Todd C; Nasir, Khurram; Shah, Nishant R; Slim, Ahmad M; Blankstein, Ron; Cheezum, Michael K

    Coronary artery calcium (CAC) testing and coronary computed tomography angiography (CTA) have significant data supporting their ability to identify coronary artery disease (CAD) and classify patient risk for atherosclerotic cardiovascular disease (ASCVD). Evidence regarding CAC use for screening has established an excellent prognosis in patients with no detectable CAC, and the ability to risk re-classify the majority of asymptomatic patients considered intermediate risk by traditional risk scores. While data regarding the ideal management of CAC findings are limited, evidence supports statin consideration in patients with CAC > 0 and individualized aspirin therapy accounting for CAD risk factors, CAC severity, and factors which increase a patient's risk of bleeding. In patients with stable or acute symptoms undergoing coronary CTA, a normal CTA predicts excellent prognosis, allowing reassurance and disposition without further testing. When CTA identifies nonobstructive CAD (<50 % stenosis), observational data support consideration of statin use/intensification in patients with extensive plaque (at least four coronary segments involved) and patients with high-risk plaque features. In patients with both nonobstructive and obstructive CAD, multiple studies have now demonstrated an ability of CTA to guide management and improve CAD risk factor control. Still, significant under-treatment of cardiovascular risk factors and high-risk image findings remain, among concerns that CTA may increase invasive angiography and revascularization. To fully realize the impact of atherosclerosis imaging for ASCVD prevention, patient engagement in lifestyle changes and the modification of ASCVD risk factors remain the foundation of care. This review provides an overview of available data and recommendations in the management of CAC and CTA findings.

  6. LITHIUM ABUNDANCES IN RED GIANTS OF M4: EVIDENCE FOR ASYMPTOTIC GIANT BRANCH STAR POLLUTION IN GLOBULAR CLUSTERS?

    SciTech Connect

    D'Orazi, Valentina; Marino, Anna F. E-mail: anna.marino@unipd.i

    2010-06-20

    The determination of Li and proton-capture element abundances in globular cluster (GC) giants allows us to constrain several key questions on the multiple population scenarios in GCs, from formation and early evolution to pollution and dilution mechanisms. In this Letter, we present our results on Li abundances for a large sample of giants in the intermediate-metallicity GC NGC 6121 (M4), for which Na and O have been already determined by Marino et al. The stars analyzed are both below and above the red giant branch bump luminosity. We found that the first and second generation stars share the same Li content, suggesting that a Li production must have occurred. This provides strong observational evidence supporting the scenario in which asymptotic giant branch stars are GC polluters.

  7. Giant lateral left ventricular wall aneurysm sparing the submitral apparatus

    PubMed Central

    2013-01-01

    Left ventricular aneurysms are a frequent and serious complication following acute transmural myocardial infarction and are most commonly located at the ventricular apex. The majority of these patients presents with severe mitral insufficiency, congestive heart failure, systemic embolism and sudden cardiac death. Giant aneurysms occurring in a submitral position between anterior and posterior papillary muscles on the lateral ventricular wall constitute a minor entity and those leaving the mitral apparatus intact are extremely rare. Herein, we report the case of a 57 y/o Caucasian male patient with a past medical history of coronary artery disease and myocardial infarction with a giant left ventricular aneurysm measuring 15x10x8 cm in diameter. Despite the size of the aneurysm and its close topographical relation to the posterior mitral annulus the mitral apparatus was intact with a competent valve and normal left atrial size. He underwent successful surgical ventricular restoration. PMID:24172071

  8. Ice Giant Exploration

    NASA Astrophysics Data System (ADS)

    Rymer, A. M.; Arridge, C. S.; Masters, A.; Turtle, E. P.; Simon, A. A.; Hofstadter, M. D.; Turrini, D.; Politi, R.

    2015-12-01

    The Ice Giants in our solar system, Uranus and Neptune, are fundamentally different from their Gas Giant siblings Jupiter and Saturn, from the different proportions of rock and ice to the configuration of their planetary magnetic fields. Kepler space telescope discoveries of exo-planets indicate that planets of this type are among the most ubiquitous universally and therefore a future mission to explore the nature of the Ice Giants in our own solar system will provide insights into the nature of extra-solar system objects in general. Uranus has the smallest self- luminosity of all the planets, potentially related to catastrophic events early in the planet's history, which also may explain Uranus' large obliquity. Uranus' atmosphere is subject to extreme seasonal forcing making it unique in the Solar System. Neptune is also unique in a number of ways, notably its large moon Triton which is likely a captured Kuiper Belt Object and one of only two moons in the solar system with a robustly collisional atmosphere. Similar to Uranus, the angle between the solar wind and the magnetic dipole axis is subject to large-amplitude variations on both diurnal and seasonal timescales, but peculiarly it has one of the quietest magnetospheres of the solar system, at least according to Voyager 2, the only spacecraft to encounter Neptune to date. A comprehensive mission, as advocated in the Decadal Survey, would provide enormous science return but is also challenging and expensive. In this presentation we will discuss mission scenarios and suggest how collaboration between disciplines and internationally can help us to pursue a mission that includes Ice Giant exploration.

  9. Giant cell arteritis

    PubMed Central

    Calvo-Romero, J

    2003-01-01

    Giant cell arteritis (GCA), temporal arteritis or Horton's arteritis, is a systemic vasculitis which involves large and medium sized vessels, especially the extracranial branches of the carotid arteries, in persons usually older than 50 years. Permanent visual loss, ischaemic strokes, and thoracic and abdominal aortic aneurysms are feared complications of GCA. The treatment consists of high dose steroids. Mortality, with a correct treatment, in patients with GCA seems to be similar that of controls. PMID:13679546

  10. Giant Cell Arteritis.

    PubMed

    Hoffman, Gary S

    2016-11-01

    This issue provides a clinical overview of giant cell arteritis, focusing on diagnosis, treatment, and practice improvement. The content of In the Clinic is drawn from the clinical information and education resources of the American College of Physicians (ACP), including MKSAP (Medical Knowledge and Self-Assessment Program). Annals of Internal Medicine editors develop In the Clinic in collaboration with the ACP's Medical Education and Publishing divisions and with the assistance of additional science writers and physician writers.

  11. Unusual Giant Prostatic Urethral Calculus

    PubMed Central

    Bello, A.; Maitama, H. Y.; Mbibu, N. H.; Kalayi, G. D.; Ahmed, A.

    2010-01-01

    Giant vesico-prostatic urethral calculus is uncommon. Urethral stones rarely form primarily in the urethra, and they are usually associated with urethral strictures, posterior urethral valve or diverticula. We report a case of a 32-year-old man with giant vesico-prostatic (collar-stud) urethral stone presenting with sepsis and bladder outlet obstruction. The clinical presentation, management, and outcome of the giant prostatic urethral calculus are reviewed. PMID:22091328

  12. Giant bulla mimicking tension pneumothorax.

    PubMed

    Gökçe, Mertol; Saydam, Ozkan; Altin, Remzi; Kart, Levent

    2009-01-01

    In the chest X-ray, we observe tension pneumothorax (TPX) as wide radiolucent view in a hemithorax and pushing the mediastinal structures contralateral. Giant bulla may mimic TPX with wide radiolucent view and mediastinal shift. The present report includes giant pulmonary bulla in 35-year-old woman. The giant bulla was diagnosed as a TPX in emergency, and chest tube was performed. The differentiation between TPX and a giant bulla may be very difficult. The therapies of these two similar entities are completely different. So that, we must be careful about anamnesis, physical examination and radiology for true diagnosis.

  13. The coronary heart team.

    PubMed

    Yanagawa, Bobby; Puskas, John D; Bhatt, Deepak L; Verma, Subodh

    2017-09-01

    The concept of a Coronary Heart Team has generated increased interest, including support from major practice guidelines. Here, we review the rationale and the published experience of Coronary Heart Teams. A Coronary Heart Team should be led by both cardiology and cardiac surgery with a shared decision-making approach. The team should incorporate data from anatomic and clinical risk prediction models to offer individualized care. Most teams focus on management of complex patients and those with indications for both coronary artery bypass graft and percutaneous coronary intervention. The potential benefits of a Coronary Heart Team include balanced decision-making, greater adherence to evidence-based practice guidelines, as well as promoting greater collegiality and exchange of knowledge between specialties. Single-center series have demonstrated consistency in decision-making by Coronary Heart Teams but prospective data demonstrating improved patient outcomes and/or cost effectiveness are necessary. The concept of a Coronary Heart Team is gaining traction for patients with complex coronary artery disease. There is a growing literature in support of Coronary Heart Teams but comparative and prospective data demonstrating improved patient outcomes are needed.

  14. Aortic valve laceration following coronary angiography and percutaneous coronary intervention.

    PubMed

    Roy, James; Manganas, Con; Youssef, George; Rees, David

    2016-11-01

    Valve complications following coronary angiography and percutaneous coronary interventions are rare. We report a case of an aortic valve laceration following cardiac catheterization and percutaneous coronary intervention, which required surgical valve replacement. © 2016 Wiley Periodicals, Inc.

  15. Safety and efficacy of dual-axis rotational coronary angiography vs. standard coronary angiography.

    PubMed

    Klein, Andrew J; Garcia, Joel A; Hudson, Paul A; Kim, Michael S; Messenger, John C; Casserly, Ivan P; Wink, Onno; Hattler, Brack; Tsai, Thomas T; Chen, S Y James; Hansgen, Adam; Carroll, John D

    2011-05-01

    To determine the safety and efficacy of dual-axis rotational coronary angiography (DARCA) by directly comparing it to standard coronary angiography (SA). Standard coronary angiography (SA) requires numerous fixed static images of the coronary tree and has multiple well-documented limitations. Dual-axis rotational coronary angiography (DARCA) is a new rotational acquisition technique that entails simultaneous LAO/RAO and cranial/caudal gantry movement. This technological advancement obtains numerous unique images of the left or right coronary tree with a single coronary injection. We sought to assess the safety and efficacy of DARCA as well as determine DARCA's adequacy for CAD screening and assessment. Thirty patients underwent SA following by DARCA. Contrast volume, radiation dose (DAP) and procedural time were recorded for each method to assess safety. For DARCA acquisitions, blood pressure (BP), heart rate (HR), symptoms and any arrhythmias were recorded. All angiograms were reviewed for CAD screening adequacy by two independent invasive cardiologists. Compared to SA, use of DARCA was associated with a 51% reduction in contrast, 35% less radiation exposure, and 18% shorter procedural time. Both independent reviewers noted DARCA to be at least equivalent to SA with respect to the ability to screen for CAD. DARCA represents a new angiographic technique which is equivalent in terms of image quality and is associated with less contrast use, radiation exposure, and procedural time than SA. Copyright © 2011 Wiley-Liss, Inc.

  16. Chromospheric Activity in Red Giants of M67

    NASA Astrophysics Data System (ADS)

    Dupree, A. K.; Whitney, B. A.; Pasquini, L.

    1994-12-01

    Red giants in the old open cluster M67 present a well-studied, homogeneous group of 1.27Msun stars with which to determine the evolution of chromospheric activity and mass loss. Echelle spectra of the Ca II H and K line region (lambda 3950) have been obtained with the 4-m telescope at KPNO, the MMT of the F. L. Whipple Observatory (K only), and the 3.6-m ESO telescope at La Silla, Chile. Spectra of 16 red giant stars down to V ~ 11 were obtained; five of the sample are identified as clump giants. The flux of the emission reversal in the Ca II K core has been calibrated using normalization based on the narrow-band absolute spectrophotometry of Gunn &\\ Stryker (1983, ApJS, 52, 121). A new spectral synthesis of the Calcium line region for radiative models of the M67 giants based on Kurucz atmospheres provides the correction necessary to extract the chromospheric component of the flux. The Ca K emission reversals display asymmetries indicative of outward motions for giants more luminous than M_V ~ +0.5. The chromospheric emission flux in Ca II K decreases with increasing stellar luminosity. Clump giants, which are thought to be in a core-helium burning stage, show Ca II emission comparable to the stars on the red giant branch. Evidence for chromospheric variability is found from multiple observations of several objects. Implications of these results upon the evolution of chromospheres and presence of mass loss in giants will be discussed.

  17. Alternative Surgical Approach to Repairing a Giant Sinus of Valsalva Aneurysm

    PubMed Central

    Cucchietti, Cristina; Pisano, Calogera; Hyde, Jonathan

    2016-01-01

    We report our method of surgically repairing an unruptured giant aneurysm of the right coronary sinus of Valsalva, a lesion that caused moderate aortic regurgitation but no symptoms in a 61-year-old woman. We excised the aneurysm, reconstructed the right sinus of Valsalva with use of a patch, performed mechanical aortic valve replacement directly through the excised aneurysm's cavity, and constructed a single bypass graft to the right coronary artery. The patient was discharged from the hospital after 5 days. Twelve months postoperatively, her clinical and echocardiographic results were normal, and she was doing well. To our knowledge, our surgical approach to this repair has not been described previously. PMID:27047284

  18. Imaging Extrasolar Giant Planets

    NASA Astrophysics Data System (ADS)

    Bowler, Brendan P.

    2016-10-01

    High-contrast adaptive optics (AO) imaging is a powerful technique to probe the architectures of planetary systems from the outside-in and survey the atmospheres of self-luminous giant planets. Direct imaging has rapidly matured over the past decade and especially the last few years with the advent of high-order AO systems, dedicated planet-finding instruments with specialized coronagraphs, and innovative observing and post-processing strategies to suppress speckle noise. This review summarizes recent progress in high-contrast imaging with particular emphasis on observational results, discoveries near and below the deuterium-burning limit, and a practical overview of large-scale surveys and dedicated instruments. I conclude with a statistical meta-analysis of deep imaging surveys in the literature. Based on observations of 384 unique and single young (≈5-300 Myr) stars spanning stellar masses between 0.1 and 3.0 M ⊙, the overall occurrence rate of 5-13 M Jup companions at orbital distances of 30-300 au is {0.6}-0.5+0.7 % assuming hot-start evolutionary models. The most massive giant planets regularly accessible to direct imaging are about as rare as hot Jupiters are around Sun-like stars. Dividing this sample into individual stellar mass bins does not reveal any statistically significant trend in planet frequency with host mass: giant planets are found around {2.8}-2.3+3.7 % of BA stars, <4.1% of FGK stars, and <3.9% of M dwarfs. Looking forward, extreme AO systems and the next generation of ground- and space-based telescopes with smaller inner working angles and deeper detection limits will increase the pace of discovery to ultimately map the demographics, composition, evolution, and origin of planets spanning a broad range of masses and ages.

  19. Giant left ventricular pseudoaneurysm.

    PubMed

    Prakash, Sumi; Garg, Nadish; Xie, Gong-Yuan; Dellsperger, Kevin C

    2010-01-01

    Left ventricular (LV) pseudoaneurysm (PS) is an uncommon, often fatal complication associated with myocardial infarction, cardiothoracic surgery, trauma, and, rarely, infective endocarditis. A 28-year-old man with prior history of bioprosthetic mitral valve replacement presented with congestive heart failure and bacteremia with Abiotrophia granulitica. Transesophageal echocardiogram showed bioprosthesis dysfunction, large vegetations, mitral regurgitation, and probable PS. Cardiac and chest CT confirmed a PS communicating with the left ventricle Patient had pulseless electrical activity and died. Autopsy showed a giant PS with layered thrombus and pseudo-endothelialized cavity. Our case highlights the importance of multimodality imaging as an important tool in management of PS.

  20. Giant mesenteric cyst

    PubMed Central

    Guraya, Salman Yousuf; Salman, Shaista; Almaramhy, Hamdi H.

    2011-01-01

    Mesenteric cysts are uncommon benign abdominal lesions with no classical clinical features. The preoperative diagnosis requires the common imaging modalities but the final diagnosis is established only during surgery or histological analysis. The treatment of choice is complete surgical excision. We report an 18-year-old female with a non-specific abdominal pain and discomfort since 3 weeks. Her CT scan showed a huge cystic swelling, which necessitated surgical exploration. Preoperatively, a giant cyst was encountered with displacement of bowel loops. The cyst was completely removed and histology report confirmed mesenteric cyst without evidence of malignancy. PMID:24765349

  1. Giant mesenteric cyst.

    PubMed

    Guraya, Salman Yousuf; Salman, Shaista; Almaramhy, Hamdi H

    2011-09-28

    Mesenteric cysts are uncommon benign abdominal lesions with no classical clinical features. The preoperative diagnosis requires the common imaging modalities but the final diagnosis is established only during surgery or histological analysis. The treatment of choice is complete surgical excision. We report an 18-year-old female with a non-specific abdominal pain and discomfort since 3 weeks. Her CT scan showed a huge cystic swelling, which necessitated surgical exploration. Preoperatively, a giant cyst was encountered with displacement of bowel loops. The cyst was completely removed and histology report confirmed mesenteric cyst without evidence of malignancy.

  2. A Giant Urethral Calculus.

    PubMed

    Sigdel, G; Agarwal, A; Keshaw, B W

    2014-01-01

    Urethral calculi are rare forms of urolithiasis. Majority of the calculi are migratory from urinary bladder or upper urinary tract. Primary urethral calculi usually occur in presence of urethral stricture or diverticulum. In this article we report a case of a giant posterior urethral calculus measuring 7x3x2 cm in a 47 years old male. Patient presented with acute retention of urine which was preceded by burning micturition and dribbling of urine for one week. The calculus was pushed in to the bladder through the cystoscope and was removed by suprapubic cystolithotomy.

  3. Coronary revascularisation in women

    PubMed Central

    Mikhail, G W

    2006-01-01

    Coronary heart disease is the leading cause of death in men and women worldwide. It is still considered a disease of men and there has been little recognition of its importance in women. Gender differences exist in acute and chronic ischaemia in terms of clinical manifestations, investigations and treatment. There are clear gender differences in coronary revascularisation with a higher mortality seen in women. At the time a woman presents with coronary artery disease she is older and has more co‐morbid factors. Furthermore, women have smaller coronary arteries making them more difficult to revascularise. In recent years there has been a general trend towards improved outcomes in women undergoing both surgical and percutaneous coronary intervention. The increasing use of drug eluting stents and adjunctive medical treatment as well as the use of off‐pump bypass surgery needs further evaluation in terms of gender differences. This article reviews the current literature on coronary revascularisation in women. PMID:16614263

  4. Assessment of coronary thrombolysis

    SciTech Connect

    Geltman, E.M.; Abendschein, D.R.; Devries, S.R.

    1987-02-01

    The efficacy of coronary thrombolysis may be assessed by several invasive and noninvasive means, including coronary angiography, contrast and radionuclide angiography, thallium 201 or /sup 99m/Tc-pyrophosphate scintigraphy, positron emission tomography, cardiac ultrasonography, electrocardiography, and analysis of plasma creatine kinase activity. Each technique has its own strengths and limitations, but when used in concert these methods may provide insight into the physiology of coronary reperfusion and the efficacy of reperfusion in individual patients and populations. 104 references.

  5. [Partial internal hemipelvectomy for a secondary giant pelvic chondrosarcoma. A case report].

    PubMed

    Rico Martínez, Genaro; Linares González, Luis Miguel; Delgado Cedillo, Ernesto A; Miranda Roa, Josué Antonio; Mendoza Cardona, Alejandro; Estrada Villaseñor, Eréndira

    2007-01-01

    The purpose of this paper is to present the orthopedic-oncologic and functional outcomes of internal partial hemipelvectomy for a secondary giant pelvic chondrosarcoma in a patient with multiple hereditary osteochondromatosis.

  6. Management of Giant Sequoia on Mountain Home Demonstration State Forest

    Treesearch

    Norman J. Benson

    1986-01-01

    Established in 1946, the Mountain Home Demonstration State Forest, Tulare County, California, is managed by the California Department of Forestry. It is a multiple-use forest with recreation as its primary focus, although timber management has always played an important role. Giant sequoia (Sequoiadendron giganteum [Lindl. ] Buchholz) occurs in...

  7. Clinical and angiographic characteristics of patients with coronary artery ectasia.

    PubMed

    Zografos, Theodoros A; Korovesis, Socrates; Giazitzoglou, Eleftherios; Kokladi, Maria; Venetsanakos, Ioannis; Paxinos, George; Fragakis, Nikolaos; Katritsis, Demosthenes G

    2013-08-20

    The relationship of the extent of coronary artery ectasia (CAE) with coronary blood flow in the major epicardial arteries has not been adequately assessed. This study aimed at investigating the association of the topographical extent of CAE with coronary flow velocity and clinical characteristics in patients with isolated CAE and in patients with coexisting obstructive coronary artery disease (CAD). We reviewed 3764 consecutive coronary angiograms performed at Athens Euroclinic and identified patients with CAE according to standard criteria. The topographical extent of ectasia was considered, and coronary flow velocity was determined using the TIMI frame count (TFC). The severity of CAD was assessed using the modified Gensini index and the number of diseased vessels. Clinical data were correlated with TFC and CAD severity analysis. Ectatic lesions were identified in 119 patients. The mean TFC correlated positively with the topographical extent of CAE (rs=0.733, p<0.001). Stepwise multiple linear regression revealed that the topographical extent of CAE and the maximum diameter of the ectatic segment in the corresponding artery are independent predictors of TFC in LAD and RCA. Using multivariate analysis, a history of myocardial infarction was independently associated with CAE extent, and CAD severity. The extent of ectasia in the coronary vasculature is correlated with coronary flow velocity and associated with clinical presentation independent of coexisting significant coronary stenoses. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  8. Giant Malignant Pheochromocytoma with Palpable Rib Metastases

    PubMed Central

    Gokce, Gokhan; Kilicli, Fatih; Elagoz, Sahande; Ayan, Semih; Gultekin, Emin Yener

    2014-01-01

    Pheochromocytoma is a rare and usually benign neuroendocrine neoplasm. Only 10% of all these tumors are malignant and there are no definitive histological or cytological criteria of malignancy. Single malignancy criteria are the presence of advanced locoregional disease or metastases. We report a case, with a giant retroperitoneal tumor having multiple metastases including palpable rib metastases, who was diagnosed as a malignant pheochromocytoma. The patient was treated with surgery. The literature was reviewed to evaluate tumor features and current diagnostic and therapeutic approaches for patients with metastatic or potentially malignant pheochromocytoma. PMID:25152826

  9. Acute and late coronary outcomes in 1073 patients with Kawasaki disease with and without intravenous γ-immunoglobulin therapy.

    PubMed

    Lin, Ming-Tai; Sun, Li-Chuan; Wu, En-Ting; Wang, Jou-Kou; Lue, Hung-Chi; Wu, Mei-Hwan

    2015-06-01

    To explore acute and late coronary outcomes and their risk/modifiers in patients with Kawasaki disease (KD). Retrospective study. 1073 patients with KD identified from a tertiary care medical centre (1980-2012; 8677 patient-years). The acute coronary severities and late outcomes (survival free of coronary aneurysm persistence and ischaemia) were assessed. Coronary arterial lesions occurred in 40.6% of cases at their acute febrile stages, and persisted beyond 1 month in 196 (18.3%, M/F=138/58) patients: 125 (11.6%) had small aneurysms, 44 (4.1%) had medium aneurysms, and 27 (2.5%) had giant aneurysms. At follow-up (1-46 years), coronary aneurysms persisted in all with giant aneurysms, in 55% of those with medium aneurysms (18% with stenosis), and in 9% of those with small aneurysms. Ischaemia events occurred in 14 patients (M/F=13/1) and caused four deaths. Among the patients with KD with coronary aneurysms, 10-year ischaemia event-free and aneurysm persistence probability was 87.5% and 20.6%, respectively. The only independent risk for aneurysm persistence was the aneurysm severity 1 month after KD onset (χ(2)=80.73, p<10(-3)). Male patients and intravenous γ-immunoglobulin (IVIG) therapy were independent risk factors of initial coronary severity but were not associated with the late coronary outcomes, even in severity stratified subgroups. The coronary severity 1 month after KD onset is most crucial to the late coronary outcomes. Although IVIG use improves the initial severity of coronary lesions, it does not further modify the long-term fate of coronary aneurysms. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  10. Giant extragenital Bowen's disease.

    PubMed

    Bakardzhiev, Ilko; Chokoeva, Anastasiya Atanasova; Tchernev, Georgi

    2015-12-01

    Giant extragenital forms of Morbus Bowen are extremely rare. The already described cases in the word literature are most commonly with periungual localization, as well as located on the foot and neck area. The clinical manifestation is presented most commonly by non-specific erythematous to erythematous-squamous plaques or papules, which is confusing to the clinician. From the pathogenic point of view, it is important to be confirmed or rejected the presence of human papilloma viruses (HPVs) in each case of affected patient, as this information is mandatory in respect to the adequate selection of the subsequent regimen. If HPVs are detected, systemic antiviral therapy could be initiated to reduce the size of the lesions before subsequent surgical eradication. A postoperative prevention through vaccination could be also considered additionally. In cases of HPV-negative giant extragenital forms of Morbus Bowen (as in the described patient), the focus should be on local immunomodulation by substances such as imiquimod, which reduce the size of the lesions, thereby creating optimal opportunities for their future surgical eradication. Other possible options described in the literature include topical application of 5-fluorouracil, photodynamic therapy, cryotherapy, and laser therapy (carbon dioxide laser). The choice of the most appropriate regimen should have been an individual decision of the clinician, considering also the location and the extent of the lesion.

  11. Gas Giants Form Quickly

    NASA Technical Reports Server (NTRS)

    2007-01-01

    This is an artist's concept of a hypothetical 10-million-year-old star system. The bright blur at the center is a star much like our sun. The other orb in the image is a gas-giant planet like Jupiter. Wisps of white throughout the image represent traces of gas.

    Astronomers using NASA's Spitzer Space Telescope have found evidence showing that gas-giant planets either form within the first 10 million years of a sun-like star's life, or not at all. The lifespan for sun-like stars is about 10 billion years.

    The scientists came to this conclusion after searching for traces of gas around 15 different sun-like stars, most with ages ranging from 3 million to 30 million years. With the help of Spitzer's Infrared Spectrometer instrument, they were able to search for relatively warm gas in the inner regions of these star systems, an area comparable to the zone between Earth and Jupiter in our own solar system. They also used ground-based radio telescopes to search for cooler gas in the outer regions of these systems, an area comparable to the zone around Saturn and beyond.

  12. Gas Giants Form Quickly

    NASA Technical Reports Server (NTRS)

    2007-01-01

    This is an artist's concept of a hypothetical 10-million-year-old star system. The bright blur at the center is a star much like our sun. The other orb in the image is a gas-giant planet like Jupiter. Wisps of white throughout the image represent traces of gas.

    Astronomers using NASA's Spitzer Space Telescope have found evidence showing that gas-giant planets either form within the first 10 million years of a sun-like star's life, or not at all. The lifespan for sun-like stars is about 10 billion years.

    The scientists came to this conclusion after searching for traces of gas around 15 different sun-like stars, most with ages ranging from 3 million to 30 million years. With the help of Spitzer's Infrared Spectrometer instrument, they were able to search for relatively warm gas in the inner regions of these star systems, an area comparable to the zone between Earth and Jupiter in our own solar system. They also used ground-based radio telescopes to search for cooler gas in the outer regions of these systems, an area comparable to the zone around Saturn and beyond.

  13. Giant Intradiverticular Bladder Tumor

    PubMed Central

    Noh, Mohamad Syafeeq Faeez Md; Aziz, Ahmad Fuad Abdul; Ghani, Khairul Asri Mohd; Siang, Christopher Lee Kheng; Yunus, Rosna; Yusof, Mubarak Mohd

    2017-01-01

    Patient: Male, 74 Final Diagnosis: Giant intradiverticular bladder tumor with metastasis Symptoms: Hematuria Medication:— Clinical Procedure: — Specialty: Urology Objective: Rare disease Background: Intradiverticular bladder tumors are rare. This renders diagnosis of an intradiverticular bladder tumor difficult. Imaging plays a vital role in achieving the diagnosis, and subsequently staging of the disease. Case Report: A 74-year-old male presented to our center with a few months history of constitutional symptoms. Upon further history, he reported hematuria two months prior to presentation, which stopped temporarily, only to recur a few days prior to coming to the hospital. The patient admitted to having lower urinary tract symptoms. However, there was no dysuria, no sandy urine, and no fever. Palpation of his abdomen revealed a vague mass at the suprapubic region, which was non tender. In view of his history and the clinical examination findings, an ultrasound of the abdomen and computed tomography (CT) was arranged. These investigations revealed a giant tumor that seemed to be arising from a bladder diverticulum, with a mass effect and hydronephrosis. He later underwent operative intervention. Conclusions: Intradiverticular bladder tumors may present a challenge to the treating physician in an atypical presentation; thus requiring a high index of suspicion and knowledge of tumor pathophysiology. As illustrated in our case, CT with its wide availability and multiplanar imaging capabilities offers a useful means for diagnosis, disease staging, operative planning, and follow-up. PMID:28246375

  14. Evaluation of Coronary Artery Status by Coronary Angiography after First Survival of Acute Myocardial Infarction

    PubMed Central

    Jain, Siddhant; Sarkar, Piyabi; Modi, Nitin; Tilkar, Mahendra

    2015-01-01

    Introduction Acute Myocardial Infarction (AMI) is a life threatening medical emergency which needs urgent medical attention. It is one of the major cause of mortality and morbidity throughout the world. Aim The aim of the present study was to assess the coronary artery status by Coronary Angiography (CAG) after first survival of the Acute Myocardial Infarction (AMI) and to correlate the CAG findings with Coronary Artery Disease (CAD) Risk Factor (RF) and effect of early thrombolysis. Materials and Methods CAG was done on 870 patients consecutively from June 2013 to May 2015. Age, Gender, Body Mass Index (BMI), CAD risk factors (RF) such as Type 2 diabetes mellitus (T2 DM), hypertension, dyslipidaemia, smoking status and history of thrombolyctic status were recorded. The correlation between the CAD risk factors (RF) and the CAG findings were statistically analyzed. Results Coronary heart disease risk factors analysis revealed ≥ three RF in 23.88%, two RF in 29.88% and one RFin 45.86% of patients. CAG showed Single Vessel Disease (SVD) in 236 (27.1%) patients, double vessel disease (DVD) in 220(25.2%) patients, Triple Vessel Disease (TVD) in 252 (28.9%) patients. Multiple coronary artery involvement were found in the high risk group patients, which was found statistically significant (p-value<0.0001). A total of 348/870 (40%) patients were thrombolysed amongst them 80 (22.9%) revealed minimal and/or normal coronary artery which was found statistically significant (p-value<0.0001). Conclusion Higher the coronary risk factors, more the chance of the multiple coronary arteries involvement. All AMI patients should be thrombolysed as early as possible to get the benefit of recanalization of the culprit vessel. PMID:26816930

  15. Reinflating Giant Planets

    NASA Astrophysics Data System (ADS)

    Kohler, Susanna

    2017-01-01

    Two new, large gas-giant exoplanets have been discovered orbiting close to their host stars. A recent study examining these planets and others like them may help us to better understand what happens to close-in hot Jupiters as their host stars reach the end of their main-sequence lives.OversizedGiantsUnbinned transit light curves for HAT-P-65b. [Adapted from Hartman et al. 2016]The discovery of HAT-P-65b and HAT-P-66b, two new transiting hot Jupiters, is intriguing. These planets have periods of just under 3 days and masses of roughly 0.5 and 0.8 times that of Jupiter, but their sizes are whats really interesting: they have inflated radii of 1.89 and 1.59 times that of Jupiter.These two planets, discovered using the Hungarian-made Automated Telescope Network (HATNet) in Arizona and Hawaii, mark the latest in an ever-growing sample of gas-giant exoplanets with radii larger than expected based on theoretical planetary structure models.What causes this discrepancy? Did the planets just fail to contract to the expected size when they were initially formed, or were they reinflated later in their lifetimes? If the latter, how? These are questions that scientists are only now starting to be able to address using statistics of the sample of close-in, transiting planets.Unbinned transit light curves for HAT-P-66b. [Hartman et al. 2016]Exploring Other PlanetsLed by Joel Hartman (Princeton University), the team that discovered HAT-P-65b and HAT-P-66b has examined these planets observed parameters and those of dozens of other known close-in, transiting exoplanets discovered with a variety of transiting exoplanet missions: HAT, WASP, Kepler, TrES, and KELT. Hartman and collaborators used this sample to draw conclusions about what causes some of these planets to have such large radii.The team found that there is a statistically significant correlation between the radii of close-in giant planets and the fractional ages of their host stars (i.e., the stars age divided by its full

  16. Allometry indicates giant eyes of giant squid are not exceptional.

    PubMed

    Schmitz, Lars; Motani, Ryosuke; Oufiero, Christopher E; Martin, Christopher H; McGee, Matthew D; Gamarra, Ashlee R; Lee, Johanna J; Wainwright, Peter C

    2013-02-18

    The eyes of giant and colossal squid are among the largest eyes in the history of life. It was recently proposed that sperm whale predation is the main driver of eye size evolution in giant squid, on the basis of an optical model that suggested optimal performance in detecting large luminous visual targets such as whales in the deep sea. However, it is poorly understood how the eye size of giant and colossal squid compares to that of other aquatic organisms when scaling effects are considered. We performed a large-scale comparative study that included 87 squid species and 237 species of acanthomorph fish. While squid have larger eyes than most acanthomorphs, a comparison of relative eye size among squid suggests that giant and colossal squid do not have unusually large eyes. After revising constants used in a previous model we found that large eyes perform equally well in detecting point targets and large luminous targets in the deep sea. The eyes of giant and colossal squid do not appear exceptionally large when allometric effects are considered. It is probable that the giant eyes of giant squid result from a phylogenetically conserved developmental pattern manifested in very large animals. Whatever the cause of large eyes, they appear to have several advantages for vision in the reduced light of the deep mesopelagic zone.

  17. Allometry indicates giant eyes of giant squid are not exceptional

    PubMed Central

    2013-01-01

    Background The eyes of giant and colossal squid are among the largest eyes in the history of life. It was recently proposed that sperm whale predation is the main driver of eye size evolution in giant squid, on the basis of an optical model that suggested optimal performance in detecting large luminous visual targets such as whales in the deep sea. However, it is poorly understood how the eye size of giant and colossal squid compares to that of other aquatic organisms when scaling effects are considered. Results We performed a large-scale comparative study that included 87 squid species and 237 species of acanthomorph fish. While squid have larger eyes than most acanthomorphs, a comparison of relative eye size among squid suggests that giant and colossal squid do not have unusually large eyes. After revising constants used in a previous model we found that large eyes perform equally well in detecting point targets and large luminous targets in the deep sea. Conclusions The eyes of giant and colossal squid do not appear exceptionally large when allometric effects are considered. It is probable that the giant eyes of giant squid result from a phylogenetically conserved developmental pattern manifested in very large animals. Whatever the cause of large eyes, they appear to have several advantages for vision in the reduced light of the deep mesopelagic zone. PMID:23418818

  18. Magma Reservoirs Feeding Giant Radiating Dike Swarms: Insights from Venus

    NASA Technical Reports Server (NTRS)

    Grosfils, E. B.; Ernst, R. E.

    2003-01-01

    Evidence of lateral dike propagation from shallow magma reservoirs is quite common on the terrestrial planets, and examination of the giant radiating dike swarm population on Venus continues to provide new insight into the way these complex magmatic systems form and evolve. For example, it is becoming clear that many swarms are an amalgamation of multiple discrete phases of dike intrusion. This is not surprising in and of itself, as on Earth there is clear evidence that formation of both magma reservoirs and individual giant radiating dikes often involves periodic magma injection. Similarly, giant radiating swarms on Earth can contain temporally discrete subswarms defined on the basis of geometry, crosscutting relationships, and geochemical or paleomagnetic signatures. The Venus data are important, however, because erosion, sedimentation, plate tectonic disruption, etc. on Earth have destroyed most giant radiating dike swarm's source regions, and thus we remain uncertain about the geometry and temporal evolution of the magma sources from which the dikes are fed. Are the reservoirs which feed the dikes large or small, and what are the implications for how the dikes themselves form? Does each subswarm originate from a single, periodically reactivated reservoir, or do subswarms emerge from multiple discrete geographic foci? If the latter, are these discrete foci located at the margins of a single large magma body, or do multiple smaller reservoirs define the character of the magmatic center as a whole? Similarly, does the locus of magmatic activity change with time, or are all the foci active simultaneously? Careful study of giant radiating dike swarms on Venus is yielding the data necessary to address these questions and constrain future modeling efforts. Here, using giant radiating dike swarms from the Nemesis Tessera (V14) and Carson (V43) quadrangles as examples, we illustrate some of the dike swarm focal region diversity observed on Venus and briefly explore some

  19. [Giant negative T waves in idiopathic apical diverticulum of the left ventricle in adults].

    PubMed

    Barboteu, M; Desnos, M; Hagège, A; Dufour, M; Chauvaud, S; Junes, G; Baleynaud, S; Bruneval, P; Guérot, C

    1995-10-01

    Left ventricular diverticula, congenital or acquired, with normal coronary arteries are rare. Apical diverticula are exceptionally rare in the adult. The authors present the clinical, paraclinical, anatomopathological pre- and postoperative data in a case of apical diverticulum of the left ventricle presenting with giant negative T waves. The differential diagnosis of these electrocardiographic changes is discussed, in particular apical cardiomyopathy, especially as the two conditions may be associated.

  20. Giant saphenous vein graft pseudoaneurysm to right posterior descending artery presenting with superior vena cava syndrome.

    PubMed

    Vargas-Estrada, Andres; Edwards, Dianna; Bashir, Mohammad; Rossen, James; Zahr, Firas

    2015-06-26

    Saphenous vein grafts (SVG) pseudoaneurysms, especially giant ones, are rare and occur as a late complication of coronary artery bypass grafting. This condition affects both genders and typically occurs within the sixth decade of life. The clinical presentation ranges from an asymptomatic incidental finding on imaging studies to new onset angina, dyspnea, myocardial infarction or symptoms related to compression of neighboring structures. An 82-year-old woman presented with acute onset back pain, dyspnea and was noted to have significantly engorged neck veins. In the emergency department, a chest computed tomographic angiogram with intravenous contrast revealed a ruptured giant bilobed SVG pseudoaneurysm to the right posterior descending artery (RPDA). This imaging modality also demonstrated compression of the superior vena cava (SVC) by the SVG pseudoaneurysm. Coronary angiogram with bypass study was performed to establish the patency of this graft. Endovascular coiling and embolization of the SVG to RPDA was initially considered but disfavored after the coronary angiogram revealed preserved flow from the graft to this arterial branch. After reviewing the angiogram films, a surgical strategy was favored over a percutaneous intervention with a Nitinol self-expanding stent since the latter would have not addressed the superior vena cava compression caused by the giant pseudoaneurysm. Intraoperative transesophageal echocardiogram demonstrated SVC compression by the giant pseudoaneurysm cranial lobe. Our patient underwent surgical ligation and excision of the giant pseudoaneurysm and the RPDA was regrafted successfully. In summary, saphenous vein grafts pseudoaneurysms can be life-threatening and its therapy should be guided based on the presence of mechanical complications, the patency of the affected vein graft and the involved myocardial territory viability.

  1. Giant saphenous vein graft pseudoaneurysm to right posterior descending artery presenting with superior vena cava syndrome

    PubMed Central

    Vargas-Estrada, Andres; Edwards, Dianna; Bashir, Mohammad; Rossen, James; Zahr, Firas

    2015-01-01

    Saphenous vein grafts (SVG) pseudoaneurysms, especially giant ones, are rare and occur as a late complication of coronary artery bypass grafting. This condition affects both genders and typically occurs within the sixth decade of life. The clinical presentation ranges from an asymptomatic incidental finding on imaging studies to new onset angina, dyspnea, myocardial infarction or symptoms related to compression of neighboring structures. An 82-year-old woman presented with acute onset back pain, dyspnea and was noted to have significantly engorged neck veins. In the emergency department, a chest computed tomographic angiogram with intravenous contrast revealed a ruptured giant bilobed SVG pseudoaneurysm to the right posterior descending artery (RPDA). This imaging modality also demonstrated compression of the superior vena cava (SVC) by the SVG pseudoaneurysm. Coronary angiogram with bypass study was performed to establish the patency of this graft. Endovascular coiling and embolization of the SVG to RPDA was initially considered but disfavored after the coronary angiogram revealed preserved flow from the graft to this arterial branch. After reviewing the angiogram films, a surgical strategy was favored over a percutaneous intervention with a Nitinol self-expanding stent since the latter would have not addressed the superior vena cava compression caused by the giant pseudoaneurysm. Intraoperative transesophageal echocardiogram demonstrated SVC compression by the giant pseudoaneurysm cranial lobe. Our patient underwent surgical ligation and excision of the giant pseudoaneurysm and the RPDA was regrafted successfully. In summary, saphenous vein grafts pseudoaneurysms can be life-threatening and its therapy should be guided based on the presence of mechanical complications, the patency of the affected vein graft and the involved myocardial territory viability. PMID:26131340

  2. Giant magnetostrictive composites

    NASA Astrophysics Data System (ADS)

    Duenas, Terrisa Ann

    The limitation of magnetostrictive composites has been in their low magnetostrictive response when compared to their monolithic counterparts. In this dissertation research is presented describing the methods and analysis used to create a giant magnetostrictive composite (GMC) producing giant strains at low fields, exhibiting magnetization ``jumping'' and the ΔE effect. This composite combines the giant magnetostrictive material, Terfenol-D (Tb0.3Dy0.7Fe2) in particle form, with a nonmetallic binder and is capable of producing strains (at room temperature) exceeding 1000 ppm at a nominal field of 1.5 kOe mechanically unloaded and 1200 ppm at 8 MPa preload (2.5 kOe). Several studies leading to the high response of this composite are presented. A connectivity study shows that a [1-3] connected composite produces 50% more strain than a [0-3] composite. A resin study indicates that the lower the viscosity of the resin, the greater the magnetostrictive response; this is attributed to the removal of voids during degassing. A void study correlates the increase in voids to the decrease in strain response. A model is used to correlate analysis with experimental results within 10% accuracy and shows that an optimal volume fraction exists based on the properties of the binder. Using a Polyscience Spurr low- viscosity (60 cps) binder this volume fraction is nominally 20%; this optimum is attributed to the balance of epoxy contracting on the particle (built-in preload) and the actuation delivered by the magnetostrictive material. In addition to the connectivity, resin, void, and volume-fraction study, particle size and gradation studies are presented. Widely dispersed (<106, <212, <300 μm), narrowly dispersed (<45, (90-106), (275-300) μm), and an optimized bimodal (18.7% of (45-90) μm with 81.3% of (250-300) μm) particle distributions are studied. Results show that the larger the particle size, the higher the magnetostrictive response; this is attributed to the reduction of

  3. On to the Ice Giants

    NASA Astrophysics Data System (ADS)

    Reh, Kim; Hofstdater, Mark; Simon, Amy; Elliott, John

    2017-04-01

    Voyager 2 mission flew by Uranus in 1986 and Neptune in 1989 resulting in stunning remote observations not previously accessible from the ground. There have been no follow-up space flight missions to examine ice giants and, as a result there are significant gaps in our understanding of planetary formation and evolution. This gap not only affects our understanding of our own solar system but also our understanding of exoplanets; the majority of planets discovered around other stars are thought to be ice giants. Ice Giants are likely to be far more abundant in our galaxy than previously thought. The U.S. 2011 Planetary Science Decadal Survey committee recognized the importance of Uranus and Neptune, and prioritized the exploration of the Ice Giants. Following from this, NASA and ESA have recently completed a study of candidate missions to Uranus and Neptune, the so-called ice giant planets. The intent was to examine what could be accomplished within the budget realities of the predictable future. This "Pre-Decadal Study," focused on opportunities for missions launching in the 2020's and early 2030's. This paper presents results from the Ice Giants study (science, architectures and technologies) and concludes that compelling and affordable missions to the Ice Giants are within our reach.

  4. Acute coronary syndromes.

    PubMed

    Lipson, Alan

    2008-07-01

    The mortality rate for coronary artery disease has decreased steadily over the past 25 yeas, attributable to a great extent to advances in medical and mechanical interventions. Nevertheless, mortality rates for acute coronary syndromes remain between 4% and 7%. This article highlights treatment options and the challenge of implementing evidence-based recommendations.

  5. Giant magnetofossils and hyperthermal events

    NASA Astrophysics Data System (ADS)

    Chang, Liao; Roberts, Andrew P.; Williams, Wyn; Fitz Gerald, John D.; Larrasoaña, Juan C.; Jovane, Luigi; Muxworthy, Adrian R.

    2012-10-01

    Magnetotactic bacteria biomineralize magnetic minerals with precisely controlled size, morphology, and stoichiometry. These cosmopolitan bacteria are widely observed in aquatic environments. If preserved after burial, the inorganic remains of magnetotactic bacteria act as magnetofossils that record ancient geomagnetic field variations. They also have potential to provide paleoenvironmental information. In contrast to conventional magnetofossils, giant magnetofossils (most likely produced by eukaryotic organisms) have only been reported once before from Paleocene-Eocene Thermal Maximum (PETM; 55.8 Ma) sediments on the New Jersey coastal plain. Here, using transmission electron microscopic observations, we present evidence for abundant giant magnetofossils, including previously reported elongated prisms and spindles, and new giant bullet-shaped magnetite crystals, in the Southern Ocean near Antarctica, not only during the PETM, but also shortly before and after the PETM. Moreover, we have discovered giant bullet-shaped magnetite crystals from the equatorial Indian Ocean during the Mid-Eocene Climatic Optimum (˜40 Ma). Our results indicate a more widespread geographic, environmental, and temporal distribution of giant magnetofossils in the geological record with a link to "hyperthermal" events. Enhanced global weathering during hyperthermals, and expanded suboxic diagenetic environments, probably provided more bioavailable iron that enabled biomineralization of giant magnetofossils. Our micromagnetic modelling indicates the presence of magnetic multi-domain (i.e., not ideal for navigation) and single domain (i.e., ideal for navigation) structures in the giant magnetite particles depending on their size, morphology and spatial arrangement. Different giant magnetite crystal morphologies appear to have had different biological functions, including magnetotaxis and other non-navigational purposes. Our observations suggest that hyperthermals provided ideal conditions for

  6. [Giant esophageal fibrovascular polyp].

    PubMed

    Palacios, Fernando; Contardo, Carlos; Guevara, Jorge; Vera, Augusto; Aguilar, Luis; Huamán, Manuel; Palomino, Américo; Yabar, Alejandro

    2003-01-01

    Fibrovascular polyps are extremely rare benign neoplasias of the esophagus, which usually originate in the lower cricoid area. They do not produce any discomfort in the patient for a long time, however it may make itself evident by the patient's regurgitation of the polyp, producing asphyxia or, more frequently, dysphagia. The case of a 58 year old male patient is presented herein, with a 9 month record of dysphagia, weight loss and intermittent melena. The barium x-ray showed a distended esophagus, with a tumor running from the upper esophageal sphincter to the cardia. The endoscopy confirmed the presence of a pediculated tumor, implanted in the cervical esophagus. Surgeons suspected the potential malignancy of the tumor and performed a transhiatal esophagectomy. The final pathologic diagnosis was giant fibrovascular esophageal polyp.

  7. Pathophysiology of coronary collaterals.

    PubMed

    Stoller, Michael; Seiler, Christian

    2014-02-01

    While the existence of structural adaptation of coronary anastomoses is undisputed, the potential of coronary collaterals to be capable of functional adaptation has been questioned. For many years, collateral vessels were thought to be rigid tubes allowing only limited blood flow governed by the pressure gradient across them. This concept was consistent with the notion that although collaterals could provide adequate blood flow to maintain resting levels, they would be unable to increase blood flow sufficiently in situations of increased myocardial oxygen demand. However, more recent studies have demonstrated the capability of the collateral circulation to deliver sufficient blood flow even during exertion or pharmacologic stress. Moreover, it has been shown that increases in collateral flow could be attributed directly to collateral vasomotion. This review summarizes the pathophysiology of the coronary collateral circulation, ie the functional adapation of coronary collaterals to acute alterations in the coronary circulation.

  8. Pathophysiology of Coronary Collaterals#

    PubMed Central

    Stoller, Michael; Seiler, Christian

    2014-01-01

    While the existence of structural adaptation of coronary anastomoses is undisputed, the potential of coronary collaterals to be capable of functional adaptation has been questioned. For many years, collateral vessels were thought to be rigid tubes allowing only limited blood flow governed by the pressure gradient across them. This concept was consistent with the notion that although collaterals could provide adequate blood flow to maintain resting levels, they would be unable to increase blood flow sufficiently in situations of increased myocardial oxygen demand. However, more recent studies have demonstrated the capability of the collateral circulation to deliver sufficient blood flow even during exertion or pharmacologic stress. Moreover, it has been shown that increases in collateral flow could be attributed directly to collateral vasomotion. This review summarizes the pathophysiology of the coronary collateral circulation, ie the functional adapation of coronary collaterals to acute alterations in the coronary circulation. PMID:23701025

  9. A giant Ordovician anomalocaridid.

    PubMed

    Van Roy, Peter; Briggs, Derek E G

    2011-05-26

    Anomalocaridids, giant lightly sclerotized invertebrate predators, occur in a number of exceptionally preserved early and middle Cambrian (542-501 million years ago) biotas and have come to symbolize the unfamiliar morphologies displayed by stem organisms in faunas of the Burgess Shale type. They are characterized by a pair of anterior, segmented appendages, a circlet of plates around the mouth, and an elongate segmented trunk lacking true tergites with a pair of flexible lateral lobes per segment. Disarticulated body parts, such as the anterior appendages and oral circlet, had been assigned to a range of taxonomic groups--but the discovery of complete specimens from the middle Cambrian Burgess Shale showed that these disparate elements all belong to a single kind of animal. Phylogenetic analyses support a position of anomalocaridids in the arthropod stem, as a sister group to the euarthropods. The anomalocaridids were the largest animals in Cambrian communities. The youngest unequivocal examples occur in the middle Cambrian Marjum Formation of Utah but an arthropod retaining some anomalocaridid characteristics is present in the Devonian of Germany. Here we report the post-Cambrian occurrence of anomalocaridids, from the Early Ordovician (488-472 million years ago) Fezouata Biota in southeastern Morocco, including specimens larger than any in Cambrian biotas. These giant animals were an important element of some marine communities for about 30 million years longer than previously realized. The Moroccan specimens confirm the presence of a dorsal array of flexible blades attached to a transverse rachis on the trunk segments; these blades probably functioned as gills.

  10. Giant Hedge-Hogs: Spikes on Giant Gravitons

    SciTech Connect

    Sadri, D

    2004-01-28

    We consider giant gravitons on the maximally supersymmetric plane-wave background of type IIB string theory. Fixing the light-cone gauge, we work out the low energy effective light-cone Hamiltonian of the three-sphere giant graviton. At first order, this is a U(1) gauge theory on R x S{sup 3}. We place sources in this effective gauge theory. Although non-vanishing net electric charge configurations are disallowed by Gauss' law, electric dipoles can be formed. From the string theory point of view these dipoles can be understood as open strings piercing the three-sphere, generalizing the usual BIons to the giant gravitons, BIGGons. Our results can be used to give a two dimensional (worldsheet) description of giant gravitons, similar to Polchinski's description for the usual D-branes, in agreement with the discussions of hep-th/0204196.

  11. Giant resonances: Progress, new directions, new challenges

    SciTech Connect

    Bertrand, J.R.; Beene, J.R.

    1989-01-01

    A review of some recent developments in the field of giant multipole resonances is presented. Particular emphasis is placed on directions that the authors feel will be followed in this field during the next several years. In particular, the use of high-energy heavy ions to excite the giant resonances is shown to provide exciting new capabilities for giant resonance studies. Among subjects covered are: Coulomb excitation of giant resonances, photon decay of giant resonances, the recent controversy over the identity of the giant monopole resonance, the most recent value for incompressibility of nuclear matter from analysis of giant monopole data, the isospin character of the 63 A/sup /minus/1/3/ GQR, agreement between (e,e/prime/) and (hadron, hadron/prime/) excitation of the giant quadrupole resonance, prospects for multiphonon giant resonance observation, and isolation of the isovector giant quadrupole resonance. 55 refs., 23 figs., 4 tabs.

  12. Coronary stenting during burn shock: diagnostic and treatment considerations.

    PubMed

    Gregg, Shea C; Fidler, Philip E; Atweh, Nabil A

    2006-01-01

    Myocardial injury is known to occur in victims of both thermal and electrical burns. A variety of mechanisms have been ascribed to the pathogenesis of cardiac damage during burn shock. However, limited evidence exists that coronary artery thrombosis plays a frequent role. Distinguishing between acute coronary syndrome (impending myocardial infarction from coronary artery occlusion) vs global cardiac injury is essential; the care diverges drastically. The following case describes a patient who was angiographically proven to have acute coronary thrombosis amidst burn shock ftera 50% TBSA electrical flash burn. Managing the patient's burn shock, myocardial injury, and multiple surgical procedures while considering antiplatelet medications for a newly placed coronary artery stent presented a number of challenges not previously reported.

  13. An apparent case of undiagnosed donor Kawasaki disease manifesting as coronary artery aneurysm in a pediatric heart transplant recipient.

    PubMed

    Friedland-Little, Joshua; Aiyagari, Ranjit; Gajarski, Robert J; Schumacher, Kurt R

    2013-02-01

    We present a case of coronary ectasia and LAD coronary artery aneurysm with angiographic characteristics of Kawasaki disease in a three-yr-old girl two-yr status post-orthotopic heart transplant. Coronary anomalies were noted during initial screening coronary angiography two yr after transplant. Subsequent review of the donor echocardiogram revealed that the LMCA had been mildly dilated prior to transplant. In the absence of any symptoms consistent with Kawasaki disease in the transplant recipient, this appears to be a case of Kawasaki disease in the organ donor manifesting with coronary anomalies in the transplant recipient. The patient has done well clinically, and repeat coronary angiography has revealed partial regression of coronary anomalies. Given multiple reports in the literature of persistent abnormalities of coronary artery morphology and function after Kawasaki disease, close monitoring is warranted, with consideration of potential coronary protective medical therapies. © 2012 John Wiley & Sons A/S.

  14. Coronary plaque imaging by coronary computed tomography angiography

    PubMed Central

    Sato, Akira

    2014-01-01

    Coronary computed tomography angiography (CTA) has become the useful noninvasive imaging modality alternative to the invasive coronary angiography for detecting coronary artery stenoses in patients with suspected coronary artery disease (CAD). With the development of technical aspects of coronary CTA, clinical practice and research are increasingly shifting toward defining the clinical implication of plaque morphology and patients outcomes by coronary CTA. In this review we discuss the coronary plaque morphology estimated by CTA beyond coronary angiography including the comparison to the currently available other imaging modalities used to examine morphological characteristics of the atherosclerotic plaque. Furthermore, this review underlies the value of a combined assessment of coronary anatomy and myocardial perfusion in patients with CAD, and adds to an increasing body of evidence suggesting an added diagnostic value when combining both modalities. We hope that an integrated, multi-modality imaging approach will become the gold standard for noninvasive evaluation of coronary plaque morphology and outcome data in clinical practice. PMID:24876919

  15. Recurrent post-partum coronary artery dissection

    PubMed Central

    2010-01-01

    Coronary artery dissection is a rare but well-described cause for myocardial infarction during the post-partum period. Dissection of multiple coronary arteries is even less frequent. Here we present a case of recurrent post-partum coronary artery dissections. This unusual presentation poses unique problems for management. A 35 year-old female, gravida 3 para 2, presented with myocardial infarction 9 weeks and 3 days post-partum. Cardiac catheterization demonstrated left anterior descending (LAD) dissection but an otherwise normal coronary anatomy. The lesion was treated with four everolimus eluting stents. Initially the patient made an unremarkable recovery until ventricular fibrillation arrest occurred on the following day. Unsynchronized cardioversion restored a normal sinus rhythm and repeat catheterization revealed new right coronary artery (RCA) dissection. A wire was passed distally, but it was unclear whether this was through the true or false lumen and no stents could be placed. However, improvement of distal RCA perfusion was noted on angiogram. Despite failure of interventional therapy the patient was therefore treated conservatively. Early operation after myocardial infarction has a significantly elevated risk of mortality and the initial dissection had occurred within 24 hours. This strategy proved successful as follow-up transthoracic echocardiography after four months demonstrated a preserved left ventricular ejection fraction of 55-60% without regional wall motion abnormalities. The patient remained asymptomatic from a cardiac point of view. PMID:20932332

  16. Recurrent post-partum coronary artery dissection.

    PubMed

    Rajab, Taufiek K; Khalpey, Zain; Kraemer, Bernhard; Resnic, Frederic S; Gallegos, Robert P

    2010-10-09

    Coronary artery dissection is a rare but well-described cause for myocardial infarction during the post-partum period. Dissection of multiple coronary arteries is even less frequent. Here we present a case of recurrent post-partum coronary artery dissections. This unusual presentation poses unique problems for management. A 35 year-old female, gravida 3 para 2, presented with myocardial infarction 9 weeks and 3 days post-partum. Cardiac catheterization demonstrated left anterior descending (LAD) dissection but an otherwise normal coronary anatomy. The lesion was treated with four everolimus eluting stents. Initially the patient made an unremarkable recovery until ventricular fibrillation arrest occurred on the following day. Unsynchronized cardioversion restored a normal sinus rhythm and repeat catheterization revealed new right coronary artery (RCA) dissection. A wire was passed distally, but it was unclear whether this was through the true or false lumen and no stents could be placed. However, improvement of distal RCA perfusion was noted on angiogram. Despite failure of interventional therapy the patient was therefore treated conservatively. Early operation after myocardial infarction has a significantly elevated risk of mortality and the initial dissection had occurred within 24 hours. This strategy proved successful as follow-up transthoracic echocardiography after four months demonstrated a preserved left ventricular ejection fraction of 55-60% without regional wall motion abnormalities. The patient remained asymptomatic from a cardiac point of view.

  17. Multifocal Central Giant Cell Granuloma - A Case Report

    PubMed Central

    Sandhya, Tamgadge; Avinash, Tamgadge; Snehal, Dhauskar; Neha, Tiwari; Uma, Mudaliar

    2016-01-01

    Central giant cell granuloma is a benign, aggressive neoplasm composed of multinucleated giant cells that almost exclusively occurs in the jaws though extra- gnathic incidence is rare. Multifocal CGCGs of the jaws are very rare and suggestive of systemic diseases such as hyperparathyroidism, an inherited syndrome such as Noonan- like multiple giant cell lesion syndrome or other disorders.Very few cases of multifocal CGCGs in the jaws without any concomitant systemic disease have been reported. This paper describes an unusual case reported to the Oral Surgery Department of Dr. D.Y.Patil Dental College & Hospital, Nerul, Navi-Mumbai in 2014 in a 45-year-old male with multifocal central giant cell granuloma involving maxilla and mandible. The serum alkaline phosphatase, calcium and phosphorus levels were within the normal limits. After complete clinical examination hyperparathyroidism and clinical characteristic of any syndromes such as Noonan-like syndrome and neurofibromatosis were ruled out. Thus this paper reports a non-syndromic multifocal central giant cell granuloma. PMID:27799978

  18. Theories of Giant Planet Formation

    NASA Technical Reports Server (NTRS)

    Lissauer, Jack J.; Young, Richard E. (Technical Monitor)

    1998-01-01

    An overview of current theories of planetary formation, with emphasis on giant planets, is presented. The most detailed models are based upon observations of our own Solar System and of young stars and their environments. While these models predict that rocky planets should form around most single stars, the frequency of formation of gas giant planets is more difficult to predict theoretically. Terrestrial planets are believed to grow via pairwise accretion until the spacing of planetary orbits becomes large enough that the configuration is stable for the age of the system. Giant planets begin their growth as do terrestrial planets, but they become massive enough that they are able to accumulate substantial amounts of gas before the protoplanetary disk dissipates. Most models for extrasolar giant planets suggest that they formed as did Jupiter and Saturn (in nearly circular orbits, far enough from the star that ice could), and subsequently migrated to their current positions, although some models suggest in situ formation.

  19. Lichens On Galapagos Giant Tortoises.

    PubMed

    Hendrickson, J R; Weber, W A

    1964-06-19

    The association of Physcia picta with the giant Galdpagos tortoise is believed to be the first reported occurrence of lichens on land animals. The habitat is restricted to specific sites on the carapace of male tortoises.

  20. Landscape of the lost giants

    NASA Astrophysics Data System (ADS)

    2013-09-01

    The Pleistocene megafauna extinction erased a group of remarkable animals. Whether humans had a prominent role in the extinction remains controversial, but it is emerging that the disappearance of the giants has markedly affected the environment.

  1. What Is Giant Cell Arteritis?

    MedlinePlus

    ... 01, 2017 Giant cell arteritis (GCA) is an inflammation (swelling) of the arteries, which are the blood ... help nourish your eyes, reduced blood flow can cause sudden, painless vision loss. This condition is called ...

  2. Pharma giants swap research programs.

    PubMed

    2014-07-01

    Pharmaceutical giants Novartis and GlaxoSmithKline (GSK) agreed in late April to swap some assets, with Novartis handing off its vaccine business to GSK and getting most of the British company's cancer portfolio in return.

  3. Giant sacrolumbar meningioma. Case report.

    PubMed

    Feldenzer, J A; McGillicuddy, J E; Hopkins, J W

    1990-06-01

    A case of giant sacral meningioma with presacral and lumbar extension is presented. The difficulties in diagnosis and management are emphasized including the staged multidisciplinary surgical approaches and preoperative tumor embolization.

  4. Atmospheres of Extrasolar Giant Planets

    NASA Technical Reports Server (NTRS)

    Marley, Mark

    2006-01-01

    The next decade will almost certainly see the direct imaging of extrasolar giant planets around nearby stars. Unlike purely radial velocity detections, direct imaging will open the door to characterizing the atmosphere and interiors of extrasola planets and ultimately provide clues on their formation and evolution through time. This process has already begun for the transiting planets, placing new constraints on their atmospheric structure, composition, and evolution. Indeed the key to understanding giant planet detectability, interpreting spectra, and constraining effective temperature and hence evolution-is the atmosphere. I will review the universe of extrasolar giant planet models, focusing on what we have already learned from modeling and what we will likely be able to learn from the first generation of direct detection data. In addition to these theoretical considerations, I will review the observations and interpretation of the - transiting hot Jupiters. These objects provide a test of our ability to model exotic atmospheres and challenge our current understanding of giant planet evolution.

  5. Theories of Giant Planet Formation

    NASA Technical Reports Server (NTRS)

    Lissauer, Jack J.; Young, Richard E. (Technical Monitor)

    1998-01-01

    An overview of current theories of planetary formation, with emphasis on giant planets, is presented. The most detailed models are based upon observations of our own Solar System and of young stars and their environments. While these models predict that rocky planets should form around most single stars, the frequency of formation of gas giant planets is more difficult to predict theoretically. Terrestrial planets are believed to grow via pairwise accretion until the spacing of planetary orbits becomes large enough that the configuration is stable for the age of the system. Giant planets begin their growth as do terrestrial planets, but they become massive enough that they are able to accumulate substantial amounts of gas before the protoplanetary disk dissipates. Most models for extrasolar giant planets suggest that they formed as did Jupiter and Saturn (in nearly circular orbits, far enough from the star that ice could), and subsequently migrated to their current positions, although some models suggest in situ formation.

  6. Giant lupus vulgaris: A rare presentation.

    PubMed

    Sacchidanand, S; Sharavana, S; Mallikarjun, M; Nataraja, H V

    2012-01-01

    Cutaneous tuberculosis continues to be an important public health problem even with the availability of highly effective anti-tuberculous drugs. It constitutes 0.1% of all cases of extrapulmonary tuberculosis. Lupus vulgaris is the most common form of cutaneous tuberculosis that occurs in previously sensitized individuals with a moderate degree of immunity against tubercle bacilli. The different types of lupus vulgaris include plaque, ulcerative, vegetative, papular and nodular, and tumor forms. A 40-year-old man presented with large multiple plaques over right upper limb, right side of chest and back, and right lower limb for the past 30 years. Histopathology showed numerous noncaseating granulomas with Langhan's type of giant cells. The Mantoux test showed strong positivity and there was excellent response to anti-tuberculous treatment. This case is being reported because of its extreme chronicity of 30 years duration, unusually large size and multiplicity of lesions.

  7. Giant lupus vulgaris: A rare presentation

    PubMed Central

    Sacchidanand, S.; Sharavana, S.; Mallikarjun, M.; Nataraja, H. V.

    2012-01-01

    Cutaneous tuberculosis continues to be an important public health problem even with the availability of highly effective anti-tuberculous drugs. It constitutes 0.1% of all cases of extrapulmonary tuberculosis. Lupus vulgaris is the most common form of cutaneous tuberculosis that occurs in previously sensitized individuals with a moderate degree of immunity against tubercle bacilli. The different types of lupus vulgaris include plaque, ulcerative, vegetative, papular and nodular, and tumor forms. A 40-year-old man presented with large multiple plaques over right upper limb, right side of chest and back, and right lower limb for the past 30 years. Histopathology showed numerous noncaseating granulomas with Langhan's type of giant cells. The Mantoux test showed strong positivity and there was excellent response to anti-tuberculous treatment. This case is being reported because of its extreme chronicity of 30 years duration, unusually large size and multiplicity of lesions. PMID:23130259

  8. Giant cell arteritis: a review

    PubMed Central

    Patil, Pravin; Karia, Niral; Jain, Shaifali; Dasgupta, Bhaskar

    2013-01-01

    Giant cell arteritis is the most common vasculitis in Caucasians. Acute visual loss in one or both eyes is by far the most feared and irreversible complication of giant cell arteritis. This article reviews recent guidelines on early recognition of systemic, cranial, and ophthalmic manifestations, and current management and diagnostic strategies and advances in imaging. We share our experience of the fast track pathway and imaging in associated disorders, such as large-vessel vasculitis. PMID:28539785

  9. Giants in the Local Region

    NASA Astrophysics Data System (ADS)

    Luck, R. Earle; Heiter, Ulrike

    2007-06-01

    We present parameter and abundance data for a sample of 298 nearby giants. The spectroscopic data for this work have a resolution of R~60,000, S/N>150, and spectral coverage from 475 to 685 nm. Overall trends in the Z>10 abundances are dominated by Galactic chemical evolution, while the light-element abundances are influenced by stellar evolution, as well as Galactic evolution. We find several super-Li stars in our sample and confirm that Li abundances in the first giant branch are related to mixing depths. Once astration of lithium on the main sequence along with the overall range of main-sequence lithium abundances are taken into account, the lithium abundances of the giants are not dramatically at odds with the predictions of standard stellar evolution. We find the giants to be carbon-diluted in accord with standard stellar evolution and that the carbon and oxygen abundances determined for the local giants are consistent with those found in local field dwarfs. We find that there is evidence for systematic carbon variations in the red giant clump in the sense that the blue side of the clump is carbon-poor (more diluted) than the red side.

  10. Kuiper Prize: Giant Planet Atmospheres

    NASA Astrophysics Data System (ADS)

    Ingersoll, Andrew P.

    2007-10-01

    The study of giant planet atmospheres is near and dear to me, for several reasons. First, the giant planets are photogenic; the colored clouds are great tracers, and one can make fantastic movies of the atmosphere in motion. Second, the giant planets challenge us with storms that last for hundreds of years and winds that blow faster the farther you go from the sun. Third, they remind us of Earth with their hurricanes, auroras, and lightning, but they also are the link to the 200 giant planets that have been discovered around other stars. This talk will cover the past, present, and future (one hopes) of giant planet research. I will review the surprises of the Voyager and Galileo eras, and will discuss what we are learning now from the Cassini orbiter. I will review the prospects for answering the outstanding questions like: Where's the water? What is providing the colors of the clouds? How deep do the features extend? Where do the winds get their energy? What is the role of the magnetic field? Finally, I will briefly discuss how extrasolar giant planets compare with objects in our own solar system.

  11. Takayasu Arteritis of the Coronary Arteries Presenting as Sudden Death in a White Teenager.

    PubMed

    Hlavaty, Leigh; Diaz, Francisco; Sung, LokMan

    2015-09-01

    Takayasu arteritis is a rare disease that expresses chronic, large vessel inflammation. The etiology remains unclear and its presentation depends on the affected arteries. With coronary artery involvement, manifestations range from chest pain and shortness of breath to sudden death. We report a case of a 15-year-old white girl who presented with syncope immediately before passing. On autopsy, all 3 major coronary arteries grossly contained multiple proximal lesions that were consistent with Takayasu arteritis, microscopically. Takayasu arteritis solely affecting multiple coronary arteries is exceedingly rare. This report discusses the significance of coronary involvement in Takayasu arteritis at autopsy and sudden death.

  12. Improved image guidance of coronary stent deployment

    NASA Astrophysics Data System (ADS)

    Close, Robert A.; Abbey, Craig K.; Whiting, James S.

    2000-04-01

    Accurate placement and expansion of coronary stents is hindered by the fact that most stents are only slightly radiopaque, and hence difficult to see in a typical coronary x-rays. We propose a new technique for improved image guidance of multiple coronary stents deployment using layer decomposition of cine x-ray images of stented coronary arteries. Layer decomposition models the cone-beam x-ray projections through the chest as a set of superposed layers moving with translation, rotation, and scaling. Radiopaque markers affixed to the guidewire or delivery balloon provide a trackable feature so that the correct vessel motion can be measured for layer decomposition. In addition to the time- averaged layer image, we also derive a background-subtracted image sequence which removes moving background structures. Layer decomposition of contrast-free vessels can be used to guide placement of multiple stents and to assess uniformity of stent expansion. Layer decomposition of contrast-filled vessels can be used to measure residual stenosis to determine the adequacy of stent expansion. We demonstrate that layer decomposition of a clinical cine x-ray image sequence greatly improves the visibility of a previously deployed stent. We show that layer decomposition of contrast-filled vessels removes background structures and reduces noise.

  13. The Giant Magnetocaloric Effect

    NASA Astrophysics Data System (ADS)

    Pecharsky, Vitalij K.

    1998-03-01

    Since the discovery of the magnetocaloric effect in pure iron by E.Warburg in 1881, it has been measured experimentally on many magnetic metals and compounds. The majority of the materials studied order magnetically undergoing a second order phase transformation. The magnetocaloric effect, typically peaking near the Curie or the Néel temperature, generally ranges from 0.5 to 2 K (in terms of adiabatic temperature change) or at 1 to 4 J/kg K (in terms of isothermal magnetic entropy change) per 1 T magnetic field change. The giant magnetocaloric effect recently discovered in Gd_5(Si_xGe_1-x)4 alloys, where x <= 0.5, is associated with a first order magnetic phase transition and it reaches values of 3 to 4 K and 6 to 10 J/kg K per 1 T field change, respectively. The refrigerant capacity, which is the measure of how much heat can be transferred from a cold to a hot reservoir in one ideal thermodynamic cycle, is larger than that of the best second order phase transition materials by 25 to 100%. When the Gd_5(Si_xGe_1-x)4 alloys are compared with other known materials, which show first order magnetic phase transition, such as Dy, Ho, Er, HoCo_2, NdMn_2Si_2, Fe_0.49Rh_0.51, and (Hf_0.83Ta_0.17)Fe_2+x, only Fe_0.49Rh_0.51 has comparable magnetocaloric properties. However, the first order magnetic phase transition in Fe_0.49Rh_0.51 is irreversible, and the magnetocaloric effect disappears after one magnetizing/demagnetizing cycle. A study of the crystal structure, thermodynamics, and magnetism of the Gd_5(Si_xGe_1-x)4 alloys, where 0 <= x <= 1 allowed us to obtain a qualitative understanding of the basic relations between the composition, the crystal structure, and the change in thermodynamics and magnetocaloric properties, which occur in the Gd_5(Si_xGe_1-x)4 system, and which brings about the giant magnetocaloric effect when x <= 0.5.

  14. Anaplastic giant cell thyroid carcinoma.

    PubMed

    Wallin, G; Lundell, G; Tennvall, J

    2004-01-01

    Anaplastic (giant cell) thyroid carcinoma (ATC), is one of the most aggressive malignancies in humans with a median survival time after diagnosis of 3-6 months. Death from ATC was earlier seen because of local growth and suffocation. ATC is uncommon, accounting for less than 5 % of all thyroid carcinomas. The diagnosis can be established by means of multiple fine needle aspiration biopsies, which are neither harmful nor troublesome for the patient. The cytological diagnosis of this high-grade malignant tumour is usually not difficult for a well trained cytologist. The intention to treat patients with ATC is cure, although only few of them survive. The majority of the patients are older than 60 years and treatment must be influenced by their high age. We have by using a combined modality regimen succeeded in achieving local control in most patients. Every effort should be made to control the primary tumour and thereby improve the quality of remaining life and it is important for patients, relatives and the personnel to know that cure is not impossible. Different treatment combinations have been used since 30 years including radiotherapy, cytostatic drugs and surgery, when feasible. In our latest combined regimen, 22 patients were treated with hyper fractionated radiotherapy 1.6Gy x 2 to a total target dose of 46 Gy given preoperatively, 20 mg doxorubicin was administered intravenously once weekly and surgery was carried out 2-3 weeks after the radiotherapy. 17 of these 22 patients were operated upon and none of these 17 patients got a local recurrence. In the future we are awaiting the development of new therapeutic approaches to this aggressive type of carcinoma. Inhibitors of angiogenesis might be useful. Combretastatin has displayed cytotoxicity against ATC cell lines and has had a positive effect on ATC in a patient. Sodium iodide symporter (NIS) genetherapy is also being currently considered for dedifferentiated thyroid carcinomas with the ultimate aim of

  15. Coronary artery ectasia in Egyptian patients with coronary artery disease.

    PubMed Central

    Waly, H M; Elayda, M A; Lee, V V; el-Said, G; Reul, G J; Hall, R J

    1997-01-01

    We conducted a retrospective study of 45 Egyptian patients with coronary artery ectasia who underwent coronary bypass grafting at our institution between 1980 and 1995. We examined the anatomic distribution and type of coronary ectasia and its association with coronary risk factors in these patients, and evaluated the severity of their coronary artery disease. We compared these findings with those from a group of 230 Egyptian patients who did not have coronary ectasia. These patients also underwent coronary artery bypass grafting between 1980 and 1995 at our institution. Obesity was present in 60% of the patients who had coronary artery ectasia, compared with 42% of patients who did not have ectasia (P < 0.01). Coronary artery ectasia was not related to any coronary risk factors other than obesity. However, patients who had ectasia did have a higher rate of triple-vessel coronary artery disease than did patients without ectasia (82% vs 67%, P < 0.05). Of the coronary vessels affected by ectasia, 43% were left anterior descending arteries. Diffuse disease was noted in 84% of all ectatic segments. We conclude that in this patient population, 2 conditions had a positive correlation with coronary ectasia: obesity and the severity of coronary artery disease. Images PMID:9456489

  16. Pictorial review of coronary anomalies in Tetralogy of Fallot.

    PubMed

    Kapur, Sangita; Aeron, Gunjan; Vojta, Christopher N

    2015-01-01

    Tetralogy of Fallot (TOF) classically consists of four characteristic features-right ventricular outflow obstruction, right ventricular hypertrophy, ventricular septal defect and an overriding aorta. In addition there are multiple other associated cardiac anomalies, including coronary artery anomalies. In this review, the role of CT angiography and the spectrum of coronary anomalies will be discussed along with importance of such anomalies in the context of surgery.

  17. Giant necrotic pituitary apoplexy.

    PubMed

    Fanous, Andrew A; Quigley, Edward P; Chin, Steven S; Couldwell, William T

    2013-10-01

    Apoplexy of the pituitary gland is a rare complication of pituitary adenomas, involving hemorrhage with or without necrosis within the tumor. This condition may be either asymptomatic or may present with severe headache, visual impairment, ophthalmoplegia, and pituitary failure. Transsphenoidal surgery is the treatment of choice, and early intervention is usually required to ensure reversal of visual impairment. Reports of pituitary apoplectic lesions exceeding 60.0mm in diameter are very rare. A 39-year-old man with long-standing history of nasal congestion, decreased libido and infertility presented with a sudden onset of severe headache and diplopia. MRI of the head demonstrated a massive skull base lesion of 70.0 × 60.0 × 25.0mm, compatible with a giant pituitary macroadenoma. The lesion failed to enhance after administration of a contrast agent, suggesting complete necrotic apoplexy. Urgent surgical decompression was performed, and the lesion was resected via a transnasal transsphenoidal approach. Pathological analysis revealed evidence of necrotic pituitary apoplexy. At the 2 month follow-up, the patient had near-complete to complete resolution of his visual impairment. To the authors' knowledge, this report is unique as the patient demonstrated complete necrotic apoplexy and it underlines the diagnostic dilemma in such a case. Copyright © 2012 Elsevier Ltd. All rights reserved.

  18. Recurrent renal giant leiomyosarcoma

    PubMed Central

    Öziş, Salih Erpulat; Gülpınar, Kamil; Şahlı, Zafer; Konak, Baha Burak; Keskin, Mete; Özdemir, Süleyman; Ataoğlu, Ömür

    2016-01-01

    Primary renal leiomyosarcomas are rare, aggressive tumors. They constitute 1–2% of adult malignant renal tumors. Although leiomyosarcomas are the most common histological type (50–60%) of renal sarcomas, information on renal leiomyosarcoma is limited. Local or systemic recurrences are common. The radiological appearance of renal leiomyosarcomas is not specific, therefore renal leiomyosarcoma cannot be distinguished from renal cell carcinoma by imaging methods in all patients. A 74-year-old female patient presented to our clinic complaining of a palpable mass on the right side of her abdomen in November 2012. The abdominal magnetic resonance imaging revealed a mass, 25 × 24 × 23 cm in size. Her past medical history revealed that she has undergone right radical nephrectomy in 2007, due to a 11 × 12 × 13 cm renal mass that was then reported as renal cell carcinoma on abdominal magnetic resonance imaging, but the pathological diagnosis was low-grade renal leiomyosarcoma. The most recent follow-up of the patient was in 2011, with no signs of local recurrence or distant metastases within this four-year period. The patient underwent laparotomy on November 2012, and a 35 cm retroperitoneal mass was excised. The pathological examination of the mass was reported as high-grade leiomyosarcoma. The formation of this giant retroperitoneal mass in 1 year can be explained by the transformation of the lesion’s pathology from low-grade to a high-grade tumor. PMID:27436926

  19. Giant cell arteritis.

    PubMed

    Ninan, Jem; Lester, Susan; Hill, Catherine

    2016-02-01

    Giant cell arteritis (GCA) is the most common vasculitis of the elderly. The diagnosis can be challenging at times because of the limitation of the American Rheumatology Association (ARA) classification criteria and the significant proportion of biopsy-negative patients with GCA. We discuss the role of advanced imaging techniques, including positron emission tomography (PET) scanning, in establishing diagnosis and improved histopathology techniques to improve the sensitivity of temporal artery biopsy. There have been significant advances in the understanding of the pathogenesis of GCA, particularly the role of cytokine pathways such as the interleukins, IL-6-IL-17 axis, and the IL-12-interferon-γ axis and their implication for new therapies. We highlight that glucocorticoids remain the primary treatment for GCA, but recognize the risk of steroid-induced side effects. A number of pharmacotherapies to enable glucocorticoid dose reduction and prevent relapse have been studied. Early diagnosis and fast-track pathways have improved outcomes by encouraging adherence to evidence-based practice. Copyright © 2016 Elsevier Ltd. All rights reserved.

  20. Novel treatment of coronary artery fistulae concealing severe coronary artery lesion: using thrombus aspiration catheter as a delivery guide

    PubMed Central

    Korkmaz, Levent; Acar, Zeydin; Dursun, İhsan; Akyüz, Ali Rıza; Korkmaz, Ayca Ata

    2014-01-01

    In this case report, we present the occlusion of multiple coronary artery fistulae originating from proximal left anterior descending (LAD) and right sinus valsavla and empting to the pulmonary artery at the same place. We occluded LAD fistulae by using thrombus aspiration catheter as a delivery guide. To the best of our knowlege, this is the first case of occlusion of coronary fistulae with the help of thrombus aspiration catheter. Our experience may suggest that thrombus aspiration catheters can be used in treating coronary artery fistulae with difficult anotomy. PMID:24748888

  1. Spontaneous Coronary Artery Dissection

    MedlinePlus

    ... artery dissection (SCAD). It's not yet clear what role these factors play in causing the disease. Common factors include: Female sex. Though spontaneous coronary artery dissection (SCAD) can occur ...

  2. Percutaneous Coronary Intervention

    MedlinePlus

    ... to open coronary arteries that are narrowed or blocked by the buildup of atherosclerotic plaque. PCI may ... that will highlight the blockage. To open a blocked artery, your doctor will insert another catheter over ...

  3. Coronary artery spasm

    MedlinePlus

    ... blocker or a long-acting nitrate long-term. Beta-blockers are another type of medicine that is used with other coronary artery problems. However, beta-blockers may make this problem worse. They should be ...

  4. Coronary Artery Disease

    MedlinePlus

    Coronary artery disease (CAD) is the most common type of heart disease. It is the leading cause of death in the United States in both men and women. CAD happens when the arteries that supply blood to ...

  5. Coronary Calcium Scan

    MedlinePlus

    ... Intramural Research Research Resources Research Meeting Summaries Technology ... complete. A coronary calcium scan uses a special scanner such as an electron beam CT or a multidetector CT (MDCT) machine. ...

  6. A unique advantage for giant eyes in giant squid.

    PubMed

    Nilsson, Dan-Eric; Warrant, Eric J; Johnsen, Sönke; Hanlon, Roger; Shashar, Nadav

    2012-04-24

    Giant and colossal deep-sea squid (Architeuthis and Mesonychoteuthis) have the largest eyes in the animal kingdom [1, 2], but there is no explanation for why they would need eyes that are nearly three times the diameter of those of any other extant animal. Here we develop a theory for visual detection in pelagic habitats, which predicts that such giant eyes are unlikely to evolve for detecting mates or prey at long distance but are instead uniquely suited for detecting very large predators, such as sperm whales. We also provide photographic documentation of an eyeball of about 27 cm with a 9 cm pupil in a giant squid, and we predict that, below 600 m depth, it would allow detection of sperm whales at distances exceeding 120 m. With this long range of vision, giant squid get an early warning of approaching sperm whales. Because the sonar range of sperm whales exceeds 120 m [3-5], we hypothesize that a well-prepared and powerful evasive response to hunting sperm whales may have driven the evolution of huge dimensions in both eyes and bodies of giant and colossal squid. Our theory also provides insights into the vision of Mesozoic ichthyosaurs with unusually large eyes. Copyright © 2012 Elsevier Ltd. All rights reserved.

  7. Clump Giants in the Hyades

    NASA Technical Reports Server (NTRS)

    Mushotzky, Richard F. (Technical Monitor); Brickhouse, Nancy

    2003-01-01

    The project is entitled 'Clump Giants in the Hyades.' This observation of one of the late-type Hyades giants (Gamma Tau) has implications for understanding the formation of late-type stellar coronae as a function of the evolutionary state of the star. The Hyades giants are interesting because they are all clump giants in the Helium burning phase, similar to the cool primary of Capella. The Hyades giants show significantly more magnetic activity than expected from their state of evolution (and slowed-down rotation). Thus these systems provide an important clue to dynamo action. The data were obtained by the satellite on 13 March 2001 for a total RGS exposure of 58220 seconds. These data were delivered to the PI on 7 August 2001. The data could not be reprocessed until SAS Version 5.3.3 which became available 7 June 2002. Although the guidelines for assessing background rates suggested that half the data were contaminated, it does not appear that the spectral region of the RGS was adversely affected by unusually high background. The spectra show strong lines of Fe XVII and XVIII, O VII and VIII, Ne IX and X, along with numerous weaker lines. The emission measure distribution is highly reminiscent of Capella; if anything, the emission measure distribution is steeper at 6 million K than for Capella. Gamma Tau is the second brightest of the Hyades clump giants. Pallavicini et al. have shown that the luminosity of the brightest Hyades giant (Theta Tau) is remarkably similar to its luminosity as measured by Einstein. Short-term variability is also modest. We are addressing the variability issue now for Gamma Tau. Initial results were reported at the 2003 Seattle AAS meeting. A paper is in preparation for submission to the Astrophysical Journal.

  8. Formation of the giant planets

    NASA Technical Reports Server (NTRS)

    Lissauer, Jack J.

    2006-01-01

    The observed properties of giant planets, models of their evolution and observations of protoplanetary disks provide constraints on the formation of gas giant planets. The four largest planets in our Solar System contain considerable quantities of hydrogen and helium, which could not have condensed into solid planetesimals within the protoplanetary disk. All three (transiting) extrasolar giant planets with well determined masses and radii also must contain substantial amounts of these light gases. Jupiter and Saturn are mostly hydrogen and helium, but have larger abundances of heavier elements than does the Sun. Neptune and Uranus are primarily composed of heavier elements. HD 149026 b, which is slightly more massive than is Saturn, appears to have comparable quantities of light gases and heavy elements. HD 209458 b and TrES-1 are primarily hydrogen and helium, but may contain supersolar abundances of heavy elements. Spacecraft flybys and observations of satellite orbits provide estimates of the gravitational moments of the giant planets in our Solar System, which in turn provide information on the internal distribution of matter within Jupiter, Saturn, Uranus and Neptune. Atmospheric thermal structure and heat flow measurements constrain the interior temperatures of planets. Internal processes may cause giant planets to become more compositionally differentiated or alternatively more homogeneous; high-pressure laboratory .experiments provide data useful for modeling these processes. The preponderance of evidence supports the core nucleated gas accretion model. According to this model, giant planets begin their growth by the accumulation of small solid bodies, as do terrestrial planets. However, unlike terrestrial planets, the growing giant planet cores become massive enough that they are able to accumulate substantial amounts of gas before the protoplanetary disk dissipates. The primary questions regarding the core nucleated growth model is under what conditions

  9. Clump Giants in the Hyades

    NASA Technical Reports Server (NTRS)

    Mushotzky, Richard F. (Technical Monitor); Brickhouse, Nancy

    2003-01-01

    The project is entitled 'Clump Giants in the Hyades.' This observation of one of the late-type Hyades giants (Gamma Tau) has implications for understanding the formation of late-type stellar coronae as a function of the evolutionary state of the star. The Hyades giants are interesting because they are all clump giants in the Helium burning phase, similar to the cool primary of Capella. The Hyades giants show significantly more magnetic activity than expected from their state of evolution (and slowed-down rotation). Thus these systems provide an important clue to dynamo action. The data were obtained by the satellite on 13 March 2001 for a total RGS exposure of 58220 seconds. These data were delivered to the PI on 7 August 2001. The data could not be reprocessed until SAS Version 5.3.3 which became available 7 June 2002. Although the guidelines for assessing background rates suggested that half the data were contaminated, it does not appear that the spectral region of the RGS was adversely affected by unusually high background. The spectra show strong lines of Fe XVII and XVIII, O VII and VIII, Ne IX and X, along with numerous weaker lines. The emission measure distribution is highly reminiscent of Capella; if anything, the emission measure distribution is steeper at 6 million K than for Capella. Gamma Tau is the second brightest of the Hyades clump giants. Pallavicini et al. have shown that the luminosity of the brightest Hyades giant (Theta Tau) is remarkably similar to its luminosity as measured by Einstein. Short-term variability is also modest. We are addressing the variability issue now for Gamma Tau. Initial results were reported at the 2003 Seattle AAS meeting. A paper is in preparation for submission to the Astrophysical Journal.

  10. Formation of the giant planets

    NASA Technical Reports Server (NTRS)

    Lissauer, Jack J.

    2006-01-01

    The observed properties of giant planets, models of their evolution and observations of protoplanetary disks provide constraints on the formation of gas giant planets. The four largest planets in our Solar System contain considerable quantities of hydrogen and helium, which could not have condensed into solid planetesimals within the protoplanetary disk. All three (transiting) extrasolar giant planets with well determined masses and radii also must contain substantial amounts of these light gases. Jupiter and Saturn are mostly hydrogen and helium, but have larger abundances of heavier elements than does the Sun. Neptune and Uranus are primarily composed of heavier elements. HD 149026 b, which is slightly more massive than is Saturn, appears to have comparable quantities of light gases and heavy elements. HD 209458 b and TrES-1 are primarily hydrogen and helium, but may contain supersolar abundances of heavy elements. Spacecraft flybys and observations of satellite orbits provide estimates of the gravitational moments of the giant planets in our Solar System, which in turn provide information on the internal distribution of matter within Jupiter, Saturn, Uranus and Neptune. Atmospheric thermal structure and heat flow measurements constrain the interior temperatures of planets. Internal processes may cause giant planets to become more compositionally differentiated or alternatively more homogeneous; high-pressure laboratory .experiments provide data useful for modeling these processes. The preponderance of evidence supports the core nucleated gas accretion model. According to this model, giant planets begin their growth by the accumulation of small solid bodies, as do terrestrial planets. However, unlike terrestrial planets, the growing giant planet cores become massive enough that they are able to accumulate substantial amounts of gas before the protoplanetary disk dissipates. The primary questions regarding the core nucleated growth model is under what conditions

  11. Association of Serum Osteocalcin with Insulin Resistance and Coronary Atherosclerosis

    PubMed Central

    2016-01-01

    Background To determine the associations between serum osteocalcin level and insulin resistance, coronary atherosclerosis by using dual-source coronary computed tomography angiography. Methods A total of 98 subjects (24 men and 74 women) were selected for this retrospective cross-sectional study who voluntarily visited a health examination center for routine health check-up including the blood test for serum osteocalcin level and coronary computed tomography angiography. Multiple regression analysis was used to determine which variables were independently related to osteocalcin levels and coronary atherosclerosis. Results Stepwise multiple regression analysis adjusted for age, sex, menopausal status, body mass index, serum alkaline phosphatase, serum calcium and phosphate showed that osteocalcin negatively correlated with serum glucose (β=-0.145, P=0.001) and homeostasis model assessment of insulin resistance (HOMA-IR) index (β=-1.794, P=0.027) independently. The age, serum glucose, smoking status but not osteocalcin level were independent risk factors for coronary atherosclerosis by use of multiple logistic regression analysis after controlling for other variables. Conclusions Serum osteocalcin level was inversely associated with fasting glucose level and insulin resistance measured by HOMA-IR, suggesting that osteocalcin is important for glucose metabolism. However, in this study, no significant difference was observed in the serum osteocalcin level according to the presence of coronary atherosclerotic plaques. PMID:27965939

  12. Coronary fistulas: a case series.

    PubMed

    Nada, Fennich; Fedoua, Elouali; Ghita, Saghi; Nadia, Bouzammour; Leila, Haddour; Jamila, Zarzur; Mohamed, Cherti

    2014-01-01

    Coronary artery fistula is an uncommon finding during angiographic exams. We report a case series of five patients with congenital coronary fistulas. The first patient was 56 years old and had a coronary fistula associated with a partial atrio ventricular defect, the second patient was 54 years old and had two fistulas originating from the right coronary artery with a severe atherosclerotic coronary disease, the third patient was 57 years old with a fistula originating from the circumflex artery associated with a rheumatic mitral stenosis, the fourth patient was 50 years old and had a fistulous communication between the right coronary artery and the right bronchial artery, and the last patient was 12 years old who had bilateral coronary fistulas draining into the right ventricle with an aneurismal dilatation of the coronary arteries. Angiographic aspects of coronary fistulas are various; management is controversial and depends on the presence of symptoms.

  13. Coronary Fistulas: A Case Series

    PubMed Central

    Fennich, Nada; Elouali, Fedoua; Saghi, Ghita; Bouzammour, Nadia; Haddour, Leila; Zarzur, Jamila; Cherti, Mohamed

    2014-01-01

    Coronary artery fistula is an uncommon finding during angiographic exams. We report a case series of five patients with congenital coronary fistulas. The first patient was 56 years old and had a coronary fistula associated with a partial atrio ventricular defect, the second patient was 54 years old and had two fistulas originating from the right coronary artery with a severe atherosclerotic coronary disease, the third patient was 57 years old with a fistula originating from the circumflex artery associated with a rheumatic mitral stenosis, the fourth patient was 50 years old and had a fistulous communication between the right coronary artery and the right bronchial artery, and the last patient was 12 years old who had bilateral coronary fistulas draining into the right ventricle with an aneurismal dilatation of the coronary arteries. Angiographic aspects of coronary fistulas are various; management is controversial and depends on the presence of symptoms. PMID:24501660

  14. Venous waterfalls in coronary circulation.

    PubMed

    Gosselin, R E; Kaplow, S M

    1991-03-21

    Several studies of flow through collapsible tubing deformed by external pressures have led to a concept known as the "vascular waterfall". One hallmark of this state is a positive zero-flow pressure intercept (Pe) in flow-pressure curves. This intercept is commonly observed in the coronary circulation, but in blood-perfused beating hearts a vascular waterfall is not the only putative cause. To restrict the possibilities, we have measured flow-pressure curves in excised non-beating rabbit hearts in which the coronary arteries were perfused in a non-pulsatile way with a newtonian fluid (Ringers solution) containing potent vasodilator drugs. Under these circumstances, vascular waterfalls are believed to be the only tenable explanation for Pe. In physical terms the waterfall is a region where the vessel is in a state of partial collapse with a stabilized intraluminal fluid pressure (Pw). It is argued that the most probable site of this collapse was the intramural veins just before they reached the epicardial surface. In accord with the waterfall hypothesis, Pe increased as the heart became more edematous, but flow-pressure curves also became flatter, implying multiple waterfalls with differing Pws, leading to complete collapse of some of the venous channels. The principal compressive force is believed to have been the interstitial fluid pressure as registered through a needle (Pn) implanted in the left ventricular wall, but a small additional force (Ps) was probably due to swelling of interstitial gels. A method is presented for estimating Ps and Pw. Unlike rubber tubing, blood vessels are both collapsible and porous. Apparently because of increased capillary filtration, Pn was found to increase linearly with the perfusion pressure. Thus, Pw was not the same at all points on the flow-pressure curve. This finding has interesting implications with respect to the concept of coronary resistance.

  15. Coronary artery imaging in children.

    PubMed

    Goo, Hyun Woo

    2015-01-01

    Coronary artery problems in children usually have a significant impact on both short-term and long-term outcomes. Early and accurate diagnosis, therefore, is crucial but technically challenging due to the small size of the coronary artery, high heart rates, and limited cooperation of children. Coronary artery visibility on CT and MRI in children is considerably improved with recent technical advancements. Consequently, CT and MRI are increasingly used for evaluating various congenital and acquired coronary artery abnormalities in children, such as coronary artery anomalies, aberrant coronary artery anatomy specific to congenital heart disease, Kawasaki disease, Williams syndrome, and cardiac allograft vasculopathy.

  16. Coronary Artery Imaging in Children

    PubMed Central

    2015-01-01

    Coronary artery problems in children usually have a significant impact on both short-term and long-term outcomes. Early and accurate diagnosis, therefore, is crucial but technically challenging due to the small size of the coronary artery, high heart rates, and limited cooperation of children. Coronary artery visibility on CT and MRI in children is considerably improved with recent technical advancements. Consequently, CT and MRI are increasingly used for evaluating various congenital and acquired coronary artery abnormalities in children, such as coronary artery anomalies, aberrant coronary artery anatomy specific to congenital heart disease, Kawasaki disease, Williams syndrome, and cardiac allograft vasculopathy. PMID:25741188

  17. Open questions about giant viruses.

    PubMed

    Claverie, Jean-Michel; Abergel, Chantal

    2013-01-01

    The recent discovery of giant viruses exhibiting double-stranded DNA genomes larger than a million base pairs, encoding more than a thousand proteins and packed in near micron-sized icosahedral particles, opened a new and unexpected chapter in virology. As of today, these giant viruses and their closest relatives of lesser dimensions infect unicellular eukaryotes found in aquatic environments, but belonging to a wide diversity of early branching phyla. This broad phylogenetic distribution of hosts is consistent with the hypothesis that giant viruses originated prior to the radiation of the eukaryotic domain and/or might have been involved in the partition of nuclear versus cytoplasmic functions in ancestral cells. The distinctive features of the known giant viruses, in particular the recurrent presence of components of the translation apparatus in their proteome, raise a number of fundamental questions about their origin, their mode of evolution, and the relationship they may entertain with other dsDNA viruses, the genome size of which exhibits the widest distribution among all biological entities, from less than 5 kb to more than 1.25 Mb (a ratio of 1:250). At a more conceptual level, the convergence between the discovery of increasingly reduced parasitic cellular organisms and that of giant viruses exhibiting a widening array of cellular-like functions may ultimately abolish the historical discontinuity between the viral and the cellular world. 2013 Elsevier Inc. All rights reserved

  18. Gravitational scattering by giant planets

    NASA Astrophysics Data System (ADS)

    Laakso, T.; Rantala, J.; Kaasalainen, M.

    2006-09-01

    We seek to characterize giant-planet systems by their gravitational scattering properties. We do this to a given system by integrating it numerically along with a large number of hypothetical small bodies that are initially in eccentric habitable zone (HZ)-crossing orbits. Our analysis produces a single number, the escape rate, which represents the rate at which the small-body flux is perturbed away by the giant planets into orbits that no longer pose a threat to terrestrial planets inside the HZ. Obtaining the escape rate this way is similar to computing the largest Liapunov exponent as the exponential rate of divergence of two nearby orbits. For a terrestrial planet inside the HZ, the escape rate value quantifies the "protective" effect that the studied giant-planet system offers. Therefore, escape rates could provide information on whether certain giant-planet configurations produce a more desirable environment for life than the others. We present some computed escape rates on selected planetary systems, focusing on effects of varying the masses and semi-major axes of the giant planets. In the case of our Solar System we find rather surprisingly that Jupiter, in its current orbit, may provide a minimal amount of protection to the Earth.

  19. Giant Magellan Telescope: overview

    NASA Astrophysics Data System (ADS)

    Johns, Matt; McCarthy, Patrick; Raybould, Keith; Bouchez, Antonin; Farahani, Arash; Filgueira, Jose; Jacoby, George; Shectman, Steve; Sheehan, Michael

    2012-09-01

    The Giant Magellan Telescope (GMT) is a 25-meter optical/infrared extremely large telescope that is being built by an international consortium of universities and research institutions. It will be located at the Las Campanas Observatory, Chile. The GMT primary mirror consists of seven 8.4-m borosilicate honeycomb mirror segments made at the Steward Observatory Mirror Lab (SOML). Six identical off-axis segments and one on-axis segment are arranged on a single nearly-paraboloidal parent surface having an overall focal ratio of f/0.7. The fabrication, testing and verification procedures required to produce the closely-matched off-axis mirror segments were developed during the production of the first mirror. Production of the second and third off-axis segments is underway. GMT incorporates a seven-segment Gregorian adaptive secondary to implement three modes of adaptive-optics operation: natural-guide star AO, laser-tomography AO, and ground-layer AO. A wide-field corrector/ADC is available for use in seeing-limited mode over a 20-arcmin diameter field of view. Up to seven instruments can be mounted simultaneously on the telescope in a large Gregorian Instrument Rotator. Conceptual design studies were completed for six AO and seeing-limited instruments, plus a multi-object fiber feed, and a roadmap for phased deployment of the GMT instrument suite is being developed. The partner institutions have made firm commitments for approximately 45% of the funds required to build the telescope. Project Office efforts are currently focused on advancing the telescope and enclosure design in preparation for subsystem- and system-level preliminary design reviews which are scheduled to be completed in the first half of 2013.

  20. Rotation of Giant Stars

    NASA Astrophysics Data System (ADS)

    Kissin, Yevgeni; Thompson, Christopher

    2015-07-01

    The internal rotation of post-main sequence stars is investigated, in response to the convective pumping of angular momentum toward the stellar core, combined with a tight magnetic coupling between core and envelope. The spin evolution is calculated using model stars of initial mass 1, 1.5, and 5 {M}⊙ , taking into account mass loss on the giant branches. We also include the deposition of orbital angular momentum from a sub-stellar companion, as influenced by tidal drag along with the excitation of orbital eccentricity by a fluctuating gravitational quadrupole moment. A range of angular velocity profiles {{Ω }}(r) is considered in the envelope, extending from solid rotation to constant specific angular momentum. We focus on the backreaction of the Coriolis force, and the threshold for dynamo action in the inner envelope. Quantitative agreement with measurements of core rotation in subgiants and post-He core flash stars by Kepler is obtained with a two-layer angular velocity profile: uniform specific angular momentum where the Coriolis parameter {Co}\\equiv {{Ω }}{τ }{con}≲ 1 (here {τ }{con} is the convective time), and {{Ω }}(r)\\propto {r}-1 where {Co}≳ 1. The inner profile is interpreted in terms of a balance between the Coriolis force and angular pressure gradients driven by radially extended convective plumes. Inward angular momentum pumping reduces the surface rotation of subgiants, and the need for a rejuvenated magnetic wind torque. The co-evolution of internal magnetic fields and rotation is considered in Kissin & Thompson, along with the breaking of the rotational coupling between core and envelope due to heavy mass loss.

  1. Plasmacytic Aortitis with Occlusion of the Right Coronary Artery

    PubMed Central

    Zambetti, Benjamin R.; Garrett, Edward

    2016-01-01

    Patient: Male, 55 Final Diagnosis: Plasmacytic aortitis Symptoms: Dizziness • nausea Medication: — Clinical Procedure: — Specialty: Surgery Objective: Unusual clinical course Background: Inflammation of the aortic wall, known as aortitis, is a rare clinical entity which is frequently asymptomatic, or identified when the patient presents with an aortic aneurysm or dissection. It is most often caused by infection or autoimmune vasculitides such as giant cell or Takayasu’s arteritis. Case Report: The case presented is that of a 55-year-old man with symptomatic occlusion of the right coronary artery caused by a plasmacytic aortitis suggestive of IgG4 disease, which was successfully treated with coronary artery bypass grafting and an ascending aortic graft. Conclusions: A review of the current literature emphasizes how poorly the etiology and natural history of plasmacytic aortitis is understood. PMID:27471062

  2. Genomic exploration of individual giant ocean viruses.

    PubMed

    Wilson, William H; Gilg, Ilana C; Moniruzzaman, Mohammad; Field, Erin K; Koren, Sergey; LeCleir, Gary R; Martínez Martínez, Joaquín; Poulton, Nicole J; Swan, Brandon K; Stepanauskas, Ramunas; Wilhelm, Steven W

    2017-08-01

    Viruses are major pathogens in all biological systems. Virus propagation and downstream analysis remains a challenge, particularly in the ocean where the majority of their microbial hosts remain recalcitrant to current culturing techniques. We used a cultivation-independent approach to isolate and sequence individual viruses. The protocol uses high-speed fluorescence-activated virus sorting flow cytometry, multiple displacement amplification (MDA), and downstream genomic sequencing. We focused on 'giant viruses' that are readily distinguishable by flow cytometry. From a single-milliliter sample of seawater collected from off the dock at Boothbay Harbor, ME, USA, we sorted almost 700 single virus particles, and subsequently focused on a detailed genome analysis of 12. A wide diversity of viruses was identified that included Iridoviridae, extended Mimiviridae and even a taxonomically novel (unresolved) giant virus. We discovered a viral metacaspase homolog in one of our sorted virus particles and discussed its implications in rewiring host metabolism to enhance infection. In addition, we demonstrated that viral metacaspases are widespread in the ocean. We also discovered a virus that contains both a reverse transcriptase and a transposase; although highly speculative, we suggest such a genetic complement would potentially allow this virus to exploit a latency propagation mechanism. Application of single virus genomics provides a powerful opportunity to circumvent cultivation of viruses, moving directly to genomic investigation of naturally occurring viruses, with the assurance that the sequence data is virus-specific, non-chimeric and contains no cellular contamination.

  3. Early severe coronary artery disease and aortic coarctation in a child with familial hypercholesterolaemia.

    PubMed

    Labib, Dina; Soliman, Haytham; Said, Kareem; Sorour, Khaled

    2016-11-30

    An 11-year-old boy presented with easy fatigability, multiple xanthomas, and absent pedal pulsations. Laboratory workup showed severe hypercholesterolaemia and non-invasive imaging revealed 'normally functioning' bicuspid aortic valve and tight aortic coarctation. Coronary angiography showed severe right coronary artery (RCA) stenosis. Medical treatment resulted in significant improvement of dyslipidaemia. We successfully performed balloon dilation and stenting of his coarctation, as well as percutaneous coronary intervention for RCA lesion.

  4. Coronary artery dissection and perforation complicating percutaneous coronary intervention.

    PubMed

    Rogers, Jason H; Lasala, John M

    2004-09-01

    Percutaneous coronary intervention (PCI) is widely utilized in the treatment of symptomatic coronary artery disease. Despite its numerous benefits, serious and potentially life-threatening complications of PCI can occur, including iatrogenic coronary artery dissection and perforation. The incidence of these complications has been augmented by the development of coronary interventional devices intended to remove or ablate tissue. We herein review the classification, incidence, pathogenesis, clinical sequelae and management of coronary artery dissection and perforation in the current era. Specifically, the current angiographic classifications of coronary artery dissections and perforations are reviewed. The findings of several recent, large registries of PCI-related coronary artery perforations are summarized. The management of coronary artery dissection and perforation is discussed at length, including the application of newer modalities such as covered stents.

  5. Polymyalgia Rheumatica and Giant Cell Arteritis

    MedlinePlus

    ... Clinical Trial Journal Articles Polymyalgia Rheumatica and Giant Cell Arteritis May 2016 Questions and Answers about Polymyalgia Rheumatica and Giant Cell Arteritis This publication contains general information about polymyalgia ...

  6. Giant cell tumour of the mandibular condyle.

    PubMed

    Della Sala, S W; Recla, M; Campolongo, F; Bortot, G; Bauer, M; Peterlongo, P

    1996-01-01

    The authors report a case of giant cell tumour of the mandibular condyle, which is a rare finding. This tumour, studied using the main three radiological modalities (plain radiography, CT and MRI) showed characteristic radiological features of "giant cell tumour".

  7. Giant lobelias exemplify convergent evolution.

    PubMed

    Givnish, Thomas J

    2010-01-14

    Giant lobeliads on tropical mountains in East Africa and Hawaii have highly unusual, giant-rosette growth forms that appear to be convergent on each other and on those of several independently evolved groups of Asteraceae and other families. A recent phylogenetic analysis by Antonelli, based on sequencing the widest selection of lobeliads to date, raises doubts about this paradigmatic example of convergent evolution. Here I address the kinds of evidence needed to test for convergent evolution and argue that the analysis by Antonelli fails on four points. Antonelli's analysis makes several important contributions to our understanding of lobeliad evolution and geographic spread, but his claim regarding convergence appears to be invalid. Giant lobeliads in Hawaii and Africa represent paradigmatic examples of convergent evolution.

  8. CMB lensing and giant rings

    SciTech Connect

    Rathaus, Ben; Itzhaki, Nissan E-mail: ben.rathaus@gmail.com

    2012-05-01

    We study the CMB lensing signature of a pre-inationary particle (PIP), assuming it is responsible for the giant rings anomaly that was found recently in the WMAP data. Simulating Planck-like data we find that generically the CMB lensing signal to noise ratio associated with such a PIP is quite small and it would be difficult to cross correlate the temperature giant rings with the CMB lensing signal. However, if the pre-inationary particle is also responsible for the bulk flow measured from the local large scale structure, which happens to point roughly at the same direction as the giant rings, then the CMB lensing signal to noise ratio is fairly significant.

  9. Giant lobelias exemplify convergent evolution

    PubMed Central

    2010-01-01

    Giant lobeliads on tropical mountains in East Africa and Hawaii have highly unusual, giant-rosette growth forms that appear to be convergent on each other and on those of several independently evolved groups of Asteraceae and other families. A recent phylogenetic analysis by Antonelli, based on sequencing the widest selection of lobeliads to date, raises doubts about this paradigmatic example of convergent evolution. Here I address the kinds of evidence needed to test for convergent evolution and argue that the analysis by Antonelli fails on four points. Antonelli's analysis makes several important contributions to our understanding of lobeliad evolution and geographic spread, but his claim regarding convergence appears to be invalid. Giant lobeliads in Hawaii and Africa represent paradigmatic examples of convergent evolution. PMID:20074322

  10. Predictors of successful percutaneous coronary intervention in chronic total coronary occlusions

    PubMed Central

    Gür, Mustafa; Acele, Armağan; Şeker, Taner; Quisi, Alaa; Kıvrak, Ali; Yıldırım, Arafat; Uçar, Hakan; Akyol, Selahattin; Çaylı, Murat

    2016-01-01

    Introduction Percutaneous coronary intervention (PCI) of chronic total coronary occlusions (CTOs) is one of the most challenging procedures of interventional cardiology and is associated with increased risk of significant complications. However, debate continues in regard to which factors adversely influence the success rate of PCI and whether the benefits of revascularization of CTO outweigh the risks and challenges. Aim To analyze the relationship between lesion characteristics and overall success rates as well as in-hospital outcomes after PCI for CTO. Material and methods We retrospectively examined the procedural outcomes of 173 consecutive native coronary artery CTO PCIs performed from February 2012 to March 2013 (78% men; mean age: 60.3 ±12.1 years). Results The CTO target vessel was the right coronary artery (53.8%), circumflex (10.4%) and left anterior descending artery (35.8%), respectively. The retrograde approach was used in 13.9% of all procedures. Successful revascularization was achieved in 83.2% of patients. Major complications occurred in 13.3% of patients. In multivariate analysis, bridge collaterals, severe calcification and tortuosity as well as tandem occlusions were independent predictors of procedural failure, whereas existence of micro-channels was the only predictor of procedural success. Conclusions Revascularization of coronary CTOs may be performed with high success and low major complication rates. Bridge collaterals, severe calcification and tortuosity, tandem/multiple occlusions and micro-channels were independent predictors of successful CTO revascularization. PMID:26966445

  11. Measurement and modeling of coronary blood flow.

    PubMed

    Sinclair, Matthew D; Lee, Jack; Cookson, Andrew N; Rivolo, Simone; Hyde, Eoin R; Smith, Nicolas P

    2015-01-01

    Ischemic heart disease that comprises both coronary artery disease and microvascular disease is the single greatest cause of death globally. In this context, enhancing our understanding of the interaction of coronary structure and function is not only fundamental for advancing basic physiology but also crucial for identifying new targets for treating these diseases. A central challenge for understanding coronary blood flow is that coronary structure and function exhibit different behaviors across a range of spatial and temporal scales. While experimental studies have sought to understand this feature by isolating specific mechanisms, in tandem, computational modeling is increasingly also providing a unique framework to integrate mechanistic behaviors across different scales. In addition, clinical methods for assessing coronary disease severity are continuously being informed and updated by findings in basic physiology. Coupling these technologies, computational modeling of the coronary circulation is emerging as a bridge between the experimental and clinical domains, providing a framework to integrate imaging and measurements from multiple sources with mathematical descriptions of governing physical laws. State-of-the-art computational modeling is being used to combine mechanistic models with data to provide new insight into coronary physiology, optimization of medical technologies, and new applications to guide clinical practice.

  12. Review of Giant cell arteritis

    PubMed Central

    Chacko, Joseph G.; Chacko, J. Anthony; Salter, Michael W.

    2014-01-01

    Giant-cell arteritis (GCA) is a systemic autoimmune disease affecting primarily the elderly. Giant cell arteritis can cause sudden and potentially bilateral sequential vision loss in the elderly. Therefore, it is considered a medical emergency in ophthalmology and a significant cause of morbidity in an increasingly aging population. Ophthalmologists need to be able to recognize the classic symptoms and signs of this disease, and then be able to work-up and treat these patients in an efficient manner. An in-depth review of GCA from the literature as well as personal clinical experience follows. PMID:25859139

  13. Charting the Giants

    NASA Astrophysics Data System (ADS)

    2004-06-01

    zero expansion asymptotically after an infinite time and has a flat geometry). All three observational tests by means of supernovae (green), the cosmic microwave background (blue) and galaxy clusters converge at a Universe around Ωm ~ 0.3 and ΩΛ ~ 0.7. The dark red region for the galaxy cluster determination corresponds to 95% certainty (2-sigma statistical deviation) when assuming good knowledge of all other cosmological parameters, and the light red region assumes a minimum knowledge. For the supernovae and WMAP results, the inner and outer regions corespond to 68% (1-sigma) and 95% certainty, respectively. References: Schuecker et al. 2003, A&A, 398, 867 (REFLEX); Tonry et al. 2003, ApJ, 594, 1 (supernovae); Riess et al. 2004, ApJ, 607, 665 (supernovae) Galaxy clusters are far from being evenly distributed in the Universe. Instead, they tend to conglomerate into even larger structures, "super-clusters". Thus, from stars which gather in galaxies, galaxies which congregate in clusters and clusters tying together in super-clusters, the Universe shows structuring on all scales, from the smallest to the largest ones. This is a relict of the very early (formation) epoch of the Universe, the so-called "inflationary" period. At that time, only a minuscule fraction of one second after the Big Bang, the tiny density fluctuations were amplified and over the eons, they gave birth to the much larger structures. Because of the link between the first fluctuations and the giant structures now observed, the unique REFLEX catalogue - the largest of its kind - allows astronomers to put considerable constraints on the content of the Universe, and in particular on the amount of dark matter that is believed to pervade it. Rather interestingly, these constraints are totally independent from all other methods so far used to assert the existence of dark matter, such as the study of very distant supernovae (see e.g. ESO PR 21/98) or the analysis of the Cosmic Microwave background (e

  14. What Is Coronary Microvascular Disease?

    MedlinePlus

    ... of Intramural Research Research Resources Research Meeting Summaries Technology Transfer Clinical Trials What Are Clinical Trials? Children & ... from traditional coronary heart disease (CHD), also called coronary artery disease. In CHD, a waxy substance called plaque (plak) ...

  15. Integrative physiology of coronary microcirculation.

    PubMed

    Kajiya, F; Goto, M

    1999-06-01

    Coronary microvessels play a crucial role for mechanoenergetic interaction between blood flow and myocardial function, which is not uniform transmurally. Thus, highly organized vascular regulations are required for matching local blood flow with myocardial energy requirement. Recently, new technologies to investigate in vivo coronary microcirculation with new knowledge of the signaling molecules for vascular regulation have revolutionized our abilities to understand the integrative regulation of coronary microcirculation. In this review, the mechanical aspects of the interaction between coronary blood flow and myocardium, coronary arte-rial tree and its roles in myocardial blood flow regulation, hierarchical and dynamic control of coronary flow, capillary network and function, function of venous drainage system, and molecular and cellular aspects of integrative coronary blood flow regulation are discussed, focusing on their integrational roles in maintaining coronary microvascular function and cell signaling.

  16. Functional Testing Underlying Coronary Revascularisation

    ClinicalTrials.gov

    2016-10-04

    Multivessel Coronary Artery Disease; Vessel Disease; Stable Angina; Unstable Angina or Stabilized Non-ST Elevated Myocardial Infarction; Patients With ST-elevated Myocardial Infarction; Revascularization of Culprit Coronary Artery

  17. Percutaneous transluminal coronary angioplasty (PTCA)

    MedlinePlus Videos and Cool Tools

    Percutaneous transluminal coronary angioplasty (PTCA) is a minimally invasive procedure to open up blocked coronary arteries, allowing blood to circulate unobstructed to the heart muscle. The procedure begins with ...

  18. Giant right atrial thrombi treated with thrombolysis

    PubMed Central

    Ruiz-Bailén, Manuel; López-Caler, Carmen; Castillo-Rivera, Ana; Rucabado-Aguilar, Luis; Cuadra, José Ángel Ramos; Toral, Juan Lara; Cabezas, Cristobal Lozano; Guerrero, Juan Carlos Fernández

    2008-01-01

    The present report describes giant atrial thrombi that were treated with thrombolysis in a community hospital. Two patients with giant atrial thrombi whose treatment involved complications are presented. Both patients developed cardiogenic shock and were treated unsuccessfully with thrombolysis. Because thrombolysis of giant thrombi may be ineffective, patients in this situation may require surgery. PMID:18401474

  19. Cabergoline treatment in invasive giant prolactinoma.

    PubMed

    Alsubaie, Sadeem; Almalki, Mussa H

    2014-01-01

    Patients with invasive giant prolactinoma suffer from a constellation of symptoms including headache, blurred vision, lethargy, and sexual dysfunction. Cabergoline, a potent dopamine agonist, is a known medication prescribed for the treatment of invasive giant prolactinoma. Here, we report a case of invasive giant prolactinoma in a 52-year-old Saudi male with dramatic response to cabergoline treatment clinically, biochemically, and radiologically.

  20. Giant right atrial thrombi treated with thrombolysis.

    PubMed

    Ruiz-Bailén, Manuel; López-Caler, Carmen; Castillo-Rivera, Ana; Rucabado-Aguilar, Luis; Ramos Cuadra, José Angel; Lara Toral, Juan; Lozano Cabezas, Cristobal; Fernández Guerrero, Juan Carlos

    2008-04-01

    The present report describes giant atrial thrombi that were treated with thrombolysis in a community hospital. Two patients with giant atrial thrombi whose treatment involved complications are presented. Both patients developed cardiogenic shock and were treated unsuccessfully with thrombolysis. Because thrombolysis of giant thrombi may be ineffective, patients in this situation may require surgery.

  1. A giant radiopaque mass in the masticatory space.

    PubMed

    Cho, Young-Ah; Yoon, Hye-Jung; Hong, Seong-Doo; Lee, Jae-Il; Hong, Sam-Pyo

    2013-05-01

    A 2-year-old boy presented with a giant mass in the masticatory space. The mass exhibited a lobulating ossification, with no attachment to the adjacent normal bone. An enucleation was performed under the tentative diagnosis of extra-articular synovial chondromatosis, benign ossifying neoplasm, non-neoplastic heterotopic ossification, or low-grade malignancy. Upon microscopic examination, the excised mass was composed of multiple osteocartilaginous areas. We hereby present detailed clinicopathological findings. Copyright © 2013 Elsevier Inc. All rights reserved.

  2. Constraining Planetary Migration Mechanisms in Systems of Giant Planets

    NASA Astrophysics Data System (ADS)

    Dawson, Rebekah I.; Murray-Clay, Ruth A.; Johnson, John Asher

    2014-01-01

    largely recovered for giants orbiting metal-rich Kepler host stars. These two studies suggest that both disk migration and planet-planet interactions may be widespread, with the latter occurring primarily in metal-rich planetary systems where multiple giant planets can form. Funded by NSF-GRFP DGE-1144152.

  3. Computer quantitation of coronary angiograms

    NASA Technical Reports Server (NTRS)

    Ledbetter, D. C.; Selzer, R. H.; Gordon, R. M.; Blankenhorn, D. H.; Sanmarco, M. E.

    1978-01-01

    A computer technique is being developed at the Jet Propulsion Laboratory to automate the measurement of coronary stenosis. A Vanguard 35mm film transport is optically coupled to a Spatial Data System vidicon/digitizer which in turn is controlled by a DEC PDP 11/55 computer. Programs have been developed to track the edges of the arterial shadow, to locate normal and atherosclerotic vessel sections and to measure percent stenosis. Multiple frame analysis techniques are being investigated that involve on the one hand, averaging stenosis measurements from adjacent frames, and on the other hand, averaging adjacent frame images directly and then measuring stenosis from the averaged image. For the latter case, geometric transformations are used to force registration of vessel images whose spatial orientation changes.

  4. Computer quantitation of coronary angiograms

    NASA Technical Reports Server (NTRS)

    Ledbetter, D. C.; Selzer, R. H.; Gordon, R. M.; Blankenhorn, D. H.; Sanmarco, M. E.

    1978-01-01

    A computer technique is being developed at the Jet Propulsion Laboratory to automate the measurement of coronary stenosis. A Vanguard 35mm film transport is optically coupled to a Spatial Data System vidicon/digitizer which in turn is controlled by a DEC PDP 11/55 computer. Programs have been developed to track the edges of the arterial shadow, to locate normal and atherosclerotic vessel sections and to measure percent stenosis. Multiple frame analysis techniques are being investigated that involve on the one hand, averaging stenosis measurements from adjacent frames, and on the other hand, averaging adjacent frame images directly and then measuring stenosis from the averaged image. For the latter case, geometric transformations are used to force registration of vessel images whose spatial orientation changes.

  5. [Coronary angioplasty today].

    PubMed

    Metzger, J P

    1991-10-01

    The rise of coronary angioplasty has been rapid in the last ten years. It is a method of myocardial revascularisation without thoracotomy or cardiopulmonary bypass and is curative in the absence of restenosis. Recent advances concern the development of the material and the pharmacological support which reduce the risk of coronary thrombosis during the procedure. The primary success rate now approaches 90%, that of emergency bypass surgery less than 5%. The use of autoperfusion catheters and the use of intra-aortic balloon pumping improve the safety of the procedure but surgical stand-by remains a necessity in cases of dilatation of proximal main coronary stenosis. Stable and unstable angina are the main indications of a technique particularly appropriate for elderly patients and the treatment of residual post-thrombolytic stenoses, post-radic stenosis or stenosis of a single functional coronary artery. Restenosis is observed in 30 to 40% of cases during the first six months after the dilatation. Its occurrence is not influenced by any of the drugs tested but it could be reduced by the insertion of an endocoronary stent. Abrasive endocoronary techniques and laser angioplasty are alternative methods of treating coronary stenoses inaccessible to conventional balloon angioplasty but they do not reduce the risk of restenosis.

  6. Magnetocardiography with sensors based on giant magnetoresistance

    NASA Astrophysics Data System (ADS)

    Pannetier-Lecoeur, M.; Parkkonen, L.; Sergeeva-Chollet, N.; Polovy, H.; Fermon, C.; Fowley, C.

    2011-04-01

    Biomagnetic signals, mostly due to the electrical activity in the body, are very weak and they can only be detected by the most sensitive magnetometers, such as Superconducting Quantum Interference Devices (SQUIDs). We report here biomagnetic recordings with hybrid sensors based on Giant MagnetoResistance (GMR). We recorded magnetic signatures of the electric activity of the human heart (magnetocardiography) in healthy volunteers. The P-wave and QRS complex, known from the corresponding electric recordings, are clearly visible in the recordings after an averaging time of about 1 min. Multiple recordings at different locations over the chest yielded a dipolar magnetic field map and allowed localizing the underlying current sources. The sensitivity of the GMR-based sensors is now approaching that of SQUIDs and paves way for spin electronics devices for functional imaging of the body.

  7. Idiopathic giant cell myocarditis and cardiac sarcoidosis.

    PubMed

    Blauwet, Lori A; Cooper, Leslie T

    2013-11-01

    Idiopathic giant cell myocarditis (GCM) and cardiac sarcoidosis (CS) are rare disorders that cause cardiomyopathy, often with ventricular arrhythmias or heart block. Infection, autoimmune processes, and genetics have all been implicated in the pathogenesis of these diseases, but the etiology for both diseases is likely a complex multifactorial process. Both GCM and CS are generally progressive despite treatment with standard heart failure and arrhythmia therapies. Making the diagnosis of GCM or CS on initial clinical presentation is possible in only a small percentage of patients, so myocardial tissue diagnosis is required. The use of multiple noninvasive imaging modalities may aid in diagnosis and assessment of response to treatment. Establishing the diagnosis of GCM or CS early is crucial, as tailored immunosuppressive treatment may significantly alter the clinical course of these patients. The prognosis of patients with GCM is poor, while the prognosis for patients with CS varies according to degree of left ventricular dysfunction.

  8. [Pathology of coronary arterial calcification].

    PubMed

    Yutani, Chikao

    2007-03-01

    Calcification is an invariable component of advanced coronary artery atherosclerosis. Recent study showed that genetic variations such as matrix inhibitory proteins, polymorphisms for tumor necrosis factor, and inflammatory cytokines may influence coronary artery calcification. And also there have been numerous studies on screening patients for coronary artery disease using electron beam computed tomography, but details of mechanism on calcification have still been unclear. An example of coronary calcification in diabetic patients disclosed that its diffuse distribution might be metabolic on calcification mechanism.

  9. Acute coronary syndromes as auto-inflammatory disorders.

    PubMed

    Suzuki, Makoto

    2012-01-01

    From the onset to the healing stage of acute coronary syndromes, an endless inflammation has been presented with complex, multiple cross-talk mechanisms at the molecular, cellular, and organ levels. Even though the early reperfusion treatment either by thrombolysis or percutaneous coronary intervention provides the excellent clinical benefits in patients with acute coronary syndromes, ischemia/ reperfusion injury may somewhat offset those great advantages. Inflammation, although potentially protective, has been deeply associated with those detrimental conditions. The hexagonal vascular inflammatory network which is composed of activated various leukocytes, vascular endothelial cells, vascular smooth muscle cells, platelets, excess reactive oxygen species, and cholesterol may contribute these vicious circles. To address these complex syndromes with more benefits regarding the prevention and treatment, this review comprehensively updates the pathogenesis of acute coronary syndromes from the view points of vascular inflammation.

  10. Giant primary angiosarcoma of the small intestine showing severe sepsis.

    PubMed

    Takahashi, Mizuna; Ohara, Masanori; Kimura, Noriko; Domen, Hiromitsu; Yamabuki, Takumi; Komuro, Kazuteru; Tsuchikawa, Takahiro; Hirano, Satoshi; Iwashiro, Nozomu

    2014-11-21

    Primary malignant tumors of the small intestine are rare, comprising less than 2% of all gastrointestinal tumors. An 85-year-old woman was admitted with fever of 40 °C and marked abdominal distension. Her medical history was unremarkable, but blood examination showed elevated inflammatory markers. Abdominal computed tomography showed a giant tumor with central necrosis, extending from the epigastrium to the pelvic cavity. Giant gastrointestinal stromal tumor of the small intestine communicating with the gastrointestinal tract or with superimposed infection was suspected. Because no improvement occurred in response to antibiotics, surgery was performed. Laparotomy revealed giant hemorrhagic tumor adherent to the small intestine and occupying the peritoneal cavity. The giant tumor was a solid tumor weighing 3490 g, measuring 24 cm × 17.5 cm × 18 cm and showing marked necrosis. Histologically, the tumor comprised spindle-shaped cells with anaplastic large nuclei. Immunohistochemical studies showed tumor cells positive for vimentin, CD31, and factor VIII-related antigen, but negative for c-kit and CD34. Angiosarcoma was diagnosed. Although no postoperative complications occurred, the patient experienced enlargement of multiple metastatic tumors in the abdominal cavity and died 42 d postoperatively. The prognosis of small intestinal angiosarcoma is very poor, even after volume-reducing palliative surgery.

  11. [Difficult respiratory management in a patient with bilateral giant bullae].

    PubMed

    Fujita, Ayaka; Hashiba, Eiji; Takahira, Yoko; Kitayama, Masatou; Tubo, Toshihito; Hirota, Kazuyoshi

    2009-10-01

    We report a case of bilateral giant bullae in a patient with multiple traumas. He had his arm amputated at the shoulder because of a machine accident and admitted to our hospital. Chest X-ray showed right-sided pneumothorax with bilateral giant bullae. Trimming of the stump was performed immediately after the placement of a right chest tube. He gradually developed hypoxia and hypercapnia with acidemia during the operation because of atelectasis due to sputum. Postoperatively, enlargement of right giant bulla led to frequent respiratory failure and he received a bilateral bullectomy through a median sternotomy 3 weeks after the accident. It was difficult to ventilate him due to air leak from the bilateral bulla and SpO2 dropped to below 70% with 100% oxygen. We continued the operation with standby extracorporeal membrane oxygenator (ECMO). Although the operation was finished without ECMO finally, ECMO had better been kept ready during anethesia with giant bullae when life threatening complication may occur at any point.

  12. Technique of Coronary Transfer for TGA with Single Coronary Artery.

    PubMed

    Kim, Tae Ho; Jung, Jae Jun; Kim, Yong Han; Yang, Ji-Hyuk; Jun, Tae-Gook

    2014-12-01

    An eight-day-old neonate was diagnosed with dextro-transposition of the great arteries, atrial septal defect, patent ductus arteriosus, and a single sinus origin of the coronary arteries. The single coronary artery originated from the left sinus (sinus 2), had a proximal left circumflex arterial branch, and passed anteriorly to the right side of the aorta, further branching into the right coronary and left anterior descending arteries. We successfully performed an arterial switch operation and coronary transfer by tube graft reconstruction with autologous aortic tissue to treat the dextro-transposition of the great arteries and atrial septal defect with a single-sinus origin of the coronary arteries.

  13. Coronary–Coronary Bypass

    PubMed Central

    Erdil, Nevzat; Ates, Sanser; Demirkilic, Ufuk; Tatar, Harun; Sag, Cemal

    2002-01-01

    There is increased risk of systemic embolism during cardiopulmonary bypass in patients with a severely atherosclerotic ascending aorta. We report a coronary–coronary bypass in a 74-year-old man with a porcelain aorta. He underwent a proximal right coronary–distal right coronary artery bypass with a saphenous vein graft, combined with a pedicled arterial graft (left internal mammary artery) to the left anterior descending artery, in the presence of a beating heart without cardiopulmonary bypass. The patient survived without evidence of perioperative myocardial infarction or cerebrovascular accident. One year later, follow-up angiography showed graft patency with good distal runoff. Coronary–coronary bypass on a beating heart without cardiopulmonary bypass can be performed safely in a patient with porcelain aorta. (Tex Heart Inst J 2002;29:54–5) PMID:11995853

  14. Spontaneous coronary artery dissection.

    PubMed

    Giacoppo, Daniele; Capodanno, Davide; Dangas, George; Tamburino, Corrado

    2014-07-15

    Spontaneous coronary artery dissection (SCAD) is a relatively rare and unexplored type of coronary disease. Although atherosclerosis, hormonal changes during pregnancy and connective tissue disorders might represent a sufficiently convincing explanation for some patients with SCAD, the many remaining cases display only a weak relationship with these causes. While on one side the clinical heterogeneity of SCAD masks a full understanding of their underlying pathophysiologic process, on the other side paucity of data and misleading presentations hamper the quick diagnosis and optimal management of this condition. A definite diagnosis of SCAD can be significantly facilitated by endovascular imaging techniques. In fact, intravascular ultrasound (IVUS) and optical coherence tomography (OCT) overcome the limitations of coronary angiography providing detailed endovascular morphologic information. In contrast, optimal treatment strategies for SCAD still represent a burning controversial question. Herein, we review the published data examining possible causes and investigating the best therapy for SCAD in different clinical scenarios.

  15. Giant Serpentine Aneurysms: Multidisciplinary Management

    PubMed Central

    Anshun, W.; Feng, L.; Daming, W.

    2000-01-01

    Summary Sixty-five cases of intracranial giant serpentine aneurysms (GSΛs), including 61 cases reported in the literature and four additional cases presented in this study were reviewed. The clinical presentation, possible causes, natural history, and especially management of GSAs are discussed with emphasis on the need for aggressive intervention and multidisciplinary management. PMID:20667180

  16. The giant panda gut microbiome.

    PubMed

    Wei, Fuwen; Wang, Xiao; Wu, Qi

    2015-08-01

    Giant pandas (Ailuropoda melanoleuca) are bamboo specialists that evolved from carnivores. Their gut microbiota probably aids in the digestion of cellulose and this is considered an example of gut microbiota adaptation to a bamboo diet. However, this issue remains unresolved and further functional and compositional studies are needed.

  17. Controlling nucleation in giant liposomes.

    PubMed

    Tester, Chantel C; Whittaker, Michael L; Joester, Derk

    2014-05-30

    We introduce giant liposomes to investigate phase transformations in picoliter volumes. Precipitation of calcium carbonate in the confinement of DPPC liposomes leads to dramatic stabilization of amorphous calcium carbonate (ACC). In contrast, amorphous strontium carbonate (ASC) is a transient species, and BaCO3 precipitation leads directly to the formation of crystalline witherite.

  18. A Case of Coronary Vasospasm after Repeat Rituximab Infusion

    PubMed Central

    Ke, Calvin; Khosla, Amit; Davis, Margot K.; Hague, Cameron; Toma, Mustafa

    2015-01-01

    Coronary artery vasospasm (CAV) can be triggered by medication reactions. CAV occurring after multiple exposures to rituximab has not been previously described. A 61-year-old woman with no cardiac risk factors was treated with the sixth cycle of gemcitabine, cisplatin, dexamethasone, and rituximab therapy. Fifteen minutes after rituximab infusion commenced, she developed typical cardiac chest pain with ST segment elevations on electrocardiogram. Angiogram revealed evidence of coronary vasospasm. The patient was successfully treated with amlodipine. This case underlines the importance of monitoring cardiac side effects of rituximab therapy, even after multiple cycles. PMID:25866684

  19. Double right coronary artery or split right coronary artery?

    PubMed

    Chen, Ying-Fu; Chien, Tsu-Ming; Chen, Chih-Wei; Lin, Ching-Cheng; Lee, Chee-Siong

    2012-02-09

    The prevalence of congenital anomalies of the coronary arteries (CAAs) is reported to be approximately 0.2-1.4% of the general population. Of them, The double right coronary artery (RCA) is one of the rarest coronary anomalies. Nonetheless, there is no consensus of the definition of a double RCA until now. Several concepts have been proposed in order to define what is and is not a double RCA. So far, it was been reported 37 times and in 44 cases after a comprehensive literature search through the PubMed database, using the keywords "double right coronary artery," "duplicated right coronary artery," "dual right coronary artery" and "split right coronary artery." Most of the published articles (28 of 37 articles) used the name "double right coronary artery." Nevertheless, some investigators contended that a split RCA is anatomically the same anomaly as the improperly named "double right coronary artery". The debate between those who favor "double RCA" and those who favor "split RCA" indicate the need for a consensus regarding the nomenclature as well diagnostic criteria of such coronary anomalies. It is the time we need to reach a consensus of the nomenclature of this congenital coronary anomaly. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  20. Associations between polymyalgia rheumatica and giant cell arteritis and 12 cardiovascular diseases.

    PubMed

    Pujades-Rodriguez, Mar; Duyx, Bram; Thomas, Sara L; Stogiannis, Dimitris; Smeeth, Liam; Hemingway, Harry

    2016-03-01

    Evidence of the association of polymyalgia rheumatica (PMR) and giant cell arteritis (GCA) with the full range of cardiovascular diseases (CVDs) is limited. We examined their relationship with the first clinical presentation of the 12 most common CVDs in an unselected population-based cohort of men and women. We analysed CArdiovascular disease research using LInked Bespoke studies and Electronic health Records (CALIBER) data, which links primary care and hospital and mortality data in England, from 1997 to 2010. We assembled a cohort of men and women initially free from CVD at baseline and included all patients with PMR and/or GCA (PMR/GCA) diagnosis, matched by age, sex and general practice with up to 10 individuals without PMR/GCA. Random effects Poisson regression analysis was used to study the association between PMR/GCA and the initial presentation of 12 types of CVDs. The analysis included 9776 patients with PMR only, 1164 with GCA only, 627 with PMR and GCA and 105 504 without either condition. During a median of 3.14 years of follow-up 2787 (24.1%) individuals with PMR/GCA and 21 559 (20.4%) without PMR/GCA developed CVDs. Patients with PMR/GCA had lower rates of unheralded coronary death (3.18 vs 3.61/1000 person-years; adjusted incidence ratio 0.79, 95% CI 0.66 to 0.95), transient ischaemic attack (5.11 vs 5.61/1000 person-years; 0.67, 95% CI 0.54 to 0.84) and coronary and death composite (24.17 vs 25.80/1000 person-years; 0.90, 95% CI 0.82 to 0.98). No associations were observed for other CVDs or cerebrovascular diseases, and in patients with only PMR or GCA. No evidence of interaction by age or sex was found. Estimates decreased with longer PMR/GCA duration and findings were robust to multiple sensitivity analyses. In this large contemporary population-based cohort the presence of PMR and/or GCA was not associated with an increased risk of CVDs or cerebrovascular diseases regardless of PMR/GCA duration. Published by the BMJ Publishing Group

  1. Nursery of Giants

    NASA Technical Reports Server (NTRS)

    2004-01-01

    Hidden behind a shroud of dust in the constellation Cygnus is a stellar nursery called DR21, which is giving birth to some of the most massive stars in our galaxy. Visible light images reveal no trace of this interstellar cauldron because of heavy dust obscuration. In fact, visible light is attenuated in DR21 by a factor of more than 10,000,000,000,000,000,000,000,000,000,000,000,000,000 (ten thousand trillion heptillion).

    New images from NASA's Spitzer Space Telescope allow us to peek behind the cosmic veil and pinpoint one of the most massive natal stars yet seen in our Milky Way galaxy. The never-before-seen star is 100,000 times as bright as the Sun. Also revealed for the first time is a powerful outflow of hot gas emanating from this star and bursting through a giant molecular cloud.

    This image is a large-scale mosaic assembled from individual photographs obtained with the InfraRed Array Camera (IRAC) aboard Spitzer. The image covers an area about two times that of a full moon. The mosaic is a composite of images obtained at mid-infrared wavelengths of 3.6 microns (blue), 4.5 microns (green), 5.8 microns (orange) and 8 microns (red). The brightest infrared cloud near the top center corresponds to DR21, which presumably contains a cluster of newly forming stars at a distance of 10,000 light-years.

    Protruding out from DR21 toward the bottom left of the image is a gaseous outflow (green), containing both carbon monoxide and molecular hydrogen. Data from the Spitzer spectrograph, which breaks light into its constituent individual wavelengths, indicate the presence of hot steam formed as the outflow heats the surrounding molecular gas. Outflows are physical signatures of processes that create supersonic beams, or jets, of gas. They are usually accompanied by discs of material around the new star, which likely contain the materials from which future planetary systems are formed. Additional newborn stars, depicted in green, can be seen surrounding the

  2. Nursery of Giants

    NASA Image and Video Library

    2004-04-13

    Hidden behind a shroud of dust in the constellation Cygnus is a stellar nursery called DR21, which is giving birth to some of the most massive stars in our galaxy. Visible light images reveal no trace of this interstellar cauldron because of heavy dust obscuration. In fact, visible light is attenuated in DR21 by a factor of more than 10,000,000,000,000,000,000,000,000,000,000,000,000,000 (ten thousand trillion heptillion). New images from NASA's Spitzer Space Telescope allow us to peek behind the cosmic veil and pinpoint one of the most massive natal stars yet seen in our Milky Way galaxy. The never-before-seen star is 100,000 times as bright as the Sun. Also revealed for the first time is a powerful outflow of hot gas emanating from this star and bursting through a giant molecular cloud. This image is a large-scale mosaic assembled from individual photographs obtained with the InfraRed Array Camera (IRAC) aboard Spitzer. The image covers an area about two times that of a full moon. The mosaic is a composite of images obtained at mid-infrared wavelengths of 3.6 microns (blue), 4.5 microns (green), 5.8 microns (orange) and 8 microns (red). The brightest infrared cloud near the top center corresponds to DR21, which presumably contains a cluster of newly forming stars at a distance of 10,000 light-years. Protruding out from DR21 toward the bottom left of the image is a gaseous outflow (green), containing both carbon monoxide and molecular hydrogen. Data from the Spitzer spectrograph, which breaks light into its constituent individual wavelengths, indicate the presence of hot steam formed as the outflow heats the surrounding molecular gas. Outflows are physical signatures of processes that create supersonic beams, or jets, of gas. They are usually accompanied by discs of material around the new star, which likely contain the materials from which future planetary systems are formed. Additional newborn stars, depicted in green, can be seen surrounding the DR21 region

  3. [Pregnancy and coronary artery dissection].

    PubMed

    Martínez-Quintana, Efrén; Rodríguez-González, Fayna

    2015-01-01

    Acute myocardial infarction during pregnancy is associated with high maternal and fetal mortality. Coronary atherosclerosis is the most common cause due to an increase in the age of the patients and the association with cardiovascular risk factors such as smoking, hypertension, diabetes mellitus, preeclampsia, and the existence of family history of coronary disease. However, thrombosis, coronary dissection or coronary vasospasms are other causes that may justify it. We report the case of a 33 weeks pregnant first-time mother, without cardiovascular risk factors, who presented an acute coronary event in the context of atherosclerotic disease and coronary dissection after percutaneous coronary intervention. Copyright © 2014 Sociedad Española de Arteriosclerosis. Published by Elsevier España. All rights reserved.

  4. Segmental quantitative analysis of digital thallium-201 myocardial scintigrams in diagnosis of coronary artery disease. Comparison with rest and exercise electrocardiography and coronary arteriography.

    PubMed Central

    Wainwrwight, R J; Maisey, M N; Sowton, E

    1981-01-01

    One hundred and forty-nine patients with suspected ischaemic heart disease were evaluated by exercise thallium-201 myocardial scintigraphy (201Tl SMS), single lead exercise electrocardiography, and coronary arteriography. Myocardial distribution of tracer was assessed semi-quantitatively from digital 201Tl scintigrams and compared with tracer distribution in subjects with normal hearts. Fifty-two of 54 (96%) patients with normal coronary arteries had normal myocardial scintigrams whereas three patients had a positive ischaemic exercise electrocardiogram and were scan normal. Conversely, 36 of 95 (38%) patients with coronary artery disease had a positive ischaemic electrocardiogram compared with 94 of 95 (99%) patients who had a positive myocardial scintigram. Disease in specific coronary arteries could be deduced from the topography of myocardial tracer deficit. Disease was predicted correctly in 76 out of 80 (95%) of left anterior descending coronary stenoses, in 48 out of 64 (75%) of right coronary artery stenoses, and in 55 out of 64 (85%) of left circumflex coronary artery stenosis, despite the presence of infarcted myocardium in other territories. Similarly, single vessel disease was predicted correctly in 14 out of 17 (82%) patients and multiple vessel disease in 64 out of 77 (83%) patients. 201Tl SMS with segmental quantitative analysis is a highly sensitive and specific technique in the diagnosis of coronary artery disease and may be useful screening procedure to select patients for further investigation, particularly those with evidence of life-threatening severe left coronary artery disease. PMID:7317214

  5. Human immunodeficiency virus (HIV) is highly associated with giant idiopathic esophageal ulcers in acquired immunodeficiency syndrome (AIDS) patients.

    PubMed

    Lv, Bei; Cheng, Xin; Gao, Jackson; Zhao, Hong; Chen, Liping; Wang, Liwei; Huang, Shaoping; Fan, Zhenyu; Zhang, Renfang; Shen, Yinzhong; Li, Lei; Liu, Baochi; Qi, Tangkai; Wang, Jing; Cheng, Jilin

    2016-01-01

    This study aimed to determine whether the human immunodeficiency virus (HIV) exists in giant idiopathic esophageal ulcers in the patients with acquired immune deficiency syndrome (AIDS). 16 AIDS patients with a primary complaint of epigastric discomfort were examined by gastroscopy. Multiple and giant esophageal ulcers were biopsied and analyzed with pathology staining and reverse transcription-polymerase chain reaction (RT-PCR) to determine the potential pathogenic microorganisms, including HIV, cytomegalovirus (CMV) and herpes simplex viruses (HSV). HIV was detected in ulcer samples from 12 out of these 16 patients. Ulcers in 2 patients were infected with CMV and ulcers in another 2 patients were found HSV positive. No obvious cancerous pathological changes were found in these multiple giant esophageal ulcer specimens. HIV may be one of the major causative agents of multiple benign giant esophageal ulcers in AIDS patients.

  6. Human immunodeficiency virus (HIV) is highly associated with giant idiopathic esophageal ulcers in acquired immunodeficiency syndrome (AIDS) patients

    PubMed Central

    Lv, Bei; Cheng, Xin; Gao, Jackson; Zhao, Hong; Chen, Liping; Wang, Liwei; Huang, Shaoping; Fan, Zhenyu; Zhang, Renfang; Shen, Yinzhong; Li, Lei; Liu, Baochi; Qi, Tangkai; Wang, Jing; Cheng, Jilin

    2016-01-01

    Objective: This study aimed to determine whether the human immunodeficiency virus (HIV) exists in giant idiopathic esophageal ulcers in the patients with acquired immune deficiency syndrome (AIDS). Methods: 16 AIDS patients with a primary complaint of epigastric discomfort were examined by gastroscopy. Multiple and giant esophageal ulcers were biopsied and analyzed with pathology staining and reverse transcription-polymerase chain reaction (RT-PCR) to determine the potential pathogenic microorganisms, including HIV, cytomegalovirus (CMV) and herpes simplex viruses (HSV). Results: HIV was detected in ulcer samples from 12 out of these 16 patients. Ulcers in 2 patients were infected with CMV and ulcers in another 2 patients were found HSV positive. No obvious cancerous pathological changes were found in these multiple giant esophageal ulcer specimens. Conclusion: HIV may be one of the major causative agents of multiple benign giant esophageal ulcers in AIDS patients. PMID:27830031

  7. Coronary flow reserve in hypertensive patients with hypercholesterolemia and without coronary heart disease.

    PubMed

    Galderisi, Maurizio; de Simone, Giovanni; Cicala, Silvana; Parisi, Michele; D'Errico, Arcangelo; Innelli, Pasquale; de Divitiis, Marcello; Mondillo, Sergio; de Divitiis, Oreste

    2007-02-01

    Coronary flow reserve (CFR) may be reduced both in arterial hypertension and in hypercholesterolemia. The aim of the study was to assess an association between CFR and levels of plasma total cholesterol (TC) in untreated arterial hypertension. We studied 54 consecutive, untreated hypertensive outpatients free of coronary heart disease. Twenty of them had normal TC and 34 high TC (>/=200 mg/dL). Standard echocardiograms and transthoracic Doppler interrogation of the distal left anterior descending artery were obtained. Coronary diastolic peak velocities were measured both at rest and after low-dose dipyridamole. The CFR was calculated as dipyridamole/resting velocities ratio. The two groups had similar age, body mass index, heart rate, and diastolic blood pressure (BP). Patients with high TC had higher systolic BP (P < .05), triglycerides (P < .02), LDL-cholesterol, and TC/HDL-cholesterol ratio (both P < .0001) than controls. Left ventricular (LV) mass index, relative wall thickness, and fractional shortening did not differ between the two groups. Coronary diastolic peak velocities were similar at rest but lower after dipyridamole in patients with high TC (P < .02). As a consequence, CFR was reduced (P < .002). In multiple linear regression analyses, adjusting for age, heart rate, systolic BP, smoking, and relative wall thickness, TC (beta = -0.338) or high LDL-cholesterol (beta = -0.301) (both P < .001) were predictors of lower CFR independently of the concomitant effect of potential confounders. In hypertensive patients free of coronary artery disease, the degree of impairment in coronary vasodilator capacity is independently associated with plasma cholesterol and LDL-cholesterol.

  8. [Acute coronary syndrome -- 2012].

    PubMed

    Becker, Dávid; Merkely, Béla

    2012-12-23

    The acute coronary syndrome is the most severe form of coronary artery disease. It is an immediate threat of life and the mortality rate can be high without proper therapy and patient management. Based on the first ECG, two different forms can be distinguished: acute coronary syndrome with and without ST elevation. Besides adequate medication, management of these patients is an essential part of treatment. In case of ST elevation, coronarography and percutaneous coronary intervention is needed in general, within 24 hours from the onset of symptoms. When ST elevation is not detected on the ECG, individual ischemic risk factors and predictable mortality of the patient may define the necessity and the date of the invasive examination. The Hungarian hemodynamic laboratory network covers almost the whole country and, therefore, practically each patient may receive a state-of-the-art therapy. Although indicators of cardiovascular diseases are still prominent, the mortality rate of myocardial Infarction is decreasing in Hungary due to the well-organized invasive care.

  9. Coronary covered stents.

    PubMed

    Kilic, Ismail Dogu; Fabris, Enrico; Serdoz, Roberta; Caiazzo, Gianluca; Foin, Nicolas; Abou-Sherif, Sara; Di Mario, Carlo

    2016-11-20

    Covered stents offer an effective bail-out strategy in vessel perforations, are an alternative to surgery for the exclusion of coronary aneurysms, and have a potential role in the treatment of friable embolisation-prone plaques. The aim of this manuscript is to offer an overview of currently available platforms and to report results obtained in prior studies.

  10. Coronary artery disease (image)

    MedlinePlus

    ... through these arteries is critical for the heart. Coronary artery disease usually results from the build-up of fatty material and plaque, a condition called atherosclerosis. As the ... blood to the heart can slow or stop, causing chest pain (stable ...

  11. Transradial artery coronary angioplasty.

    PubMed

    Kiemeneij, F; Laarman, G J; de Melker, E

    1995-01-01

    This study explored the feasibility and safety of percutaneous coronary balloon angioplasty (PTCA) with miniaturized PTCA equipment via the radial artery. Coronary angioplasty (PTCA) via the femoral or brachial arteries may be associated with rare vascular complications such as bleeding and damage to the artery and adjacent structures. It was postulated that PTCA via the radial artery with miniaturized angioplasty equipment is feasible and that no major puncture site-related complications occur because hemostasis is obtained easily and because no major structures are near the radial artery. With double blood supply to the hand, radial artery occlusion is well tolerated. In 100 patients with collateral blood supply to the right hand, PTCA was attempted with 6F guiding catheters and rapid-exchange balloon catheters for exertional angina (87 patients) or nonexertional angina (13 patients). Angioplasty was attempted in 122 lesions (type A n = 67 [55%], Type B n = 37 [30%], and type C n = 18 [15%]). Pre- and post-PTCA computerized quantitative coronary analysis was performed. Radial artery function and structure were assessed clinically and with Doppler and two-dimensional ultrasound on the day of discharge. Coronary catheterization via the radial artery was successful in 94 patients (94%). The 6 remaining patients had successful PTCA via the femoral artery (n = 5) or the brachial artery (n = 1). Procedural success (120 of 122 lesions) was achieved in 92 patients (98%) via the radial artery and in 98 patients of the total study population.(ABSTRACT TRUNCATED AT 250 WORDS)

  12. Transcatheter Arterial Embolization Alone for Giant Hepatic Hemangioma

    PubMed Central

    Zhang, Yue-Lin; Zhou, Guan-Hui; Ai, Jing; Zhou, Tan-Yang; Zhu, Tong-Yin; Zhang, Ai-Bin; Wang, Wei-Lin; Zheng, Shu-Sen

    2015-01-01

    Giant hepatic hemangioma is a benign liver condition that may be treated using surgery. We studied the digital subtraction angiographic (DSA) characteristics of giant hepatic hemangioma, and the effectiveness of transcatheter arterial embolization (TAE) alone for its treatment. This was a retrospective study of 27 patients diagnosed with giant hepatic hemangioma and treated with TAE alone (using lipiodol mixed with pingyangmycin) at the Division of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University, between January 2010 and March 2013. The feeding arteries were identified using DSA. All patients were followed up for between three weeks and 12 months. Changes in tumor diameter and symptoms were observed. The 27 patients included had giant hepatic hemangiomas ranging from 5.3 to 24.5 cm (mean, 11.24±5.08 cm) in the right (n = 13), left (n = 1) or both (n = 13) lobes. Preoperative hepatic angiography showed multiple abnormal vascular lakes in the early phase, known as the “early leaving but late returning, hanging nut on a twig” sign. On the day after TAE, hepatic transaminase levels were increased (ALT: 22.69±17.95 to 94.88±210.32 U/L; ALT: 24.00±12.37 to 99.70±211.54 U/L; both P<0.05), but not total bilirubin. Six patients complained of abdominal pain, and 12 experienced transient fever. In the months after TAE, tumor size decreased (baseline: 11.24±5.08; 3 months: 8.95±4.33; 6 months: 7.60±3.90 cm; P<0.05), and the patients’ condition improved. These results indicated that TAE was effective and safe for treating giant hepatic hemangioma. TAE may be a useful alternative to surgery for the treatment of hepatic hemangioma. PMID:26287964

  13. Ophthalmic presentation of giant cell arteritis in African-Americans.

    PubMed

    Garrity, S T; Pistilli, M; Vaphiades, M S; Richards, N Q; Subramanian, P S; Rosa, P R; Lam, B L; Osborne, B J; Liu, G T; Duncan, K E; Shin, R K; Volpe, N J; Shindler, K S; Lee, M S; Moster, M L; Tracey, E H; Cuprill-Nilson, S E; Tamhankar, M A

    2017-01-01

    PurposeTo determine the differences in the presentation of ophthalmic giant cell arteritis between African-Americans and Caucasians.MethodsThis was a multicenter retrospective case series comparing African-American patients with ophthalmic GCA to a previously published Caucasian cohort. Neuro-ophthalmic centers across the United States were contacted to provide data on African-American patients with biopsy-proven ophthalmic giant cell arteritis. The differences between African-American and Caucasian patients with respect to multiple variables, including age, sex, systemic and ophthalmic signs and symptoms, ocular ischemic lesions, and laboratory results were studied.ResultsThe Caucasian cohort was slightly older (mean=76.1 years) than the African-American cohort (mean=72.6 years, P=0.03), and there was no difference in sex distribution between the two cohorts. Headache, neck pain, and anemia were more frequent, while jaw claudication was less frequent in African-Americans (P<0.01, <0.001, 0.02, and 0.03 respectively). Acute vision loss was the most common presentation of giant cell arteritis in both groups, though it was less common in African-Americans (78 vs 98% of Caucasians, P<0.001). Eye pain was more common in African-Americans (28 vs 8% of Caucasians, P<0.01).ConclusionsThe presenting features of ophthalmic giant cell arteritis in African-Americans and Caucasians are not markedly different, although a few significant differences exist, including higher rates of headache, neck pain, anemia, and eye pain, and lower rates of jaw claudication and acute vision loss in African-Americans. Persons presenting with suspicious signs and symptoms should undergo evaluation for giant cell arteritis regardless of race.

  14. EFFECTS OF DYNAMICAL EVOLUTION OF GIANT PLANETS ON SURVIVAL OF TERRESTRIAL PLANETS

    SciTech Connect

    Matsumura, Soko; Ida, Shigeru; Nagasawa, Makiko

    2013-04-20

    The orbital distributions of currently observed extrasolar giant planets allow marginally stable orbits for hypothetical, terrestrial planets. In this paper, we propose that many of these systems may not have additional planets on these ''stable'' orbits, since past dynamical instability among giant planets could have removed them. We numerically investigate the effects of early evolution of multiple giant planets on the orbital stability of the inner, sub-Neptune-like planets which are modeled as test particles, and determine their dynamically unstable region. Previous studies have shown that the majority of such test particles are ejected out of the system as a result of close encounters with giant planets. Here, we show that secular perturbations from giant planets can remove test particles at least down to 10 times smaller than their minimum pericenter distance. Our results indicate that, unless the dynamical instability among giant planets is either absent or quiet like planet-planet collisions, most test particles down to {approx}0.1 AU within the orbits of giant planets at a few AU may be gone. In fact, out of {approx}30% of survived test particles, about three quarters belong to the planet-planet collision cases. We find a good agreement between our numerical results and the secular theory, and present a semi-analytical formula which estimates the dynamically unstable region of the test particles just from the evolution of giant planets. Finally, our numerical results agree well with the observations, and also predict the existence of hot rocky planets in eccentric giant planet systems.

  15. [Multidetector row CT in assessment of coronary artery calcification on hemodialisis].

    PubMed

    Caro, P; Delgado, R; Dapena, F; Núñez, A

    2007-01-01

    Vascular calcification is a strong predictor of cardiovascular and all-cause mortality. Coronary artery calcification is more frequent, more extensive and progresses more rapidly in CKD than in general population. They are also considered a marker of coronary heart disease, with high prevalence and functional significance. It suggests that detection and surveillance may be worthwhile in general clinical practice. New non-invasive image techniques, like Multi-detector row CT, a type of spiral scanner, assess density and volume of calcification at multiple sites and allow quantitative scoring of vascular calcification using calcium scores analogous to those from electron-beam CT. We have assessed and quantified coronary artery calcification with 16 multidetector row CT in 44 patients on hemodialysis and their relationship with several cardiovascular risk factors. Coronary artery calcification prevalence was of 84 % with mean calcium score of 1580 +/- 2010 ( r 0-9844) with calcium score > 400 in 66% of patients. It was usually multiple, affecting more than two vessels in more than 50%. In all but one patient, left anterior descending artery was involved with higher calcium score level at right coronary artery. Advanced age, male, diabetes, smoking, more morbidity, cerebrovascular disease previous, and calcium-binders phosphate and analogous vitamin D treatment would seem to be associated with coronary artery calcification. Coronary artery calcification is very frequent and extensive, usually multiple and associated to modifiable risk factors in hemodialysis patients. Multi-detector-row CT seems an effective, suitable, readily applicable method to assess and quantify coronary artery calcification.

  16. Left Main Coronary Artery Hypoplasia in Elderly

    PubMed Central

    Kenar Tiryakioglu, Selma; Bahadir, Hakan

    2016-01-01

    Congenital anomalies of the coronary artery causing coronary occlusive disease may be of many different types. A 67-year-old woman with no coronary risk factors was referred for coronary angiography with few months' history of angina. The patient underwent coronary angiography due to ischemic cardiac symptoms with nondiagnostic exercising test. In coronary angiography, the left main coronary artery was arising from normal anatomical position; however, left anterior descending artery and circumflex artery were hypoplastic. The treatment of patient was discussed in cardiology-cardiovascular surgery council and coronary surgery was found inappropriate due to the hypoplasia of the left coronary system entirely. PMID:27047696

  17. Percutaneous Coronary Intervention of Hidden Coronary Artery-Unusual Type of Isolated Single Coronary Artery

    PubMed Central

    Patil, Shivanand; Ramalingam, Rangaraj; Manjunath, Cholenahally Nanjappa; Subramanyam, Kasamsetty

    2016-01-01

    Single coronary artery is a rare congenital coronary artery anomaly, the incidence of which is 0.024-0.066% as described in literature. Report of cases having single coronary artery along with acute myocardial infarction are scanty and reports of percutaneous intervention in such a situation are even fewer, technically challenging and potentially cataclysmic. As single coronary artery supplies the entire myocardium, occlusion of this can result in significant ischemic insult, resulting in severe biventricular dysfunction. Percutaneous Coronary Intervention (PCI) of single coronary artery is technically challenging and carries high risk which may be equated to left main intervention. We report a rare interesting case of L1 variety of single coronary artery which presented as acute inferoposterior myocardial infarction with successful rescue PCI to Left Circumflex Artery (LCx). PMID:27656488

  18. Induction of giant cells by the synthetic food colorants viz. lemon yellow and orange red.

    PubMed

    Prajitha, V; Thoppil, John E

    2016-05-01

    Cytotoxicity and giant cell formation induced by lemon yellow and orange red synthetic food colorants were evaluated in the present study. The aqueous solutions of both the dye solutions were tested for cytotoxicity using Allium cepa assay. Frequency of giant cells were determined after treating the root tips with different concentrations of both food colorant solutions viz., 0.005, 0.01, 0.05, 0.1 % for varying time durations (1/2, 1, 2, 3 h). These colorants may cause giant cell formation primarily by interfering with the normal course of mitosis. Giant cells showing multiple aberrations viz. bridged and binucleate condition, cellular fragmentation, nuclear lesion, double and multiple nuclear lesions, double nuclear peaks and cellular breakage, elongated nucleus, nuclear budding, hyperchromasia, micronucleus, nuclear erosion, pulverized nucleus etc. were induced in root tips treated with both of the colorants. The synthetic food colorant treated cells showed inhibition of cell division and induction of giant cells. A dose dependant decrease in the mitotic index [88.20 % (c(-ve), 3h) to 81.54 % (Lx4, 3h) and 88.20 % (c(-ve), 3h) to 73.17 % (Ox4, 3h)] was observed. All mitotic phases show significant induction of giant cells when treated with both food colorants. Interphase stage shows higher percentage of giant cells, whereas in cytokinesis it was negligible. The orange red food colorant is observed to be more toxic because it recorded higher percentage of giant cell induction when compared with lemon yellow [27.93 % (Lx4, 3h) and 28.07 % (Ox4, 3h)].

  19. Cardiogenic Shock From Global Myocardial Ischemia Induced by Simultaneous Multivessel Coronary Spasm

    PubMed Central

    Ahn, Jihye; Kim, Bo-sung; Park, Hyekyong; Park, Kyungil

    2012-01-01

    Coronary artery spasm is an uncommon, but well recognized, etiology for acute myocardial infarction. However, cardiogenic shock with myocardial infarction resulting from simultaneous multiple coronary artery spasm has been rarely reported, and not in Korea. Recently, we experienced such a case in a 50-year-old Korean man without previous diagnosis of variant angina. The patient, hospitalized for blood sugar control, developed severe chest pain accompanying ST-segment elevation in multiple leads. The patient immediately received cardiac catheterization because of cardiogenic shock. Coronary angiogram revealed the severe and simultaneous spasm of three major epicardial arteries, which was promptly relieved by an intracoronary administration of isosorbide dinitrate. This case highlights the need to rule out the potential mechanism of coronary spasm even in the most severe episodes of acute coronary syndrome. PMID:22787475

  20. Multiple factors in the reptile extinctions of the Cretaceous period.

    PubMed

    Cloudsley-Thompson, J

    2001-08-01

    The selective extinction of the dinosaurs and other giant reptiles has long been a topic of speculation and controversy. Everyone is familiar with the theory of the giant bollide colliding with Earth. But, would it not be more likely that that multiple factors acted over a relatively long period of time to produce this mass extinction?

  1. [Intestinal infarct caused by giant cell arteritis].

    PubMed

    Kalbermatter, V; Laudanno, C; Bagilet, D; Diab, M; Giménez, D; Serra, F

    1999-01-01

    Arteritis of giant cells compromising extracranial and particularly intestinal tissues is not frequent. Therefore, it is common practice to make the diagnosis retrospectively after analyzing the surgical sample. A case is presented of an 83 year old woman admitted to the Clinical Department with a clinical course of 3 days of evolution characterized by fever and pain in the left hemiabdomen. Her personal medical history included multiple diverticulosis of colon, collecistectomy and appendicectomy. Laboratory tests showed that uremia was 0.75 g/L (N.L to 0.45 g/L), V.E.S. 90 mm at the first hour, and the rest of the determinations were normal. The chest and abdomen rays as well as the abdomen and pelvis ecographies were normal. A diagnosis was reached as acute diverticulitis and the patient was treated with 400 mgr of ciprofloxacina and 2,000 mgr a day of metronidazol. She continued in a feverish state and with abdominal pain, so that an anexial tomography of abdomen was taken. It showed a widening of peritoneal fascias with scarce liquid in the left parietocolic dripping and Douglas septum. After 96 hours, surgery exploration was done and injuries in the left colon revealed compatibility with an infarct of the colon which had to be extirpated. Pathological examination revealed an infarct of colon due to a secondary arterial thrombosis characteristic of giant cell arteritis. After the diagnosis, immunological studies and biopsy of the left temporal artery were performed and reported as normal. The patient was treated with 40 mgr of prednisone a day improving rapidly.

  2. Giant viruses come of age.

    PubMed

    Fischer, Matthias G

    2016-06-01

    Viruses with genomes up to a few megabases in length are a common occurrence in nature, even though they have escaped our notice until recently. These giant viruses infect mainly single-celled eukaryotes and isolation efforts concentrating on amoebal hosts alone have spawned hundreds of viral isolates, featuring viruses with previously unseen virion morphologies and the largest known viral genomes and particles. One of the challenges that lie ahead is to analyze and categorize the available data and to establish an approved classification system that reflects the evolutionary relationships and biological properties of these viruses. Extensive sampling of Acanthamoeba-infecting mimiviruses and initial characterization of their virophage parasites have provided a first blueprint of the genetic diversity and composition of a giant virus clade that will facilitate the taxonomic grouping of these fascinating microorganisms.

  3. Proteorhodopsin genes in giant viruses.

    PubMed

    Yutin, Natalya; Koonin, Eugene V

    2012-10-04

    Viruses with large genomes encode numerous proteins that do not directly participate in virus biogenesis but rather modify key functional systems of infected cells. We report that a distinct group of giant viruses infecting unicellular eukaryotes that includes Organic Lake Phycodnaviruses and Phaeocystis globosa virus encode predicted proteorhodopsins that have not been previously detected in viruses. Search of metagenomic sequence data shows that putative viral proteorhodopsins are extremely abundant in marine environments. Phylogenetic analysis suggests that giant viruses acquired proteorhodopsins via horizontal gene transfer from proteorhodopsin-encoding protists although the actual donor(s) could not be presently identified. The pattern of conservation of the predicted functionally important amino acid residues suggests that viral proteorhodopsin homologs function as sensory rhodopsins. We hypothesize that viral rhodopsins modulate light-dependent signaling, in particular phototaxis, in infected protists.

  4. Revisiting the "Sleeping Giant" Metaphor: Is It Still Sleeping in the Commonwealth of Virginia, and Is It Still Really a Giant?

    ERIC Educational Resources Information Center

    Hicks, David; van Hover, Stephanie

    2014-01-01

    In order to revisit Martorella's metaphor of technology as a sleeping giant this paper analyzes data collected over multiple years in order to provide a portrait of how preservice teachers make sense of and choose (if at all) to integrate digital technologies within their internship classrooms. Findings indicate that in the Commonwealth of…

  5. Revisiting the "Sleeping Giant" Metaphor: Is It Still Sleeping in the Commonwealth of Virginia, and Is It Still Really a Giant?

    ERIC Educational Resources Information Center

    Hicks, David; van Hover, Stephanie

    2014-01-01

    In order to revisit Martorella's metaphor of technology as a sleeping giant this paper analyzes data collected over multiple years in order to provide a portrait of how preservice teachers make sense of and choose (if at all) to integrate digital technologies within their internship classrooms. Findings indicate that in the Commonwealth of…

  6. Coronary vasodilatation following diazepam (Valium)

    PubMed Central

    Abel, R. M.; Reis, R. L.; Staroscik, R. N.

    1970-01-01

    1. The effects of diazepam (Valium) on coronary and systemic vascular resistance were studied in anaesthetized dogs on cardiopulmonary bypass under conditions of constant heart rate and aortic pressure. 2. Pharmacological doses of diazepam uniformly produced coronary vasodilation lasting 30 min; systemic vascular resistance also decreased, but to lesser degree. 3. When coronary blood flow was maintained constant at physiological levels, diazepam produced no changes in left ventricular contractility, as assessed by peak LV isovolumetric pressure, dp/dt max, force-velocity, and length-tension relations, whereas previous experiments had demonstrated a positive inotropic effect in a similar preparation in which coronary blood flow was responsive to alterations in coronary vascular resistance. 4. In five dogs, complete separation of the coronary and systemic circulations was accomplished by a double pump-oxygenator system; direct intracoronary administration of diazepam produced coronary vasodilatation, but coronary pressure and flow were not altered by administration of diazepam to the systemic circulation. 5. It is concluded that diazepam augments myocardial contractility by increasing coronary blood flow. This relationship is independent of extracardiac humoral mechanisms, and appears to require the delivery of diazepam to the coronary circulation. PMID:5441415

  7. Giant thermoelectric effect in graphene

    NASA Astrophysics Data System (ADS)

    Dragoman, D.; Dragoman, M.

    2007-11-01

    The paper predicts a giant thermoelectric coefficient in a nanostructure consisting of metallic electrodes periodically patterned over graphene, which is deposited on a silicon dioxide substrate. The Seebeck coefficient in this device attains 30mV/K, this value being among the largest reported ever. The calculations are based on a transfer matrix approach that takes a particular form for graphene-based devices. The results are important for future nanogenerators with applications in the area of sensors, energy harvesting, and scavenging.

  8. [Treatment of giant acoustic neuromas].

    PubMed

    Samprón, Nicolás; Altuna, Xabier; Armendáriz, Mikel; Urculo, Enrique

    2014-01-01

    To analyze the treatment modality and outcome of a series of patients with giant acoustic neuromas, a particular type of tumour characterised by their size (extracanalicular diameter of 4cm or more) and high morbidity and mortality. This was a retrospective unicentre study of patients with acoustic neuromas treated in a period of 12 years. In our institutional series of 108 acoustic neuromas operated on during that period, we found 13 (12%) cases of giant acoustic neuromas. We reviewed the available data of these cases, including presentation and several clinical, anatomical, and microsurgical aspects. All patients were operated on by the same neurosurgeon and senior author (EU) using the suboccipital retrosigmoid approach and complete microsurgical removal was achieved in 10 cases. In one case, near total removal was deliberately performed, in another case a CSF shunt was placed as the sole treatment measure, and in the remaining case no direct treatment was given. One patient died in the immediate postoperative period. One year after surgery, 4 patients showed facial nerve function of iii or more in the House-Brackman scale. The 4 most important prognostic characteristics of giant acoustic neuromas are size, adhesion to surrounding structures, consistency and vascularity. Only the first of these is evident in neuroimaging. Giant acoustic neuromas are characterised by high morbidity at presentation as well as after treatment. Nevertheless, the objective of complete microsurgical removal with preservation of cranial nerve function is attainable in some cases through the suboccipital retrosigmoid approach. Copyright © 2014 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.

  9. Giant magnetoresistance in silicene nanoribbons.

    PubMed

    Xu, Chengyong; Luo, Guangfu; Liu, Qihang; Zheng, Jiaxin; Zhang, Zhimeng; Nagase, Shigeru; Gao, Zhengxiang; Lu, Jing

    2012-05-21

    By performing first-principle quantum transport calculations, we predict a giant magnetoresistance in zigzag silicene nanoribbons (ZSiNRs) connecting two semi-infinite silicene electrodes through switch of the edge spin direction of ZSiNRs. Spin-filter efficiency of both the antiferromagnetic and ferromagnetic ZSiNRs is sign-changeable with the bias voltage. Therefore, potential application of silicene in spintronics devices is suggested.

  10. Idiopathic giant right atrial aneurysm

    PubMed Central

    Uppu, Santosh C; Sachdeva, Ritu; Imamura, Michiaki

    2013-01-01

    A 2-year-old boy with an incidental finding of massive cardiomegaly on a chest X-ray was diagnosed with a giant right atrial aneurysm upon further investigation with echocardiography. The patient underwent successful surgical reduction of the right atrium and closure of the patent foramen ovale to prevent thromboembolic complications and to lower the risk of atrial arrhythmias. The resected atrium had paper-thin walls and pathological features of interstitial fibrosis with endocardial thickening. PMID:23626440

  11. Giant viruses infecting algae.

    PubMed

    Van Etten, J L; Meints, R H

    1999-01-01

    Paramecium bursaria chlorella virus (PBCV-1) is the prototype of a family of large, icosahedral, plaque-forming, double-stranded-DNA-containing viruses that replicate in certain unicellular, eukaryotic chlorella-like green algae. DNA sequence analysis of its 330, 742-bp genome leads to the prediction that this phycodnavirus has 376 protein-encoding genes and 10 transfer RNA genes. The predicted gene products of approximately 40% of these genes resemble proteins of known function. The chlorella viruses have other features that distinguish them from most viruses, in addition to their large genome size. These features include the following: (a) The viruses encode multiple DNA methyltransferases and DNA site-specific endonucleases; (b) PBCV-1 encodes at least part, if not the entire machinery to glycosylate its proteins; (c) PBCV-1 has at least two types of introns--a self-splicing intron in a transcription factor-like gene and a splicesomal processed type of intron in its DNA polymerase gene. Unlike the chlorella viruses, large double-stranded-DNA-containing viruses that infect marine, filamentous brown algae have a circular genome and a lysogenic phase in their life cycle.

  12. Hairpin Furans and Giant Biaryls.

    PubMed

    Geng, Xin; Mague, Joel T; Donahue, James P; Pascal, Robert A

    2016-05-06

    The thermal reaction of two cyclopentadienones with 5,5'-binaphthoquinone or 6,6'-dimethoxy-5,5'-binaphthoquinone in refluxing nitrobenzene (210 °C) gives, in a single synthetic step that includes two Diels-Alder additions, two decarbonylations, and two dehydrogenations, giant biaryl bisquinones (compounds 13, 14, 15, 18, and 21). However, when two cyclopentadienones react with 6,6'-dimethoxy-5,5'-binaphthoquinone in nitrobenzene at higher temperatures (250-260 °C), the resulting products are molecular ribbons composed of two twisted aromatic systems fused to a heteropentahelicene (19, 20, and 22). These molecules are representatives of a new class of chiral polycyclic aromatic compounds, the "hairpin furans". Interestingly, reheating a dimethoxy-substituted giant biaryl (e.g., 21) in nitrobenzene at 260 °C does not yield the corresponding hairpin furan (22), and mechanistic studies indicate that some intermediate or byproduct of the synthesis of the giant biaryls is a reagent or catalyst necessary for the conversion of the dimethoxybiaryl to the furan.

  13. KEPLER RAPIDLY ROTATING GIANT STARS

    SciTech Connect

    Costa, A. D.; Martins, B. L. Canto; Bravo, J. P.; Paz-Chinchón, F.; Chagas, M. L. das; Leão, I. C.; Oliveira, G. Pereira de; Silva, R. Rodrigues da; Roque, S.; Oliveira, L. L. A. de; Silva, D. Freire da; De Medeiros, J. R.

    2015-07-10

    Rapidly rotating giant stars are relatively rare and may represent important stages of stellar evolution, resulting from stellar coalescence of close binary systems or accretion of substellar companions by their hosting stars. In the present Letter, we report 17 giant stars observed in the scope of the Kepler space mission exhibiting rapid rotation behavior. For the first time, the abnormal rotational behavior for this puzzling family of stars is revealed by direct measurements of rotation, namely from photometric rotation period, exhibiting a very short rotation period with values ranging from 13 to 55 days. This finding points to remarkable surface rotation rates, up to 18 times the rotation of the Sun. These giants are combined with six others recently listed in the literature for mid-infrared (IR) diagnostics based on Wide-field Infrared Survey Explorer information, from which a trend for an IR excess is revealed for at least one-half of the stars, but at a level far lower than the dust excess emission shown by planet-bearing main-sequence stars.

  14. Observed Properties of Giant Cells

    NASA Technical Reports Server (NTRS)

    Hathaway, David H.; Upton, Lisa; Colegrove, Owen

    2014-01-01

    The existence of Giant Cells has been suggested by both theory and observation for over 45 years. We have tracked the motions of supergranules in SDO/HMI Doppler velocity data and find larger (Giant Cell) flows that persist for months. The flows in these cells are clockwise around centers of divergence in the north and counter-clockwise in the south. Equatorward flows are correlated with prograde flows - giving the transport of angular momentum toward the equator that is needed to maintain the Sun's rapid equatorial rotation. The cells are most pronounced at mid- and high-latitudes where they exhibit the rotation rates representative of those latitudes. These are clearly large, long-lived, cellular features, with the dynamical characteristics expected from the effects of the Sun's rotation, but the shapes of the cells are not well represented in numerical models. While the Giant Cell flow velocities are small (<10 m/s), their long lifetimes should nonetheless substantially impact the transport of magnetic flux in the Sun's near surface layers.

  15. Electrodynamics in Giant Planet Atmospheres

    NASA Astrophysics Data System (ADS)

    Koskinen, T.; Yelle, R. V.; Lavvas, P.; Cho, J.

    2014-12-01

    The atmospheres of close-in extrasolar giant planets such as HD209458b are strongly ionized by the UV flux of their host stars. We show that photoionization on such planets creates a dayside ionosphere that extends from the thermosphere to the 100 mbar level. The resulting peak electron density near the 1 mbar level is higher than that encountered in any planetary ionosphere of the solar system, and the model conductivity is in fact comparable to the atmospheres of Sun-like stars. As a result, the momentum and energy balance in the upper atmosphere of HD209458b and similar planets can be strongly affected by ion drag and resistive heating arising from wind-driven electrodynamics. Despite much weaker ionization, electrodynamics is nevertheless also important on the giant planets of the solar system. We use a generic framework to constrain the conductivity regimes on close-in extrasolar planets, and compare the results with conductivites based on the same approach for Jupiter and Saturn. By using a generalized Ohm's law and assumed magnetic fields, we then demonstrate the basic effects of wind-driven ion drag in giant planet atmospheres. Our results show that ion drag is often significant in the upper atmosphere where it can also substantially alter the energy budget through resistive heating.

  16. Multimodality Cardiac Imaging in a Patient with Kawasaki Disease and Giant Aneurysms

    PubMed Central

    Srinivasan, Ranjini; Weller, Rachel; Einstein, Andrew J.

    2016-01-01

    Kawasaki disease is a well-known cause of acquired cardiac disease in the pediatric and adult population, most prevalent in Japan but also seen commonly in the United States. In the era of intravenous immunoglobulin (IVIG) treatment, the morbidity associated with this disease has decreased, but it remains a serious illness. Here we present the case of an adolescent, initially diagnosed with Kawasaki disease as an infant, that progressed to giant aneurysm formation and calcification of the coronary arteries. We review his case and the literature, focusing on the integral role of multimodality imaging in managing Kawasaki disease. PMID:27872783

  17. Outcomes of patients with spontaneous coronary artery dissection

    PubMed Central

    McGrath-Cadell, Lucy; McKenzie, Pamela; Emmanuel, Sam; Muller, David W M; Graham, Robert M; Holloway, Cameron J

    2016-01-01

    Background Spontaneous coronary artery dissection (SCAD) is an uncommon but serious condition presenting as an acute coronary syndrome (ACS) or cardiac arrest. The pathophysiology and outcomes are poorly understood. We investigated the characteristics and outcomes of patients presenting with SCAD. Methods In a retrospective study of a large cohort of patients with SCAD, data were collected regarding clinical presentation, patient characteristics, vascular screening, coronary artery involvement and clinical outcomes. Results 40 patients with SCAD (95% women, mean age 45±10 years) were included. At least 1 traditional cardiovascular risk factor was present in 40% of patients. Migraine was reported in 43% of patients. Events preceding SCAD included parturition (8%), physical stress (13%), emotional stress (10%) and vasoconstrictor substance-use (8%). 65% of patients had a non-ST elevation ACS (NSTEACS) at presentation, 30% had an ST elevation myocardial infarction (STEMI) and 13% had a cardiac arrest. The left anterior descending artery was most frequently involved (68% of patients), and 13% had involvement of multiple coronary territories. Fibromuscular dysplasia (FMD) was identified in 7 (37%) of 19 patients screened. 68% of patients were managed medically, 30% had percutaneous coronary intervention and 5% had coronary artery bypass grafting. Over a median 16-month follow-up period, 8% of patients had at least 1 recurrent SCAD event. There were no deaths. Conclusions Patients with SCAD in this study often had multiple coronary territories involved (13%) and extracardiac vascular abnormalities, suggesting a systemic vascular process, which may explain the high incidence of migraine. All patients with SCAD should be screened for FMD and followed closely due to the possibility of recurrence. PMID:27621835

  18. Guiding the Giant

    NASA Astrophysics Data System (ADS)

    1998-08-01

    New ESO Survey Provides Targets for the VLT Giant astronomical telescopes like the ESO Very Large Telescope (VLT) must be used efficiently. Observing time is expensive and there are long waiting lines of excellent research programmes. Thus the work at the telescope must be very well prepared and optimized as much as possible - mistakes should be avoided and no time lost! Astronomers working with the new 8-m class optical/infrared telescopes must base their observations on detailed lists of suitable target objects if they want to perform cutting-edge science. This is particularly true for research programmes that depend on observations of large samples of comparatively rare, distant objects. This type of work requires that extensive catalogues of such objects must be prepared in advance. One such major catalogue - that will serve as a very useful basis for future VLT observations - has just become available from the new ESO Imaging Survey (EIS). The Need for Sky Surveys Astronomers have since long recognized the need to carry out preparatory observations with other telescopes in order to "guide" large telescopes. To this end, surveys of smaller or larger parts of the sky have been performed by wide-field telescopes, paving the way for subsequent work at the limits of the largest available ground-based telescopes. For instance, a complete photographic survey of the sourthern sky (declination < -17.5°) was carried out in the 1970's with the ESO 1-metre Schmidt Telescope in support of the work at the 3.6-m telescope at the ESO La Silla observatory. However, while until recently most observational programmes could rely on samples of objects found on photographic plates, this is no longer possible. New image surveys must match the fainter limiting magnitudes reached by the new and larger telescopes. Modern digital, multi-colour, deep imaging surveys have thus become an indispensable complement to the 8-m telescopes. The new generation of imaging surveys will, without

  19. Impact of coronary bifurcation morphology on wave propagation

    PubMed Central

    Rivolo, Simone; Hadjilucas, Lucas; Sinclair, Matthew; van Horssen, Pepijn; van den Wijngaard, Jeroen; Wesolowski, Roman; Chiribiri, Amedeo; Smith, Nicolas P.

    2016-01-01

    The branching pattern of the coronary vasculature is a key determinant of its function and plays a crucial role in shaping the pressure and velocity wave forms measured for clinical diagnosis. However, although multiple scaling laws have been proposed to characterize the branching pattern, the implications they have on wave propagation remain unassessed to date. To bridge this gap, we have developed a new theoretical framework by combining the mathematical formulation of scaling laws with the wave propagation theory in the pulsatile flow regime. This framework was then validated in multiple species using high-resolution cryomicrotome images of porcine, canine, and human coronary networks. Results demonstrate that the forward well-matchedness (no reflection for pressure/flow waves traveling from the coronary stem toward the microcirculation) is a salient feature in the coronary vasculature, and this result remains robust under many scenarios of the underlying pulse wave speed distribution assumed in the network. This result also implies a significant damping of the backward traveling waves, especially for smaller vessels (radius, <0.3 mm). Furthermore, the theoretical prediction of increasing area ratios (ratio between the area of the mother and daughter vessels) in more symmetric bifurcations found in the distal circulation was confirmed by experimental measurements. No differences were observed by clustering the vessel segments in terms of transmurality (from epicardium to endocardium) or perfusion territories (left anterior descending, left circumflex, and right coronary artery). PMID:27402665

  20. Cabergoline Treatment in Invasive Giant Prolactinoma

    PubMed Central

    Alsubaie, Sadeem; Almalki, Mussa H

    2014-01-01

    Patients with invasive giant prolactinoma suffer from a constellation of symptoms including headache, blurred vision, lethargy, and sexual dysfunction. Cabergoline, a potent dopamine agonist, is a known medication prescribed for the treatment of invasive giant prolactinoma. Here, we report a case of invasive giant prolactinoma in a 52-year-old Saudi male with dramatic response to cabergoline treatment clinically, biochemically, and radiologically. PMID:25002819

  1. Giant-cell granuloma of the axis.

    PubMed

    González-Martínez, Emilio; Santamarta, David; Lomas-García, Jesús; Ibáñez-Plágaro, F Javier; Fernández-Fernández, J Javier; Ariño, Teresa Ribas; García-Cosamalón, José

    2012-02-01

    Giant-cell granuloma is a benign and nonneoplastic lesion with an expansive and locally destructive behavior. It typically involves the mandible and the maxilla. Only 1 case arising from the odontoid process of the axis has been reported previously. The authors report on a 64-year-old man with a giant-cell granuloma of the axis. They review this uncommon entity, emphasizing the complexity of differentiating between this lesion and other giant-cell tumors.

  2. Pathogenetic mechanisms of coronary ectasia.

    PubMed

    Antoniadis, Antonios P; Chatzizisis, Yiannis S; Giannoglou, George D

    2008-11-28

    Coronary ectasia is defined as local or generalized aneurysmal dilatation of the coronary arteries. The present review summarizes the molecular, cellular and vascular mechanisms which are involved in the pathobiology of coronary ectasia. Coronary ectasia likely represents an exaggerated form of expansive vascular remodeling (i.e. excessive expansive remodeling) in response to atherosclerotic plaque growth. Enzymatic degradation of the extracellular matrix of the media is the major pathophysiologic process that leads to ectasia. Atherosclerotic lesions within ectatic regions of the coronary arteries appear to be highly inflamed high-risk plaques with proclivity to rupture. Better understanding of the pathogenetic processes involved in coronary ectasia is anticipated that will provide a further insight into the clinical significance and natural history of this entity, and may also have direct clinical implications in the management and follow-up strategy of this condition.

  3. Types of Coronary Artery Bypass Grafting

    MedlinePlus

    ... from the NHLBI on Twitter. Types of Coronary Artery Bypass Grafting There are several types of coronary ... for you based on your needs. Traditional Coronary Artery Bypass Grafting Traditional CABG is used when at ...

  4. Red giants: then and now

    NASA Astrophysics Data System (ADS)

    Faulkner, John

    Fred Hoyle's work on the structure and evolution of red giants, particularly his pathbreaking contribution with Martin Schwarzschild (Hoyle and Schwarzschild 1955), is both lauded and critically assessed. In his later lectures and work with students in the early 1960s, Hoyle presented more physical ways of understanding some of the approximations used, and results obtained, in that seminal paper. Although later ideas by other investigators will be touched upon, Hoyle's viewpoint - that low-mass red giants are essentially white dwarfs with a serious mass-storage problem - is still extremely fruitful. Over the years, I have further developed his method of attack. Relatively recently, I have been able to deepen and broaden the approach, finally extending the theory to provide a unifying treatment of the structure of low-mass stars from the main sequence though both the red-giant and horizontal-branch phases of evolution. Many aspects of these stars that had remained puzzling, even mysterious, for decades have now fallen into place, and some questions have been answered that were not even posed before. With low-mass red giants as the simplest example, this recent work emphasizes that stars, in general, may have at least two distinct but very important centres: (I) a geometrical centre, and (II) a separate nuclear centre, residing in a shell outside a zero-luminosity dense core for example. This two-centre perspective leads to an explicit, analytical, asymptotic theory of low-mass red-giant structure. It enables one to appreciate that the problem of understanding why such stars become red giants is one of anticipating a remarkable yet natural structural bifurcation that occurs in them. This bifurcation occurs because of a combination of known and understandable facts just summarized namely that, following central hydrogen exhaustion, a thin nuclear-burning shell does develop outside a more-or-less dense core. In the resulting theory, both ρsh/ρolinec and

  5. Balloon catheter coronary angioplasty

    SciTech Connect

    Angelini, P.

    1987-01-01

    The author has produced a reference and teaching book on balloon angioplasty. Because it borders in surgery and is performed on an awake patient without circulatory assistance, it is a complex and demanding procedure that requires thorough knowledge before it is attempted. The text is divided into seven sections. The first section describes coronary anatomy and pathophysiology, defines the objectives and mechanisms of the procedure and lists four possible physiologic results. The next section describes equipment in the catheterization laboratory, catheters, guidewires and required personnel. The following section is on the procedure itself and includes a discussion of examination, testing, technique and follow-up. The fourth section details possible complications that can occur during the procedure, such as coronary spasms, occlusion, thrombosis, perforations and ruptures, and also discusses cardiac surgery after failed angioplasty. The fifth section details complex or unusual cases that can occur. The sixth and seventh sections discuss radiation, alternative procedures and the future of angioplasty.

  6. ORIGIN OF LITHIUM ENRICHMENT IN K GIANTS

    SciTech Connect

    Kumar, Yerra Bharat; Reddy, Bacham E.; Lambert, David L.

    2011-03-20

    In this Letter, we report on a low-resolution spectroscopic survey for Li-rich K giants among 2000 low-mass (M {<=} 3 M{sub sun}) giants spanning the luminosity range from below to above the luminosity of the clump. Fifteen new Li-rich giants including four super Li-rich K giants (log {epsilon}(Li) {>=}3.2) were discovered. A significant finding is that there is a concentration of Li-rich K giants at the luminosity of the clump or red horizontal branch. This new finding is partly a consequence of the fact that our low-resolution survey is the first large survey to include giants well below and above the red giant branch (RGB) bump and clump locations in the H-R diagram. Origin of the lithium enrichment may be plausibly attributed to the conversion of {sup 3}He via {sup 7}Be to {sup 7}Li by the Cameron-Fowler mechanism but the location for the onset of the conversion is uncertain. Two possible opportunities to effect this conversion are discussed: the bump in the first ascent of the RGB and the He-core flash at the tip of the RGB. The finite luminosity spread of the Li-rich giants serves to reject the idea that Li enhancement is, in general, a consequence of a giant swallowing a large planet.

  7. Speciation and phylogeography of giant petrels Macronectes.

    PubMed

    Techow, N M S M; O'Ryan, C; Phillips, R A; Gales, R; Marin, M; Patterson-Fraser, D; Quintana, F; Ritz, M S; Thompson, D R; Wanless, R M; Weimerskirch, H; Ryan, P G

    2010-02-01

    We examine global phylogeography of the two forms of giant petrel Macronectes spp. Although previously considered to be a single taxon, and despite debate over the status of some populations and the existence of minimal genetic data (one mitochondrial cytochrome b sequence per form), the current consensus based on morphology is that there are two species, Northern Giant Petrel M. halli and Southern Giant Petrel M. giganteus. This study examined genetic variation at cytochrome b as well as six microsatellite loci in giant petrels from 22 islands, representing most island groups at which the two species breed. Both markers support separate species status, although sequence divergence in cytochrome b was only 0.42% (corrected). Divergence was estimated to have occurred approximately 0.2mya, but with some colonies apparently separated for longer (up to 0.5 my). Three clades were found within giant petrels, which separated approximately 0.7mya, with the Southern Giant Petrel paraphyletic to a monophyletic Northern Giant Petrel. There was evidence of past fragmentation during the Pleistocene, with subsequent secondary contact within Southern Giant Petrels. The analysis also suggested a period of past population expansion that corresponded roughly to the timing of speciation and the separation of an ancestral giant petrel population from the fulmar Fulmarus clade. Copyright (c) 2009 Elsevier Inc. All rights reserved.

  8. Spontaneous thrombosis in giant intracranial aneurysms.

    PubMed Central

    Whittle, I R; Dorsch, N W; Besser, M

    1982-01-01

    Twelve patients in a series of 22 with giant intracranial aneurysms demonstrated neuroradiological features of partial or total spontaneous intra-aneurysmal thrombosis. The presence of this intra-aneurysmal clot significantly altered the computed tomographic appearance of the giant aneurysm. Massive intra-aneurysmal thrombosis did not protect against subarachnoid haemorrhage and the likelihood of rupture of a clot containing giant aneurysm was not significantly different from that of a non-thrombosed giant aneurysm. Although parent artery occlusion from a thrombosed giant aneurysm, and massive aneurysmal thrombosis leading to the formation of giant serpentine aneurysm were documented, these are rare epiphenomena. The risk of embolisation from a partially thrombosed giant aneurysm, which was documented in one case, would appear to be greater than that from a non-thrombosed giant aneurysm. The findings in this series, and a review of literature, suggest that the presence of intra-aneurysmal clot in giant intracranial aneurysms has little prognostic significance and does not alter the management or outcome after treatment. Images PMID:7175528

  9. Coronary artery disease.

    PubMed

    Hanson, Michele A; Fareed, Mohammad Tariq; Argenio, Sandra L; Agunwamba, Akochi O; Hanson, Teresa R

    2013-03-01

    Coronary artery disease (CAD) is the leading cause of death worldwide. There are several presenting clinical syndromes, including sudden cardiac death. Risk factor analysis can help the primary care provider identify patients who may need more extensive evaluation or treatment. Treatment may be medical or surgical and depends on the individual patient's comorbidities and preferences. In the future, growth of new blood vessels or cardiac cells may aid in the treatment of CAD. Copyright © 2013 Elsevier Inc. All rights reserved.

  10. Perspectives in coronary prevention.

    PubMed Central

    Turner, R. W.

    1978-01-01

    The seeds of premature coronary heart disease are often sown in childhood and it is the developing arteries of children which are the most susceptible. Paediatricians and all who work with them have the earliest and most promising opportunities for prevention. Coronary protection can be added to the potential advantages of breast feeding and to ensure appropriate fatty acid balance throughout weaning. It is reasonable to accept the strong consensus of opinion on diet reflected in the reports of the eighteen national committees. They are: to reduce total fat intake to 30-35% of the energy, to restrict consumption of saturated fat, cholesterol, sugar, and salt, to increase unrefined carbohydrate and polyunsaturated fat, and to maintain a P/S balance of 1.0-1.5:1. Food is the fundamental coronary risk factor, but others may add insult to injury. Smoking, hypertension, obesity, lack of exercise, and stress, each of which is related to behaviour, may start in childhood. Smoking doubles the overall risk CHD and increases it ten times in males under 45 years old. Good habits, including food preferences and eating patterns learned early, are those most likely to be continued. School meals require and should match revised nutritional education. The co-operation of the food industry is essential and can be anticipated, but it requires a clear lead by paediatricians. The nutritional advice should come from the medical profession. Every contact with children and their parents provides an opportunity for enquiry and giving advice. PMID:349532

  11. Immunohistochemical characterization of subependymal giant cell astrocytomas.

    PubMed

    Lopes, M B; Altermatt, H J; Scheithauer, B W; Shepherd, C W; VandenBerg, S R

    1996-01-01

    Subependymal giant cell astrocytoma (SEGA) is the most common neoplastic process involving the brain in patients with tuberous sclerosis complex (TSC). Morphologically, these tumors exhibit a wide range of cytoarchitecture with spindle and epithelioid cells resembling astrocytes, and also large, occasionally giant cells, some of which have a distinctly ganglion-like appearance. Unresolved questions regarding SEGAs center on: (a) their cytogenesis, i.e., whether they are derived from single or multiple precursors; and (b) their differentiating capacity along glial or neuronal lines. We sought to determine whether SEGAs represent truly mixed tumors or whether they consist of a single population of cells with a capacity for divergent differentiation. Twenty SEGAs were assessed for immunophenotypic features of either neuronal or glial differentiation or both. Only tumors from patients with a clinically confirmed diagnosis of TSC were included. Immunoreactivity for glial fibrillary acidic protein (GFAP) and/or S-100 protein was considered indicative of a glial phenotype, whereas the presence of neuronal differentiation was assessed by staining for cytoskeletal proteins [neurofilament epitopes, class III Beta-tubulin, microtubule-associated protein 2 (MAP2), synaptophysin], neurosecretory substances [serotonin, cholecystokinin, Beta-endorphin, substance P, somatostatin, metenkephalin, neuropeptide Y, vasoactive intestinal polypeptide (VIP), and for the 28-kDa neuron-associated calcium binding protein calbindin. Of the tumors examined, 18 exhibited both glial and neuronal epitopes, the staining pattern being variable. In 19 tumors, the constituent spindle, polygonal and giant or ganglion-like cells showed variable immunoreactivity for GFAP and S-100 proteins both within the cell body and processes. Neuron-associated cytoskeletal proteins were present in 18 cases. Class III Beta-tubulin immunoreactivity was demonstrated in 17 tumors, both within the bodies of all three

  12. Coronary Atherosclerosis and Interventional Cardiology.

    PubMed

    Peña-Duque, Marco Antonio; Romero-Ibarra, José Luis; Gaxiola-Macías, Manuel Ben Adoniram; Arias-Sánchez, Eduardo A

    2015-07-01

    The atherosclerotic process in coronary arteries begins with endothelial dysfunction and may provoke thrombotic total occlusion and myocardial infarction. In this state-of-the-art review, we discuss recent evidence of atheroslerosis, vulnerable plaque, and hemodynamic changes in the coronary tree, as well as the current techniques we implement in the catheterization lab to evaluate coronary stenosis. It is clear that atherosclerosis is a chronic inflammatory condition with several consequences in the coronary tree, however, we are able now to characterize the plaque and to select the appropriate treatment for many patients.

  13. Left Main Coronary Artery Aneurysm

    PubMed Central

    Doustkami, Hossein; Maleki, Nasrollah; Tavosi, Zahra

    2016-01-01

    Aneurysms of the left main coronary artery are exceedingly rare clinical entities, encountered incidentally in approximately 0.1% of patients who undergo routine angiography. The most common cause of coronary artery aneurysms is atherosclerosis. Angiography is the gold standard for diagnosis and treatment. Depending on the severity of the coexisting coronary stenosis, patients with left main coronary artery aneurysms can be effectively managed either surgically or pharmacologically. We herein report a case of left main coronary artery aneurysm in a 72-year-old man with a prior history of hypertension presenting to our hospital because of unstable angina. The electrocardiogram showed ST-segment depression and T-wave inversion in the precordial leads. All the data of blood chemistry were normal. Echocardiography showed akinetic anterior wall, septum, and apex, mild mitral regurgitation and ejection fraction of 45%. Coronary angiography revealed a saccular aneurysm of the left main coronary artery with significant stenosis in the left anterior descending, left circumflex, and right coronary artery. The patient immediately underwent coronary artery bypass grafting and ligation of the aneurysm. At six months’ follow-up, he remained asymptomatic. PMID:27403190

  14. Low serum paraoxonase1 activity levels predict coronary artery disease severity

    PubMed Central

    Sun, Ting; Hu, Jingchao; Yin, Zhaofang; Xu, Zuojun; Zhang, Liang; Fan, Li; Zhuo, Yang; Wang, Changqian

    2017-01-01

    Paraoxonase1 (PON1) activity is closely related to coronary artery disease (CAD). However, whether PON1 activity can predict the degree of coronary stenosis remains unknown. In the present study, the serum PON1 activity and related factors that influence PON1 activity were analyzed in 186 patients with diagnostic coronary angiography. The serum PON1 activity was determined using a spectrophotometry-based assay in 186 patients with diagnostic coronary angiography, in which coronary stenosis severity was graded and clinically defined as single- or multi-vessel stenosis >50%. Target lesion stenosis was quantified via quantitative coronary angiography (QCA). The serum PON1 activity was significantly decreased in the CAD group, the multiple coronary stenosis subgroup, and the diabetes mellitus subgroup compared with each control group. The PON1 activity was positively correlated with the High density lipoprotein cholesterol (HDL-C) and Apolipoprotein A1 (ApoA1). Males, smoking, diabetes, and heart failure were identified as factors that influenced PON1 activity. Furthermore, a Receiver Operating Characteristic Curve (ROC) analysis indicated that a PON1 activity cut-off point of 330 U/L could predict CAD with a sensitivity of 52% and a specificity of 65%. In conclusion, low PON1 activity predicted the degree of coronary lesion, particularly in multiple vessel lesions, smokers, and diabetes, which may represent a biochemical marker for the severity of CAD. PMID:28038449

  15. An adult case of Kawasaki disease with multiplex coronary aneurysms and myocardial infarction: the role of transesophageal echocardiography.

    PubMed

    Habon, T; Toth, K; Keltai, M; Lengyel, M; Palik, I

    1998-07-01

    Kawasaki disease (mucocutaneous lymph node syndrome) is an acute inflammatory disease that primarily affects infants and young children. In spite of proper therapy, coronary aneurysms develop in 10 to 25% of cases. Adult diagnosis of coronary aneurysm, presumably caused by Kawasaki disease, is rare. A 37-year-old male patient with previous inferior wall myocardial infarction (MI) was admitted with an acute anterior wall MI. Coronary angiography, performed 2 weeks after successful thrombolytic therapy, showed right coronary artery occlusion and multiplex (left main, left anterior descending, left circumflex, right coronary artery) giant coronary aneurysms. Transthoracic echocardiography was unable to detect the aneurysms. Transesophageal echocardiography (TEE) visualized a large left main coronary aneurysm with an occlusive thrombus and measured low flow velocity (0.2 m/s) in the proximal left anterior descending artery. At 4 weeks control, TEE showed marked regression of the thrombus, and it was not detectable after 6 months of oral anticoagulation with acenocumarol (International Normalized Ratio: 3-3.5) and standard postinfarction therapy. After 2 years of follow-up, the patient has no symptoms, and myocardial ischemia could not be provoked by stress tests [treadmill, dipyridamole single-photon emission computed tomography (SPECT)]. We conclude that, for diagnosis and follow-up of adult Kawasaki disease, transesophageal echocardiography is indicated. The importance and efficacy of long-term anticoagulant treatment should be emphasized in this disease.

  16. Coronary revascularization after arterial switch operation.

    PubMed

    Prifti, Edvin; Bonacchi, Massimo; Luisi, Stefano Vincenzo; Vanini, Vittorio

    2002-01-01

    We report two cases presenting bilateral coronary artery obstruction after arterial switch operation. The first patient underwent bilateral internal thoracic artery grafting to the left and right coronary arteries. The other patient, presenting a single coronary ostium, underwent surgical coronary ostial angioplasty in concomitance to proximal arterioplasty of both coronary arteries employing a single "pantaloon" shape autologous pericardial patch. Both patients survived and, at 1 year and 9 months after the coronary revascularization procedures, the coronary angiography demonstrated a good patency of the internal thoracic grafts and excellent ostial plasty results, respectively. A complete literature review of patients undergoing different coronary revascularization procedures after arterial switch operation is reported.

  17. PULSATION FREQUENCIES AND MODES OF GIANT EXOPLANETS

    SciTech Connect

    Le Bihan, Bastien; Burrows, Adam E-mail: burrows@astro.princeton.edu

    2013-02-10

    We calculate the eigenfrequencies and eigenfunctions of the acoustic oscillations of giant exoplanets and explore the dependence of the characteristic frequency {nu}{sub 0} and the eigenfrequencies on several parameters: the planet mass, the planet radius, the core mass, and the heavy element mass fraction in the envelope. We provide the eigenvalues for degree l up to 8 and radial order n up to 12. For the selected values of l and n, we find that the pulsation eigenfrequencies depend strongly on the planet mass and radius, especially at high frequency. We quantify this dependence through the calculation of the characteristic frequency {nu}{sub 0} which gives us an estimate of the scale of the eigenvalue spectrum at high frequency. For the mass range 0.5 M{sub J} {<=} M{sub P} {<=} 15 M{sub J} , and fixing the planet radius to the Jovian value, we find that {nu}{sub 0} {approx} 164.0 Multiplication-Sign (M{sub P} /M{sub J} ){sup 0.48}{mu}Hz, where M{sub P} is the planet mass and M{sub J} is Jupiter's mass. For the radius range from 0.9 to 2.0 R{sub J} , and fixing the planet's mass to the Jovian value, we find that {nu}{sub 0} {approx} 164.0 Multiplication-Sign (R{sub P} /R{sub J} ){sup -2.09}{mu}Hz, where R{sub P} is the planet radius and R{sub J} is Jupiter's radius. We explore the influence of the presence of a dense core on the pulsation frequencies and on the characteristic frequency of giant exoplanets. We find that the presence of heavy elements in the envelope affects the eigenvalue distribution in ways similar to the presence of a dense core. Additionally, we apply our formalism to Jupiter and Saturn and find results consistent with both the observational data of Gaulme et al. and previous theoretical work.

  18. Warm Disks from Giant Impacts

    NASA Astrophysics Data System (ADS)

    Kohler, Susanna

    2015-10-01

    In the process of searching for exoplanetary systems, weve discovered tens of debris disks close around distant stars that are especially bright in infrared wavelengths. New research suggests that we might be looking at the late stages of terrestrial planet formation in these systems.Forming Terrestrial PlanetsAccording to the widely-accepted formation model for our solar-system, protoplanets the size of Mars formed within a protoplanetary disk around our Sun. Eventually, the depletion of the gas in the disk led the orbits of these protoplanets to become chaotically unstable. Finally, in the giant impact stage, many of the protoplanets collided with each other ultimately leading to the formation of the terrestrial planets and their moons as we know them today.If giant impact stages occur in exoplanetary systems, too leading to the formation of terrestrial exoplanets how would we detect this process? According to a study led by Hidenori Genda of the Tokyo Institute of Technology, we might be already be witnessing this stage in observations of warm debris disks around other stars. To test this, Genda and collaborators model giant impact stages and determine what we would expect to see from a system undergoing this violent evolution.Modeling CollisionsSnapshots of a giant impact in one of the authors simulations. The collision causes roughly 0.05 Earth masses of protoplanetary material to be ejected from the system. Click for a closer look! [Genda et al. 2015]The collaborators run a series of simulations evolving protoplanetary bodies in a solar system. The simulations begin 10 Myr into the lifetime of the solar system, i.e., after the gas from the protoplanetary disk has had time to be cleared and the protoplanetary orbits begin to destabilize. The simulations end when the protoplanets are done smashing into each other and have again settled into stable orbits, typically after ~100 Myr.The authors find that, over an average giant impact stage, the total amount of

  19. High-speed coronary rotational angioplasty with the rotablator

    NASA Astrophysics Data System (ADS)

    Zacca, Nadim M.; Kleiman, Neal S.; Asimacopoulos, P. J.

    1992-08-01

    Percutaneous mechanical rotational ablation with the rotablator can be used effectively as a stand alone treatment for coronary arterial lesions, including those with angiographic morphology considered unfavorable for balloon angioplasty (eccentric, at bends, bifurcating, calcified, ulcerated, completely occluded_, as well as for balloon angioplasty procedure failures. The use of single rather than multiple burrs without balloon assistance, the use of fewer passes and of the nitroglycerine infusion through the rotablator catheter have considerably shortened the time necessary to complete a rotational atherectomy. Further, the apparently infrequent occurrence of post procedure abrupt closure makes this technique attractive in the clinical management of patients with complex coronary artery lesions.

  20. Acute coronary occlusion during percutaneous transluminal coronary angioplasty.

    PubMed Central

    Shiu, M F; Silverton, N P; Oakley, D; Cumberland, D

    1985-01-01

    Two hundred and forty percutaneous transluminal coronary angioplasty procedures were performed in three centres over a two year period. Acute occlusion of the vessel undergoing angioplasty was seen on 20 (8%) occasions. The cause of occlusion was determined angiographically and in some cases confirmed at the time of emergency open heart surgery. The mechanism of coronary occlusion was arterial dissection in six cases, persisting coronary arterial spasm in seven, and coronary thrombosis in four. In three patients the mechanism could not be determined. Immediate reintroduction of a balloon dilatation catheter was attempted in 10 patients and resulted in restoration of adequate coronary flow in six. The remaining 14 patients underwent open heart surgery as an emergency procedure. Images PMID:3160376

  1. Technique of Coronary Transfer for TGA with Single Coronary Artery

    PubMed Central

    Kim, Tae Ho; Jung, Jae Jun; Kim, Yong Han; Yang, Ji-Hyuk; Jun, Tae-Gook

    2014-01-01

    An eight-day-old neonate was diagnosed with dextro-transposition of the great arteries, atrial septal defect, patent ductus arteriosus, and a single sinus origin of the coronary arteries. The single coronary artery originated from the left sinus (sinus 2), had a proximal left circumflex arterial branch, and passed anteriorly to the right side of the aorta, further branching into the right coronary and left anterior descending arteries. We successfully performed an arterial switch operation and coronary transfer by tube graft reconstruction with autologous aortic tissue to treat the dextro-transposition of the great arteries and atrial septal defect with a single-sinus origin of the coronary arteries. PMID:25551074

  2. Planets around Giant Stars: Results from the Lick Survey

    NASA Astrophysics Data System (ADS)

    Quirrenbach, Andreas; Reffert, Sabine; Trifonov, Trifon; Bergmann, Christoph; Schwab, Christian

    2015-12-01

    We present results from a radial-velocity survey of 373 giant stars at Lick Observatory, which started in 1999. We have detected planets around 15 of these stars; an additional 20 stars host planet candidates. Companions with up to 25 Jupiter masses are rather commonly found around stars with about 2 Solar masses. The frequency of detected planetary companions appears to increase with metallicity. No planets or planet candidates are found around stars with more than 2.7 Solar masses, although our sample contains 113 such stars. We conclude that the occurrence rate of giant planets as a function of Stellar mass peaks around 2 Solar masses. This has important consequences for our understanding of giant planet formation.The stars 91 Aqr and tau Gem have companions with orbits that are among those with the lowest eccentricities of all known exoplanets, perhaps due to tidal circularization during the RGB phase. If confirmed, this would be the first evidence of planetary orbits modified through stellar evolution.We have discovered several multiple systems in our sample. An extensive dynamical analysis of the eta Cet system indicates that it contains two massive planets in a 2:1 orbital resonance. The star nu Oph is orbited by two brown dwarf companions in a 6:1 resonance. It is likely that they arrived in this resonance through migration in a circumstellar disk, arguing strongly that objects with more than 20 Jupiter masses can be formed in disks around Herbig Ae stars.

  3. FLUORINE ABUNDANCES OF GALACTIC LOW-METALLICITY GIANTS

    SciTech Connect

    Li, H. N.; Zhao, G.; Ludwig, H.-G.; Caffau, E.; Christlieb, N. E-mail: gzhao@nao.cas.cn E-mail: ecaffau@lsw.uni-heidelberg.de

    2013-03-01

    With abundances and 2{sigma} upper limits of fluorine (F) in seven metal-poor field giants, nucleosynthesis of stellar F at low metallicity is discussed. The measurements are derived from the HF(1-0) R9 line at 23358 A using near-infrared K-band high-resolution spectra obtained with CRIRES at the Very Large Telescope. The sample reaches lower metallicities than previous studies on F of field giants, ranging from [Fe/H] = -1.56 down to -2.13. Effects of three-dimensional model atmospheres on the derived F and O abundances are quantitatively estimated and shown to be insignificant for the program stars. The observed F yield in the form of [F/O] is compared with two sets of Galactic chemical evolution models, which quantitatively demonstrate the contribution of Type II supernova (SN II) {nu}-process and asymptotic giant branch/Wolf-Rayet stars. It is found that at this low-metallicity region, models cannot well predict the observed distribution of [F/O], while the observations are better fit by models considering an SN II {nu}-process with a neutrino energy of E {sub {nu}} = 3 Multiplication-Sign 10{sup 53} erg. Our sample contains HD 110281, a retrograde orbiting low-{alpha} halo star, showing a similar F evolution as globular clusters. This supports the theory that such halo stars are possibly accreted from dwarf galaxy progenitors of globular clusters in the halo.

  4. Nonlinearity in giant depolarizing potentials

    NASA Astrophysics Data System (ADS)

    Nakatani, Hironori; Khalilov, Ilgam; Gong, Pulin; van Leeuwen, Cees

    2003-12-01

    Synchronous population discharges in immature neurons, or giant depolarizing potentials (GDPs), are considered to have an important role in the development of the functional network in hippocampus and other neural tissue before or briefly after birth. Recently, theoretical models have emphasized the possible role of chaotic, nonlinear activity at circuit level in establishing functional connectivity in neural tissue. Combining these two hypotheses leads to the prediction that GDPs have chaotic characteristics. We tested nonlinearity in GDPs recorded from transverse hippocampal slices of neonatal Wistar rats. Our results provide evidence of nonlinearity in GDP activity at circuit level.

  5. Analysis of giant electrorheological fluids.

    PubMed

    Seo, Youngwook P; Seo, Yongsok

    2013-07-15

    The yield stress dependence on electric field strength for giant electrorheological (GER) fluids over the full range of electric fields was examined using Seo's scaling function which incorporated both the polarization and the conductivity models. If a proper scaling was applied to the yield stress data to collapse them onto a single curve, the Seo's scaling function could correctly fit the yield stress behavior of GER suspensions, even at very high electric field strengths. The model predictions were also compared with recently proposed Choi et al.'s model to allow a consideration of the universal framework of ER fluids. Copyright © 2013 Elsevier Inc. All rights reserved.

  6. Giant epignathus. A case report.

    PubMed

    Todd, D W; Votava, H J; Telander, R L; Shoemaker, C T

    1991-07-01

    We report the successful treatment of a 2.8 kg female infant born with a giant epignathus, and we present our current prenatal and neonatal recommendations for managing this problem. We recommend that the delivery be done by cesarean section, that an adjacent operating room be ready for the baby, and that a neonatologist, anesthesiologist, and pediatric surgeon be standing by. The term epignathus now commonly applies to a teratoma protruding from a newborn's mouth. The survival of these otherwise normal children has been very low. We discuss the perinatal, neonatal, and operative care necessary to improve survival, as evidenced by the case presented.

  7. Evolution and history of Giant Sequoia

    Treesearch

    H. Thomas Harvey

    1986-01-01

    Ancient ancestors of the giant sequoia (Sequoiadendron giganteum [Lindl.] Buchholz) were widespread throughout much of the Northern Hemisphere during the late Mesozoic Period. Climatic conditions changed, forcing the more recent ancestors of present giant sequoia into the southwestern United States. The native range is now restricted to the west slope of the Sierra...

  8. Book Analysis: ’The Straw Giant’.

    DTIC Science & Technology

    1988-04-01

    and (3) book reviews of The Straw Giant. An examination of Hadley’s professional career shows he has had a fair amount of association with the...other book on arms control no doubt provided some expertise when he discussed ,.P . this subject in The Straw Giant. Though the book reviews were mixed

  9. Coronary haemodynamics in hypertensive heart disease.

    PubMed

    Vogt, M; Motz, W; Strauer, B E

    1992-09-01

    Cardiac constituents affected in arterial hypertension comprise the myocardium, interstitium and coronary circulation. With regard to coronary circulation, arterial hypertension is an important risk factor in coronary artery disease, but even in the absence of coronary artery disease, hypertensive patients frequently have angina pectoris or reveal electrocardiographic abnormalities suggestive of myocardial ischaemia due to coronary insufficiency. Under clinical conditions, determination of coronary flow reserve (dipyridamole; Argon-method) allows for the evaluation of impairment of coronary regulatory reserve. In comparison to healthy normotensives, coronary haemodynamics in hypertensive patients with microvascular angina are characterized by a severely increased minimal coronary resistance and reduced maximal coronary blood flow to dipyridamole. Accordingly, coronary reserve is markedly reduced by about 40%, and metabolic, myocardial and vascular factors may be involved in this reduction. In the compensated stage of arterial hypertension, with concentric left ventricular hypertrophy, myocardial factors, such as myocyte hypertrophy, extravascular compressing forces and functional implications of impaired relaxation, as well as metabolic factors, contribute to impairment in coronary reserve to a minor extent. The reduction in coronary flow reserve is not proportional to the elevation in left ventricular muscle mass and thus the degree of left ventricular hypertrophy does not seem to determine the reduction in vasodilator reserve directly. Thus the reduction in coronary reserve seems to be primarily the consequence of an impaired vasodilating capacity of the coronary resistance vessels, as indicated by a severely increased minimum coronary resistance to dipyridamole, i.e. a severely reduced overall coronary conductance capacity.(ABSTRACT TRUNCATED AT 250 WORDS)

  10. Ultrastructural and Functional Properties of a Giant Synapse Driving the Piriform Cortex to Mediodorsal Thalamus Projection

    PubMed Central

    Pelzer, Patric; Horstmann, Heinz; Kuner, Thomas

    2017-01-01

    Neocortico-thalamo-cortical loops represent a common, yet poorly understood, circuit employing giant synapses also referred to as “class I”, giant, or driver synapses. Here, we characterize a giant synapse formed by projection neurons of the paleocortical piriform cortex (PIR) onto neurons of the mediodorsal thalamus (MD). Three-dimensional (3D) ultrastructure of labeled PIR-MD terminals, obtained by using serial-section scanning electron microscopy (EM) combined with photooxidation-based detection of labeled terminals, revealed a large terminal engulfing multiple postsynaptic dendritic excrescences. The terminal contained multiple synaptic contacts, a high density of synaptic vesicles and several central mitochondria. Using targeted stimulations of single identified PIR-MD terminals in combination with patch-clamp recordings from the connected MD neuron, we found large postsynaptic currents with fast kinetics and strong short-term depression, yet fast recovery upon repetitive stimulation. We conclude that the phylogenetically old paleocortex already developed giant synaptic connections exhibiting similar functional properties as connections formed by giant neocortico-thalamic projections. PMID:28197093

  11. Coronary Arteriovenous Fistulae: A Review

    PubMed Central

    Challoumas, Dimitris; Pericleous, Agamemnon; Dimitrakaki, Inetzi A.; Danelatos, Christos; Dimitrakakis, Georgios

    2014-01-01

    Coronary arteriovenous fistulae are a coronary anomaly, presenting in 0.002% of the general population. Their etiology can be congenital or acquired. We present a review of recent literature related to their epidemiology, etiology, pathophysiology, clinical presentation, diagnostic approach, and therapeutic management. PMID:24940026

  12. The Coronary Patient in Industry

    NASA Technical Reports Server (NTRS)

    Schuster, B.

    1971-01-01

    The coronary patient, as he pertains to industry particularly NASA, is discussed. Concepts of precoronary care, acute attacks which may develop while on the job, and the return of the cardiac patient to work are covered. Major emphasis was on the prevention of sudden death due to coronary disease.

  13. The Coronary Patient in Industry

    NASA Technical Reports Server (NTRS)

    Schuster, B.

    1971-01-01

    The coronary patient, as he pertains to industry particularly NASA, is discussed. Concepts of precoronary care, acute attacks which may develop while on the job, and the return of the cardiac patient to work are covered. Major emphasis was on the prevention of sudden death due to coronary disease.

  14. Giant Steps in Cefalù

    NASA Astrophysics Data System (ADS)

    Jeffery, David J.; Mazzali, Paolo A.

    2007-08-01

    Giant steps is a technique to accelerate Monte Carlo radiative transfer in optically-thick cells (which are isotropic and homogeneous in matter properties and into which astrophysical atmospheres are divided) by greatly reducing the number of Monte Carlo steps needed to propagate photon packets through such cells. In an optically-thick cell, packets starting from any point (which can be regarded a point source) well away from the cell wall act essentially as packets diffusing from the point source in an infinite, isotropic, homogeneous atmosphere. One can replace many ordinary Monte Carlo steps that a packet diffusing from the point source takes by a randomly directed giant step whose length is slightly less than the distance to the nearest cell wall point from the point source. The giant step is assigned a time duration equal to the time for the RMS radius for a burst of packets diffusing from the point source to have reached the giant step length. We call assigning giant-step time durations this way RMS-radius (RMSR) synchronization. Propagating packets by series of giant steps in giant-steps random walks in the interiors of optically-thick cells constitutes the technique of giant steps. Giant steps effectively replaces the exact diffusion treatment of ordinary Monte Carlo radiative transfer in optically-thick cells by an approximate diffusion treatment. In this paper, we describe the basic idea of giant steps and report demonstration giant-steps flux calculations for the grey atmosphere. Speed-up factors of order 100 are obtained relative to ordinary Monte Carlo radiative transfer. In practical applications, speed-up factors of order ten and perhaps more are possible. The speed-up factor is likely to be significantly application-dependent and there is a trade-off between speed-up and accuracy. This paper and past work suggest that giant-steps error can probably be kept to a few percent by using sufficiently large boundary-layer optical depths while still

  15. Sodium in weak G-band giants

    NASA Technical Reports Server (NTRS)

    Drake, Jeremy J.; Lambert, David L.

    1994-01-01

    Sodium abundances have been determined for eight weak G-band giants whose atmospheres are greatly enriched with products of the CN-cycling H-burning reactions. Systematic errors are minimized by comparing the weak G-band giants to a sample of similar but normal giants. If, further, Ca is selected as a reference element, model atmosphere-related errors should largely be removed. For the weak-G-band stars (Na/Ca) = 0.16 +/- 0.01, which is just possibly greater than the result (Na/Ca) = 0.10 /- 0.03 from the normal giants. This result demonstrates that the atmospheres of the weak G-band giants are not seriously contaminated with products of ON cycling.

  16. Spontaneous coronary artery dissection: Still a lot to learn.

    PubMed

    Neves, David; Bento, Ângela; Fernandes, Renato; Patrício, Lino; Aguiar, José

    2017-01-01

    Non-atherosclerotic spontaneous coronary artery dissection (SCAD) is an uncommon but probably underdetected pathological substrate for acute coronary syndrome. Clinical associations have been noted, like female gender and young age, but its pathophysiology is not yet fully understood. In this report we describe the case of a 50-year-old woman, without cardiovascular risk factors presenting with non-ST segment elevation myocardial infarction, in whom SCAD was diagnosed. Treatment was initially conservative but due to aggravation of the dissection she eventually underwent a complex percutaneous coronary intervention, requiring implantation of multiple stents, but with a good clinical outcome. The procedure was guided by optical coherence tomography (OCT). Carefully analyzing the combined pictures of OCT and angiography, the dissection appeared to be filled with a clear fluid, but not contrast. Copyright © 2016 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

  17. Alcohol and coronary spasm.

    PubMed

    Oda, H; Suzuki, M; Oniki, T; Kishi, Y; Numano, F

    1994-03-01

    Alcohol is known to sometimes cause coronary spasm, the mechanism of which is still unknown. The authors monitored changes in plasma levels of prostanoids (thromboxane [TX B2], 6-keto prostaglandin F1 alpha [PGF1 alpha]), catecholamines (CA), serotonin (5-HT), cyclic nucleotides (cyclic adenosine monophosphate--cAMP, cyclic guanosine monophosphate--cGMP), and platelet aggregation after alcohol ingestion (Japanese rice wine 400 mL) in 8 patients with alcohol-induced variant angina and 8 healthy men as controls. Coronary spasm was confirmed to have been induced in 4 patients nine hours after alcohol challenge (VA[+]), when their plasma ethanol levels had already returned to a null level. Neither CA nor 5-HT levels showed any change after alcohol ingestion either in patients or controls, though controls showed high levels of CA during alcohol ingestion. TX B2 in VA(+) patients increased gradually after alcohol ingestion to reach up to a statistically significantly high level just before attack, as compared with those of controls and VA(-) patients, who, on the contrary, did not show such changes. The levels of 6-keto PGF1 alpha, however, which were significantly lower in patients than in controls before the test, exhibited a gradual increase in VA(+) patients in parallel with the increase in TX B2. No significant changes in cAMP levels between either controls or patients were present. On the contrary, cGMP levels had a gradual decrease in patients after alcohol ingestion. Especially six hours after alcohol ingestion, cGMP levels in VA(+) patients decreased so much as to make a statistically significant difference, as compared with the level in controls. Platelet aggregability in controls showed a decrease after alcohol ingestion, in spite of no change or even increase in patients. These data suggest that low levels of PGF1 alpha and the decrease of cGMP levels from alcohol ingestion play important roles in the mechanism of coronary spasm induced by alcohol ingestion.

  18. Giant melanocytic nevi with neurocutaneous melanosis masquerading as neurofibromas

    PubMed Central

    Gowda, Vykuntaraju K.; Basude, Anita; Srinivas, Sahana M.; Bhat, Maya

    2016-01-01

    Neurocutaneous melanosis is congenital melanocytic nevus with neurological manifestations. We report a 4-year-old female child presenting with hyperpigmented and nodular skin lesion associated with developmental delay and convulsions. The child had multiple brownish-black nevi on the face and chest and giant melanocytic nevi on thoraco-abdomen, back, and gluteal region. Computed tomography scan of the brain showed calcification in the pons, right cerebellar hemisphere, and left medial temporal lobe. Skin biopsy done from nodular hyperpigmented site was suggestive of melanocytic nevi. Electroencephalogram showed multifocal epileptiform discharges. PMID:27857802

  19. Looking Up to the Giant

    NASA Image and Video Library

    2015-08-03

    Thanks to the illumination angle, Mimas (right) and Dione (left) appear to be staring up at a giant Saturn looming in the background. Although certainly large enough to be noticeable, moons like Mimas (246 miles or 396 kilometers across) and Dione (698 miles or 1123 kilometers across) are tiny compared to Saturn (75,400 miles or 120,700 kilometers across). Even the enormous moon Titan (3,200 miles or 5,150 kilometers across) is dwarfed by the giant planet. This view looks toward the unilluminated side of the rings from about one degree of the ring plane. The image was taken with the Cassini spacecraft wide-angle camera on May 27, 2015 using a spectral filter which preferentially admits wavelengths of near-infrared light centered at 728 nanometers. The view was obtained at a distance of approximately 634,000 miles (one million kilometers) from Saturn and at a Sun-Saturn-spacecraft, or phase, angle of 85 degrees. Image scale is 38 miles (61 kilometers) per pixel. http://photojournal.jpl.nasa.gov/catalog/PIA18331

  20. Giant Planets in Open Clusters

    NASA Astrophysics Data System (ADS)

    Quinn, S. N.; White, R. J.; Latham, D. W.

    2015-10-01

    Two decades after the discovery of 51 Peg b, more than 200 hot Jupiters have now been confirmed, but the details of their inward migration remain uncertain. While it is widely accepted that short period giant planets could not have formed in situ, several different mechanisms (e.g., Type II migration, planet-planet scattering, Kozai-Lidov cycles) may contribute to shrinking planetary orbits, and the relative importance of each is not well-constrained. Migration through the gas disk is expected to preserve circular, coplanar orbits and must occur quickly (within ˜ 10 Myr), whereas multi-body processes should initially excite eccentricities and inclinations and may take hundreds of millions of years. Subsequent evolution of the system (e.g., orbital circularization and inclination damping via tidal interaction with the host star) may obscure these differences, so observing hot Jupiters soon after migration occurs can constrain the importance of each mechanism. Fortunately, the well-characterized stars in young and adolescent open clusters (with known ages and compositions) provide natural laboratories for such studies, and recent surveys have begun to take advantage of this opportunity. We present a review of the discoveries in this emerging realm of exoplanet science, discuss the constraints they provide for giant planet formation and migration, and reflect on the future direction of the field.

  1. Clump Giants in the Hyades

    NASA Technical Reports Server (NTRS)

    Brickhouse, N.

    2001-01-01

    This report covers the NASA grant NAG5-9986 for the cycle 1 XMM Guest Observer Program. The project is entitled "Clump Giants in the Hyades." This observation of one of the late-type Hyades giants has implications for understanding the formation of late-type stellar coronae as a function of the evolutionary state of the star. As of the call for this report, the data had been obtained by the satellite, but not delivered to the PI until 2001 August 7. Thus the progress can only be described as preparation for the data to arrive. To this end the PI and Co-Is are working on spectral analysis tools for the X-ray band. The PI has attended two workshops this summer in which results on late-type stellar coronae were presented, including XMM results from GTO team members, one entitled "Stellar Coronae in the Era of Chandra and XMM-Newton" at ESTEC in Noordwijk, and the "Cool Stars Workshop" in Boulder, Colorado.

  2. Sudden cardiac death due to coronary artery dissection as a complication of cardiac sarcoidosis.

    PubMed

    Kanaroglou, Savas; Nair, Vidhya; Fernandes, John R

    2015-01-01

    Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome (ACS), cardiac tamponade and sudden cardiac death that typically affects young women in the postpartum period. Rarely, it can be caused by systemic inflammatory conditions such as sarcoidosis. Sarcoidosis is an inflammatory disease most often affecting the lung and lymph nodes that can sometimes affect the heart. The authors report a case of sudden cardiac death caused by SCAD in the context of undiagnosed and subclinical cardiac sarcoidosis. The decedent was a 47-year-old male with a relatively innocuous past medical history. He was found dead in bed. At autopsy, there was a lethal hemopericardium resulting in cardiac tamponade. Gross examination of the heart revealed dissection of the posterior descending coronary branch of the right coronary artery. Histologically, the coronary artery showed acute and organizing dissection with evidence of vasculitis. A chronic inflammatory infiltrate consisting of lymphocytes, histiocytes, eosinophils and giant cells was seen. Sections of the myocardium showed myocarditis with a nonnecrotizing granuloma. The death was attributed to cardiac tamponade secondary to SCAD in the context of systemic sarcoidosis. The presented case demonstrates two concurrent rare pathologies and highlights the importance of considering SCAD in cases of sudden cardiac death at autopsy. Copyright © 2015 Elsevier Inc. All rights reserved.

  3. The clinical utility of bivalirudin in patients with coronary artery disease.

    PubMed

    Garner, William L; Linden, Julie A; Chrysant, George S

    2013-03-01

    Bivalirudin, a direct thrombin inhibitor, is an anticoagulant commonly used in invasive cardiology procedures. It has evolved from relative obscurity, as an anticoagulation option only utilized in rare instances of allergy or resistance to heparin products, to the now preferred antithrombotic anticoagulant in the cardiac catheterization laboratory. On the way to displacing unfractionated heparin as the preferred anticoagulant for percutaneous coronary intervention, multiple studies comparing bivalirudin with heparin have consistently shown equivalent ischemic efficacy endpoints (i.e. cardiovascular death, myocardial infarction, etc.), with significant reductions in bleeding. Bleeding has been directly linked to worse hospital outcomes in cardiac patient's undergoing invasive coronary artery revascularization procedures. More recent bivalirudin studies now demonstrate reductions in mortality, which has led to a paradigm shift to bivalirudin as the anticoagulant choice both in elective and emergent coronary procedures. We present the major studies that have brought bivalirudin to the forefront of coronary artery disease, specifically coronary interventional procedures.

  4. Does working while ill trigger serious coronary events? The Whitehall II study.

    PubMed

    Westerlund, Hugo; Kivimaki, Mika; Ferrie, Jane E; Marmot, Michael; Shipley, Martin J; Vahtera, Jussi; Head, Jenny

    2009-09-01

    Working while ill has been found to predict coronary heart disease. We tested if this association was due to triggering. We used a nested case-control study in an occupational cohort to examine sickness absences during a 2-year period immediately before the first coronary event for 133 cases and 928 matched controls without a history of coronary events. Working while ill was defined as no absence despite being unhealthy (suboptimal self-rated health or psychological distress). The odds of a coronary event were not higher for cases who worked while ill than for correspondingly unhealthy controls who took >0 to 14 days of absence per year (OR = 0.62; 95% CI = 0.28 to 1.38). These results were little affected by multiple adjustments. We found no evidence that working while ill acts as a short-term trigger for coronary events.

  5. Detection of high risk coronary artery disease by thallium imaging.

    PubMed Central

    O'Hara, M J; Lahiri, A; Whittington, J R; Crawley, J C; Raftery, E B

    1985-01-01

    One hundred and three patients who underwent coronary arteriography were studied by thallium imaging and the results analysed by Bayesian principles to assess the usefulness of semiquantitative stress thallium imaging for predicting the presence or absence of multivessel coronary disease. Significant disease was found in 80 patients, of whom 77 had abnormal thallium scans (sensitivity 96%). Thallium images were normal in 15 of 23 patients with no significant disease (specificity 65%). Multiple thallium segmental defects were found to be 90% sensitive and 65% specific for multivessel coronary artery disease and were present in 80% of patients with left main stem disease and in 93% of patients with triple vessel disease. A single thallium defect or normal scan excluded multivessel, left main, and triple vessel disease with 81%, 94%, and 91% predictive accuracy respectively. By Bayesian analysis the predictive accuracy for excluding multivessel disease was greater than 90% in patients with a pretest probability of multivessel disease of less than or equal to 40%. Coronary arteriography to exclude multivessel disease is therefore unnecessary in a high proportion of patients with known or suspected coronary artery disease. PMID:4005084

  6. Separating gas-giant and ice-giant planets by halting pebble accretion

    NASA Astrophysics Data System (ADS)

    Lambrechts, M.; Johansen, A.; Morbidelli, A.

    2014-12-01

    In the solar system giant planets come in two flavours: gas giants (Jupiter and Saturn) with massive gas envelopes, and ice giants (Uranus and Neptune) with much thinner envelopes around their cores. It is poorly understood how these two classes of planets formed. High solid accretion rates, necessary to form the cores of giant planets within the life-time of protoplanetary discs, heat the envelope and prevent rapid gas contraction onto the core, unless accretion is halted. We find that, in fact, accretion of pebbles (~cm sized particles) is self-limiting: when a core becomes massive enough it carves a gap in the pebble disc. This halt in pebble accretion subsequently triggers the rapid collapse of the super-critical gas envelope. Unlike gas giants, ice giants do not reach this threshold mass and can only bind low-mass envelopes that are highly enriched by water vapour from sublimated icy pebbles. This offers an explanation for the compositional difference between gas giants and ice giants in the solar system. Furthermore, unlike planetesimal-driven accretion scenarios, our model allows core formation and envelope attraction within disc life-times, provided that solids in protoplanetary discs are predominantly made up of pebbles. Our results imply that the outer regions of planetary systems, where the mass required to halt pebble accretion is large, are dominated by ice giants and that gas-giant exoplanets in wide orbits are enriched by more than 50 Earth masses of solids.

  7. Cannabinoids and atherosclerotic coronary heart disease.

    PubMed

    Singla, Sandeep; Sachdeva, Rajesh; Mehta, Jawahar L

    2012-06-01

    Marijuana is the most abused recreational drug in the United States. Cannabinoids, the active ingredients of marijuana, affect multiple organ systems in the human body. The pharmacologic effects of marijuana, based on stimulation of cannabinoid receptors CB1 and CB2, which are widely distributed in the cardiovascular system, have been well described. Activation of these receptors modulates the function of various cellular elements of the vessel wall, and may contribute to the pathogenesis of atherosclerosis. Clinically, there are reports linking marijuana smoking to the precipitation of angina and acute coronary syndromes. Recently, large published clinical trials with CB1 antagonist rimonabant did not show any significant benefit of this agent in preventing progression of atherosclerosis. In light of these findings and emerging data on multiple pathways linking cannabinoids to atherosclerosis, we discuss the literature on the role of cannabinoids in the pathophysiology of atherosclerosis. We also propose a marijuana paradox, which implies that inhalation of marijuana may be linked to precipitation of acute coronary syndromes, but modulation of the endocannabinoid system by a noninhalation route may have a salutary effect on the development of atherosclerosis. © 2012 Wiley Periodicals, Inc.

  8. Scintigraphic anatomy of coronary artery disease in digital thallium-201 myocardial images.

    PubMed Central

    Wainwright, R J

    1981-01-01

    One hundred and eight patients with single and multiple vessel coronary artery disease confirmed by arteriography were evaluated by exercise thallium-201 (201Tl) myocardial scintigraphy to determine the scintigraphic appearances of specific coronary stenoses. In general proximal stenoses caused more widespread, but not necessarily more severe, myocardial tracer deficit than distal stenoses. In particular, proximal dominant right coronary artery disease was specifically associated with extensive inferior wall tracer deficit in the anterior scintigram, whereas proximal left circumflex disease caused similar tracer depletion best visualised in the left lateral scintigram. A triad of uptake defects was caused by left anterior descending coronary artery disease: viz. apical tracer deficit (anterior view) in 71% lesions, septal tracer deficit (left anterior oblique view) in 83% of lesions, and anterolateral wall tracer deficit (left lateral projection) in 72% of lesions. The last defect has been termed a 'diagonal window' because it was associated with independent disease of the main diagonal branch of the left anterior descending coronary artery or with disease in the main left anterior descending artery situated proximal to this branch. Diagonal window tracer deficit was the most useful scintigraphic sign distinguishing proximal from distal disease in the left anterior descending coronary artery. False negative scintigraphic defects occurred more commonly in patients with triple vessel disease and in association with well-developed coronary collateral vessels. Certain scintigraphic patterns of 201Tl myocardial accumulation appear invaluable in the noninvasive localisation of stenoses within specific coronary arteries and thus may be useful in predicting life-threatening coronary artery disease which should be confirmed by definite coronary arteriography. The digital 201Tl myocardial scintigram also provides an independent functional guide to the interpretation of

  9. Coronary collateral circulation in patients of coronary ectasia with significant coronary artery disease.

    PubMed

    Hsu, Po-Chao; Su, Ho-Ming; Lee, Hsiang-Chun; Juo, Suh-Hang; Lin, Tsung-Hsien; Voon, Wen-Chol; Lai, Wen-Ter; Sheu, Sheng-Hsiung

    2014-01-01

    Patients with coronary ectasia (CE) usually have coexisting coronary stenosis resulting in myoischemia. Coronary collateral plays an important role in protecting myocardium from ischemia and reducing cardiovascular events. However, limited studies investigate the role of CE in coronary collaterals development. We evaluated 1020 consecutive patients undergoing coronary angiography and 552 patients with significant coronary artery disease (SCAD), defined as diameter stenosis more than 70%, were finally analyzed. CE is defined as the ectatic diameter 1.5 times larger than adjacent reference segment. Rentrop collateral score was used to classify patients into poor (grades 0 and 1) or good (grades 2 and 3) collateral group. 73 patients (13.2%) had CE lesions which were most located in the right coronary artery (53.4%). Patients with CE had a lower incidence of diabetes (43.8% vs 30.1%, p = 0.03), higher body mass index (25.4±3.5 vs 26.7±4.6, p = 0.027) and poorer coronary collateral (58.2% vs 71.2%, p = 0.040). Patients with poor collateral (n = 331) had a higher incidence of CE (15.7% vs 9.5%, p = 0.040) and fewer diseased vessels numbers (1.96±0.84 vs 2.48±0.69, p<0.001). Multivariate analysis showed diabetes (odd ratio (OR) 0.630, p = 0.026), CE (OR = 0.544, p = 0.048), and number of diseased vessels (OR = 2.488, p<0.001) were significant predictors of coronary collaterals development. The presence of CE was associated with poorer coronary collateral development in patients with SCAD.

  10. Coronary Collateral Circulation in Patients of Coronary Ectasia with Significant Coronary Artery Disease

    PubMed Central

    Hsu, Po-Chao; Su, Ho-Ming; Lee, Hsiang-Chun; Juo, Suh-Hang; Lin, Tsung-Hsien; Voon, Wen-Chol; Lai, Wen-Ter; Sheu, Sheng-Hsiung

    2014-01-01

    Objectives Patients with coronary ectasia (CE) usually have coexisting coronary stenosis resulting in myoischemia. Coronary collateral plays an important role in protecting myocardium from ischemia and reducing cardiovascular events. However, limited studies investigate the role of CE in coronary collaterals development. Methods We evaluated 1020 consecutive patients undergoing coronary angiography and 552 patients with significant coronary artery disease (SCAD), defined as diameter stenosis more than 70%, were finally analyzed. CE is defined as the ectatic diameter 1.5 times larger than adjacent reference segment. Rentrop collateral score was used to classify patients into poor (grades 0 and 1) or good (grades 2 and 3) collateral group. Results 73 patients (13.2%) had CE lesions which were most located in the right coronary artery (53.4%). Patients with CE had a lower incidence of diabetes (43.8% vs 30.1%, p = 0.03), higher body mass index (25.4±3.5 vs 26.7±4.6, p = 0.027) and poorer coronary collateral (58.2% vs 71.2%, p = 0.040). Patients with poor collateral (n = 331) had a higher incidence of CE (15.7% vs 9.5%, p = 0.040) and fewer diseased vessels numbers (1.96±0.84 vs 2.48±0.69, p<0.001). Multivariate analysis showed diabetes (odd ratio (OR) 0.630, p = 0.026), CE (OR = 0.544, p = 0.048), and number of diseased vessels (OR = 2.488, p<0.001) were significant predictors of coronary collaterals development. Conclusion The presence of CE was associated with poorer coronary collateral development in patients with SCAD. PMID:24475209

  11. Arteriosclerotic coronary arterial aneurysms in a 49-year-old man with crescendo angina: family history, natural course and prevalence.

    PubMed

    Schneider, K W; Jesse, R; Deeg, P

    1977-01-01

    In a 49-year-old man with crescendo angina, elevated serum cholesterol level and an old posterior myocardial infarction, selective coronary arteriography showed multiple arteriosclerotic aneurysms of the right coronary artery associated with extensive and severe arteriosclerotic disease of the left coronary artery. The patient's mother and brother have both died of a myocardial infarction. Another brother suffers from angina and has documented arteriosclerotic coronary artery disease. Two sisters suffer from angina as well. The possibility of embolization of distal vessels from a friable clot of the aneurysms as a cause of the patient's infarction is discussed. To the best of our knowledge, this is the tenth patient with nonfistulous arteriosclerotic coronary artery aneurysm diagnosed and documented angiographically ante mortem. Including the present case and reviewing the literature, the prevalence of this condition among nonfistulous coronary aneurysms diagnosed ante mortem is 35 per cent and henceforth cannot be regarded as an incidental autopsy finding in cardiac asymptomatic patients.

  12. Giant mini-clusters as possible origin of halo phenomena observed in super-families

    NASA Technical Reports Server (NTRS)

    1985-01-01

    Among 91 mini-clusters from 30 high energy Chiron-type families in Chacaltaya emulsion chambers, there were observed several extremely large multiplicity clusters in the highest energy range, far beyond the average of ordinary type clusters. Some details of microscopic observation of those giant mini-clusters in nuclear emulsion plates and some phenomenological regularity found in common among them are described. Such giant mini-clusters are possible candidates for the origin of narrow symmetric single halo phenomena in X-ray films which are frequently observed in super-families of visible energy greater than 1,000 TeV.

  13. Sex, season, and time of day interact to affect body temperatures of the Giant Gartersnake

    USGS Publications Warehouse

    Wylie, G.D.; Casazza, M.L.; Halstead, B.J.; Gregory, C.J.

    2009-01-01

    1.We examined multiple hypotheses regarding differences in body temperatures of the Giant Gartersnake using temperature-sensitive radio telemetry and an information-theoretic analytical approach.2.Giant Gartersnakes selected body temperatures near 30 ??C, and males and females had similar body temperatures most of the year, except during the midsummer gestation period.3.Seasonal differences in the body temperatures of males and females may relate to both the costs associated with thermoregulatory behavior, such as predation, and the benefits associated with maintaining optimal body temperatures, such as successful incubation.

  14. Complimentary use of epicardial echo imaging and Doppler in quantification of coronary artery stenoses

    NASA Astrophysics Data System (ADS)

    Richards, Kent L.; Cannon, Scott R.

    1990-08-01

    As more advanced therapeutic procedures are performed on coronary arteries during open chest surgery more advanced diagnostic procedures will be required to define the location and severity of coronary artery disease. This manuscript describes our preliminary experiences in identifying human coronary artery stenoses using epicardial two-dimensional color flow Doppler. Once the lesions were identified we used standard echo Doppler and imaging techniques to define their severity. The accuracy of stenotic cross sectional area calculated using the continuity equation and pressure gradient calculated using the Bernoulli equation were defined using a pulsatile flow model of the coronary circulation. Suggestions about further hardware development required to allow easy clinical application of this technique are described. 1 - CLINICAL NEED FOR INTRA-OPERATIVE EVAUJATION OFCORONARY ARTERIES The severity of coronary artery disease in adults who require coronary bypass surgery has changed significantly in the last ten years. More effective medications used to control angina pectoris and the wide use of percutaneous y artery angioplasty have delayed the timing of surgery until atherosclerotic involvement is more extensive. In addition patients who have had initial coronary bypass operations are now reaching ages at which atherosclerotic involvement of their bypass grafts and native vessels has progressed and reoperation is required. To meet the challenge of coronary arteries with multiple lesions or diffuse disease intraoperative angioplasty devices are being developed. Whether bypass surgery for advanced lesions or reoperation of

  15. The sinus venosus contributes to coronary vasculature through VEGFC-stimulated angiogenesis

    PubMed Central

    Chen, Heidi I.; Sharma, Bikram; Akerberg, Brynn N.; Numi, Harri J.; Kivelä, Riikka; Saharinen, Pipsa; Aghajanian, Haig; McKay, Andrew S.; Bogard, Patrick E.; Chang, Andrew H.; Jacobs, Andrew H.; Epstein, Jonathan A.; Stankunas, Kryn; Alitalo, Kari; Red-Horse, Kristy

    2014-01-01

    Identifying coronary artery progenitors and their developmental pathways could inspire novel regenerative treatments for heart disease. Multiple sources of coronary vessels have been proposed, including the sinus venosus (SV), endocardium and proepicardium, but their relative contributions to the coronary circulation and the molecular mechanisms regulating their development are poorly understood. We created an ApjCreER mouse line as a lineage-tracing tool to map SV-derived vessels onto the heart and compared the resulting lineage pattern with endocardial and proepicardial contributions to the coronary circulation. The data showed a striking compartmentalization to coronary development. ApjCreER-traced vessels contributed to a large number of arteries, capillaries and veins on the dorsal and lateral sides of the heart. By contrast, untraced vessels predominated in the midline of the ventral aspect and ventricular septum, which are vessel populations primarily derived from the endocardium. The proepicardium gave rise to a smaller fraction of vessels spaced relatively uniformly throughout the ventricular walls. Dorsal (SV-derived) and ventral (endocardial-derived) coronary vessels developed in response to different growth signals. The absence of VEGFC, which is expressed in the epicardium, dramatically inhibited dorsal and lateral coronary growth but left vessels on the ventral side unaffected. We propose that complementary SV-derived and endocardial-derived migratory routes unite to form the coronary vasculature and that the former requires VEGFC, revealing its role as a tissue-specific mediator of blood endothelial development. PMID:25377552

  16. Multiple daily doses of acetyl-salicylic acid (ASA) overcome reduced platelet response to once-daily ASA after coronary artery bypass graft surgery: a pilot randomized controlled trial.

    PubMed

    Paikin, J S; Hirsh, J; Ginsberg, J S; Weitz, J I; Chan, N C; Whitlock, R P; Pare, G; Johnston, M; Eikelboom, J W

    2015-03-01

    The efficacy of ASA for prevention of graft failure following CABG surgery may be limited by incomplete platelet inhibition due to increased post-operative platelet turnover. To determine whether acetyl-salicylic acid (ASA) 325 mg once-daily or 81 mg four-times daily overcomes the impaired response to ASA 81 mg once-daily in post-operative coronary artery bypass graft (CABG) patients. We randomized 110 patients undergoing CABG surgery to either ASA 81 mg once-daily, 81 mg four times daily or 325 mg once-daily and compared their effects on serum thromboxane B2 (TXB2 ) suppression and arachidonate-induced platelet aggregation. One hundred patients were included in the final analysis. Platelet counts fell after surgery, reached a nadir on day 2, and then gradually increased. Although there was near complete suppression of TXB2 on the second or third post-operative day, TXB2 levels increased in parallel with the rise in platelet count on subsequent days. This increase was most marked in patients receiving ASA 81 mg once-daily and less evident in those receiving ASA four times daily. On post-operative day 4, (i) median TXB2 levels were lower with four times daily ASA than with either ASA 81 mg once-daily (1.1 ng/mL; Quartile(Q) Q1,Q3: 0.5, 2.4 and 13.3 ng/mL; Q1,Q3: 7.8, 30.8 ng/mL, respectively; P < 0.0001) or ASA 325 mg once-daily (3.4 ng/mL; Q1,Q3: 2.0, 8.2 ng/mL; P = 0.002), and (ii) ASA given four times daily was more effective than ASA 81 mg once-daily and 325 mg once-daily at suppressing platelet aggregation. Four times daily ASA is more effective than ASA 81 and 325 mg once-daily at suppressing serum TXB2 formation and platelet aggregation immediately following CABG surgery. © 2014 International Society on Thrombosis and Haemostasis.

  17. Giant sialocele following facial trauma.

    PubMed

    Medeiros Júnior, Rui; Rocha Neto, Alípio Miguel da; Queiroz, Isaac Vieira; Cauby, Antônio de Figueiredo; Gueiros, Luiz Alcino Monteiro; Leão, Jair Carneiro

    2012-01-01

    Injuries in the parotid and masseter region can cause serious impairment secondary to damage of important anatomical structures. Sialocele is observed as facial swelling associated with parotid duct rupture due to trauma. The aim of this paper is to report a case of a giant traumatic sialocele in the parotid gland, secondary to a knife lesion in a 40-year-old woman. Conservative measures could not promote clinical resolution and a surgical intervention for the placement of a vacuum drain was selected. Under local anesthesia, a small incision was performed adjacent to parotid duct papilla, followed by muscular divulsion and draining of significant amount of saliva. An active vacuum suction drain was placed for 15 days, aiming to form a new salivary duct. This technique was shown to be a safe, effective and low-cost option, leading to complete resolution and no recurrence after 28 months of follow up.

  18. Terrestrial versus giant planet formation

    NASA Technical Reports Server (NTRS)

    Boss, Alan P.

    1988-01-01

    Given a solar nebular surrounding the early protosun, containing dust grains that have already undergone growth through collisions to about centimeter-size, the question of the formation of the terrestrial and giant planets is considered. In contrast to the usual approach of emphasizing how well a problem is understood, the uncertainties and areas where more work needs to be done will be accentuated. Also, the emphasis will be on the dynamics of planetary formation, because profound problems still exist in this area, and because it seems most logical to concentrate first on the dynamical questions involved with assembling the planets before putting too much effort into the detailed chemical and geological consequences of certain formation mechanisms.

  19. Core formation by giant impacts

    NASA Technical Reports Server (NTRS)

    Tonks, W. B.; Melosh, H. J.

    1991-01-01

    Ideas about the accretion and early evolution of the Earth and the other terrestrial planets have recently undergone a number of revolutionary changes. It has become clear that giant impacts were far from rare events. In the later stages of accretion any given planetary embryo is liable to be struck several times by other bodies of up to half its own diameter. Such an impact may have the ability to trigger core formation. Traditional accretion models have had great difficulty explaining the formation of the core. If one admits the importance of infrequent large events that may melt an entire hemisphere, the core formation difficulty vanishes. Millimeter-size iron blebs in the melted region will rain out due to their density difference with the silicate melt. Core formation may not require the melting of the entire hemisphere of the planet. The conditions are explored under which impact induced core formation may occur.

  20. Giant tunneling magnetoresistance in silicene

    SciTech Connect

    Wang, Yu; Lou, Yiyi

    2013-11-14

    We have theoretically studied ballistic electron transport in silicene under the manipulation of a pair of ferromagnetic gate. Transport properties like transmission and conductance have been calculated by the standard transfer matrix method for parallel and antiparallel magnetization configurations. It is demonstrated here that, due to the stray field-induced wave-vector filtering effect, remarkable difference in configuration-dependent transport gives rise to a giant tunneling magnetoresistance. In combination with the peculiar buckled structure of silicene and its electric tunable energy gap, the receiving magnetoresistance can be efficiently modulated by the externally-tunable stray field, electrostatic potential, and staggered sublattice potential, providing some flexible strategies to construct silicene-based nanoelectronic device.

  1. HIDE AND SEEK BETWEEN ANDROMEDA'S HALO, DISK, AND GIANT STREAM

    SciTech Connect

    Clementini, Gisella; Contreras Ramos, Rodrigo; Federici, Luciana; Macario, Giulia; Tosi, Monica; Bellazzini, Michele; Fusi Pecci, Flavio; Diolaiti, Emiliano; Cacciari, Carla; Beccari, Giacomo; Testa, Vincenzo; Giallongo, Emanuele; Di Paola, Andrea; Gallozzi, Stefano; Cignoni, Michele; Marano, Bruno; Marconi, Marcella; Ripepi, Vincenzo; Ragazzoni, Roberto; Smareglia, Riccardo

    2011-12-10

    Photometry in B, V (down to V {approx} 26 mag) is presented for two 23' Multiplication-Sign 23' fields of the Andromeda galaxy (M31) that were observed with the blue channel camera of the Large Binocular Telescope during the Science Demonstration Time. Each field covers an area of about 5.1 Multiplication-Sign 5.1 kpc{sup 2} at the distance of M31 ({mu}{sub M31} {approx} 24.4 mag), sampling, respectively, a northeast region close to the M31 giant stream (field S2) and an eastern portion of the halo in the direction of the galaxy minor axis (field H1). The stream field spans a region that includes Andromeda's disk and giant stream, and this is reflected in the complexity of the color-magnitude diagram of the field. One corner of the halo field also includes a portion of the giant stream. Even though these demonstration time data were obtained under non-optimal observing conditions, the B photometry, which was acquired in time-series mode, allowed us to identify 274 variable stars (among which 96 are bona fide and 31 are candidate RR Lyrae stars, 71 are Cepheids, and 16 are binary systems) by applying the image subtraction technique to the selected portions of the observed fields. Differential flux light curves were obtained for the vast majority of these variables. Our sample mainly includes pulsating stars that populate the instability strip from the Classical Cepheids down to the RR Lyrae stars, thus tracing the different stellar generations in these regions of M31 down to the horizontal branch of the oldest (t {approx} 10 Gyr) component.

  2. Giant Exoplanet and Debris Disk (Artist's Concept)

    NASA Image and Video Library

    2017-10-11

    This artist's rendering shows a giant exoplanet causing small bodies to collide in a disk of dust. A study in The Astronomical Journal finds that giant exoplanets with long-period orbits are more likely to be found around young stars that have a disk of dust and debris than those without disks. The study focused on planets more than five times the mass of Jupiter. The astronomers are conducting the largest survey to date of stars with dusty debris disks, and finding the best evidence yet that giant planets are responsible for keeping that material in check. https://photojournal.jpl.nasa.gov/catalog/PIA22082

  3. Idiopathic Giant Cell Myocarditis: A Case Report

    PubMed Central

    Kumari M.K., Kalpana; Mysorekar, Vijaya V.; S., Praveen

    2012-01-01

    Giant-cell myocarditis is a disease of relatively young, predominantly healthy adults. The patients usually die of heart failure and ventricular arrhythmia unless a cardiac transplantation is performed. We are reporting here an autopsy case of idiopathic giant cell myocarditis with no symptoms in a 27-year old -worker who died suddenly. The purpose of this report was to emphasize that idiopathic giant cell myocarditis was a rare disease and that it could exist in the absence of any symptomatic heart disease. PMID:23205365

  4. Rotation and macroturbulence in bright giants

    SciTech Connect

    Gray, D.F.; Toner, C.G.

    1986-11-01

    Spectral line profiles of 35 F, G, and K bright giants were analyzed to obtain rotation rates, v sin i, and macroturbulence dispersion. This sample indicates that rotation rates of cool class II giants is less than 11 km/s, in contrast with some recent periodicity measurements. Macroturbulence dispersion generally increases with effective temperature, but the range of values at a given effective temperature is much larger than seen for lower luminosity classes; this is interpreted in terms of red-giant and blue-loop evolution. No evidence is found for angular momentum dissipation on the first crossing of the H-R diagram. 57 references.

  5. SYNOVIAL GIANT CELL TUMOR OF THE KNEE.

    PubMed

    Abdalla, Rene Jorge; Cohen, Moisés; Nóbrega, Jezimar; Forgas, Andrea

    2009-01-01

    Synovial giant cell tumor is a benign neoplasm, rarely reported in the form of malignant metastasis. Synovial giant cell tumor most frequently occurs on the hand, and, most uncommon, on the ankle and knee. In the present study, the authors describe a rare case of synovial giant cell tumor on the knee as well as the treatment approach. Arthroscopy has been shown, in this case, to be the optimal method for treating this kind of lesion, once it allowed a less aggressive approach, while providing good visualization of all compartments of knee joint and full tumor resection.

  6. [Endovascular treatment of giant intracranial aneurysms].

    PubMed

    Bracard, S; Derelle, A L; Tonnelet, R; Barbier, C; Proust, F; Anxionnat, R

    2016-02-01

    Giant aneurysms are defined as having a maximal diameter higher than 25mm. The dynamic aspect of giant aneurysms, in particular, is its growth, which was responsible for parenchyma sequellae either due to haemorrhagic complications or a compression of cranial nerves. The treatment of these giant aneurysms was challenging because of its size, the mass effect and the neck diameter. These morphologic conditions required complex endovascular procedures such as remodelling, stenting, using flow diverters. Subsequently, the complex procedures increased the risk of morbidity because of ischemic complications. Despite these procedures, the risk of recurrence was high.

  7. A giant pancreatic pseudocyst treated by cystogastrostomy

    PubMed Central

    Wang, Grace C; Misra, Subhasis

    2015-01-01

    We report a case of a giant pancreatic pseudocyst in a 65-year-old man presenting with abdominal pain, loss of appetite and abdominal distension. CT scans demonstrated a giant pancreatic pseudocyst measuring 25.7 cm×15.3 cm×10.9 cm anteroposteriorly, with significant compression of surrounding organs. An open cystogastrostomy was performed through a midline incision, and 3 L of fluid was drained from the giant pseudocyst. Recovery has been uneventful. PMID:25804943

  8. SYNOVIAL GIANT CELL TUMOR OF THE KNEE

    PubMed Central

    Abdalla, Rene Jorge; Cohen, Moisés; Nóbrega, Jezimar; Forgas, Andrea

    2015-01-01

    Synovial giant cell tumor is a benign neoplasm, rarely reported in the form of malignant metastasis. Synovial giant cell tumor most frequently occurs on the hand, and, most uncommon, on the ankle and knee. In the present study, the authors describe a rare case of synovial giant cell tumor on the knee as well as the treatment approach. Arthroscopy has been shown, in this case, to be the optimal method for treating this kind of lesion, once it allowed a less aggressive approach, while providing good visualization of all compartments of knee joint and full tumor resection. PMID:27004193

  9. The Metallicity of Giant Planets

    NASA Astrophysics Data System (ADS)

    Thorngren, Daniel P.; Fortney, Jonathan

    2015-12-01

    Unique clues about the formation processes of giant planets can be found in their bulk compositions. Transiting planets provide us with bulk density determinations that can then be compared to models of planetary structure and evolution, to deduce planet bulk metallicities. At a given mass, denser planets have a higher mass fraction of metals. However, the unknown hot Jupiter "radius inflation" mechanism leads to under-dense planets that severely biases this work. Here we look at cooler transiting gas giants (Teff < 1000 K), which do not exhibit the radius inflation effect seen in their warmer cousins. We identified 40 such planets between 20 M_Earth and 20 M_Jup from the literature and used evolution models to determine their bulk heavy-element ("metal") mass. Several important trends are apparent. We see that all planets have at least ~10 M_Earth of metals, and that the mass of metal correlates strongly with the total mass of the planet. The heavy-element mass goes as the square root of the total mass. Both findings are consistent with the core accretion model. We also examined the effect of the parent star metallicity [Fe/H], finding that planets around high-metallicity stars are more likely to have large amounts of metal, but the relation appears weaker than previous studies with smaller sample sizes had suggested. We also looked for connections between bulk composition and planetary orbital parameters and stellar parameters, but saw no pattern, which is also an important result. This work can be directly compared to current and future outputs from planet formation models, including population synthesis.

  10. Direct Imaging of Giant Exoplanets

    NASA Astrophysics Data System (ADS)

    Tamura, Motohide

    Since the first detection of exoplanets around a Sun-like star 51 Peg in 1995, their detection and characterization are mainly led by indirect methods such as radial velocity and transit methods. However, recent progresses of observational techniques have finally enabled the direct imaging observations of giant planets of solar-system-scale orbit (with their semi-major axes less than about 50 AU) around A-type stars (e.g., Marois et al. 2008, 2010) and G-type stars (e.g., Kuzuhara et al. 2013). Direct imaging is useful to obtain the physical and atmospheric parameters of exoplanets. In fact not only colors but also a medium-resolution spectroscopy of such planets has been successfully obtained for their atmospheric characterization (Barman et al. 2013). Their masses are typically a few to ~10 Jupiter masses and they orbit at a Saturn- to-Pluto distance. Therefore, like hot-Jupiters and super-Earths they are unlike any solar-system planets, and called wide-orbit giant planets. A recent large search for planets and disk on the Subaru 8.2-m telescope (SEEDS project) has detected a 3-5 Jupiter-masses planet around a Sun-like star GJ 504 (Kuzuhara et al. 2013). It is the coolest planetary companion so far directly imaged and its near-infrared color is “bluer” than that of other directly imaged planets. In this contribution, I will review the recent progresses on direct imaging of exoplanets, highlight the results of the SEEDS project, and discuss the future developments.

  11. TOWARD A DETERMINISTIC MODEL OF PLANETARY FORMATION. VII. ECCENTRICITY DISTRIBUTION OF GAS GIANTS

    SciTech Connect

    Ida, S.; Lin, D. N. C.

    2013-09-20

    The ubiquity of planets and diversity of planetary systems reveal that planet formation encompasses many complex and competing processes. In this series of papers, we develop and upgrade a population synthesis model as a tool to identify the dominant physical effects and to calibrate the range of physical conditions. Recent planet searches have led to the discovery of many multiple-planet systems. Any theoretical models of their origins must take into account dynamical interactions between emerging protoplanets. Here, we introduce a prescription to approximate the close encounters between multiple planets. We apply this method to simulate the growth, migration, and dynamical interaction of planetary systems. Our models show that in relatively massive disks, several gas giants and rocky/icy planets emerge, migrate, and undergo dynamical instability. Secular perturbation between planets leads to orbital crossings, eccentricity excitation, and planetary ejection. In disks with modest masses, two or less gas giants form with multiple super-Earths. Orbital stability in these systems is generally maintained and they retain the kinematic structure after gas in their natal disks is depleted. These results reproduce the observed planetary mass-eccentricity and semimajor axis-eccentricity correlations. They also suggest that emerging gas giants can scatter residual cores to the outer disk regions. Subsequent in situ gas accretion onto these cores can lead to the formation of distant (∼> 30 AU) gas giants with nearly circular orbits.

  12. The relationship of myocardial bridges to coronary artery dominance in the adult human heart.

    PubMed

    Loukas, Marios; Curry, Brian; Bowers, Maggi; Louis, Robert G; Bartczak, Artur; Kiedrowski, Miroslaw; Kamionek, Michal; Fudalej, Martin; Wagner, Teresa

    2006-07-01

    Myocardial bridging is recognized as an anatomical variation of the human coronary circulation in which an epicardial artery lies in the myocardium for part of its course. Thus, the vessel is 'bridged' by myocardium. The anterior interventricular branch of the left coronary artery has been reported as the most common site of myocardial bridges but other locations have been reported. The purpose of this study was to provide more definitive information on the vessels with myocardial bridges, the length and depth of the bridged segment, and the relationship between the presence of bridges and coronary dominance. Two hundred formalin-fixed human hearts were examined. Myocardial bridges were found in 69 (34.5%) of the hearts with a total of 81 bridges. One bridge was found in 59 of these hearts and multiple bridges were observed in ten (eight with double bridges and two with triple bridges). Bridges were most often found over the anterior interventricular artery (35 hearts). Bridges were also found over the diagonal branch of the left coronary artery (14), over the left marginal branch (five) and over the inferior interventricular branch of the left coronary artery (six). Bridges were also found over the right coronary artery (15 hearts), over the right marginal branch (four) and over the inferior interventricular branch of the right coronary artery (two). The presence of bridges appeared to be related to coronary dominance, especially in the left coronary circulation. Forty-six (66.6%) of the hearts with bridges were left dominant. Forty-two of these had bridges over the left coronary circulation and four over the right coronary circulation. Seventeen hearts (24.6%) were right dominant. Eleven of these had bridges over the right coronary circulation and six over the left coronary circulation. The remaining six hearts were co-dominant with four having bridges over the left coronary circulation and two over the right coronary circulation. The mean length of the bridges

  13. Unilateral giant coloboma of the upper eyelid associated with other congenital anomalies (33 years follow-up of surgical repair).

    PubMed

    Scassellati-Sforzolini, G; Scassellati-Sforzolini, B

    2003-10-01

    To describe a case of congenital unilateral giant coloboma and its successful surgical repair with 33 years of follow-up. A 6-year-old boy presented with a congenital unilateral giant coloboma of the right upper eyelid associated with madarosis of the eyebrows, microphthalmos, dystopia of the hair, and coloboma of the apex of the nose. The patient underwent surgical repair of the multiple anomalies in different steps. A multiple-step, two-layer technique for the reconstruction of the right upper eyelid was performed in a 6-year-old boy with congenital unilateral giant coloboma associated with multiple ocular and facial anomalies. After 33 years of follow-up, the cosmetic results are excellent, although it has not been possible to preserve the visual function of the right eye, which had to be enucleated.

  14. Percutaneous Coronary Intervention Enhances Accelerative Wave Intensity in Coronary Arteries

    PubMed Central

    Narayan, Om; Leung, Michael C. H.; Wong, Dennis T. L.; Meredith, Ian T.; Cameron, James D.

    2015-01-01

    Background The systolic forward travelling compression wave (sFCW) and diastolic backward travelling decompression waves (dBEW) predominantly accelerate coronary blood flow. The effect of a coronary stenosis on the intensity of these waves in the distal vessel is unknown. We investigated the relationship between established physiological indices of hyperemic coronary flow and the intensity of the two major accelerative coronary waves identified by Coronary Wave Intensity analysis (CWIA). Methodology / Principal Findings Simultaneous intracoronary pressure and velocity measurement was performed during adenosine induced hyperemia in 17 patients with pressure / Doppler flow wires positioned distal to the target lesion. CWI profiles were generated from this data. Fractional Flow Reserve (FFR) and Coronary Flow Velocity Reserve (CFVR) were calculated concurrently. The intensity of the dBEW was significantly correlated with FFR (R = -0.70, P = 0.003) and CFVR (R = -0.73, P = 0.001). The intensity of the sFCW was also significantly correlated with baseline FFR (R = 0.71, p = 0.002) and CFVR (R = 0.59, P = 0.01). Stenting of the target lesion resulted in a median 178% (interquartile range 55–280%) (P<0.0001) increase in sFCW intensity and a median 117% (interquartile range 27–509%) (P = 0.001) increase in dBEW intensity. The increase in accelerative wave intensity following PCI was proportionate to the baseline FFR and CFVR, such that stenting of lesions associated with the greatest flow limitation (lowest FFR and CFVR) resulted in the largest increases in wave intensity. Conclusions Increasing ischemia severity is associated with proportionate reductions in cumulative intensity of both major accelerative coronary waves. Impaired diastolic microvascular decompression may represent a novel, important pathophysiologic mechanism driving the reduction in coronary blood flow in the setting of an epicardial stenosis. PMID:26658896

  15. Reconsidering the Gatekeeper Paradigm for Percutaneous Coronary Intervention in Stable Coronary Disease Management.

    PubMed

    Schulman-Marcus, Joshua; Weintraub, William S; Boden, William E

    2017-10-15

    Major randomized clinical trials over the last decade support the role of optimal medical therapy for the initial management approach for patients with stable coronary artery disease (CAD), whereas percutaneous coronary intervention (PCI) ought to be reserved for patients with persistent symptoms despite optimal medical therapy. Likewise, several studies have continued to demonstrate the superiority of coronary artery bypass grafting surgery over PCI in many patients with extensive multivessel CAD, especially those with diabetes. Nevertheless, the decision-making paradigm for patients with stable CAD often continues to propagate the upfront use of "ad hoc PCI" and disadvantages alternative therapeutic approaches. In our editorial, we discuss how multiple systemic and interpersonal factors continue to favor early revascularization with PCI in stable patients. We discuss whether the interventional cardiologist can be an unbiased "gatekeeper" for the use of PCI or whether other physicians should also be involved with the patient in decision-making. Finally, we offer suggestions that can redefine the gatekeeper role to facilitate an evidence-based approach that embraces shared decision-making. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Varicella zoster virus in the temporal artery of a patient with giant cell arteritis.

    PubMed

    Nagel, Maria A; Khmeleva, Nelly; Boyer, Philip J; Choe, Alexander; Bert, Robert; Gilden, Don

    2013-12-15

    We recently detected varicella zoster virus (VZV) in the temporal arteries (TA) of 5/24 patients with clinically suspect giant cell arteritis (GCA) whose TAs were GCA-negative pathologically; in those GCA-negative, VZV+TAs, virus antigen predominated in the arterial adventitia, but without medial necrosis and multinucleated giant cells. During our continuing search for VZV antigen in GCA-negative TAs, in the TA of one subject, we found abundant VZV antigen, as well as VZV DNA, in multiple regions (skip areas) of the TA spanning 350 μm, as well as in skeletal muscle adjacent to the infected TA. Additional pathological analysis of sections adjacent to those containing viral antigen revealed inflammation involving the arterial media and abundant multinucleated giant cells characteristic of GCA. Detection of VZV in areas of the TA with pathological features of GCA warrants further correlative pathological-virological analysis of VZV in GCA. © 2013.

  17. Giant Cell Lesions in Noonan Syndrome: Case Report and Review of The Literature

    PubMed Central

    Bufalino, Andreia; Carrera, Manoela; Carlos, Roman

    2010-01-01

    Noonan-like/multiple giant cell lesion syndrome (NS/MGCLS) is a rare condition with phenotypic overlap with Noonan syndrome (NS). Once thought to be a specific and separate entity, it is now suggested to be a variant of the NS spectrum. We report a patient with classical cardinal features of NS, including short stature, mild ptosis, hypertelorism, down-slating palpebral fissures, low-set and posteriorly angulated ears, short neck, pectus excavatum, widely spaced nipples and cryptochidism, which were associated with bilateral central giant cell lesions in the mandible and germ-line mutation (C218T, Thr73Ile) in the exon 3 of the PTPN11 gene. The similar clinical and genetic aspects support the observation that NS/MGCLS is a variant of NS and giant cell lesions are an integrant part of this disorder. PMID:20383758

  18. Giant juvenile fibroadenoma: a case and review of novel modalities in treatment.

    PubMed

    Sosin, Michael; Feldman, Elizabeth

    2012-01-01

    A giant juvenile fibroadenoma is defined as a fibroadenoma greater than 5 centimeters in size occurring in the pediatric population. It frequently affects adolescents. Rapid growth of the mass may result in breast asymmetry and deformity. Varying techniques in surgical extirpation have been described in order to optimize aesthetics and minimize distortion. The advent of new methods to remove benign breast disease is in its infancy stages. Many practitioners are unaware of the novel options that are emerging in the treatment of fibroadenoma. We describe an excision of a 12 centimeter giant juvenile fibroadenoma and adjacent juvenile fibroadenoma using a strategically atypical incision that resulted in excellent cosmesis and contour of the breast without subsequent reconstruction. Multiple modalities of removing a fibroadenoma are described with a review of the associated risks, benefits, and long term implications as well as a discussion on the indication for reconstructive surgery in patients with giant juvenile fibroadenoma.

  19. Aggressive giant condyloma acuminatum associated with oncogenic human papilloma virus: a case report

    PubMed Central

    Kibrité, Antoine; Zeitouni, Nathalie C.; Cloutier, Richard

    1997-01-01

    Malignant transformation has been described in 30% of cases of giant anorectal condyloma acuminatum. The authors report on a 33-year-old man who was heterosexual and HIV negative and who had a giant anal condyloma. Despite aggressive therapy with multiple fulgurations, interferon alpha and isotretinoin, an invasive squamous cell carcinoma of the rectum developed. An abdominoperineal resection was done followed by radiotherapy and chemotherapy, but this treatment regimen was unsuccessful in controlling the progression of his carcinoma. Human papillomavirus (HPV) serotyping in tumoral tissue was positive for HPV types 11 and 16. In patients with giant anorectal condylomas associated with oncogenic HPV, the course of the disease may be aggressive, so they may benefit from early surgical and medical intervention. PMID:9126130

  20. Toward Controlled Hierarchical Heterogeneities in Giant Molecules with Precisely Arranged Nano Building Blocks

    PubMed Central

    2016-01-01

    Herein we introduce a unique synthetic methodology to prepare a library of giant molecules with multiple, precisely arranged nano building blocks, and illustrate the influence of minute structural differences on their self-assembly behaviors. The T8 polyhedral oligomeric silsesquioxane (POSS) nanoparticles are orthogonally functionalized and sequentially attached onto the end of a hydrophobic polymer chain in either linear or branched configuration. The heterogeneity of primary chemical structure in terms of composition, surface functionality, sequence, and topology can be precisely controlled and is reflected in the self-assembled supramolecular structures of these giant molecules in the condensed state. This strategy offers promising opportunities to manipulate the hierarchical heterogeneities of giant molecules via precise and modular assemblies of various nano building blocks. PMID:27163025

  1. [Vascular complications of percutaneous transradial coronary angiography and coronary intervention].

    PubMed

    Prull, Magnus W; Brandts, Bodo; Rust, Henning; Trappe, Hans-Joachim

    2005-07-15

    Vascular complications following transradial coronary angiography and coronary intervention could severely compromise perfusion of the hand. Drastic complications after cannulation of the radial artery (ischemia of the hand with occlusion of the digital arteries) are published only in brief reports. This study investigates whether percutaneous transradial artery coronary angiography/intervention results in vascular complications. 93 patients were consecutively studied over a 4-month period. The following data were recorded before and after coronary angiography and/or intervention: diameter of the radial artery, blood volume, flow velocity, and occlusion pressure. Graduation of the stenosis after intervention was done according to the principle of the peak velocity ratio. A transradial coronary angiography/intervention was performed in 93 patients (75 men, mean age 62.5 years) in case of an unremarkable Allen test. Procedural success rate was 97.2%. The intervention could not be completed successfully in three patients (2.8%). Mean vessel diameter increased from 2.46 +/- 1.7 mm (standard deviation [SD]) before intervention to 2.78 +/- 0.69 mm (SD) after intervention; this increase was statistically significant (p = 0.002). Changes in blood flow, flow velocity and occlusion pressure did not reach significance. Vascular complications were seen in nine of 93 patients (10%) after the procedure. No patient mentioned discomfort. No perfusion deficit of the digital arteries was seen. The transradial coronary angiography and intervention is a safe method with a high procedural success rate.

  2. Coronary Artery Disease Risk Factors, Coronary Artery Calcification and Coronary Bypass Surgery

    PubMed Central

    Ulusoy, Fatih Rifat; Ipek, Emrah; Korkmaz, Ali Fuat; Gurler, Mehmet Yavuz; Gulbaran, Murat

    2015-01-01

    Introduction Atherosclerosis is an intimal disease which affects large and medium size arteries including aorta and carotid, coronary, cerebral and radial arteries. Calcium accumulated in the coronary arterial plaques have substantial contribution to the plaque volume. The aim of our study is to investigate the relationship between coronary artery disease (CAD) risk factors and coronary arterial calcification, and to delineate the importance of CACS in coronary artery bypass surgery. Materials and Methods The current study is retrospective and 410 patients admitted to our clinic with atypical chest pain and without known CAD were included. These individuals were evaluated by 16 slice electron beam computed tomography with suspicion of CAD and their calcium scores were calculated. Detailed demographic and medical history were obtained from all of the patients. Results In our study, we employed five different analyses using different coronary arterial calcification score (CACS) thresold levels reported in previous studies. All of the analyses, performed according to the previously defined thresold levels, showed that risk factors had strong positive relationship with CACS as mentioned in previous studies. Conclusion Coronary arterial calcification is part of the athero-sclerotic process and although it can be detected in atherosclerotic vessel, it is absent in a normal vessel. It can be concluded that the clinical scores, even they are helpful, have some limitations in a significant part of the population for cardiovascular risk determination. It is important for an anastomosis region to be noncalcified in coronary bypass surgery. In a coronary artery, it will be helpness for showing of calcific field and anostomosis spot. PMID:26155507

  3. [Efficacy and safety of the coronary intervention therapy to prevent electrical storm in patients with coronary artery disease but without myocardial infarction].

    PubMed

    Guo, Cheng-jun; Lü, Shu-zheng; Yan, Fang-ming; Jiang, Teng-yong; Li, Hai-yan; Zhang, Jin-rong

    2005-09-01

    To study the efficacy and safety of the coronary interventional therapy to prevent electrical storm (ES) in patients with coronary artery diseases (CAD) but without myocardial infarction or ischemic cardiomyopathy. Coronary angiography and stent implantation were performed in CAD patients with ES as major symptom, according to the standardized methods. Holter Electrocardiography was recorded regularly during follow-up. Six patients, five male and one female, with mean age of 49.5 +/- 9.1 year-old, were hospitalized. In 2 patients with repetitive syncope, multiple episodes of ventricular tachycardia and/or ventricular fibrillation (VF) were documented by Holter recording. One patient developed VF during exercise test. Three patients experienced chest pain and multiple episodes of cardiac arrest. Before procedure, averaged 16.5 +/- 5.3 episodes of syncope or VF were documented in 6 patients. Coronary angiography revealed severe one or multi-vessel diseases. Total 8 stents, including 3 drug-eluting stents, were implanted in 6 patients. Symptom, ST-T changes and ES disappeared after coronary stenting. During 4 month to 6.5 year follow-up (mean 47.7 +/- 30.7 months), ES was not documented, no appropriated shock occurred in patients with implantable defibrillator for 6.5 years. In CAD patients without myocardial infarction, coronary stenting can relieve the ischemic substrate of ES, hence prevents sudden death effectively.

  4. GIANT PLANETS ORBITING METAL-RICH STARS SHOW SIGNATURES OF PLANET-PLANET INTERACTIONS

    SciTech Connect

    Dawson, Rebekah I.; Murray-Clay, Ruth A.

    2013-04-20

    Gas giants orbiting interior to the ice line are thought to have been displaced from their formation locations by processes that remain debated. Here we uncover several new metallicity trends, which together may indicate that two competing mechanisms deliver close-in giant planets: gentle disk migration, operating in environments with a range of metallicities, and violent planet-planet gravitational interactions, primarily triggered in metal-rich systems in which multiple giant planets can form. First, we show with 99.1% confidence that giant planets with semimajor axes between 0.1 and 1 AU orbiting metal-poor stars ([Fe/H] < 0) are confined to lower eccentricities than those orbiting metal-rich stars. Second, we show with 93.3% confidence that eccentric proto-hot Jupiters undergoing tidal circularization primarily orbit metal-rich stars. Finally, we show that only metal-rich stars host a pile-up of hot Jupiters, helping account for the lack of such a pile-up in the overall Kepler sample. Migration caused by stellar perturbers (e.g., stellar Kozai) is unlikely to account for the trends. These trends further motivate follow-up theoretical work addressing which hot Jupiter migration theories can also produce the observed population of eccentric giant planets between 0.1 and 1 AU.

  5. Ribosomes and polyribosomes are present in the squid giant axon: an immunocytochemical study.

    PubMed

    Sotelo, J R; Kun, A; Benech, J C; Giuditta, A; Morillas, J; Benech, C R

    1999-05-01

    Ribosomes and polyribosomes were detected by immuno-electron microscopy in the giant axon and small axons of the squid using a polyclonal antibody against rat brain ribosomes. The ribosomal fraction used as antigen was purified by ultracentrifugation on a sucrose density gradient and shown to contain ribosomal RNAs and native ribosomes. The polyclonal antibody raised in rabbits reacted with at least ten proteins on immunoblots of purified rat brain ribosomes as well as with a set of multiple ribosomal proteins prepared from the squid giant fiber lobe. Immunoreactions were performed on cryostat sections of the stellate nerve cut at a distance of more than 3 cm from the stellate ganglion, using pre-embedding techniques. Ribosomes and polyribosomes were identified within the giant axon and small axons using electron microscopic methods, following binding of peroxidase-conjugated anti-rabbit IgG secondary antibody. Polysomes were more frequently localized in peripheral axoplasm, including the cortical layer of the giant axon, and were generally associated with unidentified cytoskeletal filaments or with dense matrix material. The immunochemical demonstration of ribosomes and polyribosomes in the giant axon and small axons of the squid confirms similar observations in the squid and the goldfish obtained with the method of electron spectroscopic imaging, and strongly supports the view that a local system of protein synthesis is present in axons. The immunochemical method here described offers an alternative tool for the selective identification of ribosomes, and is likely to prove of value in the analyses of other axonal systems.

  6. Heart Attack Coronary Artery Disease

    MedlinePlus

    ... our e-newsletter! Aging & Health A to Z Heart Attack Coronary Artery Disease, Angina Basic Facts & Information What ... and oxygen supply; this is what causes a heart attack. If the damaged area is small, however, your ...

  7. Coronary microvascular dysfunction: an update

    PubMed Central

    Crea, Filippo; Camici, Paolo G.; Bairey Merz, Cathleen Noel

    2014-01-01

    Many patients undergoing coronary angiography because of chest pain syndromes, believed to be indicative of obstructive atherosclerosis of the epicardial coronary arteries, are found to have normal angiograms. In the past two decades, a number of studies have reported that abnormalities in the function and structure of the coronary microcirculation may occur in patients without obstructive atherosclerosis, but with risk factors or with myocardial diseases as well as in patients with obstructive atherosclerosis; furthermore, coronary microvascular dysfunction (CMD) can be iatrogenic. In some instances, CMD represents an epiphenomenon, whereas in others it is an important marker of risk or may even contribute to the pathogenesis of cardiovascular and myocardial diseases, thus becoming a therapeutic target. This review article provides an update on the clinical relevance of CMD in different clinical settings and also the implications for therapy. PMID:24366916

  8. Coronary collateral circulation: its relevance.

    PubMed

    Karrowni, Wassef; El Accaoui, Ramzi N; Chatterjee, Kanu

    2013-11-15

    The interest in coronary collateral circulation (CCC) as "natural bypasses" is growing, especially in patients in whom the extent of coronary atherosclerosis is too severe to allow for conventional revascularization. The anatomic foundation of CCC has been recognized for long time. Recently, reliable methods have become available for the assessment of the adequacy of collateral flow. However, the debate regarding the importance of CCC in the different clinical settings continues. In this article, we present the recent progress in the understanding of anatomy and physiology of the CCC and focus on the studies addressing their functional significance in acute, subacute, and chronic coronary artery disease. In addition, we provide a focused update on the essential role of collateral circulation in the management of coronary chronic total occlusions.

  9. Giant cell arteritis presenting with uveitis.

    PubMed

    Slemp, Stephanie N; Martin, Sarah E; Burgett, Richard A; Hattab, Eyas M

    2014-10-01

    Giant cell arteritis, also known as temporal arteritis, is the most common primary vasculitis affecting the nervous system. Early recognition of this treatable condition is essential to avoid potentially devastating complications. Giant cell arteritis occurs in adults older than 50 years and affects large and medium-sized arteries, especially the external and internal carotid arteries and their branches. Severe inflammation of the vessel wall may result in obstruction of the lumen and end-organ ischemia. Typical giant cell arteritis symptoms include headache, scalp tenderness, jaw claudication, and polymyalgia rheumatica. Ischemia induced by the arteritis can lead to blindness. Herein, we describe a rare case of giant cell arteritis in a patient who initially presented with uveitis, thus eluding timely diagnosis and prompt therapy.

  10. Excitation of giant resonances via direct reactions

    SciTech Connect

    Bertrand, F.E.

    1982-01-01

    Experimental measurements of electric giant multipole resonances are discussed. The parameters of the giant quadrupole resonance are now firmly established by an extensive set of measurements. The GQR is providing a significant influence in other areas of nuclear physics. The monopole resonance has now been established and its observation has provided the first direct measure of the nuclear compressibility. A strong case for the existence of a giant octupole resonance is now being made through a variety of hadron reactions. However, the supply of giant multipole resonances has not been exhausted. The newer techniques such as higher energy proton scattering, charge exchange reactions, heavy-ion scattering and pion reactions offer considerable hope for identifying new resonances during the next few years.

  11. Mass loss in red giants and supergiants

    NASA Technical Reports Server (NTRS)

    Sanner, F.

    1975-01-01

    The circumstellar envelopes surrounding late-type giants and supergiants were studied using high resolution, photoelectric scans of strong optical resonance lines. A method for extracting the circumstellar from the stellar components of the lines allowed a quantitative determination of the physical conditions in the envelopes and the rates of mass loss at various positions in the red giant region of the HR diagram. The observed strengthening of the circumstellar spectrum with increasing luminosity and later spectral type is probably caused by an increase in the mass of the envelopes. The mass loss rate for individual stars is proportional to the visual luminosity; high rates for the supergiants suggest that mass loss is important in their evolution. The bulk of the mass return to the interstellar medium in the red giant region comes from the normal giants, at a rate comparable to that of planetary nebulae.

  12. "GIANT" Steps to Create Online Orientations

    ERIC Educational Resources Information Center

    Bacon, Pamela

    2005-01-01

    Online orientation is provided due to the flexibility of online learning. The online orientation consists of the GIANT steps which stands for Get support, Identify your curriculum, Assemble your program, Navigate students through the pilot project and Test students.

  13. Lithium Abundance in M3 Red Giant

    NASA Astrophysics Data System (ADS)

    Givens, Rashad; Pilachowski, Catherine A.

    2015-01-01

    We present the abundance of lithium in the red giant star vZ 1050 (SK 291) in the globular cluster M3. A previous survey of giants in the cluster showed that like IV-101, vZ 1050 displays a prominent Li I 6707 Å feature. vZ 1050 lies on the blue side of the red giant branch about 1.3 magnitudes above the level of the horizontal branch, and may be an asymptotic giant branch star. A high resolution spectrum of M3 vZ1050 was obtained with the ARC 3.5m telescope and the ARC Echelle Spectrograph (ARCES). Atmospheric parameters were determined using Fe I and Fe II lines from the spectrum using the MOOG spectral analysis program, and the lithium abundance was determined using spectrum synthesis.

  14. "GIANT" Steps to Create Online Orientations

    ERIC Educational Resources Information Center

    Bacon, Pamela

    2005-01-01

    Online orientation is provided due to the flexibility of online learning. The online orientation consists of the GIANT steps which stands for Get support, Identify your curriculum, Assemble your program, Navigate students through the pilot project and Test students.

  15. Giant cell arteritis presenting as scalp necrosis.

    PubMed

    Maidana, Daniel E; Muñoz, Silvia; Acebes, Xènia; Llatjós, Roger; Jucglà, Anna; Alvarez, Alba

    2011-07-07

    The differential of scalp ulceration in older patients should include several causes, such as herpes zoster, irritant contact dermatitis, ulcerated skin tumors, postirradiation ulcers, microbial infections, pyoderma gangrenosum, and giant cell arteritis. Scalp necrosis associated with giant cell arteritis was first described in the 1940s. The presence of this dermatological sign within giant cell arteritis represents a severity marker of this disease, with a higher mean age at diagnosis, an elevated risk of vision loss and tongue gangrene, as well as overall higher mortality rates, in comparison to patients not presenting this manifestation. Even though scalp necrosis due to giant cell arteritis is exceptional, a high level of suspicion must be held for this clinical finding, in order to initiate prompt and proper treatment and avoid blindness.

  16. EUVE Observations of the Hyades Giants

    NASA Technical Reports Server (NTRS)

    Stern, Robert A.

    1998-01-01

    The contractor describes EUVE and ROSAT observations of the Hyades K0 III giants theta(sup 1(vB 71 = HR 1411) and gamma$ (vB 28 = HR 1346) Tau, and ASCA observations of theta(sup 1) Tau. The coronal activity of these "clump" giants is intermediate between that of the Sun and of high-activity stars such as RS CVn systems. There is no evidence for significant short or long term variability up to several years. Modeling of the individual and combined spectra suggest that these two X-ray and EUV- bright Hyades giants resemble in their activity levels another clump giant, beta Cet, with a peak in the emission measure distribution near log T approx. 6.8, reminiscent of the Capella emission measure "bump."

  17. EUVE Observations of the Hyades Giants

    NASA Technical Reports Server (NTRS)

    Stern, Robert A.; Oliversen, Ronald J. (Technical Monitor)

    1998-01-01

    We describe EUVE and ROSAT observations of the Hyades K0 III giants theta(sup 1) (vB 71 = HR1411) and gamma (vB 28 = HR1346) Tau. We also discuss ASCA observations of theta(sup 1)Tau. The coronal activity of these "clump" giants is intermediate between that of the Sun and of high activity stars such as RS CVn systems. There is no evidence for significant short or long term variability up to several years. Modeling of the individual and combined spectra suggest that these two X-ray and EUV-bright Hyades giants resemble in their activity levels another clump giant, beta Cet, with a peak in the emission measure distribution near log T approx. 6.8, reminiscent of the Capella emission measure "bump."

  18. Innate predator recognition in giant pandas.

    PubMed

    Du, Yiping; Huang, Yan; Zhang, Hemin; Li, Desheng; Yang, Bo; Wei, Ming; Zhou, Yingmin; Liu, Yang

    2012-02-01

    Innate predator recognition confers a survival advantage to prey animals. We investigate whether giant pandas exhibit innate predator recognition. We analyzed behavioral responses of 56 naive adult captive giant pandas (Ailuropoda melanoleuca), to urine from predators and non-predators and water control. Giant pandas performed more chemosensory investigation and displayed flehmen behaviors more frequently in response to predator urine compared to both non-predator urine and water control. Subjects also displayed certain defensive behaviors, as indicated by vigilance, and in certain cases, fleeing behaviors. Our results suggest that there is an innate component to predator recognition in captive giant pandas, although such recognition was only slight to moderate. These results have implications that may be applicable to the conservation and reintroduction of this endangered species.

  19. Giant salivary calculi of the submandibular gland

    PubMed Central

    Fowell, C; MacBean, A

    2012-01-01

    Sialolithasis is the most common salivary gland disease. A case of an unusually large sialolith arising in the submandibular gland is presented, along with a review of the management of giant salivary gland calculi. PMID:24960792

  20. Tests of the Giant Impact Hypothesis

    NASA Technical Reports Server (NTRS)

    Jones, J. H.

    1998-01-01

    The giant impact hypothesis has gained popularity as a means of explaining a volatile-depleted Moon that still has a chemical affinity to the Earth. As Taylor's Axiom decrees, the best models of lunar origin are testable, but this is difficult with the giant impact model. The energy associated with the impact would be sufficient to totally melt and partially vaporize the Earth. And this means that there should he no geological vestige of Barber times. Accordingly, it is important to devise tests that may be used to evaluate the giant impact hypothesis. Three such tests are discussed here. None of these is supportive of the giant impact model, but neither do they disprove it.

  1. Anomalous right coronary artery arising next to the left coronary ostium: unambiguous detection of the anatomy by computed tomography and evaluation of functional significance by cardiovascular magnetic resonance.

    PubMed

    Korosoglou, Grigorios; Heye, Tobias; Giannitsis, Evangelos; Hosch, Waldemar; Kauczor, Hans U; Katus, Hugo A

    2010-11-19

    Herein we report on the diagnostic potential of multi-detector row computed tomography (MDCT) combined with cardiovascular magnetic resonance (CMR) for the diagnostic workup in an adult patient with a rare coronary anomaly. MDCT unambiguously detected the anomalous right coronary artery (RCA), which originated next to the left coronary ostium and coursed inter-arterially between the ascending aorta and the pulmonary trunk. The intramural proximal intussusception of the ectopic RCA could be clearly appreciated on MDCT images, while multiple mixed plaques were detected in the left anterior descending (LAD), resulting in moderate stenosis of this vessel. CMR during adenosine infusion ruled-out inducible ischemia, yielding normal perfusion patterns both in the RCA and in the LAD coronary territory. Since ischemia was not demonstrated by stress CMR, revascularization was not performed.

  2. Dutch survey of congenital coronary artery fistulas in adults

    PubMed Central

    Said, S.A.M.; van der Werf, T.

    2006-01-01

    Aims This Dutch survey focused on the clinical presentation, noninvasive and invasive diagnostic methods, and treatment modalities of adult patients with congenital coronary artery fistulas (CAFs). Methods Between 1996 and 2003, the initiative was taken to start a registry on congenital CAFs in adults. In total 71 patients from a diagnostic coronary angiographic population of 30,829 at 28 hospitals were collected from previously developed case report forms. Patient demographic data, clinical presentation, noninvasive and invasive techniques and treatment options were retrospectively collected and analysed. Results Out of 71 patients with angiographically proven CAFs, 51 (72%) had 63 congenital solitary fistulas and 20 (28%) had 31 congenital coronary-ventricular multiple microfistulas. Patients with pseudofistulas were excluded from the registry. Coronary angiograms were independently re-analysed for morphology and specific fistula details. The majority (72%) of the fistulas were unilateral, 24% were bilateral and only 4% were multilateral. The morphological characteristics of these 94 fistulas were as follows: the origin was multiple in 47% and single in 53%; the termination was multiple in 52% and single in 48%; and the pathway of the fistulous vessels was tortuous/multiple in 66%, tortuous/single in 28%, straight/multiple in 3% and straight/single in 3%. Percutaneous transluminal embolisation (PTE) was performed in two (3%) patients; surgical ligation was undertaken in 13 (18%) patients. The overwhelming majority of the patients (56; 79%) were treated with conservative medical management. The total mortality was 6% (4/71) at a mean follow-up period of approximately five years. Cardiac mortality accounted for 4% (3/71); in all three patients, death could possibly be attributed to the presence of the fistula. Conclusion Registry of congenital coronary artery fistulas in adults in the Netherlands is feasible. In spite of restrictions imposed by the Dutch Privacy

  3. Acute Coronary Syndrome in a Puerperal Patient with Coronary Artery Ectasia due to a Coronary Artery Fistula.

    PubMed

    Okada, Taiji; Endo, Akihiro; Ito, Simpei; Nakamura, Taku; Sugamori, Takashi; Takahashi, Nubuyuki; Yoshitomi, Hiroyuki; Tanabe, Kazuaki

    Coronary artery fistulas are rare and the feeding artery is ectatic and tortuous. It is not well-known whether coronary artery ectasia (CAE) is a risk factor of acute coronary syndrome (ACS) in the puerperal periods. A 40-year-old woman with a coronary artery fistula and an ectatic right coronary artery (RCA) had delivered twins. A month later, she had chest pain and coronary angiography revealed thrombogenesis in the RCA. She had no risk factors of cardiovascular disease or thrombogenesis. We should recognize that CAE is a risk factor for ACS in women in the perinatal and puerperal periods.

  4. Physiologic assessment of coronary artery fistula

    SciTech Connect

    Gupta, N.C.; Beauvais, J. )

    1991-01-01

    Coronary artery fistula is an uncommon clinical entity. The most common coronary artery fistula is from the right coronary artery to the right side of the heart, and it is less frequent to the pulmonary artery. The effect of a coronary artery fistula may be physiologically significant because of the steal phenomenon resulting in coronary ischemia. Based on published reports, it is recommended that patients with congenital coronary artery fistulas be considered candidates for elective surgical correction to prevent complications including development of congestive heart failure, angina, subacute bacterial endocarditis, myocardial infarction, and coronary aneurysm formation with rupture or embolization. A patient is presented in whom treadmill-exercise thallium imaging was effective in determining the degree of coronary steal from a coronary artery fistula, leading to successful corrective surgery.

  5. Animal models of coronary heart disease.

    PubMed

    Liao, Jiawei; Huang, Wei; Liu, George

    2015-08-20

    Cardiovascular disease, predominantly coronary heart disease and stroke, leads to high morbidity and mortality not only in developed worlds but also in underdeveloped regions. The dominant pathologic foundation for cardiovascular disease is atherosclerosis and as to coronary heart disease, coronary atherosclerosis and resulting lumen stenosis, even total occlusions. In translational research, several animals, such as mice, rabbits and pigs, have been used as disease models of human atherosclerosis and related cardiovascular disorders. However, coronary lesions are either naturally rare or hard to be fast induced in these models, hence, coronary heart disease induction mostly relies on surgical or pharmaceutical interventions with no or limited primary coronary lesions, thus unrepresentative of human coronary heart disease progression and pathology. In this review, we will describe the progress of animal models of coronary heart disease following either spontaneous or diet-accelerated coronary lesions.

  6. Arterial Embolization of Giant Hepatic Hemangiomas

    SciTech Connect

    Giavroglou, Constantinos; Economou, Hippolete; Ioannidis, Ioannis

    2003-02-15

    Hepatic cavernous hemangiomas are usually small and asymptomatic. They are usually discovered incidentally and only a few require treatment. However, giant hemangiomas may cause symptoms,which are indications for treatment. We describe four cases of symptomatic giant hepatic hemangiomas successfully treated with transcatheter arterial embolization, performed with polyvinyl alcohol particles. There were no complications. Follow-up with clinical and imaging examinations showed disappearance of symptoms and decrease in size of lesions.

  7. Differential Lectin Binding Patterns Identify Distinct Heart Regions in Giant Danio ( Devario aequipinnatus) and Zebrafish ( Danio rerio) Hearts.

    PubMed

    Manalo, Trina; May, Adam; Quinn, Joshua; Lafontant, Dominique S; Shifatu, Olubusola; He, Wei; Gonzalez-Rosa, Juan M; Burns, Geoffrey C; Burns, Caroline E; Burns, Alan R; Lafontant, Pascal J

    2016-11-01

    Lectins are carbohydrate-binding proteins commonly used as biochemical and histochemical tools to study glycoconjugate (glycoproteins, glycolipids) expression patterns in cells, tissues, including mammalian hearts. However, lectins have received little attention in zebrafish ( Danio rerio) and giant danio ( Devario aequipinnatus) heart studies. Here, we sought to determine the binding patterns of six commonly used lectins-wheat germ agglutinin (WGA), Ulex europaeus agglutinin, Bandeiraea simplicifolia lectin (BS lectin), concanavalin A (Con A), Ricinus communis agglutinin I (RCA I), and Lycopersicon esculentum agglutinin (tomato lectin)-in these hearts. Con A showed broad staining in the myocardium. WGA stained cardiac myocyte borders, with binding markedly stronger in the compact heart and bulbus. BS lectin, which stained giant danio coronaries, was used to measure vascular reconstruction during regeneration. However, BS lectin reacted poorly in zebrafish. RCA I stained the compact heart of both fish. Tomato lectin stained the giant danio, and while low reactivity was seen in the zebrafish ventricle, staining was observed in their transitional cardiac myocytes. In addition, we observed unique staining patterns in the developing zebrafish heart. Lectins' ability to reveal differential glycoconjugate expression in giant danio and zebrafish hearts suggests they can serve as simple but important tools in studies of developing, adult, and regenerating fish hearts.

  8. 21 CFR 870.4310 - Cardiopulmonary bypass coronary pressure gauge.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Cardiopulmonary bypass coronary pressure gauge... Cardiopulmonary bypass coronary pressure gauge. (a) Identification. A cardiopulmonary bypass coronary pressure... the coronary arteries. (b) Classification. Class II (performance standards). ...

  9. Serum visfatin and omentin levels in slow coronary flow.

    PubMed

    Ucgun, Taner; Başar, Cengiz; Memişoğulları, Ramazan; Demirin, Hilmi; Türker, Yasin; Aslantaş, Yusuf

    2014-12-01

    The adipocytokines visfatin and omentin have a direct effect on inflammation and endothelial injury. The expression of visfatin is closely associated with the expression of proinflammatory cytokines. Omentin has an anti-inflammatory effect and is inversely associated with coronary artery disease (CAD). The slow coronary flow phenomenon is an angiographic finding characterized by delayed distal vessel opacification in the absence of significant epicardial coronary disease. The pathophysiology of SCF has not been clearly identified, although multiple abnormalities including endothelial dysfunction, atherothrombosis and inflammation have been reported. However, the relationship between visfatin, omentin and SCF is still unknown. In this study, we aimed to investigate the relationship of these adipocytokines with SCF. The study included slow coronary flow (n=45) and normal coronary flow (n=55) subjects, according to the corrected TIMI frame count, who underwent angiography in the catheterization laboratory of Duzce University. Statistical analyses were performed with SPSS version 12. Visfatin levels were significantly higher in patients with SCF than in controls (p<0.001). Plasma omentin levels were lower in the SCF group than in controls, although without statistical significance. Visfatin, gender and platelet count were significant predictors of SCF in multivariate logistic regression analysis (OR 0.748, 95% CI 0.632-0.886, p=0.01; OR 30.016, 95% CI 4.355-206.8, p=0.01; OR1.028, 95% CI 1.006-1.050, p=0.011, respectively). Adipocytokines such as visfatin and omentin may play a role in the pathogenesis of coronary slow flow. Copyright © 2014 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  10. Atherosclerosis and Liver Function Tests in Coronary Angiography Patients

    PubMed Central

    Doganer, YC; Rohrer, JE; Aydogan, U; Agerter, DC; Cayci, T; Barcin, C

    2015-01-01

    ABSTRACT Objective: Elevated aminotransferase levels indicating liver function, even in the normal range, have attracted great concern as potential novel markers of cardiovascular risk assessment. We hypothesized the possibility that liver function test variations in the normal range might be meaningfully associated to coronary artery disease (CAD). Method: Eighty-eight patients were randomly selected from those who underwent coronary angiography from June 2010 to June 2011 after applying to the outpatient cardiology clinic in Gulhane Military Medical Academy. According to the results of angiographies, patients were classified into three groups as normal, non-critical (< 50% involvement in coronaries), and critical (≥ 50% involvement in coronaries). In addition to angiographic intervention, measurements of serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) concentrations, albumin and the other serum parameters were performed in all patients. Results: The patient groups of CAD were balanced (28 critical cases, 30 non-critical cases and 30 normal cases). Mean age was 51.93 ± 9.3 (range 32–65) years and 19.3 per cent (n = 17) were females. Multiple linear regression analysis of all three liver function tests explained a significant portion of the variance, but adjusted r-squares were small (AST = 0.174, ALT = 0.242, albumin = 0.124). Albumin was significantly higher for patients with critical CAD than for patients with no CAD (beta = 3.205, p = 0.002). Non-critical CAD was not significantly different from no CAD for any of the dependent variables. Mean AST was significantly higher for patients taking aspirin (beta = 0.218, p = 0.049), as was mean ALT (beta = 0.264, p = 0.015). Conclusion: Alanine aminotransferase and AST may not be associated with angiographically determined coronary atherosclerosis. Albumin may be more sensitive to demonstrate the burden of atherosclerosis. These results indicate that the association between the liver

  11. Formation of Giant Planets and Brown Dwarves

    NASA Technical Reports Server (NTRS)

    Lissauer, Jack J.

    2003-01-01

    According to the prevailing core instability model, giant planets begin their growth by the accumulation of small solid bodies, as do terrestrial planets. However, unlike terrestrial planets, the growing giant planet cores become massive enough that they are able to accumulate substantial amounts of gas before the protoplanetary disk dissipates. Models predict that rocky planets should form in orbit about most stars. It is uncertain whether or not gas giant planet formation is common, because most protoplanetary disks may dissipate before solid planetary cores can grow large enough to gravitationally trap substantial quantities of gas. Ongoing theoretical modeling of accretion of giant planet atmospheres, as well as observations of protoplanetary disks, will help decide this issue. Observations of extrasolar planets around main sequence stars can only provide a lower limit on giant planet formation frequency . This is because after giant planets form, gravitational interactions with material within the protoplanetary disk may cause them to migrat inwards and be lost to the central star. The core instability model can only produce planets greater than a few jovian masses within protoplanetary disks that are more viscous than most such disks are believed to be. Thus, few brown dwarves (objects massive enough to undergo substantial deuterium fusion, estimated to occur above approximately 13 jovian masses) are likely to be formed in this manner. Most brown dwarves, as well as an unknown number of free-floating objects of planetary mass, are probably formed as are stars, by the collapse of extended gas/dust clouds into more compact objects.

  12. Management of giant liver hemangiomas: an update.

    PubMed

    Hoekstra, Lisette T; Bieze, Matthanja; Erdogan, Deha; Roelofs, Joris J T H; Beuers, Ulrich H W; van Gulik, Thomas M

    2013-03-01

    Liver hemangiomas are the most common benign liver tumors and are usually incidental findings. Liver hemangiomas are readily demonstrated by abdominal ultrasonography, computed tomography or magnetic resonance imaging. Giant liver hemangiomas are defined by a diameter larger than 5 cm. In patients with a giant liver hemangioma, observation is justified in the absence of symptoms. Surgical resection is indicated in patients with abdominal (mechanical) complaints or complications, or when diagnosis remains inconclusive. Enucleation is the preferred surgical method, according to existing literature and our own experience. Spontaneous or traumatic rupture of a giant hepatic hemangioma is rare, however, the mortality rate is high (36-39%). An uncommon complication of a giant hemangioma is disseminated intravascular coagulation (Kasabach-Merritt syndrome); intervention is then required. Herein, the authors provide a literature update of the current evidence concerning the management of giant hepatic hemangiomas. In addition, the authors assessed treatment strategies and outcomes in a series of patients with giant liver hemangiomas managed in our department.

  13. Bayesian Inference of Giant Exoplanet Physics

    NASA Astrophysics Data System (ADS)

    Thorngren, Daniel; Fortney, Jonathan J.

    2017-01-01

    The physical processes within a giant planet directly set its observed radius for a given mass, age, and insolation. The important aspects are the planet’s bulk composition and its interior thermal evolution. By studying many giant planets as an ensemble, we can gain insight into this physics. We demonstrate two novel examples here. We examine 50 cooler transiting giant planets, whose insolation is sufficiently low (T_eff < 1000 K) that they are not affected by the hot Jupiter radius inflation effect. For these planets, the thermal evolution is relatively well understood, and we show that the bulk planet metallicity increases with the total planet mass, which directly impacts plans for future atmospheric studies. We also examine the relation with stellar metallicity and discuss how these relations place new constraints on the core accretion model of planet formation. Our newest work seeks to quantify the flow of energy into hot Jupiters needed to explain their enlarged radii, in addition to their bulk composition. Because the former is related to stellar insolation and the latter is related to mass, we are able to create a hierarchical Bayesian model to disentangle the two effects in our sample of ~300 transiting giant planets. Our results show conclusively that the inflation power is not a simple fraction of stellar insolation: instead, the power increases with incident flux at a much higher rate. We use these results to test published models of giant planet inflation and to provide accurate empirical mass-radius relations for giant planets.

  14. Circulating Fibroblast Growth Factor 23 Is Associated with Angiographic Severity and Extent of Coronary Artery Disease

    PubMed Central

    Xiao, Yunjun; Peng, Chaoqiong; Huang, Wei; Zhang, Jinzhou; Xia, Min; Zhang, Yuan; Ling, Wenhua

    2013-01-01

    Objective Fibroblast growth factor 23 (FGF23) is a circulating regulator of phosphate and vitamin D metabolism and is associated with coronary artery calcification, and has been implicated in the pathogenesis of cardiovascular disease. The aim of this study was to determine whether circulating FGF23 concentration is independently associated with the severity and extent of coronary artery disease in patients undergoing coronary angiography. Method A cross-sectional design was used to examine the relationship between serum FGF23 and the severity and extent of coronary artery stenosis in 2076 patients undergoing coronary angiography (1263 male and 813 female, mean aged 62.5 years). Subgroup analyses were performed to assess the associations between FGF23 and coronary arterial plaque characteristics evaluated by intravascular ultrasound and 12-month incidence of target vessel revascularization (TVR) and target lesion revascularization (TLR). Findings We found a stepwise increase of serum FGF23 concentrations in patients with mild, moderate, severe stenosis or with increased number of stenotic vessels compared with those without stenosis (P<0.001). Serum FGF23 concentration was positively correlated with stenosis scores as the global index of the severity and extent of coronary artery stenosis in both male and female (r = 0.315 and r = 0.291, P<0.001). In multiple regression analyses, serum FGF23 concentration was a significant determinant of the stenosis scores independent of other traditional risk factors (standardized β = 0.326, P<0.001). Furthermore, subgroup analyses found FGF23 was significantly associated with plaque and dense calcium volumes. Multiple logistic regression analyses showed that serum FGF23 levels were significantly independent predictors of TVR and TLR. Conclusions We report an independent association between circulating FGF23 concentration and the severity and extent of coronary artery stenosis in the coronary angiographic patients

  15. Circulating fibroblast growth factor 23 is associated with angiographic severity and extent of coronary artery disease.

    PubMed

    Xiao, Yunjun; Peng, Chaoqiong; Huang, Wei; Zhang, Jinzhou; Xia, Min; Zhang, Yuan; Ling, Wenhua

    2013-01-01

    Fibroblast growth factor 23 (FGF23) is a circulating regulator of phosphate and vitamin D metabolism and is associated with coronary artery calcification, and has been implicated in the pathogenesis of cardiovascular disease. The aim of this study was to determine whether circulating FGF23 concentration is independently associated with the severity and extent of coronary artery disease in patients undergoing coronary angiography. A cross-sectional design was used to examine the relationship between serum FGF23 and the severity and extent of coronary artery stenosis in 2076 patients undergoing coronary angiography (1263 male and 813 female, mean aged 62.5 years). Subgroup analyses were performed to assess the associations between FGF23 and coronary arterial plaque characteristics evaluated by intravascular ultrasound and 12-month incidence of target vessel revascularization (TVR) and target lesion revascularization (TLR). We found a stepwise increase of serum FGF23 concentrations in patients with mild, moderate, severe stenosis or with increased number of stenotic vessels compared with those without stenosis (P<0.001). Serum FGF23 concentration was positively correlated with stenosis scores as the global index of the severity and extent of coronary artery stenosis in both male and female (r = 0.315 and r = 0.291, P<0.001). In multiple regression analyses, serum FGF23 concentration was a significant determinant of the stenosis scores independent of other traditional risk factors (standardized β = 0.326, P<0.001). Furthermore, subgroup analyses found FGF23 was significantly associated with plaque and dense calcium volumes. Multiple logistic regression analyses showed that serum FGF23 levels were significantly independent predictors of TVR and TLR. We report an independent association between circulating FGF23 concentration and the severity and extent of coronary artery stenosis in the coronary angiographic patients. Future studies are needed to elucidate the

  16. Variant angina and coronary artery spasm: the clinical spectrum, pathophysiology, and management.

    PubMed

    Kusama, Yoshiki; Kodani, Eitaro; Nakagomi, Akihiro; Otsuka, Toshiaki; Atarashi, Hirotsugu; Kishida, Hiroshi; Mizuno, Kyoichi

    2011-01-01

    variant angina is favorable, if early complications can be overcome. However, because coronary artery spasm cannot be suppressed in some patients, even with multiple medications, medications to suppress intractable coronary artery spasm must be developed.

  17. Increased serum levels of fetuin B in patients with coronary artery disease.

    PubMed

    Zhu, Kefu; Wang, Yuming; Shu, Pengqin; Zhou, Qinyi; Zhu, Jinzhou; Zhou, Wenjing; Du, Changqing; Xu, Chenkai; Liu, Xiaowei; Tang, Lijiang

    2017-08-19

    Recent evidence indicates a pivotal role for fetuin B, one of the cystatin superfamily of cysteine protease inhibitors, in the pathogenesis of metabolic diseases. This study investigated whether serum fetuin B levels are associated with the presence of coronary artery disease. Serum fetuin B levels were assessed in 87 patients with coronary artery disease (41 with acute coronary syndromes and 46 with stable angina pectoris) and 87 healthy controls using an enzyme-linked immunosorbent assay. The association of serum fetuin B levels with cardiac risk factors was analyzed. Serum fetuin B levels were significantly higher in patients with coronary artery disease than those in healthy controls (90.7 ± 32.1 vs. 110.0 ± 32.7 μg/ml, P < 0.001), extremely elevated in group with acute coronary syndromes (115.0 ± 35.2 μg/ml). Pearson correlation analysis showed that serum fetuin B levels were positively associated with the levels of total cholesterol (r = 0.276, P < 0.001), low-density lipoprotein cholesterol (r = 0.363, P < 0.001), and fasting blood glucose (r = 0.159, P < 0.05). In addition, multiple logistic regression analyses revealed that fetuin B was independently associated with the presence of coronary artery disease (OR, 1.019; 95% CI, 1.009 to 1.029; P < 0.001) and acute coronary syndromes (OR, 1.017; 95% CI, 1.006 to 1.028; P < 0.01). Our data revealed that high fetuin B levels are associated with the presence of coronary artery disease and acute coronary syndromes, and that fetuin B may serve as a potential biomarker for coronary artery disease.

  18. Transposition of Great Arteries with Intramural Coronary Artery: Experience with a Modified Surgical Technique

    PubMed Central

    Mishra, Amit; Jain, Anil; Hinduja, Manish; Wadhawa, Vivek; Patel, Ramesh; Vaidhya, Nikunj; Rodricks, Dayesh; Patel, Hardik

    2016-01-01

    Objective: Transposition of the great arteries is a common congenital heart disease. Arterial switch is the gold standard operation for this complex heart disease. Arterial switch operation in the presence of intramural coronary artery is surgically the most demanding even for the most experienced hands. We are presenting our experience with a modified technique for intramural coronary arteries in arterial switch operation. Methods: This prospective study involves 450 patients undergoing arterial switch operation at our institute from April 2006 to December 2013 (7.6 years). Eighteen patients underwent arterial switch operation with intramural coronary artery. The coronary patterns and technique used are detailed in the text. Results: The overall mortality found in the subgroup of 18 patients having intramural coronary artery was 16% (n=3). Our first patient had an accidental injury to the left coronary artery and died in the operating room. A seven-day old newborn died from intractable ventricular arrhythmia fifteen hours after surgery. Another patient who had multiple ventricular septal defects with type B arch interruption died from residual apical ventricular septal defect and sepsis on the eleventh postoperative day. The remainder of the patients are doing well, showing a median follow-up duration of 1235.34±815.26 days (range 369 - 2730). Conclusion: Transposition of the great arteries with intramural coronary artery is demanding in a subset of patients undergoing arterial switch operation. We believe our technique of coronary button dissection in the presence of intramural coronary arteries using coronary shunt is simple and can be a good addition to the surgeons' armamentarium. PMID:27074270

  19. Coronary computed tomography angiography in coronary artery disease

    PubMed Central

    Sun, Zhonghua; Ng, Kwan-Hoong

    2011-01-01

    AIM: To investigate the research directions of coronary computed tomography (CT) angiography in the diagnosis of coronary artery disease (CAD) based on a systematic review of the literature. METHODS: A search of articles on coronary CT angiography in the diagnosis of CAD was performed during a 6-year-period between 2005 and 2010 from five main radiology journals namely, Radiology, American Journal of Roentgenology, European Radiology, European Journal of Radiology and British Journal of Radiology. Analysis of the references was focused on the research directions of coronary CT angiography with regard to the type of studies in terms of diagnostic value, application of dose-reduction strategies and resultant effective radiation doses with use of these techniques. RESULTS: One hundred and forty two studies were identified which met the selection criteria and were included in the analysis. 64-slice CT (single source and dual-source CT) dominated 78% of the coronary CT angiography studies. Prior to 2007, research was focused on the diagnostic value of coronary CT angiography, but since 2008 more attention has been paid to radiation dose reduction. Radiation dose was reported in 64 studies, representing 45% of total studies published in the five radiology journals. Various dose-saving strategies have been implemented and prospective electrocardiography-triggering and high pitch techniques were found to be the most effective approaches for radiation dose reduction, with the corresponding mean effective dose being 3.5 ± 1.9 mSv and 1.7 ± 0.6 mSv, respectively. CONCLUSION: This review shows that the current research in coronary CT angiography has shifted from the previous focus on diagnostic accuracy in CAD to more emphasis on radiation dose reduction. PMID:21949572

  20. A New Survey for Giant Arcs

    SciTech Connect

    Hennawi, Joseph F.; Gladders, Michael D.; Oguri, Masamune; Dalal, Neal; Koester, Benjamin; Natarajan, Priyamvada; Strauss, Michael A.; Inada, Naohisa; Kayo, Issha; Lin, Huan; Lampeitl, Hubert; Annis, James; Bahcall, Neta A.; Schneider, Donald P.

    2006-11-15

    We report on the first results of an imaging survey to detect strong gravitational lensing targeting the richest clusters selected from the photometric data of the Sloan Digital Sky Survey (SDSS) with follow-up deep imaging observations from the Wisconsin Indiana Yale NOAO (WIYN) 3.5m telescope and the University of Hawaii 88-inch telescope (UH88). The clusters are selected from an area of 8000 deg{sup 2} using the Red Cluster Sequence technique and span the redshift range 0.1 {approx}< z {approx}< 0.6, corresponding to a comoving cosmological volume of {approx} 2Gpc{sup 3}. Our imaging survey thus targets a volume more than an order of magnitude larger than any previous search. A total of 240 clusters were imaged of which 141 had sub-arcsecond image quality. Our survey has uncovered 16 new lensing clusters with definite giant arcs, an additional 12 systems for which the lensing interpretation is very likely, and 9 possible lenses which contain shorter arclets or candidate arcs which are less certain and will require further observations to confirm their lensing origin. The number of new cluster lenses detected in this survey is likely > 30. Among these new systems are several of the most dramatic examples of strong gravitational lensing ever discovered with multiple bright arcs at large angular separation. These will likely become 'poster-child' gravitational lenses similar to Abell 1689 and CL0024+1654. The new lenses discovered in this survey will enable future systematic studies of the statistics of strong lensing and its implications for cosmology and our structure formation paradigm.