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Despite significant advancements in managing acute ST-segment elevation myocardial infarctions, the prevalence of heart failure has not decreased. Emerging paradigms with a focus on reducing infarct size show promising evidence in the improvement of the incidence of heart failure after experiencing acute coronary syndromes. Limiting infarct size has been the focus of multiple clinical trials over the past decades and has led to left ventricular (LV) unloading as a potential mechanism. Contemporary use of microaxial flow devices for LV unloading has suggested improvement in mortality in acute myocardial infarction complicated by cardiogenic shock. This review focuses on clinical data demonstrating evidence of infarct size reduction and highlights ongoing clinical trials that provide a new therapeutic approach to the management of acute myocardial infarction.
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Função Ventricular Esquerda , Humanos , Resultado do Tratamento , Coração Auxiliar , Infarto do Miocárdio/terapia , Infarto do Miocárdio/fisiopatologia , Infarto do Miocárdio/epidemiologia , Insuficiência Cardíaca/terapia , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/epidemiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Infarto do Miocárdio com Supradesnível do Segmento ST/fisiopatologia , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Fatores de Risco , Recuperação de Função Fisiológica , Miocárdio/patologiaRESUMO
The main objective of the present study is to explore the effects of electromagnetohydrodynamics electroosmotic flow of hybrid nanofluid through circular cylindrical microchannels. An analysis of hybrid nanofluid consisting of four different nanomaterials i.e., single and multiwall carbon nanotubes, silver, and copper is carried out. Yamada-Ota model is employed for the single and multi wall carbon nanotubes, whereas, Xue model is used for the Silver and Copper hybrid nanofluid for specifying the thermal conductivity. The imposed pressure gradient, electromagnetic field and electroosmosis actuated the fluid flow. The flow of heat transfer and Nusselt number with the account of various effects of Joule heating and viscous dissipation under the circumstances of constant heat flux are discussed graphically. The governing system of equations is molded into a system of coupled, nonlinear ordinary differential equations. The shooting technique is used to extract the numerical solutions of the converted system of equations. Also, the outturn of different parameters like Hartman number, the strength of lateral direction electric field, EDL (electric double layer) electrokinetic width, Joule heating parameters on the temperature, and velocity are investigated. The conversion of simple fluid to hybrid nanofluid has greatly alteration in the present model. It has enhanced the thermal properties of fluid. It is also noted that [Formula: see text] based hybrid nanofluid has most influential impact on Nusselt number, temperature distribution and velocity of the fluid. This attempt is useful for the designing of effectual electromagnetic appliances and exquisite.
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Cadmium (Cd) toxicity reduces growth and yield of crops grown in metal-polluted sites. Research was conducted to estimate the potential of hydrogen sulphide (H2 S) to mitigate toxicity caused by Cd in fenugreek seedlings (Trigonella foenum-graecum L.). Different concentrations of CdCl2 (Cd1-1 mM, Cd2-1.5 mM, Cd3-2mM) and H2 S (HS1-100 µM, HS2-150 µM, HS3-200 µM) were assessed. Seeds of fenugreek were primed with sodium hydrosulphide (NaHS), as H2 S donor. Seedlings growing in Cd-spiked media treated with H2 S were harvested after 2 weeks. Cd stress affected growth of fenugreek seedlings. Cd toxicity decreased leaf relative water content (LRWC), intercellular CO2 concentration, net photosynthesis, stomatal conductance and transpiration. However, application of H2 S significantly improved seedling morphological attributes by increasing the activity of antioxidant enzymes, i.e. APX, CAT and SOD, in Cd-contaminated soil. H2 S treatment also regulated phenolic and flavonoid content. H2 S-induced biosynthesis of spermidine (Spd) and putrescine (Put) could account for the enhancement of growth and physiological performance of fenugreek seedlings under Cd stress. H2 S treatment also reduced H2 O2 production (38%) and electrolyte leakage (EL, 51%) in seedlings grown in different concentrations of Cd. It is recommended to evaluate the efficacy of H2 S in alleviating Cd toxicity in other crop plants.
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Sulfeto de Hidrogênio , Trigonella , Antioxidantes/metabolismo , Cádmio/toxicidade , Peróxido de Hidrogênio , Sulfeto de Hidrogênio/farmacologia , Estresse Oxidativo , Poliaminas , Plântula , Trigonella/metabolismoRESUMO
An 82-year-old lady was found on the floor of her home, confused and surrounded by vomitus. She had a past medical history of type II diabetes, hypothyroidism, previous left total hip replacement, and previous hip fracture treated with right dynamic screw fixation. Prior to the current presentation she had been living alone, mobilizing independently with a walking stick and self-caring for her activities of daily living. She was last seen by her daughter on the previous day, and reported no concerning symptoms.
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Artroplastia de Quadril , Confusão , Fraturas do Quadril , Atividades Cotidianas , Idoso de 80 Anos ou mais , Encéfalo , Confusão/etiologia , Diabetes Mellitus Tipo 2 , Feminino , HumanosRESUMO
This is a T2 weighted image (T2WI). In T2WI compartments filled with fluid appear brighter (as is the case of the CSF in the lateral ventricles). On the contrary, tissues with a high fat content appear as dark. This T2WI demonstrates layering of debris (figure 2- marked red star) in the occipital horn of the lateral ventricles. In this particular patient, the complete MRI report additionally demonstrated that the debris did not show a high T1 signal, demonstrated diffusion restriction, and a high FLAIR sequence. There was also restricting material observed in the fourth ventricle and the sylvian fissures bilaterally. There were no parenchymal changes or pathological contrast enhancements within the brain tissue. Whilst this appearance could represent blood, the appearance of the debrinous material itself was more in keeping with infective/pus material within the ventricles suggestive of ventriculitis.
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Ventrículos Cerebrais , Imageamento por Ressonância Magnética , Encéfalo , Ventrículos Cerebrais/diagnóstico por imagem , Ventrículos Cerebrais/patologia , Ventrículos do Coração , HumanosRESUMO
This study deals with the steady laminar slip flow of an incompressible Newtonian fluid in a non-uniform permeable channel under the influence of transverse magnetic field. The reabsorption through the wall is accounted for by considering flux as a function of downstream distance. The non-linear coupled partial differential equations of motion are first transformed into a single fourth order partial differential equation and then solved analytically using Adomain decomposition method. Effects of pertinent parameters on different flow properties are discussed by plotting graphs. Results reveal that magnetic field considerably influences the behavior of flow.
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The impact of nonlinear thermal radiation in the flow of micropolar nanofluid past a nonlinear vertically stretching surface is investigated. The electrically conducting fluid is under the influence of magnetohydrodynamics, heat generation/absorption and mixed convection in the presence of convective boundary condition. The system of differential equations is solved numerically using the bvp4c function of MATLAB. To authenticate our results, two comparisons with already studied problems are also conducted and an excellent concurrence is found; hence reliable results are being presented. Complete deliberation for magnetite nanofluid with Ferric Oxide (Fe3O4) nanoparticles in the water-based micropolar nanofluid is also given to depict some stimulating phenomena. The effect of assorted parameters on velocity, homogeneous-heterogeneous reactions, temperature and micropolar velocity profiles are discussed and examined graphically. Moreover, graphical illustrations for the Nusselt number and Skin friction are given for sundry flow parameters. It is examined that temperature distribution and its associated boundary layer thickness increase for mounting values of the magnetic parameter. Additionally, it is detected that the Nusselt number decays when we increase the values of the Biot number.
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A mathematical model is envisaged to study the axisymmetric steady magnetohydrodynamic (MHD) Carreau nanofluid flow under the influence of nonlinear thermal radiation and chemical reaction past a radially stretched surface. Impact of heat generation/absorption with newly introduced zero mass flux condition of nanoparticles at the sheet is an added feature towards novelty of the problem. Further, for nanofluid the most recently organized model namely Buongiorno's model is assumed that comprises the effects thermophoresis and Brownian motion. Utilizing suitable self-similar transformations, the set of partial differential equations with high nonlinearity are converted into a dimensionless system of ordinary differential equations. Set of these transmuted equations are numerically solved by MATLAB built-in function bvp4c. Impact of germane parameters on all involved profiles are plotted to examine the heat and mass transfer characteristics. This study reveals that the temperature distribution is an escalating function of the heat generation and nonlinear radiation parameters. Also, it is noted that the incrementing values of chemical reaction parameter lowers the nanoparticles concentration profile. A comparison of the present investigation with already published explorations in limiting case is also added to authenticate the presented results; hence reliable results are being presented.
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This is the 32nd installment of a series that will highlight one case per publication issue from the bank of cases available online as part of the American Society of Emergency Radiology (ASER) educational resources. Our goal is to generate more interest in and use of our online materials. To view more cases online, please visit the ASER Core Curriculum and Recommendations for Study online at: http://www.erad.org/page/CCIP_TOC.
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Fraturas Orbitárias/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade , Fraturas Orbitárias/cirurgiaRESUMO
A numerical investigation of steady three dimensional nanofluid flow carrying effects of gyrotactic microorganism with anisotropic slip condition along a moving plate near a stagnation point is conducted. Additionally, influences of Arrhenius activation energy, joule heating accompanying binary chemical reaction and viscous dissipation are also taken into account. A system of nonlinear differential equations obtained from boundary layer partial differential equations is found by utilization of apposite transformations. RK fourth and fifth order technique of Maple software is engaged to acquire the solution of the mathematical model governing the presented fluid flow. A Comparison with previously done study is also made and a good agreement is achieved with existing results; hence reliable results are being presented. Evaluations are carried out for involved parameters graphically against velocity, temperature, concentration fields, microorganism distribution, density number, local Nusselt and Sherwood numbers. It is detected that microorganism distribution exhibit diminishing behavior for rising values of bio-convection Lewis and Peclet numbers.
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Bactérias/crescimento & desenvolvimento , Simulação por Computador , Campos Magnéticos , Modelos Teóricos , Nanotecnologia , Análise Numérica Assistida por Computador , Algoritmos , Anisotropia , Hidrodinâmica , Temperatura , ViscosidadeRESUMO
A mathematical model has been developed to examine the magneto hydrodynamic micropolar nanofluid flow with buoyancy effects. Flow analysis is carried out in the presence of nonlinear thermal radiation and dual stratification. The impact of binary chemical reaction with Arrhenius activation energy is also considered. Apposite transformations are engaged to transform nonlinear partial differential equations to differential equations with high nonlinearity. Resulting nonlinear system of differential equations is solved by differential solver method in Maple software which uses Runge-Kutta fourth and fifth order technique (RK45). To authenticate the obtained results, a comparison with the preceding article is also made. The evaluations are executed graphically for numerous prominent parameters versus velocity, micro rotation component, temperature, and concentration distributions. Tabulated numerical calculations of Nusselt and Sherwood numbers with respective well-argued discussions are also presented. Our findings illustrate that the angular velocity component declines for opposing buoyancy forces and enhances for aiding buoyancy forces by changing the micropolar parameter. It is also found that concentration profile increases for higher values of chemical reaction parameter, whereas it diminishes for growing values of solutal stratification parameter.
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Hidrodinâmica , Magnetismo , Nanopartículas/química , Análise Numérica Assistida por ComputadorRESUMO
PURPOSE: To evaluate the safety and efficacy of a novel optical coherence tomography (OCT)-guided atherectomy catheter in treating patients with symptomatic femoropopliteal disease. METHODS: The VISION trial ( ClinicalTrials.gov identifier NCT01937351) was a single-arm, multicenter, global investigational device exemption study enrolling 158 subjects (mean age 67.2±10.5 years; 87 men) across 20 participating sites. In this cohort, 198 lesions were treated with an average length of 53±40 mm using the Pantheris catheter alone or Pantheris + adjunctive therapy. The primary safety endpoint was the composite of major adverse events (MAEs) through 6 months (objective performance goal 43.2%). Technical success (primary efficacy outcome) was defined as the percent of target lesions with a residual diameter stenosis ≤50% after treatment with the Pantheris device alone (objective performance goal 87.0%). Procedural success was defined as reduction in stenosis to ≤30% after Pantheris ± adjunctive therapy. Tissue specimens retrieved from each treated lesion were histologically analyzed to evaluate the accuracy and precision of OCT image guidance. RESULTS: The primary efficacy outcome was achieved in 192 (97.0%) of the 198 lesions treated with the Pantheris catheter. Across all lesions, mean diameter stenosis was reduced from 78.7%±15.1% at baseline to 30.3%±11.8% after Pantheris alone (p<0.001) and to 22.4%±9.9% after Pantheris ± adjunctive therapy (p<0.001). Of the 198 target lesions, 104 (52.5%) were treated with the Pantheris alone, 84 (42.4%) were treated with Pantheris + adjunctive angioplasty, and 10 (5.1%) with Pantheris + angioplasty + stenting. The composite MAE outcome through 6 months occurred in 25 (16.6%) of 151 subjects. There were no clinically significant perforations, 1 (0.5%) catheter-related dissection, 4 (2%) embolic events, and a 6.4% clinically driven target lesion revascularization rate at 6 months. The 40-lesion chronic total occlusion (CTO) subset (mean lesion length 82±38 mm) achieved a similar significant reduction in stenosis to 35.5%±13.6% after Pantheris alone (p<0.001). Histological analysis of atherectomy specimens confirmed <1% adventitia in 82.1% of the samples, highlighting the precision of OCT guidance. Characterization of the OCT-guided lesions revealed evidence of an underestimation of disease burden when using fluoroscopy. CONCLUSION: OCT-guided atherectomy for femoropopliteal disease is safe and effective. Additionally, the precision afforded by OCT guidance leads to greater removal of plaque during atherectomy while sparing the adventitia.
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Aterectomia/métodos , Artéria Femoral/diagnóstico por imagem , Extremidade Inferior/irrigação sanguínea , Doença Arterial Periférica/terapia , Artéria Poplítea/diagnóstico por imagem , Tomografia de Coerência Óptica/métodos , Idoso , Angioplastia/instrumentação , Aterectomia/efeitos adversos , Aterectomia/instrumentação , Competência Clínica , Constrição Patológica , Desenho de Equipamento , Feminino , Artéria Femoral/fisiopatologia , Alemanha , Humanos , Curva de Aprendizado , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/fisiopatologia , Artéria Poplítea/fisiopatologia , Valor Preditivo dos Testes , Estudos Prospectivos , Stents , Fatores de Tempo , Tomografia de Coerência Óptica/instrumentação , Resultado do Tratamento , Estados Unidos , Dispositivos de Acesso VascularRESUMO
Materials at high pressures and temperatures are of great current interest for warm dense matter physics, planetary sciences, and inertial fusion energy research. Shock-compression equation-of-state data and optical reflectivities of the fluid dense oxide, Gd3Ga5O12 (GGG), were measured at extremely high pressures up to 2.6 TPa (26 Mbar) generated by high-power laser irradiation and magnetically-driven hypervelocity impacts. Above 0.75 TPa, the GGG Hugoniot data approach/reach a universal linear line of fluid metals, and the optical reflectivity most likely reaches a constant value indicating that GGG undergoes a crossover from fluid semiconductor to poor metal with minimum metallic conductivity (MMC). These results suggest that most fluid compounds, e.g., strong planetary oxides, reach a common state on the universal Hugoniot of fluid metals (UHFM) with MMC at sufficiently extreme pressures and temperatures. The systematic behaviors of warm dense fluid would be useful benchmarks for developing theoretical equation-of-state and transport models in the warm dense matter regime in determining computational predictions.
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AIM: Concentric hypertrophy is thought to transition to left ventricular (LV) dilatation and systolic failure in the presence of long standing hypertension (HTN). Whether or not this transition routinely occurs in humans is unknown. METHODS: We consecutively enrolled African American patients hospitalized for acute decompensated volume overload heart failure (HF) in this retrospective study. All patients had a history of HTN and absence of obstructive coronary disease. Patients were divided into those with normal left ventricular ejection fraction (LVEF) and reduced LVEF. LV dimensions were measured according to standard ASE recommendations. LV mass was calculated using the ASE formula with Devereux correction. RESULTS: Patients with normal LVEF HF were significantly older, female and had a longer duration of HTN with higher systolic blood pressure on admission. LV wall thickness was similarly elevated in both groups. LV mass was elevated in both groups however was significantly greater in the reduced LVEF HF group compared to the normal LVEF HF group. Furthermore, gender was an independent predictor for LV wall thickness in normal LVEF HF group. CONCLUSION: In African American patients with HF our study questions the paradigm that concentric hypertrophy transitions to LV dilatation and systolic failure in the presence of HTN. Genetics and gender likely play a role in an individual's response to long standing hypertension.
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Negro ou Afro-Americano , Insuficiência Cardíaca/etnologia , Hipertensão/etnologia , Hipertrofia Ventricular Esquerda/etnologia , Idoso , Idoso de 80 Anos ou mais , Pressão Sanguínea , Progressão da Doença , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Hospitalização , Humanos , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Hipertrofia Ventricular Esquerda/diagnóstico , Hipertrofia Ventricular Esquerda/fisiopatologia , Masculino , Pessoa de Meia-Idade , New Jersey/epidemiologia , Estudos Retrospectivos , Volume Sistólico , Sístole , Função Ventricular Esquerda , Remodelação VentricularRESUMO
BACKGROUND: Engagement of the brachiocephalic vessels during carotid angiography is performed using a JR-4, Vitek, or other catheters with variable success. These catheters require additional training for safe manipulation. In this study, we evaluated the feasibility of using the 3D RCA catheter which requires less manipulation in the aorta, and less training, to engage the brachiocephalic vessels. METHODS: We prospectively studied consecutive high-risk patients undergoing carotid angiography and stenting from August 2005 to March 2009 at our institution. A baseline aortogram was performed to define the arch type in all patients. Engagement of the brachiocephalic vessels was initially attempted using the 3D RCA catheter using the following approach: The 3D RCA catheter is positioned in the ascending aorta beyond the brachiocephalic vessels take off. The natural curve of the catheter usually makes it point cephalad spontaneously in most patients and as it is gently withdrawn it engages the aortic arch vessels without much manipulation. Clinical follow-up with a neurological exam was performed at one month and six months. RESULTS: A total of 52 patients were enrolled in this study. Baseline demographics and aortic arch types encountered are listed in Table I. The 3D RCA catheter readily engaged the brachiocephalic vessels in 50/52 patients (96.0 %) in our cohort of patients undergoing carotid angiography. Of the 52 patients, 43 subsequently underwent carotid stenting and shuttle sheath placement was facilitated by initial engagement of the relevant common carotid artery with the 3D RCA catheter. There was one transient neurologic complication that resolved by 5 days in a patient that underwent carotid stenting. CONCLUSIONS: The 3D RCA catheter can be used with a high success rate to engage the brachiocephalic vessels in all 3 arch types, including a bovine arch during carotid angiography and facilitates shuttle sheath placement for carotid stenting. It requires less manipulation and therefore may be a more operator friendly approach. © 2010 Wiley-Liss, Inc.
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Angiografia/instrumentação , Angioplastia/instrumentação , Tronco Braquiocefálico/diagnóstico por imagem , Doenças das Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/terapia , Catéteres , Stents , Idoso , Angiografia/efeitos adversos , Angioplastia/efeitos adversos , Aorta Torácica/anormalidades , Aorta Torácica/diagnóstico por imagem , Aortografia , Desenho de Equipamento , Estudos de Viabilidade , Feminino , Humanos , Masculino , Teste de Materiais , New Jersey , Resultado do TratamentoRESUMO
Plastic track detectors were used to measure the radon concentration and exhalation rate from the soil samples. The samples were collected from areas of southern Punjab, Pakistan. In a laboratory experiment, passive alpha dosemeters were installed inside cylindrical bottles containing the soil samples. The radon concentrations and the radon exhalation rate were found in the ranges of 34 +/- 7 to 260 +/- 42 Bq m(-3) and 38 +/- 8 to 288 +/- 46 mBq m(-2) h(-1), respectively. The on-site measurements of radon in the soil gas were also carried out in these areas using a scintillation alpha counter. The concentration of radon in the soil gas was found in the range of 423 +/- 82-3565 +/- 438 Bq m(-3).
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Contaminação Radioativa do Ar/análise , Monitoramento de Radiação/métodos , Radônio/análise , Poluentes Radioativos do Solo/análise , Gases/análise , Paquistão , Doses de RadiaçãoRESUMO
In many patients, the treatment of heart failure (HF) cannot be optimized because of pre-existing or treatment-induced hypotension. Midodrine, a peripheral alpha1-adrenergic agonist may allow for up-titration of neurohormonal antagonist therapy leading to improved outcomes. Ten consecutive patients with HF due to systolic dysfunction and symptomatic hypotension interfering with optimal medical therapy were started on midodrine. After a 6-month follow-up, a higher percentage of patients were on optimal HF therapy (angiotensin-converting enzyme inhibitor/angiotensin receptor blocker mg % of optimal dose 20% vs 57.5%; P<.001) (beta-blockers mg % optimal dose 37.5% vs 75%; P<.001) (spironolactone/eplerenone mg % 43.7% vs 95%; P<.001). This led to an improvement in left ventricular ejection fraction (baseline 24+/-9.4 vs 32.2+/-9.9; P<.001) and clinical outcomes, with a significant reduction in total hospital admissions (32 vs 12; P=.02) and total hospital days (150 vs 58; P=.02).
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Agonistas alfa-Adrenérgicos/uso terapêutico , Insuficiência Cardíaca/tratamento farmacológico , Hipotensão/tratamento farmacológico , Midodrina/uso terapêutico , Agonistas alfa-Adrenérgicos/efeitos adversos , Cardiomiopatias/complicações , Cardiomiopatias/tratamento farmacológico , Diástole , Feminino , Insuficiência Cardíaca/etiologia , Hospitalização/estatística & dados numéricos , Humanos , Hipotensão/complicações , Masculino , Pessoa de Meia-Idade , Midodrina/efeitos adversos , Isquemia Miocárdica/complicações , Isquemia Miocárdica/tratamento farmacológico , Estudos Prospectivos , Volume Sistólico/efeitos dos fármacos , Sístole , Disfunção Ventricular Direita/complicações , Disfunção Ventricular Direita/tratamento farmacológico , Função Ventricular Esquerda/efeitos dos fármacosRESUMO
Toxoplasmosis, an infection caused by Toxoplasma (T.) gondii Apicomplexa protozoan, is widespread in humans and other animal species, having already been reported in many countries and different climates. In Pakistan, no data is available on this aspect among food animals. This study was undertaken to determine the seroprevalence of T. gondii infection in sheep and goats. A total of 200 serum samples from sheep and goats, were collected from urban area of Rahim Yar Khan (Punjab), Pakistan and tested for Toxoplasmosis with a commercial latex agglutination kit (Eiken Chemical Co., Ltd. Japan). The overall seroprevalence of Toxoplasmosis was 19%. Goats had a significantly higher (p < 0.01) prevalence (25.4%) as compared to the sheep (11.2%); and higher (p < 0.01) in the female (24%) than in the males (19%) for both species. In the present study the male (both in sheep and goat) are found less seropositive T. gondii (OR = 0.23; 99% C.I. = 0.01, 1.81) as compared to female sheep and goat. The prevalence was significantly higher (p < 0.01) in adult sheep than younger animals. Among both the sheep and goats the group from 1-1.5 years are highly seropositive (OR = 1.75; 99% C.I. = 0.47, 6.51) as compared to the group less than one year of age followed by the 2-2.5 years age group (OR = 1.63; 99% C.I. = 0.50, 5.74) whereas group with more than 3 years of age least seropositive.
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Doenças das Cabras/epidemiologia , Doenças das Cabras/parasitologia , Doenças dos Ovinos/epidemiologia , Doenças dos Ovinos/parasitologia , Toxoplasma , Toxoplasmose Animal/epidemiologia , Fatores Etários , Testes de Aglutinação/veterinária , Animais , Feminino , Cabras , Masculino , Paquistão/epidemiologia , Estudos Soroepidemiológicos , OvinosRESUMO
We report a case of a 52-year-old man with multiple myeloma and rapidly progressive heart failure who died unexpectedly from a probable arrhythmia. Postmortem examination revealed infiltrative amyloid cardiomyopathy, a rare cause of predominantly diastolic myocardial disease. Cardiac amyloidosis should be considered in any patient presenting with congestive heart failure, preserved systolic function, and a discrepancy between a low QRS voltage on electrocardiography and an apparent left ventricular hypertrophy on sonogram. The pattern of left ventricular diastolic dysfunction changes during the course of amyloidosis and the classically described restrictive physiology occurs only in advanced stages of the disease.
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Amiloidose/complicações , Amiloidose/genética , Cardiomiopatia Restritiva/complicações , Cardiomiopatia Restritiva/genética , Mieloma Múltiplo/complicações , Amiloidose/diagnóstico , Arritmias Cardíacas/complicações , Cardiomiopatia Restritiva/diagnóstico , Ecocardiografia , Evolução Fatal , Insuficiência Cardíaca/complicações , Ventrículos do Coração/diagnóstico por imagem , Humanos , Hipertrofia Ventricular Esquerda/complicações , Hipertrofia Ventricular Esquerda/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/tratamento farmacológico , Ultrassonografia DopplerRESUMO
OBJECTIVE: Techniques for surgical repair of Trans-Atlantic Inter-Society Consensus (TASC) C and D lesions of the superficial femoral artery (SFA) are supragenicular bypass grafting or the less invasive remote endarterectomy (RSFAE). This trial compares the patency rates of both techniques. DESIGN: Randomized, multicenter trial. MATERIALS AND METHODS: 116 patients were randomized to RSFAE (n=61) and supragenicular bypass surgery (n=55). Indications for surgery were claudication (n=77), rest pain (n=21), or tissue loss (n=18). RESULTS: Median hospital stay was 4 days in the RSFAE group compared with 6 days in the bypass group (p=0.004). Primary patency after 1-year follow-up was 61% for RSFAE and 73% for bypass (p=0.094). Secondary patency was 79% for both groups. Subdividing between venous (n=25) and prosthetic grafts (n=30) shows a primary patency of 89% and 63% respectively at 1-year follow-up (p=0.086). CONCLUSION: RSFAE is a minimally invasive adjunct in the treatment of TASC C and D lesions of the SFA, with shorter admittance and a comparable secondary patency rate to bypass. The venous bypass is superior to both RSFAE and PTFE bypass surgery, but only 45% of patients had a sufficient saphenous vein available. This study is registered with ClinicalTrials.gov, number NCT00566436.