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INTRODUCTION: The epidemiology of atrial fibrillation (AF) in India has not been studied systematically in large scale population based surveys. Stroke is one of the leading causes of death and disability in India. As AF is a major contributor of stroke, it is important to know the burden of AF and stroke risk in the population. The Andhra Pradesh Atrial Fibrillation (AP-AF) study aims to assess the prevalence, etiology, risk factors and stroke risk among the rural population in Andhra Pradesh, India. METHODS: This is a cross-sectional survey done using a two-stage sampling process. Adults (≥18years) from villages in East and West Godavari districts were sampled. Field investigators used a structured questionnaire to collect information on basic demographics, cardiovascular risk factors and medical history. Anthropometric measurements were performed, blood pressure measured and fasting capillary blood glucose was assessed. Electrocardiogram was done using a hand-held mobile ECG device-KardioMobile. ECGs were interpreted by study cardiologists. Participants diagnosed to have AF were invited to participate in a camp conducted by cardiologists where echocardiogram was done and also a focused history related to AF was collected. Along with age and sex stratified prevalence of AF, descriptive statistics will be used to present demographics, clinical profile, and cardiovascular risk factors. Stroke risk will be calculated using CHA 2 DS 2 -Vasc score. CONCLUSION: The AP-AF study is expected to provide important information on AF epidemiology in rural India. The information may help improve health care policies in preventing stroke and other complications of AF.
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INTRODUCTION: Post-inguinal pain after a hernia surgery is prevalent and can be quite frustrating for the surgeon and patient alike. There are several sources for possible post-operative inguinal pain after a successful hernia repair; however, in the setting where a recurrent inguinal hernia is not present, it is likely related to the nerves in the inguinal canal or pelvis. Chronic inguinal groin pain after hernia repairs have been reported in a high percentage of patients following inguinal hernia surgery despite being one of the most common procedures performed annually in the USA and worldwide. MATERIALS AND METHODS: We present ten of the basic concepts utilized by peripheral nerve surgeons to limit nerve injury, which can easily be applied to open inguinal hernia surgery with or without mesh, starting with the firm understanding of the inguinal anatomy to addressing the nerves, meticulous placement of the mesh and the active revision of the surrounding structures and nerve position before closure. CONCLUSIONS: Understanding the proper handling of the inguinal nerves during hernia surgery can decrease the incidence of post-operative chronic pain by employing microsurgical concepts to day-to-day surgical procedures and prevent complications in an extensive set of patients.
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Dor Crônica , Hérnia Inguinal , Humanos , Hérnia Inguinal/complicações , Virilha/cirurgia , Herniorrafia/efeitos adversos , Herniorrafia/métodos , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/prevenção & controle , Dor Pós-Operatória/cirurgia , Nervos Periféricos/cirurgia , Dor Crônica/etiologia , Dor Crônica/prevenção & controle , Telas Cirúrgicas/efeitos adversosRESUMO
The burden of atrial fibrillation (AF) is increasing worldwide. It is often asymptomatic, with stroke being the first manifestation in some. AF burden in the community and the practice of stroke prophylaxis has not been studied in India. The problem might be higher in rural regions due to poor health awareness and challenges to healthcare access. This study aimed to estimate the prevalence of AF, clinical profile and stroke risk in rural India. METHODS: This is a community-based cross-sectional study done in rural Andhra Pradesh (AP). Adults from 40 villages formed the study population. We did a door-to door survey to collect information on demographics, and medical history. Electrocardiogram was recorded using a smart phone based Alivecor device. Participants diagnosed with AF underwent echocardiogram. Study cardiologists assessed the cardiovascular risk profile and collected detailed medical history. RESULTS: Fourteen of the 4281 individuals screened had AF (0.3%). The mean age of the sampled population was 44 ± 16.5 years with 56% women. The mean age of participants with AF was 71 ±7.8 years; males were 71%. Except for one, all were non-valvular AF. Majority had a CHA2D2S2Vasc score of ≥2. Three had history of stroke. Two were on anticoagulant therapy but without INR monitoring. CONCLUSION: The prevalence of AF is lower in this study compared to studies from the developed countries. Non-rheumatic cardiovascular risk factors were primary causes for AF. Non-adherence to stroke prophylaxis is a major threat that needs to be addressed.
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Fibrilação Atrial , Acidente Vascular Cerebral , Adulto , Idoso , Fibrilação Atrial/complicações , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/epidemiologia , Estudos Transversais , Eletrocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/prevenção & controleRESUMO
The use of rat testicular seminiferous tubular basement membrane (STBM) segments as a model substratum for the in vitro maintenance of tumor cells dissociated from a transplantable pancreatic acinar rat carcinoma (J. K. Reddy and M. S. Rao, Science (Wash. DC), 198: 78-80, 1977) is described. Ultrastructurally pure, hollow tubular segments of STBM were prepared by mechanical disaggregation, DNase digestion, and deoxycholate treatment. Dissociated pancreatic acinar carcinoma cells adhered readily to STBM segments within 1 to 6 hr, and these STBM-tumor cell aggregates were maintained for up to 7 days in serum-free chemically defined medium supplemented with hydrocortisone, insulin, vitamin C, and soybean trypsin inhibitor. The tumor cells formed acinar-like clusters and displayed intercellular junctions and polarization of secretory granules toward the center of these clusters. By 4 days, virtually all cells of this acinar carcinoma maintained on STBM in supplemented chemically defined medium contained numerous secretory granules. Cell replication, as determined by [3H]thymidine autoradiography, ceased within 18 hr of attachment of neoplastic cells to STBM; however, all cells incorporated [3H]leucine as evidenced by light and electron microscopic autoradiography. In addition, two-dimensional analysis and fluorography of newly synthesized secretory proteins discharged by these cells in response to carbamylcholine revealed the presence of Mr 24,000 protein and 19 other secretory proteins characteristic of this tumor (L. J. Hansen, M. K. Reddy, and J. K. Reddy, Proc. Natl. Acad. Sci. USA, 80: 4379-4383, 1983). The culture system utilizing STBM and supplemented chemically defined medium should allow investigation of the effects of a variety of factors on morphogenesis, cytodifferentiation, and gene expression in pancreatic acinar tumors.
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Membrana Basal/fisiologia , Carcinoma/patologia , Neoplasias Pancreáticas/patologia , Túbulos Seminíferos/fisiologia , Testículo/fisiologia , Animais , Membrana Basal/ultraestrutura , Diferenciação Celular , Replicação do DNA , Masculino , Microscopia Eletrônica , Neoplasias Pancreáticas/ultraestrutura , Biossíntese de Proteínas , Ratos , Ratos Endogâmicos F344 , Túbulos Seminíferos/citologia , Radioisótopos de Enxofre , TrítioRESUMO
The development of a transplantation system by which rat hepatocytes can be implanted and remain viable in the dorsal fascia of two-thirds hepatectomized syngeneic hosts provides an opportunity to examine whether such transplanted hepatocytes retain the capacity to recognize and respond to the peroxisome proliferators 2-[4-(2,2- dichlorocyclopropyl )phenoxy]-2- methylpropionic acid (ciprofibrate), a hypolipidemic drug, and di-(2-ethylhexyl)phthalate (DEHP), an industrial plasticizer. Male F344 rats with transplanted rat hepatocytes were fed a control diet or a diet containing either 0.05% ciprofibrate (w/w) or 2% DEHP (v/w). After 4 weeks, the animals were sacrificed, and transplanted hepatocytes revealed a significant increase in the numerical density of peroxisomes in both ciprofibrate- and DEHP-fed rats. The volume density of peroxisomes in transplanted hepatocytes increased 9.2- and 5.3-fold, respectively, in ciprofibrate- and DEHP-fed rats, whereas the volume density of mitochondria remained essentially unchanged. The magnitude of increase in peroxisome volume density in transplanted hepatocytes was comparable to increases in the volume density of these organelles in the liver parenchymal cells of syngeneic hosts. The present study also demonstrates that hepatocytes isolated from cat liver and heterotransplanted into partially hepatectomized athymic nude mice retain their biological integrity and respond to the peroxisome proliferative effect of ciprofibrate. This observation suggests the possibility that hepatocytes obtained from small segments of liver of humans, primates, and other species and heterotransplanted into nude mice might provide a valuable model system for toxicological evaluation of chemicals. These studies suggest that hepatocytes, irrespective of their location in the body, recognize the peroxisome proliferator or its active metabolite(s), which stimulates the expression of peroxisome-specific genes in these cells.
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Clofibrato/farmacologia , Dietilexilftalato/farmacologia , Transplante de Fígado , Microcorpos/fisiologia , Ácidos Ftálicos/farmacologia , Animais , Fígado/efeitos dos fármacos , Fígado/ultraestrutura , Masculino , Camundongos , Camundongos Nus , Microcorpos/efeitos dos fármacos , Microcorpos/ultraestrutura , Microscopia Eletrônica , Ratos , Ratos Endogâmicos F344 , Transplante Heterólogo , Transplante IsogênicoRESUMO
UNLABELLED: Boron neutron capture therapy (BNCT) using 4-[10B]boronophenylalanine-fructose (BPA-Fr) is in Phase II clinical trials to validate BNCT as a treatment for glioblastoma multiforme and melanoma. Successful BNCT depends on knowledge of the distribution of boron-containing agents in both tumor and normal tissue as currently determined by chemical confirmation of boron deposition in surgically removed malignant tissue before BNCT. METHODS: We used PET to noninvasively obtain in vivo information on the pharmacokinetics of the 18F-labeled analog of BPA-Fr in two patients with glioblastoma multiforme. Time-activity curves generated from the bolus injection of 18F-BPA-Fr were coinvolved to simulate a continuous infusion used for BNCT therapy. RESULTS: Distribution of 18F-BPA-Fr by PET was found to be consistent with tumor as identified by MR imaging. The 18F-BPA-Fr tumor-to-normal brain uptake ratio was 1.9 in Patient 1 and 3.1 in Patient 2 at 52 min after injection. The 18F-BPA-Fr uptake ratio in glioblastoma paralleled that of nonlabeled BPA-Fr seen in patients as previously determined by boron analysis of human glioblastoma tissue obtained from pre-BNCT surgical biopsy. CONCLUSION: Knowledge of the biodistribution of BPA-Fr enables pre-BNCT calculation of expected tissue dosimetry for a selected dose of BPA-Fr at a specific neutron exposure. Fluorine-18-BPA-Fr PET is capable of providing in vivo BPA-Fr biodistribution data that may prove valuable for patient selection and pre-BNCT treatment planning.
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Compostos de Boro , Terapia por Captura de Nêutron de Boro , Neoplasias Encefálicas/diagnóstico por imagem , Radioisótopos de Flúor , Frutose , Glioblastoma/diagnóstico por imagem , Fenilalanina/análogos & derivados , Radiossensibilizantes , Tomografia Computadorizada de Emissão , Compostos de Boro/farmacocinética , Neoplasias Encefálicas/radioterapia , Feminino , Radioisótopos de Flúor/uso terapêutico , Frutose/farmacocinética , Glioblastoma/radioterapia , Humanos , Pessoa de Meia-Idade , Fenilalanina/farmacocinética , Radiossensibilizantes/farmacocinéticaRESUMO
Thrombolytic therapy is used increasingly for prosthetic valve thrombosis. Fear of peripheral embolism has limited its use in left-sided valve occlusions. Thirty-eight patients with prosthetic valve occlusion were treated with thrombolytic agents on 44 occasions. Duration of thrombolytic therapy was individualized. Patients were followed up with clinical, echocardiographic, and cine-fluoroscopic evaluation. Average time from onset of symptoms to presentation was 9.7 days. The anticoagulation status was inadequate in 70% of instances. The majority (75%) were in functional class IV, 8 of them being in shock. Overall success was seen in 88.6%: immediate complete success in 18 and partial in 21. Nine of those with partial success had delayed opening of the leaflets. There were nine instances of rethrombosis and one instance of re-rethrombosis; 6 patients received repeat thrombolysis with success in 5. Seventy-six percent (29/38) of the patients were surviving at the time of reporting. In conclusion, the present study demonstrates the feasibility of thrombolytic therapy for left-sided prosthetic valve occlusion. Delayed opening is common in patients with initial partial success. Rethrombosis remains a major problem.
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Próteses Valvulares Cardíacas/efeitos adversos , Terapia Trombolítica , Trombose/tratamento farmacológico , Adolescente , Adulto , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Estreptoquinase/uso terapêutico , Terapia Trombolítica/efeitos adversos , Trombose/diagnóstico , Ativador de Plasminogênio Tipo Uroquinase/uso terapêuticoRESUMO
A rare case of a patient with supernumerary right coronary artery in whom the two vessels arose from the right coronary sinus from two separate ostia adjacent to each other is presented. The smaller vessel gave off the sinoatrial nodal branch and the posterior descending artery whereas the larger one gave off the conus branch, the right ventricular branches, and continued as acute marginal branch. This is the first case report in the English literature.
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Vasos Coronários/anatomia & histologia , Adulto , Angiografia Coronária , Variação Genética , Humanos , MasculinoRESUMO
Hemodynamic data and angiograms of 15 adult patients with pulmonary atresia and ventricular septal defect were reviewed to assess the pulmonary circulation and other associated features. The most common variety of pulmonary atresia was that of pulmonary valve, main pulmonary artery, and the confluence of pulmonary arteries (6 cases, 40%). The collateral vessels to the lungs were well developed in all cases; selective injections into the collateral vessels were of great value in their delineation. The left ventricle was well developed in 11 cases (73.3%). Congestive heart failure was seen in 8 (53.3%), tricuspid regurgitation in 10 (66.7%), and aortic regurgitation in 7 (46.7%) cases. The long survival in these patients was related to the favorable anatomy of central pulmonary arteries (12 cases, 80%) and adequate pulmonary collateral circulation.
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Comunicação Interventricular/fisiopatologia , Valva Pulmonar/anormalidades , Adolescente , Criança , Feminino , Cardiopatias/etiologia , Comunicação Interventricular/complicações , Comunicação Interventricular/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Pulmonar/diagnóstico por imagem , Circulação Pulmonar , RadiografiaRESUMO
BACKGROUND: Primary pulmonary hypertension is a disorder with limited treatment options and poor outcome. Sildenafil, a pulmonary vasodilator, is likely to be beneficial in primary pulmonary hypertension. We studied the clinical efficacy of sildenafil in patients with primary pulmonary hypertension. METHODS AND RESULTS: A registry of patients with primary pulmonary hypertension has been maintained in our hospital since January 1999. Of a total of 60 patients. 29 (M:16, F:13) consented to try sildenafiL. New York Heart Association functional class, six-minute walk test and Doppler echocardiographic evaluation of pulmonary artery pressure was done before and after treatment with sildenafil. Sildenafil was initiated at a dose of 25 mg thrice a day and increased up to 100 mg thrice a day as tolerated. There was a significant improvement in the functional class. The six-minute walked distance increased from 297.07+/-130.69 m at baseline to 427.68+/-85.35 m after 3 months of sildenafil therapy (p<0.0003). The mean of the pulmonary artery systolic pressure before starting sildenaffil was 109.26+/-24.15 mmHg (mean+/-SD) and it decreased to 95.15+/-24.64 mmHg (p<0.008). While 19 of the 31 historical controls in whom sildenafil was not given died during follow-up (11-44 months), only 1 of the 29 patients given sildenafil died (in an accident) during follow-up (5-20 months). CONCLUSIONS: Sildenafil, a pulmonary vasodilator, has a beneficial effect in patients with primary pulmonary hypertension in improving the functional class, six-minute walked distance and in decreasing the pulmonary artery pressures.
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Hipertensão Pulmonar/tratamento farmacológico , Piperazinas/uso terapêutico , Vasodilatadores/uso terapêutico , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Purinas , Citrato de Sildenafila , Estatísticas não Paramétricas , Sulfonas , Análise de SobrevidaRESUMO
Primary angioplasty has been shown to reduce rates of in-hospital mortality, recurrent ischaemia and infarction. However, the role of primary stenting and abciximab is presently undergoing evaluation. This study attempted to examine the feasibility, safety and outcomes of primary angioplasty in the treatment of acute myocardial infarction. Data in 100 patients who underwent primary angioplasty for evolving acute myocardial infarction was prospectively analysed to assess the safety and efficacy of various modalities. Twenty patients were in Killip class III and above. Multivessel (2 or more vessels) disease was noted in more than 52 cases. Procedural success was 99 percent; 86 patients received primary stenting, majority of them had Kalam-Raju stent implantation. Adjunct treatment included abciximab infusion in 22 and intra-aortic balloon pump support in 12. Overall mortality rate was six percent with a mortality of 2.2 percent in non-cardiogenic shock patients. Recurrent ischaemic events were noted in five, three of them had successful reperfusion with repeat angioplasty. None of the patients had emergency coronary artery bypass surgery. It is concluded that primary angioplasty is safe and effective with high procedural success. Recurrent ischaemic events are low, possibly due to routine use of stenting and selective use of abciximab.
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Angioplastia Coronária com Balão , Infarto do Miocárdio/terapia , Abciximab , Adulto , Anticorpos Monoclonais/uso terapêutico , Anticoagulantes/uso terapêutico , Angiografia Coronária , Estudos de Viabilidade , Feminino , Hemodinâmica , Humanos , Fragmentos Fab das Imunoglobulinas/uso terapêutico , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico por imagem , Infarto do Miocárdio/fisiopatologia , Estudos Prospectivos , Recidiva , Stents , Resultado do TratamentoRESUMO
The purpose of this study was to determine the feasibility, safety and efficacy of elective deployment of a new coil-stent (KR stent) in patients with coronary artery disease. KR stent deployment was attempted in 100 patients (135 lesions) enrolled prospectively at a single centre from December 1996 to March 1997. Ten, 15, 18, 24, and 32 mm long KR stents were manually crimped onto balloons and deployed in native coronary artery lesions. Majority of the patients had recent acute coronary syndromes (unstable angina 30% and post-myocardial infarction angina 56%). Diabetes was present in 34 percent of the patients. Fifty-six percent had single-vessel and 44 percent multi-vessel disease. In 38 percent, the lesions were located in proximal segments and 40 percent of lesions were long. KR stents were successfully deployed in 98 percent of patients. Mean minimal luminal diameter increased by 2.89 +/- 0.63 mm (from 0.57 +/- 0.38 mm before to 3.45 +/- 0.56 mm after the procedure). Mean percent diameter stenosis decreased from 83.33 +/- 10.84 percent before to 3.38 +/- 5.74 percent after the stent deployment. Mean reference vessel diameter was 3.45 +/- 0.56 mm. There were occasional technical complications including balloon rupture (1), stent migration (2) and distal embolisation of atheromatous material (1). One patient developed subacute stent thrombosis. There were no other major in-hospital cardiovascular events. At the end of six-month follow-up, there were no myocardial infarction or death. Six patients presented with recurrence of symptoms within six-months of the procedure, four of whom underwent target vessel revascularisation procedure. In conclusion, the in-hospital and six-month follow-up clinical results were highly encouraging with KR stent. Successful deployment rates were high despite unfavourable clinical and angiographic background. Low clinical events on follow-up will make it suitable for elective stenting.
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Angioplastia com Balão/instrumentação , Doença das Coronárias/terapia , Stents , Adulto , Idoso , Angioplastia com Balão/efeitos adversos , Angioplastia com Balão/métodos , Angioplastia com Balão/mortalidade , Angiografia Coronária , Doença das Coronárias/diagnóstico por imagem , Doença das Coronárias/mortalidade , Desenho de Equipamento , Segurança de Equipamentos , Feminino , Seguimentos , Mortalidade Hospitalar , Humanos , Índia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Stents/efeitos adversos , Taxa de Sobrevida , Resultado do Tratamento , Grau de Desobstrução Vascular/fisiologiaAssuntos
Fluoresceínas , Indicadores e Reagentes , Pancreatite/diagnóstico , Adulto , Doença Crônica , Feminino , Humanos , Masculino , Testes de Função PancreáticaRESUMO
The effect of revascularization surgery on the amputee population of 2 hospitals (VA and private) was studied in 2 time periods a decade apart--1969-70 and 1979-80. In the VA hospital there was a trend toward below-knee surgery over time; however, for patients who had prior vascular reconstruction and who ultimately came to amputation there was no change in the proportion of below-knee to above-knee surgery at either hospital. At the private hospital the average age of patients who underwent amputation increased significantly and the proportion of patients requiring amputation to the total number of patients undergoing vascular reconstruction significantly decreased in the later time period.
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Amputação Cirúrgica/estatística & dados numéricos , Perna (Membro)/cirurgia , Procedimentos Cirúrgicos Vasculares/estatística & dados numéricos , Idoso , Arteriosclerose/cirurgia , Hospitais de Veteranos , Hospitais Filantrópicos , Humanos , Pessoa de Meia-Idade , Fatores de TempoRESUMO
The effect of pretreatment with heparin on lysis of arterial thrombi by tissue-type plasminogen activator (rt-PA) was studied in 19 dogs. Copper coil-induced carotid artery thrombi were weighed, inserted into the femoral arteries, and exposed to a 15 min infusion of rt-PA at 10 micrograms/kg/min either with (n = 6 thrombi) or without pretreatment with a 200 unit/kg bolus of heparin (n = 6 thrombi). The infusion of rt-PA without pretreatment reduced the thrombus weight by 27.6 +/- 7.4%, while infusion of rt-PA with pretreatment reduced it by 79.1 +/- 12.3% (p less than .0001). To test the hypothesis that heparin enhanced thrombolysis by preventing continued incorporation of new fibrin into the thrombus during thrombolysis we repeated the experiments using pretreatment with 8 U/kg of ancrod, which rapidly depletes fibrinogen. Pretreatment with ancrod (n = 6 thrombi) depleted fibrinogen and enhanced the lytic effect of rt-PA to a similar degree as pretreatment with heparin, resulting in a 67.6 +/- 12.3% (NS) decrease in thrombus weight. We conclude that heparin significantly enhances the thrombolytic effect of rt-PA, probably by preventing new fibrin formation and its incorporation into the thrombus during lysis.
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Heparina/administração & dosagem , Trombose/tratamento farmacológico , Ativador de Plasminogênio Tecidual/administração & dosagem , Ancrod/administração & dosagem , Animais , Cães , Fibrinogênio/metabolismoRESUMO
Neuro-osteoarthropathy in diabetes mellitus is not rare. The case of a 53-year-old diabetic with involvement of both ankle joints and multiple associated skin problems complicating rehabilitation management is discussed. By applying a team approach, closely monitoring the patient's skin and joint problems, and treating them at an early stage by adaptive shoes and orthoses, we found that function could be sustained at an optimal level for a prolonged period. In addition to prevention of ulceration, modifying the weight bearing or temporarily non-weight bearing is the treatment of choice. Amputation is to be considered only as a last resort.
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Articulação do Tornozelo , Artropatia Neurogênica/reabilitação , Diabetes Mellitus Tipo 2/complicações , Neuropatias Diabéticas/reabilitação , Articulação do Tornozelo/diagnóstico por imagem , Artropatia Neurogênica/diagnóstico por imagem , Artropatia Neurogênica/etiologia , Braquetes , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , SapatosRESUMO
We present the clinical and angiographic profile of three patients with class I stable angina pectoris. All had strong coronary risk factors, and stress testing was positive in stage one of the Bruce protocol. Coronary angiography revealed total occlusion of the left main coronary artery (LMCA), and aortocoronary bypass surgery was performed. Thus, total LMCA occlusion may be an unexpected angiographic finding in patients with class I angina.