A nested case-control study on dietary fat consumption and the risk for gallstone disease.

BACKGROUND: Gallstone disease (GD) incidence and prevalence rates differ between populations. Diet and lifestyle may be involved in GD development. To our knowledge, no study to date has evaluated quantitative data on diet when studying the relationship between fat consumption levels and GD in an Argentinean population. The present study aimed to assess the association between dietary fat intake and GD. METHODS: A nested case-control study design was applied. Data were taken from subjects who participated in a previous cross-sectional study carried out in a random sample of asymptomatic people in Rosario, Argentina. Participants underwent a personal interview, and current weight and height, ancestor's ethnicity, and socio-economic status were recorded. Applying a food-frequency questionnaire and a food photography atlas, quantitative dietary data were estimated by combining the intake frequency, portion size and food composition. Logistic regression analysis was used to compute odds ratios and 95% confidence intervals adjusted by age, sex, ancestor's ethnicity, body mass index and daily total energy intake as potential confounders. RESULTS: In total, 114 patients were studied (49 cases and 65 controls), without any statistically significant differences for age, sex, socio-economic status, body mass index and ancestry. The mean energy intake was higher in cases than in controls, and significant differences were found for dietary fat consumption. Obese or overweight people have a higher GD risk than subjects with normal weight. Increased GD risks were associated with high intakes of energy, total fat, and saturated and monounsaturated fatty acids. CONCLUSIONS: According to our results, total fat, saturated and monounsaturated fatty acids high intakes are associated with increased GD risk.

[Variations of the hepatic SUV in relation to the body mass index in whole body PET-CT studies]. / Variaciones del SUV hepático con relación al índice de masa corporal en estudios PET/TC de cuerpo entero.

OBJECTIVE: To evaluate SUV changes in the liver in relation to body mass index (BMI) of patients who undergo whole body PET-CT scans. MATERIAL AND METHODS: A retrospective study was performed. The variables studied were injected dose of (18F)FDG (mCi), age (years), blood glucose level (mg/dL), height (cm) and weight (kg). BMI was calculated and the SUV mean value was expressed according to gender and BMI. A linear regression analysis was applied to identify the independent variables that best predict the SUV value. RESULTS: Six hundred and three patients were studied (305 women, 298 men; mean age: 54.9±15.2 years old). Mean SUV measurement was significantly higher in males than females and increased significantly both in male and female patients who were overweight and even more in obese patients. The independent variables that best predicted the SUV value were gender, age, and BMI. In those patients having similar characteristics related to the analyzed variables, the SUV value increased by 0.002 for each increase in one year, and by 0.066 per unit increase in the BMI value. CONCLUSIONS: Hepatic uptake of (18F)FDG increases according to the patient's BMI. The independent variables that best predict the hepatic SUV value are age and sex of patients. Our findings show that the practice of using the physiological hepatic metabolic activity level as a reference regarding questionable deposits elsewhere in the abdomen and pelvis is not useful, at least in male patients with overweightness and obesity.

Utilidad de la histerosalpingografía como método diagnóstico en la infertilidad / Usefulness of hysterosalpingography in diagnosis in infertility

Objetivo: presentar una base a nuestra experiencia el estado actual de la histerosalpingografía (HSG) discutiendo las diferentes metodologías utilizadas y los hallazgos relacionados con anormalidades tanto a nivel uterino como de las trompas de Falopio. Material y Métodos: Estudiamos 256 pacientes consecutivas desde Julio de 2004 a Mayo de 2007 con edad media de 32.3 años en los días 7 a 10 del ciclo menstrual. Se colocó espéculo y luego de la higiene y antisepsia de la cavidad vaginal se utilizó pinza listerina para la fijación uterina y se administró material de contraste iodado a la cavidad uterina a través de cánula de Rubistein con oliva plástica bajo control radioscópico. Se obtuvieron incidencias radiográficas digitales en decúbito dorsal con relleno parcial, total y ambas oblicuas. Luego de las mismas se realizó la prueba de Cotte. Resultados: En 7 casos no se pudo realizar el estudio por incapacidad de canular el orificio cervical externo. En los demás estudios los resultados fueron clasificados en normales, defectos de relleno intrauterinos, adenomiosis, anomalías mûllerianas, hidrosálpinx, espasmos tubario, obstrucción tubaria, prueba de Cotte positiva o negativa uni o bilateral y sospecha de adherencias pelvianas o masas anexiales acorde a la distribución del material de contraste en la cavidad abdominal. Conclusión: La HSG sigue siendo e la actualidad el estudio de elección para la valoración de las trompas de Falopio y también de gran utilidad para la evaluación interna de la cavidad uterina. Hemos evidenciado un incremento paulatino de las pacientes que se someten a este tipo de estudio proporcional al desarrollo de nuevas metodologías terapéuticas médicas y quirúrgicas para el tratamiento de la infertilidad.

Purpose: To show our experience related to the actual state of the hysterosalpingography including techniques and findings that compromise the uterus and the Fallopian tubes. Material and Methods:We have studied 256 patients from July 2004 till May 2007 with a media of 32.3 years of age, between the days 7 and 10 of the menstrual cycle. We have used an speculum, cleaned the vaginal cavity and afteruterus fixation, the contrast material have been introduced through a Rubistein canula with a plastic olive. We have obtained radiographs in different positions such as partial and full filled endometrial cavity, both oblique incidences and post Cotte test. Results: In 7 cases we couldn´t perform the study because of tiny external cervical orifice. In the rest of the patients thefindings have been classified in normal, uterine filling defects, adenomyosis, müllerian anomalies, hydrosalpinx, tubalspasm, tubal obstruction, positive or uni o bilateral negative Cotte test, and peritoneal or anexial masses suspicion.Conclusion: The HSG is the elective study for the study of the Fallopian tube and have great utility to evaluate theendometrial cavity. We have observed an increase in the number of patients that go through this study related to thedevelopment of new therapeutical strategies (medical or surgical) for the treatment of infertility.

Pressure recovery in pediatric aortic valve stenosis.

This study was designed to evaluate the phenomenon of pressure recovery in pediatric patients with aortic stenosis and also to evaluate how observed differences between catheter and Doppler gradients can be predicted by Doppler echocardiography. Doppler measurements of aortic valve stenosis gradients are known to overestimate observed gradients in the catheterization laboratory. Pressure recovery has been shown to be a contributing factor to this discrepancy. However, the clinical relevance of correcting Doppler gradients using the pressure recovery equation has not been evaluated in the pediatric population. Simultaneously obtained catheter and Doppler gradients were studied in 14 patients (range, 0.03-18 years; mean, 4.1 years) with aortic valve stenosis. A total of 23 data points were measured because 9 patients underwent balloon valvuloplasty and had both a pre- and a post-balloon valvuloplasty data point in the study. The catheter gradients were then compared to peak, mean, and pressure recovery corrected Doppler gradients. Pressure recovery was calculated using a previously validated equation. As expected, measured echocardiographic continuous-wave peak Doppler gradients overestimated the observed catheter gradients (range, 16-93 mmHg; mean, 43 mmHg). The continuous-wave peak Doppler gradients, mean, and pressure recovery adjusted gradients were equally as good in correlating the observed catheter gradients to those obtained by Doppler echocardiography (r = 0.92). However, pressure recovery corrected Doppler gradients were in better agreement with catheter gradients than echocardiographic mean or peak Doppler gradients (95% limit of agreement: -9 to 19 mmHg for pressure recovery corrected gradients, -30 to 11 mmHg for mean Doppler gradients, and 2-83 mmHg for peak Doppler gradients). Measured continuous-wave peak Doppler gradients consistently overestimated catheter gradients. The noted differences may be predicted using the pressure recovery equation. Pressure recovery is a significant factor in children with aortic valve stenosis.

Morphological and demographic associations of biliary symptoms in subjects with gallstones: findings from a population-based survey in Rosario, Argentina.

BACKGROUND: Gallstone disease is a frequently encountered disorder in subjects living in Rosario. The reasons for the presence or absence of symptoms are unknown. AIMS: To determine associations between biliary symptoms and ultrasonographic features of gallbladder and gallstones. SUBJECTS: A random study was conducted on 1,173 subjects, inhabitants of 20 years and older, in the city of Rosario, Argentina. METHODS: High-resolution abdominal ultrasound examinations were performed. Biliary pain was defined based on previously published definitions. RESULTS: Gallstones were found in 149 subjects (101 female, 48 male) of whom 51% of females and 35% of males with cholelithiasis were symptomatic. Mean age was 53 years in symptomatic and 55 in asymptomatic subjects. Gallbladder size was normal in 97% of symptomatic and in 96% of the asymptomatic participants. There were no significant differences between the groups as far as concerns size and gallstone number. Impacted stones were observed in 10% of symptomatic and in none of the asymptomatic subjects (p<0.01). CONCLUSIONS: Subjects' age and gender, gallstones size and number, as well as ultrasonographic features of gallbladder and biliary tract did not differ significantly between symptomatic and asymptomatic subjects. Only impacted stones were significantly more frequent in symptomatic subjects.

[Early intervention in acute coronary syndromes (unstable angina and non-Q wave infarction]. / Intervencionismo precoz en síndromes coronarios agudos (angor inestable e infarto sin onda Q).

The timing for coronary angiography and revascularization in unstable angina and infarction without Q-wave in patients without high-risk characteristics after arrival to the hospital is uncertain. If high-risk patients are not considered, there are several therapeutical strategies for the diagnosis and treatment of the patients. The first is a conservative approach, in which coronary angiography and revascularization is done only in patients presenting angina or electrocardiographic changes of ischemia after arrival to the hospital. The other one is an invasive approach, in which coronary angiography and revascularization procedure are done few days after arrival to the hospital. Several studies, in the last decade, have compared both types of therapeutical strategies in patients with unstable angina and infarction without Q-wave (TIMI IIIB, FRISC II and VANQWISH). The results of these studies were uncertain and showed that there are no advantages regarding mortality or infarction with either therapeutic approach. However, some subsets of patients benefited from the invasive approach (patients > or = 65 years, angina or electrocardiographic changes in S-T segment during the time of hospitalization). On the other side, all these studies showed that with the invasive approach there is less incidence of recurrent ischemic events during the time of hospitalization and at long range, as well as an improvement in the functional class of ischemia, and in long-range quality of life as well as a marked reduction in hospital stay. In conclusion, an early invasive approach could be justified in patients with unstable angina presenting low and intermediate risk factors.

Signal transduction pathways of IL-1beta-mediated iNOS in pulmonary vascular smooth muscle cells.

Interleukin (IL)-1beta is an important early mediator of inflammation in pulmonary artery smooth muscle cells. We previously reported that a geranylgeranyltransferase inhibitor elevated basal levels of inducible nitric oxide synthase (iNOS) and enhanced IL-1beta-mediated induction, suggesting that Rac or Rho small G proteins are candidates for antagonism of such induction. In this study, overexpression of constitutively active Rac1 or its dominant negative mutant did not affect IL-1beta induction of iNOS. Alternatively, treatment with Clostridium botulinum C3 exoenzyme, which ADP-ribosylates Rho, was associated with superinduction of iNOS, suggesting an inhibitory role for Rho. IL-1beta activated the three mitogen-activated protein kinase (extracellular signal-regulated kinases 1 and 2, c-Jun NH2-terminal kinase/stress-activated protein kinase, and p38) and the Janus kinase (JAK)-signal transducer and activator of transcription pathways. The former two pathways were not associated with IL-1beta-mediated iNOS induction, whereas the latter two appeared to have inhibitory roles in iNOS expression. These data suggest that a broad intracellular signaling response to IL-1beta in rat pulmonary artery smooth muscle cells results in elevated levels of iNOS that is opposed by the geranylgeranylated small G protein Rho as well as the p38 and JAK2 pathways.

Anomalous origin of the right coronary artery from the pulmonary artery and mitral regurgitation in a newborn.

Anomalous origin of the right coronary artery (RCA) from the pulmonary artery (PA) is a rare congenital anomaly, and only 28 cases have been reported in the pediatric age group. We describe the case of an infant who had progressive mitral regurgitation and papillary muscle dysfunction in association with anomalous origin of the RCA from the PA. The diagnosis was made by color flow Doppler, confirmed by angiography, and the case was successfully corrected by reimplantation of the anomalous RCA to the aorta. This is only the second case of anomalous origin of the RCA from the PA diagnosed in infancy without an associated congenital anomaly of the heart and great vessels.

Colonic adenomas: prevalence and incidence rates, growth rates, and miss rates at colonoscopy.

Cost-effective use of colonic imaging studies can be achieved through an understanding of the prevalence, incidence, growth, and miss rates of colon adenomas. High adenoma prevalence rates are associated with increasing age, male gender, and a family history of colorectal cancer or multiple first-degree relatives with colorectal neoplasia or neoplasia diagnosed at a young age. The incidence rate of advanced adenomas is higher in patients with multiple adenomas and is likely also associated with a family history of colorectal cancer, increased age, and large adenoma size at the index examination. Direct observational data on growth rates suggests that adenomas <1 cm in size have a fairly stable size over a 3-year interval. Although colonoscopy is the most sensitive colonic imaging study, substantial miss rates for small adenomas are inherent to the procedure. Advancements in endoscopic technology should lead to reduced miss rates, allowing expansion of intervals between examinations while reducing negative outcomes of fatal interval cancers.

Induced nitric oxide inhibits IL-6-induced stat3 activation and type II acute phase mRNA expression.

Inducible nitric oxide synthase (iNOS) can be coexpressed with acute phase reactants in hepatocytes; however, it is unknown if NO can regulate the acute phase response. We tested the hypothesis that iNOS-derived nitric oxide (NO) attenuates the acute phase response by inhibiting IL-6-enhanced Stat3 DNA-binding activity and type II acute phase mRNA expression. iNOS was overexpressed in cultured rat hepatocytes via transduction with a replication defective adenovirus containing cDNA for human iNOS (AdiNOS), and Stat3 DNA-binding activity was determined by electrophoretic mobility shift assay (EMSA). EMSAs demonstrated that AdiNOS inhibits IL-6-induced Stat3 activation and that this inhibition is reversible in the presence of the NOS inhibitor N(G)-monomethyl-L-arginine (L-NMA). The induction of beta-fibrinogen mRNA by IL-6, a Stat3 dependent process, is attenuated in AdiNOS-transduced cells and partially reversed by L-NMA. Thus, iNOS overexpression suppresses IL-6-induced Stat3 activation and type II acute phase mRNA expression in cultured hepatocytes. This suppression may represent a mechanism by which NO down-regulates the acute phase response.

Epidemiology of gallstone disease in Argentina: prevalences in the general population and European descendants.

To assess gallstone disease prevalence in Argentina, a random sample of the Rosario City population was studied, considering already known associated factors, and analyzing ethnic groups living in the city. A total of 1,173 participants (69% response), both sexes, 20 years and older were studied. Each subject underwent an abdominal ultrasound examination, a blood test, and a standardized questionnaire. It was seen that gallstone disease prevalence (gallstones or cholecystectomy), overall was 20.5% (23.8% in women and 15.5% in men; (P = 0.0005), and was associated with age and body mass index in both sexes, and with pregnancy number and hypertriglyceridemia in women. As regards ancestors' nationalities, Italian and Spanish descendants presented higher prevalence rates for all age groups than those described in Italy and Spain. Thus far, in a subsample of 78% of nonparticipants submitted to a new home visit, presence of cholecystectomy or symptoms did not differ from participants, supporting the validity of our results.

Analysis of laparoscopy in trauma.

BACKGROUND: The optimum roles for laparoscopy in trauma have yet to be established. To date, reviews of laparoscopy in trauma have been primarily descriptive rather than analytic. This article analyzes the results of laparoscopy in trauma. STUDY DESIGN: Outcome analysis was done by reviewing 37 studies with more than 1,900 trauma patients, and laparoscopy was analyzed as a screening, diagnostic, or therapeutic tool. Laparoscopy was regarded as a screening tool if it was used to detect or exclude a positive finding (eg, hemoperitoneum, organ injury, gastrointestinal spillage, peritoneal penetration) that required operative exploration or repair. Laparoscopy was regarded as a diagnostic tool when it was used to identify all injuries, rather than as a screening tool to identify the first indication for a laparotomy. It was regarded as a diagnostic tool only in studies that mandated a laparotomy (gold standard) after laparoscopy to confirm the diagnostic accuracy of laparoscopic findings. Costs and charges for using laparoscopy in trauma were analyzed when feasible. RESULTS: As a screening tool, laparoscopy missed 1% of injuries and helped prevent 63% of patients from having a trauma laparotomy. When used as a diagnostic tool, laparoscopy had a 41% to 77% missed injury rate per patient. Overall, laparoscopy carried a 1% procedure-related complication rate. Cost-effectiveness has not been uniformly proved in studies comparing laparoscopy and laparotomy. CONCLUSIONS: Laparoscopy has been applied safely and effectively as a screening tool in stable patients with acute trauma. Because of the large number of missed injuries when used as a diagnostic tool, its value in this context is limited. Laparoscopy has been reported infrequently as a therapeutic tool in selected patients, and its use in this context requires further study.

Outcome analysis of external coloanal anastomosis.

BACKGROUND: To evaluate the safety and efficacy of treating low-lying rectal lesions with resection and primary repair using a pull-through technique with rectal stump eversion and external coloanal anastomosis with immediate reintroduction into the pelvis. METHODS: All coloanal anastomoses with the above technique on the Gastrointestinal Surgery Service at the University of Pittsburgh from March 1990 to September 1995 were evaluated. RESULTS: Fifty-two patients underwent coloanal anastomoses with the above technique, and follow-up was available for 96% (50 of 52) of patients. Rectal lesions in the 50 patients included cancer (n = 34), rectal adenomas (n = 13), and other lesions (n = 3). Mean follow-up period was 29.6 +/- 21.8 months (28.5 months for patients with carcinoma). Fecal continence was normal or good in 88% (44 of 50) of patients. Moderate or complete incontinence was present in 12% (6 of 50) of patients. The local recurrence rate of rectal cancer was 0%. Morbidity occurred in 22% (11 of 50) of patients. Survival was 90% (45 of 50 patients). CONCLUSIONS: Coloanal anastomosis with this technique provides effective treatment for low-lying malignant or benign rectal lesions and has an acceptable complication rate.

The role of protein phosphatases in the expression of inducible nitric oxide synthase in the rat hepatocyte.

Previously, we demonstrated that nuclear factor-kappaB (NF-kappaB) mediates cytokine-induced hepatic inducible nitric oxide synthase (iNOS) expression. NF-kappaB activation is regulated by kinases and phosphatases whose function is only beginning to be understood. Therefore, experiments were performed to determine the role of protein phosphatases (PPase) in cytokine-induced iNOS expression. Hepatocytes were stimulated with cytokines in the presence or absence of tyrosine phosphatase inhibitors (pervanadate [PV], phenylarsine oxide [PAO]) and a serine-threonine phosphatase inhibitor (okadaic acid [OA]). Cytokines induced hepatocyte iNOS mRNA, protein, and NO2- production that was substantially decreased by the addition of the tyrosine phosphatase inhibitors (PAO and PV). The serine-threonine phosphatase inhibitor (OA) decreased NO release and protein levels in a concentration-dependent fashion; however, iNOS mRNA levels were not significantly reduced. Nuclear run-on experiments demonstrated that protein tyrosine phosphatases (PTPases) are required for iNOS transcription, while the serine-threonine phosphatase inhibitor (OA) had no effect on iNOS transcription. Electromobility shift assays (EMSAs) revealed that the tyrosine-phosphatase inhibitors blocked cytokine-induced NF-kappaB activation, while OA did not have a significant effect on NF-kappaB DNA binding activity. Therefore, tyrosine phosphatases are involved in the regulation of cytokine-induced activation of NF-kappaB, while serine-threonine phosphatases posttranscriptionally regulate iNOS translation. These results identify the regulatory role of specific protein phosphatases (PPases) in hepatic iNOS expression.

Analysis of thoracoscopy in trauma.

BACKGROUND: The role of video-assisted thoracic surgery (VATS) in trauma has yet to be established. Up to the time of this writing, reviews of thoracoscopy in trauma have been primarily descriptive rather than analytic. This article analyzes the results of thoracoscopy (nonvideo and VATS) in trauma. METHODS: Analysis was done by reviewing 28 nonoverlapping studies since the introduction of thoracoscopy in 1910, with a combined total of more than 500 patients. RESULTS: Diagnostically, thoracoscopy has been used primarily to evaluate diaphragmatic injury, continued chest tube bleeding, and suspected cardiac injury. Thoracoscopy has a 98% (188/191 patients) accuracy rate in diagnosing diaphragmatic injuries. Therapeutically, thoracoscopy has been used primarily to control chest tube bleeding, evacuate retained hemothoraces, and evacuate empyemas. Thoracoscopy is 90% (89/99 patients) effective in evacuating retained hemothoraces, 86% (19/22 patients) effective in evacuating empyemas, and 82% (33/40 patients) effective in controlling chest tube bleeding. Thoracoscopy benefits include preventing 62% (323/514) of trauma patients from having a thoracotomy or laparotomy. Risks include a 2% (11/534 patients) procedure-related complication rate and a 0.8% (4/471 patients) missed injury rate. Technical failure rates are 10% (10/99 patients) and 4% (7/199 patients) in evacuation of retained hemothoraces and evaluation of diaphragmatic injuries, respectively. CONCLUSIONS: Analysis suggests that thoracoscopy (nonvideo and VATS) can be applied safely and effectively in the care of the injured patient.

Pulmonary tractotomy as an abbreviated thoracotomy technique.

BACKGROUND: Operative abbreviated thoracotomy techniques in thoracic trauma include emergency center thoracotomy, ligation of major arterial branches, packing the thoracic cavity for diffuse bleeding, towel clip or Bogota bag closure of the chest, and pulmonary tractotomy. Pulmonary tractotomy with selective vascular ligation was originally described for deep through-and-through lung injuries that did not involve hilar vessels or airways. Pulmonary tractotomy has evolved into use as an abbreviated thoracotomy technique in patients with severe thoracic or multivisceral trauma. As with any operative technique in high-risk patients, specific procedure-related complications may occur and are analyzed herein. The objective of this manuscript is to review the indications, techniques, and results for pulmonary tractotomy in trauma patients requiring abbreviated thoracotomy. METHODS: Medical records were retrospectively reviewed for 30 of 32 consecutive tractotomy patients treated at Ben Taub General Hospital, during a 3-year period. By using a model for logistic regression analysis, the characteristics of each patient and their clinical course were tested for impact on mortality. RESULTS: Seventy percent of patients had at least one intraoperative parameter indicative of acidosis (pH < 7.2), coagulopathy (prothrombin time > 13.8 or partial thromboplastin time > 38.0 seconds), or hypothermia (core temperature < 34 degrees C), and 50% of patients manifested two of these three parameters. The mortality rate among the 30 patients was 17%. Three of the five patients who died were noted to be acidotic, coagulopathic, and hypothermic. Twelve of 25 patients who survived more than 1 day had at least one thoracic complication. There were no late deaths. There was one failed tractotomy and one missed injury. A second thoracotomy was not required for control of a lung injury in any patient. Logistic regression analysis showed that intraoperative blood loss was the only predictive factor for mortality. CONCLUSION: Pulmonary tractotomy is a simple and effective technique in injured patients who require an abbreviated thoracotomy and has an acceptable mortality and complication rate. This follow-up report notes that as definitive therapy, tractotomy continues to allow for direct control of bleeding and air leak and obviates the need for formal resection.

[The no-reflow phenomenon: its incidence and clinical characteristics in a series of cases]. / Fenómeno de no-reflujo: incidencia y características clínicas en una serie de casos.

The no-reflow phenomenon refers to the inability to reperfuse myocardial tissue despite removal of an occlusion of a coronary artery. No reflow is a complication that may occur after revascularization of patients. This study examined the incidence and, clinical characteristics of no-reflow in a patient population treated with conventional percutaneous transluminal coronary angioplasty at the Instituto Nacional de Cardiología "Ignacio Chávez". We reviewed 204 elective angioplasties and 62 direct angioplasties; 14 patients were included (4 from the first group and 10 from the second group). No-reflow were more frequently in men, the mean age was 56 years and diabetes and smoking were the risk factors more frequently reported. No-reflow was found in left anterior descending coronary artery in 7 patients, the time of reperfusion, in direct angioplasty, was 10.6 hours (mean) and the strategy most frequently used to reestablish normal anterograde flow was intracoronary verapamil. The overall incidence of no-reflow for the two modalities was 5.2% (16.12% for direct angioplasty and 1.9% for elective angioplasty). The current study shows that the no-reflow phenomenon is not uncommon after angioplasty; no-reflow appears higher than the previous reports for both modalities of treatment.

[Late thrombolysis and electrical stability in acute myocardial infarction. Role of the collateral flow]. / Trombolisis tardía y estabilidad eléctrica en el infarto agudo del miocardio: importancia del flujo colateral.

We evaluated 249 patients (pts) with first acute myocardial infarction: 1. Pts without thrombolysis, n = 119, 2. Pts treated with thrombolysis within 6 hours following MI, n = 80 and 3. Pts treated with thrombolysis between 6-12 hours after MI. Arrhythmic events were evaluated during follow up. All underwent heart rate variability studies and coronary angiogram where anterograde flow (TIMI) and collateral flow (Rentrop scale 0-2 = poor collateral flow and 3 = good collateral flow) were determined. Pts in group 2 and 3 showed a better anterograde and collateral flow than group 1 (p < 0.001). A lower spectral power in the high frequency band and a higher ratio low/high frequency band were observed in group 1 (p < 0.05). Conjunctive consolidation analysis showed more malignant arrhythmias in TIMI 0-2 with poor collateral flow than TIMI 0-2 with good collateral flow (17/138-12.3% vs 0/14-0%). Kaplan Meier analysis was able to demonstrate more cardiac sudden death events in TIMI 0-2 with poor collateral flow than TIMI 0-2 with good collateral flow or TIMI 3 (x2 = 7.22, p = 0.028), independently of thrombolytic treatment.