Coronary stenting: has the rubicon been crossed?
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Angioplasty, Balloon, Coronary↗
Biomedical subjects
D Foley
Publications and source records attributed to D Foley.
Caudate nucleus morphology in tardive dyskinesia.
OBJECTIVE: The objective of this project was to test whether there are differences in the size of the caudate nucleus in schizophrenic in-patients with and without tardive dyskinesia. METHOD: The study was cross-sectional in design, examining group differences between institutionalised schizophrenic patients with and without tardive dyskinesia, using non-enhanced computerised tomography scans of the brain. The group comprised 15 schizophrenic patients with persistent tardive dyskinesia and 21 in-patient schizophrenic controls who were group-matched for demographic variables. RESULTS: The dyskinetic subjects had a significantly larger left caudate nucleus and tended to have a larger right caudate nucleus than the controls. There were no differences between the groups on any of the measures of cerebral atrophy. CONCLUSIONS: The findings can be understood within the context of models of neostriatal function. It is possible that a larger caudate nucleus could be used to identify patients at risk of developing tardive dyskinesia.
Adult↗
Malaria in Honiara, Solomon Islands: vector studies.
Adult and larval specimens of anopheline mosquitos were collected throughout eastern Honiara during a study into risk factors for malaria illness in adults. Species identification was by morphology, DNA probes and by PCR. Only Anopheles farauti s.s. were identified from part-night landing catches carried out from 1900 to 2200 hours. Most mosquitos attracted to humans were culicines. The majority of anophelines (85%) were captured between 1900 and 2000 hours. An. farauti s.s. larvae were most common but one An. farauti No. 7, and ten An. punctulatus larvae were also collected.
Adult↗
The association between midlife blood pressure levels and late-life cognitive function. The Honolulu-Asia Aging Study.
OBJECTIVE: To assess the long-term relationship of midlife blood pressure levels to late-life cognitive function. DESIGN: The 4678 surviving cohort members of the prospective Honolulu Heart Program (baseline, 1965-1968) were examined a fourth time in 1991 through 1993 and given a cognitive test. PARTICIPANTS: The subjects were 3735 Japanese-American men living in Hawaii in the community or in institutions, with an average age of 78 years at the fourth examination. MAIN OUTCOME MEASURES: Cognitive function, measured by the 100-point Cognitive Abilities Screening Instrument (CASI), was categorized into good (reference: a CASI score of 92 to 100), intermediate (< 92 to 82), and poor (< 82). Midlife systolic blood pressure (SBP) and diastolic blood pressure (DBP) values were measured in 1965, 1968, and 1971. A respondent was classified into the following categories if two of three measurements fell into the following groups: for SBP, < 110, 110 to 139, 140 to 159, and > or = 160 mm Hg; and for DBP, < 80, 80 to 89, 90 to 94, and > or = 95 mm Hg. RESULTS: When we controlled for age and education, the risk for intermediate and poor cognitive function increased progressively with increasing level of midlife SBP category (P for trend < .03 and < .001, respectively). For every 10-mm Hg increase in SBP there was an increase in risk for intermediate cognitive function of 7% (95% confidence interval [CI], 3% to 11%) and for poor cognitive function of 9% (95% CI, 3% to 16%). Adjustment for prevalent stroke, coronary heart disease, and subclinical atherosclerosis reduced the strength of the relationship between midlife SBP and poor cognitive function to 5% (95% CI, 0% to 12%). The level of cognitive function was not associated with midlife DBP. CONCLUSIONS: Midlife SBP is a significant predictor of reduced cognitive function in later life. Early control of SBP levels may reduce the risk for cognitive impairment in old age.
Aged↗
Coronary arteriography for quantitative analysis: experimental and clinical comparison of cinefilm and video recordings.
Although use of videotape for the recording of coronary angiograms continues to grow, the validity of quantitative coronary angiographic analysis of video images remains unknown. To estimate the reliability of angiographic images recorded on videotape, experimental and clinical angiograms were recorded simultaneously on both 35 mm cinefilm and super-VHS videotape with normal images and with spatial filtering of the images (edge enhancement) on a digital cardiac imaging system. The experimental angiographic studies were performed with plexiglass blocks and stenosis phantom of 0.5 to 3.0 mm in diameter. The clinical angiograms were recorded in 20 patients undergoing percutaneous transluminal coronary angioplasty (31 frames before and 20 frames after percutaneous transluminal coronary angioplasty). The cinefilm and corresponding videotapes were analyzed off-line with the new version of the coronary angiography analysis system. For the experimental study, measurements of minimal luminal diameter obtained from cinefilm, normal-image videotape, and edge-enhanced videotape were compared with the true phantom diameter. In the clinical study the agreement between measurements obtained from cinefilm and measurements from normal-image videotape and edge-enhanced videotape was examined. In the phantom series the accuracy and precision of quantitative coronary angiography measurement for cinefilm were -0.10 +/- 0.08 mm, for normal-image videotape -0.11 +/- 0.18 mm, and for edge-enhanced videotape -0.10 +/- 0.11 mm (mean +/- SD). In the clinical series, the differences between measurements from cinefilm and normal-image videotape were 0.14 +/- 0.20 mm and from cinefilm and edge-enhanced videotape 0.04 +/- 0.13 mm.(ABSTRACT TRUNCATED AT 250 WORDS)
Angioplasty, Balloon, Coronary↗
Optimal use of directional coronary atherectomy is required to ensure long-term angiographic benefit: a study with matched procedural outcome after atherectomy and angioplasty.
OBJECTIVES: This study was designed to examine whether restenosis is related to the extent or mechanism of lumen improvement and to explore angiographic determinants of optimal atherectomy. BACKGROUND: Directional atherectomy induces a greater extent of immediate gain and late loss but has not been found to yield a better late angiographic lumen than angioplasty in randomized trials. The difference in lumen renarrowing may be related to either the extent or the mechanism of immediate gain. The design of previous studies has precluded the detection of a device-specific effect on restenosis. METHODS: A retrospective analysis was based on matching a prospectively collected series of 80 native coronary arteries successfully treated with atherectomy with a prospectively collected series of 80 native coronary arteries successfully treated with balloon angioplasty. Angiographic analysis was performed in 160 lesions to explore whether a specific device-related effect exists. Multivariate analyses were performed to determine the correlates of minimal lumen diameter at follow-up and late lumen loss and to identify the procedural characteristics for optimal atherectomy. RESULTS: Matching resulted in two comparable groups with equivalent baseline clinical and stenosis characteristics. By study design, atherectomy and angioplasty resulted in similar mean (+/- SD) immediate lumen gain (1.15 +/- 0.44 vs. 1.10 +/- 0.40 mm, p = 0.50). However, lumen loss was more pronounced after atherectomy, and, thus, the minimal lumen diameter at follow-up differed significantly between the two groups (1.78 +/- 0.57 vs. 2.00 +/- 0.56 mm, p = 0.001). Device type was retained in the multivariate analysis as an independent predictor of late minimal lumen diameter and lumen loss. Multivariate analysis identified vessel size and immediate gain as determinants of optimal atherectomy. CONCLUSIONS: Restenosis is a consequence not only of the extent of lumen improvement but also of the mechanism of vessel wall injury (debulking vs. dilating). While performing atherectomy, the operator should strive for an optimal procedural result to accommodate an increased intimal hyperplastic response.
Angioplasty, Balloon↗
Clinical, histologic and quantitative angiographic predictors of restenosis after directional coronary atherectomy: a multivariate analysis of the renarrowing process and late outcome.
OBJECTIVES: To characterize predictors of restenosis after successful directional atherectomy, we reviewed the clinical, angiographic and procedural data obtained during 132 consecutive procedures. METHODS: Clinical and angiographic follow-up data were obtained in a prospectively collected and consecutive series of 125 patients who underwent 132 atherectomy procedures for de novo (89%) or restenotic (11%) lesions in native coronary arteries. Restenosis was assessed clinically and by quantitative coronary angiography. A dual approach to data analysis was taken to gain insight into factors affecting the clinical outcome and vessel wall healing response. Therefore, multivariate analysis was performed to 1) determine the correlates of residual lumen diameter at follow-up (angiographic outcome), and 2) characterize the determinants of the late lumen loss (renarrowing process). RESULTS: Clinical and angiographic follow-up data after successful atherectomy were obtained in 100% and 95%, respectively. Atherectomy achieved an acute lumen gain of 1.28 +/- 0.48 mm (mean +/- SD), resulting in a minimal lumen diameter of 2.44 +/- 0.47 mm. At follow-up, the minimal lumen diameter decreased to 1.78 +/- 0.64 mm. The angiographic restenosis rate was 28% if the traditional 50% stenosis cutoff criterion was applied. Larger vessel size and postatherectomy minimal lumen diameter and right coronary or left circumflex artery lesions were independent predictors of a larger minimal lumen diameter (angiographic outcome). Lumen loss during follow-up (renarrowing process) was independently predicted by relative lumen gain and preprocedural minimal lumen diameter. CONCLUSIONS: In analyzing the long-term results of new interventional techniques such as directional atherectomy, the late lumen loss during follow-up (renarrowing process), which is characterized by the vessel wall healing response after an intervention, should be considered together with the residual lumen diameter at follow-up (clinical outcome). It is clear that whereas improved clinical outcome is associated with larger vessel size and postprocedural lumen diameter and non-left anterior descending artery location, greater relative gain at intervention is predictive of more extensive lumen renarrowing.
Aged↗
Radiation tolerance of the transplanted liver. A histopathologic study in three cases.
Three patients with multifocal recurrence of hepatocellular carcinoma following liver transplantation received palliative irradiation. Hyperfractionated irradiation (150 cGy/fraction b.i.d.) was delivered in two cases to the entire liver using parallel opposed oblique portals to a total dose of 30 Gy. Conventional irradiation (180 cGy/fraction) totaling 45 Gy was administered to the liver hilus with concomitant infusional 5-fluorouracil chemotherapy in the third case. Clinicopathologic correlations were performed. At autopsy all patients had massive tumor burden within the liver. Veno-occlusive changes were observed in two patients 1 and 2 months following completion of conventional and hyperfractionated irradiation, respectively. Liver transplantation in these two patients had been performed 18 and 16 months prior to palliative hepatic irradiation. In the third patient, no veno-occlusive changes were pathologically observed at autopsy 1 month after completing hyperfractionated radiation, which was delivered 6 months following liver transplantation. No significant differences in prior immunosuppressive therapy were identified among patients. Veno-occlusive changes are not spared by hyperfractionated radiation. Transplanted livers exhibit responses to radiation similar to those normally observed.
Adult↗
A 9.0-kilobase-pair circular plasmid of Borrelia burgdorferi encodes an exported protein: evidence for expression only during infection.
In this study, we report the cloning, sequencing, and molecular analysis of a gene located on a 9.0-kbp circular plasmid of virulent Borrelia burgdorferi B31 designated eppA (exported plasmid protein A). This gene encodes a precursor protein of 174 amino acids including a signal peptide of 20 amino acids and a type I signal peptidase cleavage site. The mature EppA protein of 154 amino acids has a calculated molecular weight of 17,972. Several lines of evidence suggest that eppA is not expressed by B. burgdorferi B31 during in vitro cultivation. Immunoblot analysis using hyperimmune rabbit antiserum to recombinant EppA (rEppA) did not detect the presence of EppA in B. burgdorferi B31 cultivated in vitro. Northern blot analysis using total RNA isolated from in vitro-cultivated virulent B. burgdorferi B31 failed to detect an eppA transcript. EppA was not detected in culture supernatants of virulent B. burgdorferi B31 in a sensitive antigen-capture enzyme-linked immunosorbent assay. In contrast, evidence for expression of eppA during infection was based on the observation that patients with Lyme disease as well as rabbits experimentally infected with B. burgdorferi B31 produced antibodies that recognized rEppA. Because the cellular location of EppA in B. burgdorferi cannot be determined in vivo because of very small numbers of organisms present in vertebrate infection, we examined the cellular location of rEppA expressed in Escherichia coli. In E. coli, rEppA is targeted to the outer membrane. In addition, purified E. coli outer membranes containing rEppA treated with chaotrophic agents did not result in rEppA release. These findings are consistent with the idea that EppA is not peripherally associated with the outer membrane of E. coli but rather has an integral outer membrane association.
Amino Acid Sequence↗
Isolation of the outer membranes from Treponema pallidum and Treponema vincentii.
The outer membranes from Treponema pallidum subsp. pallidum and Treponema vincentii were isolated by a novel method. Purified outer membranes from T. pallidum and T. vincentii following sucrose gradient centrifugation banded at 7 and 31% (wt/wt) sucrose, respectively. Freeze fracture electron microscopy of purified membrane vesicles from T. pallidum and T. vincentii revealed an extremely low density of protein particles; the particle density of T. pallidum was approximately six times less than that of T. vincentii. The great majority of T. vincentii lipopolysaccharide was found in the outer membrane preparation. The T. vincentii outer membrane also contained proteins of 55 and 65 kDa. 125I-penicillin V labeling demonstrated that t. pallidum penicillin-binding proteins were found exclusively with the protoplasmic cylinders and were not detectable with purified outer membrane material, indicating the absence of inner membrane contamination. Isolated T. pallidum outer membrane was devoid of the 19-kDa 4D protein and the normally abundant 47-kDa lipoprotein known to be associated with the cytoplasmic membrane; only trace amounts of the periplasmic endoflagella were detected. Proteins associated with the T. pallidum outer membrane were identified by one- and two-dimensional electrophoretic analysis using gold staining and immunoblotting. Small amounts of strongly antigenic 17- and 45-kDa proteins were detected and shown to correspond to previously identified lipoproteins which are found principally with the cytoplasmic membrane. Less antigenic proteins of 65, 31 (acidic pI), 31 (basic pI), and 28 kDa were identified. Compared with whole-organism preparations, the 65- and the more basic 31-kDa proteins were found to be highly enriched in the outer membrane preparation, indicating that they may represent the T. pallidum rare outer membrane proteins. Reconstitution of solubilized T. pallidum outer membrane into lipid bilayer membranes revealed porin activity with two estimated channel diameters of 0.35 and 0.68 nm based on the measured single-channel conductances in 1 M KCl of 0.40 and 0.76 nS, respectively.
Animals↗
Lipoprotein(a) in restenosis after percutaneous transluminal coronary angioplasty and coronary artery disease.
BACKGROUND: The purpose of the study was to investigate the relation of lipoprotein(a) and serum lipid parameters to restenosis after percutaneous transluminal coronary angioplasty (PTCA) and to assess the association of these same biochemical markers to coronary artery disease (CAD) in individuals with angiographically defined normal and diseased coronary arteries. METHODS AND RESULTS: Sixty-two patients with successful PTCA had follow-up angiography at 35 +/- 10 weeks. Restenosis occurred in 21 male patients (46%) and 6 female patients (38%). Elevated apolipoprotein B (P < .01) and decreased high-density lipoprotein-2 cholesterol (P < .02) were found to be independently associated with restenosis after angioplasty, whereas lipoprotein(a) was not. Eighty-five patients undergoing PTCA were compared with 46 subjects who had no evidence of CAD on angiography. Elevated lipoprotein(a) (P < .001) and reduced apolipoprotein A1 to B ratio (P < .001) were found to be strong independent risk factors for the presence of CAD when adjustment was made for age (P < .005), male sex (P < .01), smoking (P < .005), and hypertension (P = .06). CONCLUSIONS: Serum lipoprotein(a) levels are not associated with restenosis after PTCA, but elevated levels are strongly associated with CAD. Low-serum, high-density lipoprotein-2 cholesterol concentration and elevated apolipoprotein B concentration were found to be associated with restenosis after PTCA.
Angioplasty, Balloon, Coronary↗
Interventional techniques for the management of coronary artery lesions: an update.
Coronary balloon angioplasty has become standard treatment for ischemic coronary artery disease. Major limitations of angioplasty are the inferior results obtained with unfavorable lesions, the occurrence of abrupt occlusion responsible for in-hospital mortality and morbidity, and the high restenosis rate at 6 months. New techniques for stents, laser, and atherectomy have been developed to overcome these limitations. Until now, although the initial results are encouraging, these new techniques have not as yet shown to be clearly superior to balloon angioplasty. However, due to the limitations of balloon angioplasty, further development of new techniques should be stimulated so that nonsurgical treatment of coronary artery disease will become safer, more effective, and applicable to a wider spectrum of coronary artery disease.
Angioplasty, Balloon, Coronary↗
Visual versus quantitative assessment of the severity of coronary artery stenoses: can the angiographer's eye be reeducated?
The percent reduction of intraluminal diameter of 102 coronary stenoses before (n = 26), immediately after (n = 24), and 6 months after (n = 52) coronary balloon angioplasty as assessed by two observers experienced in quantitative coronary angiography and by automated measurement by means of the Cardiovascular Angiographic Analysis System (CAAS) was compared. Two hundred twenty-seven still frames were selected for analysis by CAAS and displayed for assessment by each of the observers, who were unaware of CAAS results. Comparisons with CAAS measurements were made for all still frames ("per view" analyses) and for each coronary stenosis after averaging the values obtained for a given coronary segment ("per stenosis" analyses). Intraobserver variability was tested on 21 still frames from 10 stenoses, assessed 6 weeks apart by one observer. Intraobserver variability was 5% (r = 0.98); interobserver variability was 6% (r = 0.94). Per view analyses showed that observer measurements correlated well with CAAS measurements (r = 0.89 and r = 0.90); the accuracy was -0.9% and -0.7% for observers 1 and 2, and the precision was 9% and 8%, respectively; for per stenosis analyses, the accuracy was -0.5% and -0.8% (r = 0.92 and 0.94) and the precision 7% and 6%, respectively. There was no difference in the accuracy and precision of visual assessment for lesions with < 50%- or > 50%-diameter stenoses. The occurrence of restenosis was likewise detected visually with a high sensitivity and specificity compared with CAAS.(ABSTRACT TRUNCATED AT 250 WORDS)
Angioplasty, Balloon, Coronary↗
Acute impact of percutaneous transluminal coronary angioplasty on the ischemic burden in stable and unstable angina.
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Angina Pectoris↗
Driving with cognitive impairment.
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Accidents, Traffic↗
Lipids and fatty acids and their relationship to restenosis.
One hundred consecutive patients had fasting lipids and percutaneous fat biopsy performed at the time of percutaneous transluminal coronary angioplasty to determine if there was an association between restenosis and lipids or fatty acids. Angiographic follow-up and complete lipid and fatty acid results were available in 82 patients. Restenosis occurred in 37/82 (45%). Total cholesterol, triglyceride, high density lipoprotein, low density lipoprotein, and apolipoproteins A1 and B were not associated with restenosis. There was a significantly lower level of the monounsaturated fat palmitoleic acid (p less than 0.02), a trend towards a lower level of the monounsaturated fat oleic acid (p less than 0.09), and a trend towards a higher level of the saturated fat palmitic acid (p less than 0.08) in the restenosis group. The polyunsaturated fatty acids were not associated with restenosis. We conclude that lipids are not significantly associated with restenosis, and that lower levels of monounsaturated fatty acids may increase the risk of restenosis.
Angina Pectoris↗
Development and testing of second generation extracorporeal shock-wave lithotriptor.
The Northgate SD-3 extracorporeal shock-wave lithotriptor is a second generation device that utilizes an ultrasound-guided computer-assisted system for calculus localization. Focused electrohydraulic shock waves are generated in a movable membrane-covered ellipsoidal reflector. Pressure wave characteristics and energy output of the SD-3 and the Dornier HM-3 were tested and found to be comparable. The ultrasound unit was capable of identifying radiolucent calculi as well as calculus fragments 2-3 mm in size. The computer-assisted aiming system was found to be accurate to within 1 mm. The overall successful calculus fragmentation rate using an animal model was 80 percent with an 87.5 percent rate following machine modifications resulting in increased energy output.
Animals↗
Computed tomography in the diagnosis of sacroiliitis.
Computed tomography (CT) and conventional radiography of the sacroiliac joint were compared in 43 patients. CT appeared to be far more sensitive and equally specific in the recognition of sacroiliitis. In a number of patients with sacroiliitis diagnosed by both techniques, CT demonstrated abnormalities that were not demonstrated by conventional radiographs. Of those patients with clinical evidence of sacroiliitis and HLA-B27 positivity, 50% had negative or equivocal radiographs compared to 19% who had negative computed tomographic images for sacroiliitis.
Adult↗