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Biomedical subjects

Gary Meyerrose

Publications and source records attributed to Gary Meyerrose.

9 recordsLinked to original sources

Elevated carboxy-terminal peptide of procollagen type I in elderly patients with diastolic dysfunction.

BACKGROUND: Diastolic dysfunction (DD) is common in elderly people. Myocardial fibrosis is a major determinant of diastolic function. Increased myocardial fibrosis has been observed with advancing age. We hypothesized that plasma levels of carboxy-terminal peptide of procollagen type I (PICP), a marker of fibrosis, is elevated in elderly subjects with DD compared to healthy control subjects. METHODS: PICP levels were measured in 29 elderly subjects with DD and 25 healthy control subjects. The relationship between PICP levels and age, gender, hypertension, and the presence of left ventricular hypertrophy were then assessed. RESULTS: PICP levels were significantly higher in elderly subjects with DD than in healthy control subjects (301.0 +/- 52.0 vs. 262.9 +/- 45.3 ng/mL; P = .006). PICP levels were higher in elderly with DD regardless of the presence of left ventricular hypertrophy. Additionally, PICP levels were not found to correlate with age. CONCLUSIONS: PICP levels are elevated in elderly people with DD. PICP may be a useful marker to determine the level of fibrotic activity in this population.

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Diastolic heart failure in the elderly and the potential role of aldosterone antagonists.

The overall incidence of heart failure increases with age, affecting up to 10% of people >65 years of age. Diastolic heart failure is also age-dependent, increasing from <15% in middle-aged patients to >40% in patients > or =70 years of age. Elderly patients usually have other co-morbid conditions such as hypertension, diabetes mellitus, coronary artery disease and atrial fibrillation that can adversely affect the diastolic properties of the heart. The clinical manifestations of diastolic heart failure are similar to those of systolic heart failure. In practice, the diagnosis is generally based on the finding of typical symptoms and signs of heart failure with preserved left ventricular ejection fraction and no valvular abnormalities on echocardiography. Altered ventricular relaxation and abnormal ventricular filling are the hallmarks of diastolic heart failure. Cardiac fibrosis and cellular disarray lead to the alterations in the diastolic properties of the heart. Diffuse foci of fibrosis in the myocardium have been reported with advancing age. Aldosterone has been shown to play a crucial role in the development of cardiac fibrosis via a direct effect on the mineralocorticoid receptors within the myocardium. Unlike the situation with treatment of systolic heart failure, few clinical trials are available to guide the management of patients with diastolic heart failure. In the absence of controlled clinical trials, patient management is based on control of the physiological factors (blood pressure, heart rate, blood volume and myocardial ischaemia) that are known to exert important effects on ventricular relaxation. Aldosterone antagonists inhibit the deposition of collagen matrix in the myocardium, thereby targeting the basic pathophysiological mechanism of diastolic dysfunction. Thus, they appear to represent a promising therapeutic approach for this condition. Currently, only small clinical trials supporting this therapy are available and large clinical trials evaluating long-term outcomes in diastolic dysfunction are therefore needed.

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Recurrent gastrointestinal bleeding diagnosed by delayed scintigraphy with Tc-99m-labeled red blood cells.

A 56-year-old woman presented with bright-red blood from the rectum. Esophagogastroduodenoscopy revealed mild gastritis. Colonoscopy demonstrated diverticulosis without active bleeding, and in vitro tagged red blood cell scintigraphy was unremarkable. There was no further evidence of bleeding and the patient was discharged home. The patient returned with recurrent bright-red blood from the rectum. Although delayed scintigraphic images seldom demonstrate the site of bleeding, delayed images at 12 hours demonstrated active bleeding near the hepatic flexure in this patient. This was confirmed with selective mesenteric angiography, and was treated with coil embolization of the tertiary branches of the right middle colic artery.

Colon↗

Embolus in transit.

A patient who presented with recurrent syncopal episodes was discovered to have a right-sided heart mass, which was revealed as an embolus in transit resulting in a lethal pulmonary embolic event. The initial focus of etiology on tumor rather than thrombus was misleading. A higher index of suspicion of thrombus in right heart mass may help future patients receive more directed therapy.

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Bilateral external iliac artery catheter-induced vasospasm during angiography--a case report.

The occurrence of catheter-induced vasospasm of small-caliber arteries during cardiac angiography is well documented. In contrast, little documentation of catheter-induced vasospasm in large-caliber arteries exists. This case presents reproducible catheter-induced vasospasm with bilateral asymptomatic occlusion of the femoral and iliac arteries.

Arterial Occlusive Diseases↗