Images in cardiology: Right atrial mass: primary angiosarcoma.
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Adult↗
Biomedical subjects
J Swafford
Publications and source records attributed to J Swafford.
Posterior-stabilized and cruciate-retaining total knee replacement: a randomized study.
A randomized controlled study was done to compare the clinical, radiographic, and quality of life outcomes between posterior-stabilized and cruciate-retaining primary total knee implants. One hundred forty-three patients were enrolled in the study. Patients ranged in age from 57 to 89 years, had a primary diagnosis of osteoarthritis, and an intact functioning posterior cruciate ligament. Patients were excluded if they had a flexion contracture greater than 15 degrees, a varus deformity greater than 20 degrees, or a valgus deformity greater than 15 degrees. Patients were randomized to one of two study groups, posterior-stabilized AMK total knee implants (76 patients) or cruciate-retaining AMK total knee implants (67 patients). One hundred eight patients have had a minimum 2-year followup including 57 patients in the posterior-stabilized group and 51 patients in the cruciate-retaining group. Seventy-three patients have had a minimum 3-year followup including 37 patients in the posterior stabilized group and 36 patients in the cruciate-retaining group. The overall total Knee Society clinical rating score at 2 years averaged 157.1 points in the posterior-stabilized group and 156.5 points in the cruciate-retaining group. At 3 years, the scores averaged 156.8 points in the posterior-stabilized group and 163.5 points in the cruciate-retaining group. The range of motion component of the Knee Society score averaged 113.6 degrees for the posterior-stabilized group and 108.5 degrees for the cruciate-retaining group at 2 years, and 108.3 degrees in the cruciate-retaining group and 108.5 degrees in the posterior-stabilized group. Based on the various parameters analyzed, there were no notable differences between the groups with a posterior-stabilized and a cruciate-retaining total knee implant at 2 years. This trend seemed to be the same at 3 years.
Aged↗
Resolution of nonbacterial endocarditis after surgical resection of a malignant liver tumor.
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Adenocarcinoma↗
Influence of additional acid etch treatment on resin cement dentin infiltration.
PURPOSE: The purpose of this study was to compare the penetration of a resin cement into dentin surfaces pretreated with self-etching primer with or without conventional acid etch. MATERIALS AND METHODS: Dentin surfaces of 8 unerupted human third molars were treated with self-etch primer (Panavia 21; Kuraray Co, Ltd, Osaka, Japan) with or without conventional acid etch treatment. A resin cement (Panavia 21) was applied according to manufacturer's instructions. Dentin/resin cement interface sections from each tooth were examined with light microscopy and scanning electron microscopy. In the light microscopy sections, exposed protein at the dentin/cement interface was stained a distinct red with Goldner's trichrome. RESULTS: The resin cement did not penetrate the depth of the zone of demineralized dentin when the self-etch primer was used in combination with conventional acid etch treatment. Inadequate resin cement penetration leaves a substantial area of exposed protein at the dentin/cement interface. In contrast, there was complete resin cement diffusion throughout the demineralized dentin when the self-etch primer was used without acid etching. CONCLUSIONS: Combining conventional acid etch treatment with a self-etching primer/resin cement system resulted in incomplete resin cement penetration and exposed protein at the dentin/cement interface.
Acid Etching, Dental↗
Cardiotoxicity in patients receiving transtuzumab (Herceptin): primary toxicity, synergistic or sequential stress, or surveillance artifact?
Human epidermal growth factor receptor-2 (HER2) is a member of the epidermal growth factor receptor family, which produces factors that are considered to be important mediators of cell growth. Overexpression of HER2, which occurs in approximately 25% to 30% of human breast cancers, has fostered considerable interest in innovative therapeutic modalities designed to target tumor cells demonstrating such overexpression. Trastuzumab (Herceptin; Genentech, San Francisco, CA), a humanized monoclonal antibody developed to target the HER2 receptor, is the most widely studied example of such a modality. In early clinical studies with trastuzumab, cardiomyopathy was observed with a clinical expression similar to that seen with the anthracyclines (ie, a potentially progressive decrease in cardiac systolic function). A number of possible explanations for this cardiotoxicity are explored in this report. The first is that trastuzumab has inherent toxicity. This consideration has some theoretical interest, since fetal myocardial cells exhibit HER2 receptors and the adult myocardium expresses HER3 receptors. A second possibility is that sequential stresses following doxorubicin administration contribute to cardiac dysfunction. A third explanation is that observational artifacts lead to an overestimation of trastuzumab cardiotoxicity. Approaches for additional study of the extent and severity of trastuzumab cardiotoxicity are briefly addressed.
Antibodies, Monoclonal↗
A minimal motor domain from chicken skeletal muscle myosin.
The myosin head (S1) consists of a wide, globular region that contains the actin- and nucleotide-binding sites and an alpha-helical, extended region that is stabilized by the presence of two classes of light chains. The essential light chain abuts the globular domain, whereas the regulatory light chain lies near the head-rod junction of myosin. Removal of the essential light chain by a mild denaturant exposes the underlying heavy chain to proteolysis by chymotrypsin. The cleaved fragment, or "motor domain" (MD), migrates as a single band on SDS-polyacrylamide gel electrophoresis, with a slightly greater mobility than S1 prepared by papain or chymotrypsin. Three-dimensional image analysis of actin filaments decorated with MD reveals a structure similar to S1, but shorter by an amount consistent with the absence of a light chain-binding domain. The actin-activated MgATPase activity of MD is similar to that of S1 in Vmax and Km. But the ability of MD to move actin filaments in a motility assay is considerably reduced relative to S1. We conclude that the globular, active site region of the myosin head is a stable, independently folded domain with intrinsic motor activity, but the coupling efficiency between ATP hydrolysis and movement declines markedly as the light chain binding region is truncated.
Actins↗
Late doxorubicin-associated cardiotoxicity in children. The possible role of intercurrent viral infection.
BACKGROUND: The most frequently encountered doxorubicin related cardiac toxicity is a dose-related myocardial dysfunction occurring 1-6 months after chemotherapy. Recently, late cardiotoxicity has been the focus of interest. This paper explores the possibility that acute intercurrent viral illness may trigger late cardiotoxicity. METHODS: Thirty selected pediatric patients were followed for changes in their echocardiographically measured fractional shortening (FS) for 2-10 years after completion of their doxorubicin chemotherapy. They were divided according to the dose of doxorubicin they received (< 300 mg/m2 or > or = 300 mg/m2) and to whether the manifestations of an acute intercurrent viral illness during the observation period were documented. Eleven patients experienced such infections. RESULTS: Changes in FS demonstrated two different responses. The usual response to doxorubicin was a gradual, dose-related fall in FS, followed by recovery; while the second response included an unexpected, late, sudden decrease in FS. Four patients in the low dose subgroup experienced an acute intercurrent viral illness, but none of these demonstrated the unexpected decrease. Of the seven patients who acquired such illness in the high dose subgroup, five demonstrated the sudden, late decrease in FS, with two of them developing severe, reversible congestive heart failure. CONCLUSIONS: The most likely explanation for the late, sudden decrease in FS is an additional stress in patients who already have sustained subclinical cardiac damage as a result of their doxorubicin chemotherapy. An acute intercurrent viral illness may have triggered late cardiac dysfunction in some of these patients.
Acute Disease↗
Quantitative coronary arteriography and its assessment of atherosclerosis. Part I. Examining the independent variables.
BACKGROUND: Previous work has demonstrated that quantitative coronary arteriography (QCA) can accurately measure phantom images to within +/- 0.1 mm and has been accepted as a reliable and reproducible method of measuring human coronary artery disease (CAD). Assessment of CAD by QCA involves the measurement of numerous variables, which are currently required to calculate stenosis flow reserve (SFR). METHODS AND RESULTS: In this study 1040 stenotic lesions were analyzed by two well-accepted methods with demonstrated accuracy and reproducibility. These methods measure percent diameter stenosis (%DS), absolute diameter, percent area stenosis, length, as well as entry and exit angles to and from a stenotic coronary artery lesion respectively. Based upon these results, the mean +/- standard deviations and range seen in CAD were determined for each of these independent variables. This study demonstrated that atherosclerotic coronary artery lesions do not appear to exceed an entry angle of -39 degrees, and exit angle of +35 degrees, or an absolute length of 4.84 cm when accurately measured by QCA. It was also noted that, once percent diameter stenosis exceeded 89% (regardless of the visual estimate) or percent area stenosis exceeds 99%, coronary arteries become completely occluded as measured by QCA. CONCLUSIONS: While previously suspected that once certain critical limits are exceeded in the deposit of cholesterol and calcium within the coronary artery, the artery will close, this study demonstrated by QCA what the limitations in human coronary arteries appear to be. These limits may be in part due to turbulent factors resulting in platelet activation or local mediators from endothelium of the coronary artery.
Coronary Angiography↗
Cardiac diastolic function in pediatric patients receiving doxorubicin.
The purpose of the study was to compare systolic and diastolic function in pediatric patients treated with doxorubicin. Left ventricular function was evaluated in 61 children prior to and following chemotherapy. None had clinical evidence of cardiac decompensation prior to treatment. All received relatively low cumulative doses of doxorubicin; the majority received the drug by continuous infusion. Systolic function was estimated using fractional shortening; diastolic function was estimated using A wave velocity, E wave velocity, E to A ratio, and deceleration time. There was a small but significant decline in systolic cardiac function as estimated from changes in fractional shortening that could not be appreciated in any of the measured parameters of diastolic function. A variety of reasons that could be responsible for the absence of significant changes in diastolic function are discussed. For the present, estimations of systolic function are preferred over the studied parameters of diastolic function in the evaluation of cardiac status in pediatric patients receiving doxorubicin containing regimens.
Adolescent↗
Postoperative atrial fibrillation in cancer surgery: preoperative risks and clinical outcome.
Postoperative atrial fibrillation (AF) is a recognized complication of cancer surgery. The purpose of this study was to define preoperative risk factors for AF, and to evaluate the clinical significance of the arrhythmia. We reviewed the medical records of 43 patients with postoperative AF admitted to the surgical intensive care unit (SICU). All patients were older than 60 years, 79% had a history of cigarette smoking, and 44% had hypertension. AF occurred an average of 2.8 days following surgery, and lasted an average of 2.1 days. No significant complications developed, and there were no long-term sequelae. This study suggests that, in cancer patients, postoperative AF is a disease of elderly patients. In addition the arrhythmia appears to be a relatively transient and benign phenomenon. Prolonged monitoring in an intensive care setting may not be necessary for asymptomatic, hemodynamically stable patients.
Aged↗
Nodus migrans: the case of the migrating knot.
Flow-directed pulmonary artery catheters provide important information regarding intravascular volume status, cardiac function and vascular resistance. We describe an unusual complication of pulmonary artery catheterization in which a knot formed at the distal end was torn away from the catheter body and migrated from its original position in the right subclavian vein to a distal branch of the right pulmonary artery. Careful attention to insertion and withdrawal techniques could prevent this potentially serious complication.
Carcinoma, Small Cell↗
Cardiac emergencies in the cancer patient.
Cardiac emergencies may be encountered during the management of patients with cancer, both in those with underlying cardiovascular disease and those with no previous history of cardiac problems. Both surgical and medical cancer treatment modalities may exacerbate preexisting cardiac conditions. Some antineoplastic agents can adversely affect the coronary arteries, myocardium, or pericardium. It has also been recognized that cardiac damage due to radiotherapy and chemotherapy may become clinically significant many years after therapy has been completed. Treatment of urgent cardiac problems in the cancer patient may differ from that recommended for other patient groups, since many cancer patients are not ideal candidates for some of the newer cardiac agents. Management of these conditions must therefore be tailored to the individual patient.
Emergencies↗
The psychosocial impact of systemic lupus erythematosus and rheumatoid arthritis.
Seventy-six ambulatory patients with systemic lupus erythematosus and a comparison group of 23 ambulatory patients with rheumatoid arthritis were given a structured interview and standard psychological tests, including the Minnesota Multiphasic Personality Inventory, to determine the psychosocial impact of the illness. Both groups had significantly elevated scores on 3 Minnesota Multiphasic Personality Inventory scales: Hypochondriasis, Depression, and Hysteria. Psychological difficulties are an integral part of systemic lupus erythematosus and are as common as most other manifestations. The implications for clinical practice are discussed.
Arthritis, Rheumatoid↗
Mesosomes in m-tyrosine-inhibited Bacillus thuringiensis.
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Bacillus↗
Using quantitative coronary arteriography to redefine SPECT sensitivity and specificity.
Previous studies looking at the sensitivity, specificity, and predictive accuracy of single photon emission computed tomography (SPECT) have been based upon the results obtained by visual interpretation of coronary arteriograms. Since the results of visual and quantitative determination of percent diameter stenosis have been shown to be statistically different, the results obtained from SPECT imaging when compared to quantitative methods for assessing coronary artery disease would be expected to provide a more correct assessment of sensitivity, specificity, and predictive accuracy. To determine the "true" sensitivity, specificity, and predictive accuracy of SPECT in diagnosing coronary artery disease, this study compared the results obtained in 44 SPECT images (20 thallium and 24 teboroxime) with the results obtained when quantitative coronary arteriography was used to analyze the coronary arteriograms. These 44 cases were then compared against 8 different definitions of significant coronary artery disease, varying from 30 to 80%, to yield 352 comparisons. The maximum specificity and predictive accuracy was found when 45% diameter stenosis was used to define the presence or absence of significant disease. At 45% diameter stenosis, SPECT imaging demonstrated an 86% sensitivity, 78% specificity, and 94% predictive accuracy with only 6% false positives. In 100% of the cases where 45% diameter stenosis was used to define the presence of disease and exercise failed to demonstrate ST segment changes or angina, when SPECT imaging demonstrated a perfusion defect(s), quantitative coronary arteriography agreed with SPECT imaging results.(ABSTRACT TRUNCATED AT 250 WORDS)
Aged↗