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Biomedical subjects

R W Barnes

Publications and source records attributed to R W Barnes.

At least 19 recordsLinked to original sources
PubMed1999

Evolution of the modified Rossetti fundoplication in children: surgical technique and results.

OBJECTIVE: To compare the modified Rossetti fundoplication with the classic Nissen. SUMMARY BACKGROUND DATA: The traditional surgical treatment of gastroesophageal reflux in children has been the classic Nissen fundoplication, defined by liver mobilization, crural repair, takedown of short gastric vessels, and floppy wrap. The authors have progressed in our technique of fundoplication and now perform a modified Rossetti fundoplication, defined by liver retraction without mobilization, no crural repair, short gastric vessels left intact, and 2-cm floppy wrap. METHODS: A retrospective chart review was performed on 407 pediatric patients who had open fundoplications (Jan. 13, 1993, to Feb. 25, 1998). Two groups were analyzed: the Nissen group (171 patients) and the Rossetti group (236 patients). Groups were compared for incidence of recurrent reflux, dysphagia, hiatal hernia, need for esophageal dilation, revision of fundoplication, time to discharge, and operative time. RESULTS: Incidence of dysphagia (3.7% vs. 3.3%), postoperative hiatal hernia (1.9% vs. 1.4%), need for esophageal dilation (1.2% vs. 0.5%), and need for fundoplication revision (2.5% vs. 2.3%) were similar between the groups. The mean operative time was significantly decreased in the Rossetti group (65 +/- 25 minutes) versus the Nissen group (73 +/- 33 minutes). Recurrent reflux occurred significantly more often in the Nissen group (11.2%) than in the Rossetti group (5.1 %). CONCLUSION: The modified Rossetti fundoplication has a low complication rate and is the authors' preferred method for the surgical treatment of gastroesophageal reflux in children.

Child, Preschool↗
PubMed1999

The North American Symptomatic Carotid Endarterectomy Trial : surgical results in 1415 patients.

BACKGROUND AND PURPOSE: This study reports the surgical results in those patients who underwent carotid endarterectomy in the North American Symptomatic Carotid Endarterectomy Trial (NASCET). METHODS: The rates of perioperative stroke and death at 30 days and the final assessment of stroke severity at 90 days were calculated. Regression modeling was used to identify variables that increased or decreased perioperative risk. Nonoutcome surgical complications were summarized. The durability of carotid endarterectomy was examined. RESULTS: In 1415 patients there were 92 perioperative outcome events, for an overall rate of 6.5%. At 30 days the results were as follows: death, 1.1%; disabling stroke, 1.8%; and nondisabling stroke, 3.7%. At 90 days, because of improvement in the neurological status of patients judged to have been disabled at 30 days, the results were as follows: death, 1.1%; disabling stroke, 0.9%; and nondisabling stroke, 4.5%. Thirty events occurred intraoperatively; 62 were delayed. Most strokes resulted from thromboembolism. Five baseline variables were predictive of increased surgical risk: hemispheric versus retinal transient ischemic attack as the qualifying event, left-sided procedure, contralateral carotid occlusion, ipsilateral ischemic lesion on CT scan, and irregular or ulcerated ipsilateral plaque. History of coronary artery disease with prior cardiac procedure was associated with reduced risk. The risk of perioperative wound complications was 9.3%, and that of cranial nerve injuries was 8.6%; most were of mild severity. At 8 years, the risk of disabling ipsilateral stroke was 5.7%, and that of any ipsilateral stroke was 17.1%. CONCLUSIONS: The overall rate of perioperative stroke and death was 6.5%, but the rate of permanently disabling stroke and death was only 2.0%. Other surgical complications were rarely clinically important. Carotid endarterectomy is a durable procedure.

Aged↗
PubMed1997

Cardiac autonomic function and incident coronary heart disease: a population-based case-cohort study. The ARIC Study. Atherosclerosis Risk in Communities Study.

Cardiac autonomic activity, as assessed by heart rate variability, has been found to be associated with postmyocardial infarction mortality, sudden death, and all-cause mortality. However, the association of heart rate variability and the incidence of coronary heart disease (CHD) is not well described. The authors report on the association of baseline cardiac autonomic activity (1987-1989) with incident CHD after 3 years (1990-1992) of follow-up of the Atherosclerosis Risk in Communities Study cohort selected from four study centers in the United States by using a case-cohort design. The authors examined 137 incident cases of CHD and a stratified random sample of 2,252 examinees free of CHD at baseline. Baseline, supine, resting beat-to-beat heart rate data were collected. High- (0.16-0.35 Hz) and low- (0.025-0.15 Hz) frequency spectral powers and high-/low-frequency power ratio, estimated from spectral analysis, and standard deviation of all normal R-R intervals, calculated from time domain analysis, were used as the conventional indices of cardiac parasympathetic, sympatho-parasympathetic, and their balance, respectively. Incident CHD was defined as hospitalized myocardial infarction, fatal CHD, or cardiac revascularization procedures during 3 years of follow-up. The age, race, gender, and other CHD risk factor-adjusted relative risks (and 95% confidence intervals) of incident CHD comparing the lowest quartile with the upper three quartiles of high-frequency power, low-frequency power, high-/low-frequency power ratio, and standard deviation of R-R intervals were 1.72 (95% confidence interval (CI) 1.17-2.51), 1.09 (95% CI 0.72-1.64), 1.25 (95% CI 0.84-1.86), and 1.39 (95% CI 0.94-2.04), respectively. The findings from this population-based, prospective study suggest that altered cardiac autonomic activity, especially lower parasympathetic activity, is associated with the risk of developing CHD.

Case-Control Studies↗
PubMed1997

Variation of common carotid artery elasticity with intimal-medial thickness: the ARIC Study. Atherosclerosis Risk in Communities.

The Atherosclerosis Risk in Communities (ARIC) study is a prospective investigation of the etiology and natural history of atherosclerosis and cardiovascular disease in four U.S. communities. The purpose of this work is to investigate the relationship between common carotid artery elasticity and intimal-medial thickness (IMT) in the four race-gender groups represented in the ARIC cohort. Noninvasive ultrasonic methods were used to measure IMT and the [systolic minus diastolic] diameter change (DC) of the left common carotid artery in 10,920 black and white, men and women between the ages of 45 and 64 y. The relationship between DC and IMT and IMT2 was examined after adjustment of DC for age, height, diastolic diameter, diastolic blood pressure and linear and quadratic terms for pulse pressure. This adjusted value of DC was used as an index of elasticity of the common carotid artery in the ARIC cohort with larger values of adjusted DC implying a more elastic vessel. The general behavior of adjusted DC with increasing IMT was observed to be qualitatively similar in all four race-gender groups. Adjusted DC remained nearly constant or increased slightly for values of IMT between approximately 0.4 and 0.8 mm, up to approximately the 90th percentile of IMT, and then decreased above the 90th percentile of IMT. Common carotid artery elasticity, defined as adjusted DC, varies with increasing IMT in the ARIC cohort in a manner consistent with results from previous studies in animals and human subjects addressing the variation of several elasticity indices with atherosclerotic involvement and risk factor exposure in the aorta, and brachial and radial arteries. Our results suggest that thicker common carotid artery walls in middle-aged U.S. populations are no stiffer than thinner walls, except for the thickest 10% of arteries. Since the distal common carotid artery frequently contains atheromatous plaques in this population, the lack of change in stiffness, indeed, the reduction in stiffness per unit thickness, may reflect the various stages of early common carotid atherosclerosis most often found in this population. These are characterized more by destruction of arterial wall structural elements than by changes such as widespread or circumferential sclerosis, which would strengthen and stiffen the artery.

Arteriosclerosis↗
PubMed1997

The next generation of vascular surgeons: how should they be trained and credentialed? Who should pay for it?

Vascular surgery has matured as a subspecialty of general surgery during the past 25 years. The discipline currently faces a number of challenges including duration and scope of training, financing of graduate medical education, specialty and subspecialty certification, hospital privileging or credentialing, and practice opportunities. This article reviews these issues in terms of present realities and future opportunities. Emphasis is placed on curricular redesign to tailor length and breadth of training to future career goals, be they private practice as a general surgeon with vascular surgery interests, a vascular surgical subspecialist, a rural versus an urban practice, or a subspecialist in an academic setting. A plea is made for regulatory bodies, including the Residency Review Committee for Surgery and the American Board of Surgery, as well as specialty societies, particularly the American College of Surgeons, to maintain a flexible and constructive posture in dealing with proposed educational innovations. With cooperative efforts of both the Association of Program Directors in Surgery and the Association of Program Directors in Vascular Surgery, vascular surgery education and training of both general surgeons and vascular surgeons should be enhanced to fulfill the workforce needs as we enter the next millennium.

Costs and Cost Analysis↗
PubMed1996

A computer algorithm to impute interrupted heart rate data for the spectral analysis of heart rate variability--the ARIC study.

The shorter term beat-to-beat heart rate data collected from the general population are often interrupted by artifacts, and an arbitrary exclusion of such individuals from analysis may significantly reduce the sample size and/or introduce selection bias. A computer algorithm was developed to label as artifacts any data points outside the upper and lower limits generated by a 5-beat moving average +/- 25% (or set manually by an operator using a mouse) and to impute beat-to-beat heart rate throughout an artifact period to preserve the timing relationships of the adjacent, uncorrupted heart rate data. The algorithm applies Fast Fourier Transformation to the smoothed data to estimate low-frequency (LF; 0.025-0.15 Hz) and high-frequency (HF; 0.16-0.35 Hz) spectral powers and the HF/LF ratio as conventional indices of sympathetic, vagal, and vagal-sympathetic balance components, respectively. We applied this algorithm to resting, supine, 2-min beat-to-beat heart rate data collected in the population-based Atherosclerosis Risk in Communities study to assess the performance (success rate) of the algorithm (N = 526) and the inter-and intra-data-operator repeatability of using this computer algorithm (N = 108). Eighty-eight percent (88%) of the records could be smoothed by the computer-generated limits, an additional 4.8% by manually set limits, and 7.4% of the data could not be processed due to a large number of artifacts in the beginning or the end of the records. For the repeatability study, 108 records were selected at random, and two trained data operators applied this algorithm to the same records twice within a 6-month interval of each process (blinded to each other's results and their own prior results). The inter-data-operator reliability coefficients were 0.86, 0.92, and 0.90 for the HF, LF, and HF/LF components, respectively. The average intra-data-operator reliability coefficients were 0.99, 0.99, and 0.98 for the HF, LF, and HF/LF components, respectively. These results indicate that this computer algorithm is efficient and highly repeatable in processing short-term beat-to-beat heart rate data collected from the general population, given that the data operators are trained according to standardized protocol.

Algorithms↗
PubMed1996

Young women with advanced aortoiliac occlusive disease: new insights.

We identified a group of 24 young (less than 50 years of age) women with isolated, premature atherosclerotic aortoiliac occlusive disease and attempted to identify distinguishing hemostatic characteristics. Most of these patients (62%) presented with acute thromboembolic events (blue toe syndrome, n = 6; macroemboli, n = 6; or aortoiliac thrombosis, n = 3). Aortoiliac reconstruction (aortoiliac endarterectomy, n = 10, aortobifurcation bypass grafts, n = 6; and percutaneous angioplasty, n = 4) was complicated by early thrombosis in 6 of 20 cases (30%), (1 of 10 endarterectomies, 4 of 6 bypass grafts, and 1 of 4 angioplasties). Fresh thrombus overlying an atherosclerotic plaque was a common finding at surgery. This observation and the relatively high incidence of thromboembolic events led us to hypothesize that a characteristic hemostatic profile might underlie the remarkably similar clinical presentations of these women. Levels of antiphospholipid antibodies (anticardiolipin antibodies and lupus anticoagulant), plasminogen activator inhibitor-1, fibrinogen, antithrombin III, protein C, protein S, plasminogen, prothrombin fragment F1 + 2, and D-dimer were determined for these young women and for 21 age-matched white female control subjects without vascular disease and nine white male patients with aortoiliac occlusive disease (mean 61 years, range 43 to 74 years). The incidence of anticardiolipin antibodies was 42% (8 of 19) in the female patients, which was significantly elevated (p = 0.028). The female (62.5%) and male (100%) patients had significantly elevated D-dimer levels (p < 0.001). Deficiencies of antithrombin III, protein C, and protein S were rare. A unique pattern of premature aortoiliac atherosclerosis exists in some young women. Intra-arterial thromboembolic events are common at presentation and complicate surgical management. The role of antiphospholipid antibodies remains uncertain.

Adult↗
PubMed1996

A technique for the creation of long autogenous tissue arterial patches.

An endarterectomized segment of an occluded artery (e.g. superficial femoral artery), is an alternative autogenous material for patch angioplasty which preserves the continuity of the saphenous vein. A technique of incising endarterectomized segments of superficial femoral artery in a spiraled manner is presented which allows for the creation of long autogenous tissue patches. A spiral is drawn on the exterior of a harvested arterial segment which is either 1 cm, 7 mm or 5 mm in width. When incised along the spiral, the length of the resulting elliptical patch will be two, three, or four times, respectively, the length of the original artery segment. The authors have used the technique to close extended profundoplasty in three patients and for construction of a patched distal anastomosis in two patients undergoing prosthetic femoropopliteal bypass grafting. There have been no early complications.

Bioprosthesis↗
PubMed1996

Population-based study of heart rate variability and prevalent myocardial infarction. The Atherosclerosis Risk in Communities Study.

Clinically based studies have indicated that patients who have suffered myocardial infarction (MI) exhibit lower heart rate variability (HRV). Such associations have not been reported at the population level. To investigate whether MI is related to lower HRV in the general population, the authors examined a stratified random sample of 2,243 men and women aged 45-64 years, of whom 260 had had MI and 1,983 were free of any coronary heart disease manifestations. All were part of the biracial cohort of the Atherosclerosis Risk in Communities study sampled from four United States communities. Resting, 2-minute supine heart rate data were analyzed using spectral analysis to estimate high-frequency (0.16-0.35 Hz) and low-frequency (0.025-0.15 Hz) spectral powers as conventional indices of HRV. The mean levels of high-frequency powers were 1.02 and 1.23 (beats/min)2 for MI and non-MI groups, respectively (P < .05), and the low-frequency means were 2.46 and 3.11 (beats/min)2 for MI and non-MI groups, respectively (P < .01). Age, race, and sex-adjusted odds ratios (95% confidence interval) of lower high-frequency and low-frequency powers contrasting MI to non-MI individuals were 1.52 (range, 1.09-2.10) and 1.54 (range, 1.12-2.10), respectively. After adjustment for use of beta-blocker medication, the odds ratios (95% confidence interval) were 1.26 (range, 0.88-1.81) and 1.22 (range, 0.87-1.69) for lower high-frequency and low-frequency powers, respectively. The findings from this first population-based study of prevalent MI and HRV provide support for an inverse association between MI and lower HRV. However, adjusting for beta-blocker use eliminates the statistical association. These findings confirm that impaired HRV is found in individuals with prevalent MI, even when drawn as a sample of community-dwelling individuals. This impaired HRV may contribute to the increased risk of subsequent cardiovascular events previously observed in survivors of acute MI. The cross-sectional data also suggest that use of beta-blockers diminishes the odds of lower HRV associated with MI.

Adrenergic beta-Antagonists↗
PubMed1996

Vascular surgery in the United States: workforce issues. Report of the Society for Vascular Surgery and the International Society for Cardiovascular Surgery, North American Chapter, Committee on Workforce Issues.

The Committee on Workforce Issues of the Society for Vascular Surgery (SVS) and the North American Chapter, International Society for Cardiovascular Surgery (NA-ISCVS) generated data on the numbers and trends of operations performed and workforce requirements to provide surgical care of patients with vascular disease. Data for analysis were obtained from The National Center for Health Statistics-National Hospital Discharge Survey and questionnaires sent to 2732 vascular surgeons. The data showed that SVS/NA-ISCVS and regional vascular society (RVS) surgeons performed 51% of 583,000 vascular procedures undertaken in the United States in 1992. This represents a 24% increase over the 41% reported in 1985 by similarly defined surgeons. Analysis of 1992 index cases documented that SVS/NA-ISCVS and RVS surgeons accounted for 80% of 31,000 aortoiliofemoral bypasses, 68% of 46,000 aortic aneurysmectomies, 64% of 91,000 carotid endarterectomies, and 72% of 98,000 angioaccess procedures. The mean numbers of vascular operations performed in 1992 by SVS/NA-ISCVS and RVS surgeons were 144 and 100, respectively. These procedures represented 64% and 39% of the total surgical caseload of SVS/NA-ISCVS and RVS surgeons, respectively. American Board of Surgery (ABS)-certified vascular surgeons performed a mean of 171 vascular operations in 1992. Other surgeons, including ABS-certified general surgeons, appear to be performing fewer vascular operations. The latter fact and the increasing incidence of vascular disease in an expanding elderly population supports a continued need for vascular surgery specialists. Evolving technology and new health care delivery systems, however, may lessen the need for surgical care of these patients. Continued assessments of workforce activity will allow better definition of changing vascular surgery needs.

Humans↗
PubMed1996

Vascular surgical training of general and vascular surgery residents.

OBJECTIVE: The opinions of general surgery program directors (SPDs) and vascular surgery program directors (VPDs) regarding vascular surgery training of general surgery residents and the construct of the vascular surgery residency were compared. METHODS: Questionnaires were mailed to 55 VPDs and 290 SPDs in 1987 and 1988, and to 80 VPDs and 277 SPDs in 1995. Both questionnaires included questions regarding attitudes about vascular surgical competence, operative experience, future vascular practice opportunities of general surgery residents, and the impact of a vascular surgery residency on general surgery resident education. In addition, the 1995 survey included questions regarding the duration, content, and prerequisite versus requisite experience for the vascular surgery residency. RESULTS: Significant differences in opinions between SPDs and VPDs persisted regarding vascular surgery training of general surgery residents. SPDs were more likely to feel that general surgery graduates are fully competent in vascular surgery, should be exposed to more complex vascular surgery during training, and should be granted unlimited vascular surgical privileges on entering practice. Most VPDs felt that general surgery graduates lack competence in vascular surgery, should be exposed to less complex vascular surgery during training, and should have limited vascular surgery privileges in practice. Both groups of program directors agreed about the construct of vascular surgery residencies and that such residencies have had a favorable impact on general surgery resident education. Both SPDs and VPDs were willing to consider creative restructuring of vascular surgery residencies to accommodate governmental restrictions on funding of graduate medical education. CONCLUSIONS: External pressures forcing residency reform may provide an opportunity for SPDs and VPDs to creatively work with regulatory bodies to resolve differences in expectations of vascular surgery education and practice.

Attitude of Health Personnel↗
PubMed1996

Can the NASCET technique for measuring carotid stenosis be reliably applied outside the trial?

PURPOSE: The North American Symptomatic Carotid Endarterectomy Trial (NASCET) and the Asymptomatic Carotid Artery Study (ACAS) both confirmed the effectiveness of carotid endarterectomy for preventing stroke in patients who have significant carotid stenosis. A uniform technique for measuring carotid stenosis from an arteriogram (% stenosis = [1 - minimum residual lumen/normal distal cervical internal carotid artery diameter] x 100) was used in both trials, with reproducibility internally validated. The reliability of this measurement when used outside the trials for defining carotid stenosis has not been validated. Imprecise calculation of carotid stenosis can result in a 50% overestimation of significant carotid disease and potential overuse of carotid surgery. This is a prospective study of the reliability of carotid stenosis measurements performed by practicing physicians of different specialties and different levels of clinical experience. METHODS: Two vascular surgeons and two interventional radiologists (one resident and one staff member per specialty), blinded to results, calculated the percent stenosis from 219 consecutive arteriograms performed to evaluate extracranial carotid artery occlusive disease; 72 random films were reread by each individual. The interpretations were grouped as < 60% or > or = 60% stenosis (ACAS) and as < 30%, 30% to 69%, and > or = 70% stenosis (NASCET). Interobserver and intraobserver agreement were analyzed with the kappa statistic and Pearson correlation coefficients. RESULTS: Interobserver reliability in categorizing carotid stenosis revealed excellent agreement for both ACAS (kappa = 0.825 to 0.903) and NASCET groups (kappa = 0.729 to 0.793). Interobserver correlation coefficients ranged from 0.91 to 0.95. Intraobserver agreement was also highly reproducible for both the ACAS (kappa = 0.732 to 0.970) and NASCET categories (kappa = 0.634 to 0.805). Intraobserver correlation coefficients ranged from 0.89 to 0.95. CONCLUSION: The NASCET technique for quantification of carotid stenosis can be easily learned by physicians and reliably implemented for appropriate identification of candidates for carotid endarterectomy.

Angiography, Digital Subtraction↗
PubMed1996

Primary Clostridium septicum aortitis: a rare cause of necrotizing suprarenal aortic infection. A case report and review of the literature.

A 74-year old woman sought medical attention for general symptoms of nausea, vomiting, and back pain. A computed tomographic scan showed gas in the wall of the descending thoracic and suprarenal aortas. Emergency thoracoabdominal exploration revealed a necrotizing infection of the thoracic aorta extending to the origin of the celiac axis. After surgery Clostridium septicum was identified in tissue culture. Surgical management consisted of in-situ graft replacement of the thoracoabdominal aorta. Three months later, a pseudoaneurysm developed at the distal anastomosis. The patient refused further surgery and died 3 days later. The cause of death was presumed to be a ruptured mycotic aneurysm as a result of recurrent C. septicum infection. The relationship of C. septicum with occult gastrointestinal and hematologic malignancy has been documented. This patient represents the 10th reported case of C. septicum arteritis. Including the nine previous case reports of C. septicum arteritis, the mortality rate is 70%. When evaluating a patient with a mycotic aneurysm or aortitis, C. septicum should be considered. If it is found, a search should be carried out for an associated gastrointestinal or hematologic malignancy. Surgical repair should include extraanatomic revascularization and wide debridement of the infected field. Consideration should be given to lifelong antimicrobial therapy for this potentially fatal infection.

Aged↗
PubMed1996

Association of cardiac autonomic function and the development of hypertension: the ARIC study.

To relate cardiac autonomic function measured by heart rate variability (HRV) with prevalent and incident hypertension at the population level, the authors examined a stratified random sample of 2,061 examinees from the biracial Atherosclerosis Risk in Communities (ARIC) cohort. Baseline, supine, resting beat-to-beat heart rate data were collected. High frequency (HF, 0.15 to 0.35 Hz), low frequency (LF, 0.025 to 0.15 Hz) spectral powers, and LF/HF ratio, estimated from spectral analysis, and standard deviation of all normal RR intervals (SDNN), calculated from time domain analysis, were used as the conventional indices of cardiac autonomic function. From this sample, 650 prevalent hypertensives were identified. Of those normotensive at baseline (n = 1,338), 64 participants developed hypertension during 3 years of follow-up. In the cross-sectional analysis, the adjusted geometric means of HF were 1.26, 1.20, and 1.00 (beat/min)2 for normotensives, untreated hypertensives, and treated hypertensives, respectively; means of LF were 3.24, 3.26, and 2.58; means of LF/HF ratio were 2.57, 2.70, and 2.56; and means of SDNN were 39, 34, and 35 (ms) respectively. In the prospective analysis, a statistically significant, graded inverse association between baseline HF and the risk of incident hypertension was observed: the adjusted incident odds ratios (95% CI) were 1.00, 1.46 (0.61, 3.46), 1.50 (0.65, 3.50) and 2.44 (1.15, 5.20) from the highest to the lowest quartile of HF. No clear pattern of association was observed for LF. Significant trends of association for LF/HF and SDNN and incident hypertension were also found. These results suggest that cardiac autonomic function is associated with prevalent hypertension, and that reduced vagal function and the imbalance of sympatho-vagal function are associated with the risk of developing hypertension.

Adult↗
PubMed1996

Candida arteritis: are GI endoscopic procedures a source of vascular infections?

A 53-year-old woman, 11 years after a renal transplant on chronic immunosuppression, presented with a sudden onset of a painless left groin mass. Ultrasound revealed a 3 cm common femoral artery pseudoaneurysm and a 3 cm saccular aneurysm of the infrarenal aorta. Operative repair was excision and patch angioplasty of the aortic aneurysm with internal iliac artery and interposition grafting of the femoral artery aneurysm with saphenous vein. Postoperatively, Candida albicans was identified in the aortic and common femoral arterial cultures. Candida infections often occur in patients with impaired cellular immunity due to seeding from urinary tract infections, vascular catheters, or manipulation of the gastrointestinal tract. Our patient, without any prior history of a fungal infection, had undergone a colonoscopy 3 weeks earlier. Without any other possible source being identified, the proposed mechanism for fungal entry into the vascular system was via the gastrointestinal tract, with seeding from the portal venous system. The exact medical and surgical management of these patients remains undefined, and a transplant vascular registry is really needed. However, immunocompromised solid organ transplant recipients undergoing gastrointestinal endoscopic procedures may be at a greater risk for the development of subsequent septicemia. Further reports are really needed to confirm the possible need in these patients for both periprocedural antibiotic and antifungal prophylactic coverage.

Aneurysm, Infected↗
PubMed1995

Age, race, and sex differences in autonomic cardiac function measured by spectral analysis of heart rate variability--the ARIC study. Atherosclerosis Risk in Communities.

To investigate the distribution of heart rate variability (HRV) spectral power in an unselected sample of the population, and to ascertain the population correlates of HRV, we examined 1,984 healthy persons, aged 45 to 64 years, randomly selected from the Atherosclerosis Risk in Communities (ARIC) study cohort. Resting, supine, 2-minute, beat-to-beat heart rate data were collected between 7 A.M. and 12 noon. The race- and sex-adjusted geometric means of low-frequency component (LF, 0.025 to 0.15 Hz) were 4.00 and 3.13 (beats/min)2; of high-frequency component (HF, 0.16 to 0.35 Hz), 1.65 and 1.21 (beats/min)2; and of the HF/LF ratio, 0.41 and 0.39, for 45-to-54 and 55-to-64 years age groups, respectively (test of mean difference by age, p < 0.01, p < 0.01, and p = 0.11 for LF, HF, and HF/LF ratio, respectively). Comparing black with white examinees, the age- and sex-adjusted geometric means of LF were 3.06 and 3.70 (beats/min)2; of HF, 1.66 and 1.36 (beats/min)2; of HF/LF, 0.54 and 0.37, respectively (test of mean difference by race, p < 0.01, p < 0.01, and p < 0.01). The age- and race-adjusted geometric means of LF for women and men were 3.12 and 4.10 (beats/min)2; of HF, 1.46 and 1.38 (beats/min)2; and of HF/LF, 0.47 and 0.34, respectively (test of mean difference, p < 0.01, p = 0.34, and p < 0.01). We conclude that HRV spectral indexes are associated with age, race, and sex. With increasing age, the parasympathetic and sympathetic spectral power components decrease.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗