A stent is a stent is a stent (not)
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Coronary Disease↗
Biomedical subjects
W Laskey
Publications and source records attributed to W Laskey.
Variability of radiation output dynamic range in modern cardiac catheterization imaging systems.
Automatic exposure control (AEC) is one of the most important characteristics for optimizing cardiac catheterization imaging; this allows the X-ray system to provide sufficient radiation output under a variety of clinical conditions so that a satisfactory image is obtained. AEC was assessed in 97 cardiac catheterization laboratories using a standard set of phantoms. Three different copper attenuators were used to simulate three patient sizes. As magnification increased, many systems had limited dynamic range and were unable to increase radiation output. With increasing atttenuator thickness, the problem worsened. With the thickest attenuator and largest magnification (4.5"-5.0" FOV), 60% of systems could not achieve the typical 70% increase in exposure while 20% were unable to increase radiation output at all.
Body Burden↗
Multivariable model for prediction of risk of significant complication during diagnostic cardiac catheterization. The Registry Committee of the Society for Cardiac Angiography & Interventions.
Although adequate data exist on the frequency of procedural-related complications during diagnostic cardiac catheterization, little information is available for the quantitative assessment of risk factors for significant complication. We analyzed 58,332 procedures in the 1990 SCA&I Registry Database in order to assess 1) the independent and cumulative significance of easily obtainable pre-procedural factors predictive of major complication and 2) the likelihood of a significant complication given the presence of these risk factors. A model was developed on a random sample of 38,888 patients and validated in the remaining 19,444 patients. Twelve variables were identified as having independent predictive behavior for significant complication with excellent agreement in the validation sample. The current model is an accurate and reliable instrument for stratifying risk of a significant complication during diagnostic catheterization.
Aged↗
Characteristics of the sympathetic preganglionic neuron and its synaptic input.
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Animals↗
Sequential changes in regional coronary flow during pacing-induced angina pectoris: coronary flow limitation precedes angina.
To investigate the sequence of changes in regional myocardial perfusion which precedes stress-induced angina, we measured great cardiac vein flow (GCVF), draining the anterior left ventricle, during incremental atrial pacing in 10 patients with normal anterior perfusion (group I) and in 11 patients with greater than or equal to 50% diameter stenosis of the left main or proximal left anterior descending coronary artery (group II). Pacing produced angina in 11 of 11 and regional lactate production in 9 of 11 group II patients. Both groups had comparable resting GCVF (group I = 62 +/- 7 ml/min vs group II = 76 +/- 9 ml/min; p = NS) and both exhibited progressive increases in GCVF with pacing. However, the entire flow-demand relationship was displaced downward in group II, as evidenced by a reduction in the percent increase in GCVF both following the first 20-beat pacing increment (group I = 46 +/- 6% vs group II = 16 +/- 4%; p less than 0.001) and at angina (group I = 113 +/- 16% vs group II = 44 +/- 9%; p less than 0.001). The first 20-beat pacing increment increased the heart rate to only 77 +/- 2 bpm in group II whereas angina and ECG changes did not occur until a pacing rate of 117 +/- 6 bpm. These data indicate that regional flow abnormalities precede the onset of pacing-induced angina in patients with coronary disease (CAD) and that these flow abnormalities frequently are detectable at heart rates substantially below the anginal threshold.
Adult↗
Effects of 4-aminopyridine on sympathetic preganglionic neuron activity.
Sympathetic preganglionic neuron (SPN) activity (mass or single unit discharge) was recorded extracellularly from axons of the cervical sympathetic trunk (CST) in unanaesthetized, midcollicular decerebrate or C1 spinal anemically decerebrate cats which were paralyzed and artificially ventilated. Phrenic motoneuron activity was also recorded in the midcollicular preparation. The drug 4-aminopyridine (4-AP) was administered intravenously. Doses of 0.5 to 1.0 mg/kg increased the background firing rate of SPNs in a dose-dependent manner. These doses increased the repetition rate of phrenic nerve bursts and, in a parallel fashion, that of the inspiration-synchronous activity of the CST. In contrast, the action of 4-AP on activity evoked by stimulation of high threshold myelinated afferents in the radial, femoral or pelvic nerve, or in the L7 dorsal root, was very variable. The evoked responses could be increased, decreased or not affected by the drug. Thus, treatment with 4-AP produces a graded increase in background firing of SPNs, but the drug is ineffective at reliably enhancing somato- or viscero-sympathetic reflexes.
4-Aminopyridine↗
Effect of atrial pacing on intracoronary thromboxane production in coronary artery disease.
The effect of atrial pacing on intracoronary thromboxane production was investigated in 35 patients with stable (n = 19) or unstable (n = 16) angina. Arterial and coronary sinus thromboxane B2, the stable metabolite of thromboxane A2, myocardial lactate extraction and thermodilution coronary sinus flow were measured before, during and immediately after atrial pacing until the onset of angina. Pacing did not significantly increase coronary sinus thromboxane B2 (rest, 233 +/- 107 pg/ml; pacing, 249 +/- 154 pg/ml; postpacing, 330 +/- 309 pg/ml) (mean +/- standard deviation) despite a moderate increase in arterial thromboxane B2 (rest, 270 +/- 170 pg/ml; pacing, 387 +/- 364 pg/ml; postpacing, 446 +/- 420 pg/ml) (all changes probability [p] less than 0.05). A positive transmyocardial thromboxane B2 gradient, suggesting intracoronary thromboxane A2 production, occurred in only five patients at rest (gradient = 60 +/- 35 pg/ml). During pacing, a transmyocardial thromboxane B2 gradient was not observed despite myocardial lactate production in 18 patients. A postpacing gradient was observed in eight patients (gradient = 284 +/- 349 pg/ml). These gradients were significantly more frequent in patients who produced lactate during pacing (7 of 18) than in patients without lactate production (1 of 17) (p less than 0.05). In patients with and without a postpacing gradient, coronary vascular resistance decreased with pacing and returned to rest levels immediately after pacing, suggesting that a postpacing thromboxane gradient does not significantly alter coronary tone. These data suggest that: 1) pacing-induced angina is usually not associated with substantial intracoronary thromboxane A2 production; 2) in a minority of patients who develop intracoronary thromboxane A2 production, the amount is small and does not produce significant coronary vasoconstriction.
Angina Pectoris↗
Hemodynamic changes induced by cardiac angiography with ioxaglate: comparison with diatrizoate.
The hemodynamic and electrocardiographic changes induced by left ventriculography and coronary arteriography with ioxaglate (a new low osmolality angiographic contrast agent) were characterized and compared with the changes induced by a commercial formulation of the commonly used angiographic contrast agent, diatrizoate (Renografin-76). Left ventriculography and coronary arteriography were performed in 25 patients utilizing ioxaglate and in another 25 patients utilizing diatrizoate. Both agents increased left ventricular end-diastolic pressure and decreased arteriovenous oxygen difference after left ventriculography, but the magnitude of the increase caused by ioxaglate was significantly less than that caused by diatrizoate (changes in left ventricular end-diastolic pressure was 5.3 +/- 1.3 mm Hg with ioxaglate and 9.5 +/- 1.5 mm Hg with diatrizoate [p less than 0.02] ). Change in arteriovenous oxygen difference was -0.33 +/- 0.19 ml/100 ml with ioxaglate and -0.85 +/- 0.13 ml/100 ml with diatrizoate (p less than 0.05). Both agents were well tolerated when used for coronary arteriography with no adverse events occurring in either group. Ioxaglate is a well tolerated cardiac angiographic contrast agent that produces less hemodynamic disturbance than diatrizoate. Accordingly, it may be particularly well suited to use in patients with impaired left ventricular function.
Adult↗
The mechanics of ventricular function.
The introduction of new pharmacotherapies for long-term treatment of chronic cardiac failure has underscored the need for serial measurement of ventricular function in the ambulatory patient. Management strategies can best be guided by physiologic assessment of the heart's function as a muscular pump that must serve to propel gases to the metabolizing tissues on a moment-to-moment basis.
Heart↗
Upper thoracic sympathetic neuron responses to input from urinary bladder afferents.
The aim of the present study was to evaluate the organization of neural circuitry responsible for the intersegmental transmission of input from urinary bladder afferents to sympathetic preganglionic neurons (SPNs). The electrical activity of SPNs was recorded from axons of the cervical sympathetic trunk in anesthetized central nervous system (CNS)-intact and in unanesthetized midcollicular-decerebrate or acute C1 spinal cats. In all three preparations, tonically active SPNs were excited or inhibited by 1) electrical stimulation of myelinated afferents of the pelvic or hypogastric nerve, both of which contain bladder afferents, and 2) spontaneous contraction or distension of the urinary bladder. The SPN responses to bladder distension were abolished by pelvic nerve section. A comparison of responses of SPNs in CNS-intact and acute spinal animals to electrical stimulation of pelvic nerve afferents suggests that both propriospinal and supraspinal circuits are involved in the intersegmental transmission of input from bladder afferents to SPNs.
Afferent Pathways↗
Stabilization of the discharge rate of sympathetic preganglionic neurons.
A characteristic feature of the sympathetic preganglionic neuron (SPN) is the low rate of firing during both tonic and evoked activity. Firing rates between 1 and 2 Hz are typical of tonic activity, and the rates increase only slightly during sustained reflex activation. The low mean firing rate of the SPN may result from mechanisms which depress the excitability of the neuron and /or from a very low synaptic efficacy of its excitatory inputs. In recent years depressant mechanisms, other than baroreceptor inhibition, have been identified which may be involved in the control of SPN firing rate. Some of these mechanisms are spinal. This paper reviews data on 3 depressant mechanisms, namely post-impulse depression, recurrent inhibition and inhibition by myelinated spinal afferents, which are operating within the spinal cord.
Action Potentials↗
The effect of burst patterning of preganglionic input on the efficacy of transmission at the cat stellate ganglion.
1. The effect of burst patterned preganglionic stimulation on the efficacy of transmission at the cat stellate ganglion in vivo was studied to determine whether the increase in acetylcholine (ACh) release that occurs at preganglionic terminals with similar stimulation is synaptically active.2. Stimulation of the whole or a portion of the thoracic sympathetic trunk between rami T4 and T5 with recording of evoked compound action potentials in the inferior cardiac nerve yielded a preparation with a subliminal fringe with a mean value 2.5 times the size of the discharge zone.3. Preganglionic stimulation with 0.5 s bursts at 10, 20 and 40 Hz with 10 s interburst intervals caused an increase with time in the area of the compound action potential evoked by a single interburst test stimulus. The increase reached 70-75% of the final value after the first burst, 75-90% after 5 bursts and was virtually complete after 5 min. It was then maintained without attenuation as stimulation was continued.4. On cessation of burst patterned stimulation test compound action potentials returned to control levels with a half-time of 5 min.5. The increase in area of test compound action potentials with 40 Hz intraburst frequency was always as great as the increase following tetanization of the pathway. The increases with 20 and 10 Hz bursts were less.6. There was no increase in area of compound action potentials when equally spaced pulses at 2 Hz or less were applied preganglionically, nor was there any increase when 40 Hz burst patterns were delivered directly to the inferior cardiac nerve.7. It is concluded that burst patterned preganglionic activity at frequencies similar to those observed in vivo can recruit rapidly into the discharge zone all of the ganglionic neurones that were originally in the subliminal fringe. It is proposed that this effect is related directly to the increase in ACh release at ganglionic synapses that such activity has been shown to induce.
Action Potentials↗
Intersegmental connections and interactions of myelinated somatic and visceral afferents with sympathetic preganglionic neurons in the unanesthetized spinal cat.
The aim of this study was to obtain a measure of the interactions through exclusively spinal circuits, of myelinated afferents with sympathetic preganglionic neurons. Experiments were performed on 16 unanesthetized cats rendered insensitive by bilateral vertebral and carotid occlusion, whose spinal cords had been transected at C1 6-12 h before recording. The evoked responses of 68 tonically active sympathetic preganglionic neurons were recorded from filaments dissected from the cervical sympathetic trunk. Excitation, inhibition and excitation-inhibition sequences were evoked by electrical stimulation of radial, femoral and pelvic nerve afferents. Inhibition was most often observed during pelvic nerve stimulation. Ninety percent of the sympathetic preganglionic neurons tested responded to radial, 77% to femoral and 85% to pelvic nerve stimulation. These differences in percentage of units responding to the three nerves were statistically insignificant. Thus, in the acute spinal cat, the fraction of tonically active sympathetic preganglionic neurons whose activity can be influenced by myelinated afferents is independent of the length of the intraspinal pathway which conveys the input. A main difference between the long pathway (mediating the responses to femoral or pelvic nerve) and the short pathway (mediating the responses to radial nerve) seems to be the efficacy of their connections. While single shocks reliably evoked responses from the radial nerve, trains (200 Hz, 20 msec) were usually necessary to elicit responses from femoral or pelvic nerve, indicating a requirement for summation in the long pathway.
Animals↗
The radiological appearance of pulmonary blastomycosis.
A retrospective analysis of patients with pulmonary blastomycosis was made. Correlation of the mode of clinical presentation with the thoracic radiograph revealed a spectrum of clinical and radiological disease. The results substantiate the absence of specific clinico-radiological patterns, and amplify current concepts of clinical and radiological manifestations.
Adult↗
Endogenous activation in blastomycosis.
Recent work established the fact that the portal of entry in blastomycosis is the lung. After the initial exposure to the fungus, a pneumonic process develops that may heal spontaneously or progress locally or at distant sites, or both. Frequently, however, patients present with disseminated disease, whose chest roentgenograms do not show any lesions. We have recently seen three patients with disseminated blastomycosis with negative chest roentgenograms at the time of diagnosis. Past history showed a pneumonic illness 33, 32, and 4 months before diagnosis. Chest roentgenograms from the time of the original illness showed a pneumonic process compatible with blastomycosis in all three. Examination of postbronchoscopy sputa showed the characteristic yeasts of Blastomyces dermatitidis. These three patients document for the first time apparent endogenous activation in blastomycosis. A possible explanation for this apparent endogenous activation may reside in the histopathologic similarity between blastomycosis and other chronic granulomatous diseases, especially tuberculosis.
Adolescent↗