Late angiographic stent thrombosis of polymer based paclitaxel eluting stent.
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Adult↗
Biomedical subjects
Y T Lim
Publications and source records attributed to Y T Lim.
Simultaneous thromboses of multiple coronary arteries in acute myocardial infarction.
Simultaneous thrombotic occlusion of multiple coronary arteries in acute myocardial infarction is a well-recognised phenomenon. Studies have reported diffuse destabilisation of atherosclerotic plaques in patients with acute myocardial infarction, leading to the concept of "pan-coronaritis". The putative mechanism is attributed to a systemic thrombophilic and inflammatory state. We report the occurrence of this phenomenon in two middle-aged male patients.
Acute Disease↗
ReoPro Observational Registry (RAPOR): insights from the multicentre use of abciximab in Asia.
INTRODUCTION: The pattern of use of abciximab in real-life clinical patients undergoing percutaneous coronary intervention (PCI) in 11 high-volume centres in Singapore, Malaysia, Thailand, Philippines, India, Pakistan and Korea was prospectively examined. METHODS: These centres enrolled 224 consecutive patients over eight months to receive abciximab during PCI for the study. The cohort consisted of 82.1 percent males, with mean age of 55 (+/- 11) years and mean weight of 67 (+/- 17) kg. RESULTS: The use of abciximab during PCI ranged between 6.2 percent and 21.6 percent. The indications for the use of abciximab were: acute coronary syndromes (34.3 percent), complex coronary lesions (17.9 percent) and multivessel PCI (17.7 percent). Based on a risk scoring system devised for this registry, majority (60.0 percent) of the patients was considered high risk when abciximab was used. Among the patients enrolled, 36.6 percent received abciximab as a "bail-out". The overall in-hospital ischaemic event rates were low at 4.0 percent. The complication rates included major bleeding 0.7 percent, thrombocytopenia 2.7 percent and need for blood transfusion 2.8 percent. There was a trend towards a higher incidence of in-hospital non-Q myocardial infarction in the "bail-out" group (2.1 percent versus 7.3 percent, p-value equals 0.07). CONCLUSION: Abxicimab was uncommonly used among patients (9.4 percent) undergoing PCI in this Asian region, with the operators reserving it mainly for high-risk patients.
Abciximab↗
Clinical predictors of a positive troponin T test in patients presenting with probable acute coronary syndromes.
Acute coronary syndrome (ACS) patients with positive troponin T (TnT) test are at higher risk for death and myocardial reinfarction. They would significantly benefit from early aggressive pharmacologic and invasive therapy. However, TnT test is not widely available. This retrospective study of 173 patients with ACS showed: that prolonged or repetitive episodes of angina at rest in the previous 24 hours (p = 0.01) and evidence of myocardial ischaemia on ECG (p < 0.001) were associated with positive TnT tests (> or = 0.1 ng/mL). The two variables in combination showed 100% positive predictive value, facilitating early identification and streamlining of therapy.
Acute Disease↗
Late thrombotic occlusion of paclitaxel eluting stent more than one year after stent implantation.
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Adult↗
The impact of diabetes mellitus on the prognostic value of a normal dobutamine stress echocardiogram in patients with intermediate to high cardiovascular risk.
INTRODUCTION: There is currently limited data on the prognostic value of a normal dobutamine stress echocardiogram (DSE) in patients with intermediate to high cardiovascular risk. The impact of diabetes mellitus, recently recognised as a cardiovascular risk-equivalent, has not been previously evaluated. This study aims to determine the prognostic value of a normal DSE in these patients. METHODS: The study population includes all patients with two cardiovascular risk factors or diabetes mellitus and a normal DSE (baseline and peak stress) with three months follow-up. A total of 122 patients (47 females, 75 males; mean age 59.6 years) were recruited. Impact of diabetes mellitus on subsequent cardiovascular events was determined. RESULTS: Diabetes mellitus was present in 32.8 percent, hypertension in 72.1 percent, smoking in 27.0 percent, family history of premature coronary artery disease in 15.6 percent, and hypercholesterolemia in 66.4 percent. On follow-up until 6.4 years (mean 4.1 years), there were four myocardial infarctions (0.8 percent per patient/year) and five revascularisation procedures (1.0 percent per patient/year). The majority of adverse events occurred among patients with diabetes mellitus (three out of four myocardial infarctions; four out of five revascularisations). Diabetes mellitus independently predicted subsequent cardiac events on both univariate and multivariate analyses (p value is equal to 0.015 and 0.011, respectively). Presence of diabetes mellitus also conferred a worse outcome on survival analysis (p value is equivalent to 0.0046). CONCLUSION: The presence of diabetes mellitus adversely affects clinical outcome despite a normal DSE. Patients without diabetes mellitus, but with intermediate to high cardiovascular risk, and a normal DSE have a better medium term outcome.
Adult↗
High-sensitivity C-reactive protein is predictive of medium-term cardiac outcome in high-risk Asian patients presenting with chest pain syndrome without myocardial infarction.
INTRODUCTION: High-sensitivity C-reactive protein (hs-CRP) has been shown to be predictive of cardiac events but data among Asians is comparatively few. We evaluated the role of hs-CRP in the prediction of adverse cardiac outcome in a cohort of high-risk patients presenting with chest pain syndrome without myocardial infarction (MI). MATERIALS AND METHODS: Three hundred and forty-seven patients were prospectively recruited over an 18-month period and patients with MI as documented by serial electrocardiogram abnormalities, and creatinine kinase or troponin elevation were excluded. Mean follow-up duration was 901 +/- 306 days. Kaplan-Meier and Cox proportional hazards modelling were used to evaluate outcome and determine association with predictor variables. RESULTS: The composite primary endpoint of cardiac mortality, non-fatal MI, cardiac failure or coronary revascularisation procedure (coronary artery bypass grafting or angioplasty) unrelated to the index admission was reached in 37 patients. History of previous MI (P = 0.002), presence of at least 1 coronary artery with > or =50% stenosis (P = 0.028) and elevated hs-CRP levels were associated with an adverse cardiac outcome (P = 0.001 for CRP in the upper quartile, and 0.002 for CRP > or = 1mg/L, respectively). None of the traditional cardiovascular risk factors (hypertension, diabetes mellitus, dyslipidaemia, significant family history, smoking, male gender and increased age) was predictive. Multivariate modelling showed elevated hs-CRP to confer the highest risk for an adverse cardiac outcome (P <0.001). CONCLUSION: Hs-CRP is useful in further stratifying high-risk multi-ethnic patients presenting with chest pain despite no evidence of MI. Close follow-up and aggressive management of these patients may be warranted.
Aged↗
Human VEGF165-myoblasts produce concomitant angiogenesis/myogenesis in the regenerative heart.
Bioengineering the regenerative heart may provide a novel treatment for heart failure. On May 14, 2002, a 55-year-old man suffering from ischemic myocardial infarction received 25 injections carrying 465 million cGMP-produced pure myoblasts into his myocardium after coronary artery bypass grafting. As on August 28, 2002, his EKG was normal and showed no arrhythmia. His ejection fraction increased by 13%. He no longer experienced shortness of breath and angina as he did before the treatment. Three myogenesis mechanisms were elucidated with 17 human/porcine xenografts using cyclosporine as immunosuppressant. Some myoblasts developed to become cardiomyocytes. Others transferred their nuclei into host cardiomyocytes through natural cell fusion. As yet others formed skeletal myofibers with satellite cells. De novo production of contractile filaments augmented the heart contractility. Human myoblasts transduced with VEGF165 gene produced six times more capillaries in porcine myocardium than in placebo. Xenograft rejection was not observed for up to 20 weeks despite cyclosporine discontinuation at 6 weeks. Pros and cons of autografts vs. allografts are compared to guide future development of heart cell therapy.
Animals↗
Impact of reversibility of no-reflow phenomenon on 30-day mortality following percutaneous revascularisation for acute myocardial infarction--insights from a 1328-patient registry.
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Adult↗
Lower trunk muscle activity during the tennis serve.
Prior electromyographic (EMG) analyses of the tennis serve have focused on the muscles in the hitting arm and shoulder region. This preliminary study aimed to examine the muscle activation patterns of selected lower trunk muscles during three different types of tennis serve--flat, topspin, and slice. Five male highly skilled tennis players completed 10 trials for each type of serve. Surface EMG electrodes were used to monitor the rectus abdominis (RA), external oblique (EO), internal oblique (IO), and lumbar erector spinae (ES) muscles. For each subject, the two trials with the highest self-reported ratings were analysed. Average EMG levels during each phase of a tennis serve for each muscle were analysed using a non-parametric ANOVA design. No major differences in muscle activation pattern were found across different serve types, and bilateral differences in muscle activation were more pronounced in RA and EO than in IO and ES muscles. The abdominal muscles were more active in the topspin than in the other two types of serves during the upward swing of the racket. An appreciable amount of abdominal/low back and bilateral co-activation was observed during certain phases of the serve. The co-activation of lower trunk muscles may help to stabilise the lumbar spine during the arch back and forward swing phases of the serve. The results reinforce the importance of abdominal and low back exercises in the strength and rehabilitation programs designed for tennis players.
Abdomen↗
A case of broken heart from blunt trauma.
A young man with blunt chest trauma presented acutely in shock as a result of cardiac rupture causing acute bloody tamponade. We discuss the clinical presentation, the importance of rapid and accurate diagnosis and management of such cases.
Accidents↗
Fatal pulmonary haemorrhage with the combined use of abciximab and fibrinolytic agent.
The increased bleeding risk associated with the use of abciximab has been well reported. The risk appears to be amplified when abciximab is administered concurrently with a fibrinolytic agent. We report and review the literature on the occurrence of a case of fatal pulmonary haemorrhage, a rare bleeding complication, in a patient who received both these drugs.
Abciximab↗
Tissue-engineered growth of bone by marrow cell transplantation using porous calcium metaphosphate matrices.
In this study we investigated not only osteoblastic cell proliferation and differentiation on the surface of calcium metaphosphate (CMP) matrices in vitro but also bone formation by ectopic implantation of these cell-matrix constructs in athymic mice in vivo. Interconnected porous CMP matrices with pores 200 microm in size were prepared to use as scaffolds for rat-marrow stromal-cell attachment. Cell-matrix constructs were cultured in vitro, and cell proliferation and ALPase activities were monitored for 56 days. In addition to their being cultured in vitro, cell-matrix constructs were implanted into subcutaneous sites of athymic mice. In vitro these porous CMP matrices supported the proliferation of osteoblastic cells as well as their differentiation, as indicated by high ALPase activity. In vivo the transplanted marrow cells gave rise to bone tissues in the pores of the CMP matrices. A small amount of woven bone formation was detected first at 4 weeks; osteogenesis progressed vigorously with time, and thick lamellar bones that had been remodeled were observed at 12 weeks. These findings demonstrate the potential for using a porous CMP matrix as a biodegradable scaffold ex vivo along with attached marrow-derived mesenchymal cells for transplantation into a site for bone regeneration in vivo.
Alkaline Phosphatase↗
Recurrent self-limited fungemia caused by Yarrowia lipolytica in a patient with acute myelogenous leukemia.
Yarrowia lipolytica is a weakly pathogenic yeast that is rarely isolated from the blood. We observed transient recurrent catheter-related fungemia attributable to this organism in a leukemic patient. The fungemia and accompanying fever subsided spontaneously. The data suggest that it might be possible to withhold specific treatment for Y. lipolytica fungemia even in an immunocompromised patient.
Adolescent↗
Usefulness of ST elevation II/III ratio and ST deviation in lead I for identifying the culprit artery in inferior wall acute myocardial infarction.
In a study of 92 patients presenting with inferior wall acute myocardial infarction, the infarct-related artery was the right coronary artery in 72 patients (78%) and the left circumflex artery in 20 (22%). An ST II/III ratio of 1 or an isoelectric ST in lead I are sensitive and specific markers of left circumflex artery occlusion, whereas an ST II/III ratio <1 (ST elevation in lead III >II) or ST depression in lead I are sensitive and specific markers of right coronary artery occlusion.
Adult↗
Ruptured giant intrathoracic lipoblastoma in a 4-month-old infant: CT and MR findings.
BACKGROUND: We describe a 4-month-old infant with a ruptured intrathoracic lipoblastoma arising from the parietal pleura and associated with a pleural effusion. OBJECTIVE: The clinical presentation was rapidly evolving respiratory distress. The chest radiograph showed a large mass and a pleural effusion in the right thoracic cavity. CT demonstrated an inhomogeneous low-attenuation mass which was 7 cm in diameter and which showed areas of enhancement after intravenous contrast medium. MRI showed a fatty intrathoracic mass with intratumoral streaks and whorls, which were attributed to loose fibrovascular connective tissue on pathological examination. RESULTS: Thoracotomy and pathological examination revealed a ruptured intrathoracic lipoblastoma arising from the parietal pleura. CONCLUSION: The pleural effusion might have suggested rupture of the tumour.
Female↗
Can bone turnover markers correlate bone mass at the hip and spine according to menopausal period?
Changes in bone turnover with years since menopause (YSM) are responsible for bone loss and play a major role in osteoporosis. Although single measurements of the bone turnover marker appear unlikely to be clinically useful in predicting bone mineral density, the usefulness of these measurements in relation to the YSM has not been well established. The establishment of this relationship was the aim of this study. To address this issue, we have measured a battery of sensitive and specific markers of bone turnover in 272 women postmenopausal from -5 to 15 a, and the data was correlated with bone mineral density (BMD) at different skeletal sites measured utilizing dual-energy X-ray absorptiometry (DXA). Bone formation was assessed by serum osteocalcin (OC), and bone resorption by Pyr and D-pyr. The three markers and BMD were compared between the groups (YSM). Among the three markers, only Pyr exhibited a significant difference between pre and postmenopausal groups. In the aspect of correlation between bone turnover marker and BMD according to the groups (YSM), we found negative strong correlations between the BMD of lumbar spine (L2-4) vs. Pyr (P=0.01, r=-0.75) in the premenopausal group (-5 approximately 0 YSM), and we found negative correlation between the BMD of L2-4 vs. osteocalcin (P=0.05, r=-0.2 and P=0.01, r=-4).44) in the postmenopause groups (0 approximately 5 and 5 approximately 10 YSM). We concluded that Pyr in women -5 approximately 0 YSM and osteocalcin in women 0 approximately 10 YSM displayed negative correlation with BMD of L2-4.
Absorptiometry, Photon↗
Mechanism of reduced GFR in rabbits with ischemic acute renal failure.
A reduction in glomerular filtration rate (GFR) is a primary characteristic of ischemic acute renal failure. The present study was undertaken to examine the roles of angiotensin II, tubuloglomerular-feedback (TGF) mechanism, and tubular obstruction for the GFR reduction in the post-ischemic kidney. Renal ischemia was induced by occlusion of the bilateral renal arteries for 60 min, and renal function was examined at 2 and 24 h after the onset of reflow. After the end of 2-h reflow, the GFR was not significantly changed, but the urine flow increased significantly. On the other hand, at the end of 24-h reflow, the GFR and urine flow decreased markedly along with increased filtration fraction. The renal blood flow significantly decreased at 24 h, but not 2 h, after reflow, which was accompanied by increased total renal vascular resistance. Furosemide infusion (1 mg/min/kg) after 24 h of reflow prevented the reduction in GFR and filtration fraction without no changes in renal blood flow and total renal vascular resistance. Pretreatment of enalapril and losartan did not prevent the reduction in GFR, indicating that angiotensin II was not involved. In morphological examinations, tubular obstruction was seen in the proximal and distal tubules of kidneys both at 2 and 24 h after the onset of reflow. In two rabbits subjected to 48 h of reflow, the tubular obstruction was not observed, despite GFR remained depressed. These results suggest that the late reduction in GFR in postischemic kidneys is not mediated by angiotensin II, but is mediated, at least in part, by the TGF mechanism. The tubular obstruction may be not prerequisite for the GFR reduction in rabbits.
Acute Kidney Injury↗