Care of acute myocardial infarction by noninvasive and invasive cardiologists: procedure use, cost and outcome.

Objectives: This study sought to determine how noninvasive and invasive cardiologists may differ in the hospital care of patients with acute myocardial infarction.

Background: Scant information exists regarding the effect of noninvasive and invasive cardiology subspecialization on invasive cardiac procedural use, cost and outcome in the care of patients with acute myocardial infarction.

Methods: This study analyzed a prospective cohort of 292 patients admitted to an urban tertiary care hospital from the emergency room under the care of noninvasive or invasive cardiologists.

Axonal regeneration and limited functional recovery following hippocampal deafferentation.

Although central neurons do not naturally recover following injury, damaged adult septal neurons can regenerate when nerve growth factor (NGF) is provided along with a suitable cellular substrate. This study investigates the outgrowth of axotomized septal neurons grafted with primary fibroblasts genetically modified to produce NGF. Confocal microscope images of double staining for neuritic markers (neurofilament or low-affinity NGF receptor) and the astrocytic marker glial fibrillary acidic protein (GFAP) demonstrated that regenerating neurites crossed dense buildups of astrocytic processes at the edges of NGF-producing grafts and were in apposition with astrocytic processes within NGF-producing grafts.

Do gender-based differences in presentation and management influence predictors of hospitalization costs and length of stay after an acute myocardial infarction?

Previous studies have reported conflicting results on gender differences in the management of acute myocardial infarction (AMI) and have not evaluated hospital length of stay or costs. To determine gender-based differences in presentation, management, length of stay, costs, and prognosis after AMI, we studied 561 patients with AMI. Women were older, had systemic hypertension, diabetes mellitus, and a non-Q-wave AMI more frequently, whereas more men smoked cigarettes.

Syncope: diagnosis of cardiac and noncardiac causes.

Syncope is a sudden and temporary loss of consciousness not caused by trauma or seizures. Patients age 65 and older are at elevated risk of syncope-related falls and sudden cardiac death. Cardiovascular causes are generally electrical (ie, arrhythmias) or mechanical (obstruction of central circulation at a cardiac valve or major vascular structure).

A stepwise strategy for coronary risk assessment for noncardiac surgery.

Physicians should adapt a systematic approach to cardiac risk stratification for patients being considered for noncardiac surgery, involving clinical evaluation, functional assessment, and surgical risk assessment for all patients and then deciding which patient needs to undergo noninvasive testing, coronary angiography and revascularization, perioperative monitoring, and aggressive postoperative care.

Comparative early and late cardiac morbidity among patients requiring different vascular surgery procedures.

Purpose: The evaluation of coronary artery disease (CAD) in patients undergoing vascular surgery can provide information with respect to perioperative and long-term risk for CAD-related events. However, the extent to which the required surgical procedure itself imparts additional risk beyond that dictated by the presence of CAD determinants remains in question. The purpose of this study was to quantify the relative contributions of specific vascular procedures and CAD markers on perioperative and long-term cardiac risk.

Sex differences in perioperative and long-term cardiac event-free survival in vascular surgery patients. An analysis of clinical and scintigraphic variables.

Background: Little information is available regarding the occurrence of perioperative and late cardiac events in women with vascular disease. The current study was performed to examine whether sex-specific differences exist in these outcomes in a large population of vascular surgery patients and to determine the value of clinical and dipyridamole thallium variables in predicting myocardial infarction and cardiac death.

Methods And Results: Preoperative dipyridamole thallium imaging was performed in 567 vascular surgery patients, including 380 men and 187 women.

Cyclophosphamide induced remission in relapsed, progressive idiopathic orbital inflammation ('Pseudotumour').

A patient with orbital pseudotumour with intracranial extension is reported. At presentation, the disease was confined to the orbit. Steroid therapy and orbital irradiation failed to control the condition, which then extended intracranially.

Surgical therapy for coronary artery disease among patients with combined coronary artery and peripheral vascular disease.

Background: Among patients with combined coronary artery and peripheral vascular disease, long-term benefits of surgical therapy compared with medical therapy for coronary artery disease are unknown.

Methods And Results: Using prospectively collected data from the Coronary Artery Surgery Study registry, we performed a retrospective cohort analysis of 1834 patients (mean age, 56 years; 20% women) with both coronary artery and peripheral vascular disease and evaluated their long-term outcomes. Of these patients, 986 received (nonrandomly) coronary artery bypass graft surgery, and 848 were treated medically.

A clinical rule to predict preserved left ventricular ejection fraction in patients after myocardial infarction.

Objective: To derive and validate a clinical prediction rule that identifies patients after myocardial infarction who have preserved left ventricular systolic function.

Design: Retrospective analysis of a prospective cohort study, with a derivation set to generate a clinical prediction rule and a validation set to test the prediction rule.

Setting: Urban tertiary care hospital.

Perforant path damage results in progressive neuronal death and somal atrophy in layer II of entorhinal cortex and functional impairment with increasing postdamage age.

In vivo model systems that can evaluate neuronal death, survival, and regeneration are critical to revealing basic mechanisms of neuronal response and developing strategies for CNS repair. We propose a distinct experimental model of CNS degeneration following lesions to the perforant path connecting the hippocampus and the entorhinal cortex. Within 2 weeks of a unilateral aspirative perforant path lesion, 30% of the ipsilateral entorhinal cortex layer II (ECL II) projection neurons had died with no change in the contralateral ECL II population.

Cardiac tamponade complicating proximal aortic dissection. Is pericardiocentesis harmful?

Background: Cardiac tamponade frequently complicates acute proximal aortic dissection and is one of the most common causes of death from aortic dissection. Well-defined strategies for the management of acute aortic dissection now exist; however, little is known about how best to manage the hemopericardium that may complicate it.

Methods And Results: Using a computer-based review, we retrospectively identified 10 patients presenting to our hospital over a 13-year period who were diagnosed with both aortic dissection and cardiac tamponade.

Radioimmunotherapy of metastatic colorectal tumours with iodine-131-labelled antibody to carcinoembryonic antigen: phase I/II study with comparative biodistribution of intact and F(ab')2 antibodies.

Studies in animal tumour models of colorectal cancer suggest that F(ab')2 antibody fragments to carcinoembryonic antigen (CEA) labelled with iodine-131 give superior therapy compared with intact anti-CEA antibody. The purpose of this study was to investigate this hypothesis in patients. Ten patients received intact A5B7 IgG1 mouse monoclonal antibody (MAb) to CEA and nine patients received the F(ab')2 fragment of the same antibody.

Preoperative cardiac risk assessment for noncardiac surgery.

Patients presenting for noncardiac surgery should receive careful preoperative cardiac risk stratification. This has implications not only for the perioperative period, but also for long-term survival. After an initial clinical evaluation, certain patients will be referred for noninvasive testing.

Costs and effectiveness of angiotensin converting enzyme inhibition in patients with congestive heart failure.

Background: Chronic heart failure is associated with a poor prognosis and reduced survival rates. The addition of vasodilator drug therapy to conventional therapy for congestive heart failure has resulted in improved survival.

Methods: Adopting a societal viewpoint, we designed a decision analytic model to analyze the costs and effectiveness of three therapies available for the treatment of congestive heart failure: standard therapy (digoxin and diuretic therapy) plus (1) no vasodilator agents, (2) hydralazine hydrochloride-isosorbide dinitrate combination, and (3) enalapril.

Left atrial myxoma presenting as acute respiratory failure.

We report the unusual case of a young man with acute respiratory failure caused by a left atrial myxoma. The patient's rapid clinical deterioration and severe hypoxemia suggested the acute respiratory distress syndrome; however, unexpected physical examination findings and a markedly elevated pulmonary capillary wedge pressure implied cardiac abnormality. The use of echocardiography as a bedside tool allowed correct, rapid diagnosis.

Long-term survival in patients with coronary artery disease: importance of peripheral vascular disease. The Coronary Artery Surgery Study (CASS) Investigators.

Objectives: The purpose of this study was to determine the importance of peripheral arterial disease in predicting long-term survival in patients with clinically evident coronary artery disease.

Background: Patients in the Coronary Artery Surgery Study (CASS) Registry were followed up for > 10 years.

Methods: Survival in 2,296 patients with peripheral arterial disease was compared with that of 13,953 patients without peripheral arterial disease using Kaplan-Meier survival curves.

Potential impact of pulmonary artery catheter placement on short-term management decisions in the medical intensive care unit.

The purpose of this study was to examine the potential impact of pulmonary artery (PA) catheter placement on short-term management decisions in the medical intensive care unit (ICU). One hundred three patients were examined over an 18-month period. The predominant indications for PA-catheter placement included refractory congestive heart failure, airspace disease, uncertain cardiac filling pressures, or hypotension.

Economic impact of regression of left ventricular hypertrophy by antihypertensive drugs.

We examined the long-term cost effectiveness of treating hypertensive patients aged 47 to 65 yrs with agents that promote regression of left ventricular hypertrophy (LVH). Beta-blockers, calcium channel blockers, and ACE inhibitors were compared with standard therapy. To estimate the effect of drug therapy on LVH regression, we pooled data from 25 studies.

Variables associated with a poor prognosis in patients with an ischemic thallium-201 exercise test.

To determine the exercise workload, ECG, and thallium-201 image parameters that are most closely associated with a poor prognosis from ischemic heart disease, the test results of 268 patients were reviewed. Only patients with unequivocal thallium-201 redistribution were selected. A multivariate analysis was performed to find the variables that were most strongly associated with the outcomes of coronary revascularization, myocardial infarction, and cardiac death during a follow-up period of 25 +/- 19 months.