Flexible fiberoptic pericardioscopy for the diagnosis of pericardial disease

Pericardiocentesis provides an etiologic diagnosis for pericardial effusions approximately 25% of the time. In seven patients with evidence of a large pericardial effusion of unknown origin without cardiac tamponade, a flexible fiberoptic bronchoscope was inserted through a subxiphoid incision after the effusion was drained. Pericardioscopy allowed visualization of all pericardial surfaces and made it possible to perform selective biopsy not limited to a subxiphoid window. It is a safe procedure that can permit distinction among benign, malignant and tuberculous origins of pericardial effusion

Women and non-cardiac chest pain: gender differences in symptom presentation.

A substantial number of individuals evaluated for complaints of chest pain do not suffer from coronary heart disease (CHD). Studies show that many patients who complain of symptoms that might be caused by CHD, such as shortness of breath or chest pain, may actually have an anxiety disorder. Gender differences in how patients present with these symptoms have not been adequately explored. The purpose of this study was to explore possible gender differences in the presentation of patients with CHD-like symptoms. Two groups were examined, one comprising 6,381 individuals self-referred for electron beam tomography (EBT) studies and a subset of these individuals who defined a low-risk group based on the absence of risk factors for CHD and low coronary artery calcium (CAC) scores. We explored gender differences in symptom presentation in each group after controlling for relevant variables by using logistic regression models. These analyses showed that women were significantly more likely than men to endorse CHD symptoms that might also be caused by an anxiety disorder. Women in the low risk group reported CHD symptoms also referable to anxiety more often than men, but unlike men did not complain primarily of chest pain. Women were also more likely to have been prescribed antianxiety or antidepressant medication. In previous studies, non-cardiac chest pain has been considered a hallmark of anxiety in individuals seen in medical settings. This study suggests that in individuals with low risk for CHD chest pain was not related to gender, but other anxiety-related symptoms including heart flutter, lightheadedness, nausea, and shortness of breath were more likely to be reported in women than in men

Clinical applications of cardiac CT angiography

ECG-gated multislice CT provides a cost-effective, non-invasive technology for evaluation of the coronary arteries, as well as for additional clinical applications, which require morphological assessment of the heart and adjacent structures with simultaneous evaluation of the coronary circulation

Damping measurements on a carbon fibre reinforced laminate

By performing force-displacement tests in a universal testing machine it is possible to accurately measure the damping of a material. By providing accurate estimates of the damping for a set of given conditions, it should be possible to determine which model is more adequate to describe damping: viscous, hysteretic or a combination of both. On the other hand, by changing the amplitude it should be possible to assess the linearity of the material behaviour. In this work, the authors present the experimental results of the damping measurements on a specimen of a quasi-isotropic Carbon Fibre Reinforced Laminate, for different testing parameters, like frequency and amplitude. The setup is fully described and results are presented in detail, giving a special attention to the experimental problems, so that this work can become a useful contribution to further studies

Impact of Treatment Guidelines on Clinical and Economic Outcomes of Acute Decompensated Heart Failure

BACKGROUND: No data exist that demonstrate the impact of comprehensive acute decompensated heart failure (ADHF) treatment guidelines on clinical and economic outcomes in hospitalized patients with this condition. OBJECTIVES: To compare clinical and economic outcomes before and after implementation of treatment guidelines for ADHF. METHODS: A single-center, retrospective, chart review study was conducted in a university hospital. ADHF treatment guidelines were developed and implemented on January 1, 2004. Patients hospitalized for ADHF between January 2003 and November 2004 were identified using the Acute Decompensated Heart Failure Registry. Study periods were 12 months prior to and the 11 months following guideline implementation. RESULTS: This cohort was comprised of 683 ADHF hospitalizations (357 preguideline, 326 postguideline); several patients were admitted more than once. There was a trend toward increased use of intravenous vasoactive drugs (VADs) following guideline implementation (19.9% vs 24.2%; p = 0.05). The duration of intravenous VAD use decreased by more than 40% following guideline implementation, but this was not statistically significant after risk adjustment (p = 0.22). The need for intensive care unit monitoring decreased from 45.1% before guideline implementation to 25.3% following guideline implementation (p \u3c 0.02) in patients treated with intravenous VADs. The need for mechanical ventilation was reduced by nearly 80% (p = 0.04) following guideline implementation. Significantly more patients of the postguideline cohort were prescribed beta-blockers at discharge (54.9% vs 75.2%; p = 0.0001). Costs were not significantly different between the groups. CONCLUSIONS: Implementation of ADHF treatment guidelines was associated with reduced need for mechanical ventilation, improved utilization of beta-blockers at discharge, and trends toward increased use of intravenous VADs, while not significantly changing total costs. More rigorous studies need to be conducted to estimate the true effect of treatment guidelines on ADHF care and outcomes

Influence of age and gender on the presence of coronary calcium detected by ultrafast computed tomography

AbstractObjectives. This study sought to determine the relation between coronary calcification detected with ultrafast computed tomography and lumen narrowing defined with angiography and evaluated whether this relation is influenced by age and gender.Background. Ultrafast computed tomography has been shown to be a sensitive method for detection of coronary calcification associated with atherosclerotic disease, but the relation between the extent of coronary calcification and degree of lumen narrowing and the possible influence of gender or age, or both, on this relation have not been clarified.Methods. Seventy men and 70 women were studied with ultrafast computed tomography for analysis of coronary calcification and coronary angiography. Coronary atherosclerosis was considered present if any lumen irregularity was noted on angiography, and obstructive coronary artery disease was defined as a lumen diameter narrowing ≥70%.Results. Coronary calcification had a sensitivity of 88% for identification of patients with atherosclerotic disease and 97% for those with obstructive disease, with corresponding specificities of 55% and 41%, respectively. The sensitivity of coronary calcium for detection of atherosclerotic disease in women <60 years old was 50%, significantly less than the 97% sensitivity in women > 60 years old and the 87% sensitivity in men <60 years old (p < 0.05 for each comparison). Logistic regression analysis revealed a 1.81-fold increase in the likelihood of detecting coronary calcification in the atherosclerotic lesions of men compared with those in women (95% confidence interval 1.12 to 2.93, p = 0.016) when controlled for age and severity of coronary disease by angiography.Conclusions. Atherosclerotic lesions in women are less likely to have coronary calcium than lesions with a similar degree of lumen narrowing in men. Differences in the pattern of coronary calcification between men and women may provide insight into the gender differences observed in the clinical development of symptomatic coronary artery disease