Usefulness of transesophageal echocardiography in the assessment of aortic dissection

The acute dissection of the ascending aorta requires prompt and reliable diagnosis to reduce the high risk of mortality; in addition, prognosis is influenced by longterm complications. The aim of this article is to discuss transesophageal echocardiography (TEE) and (1) its diagnostic accuracy in the presurgical evaluation of patients, (2) its role in reducing time of diagnosis and surgery, and (3) its ability to reduce hospital mortality. TEE has also been tested as a screening method in the postsurgical follow-up of these patients. The retrospective investigation concerns a sample of 80 cases of acute dissection of the aorta, submitted for surgical intervention from April 1986 to February 1999. TEE has allowed a precise estimation of aortic diameters and optimal visualization of intimal flap and tear entry with a fine distinction between true and false lumen. A direct comparison of the results of TEE and of transthoracic echocardiography has demonstrated that some elements (visualization of flap and diameters in descending aorta, sites of entry and reentry, direction of let trough intimal tears, phasic intimal flap movement, diastolic collapse of flap on the valvular plane, false lumen thrombosis, coronary involvement, intramural hematoma, and aortic fissuration) were identified only by TEE, whereas other additional diagnostic elements (cardiac tamponade, aortic valve insufficiency, left ventricular function) show a similar pattern of significance. Routine employment of this method has confirmed a reduction of hospitalization time (about 1.5 hours of waiting time), and hospital mortality has changed from 42.8% to 17.3%. In the follow-up of patients operated on for aortic dissection, fundamental information may be obtained from TEE (assessment of the progression of thrombosis in the false lumen with its complete obliteration and modifications in aortic diameter with a consequent, possible worsening of aortic valve insufficiency). In conclusion, our study demonstrated that TEE may provide fast and efficient detection of acute aortic dissection. In the postsurgical follow-up, TEE has confirmed detection of major complications that can influence long-term prognosis and may be proposed as a method with easy access-one that is repeatable and inexpensive for the screening of aortic dissection surgical patients. (C) 2000 by Excerpta Medica, Inc

Long-Term Outcomes with Subcutaneous C1-Inhibitor Replacement Therapy for Prevention of Hereditary Angioedema Attacks

Background For the prevention of attacks of hereditary angioedema (HAE), the efficacy and safety of subcutaneous human C1-esterase inhibitor (C1-INH[SC]; HAEGARDA, CSL Behring) was established in the 16-week Clinical Study for Optimal Management of Preventing Angioedema with Low-Volume Subcutaneous C1-Inhibitor Replacement Therapy (COMPACT). Objective To assess the long-term safety, occurrence of angioedema attacks, and use of rescue medication with C1-INH(SC). Methods Open-label, randomized, parallel-arm extension of COMPACT across 11 countries. Patients with frequent angioedema attacks, either study treatment-naive or who had completed COMPACT, were randomly assigned (1:1) to 40 IU/kg or 60 IU/kg C1-INH(SC) twice per week, with conditional uptitration to optimize prophylaxis (ClinicalTrials.gov registration no. NCT02316353). Results A total of 126 patients with a monthly attack rate of 4.3 in 3 months before entry in COMPACT were enrolled and treated for a mean of 1.5 years; 44 patients (34.9%) had more than 2 years of exposure. Mean steady-state C1-INH functional activity increased to 66.6% with 60 IU/kg. Incidence of adverse events was low and similar in both dose groups (11.3 and 8.5 events per patient-year for 40 IU/kg and 60 IU/kg, respectively). For 40 IU/kg and 60 IU/kg, median annualized attack rates were 1.3 and 1.0, respectively, and median rescue medication use was 0.2 and 0.0 times per year, respectively. Of 23 patients receiving 60 IU/kg for more than 2 years, 19 (83%) were attack-free during months 25 to 30 of treatment. Conclusions In patients with frequent HAE attacks, long-term replacement therapy with C1-INH(SC) is safe and exhibits a substantial and sustained prophylactic effect, with the vast majority of patients becoming free from debilitating disease symptoms

Las microesferas de Valle Morín, estado Aragua, Venezuela: Evidencia de impacto meteórico.

En Ia región de Camatagua, al sureste del pueblo de Valle Morín, en el curso de Ia quebrada Camatagúita se. reconocieron en muestras de lutita carbonática y limolita silícea, varias microesferas con brillo metálico. Estas microesferas fueron estudiadas con lupa binocular, microscopía electrónica de barrido y microanálisis químico cualitativo mediante espectroscopía por energía dispersa de rayos X, interpretándose como equivalentes metálicos de microtectitas. El origen por el impacto de un cuerpo extraterrestre de estas microesferas se infiere a partir de evidencias en su morfología superficial y composición química. Se trata del primer hallazgo documentado en Venezuela de estos corpúsculos. Su posición en el tiempo (Cretacico Tardío), así como Ia presencia de cuerpos simi!ares y estructuras asociadas en el Caribe, las hace candidatas para continuar estudios posteriores pertinentes, que permitan profundizar sobre su origen y ver sus relaciones con formas simi!ares del área. Abstract Various microspheres with metallic luster have been recognized in mudrocks from the Camatagua region, south-east of the Valle Morin town, along the course of the Camataguita creek. These microspheres were studied with the aid of a binocular magnifier, scanning electron microscope and semiquantitative energy dispersive X-ray spectroscopy, suggesting them to represent the metallic equivalents of microtektites. The impact related origin is suggested by surface morpho!ogy and chemical composition. This is the first documented find of cosmic microspheres in Venezuela, and because of the age of the rocks in which they where found (Late Cretaceous), as well as the presence of similar bodies and related structures in the Caribbean region, it makes them interesting for further studies that could provide new insight on their origin and relationship with similar bodies in the Caribbean

The correlation between left ventricular segmental kinesis and a Selvester QRS analysis in stabilized myocardial infarct

We have studied the relationship between left ventricular segmental wall motion evaluated by means of biplane left ventricular cineangiography and the myocardial infarct size estimated using Selvester's scoring system based on the QRS of the electrocardiogram. Seventy consecutive patients with old myocardial infarction were recruited. All patients underwent diagnostic retrograde left heart catheterization including left ventriculography and selective coronary arteriography. Nineteen patients were excluded from the study due to intraventricular conduction disturbances and left ventricular hypertrophy. Of the remaining 51 patients, aged 33-76 years (mean 56 years), 31 had inferior or postero-inferior myocardial infarction (Group 1); 7 patients had combined anterior and inferior myocardial infarction (Group 2); 13 patients had anterior or antero-septal myocardial infarction (Group 3). The analysis of left ventricular segmental wall motion was performed according to the Collaborative Studies in Coronary Artery Surgery assigning at hypokinesia, akinesia and dyskinesia 1, 2 and 3 points, respectively. The values of statistical correlations between QRS scoring system and ventricular scoring were: r = 0.85 (Group 1); r = 0.78 (Group 2); r = 0.70 (Group 3). Our data indicate that Selvester's scoring system may provide useful information on functional status and on the extent of left ventricular wall motion abnormalities in patients with previous myocardial infarction

Fatal leptospiral myocarditis

Clinical, instrumental and post-mortem studies were carried out in a patient with intractable cardiac failure, whose death was attribute to Weil's syndrome. A post-mortem examination showed the presence of numerous petechiae on the heart layers and diffuse lymphomonocytic infiltrates in the myocardium, epicardium and endocardium. We suggest that in patients affected by leptospirosis--an endemic disease with a possible fatal outcome--it is necessary to determine carefully any involvement of the cardiovascular system which may play a determinant role in the evolution of the disease

FINVALI 2005 - Aree scientifiche: percorsi e risultati

Si presenta l'attività di ricerca del PROGETTO FINALIZZATO “FINVALI 2005”: obiettivi cognitivi, saperi minimi e linguaggi nelle prove nazionali di fine ciclo relativamente all'area matematica e all’area delle scienze sperimentali

A Two-Dimensional Borophene Supercapacitor

This work introduces a new two-dimensional (2D) borophene-based (BB) supercapacitor produced by a chemical vapor deposition method and used in the facile fabrication of nanosupercapacitors (spin-coating on graphite substrates). Structural properties of the as-prepared borophene sheets are fully characterized via AFM, HRTEM, and FESEM, and Raman spectrum of the 2D sheets is scrutinized and discussed, as well as the electrochemical response of the fabricated nanosupercapacitors. A high specific capacity (sCap) of 350 F g(-1) is attributed to the device according to the electrochemical tests, that is almost three times higher than previous boron-based supercapacitors and surpasses the best reported 2D materials including graphene. Based on the surface charge-storage mechanism, it is posited that the electrical conductivity and surface area of 2D electrode materials highly affect the performance of the supercapacitor. Simulation studies are also conducted using joint density-functional theory (JDFT), the results of which are in agreement with the reported outcomes of experiments. Application of the newly synthesized 2D BB supercapacitors in the current study is expected to be promising in the energy storage field, inventive class of sensing devices, as well as novel highly sensitive biosensors

Low-field magnetic resonance imaging in the evaluation of mechanical and biological heart valve function.

Magnetic resonance imaging (MRI) has been frequently considered unsafe for patients with ferromagnetic implants: risks to be considered include induction of electric current, heating and dislocation of the prosthesis. Previous in vitro and in vivo studies have indicated the possibility of performing MRI examinations on patients with prosthetic heart valves. The aim of our study was to verify the presence of artifacts at the level of the prosthetic heart valve in vivo using a low-field MR unit (0.2 T) and to define the possibility of a functional analysis of the valve in patients with biomedical or mechanical prostheses. We evaluated 14 patients surgically treated for implantation of nine biological and seven mechanical aortic and mitral valves. A low-field MR unit (0.2 T) was employed using cine-MR technique on long- and short-axis view. The images were acquired on planes parallel and perpendicular to the valvular plane. Semiquantitative analysis with double-blind evaluation for definition of the extent of the artifact was performed. Three classes of artifacts were distinguished from minimal to significant. The examinations showed the presence of minimal artifacts in all biological heart valves and moderate artifacts in mechanical valves giving good qualitative data on blood flow near the valve. Analysis of the flow behind the valve showed signs of normal function in 13 prostheses and pathological findings in the remaining three. In these latter cases, MRI was able to define the presence of a pathologic aortic pressure gradient, mitral insufficiency and malpositioning of the mitral valve causing subvalvular turbulence. Nevertheless, we believe that the application of velocity-encoding cine-MR is more promising than semiquantitative analysis of artifacts

FINVALI 2005 - Aree scientifiche: percorsi e risultati

Si presenta l'attività di ricerca del PROGETTO FINALIZZATO “FINVALI 2005”: obiettivi cognitivi, saperi minimi e linguaggi nelle prove nazionali di fine ciclo relativamente all'area matematica e all’area delle scienze sperimentali