Recurrence of a left atrial myxoma

A fatal recurrence of a left atrial myxoma was observed despite resection of the original tumor complete with its stalk and a portion of atrial septum. The evidence suggests that this recurrent tumor developed from "pre-tumor" cells in the region of the fossa ovalis. The rate of growth of the second tumor was faster than would have been predicted. Clinical manifestations were similar to those with the initial tumor. Wide excision of the atrial septum with the stalk of such tumors should offer the best chance for operative cure, but prolonged postoperative observation is important if signs of recurrence are to be detected at a time when operative removal can be carried out with minimal risk to the patient.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/34209/1/0000498.pd

A natural history study of the prognostic role of coronary arteriography

Coronary cinearteriograms, clinical records, and left ventriculograms of 304 patients studied for evaluation of chest pain were reviewed. Clinical and follow-up data on survival of the normal subjects and the nonoperative group with abnormal arteriograms are presented.Ninety-two per cent of patients with typical angina pectoris had serious coronary occlusive disease. Ninety-eight per cent of patients with relatively normal coronary arteriograms survived for one to 60 or more months (mean follow-up period 24 months).There was a high mortality rate when the left main coronary artery was involved (47 per cent) and when the left coronary anterior descending branch was seriously occluded (28 per cent when arteriographic scores were high and 14 per cent when total scores were low) and a low mortality rate (0 to 7 per cent) when the LAD was normal. Mean follow-up interval in these groups was 19 months.The mortality rate was nearly three times greater when patients had QRS changes on ECG of prior myocardial infarction and six times greater when left ventricular contraction was significantly impaired.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/22297/1/0000740.pd

Sensitivity of quantitative segmental wall motion analysis of rest and exercise ventriculograms in detecting coronary artery disease

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/24143/1/0000400.pd

Infarct vessel status after intravenous tissue plasminogen activator and acute coronary angioplasty: Prediction of clinical outcome

To determine the risk of arterial reocclusion or recurrent ischemia after acute intervention in myocardial infarction, we analyzed the results of coronary arteriography performed acutely and at 1 week in 50 consecutive patients who received acute intervention. Successful recanalization of the infarct vessel was achieved in 46 (92%) patients after therapy with intravenous tissue plasminogen activator, percutaneous coronary angioplasty, or both. Follow-up angiography in 44 showed early reocclusion in 10 patients (23%). Intermittent patency during acute arteriography was always associated with reocclusion; suboptimal (Thrombolysis in Myocardial Infarction [TIMI] class 2) flow was associated with a 50% rate of reocclusion. Although residual stenosis of >50% alone was not predictive of rethrombosis, 90% of all reocclusions were associated with either stenosis >50%, TIMI 2 flow, or intermittent patency. Absence of these angiographic risk factors predicted a 95% patency rate at follow-up. In-hospital cardiac complications occurred in 17 of 23 (74%) patients with residual stenosis of >50% (death in four, ischemia in 13), and late revascularization was required in 53% of survivors. Only 15% of the group with p =50% appears to predict a high incidence of negative in-hospital clinical outcomes and the need for subsequent revascularization.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/27437/1/0000475.pd

Festchrift: A Collection of Essays on Architectural History

A collection of essays on architectural history prepared by the Northern Pacific Coast Chapter Society of Architectural Historians dedicated to Professor Marion Dean Ross, chapter founder, on the occasion of his 65th birthday

Incidence and predictors of early recurrent ischemia after successful percutaneous transluminal coronary angioplasty for acute myocardial infarction

Two hundred forty consecutive patients with acute myocardial infarction treated within 48 hours by successful percutaneous transluminal coronary angioplasty (PTCA) were analyzed to determine the incidence and predictors of recurrent ischemic events during hospitalization. Thirty-nine patients had recurrent ischemia: 20 patients had chest pain or electrocardiographic changes requiring repeat PTCA or bypass surgery, or resulting in a second creatine kinase elevation suggestive of myocardial infarction; 12 had total occlusion of the dilated artery on follow-up angiography; and 7 had exercise-induced ischemia and >= 70% diameter stenosis that required PTCA or bypass surgery before hospital discharge. In-hospital mortality was 15% in the recurrent ischemia group, compared to 1% in the group without recurrent myocardial ischemia (p 25 mm Hg (p = 0.001), dissection (p = 0.01) and post-PTCA Thrombolysis in Myocardial Infarction 2 flow pattern (p = 0.016). However, even in the absence of these risk factors recurrent ischemic events occurred in 13% of patients. Post-PTCA percent diameter stenosis (whether assessed by objective or visual assessment), degree of the early systemic fibrinolytic state, post-PTCA residual minimal diameter and concomitant use of thrombolytic agents were not predictive. Thus, recurrent ischemia after successful PTCA for acute myocardial infarction occurs in 16 to 20% of patients, is significantly more common with post-PTCA translesional gradient >= 25 mm Hg, dissection or Thrombolysis in Myocardial Infarction 2 flow, but may also occur unpredictably.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/28072/1/0000515.pd

Early reperfusion therapy improves left ventricular function after acute inferior myocardial infarction associated with right coronary artery disease

Quantitative global and regional ventriculographic analysis was performed acutely and 1 week later in 46 patients undergoing reperfusion procedures within 6 hours of acute inferior myocardial infarction due to right coronary artery disease. While serial improvement in global left ventricular ejection fraction was not demonstrated for the group, infarct zone regional wall motion did improve (-2.7 +/- 0.9 vs -2.3 +/- 1.4 SD/chord, p p p p p < 0.0001). We conclude that significant improvement in global and reglonal left ventricular function in patients with inferior myocardial infarction is possible when reperfusion therapy is begun early or when arterial patency is achieved.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/26625/1/0000166.pd

High Burden of Impetigo and Scabies in a Tropical Country

Scabies and impetigo are often thought of as nuisance diseases, but have the potential to cause a great deal of morbidity and even mortality if infection becomes complicated. Accurate assessments of these diseases are lacking, particularly in tropical developing countries. We performed a series of studies in infants and primary school children in Fiji, a tropical developing country in the South Pacific. Impetigo was very common: more than a quarter of school-aged children and 12% of infants had active impetigo. Scabies was also very common affecting 18% of school children and 14% of infants. The group A streptococcus was the most common infective organism followed by Staphylococcus aureus. The size of the problem has been underestimated, particularly in the Pacific. It is time for more concerted public health efforts in controlling impetigo and scabies

Latent Factor Analysis to Discover Pathway-Associated Putative Segmental Aneuploidies in Human Cancers

Tumor microenvironmental stresses, such as hypoxia and lactic acidosis, play important roles in tumor progression. Although gene signatures reflecting the influence of these stresses are powerful approaches to link expression with phenotypes, they do not fully reflect the complexity of human cancers. Here, we describe the use of latent factor models to further dissect the stress gene signatures in a breast cancer expression dataset. The genes in these latent factors are coordinately expressed in tumors and depict distinct, interacting components of the biological processes. The genes in several latent factors are highly enriched in chromosomal locations. When these factors are analyzed in independent datasets with gene expression and array CGH data, the expression values of these factors are highly correlated with copy number alterations (CNAs) of the corresponding BAC clones in both the cell lines and tumors. Therefore, variation in the expression of these pathway-associated factors is at least partially caused by variation in gene dosage and CNAs among breast cancers. We have also found the expression of two latent factors without any chromosomal enrichment is highly associated with 12q CNA, likely an instance of “trans”-variations in which CNA leads to the variations in gene expression outside of the CNA region. In addition, we have found that factor 26 (1q CNA) is negatively correlated with HIF-1α protein and hypoxia pathways in breast tumors and cell lines. This agrees with, and for the first time links, known good prognosis associated with both a low hypoxia signature and the presence of CNA in this region. Taken together, these results suggest the possibility that tumor segmental aneuploidy makes significant contributions to variation in the lactic acidosis/hypoxia gene signatures in human cancers and demonstrate that latent factor analysis is a powerful means to uncover such a linkage