Temporal trends in eversion carotid endarterectomy for carotid atherosclerosis: single-center experience with 5,034 patients

The aim of this article is to review our experience in surgical treatment of carotid atherosclerosis using eversion carotid endarterectomy (ECEA) in 5,034 patients, with particular attention to temporal changes in patients' characteristics, diagnostic approach, surgical technique, medical therapy, and outcome in the early (group A, 1991-1997) versus late (group B 1998-2004) period of ECEA. From January 1991 to December 2004, 5,034 primary ECEAs were performed for high-grade carotid stenosis. Patients treated for restenosis after previous carotid surgery were excluded from the analysis. Group A consisted of 1,714 patients who underwent surgery between 1991 and 1997, and group B consisted of 3,320 patients who underwent surgery between 1998 and 2004. Follow-up included routine clinical evaluation and noninvasive surveillance, with duplex scanning at 1 month after surgery, after 6 months, and annually afterward. Only 3% of patients in group A and 0.6% in group B were asymptomatic, with 23% and 47% of them having preoperative stroke, respectively. In group A, angiography was used for the final diagnosis in 78% of patients. In group B, duplex scanning was performed in 82% of patients and angiography in only 18% (p < .001). Clamping time was shorter in the latter group (12.4 +/- 3.1 vs 14.5 +/- 4.1 min, p < .01). Introperative shunting and regional anesthesia were rarely performed in both groups (1.4% vs. 0.4%, p < .01, and 2% vs 0.3%, p < .001). Total and neurologic morbidity was significantly higher in group A than in group B (6.41% +/- 0.47% vs 4.81% +/- 0.53%, p < .001, and 2.14% +/- 0.31% vs 1.23% +/- 0.29%, p < .001, respectively). Total mortality was also higher in group A than in group B (1.92% +/- 0.24% vs 1.36% +/- 0.50%, p < .05), but although there was a trend toward lower neurologic mortality, it did not reach statistical significance (1.04% +/- 0.5% vs 0.57% +/- 0.25%, p = .074). There was a lower rate of nonsignificant restenosis (< 50%) in group B (2% vs 5%, p < .01), but the incidence of restenosis > or = 50% was identical between the groups (5.5% for both). Our data show that ECEA is a reliable surgical technique for the treatment of atherosclerotic carotid disease. Temporal trends in our patients demonstrated a decline in periopertive mortality and morbidity, despite a higher incidence of preoperative stroke.     

Whole-cell-analysis of live cardiomyocytes using wide-field interferometric phase microscopy

We apply wide-field interferometric microscopy techniques to acquire quantitative phase profiles of ventricular cardiomyocytes in vitro during their rapid contraction with high temporal and spatial resolution. The whole-cell phase profiles are analyzed to yield valuable quantitative parameters characterizing the cell dynamics, without the need to decouple thickness from refractive index differences. Our experimental results verify that these new parameters can be used with wide field interferometric microscopy to discriminate the modulation of cardiomyocyte contraction dynamics due to temperature variation. To demonstrate the necessity of the proposed numerical analysis for cardiomyocytes, we present confocal dual-fluorescence-channel microscopy results which show that the rapid motion of the cell organelles during contraction preclude assuming a homogenous refractive index over the entire cell contents, or using multiple-exposure or scanning microscopy.     

Autofluorescent diagnostics in laryngeal pathology

Autofluorescent diagnostics are based on the ability of oxidized flavin mononucleotide (FMN) in normal cells to emit green fluorescence when exposed to blue light. Neoplastic cells have significantly lower concentrations of FMN and do not emit green fluorescence. Autofluorescent endoscopy is designed for early, accurate and minimally invasive diagnostics for laryngeal pathology. This procedure has the ability to give information about the nature of laryngeal lesions without the devastation of tissue and has important advantages over standard biopsy. In our investigation we used the System of AutoFluorescent Endoscopy (SAFE 1000) designed by Pentax. We examined 38 patients using the SAFE 1000 system, and then all of the patients underwent laryngomicroscopy (LMS). In LMS, a biopsy was taken, and the diagnostic sensitivity of these two methods was compared according to the pathohistologic diagnosis. For statistical evaluation we used Fisher's exact test. We found that autofluorescent endoscopy has greater sensitivity in the detection of precancerous and malignant conditions in the larynx than standard laryngomicroscopy. We believe that autofluorescent endoscopy in addition to laryngomicroscopy gives a more accurate diagnosis of laryngeal pathology than laryngomicroscopy alone.     

The pressor response to acute hyperlipidemia is enhanced in lean normotensive offspring of hypertensive parents

Family history is an important predictor of the cardiovascular risk factor cluster associated with insulin resistance. The dyslipidemia associated with insulin resistance may contribute to elevated blood pressure (BP). This study was undertaken to further explore the link between family history, dyslipidemia, and BP regulation. Twenty-three lean normal volunteers with a negative family history (FH-, n = 11) or positive family history (FH+, n = 12) of hypertension were evaluated under baseline conditions and during a 4-h infusion of intralipid and heparin (acute hyperlipidemia). Fasting blood was drawn for lipids including nonesterified fatty acids (NEFA). After 2 and 4 h of intralipid and heparin, blood was drawn for NEFA. The BP was measured at baseline and every 30 min after starting the intralipid and heparin infusion. Baseline triglycerides and very low density lipoprotein cholesterol concentrations were higher in FH+ than FH- subjects (P < .05). However, NEFA increased similarly in both groups during the infusion of intralipid and heparin. The BP and heart rate increased with acute hyperlipidemia in all subjects combined (P < .05). Despite the similar increase of NEFA, mean BP, pulse pressure, and pressure-rate product increased significantly in FH+ subjects but not in FH- volunteers with acute hyperlipidemia. Although systolic BP increased in both groups, the increase was greater in FH+ than in FH- volunteers during acute hyperlipidemia (14 +/- 2 v 10 +/- 2 mm Hg, P < .05). These results suggest that higher plasma lipids combined with a greater pressor response to hyperlipidemia may contribute to the development of high BP in subjects with a family history of hypertension.     

Activation of coagulation during alimentary lipemia under real-life conditions

High intake of saturated fat is a predictor of coronary heart disease mortality. The phenomenon of postprandial angina pectoris has been described many years ago. Although earlier studies have demonstrated postprandial activation of coagulation factors VII and XII, platelets and monocytes, conclusive evidence for intravascular fibrin formation after a fat-rich meal has not been reported yet. The present study included 33 healthy physicians (7 females, 26 males) with a mean age of 42 years (range 27-62 years), and 27 coronary heart disease patients (8 females, 19 males) with a mean age of 63 years (range 47-81 years). Of the coronary heart disease patients, 26/27 were treated with acetylsalicylic acid and 25/27 with lipid-lowering drugs simvastatin or atorvastatin. Blood samples were drawn 30-60 min before and 30-60 min after a dinner consisting of rye bread with liversausage and black pudding as hors d'oeuvre, lettuce with smoked bacon in a lard dressing, stuffed fried goose with red cabbage, potato dumplings and sweet chestnuts, and white and brown mousse au chocolat. Average intake per person was 3760 kcal, with 125.9 g protein, 238.0 g fat and 268.9 g carbohydrate. We measured a significant postprandial increase in fibrinopeptide A (FpA) levels from 1.14+/-1.23 microg/l to 4.18+/-2.86 microg/l (p<0.0001) in healthy probands, and 4.66+/-13.61 microg/l to 12.80+/-15.04 microg/l (p<0.0001) in coronary heart disease patients. Triglycerides increased from 137.6+/-60.5 to 201.5+/-75.0 mg/dl in healthy probands and from 211.9+/-94.6 to 273.6+/-122.5 mg/dl in coronary heart disease patients. Fat-rich meals may cause procoagulant episodes, which may promote vascular complications such as myocardial infarction, transient ischemia attacks in susceptible persons.     

Automatic analysis of cardiac repolarization morphology using Gaussian mesa function modeling

A novel fully automated method for wave identification and extraction from electrocardiogram (ECG) waveforms is presented. This approach implements the combined use of a new machine-learning algorithm and of specified parameterized functions called Gaussian mesa functions (GMFs). Individual cardiac cycle waveforms are broken up into GMFs using a generalized orthogonal forward regression algorithm; each individual GMF is subsequently identified (wave labeling) and analyzed for feature and morphologic extraction.The GMF associated with the repolarization waveform of the main vector lead, based on principal components analysis, was analyzed, and a set of morphologic parameters were derived under 2 experimental settings: first, in 100 digital 12-lead ECG Holter recordings acquired during three 24-hour periods (baseline and after 160 and 320 mg of sotalol) from 38 healthy subjects; second, in drug-free 12-lead resting ECGs from 100 genotyped long QT syndrome (LQTS) patients (50 each with LQT1 and LQT2).QT-interval duration was measured using an on-screen method applied to the global representative beats and reviewed by a senior cardiologist. QTci (individual correction) was used for analysis.All parameters in the sotalol test showed highly significant differences between the time of peak plasma concentration (Tmax) and baseline ECGs; however, the dynamic pattern of individual parameters followed different patterns. The LQTS test confirmed the results of the sotalol test, showing that GMF-based repolarization parameters were strongly modified as compared with healthy controls. In particular, T-wave width and descending phase of repolarization were more prolonged in LQT2 compared to LQT1.     

Serum platelet-activating factor acetylhydrolase and paraoxonase-1 activity in horses infected with Leptospira spp

Chagas disease is a tropical parasitic disease endemic to Latin America which affects more than 10 million people, and kills more than 15,000 people each year. This condition, caused by the protozoan parasite Trypanosoma cruzi, is principally transmitted by kissing bugs (Triatominae). In Bolivia, recent reports by the Departmental Health Service showed the presence of Panstrongylus rufotuberculatus in dwellings located in the Charazani Valley (La Paz). A study was then carried out in the area to evaluate the degree of domiciliation of this species, and its possible role in the transmission of Chagas disease. In seven communities, 108 dwellings were visited to actively search for the bugs and 217 people participated in a serological study to determine the prevalence of Chagas disease in the population. Nymphs and adults belonging to two species: Panstrongylus geniculatus (5 insects, 1.5%) and P. rufotuberculatus (344 insects, 98.5%) were collected. One P. rufotuberculatus was captured in a bed, while all the other specimens of this species were found in kitchens in which guinea pigs were being reared. A large bug colony has been encountered in a kitchen environment, with more than 300 specimens of all stages. None of the 201 analyzed bugs was positive for T. cruzi. The seroprevalence of Chagas disease in the human population was low (1.3%); no evidence of a local vectorial transmission was found. In conclusion, for the time being there is no evidence of vectorial transmission of Chagas disease in the region. The possible association between reared guinea pigs and the bugs is discussed. The presence of infected people, the migratory movement of the human population and the relatively high colonization process demonstrate that the region needs to be regularly controlled to prevent the area from becoming a local source of Chagas transmission.