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1.
Ther Adv Infect Dis ; 4(3): 75-82, 2017 May.
Article in English | MEDLINE | ID: mdl-28634537

ABSTRACT

OBJECTIVES: Cardiac implantable electronic device (CIED) infection has been a major clinical problem in addition to being a major financial burden. In spite of antimicrobial prophylaxis, CIED infection rates have been increasing disproportionately. We therefore conducted this meta-analysis to assess the role of TYRX antibiotic envelope for the prevention of CIED infection. METHODS: Using extensive online search, we conducted a meta-analysis of studies reporting CIED infections with versus without the use of TYRX antibiotic envelope. A random-effect model was used, and between studies heterogeneity was estimated with I2. All analyses were performed with RevMan (version 5.0.20). RESULTS: Five cohort studies were included in this meta-analysis. The pooled odds ratio (OR) of included studies was 0.29 [95% confidence interval (CI): 0.09-0.94; p < 0.004]. There was evidence of heterogeneity with I2 of 58%. There was also evidence of publication bias on funnel plot analysis. On sensitivity analysis, no statistically significant difference was noted when stratified by study design or duration of follow-up. CONCLUSION: The results of our study demonstrate a significant beneficial effect of TYRX antibiotic envelope for the prevention of CIED infections.

2.
Int J Med Sci ; 9(5): 391-6, 2012.
Article in English | MEDLINE | ID: mdl-22859898

ABSTRACT

Post-reperfusion syndrome (PRS) is a serious, widely reported complication following the reperfusion of an ischemic tissue or organ. We sought to determine the prevalence, risk factors and short-term outcomes of PRS related renal transplantation. We conducted a retrospective, case-control study of patients undergoing renal transplantation between July 2006 and March 2008. Identification of PRS was based on a drop in mean arterial pressure by at least 15% within 5 minutes of donor kidney reperfusion. Of the 150 consecutive renal transplantations reviewed, 6 patients (4%) met criteria for post-reperfusion syndrome. Univariate analysis showed that an age over 60, diabetes mellitus, Asian race, and extended criteria donors increased the odds of developing PRS by 4.8 times (95% CI [1.2, 20]; P=.0338), 4.5 times (95% CI [1.11, 18.8]; P=.0378), 35.5 times (95% CI [3.94, 319.8]; P=0.0078) and 9.6 times (95% CI [1.19, 76.28] P=0.0115) respectively. Short term follow-up revealed increased graft failure rate within 6 months (6% vs. 16% P=0.0125) and almost twice the number of hospital days post-transplant in PRS cohorts (5.43 ± 2.29 vs. 10.8 ± 7.29 P=<0.0001). Despite limited reporting, PRS appears to be a relatively common complication of renal transplantation and is associated with increase morbidity.


Subject(s)
Kidney Transplantation/adverse effects , Reperfusion/adverse effects , Female , Humans , Male , Middle Aged , Retrospective Studies
3.
Pacing Clin Electrophysiol ; 35(7): e185-6, 2012 Jul.
Article in English | MEDLINE | ID: mdl-21535035

ABSTRACT

Although the majority of temporary epicardial leads used during cardiac surgery are removed in the perioperative period, occasionally, the wires are cut and allowed to retract into the subcutaneous tissue. Complications arising from such retained epicardial wires are rare. We present a case of transmyocardial migration of a retained epicardial wire through the right ventricular myocardium into the pulmonary artery in a patient who had undergone coronary artery bypass graft surgery 13 years ago. We describe the presentation and successful management of this case.


Subject(s)
Electrodes, Implanted/adverse effects , Foreign-Body Migration/diagnosis , Foreign-Body Migration/etiology , Heart Failure/diagnosis , Heart Failure/etiology , Pacemaker, Artificial/adverse effects , Aged , Device Removal , Foreign-Body Migration/surgery , Heart Failure/surgery , Humans , Longitudinal Studies , Male , Treatment Outcome
4.
Heart Lung ; 41(1): 87-9, 2012.
Article in English | MEDLINE | ID: mdl-21420734

ABSTRACT

Although pulmonary artery stenosis and its treatment has been well characterized in pediatric populations, its diagnosis and even how to determine the significance of a stenosis can be difficult and optimal management is currently unknown. This case report and review of the literature outlines how we successfully diagnosed, evaluated, and stented a patient with radiation induced pulmonary artery stenosis. This case further adds support to a very limited data pool suggesting that percutaneous angioplasty of pulmonary artery stenosis may be a safe and effective treatment option for this unique patient population.


Subject(s)
Endovascular Procedures/methods , Pulmonary Artery/pathology , Pulmonary Valve Stenosis/therapy , Radiotherapy/adverse effects , Endovascular Procedures/instrumentation , Female , Humans , Middle Aged , Pulmonary Valve Stenosis/etiology , Stents
5.
Cardiovasc Ultrasound ; 9: 42, 2011 Dec 20.
Article in English | MEDLINE | ID: mdl-22185470

ABSTRACT

BACKGROUND: Blood flow between the right and left ventricles is subject to the continuity equation and systolic ventricular interdependence. Quantification of this relationship might aid in understanding inter-ventricular function. The purpose of this study was to evaluate and quantify ventricular interdependence by directly comparing right and left ventricular systolic function though echocardiographic surrogates of right and left ventricular systolic function such as MAPSE, TAPSE, RV TVI and LV TVI. METHODS: This study prospectively evaluated 51 healthy participants (mean age, 41 ± 17 years) by resting echocardiography. In addition to standard measurements, tricuspid annular plane of systolic excursion, (TAPSE), mitral annular plane of systolic excursion (MAPSE), and the peak annulus systolic velocity of the right ventricular (RVs) and left ventricular (LVs) free walls were measured by M-mode and pulsed wave Doppler tissue echocardiography and further evaluated for variance across age, gender, and body surface area. RESULTS: TAPSE (22.1 ± 2.9 mm) was over 54.5% greater than MAPSE (14.3 ± 2.6 mm) and RVs was 64.4% greater than LVs. The LV to RV systolic relationship measured by MAPSE/TAPSE and LVs/RVs ratios were 0.66 ± 0.14 and 0.76 ± 0.21 respectively. These values were not significantly affected by age, gender or body surface area (BSA). CONCLUSION: MAPSE/TAPSE and LVs/RVs ratios appear stable across age, gender, and BSA potentially making them good surrogates of systolic ventricular relationship and interdependence.


Subject(s)
Echocardiography, Doppler, Pulsed/methods , Echocardiography, Doppler, Pulsed/standards , Systole/physiology , Ventricular Function, Left/physiology , Ventricular Function, Right/physiology , Adult , Body Surface Area , Female , Humans , Male , Middle Aged , Prospective Studies , Reference Values , Reproducibility of Results , Rest/physiology , Ventricular Pressure/physiology , Young Adult
6.
Cardiol J ; 17(6): 623-4, 2010.
Article in English | MEDLINE | ID: mdl-21154267

ABSTRACT

Patients presenting with acute coronary syndromes are classically described as having chest pressure with radiation to the left arm. However, pain can be referred to multiple sites including the face, the neck, the abdomen and the contra-lateral arm. We present a case of sudden bilateral ear pain as the sole presentation of acute coronary syndrome in an elderly man. The importance of recognizing these atypical presentations is vital, as outcomes may be worsened as appropriate therapy may be delayed or misdirected.


Subject(s)
Acute Coronary Syndrome/diagnosis , Delayed Diagnosis , Earache/etiology , Acute Coronary Syndrome/complications , Acute Coronary Syndrome/therapy , Aged, 80 and over , Earache/therapy , Fatal Outcome , Humans , Male , Palliative Care , Treatment Outcome
7.
Int J Cardiol ; 141(2): e23-5, 2010 May 28.
Article in English | MEDLINE | ID: mdl-19150143

ABSTRACT

Inherent risks of coronary artery stenting include restenosis and thrombosis. More recently, stent fractures (SF) have emerged as a complication. Lengthy coronary stents, overlapping stents, saphaneous vein graft stents, and right coronary artery lesions treated with sirolimus-eluting stents (SES; Cypher, Cordis, Miami Lakes, Florida, USA) are some of the predisposing factors that have been linked to fractures. Early detection and management may help alleviate the complications of SF including acute thrombosis and restenosis at the site of fracture. We present an interesting case of a SES fracture in the left main coronary artery.


Subject(s)
Acute Coronary Syndrome/etiology , Drug-Eluting Stents/adverse effects , Prosthesis Failure , Coronary Angiography , Coronary Stenosis/surgery , Humans , Male , Middle Aged , Ultrasonography, Interventional
8.
Cases J ; 2: 8553, 2009 Jul 30.
Article in English | MEDLINE | ID: mdl-19830082

ABSTRACT

INTRODUCTION: Glycoprotein IIb/IIIa inhibitors have a key role in the treatment of patients with acute coronary syndromes undergoing percutaneous interventions. Although, an increased risk of bleeding complications is well recognized, its association with diffuse alveolar hemorrhage is much less recognized. Previous authors have suggested that the incidence of glycoprotein IIb/IIIa inhibitor associated diffuse alveolar hemorrhage has been significantly underestimated due to under reporting. CASE PRESENTATIONS: In order to help better determine the incidence of GP IIb/IIIa inhibitor associated DAH, a retrospective review of medical records was conducted over a 1 year period at a single high volume medical hospital. The medical records of all patients diagnosed with diffuse alveolar hemorrhage were evaluated for treatment with a GP IIb/IIIa inhibitor within 48 hours of its diagnosis. Each patient meeting the inclusion and exclusion criteria were included in the case series. This number was compared with the total number of patients receiving a GP IIb/IIIa inhibitor during the same time period and an incidence of the complication was calculated. 292 patients received either abciximab or eptifibatide during the one year review period and two patients were diagnosed with diffuse alveolar hemorrhage confirmed by serial bronchiolar lavage for an incidence of 0.68%. Of the total 292 patients receiving GP IIb/IIIa inhibitors, 172 patients received abciximab with one occurrence of diffuse alveolar hemorrhage for an incidence of 0.58% while 120 patients received eptifibatide with one occurrence for an incidence of 0.83%. Both patients developed significant morbidity as a result of the complication and 1 of the 2 patients died as a complication of the disease. CONCLUSIONS: Our findings support the claim that the incidence of GP IIb/IIIa induced diffuse alveolar hemorrhage is substantially higher than initially suggested by drug manufacturer studies. Although these drugs have proven mortality benefits, its association with diffuse alveolar hemorrhage is likely under-recognized leading to significant under-reporting. The best way to more accurately determine the true incidence of this complication and decrease its morbidity and mortality is to increase awareness as well as include diffuse alveolar hemorrhage as a serious complication in product labeling.

9.
Catheter Cardiovasc Interv ; 73(5): 666-8, 2009 Apr 01.
Article in English | MEDLINE | ID: mdl-19199363

ABSTRACT

Pneumopericardium is a rare but serious cause of morbidity and mortality. Untreated, it can lead to cardiac tamponade and thus must be promptly identified to treat the underlying etiology. Here, we report a case of spontaneous pneumopericardium secondary to gastric ulcer perforation in association with a hiatal hernia. The diagnosis of pneumopericardium was first made under fluoroscopy during cardiac catheterization and a follow-up CT of the chest revealed a gastropericardial fistula as the initiating event. The patient underwent emergent thoracotomy and partial esophagogastrectomy which eventually resulted in a full recovery and discharge on postoperative day 19. Our unique experience with this rare and often fatal disease suggests that early diagnosis combined with an early and aggressive surgical strategy is critical for minimizing morbidity and mortality.


Subject(s)
Cardiac Tamponade/etiology , Fistula/complications , Gastric Fistula/complications , Heart Diseases/complications , Pneumopericardium/etiology , Cardiac Tamponade/diagnostic imaging , Cardiac Tamponade/surgery , Electrocardiography , Esophagectomy , Fistula/diagnostic imaging , Fistula/etiology , Fistula/surgery , Fluoroscopy , Gastrectomy , Gastric Fistula/diagnostic imaging , Gastric Fistula/etiology , Gastric Fistula/surgery , Heart Diseases/diagnostic imaging , Heart Diseases/etiology , Heart Diseases/surgery , Hernia, Hiatal/complications , Humans , Male , Middle Aged , Peptic Ulcer Perforation/complications , Pneumopericardium/diagnostic imaging , Pneumopericardium/surgery , Stomach Ulcer/complications , Thoracotomy , Tomography, X-Ray Computed , Treatment Outcome
10.
Peptides ; 26(5): 863-73, 2005 May.
Article in English | MEDLINE | ID: mdl-15808917

ABSTRACT

Involvement of Angiotensin II (Ang II) in the regulation of sodium levels by modulating the Na+/H+ exchangers is demonstrated in many tissues. Screening of a mouse 17-day fetus cDNA library with the Angiotensin II receptor AT2 as the bait in yeast two-hybrid assay led us to identify an AT2-interacting mouse fetus peptide that shared 98% amino acid identity with the corresponding region of the human NHE6. NCBI Blast search showed that the clone 6430520C02 (GenBank Accession # AK032326) of the mouse genome project carried the complete sequence of this new mouse NHE6 isoform. The human and mouse NHE6 peptides share 97% overall homology. Further analysis showed that the region spanning the third intracellular loop and C-terminal cytoplasmic tail of the AT2 directly interacted with a 182 amino acid region that spans the predicted 5th intracellular loop and the initial part of the C-terminus of the mouse NHE6 in yeast two-hybrid assay. This 182-amino acid region that interacted with the AT2 also shares 98% homology with the corresponding region of rat NHE6 and therefore is highly conserved across species. We detected widespread expression of this NHE6 isoform in several rat tissues including 10-day fetus, 17-day fetus, and 30-day post-natal tissues of heart, brain, kidney and muscle. Moreover, the AT2 co-immunoiprecipitated with a hemagglutinin tagged NHE6 when expressed in human cell line MCF-7, and activated by AngII. This ligand-dependent complex formation between the AT2 and NHE6 suggests that the hormone Ang II may act as a regulator of NHE6, and Ang II-mediated direct protein-protein interaction between AT2 and NHE6 could be a mechanism for modulating the functions of the ubiquitously expressed NHE6 in different tissues.


Subject(s)
Receptor, Angiotensin, Type 2/metabolism , Sodium-Hydrogen Exchangers/metabolism , Amino Acid Sequence , Angiotensin II/pharmacology , Animals , Base Sequence , Cells, Cultured , Conserved Sequence , Gene Expression , Humans , Ligands , Membrane Proteins/chemistry , Membrane Proteins/genetics , Membrane Proteins/metabolism , Mice , Molecular Sequence Data , Peptides/chemistry , Peptides/genetics , Peptides/metabolism , Protein Structure, Tertiary , Rats , Sodium-Hydrogen Exchangers/chemistry , Sodium-Hydrogen Exchangers/genetics , Two-Hybrid System Techniques
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