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1.
Eur Heart J ; 25(6): 508-13, 2004 Mar.
Article in English | MEDLINE | ID: mdl-15039131

ABSTRACT

OBJECTIVES: To investigate the elastic properties of medium-size extracardiac arteries and veins between patients with and without left main stem coronary artery disease. METHODS: The compliance, distensibility, and incremental elastic modulus (iEmod) of the internal thoracic arteries (n=53), long saphenous veins (n=38), and radial arteries (n=35) from 74 patients undergoing coronary surgery were studied in organ baths. Twenty-four patients had left main stem (LMS) disease and 50 non-LMS coronary disease. RESULTS: Internal thoracic arteries from patients with LMS presented significantly lower compliance (-17%) and distensibility (-18%) and significantly higher iEmod (19%) than internal thoracic arteries from patients with non-LMS disease. Radial arteries from patients with LMS presented higher iEmod (50%) than radial arteries from patients with non-LMS disease. Furthermore, long saphenous veins from patients with LMS had reduced compliance (-45%), reduced distensibility (-40%) and increased iEmod (34%) compared to those from patients with non-LMS disease. CONCLUSIONS: LMS coronary disease is associated with a significantly reduced elasticity of extracardiac arteries and veins compared to non-LMS coronary disease. This finding suggests that widespread vascular elasticity defects may play a role in the development of LMS disease and be responsible for the higher incidence of early and late cardiovascular morbidity observed in this condition.


Subject(s)
Coronary Artery Disease/physiopathology , Radial Artery/physiology , Saphenous Vein/physiology , Thoracic Arteries/physiology , Elasticity , Female , Humans , Male , Middle Aged , Regression Analysis , Vascular Resistance/physiology
2.
Eur J Cardiothorac Surg ; 23(2): 143-8, 2003 Feb.
Article in English | MEDLINE | ID: mdl-12559333

ABSTRACT

OBJECTIVE: The true incidence and survivability of blunt traumatic aortic rupture following road traffic accidents in the UK is unclear. The objective of this study was to determine the extent of blunt traumatic aortic rupture in the UK after road traffic accidents and the conditions under which it occurs. METHODS: Data for the study was obtained from the Co-operative Crash Injury Study database. Road traffic accidents that happened between 1992 and 1999 and included in the Co-operative Crash Injury Study database were retrospectively investigated. RESULTS: A total of 8285 vehicles carrying 14,435 occupants were involved in 7067 accidents. There were 132 cases of blunt traumatic aortic rupture, of which the scene survival was 9% and the overall mortality was 98%. Twenty-one percent of all fatalities had blunt traumatic aortic rupture (130/613). Twenty-nine percent were due to frontal impacts and 44% were due to side impacts. Twelve percent of the blunt traumatic aortic rupture cases in frontal vehicle impacts were wearing seat belts and had airbag protection and 19% had no restraint mechanism. The Equivalent Test Speed of the accident vehicles, (where equivalent test speed provides an estimate of the vehicle impact severity and not an estimate of the vehicle speed at the time of the accident), ranged from 30 to 110 km/h in frontal impacts and from 15 to 82 km/h in side impacts. CONCLUSION: Blunt traumatic aortic rupture carries a high mortality and occurred in 21% of car occupant deaths in this sample of road traffic accidents. Impact scenarios varied but were most common from the side. The use of an airbag or seat belt does not eliminate risk. The injury can occur at low severity impacts particularly in side impact.


Subject(s)
Accidents, Traffic/statistics & numerical data , Aortic Rupture/epidemiology , Wounds, Nonpenetrating/epidemiology , Adolescent , Adult , Air Bags , Aortic Rupture/mortality , Humans , Incidence , Retrospective Studies , Seat Belts , Survival Rate , United Kingdom/epidemiology , Wounds, Nonpenetrating/mortality
3.
Eur J Cardiothorac Surg ; 21(1): 130-2, 2002 Jan.
Article in English | MEDLINE | ID: mdl-11788283

ABSTRACT

Disorders of the oesophagus present a diagnostic and therapeutic challenge. The presenting symptoms of dysphagia, reflux, pain and vomiting are almost universal, irrespective of the underlying pathology. A combination of endoscopy, barium studies, pH studies and manometry are often required to determine the exact diagnosis and to plan the most effective treatment. Paraoesophageal hiatal hernia is an uncommon condition, present in 14% of all hiatal hernias, which requires urgent correction to prevent life-threatening complications. It is unusual for other oesophageal disorders to coexist. We present a case where achalasia and a paraoesophageal hiatal hernia probably coexisted.


Subject(s)
Esophageal Achalasia/complications , Hernia, Hiatal/complications , Aged , Deglutition Disorders/etiology , Esophageal Achalasia/surgery , Female , Fundoplication , Hernia, Hiatal/diagnostic imaging , Hernia, Hiatal/surgery , Humans , Jejunostomy , Manometry , Radiography , Reoperation , Vomiting/etiology
5.
Eur J Cardiothorac Surg ; 16(3): 362-3, 1999 Sep.
Article in English | MEDLINE | ID: mdl-10554860

ABSTRACT

We present a case of prosthetic valve endocarditis and paravalvular abscess caused by the canine bacteria Capnocytophaga canimorsus in a 63-year-old man, who made a habit of snogging his pet dog. Capnocytophaga canimorsus can cause culture-negative endocarditis, therefore a high level of clinical awareness and the appropriate isolation techniques are important for making the diagnosis. Antibiotic therapy and properly timed excision of the infected focus are recommended.


Subject(s)
Capnocytophaga/isolation & purification , Endocarditis, Bacterial/microbiology , Gram-Negative Bacterial Infections/diagnosis , Heart Valve Prosthesis/adverse effects , Prosthesis-Related Infections/microbiology , Animals , Anti-Bacterial Agents/therapeutic use , Combined Modality Therapy , Dogs , Endocarditis, Bacterial/diagnosis , Endocarditis, Bacterial/therapy , Follow-Up Studies , Gram-Negative Bacterial Infections/etiology , Gram-Negative Bacterial Infections/therapy , Humans , Male , Middle Aged , Prosthesis-Related Infections/diagnosis , Prosthesis-Related Infections/therapy , Reoperation , Treatment Outcome
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