Frequency Of Stenosis Research Articles

Frequency of Ectasia among Patients with Coronary Atherosclerosis by Angiography Dual Source & 64 CT SLICE Evaluatin

Introduction: The aim of this study is Frequency of ectasia among patients with coronary atherosclerosis.
 
 Materials and Methods: This is a cross-sectional study, which retrospectively had evaluated a percentage of total frequency ectasia among patients with coronary atherosclerosis by angiography Dual a source & 64 CT SLICE between 2007-20012 in Imag Center of Imam Khomeini Hospital and shahid Rajai Hospital.
 
 Results: Totally 2770 patients were enrolled in the study. The frequency of ectasia among all patients was 42 [1.5%]. The frequency of stenosis in patients with LAD ectasia was 36.8% [7 out of 19] while the frequency of LAD stenosis in other patients was 59.5% [1637 out of 2751] [P=0.045]. Distribution of stenosis in ecstatic LCx and RCA was not statistically different with patients without non ecstatic LCx and RCA. [P=0.47 and 0.45 respectively]. In patients with ectasia, the frequency of stenosis was 71.4 while it was 64.4% in patients without ectasia [P=0.35].
 
 Discussion: Furthermore, detection and investigation of Ectasia in patients with stenosis will lead to more accurate determination of the treatment plan and the purpose of this study is finging a new assess prevalence of morphological changes Ectasia by CT angiography and coronary sclerosing Prevalence this group of patients.

HEAMODIALYSIS PATIENTS;

Background: Internal jugular vein is considered the preferred site of insertion.Prevalence of central vein stenosis following temporary double lumen catheterization at differentsites seems to be different in Asian countries. Objectives: To evaluate the number of cases havingcatheterization and stenosis after being subjected to central vein catheterization (CVC) amongPakistani population. Study Design: Cross sectional study. Period: 6 months period. Setting:Admitted in the Department of Nephrology or already undergoing maintenance hemodialysisfulfilling the inclusion criteria were included in the study. Material and Method: The samplewhich was considered suitable for this study was 150 cases after checking the inclusion criteriacarefully. The patients were advised to undergo color Doppler ultrasonography of IJV and SCVof both sides. Demographics and outcome variables were noted and recorded for the analysispurposes. Data was analyzed used SPSS 20.inc Results: The frequency of catheterization ofcatherization at IJV was found to be 128(85.3%) and frequency of catheterization at SCV was22(14.7%). The frequency of CVS at IJV was found to be 43(29.68%) and the frequency of CVSat SCV was 81(54.54%). The frequency of stenosis at SCV was found to be significantly higherwith a p value of 0.029 (<0.05). Conclusion: Internal jugular vein is the most frequent andpreferred site of temporary double lumen catheterization for haemodialysis as it is associatedwith significantly lower rate of stenosis as compared to subclavian vein.

Primary cough headache, primary exertional headache, and primary headache associated with sexual activity: a clinical and radiological study

The purposes of this study are to describe clinical features of primary cough headache, primary exertional headache, and primary headache associated with sexual activity and to evaluate potential association with abnormalities in the cerebral or cervical venous circulation. This multicentre, observational, non-interventional consecutive cohort study included patients fulfilling ICHD-II criteria for primary cough headache (N = 10), primary exertional headache (N = 11), or primary headache associated with sexual activity (N = 20), as well as 16 headache-free controls. Each patient was evaluated clinically and underwent craniocervical MRV of the cranial circulation. All scans were interpreted centrally by blinded raters, using the Farb criteria proposed for idiopathic intracranial hypertension. Stenosis was defined as a Farb score <3 in left or right transverse sinuses or jugular veins. In all primary headache groups, headaches were most frequently diffuse, severe, or very severe. Headache duration was significantly shorter in patients with cough headache (median 6.5 versus 20 and 60 min). An exploitable magnetic resonance venogram was obtained for 36 patients. Stenosis was detected in none of the control group, but in 5/7 patients with primary cough headache group, 2/10 patients with primary exertion headache, and 12/19 patients with primary headache associated with sexual activity. The frequency of stenosis was significantly different from the control group in the primary cough headache and primary headache associated with sexual activity groups. Headaches provoked by cough and sexual activity are possibly associated with venous abnormalities in a significant subgroup of affected patients. As the literature shows conflicting results, this venous stenosis can be considered as a promoting factor.

Cardiac magnetic resonance differentiates subtypes in bicuspid aortic valve and reveals various frequencies of aortic stenosis among subtypes

In a large series of 216 consecutive patients CMR could noninvasively differentiate various types of bicuspid aortic valve (BAV) morphology. BAV type was related to the frequency of stenosis but not to the frequency of aortic dilatation.

Juvenile-onset Takayasu arteritis: peculiar vascular involvement and more refractory disease

Objectives: To compare prognosis parameters and arterial site involvement in Takayasu arteritis (TA) patients with disease onset at age ≤ 18 and ≥ 21 years.Methods: Sixty-two TA patients [American College of Rheumatology (ACR) and European League Against Rheumatism/Paediatric Rheumatology European Society (EULAR/PreS) criteria] were enrolled consecutively and divided into two groups according to disease onset, and matched for disease duration: juvenile TA patients aged ≤ 18 years (n = 17) and adult TA patients aged ≥ 21 years (n = 45). The protocol evaluated the following prognostic factors: aortic insufficiency, ischaemic retinopathy, severe systemic hypertension, and arterial aneurysms. In addition, death and remission [defined as stable disease > 6 months (no complaints without immunosuppressive and prednisone use) and normal erythrocyte sedimentation rate (ESR)] were also analysed. Stenosis and aneurisms were investigated by magnetic angioresonance or arteriography and angiographic classification was defined according to Hata criteria.Results: Mean disease duration was similar in the juvenile and adult TA groups (13.50 ± 10.73 vs. 13.80 ± 7.17 years, p = 0.092) and a trend to a lower predominance of female gender in the juvenile TA group was observed (64.71% vs. 88.89%, p = 0.056). The prognosis was distinct in the two groups, with juvenile patients having a lower frequency of disease remission (23.53% vs. 55.56%, p = 0.04) and a significantly higher frequency of aneurism (41.0% vs. 11.1%, p = 0.013). Almost half of the juvenile TA patients had left renal stenosis, a frequency significantly higher than in the adult TA group (41.18% vs. 11.10%, p = 0.013), whereas the stenosis frequency was comparable in all other vascular sites evaluated. No differences were observed between the two groups regarding the frequency of aortic insufficiency, ischaemic retinopathy, severe systemic arterial hypertension, vascular procedures, and mortality. Angiographic classification revealed a similar distribution of arterial involvement in both groups (p > 0.05).Conclusions: Juvenile TA patients have distinct characteristics, with a peculiar renal vascular involvement, the presence of aneurism, and a more refractory disease compared with adult TA patients.

Asymmetric septal hypertrophy in patients with coronary artery disease

To assess the relationship between asymmetric septal hypertrophy (ASH) and manifestations of coronary artery disease (CAD). A total of 5128 consecutive patients with proven diagnosis of CAD were examined. There were 2469 patients with left ventricular (LV) hypertrophy (LVH) (48.2%), among whom 297 (5.8%) had ASH (echocardiographic ventricular septum thickness to LV posterior wall thickness ratio > or =1.3). There were more male patients with ASH than patients with symmetric LVH (SLVH). ASH patients were significantly older and more obese, more of them were in NYHA class III/IV compared with SLVH patients. The prevalence of prior myocardial infarction (MI), systemic hypertension, heart rhythm disorders were higher in patients with ASH compared with SLVH patients. The groups differed significantly in echocardiographic parameters: LV and right ventricular (RV) end-diastolic dimensions, LV ejection fraction, left atrial dimension, extent of LV wall motion abnormalities, wall motion score index, LV mass/body surface area, signs of prior MI, and frequency of moderate mitral regurgitation. The frequency of stenosis and more severe (>90% stenosis) lesion of right coronary artery (RCA) and left circumflex artery (LCA) were higher in patients with ASH. Multivariate analysis identified that heart rhythm disorder, LV and RV end-diastolic dimensions, aortic root diameter, impaired LV ejection fraction, echocardiographic signs of previous MI, LV mass, and severe lesions of RCA were independently associated with ASH. In patients with CAD, ASH is associated with significant atherosclerosis of RCA and LCA, and more severe clinical manifestations of CAD and impaired LV function.

The Impact of an Acute Myocardial Infarction Guideline and Pathway on Racial Outcomes at a University Hospital

Historically, African Americans who present with acute myocardial infarction were less likely to survive or be revascularized compared to Whites in the United States. Variation in practice has been implicated as a cause. Some researchers have proposed that the explanation for this variation was that coronary artery disease (CAD) was less severe in African Americans than Whites. A university hospital compared the extent of CAD by race for its acute myocardial infarction (AMI) patients and determined the effect of implementing evidenced-based guidelines on racial differences in cardiovascular outcomes. From 1991 to 1994, using the National Registry for Myocardial Infarction 1 and the hospital AMI database, 323 of the 521 consecutive patients were catheterized during their initial admission. The extent of CAD was defined as the frequency of CAD stenosis > or =70% seen in the major coronary arteries and/ or their major branches. Cardiac function was measured by left ventricular ejection fraction (LVEF). Short-term hospitalized outcomes were determined for death, treatment, and coronary revascularization. We assessed 82 (25.4%) African Americans and 241 (74.6%) Whites. No significant difference in the frequency of stenosis > or =70% or clinical outcomes existed between races. However, African Americans had a lower LVEF of 49.13% compared to 54.98% for Whites (P=.04). African Americans were 2.54 times more likely to have LVEF <45% (P=0.024). We saw no racial difference in death, coronary artery bypass graft, percutaneous transluminal coronary angioplasty, or thrombolytic therapy. In high-risk AMI patients, this study found no difference in the burden of CAD by race. However, for African Americans, left ventricular function was more depressed. The use of an AMI management guideline and pathway-driven protocol resulted in no significant racial difference in cardiac interventions or clinical outcomes. A guideline or protocol-driven approach to the management of AMI may significantly reduce the observed racial

Esophageal anastomotic failure: An experimental study

Background. Postsurgical complications in patients with esophageal atresia have remained unchanged during the last three decades. This study was aimed at investigating certain risk factors for small-sized esophageal anastomosis and to assess the probable relationship between esophageal length and body weight in rabbit. Methods. Six groups of 10 adult rabbits were subjected to section or 1-cm segmental resection of thoracic esophagus followed by end-to-end anastomosis. Approximation strength of esophageal ends was measured. Three different suture materials were used, and three different surgeons carried out procedures. Observed morbidity was recorded, as well as leakage or stenosis frequency in suture line. Esophageal length and body weight of nonresected rabbits were measured. Results. Fifteen leakages were observed in suture line; there were no differences in relative risk between groups with and without resection, or in ratio of this complication among surgeons; nonetheless, a greater number of leakages ( p<0.05) was observed at higher tension. There were no differences in magnitude of stenosis among surgeons, tension degree, or suture material used. Quadratic association was found between length of thoracic esophagus and body weight in nonresected rabbits. Conclusions. Rabbit esophagus is a suitable model to assess early surgical complications but not for late complications. Among three assessed factors, increased tension in patients with segmental deficit was the most significant factor in development of anastomotic leakage. Existence of nonlineal correlation between esophageal length and body weight in rabbit showed that resection of 1 cm of esophagus represented a different weight-dependent segmental deficit, which increased as weight decreased.

Early results of percutaneous transluminal angioplasty (PTA) of failing below-knee bypass grafts

An audit of treating femoro-crural bypass stenosis in the first instance by PTA. Prospective clinical pilot study in consecutive patients. Prior to vascular bypass grafting all patients had critical ischaemia. Sixty-four PTA procedures in 50 grafts in 49 patients were carried out. Thirteen were in situ saphenous grafts, 16 were combined venous segments, 18 were combined PTFE and vein and three were PTFE only. Conventional cross-over or antegrade PTA, eventually combined with local thrombolytic therapy. The nine-month assisted patency using PTA was 72%, following surgical repair in five cases after failed PTA the secondary patency was 86%. The amputation free survival rate was 88%. In 11 cases thrombosis was treated successfully with local thrombolysis. In two cases the balloon ruptured the native artery wall below the distal anastomosis with pseudoaneurysm formation. Six limbs were amputated during follow-up. The frequency of stenosis in combined grafts was significantly higher than in in situ vein grafts. Our results are comparable with surgery. About 600 hospital beds/days were saved. This shortened the time from the diagnosis of stenosis to therapy and shortened the waiting list for vascular surgery.

Prospective evaluation of postoperative morbidity in patients with esophageal atresia

Patients treated for esophageal atresia during 1984 and 1985 were evaluated prospectively to ensure early detection and treatment of gastroesophageal reflux, in an attempt to reduce postoperative morbidity. A previous, retrospective study had indicated that spontaneous reflux was the major cause of morbidity, leading to esophagitis and stenosis. Surgery consisted of an end-to-end anastomosis for all 19 patients. Postoperatively, an antacid was administered at the first sign of reflux with domperidone as adjuvant therapy on roentgenographic evidence of esophagitis. Stenosis was treated with esophageal dilation. Regular, 6-weekly examinations included an esophagram and, on indication, esophagoscopy. Of 12 patients with reflux, 9 developed stenosis and 7 had esophagitis. Six patients with persistent reflux underwent Nissen fundoplication; 5 of them suffered from esophagitis, in 4 cases associated with stenosis, while the 6th patient had life-threatening cyanotic spells. At 6 months of age all 19 patients were asymptomatic, although 2 had mild dysphagia secondary to a motility disorder of the esophagus. While early detection and conservative treatment of reflux did not reduce the frequency of stenosis or esophagitis, it did reduce the morbidity rate and duration of hospitalization, because effective treatment of stenosis and esophagitis could be initiated at an early stage.