Biomedical subjects
Publications and source records attributed to I De Scheerder.
Adipositas cordis is a very rare disorder, characterized by fatty infiltration of myofibers. It has been related to dilated or hypertrophic cardiomyopathy and obesity. In this report, however, we present a non-obese patient, presenting with a restrictive syndrome and showing massive infiltration of adipocytes in the interventricular septum, proving adipositas cordis.
Endomyocardial biopsy is a safe, reliable, and reproducible technique to confirm or establish the diagnosis of the pathology that affects cardiac function in conditions previously classified as cardiomyopathies of unknown cause. The first 64 consecutive patients to undergo endomyocardial biopsy were reviewed to determine its utility in various clinical settings. Furthermore a review of literature relating to endomyocardial biopsy is presented. On the basis of these findings, we conclude that endomyocardial biopsy is indicated in the clinical setting of dilated cardiomyopathy, for evaluating underlying myocarditis. In patients with dysrhythmias or clinical myocarditis, endomyocardial biopsy may disclose myocarditis or changes consistent with congestive cardiomyopathy. In patients with systemic disease endomyocardial biopsy is instructive to prove or to exclude myocardial involvement. In patients with angina-like chest pain but with normal coronary angiograms or exercise tests, endomyocardial biopsy may prove underlying heart disease.
Explore the source record for details and available documents.
In a group of 3000 hospital patients the prevalence of immunoglobulin bound creatine kinase (macro CK type 1) was 4.3%. The relative frequency was greater in the older age categories. The highest prevalence was found in patients with rheumatic and cardiac diseases. In a group of 556 cardiac patients selected for coronary angiography a prevalence of 13.8% was observed. No significant correlation was obtained between the findings of the coronary angiography and the activity of macro CK type 1. CK MB results determined by ion-exchange or immuno-inhibition techniques in macro CK type 1 positive patients are falsely positive. Macro CK type 1 may be seen as an antigen-antibody complex against CK BB, which originates at least partly from the vascular wall.
The pathogenesis of post-cardiac injury syndrome was studied prospectively in 62 patients who underwent coronary bypass grafting. Preoperative and serial postoperative titres of actin and myosin antibodies were measured by an enzyme linked immunosorbent assay. Perioperative cumulative release of serum aspartate and alanine aminotransferases, lactate dehydrogenase, and creatine kinase was calculated by approximation formulas that are used to estimate infarct size. Complete post-cardiac injury syndrome developed in eight (13%) patients and an incomplete syndrome developed in 16 (26%). There was a significant correlation between frequency and intensity of the syndrome and the ratio of postoperative to preoperative titres of actin and myosin antibodies. Furthermore, there was a significant correlation between the cumulative release of lactate dehydrogenase, serum aspartate aminotransferase, and creatine kinase and the number of coronary vessels that were grafted, but no correlation was found between the incidence of post-cardiac injury syndrome and the number of coronary bypasses grafted or between the cumulative enzyme release and the postoperative immunological response against the major contractile proteins, actin and myosin. The amount of enzymes released during coronary bypass surgery seems to be a good indicator of the extent of myocardial damage during operation but it does not determine either the incidence of post-cardiac injury syndrome or the postoperative immunological response against the main contractile proteins actin and myosin.
Explore the source record for details and available documents.
To better understand the pathogenesis of the post-cardiac injury syndrome (PCIS) 2 models of cardiac injury were studied. One hundred twenty-nine patients who underwent cardiac surgery and 80 patients with acute myocardial infarction (AMI) were prospectively followed and the levels of anti-heart antibodies (AHA), anti-actin antibodies (AAA) and anti-myosin antibodies (AMA) were determined. In the surgical group, PCIS developed in 27 patients (21%) and incomplete PCIS in 36 (28%). In the AMI group, PCIS did not develop in any patient, but incomplete PCIS developed in 11 patients (14%) (p less than 0.001). The surgical group showed a significantly higher humoral immune response than the AMI group when analyzed for AHA and anti-contractile protein antibodies. After cardiac surgery, AHA developed in 59 patients (46%), AAA developed in 33 (26%) and AMA developed in 49 (38%); in the AMI group, significant levels of AHA, AAA and AMA developed in 16 (20%), 7 (9%) and 13 patients (16%), respectively. These studies show a significant correlation between the PCIS clinical classification and auto-antibodies raised against heart contractile proteins.
Fever, leucocytosis, and pericardial and pleural effusions developed after the first postoperative week in a 56 year old man who had undergone aortic valve replacement. Four months later, coronary angiography showed bilateral proximal stenosis of the coronary arteries. In this patient post-pericardiotomy syndrome and subsequent coronary artery stenosis were thought to be associated and an immunological mechanism was suspected.
Sera from 196 patients were collected before and after cardiac surgery to measure antibodies against heart tissue and against actin and myosin. In the post-operative period antibodies were found in 87 patients (44%) producing a cross-striated fluorescence pattern in heart tissue. Antibodies against the major contractile proteins were found in 91 patients (46%), anti-actin antibodies in 49 patients (25%) and anti-myosin antibodies in 65 patients (33%). We found a significant correlation (P less than 0.0001) between the antibodies producing a cross-striated fluorescence pattern and antibodies recognizing contractile proteins. These results suggest that contractile proteins evoke an immune response after cardiac surgery and that this response may compromise cardiac function.
A 40-year-old male patient with known generalised neurofibromatosis presented with a radiological pattern of interstitial fibrosis and a coin lesion in the left lung. Closed lung biopsy revealed an adenosquamous carcinoma. The pulmonary complications of generalised neurofibromatosis and the possible pathogenesis of scar cancer in this condition are discussed.
The post-pericardiotomy syndrome (PPS) is a common complication of cardiac surgery. In order to better understand the pathogenesis of this complication we undertook a prospective, triple blind study of consecutive long term survivors of cardiac surgery. We followed 82 patients and determined anti-heart antibodies (AHA), circulating immune complexes (CIC) and anti-viral antibodies (AVA) on sera pre-operatively and serially post-operatively. According to the clinical features of pericarditis, fever and leucocytosis, patients were divided into three groups: (1) complete PPS with all three symptoms, (2) incomplete PPS with two symptoms and (3) no PPS with one or no symptoms. Clinical PPS was found in 16 patients (19.6%). All of these patients had positive AHA, 12 patients (75%) had increased CIC and five patients (31%) had a four-fold or greater rise in titre to viruses studied. Twenty-four patients (29.2%) had an incomplete PPS. It was accompanied by positive AHA in 17 patients (70.8%), increased CIC in 14 patients (58.3%) and a four-fold rise or greater in virus titre in seven patients (29.2%). No PPS was found in forty-two patients (51.2%). It was accompanied by positive AHA in eight patients (19%), increased CIC in 10 patients (24%) and a four-fold or greater rise in virus titre in 12 patients (28.6%). There was a good correlation between the presence of PPS, AHA, CIC and the type of operation. Heart valve replacement surgery was more frequently complicated by PPS. Development of post-operative AHA and increased CIC were also more frequently found. We found a good correlation between PPS, positive AHA and increased CIC. No correlation was found between PPS and virus serology.
The potential beneficial effect of metal surface treatment using electrochemical polishing on stent thrombogenicity and neointimal hyperplasia was evaluated in a rat A-V model and a porcine coronary model. Thrombogenicity of polished stents (n=6) was compared to non-polished stents (n=5) in a rat A-V shunt model using 125I-fibrinogen and 51Cr-labelled platelets. Total clot weight after 30 min was significantly lower in the polished stents (32.1+/-2.8 vs 18.1+/-4.4: p<0.001). Also, 125I-fibrinogen deposition was significantly lower in the polished stents (1.30+/-0.07 vs 0.66+/-0.04: p<0.001). Platelet deposition was, however, not significantly reduced (12.7+/-3.4 vs 9.87+/-1.9, NS). Subsequently, the effect of electrochemical polishing on neointimal hyperplasia was evaluated in a porcine coronary model. Polished (n=10) and non-polished stents (n=10) were randomly implanted in the right coronary artery of healthy pigs. Neointimal hyperplasia was significantly decreased in the polished stents (0.56+/-0.28 vs 0.94+/-0.34 mm2: p<0.01).