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PubMed1993

Pathophysiological and biochemical characterisation of an avian model of dilated cardiomyopathy: comparison to findings in human dilated cardiomyopathy.

OBJECTIVE: With the recent availability of human myocardium, many animal models have been shown to be unsuitable as models of human heart failure. The aim of this study was to describe the pathophysiological changes in a model of dilated cardiomyopathy in turkey poults and to compare them to results obtained from failing human hearts. METHODS: After receiving furazolidone for 2-3 weeks, animals developed cardiomyopathy (Fz-DCM) and were studied at the whole heart and isolated muscle level. Myofibrillar ATPase activity and noradrenaline turnover were determined in tissue homogenates in failing and non-failing control hearts. RESULTS: Fz-DCM animals had greater heart weights, heart weight/body weight ratios, and end diastolic volumes. Fractional shortening of the left ventricle and systolic blood pressures were reduced (p < 0.01) in myopathic animals. Isolated perfused hearts had lower peak developed pressures (p < 0.01). Isolated muscle preparations showed no significant differences in peak twitch forces between control and Fz-DCM muscles at a 1 Hz stimulation rate. The relationship between force and frequency of stimulation was positive in control muscles up to 1.7 Hz, whereas in Fz-DCM muscles the relationship was sharply negative above 1 Hz. Time to 80% relaxation was markedly slower in the Fz-DCM muscles. Although [Ca2+]o responsiveness was similar for Fz-DCM and normal animals, responsiveness to isoprenaline was significantly reduced in Fz-DCM hearts. Cardiomyopathic animals displayed diminished noradrenaline content in the left ventricle. Fractional noradrenaline turnover was higher (p < 0.05) in the cardiomyopathic birds. In skinned fibre preparations from control and Fz-DCM hearts calcium activations were similar. Maximum myofibrillar ATPase activities were, however, significantly lower in myopathic animals and myofibrillar protein content was reduced by 25%. CONCLUSIONS: In this model of dilated cardiomyopathy: (1) relaxation is markedly prolonged; (2) the response to beta adrenergic stimulation is diminished; (3) Mg-ATPase activities and myofibrillar protein content are reduced; and (4) sympathetic activity in the heart is markedly increased with depletion of noradrenaline stores. Furthermore, a reduction in tissue noradrenaline content per se is a misleading index of the dynamic state of cardiac noradrenaline stores. With its similarities to human cardiomyopathy, this model promises to provide new insights into the pathophysiology and progression of dilated cardiomyopathy.

Adenosine Triphosphatases↗
PubMedDate not supplied

Pouch dilatation following laparoscopic adjustable gastric banding: psychobehavioral factors (can psychiatrists predict pouch dilatation?).

BACKGROUND: Laparoscopic adjustable gastric banding is increasingly being performed in morbidly obese individuals for weight loss. Some patients develop pouch dilatation as a postoperative complication that limits the utility of the procedure. Surgical variables are poor predictors of this complication. 5 patients from a series of 157 who underwent LAGB at a single center developed the condition. METHODS: Psychiatric and surgical case-notes were analyzed retrospectively for the presence of operationally defined psychiatric disorders and compared to 10 controls from the same population. RESULTS: Cases were significantly more likely to have past or current binge eating, emotionally triggered eating with reduced awareness of the link, a history of affective disorder, reduced sexual functioning and successful preoperative weight loss. No difference between groups was observed for compliance with orlistat, childhood sexual abuse, relationships with parents, history of bulimia nervosa, rate of band inflation or preoperative BMI. CONCLUSIONS: Psychological factors may be better predictors of pouch dilatation than biomedical variables. Disordered eating can be an attempt to modulate negative emotions. Pouch dilatation may be a consequence of this eating behavior.

Adult↗
PubMed1989

The influence of cervical dilatation by laminaria tent and with Hegar dilators on the intrauterine microflora and the rate of postabortal pelvic inflammatory disease.

In a prospective study, 519 women were randomly selected for cervical dilatation by laminaria tents or Hegar dilators before scheduled vacuum aspiration. In other 68 women randomly divided into a laminaria group and a control (Hegar) group, placenta, decidua and blood were separately aspirated from the uterine cavity before the vacuum aspiration and cultured for micro-organisms. The rate of postabortal inflammatory disease (PID) was significantly lower after pretreatment with laminaria tent irrespective of patient's age and parity. However, a higher risk of postabortal PID was found in gestational age of 10-12 weeks than of 5-9 weeks. Previous PID and abortion did not increase the risk of postabortal PID. Vaginal/cervical micro-organisms were, irrespective of method for cervical dilatation, identified in two thirds of the patients.

Abortion, Induced↗
PubMed2005

Review of dilated cardiomyopathies. Dilated cardiomyopathies and altered prothrombotic state: a point of view of the literature.

Heart failure is an enormously important clinical problem that, if not faced, may overwhelm health care resources. Primary and secondary cardiomyopathies cause the majority of cases of clinical heart failure, which is thus better approached from the utility point of view of myocardial failure. Furthermore, the risk of thromboembolic complications presenting in such disease may be higher than in ischemic cardiomyopathy. Intracardiac thrombi and mural endocardial plaques (from the organization of thrombi) are present at necropsy in more than 50% of patients with dilated cardiomyopathy (DCM). Several studies have shown that systemic and pulmonary emboli are more frequent in patients with ventricular thrombi or plaques. Dilated cardiomyopathy has been associated with left ventricular thrombosis which leads to substantial morbidity and mortality as a site for peripheral emboli. There are some studies on patients with dilated cardiomyopathy showing altered hemostasis and platelet behavior despite sinus rhythm. Platelet activation, thrombin activation and fibrinolytic activity are increased in patients with DCM compared to normal subjects. However, these markers reflecting coagulation activation in patients with left ventricle thrombus are comparable to those in patients without thrombus in the left ventricle. The pathophysiology and clinical issues concerning the susceptibility to develop left ventricular (LV) thrombosis and its complications like cerebrovascular disease in patients with DCM are summarized and the most recent articles present in the medical literature are reviewed.

Animals↗
PubMed1985

Cylindrical dilatation of the choledochus: a special type of congenital bile duct dilatation.

Cylindrical dilatation of the choledochus develops in 20% of patients with congenital bile duct dilatation and usually has acute-angled unions of the pancreatobiliary ductal system. Symptoms generally develop in patients over 1 year of age. The patients frequently complain of abdominal pain, vomiting, and fever as in those with acute pancreatitis. Ultrasonography and infusion cholangiography are the most useful tools in making a correct diagnosis. A high amylase level in the bile caused by the refluxing of pancreatic juice through anomalous ductal unions is commonly observed. This is responsible for biliary perforation in infancy and possibly carcinoma arising in the bile duct. The amylase concentration in the serum at the time of epigastric pain often is high, which leads to the diagnosis of acute pancreatitis. However, evidence of pancreatic inflammation is seldom noted. Accordingly, amylase in the bile may enter the circulating blood through the denuded epithelium or sinusoids of the liver. Excision of the whole extrahepatic duct along with hepaticoenterostomy would be essential for the treatment of cylindrical dilatation of the bile duct, especially when an anomalous ductal union is present.

Adolescent↗
PubMed1998

Barriers to cardiac transplantation in idiopathic dilated cardiomyopathy: the Washington, DC, Dilated Cardiomyopathy Study.

Although cardiac transplantation offers prolonged survival and improved quality of life to patients with end-stage heart failure, many patients with idiopathic dilated cardiomyopathy do not undergo this procedure. Possible barriers to cardiac transplantation were examined among 138 patients with idiopathic dilated cardiomyopathy from five hospitals in Washington, DC. Patients underwent follow-up for approximately 5 years. The patients or a close family member were interviewed at baseline about socioeconomic factors and medical history. The patients or their next-of-kin were recontacted at 1-year intervals to determine patients' vital status and to obtain information about cardiac transplantation. Overall, the cumulative survival at 12 and 60 months was 75.8% and 37.3%, respectively. Only 3.6% (5 of 138) of the patients underwent cardiac transplantation, and 19 (13.8%) patients had been placed on a waiting list for a heart transplant. Black race and nonmarried status were inversely associated with cardiac transplantation. Factors associated with not having been placed on a waiting list included older age, lower income, and lack of private health insurance. Black race was found to be significantly, but inversely associated with cardiac transplantation while older age was inversely associated with having been placed on a waiting list after adjusting for sex, race, education, and private insurance. These findings suggest that black patients with idiopathic dilated cardiomyopathy are less likely to undergo cardiac transplantation.

Black People↗
PubMed1993

Parallel angioplasty dilatation catheter and guide wire: a new technique for the dilatation of calcified coronary arteries.

Percutaneous transluminal coronary angioplasty (PTCA) of heavily calcified rigid coronary arteries has decreased success and increased complication rates. Three cases are presented describing a new technique for the dilatation of severely calcified coronary arteries that were not dilatable by conventional angioplasty methods. This technique involves the use of a balloon dilatation catheter system parallel to a guide wire.

Aged↗
PubMed1991

Retrograde dilation of esophageal strictures with balloon dilators.

Balloon dilators may be safely applied for retrograde dilation of esophageal strictures without the use of fluoroscopy or a pressure-gauge attachment. The turgidity of the dilating balloon is preferred to that of other materials such as polyvinyl, rubber, or metal. The technique enables endoscopic monitoring and can be adapted for strictures elsewhere in the gastrointestinal tract.

Aged↗
PubMed2000

Dilatation of the collecting system during pregnancy: physiologic vs obstructive dilatation.

Dilatation of the collecting system is a classical phenomenon during pregnancy, due to hormonal and extrinsic compressive factors. Imaging has to differentiate a physiological dilatation and a pathological obstruction due to urolithiasis. Presently, sonography, using both, B-mode and color Doppler, has the potential to demonstrate the physiological compression of ureters at the level of the pelvic brim. A pathological obstruction is considered either when a stone is detected above the usual site of compression or when the ureter appears dilated beyond. Color Doppler helps in localizing the site of ureteral compression against the vessels and in differentiating ureters from veins. Magnetic resonance urography, with strongly T2-weighted sequences, also may show the site and type of obstruction without contrast agent administration. These two non-radiating techniques make it possible to avoid the use of X-rays in most cases for management of these patients. The type of treatment is based mostly on the level of pain and the presence or absence of stone.

Female↗
PubMed1993

Impaired coronary dilator responses to substance P and impaired flow-dependent dilator responses in heart transplant patients with graft vasculopathy.

OBJECTIVES: Because pathologic mechanisms for transplant vasculopathy are still uncertain, we tested the hypothesis that endothelial function, in terms of the release of endothelium-derived relaxing factor (EDRF), is impaired in patients with evidence of angiographic transplant vasculopathy. BACKGROUND: The long-term prognosis after heart transplantation is mainly determined by the development of transplant vasculopathy. METHODS: The study included 23 patients undergoing diagnostic cardiac catheterization approximately 40 months after heart transplantation. Patients were classified into those with (n = 8) and those without (n = 15) angiographic evidence of transplant vasculopathy. Coronary flow velocity (by intravascular Doppler echocardiography) and epicardial coronary diameter (by quantitative angiography) were determined after intracoronary bolus injections (1 ml) of the endothelium-dependent dilator substance P (20 pmol) and the endothelium-independent dilators nitroglycerin (0.1 mg) and papaverine (8 mg). Substances were injected through the lumen of the Doppler catheter, which was placed into the midportion of the left anterior descending artery. RESULTS: Increases in blood flow velocity in response to substance P were significantly less in patients with than in patients without evidence of transplant vasculopathy. In addition, flow-mediated dilation of epicardial coronary arteries in response to papaverine was abolished in patients with such evidence. Vasodilation of epicardial coronary arteries in response to nitroglycerin and increases in flow velocity in response to papaverine were similar in both groups. CONCLUSIONS: These results suggest that transplant vasculopathy in heart transplant patients is associated with endothelial dysfunction (that is, impaired EDRF-mediated vasodilation). Furthermore, responsiveness of epicardial arteries to increased flow appears to be abolished in patients with evidence of transplant vasculopathy. These abnormal vascular functions may contribute to the pathogenesis of transplant vasculopathy and its vascular complications.

Adult↗
PubMed2000

A case of pancreatic carcinoma with marked ductal dilatation: what contributed to the dilatation?

BACKGROUND: We report the case of an 82-yr-old man with invasive ductal carcinoma of the pancreatic head, in which the main pancreatic duct and duct of Santorini were markedly dilated, measuring 1.6 and 1.1 cm, respectively, in diameter on computed tomography. METHODS: A preoperative diagnosis of ductal carcinoma of the pancreatic head was made, and Whipple's procedure was carried out. RESULTS: Histopathologically, the tumor was diagnosed as moderately differentiated tubular adenocarcinoma, and the resected pancreatic parenchyma showed low papillary mucous cell hyperplasia and atypical hyperplasia in dilated ductular branches. Conclusion. Even among patients with tubular adenocarcinoma, the most common type of pancreatic ductal carcinoma, if the patient is aged and has chronic pancreatitis, the main pancreatic duct and duct of Santorini may dilate to the same degree as in mucin-hypersecreting neoplasm.

Adenocarcinoma↗
PubMedDate not supplied

Radiologic control of operative carotid dilatation. Aneurysm formation following balloon dilatation.

Dilatation of the dysplastic internal carotid artery has been controlled by intraoperative radiography including angiography. The method minimizes the risk of damaging the artery at the base of the skull while allowing immediate visualisation of the results. In one case persisting stenosis after passage of a metal dilator was treated by balloon dilatation with the formation of a localised aneurysm.

Aneurysm↗
PubMed1995

Pneumatic dilatation of achalasia cardia with indigenous pneumatic dilator.

Fifteen patients with achalasia cardia underwent pneumatic dilatation using an indigenous pneumatic dilator. The dilator was prepared using a Levin's tube, latex condoms and silk cloth and was introduced under vision with the help of an endoscope. Clinical improvement was seen in all the patients whereas radiological improvement occurred in 11 patients. There were no procedure-related complications.

Adolescent↗
PubMed1997

[Dilatation of esophageal strictures with balloon catheter. Safety and effectiveness of balloon dilatation].

Radioscopically-guided balloon dilation of esophageal stenosis is an effective and easily performed palliative procedure. Our experience with balloon dilation of esophageal stenosis in 12 patients was reviewed. Every patient underwent 2-5 sessions. Dysphagia disappeared completely in 2 patients. Ten patients had significant improvement. No case of esophageal perforation occurred during balloon dilation.

Adolescent↗
PubMed1996

Marital status as a predictor of survival in idiopathic dilated cardiomyopathy: the Washington, DC dilated cardiomyopathy study.

Marital status and other socioeconomic and clinical factors were examined as predictors of survival in idiopathic dilated cardiomyopathy using data from a hospital-based study in Washington, DC. Twenty-five (18.1%) of the cases (n = 138) were single, 66 (47.8%) were married, 25 (18.1%) were divorced or separated, and 22 (15.9%) were widowed. Married patients were more likely to be male, to have an annual household income greater than $15,000, and to live with another person (p < or = 0.01) as compared with those who were single, widowed, divorced or separated. Widowed patients were older on average and more likely to abstain from drinking alcohol. The cumulative survival among widowed patients at 12 and 24 months was 54.6 and 48.5%, respectively, as compared with 75.8 and 59.0% among single patients and 80.0 and 71.2% among married patients. The survival of divorced or separated patients was relatively good with a cumulative survival of 84.0% at both 12 and 24 months. Older age, lower ejection fraction, ventricular arrhythmias, bundle branch block, and marital status were significant predictors of survival in univariate analysis using the proportional hazards model. In multivariable analysis, age, race, ejection fraction, and marital status were statistically significant independent predictors of survival, with single patients with idiopathic dilated cardiomyopathy having a poorer survival than those who were married (adjusted RR = 2.5, 95% CI 1.1-6.2, p < 0.05). The observed association with marital status may be explained by psychosocial factors not examined in the present study such as quality of social network or psychological stress.

Adult↗
PubMed1996

Quality of life on treatment with metoprolol in dilated cardiomyopathy: results from the MDC trial. Metoprolol in Dilated Cardiomyopathy trial.

Quality of life in heart failure patients is receiving increased attention as a reflection of a treatment's potential secondary benefit of general well-being and daily functioning. The Metoprolol in Dilated Cardiomyopathy (MDC) trial was conducted as a large, multicenter trial to establish the effects of metoprolol on mortality and need for heart transplantation in patients with symptomatic idiopathic cardiomyopathy. It was found that metoprolol was well tolerated, improved symptoms and cardiac function, and prevented clinical deterioration in patients with symptomatic idiopathic dilated cardiomyopathy. Quality of life was evaluated as a secondary endpoint in 345 out of 383 randomized patients using a disease-specific questionnaire, the Quality of Life in Heart Failure Questionnaire, depicting physical activity, somatic symptoms, emotions, and life satisfaction. In a comparison of patients treated with metoprolol or placebo, patients treated with metoprolol noted a significantly more favorable response than those treated with placebo in terms of the overall treatment evaluation (p < 0.05). Additionally, an analysis of the changes from baseline to 18 months, using 95% confidence intervals, revealed that patients treated with metoprolol showed a significant improvement from baseline to 18 months in life satisfaction, physical activity, and the total score, while patients treated with placebo did not change at all. The improvement in quality of life was supported by the correlations with improvement in traditional clinical parameters.

Adrenergic beta-Antagonists↗
PubMed2001

Comparative clinical trial of progressive dilatational and forceps dilatational tracheostomy.

OBJECTIVE: To compare the safety and early complications of progressive dilatational tracheostomy (PDT) and forceps dilatational tracheostomy (FDT). DESIGN: Prospective randomized trial. SETTING: Three-centre university and public teaching hospitals. PATIENTS: One hundred and twenty-seven consecutive patients were randomized to undergo PDT or FDT. RESULTS: The duration of the procedure was 7.0 +/- 3.5 min in the PDT group and 6.4 +/- 4.9 min in the FDT group, which was not significantly different. Intraprocedural complications occurred in 14 % with PDT and 31% with FDT (p = 0.03), and were usually minor. Difficult or false insertion of the cannula in eight patients after FDTwas the most common complication. CONCLUSIONS: Both percutaneous tracheostomy techniques are safe. The early complication rate of PDT appeared to be lower than FDT, but the early complication rate of FDT may be decreased significantly with small modifications to the set.

Aged↗