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At least 145 records · Page 8Linked to original sources
PubMed1980

A new approach to visualize the left main coronary artery using apical cross-sectional echocardiography.

Patients undergoing coronary arteriography were studied to evaluate the feasibility of use of cross-sectional echocardiography to detect the left main coronary artery. Visualization of the left main coronary artery from the cardiac apex was attempted using a cranial transducer angulation. With this approach, the left main coronary artery was adequately visualized in 27 of 35 consecutive patients (77 percent) who were prospectively evaluated; in 12 of the 27 the bifurcation was clearly seen. In 26 of the 27 patients cross-sectional echocardiography correctly assessed the patency of the left main coronary artery as judged with coronary angiography. One patient had a false positive echocardiographic study; there were no false negative studies. A comparison of the short axis versus apical cross-sectional techniques in another group of 30 patients revealed the superiority of the apical approach in visualization of the left main coronary artery and its bifurcation; combined use of both techniques allowed for a 93 percent (rate of) success. Thus, apical cross-sectional echocardiography permits visualization of the left main coronary artery and its bifurcation and, therefore, has the potential for detecting left main coronary obstructive lesions.

Adult↗
PubMed1981

Effect of coronary bypass surgery on survival patterns in subsets of patients with left main coronary artery disease. Report of the Collaborative Study in Coronary Artery Surgery (CASS).

The 3 year cumulative survival rate of 1,492 patients with left main coronary artery disease (50 percent or greater stenosis of luminal diameter) enrolled in the Collaborative Study in Coronary Artery Surgery (CASS) was 91 percent for the surgical group and 69 percent for patients treated medically (p less than 0.0001). Mortality was significantly greater in patients with impaired left ventricular function. The difference between medical and surgical therapy was significant for patients who had normal, moderately abnormal and severely impaired left ventricular function and for patients with stenosis of the left main coronary artery of 50 to 59, 60 to 69, 70 to 79 and 80 percent or greater. Aortocoronary bypass surgery did not significantly improve survival in patient subgroups who had (1) a nonstenotic dominant right or balanced coronary circulation, (2) a stenotic dominant right coronary artery and normal left ventricular function, and (3) left main coronary stenosis of 50 to 59 percent and normal or mildly abnormal left ventricular function. The Cox proportional hazards model was used to select baseline variables that were independent predictors of long-time mortality. The model selected left ventricular score, age, congestive heart failure score, hypertension, percent left main coronary arterial stenosis and coronary arterial dominance as the baseline variables most predictive of long-term survival. A clinical and angiographic prognostic risk index developed from these six baseline variables showed significantly improved survival for the surgical cohort in each of four risk categories. In the best and worst risk category, the 3 year survival rate was 97 and 82 percent, respectively, for the surgical group and 85 and 34 percent, respectively, for the medical group (p less than or equal to 0.0002). The data from this observational study show that coronary bypass surgery prolongs life in most patients with left main coronary artery disease, particularly those who have severe narrowing of the left main coronary artery or impaired left ventricular function. The results permit a better understanding of the natural history of left main coronary artery disease and permit a more accurate estimate of long-term survival for individual patients through the use of a clinical-angiographic risk index.

Cardiac Catheterization↗
PubMed1996

A new noninvasive method of diagnosing vasospastic angina based on dilation response of the left main coronary artery to nitroglycerin as measured by echocardiography.

OBJECTIVES: The purpose of the present study was to evaluate the feasibility of diagnosing vasospastic angina based on coronary artery tone as assessed by M-mode echocardiographic measurement of the dilation response of the left main coronary artery to nitroglycerin. BACKGROUND: The definite diagnosis of vasospastic angina is done by a coronary spasm provocative test using ergonovine maleate or acetylcholine during cardiac catheterization. Current noninvasive, nonpharmacologic diagnostic methods are not sensitive enough for the diagnosis of vasospastic angina. METHODS: Thirty-eight patients who had an angiographically normal left main trunk were studied. These patients were classified into four groups based on the presence or absence of more than 50% stenosis in the coronary arteries except for the left main trunk and the results of the acetylcholine or ergonovine provocative test. At 7 a.m. and at noon on the same day, the left main trunk diameter was measured by M-mode echocardiography before and after sublingual administration of nitroglycerin (0.3 mg), and its present dilation was calculated to assess coronary artery tone. RESULTS: The percent dilation of the left main trunk diameter induced by sublingual nitroglycerin at 7 a.m. and at noon was 22.4 +/- 4.7% (mean +/- SD) and 18.1 +/- 4.0% in 11 patients with vasospastic angina and without coronary stenosis, 14.9 +/- 7.1% and 11.2 +/- 6.9% in 9 patients with vasospastic angina and coronary stenosis, 6.1 +/- 3.5% and 7.0 +/- 5.1% in 8 patients without vasospastic angina but with coronary stenosis and 8.1 +/- 5.6% and 7.8 +/- 5.7% in 10 control subjects. The percent dilation at 7 a.m. was significantly greater in the vasospastic angina without coronary stenosis group than in the remaining three groups, and in the vasospastic angina groups, the percent dilation at 7 a.m. was significantly greater than that at noon. When percent dilation at 7 a.m. exceeding 15% was defined as positive for the diagnosis of vasospastic angina, the sensitivity was 80% and the specificity 94%. CONCLUSIONS: Basal tone of the left main trunk is elevated in the early morning in vasospastic angina. Dilation of the left main trunk diameter exceeding 15% induced by sublingual nitroglycerin in the early morning as measured by M-mode echocardiography is a highly sensitive and specific criterion for the diagnosis of vasospastic angina.

Angina Pectoris↗
PubMed2006

Optical coherence tomography compared with histology of the main pancreatic duct structure in normal and pathological conditions: an 'ex vivo study'.

BACKGROUND AND STUDY AIMS: Optical coherence tomography permits high-resolution imaging of tissue microstructures by a probe inserted into the main pancreatic duct through a standard ERCP catheter. The aim of this study was to compare optical coherence tomography images of the main pancreatic duct with histology and identify the optical coherence tomography pattern of the normal and pathological structure of the main pancreatic duct. PATIENTS AND METHODS: Multiple sections of neoplastic and non-neoplastic segments of 10 consecutive surgical pancreatic specimens obtained from patients with pancreatic head adenocarcinoma were investigated by optical coherence tomography scanning within 1h of resection. One hundred optical coherence tomography findings were then compared with the corresponding histopathological diagnoses. RESULTS: Main pancreatic duct wall architecture appeared at optical coherence tomography investigation as a three-layer structure with a different back-scattered signal from each layer. Optical coherence tomography imaging was concordant with histology in 81.8% and 18.75% of sections with normal tissue and chronic inflammatory changes. The K statistic between the two procedures was equal to 0.059 for non-neoplastic main pancreatic duct wall appearance. In all neoplastic sections optical coherence tomography showed a subverted layer architecture with heterogeneous back-scattering of the signal and was concordant with histology. CONCLUSIONS: Optical coherence tomography provided images of main pancreatic duct wall structure that were concordant with histology in 100% of cases in presence of neoplastic ductal changes and did not have false-positive or negative results. Optical coherence tomography images were also concordant with histology in about 80% of cases with normal main pancreatic duct structure; however, the differential diagnosis between normal tissue and chronic pancreatitis or dysplastic changes appeared very difficult.

Adenocarcinoma↗
PubMed2006

Current percutaneous coronary intervention and coronary artery bypass grafting practices for three-vessel and left main coronary artery disease. Insights from the SYNTAX run-in phase.

OBJECTIVE: Percutaneous coronary intervention with drug-eluting stents is challenging coronary artery bypass grafting (CABG) as the gold standard for treatment of three-vessel and left main coronary disease. We evaluated the current practice pattern in hospitals throughout Europe and USA. METHODS: To qualify for participation in the SYNTAX (Synergy between PCI with TAXUS drug-eluting stent and Cardiac Surgery) study, a randomized trial comparing percutaneous coronary intervention with drug-eluting stent versus coronary artery bypass grafting for three-vessel and left main disease, 104 centers were asked to provide their case volume in 3 months in 2004. Anonymous procedural data were collected. RESULTS: A total of 12,072 patients were recorded. Coronary artery bypass grafting was the most frequently performed procedure (N=8895, 74%). Three-vessel disease (3VD) predominated in this population (N=8532, 71%) versus left main (N=3540, 29%). In the 3-month period, per center a mean of 8.3 patients with left main and 22.3 patients with three-vessel disease were treated by percutaneous coronary intervention, while 26.0 patients with left main and 60.3 patients with three-vessel disease were treated by coronary artery bypass grafting. In USA, percutaneous coronary intervention for left main and/or three-vessel disease was performed in 18% of the cases while this was performed in 29% of the cases in Europe. Of all CABG procedures, only 12% were done with total arterial grafting while 7% were treated with only venous grafts. CONCLUSIONS: In patients with multivessel or left main disease, still coronary artery bypass grafting remains the dominant revascularization strategy. Percutaneous coronary intervention is performed frequently without supporting data from the literature. Percutaneous coronary intervention for this indication is performed more often in Europe than in USA. Only a minority of the patients receives total arterial grafting in case of coronary artery bypass grafting. The SYNTAX trial with randomized and registry cohorts should provide guidance for selecting the preferred form of treatment.

Angioplasty, Balloon, Coronary↗
PubMed2003

The dopamine D1 receptor-rich main and paracapsular intercalated nerve cell groups of the rat amygdala: relationship to the dopamine innervation.

The intercalated cell masses are GABAergic neurons interposed between the major input and output structures of the amygdala. Dopaminergic projections to the main and paracapsular intercalated islands were examined by determining the relationship of the dopamine nerve-terminal networks to the D1-receptor immunoreactive staining of cells within the intercalated islands, using double-fluorescence immunolabelling procedures in combination with confocal laser microscopy. The relationship of terminals positive for both tyrosine hydroxylase and dopamine beta-hydroxylase (noradrenaline and/or adrenaline) to terminals positive for tyrosine hydroxylase but negative for dopamine beta-hydroxylase (dopamine terminals) was studied in relation to the D1-receptor immunoreactivity in adjacent sections at various rostrocaudal levels. The microscopy and image analysis revealed that there was only a minor dopaminergic innervation of the D1 receptor-immunoreactive cells in the rostromedial and caudal component of the main intercalated island, suggesting volume transmission as the main communication mode for dopamine in these regions. In contrast, the D1 receptor-immunoreactive areas in the rostrolateral part of the main island and also the paracapsular intercalated islands showed a high degree of dopaminergic innervation, indicating that synaptic and perisynaptic dopamine transmission plays a dominant role in these regions. It is known that amygdala neurons are involved in the elicitation and learning of fear-related behaviors. We suggest that slow dopaminergic volume transmission in the rostromedial and caudal parts of the main intercalated island may have a role in tonic excitatory modulation in these parts of the main island, allowing GABAergic activity to develop in the central amygdaloid nucleus and thereby contributing to inhibition of fear-related behavioral and autonomic responses. In contrast, a faster synaptic and perisynaptic dopaminergic transmission in the rostrolateral part of the main intercalated island and in the paracapsular intercalated islands may have a role in allowing a more rapid elicitation of fear-related behaviors.

Afferent Pathways↗
PubMed1999

An algorithm for noninvasive identification of angiographic three-vessel and/or left main coronary artery disease in symptomatic patients on the basis of cardiac risk and electron-beam computed tomographic calcium scores.

OBJECTIVES: We sought to model an algorithm for noninvasive identification of angiographically obstructive three-vessel and/or left main disease based on conventional cardiac risk assessment and site and extent of coronary calcium determined by electron-beam computed tomography (EBCT). BACKGROUND: Such an algorithm would greatly facilitate clinical triage in symptomatic patients with no previous diagnosis of coronary artery disease (CAD). METHODS: We examined 291 patients with suspected, but not previously diagnosed, CAD who underwent coronary angiography for clinical indications. Cardiac risk factors were determined as defined by the National Cholesterol Education Program. An EBCT scan was performed in all patients, and a coronary calcium score (Agatston method) was computed. Total per-patient calcium scores and separate scores for the major coronary arteries were generated. These scores were also analyzed for localization of coronary calcium in the more distal versus proximal tomographic sections. These parameters and the risk factors were considered for the model described in the following section. RESULTS: Sixty-eight patients (23%) had angiographic three-vessel and/or left main CAD. Multiple logistic regression analysis determined male sex, presence of diabetes and left anterior descending (LAD) and circumflex (LCx) coronary calcium scores, independent from more distal calcium localization, as independent predictors for identification of three-vessel and/or left main CAD. Based on this four variable model, a simple noninvasive index (NI) was constructed as the following: loge(LAD score) + log(e)(LCx score) + 2[if diabetic] + 3[if male]. Receiver operating characteristic curve analysis for this NI yielded an area under the curve of 0.88+/-0.03 (p < 0.0001) for separating patients with, versus without, angiographic three-vessel and/or left main CAD. Various NI cutpoints demonstrated sensitivities from 87-97% and specificities from 46-74%. The NI values >14 increased the probability of angiographic three-vessel and/or left main CAD from 23% (pretest) to 65-100% (posttest), and NI values <10 increased the probability of no three-vessel and/or left main CAD from 77% (pretest) to 95-100% (posttest). CONCLUSIONS: On the basis of a simple algorithm ("noninvasive index"), EBCT calcium scanning in conjunction with risk factor analysis can rule in or rule out angiographically severe disease, i.e., three-vessel and/or left main CAD, in symptomatic patients.

Algorithms↗
PubMed1997

Left main coronary artery atresia: literature review and therapeutical considerations.

OBJECTIVE: Left main coronary artery atresia is a rare coronary anomaly in which there is no left coronary ostium, the proximal left main trunk ends blindly, blood flows from the right coronary artery to the left via small collateral arteries and retrogradely in at least one of the left-sided arteries. Since published case reports are few and rather scattered, no comprehensive information about this uncommon anomaly is available. METHODS: A through search for published cases of left main coronary atresia was performed in the major medical journals by electronic (MEDLINE and INTERNET) and hand-scanning. RESULTS: The authors found 28 cases of left main atresia (including two from their own experience), 15 of which were pediatric; five of these cases had associated cardiac anomalies. While pediatric patients were usually overtly symptomatic early in their life (syncope, dyspnea, sudden death, failure to thrive, infarction, ventricular tachycardia), adult patients began showing symptoms (angina, dyspnea, sudden death) only at an advanced age; associated coronary atherosclerosis seemed to be uncommon, though (2/13 adult patients, 15%). We know of only one asymptomatic patient, a 76-year old lady who had died of unrelated causes; in her case left main atresia was an unforeseen autopsy finding. Four untreated patients had died suddenly; most of the others were highly symptomatic and required surgical therapy, usually as direct coronary artery revascularization via one or more saphenous vein or mammary artery grafts to the left-sided arteries; all revascularized patients were reported to be alive and well; in one pediatric case the left main coronary artery was reconstructed using an aortic wall baffle, with a good result. In contrast, the outcome of patients who did not receive revascularization has been poor. CONCLUSION: In light of the favorable results obtained by surgical therapy, the authors endorse prompt coronary artery revascularization for all patients with left main coronary artery atresia.

Adolescent↗
PubMed1995

Structural determinants of protein dynamics: analysis of 15N NMR relaxation measurements for main-chain and side-chain nuclei of hen egg white lysozyme.

15N-labeled hen lysozyme has been studied by 2D and 3D NMR in order to characterize its dynamic behavior. The resonances of all main-chain amide nitrogen atoms were assigned, as were resonances of nitrogen atoms in 28 side chains. Relaxation measurements for the main-chain and arginine and tryptophan side-chain 15N nuclei used standard methods, and those for the 15N nuclei of asparagine and glutamine side chains used pulse sequences designed to remove unwanted relaxation pathways in the NH2 groups. The calculated order parameters (S2) show that the majority of main-chain amides undergo only small amplitude librational motions on a fast time scale (S2 > or = 0.8). Increased main-chain motion (0.5 < S2 < 0.8) is observed for a total of 19 residues located at the C-terminus, in loop and turn regions, and in the first strand of the main beta-sheet. Order parameters derived for the side chains range from 0.05 to 0.9; five of the six tryptophan residues have high order parameters (S2 > or = 0.8), consistent with their location in the closely packed core of the protein, whereas the order parameters between 0.05 and 0.3 for arginine residues confirm increased side-chain mobility at the protein surface. Order parameters for the side chains of asparagine and glutamine residues range from 0.2 to 0.8; high values are found for side chains that have low solvent accessible surfaces and well-defined chi 1 values, as measured by 3J alpha beta coupling constants. Many of the main-chain and side-chain groups with low order parameters have higher than average temperature factors in X-ray crystal structures and increased positional uncertainty in NMR solution structures. They also tend to lack persistent hydrogen bond interactions and protection against amide hydrogen exchange. The most significant correlations are found between residues with low order parameters and high surface accessibility in both crystal and solution structures. The results suggest that a lack of van der Waals contacts is a major determinant of side-chain and main-chain mobility in proteins.

Amino Acid Sequence↗
PubMed2000

Intraductal papillary mucinous tumors of the pancreas confined to secondary ducts show less aggressive pathologic features as compared with those involving the main pancreatic duct.

Intraductal papillary mucinous tumors (IPMTs) of the pancreas are rare tumors characterized by a malignant potential. Because of the progress of imaging procedures, smaller cystic pancreatic lesions are now detected and some of them correspond to IPMTs that involve ectatic pancreatic branch ducts but spare the main pancreatic duct. To investigate differences in morphology and clinical behavior of branch and main duct types of IPMT, a surgical series of 43 cases was studied. All pathologic specimens of IPMT, surgically resected in our institution between October 1987 and July 1998, were analyzed. In all cases, the entire pancreatic specimen was systematically examined. IPMT of the branch type was found in 13 (30%) patients, whereas IPMT of main pancreatic duct type that involved the main pancreatic duct and branch ducts was observed in 30 (70%) patients. Patients with IPMT of the branch type were younger (median age, 55 yrs vs 64 yrs), and all but one of the lesions were located in the head and neck of the pancreas (vs 17 of 30 patients with the main duct type). The size of the cysts ranged from 4 to 55 mm, and the major duct showed a mild dilation in most cases. In contrast to the main pancreatic duct type, which showed invasive carcinoma and in situ carcinoma in 11 (37%) of 30 patients and 6 (20%) of 30 patients, respectively, IPMT of the branch type showed significantly less aggressive histologic lesions with five (39%) patients with simple hyperplasia, six (46%) patients with atypical hyperplasia, and two (15%) patients with in situ carcinoma. No invasive carcinoma was observed in this group. IPMT of the branch type occurs in younger patients and is associated with less aggressive histologic features than is the main pancreatic duct type. Our findings raise the difficult issue of clinical management of IPMT of the branch type as a distinctive group.

Adult↗
PubMed1982

Side chain characteristic main chain conformations of amino acid residues.

Main chain conformation characteristics of the respective side chains of the 20 naturally occurring amino acid residues were obtained by the analysis of (phi, psi)-data from the crystal structures of 38 different globular proteins. The following observations are of interest: (i) For amino acids other than Glu, Thr and aliphatic amino acids, at least one main chain conformation is stabilised solely by side chain atoms. Such conformations are listed. (ii) In globular proteins, the main chain conformations which are significantly destabilised by side chain atom interactions are observed. The stabilising force for those conformations seems to come from main chain atom interactions. (iii) A set of conformations for which the main chain and side chain interactions are almost equal but in opposite directions, is listed and these conformations will be taken by residues mainly due to the effect of surroundings. The results can be used to study the folding of polypeptide chains and they also provide an insight into the role of the respective side chains on main chin conformations of amino acid residues.

Amino Acids↗
PubMed1983

Declination of fundamental frequency in speakers' production of parenthetical and main clauses.

An experimental study was conducted to investigate fundamental frequency (F0) contours in sentences with and without parenthetical clauses. Sentences consisted of a systematically lengthened parenthetical clause inserted between the subject noun phrase and the verb phrase of the main clause. The middle portion of the parenthetical was lengthened incrementally in each sentence to test the effects of sentence length on fundamental frequency contours of seven test sentences. Computer-aided measurements were made for: F0 peaks of key stressed segments; duration of the main clause, parenthetical clause, and clause-final syllables within each; and pauses immediately preceding and following the parenthetical. Mean results demonstrate: (1) a drop in F0 for the parenthetical clause, well below the main clause declination and forming a separate contour of declination; (2) a sharp rise in F0 on return to the main clause; (3) no effect of longer parenthetical length on final segment durations of either the parenthetical or the main clause; and (4) no effect of increased parenthetical length on main clause duration or pause length. These results suggest that parenthetical clauses are mentally programmed as independent constituents, but are subject to some of the same general declination constraints as main clauses.

Humans↗
PubMed1996

Cardiac catheter complications related to left main stem disease.

OBJECTIVE: To examine the incidence and outcome of cardiac catheter complications related to left main coronary artery disease or damage using the CECCC (Confidential Enquiry into Cardiac Catheter Complications) database. SETTING: Coordinating centre for national database. DESIGN: Retrospective analysis of reports to a national multicentre database for cardiac catheter complications. Complications involving the left main coronary artery were flagged at entry. Where necessary additional information was sought from participating centres. 112,921 procedures were registered, 12,849 of which were coronary angioplasties and the remainder diagnostic studies. RESULTS: The total number of cases for which complications were recorded was 993 (0.88%). In 61 (6.14%) of the 993 cases complications were associated with left main coronary disease or damage. In 57 (93%) of these 61 cases complications were major, necessitating resuscitation or immediate coronary bypass grafting. Ten patients (16%) died in the catheter laboratory, a further 9 (15%) within 24 hours, and a total of 23 patients (38%) died within one month of the procedure. Left main stem related complications account for 17% of total mortality in the CECCC database. Urgent coronary bypass grafting was attempted in 42 patients, of whom 31 were alive at one month. In all of the six reported PTCA-related complications the cause was traumatic damage to the left main coronary artery. Operators of all grades of seniority experienced complications in similar proportions. CONCLUSIONS: The risk of a complication relating to the left main stem is relatively low, but when such complications occur they tend to be life-threatening and contribute a fifth of total catheter-related mortality. In the absence of a widely available non-invasive investigation with good predictive value for left main stem disease, the best safeguard is careful technique. Patients who do develop complications should have emergency coronary bypass grafting.

Cardiac Catheterization↗
PubMed1983

A life table and Cox regression analysis of patients with combined proximal left anterior descending and proximal left circumflex coronary artery disease: non-left main equivalent lesions (CASS).

Combined proximal left anterior descending and proximal left circumflex artery stenoses greater than or equal to 70% have been referred to as "left main equivalent" lesions. We compared the survival rates of medically treated patients who have this type of coronary anatomic characteristics with the survival rates of patients who have left main coronary artery stenoses greater than or equal to 70% by use of a stratified life table approach and a Cox regression model. Comparison of the patients with left main coronary artery stenoses with those who have left main equivalent lesions by use of life table analysis and three different calculations of patient exposure time revealed a poorer prognosis for the patients who had left main coronary artery disease (p less than or equal to .04 for all three methods). The stepwise Cox analysis also determined that patients who had left main artery stenoses had a significantly poorer prognosis than patients who had left main equivalent coronary disease (p = .002), even after consideration of important baseline variables known to affect survival rates. We then compared the patients who had combined proximal left anterior descending and proximal left circumflex artery disease with patients who had combined stenoses greater than or equal to 70% in the nonproximal left anterior descending stenosis influenced survival rates. The 5 year to determine if location of the left anterior descending stenosis influenced survival rates. The 5 year survival rate was not as high for the patients who had proximal left anterior descending artery disease (55% vs 70%, p = .001). In conclusion, combined proximal left anterior descending and proximal left circumflex artery disease identifies a high-risk (as determined by angiography) patient subset.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed1989

Asymptomatic left main coronary artery disease in the Coronary Artery Surgery Study (CASS) registry.

Left main coronary artery disease (i.e., greater than or equal to 50% stenosis) was found in 1,477 of 20,137 patients in the Coronary Artery Surgery Study (CAS) registry. Of these patients, 53 (3.6%) were asymptomatic. Asymptomatic and symptomatic patients were similar in regard to 1) severity of left main coronary artery stenosis (67% vs. 70%), 2) extent of proximal coronary artery disease (no differences in number of or severity of proximal stenoses), 3) left ventricular end-diastolic pressure (13 mm Hg vs. 14 mm Hg), 4) left ventricular wall motion score 9.1 vs. 8.7), and 5) number of coronary artery segments with greater than 70% stenosis (4.4 vs. 4.8). Among the asymptomatic patients, 47% received medical and 49% received surgical treatment. In the symptomatic group, 20% received medical and 78% received surgical therapy. The survival rate 5 years after surgery for treatment of left main coronary artery stenosis was 84% for the symptomatic patients and 88% for the asymptomatic patients (p = NS). Medical management of left main coronary artery disease produced a 5-year survival rate of 57% for asymptomatic patients and 58% for symptomatic patients. Within the asymptomatic subgroup, 88% of those surgically treated survived 5 years, whereas only 57% of those medically treated survived 5 years (p = 0.02). Thus, for CASS patients with left main coronary artery disease, the percentage of those that were asymptomatic is low (3.6%); asymptomatic and symptomatic patients with left main coronary artery disease had no significant difference in severity of left main coronary artery stenosis, extent of overall coronary artery disease, or left ventricular function.(ABSTRACT TRUNCATED AT 250 WORDS)

Coronary Angiography↗
PubMedDate not supplied

Prospective evaluation of a clinical and exercise-test model for the prediction of left main coronary artery disease.

In a multivariate logistic regression analysis of data from 508 patients, only two clinical factors, age and typicality of pain, were independently significant predictors of left main coronary artery disease. The resulting multivariate equation was prospectively applied to another 370 patients to derive pre-exercise-test (ETT) probabilities of left main coronary artery disease, and these pre-ETT probabilities were combined with literature-derived likelihood ratios for various ETT findings to derive post-ETT probabilities. This model, which can be displayed in simple graphic form, accurately predicted the probability of left main coronary artery disease when prospectively evaluated in this independent validation set of patients. The likelihood of left main coronary artery disease was 16% when the ETT increased the probability, and 4% when it decreased the probability (p less than 0.001). While 48% of patients had mid-range (5-15%) probabilities of left main coronary artery disease before the ETT, only 24% fell into this range of probabilities after the ETT (p less than 0.0001), as ETT results moved patients into higher and lower probability ranges. Thus, probability of left main coronary artery disease can be calculated from clinical and ETT data with this model. These estimated pre- and post-ETT probabilities of left main coronary artery disease may aid in the selection of patients for noninvasive testing or for cardiac catheterization.

Age Factors↗
PubMed2006

Prevalence and types of main and right portal vein branching variations on MDCT.

OBJECTIVE: Our objective was to investigate the prevalence of variant main and right portal vein ramification in a large group of patients. SUBJECTS AND METHODS: The study group consisted of 200 patients who underwent consecutive contrast-enhanced abdominal CT examinations performed with an 8-MDCT scanner. Two observers evaluated both thin axial sections and 3D maximum-intensity-projection and volume-rendered images for branching patterns of the main and right portal veins. RESULTS: Conventional main portal vein anatomy was present in 64.5% of the patients. In 9.5% of the patients, the main portal vein trifurcated into the left portal and right anterior and posterior portal veins. In 23.5% of the patients, the main portal vein divided into a common left portal vein-right anterior portal vein trunk and the right posterior portal vein. Three patients (1.5%) had miscellaneous variations. Twenty-two (16.8%) of 131 patients with conventional main portal vein branching had variant right portal vein branching, most of which was a trifurcation, followed by an abnormally proximal origin of the segment VII vein from the right portal vein. CONCLUSION: Variant main portal vein branching seems to be very frequent. Common right anterior portal vein-left portal vein trunk is far more common than trifurcation. Although less frequent, variations also occur in right portal vein branching.

Adolescent↗
PubMed2006

Main bronchial reconstruction with sparing of pulmonary parenchyma for benign diseases.

Main bronchial reconstruction is anatomically suitable for benign main bronchial stenosis. But, it has been hardly recommended for operative mortality and morbidity. This study was aimed at providing validity and the proper clinical information of bronchoplasty for benign main bronchial stenosis by reviewing the results we obtained over the last ten years for main bronchial reconstruction operations. We retrospectively reviewed admission and office records. Twenty eight consecutive patients who underwent main bronchoplasty were included. Enrolled patients underwent main bronchial reconstruction for benign disease (tuberculosis in 21, trauma in 4, endobronchial mass in 3). Concomitant procedures with main stem bronchoplasty were performed in 19 patients. There were no incidences of postoperative mortality and significant morbidity. There were 2 cases of retained secretions, and these problems were resolved by bronchoscopy or intubation. All of the patients are still alive without obstructive airway problem. Bronchoplasty should be considered as one of the primary treatment modalities, if it is anatomically feasible.

Adolescent↗