Joseph W. Cook

Effects of combined aerobic and resistance training versus aerobic training alone in cardiac rehabilitation.

PURPOSE This study examined the effects of performing combined resistance and aerobic training, versus aerobic training alone, in patients with coronary artery disease. METHODS Thirty-six patients with coronary artery disease were randomized to either an aerobic-only training group (AE) or a combined aerobic and resistance training group (AE + R). Both groups performed 30 minutes of aerobic exercise 3 days/week for 6 months. In addition, AE + R group performed two sets of resistance exercise on seven different Nautilus machines after completion of aerobic training each day. Twenty patients (AE: n = 10; AE + R: n = 10) completed the training protocol with > 70% attendance. RESULTS Strength gains for AE + R group were greater than for AE group on six of seven resistance machines (P < 0.05). VO2peak increased after training for both AE and AE + R (P < 0.01) with no difference in improvement between the groups. Resting and submaximal exercise heart rates and rate-pressure product were lower after training in the AE + R group (P < 0.01), but not in the AE group. AE + R increased lean mass in arm, trunk, and total body regions (P < 0.01), while AE increased lean mass in trunk region only (P < 0.01). Percent body fat was reduced for AE + R after training (P < 0.05) with a between group trend toward reduced body fat (P = 0.09). Lean mass gain significantly correlated with strength increase in five of seven resistance exercises for AE + R. CONCLUSIONS Resistance training adds to the effects of aerobic training in cardiac rehabilitation patients by improving muscular strength, increasing lean body mass, and reducing body fat.

Thoracoabdominal aortic aneurysms. A review and current status.

Surgical management of the thoracoabdominal aortic aneurysm is a formidable undertaking. Presently two fairly distinct operative methods are available. The conventional technique, pioneered by Etheredge, involves replacement of the aneurysm with a synthetic graft and then, step by step, revascularization of the abdominal organs with prosthetic side limbs taken from the primary graft. Individual organ ischemic time is limited to that time required for the performance of each distal side limb anastomosis. The second operative method, first described by Crawford, consists of proximal and distal control of the aneurysm, followed by its incision to simultaneously expose the origin of all four major intra-abdominal arteries. Replacement is then rapidly performed with a tubular Dacron® graft including anastomosis of these major intra-abdominal arteries to four elliptical graft incisions, from within the aneurysm. Total operating time is reduced at the expense of prolonged organ ischemia. The conventional method allows for step-by-step intraoperative planning and action, and this technique is accordingly recommended to most surgeons, who have had little experience with this unusual lesion. Our recent successful experience with two cases of extensive thoracoabdominal aortic aneurysms is described as well as a discussion of additional measures which may become useful in certain cases to favor a successful outcome. Finally the problem of potential resultant paraplegia is discussed.

Age influences anthropometric and fitness-related predictors of bone mineral in men

Objective. This study assessed the influence of age on the predictors of bone mineral in men. Methods. Middle-age (n = 41, 54 ± 4 yrs) and older (n = 40, 69 ± 5 yrs) men underwent grip and knee extensor strength tests, total body dual-energy X-ray absorptiometry with regional analyses and a graded exercise treadmill test. Results. Bone-free lean mass (BFLM) and, to a lesser extent, fat mass (FM) were correlated with bone mineral variables in middle-age men. In older men, BFLM and, to a lesser extent, FM were related to bone mineral content (BMC) at most sites, but inconsistently to bone mineral density (BMD). Knee extensor strength related to bone mineral (BMC and BMD) at most sites in middle-age men, but none in older men. Grip strength inconsistently related to bone mineral in both groups. Aerobic capacity related to bone mineral in middle-age men, but none in older men. In multiple regression, body weight or BFLM predicted bone mineral in middle-age men (R2 = 0.33–0.68) and BMC in older men (R2 = 0.33–0.50). Predictors of BMD were inconsistent in older men. Conclusions. Relationships of body composition, muscular strength and aerobic capacity to bone mineral are stronger in middle-age versus older men.

Concomitant surgical treatment of dental and valvular heart diseases

BACKGROUND Invasive dental procedures are often indicated before cardiac valve surgery. The purpose of this case-control study was to determine the risks and benefits of concomitant dental and thoracic surgery. METHODS Critically ill cardiac inpatients requiring cardiac valve surgery were referred by the Department of Thoracic and Cardiovascular Surgery to our Oral Medicine consult service. Those requiring dental extractions were considered for dental treatment during the same general anesthetic as the cardiac surgery. These study patients were compared with control patients who had extractions before valve surgery in a different setting. There was no attempt to analyze the impact of this practice on the development of infective endocarditis. All patients received broad-spectrum antibiotics during dental surgery. RESULTS Twenty-one patients had concomitant oral and cardiac valve surgery. Seventeen patients were in the control group. There were no statistically significant differences between cases and controls in demographics, length of stay, nature of the dental surgery, mean number of teeth removed, oral bleeding, or postoperative infections. One patient in the control group developed prosthetic valve endocarditis versus none in the concomitant surgery group. CONCLUSIONS This case-control study suggests that concomitant surgical procedures for dental and valvular heart disease can be accomplished without clinically significant oral complications. Given the risk from poor oral health following cardiac valve surgery, this approach should be considered for patients who would benefit by avoiding a second general anesthetic and/or a delay in cardiac surgery, and by having their oral surgery performed in the safest environment.

Accurate adjustment of de Vega tricuspid annuloplasty using transesophageal echocardiography.

Intraoperative transesophageal echocardiography is used to adjust the tension of a de Vega tricuspid annuloplasty suture. Leading the suture outside the right atrium allows the annulus to be adjusted after cardiopulmonary bypass is discontinued when cardiac function has returned.

“Half and Half” Woven and Knitted Dacron Grafts in the Aortoiliac and Aortofemoral Positions: Seven and One-Half Years Follow-Up

One-hundred fifty-eight patients received specially manufactured aortoiliac or aortofemoral bifurcated grafts with one limb woven, the other knitted from Dacron. During an observation period ranging from 1,567 to 2,555 days (average 2,130 days) no statistically significant difference was found in either platelet adherence (30 patients studied) or in clinical patency. According to the results of the study, the type of graft (woven or knitted) did not seem to influence either platelet adherence or patency rate in the aortoiliac or aortofemoral positions.

Inhibition of needlestick-induced simulated viremia by local measures

BACKGROUND The possibility of confinement of simulated retrovirus to the inoculation site after needlestick injuries to enhance chances of local intervention and function of lymphaticovenous communications was investigated. METHODS Using the canine model, technetium-99 m sulfur colloid particles were injected subcutaneously and into the vein and lymphatics. Blood and lymph were collected at a higher level from the femoral vein and the major lymphatic. Flow rates, particle arrival times, concentrations, and other variables were evaluated for 45 minutes by gamma counting. A tourniquet was used to slow dissemination after subcutaneous injection. RESULTS After subcutaneous inoculation, particles arrived in the blood at 2.81 +/- 0.54 minutes and in the lymph at 6.0 +/- 1.47 minutes. Application of a tourniquet delayed appearance in the blood to 7.11 +/- 1.5 minutes and in the lymph to 40.0 +/- 5.1 minutes. Concentration of particles in lymph was 1,000 times higher than in the blood. Flux values were comparable in both pathways, but accumulation patterns were different. After intravenous injection, particles arrived in lymph at 25.4 +/- 6.44 minutes. After intralymphatic injection particles arrived in the blood within 4 seconds. CONCLUSIONS There are functional lymphaticovenous communications at the peripheral level. The period between virus inoculation and blood and lymph invasion may be extended by application of a tourniquet; therefore, time could be gained for local intervention.

A New Method to Revascularize the Celiac Axis

While the fact that chronic celiac artery obstruction is compatible with long-term survival has been known to the patholgist for more than a century,3 the clinical significance of this condition as a possible cause of upper abdominal discomfort and pain has been appreciated only for the past three decades. 1, 2, 4-26 Three different factors have been incriminated as the principal cause of this disease: arteriosclerosis 6, 8, 1g°’s fibroelaStoSiS2’ and compression by the arcuate ligament. 1, 7, 9, 17, 24, 26 Operative indication for celiac artery disease is a controversial issue. While most investigators’, 6, 9, 12, 14, 16 believe that isolated celiac artery obstruction could indeed cause significant clinical symptoms, others 13, &dquo;° 18, 24 state that blood flow through the mesenteric artery usually compensates for celiac artery disease, and the syndrome of &dquo;abdominal angina&dquo; does not occur unless both of these vessels are diseased. Szilagyi, 25 a noted authority in the field, even doubts the existence of celiac artery obstruction as a clinical syndrome. In cases where the impediment of the celiac flow is caused by external compression by the arcuate ligament, simple division of this ligament proved to be an effective solution.!’ 9, 16, z4° ~’b If the cause of the obstruction, however, lies in the arterial wall or within the lumen, it is evident that a more radical procedure is necessary. Studying the pathologic anatomy of celiac artery disease in 1961, Morris&dquo; found that a direct attack on this short and hidden artery had a number of undesirable technical features, and recommended the &dquo;adaption of the bypass principle as the safest and most satisfactory method&dquo; for restoring normal circulation in the splanchnic area. To him the splenic artery appeared to be the most suitable vessel to receive a bypass graft intended to revascularize the entire celiac system. Morrisl8° 19 indeed performed a number of successful such operations using knitted Dacron tubes anastomosed end-to-side to the abdominal aorta and the