Martha Hernández-González

Intraluminal aortoplasty vs. surgical aortic resection in congenitalaortic coarctation

BACKGROUND Our objective was to compare results of two therapeutic modalities to treat congenital aortic coarctation: intraluminal aortoplasty without endoluminal stent installation (patients in group A) vs. surgical aortic resection (patients in group B). Trans-coarctation gradient pressure was evaluated prior to and immediately after treatment. Re-coarctation, aneurysm formation, in-hospital morbidity and mortality, and complications related to treatment were also evaluated. METHODS A clinical, randomized, multicenter study was performed in pediatric patients with congenital aortic coarctation. Immediate and mid- to late therapeutic results were evaluated. With regard to statistics, we evaluated event variations by Kaplan-Meier model, nonparametric Wilcoxon test, Mann-Whitney U test, two-tailed Student t and chi-square tests, and Fisher analysis. Significance was considered relevant when p<0.05. RESULTS There were no differences in demographic variables, procedure failure, complications, mortality, or aortic aneurysm between groups A and B, respectively. Intraluminal angioplasty and surgical aortic resection were similarly effective in reducing trans-coarctation pressure gradient, as well as arterial systemic pressure. However, differences were found between groups A and B at follow-up. Group A showed higher re-coarctation (50 vs. 21%). Absence of peripheral arterial pulses in limbs was higher in group A (50 vs. 21%), as well as persistence of arterial hypertension (49 vs. 19%); these differences were significant (p<0.05). On the other hand, complications observed after surgical aortic resection were more serious than post-angioplasty complications, but these differences were not statistically significant. CONCLUSIONS Although re-coarctation and persistency of arterial hypertension were less frequent after surgical aortic resection, complications observed with this procedure are more serious than complications related to angioplasty, although these differences are not statistically significant.

Telomere length and type 2 diabetes in males, a premature aging syndrome

Background: Increased telomere shortening has been demonstrated in several diseases including type 2 diabetes. However, it is not known whether telomere length changes during the course of type 2 diabetes. Objective: To determine telomere length at different stages of type 2 diabetes, including early and late stages. Methods: A total of 93 males with type 2 diabetes and 10 years or more since original diagnosis; 96 males with less than one year of diagnosis; 98 age matched healthy males. Telomere length was estimated by means of real-time polymerase chain reaction. Fasting venous blood samples were obtained for measurement of lipid peroxidation and inflammation markers.Results: We found a greater telomere shortening in group (A) with type 2 diabetes of 10 years or more since original diagnosis, compared with the control group (C) of healthy males (5.4 vs 9.6 Kb) (p = 0.04) and with group B (5.4 vs 8.7kb) (p = 0.05). With regard to inflammatory markers TNF-α, malondialdehyde peroxidation and adiponectin we found significant differences. Conclusion: Telomere shortening increases with the duration of diabetes. The time of exhibition suggests in parallel that the progressive increase of inflammation and/or oxidative stress plays a direct role in telomere shortening.

Angiographic concurrence of coronary artery disease and aortoiliac lesions.

The importance of recognizing the association between aortoiliac disease and coronary artery disease includes the following: (1) Long-term morbidity is higher and survival ratio poorer in patients with coronary heart disease compared with isolated lower extremity revascularization surgery. (2) Coronary artery bypass grafting is a relatively high-risk procedure in patients with severe vascular disease. (3) There is the prospect that the patient will eventually face simul taneous coronary artery and vascular surgery, or coronary artery angioplasty previous to aortoiliac surgery. The aim of this investigation is to know the frequency of the association of coronary artery disease with aortoiliac lesions and to stratify the risk factors related to such an association. In total, 65 men and 19 women (30 to 76 years of age) with a history of coronary heart disease underwent abdominal aortography after selective coronary artery and left ventricle angiography. Aortoiliac lesions were identified at angiograms. Relevant coronary artery disease was diagnosed when at least 1 coronary artery was obstructed > 50%. The frequency of association between aortoiliac and coronary artery lesions was established, as well as the relationship of these lesions to the following clinical variables: age, weight, height, smoking habit, history of coronary heart disease, systemic arterial hypertension, diabetes mellitus, intermittent claudication, glycemia, uricemia, and triglyceridemia. There were 36 patients (42.9%) with aortoiliac lesions. In 34 patients (40.5%) coronary artery disease was associated with aortoiliac lesions. Abdominal aortic dilations were found in 10 instances, abdominal aortic stenosis in 13 patients, and stenosis of the iliac arteries or their branches on 28 occasions. The variables statistically related to the presence of aortoiliac lesions were smoking habit and a history of intermittent claudication. The number of affected coronary arteries was directly related to the frequency of aortoiliac lesions. In the entire sample, 11 patients (13%) had no coronary artery disease, and 15 (17.9%) had 1-vessel, 24 (28.6%) 2- vessel, and 34 (40.5%) 3-vessel disease. The extent of coronary disease was directly related to the frequency and extent of aortoiliac lesions. Frequencies of aortoiliac lesions were strongly related to a history of smoking habit and intermittent claudication and directly related to the extent of coronary artery disease.

Association between telomere length and C-reactive protein and the development of coronary collateral circulation in patients with coronary artery disease.

Background: Coronary collateral circulation is a stabilizer factor in myocardial ischemia. We attempted to establish a link between collateral circulation, C-reactive protein (CRP), and telomere shortening. Patients and Methods: A case-control study was performed in patients with (group A) and without (group B) coronary collaterals using coronariography. The patients were males, CRP levels and telomere length in circulating leucocytes were measured; Student t test and logistic regression were used to analyze the data. Results: The study included 40 patients aged 53.9 ± 7.0 years (20 per group). Group A exhibited lower CRP levels (2.76 ± 3.34 vs 4.04 ± 3.38; P = .004); whereas telomere length was shorter in group B (2.3 ± 6.9 kb vs 6.1 ± 5.9 kb; P < .0001). Conclusions: Collateral circulation was associated with telomere shortening and elevation of CRP levels.

Iron overload as cardiovascular risk factor in children and adolescents with renal disease

BACKGROUND Iron overload can affect cardiac structure and function by the production of free radicals in addition to iron deposits in heart muscle. The purpose of this study was to compare traditional and non-traditional cardiovascular risk factors (CVRF) in children and adolescents on renal replacement with and without iron overload. Also, we evaluated the relationships between iron overload and left ventricular mass (LVM). METHODS First, in a cross-sectional study, we evaluated traditional and non-traditional CVRF in 143 children and adolescents, 48 on peritoneal dialysis (PD), 53 on hemodialysis (HD) and 42 after renal transplantation according to iron overload. In a second phase with a case-control study, we measured LVM in 12 case patients and 12 matched controls. RESULTS Iron overload was identified in 15 patients (10.5%), 11 in HD and 4 in PD (P = 0.002). The group with iron overload had lower body mass index (17 versus 19; P = 0.01), total cholesterol (132 versus 165 mg/dL; P = 0.03) and hemoglobin (8.5 versus 10.6 g/dL; P = 0.003) but higher interleukin (IL)-6 levels (4.8 versus 3.6 ng/L; P = 0.04) and hypertension diagnosis (79 versus 48%; P < 0.001) than those without iron overload. Ferritin showed a positive correlation with C-reactive protein (CRP) and IL-6 levels. In a subgroup of 24 patients (12 with and 12 without iron overload), LVM was not different. However, ferritin levels showed a borderline positive correlation (r = 0.44, P = 0.05) with LVM. CONCLUSION Children and adolescents with iron overload show more CVRFs, especially if they received replacement therapy with HD. Ferritin is related to CRP and IL-6 levels.

Expression of estrogen receptor alpha and beta in breast cancers of pre- and post-menopausal women.

Expression of estrogen receptors (ER) is clinically relevant in designing therapeutic strategies. The relative importance of the two types of estrogen receptors (ER-alpha and ER-beta) in human breast cancers in pre- and post-menopausal women has not been properly defined. To determine the possible association between the expression of estrogen receptor and serum estradiol levels in pre- and post-menopausal women with breast cancer. 44 patients with invasive ductal carcinoma of the breast were studied and a breast tissue biopsy was taken. ER-alpha and ER-beta were detected by immunocytochemistry. Serum levels of estradiol and estrone were measured by radioimmunoassay and FSH was measured using IRMA. We studied 21 pre- and 23 post-menopausal women with breast carcinoma. Examining the number of cases with tumors positive for ER, we found no differences in the frequency of ER-alpha between pre- and post-menopausal women, but ER-beta decreased marginally after menopause (p < 0.051). In cases with tumors positive for ER, the proportion of cells positive for ER-alpha was similar post-menopausally (53.95%) and pre-menopausally (57.21%), but for ER-beta the number of positive cells decreased significantly after menopause (p < 0.051). In pre-menopausal women there was a correlation between serum estradiol levels and ER-beta; in post-menopausal women there was a correlation between serum FSH levels and ER-alpha. These results indicate that estradiol levels in women with mammary carcinoma are related to ER-beta expression in the breast tumor tissue.

Resonancia magnética cardiovascular en la cuantificación de los cortocircuitos de izquierda a derecha en los defectos septales cardiacos con hipertensión arterial pulmonar

INTRODUCTION AND OBJECTIVES As cardiac septal defects are frequently associated with pulmonary arterial hypertension, hemodynamic assessment is essential before deciding on surgery. The aim of this study was to evaluate the use of cardiovascular magnetic resonance imaging for assessing cardiac shunts and for quantifying pulmonary artery systolic pressure in patients with cardiac septal defects. METHODS This cross-sectional study involved patients with cardiac septal defects and clinically suspected severe pulmonary arterial hypertension who had an indication for cardiac catheterization and in whom magnetic resonance imaging was not contraindicated. Each tests results were evaluated independently by two expert radiologists and interventional cardiologists who were blinded to the results of the other test. The procedures were compared using confidence limits and intraclass correlation coefficients. RESULTS The study involved 29 patients (18 female and 11 male) aged from 30 days to 18 years; seven had an atrial septal defect, 14 had a ventricular septal defect, and eight had an atrioventricular septal defect. The correlation coefficients for measurements made using the two procedures were 0.80, 0.75, 0.81 and 0.58 for pulmonary output, systemic output, flow ratio, and systolic pressure in the pulmonary artery, respectively. Cardiovascular magnetic resonance tended to underestimate systemic output by 0.80 L/min, pulmonary output by 1.35 L/min, left-to-right shunt flow by 0.12 L/min, and systolic pressure in the pulmonary artery by 16.5 mmHg. The complication rate with cardiac catheterization was 31% compared with 3.4% with cardiovascular magnetic resonance imaging. CONCLUSIONS The evaluation of patients with cardiac septal defects and pulmonary arterial hypertension should initially be performed using noninvasive diagnostic techniques.

Image of an extensive aneurysm in a young patient

The acute aortic syndrome refers to a spectrum of lifethreatening aortic emergencies. Acute aortic syndromes include non-traumatic entities as aortic dissection with an incidence of 80--90% of the cases, affecting 5--30 personyears, penetrating atherosclerotic ulcer with a incidence of 2.8% and intramural hematoma with incidence of 5--25%. Nowadays there are several imaging modalities for diagnosis, such as echocardiography, magnetic resonance imaging

Ultrasound Measurement in M Mode of Peristalsis and Gastric Emptying

The use of ultrasound equipment in routine clinical evaluation of the gastrointestinal tract is still standby. Objective: to show an alternative application of ultrasound technique for monitoring peristalsis and gastric emptying through an executable routine implemented in LabVIEW. Methods: an ultrasound equipment (Medison SONACE 800 SE) was used in ten healthy subjects and four patients; dominant peristalsis frequency and gastric emptying were measured after fasting nights of the patients; subjects ingested, first 300 mL of water and then a solid meal (240 kCal). Results: the video acquisition in M mode and imaging processing were performed in a LabVIEW platform, as long as digital signal processing was carried out in matlab 2008a; peristaltic frequency of 2.4 cpm (cycles per minute) and a half time of the gastric emptying around 35 s were found. Discussion: these findings are congruent with similar evaluations of GI tract obtained by using the gold standard technique. So, ultrasound technique is now an alternative procedure for gastric evaluation with the advantage that patients are free of ionizing radiation, and these equipments are amply available in the world hospitals.